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10 Scientific basis for information on vaccines

Sunday, June 6, 2021

Vaccines

Scientific basis for information on vaccines

Preventing Influenza in Immunosuppressed Cancer Patients

Some of the treatments for cancer patients can depress their immune function.

Immunosuppressed patients are more likely to suffer from influenza and other illnesses, so how effective are vaccinations compared to healthy people? Here is a research paper on this topic.

The study

We identified six studies that included a total of 2275 participants.

Five studies that did not compare vaccination to immunization, and one study that compared adjuvanted to non-adjuvanted vaccines. For the comparison of vaccination versus no vaccination, we included two RCTs and three observational studies involving 2202 participants. One study reported results in person-years, while the other reported results on a person-by-person basis.

The five studies were conducted between 1993 and 2015 and included adults with hematologic diseases (three studies), patients after bone marrow transplantation (BMT) (two studies), and solid malignancies (three studies).

Conclusion.

Observational data suggest that influenza vaccination results in reduced mortality and infection association. The strength of the evidence is limited by the small number of studies and the low grade of evidence. The evidence, although weak, seems to indicate that the benefits outweigh the potential risks of vaccinating adults against influenza. However, placebo- or treatment-free controlled RCTs of additional influenza vaccination in adults with cancer are ethically questionable. There is no conclusive evidence on the use of adjuvanted versus non-adjuvanted influenza vaccine in this population.

Bitterman R, Eliakim-Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M. Influenza vaccine in adults with immunosuppressed cancer.Cochrane Database of Systematic Reviews 2018, Issue 2. Art. number: CD008983 DOI: 10.1002 / 14651858.CD008983.pub3. 

HPV vaccination differs between men and women

HPV may be known to those who have had or prevented cervical cancer and other cancers, but there has been controversy about some cases of vaccination for it, so some of you may know about it. One thing that might be helpful is whether the HPV vaccine is good or not? I found a conclusion from one paper that may be helpful.

The content of the paper was about the vaccination schedule for women and men.

The study

20 RCTs with 31,940 participants were included.

The follow-up period for the included studies ranged from 7 months to 5 years.

Two and three doses of HPV vaccine in women aged 9 to 15 years

Antibody responses after two- and three-dose HPV vaccine schedules were similar after up to five years of follow-up.

There are no RCTs that collected clinical outcome data.

Evidence for serious adverse events in studies comparing dose schedules was highly uncertain due to imprecision and indirectness.

One death was reported in the 3-dose group, and 1 death was reported in the 2-dose group.

HPV vaccine dosing intervals and antibody responses in females and males aged 9 to 14 years were stronger with longer intervals (6 or 12 months) between the first two doses of HPV vaccine than with shorter intervals (2 or 6 months) at up to 3 years of follow-up. There are no RCTs that collected data on clinical outcomes.

Evidence on serious adverse events in studies comparing intervals was of very low certainty due to imprecision and indirectness.

No deaths were reported in any of the studies.

HPV vaccination of males aged 10 to 26 years

In one RCT, there was moderate certainty evidence that the quadrivalent HPV vaccine reduced the incidence of external genital lesions compared to controls.

The quadrivalent vaccine caused more injection site adverse events, such as pain and redness, than controls.

Non-shared and quadrivalent vaccines in women and men aged 9-26 years

Three RCTs were included: one in females aged 9 to 15 years (n = 600), one in females aged 16 to 26 years (n = 14,215), and one in males aged 16 to 26 years (n = 500). 

RCTs of women aged 16-26 years reported clinical outcomes.

There was little difference in the incidence of the combined outcome of high-grade cervical epithelial neoplasia, intraepithelial adenocarcinoma, or cervical cancer between HPV vaccines.

The other two RCTs did not collect data on clinical outcomes.

There were slightly more local adverse events with the non-shared vaccine (905 per 1000) than with the quadrivalent vaccine (846 per 1000).

HPV Vaccination for People Living with HIV

Seven RCTs reported on HPV vaccines for people living with HIV, with two smaller trials collecting data on clinical outcomes.

Antibody responses were higher than controls after vaccination with either bivalent or quadrivalent HPV vaccine, and these responses were shown to be maintained for up to 24 months in HIV-infected children. Evidence on the clinical outcomes and harms of HPV vaccines in HIV-infected individuals is highly uncertain due to imprecision and indirectness.

Conclusion.

The immunogenicity of two- and three-dose HPV vaccine schedules measured using antibody responses in young women is comparable. The quadrivalent vaccine presumably reduces external genital lesions and anal genital warts in men compared with men. In people living with HIV, both bivalent and quadrivalent HPV vaccines result in higher antibody responses. In all comparisons of alternative HPV vaccine schedules, the certainty of the set of evidence for serious adverse events reported during the study period was low or very low because either the number of events was small, the evidence was indirect, or both. Post-marketing surveillance is needed to continue to monitor possible harms associated with the HPV vaccine in the population, and this evidence will be incorporated into future updates of this review. the effectiveness of weight loss schedules on HPV-related cancer endpoints and whether adoption of these schedules improves vaccination rates. Long-term observational studies are needed to determine the effectiveness of weight loss schedules on HPV-related cancer endpoints and whether adoption of these schedules improves vaccination rates.

Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros-Balta AX, Low N, Henschke N. Women and men. Cochrane Database of Systematic Reviews 2019, No. 11. Number: CD013479. doi: 10.1002 / 14651858.CD013479 

Biologics and Adverse Reporting

In this blog, I will explain and suggest how to use biologics.

This is the first time I've seen this term in a paper.

This is the first time I've seen the term "biologics" used in a paper.

In the case of a biospecimen resource, it is important to have a clear understanding of what is happening. In addition to the above, it is important to consider the following This is the first time I have used the term.

Blood products

Speaking of vaccines, there has been a lot of talk about the serious adverse effects of ingesting them. I am sure many of you are familiar with this story, but here is a paper by Cochrane that investigates this issue.

In the first place, biologics are used to treat rheumatoid arthritis and many other conditions. While the efficacy of biologics has been established, there is uncertainty about the negative effects of this treatment.

Important risks such as lymphoma, serious infections, and reactivation of tuberculosis (TB) are more common for biologics, but Because they may occur in small numbers across a variety of indications, this study aims to plan to combine results from biologics used in many conditions to obtain many needed risk estimates.

Let's start with reports of serious side effects.

Of the people who took the biologic, 127 out of 1,000 showed serious side effects, compared to 118 out of 118 (1% absolute harm) of those who took the placebo.

All reported side effects

Of those who took the biologic, 770 out of 1,000 had side effects, compared to 724 who took the placebo (5% absolute harm).

Discontinuation of the study due to side effects

Of those who took any biologic, 137 out of 1,000 were excluded from the study due to side effects, compared to 4 out of 98 who were taking placebo (absolute harm).

Serious infections

Of those who took the biologic, 35 out of 1,000 experienced serious infections, compared to 26 out of 1,000 who took the placebo (1% absolute harm).

Tuberculosis

Of those who took any biologic, 20 out of 10,000 had tuberculosis, compared to 4 out of 10,000 who took placebo (0.16% absolute harm).

However, our confidence in this result is low because there were not that many cases of TB.

Lymphoma (blood cancer)

Over the short duration of these trials, there may be little or no difference in the number of people who experienced cancer while taking any biologic compared to those who took a placebo.

However, our confidence in this result is low because there were not that many cases of cancer.

Congestive heart failure

There may be little or no difference in the number of people experiencing heart failure taking any biologic compared to those taking a placebo. However, our confidence in these results is low because there were not as many cases of congestive heart failure.

Singh JA, Wells GA, Christensen R, Tanjong-Gom E, MacDonald JK, Phillipney G, Scotes N, Francis DK, Rhoads LC, Guyatt GH, Schmidt J, Lamantia L, Roos JF, Roos JF, Siebert H, Hershan S, Cameron C, Lunn MPT, Tugwell P, Buchbinder R. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database of Systematic Reviews 2011, No. 2. Number: CD008794. doi: 10.1002 / 14651858.CD008794.pub2.

The above data is the result of a survey of 48,676 people.

This includes a large number of bacterial infections such as opportunistic infections, and although the number of people is small, it is true that some of them are firmly affected. Although there were significant adverse effects reported when compared to the control group. However, because of the conflicting results in the outcome reports, this conclusion requires further study.

Vaccination for cervical cancer


I'm talking about vaccination systems, and how people view vaccinations in different ways. Even if it is statistically considered beneficial, it may not be one of those numbers. Some people see it as Or we can do what we can to reduce the risk as much as possible. In other cases, we can do what we can to reduce the risk.

This time, I'd like to introduce a study on vaccination against cervical cancer caused by HPV. This time, I'd like to introduce you to a study on HPV vaccination.

What are the studies?

26 studies (73,428 participants) were included.
Protection against CIN / AIS was addressed in 10 trials with follow-up of 1.3 to 8 years. Vaccine safety was assessed in 23 studies over a period of 6 months to 7 years. The studies are not large enough or of sufficient duration to assess cervical cancer outcomes.

All but one trial was funded by the vaccine manufacturer.
Most of the included trials were judged to have a low risk of bias.
The studies included monovalent (n = 1), bivalent (n = 18), and quadrivalent vaccines (n = 7). Most women were under 26 years of age; three trials recruited women over 25 years of age. Vaccine efficacy in participants who received at least one dose of vaccination is summarized.

Results.

There is solid evidence that the HPV vaccine prevents cervical precancer in adolescent girls and young women between the ages of 15 and 26.
Regardless of the type of HPV, the effect is higher for lesions associated with HPV16 / 18. Those who are negative for hrHPV or HPV16 / 18 DNA at the time of enrollment will have a greater effect than those whose HPV DNA status is not selected. There is evidence of moderate certainty that the HPV vaccine reduces CIN2+ in older women who are HPV16/18 negative, but not in those who are unselected for HPV DNA status.

There was no increased risk of serious adverse effects.

Although the overall number of deaths was small, there were more deaths among women over 25 years of age who received the vaccine.
It has been determined that the deaths reported in this study were not related to the vaccine. An increased risk of adverse pregnancy outcomes after HPV vaccination cannot be ruled out, but the risk of miscarriage and termination is similar between the study groups. Long-term follow-up is needed to monitor the effects on cervical cancer, the occurrence of rare harms, and pregnancy outcomes.

Arbyn M, Xu L, Simoens C, Martin-Hirsch PPL. Vaccination against human papillomavirus to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. Issue 5. art. no.: CD009069. doi: 10.1002 / 14651858.CD009069.pub3.

A critical review of vaccination


In this article, we will discuss the critical review of vaccination in various countries and in the medical industry. In this article, I will introduce a paper that is critical of the importance of vaccination in each country and in the medical industry.

Manipulation of vaccination rates?

When the vaccination rate was calculated, the vaccination rate was based on the numbers of only the positive and negative groups. How do you count the number of people who don't deny it, but haven't been vaccinated yet? One reason is that it is unclear how to count the number of people who have not yet been vaccinated.

Distrust of vaccinations

First of all, there is a lack of knowledge about vaccinations, how they work, and what symptoms they are effective for. First of all, there is a lack of knowledge about vaccinations, how they work and what symptoms they treat. And with the lack of knowledge, an example of distrust would be Distrust of doctors, distrust of government agencies, and distrust of pharmaceutical companies. These feelings of distrust can be felt even if you have enough knowledge about vaccines, etc. Some people said that they had enough information but did not feel they had the right to choose. There are also opinions such as

Distrust of the provider

As mentioned above, some people are suspicious of even the published measurements of effectiveness due to distrust of doctors, the government, and pharmaceutical companies. For example, there are reports of serious side effects, but no reports of such side effects have been published. Some of these disbelievers are parents who have had their children vaccinated, and some of them feel that way. A sense of experimentation among those who implement the program
In the case of the vaccination campaign in Eastern Europe, some parents lost trust in the attitude of the doctors and refused to have their children vaccinated, feeling that the campaign itself was part of an experiment. In some cases, people felt that the campaign itself was part of an experiment and refused.

People don't feel good when they are told they are being experimented on.

https://doi.org/10.1016/j.socscimed.2014.04.018

Using the Measles Vaccine as a Base for the COVID-19 Vaccine

With the background that the measles vaccine is the safest and most effective vaccine available, the story goes that researchers have used it to develop an experimental vaccine against SARS-CoV-2.

The Ohio State University.

The research team, led by Dr. Jianrong Li, created and tested a series of measles-based vaccine candidates and developed various forms of coronavirus spike protein genes inserted into the measles vaccine genome. The modified measles virus acts as a medium to carry the genes for the spike proteins into the body, so it can instruct the body's cells to produce the coronavirus spike proteins and encourage the immune system to produce antibodies that recognize the proteins.

This research was conducted by the

Funded in part by the NIH's National Institute of Allergy and Infectious Diseases (NIAID), the National Human Genome Research Institute (NHGRI), and the National Cancer Institute (NCI), the results will be published in the Proceedings of the National Academy of Sciences on March 23, 2021. In rodents, the team identified a candidate that could be the most promising vaccine to generate the highest levels of neutralizing antibodies against SARS-CoV-2. The vaccine was a gene for a stabilized "pre-fusion" version of the spike protein, the shape of the protein before it infects the cell. The structure of the pre-fusion spike protein is the basis for currently available vaccines, including mRNA vaccines produced by Moderna and Pfizer-BioNTech. Experiments have now shown that the new vaccine, called rMeV-preS, produces higher levels of neutralizing antibodies in rodents than are found in recovered COVID-19 patients.

In addition, the vaccine was found to produce a strong T-cell response, indicating that the vaccine was effective.

The next step was to test whether the vaccine would prevent SARS-CoV-2 infection.

The team used Golden Sirian hamsters, which can be infected with COVID-19, and found that rMeV-preS prevented the hamsters from becoming infected. They also found that this prevented the virus from replicating in the lungs and nasal cavity.

These findings show the potential of rMeV-preS, and this new vaccine may also have advantages. This is because the measles vaccine has already been established as safe, effective, and long-lasting. It remains to be seen how long the mRNA vaccine will protect and how much it will cost. Until then, we need long-term protection, and an alternative vaccine that is easy to manufacture and inexpensive seems like a good idea. said co-author Dr. Stefan Niewiesk of Ohio State University.

 A safe and highly effective measles virus-based vaccine expressing a pre-fusion spike stabilized by SARS-CoV-2.Lu M, Dravid P, Zhang Y, Trivedi S, Li A, Harder O, Kc M, Chaiwatpongsakorn S, Zani A, Kenney A Zeng C, Cai C, Ye C, Liang X, Shimamura M, Liu SL, Mejias A, Ramilo O, Boyaka PN, Qiu J, Martinez-Sobrido L, Yount JS, Peeples ME, Kapoor A, Niewiesk S, Li J. Proc Natl Acad SciUSA . 2021 Mar 23; 118(12): e2026153118. doi: 10.1073 /pnas.2026153118. PMID: 33688034.

Non-vaccinated individuals

Epidemiological data indicate that a large proportion of the population needs to be vaccinated in order to achieve herd immunity. Therefore, it is very important for public health authorities to know if people will be vaccinated against COVID-19, and therefore this study was conducted to determine the willingness of adult residents of Greece to be vaccinated against COVID-19. From April 28, 2020 to May 3, 2020 (the last week of the lockdown). A cross-sectional survey was conducted in the general adult population of Greece using computer-assisted telephone interviewing (CATI), a mixed-methods approach to data collection, and computer-assisted web. Using a sample size calculator, we found that the target sample size was approximately 1000 respondents, so we recruited participants using a proportional sampling procedure stratified by region to ensure a nationally representative sample of the urban/rural population according to the 2011 Greek census. Participants were recruited using a proportional sampling procedure stratified by region.

Data collection was guided through a structured questionnaire, in which participants were asked to answer the following questions regarding their willingness to be vaccinated against COVID-19: "What is the availability of new coronaviruses?

"If there was a vaccine available for a new coronavirus, would you be willing to be vaccinated?

As a result.

Of the 1004 respondents, 57.7% stated that they would be vaccinated against COVID-19. Respondents who were 65 years of age or older, who belonged to a group that had health concerns for themselves or a family member, who believed that the COVID-19 virus was not developed in a laboratory by humans, who believed that coronaviruses are much more contagious and deadly, who were infected with the H1N1 virus, and who believed that the next wave was coming, were found to be statistically significantly more likely to be willing to get the COVID-19 vaccine. Higher knowledge scores about symptoms, transmission routes, prevention and control measures against COVID-19 were significantly associated with higher willingness of respondents to be vaccinated.

In conclusion,

it was found that people who have "correct knowledge" about the COVID-19 virus and know how to control, prevent and manage it are more likely to be vaccinated.

Kourlaba, G., Kourkouni, E., Maistreli, S. et al. Willingness of the Greek general population to get a COVID-19 vaccine. glob health res policy 6, 3 (2021). Available at: https://doi.org/10.1186/s41256-021-00188-1

What is herd immunity? Why we need to vaccinate

Studies supported by the NIH and others have shown that the benefits of vaccines to prevent disease and death greatly outweigh the risks.

Children are at risk for many infectious diseases, including measles, mumps, rubella, diphtheria, whooping cough, polio, meningitis, influenza, and rotavirus, and in the days before vaccines, many children in the United States died or became disabled from these diseases. However, in some countries and regions where vaccination rates are low, these infections may still be a problem.

Because of these circumstances, it is important to get vaccinated when traveling abroad. Here is an example of what can happen if you do not. By 2000, measles in the U.S. had been virtually wiped out by vaccination, but an outbreak in 2005 was attributed to the infection of an unvaccinated U.S. resident traveling to Europe. These were studied, and the results showed that vaccination as a child is safe and effective. At that time, it did not become an epidemic, and this was due to the fact that enough people in the surrounding areas had been vaccinated against measles.

Dr. Mark Lipschitz of the Harvard School of Public Health explained that when people are vaccinated, they are protecting not only themselves, but also those around them and others in the community.

This is known as "community immunity" or "herd immunity," and when a sufficient number of a community is vaccinated against a contagious disease, most members of the community are protected from infection because there is little chance of the disease spreading. Newborns, pregnant women, and people with compromised immune systems may not be eligible for certain vaccines. However, it is also expected to provide some prevention as the spread of the epidemic is controlled.

Epidemiologists consider infection as a chain reaction and explain that its rate depends on its contagiousness. The higher the contagiousness of the disease, the more vaccinations are needed, and data show that herd immunity is working.

Recently, infant vaccination against influenza type b (Hib, which can cause meningitis) has reduced the risk of disease in the entire population. Prior to vaccination, Hib infected about 1 in 200 children under the age of 5, killing many and leaving some with permanent brain damage. after the introduction of the Hib vaccine in the mid-1980s, the incidence of Hib was reduced by 99%.

According to Dr. Lipsitch, eradication of infectious diseases is possible, and even if diseases such as measles and Hib are not completely wiped out, vaccination reduces the transmission of the disease, making outbreaks less frequent.

COVID-19 and mRNA vaccines

The mRNACOVID-19 vaccine has been shown to be effective in preventing symptomatic SARS-CoV-2 infection in a randomized, placebo-controlled phase III trial.

3,950 health care workers, including

A prospective cohort of 3,950 health care workers, first responders, and other workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks and found that under real-world conditions, the efficacy of full immunization (at least 14 days after the second dose) mRNA vaccine was 90% against SARS-CoV-2 infection, regardless of symptomatic status. The vaccine efficacy for partial immunization (more than 14 days after the first dose and before the second dose) was 80%.

Results.

The licensed mRNACOVID-19 vaccine is effective in preventing SARS-CoV-2 infection, and COVID-19 vaccination is considered recommended for all eligible individuals.

Thompson MG, Burgess JL, Naleway AL, et al. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS- Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS- CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021;70:495-500. DOI: http://dx.doi.org/10.15585/mmwr.mm7013e3 external icon.

Activities for the unvaccinated

Several different approaches to vaccination advocacy have been found to have the potential to increase the number of adolescents who receive the recommended vaccines. Approaches include providing health education, offering gifts, and passing legislation. However, we will present a review done from more research to understand which approaches are most effective when focusing on low and middle income countries.

The authors of this review

The authors of this review have reviewed 16 relevant studies.

They found that when adolescents and their parents were provided with information and education about vaccination, more adolescents received the HPV vaccine. (Based on high certainty evidence) It is also possible that more adolescents received the HPV vaccine when gift certificates were offered.

However, it was not clear whether providing health education, cash, and gift packages to adolescents and their parents would result in more adolescents getting the hepatitis B vaccine. And if a law were enacted that made vaccination a requirement for adolescents to attend school, a significantly larger number of adolescents might get the hepatitis B vaccine.

We found that if health care providers opened electronic health records and encouraged adolescents to be vaccinated, it would have little effect on the number of adolescents who received tetanus, diphtheria, pertussis, meningococcal, HPV, and influenza vaccines. However, more adolescents may be vaccinated against HPV when health care workers receive education with performance feedback.

Also, more adolescents are likely to get the HPV vaccine when health care providers are given education, individualized feedback, frequent visits, and incentives.

More adolescents are likely to get the HPV vaccine when health care providers and parents are targeted in several ways, including education, phone calls, and radio messages.

In addition.

In one study in Tanzania, which targeted schools, girls in classes that were not composed of the same age group were provided information about vaccination. The boys were compared to girls who were the same age, but not in the same class, and therefore were given information on immunization.

The study showed that a class-based approach may result in a small increase in the number of girls who receive the HPV vaccine.

Abdullahi LH, Kagina BM, Ndze VN, Hussey GD, Wiysonge CS. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020 Cochrane Database of Systematic Reviews 2020, Issue 1, Art. No.: CD011895, DOI: 10.1002/14651858.CD011895.pub2.

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