Haemophilus type b / Meningococcal C conjugate vaccine powder and solvent for solution for injection 0.5ml vials

BackgroundThis systematic review was conducted as part of a 10-year update to a clinical practice guideline about reducing distress during vaccine injections and evaluated procedural interventions (injection techniques) that clinicians and organizations can use. Altogether, 4 clinical questions were included: (1) no aspiration before injection; (2) fast injection; (3) injecting the vaccine causing the most distress last; and (4) reducing fear cues before injection.MethodsPanel members voted on clinical questions and outcomes, as per GRADE methodology. A search strategy was executed across 5 databases: MEDLINE, EMBASE, APA PsycINFO, CINAHL, and ProQuest Dissertations. Randomized and quasi-randomized controlled trials involving individuals undergoing vaccination across the lifespan were eligible and identified in a stepwise fashion involving at least 2 reviewers. The critical outcome was distress, assessed by vaccine recipients or observers. Data were combined using standardized mean difference (SMD) with 95% CIs. Summary statements were developed according to certainty of evidence and magnitude of effect (threshold SMD ≥0.2).ResultsAltogether, 12 studies were included. Meta-analysis of 6 trials indicates that injecting without aspiration may result in a reduction in distress (SMD=-0.77, low certainty), as reported by vaccine recipients and observers. Fast injection may reduce distress slightly, according to self- and observer-report in 2 trials (SMD=-0.27, low certainty). Injecting the vaccine that causes the most distress last likely reduces distress (SMD=-0.73, moderate certainty), as reported by observers in 4 included trials. One trial providing indirect evidence demonstrates that reducing fear cues may reduce distress (SMD=-0.26, very low certainty), but the evidence is very uncertain.ConclusionsProcedural interventions are associated with benefits for vaccination-related distress and provide feasible options for clinicians and organizations to improve the vaccination experiences of vaccine recipients.

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ObjectiveTo systematically review and critically appraise human evidence on potential health effects of aluminium adjuvanted vaccines.DesignSystematic review following PRISMA (preferred reporting items for systematic review and meta-analysis) 2020 guidelines.Data sourcesSix databases and trial registries were searched from inception to 3 March 2023 then updated to 27 November 2025. Reference lists of eligible studies were also screened.Eligibility criteria for selecting studiesHuman studies assessing health outcomes after aluminium adjuvanted vaccination, including randomised controlled trials, cohort studies, case series, and ecological studies. Investigational vaccines, case reports, and review articles were excluded.Data extraction and synthesisTwo reviewers screened studies (with AI assistance for the 2023-25 update), extracted data, and assessed risk of bias (using RoB 2.0, ROBINS-I, or an adapted tool for case series). Certainty of evidence was rated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).ResultsThe review included 59 studies (37 case series, 11 randomised controlled trials, nine cohort studies, two ecological studies). High quality evidence from randomised controlled trials and large cohorts consistently showed no association between aluminium adjuvanted vaccines and serious or long term health outcomes, such as asthma, autism spectrum disorders, or other chronic conditions. Studies on macrophagic myofasciitis were generally small and methodologically limited, and did not provide credible evidence of a causal association (very low certainty). Localised persistent nodules or granulomas were observed infrequently after diphtheria-tetanus-pertussis vaccines, consistent with delayed type hypersensitivity (ConclusionsCurrent evidence does not support causal associations between aluminium adjuvanted vaccines and serious or long term health outcomes. The most consistently documented reactions were persistent nodules or granulomas that are uncommon, local, and self-limited hypersensitivity reactions. These findings are broadly consistent with post-licensure surveillance findings. The predominance of methodologically limited studies for some outcomes highlights the need for higher quality research.Systematic review registrationPROSPERO CRD42023462831.

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BackgroundMeningitis is a significant health concern that is associated with high fatality rates, particularly in resource-limited settings such as Ghana, whose northern regions lie within the African Meningitis Belt. Despite the plethora of primary research data on meningitis in Ghana, a systematic review that provides comprehensive information to guide prevention, control, and management efforts is yet to be undertaken. This systematic review, therefore, aimed at bridging this gap by describing the epidemiology of meningitis in Ghana, including its prevalence, aetiology, and antimicrobial resistance.MethodA comprehensive review of electronic databases, including PubMed and Scopus, was conducted between 2nd and 4th December, 2023, following the established PRISMA guidelines. The search encompassed articles published from 1975 to 2023. With no age limitations on study participants, data extraction was performed on peer-reviewed journal articles reporting primary findings. Studies that exclusively reported on meningitis in animal models, in vitro or in vivo were excluded. Studies with a sample size of less than ten were excluded from the analysis. A meta-analysis was carried out to determine the pooled estimate of meningitis prevalence in the country.ResultsThere were 71,205 suspected meningitis cases analysed during the study period, with 3865 confirmed, and a pooled (overall) prevalence of 18.13%. Specifically, the cases that occurred during non-outbreak and outbreak periods had a pooled prevalence of 16.22% and 23.91%, respectively. The case fatality rates ranged from 20% to 47% between 1998 and 2015 and from 0.82% to 28.6% between 2016 and 2021. The three northern regions - Upper East (30.8%-54.35%), Northern (16.3%-46.4%), and Upper West (17.96%-38.8%) - had relatively high meningitis prevalence, while the Greater Accra and Ashanti Regions had prevalence ranging between 0.8% and 3.29%. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were the predominant isolates, accounting for 0.48%-77.7%, 2.5%-69.5%, and 0.90%-3.40% of the cases, respectively. All bacterial isolates from meningitis cases were susceptible to ceftriaxone. The most common Neisseria meningitidis serogroups were W135, A, Y, and X, while Serotype 1 dominated among the Streptococcus pneumoniae serotypes.ConclusionThere is a disparity in the distribution of meningitis in Ghana, with the highest prevalence occurring in the northern parts of the country. There seems to have been a reduction in the case fatality rate over the years, probably due to interventions such as vaccinations. Ceftriaxone continues to be a suitable treatment option for meningitis. There should be continuous surveillance of meningitis aetiological agents - especially serotyping of the common pathogens - to help guide national vaccination policies and programmes.

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Background: Co-administration of vaccines can impact the immune response and safety. We aim to systematically review the current scientific literature and find evidence regarding the immunogenicity and safety of pneumococcal vaccines co-administered with common vaccines that are recommended for travelers, including hepatitis A, hepatitis B, yellow fever, tetanus, diphtheria, and acellular pertussis (Tdap), Japanese encephalitis, rabies, typhoid, or meningococcal (MCV) vaccine in adults (18 years or older). Methods: We followed the PRISMA 2020 guidelines and used the PICOS process to select the keywords. We searched PubMed, Web of Science, Scopus, EMBASE, and Google from 1 January 2000 to 30 June 2024. We included randomized controlled trials, non-randomized controlled trials, observational studies, case series, and case reports in adults, all published in English. Results: Out of 598 articles screened, 6 studies were included in our study. Three studies involved immunocompetent individuals, and three involved immunocompromised individuals. Co-administration of pneumococcal vaccine with Tdap or Hepatitis A in immunocompetent individuals was safe and immunogenic. Similar findings were reported for immunocompromised individuals when pneumococcal vaccines were co-administered with Tdap, hepatitis A, and hepatitis B. However, no reports investigated the co-administration of yellow fever, rabies, Japanese encephalitis, and typhoid. Two non-randomized studies in immunocompromised individuals had a high risk of bias. Conclusions: The studies collectively indicate that the co-administration of pneumococcal vaccines with Hepatitis A and Tdap vaccines in adult immunocompetent and immunocompromised individuals is safe and immunogenic. However, a knowledge gap remains, and further high-quality studies are needed, particularly due to the limited number of studies and the potential risk of bias.

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Scientific evidence from public health findings can enhance the management, treatment, and prevention policies for bacterial meningitis (BM) infections. However, comprehensive epidemiological data on BM prevalence in South Africa is limited. We aimed to assess the prevalence and characteristics of laboratory-confirmed BM cases at the national population level. Using PRISMA standards, we retrieved data from electronic databases and selected reference articles. Out of 115,626 participants, 57,964 (50.13%) were infected with BM, with the highest prevalence (7.67%) in the age group 6-17 years. Our meta-analysis of 19 studies revealed an overall pooled prevalence of 38.01%, 95% confidence interval (CI: 0.26-0.50), with significant heterogeneity (I² = 99.86%, Q = 13117.45, p < 0.0001). The Egger test indicated publication bias (z = 3.4977, p = 0.0005). Subgroup analyses showed a higher prevalence in studies with sample sizes over 1000 (60.22%, 95% CI: 0.3899-0.7819, I² = 99.92%), over long study years (37.50%, 95% CI: 0.2642-0.5005, I² = 99.84%), cross-sectional study design (58.69%, 95%CI: 0.4906-0.6770, I2 = 99.72%), and particularly in Gauteng province (60.42%, 95% CI: 0.4539-0.7371, I² = 98.45%). The infectious types included Listeria (83.33%, 95% CI: 0.1936-0.9905, I² = 0.00%) and Neisseria (62.64%, 95% CI: 0.6126-0.6400, I² = 0.00%). Significant heterogeneity was noted in study design (R² = 52.93%, p < 0.0001), sample size (R² = 0.00%, p = 0.0117), and province (R² = 0.0%, p < 0.0001). These findings underscore a high prevalence of BM infections in South Africa's epidemiological landscape, highlighting the urgent need for targeted surveillance for effective prevention and treatment strategies.

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The transmission dynamics of many pathogens were altered during the coronavirus disease 2019 (COVID-19) pandemic. Several factors, including control measures and social distancing, have influenced the circulation and epidemiology of major etiological agents of meningitis during this period. This review examined trends in the primary etiologic agents of meningitis during and after the COVID-19 pandemic. A comprehensive literature search was conducted using the MEDLINE, Embase, LILACS, and SciELO databases for studies published between 2020 and 2024. The data were summarized descriptively and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-eight studies are included in this review. Bacterial and viral meningitis pathogens exhibited significant epidemiological shifts during the pandemic. A marked decline in infections caused by the enteroviruses, Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae was observed from 2020 to 2021 in the northern and southern hemispheres during the pandemic. Post-pandemic, meningitis cases increased, with a resurgence in various countries. Despite the heterogeneity of the studies, the evidence indicates that the COVID-19 pandemic significantly affected the epidemiology of meningitis-causing microorganisms during and after the pandemic. Understanding these epidemiological shifts and dynamics is crucial for defining the control measures, vaccination strategies, and public health policies in the post-COVID-19 era.

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BackgroundAcute lymphoblastic leukemia is the most prevalent childhood cancer and the leading cause of cancer mortality before the age of 20. Although therapeutic advances have significantly improved survival, children and adolescents treated for acute lymphoblastic leukemia remain vulnerable to infections, largely preventable by vaccination, due to humoral and cellular immune dysfunction induced by disease and treatment.Materials and methodsThis systematic review, based on electronic databases, aims to evaluate antibody levels associated with potential protective immunity against vaccine antigens for diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, influenza, varicella-zoster virus, yellow fever, pneumococcal, and meningococcal diseases in children and adolescents treated for acute lymphoblastic leukemia after completion of chemotherapy.ResultsA total of twenty-four studies published between 1981 and 2023 were included, comprising 1110 children and adolescents. Protective antibody levels ranged from 11% to 97% for diphtheria, 0% to 90% for pertussis, 20% to 100% for tetanus, and 11% to 95% for poliomyelitis. Haemophilus influenzae type b, protection ranged from 16.7% to 100%. Viral vaccines also showed heterogeneous responses, with protection rates of 25-79% for mumps, 16-86% for measles, 35-98% for rubella, and 23-75% for varicella-zoster virus. Antibody responses to pneumococcal and meningococcal vaccines were consistently low, with protection rates of 5-38% for pneumococcal studies and 12% in a single meningococcal study.ConclusionsThis review found a consistent and clinically relevant loss of vaccine-induced immunity in children and adolescents treated for acute lymphoblastic leukemia. The recommendation of vaccine booster doses for this vulnerable population, irrespective of serological status, may represent a more practical approach to ensuring adequate post-chemotherapy treatment protection.

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Hydro-meteorological and geological disasters can pose serious harm to community health, such as an increased risk of infectious diseases and related mortality. We conducted a scoping review to compile the available literature on the effects of hydro-meteorological and geological disasters on routine immunisation and vaccine-preventable disease (VPD) outbreaks among children and adolescents under 18 years. We searched Medline, Embase, Global Health, Scopus, and Web of Science for original studies and systematic reviews on the topic published by the 21st of October 2024. We included studies that quantitatively analysed the effect of any of the thirty Emergency Events Database (EM-DAT) recognised hydro-meteorological and geological disasters (or those fitting EM-DAT criteria) on a comprehensive list of World Health Organization (WHO)-recommended vaccines and the 23 diseases against which they prevent. We included 26 studies, of which 19 concerned with vaccine-preventable disease outbreaks and seven focused on routine immunisation disruption.. Our review indicates that floods, cyclones, droughts, extreme temperatures, tsunamis, and earthquakes may result in vaccine-preventable disease outbreaks and routine immunisation disruption, and identified young children and refugees as at-risk populations. Flooding was reported to be associated with water-borne and vector-borne vaccine-preventable disease outbreaks such as malaria. Poor water, sanitation and hygiene (WASH) were further recognised as facilitating conditions for vaccine-preventable disease outbreaks after disasters. The vaccination studies reported reduction in routine immunisation rates in the months following a disaster, considering infrastructural damage to health facilities and vaccine storage issues as common causes. Finally, there was significant knowledge gap on the effects of specific disasters (e.g., wildfires and volcanic eruptions) and diseases (e.g., influenza, yellow fever, malaria, and dengue).In conclusion, our review reinforce the need for better policies to ensure vaccine equity, resilient health system and safe WASH to prevent vaccine-preventable disease (VPD) outbreaks following hydro-meteorological and geological disasters.

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BackgroundFunctional active safety surveillance is essential for post-authorization assessment and life-cycle safety evidence generation of vaccines and medicines. Data collected through active surveillance methods are routinely used for post-approval surveillance of novel vaccines and medicines. Implementing these methods in low- and middle-income countries remains challenging.ObjectiveThis systematic review identified and assessed existing active safety surveillance in low- and middle-income countries, including key features, strengths, and limitations.MethodsA search of EMBASE and PubMed Google Scholar databases was conducted. The protocol was registered with PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Findings were synthesized narratively and categorized by surveillance systems characteristics.ResultsOf 13,027 records identified, 423 publications met inclusion criteria. Articles spanned 96 low- and middle-income countries, with India (96), China (57), Brazil (30), Iran (26), Ethiopia (21), Indonesia (20), Uganda (18), Kenya (17), and Ghana (16), most represented. The majority focused on vaccines (211). A total of 127 articles utilized mobile technologies for follow-up, online data collection, and/or adverse event reporting. Fifteen percent of vaccine surveillance systems described in articles demonstrated flexibility to incorporate new vaccines, 34% reported multi-sectoral collaborations, and 10% involved multiple countries. Gaps identified include small sample sizes, lack of sustainability, limited flexible surveillance, staffing challenges, and limited use of standard case definitions and digital technologies.ConclusionsActive safety surveillance in low- and middle-income countries has made progress but still faces challenges. The capture and management of safety data through harmonized digital tools that promote consistency in recording and reporting and cross-country collaborations are crucial in further strengthening active safety surveillance in low- and middle-income countries.

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