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Vaccines
Special Issues
Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic
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Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "COVID-19 Vaccines and Vaccination".

Deadline for manuscript submissions: closed (15 February 2025) | Viewed by 17236

Special Issue Editors

Dr. Federico Marchesi

E-Mail Website
Guest Editor
Unit of Clinical Surgery, Department of Medicine and Surgery, University of Parma, I-43123 Parma, Italy
Interests: general surgery; obesity surgery; health promotion; public health; infectious diseases and vaccines
Dr. Matteo Riccò

E-Mail Website
Co-Guest Editor
Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42122 Reggio Emilia, Italy
Interests: healthcare; occupational injuries; environmental temperatures; health-environment interaction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The SARS-CoV-2 Pandemic has severely impacted the daily practice of medical professionals all around the world, as a large share of Healthcare Workers has seen their daily activities either disrupted or shifted on settings directly related in the global efforts to contain the effect of the pandemic. Vaccination services have been severely impacted, not only during the early stages of the pandemic, but also in its aftermath, as the global campaign for the delivery of SARS-CoV-2 vaccines has drained human and material resources from more “conventional” vaccine interventions. In the meantime, global attitudes towards vaccines and immunizations have been impacted by an unprecedented infodemic on infectious diseases and public health interventions. In such a setting, this Special Issue will provide an up-to-date appraisal of vaccination rates, vaccination acceptance (specifically focusing on positive and negative effectors), and innovative immunization strategies (including the introduction of monoclonal antibodies in the prevention of infectious diseases likewise RSV). Our aim is to share a broader point of view, specifically including all the professionals (e.g., Gynecologist and Obstetrics, Occupational Physicians, etc.) who are actively involved in vaccination campaigns in specific population groups. 

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: epidemiological studies, cross-sectional studies on drivers and barriers, ecological studies, prospective studies.

We look forward to receiving your contributions.

Dr. Federico Marchesi
Dr. Matteo Riccò
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • attitudes
  • healthcare workers
  • immunizations
  • knowledge
  • practices
  • vaccines
  • drivers
  • barriers

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Published Papers (8 papers)

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Research

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13 pages, 1409 KiB  
Article
Routine Immunisation Coverage Shows Signs of Recovery at Global Level Postpandemic, but Important Declines Persist in About 20% of Countries
by Beth Evans, Laurent Kaiser, Olivia Keiser and Thibaut Jombart
Vaccines 2025, 13(4), 388; https://doi.org/10.3390/vaccines13040388 - 3 Apr 2025
Viewed by 241
Abstract
Background/Objectives: Routine immunisation (RI) coverage declines during the COVID-19 pandemic, from 2020 to 2022, are well-reported. With the declared end to the Public Health Emergency of International Concern in May 2023, and the cessation of most nonpharmaceutical interventions that were introduced to prevent [...] Read more.
Background/Objectives: Routine immunisation (RI) coverage declines during the COVID-19 pandemic, from 2020 to 2022, are well-reported. With the declared end to the Public Health Emergency of International Concern in May 2023, and the cessation of most nonpharmaceutical interventions that were introduced to prevent or minimise COVID-19 spread, we (I) assess whether routine immunisation coverage has rebounded to the level of prepandemic trends and (II) seek to identify factors that help predict whether country performance has exceeded, maintained, or declined compared with expectations (based on time-series forecasting). Methods: We quantified global and country-level routine immunisation diphtheria–tetanus–pertussis (DTP) coverage trends postpandemic (2023) compared with prepandemic trends using time-series forecasting across 190 countries. We used discriminant analysis of principal components and random forests to identify relevant predictors of country-level coverage performance, including twenty-eight indicators of health system strength, health workforce, country income, pandemic containment, economic and health policies, and demographic aspects. Results: We show that mean global DTP third-dose coverage levels remained on average 2.7% [95% confidence intervals: 1.1–4.3%] lower than expected in 2023. However, once accounting for temporal demographic changes, we find that this translated to the total number of immunised children almost reverting to expected levels because of decreasing fertility reducing global-level immunisation target populations. At the country level, notable disruption remained in over thirty countries (16.8% of countries below expectations, 81.6% within expected ranges, and 1.6% above expectations). Neither predictive method performed well at identifying factors associated with coverage disruptions. Conclusions: Despite the end of COVID-19 pandemic measures, RI remains below expectations in about 20% of countries. No clear drivers of this continued disruption were identified. Further research is required to inform recovery efforts and prevent future epidemic and pandemic disruptions to routine health services. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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14 pages, 505 KiB  
Article
Post-Pandemic Perspectives: Willingness, Risk Perception and Factors Influencing COVID-19 Booster Vaccine Uptake Among Thai Healthcare Workers and Vulnerable Populations
by Amornphat Kitro, Wachiranun Sirikul, Chanachai Polpitakchai, Jinjuta Panumasvivat, Ranchana Yamsiri, Pacharee Tasena, Chutima Punyaphab, Chaiy Rungsiyakull, Ratana Sapbamrer, Penprapa Siviroj and Kriengkrai Srithanaviboonchai
Vaccines 2024, 12(12), 1381; https://doi.org/10.3390/vaccines12121381 - 7 Dec 2024
Viewed by 1213
Abstract
Background: The emergence of new COVID-19 variants continues to affect healthcare workers (HCWs) and vulnerable populations in the post-pandemic era. This study aims to assess the willingness, perceptions, and factors associated with booster COVID-19 vaccine uptake in this context. Methods: A cross-sectional study [...] Read more.
Background: The emergence of new COVID-19 variants continues to affect healthcare workers (HCWs) and vulnerable populations in the post-pandemic era. This study aims to assess the willingness, perceptions, and factors associated with booster COVID-19 vaccine uptake in this context. Methods: A cross-sectional study was conducted between October 2023 and May 2024 among Thai adults (>20 years old) in Chiang Mai, Northern Thailand. Participants included HCWs and patients with chronic medical conditions. People who had received a monovalent XBB-derived booster vaccine were excluded. Results: Data related to a total of 811 participants were analyzed, with 328 from the vulnerable group and 483 HCWs. Willingness to receive the booster was similar in both groups (43.3% in HCWs, 45.0% in the vulnerable group). Low-risk perception (59.6%–83.5%), minimal impact on daily life (60.4%–62.9%), and doubts about booster efficacy (75.9%–81.4%) were prevalent negative thoughts toward the booster. Having received a flu vaccine (aOR 2.1), concerns about the impact on life of COVID-19 (aOR 1.8), and beliefs in booster safety (aOR 1.8) and vaccine effectiveness against severe disease (aOR 2.7) were associated with increased willingness. Conclusions: Only 44% of participants were willing to receive a COVID-19 booster. Policymakers can use these insights to develop strategies to increase vaccine uptake in the post-pandemic era. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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13 pages, 1702 KiB  
Article
Association Between County-Level Social Vulnerability and Vaccine-Related Attitudes and Hesitancy Toward COVID-19 Vaccination in the United States
by Yun Kim, Ronaldo Iachan, John Boyle and Yangyang Deng
Vaccines 2024, 12(12), 1368; https://doi.org/10.3390/vaccines12121368 - 3 Dec 2024
Viewed by 974
Abstract
Background/Objectives: Understanding attitudes and behaviors related to vaccination is critical for enhancing COVID-19 vaccination acceptance and reducing disparities in vaccination coverage. This study examines disparities in vaccine-related attitudes and COVID-19 vaccine hesitancy in the United States in relation to community-level social vulnerability. Methods: [...] Read more.
Background/Objectives: Understanding attitudes and behaviors related to vaccination is critical for enhancing COVID-19 vaccination acceptance and reducing disparities in vaccination coverage. This study examines disparities in vaccine-related attitudes and COVID-19 vaccine hesitancy in the United States in relation to community-level social vulnerability. Methods: This study analyzed cross-sectional national surveys conducted repeatedly between July 2020 and August 2021 (n = 6716). We assessed the association between county-level social vulnerability and general vaccine-related attitudes, as well as COVID-19 vaccine hesitancy. We developed Poisson models with robust variance estimation. The analysis also included the association of county social vulnerability with parental COVID-19 vaccine hesitancy. Results: Living in counties with high Socioeconomic Status vulnerability was associated with less vaccine support (adjusted Prevalence Ratio (aPR) 1.10; 95% CI 1.05–1.14) and residing in counties with high Household Characteristics vulnerability was associated with higher likelihood of COVID-19 vaccine hesitancy (aPR 1.13; 95% CI 1.07–1.20). In contrast, high vulnerability in the Racial and Ethnic Minority was associated with more positive attitudes toward vaccines (aPR 0.91; 95% CI 0.88–0.94) and lower COVID-19 vaccine hesitancy for both themselves (aPR 0.81; 95% CI 0.76–0.87) and children (aPR 0.84; 95% CI 0.75–0.94), after adjusting for sociodemographic factors. Conclusions: Our study highlights the importance of addressing vulnerabilities related to socioeconomic status and household characteristics to reduce disparities in vaccine perceptions and hesitancy in socially vulnerable populations. The findings provide evidence for targeted public health interventions at the community level. They also demonstrate that the relationship between social vulnerability and vaccine attitudes varies across different vulnerability components. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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13 pages, 409 KiB  
Article
Recovery of Routine Immunisation: Mapping External Financing Opportunities for Reaching Zero-Dose Children
by Sarah Tougher, Nikhil Mandalia and Ulla Kou Griffiths
Vaccines 2023, 11(7), 1159; https://doi.org/10.3390/vaccines11071159 - 26 Jun 2023
Viewed by 1934
Abstract
The COVID-19 pandemic has precipitated large declines in childhood vaccination coverage and, consequently, substantial increases in the number of zero-dose children. To effectively respond to these declines, it is necessary to direct resources for recovery. We mapped active external financing for immunisation and [...] Read more.
The COVID-19 pandemic has precipitated large declines in childhood vaccination coverage and, consequently, substantial increases in the number of zero-dose children. To effectively respond to these declines, it is necessary to direct resources for recovery. We mapped active external financing for immunisation and primary healthcare in 20 countries with the highest numbers of zero-dose children to promote transparency and donor coordination. We found that countries have disparate access to external financing, with the two upper-middle-income countries (Brazil and Mexico) only having access to loans from the International Bank for Reconstruction and Development. Domestic resource mobilization is, therefore, key in these two countries, although fiscal space is likely constrained. Four additional countries (Angola, Indonesia, Philippines, and Vietnam) do not have allocations from Gavi, the Vaccine Alliance for Health Systems Strengthening, or Equity Accelerator Funding, but are eligible for support under Gavi’s Middle-Income Countries Approach. Our methods, which focus on current donor financing, are novel and reveal substantial variations in access to external financing to support immunisation in high-burden countries. The available data differ considerably across financing mechanisms, making it difficult to synthesise the results across funding sources. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)

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14 pages, 806 KiB  
Systematic Review
The Global Burden of Absenteeism Related to COVID-19 Vaccine Side Effects Among Healthcare Workers: A Systematic Review and Meta-Analysis
by Marios Politis, Georgios Rachiotis, Varvara A. Mouchtouri and Christos Hadjichristodoulou
Vaccines 2024, 12(10), 1196; https://doi.org/10.3390/vaccines12101196 - 19 Oct 2024
Viewed by 1633
Abstract
Background: A rise in absenteeism among healthcare workers (HCWs) was recorded during the COVID-19 pandemic, mostly attributed to SARS-CoV-2 infections. However, evidence suggests that COVID-19 vaccine-related side effects may have also contributed to absenteeism during this period. This study aimed to synthesize the [...] Read more.
Background: A rise in absenteeism among healthcare workers (HCWs) was recorded during the COVID-19 pandemic, mostly attributed to SARS-CoV-2 infections. However, evidence suggests that COVID-19 vaccine-related side effects may have also contributed to absenteeism during this period. This study aimed to synthesize the evidence on the prevalence of absenteeism related to COVID-19 vaccine side effects among HCWs. Methods: The inclusion criteria for this review were original quantitative studies of any design, written in English, that addressed absenteeism related to the side effects of COVID-19 vaccines among HCWs. Four databases (PubMed, Scopus, Embase, and the Web of Science) were searched for eligible articles on 7 June 2024. The risk of bias was assessed using the Newcastle–Ottawa scale. Narrative synthesis and a meta-analysis were used to synthesize the evidence. Results: Nineteen observational studies with 96,786 participants were included. The pooled prevalence of absenteeism related to COVID-19 vaccine side effects was 17% (95% CI: 13–20%), while 83% (95% CI: 80–87%) of the vaccination events did not lead in any absenteeism. Study design, sex, vaccination dose, region, and vaccine type were identified as significant sources of heterogeneity. Conclusions: A non-negligible proportion of HCWs were absent from work after reporting side effects of the COVID-19 vaccine. Various demographic factors should be considered in future vaccination schedules for HCWs to potentially decrease the burden of absenteeism related to vaccine side effects. As most studies included self-reported questionnaire data, our results may be limited due to a recall bias. Other: The protocol of the study was preregistered in the PROSPERO database (CRD42024552517). Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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7 pages, 16715 KiB  
Case Report
Kaposi Sarcoma as a Possible Cutaneous Adverse Effect of ChAdOx1 nCov-19 Vaccine: A Case Report
by Yan-Han Li, Yu-Tzu Lin, Shu-Han Chuang and Hui-Ju Yang
Vaccines 2024, 12(10), 1168; https://doi.org/10.3390/vaccines12101168 - 14 Oct 2024
Cited by 1 | Viewed by 2306
Abstract
The COVID-19 pandemic prompted the rapid development of vaccines, including the ChAdOx1 nCov-19 (AstraZeneca) vaccine. While effective, adverse effects have been reported, including cutaneous manifestations. Kaposi sarcoma (KS), a vascular tumor linked to Kaposi sarcoma herpesvirus/human herpesvirus 8 (HHV-8), has seen increased detection [...] Read more.
The COVID-19 pandemic prompted the rapid development of vaccines, including the ChAdOx1 nCov-19 (AstraZeneca) vaccine. While effective, adverse effects have been reported, including cutaneous manifestations. Kaposi sarcoma (KS), a vascular tumor linked to Kaposi sarcoma herpesvirus/human herpesvirus 8 (HHV-8), has seen increased detection during the pandemic. This study reports a case of classic cutaneous KS in a 79-year-old male following the first dose of the ChAdOx1 nCov-19 vaccine, without prior SARS-CoV-2 infection. The patient developed multiple reddish-blue papules on his legs and feet, confirmed as KS through histopathology. Treatment included radiotherapy and sequential chemotherapy with Doxorubicin. The potential reactivation of latent HHV-8 by the vaccine is explored through mechanisms involving the SARS-CoV-2 spike protein and adenovirus vector, which may induce immune responses and inflammatory pathways. Although establishing a direct causal link remains challenging, the case highlights the need for vigilance regarding KS reactivation post-vaccination. Further large-scale studies are warranted to elucidate the relationship between COVID-19 vaccines and latent virus reactivation, ensuring comprehensive safety assessments and informed public health decisions. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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30 pages, 8536 KiB  
Systematic Review
Impact of Nirsevimab Immunization on Pediatric Hospitalization Rates: A Systematic Review and Meta-Analysis (2024)
by Matteo Riccò, Antonio Cascio, Silvia Corrado, Marco Bottazzoli, Federico Marchesi, Renata Gili, Pasquale Gianluca Giuri, Davide Gori and Paolo Manzoni
Vaccines 2024, 12(6), 640; https://doi.org/10.3390/vaccines12060640 - 8 Jun 2024
Cited by 14 | Viewed by 4758
Abstract
A systematic review with a meta-analysis was performed to gather available evidence on the effectiveness of monoclonal antibody nirsevimab in the prevention of lower respiratory tract diseases (LRTDs) due to respiratory syncytial virus (RSV) in children and newborns (CRD42024540669). Studies reporting on real-world [...] Read more.
A systematic review with a meta-analysis was performed to gather available evidence on the effectiveness of monoclonal antibody nirsevimab in the prevention of lower respiratory tract diseases (LRTDs) due to respiratory syncytial virus (RSV) in children and newborns (CRD42024540669). Studies reporting on real-world experience and randomized controlled trials (RCTs) were searched for in three databases (PubMed, Embase, and Scopus) until 1 May 2024. Our analysis included five RCTs, seven real-world reports, and one official report from the health authorities. Due to the cross-reporting of RCTs and the inclusion of multiple series in a single study, the meta-analysis was performed on 45,238 infants from 19 series. The meta-analysis documented a pooled immunization efficacy of 88.40% (95% confidence interval (95% CI) from 84.70 to 91.21) on the occurrence of hospital admission due to RSV, with moderate heterogeneity (I2 24.3%, 95% CI 0.0 to 56.6). Immunization efficacy decreased with the overall length of the observation time (Spearman’s r = −0.546, p = 0.016), and the risk of breakthrough infections was substantially greater in studies with observation times ≥150 days compared to studies lasting <150 days (risk ratio 2.170, 95% CI 1.860 to 2.532). However, the effect of observation time in meta-regression analysis was conflicting (β = 0.001, 95% CI −0.001 to 0.002; p = 0.092). In conclusion, the delivery of nirsevimab was quite effective in preventing hospital admissions due to LRTDs. However, further analyses of the whole RSV season are required before tailoring specific public health interventions. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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9 pages, 1221 KiB  
Perspective
A Practical Guide to Full Value of Vaccine Assessments
by Caroline Trotter, Birgitte Giersing, Ann Lindstrand, Naor Bar-Zeev, Tania Cernuschi, Lauren Franzel-Sassanpour, Martin Friede, Joachim Hombach, Maarten Jansen, Mateusz Hasso-Agopsowicz, Mitsuki Koh, So Yoon Sim, Dijana Spasenoska, Karene Hoi Ting Yeung and Philipp Lambach
Vaccines 2024, 12(2), 201; https://doi.org/10.3390/vaccines12020201 - 16 Feb 2024
Cited by 4 | Viewed by 3186
Abstract
Articulating the wide range of health, social and economic benefits that vaccines offer may help to overcome obstacles in the vaccine development pipeline. A framework to guide the assessment and communication of the value of a vaccine—the Full Value of Vaccine Assessment (FVVA)—has [...] Read more.
Articulating the wide range of health, social and economic benefits that vaccines offer may help to overcome obstacles in the vaccine development pipeline. A framework to guide the assessment and communication of the value of a vaccine—the Full Value of Vaccine Assessment (FVVA)—has been developed by the WHO. The FVVA framework offers a holistic assessment of the value of vaccines, providing a synthesis of evidence to inform the public health need of a vaccine, describing the supply and demand aspects, its market and its impact from a health, financial and economic perspective. This paper provides a practical guide to how FVVAs are developed and used to support investment in vaccines, ultimately leading to sustained implementation in countries. The FVVA includes a range of elements that can be broadly categorised as synthesis, vaccine development narrative and defining vaccine impact and value. Depending on the features of the disease/vaccine in question, different elements may be emphasised; however, a standardised set of elements is recommended for each FVVA. The FVVA should be developed by an expert group who represent a range of stakeholders, perspectives and geographies and ensure a fair, coherent and evidence-based assessment of vaccine value. Full article
(This article belongs to the Special Issue Immunization Strategies and Vaccine Uptake after the SARS-CoV-2 Pandemic)
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