Search Results (214)

Background: Human papillomavirus-induced disruption of the anogenital mucosal barrier may increase susceptibility to other sexually transmitted infections (STIs), and guidelines recommend STI screening in patients with anogenital warts (AGW). We aimed to determine the seroprevalence of concomitant STIs in patients with AGW over a five-year period and to perform an exploratory assessment of associated demographic factors. Methods: In this retrospective, cross-sectional study, all consecutive patients clinically diagnosed with AGW between December 2020 and October 2025 (n = 779) were evaluated. Serological results for HBsAg, anti-HBs, anti-HCV, anti-HIV, and syphilis (treponemal and non-treponemal) were obtained. Seroprevalence was estimated with Wilson 95% confidence intervals (CIs) using the number of patients actually tested as the denominator. Patterns of multiple reactive serological markers were described, and the relationship between age and seropositivity was examined using a Cochran–Armitage trend test. Associations of demographic factors with concomitant STI seropositivity were explored using Fisher’s exact test with Woolf logit CIs and a complementary Firth penalized logistic regression; given the small number of events, these analyses were considered exploratory and hypothesis-generating. Results: Among 779 patients (585 [75%] male; mean age, 35.80 ± 12.32 years), the overall seroprevalence of concomitant STIs was 2.4% (19/779; 95% CI, 1.6–3.8). Seroprevalence was 1.4% for HBsAg, 0.9% for anti-HCV, 0.2% for anti-HIV, and 1.6% for treponemal antibodies, while anti-HBs immunity was present in 53.5% of patients. Two patients (10.5% of seropositive cases) had more than one concomitant STI. Seropositivity increased from 0.7% in patients aged 17–24 years to 3.5% in those aged ≥45 years, although the trend was not statistically significant (p = 0.13). Anti-HBs negativity was associated with concomitant STI seropositivity (OR = 5.63; 95% CI, 1.60–19.83; p = 0.003); this association was attenuated and no longer statistically significant after excluding HBV markers (OR = 2.73; 95% CI, 0.70–10.69; p = 0.200). A complete-case analysis restricted to patients with a fully defined testing panel yielded a similar prevalence estimate (2.8%; 95% CI, 1.7–4.5). Conclusions: The seroprevalence of the tested markers in patients with AGW was low but non-negligible and increased with age, while the subgroup of markers more consistent with current infection was less common. Anti-HBs negativity was associated with the composite outcome, but a sensitivity analysis showed this was largely attributable to its expected link with HBV status. These findings support guideline-recommended serological screening—including hepatitis B vaccination assessment—in all patients with AGW, and should be regarded as hypothesis-generating given the limited number of seropositive cases. Full article

Background/Objectives: Despite the availability of safe and highly effective human papillomavirus (HPV) vaccines, vaccination coverage remains below global targets in many low- and middle-income countries. School-based HPV prevention campaigns represent a promising strategy to promote adolescent engagement in preventive health behaviors; however, little is known about the factors of adolescents’ intention to participate in these initiatives, particularly in Latin America. This study aimed to identify factors of adolescents’ intention to participate in a school-based HPV prevention campaign in Bogotá, Colombia. Methods: A cross-sectional study was conducted among 125 adolescents aged 11–17 years. Sociodemographic characteristics, HPV-related knowledge, exposure to HPV-related information on social media, and intention to receive HPV vaccination were assessed as potential factors of participation. Associations with intention to participate were estimated using Poisson regression with robust variance, and adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 52.8% of adolescents reported an intention to participate in a school-based HPV prevention campaign. Exposure to HPV-related information on social media showed the strongest positive association with participation (aPR = 1.80; 95% CI: 1.25–2.58), followed by accurate knowledge of the recommended age for HPV vaccination (aPR = 1.68; 95% CI: 1.10–2.57), religious practice (aPR = 1.67; 95% CI: 1.23–2.27), and intention to receive HPV vaccination (aPR = 1.49; 95% CI: 1.01–2.21). Conclusions: These findings identify factors associated with adolescents’ intention to participate in school-based HPV prevention campaigns. Integrating evidence-based digital communication with practical HPV education may inform strategies to promote adolescent engagement. Future studies should determine whether these factors predict actual participation and implementation outcomes. Full article

Background/Objectives: Herpes zoster (HZ) represents a substantial public health burden, particularly among older adults and individuals at increased risk of severe disease. Despite effective vaccines, uptake remains suboptimal. This systematic review aimed to update evidence on HZ vaccination willingness, acceptance, and hesitancy, and to classify determinants according to the 5C model: Confidence, Complacency, Constraints, Calculation, and Collective Responsibility. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Scopus from the date of the most recent relevant review (2022) to 15 June 2026. Eligible studies were observational studies assessing HZ vaccine hesitancy, willingness, acceptance, and related determinants among adults. Studies included in the previous systematic review were also reassessed. Study selection and data extraction were independently performed, and methodological quality was assessed using a modified Newcastle–Ottawa Scale. Due to substantial heterogeneity, findings were synthesized qualitatively. Results: Thirty-seven studies were included. Actual HZ vaccine uptake was generally low, despite moderate-to-high willingness in several populations. Healthcare professional (HCP) recommendation was the most consistent facilitator of vaccination. Within the 5C framework, low perceived susceptibility and severity of HZ, particularly its complications, were frequently associated with hesitancy, while vaccine cost, out-of-pocket payment, and limited access represented major constraints. Greater knowledge and awareness of HZ and HZ vaccination were generally associated with greater willingness, although knowledge alone did not consistently overcome hesitancy. Collective Responsibility was the least investigated domain. Conclusions: HZ vaccination uptake remains suboptimal despite favorable vaccination intentions. Strengthening HCP recommendations, reducing financial and structural barriers, and improving risk communication may enhance uptake. The 5C model provides a useful framework for understanding HZ vaccine hesitancy and informing targeted adult immunization strategies. Full article

Background/Objectives: During the 2025–26 influenza season, the antigenically distinct A(H3N2) subclade K emerged and spread globally, raising significant concerns regarding seasonal vaccine effectiveness. This study aimed to map antigenic and structural divergence of this novel strain compared to the 2025/26 A(H3N2) vaccine component. Furthermore, we investigated how this vaccine mismatch impacts functional humoral immunity by directly comparing antibody neutralization profiles between individuals with vaccine-induced protection and those with infection-acquired immunity. Methods: Phylogenetic and structural modeling analyses were performed on 2025–26 Israeli influenza samples to identify genetic distances and mutations in the hemagglutinin protein compared to the 2025/26 A(H3N2) vaccine component. Hemagglutination inhibition (HI) and microneutralization assays were conducted using 2025–26 winter serum samples from a cohort of vaccinated healthcare workers and vaccinated convalescents to quantify antibody responses against both vaccine-like and subclade K strains. Results: Phylogenetic analysis revealed a clear dominance of the subclade K strain in Israel during the winter of 2025–26. Significant vaccine mismatch was defined by eight newly identified hemagglutinin mutations in the circulating subclade K strains. Serological testing demonstrated that while vaccination alone produced a modest two-to-three-fold increase in antibody titers, baseline protection against subclade K remained critically low. Conversely, natural infection in vaccinated convalescents elicited a significantly stronger, broader immune response, demonstrating a 6-fold and 13-fold increase in neutralizing antibodies against the vaccine-like and subclade K strains, respectively. Conclusions: Natural infection provides a more pronounced increase in both binding and neutralizing antibodies compared to vaccination alone, which might contribute to broader cross-protection against antigenically drifted variants. These findings highlight the primary limitations of current influenza strain prediction and emphasize the urgent need for faster, more adaptable vaccine manufacturing platforms to better match actual circulating strains. Full article

Lumpy skin disease (LSD) is a rapidly spreading viral disease of cattle that threatens livestock productivity and agricultural trade across Africa, the Middle East, and Asia. Despite effective vaccines being available, evidence-based guidance on allocating limited veterinary budgets across competing interventions remains lacking, and no LSD study has yet combined dynamic transmission modelling with a hard budget constraint and formal cost-effectiveness analysis. We develop a deterministic $S_h{V}_h{E}_h{I}_h{R}_h$–$S_v{I}_v$ (SVEIRSI) compartmental model for LSD, embedded within a budget-constrained optimal control framework with three time-dependent controls—vaccination ($u_1$), vector control ($u_2$), and movement restriction ($u_3$)—evaluated across all eight strategy combinations. The basic reproduction number is ${\mathcal{R}}_0=2.7899$. Pontryagin’s Maximum Principle characterises the optimality conditions. The resulting two-point boundary value problem is solved via forward–backward sweep with budget bisection over a 180-day horizon at three budget levels (${\mathcal{W}}_L=\mathrm{NAD}5000$, ${\mathcal{W}}_M=\mathrm{NAD}\mathrm{15,000}$, ${\mathcal{W}}_H=\mathrm{NAD}\mathrm{40,000}$). Vaccination dominates the optimal allocation at every budget, reducing peak infectious prevalence by 54–57% and averting 15,645–17,970 animal-days of cumulative burden relative to the uncontrolled baseline (${\mathcal{I}}_0=\mathrm{97,313}$ animal-days). Shadow-price analysis reveals that the budget constraint is non-binding across all three policy budget levels (actual optimal spend ≈ NAD 572), indicating that logistical (rather than financial) barriers are the true bottleneck, with the shadow price dropping to zero at $\mathcal{W}\approx \mathrm{NAD}1862$. Incremental cost-effectiveness analysis places vaccination alone ($S_1$), vaccination plus vector control ($S_{12}$), and the combined strategy ($S_{123}$) on the efficiency frontier, with ICERs of NAD 0.012, 0.015, and 0.166 per animal-day averted, respectively. One-way sensitivity analysis identifies vaccine efficacy $\epsilon$ as the dominant driver of cases averted (swing $\approx \mathrm{85,601}$ animal-days), while global sensitivity analysis via Latin Hypercube Sampling identifies the midge biting rate a as the strongest driver of cumulative infectious burden ($\mathrm{PRCC}=0.926$, $p<0.001$). These results provide actionable, quantitative guidance for LSD outbreak response in Namibia and comparable resource-limited settings. Full article

The 2026 Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda, the first Ebola-related PHEIC caused by a species lacking a licensed vaccine, has been accompanied by an information crisis marked by conspiracy-driven violence against response teams and destruction of treatment centres. Understanding what populations actually seek to know during such events is essential for designing effective communication strategies, yet the content of public information demand during Ebola outbreaks has not been systematically characterised. We combined Google Autocomplete query extraction (7347 unique queries from 83 seed terms in English and French) with Google Trends temporal analysis across six Ebola outbreaks (2014–2026). The autocomplete suggestion landscape was dominated by risk quantification and transmission concerns. Google Trends temporal analysis showed moderate to strong co-movement between misinformation-related search terms and overall Ebola search interest (Spearman ρ = 0.359–0.697, nominal p < 0.001). Substantial differences emerged between the English-language and French-language suggestion sets: French-language suggestions contained six times more misinformation and conspiracy content (4.9% vs. 0.8%) and nearly nine times more fear-related content (3.5% vs. 0.4%) than English-language suggestions. These findings demonstrate that infodemic management strategies designed in Anglophone contexts are inadequate for the populations most at risk and should inform linguistically adapted interventions for the ongoing response. Full article

Background: HPV vaccination coverage in Pakistan is extremely low, and there are complex psychosocial, cultural, and logistical barriers that currently impede vaccinations. There is no validated measurement tool that is appropriate to the context to measure these determinants systematically. Objective: To develop and validate a multidimensional instrument measuring important factors associated with HPV vaccine uptake and readiness in Pakistan through partial least squares structural equation modelling (PLS-SEM). Methods: A cross-sectional survey was administered to caregivers of girls aged 9–16 years, recruited via purposive/convenience sampling from schools, EPI sites, and household outreach in three Punjab/ICT districts (Rawalpindi, Islamabad, Bahawalpur) during September–November 2025, coinciding with Pakistan’s national HPV vaccination campaign (700 initial responses; 639 retained after screening). The instrument comprised 75 initial items across six constructs: thinking and feeling, social processes, motivation, practical issues, cultural integration, and the vaccination uptake composite index (a composite index of actual vaccination receipt, intention, perceived importance, and perceived access). The measurement model was evaluated for indicator/construct reliability, convergent validity (AVE), and discriminant validity (HTMT, Fornell–Larcker, cross-loadings); the structural model tested direct effects, mediation via motivation, and moderation by practical issues and cultural integration. Results: The number of indicators after model refinement was 27 in six constructs. All outer loadings exceeded 0.70 (range: 0.765–0.939). Cronbach’s α ranged from 0.854 to 0.928, composite reliability from 0.912 to 0.945, and AVE from 0.710 to 0.850. All the HTMT ratios were less than 0.90; Fornell–Larcker and cross-loadings criteria supported discriminant validity. The relationships between thinking and feeling (β = 0.098, p < 0.001) and social processes (β = 0.155, p < 0.001) with vaccination uptake were significantly mediated by motivation. Social and cognitive pathways were moderated by cultural integration. The model accounted for 65.8% of the variance in motivation and 59.4% in uptake of vaccination. Conclusions: The instrument was found to have good psychometric properties and to be suitable suitable for evaluating the determinants of HPV vaccination in conservative, resource-constrained countries such as Pakistan. Findings have direct implications for targeted public health interventions to improve HPV vaccine readiness and uptake. Full article

Vaccination is a fundamental tool for the prevention and control of infectious diseases in canine shelters, where high population density and frequent animal turnover increase the risk of pathogen transmission. However, in Italy there is currently no unified regulatory framework governing vaccination protocols for shelter dogs. In this context, the aim of this study was to evaluate vaccination protocols and preventive health practices adopted in canine shelters in the province of Bologna (Northern Italy). Data were collected through on-site visits and review of institutional documentation and collection of information from shelter personnel using a structured data collection instrument designed to gather information on vaccination protocols, vaccine types, administration intervals, epidemiological history of the facilities, and preventive measures. Additionally, vaccination records from a sample of dogs in each shelter were examined to compare the protocols formally adopted with the vaccinations actually administered. The analysis revealed substantial heterogeneity among shelters in the vaccination protocols applied, largely reflecting the professional discretion of veterinary practitioners. Furthermore, several inconsistencies and errors in vaccination schedules were identified, which may compromise immunological protection within the shelter population. These findings underline the importance of implementing standardized vaccination protocols tailored to the local epidemiological context to improve disease prevention and health management in canine shelters. Full article

Objectives: To identify factors influencing influenza vaccination willingness and uptake among adults aged ≥60 years in Henan Province and to evaluate the effect of a brief educational intervention on vaccination willingness and behavior. Methods: In September 2024, a cross-sectional survey based on the Behavioral and Social Drivers (BeSD) framework was conducted among adults aged ≥60 years across five counties in Henan. For participants without baseline willingness, a 3 min one-on-one educational intervention was delivered. In May 2025, following the end of the 2024–2025 influenza vaccination season (which runs from 1 October to 31 March in Henan Province), we retrieved vaccination records for all participants from the Henan Provincial Immunization Information System. This system captures all influenza vaccinations administered at designated vaccination clinics across the province. To ensure completeness for doses administered outside the provincial system (e.g., in other provinces or at private healthcare facilities), we conducted telephone follow-up interviews with all participants whose baseline vaccination intention was inconsistent with their actual vaccination behavior (i.e., willing but unvaccinated or unwilling but vaccinated). During these interviews, for those who reported receiving the vaccine outside Henan Province or at private facilities, we inquired about the specific date and location of vaccination to supplement the registry data. We also explored the reasons behind the intention–behavior discrepancy. For these participants, we requested vaccination certificates or other supporting documentation to confirm their vaccination status. Results: Baseline vaccination willingness was 68.20% (1630/2390), whereas the actual vaccination rate was only 6.95% (166/2390), yielding a willingness-to-behavior conversion rate of 9.51% (155/1630) among those with baseline willingness. Of the 760 participants without baseline willingness, 543 (71.45%) completed the 3 min one-on-one instant educational intervention and the follow-up assessment; the remaining 217 were excluded due to refusal or loss to follow-up. Among these 543 completers, 46 (8.47%) became willing to vaccinate, and eight (1.47%) were subsequently vaccinated. Multivariate analysis identified the social processes dimension as the strongest correlate of both willingness (OR = 1.38 per 1-point increase, 95% CI: 1.33–1.44) and uptake (OR = 1.12, 95% CI: 1.03–1.22). Urban residence was associated with higher willingness (OR = 1.41, 95% CI: 1.12–1.78) and higher uptake (OR = 1.64, 95% CI: 1.11–2.42). Current smokers had a significantly lower uptake than never smokers (OR = 0.43, 95% CI: 0.22–0.85). Among the 11 participants without baseline willingness who were eventually vaccinated (eight from the intervention group and three from the non-intervention group), family/friend influence (63.64%, 7/11) and physician recommendation (36.36%, 4/11) were the primary drivers. For those with willingness but no action (n = 1475), the main barriers were perceived good health (33.29%), high vaccine cost (27.12%), and lack of time (26.31%). Conclusions: Influenza vaccination among older adults in Henan exhibits a “high willingness, low conversion” pattern, with social processes as the strongest driver bridging the intention–behavior gap. A brief educational intervention improved willingness but failed to translate into meaningful uptake, underscoring that knowledge transfer alone is insufficient. We recommend a multi-component strategy that (1) mobilizes family members and community doctors as trusted vaccine advocates; (2) leverages family and village doctor networks to reduce urban–rural disparities; (3) counters the “perceived good health” barrier with age-specific risk communication; and (4) integrates vaccine recommendations into routine care for high-risk groups, particularly frequent outpatient attendees and smokers. Full article

Background: Herpes zoster (HZ), commonly known as shingles, and post-herpetic neuralgia (PHN) represent growing public health concerns, particularly among older adults. Despite the established efficacy of the herpes zoster vaccine (HZV), global uptake remains suboptimal. Objectives: This scoping review maps evidence from Saudi Arabia evaluating the baseline knowledge, awareness, attitudes, acceptance, hesitancy, and clinical uptake of the HZV among general adults, high-risk populations, and healthcare workers (HCWs). Methods: The JBI and PRISMA-ScR methodological frameworks were strictly adhered to during mapping. Eligible sources included peer-reviewed, observational cross-sectional studies conducted in Saudi Arabia and published in English between 2022 and 2026. The search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Data were systematically extracted and charted using a standardized digital piloting framework to capture study characteristics (author, year, and region), sample sizes, target populations, knowledge percentages, actual vaccine uptake rates, and self-reported barriers. Results: Out of 25 retrieved records, 19 unique primary studies were mapped. Public knowledge of HZ complications and vaccine eligibility criteria was consistently low to moderate, falling below 50% across most cohorts. Conversely, while verbal willingness to receive the vaccine was highly favorable (ranging from 60% to 75%), a profound “intention–behavior gap” was observed, with actual clinical uptake being below 10%. Key barriers included a lack of public health campaigns, safety concerns regarding reactogenicity, online misinformation, and a lack of proactive provider communication. For HCWs, barriers included unclear local guidelines and a lack of workplace mandates. Ultimately, a proactive physician recommendation was identified as the single most powerful clinical facilitator, increasing vaccine acceptance by over 80% across all cohorts. Conclusions: While the shingles vaccine is now distributed completely free across Saudi Arabia, high public willingness has not translated into actual vaccination rates (10%) due to low public awareness of disease severity. Free vaccine availability alone is insufficient; primary care systems must shift from a passive delivery model to an active, provider-driven framework to successfully close this gap Full article

Background: Cervical cancer is among the most common cancers affecting women worldwide, with high morbidity and mortality in low- and middle-income countries. In Saudi Arabia, most cases are diagnosed at a late stage despite the availability of free HPV vaccination and screening. Objectives: To identify Saudi women’s perceptions of the HPV vaccine using the Health Belief Model, estimate willingness to receive the HPV vaccine and the factors influencing it, assess uptake of Pap smear and HPV vaccine, and define barriers to both practices. Methodology: A cross-sectional study of a convenience sample of 1334 Saudi women aged 16 to 65 years, from all regions of Saudi Arabia, was conducted. Data were collected via an online questionnaire that included sociodemographic characteristics, beliefs about the HPV vaccine based on the Health Belief Model, vaccine hesitancy, and HPV vaccine and Pap smear uptake. Data were analyzed using SPSS version 29. Results: Only 6% completed their vaccination series or received at least one dose; 37.3% planned to get vaccinated; and 56.7% stated they do not intend to get vaccinated. The main reasons for vaccine refusal were lack of trust (41.8%) and fear of side effects (32.3%). Only 21% had undergone Pap smear testing, with barriers including embarrassment and fear. Among the HBM constructs, perceived susceptibility, benefits, and barriers remained statistically significant predictors of HPV vaccination. Increased perceived susceptibility and benefits raise the likelihood of accepting the HPV vaccine, while higher perceived barriers lessen it. Vaccine hesitancy had a significant negative effect on willingness to receive the HPV vaccine (OR = 0.78, 95% CI 0.69–0.90, p < 0.01). Additionally, Pap smear uptake was an independent predictor of the intent to get the HPV vaccine (OR = 1.78, 95% CI 1.25–2.54, p < 0.01). The independent factors influencing HPV vaccine uptake were largely similar to those affecting the willingness to receive the vaccine, except for age, perceived benefits, and Pap smear uptake. Conclusions: There is a gap between Saudi women’s intention to get HPV vaccinated and actual vaccination. Women who saw a high risk of HPV-related cancer, believed in vaccine efficacy, had a Pap smear, and were open to vaccination were more likely to vaccinate. Hesitant women and those perceiving barriers were less likely to vaccinate or consider it. The main gaps for future campaigns are perceptions of HPV severity and cultural factors influencing decision-making. Emphasizing HPV as a cancer-related virus rather than a sexually transmitted infection can reduce barriers and highlight its severity. Full article

dTDP-L-rhamnose (Deoxythymidine diphospho-L-rhamnose) is a crucial active sugar nucleotide that serves as the key glycosyl donor for the synthesis of rhamnose-containing polysaccharides in bacteria, holding broad application potential in pathogen-associated molecular mimicry and vaccine development. In this study, the rhamnose synthase gene cluster (Pa-RmlABCD) was successfully cloned for the first time from the marine bacterium Pseudoalteromonas agarivorans Hao 2018. Four key enzymes—Glc-1-P thymidylyltransferase (Pa-RmlA), dTDP-glucose-4,6-dehydratase (Pa-RmlB), dTDP-4-keto-6-deoxyglucose 3,5-epimerase (Pa-RmlC), and dTDP-4-keto-rhamnose reductase (Pa-RmlD)—were heterologously expressed in Escherichia coli. A one-pot four-enzyme synthesis system was constructed, and the successful synthesis of dTDP-L-rhamnose was verified by Q Exactive Focus. After correction for recovery (92% ± 2%), the actual yield reached 3.47 mg/L with a conversion rate of 53.4% ± 1.1%. Combined with bioinformatics analysis, tertiary structure modeling, and molecular docking simulations, the sequence characteristics, substrate binding modes, and catalytic mechanisms of Pa-RmlABCD were systematically elucidated. By characterizing the marine-derived Pa-RmlABCD system and achieving efficient one-pot synthesis, this work opens up a new avenue for the sustainable production of dTDP-L-rhamnose, with the potential to alleviate the current industrial supply constraints. Full article

Ensuring the quality, reliability, and efficiency of cold chain logistics for thermolabile pharmaceutical products, particularly vaccines, remains a critical challenge in global health supply chains. These biologics require stringent temperature control throughout storage, transport, and distribution to preserve their efficacy. Persistent issues such as maintaining product integrity, accurately forecasting vaccine demand, and fostering trust among stakeholders often result in inefficiencies, waste, and public mistrust. This study proposes an intelligent digital management framework specifically designed for vaccine cold chains, integrating blockchain, the Internet of Things (IoT), and machine learning (ML) to address these challenges in a holistic and sustainable manner. The main innovation of the study lies in combining secure traceability, real-time cold chain monitoring, and predictive decision support within a unified vaccine cold chain management framework rather than treating these functions as isolated technological solutions. Using WHO immunization coverage data and vaccine-related review data, the framework supports vaccine demand forecasting through the Informer model and stakeholder trust assessment through BERT-based sentiment analysis. In the sentiment analysis task, the BERT model achieved ~80% accuracy on dominant sentiment classes, with a weighted F1-score of 0.6974, demonstrating strong performance on imbalanced datasets. By minimizing vaccine spoilage and enabling more accurate demand planning, the system reduces excess production and distribution, thus lowering resource consumption, carbon emissions, and financial waste. Moreover, trust-informed analytics support better alignment of supply with actual community needs, fostering equity and resilience in vaccine distribution. While this framework has been validated through simulations and experimental evaluation, further real-world testing is needed to assess long-term stability and stakeholder adoption. Nonetheless, it provides a scalable and adaptive foundation for advancing sustainability and transparency in pharmaceutical cold chains. Full article

Objective: This study assessed the influence of a highly publicized influenza-related death event on caregivers’ influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors. Methods: A cross-sectional survey was conducted from March to April 2025 using a multi-stage, stratified cluster sampling method across 10 districts/counties. Caregivers completed electronic questionnaires covering sociodemographics, event awareness, vaccination history, hesitancy, and cognitive attitudes. Factors associated with vaccination intention were analyzed using chi-square tests and logistic regression. Results: Among 2153 caregivers, overall vaccination intention for the 2025 season was 60.10%, markedly higher than the 2024 season’s actual rate (27.45%). Caregiver awareness of this event was 91.92%, primarily via social media (92.02%). In univariate analyses, event-related characteristics were significantly associated with vaccination intention: perceived “completely objective” coverage showed the highest willingness (79.68%, χ² = 79.92, p < 0.001), whereas the “exaggerated risk” (52.44%) and “unaware” (51.15%) groups showed lower willingness. Exposure frequency also correlated positively: low exposure (0–2 times) had 53.39% willingness, moderate (3–5) 61.11%, and high (≥6) 66.10% (χ² = 27.75, p < 0.001). However, stronger vaccination intention was independently associated with factors such as no prior vaccination refusal [aOR(95% CI) = 2.74(2.03,3.72)] or hesitancy history [1.47(1.13,1.92)], greater information need (aOR = 6.42–8.83), and disbelief in influenza’s spontaneous resolution [1.39(1.08,1.77)]. Weaker intention was associated with poorer child health status [0.19(0.04,0.74)], no influenza vaccination in 2024 [0.41(0.30,0.55)], no influenza illness in 2024 [0.73(0.56,0.95)], belief in vaccine protection [0.60(0.46,0.79)], and the perception that most parents have their children vaccinated [0.70(0.53,0.93)]. Conclusions: Following a highly publicized celebrity influenza death, vaccination intention was primarily driven by caregivers’ cognitive, psychological, and behavioral experience factors. Caregivers who perceived event coverage as completely objective showed higher vaccination intention, while prior vaccination behavior exhibited inertia. Targeted interventions should enhance information credibility and focus on previously unvaccinated and vaccine-hesitant groups to improve coverage. Full article

Background: Pertussis and influenza immunization during pregnancy protects both mother and infant through transplacental transfer of antibodies. However, global vaccination coverage among pregnant women remains suboptimal. Aim: This systematic review aimed to assess influenza and pertussis vaccination coverage during pregnancy and identify determinants influencing vaccine uptake. Methods: A systematic search of MEDLINE, SCOPUS, and grey literature was conducted for studies published between 2000 and 2023. Studies reporting actual vaccination rates for influenza and/or pertussis among pregnant women were included, while those assessing only willingness were excluded. Studies on H1N1 pandemic vaccination in pregnant women were excluded to avoid bias, as awareness levels during the pandemic differed from routine influenza vaccination. Determinants of vaccine acceptance were recorded. Study quality was evaluated using the Newcastle–Ottawa Scale. Results: Of 3251 identified records, 78 studies on influenza (N₁ = 287,124 participants) and 51 on pertussis (N₂ = 172,801) met inclusion criteria after removing overlapping populations. Most influenza studies (55/78) reported vaccination coverage below 50%. A key determinant of influenza vaccination uptake was physician recommendation, while maternal attitudes, parity, and previous influenza vaccination also had a significant impact. For pertussis, vaccination coverage was primarily driven by physician recommendation, with parity and maternal perceptions of vaccine safety and effectiveness further influencing uptake. Regarding quality assessment, 52.5% of influenza studies and 37.5% of pertussis studies scored above 6 on the Newcastle–Ottawa Scale. Conclusions: Maternal vaccination coverage for influenza and pertussis remains inadequate worldwide and is shaped by national strategies, healthcare provider practices, and maternal perceptions. Addressing vaccine hesitancy and improving awareness are essential to increase uptake. Full article