Search Results (621)

Background/Objectives: Vaccination coverage among adolescents remains below the recommended target, highlighting the need for effective educational strategies to improve vaccine knowledge. This study aimed to assess baseline knowledge of vaccines and immune mechanisms among adolescents and to evaluate whether a school-based educational intervention can improve knowledge related to vaccination. Methods: A prospective quasi-experimental pre–post study was conducted between 1 February 2025 and 1 June 2025 among adolescents aged 14–19 years attending high schools in Southern Italy. The intervention was based on the e-Bug educational module and delivered by trained nurses through interactive lessons, gamification, and guided discussions. Vaccine-related knowledge was assessed using a questionnaire administered before and after the intervention. Changes in knowledge scores were analyzed using paired statistical tests, and the effect size was estimated. A stepwise multivariate linear regression model was employed to identify factors associated with post-intervention test scores, with statistical significance set as p ≤ 0.05. Results: Among 386 participants, the majority were female (74.2%), the average age was 15.8, and 15% reported a chronic medical condition. Knowledge gaps were observed at baseline, particularly regarding the items on recommended adolescent vaccinations (37.4%), the definition of innate immunity (25.6%), and the mechanism of vaccines’ action (51%). After the intervention, all the items showed an improvement in correct answers, statistically significant for 5 of the 7 analyzed items (r = 0.364, p < 0.001). The most pronounced improvement was in the awareness of age-specific recommended vaccines (61.2%). The multivariate linear regression analysis showed that those with higher pre-intervention test scores, those who had parents with chronic medical conditions, those whose fathers worked, and those willing to participate in similar future interventions were more likely to achieve higher post-intervention test scores. Conclusions: School-based interventions may represent an effective strategy for enhancing adolescents’ knowledge related to vaccination, but further studies with control groups and long-term follow-up are needed to confirm effectiveness. Full article

Background/Objectives: Uveal melanoma (UM) is the most common intraocular malignancy in adults. Although brachytherapy of the primary tumor provides an approximate 80% five-year survival, with time, nearly half of patients experience predominant liver metastases. It was proposed that malignant cells migrate early and stay dormant as they adapt to the liver microenvironment. We propose that cancer vaccine-mediated activation of UM-targeted immunity in primary UM patients could prevent progression of metastatic disease from dormant cells or malignant seeds. Thus, this study explored DNA vaccination as a measure to educate the immune system to recognize the most common UM-associated Q209L tumor driver mutation in GNAQ and GNA11 G-alpha proteins. Methods: Several DNA constructs encoding mutated GNAQ were developed and tested for activation of UM-reactive T cells in HLA-A2/Hd transgenic mice and human T cells ex vivo. Results: Constructs containing immune-enhancing PADRE and VP22-derived epitopes boosted T cell responses against mutant GNAQ, which correlated with reduced experimental lung metastases. Ex vivo dendritic cell-mediated T cell activation with vaccine constructs containing optimized structure produced cytolytic T cells that secreted IFN gamma and killed mutated GNAQ-expressing UM cells in vitro. Conclusions: These findings propose the utility of the fusion DNA vaccines in eliciting T cell immunity against UM cells bearing the Q209L mutation in GNAQ/GNA11 protein to prevent the establishment and progression of metastatic disease. Full article

Objectives: To analyze the changes in the proportion of the rotavirus vaccine among children born in the 2017–2023 cohort and to assess the current status of rotavirus vaccination coverage in Suzhou, China. To monitor adverse events following immunization (AEFIs) so as to provide data for scientific guidance regarding the rotavirus vaccine. Methods: The basic information of children born between 1 January 2017 and 31 December 2023 in Suzhou and information regarding rotavirus vaccination were collected through the child module of Jiangsu Province Vaccination Integrated Service Management Information System. Information on AEFI case reports was collected from the AEFI monitoring system of the China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the rotavirus vaccine characteristics and AEFI classification, and the Mann–Whitney U test was used for comparative analysis. Results: The proportion of children born in the 2017–2023 cohort who received the first dose of the rotavirus vaccine was 14.65%. The reassortant rotavirus vaccine, live, oral, pentavalent (RV5) proportion gradually increased, and the vaccine proportion of children in the 2023 birth cohort reached the highest. The peak age for rotavirus vaccination was between 2 and 8 months. A total of 49,507 children (99.88%) received the first dose of RV5 at the age of 6–12 weeks in this birth cohort, and there was a statistically significant difference in the median duration of the first dose of RV5 among children of different age groups (p < 0.001). A total of 89 cases of AEFIs were reported, and the reported incidence of AEFIs was 3.47/10,000 doses. Among them, 86 cases of general reactions were reported, with a reported incidence of 3.35/10,000 doses, and three cases of abnormal reactions were reported, with a reported incidence of 0.12/10,000 doses. Conclusions: The rotavirus vaccine proportion of children born in Suzhou from 2017 to 2023 was not high. The incidence of AEFI reports from the rotavirus vaccine is relatively low, indicating a favorable safety profile. Efforts should prioritize strengthening health education on rotavirus gastroenteritis to enhance public confidence in vaccination, thereby ensuring the effective prevention and control of rotavirus gastroenteritis. Full article

(1) Background: Human rabies continues to be a significant public health challenge and imposes a heavy disease burden. The epidemiological characteristics and post-exposure prophylaxis (PEP) of human rabies in Chongqing were analyzed to provide a scientific basis for its prevention and control in Chongqing. (2) Methods: Data and case investigation forms of the human rabies epidemic in Chongqing from 2016 to 2024 were collected and analyzed using descriptive epidemiological methods. (3) Results: From 2016 to 2024, 84 human rabies cases were reported in Chongqing, with an average annual incidence rate of 0.03 per 100,000 population. Among the cases, 72.6% were aged 45 and above. Farmers constituted the primary infected group (73.8%). Analysis of exposure patterns and PEP revealed that 92.4% of cases involved dog transmission, with domestic dogs responsible for 65.2% and stray dogs for 31.8%. After exposure, 51.5% received no treatment, while only 6 individuals were vaccinated against rabies. (4) Conclusions: Although rabies incidence in Chongqing is low, dogs remain the primary source, and post-exposure vaccination is often delayed. Strengthening health education and dog immunization is crucial for supporting the global “Zero by 30” target. Full article

Early life is a critical window for immune system development, during which the gut microbiome shapes innate immunity, antigen presentation, and adaptive immune maturation. Disruptions in microbial colonization—driven by factors such as cesarean delivery, antibiotic exposure, and formula feeding—deplete beneficial early-life taxa (e.g., Bifidobacterium, Bacteroides, and Enterococcus) and impair key microbial functions, including short-chain fatty acid (SCFA) production by these keystone species, alongside regulatory T cell induction. These dysbiosis patterns are associated with an increased risk of pediatric autoimmune diseases, notably type 1 diabetes, inflammatory bowel disease, celiac disease, and juvenile idiopathic arthritis. This review synthesizes current evidence on how the early-life microbiota influences immune maturation, with potential effects on the development of autoimmune diseases later in life. We specifically focus on human observational and intervention studies, where treatments with probiotics, synbiotics, vaginal microbial transfer, or maternal fecal microbiota transplantations have been shown to partially restore a disrupted microbiome. While restoration of the gut microbiome composition and function is the main reported outcome of these studies, to date, no reports have disclosed direct prevention of autoimmune disease development by targeting the early-life gut microbiome. In this regard, a better understanding of the early-life microbiome–immune axis is essential for developing targeted preventive strategies. Future research must prioritize longitudinal evaluation of autoimmune outcomes after microbiome modulation to reduce the burden of chronic immune-mediated diseases. Full article

Background and Objectives: Immune checkpoint inhibitors (ICIs) have transformed cancer care, but their impact on cognition is unclear. This study examined the prevalence and clinical correlates of cognitive impairment in patients receiving ICIs. Materials and Methods: In this two-center, cross-sectional cohort of 189 adults with solid tumors treated with ICIs, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Cognitive impairment was defined as MoCA ≤ 21. Age, sex, education, Eastern Cooperative Oncology Group (ECOG) performance status, treatment line, number of metastatic sites, and ICI exposure were compared between cognitive groups using chi-square tests. Univariate and multivariate logistic regression models were used to identify independent predictors of cognitive impairment. Results: The median age was 65 years and 73% of patients were male. Overall, 102 of 189 participants (54%) met criteria for cognitive impairment. Patients with impaired cognition were more often aged ≥65 years, female, and educated at or below high school level, and more frequently had ECOG ≥ 1, second- or later-line ICI therapy, and ≥2 metastatic sites (all p < 0.05). In multivariate analysis, independent predictors of cognitive impairment were age ≥ 65 years (OR: 2.98, 95% CI 1.45–6.12, p = 0.003), female sex (OR: 2.48, 1.09–5.67, p = 0.030), lower education (OR: 3.10, 1.35–7.07, p = 0.007), later-line therapy (OR: 3.51, 1.56–7.88, p = 0.002), ECOG ≥ 1 (OR: 3.38, 1.46–7.83, p = 0.004), and ≥2 metastatic sites (OR: 2.85, 1.37–5.90, p = 0.005). Conclusions: More than half of patients receiving ICIs exhibit objective cognitive deficits. Systematic cognitive screening in high-risk subgroups may allow for earlier recognition of impairment and more timely supportive care. Full article

In type 1 diabetes (T1D) in non-obese diabetic (NOD) mice, dendritic cells (DCs) exhibit a Stat5b mutation that impairs regulatory T cell (Tregs) numbers and suppressive function. To correct this defect, we generated transgenic NOD mice expressing constitutively active Stat5b (NOD.Stat5b-CA) in DCs, which conferred protection from diabetes that was associated with an expanded Treg population and a marked reduction in CD8⁺ T cell frequencies in secondary lymphoid organs. However, the phenotypic characteristics and underlying mechanisms to eliminate CD8⁺ T cells in NOD.Stat5b-CA mice are unknown. In this study, we found that the frequency of Tregs was significantly higher in the thymus and peripheral lymphoid organs of NOD.Stat5b-CA mice compared with NOD mice. Tregs in the peripheral lymphoid organs exhibited increased expression of activation markers CD69 and OX40, alongside reduced CD62L. We also found that CD8⁺ T cell frequencies were reduced in the peripheral organs but not in the thymus of NOD.Stat5b-CA mice, while CD4⁺ T cell frequencies remained unchanged across all organs. Furthermore, NOD.Stat5b-CA mice exhibited a reduced frequency of central Tregs (CD62L^high CD44^low) and increased frequency of effector Tregs (CD62L^low CD44^high) under steady-state conditions compared to NOD mice. Notably, Tregs from NOD.Stat5b-CA mice displayed enhanced cytotoxic activity, evidenced by increased expression of perforin, granzyme B, and Fas ligand, potentially mediating CD8⁺ T cell frequency reduction. Collectively, these findings highlight a novel role for Stat5b-CA.DC-educated Tregs in modulating immune responses by eliminating peripheral pathogenic CD8⁺ T cells via cytotoxic pathways, thereby contributing to immune regulation in NOD.Stat5b-CA mice. Full article

Background/Objectives: The COVID-19 pandemic caused over seven million deaths globally as of July 2024. In an attempt to bring the pandemic under control, immunization was implemented as the main preventive strategy. This study aimed to investigate the knowledge, attitudes, and practices (KAP) of hospitalized patients and healthcare workers (HCWs) regarding COVID-19 vaccination, as well as the factors contributing to COVID-19 vaccination rates. Methods: This cross-sectional, survey-based KAP study was conducted between November 2024 and February 2025 in five hospitals across five cities of the Republic of Srpska, Bosnia and Herzegovina. Results: There were 571 respondents, 68% of whom were female, with an average age of 39.17 ± 14.74 years; one-third held a university degree. The study sample consisted of patients and healthcare workers (HCWs) (59% vs. 41%). During the pandemic period, 46.6% of respondents were diagnosed with COVID-19, with a higher prevalence among healthcare workers compared to patients (54.2% vs. 41.2%). Among the 55.2% of respondents who were vaccinated, HCWs were more often vaccinated than patients (70.9% vs. 44.2%) and more likely to know that vaccines protect against severe forms of disease and death (80.8% vs. 68.5%). Patients more often believed that vaccination against COVID-19 may lead to sterility in young patients (11.3% vs. 6%) and were more often afraid of vaccination compared to the occurrence of COVID-19 (35.6% vs. 24.8%). Regression analyses showed that independent predictors of COVID-19 vaccination were older age (p < 0.001), higher education level (p = 0.039), knowledge of vaccine production technology, and the belief that vaccinated individuals have milder symptoms of the disease (p = 0.002). Conversely, the belief that the COVID-19 situation was overblown was negatively associated with vaccination (p = 0.004). Conclusions: HCWs had better knowledge, more positive attitudes, and better vaccination practices against COVID-19 in comparison to patients. However, there are still certain dilemmas and hesitations among HCWs toward COVID-19 vaccination. Full article

N-acetylcysteine (NAC) is a widely used antioxidant. It has also attracted significant research interest with regard to its role in cancer progression, although the mechanisms involved remain controversial and poorly understood. Here, using murine models of breast cancer metastasis, we found that systemic NAC administration significantly enhanced pulmonary metastasis without altering primary tumor growth in immunocompetent mice, whereas this metastasis-promoting property of NAC was abrogated in T cell-deficient mice. This phenomenon was not due to the direct effects of NAC on T cells or tumor cells, since in vitro studies indicated that NAC exhibited no impact on the effector functions of T cells or the malignant behavior of breast cancer cells. Mechanistically, we demonstrated that NAC endows neutrophils with an immunosuppressive phenotype, which is characterized by the upregulation of immunosuppressive genes, and these NAC-educated neutrophils potently suppress the activation and effector functions of T cells. Collectively, our study reveals a previously unrecognized role played by NAC in regulating breast cancer lung metastasis by orchestrating the myeloid-dependent suppression of anti-tumor T cell immunity and suggests a need to consider immune-mediated mechanisms when evaluating the systemic impact of antioxidant agents in cancer patients. Full article

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

Background/Objectives: Tumor-induced immune reprogramming is increasingly recognized as a key mechanism by which cancers evade surveillance and promote disease progression. The interaction between cancer and immune cells within the tumor microenvironment (TME) can drive phenotypic and functional changes in immune populations, facilitating metastasis and immune evasion. Methods: In this study, we used co-culture models to expose THP1 monocytes to triple-negative breast cancer (TNBC) cells, MDA-MB-231 and BT-549, either directly or indirectly via tumor-conditioned media, to mimic tumor–immune cell communication. Transcriptomic and pathway analyses revealed that cancer-exposed monocytes adopt a reprogrammed phenotype marked by activation of pro-tumorigenic signaling pathways, enhanced proliferative capacity, and elevated expression of pro-inflammatory cytokines such as IL6. Results: Functional assays confirmed a significant increase in monocyte proliferation under both direct and indirect tumor exposure. Importantly, we demonstrated that this tumor-driven proliferation of THP1 cells could be suppressed by the STAT3 inhibitor STAT3-IN-12. This highlights the critical role of STAT3 signaling in mediating immune cell transformation and supporting a novel immunomodulatory approach for therapeutic intervention. Conclusions: These findings support the potential for targeting tumor-educated transcriptional programs as a novel immunomodulatory strategy in cancer treatment. Restoring immune cell homeostasis and suppressing pro-tumor phenotypes through pharmacological inhibition of the key signaling nodes such as STAT3 may complement existing cancer therapies. This study provides new insights into immune cell plasticity in cancer and identifies actionable strategies to counteract tumor-driven immune dysregulation. Full article

Vaccine hesitancy represents a threat to immunization programs and herd immunity. Our objective was to validate a Spanish-language questionnaire to assess knowledge, attitudes, and practices (KAP) of students in the healthcare field regarding vaccination and the immunization schedule. Methods: An online questionnaire was developed and distributed via RedCap v.13.7.1 to healthcare students undertaking clinical placements at the University Hospital of Santiago de Compostela during the 2024–2025 academic year. The questionnaire assessed nine dimensions through thirty-four items. Validation was carried out in two phases: (1) translation and expert content validation, and (2) reliability testing using Cronbach’s alpha and validity assessment through principal component analysis (PCA). Results: A total of 398 students completed the questionnaire. The mean age was 23.78 ± 3.77 years. Of these, 19.60% were men (n = 80) and 77.50% were women (n = 316). Validation of the questionnaire was carried out with a random sample of 294 students. The final 30-item questionnaire demonstrated high internal consistency (Cronbach’s alpha = 0.83) and construct validity, confirmed by PCA, supporting the presence of nine dimensions that explained 60.93% of the total variance. Overall, 74.70% of students reported that scientific evidence was the main influence on their opinion about vaccines. Regarding practices, 76.10% believed that certain vaccines should be mandatory for healthcare personnel. Conclusions: The questionnaire demonstrated reliability and validity for evaluating KAP on vaccination among future healthcare professionals. Having this instrument available will help guide future educational interventions and strengthen their role as trusted agents in immunization. Full article

Introduction: Children with chronic kidney disease (CKD) are susceptible to infections due to impaired immunity, immunosuppressive treatments, and dialysis, which lead to increased mortality, morbidity, and hospitalization rates. Immunization is an efficient preventive strategy, but despite the long-existing guidelines, vaccination rates of children with CKD remain suboptimal. Aim: This review aims to summarize the available data on vaccine-preventable infection morbidity and vaccination coverage in children with CKD, the reasons of vulnerability and suboptimal vaccination of this population and strategies that have been proposed for their overcoming. Results: Vaccination coverage studies for children with CKD are limited and outdated but, despite their variability, they confirm suboptimal vaccine coverage. The vulnerability of children with CKD to infectious dis-eases has been better understood with advanced molecular studies of their immune re-sponse. Several barriers, some of them unique to this population, hamper adherence with vaccination guidelines. Targeted interventions at different levels that have already been tried in adults with CKD, such as enhanced communication with families, cocooning strategies for the most vulnerable, education of specialists on vaccines, and organization of vaccination teams, seem promising in improving vaccination rates and infection prevention. Conclusions: The suboptimal protection from infections of children with CKD can be improved with prioritization of vaccination in their complicated care. Full article

Background: Childhood immunization is one of the most effective public health strategies for reducing morbidity and mortality from vaccine-preventable diseases. Although overall vaccination coverage in the United States remains high, disparities persist across socioeconomic and healthcare access groups. Understanding these disparities is particularly important in the post-COVID-19 era, when increased vaccine hesitancy may threaten progress in maintaining equitable coverage. Materials and Methods: We analyzed data from the National Immunization Survey–Child (NIS-Child), focusing on U.S. children aged 19–35 months in 2023, corresponding to cohorts reaching this age during or after the COVID-19 pandemic. The primary outcome was receipt of the up-to-date combined 7-vaccine series (4:3:1:3:3:1:3: ≥4 doses of DTaP, ≥3 doses of polio, ≥1 dose of measles-containing vaccine, full Hib series, ≥3 doses of hepatitis B, ≥1 dose of varicella, and ≥3 doses of PCV). Logistic regression models were used to estimate associations between vaccination coverage and key explanatory variables: household income-to-poverty ratio, maternal education, health insurance type, and provider facility type, controlling for demographic and regional covariates. Disparities were quantified using concentration indices (CIs). Results: Among children in the analytic sample, overall coverage for the 7-vaccine series was only 78.5%. Nonetheless, disparities were evident. Children from households with lower income-to-poverty ratios (<1 × FPL: OR = 0.44, 95% CI = 0.37–0.53; 100–200%: OR = 0.66, 95% CI = 0.56–0.79), those covered by Medicaid (OR = 0.54, 95% CI = 0.45–0.64), other insurance (OR = 0.48, 95% CI = 0.37–0.61), or uninsured (OR = 0.27, 95% CI = 0.18–0.42), and those whose mothers had lower educational attainment (<12 years: OR = 0.35, 95% CI = 0.28–0.44) had significantly lower odds of being up-to-date. Similar associations were observed across specific vaccines. Unadjusted CIs for income-to-poverty ratio (0.04, p < 0.01), maternal education (0.04, p < 0.01), health insurance (0.03, p < 0.01), and provider type (0.03, p < 0.01) decreased but remained statistically significant after adjustment (0.02, 0.02, 0.01, and 0.02, respectively; all p < 0.01). No significant disparities were found by census region or race/ethnicity. Discussion: Despite relatively high overall vaccination coverage among U.S. children born during and after the COVID-19 pandemic, disparities by socioeconomic and healthcare access factors persisted. However, the absolute magnitude of these disparities was very small (concentration indices ≤ 0.04). These findings suggest that while inequities remain statistically measurable, their scale is limited in absolute terms. Targeted efforts to address income, insurance, maternal education, and provider-related barriers will be important to sustain equitable immunization coverage in the post-pandemic era. Full article

Background: Infectious diseases accounted for approximately 18.4% of global mortality in 2019. According to the World Health Organization (WHO), vaccines are available for about 30 potentially lethal diseases. Vaccination prevents substantial mortality and hospitalization. However, its ability to improve overall public health depends on equitable access across all populations, regardless of race, ethnicity, education, or socioeconomic status. Objectives: This study aims to examine how disparities in social determinants of health (SDOH) affect COVID-19 vaccination uptake across Jefferson County, Kentucky. Using ZIP code–level spatial mapping, this study investigates the intersection of SDOH, racial composition, and geographic characteristics to identify inequities and inform equitable interventions. Methods: Data from the Kentucky Immunization Registry (KYIR) were analyzed to assess two-dose COVID-19 vaccination rates at the ZIP code and regional levels in Jefferson County, Kentucky. Vaccination rates were stratified by race and ethnicity and linked with SDOH, including education, employment, insurance status, and income, obtained from the 2021 American Community Survey. Results: By May 2021, vaccination rates ranged from 25.9% in the West region to 57.0% in the Inner East region; by May 2022, these rates increased to 46.2% and 73.9%, respectively. White residents consistently had the highest two-dose vaccination rates (66.4% by May 2022), while Black and Hispanic residents had lower rates (45.7% and 43.9%, respectively). Vaccination rates were strongly correlated with SDOH, especially educational attainment, average family income, and employment rate, underscoring the role of socioeconomic inequities in vaccination disparities. Conclusions: Geographical and racial disparities emphasize the influence of social and economic inequality on vaccine uptake. Full article