INTRODUCTION: Respiratory syncytial virus (RSV) poses a significant health burden on infants, particularly during their first RSV season. Immunoprophylactic strategies, such as the administration of nirsevimab, a long-acting monoclonal antibody, have been developed to prevent RSV lower respiratory tract disease (LRTD). This study evaluated the public health and economic impact of nirsevimab or maternal immunisation (MI) compared with standard of practice (SoP) in the United Kingdom (UK). METHODS: A static decision-analytic model was employed to track the UK birth cohort during their first RSV season. The model incorporated UK-specific data on costs, epidemiology and healthcare resource utilisation. Three strategies were compared: historical SoP (pre-September 2024), universal immunisation with nirsevimab and MI. Outcomes measured included RSV-related primary care (PC) visits, accident and emergency (AE) visits, hospitalisations, intensive care unit (ICU) admissions and deaths. The model also considered the impact of recurrent wheezing episodes, all-cause LRTD hospitalisations and non-medically attended RSV-LRTDs. RESULTS: Under the current SoP, RSV was estimated to cause 375,154 total health events and 24,360 RSV-LRTD hospitalisations (including ICU admissions) annually, resulting in an economic burden of £252 million. Universal immunisation with nirsevimab could prevent 208,691 total health events and 16,664 hospitalisations (including ICU admissions) and reduce costs by £105.7 million. MI showed a reduction in RSV-related outcomes but was less effective than nirsevimab, especially in preventing hospitalisations and ICU admissions or protecting infants born outside the RSV season. CONCLUSIONS: Universal immunisation with nirsevimab for all infants during their first RSV season could significantly reduce both the health and economic burden of RSV in the UK. This strategy is more effective than MI, particularly in reducing severe RSV outcomes and protecting infants born outside the RSV season, thus offering substantial benefits across the infant population.
Mersha Chetty, Paul Costello, Benjamin Yarnoff et al.
OBJECTIVE: Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS: We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS: A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION: Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
BACKGROUND: Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE: The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN: The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING: The trial took place in Birmingham, UK. PARTICIPANTS: Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS: The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES: The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS: The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS: Fewer participants were recruited than planned. CONCLUSIONS: Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK: Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12209332. FUNDING: ; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
Amanda Daley, Kate B Jolly, Natalie J. Ives et al.
Maintaining high vaccine coverage (VC) for pediatric vaccinations is crucial to ensure herd immunity, reducing the risk of vaccine-preventable diseases (VPD). The Italian vaccination Law (n. 119/2017) reinforced mandates for polio, diphtheria, tetanus, and hepatitis B, extending the mandate to pertussis, Haemophilus influenzae type b, chickenpox, measles, mumps, and rubella, for children up to 16 years of age. We analyzed the national temporal trends of childhood immunization rates from 2014 to 2019 to evaluate the impact of the mandatory reinforcement law set in 2017 as a sustainable public health strategy in Italy. In a 3-year period, 9 of the 10 compulsory vaccinations reached the threshold of 95% and VC for chicken pox increased up to 90.5%, significantly. During the same period, the recommended vaccinations (against meningococcus B and C, pneumococcus, and rotavirus) also recorded a significant increase in VC trends. In conclusion, although the reinforcement of compulsory vaccination generated a wide public debate that was amplified by traditional and social media, the 3-year evaluation highlights positive results.
Michela Sabbatucci, Anna Odone, Carlo Signorelli et al.
INTRODUCTION: School-based vaccine programme delivery offers convenience to parents, and reduces the burden on primary care capacity. Vaccine coverage among school-age children is lower in Hackney (northeast London), and post-pandemic coverage recovery has been limited in Hackney compared to London and England. Hackney is home to the largest Orthodox Jewish (OJ) population in Europe where most children attend independent faith schools. This study aimed to assess (i): vaccine programme delivery gaps via independent OJ schools in Hackney; and (ii) the primary care catch-up and commissioning strategies undertaken to help close gaps. METHODS: Qualitative evaluations of national incident responses for poliovirus and measles tailored to underserved communities in northeast London (2022-24). Data consisted of in-depth semi-structured interviews (n = 53) with public health professionals, healthcare practitioners, community partners, and OJ parents. Vaccine clinic visits (n = 11) were conducted in northeast London, affording additional (n = 43) focused and opportunistic interviews with OJ parents attending for catch-up. RESULTS: Evaluating the delivery of routine and outbreak vaccination campaigns to school-age children demonstrates that independent OJ schools in Hackney are a key programme delivery gap, directly impacting access to catch-up and routine adolescent programmes. OJ parents reported that they did not receive relevant vaccine programme information and invitations for school-age children via independent faith schools. Primary care-led outreach clinics were hosted to offer school-age immunisations to OJ adolescents, but did not offer HPV vaccines. Sub-commissioning community organisations to liaise with independent schools may be a strategy to help resolve this delivery gap, but would require responsibilities within school-age immunisation partnerships to be clearly assigned. CONCLUSION: Limitations in vaccine programme delivery via independent faith schools in northeast London may play a role in suboptimal vaccination coverage. Programme gaps must be addressed to help ensure that every eligible child is invited for, and can access, routine vaccination via accessible pathways.
BACKGROUND: Recently, the number of measles and pertussis cases increased worldwide, including in the Netherlands. As schools are important in transmission of several vaccine-preventable diseases, we systematically assessed childhood vaccination coverage in the Netherlands among primary school children by birth cohort for all school denominations. METHODS: We linked nationwide vaccination data with sociodemographic registries for children born 2013-2020 attending primary school on 01-10-2024. Vaccination status for MMR (at 14 months), DTaP-IPV (at (2)3-5-11 months), and DTaP-booster (at 4 years) was retrieved from the immunisation register. Vaccination coverage was stratified by school denomination, birth year and sociodemographic characteristics. Poisson regression assessed independent associations between denomination and vaccination uptake. RESULTS: MMR and DTaP-IPV coverage was high (>94 %) in general, Catholic, Protestant, collaborative, and other schools, but lower in Anthroposophical (78 % MMR, 77 % DTaP-IPV), Islamic (74 % MMR, 75 % DTaP-IPV), and Orthodox Protestant schools (57 % MMR, 58 % DTaP-IPV). DTaP-IPV booster coverage was lower than the primary series, ranging from 50 % (Orthodox Protestant) to 88 % (Catholic/Protestant). Primary coverage remained stable for most denominations (overall 95 %) but declined at Islamic schools (MMR: 87 % to 59 %, DTaP-IPV: 88 % to 60 %) and moderately at Orthodox Protestant schools (MMR: 60 % to 54 %, DTaP-IPV: 60 % to 55 %), while coverage at Anthroposophical schools fluctuated (MMR: range 76-81 %, DTaP-IPV: range 74-79 %). Adjusting for sociodemographic variables had little impact. CONCLUSIONS: Although most unvaccinated children attend schools with high coverage, clustering at Orthodox Protestant, Anthroposophical, and increasingly Islamic schools poses ongoing outbreak risks. Further research on vaccination barriers, drivers, and the role of social networks is needed to better understand vaccination decisions.
Joyce Pijpers, Annika M. van Roon, Susan van den Hof et al.
BACKGROUND: Respiratory syncytial virus (RSV) infection is a major cause of severe lower respiratory tract infections in newborns and young infants, especially during the winter season from October to March. In Switzerland, RSV infection represents a leading cause of hospital admissions among newborns. Since October 2024, a long-acting monoclonal antibody, nirsevimab (Beyfortus®), has been available in Switzerland for standard care in newborns. OBJECTIVES: This paper presents a multidisciplinary, standardised protocol for the administration of nirsevimab, as well as immunisation data from the first season of application in 2024/25 at a tertiary centre in Switzerland. METHODS: A protocol for implementing the RSV immunisation strategy was developed at University Hospital Zurich by a multidisciplinary team of obstetricians, neonatologists, nurses, from in- and outpatient services. The focus was on prenatal counselling during outpatient consultations as well as inpatient procedures on maternity and neonatology wards. The goal was to provide expectant parents with consistent information by different healthcare professionals. Neonatal immunisation data from the first season in 2024/25 (25 October to 31 March ) were retrieved from patient charts (Yes/No) in a retrospective, quality control, observational cohort study. All newborns discharged from the maternity ward or the neonatology unit of our centre were included in the analysis. RESULTS: The protocol included early and multidisciplinary parental education, offering consistent oral and written information, as well as opportunities to discuss their questions regarding the new immunisation, ensured informed consent and enabled timely administration of nirsevimab by healthcare professionals in the obstetrics and neonatology units. Over the 2024/25 season, 78% of the newborns were immunised before leaving hospital care: 78% (588/758) of newborns discharged home from the maternity ward were immunised and 82% (125/153) of those discharged home from the neonatology unit were immunised. CONCLUSION: The implementation of passive RSV immunisation was overall successful with an immunisation rate of around 80% for the first season in 2024/25.
INTRODUCTIONChildhood vaccination coverage has declined in recent years in many countries, including the Netherlands.AIMTo understand differences in coverage between population subgroups in the Netherlands over time, we studied sociodemographic factors associated with measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis-poliomyelitis (DTaP-IPV) vaccination.METHODSWe conducted a national retrospective database study including children born between 2008 and 2020. Individual-level data linkage allowed examination of associations of sociodemographic variables with MMR and DTaP-IPV vaccination status at age 2 years. We calculated coverage for each variable, stratified by birth cohort. Multivariable Poisson regression assessed independent associations and changes in coverage over time.RESULTSMMR coverage decreased in all population subgroups (overall 95% in cohort 2008 and 89% in cohort 2020), more substantially in some. In multivariable analysis, children of non-Dutch origin, particularly Moroccan and Turkish origin, showed more pronounced declines (respectively -25% and -12% as children of Dutch origin in cohort 2020). Among children not attending daycare and children living in larger families (≥ 4 children), coverage declined faster than in those attending daycare and living in smaller families (both -12% in cohort 2020). Coverage among children of self-employed mothers and children in the lowest income households was lower than among children of mothers in employment and the highest income households (respectively -8% and -7% in cohort 2020). Trends for DTaP-IPV vaccination were nearly identical.CONCLUSIONChildhood vaccination coverage in the Netherlands declined substantially, with increasing disparities between sociodemographic groups. Vaccination efforts should be prioritised to protect public health equitably.
Joyce Pijpers, Annika M. van Roon, Maarten Schipper et al.
After the 2016 Balkan route border closures, vaccination of refugee children in Greece was mainly performed by non-governmental organisations. Activities varied between camps, resulting in heterogeneity of vaccination coverage (VC). In April 2017, the European programme ‘PHILOS - Emergency health response to refugee crisis’ took over vaccination coordination. Interventions were planned for the first time for refugee children in the community and unaccompanied minors at safe zones. From April 2017–April 2018, 57,615 vaccinations were performed against measles-mumps-rubella (MMR) (21,031), diphtheria-tetanus-pertussis (7,341), poliomyelitis (7,652), pneumococcal disease (5,938), Haemophilus influenzae type b (7,179) and hepatitis B (8,474). In April 2018, the vaccination status of children at camps (reception and identification centres and community facilities such as hostels/hotels were excluded) was recorded and VC for each disease, stratified by dose, nationality and camp size, was calculated. More than 80% of the children received the first MMR dose, with VC dropping to 45% for the second dose. For all other vaccines, VC was < 50% for the first dose in children aged 0–4 years and < 25% for the second dose. Despite challenges, PHILOS improved planning and monitoring of vaccination activities; however, further efforts towards improving VC in refugee children are needed.
Kassiani Μellou, Chrysovalantis Silvestros, Eirini Saranti Papasaranti et al.
Human health and well-being have advanced substantially during the past two centuries, mainly due to improvements in nutrition, hygiene, and clinical medicine. During this period, a close interrelationship has been established among nutrition, infection, and hygiene. In fact, nutritional status greatly influences infectious disease morbidity and mortality. In most developed countries, improvements in diet have resulted in the virtual disappearance of nearly all nutritional deficiency disorders. However, there is now a transition from nutritional deficiency-related disorders to health problems associated with excessive caloric intake, such as obesity, diabetes, and cardiovascular disease. In this special issue dedicated to nutrition in child health and disease, we provide an overview of current trends in research and clinical practice focusing on the impact of nutritional status on child health. Nutritional adequacy is defined as the sufficient intake of essential nutrients needed to fulfill requirements for optimal health. The criteria that are now generally used to define adequacy of intake are the prevention of deficiency or chronic diseases and the reduction in risk for diet-associated diseases. Here, we present a review of the special nutritional needs in specific disorders of childhood where diet is essential for effective treatment, such as hypercholesterolemia and nephropathy. Current and future scenarios also include the shift in importance from under- to overnutrition. Accumulating evidence shows that atherosclerosis begins in youth. The recommended initial step to reduce cholesterol levels in children is the institution of a “heart-healthy” diet, which is safe and often effective. This diet is low in cholesterol and saturated fat and high in complex carbohydrates. It should provide adequate energy for growth, development, and maintenance of a desirable weight. An appropriately tailored diet is essential for kidney disease patients. Patients with kidney damage should limit the intake of certain foods to reduce the accumulation of unexcreted metabolic products and to protect against hypertension, proteinuria, and other heart- and bone-related health problems. The influences of various nutrients on kidney function and overall health in kidney disease patients has been studied extensively, but there are few studies on the impact of specific diets on patient survival. Another condition in which diet is an essential aspect of treatment is celiac disease (CD). A strict, lifelong gluten-free diet free of wheat, rye, and barley products remains the treatment of choice for CD. Although the maximum safe amount of gluten for patients with CD is unclear, <10 mg daily is probably safe for preventing ongoing intestinal injury. For foods to be labeled gluten-free, there must be < 20 ppm. All patients with CD should be referred to a dietitian well-versed in gluten-free diets because parents encounter misinformation and may unnecessarily restrict intake of necessary nutrients. Other practical topics that should be addressed include how to avoid cross-contact at home, travel, and restaurant tips, and how to find reliable information on the Internet. The review also includes three topics in which diet is of special importance: adolescence, young athletes, and future bone health. Adolescence is generally considered to begin with puberty and to end with completion of physical, mental, and sexual maturation. However, the endpoints are often unclear because adult roles and responsibilities, including the formation of life partnerships and the transition to employment and financial independence, may occur at different ages in different parts of the world, so the cultural concept of adolescence varies greatly. Adolescent nutrition is crucial for proper growth and development and a prerequisite for achieving full developmental potential. Suboptimal nutrition may contribute to delayed and stunted growth as well as impaired physical and mental development. As adolescents undergo a period of rapid growth and development, adequate intake of both macro- and micronutrients is critical. Eating disorders with different forms of restrictive eating and overweight/obesity are two problems very prevalent at this age. Nutrition is an integral part of all athletes' lives; however, the importance of proper nutrition is even greater for the adolescent athlete. Proper nutrition provides all athletes with fuel for energy and the resources necessary to recover from exercise stress. With the rising rate of childhood and adolescent obesity, a great deal of attention is now given to general youth nutrition; however, little focus is given to the specific nutritional needs of the young athlete. In youth athletes, nutrition plays the same vital role as in adult athletes but, more importantly, is also required to support growth and maturation. Young athletes require greater caloric intake than their non-exercising counterparts because of the increased energy expenditures related to training and competition. The greater energy requirements compared with their nonathletic peers include an increased need for protein and, likely, carbohydrate. Factors that affect bone mineral accrual during growth include genetics, sex, race, diet, mobility, weight-bearing activity, and hormonal factors. The impact of nutrition on bone health has been extensively examined, and various diets, foods, and nutrients have been studied for their potential effects on bone. The effects of dietary components on bone metabolism and bone mass in early life are important because the accretion of bone during growth may help reduce the risk of osteoporosis in later life. The benefits of dairy food products on bone acquisition and maintenance have been the object of particular interest. Among micronutrients, calcium and vitamin D are especially critical for adequate bone development. However, a significant proportion of children fail to achieve the recommended intake from daily products because of digestive intolerance, so there is emerging recognition of the importance of other animal and/or plant sources for bone health. The roles of other micronutrients, specifically vitamin K, magnesium, phosphorus, and strontium, also need to be considered regarding their effects on calcium economy, bone metabolism, and resistance to mechanical loading. Finally, there is emerging interest in the impact of nutrition on circadian rhythms. Melatonin acts as a chemical signal for time of day and its suppression is a marker for disruption of circadian rhythms. Recently, several studies have provided support for a link between altered sleep/wake patterns and obesity, leading to a growing body of research in this area. Children must have sleep of sufficient quality and duration for proper growth and development as growth hormone is mainly secreted at night. Excess evening electric light, whether inside the home or outside in the neighborhood and city, is a rapidly growing problem in the modern world. Prolonged media screen time is now common in children, even preschoolers. The circadian effects could be considerable because computer screens expose children to bright light close to the face, which is the main stimulus for inhibition of melatonin production. Early identification of how nutrition interacts with child health conditions first requires healthcare providers to be aware of these problems. Qualitative research should be performed to gain insight into how parents can be motivated to emphasize new norms in childhood nutrition. This issue aims to reveal key knowledge gaps that need to be filled to provide stronger dietary advice for the healthcare of children.
