Daniel A. Salmon

The article argues that U.S. vaccine confidence requires an independent National Vaccine Safety Board, expanded real-world surveillance, public-responsive research, and genomic studies to distinguish causal adverse events, identify vulnerable individuals, and improve vaccine safety and trust.

Background: mRNA COVID-19 vaccines have been associated with myocarditis and pericarditis, with the highest risk among adolescent and young adult males after the second dose. However, risks following subsequent doses and across age- and sex-specific subgroups remain inadequately characterized, particularly for less common vaccine platforms and later doses.Methods: A self-controlled case series (SCCS) study was conducted through Global Vaccine Data Network™ (GVDN®) and included 15 sites across 18 countries and regions. This study evaluated the relative incidence and attributable risk of myocarditis and pericarditis following COVID-19 vaccination, stratified by vaccine platform and brand, dose number, and age and sex groups.Findings: The study identified 4,333 myocarditis cases and 7,875 pericarditis cases from an estimated population of 344 million people. An increased relative incidence of myocarditis was found following doses one, two, and three of mRNA vaccines in all age/sex groups and pericarditis in most age/sex groups, with the highest attributable risk of 1 in 20,000 for myocarditis after the second dose of mRNA vaccines among males 12–17 years. Non-replicating viral vector and inactivated vaccines were not associated with myocarditis or pericarditis.Interpretation: In this large multinational SCCS study of COVID-19 vaccination and myocarditis/pericarditis, mRNA vaccines were associated with an increased relative incidence of both myocarditis and pericarditis. While an increase in relative incidence was found across all age and sex groups, the magnitude of the increase and corresponding attributable risk varied widely between age and sex groups. This study provides precise attributable risk estimates for each age and sex group. Patient decision-making, provider recommendations, and vaccine recommendations must consider the risks of myocarditis and pericarditis in the context of vaccine benefits.

Introduction: Community engagement offers an approach to improve our understanding of vaccine hesitancy, yet some worry that public engagement centered around controversial and politicized topics such as COVID-19 vaccines carries a risk of increasing concerns. Methods: Respondents who reported hesitance to vaccinate against COVID-19 in a December 2020 national panel survey were recruited to participate in three interactive and respectful virtual community engagement meetings. A second survey in September 2021 resampled respondents to ascertain changes over time. Of the 291 respondents to both survey waves who had been willing to participate in community meetings, 94 (32%) participated. Multivariate linear and logistic regressions were used to assess the potential impact of meeting participation on outcomes of interest. Results: At follow-up, participants had nearly double the odds of vaccinating against COVID-19 (adjusted Odds Ratio: 1.88; 95% Confidence Interval: 1.06–3.34), about one-third the odds of contracting COVID-19 disease (aOR: 0.37; 95% CI: 0.14–0.96), and increased trust in the Centers for Disease Control and Prevention (CDC) (adjusted Regression Coefficient: 4.16; 95% CI: 0.37–7.94), compared to non-participants. Most participants found the meetings unbiased (89%) and trustworthy (90%). Conclusions: The design of our community meetings to focus on learning from and supporting the decision-maker (versus only promoting “shots in arms”) improved health outcomes and increased trust. Similar meetings could improve how public health engages communities.

ImportanceQuality improvement (QI) programs for healthcare providers have increased childhood immunization coverage. However, practice-level strategies for adult immunization are less clearly defined and may differ from pediatric approaches. ObjectiveTo identify and summarize adult immunization QI programs described in published and unpublished literature. Evidence ReviewWe searched PubMed, Embase, ClinicalTrials.gov, and the Networked Digital Library of Theses and Dissertations in December 2023 using terms covering four main concepts (QI, adults, healthcare providers, and immunization). Results were exported to Covidence for deduplication, screening, and data extraction. Articles describing at least one U.S. adult immunization QI program were included. FindingsWe included 272 studies. QI programs most frequently targeted influenza (64%) and pneumococcal (43%) vaccines and used patient education (49%), patient reminders (38%), provider reminders (36%), and provider education (35%). Most (81%) of the studies assessing vaccine coverage following QI programs found a statistically significant increase. Conclusions and RelevanceAdult immunization QI programs often focus on reminders and education about influenza and pneumococcal vaccines, and they frequently increased adult immunization coverage. Further research is needed to determine the QI components most effective for adult vaccination.

Although COVID-19 vaccines are generally very safe, the risks of myocarditis and pericarditis after receiving an messenger RNA (mRNA) vaccine have been established, with the highest risk in young men. Most systematic reviews and meta-analyses of the risk of myocarditis or pericarditis have included passive surveillance data, which is subject to reporting errors. Accurate measures of age-, sex-, and vaccine dose– and type–specific risks are crucial for assessment of the benefits and risks of the vaccination. A systematic review and meta-analysis of the risks of myocarditis and pericarditis attributable COVID-19 vaccines were conducted, stratified by age groups, sex, vaccine type, and vaccine dose. Five electronic databases and gray literature sources were searched on November 21, 2023. Article about studies that compared a COVID-19–vaccinated group with an unvaccinated group or time period (eg, self-controlled) were included. Passive surveillance data were excluded. Meta-analyses were conducted using random-effects models. A total of 4030 records were identified; ultimately, 17 articles were included in this review. Compared with unvaccinated groups or unvaccinated time periods, the highest attributable risk of myocarditis or pericarditis was observed after the second dose in boys aged 12-17 years (10.18 per 100 000 doses [95% CI, 0.50-19.87]) of the BNT162b2 vaccine and in young men aged 18-24 years (attributable risk, 20.02 per 100 000 doses [95% CI, 10.47-29.57]) for the mRNA-1273 vaccine. The stratified results based on active surveillance data provide the most accurate available estimates of the risks of myocarditis and pericarditis attributable to specific COVID-19 vaccinations for specific populations. Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42023443343

Dengue virus (DENV) is a mosquito-borne virus with a significant human health concern. With 390 million infections annually and 96 million showing clinical symptoms, severe dengue can lead to life-threatening conditions like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The only FDA-approved vaccine, Dengvaxia, has limitations due to antibody-dependent enhancement (ADE), necessitating careful administration. The recent pre-approval of TAK-003 by WHO in 2024 highlights ongoing efforts to improve vaccine options. This review explores recent advancements in dengue vaccine development, emphasizing potential utility of mRNA-based vaccines. By examining current clinical trial data and innovations, we aim to identify promising strategies to address the limitations of existing vaccines and enhance global dengue prevention efforts.