The Task Force for Global Health

To describe (1) the proportion of deaths that were in recently hospitalised children and (2) causes of mortality among deceased children aged 0-59 months with preceding hospitalisations who enrolled in a mortality surveillance programme. Descriptive study using prospectively collected data. Eight Child Health and Mortality Prevention Surveillance (CHAMPS) community and healthcare sites in sub-Saharan Africa and South Asia. Deaths among children aged 0-59 months enrolled in CHAMPS 2016-2023. None. Deaths with antecedent hospitalisations within 180 days of death. Causes of death determined by expert panels who reviewed clinical data and histopathologic and microbiologic results from postmortem minimally invasive tissue sampling. CHAMPS enrolled 8548 deaths; we excluded 3688 neonates who died before discharge or ≤24 hours of birth and 482 with unclear information on antecedent hospitalisations. Out of the 4378 remaining deaths, 16.7% (95% CI 15.7% to 17.9%) were deaths that occurred within 180 days of a hospitalisation (n=733/4378). Of these, 55.7% (95% CI 52.0% to 59.3%) occurred outside healthcare facilities. Among included deaths with minimally invasive tissue sampling completed (n=337), lower respiratory tract infections (41.2%, 95% CI 36.0% to 46.7%), sepsis (39.8%, 95% CI 34.5% to 45.2%) and undernutrition (n=92, 27.3%, 95% CI 22.7% to 32.4%) were most common causes of death among cases with antecedent hospitalisations. The greatest proportion of deaths with antecedent hospital admissions occurred among cases aged 1-11 months (48.0%, 95% CI 44.4% to 51.7%), compared with those aged 0-1 months (21.7%, 95% CI 18.8% to 24.9%) and those aged 1-5 years (30.3%, 95% CI 27.0% to 33.8%). Moreover, the greatest proportion of deaths with antecedent hospital admissions occurred among infants/children with weight-for-age Z-score of <-3 (62.5%, 95% CI 56.5% to 68.0%) compared with those with weight-for-age Z-score of ≥-3 (37.5%, 95% CI 32.0% to 43.5%). We observed a high proportion of deaths with antecedent hospitalisations within 180 days among young children across eight sites in sub-Saharan Africa and Asia. Among those deaths, children aged 1-11 months and undernourished infants were over-represented, suggesting early follow-up as a potential point to focus targeted support and future research.

Respiratory infections cause substantial morbidity and mortality in older adults and other at-risk adult populations. Despite the availability of effective vaccines, adult vaccination coverage remains suboptimal. This narrative review examines strategies designed to improve vaccine uptake among non-pregnant adults aged ≥18 years and inform future adult vaccination strategies. We conducted a targeted literature search using keywords for vaccination, respiratory diseases, strategy/program/implementation, and adults in PubMed database and CDC, WHO, and ECDC websites, between 2014 and 2024. A snowball search of literature reviews and key references was also performed to identify additional relevant studies. Eligible publications focused on vaccination strategies against influenza, COVID-19, and pneumococcal disease targeting non-pregnant adults (≥18 years). We categorized the strategies by intervention type to describe their influence on vaccination campaigns and vaccine uptake/coverage. We included 45 publications, encompassing strategies focused on individual decision-making, healthcare system functions, and national policy. Educational and awareness interventions (such as healthcare worker/provider recommendations during consultation, phone calls, letters, text messages, and social media outreach) reportedly raised vaccination rates. Access-related factors, including convenient vaccination sites and free or subsidized vaccines, were reported to be important factors in improving coverage in underserved communities. Within healthcare settings, strategies such as continuous vaccine provider training and workflow/process optimization were shown to enhance vaccination delivery. At the local or national policy levels, legislation governing program targets shaped immunization efforts and facilitated collaborations and partnerships to expand campaign reach. The findings may inform policymakers and public health/immunization practitioners in designing context-specific immunization initiatives that effectively reach adult populations.

Health workers (HWs) set an example for vaccine recipients, convey vaccine benefits and risks and interface with patients at increased risk for complications in pandemic settings. We explored HWs' acceptance of and recommendation for COVID-19 vaccine with and without previous receipt of seasonal influenza vaccine (SIV) in nine countries. In 2023-2024, cross-sectional surveys among HW were conducted in Bangladesh, Cote d'Ivoire, Ghana, Laos, Lebanon, Morocco, Philippines, Thailand and Tunisia. Country researchers used a standard protocol and questionnaire to assess beliefs, perceptions and acceptance around SIV and COVID-19 vaccine and likelihood of recommending these vaccines to patients. Pooled findings were stratified by the presence or absence of a national HW SIV recommendation. Generalised mixed effects models were used to characterise the relationship between receipt of SIV and COVID-19 vaccine acceptance and recommendation, adjusting for WHO region, sex and duration of employment. Our analysis included 12 296 HWs from nine countries representing four WHO regions: African, Eastern Mediterranean, Southeast Asian and Western Pacific. Five countries had a national HW SIV recommendation (61% of HWs surveyed) prior to COVID-19 vaccine introduction. More than 90% of HWs reported completing the COVID-19 vaccination series, whereas intention to continue receiving annual COVID-19 vaccine was lower (61%). HWs who received SIV in the last season compared with those who did not were more likely to have received one or more COVID-19 booster doses (adjusted OR (aOR) 2.63, 95% CI 2.27 to 3.04) and to have recommended COVID-19 vaccine to patients (aOR 1.53, 95% CI 1.29 to 1.82). Prior experience with SIV was associated with HW behaviour and recommendations regarding COVID-19 vaccination. Intention to continue receiving COVID-19 vaccines remains a challenge; ongoing training and education for vaccination staff could be beneficial. HWs play a critical role in the successful delivery of new and existing vaccines, particularly in a pandemic setting.

Abstract Background The new and effective RSV vaccine can reduce morbidity from RSV among older adults, yet uptake is below goal and there are differences in uptake across race/ethnicity and income groups. Thus, we sought to describe barriers and facilitators to RSV vaccine uptake among Latino older adults and likelihood of recommending the vaccine to their family members.Demographics of Survey ParticipantsBehavioral and Social Determinants of RSV Vaccination Among adults 60+ years Methods In this cross-sectional study, we administered surveys to a convenience sample of adults at Latino-focused community-based organizations and churches. Surveys assessed barriers and facilitators of RSV vaccination using Behavioral and Social Drivers (BeSD) conceptual model (Figure 1). We assessed sociodemographic variables and the odds of being motivated to get the RSV vaccine (60+ years) with a logistic regression, adjusting by age, sex, and race.Predictors of Intention to Vaccinate (BeSD Domain: Motivation) and Confidence in Vaccine Benefits (BeSD Confidence) Among Adults 60 Years of Age and OlderBehavioral and Social Drivers of Vaccination Results From November 2024 to February 2025, we administered 403 surveys (200 among adults 60+). Majority of participants were Latino (87%) and born outside of the US (87%) (Table 1). Among adults 60+, 3% received the RSV vaccine, whereas 47% received the zoster vaccine and 82% received a COVID booster. Prior to the survey, 58% had never heard of the RSV virus. Once made aware of RSV and vaccine eligibility, 67% were motivated to get vaccinated and 68% felt the vaccine was very important (Table 2). Confidence in vaccine benefits was highly correlated with motivation, with 71% of people who felt the vaccine was important expressing strong motivation to get the vaccine. After adjusting for age, sex, and race, older adults’ motivation to get the RSV vaccine was positively associated with confidence in vaccine safety (aOR: 9.8, 95%CI: 3.2-30.2), trust in health workers (aOR: 5.1, 95%CI: 1.7-15), and social norms-- family and friends want them to get vaccine (aOR: 5.3, 95%CI: 2.5-11) (Table 3). Practical challenges were reported, with 73% expressing cost concerns. Among people 18-59 years, 77% discuss health matters with their older family members and 70% would recommend the RSV vaccine. Conclusion After hearing about RSV vaccine eligibility, motivation to get vaccinated was high, though actual vaccine uptake was only 3%. Strategies to increase uptake should include education from trusted sources including health care providers, family members and friends about vaccine eligibility and access. Disclosures Diane Havlir, MD, VIiV: Grant/Research Support

Influenza contributes substantially to severe acute respiratory infection (SARI) morbidity and mortality worldwide. However, few countries have estimated influenza disease burden, especially middle and low-income countries. Burden data are important to understand the impacts of illness on the population and to inform interventions. Currently, Niger has no recommendations for seasonal influenza vaccination or antiviral use. We estimated the national number and rates of SARI and influenza-associated SARI hospitalizations, mild/moderate illness, and death among children aged < 5 years in Niger. We utilized influenza surveillance data among children aged < 5 years hospitalized with SARI at three sentinel hospitals located in Niamey during 2015-2018 along with estimated catchment area population data to calculate the influenza-associated SARI hospitalization rates per 100,000 population. Rates were calculated for age groups < 1, 1-4, and < 5 years using the World Health Organization (WHO) methods and a hospital admission survey; then, we extrapolated the estimates nationally. We also used the influenza burden pyramid tool developed by WHO and the John Hopkins Center for Health Security to estimate influenza-associated mild/moderate illnesses and influenza-associated deaths for Niger. Influenza viruses were detected in 175/1796 (9.7%) specimens collected and tested during the study period from children aged < 5 years at the three SARI sentinel surveillance sites. The influenza percentage positive was 7.7% (58/754) among infants aged < 1 year and 11.3% (117/1038) among children aged 1-4 years. The estimated mean annual national number of SARI hospitalizations among children aged < 5 years was 16,406 (95% CI: 15,117-17,779) and the estimated SARI hospitalization rate per 100,000 population was 405.3 (95% CI: 373.5-439.2). The estimated mean annual national number of influenza-associated SARI hospitalizations among children aged < 5 years was 1484 (95% CI: 1162-1813; rate: 36.7; 95% CI: 28.7-44.8). The estimated mean annual national number of influenza-associated mild illnesses, hospitalized patients, and deaths among children aged < 5 years in Niger was 218,030 (95% CI: 43,303-527,236), 1261 (95% CI: 38-3271), 223 (95% CI: 22-614), and 15 (95% CI: 6-373) respectively. 'This study estimated a substantial influenza disease burden among children aged < 5 years in Niger, highlighting, for decision makers, the importance of resource allocation and public health interventions like vaccination. Future efforts should consider estimating the potential cost-benefit of implementing prevention and control measures (e.g., influenza vaccine or antivirals) among children aged 6-59 months in Niger.

A target specimen profile (TSP) corresponds to the required characteristics of the specimen panels needed to demonstrate that a diagnostic kit meets the target product profile (TPP). TSPs can guide biobanks in the prospective collection of sample panels to support the development and validation of diagnostics.