Lancet Regional Health-Americas最新文献

{"title":"The silent trauma: U.S. immigration policies and mental health","authors":"Omid Dadras , Mohammad Sediq Hazratzai","doi":"10.1016/j.lana.2025.101048","DOIUrl":"10.1016/j.lana.2025.101048","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101048"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaching pediatric mental health screening and care in immigration detention","authors":"Shela Sridhar ,&nbsp;Leah Ratner ,&nbsp;Matthew G. Gartland ,&nbsp;Dennis Kunichoff ,&nbsp;Margaret M. Sullivan ,&nbsp;Vasileia Digidiki","doi":"10.1016/j.lana.2025.100999","DOIUrl":"10.1016/j.lana.2025.100999","url":null,"abstract":"<div><div>Children held in US immigration detention facilities often arrive with significant mental health conditions requiring prompt attention. Despite the abundance of literature highlighting the need for adequate mental health care in migrant children, there is a chasm between the care offered to detained migrant children in the US and the minimum standards of healthcare in the US. This discrepancy is fueled by the mandate of Immigration and Customs Enforcement (ICE), which prioritizes immigration enforcement rather than the health and well-being of detained children. The tension between the existing ICE's enforcement mandate and the internationally recognized right to health care for children results in inadequate mental health care, causing long-term harm. We highlight current pediatric mental health screening and treatment practices in immigration detention facilities, exploring the role of ICE and child protection frameworks. We conclude by providing policy recommendations to improve mental health care in US-based detention facilities.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 100999"},"PeriodicalIF":7.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances and challenges for gene therapies in Brazil","authors":"Antonio Carlos Campos de Carvalho ,&nbsp;Adriana Bastos Carvalho","doi":"10.1016/j.lana.2025.101035","DOIUrl":"10.1016/j.lana.2025.101035","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101035"},"PeriodicalIF":7.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic correlates of hypertension prevalence, awareness, and control in the Eastern Caribbean","authors":"Carol R. Oladele ,&nbsp;Mary I. Miller ,&nbsp;Oswald P. Adams ,&nbsp;Rohan G. Maharaj ,&nbsp;Cruz M. Nazario ,&nbsp;Maxine Nunez ,&nbsp;Marcella Nunez-Smith ,&nbsp;Mayur Desai","doi":"10.1016/j.lana.2025.101012","DOIUrl":"10.1016/j.lana.2025.101012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;This study aimed to quantify prevalence, awareness, and control of hypertension in the Eastern Caribbean and identify sociodemographic correlates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Baseline data (2013–2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) was used (n = 2961). The ECS is an ongoing longitudinal study of community-dwelling persons 40 years and older conducted in Barbados, Puerto Rico, Trinidad and Tobago, and U.S. Virgin Islands. Participants completed a self-administered health survey, clinical examination, and laboratory testing. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines defined hypertension prevalence and control. Self-reported hypertension and clinical blood pressure values defined awareness. Binomial proportions, including 95% confidence intervals and logistic regression, were used for analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Analyses included 2932 participants with complete data. The mean age of participants was 57 (SD = 10.3) years, and 65.3% (n = 1916/2932) were women. Prevalence of hypertension was 57.9% (n = 1698/2932), among whom 36.8% (n = 591/1698) were unaware, and 56.4 percent (n = 624/1107) of aware persons lacked control. Persons who were 70 and older (82.9%, n = 325/392, 95% CI:79.2%–86.6%), had low educational attainment (63.4%, n = 642/1012, 95% CI:60.5%–66.4%), obese (67.2%, n = 753/1121, 95% CI:64.4%–69.9%), and low physical activity (63.3%, n = 766/1210, 95% CI:60.6%–66.0%) had the highest prevalences of hypertension. Awareness was highest among persons 70 and older (76.6%, n = 249/325, 95% CI:72.0%–81.2%), women (70.7%, n = 781/1104, 95% CI:68.1%–73.4%), and those with a usual source of healthcare (70.4%, n = 1042/1480, 95% CI:68.1%–72.7%). Persons with lower educational attainment had lowest control across sociodemographic groups (36.1%, n = 154/427, 95% CI:31.5%–40.6%). Multivariable results showed ages 70 and older (OR = 10.6, 95% CI:7.4–15.2) and obesity (OR = 4.0, 95% CI:3.1–5.1) were the strongest predictors of hypertension. Usual source of care (OR = 5.66, 95% CI:3.8–8.4) and ages 70 and older (OR = 4.2, 95% CI:2.7–6.5) were most strongly associated with awareness. Results for control were not statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Findings highlight challenges across the hypertension care cascade in the Eastern Caribbean, particularly with control. These findings have implications for public health and healthcare system solutions to improve screening and blood pressure control.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;&lt;span&gt;National Heart, Lung, and Blood Institute&lt;/span&gt; Award--&lt;span&gt;&lt;span&gt;1K01HL145347-01A1&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;National Institute on Minority Health and Health Disparities&lt;/span&gt; (Yale-TCC)--&lt;span&gt;&lt;span&gt;U54MD010711&lt;/span&gt;&lt;/span&gt;, and &lt;span&gt;National Institute on Minority Health and Health ","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101012"},"PeriodicalIF":7.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural racism and breast cancer stage at presentation in a South Florida majority-minority population: a retrospective study","authors":"Alexandra E. Hernandez ,&nbsp;Maya Lubarsky ,&nbsp;Ashly C. Westrick ,&nbsp;Brianna L. Cohen ,&nbsp;Cheyenne Thompson ,&nbsp;Susan B. Kesmodel ,&nbsp;Neha Goel","doi":"10.1016/j.lana.2024.100962","DOIUrl":"10.1016/j.lana.2024.100962","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Residential segregation, both economic, racial and ethnic, is a social determinant of health that contributes to disparities in breast cancer outcomes. The objective of this study was to examine the association of economic and racial and ethnic residential segregation, as measured by the Index of Concentration at the Extremes (ICE), with breast cancer stage at presentation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this retrospective two-institution study, we included patients with stage I-IV breast cancer from 2005 to 2017. Using five-year estimates from the American Community Survey (2009–2013), five ICE variables were computed to create five models, controlling for economic segregation, Non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models determined the association between economic and racial segregation on breast cancer stage at presentation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;4898 patients were included: 56% Hispanic, 27% Non-Hispanic White, 17% NHB. Those living in the most economically marginalised neighbourhoods [by quartiles (Q)] [OR&lt;sub&gt;Q1&lt;/sub&gt; 1.38 (95% CI: 1.14–1.68), &lt;em&gt;p&lt;/em&gt; &lt; 0.05, majority NHB neighbourhoods [OR&lt;sub&gt;Q1&lt;/sub&gt;1.51 (95% CI: 1.01–2.27)], majority Hispanic neighbourhoods [OR&lt;sub&gt;Q1&lt;/sub&gt; 1.29 (95% CI: 1.06–1.56)], the most NHB and economically segregated neighbourhoods [NHB and economic: OR&lt;sub&gt;Q1&lt;/sub&gt; 1.64 (95% CI: 1.28–2.09), and the most Hispanic and economically segregated neighbourhoods [Hispanic and economic: OR&lt;sub&gt;Q1&lt;/sub&gt; 1.60 (95% CI: 1.24–1.68)] had significantly increased odds of presenting with later stage disease compared to the reference group in each category.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study, to our knowledge, is the first to evaluate stage at presentation by ICE, which allows us to evaluate the association between racial and economic residential segregation and breast cancer disparities. Our findings suggest that structural racism influences stage at presentation. To address these disparities, effective interventions are needed to account for the social and environmental contexts in which cancer patients live and can access care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Research reported in this publication was supported by the &lt;span&gt;National Cancer Institute&lt;/span&gt; of the &lt;span&gt;National Institutes of Health&lt;/span&gt; under Award Number R37CA288502. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The research was also supported by a &lt;span&gt;University of Miami School of Medicine DREAM Scholar Award&lt;/span&gt;, a NIH/NCI T32CA211034, an &lt;span&gt;American Surgical Association Fellowship Award&lt;/span&gt;, a &lt;span&gt;Breast Cancer Research Foundation&lt;/span&gt;, an &lt;span&gt;ASCO Career Development Award&lt;/span&gt;, a &lt;span&gt;Florida Department of Health Bankhead Cole Cancer Resea","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 100962"},"PeriodicalIF":7.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging machine learning on the role of hospitalizations in the dynamics of dengue spread in Brazil: an ecological study of health systems resilience","authors":"Paula de Castro-Nunes,&nbsp;Paloma Palmieri,&nbsp;Patrícia Passos Simões,&nbsp;Paulo Victor Rodrigues de Carvalho,&nbsp;Alessandro Jatobá","doi":"10.1016/j.lana.2025.101042","DOIUrl":"10.1016/j.lana.2025.101042","url":null,"abstract":"<div><h3>Background</h3><div>The alarming rise in dengue cases and fatalities worldwide necessitates an in-depth analysis of essential public health functions (EPHFs) to fortify the resilience of health systems in the face of upcoming surges. This study focuses on the resilience of Brazil’s health system in managing dengue from 2010 to 2024, leveraging machine learning techniques to correlate EPHF variables with dengue outcomes.</div></div><div><h3>Methods</h3><div>Utilizing public data from DATASUS and IBGE, we evaluated indicators such as healthcare workforce, health facilities, and dengue-specific data. A regression tree analysis identified associations between dengue hospitalizations and dengue deaths among Brazilian capitals, emphasizing the importance of strengthening outpatient services and monitoring systems for resilient performance.</div></div><div><h3>Findings</h3><div>This study revealed that capitals with fewer hospitalizations have seen recent improvements; nevertheless, continuous efforts are vital to prevent sudden surges. These findings underscore the critical role of health surveillance and community involvement in enhancing EPHF performance.</div></div><div><h3>Interpretation</h3><div>This research contributes to understanding the dynamic interactions within health systems and highlights the importance of proactive and integrated public health strategies to manage dengue and similar arboviruses.</div></div><div><h3>Funding</h3><div>The present study was funded by the <span>Inova Fiocruz Program</span>, grant <span><span>1366515559697323</span></span>; and by the <span>National Council for Scientific and Technological Development</span> (CNPq), grant <span><span>401278/2022-0</span></span>. Alessandro Jatobá is partially funded by <span>CNPq</span>, grants <span><span>307029/2021-2</span></span> and <span><span>405469/2023-3</span></span> and by the <span>Carlos Chagas Filho Foundation for Research</span> Support of the <span>State of Rio de Janeiro</span> (FAPERJ), grant <span><span>E-26/210.728/2023</span></span> and <span><span>E-26/201.252/2022</span></span>. Paulo Victor Rodrigues de Carvalho is partially funded by <span>CNPq</span>, grant: <span><span>304770/2020-5</span></span> and by <span>FAPERJ</span>, grant <span><span>E-26/203.934/2024</span></span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101042"},"PeriodicalIF":7.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunogenicity and reactogenicity of fractional vs. full booster doses of COVID-19 vaccines: a non-inferiority, randomised, double-blind, phase IV clinical trial in Brazil","authors":"Marco Antonio Moreira Puga ,&nbsp;Roberto Dias de Oliveira ,&nbsp;Patricia Vieira da Silva ,&nbsp;Vivek Charu ,&nbsp;Haley Hedlin ,&nbsp;Di Lu ,&nbsp;Amy Zhang ,&nbsp;Blake Shaw ,&nbsp;Joelle Ivy Rosser ,&nbsp;Jessica Couvillion Seidman ,&nbsp;Alice Scott Carter ,&nbsp;Farah Naz Qamar ,&nbsp;Stephen P. Luby ,&nbsp;Denise O. Garrett ,&nbsp;Julio Croda","doi":"10.1016/j.lana.2025.101031","DOIUrl":"10.1016/j.lana.2025.101031","url":null,"abstract":"<div><h3>Background</h3><div>Fractional doses of vaccine to protect against COVID-19 offer the potential to expand vaccine availability, reduce side effects, and enhance vaccination campaign efficiency. This study aimed to assess the immune response and safety of fractional doses of SARS-CoV-2 booster vaccines compared to full doses in immunocompetent adults aged 18–60 who had previously received a full series of Sinovac, AZD1222 (AstraZeneca), or BNT162b2 (Pfizer/BioNTech).</div></div><div><h3>Methods</h3><div>This trial was structured as a parallel-group, double-blind, randomised Phase IV non-inferiority study, carried out in Campo Grande, Midwest, Brazil. After obtaining consent, eligible participants were randomised to one of 5–6 study arms, depending on their priming vaccine. Participants were followed for 21–60 days after vaccination through in-person visits and remote contact for blood collection and safety evaluation. Anti-spike binding IgG antibodies were measured by ELISA. The primary outcome was the difference in seroresponse rates between the full and fractional doses, with a non-inferiority threshold of 10%.</div></div><div><h3>Findings</h3><div>A total of 1451 participants were randomised and administered booster vaccines between 5 July and 3 October, 2022. A half dose of BNT162b2 met the non-inferiority threshold, compared to a full dose in the Sinovac and AZD1222 primed groups. Sinovac induced an inferior response compared to AZD1222 and BNT162b2 full or fractional dose boosters in participants primed with Sinovac. Fractional booster doses of BNT162b2 consistently resulted in higher seroresponse rates (ranging from 35.4% to 78.3%) compared to fractional boosters of AZD1222 (ranging from 10.0% to 44.7%) or a full dose of Sinovac (4.2%). Both full and fractional dose vaccines were generally well tolerated. Local and systemic adverse events occurred across all treatment arms in line with expectations, with nine serious adverse events reported, none of which were determined to be related to study vaccination.</div></div><div><h3>Interpretation</h3><div>Our data show that the immunogenicity of booster vaccines depends on the initial vaccine, baseline antibody levels, and the booster vaccine used. Fractional doses of BNT162b2 and AZD1222 were non-inferior to a full Sinovac booster in individuals primed with Sinovac. However, fractional doses of BNT162b2 were not non-inferior in BNT162b2-primed individuals, and AZD1222 fractional doses were only non-inferior in the AZD1222 priming arm. We advise against Sinovac as a booster. Fractional doses of BNT162b2 or AZD1222 remain practical alternatives for Sinovac-primed populations in resource-limited settings.</div></div><div><h3>Funding</h3><div><span>Coalition for Epidemic Preparedness Innovations</span> (CEPI)/<span>Sabin Vaccine Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101031"},"PeriodicalIF":7.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A global call for family-centered ICU care","authors":"Bradley A. Firchow","doi":"10.1016/j.lana.2025.101036","DOIUrl":"10.1016/j.lana.2025.101036","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101036"},"PeriodicalIF":7.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study","authors":"Peter J. Gill ,&nbsp;Caitlyn L. Kaziev ,&nbsp;Haifa Mtaweh ,&nbsp;Tuana Kant ,&nbsp;Claire Seaton ,&nbsp;Daniel S. Farrar ,&nbsp;Hayley Wagman ,&nbsp;Mei Han ,&nbsp;Rohini R. Datta ,&nbsp;Sanjay Mahant ,&nbsp;Gabrielle Freire ,&nbsp;Aaron Campigotto ,&nbsp;Jeffrey N. Bone ,&nbsp;Manish Sadarangani ,&nbsp;Francine Buchanan ,&nbsp;Shaun K. Morris","doi":"10.1016/j.lana.2025.101034","DOIUrl":"10.1016/j.lana.2025.101034","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory tract infections with viral pathogens are frequently identified using the World Health Organization (WHO) case definition of severe acute respiratory infection (SARI), defined as fever of ≥38°Celsius, cough, onset within 10 days, and hospitalization. While there is extensive research in adults, less is known about the WHO SARI case definition performance in children and youth. We aimed to determine the performance of the WHO SARI and modified case definitions in identifying viral respiratory tract infections in hospitalized children and youth.</div></div><div><h3>Methods</h3><div>Retrospective observational cross-sectional study of hospitalized children (0–18 years) with an acute respiratory infection and who received a respiratory viral test at two large Canadian children’s hospitals from July 2022 to June 2023. The WHO SARI and modified SARI case definitions were evaluated overall, by virus and age, with reporting of sensitivity and specificity.</div></div><div><h3>Findings</h3><div>There were 2333 hospital admissions, with a median age of 2.4 years (IQR 0.8–5.0). 78% (n = 1828) had one or more viruses identified, most commonly respiratory syncytial virus (30%, n = 709). The WHO SARI definition had a sensitivity of 58% and specificity of 49% for identifying infections with a microbiologically confirmed virus. For Influenza only, the sensitivity was 71% and specificity 44%. The lowest sensitivity was among young children &lt;3 months (28%) and 3 to &lt;6 months (45%). Modified SARI definitions had similarly poor performance, with trade-offs of sensitivity and specificity.</div></div><div><h3>Interpretation</h3><div>The widely implemented WHO SARI case definition has sub-optimal performance among children and youth hospitalized with acute respiratory infections. Public health surveillance based on these case definitions may inadequately detect and monitor known and emerging infections, highlighting the need to develop an accurate and reliable SARI case definition for children and youth globally.</div></div><div><h3>Funding</h3><div><span>Public Health Agency of Canada</span>, <span>SickKids Foundation</span>, <span>BC Children’s Hospital</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101034"},"PeriodicalIF":7.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of revising MenACWY vaccination schedule for adolescents in the United States: a modelling study","authors":"Affan Shoukat ,&nbsp;Chad R. Wells ,&nbsp;Thomas Shin ,&nbsp;Lilia Potter-Schwartz ,&nbsp;Alison P. Galvani ,&nbsp;Seyed M. Moghadas","doi":"10.1016/j.lana.2025.101033","DOIUrl":"10.1016/j.lana.2025.101033","url":null,"abstract":"<div><h3>Background</h3><div>The current recommendation for MenACWY vaccination against invasive meningococcal disease (IMD) in the United States (US) includes two doses: the first dose at ages 11–12 and a booster dose at age 16. The Advisory Committee on Immunization Practices has proposed options for revising this schedule by either eliminating the first dose or adjusting the timing of the first dose to age 15 and the booster to ages 17–18. The impact of these alternative schedules on IMD incidence remains undetermined.</div></div><div><h3>Methods</h3><div>We developed an age-stratified, agent-based Monte-Carlo simulation model of meningococcal transmission dynamics, parameterised with US age demographics, to assess the impact of the proposed changes to the MenACWY vaccination schedules. Excluding serogroup A, absent in the US for decades, the model included serogroups C, W, and Y for asymptomatic infection (carriage) and vaccine effectiveness against IMD. We calibrated serogroup-specific transmission and IMD development probabilities by fitting the model to reported IMD cases from 1997 to 2004, before vaccine introduction. The calibrated model then simulated the current vaccination schedule (CVS) starting in 2005 and alternative schedules from January 1, 2025 to December 31, 2035, comparing outcomes over the same period.</div></div><div><h3>Findings</h3><div>Switching from the CVS to a single-dose program at age 16 with 61% vaccine uptake (as reported for the booster in 2022) would result in 1062 (95% Uncertainty Range [UR]: 724–1419) additional IMD cases during the 11-year study period. With a case fatality rate of 14.5%, this change could cause an estimated 154 (95% UR: 105–206) additional deaths. Even if vaccine uptake increased to 90% at age 16, the program would still result in 934 (95% UR: 640–1242) additional cases and 135 (95% UR: 93–180) more deaths compared to the CVS. The second alternative schedule (i.e. first dose at age 15, booster at ages 17–18) also increased IMD cases, notably shifting a substantial burden to adolescents aged 11–15 years.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that the current MenACWY vaccination program remains more effective than the proposed alternatives, even with increased vaccine uptake during late adolescence. Improving the uptake rate of the booster at age 16 while maintaining the 11–12-year dose within the existing program would reduce the IMD burden among high-risk adolescents and young adults.</div></div><div><h3>Funding</h3><div>This study was in part supported by Sanofi. Seyed M. Moghadas acknowledges support from the <span>Natural Sciences and Engineering Research Council</span> of Canada Discovery Grant and Alliance Grant (ALLRP 576914-22). Alison P. Galvani acknowledges support from The <span>Notsew Orm Sands Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101033"},"PeriodicalIF":7.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}