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\"An intelligent and compelling examination of the science of immunity, the public policy implications of vaccine denial, and the real-world outcomes of failing to vaccinate. If you have a child in school, you may have heard stories of long-dormant diseases suddenly reappearing--cases of measles, mumps, rubella, and whooping cough cropping up everywhere from elementary schools to Ivy League universities. How does a small group of people's failure to vaccinate have the potential to affect future generations? Are we at a turning point in medical history, where deadly diseases, once dormant, flourish anew? Will our children face summers of abandoned swimming pools due to polio outbreaks just like our great-grandparents did? Pioneering medical researcher Michael Kinch tells the remarkable story of vaccine-preventable infectious diseases in [this book], which explains how the science of immunity actually works and places immunology within the context of its social and political implications. While detailing the history of vaccine invention, from the steppes of Mongolia to the serendipitous connection between cowpox and smallpox, Kinch reveals the ominous reality that our victories against vaccine-preventable diseases are not permanent--and could easily be undone. ... Between Hope and Fear illuminates the fascinating intersection of science, technology, and disease that has helped eradicate many of the deadliest plagues known to man.\"-- Jacket.

Objective To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services.Design Clustered randomised controlled study. Setting Rural Rajasthan, India.Participants 1640 children aged 1-3 at end point.Interventions 134 villages were randomised to one of three groups: a once monthly reliable immunisation camp (intervention A; 379 children from 30 villages); a once monthly reliable immunisation camp with small incentives (raw lentils and metal plates for completed immunisation; intervention B; 382 children from 30 villages), or control (no intervention, 860 children in 74 villages). Surveys were undertaken in randomly selected households at baseline and about 18 months after the interventions started (end point).Main outcome measures Proportion of children aged 1-3 at the end point who were partially or fully immunised.Results Among children aged 1-3 in the end point survey, rates of full immunisation were 39% (148/382, 95% confidence interval 30% to 47%) for intervention B villages (reliable immunisation with incentives), 18% (68/379, 11% to 23%) for intervention A villages (reliable immunisation without incentives), and 6% (50/860, 3% to 9%) for control villages. The relative risk of complete immunisation for intervention B versus control was 6.7 (4.5 to 8.8) and for intervention B versus intervention A was 2.2 (1.5 to 2.8). Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8). The average cost per immunisation was $28 (1102 rupees, about £16 or €19) in intervention A and $56 (2202 rupees) in intervention B.Conclusions Improving reliability of services improves immunisation rates, but the effect remains modest. Small incentives have large positive impacts on the uptake of immunisation services in resource poor areas and are more cost effective than purely improving supply.Trial registration IRSCTN87759937.

BackgroundThe Netherlands has had a large influx of MSM refugees in recent years. Soon after arriving many of them start dating other MSM for sexual hook-ups, while insufficiently aware of risks that sex between men entails for HIV/STI. They are also unfamiliar with existing facilities for HIV/STI testing, HBV-vaccination and HIV-care in the Netherlands.Methods In 2017 and 2018, MSM refugees were invited for meet-ups in Amsterdam and three other cities, where information and counseling about STI and HIV and how to prevent these was given in multiple languages. HIV and STI tests and vaccination for HBV were also offered on the spot. Only refugees were allowed in, thus creating a safer space atmosphere. Those tested and/or vaccinated received follow-up appointments on regular office hours for test results, further HIV/STI care or completion of HBV vaccinations. These meet-ups were possible through very close cooperation between self-organizations of migrant MSM, regional Public Health Services, gay bars and a national NGO.Results In 2017 and 2018 a total of 858 MSM refugees attended 8 meet-ups on which 223 HIV/STI tests were done and 226 HBV-vaccinations were given. 43 STI’s and 3 HIV infections were found. A survey among visitors showed huge appreciation of the meet-ups. A large proportion of the visitors visited more than one meet up, thus showing appreciation for and trust in the organisers. One on one counselling of visitors by volunteers and health professionals during the meet ups showed lack of knowledge about HIV and STI and lack of behavioural skills among visitors and the need for development of behavioural interventions specifically for this group.ConclusionMSM refugees can be reached through gay community meet-ups for HIV/STI testing and HBV vaccination. Extra data have to be collected for the development of much needed behavioural interventions.DisclosureNo significant relationships.

Given the importance of flexible use of different COVID-19 vaccines within the same schedule to facilitate rapid deployment, we studied mixed priming schedules incorporating an adenoviral-vectored vaccine (ChAdOx1 nCoV-19 [ChAd], AstraZeneca), two mRNA vaccines (BNT162b2 [BNT], Pfizer–BioNTech, and mRNA-1273 [m1273], Moderna) and a nanoparticle vaccine containing SARS-CoV-2 spike glycoprotein and Matrix-M adjuvant (NVX-CoV2373 [NVX], Novavax). Com-COV2 is a single-blind, randomised, non-inferiority trial in which adults aged 50 years and older, previously immunised with a single dose of ChAd or BNT in the community, were randomly assigned (in random blocks of three and six) within these cohorts in a 1:1:1 ratio to receive a second dose intramuscularly (8–12 weeks after the first dose) with the homologous vaccine, m1273, or NVX. The primary endpoint was the geometric mean ratio (GMR) of serum SARS-CoV-2 anti-spike IgG concentrations measured by ELISA in heterologous versus homologous schedules at 28 days after the second dose, with a non-inferiority criterion of the GMR above 0·63 for the one-sided 98·75% CI. The primary analysis was on the per-protocol population, who were seronegative at baseline. Safety analyses were done for all participants who received a dose of study vaccine. The trial is registered with ISRCTN, number 27841311. Between April 19 and May 14, 2021, 1072 participants were enrolled at a median of 9·4 weeks after receipt of a single dose of ChAd (n=540, 47% female) or BNT (n=532, 40% female). In ChAd-primed participants, geometric mean concentration (GMC) 28 days after a boost of SARS-CoV-2 anti-spike IgG in recipients of ChAd/m1273 (20 114 ELISA laboratory units [ELU]/mL [95% CI 18 160 to 22 279]) and ChAd/NVX (5597 ELU/mL [4756 to 6586]) was non-inferior to that of ChAd/ChAd recipients (1971 ELU/mL [1718 to 2262]) with a GMR of 10·2 (one-sided 98·75% CI 8·4 to ∞) for ChAd/m1273 and 2·8 (2·2 to ∞) for ChAd/NVX, compared with ChAd/ChAd. In BNT-primed participants, non-inferiority was shown for BNT/m1273 (GMC 22 978 ELU/mL [95% CI 20 597 to 25 636]) but not for BNT/NVX (8874 ELU/mL [7391 to 10 654]), compared with BNT/BNT (16 929 ELU/mL [15 025 to 19 075]) with a GMR of 1·3 (one-sided 98·75% CI 1·1 to ∞) for BNT/m1273 and 0·5 (0·4 to ∞) for BNT/NVX, compared with BNT/BNT; however, NVX still induced an 18-fold rise in GMC 28 days after vaccination. There were 15 serious adverse events, none considered related to immunisation. Heterologous second dosing with m1273, but not NVX, increased transient systemic reactogenicity compared with homologous schedules. Multiple vaccines are appropriate to complete primary immunisation following priming with BNT or ChAd, facilitating rapid vaccine deployment globally and supporting recognition of such schedules for vaccine certification. UK Vaccine Task Force, Coalition for Epidemic Preparedness Innovations (CEPI), and National Institute for Health Research. NVX vaccine was supplied for use in the trial by Novavax.