Seasonal influenza causes millions of severe illnesses and deaths globally, especially in vulnerable populations. Influenza vaccines reduce morbidity and mortality, if given to vulnerable populations prior to the peak influenza season. WHO regularly analyzes data on seasonal influenza vaccination provided by Member States and Territories (MST) to monitor the global status of vaccination policies, programmes, and coverage as national seasonal influenza vaccination programmes have been repeatedly documented to provide a platform for pandemic preparedness and response. This manuscript examines global influenza vaccination coverage between 2018 and 2023.We analyzed the recommendations and vaccination coverage data as reported by MST to the WHO-UNICEF Joint Reporting Form on Immunization (JRF) together with income classifications from the World Bank to report on recommendations and vaccination coverage per WHO region and income groups over time. We undertook two linear regressions to understand associations between higher vaccination coverage rates in older adults and independent variables.Globally, MST reporting to JRF increased over time (from 84% to 93%). While reporting of influenza vaccination recommendations by target group has remained steady (from 65% to 64%), reporting of coverage data increased slightly (from 51% to 53%), with variations between WHO regions. Among MST who completed the JRF, recommendations for vaccinating Health and Care Workers (HCWs) (63%) and older adults (62%) remain the most frequent, with median coverage of HCWs higher than that for older adults in four WHO regions. Median coverage for pregnant women increased substantially in WPR. Gross domestic product was the only statistically significant predictor for high coverage in older adults.Since 2018, a growing number of MST have issued national recommendations for seasonal vaccination and improved coverage of seasonal influenza vaccination, although significant differences remain between WHO regions. Continuing this positive trajectory will keep strengthening national preparedness for and resilience to future respiratory pathogen pandemics.
PURPOSE:Early integration of palliative care (PC) for children with cancer is vital to improved patient outcomes. Despite this, access to PC services for children in Asia Pacific (AP) is sparce. We aimed to explore potential barriers to PC provision in childhood cancer care across AP. METHODS:The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels. RESULTS:Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly. CONCLUSION:Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.
In South-East Asia, government implementation of policies recommended for addressing unhealthy diets has generally been slow and fragmented, largely due to food industry opposition and a lack of effective cross-sectoral policy action. To help government policy-makers and other interest-holders address these issues, this study aimed to identify key arguments that undermine implementation of policies for addressing unhealthy diets in the region, and to propose a set of counter-strategies. We conducted semi-structured interviews with 15 interest-holders based in India, Indonesia, Sri Lanka, and Thailand, and performed a scoping review of diverse literature. Data analysis was guided by the ‘Policy Dystopia Model’, initially used to study the corporate political activity of the tobacco industry. Identified arguments were categorized into six themes: (i) questioning the policy design and development process; (ii) misrepresenting or distorting the supporting evidence, and/or presenting counter evidence; (iii) exaggerating and/or fabricating unintended consequences for health and equity; (iv) raising concerns about effects on the economy; (v) querying the policy’s compatibility with trade and investment agreements and national laws; and (vi) raising concerns about restrictions on personal ‘freedom’. To help counter these arguments, along with key material and structural factors that may increase their salience, we proposed the following set of counter-strategies: (i) develop a communication strategy to counter opposing arguments; (ii) implement governance measures to mitigate corporate influence on public health policy, research, and practice; (iii) implement governance measures to enable effective health-promoting intersectoral and interdepartmental coordination; and (iv) strengthen research, advocacy, and capacity-building on the determinants of health. Successful implementation of these counter-strategies will require extensive organization and collaboration among diverse interest-holders in South-East Asia and beyond.
BACKGROUND:Rapid laboratory confirmation of suspected cases is essential for measles control, but current methods require a complex laboratory infrastructure. We developed loop-mediated isothermal amplification coupled with CRISPR-Cas-mediated diagnostic (LAmCaD), a novel two-pot diagnostic platform that integrates rapid nucleic acid extraction, RT-LAMP amplification, and in-house purified AapCas12b as a rapid test to detect measles RNA that could be used in settings lacking laboratory infrastructure. METHODS:LAmCaD is based on dual detection modalities, fluorescence and lateral flow biosensor readouts. The LAmCaD assay was evaluated for analytical sensitivity and specificity using RNA from Vero/hSLAM-grown measles virus, and diagnostic evaluation was performed using patient samples, compared with standard RT-PCR. The cross-genotype detection capability was assessed across epidemiologically relevant measles genotypes D8, D4, and B3. RESULTS:The in-house purified protein AapCas12b from Alicyclobacillus acidiphilus exhibited strong cis and trans cleavage activities, eliminating dependence on commercial enzyme preparations. The platform enables the use of clinical samples from patients through rapid nucleic acid extraction that eliminates the need for RNA purification steps, allowing direct use of extracted material in RT-LAMP reactions. RT-LAMP alone achieved analytical sensitivity of ∼103 copies, while the complete protocol detected measles virus at ∼105 copies by fluorescence and ∼104 copies by lateral flow detection. Diagnostic evaluation demonstrated sensitivity of 64.00 %, specificity of 92.59 %, and negative predictive value of 99.95 % with an overall accuracy of 92.56 %. ROC curve analysis revealed an AUC of 0.717, indicating fair discriminatory performance. The assay demonstrated moderate agreement with RT-PCR (κ = 0.6) and successfully identified genotypes D8, D4, and B3. The entire testing process took 90 min to complete. CONCLUSIONS:This proof-of-concept LAmCaD platform establishes the foundation for a cost-effective, field-deployable diagnostic test without relying on commercial enzymes or complex sample processing. The platform could facilitate the rapid confirmation of measles cases in resource-limited and/or remote settings, thereby contributing to global measles elimination goals. Conducted within the WHO South-East Asia Region, this study is particularly relevant to the region's 2023 elimination target, addressing current surveillance gaps and specimen transport challenges that hinder efforts to eliminate the disease.
