Introduction Respiratory syncytial virus (RSV) can cause serious disease in older adults (OAs), particularly those with underlying medical conditions. It can lead to acute respiratory illness and lower respiratory tract infections in adults ≥60 years and at increased risk groups. RSV morbidity, mortality, and health care burden are increasingly evident. This review aims to equip clinicians with practical guidance to support consistent implementation of RSV vaccination recommendations.Areas covered We examined global implementation of RSV vaccination recommendations by extracting guidelines from national immunization technical advisory groups, ministries of health, global and regional recommendations, and local medical societies. We categorized guidance by age, risk factors and comorbidities. We compared differences in indications, age thresholds, and frameworks. Across >24 countries and >50 medical societies, a common recommendation supports RSV vaccination in ≥60 years and immunocompromised individuals. The set cutoff date was November 2025. However, significant heterogeneity exists across countries in age threshold indications and risk-based eligibility, as well as in implementation depending on health system infrastructure and resources.Expert opinion Global guidance converges on prioritizing vaccination for OAs and individuals at high risk of severe disease. By synthesizing worldwide RSV vaccination recommendations, this review offers clinicians an accessible guide to support consistent RSV vaccination.
Background Two-dose varicella vaccine (VarV) schedule has not been included in the China’s National Immunization Program. Shanghai was the first provincial-level region to implement a publicly funded two-dose VarV policy in 2018. The study assessed the policy’s impact on varicella incidence in Shanghai.Methods Varicella surveillance data from two comparable districts in Shanghai were analyzed using an interrupted time series design. Counterfactual and age-stratified analyses were further conducted.Results A total of 26,241 varicella cases were reported during 2012–2024. The overall age-standardized varicella incidence rate in Shanghai decreased from 104.8 to 74.0 cases per 100,000 person-years (RR = 0.75, p < 0.001). In 2023–2024, varicella incidence exhibited a rebound trend (p = 0.024). The counterfactual model estimated a 52.1% reduction. The age-standardized monthly incidence rate showed a non-significant immediate decrease of 11.09 per 100,000 individuals (p = 0.053), followed by an additional monthly decrease of 0.75 cases per 100,000 individuals (p < 0.001). Age-stratified analysis indicated an immediate reduction in varicella incidence among children aged 0–4 and 5–9 years, and a significant long-term decline across all age groups (each p < 0.001).Conclusion Following policy implementation in 2018, varicella incidence in Shanghai declined substantially and showed a sustained downward trend. The findings support optimization of VarV strategies in China.
Background Adult vaccination remains suboptimal despite frequent primary care contact. We evaluated changes in vaccination uptake associated with implementation of the Intelligent Vaccine Educational Prescription System (IVEPS) and examined implementation factors.Methods We conducted an explanatory sequential mixed-methods study in Shenzhen, China. IVEPS was introduced in 40 community health centers (CHCs) during June–November 2025. After common-support restriction, 298 CHCs (31 treated, 267 never treated) were analyzed using ATT-IPW Sun–Abraham staggered difference-in-differences models. Interviews with 21 stakeholders from 10 CHCs were analyzed using the Consolidated Framework for Implementation Research.Results IVEPS was associated with increased PPSV23 vaccination (ATT = 0.00249, 95% CI 0.00104–0.00394; p < 0.001), equivalent to 249 additional vaccinations per 100,000 eligible residents. Associations were not significant for influenza (ATT = 0.00105; p = 0.185) or herpes zoster (ATT = 0.00046; p = 0.097). Residual pre-intervention trends for PPSV23 and herpes zoster warranted cautious interpretation. Interviews suggested that digital prompts supported recommendations, while limited consultation time, incomplete workflow linkage, and affordability concerns constrained conversion.Conclusions IVEPS facilitated integration of adult vaccination recommendations into routine primary care, but increased recommendation did not consistently translate into higher vaccination uptake. Combining digital decision support with downstream implementation support may be important for improving vaccination conversion.
Background Older adults and those with comorbidities have increased risk of severe disease and mortality from COVID-19. This analysis estimated the cost-effectiveness of COVID-19 vaccination versus no vaccination in the US and potential impact of increased vaccine coverage.Research design and methods A Markov-based model was updated using the latest epidemiology and vaccine reactogenicity data. Cases, costs, and outcomes for individuals aged 18–64 with ≥1 comorbidity and ≥65 years were estimated for NVX-CoV2705 (Nuvaxovid) versus no vaccination from a third-party payer perspective. Scenario analyses considered the societal perspective and analogous comparisons for BNT162b2 (Comirnaty), mRNA-1273 (Spikevax), and mRNA-1283 (mNEXSPIKE). Results were scaled for public health impact analyses.Results Base-case results associated NVX-CoV2705 with fewer cases (0.0447), hospitalizations (0.0037), and deaths (0.0004) per person on average. NVX-CoV2705 yielded an ICER of $9,840/QALY gained, reflecting fewer QALYs lost (0.0039) alongside increased direct costs ($38.09) per person. Differences for mRNA vaccines were driven by price and reactogenicity. Increasing vaccine coverage by 5–15 percentage points resulted in 114–341 hospitalizations and 11–33 deaths averted per 1,000,000 individuals.Conclusions NVX-CoV2705 was predicted to be cost-effective over no vaccination. This analysis included a more granular approach to modeling reactogenicity events, an important consideration in vaccine cost-effectiveness analyses.
Introduction HIV-1 subtype C (HIV-1C) accounts for most infections globally, with sub-Saharan Africa bearing a disproportionate burden. Despite decades of research and multiple clinical trials, no effective prophylactic vaccine exists for this or any other HIV subtype – and candidate vaccines for subtype C are less well researched than for subtypes occurring most frequently in the developed world. The anticipated reduction in US funding for HIV treatment and prevention programs from 2026 in the regions where subtype C predominates makes the urgency of developing an effective vaccine or vaccines more acute than ever.Areas covered This review explores the experimental vaccine investigations and clinical trials that have dealt specifically with vaccines for HIV-1 subtype C viruses, including coverage of the vectors and protein antigens used in pre- and clinical trials, vaccine regimes tested in animals and in humans, and modifications made to antigens to stabilize them and enhance immunogenicity, in the light of findings for other subtypes.Expert opinion The appropriateness and feasibility of various vaccine approaches are discussed, and suggestions are made with regard to strategies for coping with the prevention of HIV infection in developing countries with high subtype C prevalence.
