Background: Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. Methods and findings: We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: “influenza” AND “cost” OR “economic.” The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. Conclusions: The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.

Background: Although healthcare personnel (HCP) are targeted for influenza vaccination they typically under-utilize vaccines especially in low- and middle-income countries. We explored knowledge, attitudes, and practices of HCP about seasonal influenza vaccines (SIV) to identify factors associated with and modifiable barriers to SIV uptake. Methods: We pooled individual-level data from cross-sectional surveys about SIV conducted among health workers in 12 low- and middle- income countries during 2018-2020 (i.e., Albania, Armenia, Cote d'Ivoire, Kenya, Kyrgyzstan, Lao PDR, Lebanon, Morocco, North Macedonia, Tunisia, Tajikistan, and Uganda). Eleven countries used a standard protocol and questionnaire based on the Health Belief Model to measure perceptions of susceptibility and severity of influenza disease, benefits of, barriers to, and motivators for vaccination. We analyzed attitudes and perceptions among HCP, including acceptance of vaccine for themselves and willingness to recommend vaccines to patients, grouped by the presence/absence of a national influenza vaccination program. Models were adjusted for geographic region. Results: Our analysis included 10,281 HCP from 12 countries representing four of the six World Health Organization regions: African, Eastern Mediterranean, European, and Western Pacific. The sample was distributed across low income (LIC) (3,183, 31 %), lower-middle (LMIC) (4,744, 46 %), and upper-middle income (UMIC) (2,354, 23 %) countries. Half (50 %) of the countries included in the analysis reported SIV use among HCP in both the year of and the year preceding data collection while the remainder had no influenza vaccination program for HCP. Seventy-four percent (6,341) of HCP reported that they would be willing to be vaccinated if the vaccine was provided free of charge. HCP in LICs were willing to pay prices for SIV representing a higher percentage of their country's annual health expenditure per capita (6.26 % [interquartile range, IQR: 3.13-12.52]) compared to HCP in LMICs and UMICs. HCP in countries with no SIV program were also willing to pay a higher percentage for SIV (5.01 % [IQR: 2.24-8.34]) compared to HCP in countries with SIV programs.. Most (85 %) HCP in our analysis would recommend vaccines to their patients, and those who would accept vaccines for themselves were 3 times more likely to recommend vaccines to their patients (OR 3.1 [95 % CI 1 center dot 8, 5 center dot 2]). Conclusion: Increasing uptake of SIV among HCP can amplify positive impacts of vaccination by increasing the likelihood that HCP recommend vaccines to their patients. Successful strategies to achieve increased uptake of vaccines include clear guidance from health authorities, interventions based on behavior change models, and access to vaccine free-of-charge.

Vaccination is the most effective way to prevent influenza infection and adverse outcomes; despite global recommendations to vaccinate pregnant persons, access to influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons to inform actions to improve vaccine uptake. We pooled data from cross-sectional surveys assessing pregnant persons’ attitudes toward influenza vaccines in 8 low- and middle-income countries. Countries used standard methods to measure attitudes and intents toward influenza vaccination. We stratified by presence/absence of a national influenza vaccination program, income group, geographic region, and individual-level factors. Our analysis included 8556 pregnant persons from 8 countries. Most pregnant persons (6323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without programs (2383, 89%) than in those with programs (3940, 67%, P < .001). Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs present an opportunity to avert illness both in pregnant persons themselves and in their newborn babies.

Background/Objectives: The COVID-19 pandemic presented an urgent global need to quickly vaccinate health workers (HWs). We used this unique circumstance to assess whether mature influenza vaccination programs for HWs facilitated rapid deployment of COVID-19 vaccines in low- and middle-income countries (LMICs). Methods: We used publicly available population-level COVID-19 vaccination coverage data from the World Health Organization (WHO) COVID-19 PowerBI Dashboard for 60 LMICs to investigate general population coverage with the COVID-19 vaccine over the first year of vaccine rollout. We also evaluated country-level policy and program data reported to the WHO–United Nations Children’s Fund (UNICEF) electronic Joint Reporting Form (eJRF) in 2022 or earlier to determine if the presence of a mature (≥2 years of influenza vaccine introduction in HWs prior to 2019) HW influenza vaccination program was associated with more rapid COVID-19 vaccine deployment and/or pandemic preparedness. We used a mixed-effects beta regression model to investigate whether having a mature HW influenza vaccination program was associated with COVID-19 vaccination coverage levels and/or deployment timeliness. Finally, to provide a better understanding of the possible relationship between the presence of a mature HW influenza vaccination program and the COVID-19 vaccine rollout, we analyzed interview data collected during COVID-19 vaccine post-introduction evaluations (cPIEs). Results: Twenty-four of our study countries (40%) had mature HW influenza vaccination programs prior to the COVID-19 pandemic, and 16 (27%) participated in cPIEs. The overall adjusted mean general-population COVID-19 vaccination coverage at 12 months post-deployment in countries with mature HW influenza vaccination programs was 46% (95% CI: (35%, 56%)), compared with 25% (95% CI: (19%, 32%)) in countries without such programs. Vaccination coverage was 2.5 times higher in countries with mature programs (adjusted odds ratio 2.5, 95% CI: (1.5, 4.5); p = 0.001). Conclusions: Our analysis suggests that mature influenza vaccination programs for HWs were associated with timelier and more complete COVID-19 vaccination rollout.

BioFire® Blood Culture Identification 2 (BCID2) panel is a rapid multiplex polymerase chain reaction (rm-PCR) testing for 43 organisms associated with bloodstream infections and 10 antimicrobial resistance genes. Previous literature suggested combination of rm-PCR and antibiotic stewardship program (ASP) would improve time to organism identification, optimal therapy, and de-escalation of antibiotics. This study was a retrospective study at Touro Infirmary in New Orleans, Louisiana. All adult patients with positive blood cultures before and after BCID2 implementation in January 2022 (April to September 2021 and April to September 2022 respectively) were included. The outcomes of interest included time to organism identification, time to change of antibiotics (either appropriate escalation or de-escalation), hospital length of stay, 30-day re-admission, and 30-day mortality. A total of 117 patients met the study criteria (refer to Figure 1 and Table 1 for the flowchart of participants and characteristics of participants respectively). Patients with blood cultures that grew one of the organisms of interest were analyzed: methicillin sensitive Staphylococcus aureus (MSSA), coagulase negative Staphylococcus species, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), AmpC beta-lactamase-producing Enterobacterales, and Pseudomonas aeruginosa. There was a significant difference in the time to organism identification between pre- and post-BCID groups (45 hours vs. 25.1 hours, p < 0.0001) and there was no discordance between the BCID and blood culture results. In addition, there was a significant decrease in time to antibiotics change between pre- and post-BCID groups (p < 0.01). Notably for patients with MSSA bacteremia, post-BCID group had significantly shorter duration to de-escalate antibiotics than pre-BCID group (43 hours vs. 66.7 hours, p < 0.038). However, there is no statistical difference between pre- and post-BCID groups regarding hospital length of stay, 30-day readmission, and 30-day mortality. Organisms of interest include: methicillin sensitive Staphylococcus aureus, coagulase negative Staphylococcus species, extended-spectrum beta-lactamase producing Enterobacterales, AmpC beta-lactamase producing Enterobacterales, and Pseudomonas aeruginosa. Abbreviations: BCID, blood culture identification panel, BCx, blood cultures. BCID2 significantly reduced the time to organism identification and improved time to effective therapy for MSSA bacteremia. However, significance was limited in other measures due to small sample size. All Authors: No reported disclosures