Effects of fractional dose yellow fever vaccination: a systematic review and meta-analysis

Persistent yellow fever endemicity and continued outbreaks have continued to increase vaccine demand, while straining global vaccine supply. Fractional dose vaccination is being considered as a dose-sparing strategy to mitigate current global vaccine shortages. This study therefore assessed the effects of fractional dose yellow fever vaccination, in comparison to those of the standard dose. We registered the review in the prospective register of systematic reviews; conducted a comprehensive search of published and grey literature; used standard Cochrane methods to collect and synthesise the evidence and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. We stratified analyses by the strength of the fractional dose. We retrieved 2495 records from the literature search, nine of them potentially eligible. We included six eligible studies (three randomised and three quasi-randomised trials), with 2371 participants. There was no statistically significant difference in immunogenicity between participants who received fractional doses containing one-third (two trials, 547 participants: RR 1.02, 95% CI 1.00 to 1.04; I2 = 0%), 1/5th (one trial, 155 participants: RR 1.00, 95% CI 0.98 to 1.03), 1/10th (four trials, 890 participants: RR 0.99, 95% CI 0.96 to 1.01, I 2 = 0%), and 1/50th (three trials, 661 participants: RR 0.97, 95% CI 0.92 to 1.02, I2 = 72%) of the standard dose and those who received the full standard dose. However, immunogenicity was significantly lower among participants who received fractional doses containing 1/100th (four trials, 868 participants: RR 0.92, 95% CI 0.87 to 0.97, I2 = 60%) and < 1/100th (five trials, 1053 participants; RR 0.53, 95% CI 0.44 to 0.64, I2= 98%) of the standard dose compared to participants who received the full standard dose. Minor adverse events following vaccination did not differ across doses, but no serious adverse events were reported in any study arm. The combined data provide moderate certainty evidence that there is little or no difference in immunogenicity between ≥1/50th fractional doses and the standard dose of yellow fever vaccines. However, these studies were of short duration ranging from four weeks to a year. These findings support the use of fractional dose vaccination as a dose-sparing strategy for yellow fever vaccination

Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries: a systematic review protocol.

INTRODUCTION: Breast and cervical cancers pose a major public health burden globally, with disproportionately high incidence, morbidity and mortality in low- and middle-income countries (LMICs). The majority of women diagnosed with cancer in LMICs present with late-stage disease, the treatment of which is often costlier and less effective. While interventions to improve the timely diagnosis of these cancers are increasingly being implemented in LMICs, there is uncertainty about their role and effectiveness. The aim of this review is to systematically synthesise available evidence on the nature and effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in LMICs. METHODS AND ANALYSIS: A comprehensive search of published and relevant grey literature will be conducted. The following electronic databases will be searched: MEDLINE (via PubMed), Cochrane Library, Scopus, CINAHL, Web of Science and the International Clinical Trials Registry Platform (ICTRP). Evidence will be synthesised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Two reviewers will independently screen the search outputs, select studies using predefined inclusion criteria and assess each included study for risk of bias. If sufficient data are available and studies are comparable in terms of interventions and outcomes, a meta-analysis will be conducted. Where studies are not comparable and a meta-analysis is not appropriate, a narrative synthesis of findings will be reported. ETHICS AND DISSEMINATION: As this will be a systematic review of publicly available data, with no primary data collection, it will not require ethical approval. Findings will be disseminated widely through a peer-reviewed publication and forums such as conferences, workshops and community engagement sessions. This review will provide a user-friendly evidence summary for informing further efforts at developing and implementing interventions for addressing delays in breast and cervical cancer diagnosis in LMICs. PROSPERO REGISTRATION NUMBER: CRD42020177232.This research was jointly supported by the Cancer Association of South Africa (CANSA), the University of Cape Town and the SA Medical Research Council with funds received from the SA National Department of Health, GlaxoSmithKline Africa Non-Communicable Disease Open Lab (via a supporting grant, Project Number: 023), the UK Medical Research Council (via the Newton Fund). FMW is Director of the multi-institutional CanTest Collaborative, which is funded by Cancer Research UK (C8640/A23385). Authors retained control of the final content of the publication

Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context