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Jul 2025 DOI 10.14302/issn.2577-137X.ji-25-5581
Muthee Waweru EdmondCorresponding author
Coronavirus Disease 2019 (COVID-19) placed significant pressure on global health systems, necessitating rapid and widespread immunization, especially among healthcare workers (HCWs). Despite being prioritized in immunization programs, variations in vaccine uptake among HCWs have been reported across different settings. This study aimed to investigate the predictors of COVID-19 vaccine uptake among HCWs in Kiambu County, Kenya. An analytical cross-sectional study design was employed, involving 112 HCWs sampled using stratified random sampling from Level 2 to Level 5 healthcare facilities. Data were collected through a pre-tested and validated 18-item questionnaire and analyzed using SPSS version 29.0. Statistical methods included descriptive analysis, chi-square tests, logistic regression, and ANOVA. The overall COVID-19 vaccine uptake was 88.9%. Significant predictors of uptake included age (p = 0.048), cadre (p = 0.015), and facility level (p = 0.031). Knowledge of COVID-19 vaccines emerged as the strongest predictor, with HCWs demonstrating good-to-excellent knowledge being 14.97 times more likely to be vaccinated (p < 0.001). Confidence in vaccine safety and effectiveness was also significantly associated with uptake (p < 0.001). Uptake was highest in Level 5 hospitals and lowest in dispensaries. The study reveals high vaccine uptake among HCWs in Kiambu County, but disparities persist due to individual and systemic factors. Strengthening vaccine education, institutional support, and deploying mobile vaccine education units in lower-level facilities could help close these gaps, offering practical strategies for improving HCW vaccine coverage in Kenya and other low- and middle-income countries.
Sep 2024 DOI 10.14302/issn.2577-137X.ji-24-5207
Olutola AyodotunCorresponding author
COVID-19 vaccine hesitancy has emerged as a major challenge to global efforts to control the pandemic, particularly in Nigeria, where hesitancy to other effective vaccines such as polio and measles has been widely reported. Several individual, societal, and structural factors contribute to this behaviour and prevent the effectiveness of COVID-19 prevention efforts. Objectives This study sought to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria. Methods A population-based cross-sectional online survey was conducted among residents using a semi-structured questionnaire adapted from the WHO SAGE vaccine hesitancy scale and distributed via social media networks over 8-weeks. Results A total of 1,429 responses met the inclusion criteria and were analysed. Among the respondents, 60.7% were males, 47.5% were between the ages of 26 and 45, and 80.1% had postsecondary education. A total of 421 respondents (29.5%) were hesitant and unwilling to receive the vaccine. The reasons for hesitancy were concerns about side effects (37.1%), doubt about the existence of COVID-19 (11.0%), and the perception of time required to receive the vaccine (9.6%). Post-secondary education (AOR: 0.49, 0.36-0.66) and people of the Islamic faith (AOR: 0.68, 0.52-0.90) were found to be associated with lower levels of hesitancy. Conclusion The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment, lower income and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. In order to protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.
Feb 2024 DOI 10.14302/issn.2379-7835.ijn-24-4938
Suh MinaCorresponding author
Public health interest in vaccinations and immune protection has increased with the COVID-19 pandemic. Dairy products are an important source of protein and other nutrients, and there are unresolved research questions regarding the potential health impact of dairy products on the enhancement of immune response. A systematic literature review was conducted to synthesize the published literature reporting the effects of dairy interventions on: 1) the vaccine-specific immune response and 2) immunoglobulins in the absence of vaccination. To assess study validity and quality, we used the Academy of Nutrition and Dietetics Quality Criteria Checklist. Sixty-one studies (59 clinical trials, 1 cohort, 1 cross-sectional survey) were included, spanning 1983-2017. Ten trials evaluated the effect of dairy intervention on vaccine-specific IgG, IgA, IgM, vaccine-specific antibody titers, seroprotection rates, or seroconversion rates. Of these, 7 reported significant increases with dairy interventions for post-vaccine tetanus antibodies, mean change in tetanus antibody level, total antibody titers to flagellin from Salmonella Adelaide, mean antibody titers to influenza B, influenza-specific IgA and IgG levels, and seroconversion or seroprotection rates for influenza A and B. Fifty-six studies evaluated dairy’s effects on immunoglobulins without vaccinations. The results were heterogenous, with some studies reporting significant enhancement of immunoglobulins (IgA, IgE, or IgG), while others observed no differences between groups. Clinical relevance of the immunoglobulin changes was not investigated in these studies. Dairy products and their components could enhance the efficacy of vaccines. This review highlights the evidence gaps and provides a potential roadmap for additional research.
Jul 2023 DOI 10.14302/issn.2997-1977.jd-23-4588
Mboko Byamungu FreddyCorresponding author
Introduction Acute diarrhea remains one of the major health problems in developing countries. According to the WHO, rotavirus contributes to approximately 40% hospitalizations and is the leading cause of severe diarrhea in children 0-5 years old. The objective was to determine the prevalence of rotavirus and the sociodemographic and clinical profile among children with diarrhea in 4 hospitals in the DRC. Methods This study is documentary, retrospective and analytical taking two periods, before and after introduction of the vaccine, i.e. January 2017 to December 2018 and January 2020 to December 2021 in 4 hospitals, i.e. 2 in Kinshasa and 2 in Lubumbashi. Results Total 1872 children, 924 (49.4%) of whom were enrolled before the introduction of the vaccine and 948 (50.6%) after. Only 1737 had performed serology, of which 875 (50.4%) were rotavirus positive and 862 (49.6%) were negative. Positive results, a reduction of 30.6% is noted since the introduction of the vaccine. The predominant age range was 6 to 11 months. The male gender was predominant at 56.7%. Diarrhea was found in 88.5%, vomiting in 73.7% and fever in 73.9%. Before vaccination, the risk was more: 11 times to have diarrhea, 9-10 times the frequency between 3-10 times a day, 9 times vomiting, 2 times fever and 2 times to have a positive result. Conclusion From this study, we note a reduction frequency due to diarrhea unlike previous years, probably attributable to the vaccine.
Mar 2022 DOI 10.14302/issn.2641-4538.jphi-22-4113
L ProvvidentiCorresponding author
Postgraduate School of Public Health, Department of MESVA, University of L’Aquila (Italy).
Objectives Our study aims to determine the trend of the antibody titer and assess the efficacy of the vaccine. Methods It was conducted on 983 healthcare professionals between 27 February 2020 and 22 October 2021 at the Local Health Authority (ASL) of Rieti. Workers voluntarily underwent serological testing before vaccination (T1), at least 15 days after vaccination (T2), and at least 150 days after vaccination (T3). We picked individuals who had received two doses of the vaccine. As for positivity, we assessed incidence – and therefore symptomatology – in three time intervals. We used a contingency tables for the analysis and tested the relation to the chi-square test and ANOVA test. Regarding differentials in terms of antibody capacity, we considered different time intervals: the methodological approach was the same. Results The average value of the dimeric serological testing at T1 was equal to 28.80 AU/mL, which increased to 220.55 AU/mL at T2, and then decreased to 143.62 AU/mL at T3 (P = 0.000). At T2, the number of people with a protective titer was equal to 95.96% of the total; at T3, it was equal to 96.39% (P = 0.019). Before the vaccination campaign, 75 workers tested positive (25 paucisymptoms, 4 severe symptoms). After vaccination, 14 workers tested positive: almost all were asymptomatic. Conclusion Vaccination determines a statistically significant variation of the average value of antibody titer, a statistically significant reduction of positive swab tests and a better prognosis.
Mar 2022 DOI 10.14302/issn.2692-1537.ijcv-22-4117
Wu JianqingCorresponding author
Healthier World (Independent researcher for cause), P. O. Box 689, Beltsville, MD 20704. USA
Several mRNA vaccines are used on the population in the U.S. I started predicting the dangers of mRNA vaccines before March 2021 and update my findings periodically. My prior model study enabled me to identify many flaws in clinical trials, side-effect evaluation methods and mechanism studies, and I also considered consistent failure in predicting drug side effects in the past and systematic failure of FDA in keeping out dangerous drugs from market. I found that the risks of vaccination cannot be determined by experiments alone and must be determined by using a combination of methods. By studying mRNA expression dynamics and kinetics, I predict that vaccination with mRNA vaccines may increase cancer risks, multiple organ failure risks, earlier death risks, genome alteration speeds by one or more mechanisms, alter the normal selection process for viral evolution resulting in more virulent viruses, and aggravate chronic diseases or cause healed diseases to relapse. Two root problems are practical inability to control expression sites and severe adverse reactions from repeated vaccination. Based on mRNA bio-distribution, the mRNA mainly strikes the liver and other vital organs, and poses grave dangers to persons whose vascular functional reserves are relatively small, or whose vascular systems are temporarily burdened by other causes such as viral infections or life activities. If an mRNA vaccine is administered on a pregnant woman by second or booster shots, spike protein synthesis in fetus brain disrupts the highly regulated protein synthesis processes, resulting in potential brain damages. In less than a year, most of my early predicted damages are being materialized or are on the track to hit the population. In this update, I present a benefits-and-risks map to show how the number of deaths caused by mRNA vaccines is grossly underestimated and why claimed benefits like 95% effectiveness rate and 90% death rate reduction are meaningless and misleading.
Feb 2022 DOI 10.14302/issn.2692-1537.ijcv-21-4053
Wu JianqingCorresponding author
Healthier World (Independent researcher for cause), P. O. Box 689, Beltsville, MD 20704. USA
Drug industry, controlling medical publishers and large media promote flawed medicine for their revenues by systematically laundering medical knowledge in decades. They maintain and promote flawed research models and suppress disruptive discoveries, thereby precluding reform of medicine. In this study, I will deeply explore how the wrong life model, population-based research model, misused clinical trials, flawed statistical models, the symptom based research methods, binary disease classification, failure to address the massive vital organ capacities, failure to correct biases caused by expected delay in realizing side effects, and failure to address the interference effects of non-controllable factors affect the conclusions of “effectiveness and safety” for mRNA vaccines. I will directly analyze three studies that have been relied upon by FDA in approving mNRA use authorizations: one BNT162b2 effectiveness study published in NEJM, one booster shot study published in NEJM and a Seven Integrated Health Care Organizations study published by CDC. I will expose fatal flaws in the frequency risk concept, effectiveness rate, and hazard reduction ratios, and show why 3% death rate, 95% effectiveness rate and 90% mortality reduction are all meaningless and misleading, and should never have been used as treatment guidance. I will also examine common biases that can be easily practiced by sponsors’ researchers to alter conclusions in favor of approval. By relying on laundered medical “knowledge”, FDA has consistently failed to predict latent drug side effects for any drugs and vaccines in its history. FDA approved disastrous DES in 1941, Swine Flu vaccine in 1976, and mRNA vaccines in 2020. The vaccines are used to deliver short-term benefits on a small percent of persons at the costs of damaging health, causing deaths that could be avoided, and shortening lifespans for all people in the population. I thus urge FDA to reevaluate all mRNA vaccines and revoke their use authorizations.
Dec 2021 DOI 10.14302/issn.2691-8862.jvat-21-3999
Pino Marrero KatiaCorresponding author
Holguin's university of medical sciences, Cuba.
Vaccines symbolize the main pandemic control tool in the world, which is why they are the object of study in many investigations. In this work, the Abdala vaccine was characterized in terms of adverse reactions by conducting a survey and statistical processing of the data taken through distribution graphs of the same, developed in the Minitab software 16. Of the people involved, 47.67% presented Symptoms that were mild to moderate with the presence of pain in the area of the injection, drowsiness and decay, mainly. Based on the distribution of the data in histograms, the duration of these symptoms was approximately 1 day. Likewise, it was observed that the symptoms occur mainly in females, for 33.72% of the cases in the first dose and 23.26% after the second dose was applied.
Oct 2020 DOI 10.14302/issn.2692-1537.ijcv-20-3587
Isea RaúlCorresponding author
Fundación Instituto de Estudios Avanzados, Hoyo de la Puerta, Baruta. Venezuela.
The work analyzes the dynamics of transmission of infections by the new coronavirus in twelve European countries, including France, Germany, Italy, Spain, UK, Austria, Croatia, Denmark, Greece, Romania, Czech Republic, and Portugal, whose data from contagion were obtained by Johns Hopkins University until September 24, 2020. The study confirmed that this new coronavirus (SARS-CoV-2) surprised all the countries of the world that had to improve their public health policies to confront this disease according to the results obtained from the calculation of the mantissa. Although the countries were able to improve their policies after the first wave of contagion, Spain and France have the highest proportion of cases that stand out significantly with the rest of the countries in the second wave of infections that the world faces again. Likewise, the beginning of the epidemic outbreak was determined, which could help to track the spread of the disease through European countries (not the first case registered in each country), from which it can be inferred that the outbreak begins in Italy and later the rebound begins in Germany, France, and Spain. Within days, it significantly affects Greece and Austria, reaching Denmark, the Czech Republic, Romania, and Croatia. Finally, the number of people who must be vaccinated to counteract the advance of Covid-19 in these European countries was determined based on the calculation of the Effective Reproductive Number, Rt. The number of people that would have to be vaccinated in all these countries to counteract this disease sums up to 206.830.361.
Sep 2020 DOI 10.14302/issn.2577-137X.ji-19-3002
AGARWAL ANILCorresponding author
Professor, Department of Community Medicine, GR Medical College, Gwalior
A perspective on vaccine hesitancy discusses drivers, misinformation, and trust. It proposes communication and policy strategies to improve uptake while respecting community concerns.
Aug 2020 DOI 10.14302/issn.2691-8862.jvat-20-3513
Patel JainishCorresponding author
Indira Gandhi National Open University, Regional Center, Surat, Gujarat, India
This paper explores the trends, issues and challenges confronting the successful vaccine development for the novel Coronavirus disease (COVID-19). Right from the commencement of the COVID-19 pandemic, no drugs or vaccine has been developed nor approved for treating those down with COVID-19. This year, the scientific community and the vaccine industry have been asked to respond urgently to SARS-COVID-2 pandemic. Presently numerous vaccine development platforms are under process and DNA- and RNA-based platforms showing great potential followed by recombinant-subunit vaccines. Through explorative research, it was established that companies involved in COVID-19 vaccine development are facing big challenges in the scientific, economic and logistical perspectives. Amongst these challenges are distrust, misinformation, and about understanding the immune system interaction with the vaccine being developed, as well as with the pathogen itself. Adjudged as insurmountable may be too early a conclusion. The race is on and progresses are being made. Proper understanding of trends, metrics and dynamics revolving around COVID-19 vaccine development is crucial in expanding possibilities for positive results from ongoing vaccine research. In this review, we spotlight on the most recent developments in COVID-19 vaccine, including top 10 early candidates that may hit the market in next few months.
Dec 2018 DOI 10.14302/issn.2577-137X.ji-25-5837
R Patil RajanCorresponding author
Jan 2018 DOI 10.14302/issn.2577-137X.ji-17-1800
R Patil RajanCorresponding author
School of Public Health, SRM University.
This article has been retracted on December 28, 2018. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2577-137X.ji-25-5837) This paper attempts to summarizes possible reasons for BCG trial failure in India. It also lists out some of the important controversies and questions raised with regards to BCG trial in the context of Non Specific sensitivity. It emphasizes on the fact, that Tuberculin test does not accurately reflect individual’s responded immunologically to mycobacterium, it only indicates nature of immune response that has been elicited in an infected individual. The dynamics of tuberculin reaction needs to be understood through immunological considerations. Categorization of Tuberculin test results factoring in immunological considerations,will have great implication on the interpretation of tuberculin test and therefore on the estimation of annual risk of infection of tuberculosis.
Dec 2025 DOI 10.14302/issn.2643-2811.jmbr-25-5731
Mukeredzi InnocentCorresponding author
Background Typhoid fever remains a significant public health issue in Harare City, Zimbabwe, exacerbated by recurrent outbreaks between 2018 and 2020. Key challenges, including inadequate water supply and sanitation infrastructure, high population density, and limited healthcare access, have intensified the disease burden. Understanding the key transmission drivers and assessing the impact of various interventions are essential for informing policy and health strategies. Objectives This study aimed to: 1: To predict future trends in typhoid fever cases Harare City typhoid hot areas. 2: To develop a mathematical model to simulate the spread of typhoid fever incidence under different intervention scenarios and recommend evidence-based strategies for reducing the disease burden in Harare City. Methods A dynamic compartmental SIR-based model, adapted from the Pitzer Vaccine Effectiveness (VE) framework, was employed to simulate disease transmission. This model accounted for both short-cycle (human-to-human) and long-cycle (environmental) transmission pathways. Data from Harare City (2018–2020) were used for model calibration and forecasting, and sensitivity analysis was performed to assess the impact of different intervention levels. Findings The model identified inadequate sanitation, contaminated water sources, and low health- seeking behaviors as primary drivers of typhoid transmission. In the absence of interventions, the model projected a sustained high rate of transmission. However, treatment and WASH interventions could reduce the disease burden by 50–60%, while combined strategies incorporating vaccination and education led to an 80% reduction in cases. Sensitivity analysis indicated that treatment and WASH interventions were particularly impactful at moderate coverage levels. Conclusion Mathematical modeling effectively demonstrated the multifactorial drivers of typhoid fever transmission in Harare. Integrated interventions that combine WASH, vaccination, treatment, and education present the most promising approach for long-term control of the disease. The findings offer a solid, data-driven foundation for public health decision-making and resource allocation.
Oct 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5729
Collins Adeyanju GbadeboCorresponding author
Background In sub-Saharan Africa, where many countries continue to experience high burdens of vaccine-preventable diseases, increasing immunization access have been a priority for the governments and international organizations such as Gavi, the Vaccine Alliance. Over 40 Gavi-supported African countries have been impacted, with 364 million children reached and over US$5.7 billion disbursed, averting over 8.9 million child deaths. Despite this progress, the African region has struggled with immunization coverage due to various factors. Nevertheless, some African countries are transitioning out of Gavi support due to economic growth. However, many require strong political will to increase their expenditure on immunization. This study therefore aims to understand the factors influencing immunization performance and its relationship to public expenditure. Methods Data on 37 Gavi-eligible sub-Saharan African countries between 2006 and 2019 was obtained from the World Bank’s World Development Indicators, the WHO and UNICEF Joint Reporting Form and the Transparency International’s Corruption Perception Index. Descriptive immunization and health expenditure were analyzed using a panel regression of variables. DPT3 was used as an indicator of immunization uptake. The indicator for public expenditure on immunization per child was based on government spending on immunization divided by the number of children in the birth cohort. Results The average gross national income increased from US$639 to US$1,192 per capita, while government spending on immunization increased from US$1.7 to about US$4.5 per child. The findings show that there is a correlation between improved immunization financing, increased gross national income, reduced corruption, and improved immunization coverage. However, performance declines beyond a certain threshold when gross national income per capita increases. In addition, an English-speaking country effect was observed. Conclusions While improved immunization financing increases immunization coverage and constitutes an advocacy talking point, there is a need to understand why an increase in gross national income per capita does not translate into an improved immunization coverage. Key highlights Increasing national spending on immunization drives up the uptake of childhood vaccines. There is a threshold beyond which immunization coverage falls despite increased GNI. Controlling corruption increases immunization coverage tendency. French- and English-speaking countries’ immunization coverage differs. Immunization and health system financing have separate outcomes.
Sep 2024 DOI 10.14302/issn.2690-4721.ijcm-24-5195
Mutile Kavai SusanCorresponding author
The persistence of multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) is a challenge especially in regions where typhoid is endemic. Surveillance of circulating genotypes of MDR S. Typhi is crucial in typhoid acute cases and carriers. This study aimed to investigate genotypic diversity of S. Typhi from symptomatic and asymptomatic children in endemic settings in Nairobi, Kenya. Symptomatic and asymptomatic individuals’ ≤ 16 years were recruited at four health facilities and tested for typhoid through stool cultures. The S. Typhi isolates were subjected to antibiotic susceptibility testing to investigate multidrug resistance. The MDR S. Typhi isolates’ DNA was extracted and illumina sequenced. Raw reads were de novo assembled and analyzed by pathogen-watch. From the 90 sequenced isolates, 60 (67%) were confirmed to be S. Typhi (sequence Type 1 and genotype 4.3.1). Out of the 60 S. Typhi strains; 39 (65%) had plasmids, from these 38 (97%) had IncHI1 plasmids alone. Out of the 60, 59 (98%) S. Typhi isolates had blaTEM-1D. Point mutations conferring reduced susceptibility to quinolones were detected in 42 (70%) of S. Typhi isolates, from these; 14 (33%) had gyrA S83Y , and 28 (67%) gyrB S464F genes, respectively. This study reports 4.3.1 (H58) as the most dominant S. Typhi genotype responsible for spread of MDR phenotypes carried on IncHI1 plasmids. Presence of MDR S. Typhi with resistance genes such as blaTEM-1Dand reduced susceptibility to ciprofloxacin especially among asymptomatic individuals, reiterates the need for use of typhoid conjugate vaccine among vulnerable children as a control and prevention measure against typhoid.
Sep 2024 DOI 10.14302/issn.2574-4488.jna-24-5219
V. Liang KellyCorresponding author
Primary membranous nephropathy (MN) is due to autoantibodies to phospholipase A2 receptor (PLA2R Ab). It is unclear whether COVID-19 vaccines can trigger flares of glomerular diseases such as primary MN. There have been increasing reports of glomerular diseases presenting or flaring after receipt of COVID-19 vaccines. We present a patient with primary MN who developed nephrotic syndrome after receiving her second mRNA-1273 COVID-19 vaccine with positive PLA2R Ab. Renal biopsy confirmed primary MN. She was treated for her primary MN flare with rituximab in a manner similar to non-vaccine-associated MN, which led to significant reduction in both PLA2R Ab level and proteinuria. This case adds to the growing literature on MN flares after receipt of mRNA COVID-19 vaccines. Close follow-up of patients with primary MN and other glomerular diseases after COVID-19 vaccination is warranted. Further research is needed to determine the pathophysiology behind vaccine-induced MN flares and whether there is a potential association between exposure to SARS-CoV-2 antigens and loss of tolerance to the PLA2R antigen.
Feb 2024 DOI 10.14302/issn.2693-1176.ijgh-23-4879
Lin Shih-PingCorresponding author
Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.
Oct 2023 DOI 10.14302/issn.2641-4538.jphi-23-4622
Geinoro Alleyo TarikuCorresponding author
The Ortho-poxvirus virus, which causes monkey pox, is a member of the Poxviridae genus. It was initially found in primates. In 1970, the Democratic Republic of the Congo reported the first instance of monkey pox. From there, it spread to a number of countries both inside and outside of Africa. There are two genetic varieties of monkey pox, which have been spread to people through respiratory droplets, and touch with objects contaminated by an affected person and consequently is often encountered in work situations. Among the countries with the worst effects are Nigeria and the Democratic Republic of the Congo. Non-human primates, rats, squirrel, and or mice are just a few of the creatures that can become infected by monkey pox. Although the origins of monkey pox infections are unknown, rodents from Africa and non-human primates like monkeys may contain the viruses and infect humans. Monkey pox is more likely to naturally infect rodents. Monkey pox has symptoms and lesions that are difficult to distinguish from smallpox in its clinical manifestations. Fever, chills, migraines, tiredness, tonia, swollen lymph nodes, back pain, and myalgia are some of the clinical symptoms of monkey-pox. A few examples of diagnostic tests include immune-fluorescent antibody assays, enzyme-linked immune-sorbent assays, and real-time polymerase chain reactions. A specialized vaccine that offers complete protection against by them on key-pox virus exists, yet there is no specific therapy for human monkey infection and interaction with the vaccinia virus. Smallpox vaccination can give cross-immunity with partial protection against infection and a reduction in symptom severity. Unfortunately, community health effects in the view of one health approach has not been addressed in vast. Therefore, the objectives of this review paper are to discuss the community health effects of monkey pox and to emphasize the role of one health approach against monkey pox.
Sep 2023 DOI 10.14302/issn.2692-1537.ijcv-23-4660
Amel Jamehdar SaeidCorresponding author
SARS-CoV-2 real-time reverse-transcription PCR (rRT-PCR) is the most effective testing system available to combat COVID-19, given the absence of any specific treatment or vaccine. Moreover, numerous SARS-CoV-2 rRT-PCR kits have been approved under emergency-use-authorization (EUA) worldwide. In this article, we present a comparison of important performance features among five commercial RT-PCR assays. A total of consecutive nasopharyngeal (NPS) samples and oropharyngeal (OP) swabs were collected from 50 COVID-19 patients to analyze sensitivity and specificity. The results showed variations in sensitivity among all the RT-PCR kits examined. The Pishtaz teb assays demonstrated the highest positive percent agreement (PPA) of 95.2% (40/42), followed by Covitech (90.5% - 38/42), DaAn Gene (83.3% - 35/42), Sansure (66.66% - 28/42), and Power check of SARS- CoV-2 panel (64.3% - 27/42). Conversely, all five molecular assays demonstrated a negative percent agreement (NPA) of 100% (8/8). These findings provide a technical baseline for assessing the performance of five distinct commercial PCR assays for detecting SARS-CoV-2. They could prove practical and useful for laboratories seeking to purchase any of these assays for further clinical validation. Highlights ·Compared five COVID-19 RT-PCR kits approved and available by Iran Ministry of Health. ·Pishtaz teb's kit identified the highest number of positive clinical samples.
Jun 2023 DOI 10.14302/issn.2692-1537.ijcv-23-4586
Isea RaúlCorresponding author
The goal is to do a text mining analysis of all scientific publications and find out what journal and what aspects are studying about the conspiracy theories of Covid-19. For this purpose, all publications available in the National Center for Biotechnology Information (NCBI) database were consulted as they were peer-reviewed papers. Of all these papers, only the abstracts of each one were studied using artificial intelligence techniques to determine, for example, whether the subject is of importance depending on the journals where it has been published, and above all, what possible relationships could be extracted from the information published in them. In addition, the "Net Prevalence per Covid19" index was definedin those countries with a high value, greater campaigns should be sponsored to avoid the misinformation generated by Covid-19, although this comment should be verified in future publications. The main challenge was to unify the abstracts and for this purpose, a text summarizer was used under artificial intelligence schemes. The results obtained indicate the tendency of certain topics by the frequency of the words obtained where the focus on the conspiration are the Covid-19 vaccines, but further work is still needed to continue working on this methodology to unify the results.
Mar 2023 DOI 10.14302/issn.2690-4837.ijip-22-4342
Massood Nabavi SeyedCorresponding author
Introduction Vaccination against SARS CoV-2 started on March 2020 in Iran and people with multiple sclerosis (pwMS) have a priority to be vaccinated in line of other high-risk population. Up to now, BBIBP-CorV (Sinopharm) is the main vaccine which have been used in Iranian population, and in high risk population such as pwMS. Method In this survey, the safety and possible side effects of this vaccine after the first or/and second doses in 520 pwMS have been assessed from July to August 2021. MS Patients who have received one or two doses of Sinopharm vaccine were evaluated. Results Around 44% of pwMS who received Sinopharm reported few minor side effects, whereas its side effect have been reported in 60% of patients who received the second dose. All side effects have begun within the first 24 hours and subsided between 48-96 hours afterward. No serious side effects or mortality have been reported. There was no correlation between the side effects and age, the disability status, and the type of first or second line DMDs (disease modifying drugs). Only some side effects were significantly higher in the progressive form of the disease. Conclusion MS patients can receive Sinopharm vaccine safely and the minor side effects should not scare them.
Mar 2023 DOI 10.14302/issn.2994-6743.ijstd-22-4411
Tunta AbaynehCorresponding author
Background HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision. Method From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression. Result Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination. Conclusion Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.
May 2021 DOI 10.14302/issn.2689-4602.jes-21-3837
O. Henderson JeffreyCorresponding author
Department of Science and Mathematics, Judson University, Elgin, IL 60123, USA
The coronavirus infectious disease (20)19 (COVID-19) pandemic is caused by a newly identified virus (2019) SARS-CoV-2, a beta coronavirus that shares similarities with other human-infecting coronaviruses. Genomic analysis suggests that SARS-CoV-2 is closely related to SARS-CoV, a bat-related coronavirus, RaTG13, and to other pangolin-associated coronaviruses. The spike protein of coronaviruses are glycoproteins and are responsible for attaching the virus to the host cell and entering. Amino acid changes within the spike protein-encoding gene from SARS-CoV to SARS-CoV-2 enable SARS-CoV-2 to form a stable spike protein, to form a stable complex between the S protein and the receptor ACE2, to increase binding points between the S protein and ACE2, and to survive at higher temperatures. SARS-CoV-2 is zoonotic, with genomic analysis implicating bats as the original host and pangolins as the most likely intermediate host to infect humans. As SARS-CoV-2 infects humans, viral point mutations will continually occur and cause the emergence of new competitive SARS-CoV-2 strains. Two major strains include D614G and N501Y and have increased infectivity and transmission, further complicating the scope of the current COVID-19 pandemic. Vigilant monitoring of viral development and evolution is necessary for developing proper treatment methods and vaccine targets.
Apr 2021 DOI 10.14302/issn.2641-4538.jphi-21-3776
Uwizeyimana TheogeneCorresponding author
Mount Kenya University, School of Health Sciences, Department of Public Health, P.O. Box 5826, Kigali Campus, Rwanda
COVID-19 has unprecedentedly shaken the health systems across the globe. Rwanda, a low-income country in East Africa, has succeeded to contain the first wave but is struggling to curb the second wave in the wait for a massive vaccination program. The national committee composed of different ministries and a COVID-19 Joint Task Force was established as a Multi-sectoral approach in the early days of the pandemic. The approach together with transparent communication to the population has been effective. However, much more tailored and cost-effective measures against the drivers of cluster outbreaks are needed to save both the economy and more lives. It is challenging to produce evidence about behaviors attributable to the surge of infections, and their hardship, and how to allow the population to live their lives with less risk. With important research, policymakers will be able to think locally and provide easy and inexpensive recommended behaviors while awaiting the vaccine.
Jan 2021 DOI 10.14302/issn.2692-1537.ijcv-20-3685
Elkhenany HodaCorresponding author
Department of Surgery, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt.
The current uncontrollable outbreak of novel coronavirus (COVID-19) has unleashed severe global consequences in all aspects of life and society, bringing the whole world to a complete halt and has modeled significant threats to the global economy. The COVID-19 infection manifests with flu-like symptoms such as cough, cold, and fever resulting in acute respiratory distress syndrome (ARDS), lung dysfunction, and other systemic complications in critical patients are creating panic across the globe. However, the licensed vaccine has started to show up; some resulted in side effects that would limit its possibility in some circumstances as allergic personnel, for example. Moreover, the production and approval of new drugs is a very complicated process and takes a long time. On the other hand, stem cells have gone the extra mile and intensively investigated at preclinical and clinical studies in various degenerative diseases, including infectious ones. Stem cells are proposed as a broad-spectrum therapeutic agent, which may suppress the exaggerated immune response and promote endogenous repair by enhancing COVID-19 infected lung microenvironment. Also, stem cells have different application manners, either direct transplantation, exosome transplantation, or drug delivery of specific cytokines or nanoparticles with antiviral property by engineering stem cells. This review discusses and summarizes the possible emerging role of cell-based therapy, especially stem cell therapy, as an alternative promising therapeutic option for the treatment and control of novel COVID-19 and its potential role in tissue rejuvenation after COVID-19 infection.
Jan 2021 DOI 10.14302/issn.2692-1537.ijcv-20-3383
Zhao BinCorresponding author
School of Science, Hubei University of Technology, Wuhan, Hubei, China.
With the spread of the new coronavirus around the world, governments of various countries have begun to use the mathematical modeling method to construct some virus transmission models assessing the risks of spatial spread of the new coronavirus COVID-19, while carrying out epidemic prevention work, and then calculate the inflection point for better prevention and control of epidemic transmission. This work analyzes the spread of the new coronavirus in China, Italy, Germany, Spain, and France, and explores the quantitative relationship between the growth rate of the number of new coronavirus infections and time. In investigating the dynamics of a disease such as COVID-19, its mathematical representation can be constructed at many levels of details, guided by the questions the model tries to help answer. Mathematical sophistication may have to yield to a more pragmatic approach closer to the ability to make predictions that inform public health policies. Background In December 2019 , the first Chinese patients with pneumonia of unknown cause is China admitted to hospital in Wuhan, Hubei Jinyintan , since then, COVID-19 in the rapid expansion of China Wuhan, Hubei, in a few months time, COVID-19 is Soon it spread to a total of 34 provincial-level administrative regions in China and neighboring countries, and Hubei Province immediately became the hardest hit by the new coronavirus. In an emergency situation, we strive to establish an accurate infectious disease retardation growth model to predict the development and propagation of COVID-19, and on this basis, make some short-term effective predictions. The construction of this model has Relevant departments are helpful for the prevention and monitoring of the new coronavirus, and also strive for more time for the clinical trials of Chinese researchers and the research on vaccines against the virus to eliminate the new corona virus as soon as possible. Methods According to the original data change law, Establish a Logistic growth model, we collect and compare and integrate the spread of COVID-19 in China, Italy, France, Spain and Germany, record the virus transmission trend among people in each country and the protest measures of relevant government departments. Findings Based on the analysis results of the Logistic model model, the Logistic model has a good fitting effect on the actual cumulative number of confirmed cases, which can bring a better effect to the prediction of the epidemic situation and the prevention and control of the epidemic situation. Interpretation In the early stage of the epidemic, due to inadequate anti-epidemic measures in various countries, the epidemic situation in various countries spread rapidly. However, with the gradual understanding of COVI D -19, the epidemic situation began to be gradually controlled, thereby retarding growth
Aug 2020 DOI 10.14302/issn.2474-9273.jbtm-20-3497
Patel JainishCorresponding author
Indira Gandhi National Open University, Regional Center, Surat, Gujarat, India
This paper explores the two major preventive concepts of the unpredictable life-threatening viral infection caused by Coronavirus that is ravaging the entire world from the beginning of the year 2020, as it pertains to mental health. Through scientific consultations, the expectation is that effective vaccine for the Coronavirus disease-2019 (COVID-19) may not come into the market this year. Two (among others) preventive measures, namely Social Distancing and Quarantine are suggested by the World Health Organization (WHO). Using the principle of explorative research, this study established the flipside of quarantine and social distancing from the metal health perspective. It was discovered that there is a relationship between a long period of self-isolation and a high probability of concerned persons having anxiety, stress, and depression, which gradually leads to mental and emotional health issues. Consequently, mental health affects the overall health and affects how we handle different situations during the Covid-19 pandemic. By considering this important matter, this article recommended different ways to improve mental health during the pandemic in the quest to keep oneself away from psychological issues arising due to the Covid-19 situation.
May 2020 DOI 10.14302/issn.2692-1537.ijcv-20-3345
Ozcelik FatihCorresponding author
University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, Department of Medical Biochemistry, Istanbul, Turkey
While the COVID-19 pandemic has raised concerns about the future of people worldwide, it has made it necessary to take measures with high economic costs, including quarantine. We consider it is more logical for some scientists to investigate time-saving treatment options until vaccination studies, which are started to be studied rapidly, are accomplished or specific antiviral agents are found. In this context, treatment combinations of one or more of the immune modulators known as cytokines, which can stimulate or accelerate the immune system, should be tried. In our opinion, although such options are not as effective as specific treatments such as vaccines, such options will offer highly effective alternatives in times of emergency. For this reason, we found it appropriate to make a reminder by preparing a broad review about interferon gamma, which is an antivirus and is an immunomodulator and which plays a critical role in humoral and cellular immunity.
Apr 2020 DOI 10.14302/issn.2691-8862.jvat-20-3278
Isea RaúlCorresponding author
Fundación Instituto de Estudios Avanzados, Hoyo de la Puerta, Baruta. Venezuela.
The goal of this paper is to obtain the numerical consensus of B cell epitopes from the three-dimensional structure of the prefusion spike glycoprotein of the new betacoronavirus that could lead to the development of a vaccine to 2019-nCoV. In order to do that, we first calculated the B-cell epitopes that are predicted using fourteen different mathematical algorithms. Later, we obtained the consensus of B-cell epitopes according to the Similarity Index, and finally selecting the best candidates according to the results of a function called <F> which is evaluated for the glycoprotein. The best candidates that we obtained in order to design a vaccine are SSANNCT, PLQSYGFQPT, TESNKKFLP, NNSYEC, AENS, LPDPSK and YDPLQPE.
Aug 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2983
Léhleng AGBACorresponding author
Neurology Department, University Hospital Center of Kara, Kara University, PoBox 18 Kara (Togo)
Although it is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa. Because of its rarity, this disease poses two problems for doctors of the 21st century: to make early diagnosis in order to refer patients to appropriate care structures, and to continue to ensure correct prevention of an affection that few current doctors have met. In it generalized form, the diagnosis of tetanus is easy, but when the beginning is localized, tetanus can be change with other diseases leading to a diagnostic wandering and a delay of adequate management. We report a case of tetanus in an 18-year-old male, who was received for neck pain and stiffness of the neck with a positive Kernig sign associated to fever since 48 hours. Initially treated for meningitis, the patient will develop at day 3 of hospitalization, the signs of generalized tetanus which led to evoked the diagnosis of tetanus. This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. After using tetanus serum and vaccination with antibiotics (Metronidazole and Penicillin) and Diazepam in association with stripping of the wound under the foot, the patient was improved. This case illustrates that any neurological sign with the first trismus must evoke until proof of the contrary, a tetanus especially in case of association with a wound even if the immunization schedule is up to date.
Nov 2018 DOI 10.14302/issn.2474-3585.jpmc-18-2359
Gedik HabipCorresponding author
Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Objective: This study aimed to assess the knowledge and attitude levels of pediatricians in terms of the pertussis vaccine. Materials and Methods: A survey study was carried out to evaluate the knowledge and attitude levels of pediatricians working in Istanbul in terms of the pertussis vaccine between May 1, 2015 and July 1, 2015. Results: A total of 104 pediatricians who comprised of 53 male and 51 female physicians, participated in this study. It was found that 35.6% of them at low-level, 51% at middle-level and 13.5% at a high-level of knowledge. The knowledge-level scores of the pediatricians who had children were significantly higher than those of pediatricians who had not a child on pertussis vaccine. Moreover, the knowledge-level scores of the specialist doctors in terms of the pertussis vaccine were significantly higher than those of the assistant doctors. It was significant that pediatricians who had children suffering from chronic diseases had greater knowledge-level scores in terms of the pertussis vaccine than those who had children without any disease. Conclusion: The knowledge and awareness of physicians in terms of the pertussis vaccine should be increased with in-service trainings, as the surveyors presented an insufficient knowledge level.
Sep 2017 DOI 10.14302/issn.2577-137X.ji-17-1736
Ahmed Kamal SamiaCorresponding author
Animal Health Research Institute, Dokki, Giza, Egypt
Some strains of Foot and mouth disease virus (FMDV) are endemic in Egypt. The present study was performed on cattle and buffaloes (ages: 3 months up to 1.5 years old, of years 2015 and 2016), which were suffering foot and mouth disease (FMD). Sera and tissues samples were tested by different techniques including serum and virus neutralization tests (SNT, VNT), virus isolation and identification by tissue culture methods, Enzyme linked immune-Sorbent Assays (ELISA); and by the pathological and hematology techniques. The results showed the predominance of FMDV serotype O with the presence of serotypes SAT2 and A. The results showed the pathologic picture of FMD was similar regardless its specific subtypes, as apparently the studied strains produces same pathological and hematological changes. Microscopic examination reveals severe hydropic degenerations and necrosis in most affected organs, accompanied by significant changes in blood parameters which indicate severity and direct effects of FMDV on the hematopoietic system. These findings indicates the mode of pathogenesis of FMD virus in its way to exhibits the characteristic symptoms of illness. However, the investigation showed the presence of FMDV type O, A and SAT2 in the studied areas of delta governorates. It is important to focus on producing of vaccines which have only these serotypes as solution to get rid of the endemic behavior of FMDV in delta of Egypt.
Aug 2017 DOI 10.14302/issn.2575-1212.jvhc-17-1662
Díaz Otero FernandoCorresponding author
Instituto Nacional de Investigaciones Forestales, Agrícolas y Pecuarias, Centro Nacional de Investigación Disciplinaria en Microbiología Animal, Carretera México-Toluca, Km 15.5, D.F., 05110, México
Immunization of cattle with the bacillus Calmette-Guérin (BCG) vaccine, especially neonates, induces protection against Mycobacterium bovis (M. bovis) and has been proposed as a strategy for bovine tuberculosis (bTB) control. Therefore, the aim of this study was to evaluate the immune response induced under field conditions in neonatal calves vaccinated with BCG Phipps, a strain that has rarely been evaluated in the bovine population, using interferon (IFN)-γ and tuberculin tests, flow cytometry and enzyme-linked immunosorbent assay. Two groups (vaccinated and control) of 5 calves were monitored for 12 weeks, and increases in the in vitro IFN-γ production, the percentage of cluster of differentiation (CD)8+ T cells and the activation levels of CD4+ and CD8+ T cells were observed 3 to 4 weeks post-vaccination. Bovine purified protein derivative-specific IFN-γ production was increased about 4.8- and 5.5-fold in vaccinated animals compared to non-vaccinated animals 3 and 4 weeks post-vaccination respectively. CD8+ T cells of the vaccinated group were increased 1.6-, 1.5- and 1.6-fold at weeks 2, 3 and 4 respectively. Levels of activation were 1.7- and 1.9-fold higher for CD4+ T cells and 2.3- and 1.8-fold higher for CD8+ T cells in the vaccinated group at weeks 3 and 4 respectively in response to M. bovis antigens. However, no animals (vaccinated or control) showed positive results for the single intradermal comparative tuberculin test (SICTT). Therefore, our results indicate that vaccination with M. bovis BCG Phipps strain stimulated peripheral blood T cell activity and induced a cell-mediated immune response. In addition, vaccination did not interfere with the SICTT, as previously reported, which indicates that this vaccine could be successfully applied in bTB control campaigns.
Jun 2016 DOI 10.14302/issn.2577-137X.ji-16-1026
N. Babirye JulietCorresponding author
School of Public Health, Makerere University College of Health Sciences.
Millions of children continue to miss immunizations each year despite global increases in financing and advances in vaccine technology. Male involvement in routine child immunization activities could improve and sustain coverage but is rarely emphasized in immunization programs or research. This study identified factors associated with male involvement in routine child immunization using the attitude, social influence and self-efficacy model.A household cluster survey was conducted among 460 fathers aged 18 years or more, with children aged 10-23 months. A semi-structured interviewer-administered questionnaire was used to collect data. Prevalence Risk Ratios (PRRs) were used to measure associations with level of involvement using generalized linear models with Poisson family, log link and robust standard errors in STATA 12. Our findings show that half (51%, 236/460) of the respondents were aged 25-34 years; 36% (166/460) had completed eight or more years of formal education. Although90% (415/460) of the respondents were willing to be involved, only 29% (133/460) were highly involved in routine child immunization. Highly involved fathers had a positive attitude towards involvement in routine child immunization (adj. PRR 2.3, 95% CI 1.18 – 4.98) and were ≥45 years adjusted prevalence risk ratio (adj. PRR) 2.0, 95% confidence interval (CI) 1.15 - 3.76. Traders had a lower involvement compared to those engaged in other occupations (adj. PRR 0.55, 95% CI: 0.37 - 0.82). In conclusion, few fathers were involved in routine child immunization. Strategies to improve fathers’ positive attitude such as health education are needed to increase their involvement, specifically targeting younger fathers and traders.
Mar 2016 DOI 10.14302/issn.2577-137X.ji-15-834
Z Kompithra RajeevCorresponding author
Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, 632004, India
The Expanded Program on Immunization (EPI) in India delivers vaccines under its policy, through government hospitals, health centers and outreach clinics. However, the national average full immunization coverage is stagnating at about 70%. The days and times of clinics are not always convenient for mothers working at home or employed outside. Moreover, vaccines not under EPI, but recommended by the Indian Academy of Pediatrics (IAP), are unavailable there, forcing mothers to go to private sector immunization clinics to get them. Recognizing the local need for user-friendly immunization clinic, we designed one in the Department of Child Health. The impetus came from local demand by a civil society organization (Rotary Club of Vellore). Our immunization clinic is open every working day (8.30 am to 4.00 pm) offering both groups of vaccines. Its success is illustrated by the fact that over 7000 children per month receive immunization in this clinic. We describe its design and operation so that this model may be replicated in other urban hospitals with pediatric sections.
Apr 2014 DOI 10.14302/issn.2377-2549.jndc-13-329
Kumar Dinda AmitCorresponding author
Department of Pathology, All India Institute of Medical Sciences,Ansari Nagar, New Delhi-110029 (INDIA)
The aim of the study was to synthesize sub-100nm poly-ε-caprolactone nanoparticles (PCL NP), load them with the mycobacterial protein, ESAT 6 and study the resulting immune responses in CD4+ and CD8+ T cells when incubated with human peripheral blood monocyte derived macrophages that had internalized the PCL NP. The synthesized PCL NP were characterized for size, shape and charge. They were found to be about 60nm in size with spherical shape. MTT assay revealed that the particles were perfectly biocompatible when tested in vitro on THP1 human monocytic cell line. The particles had a slow protein release kinetics and did not degrade appreciably even after 30 days in buffer solution. ELISA was used to quantify the cytokine response of CD4+ and CD8+ T cells when incubated with the monocyte derived macrophages as antigen presenting cells. The result of antigen presentation assay revealed that the antigen loaded PCL NP enhanced Th1 and CD8+ T cell responses significantly compared to the pure antigen. Thus we conclude that PCL NP of 60nm size can be effectively tested as a vaccine adjuvant with resulting activation of Th1/Th2 immunity as well as cytotoxic T cell response.