Purpose: Adult vaccination, which is among the duties of family physicians, is an important issue that reduces morbidity and mortality. In this study, it was aimed to evaluate knowledge, attitudes, and behaviors of adults about adult vaccines. Materials and Methods: This study is a descriptive, cross-sectional research; which was performed by a questionnaire including sociodemographic data and questions about adult vaccination to the patients and their relatives who applied to Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics for any reason. Mean, standard deviation and chi-square tests were used for the analysis; p<0.05 was considered significant. Results: The study included 182 people, 93 of them were women (51.1%) and 89 (48.9%) were men. The mean age was 32.9±12.8 years; most of them (n=144, 79.1%) were high educated and 38.5% were married. The most known vaccine was tetanus (n=154, 84.6%), the least known was zona vaccine (n=30, 16.5%). Health care professionals and television (n=60, 33%) were the most information sources about vaccines (n=78, 42.9%). Vaccination was mostly (26.9%) recommended by family physicians 144 (79.1%). The students had more knowledge about human papilloma virus (HPV), zoster, and measles, mumps, and rubella vaccines (p≤0.05), and mostly the information was got from internet and school (p≤0.05). As education status increased, knowledge about tetanus, hepatitis A, pneumonia, and HPV vaccines increased significantly, whereas only tetanus vaccination was performed in practice (p≤0.05). As the income increased, knowledge about pneumonia and HPV vaccines increased, but vaccination was not performed as expected. Conclusion: Age, occupation, education, and income level are directly related to knowledge and attitudes about adult vaccination. Adult vaccines are still not known and performed enough in Turkey. It is important to encourage and increase the number of trainings via media on this subject.

Purpose: Human papillomavirus (HPV) genotype and age distribution of HPV infection were crucial for the national vaccination and screening program planning. However, there was a limited study providing these data in the normal cervix population. This study aimed to explore the HPV genotypes profile of women with clinically normal cervix based on Visual Inspection of Acetic Acid (VIA) test. Materials and Methods: A 7-year cross-sectional study was conducted from 2012 to 2018 in private and public health care centers in Jakarta. Subjects were recruited consecutively. Data were collected by anamnesis, VIA, and HPV DNA test using the polymerase chain reaction (PCR; SPF10-DEIA-LiPA25) method. HPV genotyping procedures include DNA extraction, PCR (SPF10-DEIA-LiPA25) using the HPV XpressMatrix kit (PT KalGen DNA, East Jakarta, Indonesia), and hybridization. The IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) were used to analyze the data. Results: A total of 1,397 subjects were collected. Positive HPV-DNA tests were found in 52 subjects (3.7%); 67% were single and 33% were multiple HPV infections. HPV 52 was the most frequently detected HPV genotype, followed by HPV 39, 16, 18 74, 44, 31, 54, and 66, respectively. The highest HPV infections in this population were in the 31-40 and 41-50 years old group. Conclusion: This study suggested beneficial screening for women aged 31-50 years old. Instead of "original" nonavalent (HPV 16, 18, 6, 11, 31, 33, 45, 52, 58), the different "nonavalent" formula for HPV vaccines protecting against HPV 16, 18, 6, 11, 31, 39, 44, 52, 74 might be useful for Indonesian population. However, further multicenter studies with a huge sample size are still needed.

Purpose: The human papillomavirus (HPV) vaccine is safe and effective for preventing HPV-related diseases. However, HPV vaccination rates in Japan are low because the "Ministry of Health, Labour and Welfare" had stopped recommending vaccination. We assessed healthcare workers' (HCWs) current recommendations regarding the HPV vaccine and how the provision of information about HPV vaccination affected their recommendations. Materials and Methods: A survey was conducted among nurses and physicians in Nara prefecture from March 2021 to July 2021. The questionnaire asked about their understanding, recommendations, and opinions regarding HPV vaccination. Before answering the last two questions (optional), the HCWs read evidence-based information quantifying the risks and benefits of HPV vaccination. Results: A total of 441 HCWs completed the questionnaire. Only 19% of HCWs always recommended HPV vaccination for girls aged 12-16 years. The evidence-based information significantly improved the percentage of HCWs who would "always recommend" vaccination. Conclusion: This study showed that the proportion of HCWs who recommend HPV vaccination to adolescent girls remains low in Japan. However, we found that evidence-based information describing the causal relationship between adverse events and vaccination, quantifying the risks and benefits, noting the importance of HCW communications with families, and reporting the recommendations of national societies, might increase HCWs' recommendations for HPV vaccination.

Purpose: Vaccines adsorbed on aluminum adjuvants irreversibly lose potency after freezing and their safety is affected. To prevent the administration of such vaccines, the World Health Organization developed the Shake Test designed to determine whether adsorbed vaccines have been frozen or not. However, the Shake Test is difficult and time-consuming when routinely conducted at the place of vaccination. In this study, a modified shake test for prequalification of potentially frozen vaccines was elaborated. Materials and Methods: Vaccines used in the Polish Immunization Schedule were investigated and the analysis includes an assessment of precipitation time and the influence of the container type, amount and type of aluminum compound, and a volume of vaccine dose on the precipitation time. Results: Significant differences between the precipitation time of frozen and non-frozen vaccines routinely used in the Polish Immunization Schedule were observed. The precipitation time of all non-frozen vaccines was above 30 minutes. The longest precipitation time of frozen vaccines was 10 minutes. Conclusion: The finding of the study can be used in practice by the personnel administering vaccines to patients. Step-by-step recommendations for the preparation of the test have been proposed in the article.

Purpose: Epithelial ovarian carcinoma (EOC) is the most lethal of all human gynecologic malignancies. We previously reported that vaccination of female mice with the extracellular domain of anti-Müllerian hormone receptor II (AMHR2-ED) in complete Freund's adjuvant (CFA) generates AMHR2-ED specific immunoglobulin G (IgG) that provides prevention and therapy against murine EOCs. Although CFA is the "gold standard" adjuvant in animal studies, it is not approved for human use because it often induces painful granulomas and abscesses. Thus, the objective of this study is to identify an alternative adjuvant to CFA for use in our ovarian cancer vaccine clinical trials. Materials and Methods: Because it has been used successfully without serious adverse effects in numerous human clinical trials, we selected the IgG-inducing squalene-based adjuvant, AddaVax^TM, for evaluation of its ability to facilitate vaccine-induced prevention and treatment of EOC in mice. To this end, we immunized female C57BL/6 mice with recombinant mouse AMHR2-ED emulsified with either AddaVax or CFA as adjuvant and compared the results. Results: We found that formulation of the AMHR2-ED vaccine with AddaVax adjuvant induced high serum titers of IgG and significant inhibition of EOC growth with significantly enhanced overall survival of mice using both prevention and therapeutic protocols. These results were compared favorably with results obtained using CFA as an adjuvant in the AMHR2-ED vaccine. Conclusion: Our data indicate that the AMHR2-ED vaccine formulated with AddaVax may be used in human clinical trials and thereby serve as a novel and effective way to control human EOC.

The coronavirus disease 2019 pandemic has not ended, and several variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continue to emerge. The emergence of new variants is worrying because higher transmission leads to spikes in infections, vaccine efforts, and other therapeutic developments. Existing literature reports that with new variants affecting vaccine efficacy, hospitalization and risk of a recurrent infection increase. In this review article, we describe the latest variants of SARS-CoV-2, and the impact of each new variant on the efficacy of the developed vaccines reported in the literature and findings. The report concludes that the emergence of a variant that completely evades the immune response and reduces neutralizing antibodies.

The coronavirus disease 2019 (COVID-19) pandemic revolutionized the vaccine market and initiated the momentum for alternative routes of administration for vaccines. The intranasal route of immunization is one such possibility that appears to be the most promising since it has some significant advantages, particularly in the prevention of respiratory infection. To analyze and summarize the role of nasal vaccines over conventional vaccines during COVID-19 and the need for the nasal vaccine as a booster shot. In this narrative review, the required data was retrieved using keywords "COVID-19," "Intranasal," "Immunity," "Nasal spray," and "Mucosal" in databases including PubMed, Scopus, Embase, Science Direct, and Web of Sciences. The results of the study showed that the nasal vaccines were both effective and protective according to the current researches approaching during the COVID-19 period and the preclinical and clinical phase trials prove the intranasal vaccination elicits more robust and cross-protective immunity than conventional vaccines. In this narrative review article, mechanisms across the nasal mucosa will be briefly presented and the current status of nasal vaccines during the COVID-19 pandemic is summarized, and advantages over traditional vaccines are provided. Furthermore, after exploring the primary benefits and kinetics of nasal vaccine, the potential for consideration of nasal vaccine as a booster dose is also discussed.

Purpose: The coronavirus disease 2019 (COVID-19) vaccine is the key to getting out of the pandemic. However, acceptance of the vaccine has been affected by false information and rumors, which have kept people from getting the shot since it was rolled out. Materials and Methods: This study aimed to investigate the various misconceptions surfaced about the COVID-19 vaccines in Africa. We performed an online survey using an anonymous questionnaire to reach out to African respondents by social media and all possible online platforms such as Facebook, WhatsApp, Instagram, Twitter, YouTube, and so forth. The web-based questionnaires about the myths surrounding the vaccines were extracted from nonscientific information, unproven statements, social media posts, news reports, and people's concerns about the safety of the COVID-19 vaccines. Participants indicated their level of agreement with each statement. Results: A total of 2,500 people responded to the online survey in Africa. The two common myths that respondents agreed with were that "since vaccines for COVID-19 have been developed, we can make vaccines for the common cold, human immunodeficiency viruses, and other diseases" (n=892, 35.7%) and that "researchers rushed the development of the COVID-19 vaccines; therefore, it is not very effective, safe and cannot be trusted" (n=595, 23.8%). The range of respondents who neither agreed nor disagreed with these myths was 12.4%-33.0%. The majority (1,931, 77.2%) indicated disagreement with the statement "after getting the COVID-19 vaccine, one can stop wearing a mask as well as taking safety precautions." Conclusion: Myths surrounding the COVID-19 vaccines have impact on acceptance. Exploring them helps public health authorities in Africa dispel them and provide accurate information to promote vaccination campaigns, education, and acceptance.

Purpose: This study was performed to investigate humoral immune response and adverse events upon the heterologous prime-boost with a single dose of the mRNA-1273 vaccine among fully CoronaVac-vaccinated, infection-naïve healthcare workers in Indonesia. Materials and Methods: One hundred twenty-five eligible healthcare workers were recruited from one hospital for this prospective cohort study. Blood collection was conducted twice, i.e., on 7 days before and 28 days after the booster vaccination. The titer of anti-SARS-CoV-2 receptor-binding domain (RBD) antibodies was quantified accordingly. The post-vaccination adverse event was recorded for both CoronaVac and mRNA-1273 vaccinations. Any breakthrough infection was monitored during the follow-up period. Wilcoxon matched-pairs signed rank test was used to test differences between groups. Results: A significant increase was observed in the titer of anti-SARS-CoV-2 RBD antibodies upon receiving the mRNA-1273 booster (geometric mean titers of 65.57 and 47,445 U/mL in pre-and post-booster, respectively), supporting the argument to use heterologous prime-boost vaccination to improve the protection against COVID-19 in a high-risk population. The mRNA1273 vaccine, however, caused a higher frequency of adverse events than the CoronaVac vaccine. Nonetheless, the adverse events were considered minor medical events and temporary as all subjects were not hospitalized and fully recovered. Of note, no breakthrough infection was observed during the follow-up to 12 weeks post-booster. Conclusion: The heterologous prime-boost vaccination of healthcare workers with a single dose of the mRNA-1273 vaccine generated a significant elevation in humoral immune response towards RBD of SARS-CoV-2 and was associated with a higher frequency, but minor and transient, adverse events.

Lacunar strokes occur when a branch of a large cerebral artery is blocked. The thalamus is often affected, causing uncontrollable motions. A 72-year-old previously healthy man presented with involuntary motions in the right limbs, which were present at rest, and exacerbated during voluntary actions. He had received the first dose of the adenoviral vector-based coronavirus disease 2019 vaccine (ChAdOx1 nCoV-19) 9 days ago. Severe thrombocytopenia and elevated levels of lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer were found, without any evidence of connective tissue disease. Electromyography demonstrated typical choreiform movements, and the brain magnetic resonance imaging indicated a small high signal lesion on the left side of the thalamus. Detection of the immunoglobulin G antibodies against platelet factor 4 in the blood, negative heparin-induced platelet activation (HIPA) test, and positive modified HIPA test confirmed the thalamic stroke due to the vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). He was admitted to the intensive care unit and received nadroparin, sodium ozagrel, edaravone, methylprednisolone, and haloperidol. His hemi-chorea improved gradually over 2 weeks, and he was discharged after 21 days with rehabilitation advice. VIPIT due to the ChAdOx1 nCoV-19 is a novel immune-mediated response that needs clinicians' awareness and further investigations.

We present the case of a 24-year-old Caucasian man, who developed a scaly erythematous skin rash after the second dose of coronavirus disease 2019 (COVID-19) vaccination with Comirnaty (BNT162b2, BioNTech/Pfizer; Pfizer, New York, NY, USA) and proved positive for Epstein-Barr virus (EBV) reactivation. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines have been associated with an up-regulated T helper type 1-cell response, possibly favoring an immune system imbalance. Also, EBV reactivation has been postulated after COVID-19 vaccination, but only in the immunosuppressed. Noteworthy we report the first case of EBV viral reactivation associated with cutaneous manifestations in an immunocompetent patient after the COVID-19 vaccine.

A 38-year-old female patient, with healthy history, was vaccinated with ChAdOx1 nCoV-19 (Astra Zeneca Cambridge, UK). Five days after the second injection, the patient presented headache, vertigo, then fatigue, nervousness, palpitations, shortness of breath, small amplitude tremors, and sweating episodes. Laboratory investigation revealed a suppressed thyroid-stimulating hormone (TSH), with elevated free thyroxine. However, the TSH receptor antibody and anti-thyroid peroxidase antibody were normal and thyroid-stimulating immunoglobulin negative. The patient was maintained on Metoprolol, and no specific treatment was added. After 3 months of following, the patient now feels comfortable. Our literature review found that 21 cases of subacute thyroiditis (SAT) following coronavirus disease 2019 (COVID-19) vaccines were reported. Most patients were young women who presented neck pain and systemic symptoms, with or without fever. These symptoms can appear as early (3 to 5 days), or later (1 month) after vaccination, regardless of vaccine type and mechanism of action. Laboratory tests showed decreased levels of TSH and elevated thyroid hormone. The mechanism of this event remains unknown. Further study is recommended to investigate the possible predisposing factors to developing SAT after receiving the COVID-19 vaccine.