Formulating new strategies to improve the population's level of knowledge, assuring the population about the safety and the efficacy of the vaccine and the inclusion of the vaccine within the national immunization program are the essential factors to enhance vaccination coverage in Jordan.

TLR9 activation induces expression of membrane-bound BAFF on human B cells and leads to increased proliferation in response to both soluble and membrane-bound BAFF. These data extend our understanding of the role of TLR9 activation on human B cells and provide insights into the mechanisms by which TLR9 may participate in the pathogenesis of SLE.

is observed in the principal PGB-indicated conditions which share the alteration in IL-6, TNF-α, IL-2 and IL-1β cytokines level. Yet, reports on PGB immunomodulatory and anti-inflammatory effects are a few and focused mainly on in vitro assays, local inflammatory changes within the nervous system, and attenuation of the secretion of only IL-1β and TNF-α cytokines 18-20. In addition, PGB effects on cytokines secretion in immune cells, such as isolated splenocytes and peritoneal macrophages (PMs), and its effect on lymphoid organs, were not examined before. Therefore, there is a need to perform a simultaneous assessment of the effect of PGB on the secretion of the cytokines that were commonly elevated in the aforementioned PGB-indicated conditions (IL-6, TNF-α, IL-1β and IL-2) and to expand the investigation to its effect on lymphoid organs and cytokine secretion in immune cells. As peripheral inflammation and elevated systemic cytokines levels were demonstrated in the above-mentioned PGB-indicated conditions, we investigated in this study the effect of PGB on murine models of peripheral inflammation. In this study, we used for the first time, LPS and ConA-induced murine models of inflammation to examine the effect of PGB on peripheral proinflammatory cytokine secretion (IL-6, TNF-α, IL-1β and IL-2) in vitro and in vivo in BALB/c mice. LPS-model of inflammation has been employed before to study neuroinflammatory conditions, seizure and anxiety disorders in mice 21-25 , while ConA was used to investigate T-cell function in patients with fibromyalgia 26. Additionally, in this study, the effect of PGB on mitogen-induced inflammatory changes in the spleen, as a lymphoid organ, was also examined for the first time. Regarding in vitro investigation, the lack of reports that examined the effect of PGB on the secretion of cytokines in immune cells prompted us to investigate such effects of PGB on basal and mitogen-induced proinflammatory cytokines secretion in splenocytes and peritoneal macrophages (PMs).

Limited data exist regarding pneumococcal vaccination coverage among the elderly in Middle Eastern countries including Jordan. The pharmacists' role in improving vaccine acceptance has become increasingly evident. Yet, large-scale studies of the assessment of the pharmacists' role on pneumococcal vaccines acceptance among the elderly are scarce. Hence, we assessed for the first time the current state of knowledge and pneumococcal vaccination coverage among the elderly and the role of pharmacist-led educational intervention on the attitude, awareness, vaccine acceptance, and prompts for physician consultation regarding pneumococcal vaccines in Jordan. This interventional study enrolled 916 randomly selected adults aged ≥ 65 years in Amman, Jordan. We showed that only 3.9% of the participants have ever heard about pneumococcal disease with 0.5% vaccination coverage. Immediately after educational intervention, 21.7% of the participants perceived pneumococcal disease as a threat, 52.1% of them believed in the importance of the vaccine, and 93.9% of them were willing to consult a physician in this regard. At a two-month follow-up, 30.5% had a positive attitude toward the vaccine and 36% consulted their physician regarding the vaccine. Vaccination coverage was significantly increased to 1.9% (P value = 0.008). The main obstacles against vaccination were a negative attitude and that physicians had not recommended the vaccine. Vaccine uptake was significantly associated with physician consultation (P value = 0.011). Insurance, employment, attitude, and reading the booklet significantly predicted physician consultation. In conclusion, very low pneumococcal vaccination coverage was observed among the elderly in Jordan. Enrollment of pharmacists in immunization education and recommendation is suggested to improve pneumococcal vaccine coverage among the elderly in Jordan.