Vaccines

Research

10 pages, 253 KiB

Open AccessArticle

Exploring the Willingness to Accept SARS-CoV-2 Vaccine in a University Population in Southern Italy, September to November 2020

by Gabriella Di Giuseppe, Concetta Paola Pelullo, Giorgia Della Polla, Maria Pavia and Italo Francesco Angelillo

Vaccines 2021, 9(3), 275; https://doi.org/10.3390/vaccines9030275 - 18 Mar 2021

Cited by 50 | Viewed by 3462

Abstract

Understanding whether members of the university population are willing to receive a future vaccination against COVID-19 and identifying barriers may help public health authorities to develop effective strategies and interventions to contain COVID-19. This cross-sectional study explored the willingness to accept a future [...] Read more.

Understanding whether members of the university population are willing to receive a future vaccination against COVID-19 and identifying barriers may help public health authorities to develop effective strategies and interventions to contain COVID-19. This cross-sectional study explored the willingness to accept a future SARS-CoV-2 vaccine in a university population in Southern Italy. The perceived risk level of developing COVID-19 was 6.5 and it was significantly higher among females, younger subjects, and those who agreed/strongly agreed that COVID-19 is a severe disease. Only 21.4% of respondents were not worried at all regarding the safety of the vaccine. Males, not being married/cohabitant, being a faculty member, those who perceived a lower risk of developing COVID-19, and those who did not need information regarding the vaccination against COVID-19 were significantly more likely to have no concern at all regarding the safety of the vaccine. The vast majority (84.1%) were willing to receive a future vaccine against COVID-19. Almost coherently with predictors of concern on the safety of the vaccine, being male, not being married/cohabitant, being a faculty member, not being concerned at all that COVID-19 vaccination might not be safe, and agreeing that COVID-19 can have serious health consequences were significant predictors of the willingness to receive the vaccine against COVID-19. A considerable proportion of the population had a positive willingness to receive the future COVID-19 vaccine, although some concerns have been expressed regarding the effectiveness and safety and public health activities seem necessary to achieve the rate that can lead to the protection of the community. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

14 pages, 1893 KiB

Open AccessArticle

Assessment of Vaccine Hesitancy to a COVID-19 Vaccine in Cameroonian Adults and Its Global Implication

by Jerome Nyhalah Dinga, Leontine Kouemou Sinda and Vincent P. K. Titanji

Vaccines 2021, 9(2), 175; https://doi.org/10.3390/vaccines9020175 - 19 Feb 2021

Cited by 92 | Viewed by 14569

Abstract

Since the outbreak of COVID-19 in December 2019, no global consensus treatment has been developed and generally accepted for the disease. However, eradicating the disease will require a safe and efficacious vaccine. In order to prepare for the eventual development of a safe [...] Read more.

Since the outbreak of COVID-19 in December 2019, no global consensus treatment has been developed and generally accepted for the disease. However, eradicating the disease will require a safe and efficacious vaccine. In order to prepare for the eventual development of a safe and efficacious COVID-19 vaccine and to enhance its uptake, it is imperative to assess vaccine hesitancy in Cameroonians. After obtaining ethical clearance from the Institutional Review Board of the University of Buea, a questionnaire was administered (May–August 2020) to consenting adults either online or in person. A qualitative thematic analysis was done to analyze the participants’ answers to the open questions. A deductive approach was used, that is, the codes and patterns according to the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group Matrix of Determinants of vaccine hesitancy. The number of consenting adult Cameroonians who completed the questionnaire were 2512 (Two thousand five hundred and twelve). Vaccine hesitancy to a COVID-19 vaccine was 84.6% in Cameroonians. Using the WHO recommended Matrix of Determinant of Vaccine hesitancy, the most prominent determinants observed in this study were: Communication and Media Environment, Perception of pharmaceutical industry, Reliability and/or source of vaccine and cost. Most Cameroonians agree that even though there are benefits of a clinical trial, they will prefer it should be done out of the continent and involving African scientists for eventual acceptance and uptake. The concerns of safety, efficacy and confidence has to be addressed using a Public Engagement approach if a COVID-19 vaccine has to be administered successfully in Africa or Cameroon specifically. Since this study was carried out following WHO standards, its result can be compared to those of other studies carried out in different cultural settings using similar standards. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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11 pages, 588 KiB

Open AccessArticle

COVID-19 Vaccine Acceptance in the Democratic Republic of Congo: A Cross-Sectional Survey

by John D. Ditekemena, Dalau M. Nkamba, Armand Mutwadi, Hypolite M. Mavoko, Joseph Nelson Siewe Fodjo, Christophe Luhata, Michael Obimpeh, Stijn Van Hees, Jean B. Nachega and Robert Colebunders

Vaccines 2021, 9(2), 153; https://doi.org/10.3390/vaccines9020153 - 14 Feb 2021

Cited by 95 | Viewed by 9680

Abstract

We investigated the level of willingness for COVID-19 vaccination in the Democratic Republic of Congo (DRC). Data were collected between 24 August 2020 and 8 September 2020 through an online survey. A total of 4131 responses were included; mean age of respondents was [...] Read more.

We investigated the level of willingness for COVID-19 vaccination in the Democratic Republic of Congo (DRC). Data were collected between 24 August 2020 and 8 September 2020 through an online survey. A total of 4131 responses were included; mean age of respondents was 35 years (standard deviation: 11.5); 68.4% were females; 71% had elementary or secondary school education. One fourth (24.1%) were convinced that COVID-19 did not exist. Overall, 2310 (55.9%) indicated they were willing to be vaccinated. In a multivariable regression model, belonging to the middle and high-income category (OR = 1.85, CI: 1.46–2.35 and OR = 2.91, CI: 2.15–3.93, respectively), being tested for COVID-19 (OR = 4.71, CI: 3.62–6.12; p < 0.001), COVID-19 community vaccine acceptance (OR = 14.45, CI: 2.91–71.65; p = 0.001) and acknowledging the existence of COVID-19 (OR = 6.04, CI: 4.42–8.23; p < 0.001) were associated with an increased willingness to be vaccinated. Being a healthcare worker was associated with a decreased willingness for vaccination (OR = 0.46, CI: 0.36–0.58; p < 0.001). In conclusion, the current willingness for COVID-19 vaccination among citizens of the DRC is too low to dramatically decrease community transmission. Of great concern is the low intention of immunization among healthcare workers. A large sensitization campaign will be needed to increase COVID-19 vaccine acceptance. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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10 pages, 240 KiB

Open AccessArticle

HPV Vaccination Attitudes and Behaviors among General Practitioners in Italy

by Francesco Napolitano, Concetta Paola Pelullo, Giorgia Della Polla and Italo Francesco Angelillo

Vaccines 2021, 9(1), 63; https://doi.org/10.3390/vaccines9010063 - 19 Jan 2021

Cited by 18 | Viewed by 2931

Abstract

This cross-sectional electronic online or telephone survey assessed the attitudes and behaviors regarding human papillomavirus (HPV) vaccination and the effect of different factors among a nationally representative random sample of 349 general practitioners (GPs) in Italy. A semi-structured interview was performed between September [...] Read more.

This cross-sectional electronic online or telephone survey assessed the attitudes and behaviors regarding human papillomavirus (HPV) vaccination and the effect of different factors among a nationally representative random sample of 349 general practitioners (GPs) in Italy. A semi-structured interview was performed between September 2018 and October 2020. Almost all respondents considered the HPV vaccine safe with an overall mean value of 8.8, on a scale ranging from 1 to 10, and 59.9% and 32.6% believed that the vaccination was very effective in preventing the related diseases among 12–26 years’ girls and boys. Multivariate logistic regression analysis showed that GPs who had received information about HPV vaccination from scientific journals were more likely to have positive attitude towards the effectiveness of the vaccine in preventing HPV-related diseases in girls between 12–26 years. A large majority (81.5%) of GPs who provided assistance to girls’ patients aged 11–12 years often or always recommend the HPV vaccine to them, and this behavior was more likely to occur in those who believed that the vaccine was very effective in preventing HPV-related diseases in girls between 12–26 years. GPs were more likely to often or always recommend the HPV vaccine to boys aged 11–12 years if they often or always recommended the vaccine to girls aged 11–12 years, if they believed that the vaccine was very effective in preventing HPV-related diseases in boys between 12–26 years, and if they considered the HPV vaccine very safe. GPs should receive information about the HPV immunization to ensure that they routinely communicate with their patient population in order to achieve better coverage rates. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

15 pages, 729 KiB

Open AccessArticle

Change of Willingness to Accept COVID-19 Vaccine and Reasons of Vaccine Hesitancy of Working People at Different Waves of Local Epidemic in Hong Kong, China: Repeated Cross-Sectional Surveys

by Kailu Wang, Eliza Lai-Yi Wong, Kin-Fai Ho, Annie Wai-Ling Cheung, Peter Sen-Yung Yau, Dong Dong, Samuel Yeung-Shan Wong and Eng-Kiong Yeoh

Vaccines 2021, 9(1), 62; https://doi.org/10.3390/vaccines9010062 - 18 Jan 2021

Cited by 182 | Viewed by 22081

Abstract

Vaccine hesitancy is among the major threats to the effectiveness of vaccination programmes. This study aimed to report the trend in response to willingness to accept the COVID-19 vaccine between two waves of the local epidemic and examine differences among occupations. Two cross-sectional [...] Read more.

Vaccine hesitancy is among the major threats to the effectiveness of vaccination programmes. This study aimed to report the trend in response to willingness to accept the COVID-19 vaccine between two waves of the local epidemic and examine differences among occupations. Two cross-sectional surveys were conducted online during the first wave (February) and third wave (August to September) of the local epidemic in 2020. Acceptance of the COVID-19 vaccine was measured along with personal protection behaviours and occupations. A total of 2047 participants provided valid responses. The willingness to accept the COVID-19 vaccine among the participants was lower in the third wave (34.8%) than the first wave (44.2%). There were more concerns over vaccine safety in the third wave. Clerical/service/sales workers were less likely to accept the vaccine (adjusted odds ratio: 0.62, 95% confidence interval: 0.43–0.91). A high-level compliance of facemask wearing was found, and more people maintained social distancing and used alcohol hand rub in the third wave. Decreasing willingness to accept the COVID-19 vaccine may be associated with increasing concerns about vaccine safety and growing compliance of personal protection behaviours. The rush of vaccine development with higher risks of safety issues may jeopardize the public’s trust and lower uptake rates. Education and favourable policy should be provided to the general working population for the vaccination, especially for those who are not professional and are frequently exposed to crowds. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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13 pages, 1630 KiB

Open AccessArticle

A Review of Adherence and Predictors of Adherence to the CONSORT Statement in the Reporting of Tuberculosis Vaccine Trials

by Veranyuy D. Ngah, Akhona V. Mazingisa, Moleen Zunza and Charles S. Wiysonge

Vaccines 2020, 8(4), 770; https://doi.org/10.3390/vaccines8040770 - 16 Dec 2020

Cited by 6 | Viewed by 2831

Abstract

The statement on Consolidated Standards of Reporting Trials (CONSORT) ensures transparency in the reporting of randomized trials. However, it is unclear if the statement has led to improvement in the quality of reporting of tuberculosis (TB) vaccine trials. We explored the quality of [...] Read more.

The statement on Consolidated Standards of Reporting Trials (CONSORT) ensures transparency in the reporting of randomized trials. However, it is unclear if the statement has led to improvement in the quality of reporting of tuberculosis (TB) vaccine trials. We explored the quality of reporting of TB vaccine trials according to the latest version of the CONSORT statement, released in 2010. We searched PubMed and the Cochrane Central Register of Controlled Trials in August 2019. We conducted screening, study selection, and data extraction in duplicate; and resolved differences through discussion. We assessed reporting to be adequate if trials reported at least 75% of the CONSORT 2010 items. We conducted a trend analysis to assess if there was improvement in reporting over time. We also used logistic regression to assess factors associated with adequate reporting. We included 124 trials in the analyses. The mean proportion of adherence was 67.3% (95% confidence interval 64.4% to 70.1%), with only 46 (37%) trials having adequate reporting. There was a significant improvement in the quality of reporting over time (p < 0.0001). Trials published in journals with impact factors between 10 and 20 were more likely to have adequate reporting (odds ratio 9.4; 95% confidence interval 1.30 to 67.8), compared to lower-impact-factor journals. Despite advances over time, the reporting of TB vaccine trials is still inadequate and requires improvement. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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16 pages, 466 KiB

Open AccessArticle

Repertoires of Vaccine Refusal in Romania

by Cosmin Toth

Vaccines 2020, 8(4), 757; https://doi.org/10.3390/vaccines8040757 - 13 Dec 2020

Cited by 12 | Viewed by 4051

Abstract

Repertoires are basic analytic units in discourse analysis and discursive psychology, characterized as repeatable building blocks speakers use for constructing versions of actions. In this study my aim is to analyze public repertoires which are available to parents as discursive resources to substantiate [...] Read more.

Repertoires are basic analytic units in discourse analysis and discursive psychology, characterized as repeatable building blocks speakers use for constructing versions of actions. In this study my aim is to analyze public repertoires which are available to parents as discursive resources to substantiate their decision not to vaccinate their children. Online content, two televised talk shows and a series of interviews with parents who refused vaccination from 2017–2019 were analyzed. As a result of this analysis, I have identified a series of repertoires such as distrust repertoires, rejecting any risks when it comes to children, vaccine ineffectiveness and ‘immunity is a limited resource that should not be forced’. These repertoires do a discursive work that seem to go beyond signs of concern or challenges to vaccine safety to perform a moral and epistemic delegitimization of the current system of medical services, medical research and government authorities. Moreover, the identification of the repertoires that circulate in the public space as resources fulfil a discursive function of replacing the current system with new moral and epistemic perspectives. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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15 pages, 603 KiB

Open AccessArticle

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

by Heather M. Brandt, Beth Sundstrom, Courtney M. Monroe, Gabrielle Turner-McGrievy, Chelsea Larsen, Melissa Stansbury, Karen Magradey, Andrea Gibson and Delia Smith West

Vaccines 2020, 8(4), 749; https://doi.org/10.3390/vaccines8040749 - 10 Dec 2020

Cited by 23 | Viewed by 4147

Abstract

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination [...] Read more.

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by “liking” a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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20 pages, 722 KiB

Open AccessArticle

Attitudes and Beliefs on Influenza Vaccination during the COVID-19 Pandemic: Results from a Representative Italian Survey

by Alexander Domnich, Maura Cambiaggi, Alessandro Vasco, Luca Maraniello, Filippo Ansaldi, Vincenzo Baldo, Paolo Bonanni, Giovanna Elisa Calabrò, Claudio Costantino, Chiara de Waure, Giovanni Gabutti, Vincenzo Restivo, Caterina Rizzo, Francesco Vitale and Riccardo Grassi

Vaccines 2020, 8(4), 711; https://doi.org/10.3390/vaccines8040711 - 30 Nov 2020

Cited by 90 | Viewed by 9763

Abstract

The last 2019/20 northern hemisphere influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. Italy was the first western country where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to a significant extent. In this representative cross-sectional survey, we [...] Read more.

The last 2019/20 northern hemisphere influenza season overlapped with the first wave of coronavirus disease 2019 (COVID-19) pandemic. Italy was the first western country where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to a significant extent. In this representative cross-sectional survey, we aimed to describe some opinions and attitudes of the Italian general population towards both influenza vaccination and the COVID-19 pandemic, and to identify potential modifiers of the decision-making process regarding the uptake of the 2020/21 influenza vaccine. A total of 2543 responses were analyzed. Although most (74.8%) participants valued influenza vaccination positively and declared that it should be mandatory, some misconceptions around influenza persist. The general practitioner was the main source of trusted information on influenza vaccines, while social networks were judged to be the least reliable. Younger and less affluent individuals, subjects not vaccinated in the previous season, and those living in smaller communities showed lower odds of receiving the 2020/21 season influenza vaccination. However, the COVID-19 pandemic may have positively influenced the propensity of being vaccinated against 2020/21 seasonal influenza. In order to increase influenza vaccination coverage rates multidisciplinary targeted interventions are needed. The role of general practitioners remains crucial in increasing influenza vaccine awareness and acceptance by effective counselling. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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8 pages, 246 KiB

Open AccessArticle

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

by Duduzile Ndwandwe, Chukwudi A. Nnaji and Charles S. Wiysonge

Vaccines 2020, 8(4), 705; https://doi.org/10.3390/vaccines8040705 - 25 Nov 2020

Cited by 10 | Viewed by 3619

Abstract

Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV [...] Read more.

Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

10 pages, 218 KiB

Open AccessArticle

Understanding How Adolescents Think about the HPV Vaccine

by Robyn A. Pennella, Katherine A. Ayers and Heather M. Brandt

Vaccines 2020, 8(4), 693; https://doi.org/10.3390/vaccines8040693 - 18 Nov 2020

Cited by 10 | Viewed by 3062

Abstract

Despite educational efforts, Tennessee human papillomavirus (HPV) vaccination rates are 43%, among the lowest in the United States. This study examined how adolescents think about the HPV vaccine to identify patterns and misconceptions to enhance educational efforts. Adolescents (ages 11–12) (N = [...] Read more.

Despite educational efforts, Tennessee human papillomavirus (HPV) vaccination rates are 43%, among the lowest in the United States. This study examined how adolescents think about the HPV vaccine to identify patterns and misconceptions to enhance educational efforts. Adolescents (ages 11–12) (N = 168) responded to open-ended questions regarding their thinking about the HPV vaccine. Data were analyzed and interpreted using qualitative thematic analysis. Three domains of themes emerged from responses: (1) characteristics of HPV vaccination, (2) knowledge-related themes, and (3) beliefs-related themes. Prevention of HPV and cancer was the most referenced characteristic of HPV vaccination followed by HPV vaccine rates and HPV vaccine efficacy. Student inquiries were mostly centered on HPV vaccine composition, administration, duration and how the vaccine interacts with the body. Some responses indicated a desire for more information about HPV not specific to the HPV vaccine. Overall, adolescent attitudes were positive towards the HPV vaccine. This study highlights specific questions adolescents have about the vaccine that can be used to tailor future HPV educational efforts, empowering adolescents with the knowledge to be more active students in the decision-making process. In addition, the potential for adolescents to serve as community advocates for the vaccine should be considered for future interventions. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

14 pages, 2851 KiB

Open AccessArticle

Characterizing News Report of the Substandard Vaccine Case of Changchun Changsheng in China: A Text Mining Approach

by Ping Zhou, Yao He, Chao Lyu and Xiaoguang Yang

Vaccines 2020, 8(4), 691; https://doi.org/10.3390/vaccines8040691 - 17 Nov 2020

Cited by 2 | Viewed by 2973

Abstract

Background: The substandard vaccine case of that broke out in July 2018 in China triggered an outburst of news reports both domestically and aboard. Distilling the abundant textual information is helpful for a better understanding of the character during this public event. Methods [...] Read more.

Background: The substandard vaccine case of that broke out in July 2018 in China triggered an outburst of news reports both domestically and aboard. Distilling the abundant textual information is helpful for a better understanding of the character during this public event. Methods: We collected the texts of 2211 news reports from 83 mainstream media outlets in China between 15 July and 25 August 2018, and used a structural topic model (STM) to identify the major topics and features that emerged. We also used dictionary-based sentiment analysis to uncover the sentiments expressed by the topics as well as their temporal variations. Results: The main topics of the news report fell into six major categories, including: (1) Media Investigation, (2) Response from the Top Authority, (3) Government Action, (4) Knowledge Dissemination, (5) Finance Related and (6) Commentary. The topic prevalence shifted during different stages of the events, illustrating the actions by the government. Sentiments generally spanned from negative to positive, but varied according to different topics. Conclusion: The characteristics of news reports on vaccines are shaped by various topics at different stages. The inner dynamics of the topic and its alterations are driven by the interaction between social sentiment and governmental intervention. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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13 pages, 790 KiB

Open AccessArticle

Parental Vaccine Preferences for Their Children in China: A Discrete Choice Experiment

by Tiantian Gong, Gang Chen, Ping Liu, Xiaozhen Lai, Hongguo Rong, Xiaochen Ma, Zhiyuan Hou, Hai Fang and Shunping Li

Vaccines 2020, 8(4), 687; https://doi.org/10.3390/vaccines8040687 - 16 Nov 2020

Cited by 12 | Viewed by 3845

Abstract

Background: Vaccination is one of the most cost-effective health investments to prevent and control communicable diseases. Improving the vaccination rate of children is important for all nations, and for China in particular since the advent of the two-child policy. This study aims to [...] Read more.

Background: Vaccination is one of the most cost-effective health investments to prevent and control communicable diseases. Improving the vaccination rate of children is important for all nations, and for China in particular since the advent of the two-child policy. This study aims to elicit the stated preference of parents for vaccination following recent vaccine-related incidents in China. Potential preference heterogeneity was also explored among respondents. Methods: A discrete choice experiment was developed to elicit parental preferences regarding the key features of vaccines in 2019. The study recruited a national sample of parents from 10 provinces who had at least one child aged between 6 months and 5 years old. A conditional logit model and a mixed logit model were used to estimate parental preference. Results: A total of 598 parents completed the questionnaire; among them, 428 respondents who passed the rational tests were analyzed. All attributes except for the severity of diseases prevented by vaccines were statistically significant. The risk of severe side effects and protection rates were the two most important factors explaining parents’ decisions about vaccination. The results of the mixed logit model with interactions indicate that fathers or rural parents were more likely to vaccinate their children, and children whose health was not good were also more likely to be vaccinated. In addition, parents who were not more than 30 years old had a stronger preference for efficiency, and well-educated parents preferred imported vaccines with the lowest risk of severe side effects. Conclusion: When deciding about vaccinations for their children, parents in China are mostly driven by vaccination safety and vaccine effectiveness and were not affected by the severity of diseases. These findings will be useful for increasing the acceptability of vaccination in China. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 255 KiB

Open AccessArticle

Association between Exposure to Influenza Vaccination and COVID-19 Diagnosis and Outcomes

by Pietro Ragni, Massimiliano Marino, Debora Formisano, Eufemia Bisaccia, Stefania Scaltriti, Emanuela Bedeschi and Roberto Grilli

Vaccines 2020, 8(4), 675; https://doi.org/10.3390/vaccines8040675 - 12 Nov 2020

Cited by 53 | Viewed by 6540

Abstract

We explored whether influenza vaccination (IV) affects susceptibility to SARS-CoV-2 infection and clinical outcomes in COVID-19 patients in 17,608 residents of the Italian province of Reggio Emilia undergoing a SARS-CoV-2 test. Exposure to IV was ascertained and the strength of the association with [...] Read more.

We explored whether influenza vaccination (IV) affects susceptibility to SARS-CoV-2 infection and clinical outcomes in COVID-19 patients in 17,608 residents of the Italian province of Reggio Emilia undergoing a SARS-CoV-2 test. Exposure to IV was ascertained and the strength of the association with SARS-CoV-2 positivity expressed with odds ratios (OR). Rates of hospitalisations and death in those found positive were assessed and hazard ratios (HR) were estimated. The prevalence of IV was 34.3% in the 4885 SARS-CoV-2 positive and 29.5% in the 12,723 negative subjects, but the adjusted OR indicated that vaccinated individuals had a lower probability of testing positive (OR = 0.89; 95% CI 0.80–0.99). Among the 4885 positive individuals, 1676 had received IV. After adjusting for confounding factors, there was no association between IV and hospitalisation (1.00; 95% CI 0.84–1.29) or death (HR = 1.14; 95% CI 0.95–1.37). However, for patients age ≥65 vaccinated close to the SARS-CoV-2 outbreak, HRs were 0.66 (95% CI: 0.44–0.98) and 0.70 (95% CI 0.50–1.00), for hospitalisation and death, respectively. In this study, IV was associated with a lower probability of COVID-19 diagnosis. In COVID-19 patients, overall, IV did not affect outcomes, although a protective effect was observed for the elderly receiving IV almost in parallel with the SARS-CoV-2 outbreak. These findings provide reassurance in planning IV campaigns and underscore the need for exploring further their impact on COVID-19. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 1050 KiB

Open AccessArticle

Missed Opportunities of Flu Vaccination in Italian Target Categories: Insights from the Online EPICOVID 19 Survey

by Andrea Giacomelli, Massimo Galli, Stefania Maggi, Gabriele Pagani, Raffaele Antonelli Incalzi, Claudio Pedone, Mauro Di Bari, Marianna Noale, Caterina Trevisan, Fabrizio Bianchi, Marcello Tavio, Massimo Andreoni, Claudio Mastroianni, Aleksandra Sojic, Federica Prinelli and Fulvio Adorni

Vaccines 2020, 8(4), 669; https://doi.org/10.3390/vaccines8040669 - 9 Nov 2020

Cited by 7 | Viewed by 4503

Abstract

We aimed to assess the reported rate of flu vaccination in the 2019/2020 season for respondents to the Italian nationwide online EPICOVID 19 survey. A national convenience sample of volunteers aged 18 or older was assessed between 13 April and 2 June 2020. [...] Read more.

We aimed to assess the reported rate of flu vaccination in the 2019/2020 season for respondents to the Italian nationwide online EPICOVID 19 survey. A national convenience sample of volunteers aged 18 or older was assessed between 13 April and 2 June 2020. Flu vaccine rates were calculated for all classes of age. The association between the independent variables and the flu vaccine was assessed by applying a multivariable binary logistic regression model. Of the 198,822 respondents, 41,818 (21.0%) reported having received a flu vaccination shot during the last influenza season. In particular, 15,009 (53.4%) subjects aged 65 years or older received a flu vaccination shot. Being 65 years aged or older (Adjusted Odds Ratios (aOR) 3.06, 95% Confidence Interval (CI) 2.92–3.20) and having a high education level (aOR 1.34. 95%CI 1.28–1.41) were independently associated to flu vaccination. Heart and lung diseases were the morbidities associated with the higher odds of being vaccinated (aOR 1.97 (95%CI 1.86–2.09) and aOR 1.92 (95%CI 1.84–2.01), respectively). Nursing home residents aged ≥ 65 years showed lower odds of being vaccinated (aOR 0.39 (95%CI 0.28–0.54)). Our data indicate the need for an urgent public heath effort to fill the gap of missed vaccination opportunities reported in the past flu seasons. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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14 pages, 2154 KiB

Open AccessArticle

Influenza Vaccination Hesitancy among Healthcare Workers in South Al Batinah Governorate in Oman: A Cross-Sectional Study

by Salah T. Al Awaidy, Zayid K. Al Mayahi, Malak Kaddoura, Ozayr Mahomed, Nathalie Lahoud, Abdinasir Abubakar and Hassan Zaraket

Vaccines 2020, 8(4), 661; https://doi.org/10.3390/vaccines8040661 - 6 Nov 2020

Cited by 19 | Viewed by 4524

Abstract

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families [...] Read more.

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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15 pages, 236 KiB

Open AccessCommunication

Vaccine Hesitancy in China: A Qualitative Study of Stakeholders’ Perspectives

by Ronghui Yang, Bart Penders and Klasien Horstman

Vaccines 2020, 8(4), 650; https://doi.org/10.3390/vaccines8040650 - 3 Nov 2020

Cited by 20 | Viewed by 6050

Abstract

A series of vaccine incidents have stimulated vaccine hesitance in China over the last decade. Many scholars have studied the institutional management of these incidents, but a qualitative study of stakeholders’ perspectives on vaccine hesitancy in China is missing. To address this lacuna, [...] Read more.

A series of vaccine incidents have stimulated vaccine hesitance in China over the last decade. Many scholars have studied the institutional management of these incidents, but a qualitative study of stakeholders’ perspectives on vaccine hesitancy in China is missing. To address this lacuna, we conducted in-depth interviews and collected online data to explore diverse stakeholders’ narratives on vaccine hesitance. Our analysis shows the different perspectives of medical experts, journalists, parents, and self-defined vaccination victims on vaccination and vaccination hesitance. Medical experts generally consider vaccines, despite some flaws, as safe, and they consider most vaccine safety incidents to be related to coupling symptoms, not to vaccinations. Some parents agree with medical experts, but most do not trust vaccine safety and do not want to put their children at risk. Media professionals, online medical experts, and doctors who do not need to align with the political goal of maintaining a high vaccination rate are less positive about vaccination and consider vaccine hesitance a failure of expert–lay communication in China. Our analysis exhibits the tensions of medical expert and lay perspectives on vaccine hesitance, and suggests that vaccination experts ‘see like a state’, which is a finding consistent with other studies that have identified the over-politicization of expert–lay communication in Chinese public discourse. Chinese parents need space to express their concerns so that vaccination programs can attune to them. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

10 pages, 710 KiB

Open AccessArticle

The Experience of VaccinarSinToscana Website and the Role of New Media in Promoting Vaccination

by Sara Boccalini, Paolo Bonanni, Fabrizio Chiesi, Giulia Di Pisa, Federica Furlan, Barbara Giammarco, Beatrice Zanella, Francesco Mandò Tacconi and Angela Bechini

Vaccines 2020, 8(4), 644; https://doi.org/10.3390/vaccines8040644 - 3 Nov 2020

Cited by 17 | Viewed by 3500

Abstract

The Department of Health Sciences (University of Florence) developed a regional website “VaccinarSinToscana” in order to provide information on vaccines and communicate with the general population, as well as the healthcare community, at a regional and local level. The aim of this paper [...] Read more.

The Department of Health Sciences (University of Florence) developed a regional website “VaccinarSinToscana” in order to provide information on vaccines and communicate with the general population, as well as the healthcare community, at a regional and local level. The aim of this paper is to present the VaccinarSinToscana website framework and analyze the three-year activity of the website and the related social network account on Facebook in terms of dissemination and visibility. In the first three years since its launch, the VaccinarSinToscana portal has increased its visibility: the number of single users, visits and single web pages has grown exponentially. Our results also demonstrate how the Facebook account launch contributed enormously to the increase in the visibility of the website. The objective for the future of the VaccinarSinToscana portal is to grow further, in order to reach out to an even wider audience. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 563 KiB

Open AccessArticle

14-year-old Schoolchildren can Consent to Get Vaccinated in Tyrol, Austria: What do They know about Diseases and Vaccinations?

by Peter Kreidl, Maria-Magdalena Breitwieser, Reinhard Würzner and Wegene Borena

Vaccines 2020, 8(4), 610; https://doi.org/10.3390/vaccines8040610 - 15 Oct 2020

Cited by 6 | Viewed by 2768

Abstract

In Austria, consent to receiving vaccines is regulated at the federal state level and in Tyrol, children aged 14 years are allowed to consent to receiving vaccination. In August 2017, we investigated determinants associated with vaccine hesitancy, having been vaccinated against measles and [...] Read more.

In Austria, consent to receiving vaccines is regulated at the federal state level and in Tyrol, children aged 14 years are allowed to consent to receiving vaccination. In August 2017, we investigated determinants associated with vaccine hesitancy, having been vaccinated against measles and human papillomavirus (HPV) and the intention to vaccinate among schoolchildren born in 2002 and 2003. Those who consider measles and HPV a severe disease had a significantly higher intention to be vaccinated (prevalence ratio (PR) of 3.5 (95% CI 1.97–6.32) for measles and a PR of 3.2 (95% CI 1.62–6.35) for HPV). One-third of the participants (32.4%; 95% CI 27.8–37.4) were not aware that they are allowed to consent to receiving vaccines. The most common trusted source reported by respondents (n = 311) was the medical doctor (80.7%; 95% CI 75.7–84.7). The main finding related to the aim of the study was that the proportion of objectors is below 4% and therefore it should still be possible to reach measles elimination for which a 95% uptake is necessary. Although the proportion of objectors is not higher compared to adults, we recommend to intensify health education to increase health literacy. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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20 pages, 1087 KiB

Open AccessArticle

Promoting Influenza Vaccination among Staff of Nursing Homes According to Behavioral Insights: Analyzing the Choice Architecture during a Nudge-Based Intervention

by Chiara Lorini, Francesca Ierardi, Claudia Gatteschi, Giacomo Galletti, Francesca Collini, Laura Peracca, Patrizio Zanobini, Fabrizio Gemmi and Guglielmo Bonaccorsi

Vaccines 2020, 8(4), 600; https://doi.org/10.3390/vaccines8040600 - 12 Oct 2020

Cited by 18 | Viewed by 4882

Abstract

(1) Background: Influenza vaccination uptake in nursing home (NH) workers is uncommon. The aim of this study was to understand the choice architecture of influenza vaccination acceptance or refusal among them and to promote vaccination acceptance using the nudge approach. (2) Methods: In [...] Read more.

(1) Background: Influenza vaccination uptake in nursing home (NH) workers is uncommon. The aim of this study was to understand the choice architecture of influenza vaccination acceptance or refusal among them and to promote vaccination acceptance using the nudge approach. (2) Methods: In autumn 2019, a nudge intervention with a contextual qualitative analysis of choice architecture of vaccination was performed among the staff of eight Tuscan NHs. In summer 2020, a cross-sectional study including the staff of 111 NHs (8 in the nudge, 103 in the comparison group) was conducted to assess the impact of the nudge intervention in promoting vaccination uptake. (3) Results: Macro-categories of motivations for vaccination uptake that emerged from the qualitative analysis were risk perception, value dimension, and trust, while those regarding refusal were risk perception, distrust, value dimension, and reasons related to one’s health. Considering the cross-sectional study, influenza vaccination uptake in the 2018–2019 season was similar in the two groups (23.6% vs. 22.2% respectively, in the nudge and comparison group), but significantly different in the 2019–2020 season: 28% in the nudge vs. 20% in the comparison group. Also, the intention to get the vaccine in the 2020–2021 season was significantly different in the two groups: 37.9% in the nudge and 30.8% in the comparison group. (4) Conclusions: Nudge interventions-simple, fast, low cost-could be effective in promoting vaccination acceptance among NH workers and the analysis of choice architecture could be useful in improving tailored, new nudge interventions aimed at modifying irrational biased and cognitive errors. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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14 pages, 1756 KiB

Open AccessEditor’s ChoiceArticle

Influences on Attitudes Regarding Potential COVID-19 Vaccination in the United States

by Kendall Pogue, Jamie L. Jensen, Carter K. Stancil, Daniel G. Ferguson, Savannah J. Hughes, Emily J. Mello, Ryan Burgess, Bradford K. Berges, Abraham Quaye and Brian D. Poole

Vaccines 2020, 8(4), 582; https://doi.org/10.3390/vaccines8040582 - 3 Oct 2020

Cited by 370 | Viewed by 29761

Abstract

The COVID-19 pandemic continues to ravage the world, with the United States being highly affected. A vaccine provides the best hope for a permanent solution to controlling the pandemic. However, to be effective, a vaccine must be accepted and used by a large [...] Read more.

The COVID-19 pandemic continues to ravage the world, with the United States being highly affected. A vaccine provides the best hope for a permanent solution to controlling the pandemic. However, to be effective, a vaccine must be accepted and used by a large majority of the population. The aim of this study was to understand the attitudes towards and obstacles facing vaccination with a potential COVID-19 vaccine. To measure these attitudes a survey was administered to 316 respondents across the United States by a survey corporation. Structural equation modeling was used to analyze the relationships of several factors with attitudes toward potential COVID-19 vaccination. Prior vaccine usage and attitudes predicted attitudes towards COVID-19 vaccination. Assessment of the severity of COVID-19 for the United States was also predictive. Approximately 68% of all respondents were supportive of being vaccinated for COVID-19, but side effects, efficacy and length of testing remained concerns. Longer testing, increased efficacy and development in the United States were significantly associated with increased vaccine acceptance. Messages promoting COVID-19 vaccination should seek to alleviate the concerns of those who are already vaccine-hesitant. Messaging directed at the benefits of vaccination for the United States as a country would address the second predictive factor. Enough time should be taken to allay concerns about both short- and long-term side effects before a vaccine is released. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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15 pages, 278 KiB

Open AccessArticle

Acceptability of a Hypothetical Zika Vaccine among Women from Colombia and Spain Exposed to ZIKV: A Qualitative Study

by Elena Marbán-Castro, Ana Villén-Gonzalvo, Cristina Enguita-Fernàndez, Kelly Carolina Romero-Acosta, Anna Marín-Cos, Germán J. Arrieta, Salim Mattar, Clara Menéndez, Maria Maixenchs and Azucena Bardají

Vaccines 2020, 8(4), 580; https://doi.org/10.3390/vaccines8040580 - 3 Oct 2020

Cited by 8 | Viewed by 3669

Abstract

Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015–2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women’s willingness to [...] Read more.

Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015–2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women’s willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child’s health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 238 KiB

Open AccessArticle

Vaccinations and Chronic Diseases: Knowledge, Attitudes, and Self-Reported Adherence among Patients in Italy

by Francesco Napolitano, Giorgia Della Polla, Maria Simona Capano, Michela Augimeri and Italo Francesco Angelillo

Vaccines 2020, 8(4), 560; https://doi.org/10.3390/vaccines8040560 - 25 Sep 2020

Cited by 22 | Viewed by 3310

Abstract

The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), [...] Read more.

The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), those with diabetes, those who had received information by Internet, physicians, and friends/relatives, and those who needed more information were more likely to know that the influenza vaccine is recommended for patients with chronic diseases. More than half (58.2%) and 8.9% self-reported to have received at least one recommended vaccination and more than one, respectively. Patients who believed that vaccine-preventable diseases (VPDs) were dangerous for them, those who had received information by physicians, and those who needed information were more likely to have received at least one recommended vaccination. This behavior was less likely in married patients, those who were worried about the side effects of the vaccines, and those who suffered from renal failure. The results highlight the need to implement effective vaccination programs in order to decrease the complication of VPDs in at-risk population. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

11 pages, 235 KiB

Open AccessArticle

Meningococcal Disease and Related Vaccinations: Knowledge, Attitudes, and Practices among Healthcare Workers Who Provide Care to Patients with Underlying High-Risk Medical Conditions

by Gabriella Di Giuseppe, Concetta P. Pelullo, Giorgia Della Polla and Maria Pavia

Vaccines 2020, 8(3), 543; https://doi.org/10.3390/vaccines8030543 - 18 Sep 2020

Cited by 12 | Viewed by 3221

Abstract

This cross-sectional study assessed knowledge, attitudes, and practices regarding meningococcal disease and related vaccinations among healthcare workers (HCWs) who provided care to patients with underlying high-risk medical conditions. A total of 411 HCWs returned the survey. Only 35% of the respondents had a [...] Read more.

This cross-sectional study assessed knowledge, attitudes, and practices regarding meningococcal disease and related vaccinations among healthcare workers (HCWs) who provided care to patients with underlying high-risk medical conditions. A total of 411 HCWs returned the survey. Only 35% of the respondents had a good knowledge about the incidence and lethality of meningococcal disease, the most frequent serogroups in Italy and the diseases or conditions that expose patients to a high-risk of severe complications caused by meningococcal disease. Vaccination against meningococcal disease was perceived to be highly effective by 38.4% of participants, very safe by 36.2%, and 82% agreed or strongly agreed that HCWs should promote adherence to recommended vaccinations even in hesitant patients. Moreover, 34.1% recommended meningococcal vaccinations to all eligible patients and the results of the multivariate analysis showed that older HCWs, who work in pediatric/neonatal wards, have good knowledge about meningococcal vaccinations, have a favourable attitude towards vaccinations, and do not need additional information about meningococcal vaccinations, were more likely to recommend meningococcal vaccinations to all eligible patients. Interventions aimed at the enhancement of knowledge and awareness of HCWs who provide care to these patients on the benefits of meningococcal vaccinations are warranted. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

11 pages, 986 KiB

Open AccessArticle

Relationship between Influenza Vaccination Coverage Rate and COVID-19 Outbreak: An Italian Ecological Study

by Mauro Amato, José Pablo Werba, Beatrice Frigerio, Daniela Coggi, Daniela Sansaro, Alessio Ravani, Palma Ferrante, Fabrizio Veglia, Elena Tremoli and Damiano Baldassarre

Vaccines 2020, 8(3), 535; https://doi.org/10.3390/vaccines8030535 - 16 Sep 2020

Cited by 106 | Viewed by 24458

Abstract

Background: The lack of specific vaccines or drugs against coronavirus disease 2019 (COVID-19) warrants studies focusing on alternative clinical approaches to reduce the spread of this pandemic disease. In this study, we investigated whether anti-influenza vaccination plays a role in minimizing the diffusion [...] Read more.

Background: The lack of specific vaccines or drugs against coronavirus disease 2019 (COVID-19) warrants studies focusing on alternative clinical approaches to reduce the spread of this pandemic disease. In this study, we investigated whether anti-influenza vaccination plays a role in minimizing the diffusion of COVID-19 in the Italian population aged 65 and over. Methods: Four COVID-19 outcomes were used: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, hospitalizations for COVID-19 symptoms, admissions to intensive care units for reasons related to SARS-CoV-2, and deaths attributable to COVID-19. Results: At univariate analyses, the influenza vaccination coverage rates correlated negatively with all COVID-19 outcomes (Beta ranging from −134 to −0.61; all p < 0.01). At multivariable analyses, influenza vaccination coverage rates correlated independently with SARS-CoV-2 seroprevalence (Beta (95% C.I.): −130 (−198, −62); p = 0.001), hospitalizations for COVID-19 symptoms (Beta (95% C.I.): −4.16 (−6.27, −2.05); p = 0.001), admission to intensive care units for reasons related to SARS-CoV-2 (Beta (95% C.I.): −0.58 (−1.05, −0.12); p = 0.017), and number of deaths attributable to COVID-19 (Beta (95% C.I.): −3.29 (−5.66, −0.93); p = 0.010). The R² observed in the unadjusted analysis increased from 82% to 159% for all the considered outcomes after multivariable analyses. Conclusions: In the Italian population, the coverage rate of the influenza vaccination in people aged 65 and over is associated with a reduced spread and a less severe clinical expression of COVID-19. This finding warrants ad hoc studies to investigate the role of influenza vaccination in preventing the spread of COVID-19. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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11 pages, 373 KiB

Open AccessArticle

Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment

by Na Guo, Jian Wang, Stephen Nicholas, Elizabeth Maitland and Dawei Zhu

Vaccines 2020, 8(3), 527; https://doi.org/10.3390/vaccines8030527 - 14 Sep 2020

Cited by 16 | Viewed by 4406

Abstract

Understanding behavioral factors differences in the preferences for vaccinations can improve predictions of vaccine uptake rates and identify effective policy interventions to increase the demand for vaccinations. In this study, 353 adults in Shandong province in China were interviewed about their preferences for [...] Read more.

Understanding behavioral factors differences in the preferences for vaccinations can improve predictions of vaccine uptake rates and identify effective policy interventions to increase the demand for vaccinations. In this study, 353 adults in Shandong province in China were interviewed about their preferences for hepatitis B virus (HBV) vaccination. A discrete choice experiment (DCE) was employed to analyze the preference for HBV vaccinations, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE. While the protection rate against hepatitis B (HB), duration of protection, risk of side-effects, and vaccination cost were shown to influence adults’ preferences for HBV vaccination, adults valued “99% hepatitis B protection” above other attributes, followed by “20 years’ protection duration” and “1 in 150,000 risk of side-effects”. Individuals with lower time discount rates, non-overconfidence, or higher risk aversion were more likely to choose a vaccine. Lower risk aversion individuals showed a higher preference for lower risk of side-effects. Lower time discount rate individuals showed a higher preference for longer protection duration. Non-overconfidence individuals showed a higher preference for higher hepatitis B protection and cost. Interventions should be targeted to the behavioral determinants impeding vaccination. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 1560 KiB

Open AccessArticle

Trends, Spatial Disparities, and Social Determinants of DTP3 Immunization Status in Indonesia 2004–2016

by Holipah Holipah, Asri Maharani, Sujarwoto Sujarwoto, Takuji Hinoura and Yoshiki Kuroda

Vaccines 2020, 8(3), 518; https://doi.org/10.3390/vaccines8030518 - 10 Sep 2020

Cited by 4 | Viewed by 3492

Abstract

Although 91% of 12–23-month-old children in Indonesia received at least one immunization in 2013, only 76% completed DTP3 immunization. This percentage is below the UNICEF and WHO recommended standards. Thus, this study aims to investigate trends, spatial disparities, and social determinants related to [...] Read more.

Although 91% of 12–23-month-old children in Indonesia received at least one immunization in 2013, only 76% completed DTP3 immunization. This percentage is below the UNICEF and WHO recommended standards. Thus, this study aims to investigate trends, spatial disparities, and social determinants related to low coverage of DTP3 immunization in Indonesia. Using a multilevel approach, we analyzed data from 305,090 12–23-month-old children living across approximately 500 districts in Indonesia to study demand and supply factors determining DTP3 immunization status. We examined unique, nationally representative data from the National Socioeconomic Survey (Survei Sosial Ekonomi Nasional or Susenas) and Village Potential Census (Potensi Desa or Podes) from 2004 to 2016. The percentage of children receiving complete DTP3 immunization increased from 37.8% in 2004 to 75.9% in 2016. Primarily income, parity status, and education, showed influence on DTP3 coverage. Among individual-level factors, the presence of a professional birth attendant was the most influential factor. At the district level, the factors varied. Low progress in DTP3 immunization status in Indonesia is due to huge disparities across the country’s islands, in the density of health services, and in household socioeconomic status. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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13 pages, 259 KiB

Open AccessArticle

A Comparison of the Attitudes to Influenza Vaccination Held by Nursing, Midwifery, Pharmacy, and Public Health Students and Their Knowledge of Viral Infections

by Sylwia Kałucka, Elżbieta Dziankowska-Zaborszczyk, Izabela Grzegorczyk-Karolak and Agnieszka Głowacka

Vaccines 2020, 8(3), 516; https://doi.org/10.3390/vaccines8030516 - 9 Sep 2020

Cited by 12 | Viewed by 3582

Abstract

Influenza is a viral vaccine-preventable disease. The present study aims to explore the attitude to influenza immunization and the knowledge of influenza among students in Poland. A cross-sectional survey was conducted at the end of 2019 and the beginning of 2020 among students [...] Read more.

Influenza is a viral vaccine-preventable disease. The present study aims to explore the attitude to influenza immunization and the knowledge of influenza among students in Poland. A cross-sectional survey was conducted at the end of 2019 and the beginning of 2020 among students of Nursing, Midwifery, Pharmacy, and Public health in all years of study. Data was obtained from 1137 students (90.7% female, 9.3% male), mean age 21.3 ± 1.62 years. The urban students were more likely to be vaccinated against seasonal influenza than rural students (OR: 1.52; 95% CI [1.10–2.10], p = 0.010362). The students of Public health were more likely to be vaccinated against influenza (48.9%, regularly annually 1.1%) than Pharmacy (31%, regularly annually 2.5%), Nursing (30.7%, regularly annually 1.3%) or Midwifery (25.1%, regularly annually 2.4%). First-year and second-year students were vaccinated more often (OR: 2.75; 95% CI [1.99–3.82], p = 0.00000; OR: 1.84; 95% CI [1.32–2.59], p = 0.0004, respectively) than later-year students. All students reported the main reasons for vaccination to be their own protection and parental decision. Concluded, present findings demonstrate a low prevalence of flu vaccination among medical students. Therefore, strategies are needed to increase the uptake of influenza vaccine in students, especially considering the future contact between this group of future health care workers and higher risk groups. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 285 KiB

Open AccessArticle

Healthcare Workers Training Courses on Vaccinations: A Flexible Format Easily Adaptable to Different Healthcare Settings

by Laura Serino, Massimo Maurici, Gian Loreto D’Alò, Fabiana Amadori, Elisa Terracciano, Laura Zaratti, Elisabetta Franco and Local Health Units Vaccination Group

Vaccines 2020, 8(3), 514; https://doi.org/10.3390/vaccines8030514 - 8 Sep 2020

Cited by 4 | Viewed by 2763

Abstract

Since 2017, Italy has expanded the compulsory vaccination from 4 to 10 for those aged 0 to 16 years. Because of the great organizational effort required for the immunization services, minor attention was given to the vaccinations not included among the mandatory ones. [...] Read more.

Since 2017, Italy has expanded the compulsory vaccination from 4 to 10 for those aged 0 to 16 years. Because of the great organizational effort required for the immunization services, minor attention was given to the vaccinations not included among the mandatory ones. This situation led to a real difficulty in harmonizing the vaccination procedures even inside a single region. In the Lazio region, the Laboratory of Vaccinology of the University of Rome Tor Vergata established a working group to create a new training model for healthcare professionals. The course program proposed an update of three vaccinations which are not mandatory but actively offered. It included the same part of scientific updating and a variable part based on local experiences. A specific anonymous questionnaire on knowledge and attitude was administered. The study aimed to propose a general format of training courses for vaccination centers adaptable to the individual local health units (ASLs) and to evaluate through questionnaires. The results show differences in knowledge and attitudes toward non-mandatory vaccinations among the ASLs of Lazio, confirming the usefulness of a support to make knowledge and procedures homogeneous. This model could be adapted to any healthcare setting and exported to other services. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 232 KiB

Open AccessArticle

Investigating HPV- and HPV Vaccine-Related Knowledge, Perceptions, and Information Sources among Health Care Providers in Three Big Cities in China

by Jie Li, Jingshi Kang, Yimeng Mao, Pinpin Zheng, Abu S Abdullah, Guoli Wu and Fan Wang

Vaccines 2020, 8(3), 499; https://doi.org/10.3390/vaccines8030499 - 2 Sep 2020

Cited by 9 | Viewed by 3852

Abstract

The limited access to vaccination and vaccine hesitancy are prevalent even among health care providers in less developed countries. This study assessed the relationships between (i) health care providers’ knowledge on human papillomavirus (HPV) and vaccination for HPV and (ii) their perceptions, demographic [...] Read more.

The limited access to vaccination and vaccine hesitancy are prevalent even among health care providers in less developed countries. This study assessed the relationships between (i) health care providers’ knowledge on human papillomavirus (HPV) and vaccination for HPV and (ii) their perceptions, demographic characteristics, and the use of information sources. In this large-scale online survey, participants (n = 1394) were recruited from hospitals of three big cities in China (Shanghai, Guangzhou, and Shenzhen). Descriptive analysis, the chi-square test, and logistic regression analysis were used to answer different research questions. Health care providers’ overall knowledge scores are consistent with their perceptions about HPV and HPV vaccine. Occupation, specialty, the type of hospitals, and the frequency of participants’ search for information using professional informational sources are the most significant characteristics that are closely associated with their knowledge of HPV and its vaccine. Targeted educational interventions are needed to improve health care providers’ engagement in the promotion of the HPV vaccine. Such interventions, besides increasing knowledge, should also emphasize the importance of appropriate information sources to acquire information. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

14 pages, 864 KiB

Open AccessEditor’s ChoiceArticle

Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China

by Jiahao Wang, Rize Jing, Xiaozhen Lai, Haijun Zhang, Yun Lyu, Maria Deloria Knoll and Hai Fang

Vaccines 2020, 8(3), 482; https://doi.org/10.3390/vaccines8030482 - 27 Aug 2020

Cited by 671 | Viewed by 50297

Abstract

Background: Faced with the coronavirus disease 2019 (COVID-19) pandemic, the development of COVID-19 vaccines has been progressing at an unprecedented rate. This study aimed to evaluate the acceptance of COVID-19 vaccination in China and give suggestions for vaccination strategies and immunization programs accordingly. [...] Read more.

Background: Faced with the coronavirus disease 2019 (COVID-19) pandemic, the development of COVID-19 vaccines has been progressing at an unprecedented rate. This study aimed to evaluate the acceptance of COVID-19 vaccination in China and give suggestions for vaccination strategies and immunization programs accordingly. Methods: In March 2020, an anonymous cross-sectional survey was conducted online among Chinese adults. The questionnaire collected socio-demographic characteristics, risk perception, the impact of COVID-19, attitudes, acceptance and attribute preferences of vaccines against COVID-19 during the pandemic. Multivariate logistic regression was performed to identify the influencing factors of vaccination acceptance. Results: Of the 2058 participants surveyed, 1879 (91.3%) stated that they would accept COVID-19 vaccination after the vaccine becomes available, among whom 980 (52.2%) wanted to get vaccinated as soon as possible, while others (47.8%) would delay the vaccination until the vaccine’s safety was confirmed. Participants preferred a routine immunization schedule (49.4%) to emergency vaccination (9.0%) or either of them (41.6%). Logistic regression showed that being male, being married, perceiving a high risk of infection, being vaccinated against influenza in the past season, believing in the efficacy of COVID-19 vaccination or valuing doctor’s recommendations could increase the probability of accepting COVID-19 vaccination as soon as possible, while having confirmed or suspected cases in local areas, valuing vaccination convenience or vaccine price in decision-making could hinder participants from immediate vaccination. Conclusion: During the pandemic period, a strong demand for and high acceptance of COVID-19 vaccination has been shown among the Chinese population, while concerns about vaccine safety may hinder the promotion of vaccine uptake. To expand vaccination coverage, immunization programs should be designed to remove barriers in terms of vaccine price and vaccination convenience, and health education and communication from authoritative sources are important ways to alleviate public concerns about vaccine safety. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 553 KiB

Open AccessArticle

Effectiveness and Impact of the 4CMenB Vaccine against Group B Meningococcal Disease in Two Italian Regions Using Different Vaccination Schedules: A Five-Year Retrospective Observational Study (2014–2018)

by Chiara Azzari, Maria Moriondo, Francesco Nieddu, Valentina Guarnieri, Lorenzo Lodi, Clementina Canessa, Giuseppe Indolfi, Mattia Giovannini, Giuseppina Napoletano, Francesca Russo, Tatjana Baldovin, Silvia Cocchio, Silvia Ricci and Vincenzo Baldo

Vaccines 2020, 8(3), 469; https://doi.org/10.3390/vaccines8030469 - 22 Aug 2020

Cited by 51 | Viewed by 7324

Abstract

Background: A few years after the introduction in Italy of a four-component anti-meningococcal B vaccine (4CMenB), we evaluated the effectiveness and impact of vaccination in two regions using different schedules (2, 4, 6, 12 months in Tuscany vs. 7, 9, 15 months in [...] Read more.

Background: A few years after the introduction in Italy of a four-component anti-meningococcal B vaccine (4CMenB), we evaluated the effectiveness and impact of vaccination in two regions using different schedules (2, 4, 6, 12 months in Tuscany vs. 7, 9, 15 months in Veneto) through an observational retrospective study. Methods: Vaccination started in 2014 in Tuscany and in 2015 in Veneto; the data collected referred to the period 2006–2018 for Tuscany and 2007–2018 for Veneto. Cases of invasive meningococcal disease due to N. Meningitidis B were identified by culture and/or real-time PCR. Results: In Tuscany, pre-vaccine incidence was 1.96 (95% CL 1.52; 2.40) and dropped to 0.62 (95% CL 0.60; 0.64) in the post-4CMenB era. Evaluating only vaccinated children, post-4CMenB incidence was 0.12 (95% CL 0.08; 0.15). In Veneto pre-vaccine incidence was 1.94 (95% CL 1.92; 1.96) and dropped to 1.34 (95% CL 1.31; 1.38) in the post-4CMenB era. In the vaccinated population, MenB incidence was 0.53 (95% CL 0.50; 0.56). Vaccine effectiveness was 93.6% (95% CL 55.4; 99.1) in Tuscany and 91.0% (95% CL 59.9; 97.9) in Veneto, with mean vaccine coverages of 83.9% and 81.7%, respectively. The overall impact (evaluating both vaccinated and unvaccinated children) was 0.68 (95% CL 0.10; 0.89) in Tuscany and 0.31 (95% CL −0.56; 0.69) in Veneto; the total impact (evaluating only vaccinated children) was 0.94 (95% CL 0.56; 0.99) and 0.90 (95% CL 0.57; 0.97), respectively. The relative case reduction (RCR) was 65% in Tuscany and 31% in Veneto. Considering the vaccinated population, the RCR was equal to 91% and 80%, respectively. Conclusion: In conclusion, 4CMenB appears to have a very high effectiveness in Italy; the impact of vaccination appears greater where the immunization program is started early. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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13 pages, 744 KiB

Open AccessArticle

Incidence of Guillain-Barré Syndrome Is Not Associated with Influenza Vaccination in the Elderly

by Hankil Lee, Hye-Young Kang, Sun-Young Jung and Young-Mock Lee

Vaccines 2020, 8(3), 431; https://doi.org/10.3390/vaccines8030431 - 31 Jul 2020

Cited by 6 | Viewed by 3806

Abstract

We aimed to analyze the incidence of Guillain-Barré syndrome (GBS) and its association with influenza vaccination (IV) in the elderly population. This study included 2470 patients hospitalized with GBS (G61.0) between 2014 and 2016 based on the Korean National Health Insurance Service (NHIS) [...] Read more.

We aimed to analyze the incidence of Guillain-Barré syndrome (GBS) and its association with influenza vaccination (IV) in the elderly population. This study included 2470 patients hospitalized with GBS (G61.0) between 2014 and 2016 based on the Korean National Health Insurance Service (NHIS) claims data. We reviewed every medical claim in the 42 days preceding GBS diagnosis looking for precedent causes of GBS. To assess the relationship between IV and the development of GBS, data from the NHIS and the National Vaccination Registry were combined and analyzed. Using a self-controlled case series (SCCS) approach, we calculated the incidence rate ratio by setting the risk period as 42 days following vaccination. The annual background incidence of GBS was estimated at 4.15 per 100,000 persons. More than half of the patients with newly developed GBS had a previous infection or surgery. The incidence of GBS within 42 days of IV was estimated at 0.32 per 100,000 vaccinated persons. SCCS analysis showed that the risk of GBS was not significantly higher. While GBS can potentially develop from various infections, no association was found between GBS and IV. These results will contribute to developing an evidence-based vaccine policy that includes a clear causality assessment of adverse events. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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14 pages, 1814 KiB

Open AccessArticle

Significantly Improved COVID-19 Outcomes in Countries with Higher BCG Vaccination Coverage: A Multivariable Analysis

by Danielle Klinger, Ido Blass, Nadav Rappoport and Michal Linial

Vaccines 2020, 8(3), 378; https://doi.org/10.3390/vaccines8030378 - 11 Jul 2020

Cited by 54 | Viewed by 19511

Abstract

The COVID-19 pandemic that started in China has spread within 3 months to the entire globe. We tested the hypothesis that the vaccination against tuberculosis by Bacille Calmette–Guérin vaccine (BCG) correlates with a better outcome for COVID-19 patients. Our analysis covers 55 countries [...] Read more.

The COVID-19 pandemic that started in China has spread within 3 months to the entire globe. We tested the hypothesis that the vaccination against tuberculosis by Bacille Calmette–Guérin vaccine (BCG) correlates with a better outcome for COVID-19 patients. Our analysis covers 55 countries complying with predetermined thresholds on the population size and number of deaths per million (DPM). We found a strong negative correlation between the years of BCG administration and the DPM along with the progress of the pandemic, corroborated by permutation tests. The results from multivariable regression tests with 23 economic, demographic, health-related, and pandemic restriction-related quantitative properties, substantiate the dominant contribution of BCG years to the COVID-19 outcomes. The analysis of countries according to an age-group partition reveals that the strongest correlation is attributed to the coverage in BCG vaccination of the young population (0–24 years). Furthermore, a strong correlation and statistical significance are associated with the degree of BCG coverage for the most recent 15 years, but no association was observed in these years for other broadly used vaccination protocols for measles and rubella. We propose that BCG immunization coverage, especially among the most recently vaccinated population, contribute to attenuation of the spread and severity of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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10 pages, 224 KiB

Open AccessArticle

Strategies to Improve Vaccination among At-Risk Adults and the Elderly in Italy

by Giovanna Elisa Calabrò, Alessia Tognetto, Elettra Carini, Silvia Mancinelli, Laura Sarnari, Vittoria Colamesta, Walter Ricciardi and Chiara de Waure

Vaccines 2020, 8(3), 358; https://doi.org/10.3390/vaccines8030358 - 4 Jul 2020

Cited by 5 | Viewed by 3688

Abstract

The World Health Organization (WHO), the United States (US) Centers for Disease Control and Prevention (CDC), the European Center for Disease Control (ECDC), and the immunization guidelines of many countries issue vaccination recommendations for adults and the elderly. However, the uptake of vaccination [...] Read more.

The World Health Organization (WHO), the United States (US) Centers for Disease Control and Prevention (CDC), the European Center for Disease Control (ECDC), and the immunization guidelines of many countries issue vaccination recommendations for adults and the elderly. However, the uptake of vaccination in these groups is generally low due to several reasons. The present study aimed to identify strategies implemented in Italy in unconventional settings to promote vaccination against influenza, pneumococcal, and herpes zoster virus (HZV) infections among these subjects, i.e., the at-risk adult population and the elderly. We conducted a literature review and a survey of experts. The literature search yielded seven strategies; all of these concerned influenza vaccination, while three also addressed pneumococcal and HZV vaccination. The survey of experts identified 15 strategies; 10 regarded influenza vaccination, while four regarded pneumococcal vaccination and one regarded HZV vaccination. Most of the strategies were implemented in hospital clinics and rest homes. Regarding influenza and pneumococcal vaccinations, the target population mainly comprised at-risk adults, while the elderly represented the main target population for HZV vaccination. Our results show that, in Italy, there are initiatives aimed at promoting vaccination in unconventional settings, but further efforts are required to assess their effectiveness and to further extend them. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

11 pages, 882 KiB

Open AccessArticle

Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study

by Silvia Cocchio, Tolinda Gallo, Stefania Del Zotto, Elena Clagnan, Andrea Iob, Patrizia Furlan, Marco Fonzo, Chiara Bertoncello and Vincenzo Baldo

Vaccines 2020, 8(3), 344; https://doi.org/10.3390/vaccines8030344 - 28 Jun 2020

Cited by 9 | Viewed by 3759

Abstract

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact [...] Read more.

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016–2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R² = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59–0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70–0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59–0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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19 pages, 1725 KiB

Open AccessArticle

Grippenet: A New Tool for the Monitoring, Risk-Factor and Vaccination Coverage Analysis of Influenza-Like Illness in Switzerland

by Aude Richard, Laura Müller, Ania Wisniak, Amaury Thiabaud, Thibaut Merle, Damien Dietrich, Daniela Paolotti, Emilien Jeannot and Antoine Flahault

Vaccines 2020, 8(3), 343; https://doi.org/10.3390/vaccines8030343 - 27 Jun 2020

Cited by 3 | Viewed by 3367

Abstract

Implemented in Switzerland in November 2016, Grippenet provides Internet-based participatory surveillance of influenza-like illness (ILI). The aim of this research is to test the feasibility of such a system and its ability to detect risk factors and to assess ILI-related behaviors. Participants filled [...] Read more.

Implemented in Switzerland in November 2016, Grippenet provides Internet-based participatory surveillance of influenza-like illness (ILI). The aim of this research is to test the feasibility of such a system and its ability to detect risk factors and to assess ILI-related behaviors. Participants filled in a web-based socio-demographic and behavioral questionnaire upon registration, and a weekly symptoms survey during the influenza season. ILI incidence was calculated weekly, and risk factors associated to ILI were analyzed at the end of each season. From November 2016 to May 2019, 1247 participants were included. The crossing of the Sentinel System (Sentinella) epidemic threshold was associated with an increase or decrease of Grippenet ILI incidence, within the same week or earlier. The number of active users varied according to ILI incidence. Factors associated with ILI were: ages 0–4 compared with 5–14 (adjusted odds ratio (AOR) 0.6, 95% confidence interval (CI) 0.19–0.99), 15–29 (AOR 0.29, 95% CI 0.15–0.60), and 65+ (AOR 0.38, 95% CI 0.16–0.93); female sex (male AOR 0.81, 95% CI 0.7–0.95); respiratory allergies (AOR 1.58, 95% CI 1.38–1.96), not being vaccinated (AOR 2.4, 95% CI 1.9–3.04); and self-employment (AOR 1.97, 95% CI 1.33–3.03). Vaccination rates were higher than those of the general population but not high enough to meet the Swiss recommendations. Approximately, 36.2% to 42.5% of users who reported one or more ILIs did not seek medical attention. These results illustrate the potential of Grippenet in complementing Sentinella for ILI monitoring in Switzerland. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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6 pages, 218 KiB

Open AccessCommunication

Strengthening the Evidence-Based Approach to Guiding Effective Influenza Vaccination Policies

by Giovanna Elisa Calabrò, Maria Lucia Specchia, Sara Boccalini, Donatella Panatto, Caterina Rizzo, Stefano Merler, Anna Maria Ferriero, Maria Luisa Di Pietro, Paolo Bonanni and Chiara de Waure

Vaccines 2020, 8(3), 342; https://doi.org/10.3390/vaccines8030342 - 27 Jun 2020

Cited by 7 | Viewed by 3232

Abstract

The availability of several effective and safe vaccines enables health systems to counteract annual influenza epidemics. However, the criteria of appropriateness and sustainability require that each citizen should receive the right vaccine. The value of each vaccine can be assessed within well-known frameworks, [...] Read more.

The availability of several effective and safe vaccines enables health systems to counteract annual influenza epidemics. However, the criteria of appropriateness and sustainability require that each citizen should receive the right vaccine. The value of each vaccine can be assessed within well-known frameworks, such as the Health Technology Assessment (HTA), a step that is fundamental to the process of allocating resources to vaccination strategies. The paper describes how HTA has been incorporated as an evidence-based tool to support the definition of Italian vaccination strategies, reports the results of the HTA report on the most recently available influenza vaccine in Italy (cell-based quadrivalent vaccine (QIVc)—Flucelvax^® Tetra) and elaborates on current and future recommendations in the field of influenza vaccination. Recommendations issued by the Italian Ministry of Health foster the appropriate use of influenza vaccines from 2018–2019 onwards. Evidence of the value of newly available vaccines will hopefully support future decisions and promote the appropriate use of these vaccines on the basis of the characteristics of the target population. However, the success of influenza vaccination will also depend on citizens’ empowerment and engagement in the decision-making process. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

6 pages, 622 KiB

Open AccessCommunication

Risk Assessment and Virological Monitoring Following an Accidental Exposure to Concentrated Sabin Poliovirus Type 3 in France, November 2018

by Marion Jeannoël, Denise Antona, Clément Lazarus, Bruno Lina and Isabelle Schuffenecker

Vaccines 2020, 8(2), 331; https://doi.org/10.3390/vaccines8020331 - 22 Jun 2020

Cited by 3 | Viewed by 2882

Abstract

The safe and secure containment of infectious poliovirus (PV) in facilities where live PV are handled is the condition to achieve and maintain poliomyelitis eradication. Despite precautions to minimize the risk of release of PV from such facilities to the environment, breaches of [...] Read more.

The safe and secure containment of infectious poliovirus (PV) in facilities where live PV are handled is the condition to achieve and maintain poliomyelitis eradication. Despite precautions to minimize the risk of release of PV from such facilities to the environment, breaches of containment have already been documented. Here, we report the management of an incident that occurred on 30 November 2018 in a French vaccine manufacturing plant. Five adequately vaccinated operators were exposed to a Sabin poliovirus type 3 (PV3) spill. A microbiological risk assessment was conducted and the operators were monitored for PV shedding. On day 5 after exposure, Sabin PV3 was detected only in the stool sample of the most exposed worker. Shedding of Sabin PV3 (as detected by viral culture) was restricted to a very short period (less than 15 days). Monitoring of this incident was an opportunity to assess the relevance of our national response plan. We concluded that the measures undertaken and reported here were appropriate and proportional. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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18 pages, 640 KiB

Open AccessArticle

Trends, Coverage and Influencing Determinants of Influenza Vaccination in the Elderly: A Population-Based National Survey in Spain (2006–2017)

by Silvia Portero de la Cruz and Jesús Cebrino

Vaccines 2020, 8(2), 327; https://doi.org/10.3390/vaccines8020327 - 19 Jun 2020

Cited by 18 | Viewed by 3922

Abstract

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to [...] Read more.

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to report the coverage of influenza vaccination in Spain among the population aged ≥65 years and high-risk groups for suffering chronic diseases, to analyze the time trends from 2006 to 2017 and to identify the factors which affect vaccination coverage. A nationwide cross-sectional study was conducted including 20,753 non-institutionalized individuals aged ≥65 years who had participated in the Spanish National Health Surveys in 2006, 2011/2012, and 2017. Sociodemographic, health-related variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with influenza vaccination. Influenza vaccination coverage was 60%. By chronic condition, older people with high cholesterol levels and cancer had the lowest vaccination coverage (62.41% and 60.73%, respectively). This coverage declined from 2006 to 2017 in both groups. Higher influenza vaccination was associated with males, Spanish nationality, normal social support perceived, polypharmacy, worse perceived health, participation in other preventive measures, and increasing age and the number of chronic diseases. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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17 pages, 1888 KiB

Open AccessArticle

Defining Elimination of Genital Warts—A Modified Delphi Study

by Laila Khawar, Dorothy A. Machalek, David G. Regan, Basil Donovan, Skye McGregor and Rebecca J. Guy

Vaccines 2020, 8(2), 316; https://doi.org/10.3390/vaccines8020316 - 18 Jun 2020

Cited by 1 | Viewed by 4061

Abstract

Background: Substantial declines in genital warts (GW) have been observed in countries with quadrivalent HPV vaccination programmes, with Australia showing the highest reductions due to early commencement and high vaccination coverage. There is a real potential to achieve GW elimination; however, no GW [...] Read more.

Background: Substantial declines in genital warts (GW) have been observed in countries with quadrivalent HPV vaccination programmes, with Australia showing the highest reductions due to early commencement and high vaccination coverage. There is a real potential to achieve GW elimination; however, no GW elimination definition exists. Taking Australia as a case study, we aimed to reach expert consensus on a proposed GW elimination definition using a modified Delphi process. Method: We used modelling and epidemiological data to estimate the expected number of new GW cases, from pre-vaccination (baseline) in 2006 to the year 2060 in Australian heterosexuals, men who have sex with men (MSM), and newly arrived international travellers and migrants. We used these data and the literature, to develop a questionnaire containing ten elimination-related items, each with 9-point Likert scales (1—strongly disagree; 9—strongly agree). The survey was completed by 18 experts who participated in a full day face-to-face modified Delphi study, in which individuals and then small groups discussed and scored each item. The process was repeated online for items where consensus (≥70% agreement) was not initially achieved. Median and coefficient of variation (COV) were used to describe the central tendency and variability of responses, respectively. Findings: There was a 95% participation rate in the face-to-face session, and 84% response rate in the final online round. The median item score ranged between 7.0 and 9.0 and the COV was ≤0.30 on all items. Consensus was reached that at ≥80% HPV vaccination coverage, GW will be eliminated as a public health problem in Australia by 2060. During this time period there will be a 95% reduction in population-level incidence compared with baseline, equivalent to <1 GW case per 10,000 population. The reductions will occur most rapidly in Australian heterosexuals, with 73%, 90% and 97% relative reductions by years 2021, 2030 and 2060, respectively. The proportion of new GW cases attributable to importation will increase from 3.6% in 2006 to ~49% in 2060. Interpretation: Our results indicate that the vaccination programme will minimise new GW cases in the Australian population, but importation of cases will continue. This is the first study to define GW elimination at a national level. The framework developed could be used to define GW elimination in other countries, with thresholds particularly valuable for vaccination programme impact evaluation. Funding: LK supported through an Australian Government Research Training Programme Scholarship; unconditional funding from Seqirus to support the Delphi Workshop. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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9 pages, 1103 KiB

Open AccessFeature PaperArticle

ImmunizziAMO: A School-Based Field Trial to Teach New Generations the Importance of Vaccination through Games and to Fight Vaccine Hesitancy in Italy

by Giuseppe La Torre, Valeria D’Egidio, Cristina Sestili, Rosario Andrea Cocchiara, Sara Cianfanelli, Ornella Di Bella, Lorenza Lia, Barbara Dorelli, Vittoria Cammalleri, Insa Backhaus, Federica Pagano, Chiara Anguissola, Amelia Vitiello, Rita Carsetti, Alice Mannocci and Giochiamo Collaborative Group

Vaccines 2020, 8(2), 280; https://doi.org/10.3390/vaccines8020280 - 5 Jun 2020

Cited by 4 | Viewed by 3285

Abstract

Background: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be [...] Read more.

Background: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be aware of the value of vaccination and motivated. In order to implement the spread of a correct culture about these issues, schools were recognized as a privileged operational setting. The aim of this project was to transmit knowledge and convey educational messages on the importance of vaccines, through the use of games, in elementary school children, their families and teachers. Materials and Methods: A field trial study was implemented between April and October 2019. Sample size calculations highlighted the need to recruit at least 136 students in the schools. The intervention involved 10 classes (five first grade and five s grade classes) and was structured in frontal teaching sessions and gaming sessions. Knowledge was assessed comparing the results of a questionnaire administered before and after the intervention. The questionnaires referred to the following items: dangerousness of bacteria and viruses; capability of defending from microorganisms; the role of antibodies; functioning of the vaccine in a child; type of disease for which a vaccine is efficacious; duration of a vaccine; mother- child transmission of antibodies; herd immunity. Results: 143 children participated in all the phases of the study. The comparison between the scores at the beginning and end of the intervention showed a significant increase in the knowledge about vaccines and immunity. The mean knowledge score arose from 3.52 (SD = 1.67) to 5.97 (SD = 1.81). Conclusions: This study suggests that the use of games in an elementary school effectively increase the knowledge related to the important topic of vaccination starting at childhood. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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9 pages, 226 KiB

Open AccessArticle

Socioeconomic Determinants in Vaccine Hesitancy and Vaccine Refusal in Italy

by Chiara Bertoncello, Antonio Ferro, Marco Fonzo, Sofia Zanovello, Giuseppina Napoletano, Francesca Russo, Vincenzo Baldo and Silvia Cocchio

Vaccines 2020, 8(2), 276; https://doi.org/10.3390/vaccines8020276 - 5 Jun 2020

Cited by 119 | Viewed by 10639

Abstract

Childhood vaccination has been a milestone in the control of infectious diseases. However, even in countries offering equal access to vaccination, a number of vaccine-preventable diseases have re-emerged. Suboptimal vaccination coverage has been called into question. The aim was to explore socioeconomic inequalities [...] Read more.

Childhood vaccination has been a milestone in the control of infectious diseases. However, even in countries offering equal access to vaccination, a number of vaccine-preventable diseases have re-emerged. Suboptimal vaccination coverage has been called into question. The aim was to explore socioeconomic inequalities in vaccine hesitancy and outright refusal. Families with at least one child aged between 3 months and 7 years were involved through an online survey. Families were classified as provaccine, hesitant, or antivaccine. The association between socioeconomic determinants and hesitancy/refusal was investigated with a logistic-regression model. A total of 3865 questionnaires were collected: 64.0% of families were provaccine, 32.4% hesitant, and 3.6% antivaccine. Rising levels of perceived economic hardship were associated with hesitancy (adjusted odds ratio (AOR) from 1.34 to 1.59), and lower parental education was significantly associated with refusal (AOR from 1.89 to 3.39). Family economic hardship and parental education did not move in parallel. Economic hardship was a determinant of hesitancy. Lower education was a predictor of outright refusal without affecting hesitancy. These findings may serve as warnings, and further explanations of socioeconomic inequities are needed even in universal healthcare systems. Insight into these factors is necessary to improve convenience and remove potential access issues. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

16 pages, 1938 KiB

Open AccessArticle

Game Analysis on the Evolution of Decision-Making of Vaccine Manufacturing Enterprises under the Government Regulation Model

by Na Zhang, Yingjie Yang, Xiaodong Wang and Xinfeng Wang

Vaccines 2020, 8(2), 267; https://doi.org/10.3390/vaccines8020267 - 31 May 2020

Cited by 6 | Viewed by 2651

Abstract

The harm caused by defective vaccines to human health and social stability is immeasurable. Aiming at the government’s supervision of the vaccine market, an evolutionary game model is constructed to analyze the quality of supervision and the key factors in the dynamic interaction [...] Read more.

The harm caused by defective vaccines to human health and social stability is immeasurable. Aiming at the government’s supervision of the vaccine market, an evolutionary game model is constructed to analyze the quality of supervision and the key factors in the dynamic interaction between government departments and vaccine manufacturers under different supervision modes in the vaccine manufacturing process. The results show that: (1) Severe punishment by government regulatory authorities, and increased costs of rectification after investigation and handling of involuntary behaviors of vaccine enterprises can effectively prevent involuntary behaviors of vaccine enterprises. (2) In the early stage of the game, the success rate of the government’s efficient supervision will make the vaccine enterprises continuously self-disciplined; when the vaccine market is relatively stable, the government’s supervision departments tend to be more conducive to passive supervision. (3) The success rate of government regulatory departments and the probability of a third-party reporting to play a great role in promoting the self-discipline of enterprises. (4) The power of government and regulation are conducive to promoting the active supervision of the government regulatory authorities but corruption of government and awareness of people are different. Once the phenomenon of vaccine enterprises’ non-discipline increases, the government regulation must change from passive regulation to active regulation. Therefore, the government should implement different measures according to the characteristics of each period in the manufacturing process to effectively prevent problematic vaccines. The conclusions and policy recommendations are significant for addressing the issue of insufficient self-discipline of vaccine manufacturers. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 547 KiB

Open AccessArticle

Seasonal Influenza Vaccination and Recommendation: The Difference between General Practitioners and Public Health Workers in China

by Hongguo Rong, Xiaozhen Lai, Xiaochen Ma, Zhiyuan Hou, Shunping Li, Rize Jing, Haijun Zhang, Zhibin Peng, Luzhao Feng and Hai Fang

Vaccines 2020, 8(2), 265; https://doi.org/10.3390/vaccines8020265 - 31 May 2020

Cited by 22 | Viewed by 3574

Abstract

Seasonal influenza vaccination for healthcare workers (HCWs) is critical to the protection of HCWs and their patients. This study examined whether the separation of public health workers and general practitioners could affect the influenza vaccine uptake and recommendation behaviors among HCWs in China. [...] Read more.

Seasonal influenza vaccination for healthcare workers (HCWs) is critical to the protection of HCWs and their patients. This study examined whether the separation of public health workers and general practitioners could affect the influenza vaccine uptake and recommendation behaviors among HCWs in China. A survey was conducted from August to October 2019, and HCWs from 10 provinces in China were recruited. A self-administered and anonymous questionnaire was used to assess HCWs’ demographic information, knowledge, and attitudes toward influenza vaccination, as well as vaccine uptake and recommendation behaviors. The primary outcome was HCWs’ vaccination and recommendation status of seasonal influenza vaccine. Multivariate logistic regression models were used to identify the influence factors of influenza vaccine uptake and recommendation among HCWs. Of the 1159 HCWs in this study, 25.3% were vaccinated against influenza in the previous season. “No need to get vaccinated” was the primary reason for both unvaccinated public health workers and general practitioners. Multivariate logistic regression showed that public health workers were more likely to get vaccinated against influenza (OR = 2.20, 95% CI 1.59–3.05) and recommend influenza vaccination to children (OR = 2.10, 95% CI 1.57–2.80) and the elderly (OR = 1.69, 95% CI 1.26–2.25) than general practitioners. Besides, the knowledge and perceived risk of influenza can give rise to HCWs’ vaccination and recommendation behaviors, and HCWs who got vaccinated in the past year were more likely to recommend it to children and the elderly in their work. The influenza vaccine coverage and recommendation among HCWs are still relatively low in China, especially for general practitioners. Further efforts are needed to improve the knowledge and attitudes toward influenza and influenza vaccination among HCWs, and coherent training on immunization for both public health workers and general practitioners might be effective in the face of separated public health and clinical services in China. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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10 pages, 229 KiB

Open AccessArticle

Knowledge and Attitude towards Vaccination among Healthcare Workers: A Multicenter Cross-Sectional Study in a Southern Italian Region

by Giuseppe Di Martino, Pamela Di Giovanni, Arturo Di Girolamo, Piera Scampoli, Fabrizio Cedrone, Michela D’Addezio, Francesca Meo, Ferdinando Romano, Maria Bernadette Di Sciascio and Tommaso Staniscia

Vaccines 2020, 8(2), 248; https://doi.org/10.3390/vaccines8020248 - 24 May 2020

Cited by 60 | Viewed by 7033

Abstract

Background: In Italy, the loss of confidence towards vaccination resulted in low vaccine coverage, also among healthcare workers (HCWs). Indeed, low vaccination coverage among HCWs can lead to dangerous outbreaks of disease, reduce productivity, and increase absenteeism. The aim of this study [...] Read more.

Background: In Italy, the loss of confidence towards vaccination resulted in low vaccine coverage, also among healthcare workers (HCWs). Indeed, low vaccination coverage among HCWs can lead to dangerous outbreaks of disease, reduce productivity, and increase absenteeism. The aim of this study was to investigate the vaccine coverage and attitudes toward vaccination among HCWs. Methods: A multicenter cross-sectional study was conducted among HCWs referred to all hospitals of the Local Health Authority 02 of Abruzzo Region, Italy. The survey was based on the questionnaire proposed by the H-ProImmune Project. Results: A total of 347 HCWs were enrolled in the study. Of these, 57.3% reported missing diphtheritis-tetanus-pertussis (DTP) vaccination, 50.1% reported missing measles-mumps-rubella (MMR) vaccination, and 62.5% reported missing flu vaccination. Regarding attitudes, other healthcare professionals reported to believe more in natural immunization compared to vaccination (26.5%; p < 0.001), and they were worried about long-term effects of vaccination (10.2%; p = 0.044). Conclusions: This survey showed all vaccination coverage considered resulted below the 95% threshold. Training on vaccination and mandatory measures may be needed in order to achieve better coverage. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

9 pages, 243 KiB

Open AccessArticle

Systemic Sclerosis and Vaccinations: A Register-Based Cohort Study about Seasonal Influenza and Streptococcus pneumoniae Vaccination Rate and Uptake from Liguria Regional Center, Northwest Italy

by Giuseppe Murdaca, Giovanni Noberasco, Alberto Battaglini, Chiara Vassallo, Francesca Giusti, Monica Greco, Chiara Schiavi, Laura Sticchi, Giancarlo Icardi and Andrea Orsi

Vaccines 2020, 8(2), 204; https://doi.org/10.3390/vaccines8020204 - 28 Apr 2020

Cited by 7 | Viewed by 3425

Abstract

Systemic sclerosis (SSc) is the connective tissue disease with the highest mortality and patients with chronic inflammatory immune-mediated diseases are at high risk of acquiring infections as they are often treated with immunosuppressive or biological drugs. This study, conducted among the patients followed [...] Read more.

Systemic sclerosis (SSc) is the connective tissue disease with the highest mortality and patients with chronic inflammatory immune-mediated diseases are at high risk of acquiring infections as they are often treated with immunosuppressive or biological drugs. This study, conducted among the patients followed by our clinical immunology, part of the Internal Medicine Department in the Ospedale Policlinico San Martino, Genoa, northwest Italy, has set itself the primary objective of analyzing the vaccine uptake and the vaccination coverage against both seasonal influenza and S. pneumoniae in a cohort of patients with SSc. We evaluated the influenza and pneumococcal vaccination rate among various subgroups of patients and the source of the recommendation for vaccination. We evaluated the vaccination rate changes between the two years considered in our study. We also calculated a binomial logistic regression between vaccination acceptance and clinical and demographics characteristics of the patients to evaluate the adjusted odds ratio (OR) of each factor on vaccination. The vaccination coverage that resulted was significantly higher than in other similar studies. Age over 65 years old, interstitial lung disease, and ongoing immunosuppressive therapy were significantly related with acceptance to both vaccinations using univariate analyses, but the multivariate logistic regression found a significant correlation only with the age and therapy factors. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 3866 KiB

Open AccessArticle

Health Care Professionals’ Perspectives on Life-Course Immunization: A Qualitative Survey from a European Conference

by Roy K. Philip and Alberta Di Pasquale

Vaccines 2020, 8(2), 185; https://doi.org/10.3390/vaccines8020185 - 14 Apr 2020

Cited by 3 | Viewed by 3518

Abstract

Today, fewer children die each year from vaccine-preventable diseases than older adults. Health systems need new immunization strategies to tackle the burden of vaccine-preventable disease in an aging society. A life-course immunization (LCI) approach—which entails vaccination throughout an individual’s lifespan—enables adults to age [...] Read more.

Today, fewer children die each year from vaccine-preventable diseases than older adults. Health systems need new immunization strategies to tackle the burden of vaccine-preventable disease in an aging society. A life-course immunization (LCI) approach—which entails vaccination throughout an individual’s lifespan—enables adults to age with reduced risk to disease, thereby enabling healthy, active and productive aging. We conducted an audience response system (ARS)-based survey to investigate HCP perspectives on LCI in an opportunistic sample of 222 health care professionals (HCPs) from around the world who attended a European infectious diseases conference. Survey results show that LCI is a priority for HCPs (77.4%–88.6%), with most of them stating the need to frame it as a part of a healthy lifestyle (91.0%–100.0%). Insufficient LCI recommendations by vaccine providers (12.9%–33.3%) and governments (15.2%–41.9%) and insufficient targeted budget allocation (6.1%–21.7%) were indicated as the main barriers to implement LCI, ahead of vaccine hesitancy (9.7%–15.2%). HCPs were willing to make LCI a gateway to healthy aging but need support to work together with other stakeholders involved in the vaccination journey. This could be a step towards equitable health care for all of society. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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11 pages, 441 KiB

Open AccessArticle

The Impact of Narrative Strategy on Promoting HPV Vaccination among College Students in Korea: The Role of Anticipated Regret

by Jarim Kim

Vaccines 2020, 8(2), 176; https://doi.org/10.3390/vaccines8020176 - 10 Apr 2020

Cited by 12 | Viewed by 4053

Abstract

Human papillomavirus (HPV) vaccine hesitancy contributes to unsatisfactory vaccination coverage in Korea despite its high efficacy in preventing various diseases including cervical cancer. To enhance HPV vaccine uptake, effective communication with the public is key. To develop effective health promotion messages, this study [...] Read more.

Human papillomavirus (HPV) vaccine hesitancy contributes to unsatisfactory vaccination coverage in Korea despite its high efficacy in preventing various diseases including cervical cancer. To enhance HPV vaccine uptake, effective communication with the public is key. To develop effective health promotion messages, this study examined the effects of message format on attitudes and intentions toward HPV vaccination, specifically focusing on anticipated action and inaction regrets. It employed a randomized experimental message design format (narrative versus didactic messages). A total of 222 Korean undergraduate students who had not received the HPV shot participated in the experiment. The results showed that didactic messages produce greater anticipated inaction regret, which further influences HPV vaccination attitudes and behaviors. Anticipated regret could potentially explain mixed narrative effects across health behaviors as described in existing literature. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 1294 KiB

Open AccessArticle

Anal Human Papillomavirus Infection among MSM Attending University in China: Implications for Vaccination

by Song Fan, Peiyang Li, Lin Ouyang, Tanwei Yuan, Hui Gong, Yi Ding, Zhenzhou Luo, Guohui Wu, Maohe Yu and Huachun Zou

Vaccines 2020, 8(2), 175; https://doi.org/10.3390/vaccines8020175 - 9 Apr 2020

Cited by 14 | Viewed by 3611

Abstract

Men who have sex with men (MSM) attending university are a high-risk population for human papillomavirus (HPV) infection and are a neglected population of HPV vaccination programs in China. To provide evidence for HPV vaccination policies, we conducted this study to examine the [...] Read more.

Men who have sex with men (MSM) attending university are a high-risk population for human papillomavirus (HPV) infection and are a neglected population of HPV vaccination programs in China. To provide evidence for HPV vaccination policies, we conducted this study to examine the prevalence and factors associated with anal HPV infection among MSM attending university in China. A self-administered online questionnaire was conducted to collect information on social demographics and sexual behaviors. A self-collected rectal swab specimen was collected to test for 37 HPV types. A total of 426 participants were tested for HPV. The median age was 20 years. HPV prevalence was 37.5% for any type, 29.8% for nine-valent vaccine types, 24.6% for four-valent vaccine types, 11.5% for HPV-16/18, and 15.7% for HPV-6/11. Men enrolled in a technical diploma, living in Northern China, having more than two sex partners, being bottom or versatile in anal sex, and having a human immunodeficiency virus (HIV) testing history were more likely to have positive anal HPV of any type. Our study found a high prevalence of anal HPV infection among MSM attending university in China, with HPV vaccine-preventable types being the most popular types in this group. Thus, our findings highlight the urgency of promoting HPV vaccination among teenage MSM. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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20 pages, 280 KiB

Open AccessArticle

A Qualitative Study of Views and Experiences of Women and Health Care Professionals about Free Maternal Vaccinations Administered at Community Pharmacies

by Natalie Gauld, Samuel Martin, Owen Sinclair, Helen Petousis-Harris, Felicity Dumble and Cameron C. Grant

Vaccines 2020, 8(2), 152; https://doi.org/10.3390/vaccines8020152 - 29 Mar 2020

Cited by 17 | Viewed by 4664

Abstract

Background: A policy to extend funding of maternal pregnancy influenza and pertussis vaccinations to community pharmacies could address low pregnancy vaccine uptake. The policy has been implemented in one region in New Zealand. This study explored the views and experiences of women eligible [...] Read more.

Background: A policy to extend funding of maternal pregnancy influenza and pertussis vaccinations to community pharmacies could address low pregnancy vaccine uptake. The policy has been implemented in one region in New Zealand. This study explored the views and experiences of women eligible for the vaccines and health care professionals regarding funded maternal vaccinations in pharmacy. Methods: Women in late pregnancy or with an infant, and midwives, pharmacists, and general practice staff were selected purposively and interviewed regarding maternal vaccinations and the new policy, including their awareness and views of the funded vaccinations in pharmacies, and how this policy worked in practice. Enablers and barriers to vaccination by pharmacists were explored. Interviews were transcribed and analysed using a framework approach. Results: Fifty-three interviews were conducted. Most women and health care professionals viewed funded maternal vaccinations in pharmacies positively with respect to increasing awareness and providing delivery options. Many women received messages from pharmacies. Most pharmacies used posters, leaflets and/or verbal explanation to pregnant women to raise awareness of the vaccinations. Not all pharmacies provided these vaccinations, and frontline staff could help to raise awareness. Conclusion: Funded maternal vaccinations in pharmacies are generally well accepted and provide an opportunity to increase uptake and prevent disease. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

9 pages, 245 KiB

Open AccessArticle

Healthcare Workers’ Knowledge, Attitudes, and Practices about Vaccinations: A Cross-Sectional Study in Italy

by Concetta P. Pelullo, Giorgia Della Polla, Francesco Napolitano, Gabriella Di Giuseppe and Italo F. Angelillo

Vaccines 2020, 8(2), 148; https://doi.org/10.3390/vaccines8020148 - 26 Mar 2020

Cited by 42 | Viewed by 5344

Abstract

The cross-sectional study assessed the knowledge, attitudes, and practices regarding the recommended vaccinations and factors affecting such outcomes among a sample of healthcare workers (HCWs) in public hospitals in Italy. Only 14.1% knew all the recommended vaccinations for HCWs. Physicians and those who [...] Read more.

The cross-sectional study assessed the knowledge, attitudes, and practices regarding the recommended vaccinations and factors affecting such outcomes among a sample of healthcare workers (HCWs) in public hospitals in Italy. Only 14.1% knew all the recommended vaccinations for HCWs. Physicians and those who had received information about vaccinations from scientific journals, educational activities, or professional associations were more likely to have this knowledge, while those aged 36–45 were more likely to have less knowledge than those in the age group below 36 years. Only 57.3% agreed that the information received about vaccinations was reliable. Respondents who had children, who worked in pediatric/neonatal wards, who were more knowledgeable, or who did not need further information about vaccinations considered the available information to be reliable. Only 17.7% of respondents always recommended vaccinations to their patients. This behavior was more likely to occur in physicians, in HCWs, in pediatric/neonatal wards, in those who considered the information received about vaccinations reliable, and in those who considered themselves to be at high risk of transmitting an infectious disease to their patients. Health promotion programs and efforts are needed to improve the level of knowledge about vaccinations and immunization coverage among HCWs. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 236 KiB

Open AccessArticle

Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

by Yu-Chia Chang, Huang Yu-Tung, Long-Sheng Chen, Ho-Jui Tung, Kuang-Hua Huang, Ernawaty Ernawaty and Szu-Yuan Wu

Vaccines 2020, 8(1), 140; https://doi.org/10.3390/vaccines8010140 - 22 Mar 2020

Cited by 6 | Viewed by 3396

Abstract

This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability. Purpose: To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting [...] Read more.

This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability. Purpose: To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study. Methods: Data from Taiwan’s National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk. Results: The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68–0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95–1.01), 0.96 (0.94–0.99), 0.85 (0.82–0.89), 0.96 (0.93–0.99), 0.85 (0.75–0.97), and 0.89 (0.84–0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals. Conclusions: Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

7 pages, 223 KiB

Open AccessArticle

Vaccination Perception and Attitude among Undergraduate Medical and Teacher Education Students at Charles University, Prague, Czech Republic

by Jiří Šálek, Alexander M. Čelko and Jana Dáňová

Vaccines 2020, 8(1), 136; https://doi.org/10.3390/vaccines8010136 - 19 Mar 2020

Cited by 5 | Viewed by 3356

Abstract

This cross-sectional comparative study was designed to evaluate different opinions and their impact on vaccine confidence, as perceived by students of two different university programs (medicine and teacher education), as both of them play important roles in patient education, with the latter major [...] Read more.

This cross-sectional comparative study was designed to evaluate different opinions and their impact on vaccine confidence, as perceived by students of two different university programs (medicine and teacher education), as both of them play important roles in patient education, with the latter major shaping the skills of critical thinking. Multi-item, opinion-based, paper-and-pencil anonymous questionnaires were distributed among students of medicine and teacher education. Data were sorted and divided into two sets to be analyzed using logistic regression. Out of a total of 722 respondents, 386 were medical students and 336 were teacher education students. While most respondents said they were not in favor of alternative medicine, a significantly higher number of alternative medicine followers were teacher education students. The positive vaccination perception rate (PVPR) is not dependent on the behavioral factors of student respondents (irrespective of their major) but is largely affected by their attitude to alternative medicine. Fear of infection dramatically increased the PVPR (up to 6.7 times) in those who were versus were not afraid of getting infected or were not quite sure whether to fear it. Fear of side effects of vaccination clearly decreased the PVPR, by at least 84%. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

12 pages, 909 KiB

Open AccessArticle

Trends of Adverse Events Following Immunization (AEFI) Reports of Human Papillomavirus Vaccine in the Valencian Community—Spain (2008–2018)

by Cecilia M. Egoavil, José Tuells, Juan José Carreras, Emilia Montagud, Eliseo Pastor-Villalba, Pablo Caballero and Andreu Nolasco

Vaccines 2020, 8(1), 117; https://doi.org/10.3390/vaccines8010117 - 2 Mar 2020

Cited by 4 | Viewed by 11134

Abstract

Vaccine safety surveillance is essential in vaccination programs. We accomplished a descriptive study of surveillance AEFI-reporting rate in human papillomavirus (HPV) vaccine administered in the Valencian Community, Spain. Data were obtained from Spanish Pharmacovigilance Adverse Reactions Data (FEDRA). Reporting rates were calculated using [...] Read more.

Vaccine safety surveillance is essential in vaccination programs. We accomplished a descriptive study of surveillance AEFI-reporting rate in human papillomavirus (HPV) vaccine administered in the Valencian Community, Spain. Data were obtained from Spanish Pharmacovigilance Adverse Reactions Data (FEDRA). Reporting rates were calculated using local net doses distributed as the denominator. Trends were assessed using joinpoint regression with annual percent change (APC) reported. The AEFI-reports decreased between 2008 and 2018 in two periods, a fast decreasing rate from 2009 to 2011 (from 192.2 to 24.93 per 100000 doses; APC, −54.9%; 95%CI [−75.2; −17.7]), followed by a stable trend (−13% APC, 95%CI [−26.1; 2.4]). For the age group analysis, only the group aged 14–15 years old followed the same trend with -58.4% (95%CI [−73.9; −33.8]) APC during 2008–2011, and −8.8% (95%CI [−27.7; 15]) APC during 2011-2018. The majority of the reports (73.82%) were nonserious, involving reactions at or near the vaccination site, headache, and dizziness events. No death was reported. AEFI-reporting rates for HPV immunization in the Valencian Community have decreased considerably with two trend periods observed for girls aged 14–15 years old. Currently, the AEFI reporting rate shows a decreasing trend, perhaps following the Weber effect, and it could also be affected by media attention and coverage. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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10 pages, 1148 KiB

Open AccessArticle

Will We Have a Cohort of Healthcare Workers Full Vaccinated against Measles, Mumps, and Rubella?

by Andrea Trevisan, Chiara Bertoncello, Elisa Artuso, Clara Frasson, Laura Lago, Davide De Nuzzo, Annamaria Nicolli and Stefano Maso

Vaccines 2020, 8(1), 104; https://doi.org/10.3390/vaccines8010104 - 27 Feb 2020

Cited by 8 | Viewed by 3605

Abstract

Healthcare workers are a population exposed to several infectious diseases, and an immunization programme is essential for the maintenance of good vaccination coverage to protect workers and patients. A population of 10,653 students attending degree courses at Padua Medical School (medicine and surgery, [...] Read more.

Healthcare workers are a population exposed to several infectious diseases, and an immunization programme is essential for the maintenance of good vaccination coverage to protect workers and patients. A population of 10,653 students attending degree courses at Padua Medical School (medicine and surgery, dentistry and health professions) was screened for vaccination coverage and antibody titres against rubella, mumps, and measles. The students were subdivided into five age classes according to their date of birth: those born before 1980, between 1980 and 1985, between 1986 and 1990, between 1991 and 1995, and after 1995. Vaccination coverage was very low in students born before 1980, but the rate of positive antibody titre was high due to infection in infancy. Increasing date of birth showed increased vaccination coverage. In contrast, immune coverage was high for rubella (more than 90%) but not for mumps and measles (approximately 80%). An “anomaly” was observed for mumps and measles in the cohort born between 1991 and 1995, probably due to the trivalent vaccine formulation. Students born after 1990 showed vaccination coverage that exceeded 90%. It is therefore very likely that we will have a future generation of healthcare workers with optimal vaccination coverage. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 1583 KiB

Open AccessArticle

Seroprevalence to Measles Virus after Vaccination or Natural Infection in an Adult Population, in Italy

by Gabriele Anichini, Claudia Gandolfo, Simonetta Fabrizi, Giovan Battista Miceli, Chiara Terrosi, Gianni Gori Savellini, Shibily Prathyumnan, Daniela Orsi, Giuseppe Battista and Maria Grazia Cusi

Vaccines 2020, 8(1), 66; https://doi.org/10.3390/vaccines8010066 - 3 Feb 2020

Cited by 39 | Viewed by 4480

Abstract

An increase in measles cases worldwide, with outbreaks, has been registered in the last few years, despite the availability of a safe and highly efficacious vaccine. In addition to an inadequate vaccination coverage, even in high-income European countries studies proved that some vaccinated [...] Read more.

An increase in measles cases worldwide, with outbreaks, has been registered in the last few years, despite the availability of a safe and highly efficacious vaccine. In addition to an inadequate vaccination coverage, even in high-income European countries studies proved that some vaccinated people were also found seronegative years after vaccination, thus increasing the number of people susceptible to measles infection. In this study, we evaluated the immunization status and the seroprevalence of measles antibodies among 1092 healthy adults, either vaccinated or naturally infected, in order to investigate the persistence of anti-measles IgG. Among subjects who received two doses of measles vaccine, the neutralizing antibody titer tended to decline over time. In addition, data collected from a neutralization assay performed on 110 healthy vaccinated subjects suggested an inverse correlation between neutralizing antibody titers and the time elapsed between the two vaccinations, with a significant decline in the neutralizing titer when the interval between the two doses was ≥11 years. On the basis of these results, monitoring the serological status of the population 10–12 years after vaccination could be important both to limit the number of people who are potentially susceptible to measles, despite the high efficacy of MMR vaccine, and to recommend a booster vaccine for the seronegatives. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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Review

Jump to: Research, Other

15 pages, 3064 KiB

Open AccessReview

Parents’ Knowledge, Attitude and Perceptions on Childhood Vaccination in Saudi Arabia: A Systematic Literature Review

by Marwa Alabadi and Zakariya Aldawood

Vaccines 2020, 8(4), 750; https://doi.org/10.3390/vaccines8040750 - 10 Dec 2020

Cited by 13 | Viewed by 15311

Abstract

(1) Background: The responsibility of vaccinating children lies with their parents. Therefore, parents’ attitudes, knowledge and perceptions towards vaccination are of great importance as it drives their actions for timely and complete immunisation. This systematic literature review was conducted to gain a better [...] Read more.

(1) Background: The responsibility of vaccinating children lies with their parents. Therefore, parents’ attitudes, knowledge and perceptions towards vaccination are of great importance as it drives their actions for timely and complete immunisation. This systematic literature review was conducted to gain a better understanding of parents’ knowledge, attitudes and perceptions regarding childhood vaccination in Saudi Arabia. (2) Methods: A comprehensive systematic literature review was conducted to identify evidence demonstrating parents’ knowledge, attitudes and perceptions on childhood vaccination in Saudi Arabia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were used for this review. (3) Results: Nine studies were subsequently included in this systematic review. (4) Conclusions: All the individual reports in the literature do not cover the entire nation of Saudi Arabia, indicating the necessity of more comprehensive investigations so that the government and policymakers can develop versatile fact-based policies for the well-being of future generations. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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16 pages, 896 KiB

Open AccessReview

Multiple Vaccinations and the Enigma of Vaccine Injury

by Anthony R. Mawson and Ashley M. Croft

Vaccines 2020, 8(4), 676; https://doi.org/10.3390/vaccines8040676 - 12 Nov 2020

Cited by 4 | Viewed by 18452

Abstract

A growing number of vaccines are administered at the same time or in close succession, increasing the complexity of assessing vaccine safety. Individual vaccines are assumed to have no other effect than protection against the targeted pathogen, but vaccines also have nonspecific and [...] Read more.

A growing number of vaccines are administered at the same time or in close succession, increasing the complexity of assessing vaccine safety. Individual vaccines are assumed to have no other effect than protection against the targeted pathogen, but vaccines also have nonspecific and interactive effects, the outcomes of which can be beneficial or harmful. To date, no controlled trials and very few observational studies have determined the impact of vaccination schedules on overall health. The balance of the risks and benefits from mass vaccination therefore remains uncertain. Recent studies worryingly suggest links between multiple vaccinations and increased risks of diverse multisystem health problems, including allergies, infections, and neuropsychiatric or neurodevelopmental disorders. Here, we propose that, in susceptible persons, multiple vaccinations activate the retinoid cascade and trigger apoptotic hepatitis, leading to cholestatic liver dysfunction, in which stored vitamin A compounds (retinyl esters and retinoic acid) enter the circulation in toxic concentrations; this induces endogenous forms of hypervitaminosis A, with the severity of adverse outcomes being directly proportional to the concentration of circulating retinoids. In very low concentrations, vitamin A and its major metabolite retinoic acid contribute to immune function and to the process of immunization, whereas excess vitamin A increases the risk of adverse events, including common “side-effects” as well as chronic adverse outcomes. The increasing rates of allergy, ear infections, and neurodevelopmental disorders (NDDs) in countries with high rates of vaccination could be related to mass vaccination and to its impact on liver function and vitamin A metabolism, collectively representing endogenous manifestations of hypervitaminosis A. Further studies of health outcomes in vaccinated and unvaccinated groups are urgently needed, to increase understanding of the pathophysiology and treatment of vaccine injury, to identify the risk factors and screen for vaccine injury, to inform public health policy on potential hazards related to vaccination schedules, and to optimize the safety and benefits of vaccines. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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18 pages, 1629 KiB

Open AccessReview

Driving Adoption and Commercialization of Subunit Vaccines for Bovine Tuberculosis and Johne’s Disease: Policy Choices and Implications for Food Security

by Albert I. Ugochukwu, Peter W. B. Phillips and Brian J. Ochieng’

Vaccines 2020, 8(4), 667; https://doi.org/10.3390/vaccines8040667 - 9 Nov 2020

Cited by 6 | Viewed by 3551

Abstract

Infectious animal diseases, such as Johne’s disease (JD) caused by Mycobacterium avium paratuberculosis (MAP) and bovine tuberculosis (bTB) caused by Mycobacterium bovis, have been a challenge to the livestock industry globally, impacting negatively on animal, human and environmental health, and overall food [...] Read more.

Infectious animal diseases, such as Johne’s disease (JD) caused by Mycobacterium avium paratuberculosis (MAP) and bovine tuberculosis (bTB) caused by Mycobacterium bovis, have been a challenge to the livestock industry globally, impacting negatively on animal, human and environmental health, and overall food security. Despite several industry-led and government initiatives and programs aimed at preventing and reducing losses associated with JD and bTB outbreaks, JD has remained endemic in many parts of the world while there have been incidental outbreaks of bTB. While several studies focus on sustainable intensification of food (crop) production as a critical solution to food insecurity, following the existential interconnection between animals, humans and the environment recognized by one health, we frame food security through the lens of animal disease prevention and control, given the importance of livestock products to human health and livelihood. Vaccination has been a popular strategy successfully used in controlling other infectious diseases. The paper focuses on an alternate strategy of two subunit vaccines with companion diagnostics targeted at individual pathogens to attain satisfactory immunological responses for JD and bTB. We examine gaps in vaccine policies, commercialization, and potential strategies that would strengthen animal disease prevention and enhance food security. The potential of public–private partnership in strengthening private sector participation in effective animal disease control and health delivery and the implications for global food security are discussed. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 446 KiB

Open AccessReview

Vaccine Prices: A Systematic Review of Literature

by Rabia Hussain, Nadeem Irfan Bukhari, Anees ur Rehman, Mohamed Azmi Hassali and Zaheer-Ud-Din Babar

Vaccines 2020, 8(4), 629; https://doi.org/10.3390/vaccines8040629 - 29 Oct 2020

Cited by 13 | Viewed by 6095

Abstract

Vaccines are among the most vital interventions to control and reduce the morbidity and mortality worldwide. In accessing vaccines, pricing is usually the single most important deciding element. However, there is a scarcity of the literature on the vaccines pricing. The current study [...] Read more.

Vaccines are among the most vital interventions to control and reduce the morbidity and mortality worldwide. In accessing vaccines, pricing is usually the single most important deciding element. However, there is a scarcity of the literature on the vaccines pricing. The current study aims to review vaccine prices from the published literature and to evaluate factors that impact the pricing of vaccines. The literature (from 2015–2020) was reviewed to identify the original research articles. Systematic searches were conducted across the five databases including, Google Scholar, PubMed, Science Direct, Scopus and Springer Link. Literature search yielded 23,626 articles, of which 7351 were screened and 7310 articles were excluded based on title and abstracts relevance. The 41 studies were selected for full text review and 4 studies were found to meet the inclusion criteria. The included studies discussed vaccine prices for childhood vaccines, for Human Papilloma Virus (HPV) in US, China and in Europe. One study detailed the various scenarios of the HPV vaccines pricing. It was found that recently introduced vaccines have higher prices owing to the involvement of technology and research for their manufacture. However, prices tended to decrease over some maturation in price and by the involvement of Global Alliance for Vaccine Initiative (GAVI) and other allies. The prices of vaccines in China were much lower than the other high-income countries and the prices offered through United Nations Children’s Fund (UNICEF), mainly due to the large scale of demand in China. The affordable prices of vaccines were related to delicate procedures involving multiple stakeholders and a shorter duration of contract. This review systematically evaluated the literature and identified key factors that could impact vaccines pricing. The prices were higher for the newly introduced vaccines into the market. However, with the price maturation, there was a decline in the pricing and affordable prices could be achieved through tender pricing and involvement of GAVI and other allies. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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25 pages, 950 KiB

Open AccessReview

Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies

by Olivia Olson, Corinne Berry and Nirbhay Kumar

Vaccines 2020, 8(4), 590; https://doi.org/10.3390/vaccines8040590 - 8 Oct 2020

Cited by 128 | Viewed by 30897

Abstract

Parental vaccine hesitancy is becoming an increasingly important public health concern in the United States. In March 2020, an assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 [...] Read more.

Parental vaccine hesitancy is becoming an increasingly important public health concern in the United States. In March 2020, an assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 months were not following the recommended early childhood immunization schedule. Furthermore, a 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Vaccine hesitancy is now associated with a decrease in vaccine coverage and an increase in vaccine-preventable disease outbreaks and epidemics in the United States. Many studies have focused on understanding and defining the new socio-medical term, vaccine hesitancy; few have attempted to summarize past and current health communication interventions and strategies that have been successful or unsuccessful in tackling this growing phenomenon. This systematic literature review will attempt to aid public health professionals with a catalogue of health communication interventions and strategies to ultimately address and prevent parental vaccine hesitancy in the long term. Out of 1239 search results, a total of 75 articles were included for analysis, ranging from systematic reviews, quantitative surveys, and experimental designs to ethnographic and qualitative studies. For the presentation of results, a taxonomy was used to organize communication interventions according to their intended purpose. The catalogue of interventions was further broken down into specific components and themes that were identified in the literature as essential to either the success or failure in preventing and addressing parental vaccine hesitancy towards childhood vaccines. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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18 pages, 1786 KiB

Open AccessReview

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

by Neily Zakiyah, Widya N. Insani, Auliya A. Suwantika, Jurjen van der Schans and Maarten J. Postma

Vaccines 2020, 8(3), 426; https://doi.org/10.3390/vaccines8030426 - 30 Jul 2020

Cited by 9 | Viewed by 5044

Abstract

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness [...] Read more.

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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12 pages, 298 KiB

Open AccessReview

HPV Vaccination: The Position Paper of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV)

by Andrea Ciavattini, Luca Giannella, Rosa De Vincenzo, Jacopo Di Giuseppe, Maria Papiccio, Ankica Lukic, Giovanni Delli Carpini, Antonio Perino, Antonio Frega, Francesco Sopracordevole, Maggiorino Barbero and Murat Gultekin

Vaccines 2020, 8(3), 354; https://doi.org/10.3390/vaccines8030354 - 2 Jul 2020

Cited by 25 | Viewed by 5654

Abstract

Human papillomavirus (HPV) related cervical cancer represents an issue of public health priority. The World Health Organization recommended the introduction of HPV vaccination in all national public programs. In Europe, vaccines against HPV have been available since 2006. In Italy, vaccination is recommended [...] Read more.

Human papillomavirus (HPV) related cervical cancer represents an issue of public health priority. The World Health Organization recommended the introduction of HPV vaccination in all national public programs. In Europe, vaccines against HPV have been available since 2006. In Italy, vaccination is recommended and has been freely offered to all young girls aged 11 years since 2008. Three prophylactic HPV vaccines are available against high- and low-risk genotypes. The quadrivalent vaccine contains protein antigens for HPV 6, 11, 16, and 18. The bivalent vaccine includes antigens for HPV 16 and 18. The nonavalent vaccine was introduced in 2014, and it targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Clinical trials demonstrated the effectiveness of the three vaccines in healthy young women. Likewise, all vaccines showed an excellent safety profile. The bivalent vaccine provides two doses in subjects aged between 9 and 14 years and three doses in subjects over 14 years of age. The quadrivalent vaccine provides two doses in individuals from 9 to 13 years and three doses in individuals aged 14 years and over. The nonavalent vaccine schedule provides two doses in individuals from 9 to 14 years of age and three doses in individuals aged 15 years and over at the time of the first administration. Preliminary results suggest that the HPV vaccine is effective in the prevention of cervical squamous intraepithelial lesions even after local treatment. Given these outcomes, in general, it is imperative to expand the vaccinated target population. Some interventions to improve the HPV vaccine’s uptake include patient reminders, physicians-focused interventions, school-based vaccinations programs, and social marketing strategies. The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV) is committed to supporting vaccination programs for children and adolescents with a catch-up program for young adults. The SICPCV also helps clinical and information initiatives in developing countries to decrease the incidence of cervico-vaginal and vulvar pathology. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

19 pages, 664 KiB

Open AccessReview

Impact of Switch Options on the Economics of Pneumococcal Conjugate Vaccine (PCV) Introduction in Indonesia

by Auliya A. Suwantika, Neily Zakiyah, Arif S. W. Kusuma, Rizky Abdulah and Maarten J. Postma

Vaccines 2020, 8(2), 233; https://doi.org/10.3390/vaccines8020233 - 18 May 2020

Cited by 7 | Viewed by 5651

Abstract

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the [...] Read more.

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the existing product/presentation of PCV (single-dose of PCV13) to the new product/presentation of PCV (multi-dose of PCV13, PCV10 A and B) since PCV is one of the most expensive vaccines in the Expanded Program on Immunization (EPI) schedule. Assuming that Gavi-Advance Market Commitment (AMC) price for all PCVs can be accessed in 2021, the use of multi-dose PCV13, PCV10 A and PCV10 B with Gavi-AMC price in 2021–2024 were considered as respective scenarios. The result showed that the scenario assuming the use of single-dose of PCV13 with contract price in 2019–2020 that would be switched into multi-dose of PCV10 B with Gavi-AMC price in 2021–2024 resulted in the highest potential saving, compared with other scenarios. Our analysis suggests an economic advantage to switch from single-dose into a multi-dose presentation. Vaccination coverage, vaccine price, vaccine wastage and additional Gavi-AMC vaccine costs were considered to be the most influential parameter affecting the savings in all scenarios. Applying the effectiveness of PCV13 and PCV10 A on reducing the risk for invasive pneumococcal disease (IPD), potential averted incidence of IPD in children under one year of age during 2019–2024 would be 246,164 and 105,587 in both scenarios. Despite the result confirmed that PCV13 may provide an additional benefit, a more comprehensive economic evaluation study is required to investigate further the comparison of cost-effectiveness values among all PCVs in Indonesia. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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11 pages, 657 KiB

Open AccessReview

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

by Azizul Haque, Bourèma Kouriba, N’diaye Aïssatou and Anudeep Pant

Vaccines 2020, 8(2), 181; https://doi.org/10.3390/vaccines8020181 - 14 Apr 2020

Cited by 10 | Viewed by 5493

Abstract

Background: The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as [...] Read more.

Background: The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as lack of awareness, social myths, reluctance to vaccine acceptance and stigma with sexually transmitted diseases. Here, we formulate strategies to implement intervention programs against HPV infections and other risk factors for cervical cancer in these countries. Methods: We searched PubMed, Web of Science, and African Journals Online for this review. The current status of anti-HPV vaccination and precancerous screening programs in Mali and Senegal has been assessed by onsite visits. Collaborators from Mali and Senegal collected data and information concerning HPV vaccination and screening programs in these countries. Findings: We found that anti-HPV vaccination and cervical cancer screening have been conducted sporadically mainly in urban areas of Mali and Senegal. No known population-based programs are in progress in either of the two countries. We highlighted the advantages and drawbacks of currently available screening tests and proposed that screening by visual inspection with acetic acid (VIA) accompanied by self-sampling is the most cost-effective, culturally acceptable and most feasible strategy to implement in primary care settings. In addition, HPV DNA testing would be affordable, if local laboratory facilities could be established. We found that many of the factors that increase HPV acquisition and promote the oncogenic effect of the virus are largely widespread in both Senegal and Mali. These include infections with HIV and other sexually transmitted infections (STIs), immunosuppression, polygamous marriages, high parity, early sexual activities, early pregnancies, and multiple sexual partners. Interpretation: Neither vaccines nor screening tests are within the reach of the population in Mali and Senegal because of the high cost. The effective intervention measure would be to integrate anti-HPV vaccines into the Extended Program for Immunization (EPI), which has saved 3 million young lives per year in Africa with the support of GAVI, to implement cost control mechanisms for HPV vaccinations via price negotiations with manufacturing companies, as has recently been done by Rwanda. The collective efforts by local governments, researchers, private sector, and donors may lead to the introduction of affordable screening tests. A robust awareness campaign coupled with sustained and regular engagement of local communities about the prevention and risk factors is extremely important. The projected solutions may be well applicable to other Sub-Saharan countries that face similar challenges containing cervical cancer. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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11 pages, 1694 KiB

Open AccessReview

Is an Increased Risk of Developing Guillain–Barré Syndrome Associated with Seasonal Influenza Vaccination? A Systematic Review and Meta-Analysis

by Marek Petráš, Ivana Králová Lesná, Jana Dáňová and Alexander M. Čelko

Vaccines 2020, 8(2), 150; https://doi.org/10.3390/vaccines8020150 - 27 Mar 2020

Cited by 17 | Viewed by 6032

Abstract

While the weight of epidemiological evidence does not support a causal link with influenza vaccination evaluated over the last 30 years, Guillain–Barré syndrome (GBS) has been considered a vaccine-associated adverse event of interest since 1976. To investigate the existence of GBS risk after [...] Read more.

While the weight of epidemiological evidence does not support a causal link with influenza vaccination evaluated over the last 30 years, Guillain–Barré syndrome (GBS) has been considered a vaccine-associated adverse event of interest since 1976. To investigate the existence of GBS risk after vaccination against seasonal influenza, a systematic review and meta-analysis have been conducted based on 22 eligible epidemiological studies from 1981 to 2019 reporting 26 effect sizes (ESs) in different influenza seasons. The primary result of our meta-analysis pointed to no risk of vaccine-associated GBS, as documented by a pooled ES of 1.15 (95% CI: 0.97–1.35). Conversely, an obvious high risk of GBS was observed in patients with previous influenza-like illness (ILI), as demonstrated by a pooled ES of 9.6 (95% CI: 4.0–23.0) resulting from a supplementary analysis. While the meta-analysis did not confirm the putative risk of vaccine-associated GBS suggested by many epidemiological studies, vaccination against seasonal influenza reduced the risk of developing ILI-associated GBS by about 88%. However, to obtain strong evidence, more epidemiological studies are warranted to establish a possible coincidence between vaccination and ILI prior to GBS onset. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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21 pages, 1833 KiB

Open AccessReview

Safety of Administering Live Vaccines during Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

by Almudena Laris-González, Daniel Bernal-Serrano, Alexander Jarde and Beate Kampmann

Vaccines 2020, 8(1), 124; https://doi.org/10.3390/vaccines8010124 - 11 Mar 2020

Cited by 20 | Viewed by 7224

Abstract

Live-attenuated vaccines (LAV) are currently contraindicated during pregnancy, given uncertain safety records for the mother–infant pair. LAV might, however, play an important role to protect them against serious emerging diseases, such as Ebola and Lassa fever. For this systematic review we searched relevant [...] Read more.

Live-attenuated vaccines (LAV) are currently contraindicated during pregnancy, given uncertain safety records for the mother–infant pair. LAV might, however, play an important role to protect them against serious emerging diseases, such as Ebola and Lassa fever. For this systematic review we searched relevant databases to identify studies published up to November 2019. Controlled observational studies reporting pregnancy outcomes after maternal immunization with LAV were included. The ROBINS-I tool was used to assess risk of bias. Pooled odds ratios (OR) were obtained under a random-effects model. Of 2831 studies identified, fifteen fulfilled inclusion criteria. Smallpox, rubella, poliovirus, yellow fever and dengue vaccines were assessed in these studies. No association was found between vaccination and miscarriage (OR 0.98, 95% CI 0.87–1.10), stillbirth (OR 1.04, 95% CI 0.74–1.48), malformations (OR 1.09, 95% CI 0.98–1.21), prematurity (OR 0.99, 95% CI 0.90–1.08) or neonatal death (OR 1.06, 95% CI 0.68–1.65) overall. However, increased odds of malformations (OR 1.24; 95% CI 1.03–1.49) and miscarriage after first trimester immunization (OR 4.82; 95% CI 2.38–9.77) was found for smallpox vaccine. Thus, we did not find evidence of harm related to LAV other than smallpox with regards to pregnancy outcomes, but quality of evidence was very low. Overall risks appear to be small and have to be balanced against potential benefits for the mother-infant pair. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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9 pages, 227 KiB

Open AccessPerspective

Using the Past to Maximize the Success Probability of Future Anti-Viral Vaccines

by Philip Serwer

Vaccines 2020, 8(4), 566; https://doi.org/10.3390/vaccines8040566 - 1 Oct 2020

Viewed by 2687

Abstract

Rapid obtaining of safe, effective, anti-viral vaccines has recently risen to the top of the international agenda. To maximize the success probability of future anti-viral vaccines, the anti-viral vaccines successful in the past are summarized here by virus type and vaccine type. The [...] Read more.

Rapid obtaining of safe, effective, anti-viral vaccines has recently risen to the top of the international agenda. To maximize the success probability of future anti-viral vaccines, the anti-viral vaccines successful in the past are summarized here by virus type and vaccine type. The primary focus is on viruses with both single-stranded RNA genomes and a membrane envelope, given the pandemic past of influenza viruses and coronaviruses. The following conclusion is reached, assuming that success of future strategies is positively correlated with strategies successful in the past. The primary strategy, especially for emerging pandemic viruses, should be development of vaccine antigens that are live-attenuated viruses; the secondary strategy should be development of vaccine antigens that are inactivated virus particles. Support for this conclusion comes from the complexity of immune systems. These conclusions imply the need for a revision in current strategic planning. Full article

(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and Behavioral Science Theory, Principles, and Strategies)

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