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COVID-19 vaccination reduces the risk of severe disease, in children as well as adults. We studied COVID-19 vaccination coverage among children, parental COVID-19 vaccination intent for their children and determinants of vaccination among children to inform communication strategies. We invited parents of children aged 6 months–11 years in Munich, Germany, to an anonymous online survey between 13.10.2022 and 15.01.2023. Parents reported COVID-19 vaccination status and, for unvaccinated children, vaccination intent per child. We determined vaccination coverage (≥ 1 dose) and parental intent, and subsequently used logistic regression to identify determinants of vaccination, including the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, collective responsibility). In total, 339 parents reported on 591 children. Vaccination coverage was 7% (6/86) amongst 6-months–4-year-olds and 59% (295/498) amongst 5–11-year-olds. For unvaccinated 6-months–4-year-olds, 31% of parents reported high, 13% medium, 56% low vaccination intent; for 5–11-year-olds 8% reported high, 20% medium, 71% low intent. Positive determinants of vaccination were older child age, child belonging to a clinically vulnerable group, as well as parental COVID-19 vaccination, higher education level, country of birth Germany, and high level of trust in official guidelines; a negative determinant was previous vaccination refusal. For 5–11-year-olds, additional positive determinants were higher confidence and lower complacency. Conclusion: While a substantial proportion of 5–11-year-olds were vaccinated against COVID-19, coverage was low among 6-months–4-year-olds. Parental vaccination intent for unvaccinated children was low. Vaccination communication should take into account parental socio-demographic characteristics and specifically address individual risks and benefits of child vaccination. What is Known: • COVID-19 vaccination lowers severe disease risk in all ages. • Germany recommends vaccination for 5–11-years-olds since December 2021 and for 6 months–4 year-olds since November 2022. What is New: • In Munich, vaccine uptake was high in 5–11-year-olds but parental intent for not yet vaccinated children was low; the opposite was the case for 6-months–4-year-olds; vaccination determinants were eligibility, parental education, birth country and general vaccination hesitancy; psychological antecedents were confidence and complacency. • Tailored interventions should address guidelines, health literacy, cultural sensitivity, and boost confidence in vaccines and institutions while raising awareness of COVID-19 risks for children. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16–23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. Methods: An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Results: Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2–3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Conclusions: Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article. [ABSTRACT FROM AUTHOR]

Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023–2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people. [ABSTRACT FROM AUTHOR]

High childhood disease prevalence and under-five mortality rates have been consistently reported in Nigeria. Vaccination is a cost-effective preventive strategy against childhood diseases. Therefore, this study aimed to identify the determinants of Incomplete Vaccination (IV) among children aged 12–23 months in Nigeria. This cross-sectional design study utilized the 2018 Nigeria Demographic and Health Survey (NDHS) dataset. A two-stage cluster sampling technique was used to select women of reproductive age who have children (n = 5475) aged 12–23 months. The outcome variable was IV of children against childhood diseases. Data were analyzed using Integrated Nested Laplace Approximation and Bayesian binary regression models (α0.05). Visualization of incomplete vaccination was produced using the ArcGIS software. Children’s mean age was 15.1 ± 3.2 months and the median number of vaccines received was four. Northern regions contributed largely to the IV. The likelihood of IV was lower among women aged 25–34 years (aOR = 0.67, 95% CI = 0.54–0.82, p < 0.05) and 35–49 years (aOR = 0.59, 95%CI = 0.46–0.77, p < 0.05) compared to younger women in the age group 15–24 years. An increasing level of education reduces the risk of odds of IV. Other predictors of IV were delivery at the health facility (aOR = 0.64, 95% CI = 053–0.76, p < 0.05), and media exposure (aOR = 0.63, 95%CI = 0.54–0.79, p < 0.05). Mothers’ characteristics explained most of the variability in the IV, relatively to smaller overall contributions from the community and state-level factors (p < 0.05). The level of IV against childhood diseases was high in Nigeria. However, disparities exist across the regions and other socioeconomic segments of the population. More efforts are required to improve vaccination sensitization programs and campaigns in Nigeria. [ABSTRACT FROM AUTHOR]

According to official data, the ultra-Orthodox group in Israel had the highest COVID-19 infection rate yet the lowest vaccination rate compared to the general population. The present study aimed to explore the rate of vaccine uptake as well as reported reasons for vaccine avoidance. In addition, we examined whether several protection motivation theory (PMT) components are good predictors of vaccine uptake. The components we addressed were: perceived susceptibility to the threat of COVID-19, perceived severity of the virus, and perceived efficiency and safety of the vaccine (i.e., response efficacy). The sample included 623 individuals (337 men) aged 18 + who were drawn from a database of a survey company specializing in the ultra-Orthodox community. We conducted a cross-sectional online survey between June 22, 2021, and July 7, 2021, approximately six months after the beginning of vaccination distribution. Results revealed that 65.8% of the participants (versus 89% of the general population) were vaccinated. Women were vaccinated at lower rates than men, whereas those in the Misnagdim ultra-Orthodox subgroup were vaccinated at higher rates than other subgroups in that community. The most prominent reasons for vaccine avoidance were perceived immunity based on prior infection by the virus and lack of trust in the vaccine's safety. In support of the PMT model, the perceived severity of the virus and the vaccine high efficacy were significant predictors of vaccine uptake. The study results call for better outreach to this community and specific psycho-education interventions tailored for its women. [ABSTRACT FROM AUTHOR]

Purpose: Considering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps. Methods: Between October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status. Results: Among German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001). Conclusion: Full PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register. [ABSTRACT FROM AUTHOR]

Purpose: Despite substantial vaccination progress, persistent measles outbreaks challenge global elimination efforts, particularly within healthcare settings. In this paper, we critically review the factors contributing to measles outbreak and effective control measures for nosocomial transmission of measles. Methods: We systematically searched electronic databases for articles up to 17th May, 2023. This was performed by two independent reviewers, with any disagreements resolved by a third reviewer. We also searched governmental and international health agencies for relevant studies. Results: Forty relevant articles were systematically reviewed, revealing key factors fuelling measles outbreak in healthcare settings, including high transmissibility capability; high intensity exposure; delayed care; failure to use protective equipment and implement control measures; vaccine failure; unclear immunisation history and lack of registries; and lacking recommendation on healthcare workers' (HCWs) measles vaccination. To combat these challenges, successful control strategies were identified which include early notification of outbreak and contact tracing; triaging all cases and setting up dedicated isolation unit; strengthening protective equipment use and physical measures; improving case detection; determining immunity status of HCWs; establishing policy for measles vaccination for HCWs; management of exposed personnel; and developing a pre-incident response plan. Conclusion: A coordinated and comprehensive approach is essential to promptly identify and manage measles cases within healthcare settings, necessitating multifactorial strategies tailored to individual settings. These findings provide a valuable foundation for refining strategies to achieve and maintain measles elimination status in healthcare environments. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate, by a novel spatiotemporal approach in an environment of non-funded rotavirus (RV) vaccines, the RV vaccine effectiveness (VE) to prevent acute gastroenteritis primary care (AGE-PC)–attended episodes, demonstrating how indirect protection leads to underestimation of direct VE under high vaccine coverage (VC). This population-based retrospective cohort study used electronic healthcare registries including all children 2 months–5 years old, born from 2009 to 2018 in the Valencia Region (Spain). Direct RV VE preventing AGE-PC episodes was estimated using propensity score matching and Poisson regressions stratified by VC, adjusted by age and calendar season. Indirect VE was estimated by Poisson regression comparing AGE-PC rates in unvaccinated children among the different VC levels. A total of 563,442 children were included for the RV VC estimation; of them, 360,576 were included in the birth-cohort for VE analysis. RV VC showed strong variability among districts and seasons, rising on average from 21% in 2009/2010 to 55% in 2017/2018. The highest direct VE was found in vaccinated children from districts with 0–30% RV VC (16.4%) and the lowest in those from districts with ≥ 70% RV VC (9.7%). The indirect protection in unvaccinated children raised from 6 to 16.6% for those living with 20–30% and ≥ 70% VC, respectively. Conclusion: Considering that RV is the causative agent in 20% of AGE cases, a direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with VC over 70% because of indirect protection. What is Known: • The effectiveness of RV vaccines preventing hospitalizations due to RV-acute gastroenteritis (RV-AGE) has been extensively studied. However, RV also burdens the primary care (PC) setting, and data on vaccine effectiveness (VE) in preventing AGE-PC visits are scarce. • The RV vaccine distribution in Spain (non-funded), with large differences in vaccine coverage (VC) among healthcare districts, provides an ideal scenario to assess the actual VE in preventing AGE-PC consultations, including the direct and indirect protection. What is New: • A direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with high VC because of indirect protection. • These findings, together with existing data on the impact on hospitalizations due to RV-AGE, offer valuable insights for implementing vaccination initiatives in countries that have not yet commenced such programs. [ABSTRACT FROM AUTHOR]

Continued circulation of the whooping cough pathogen, even in countries with high vaccine coverage, can be related to persistence of Bordetella pertussis biofilms in the respiratory tract. The films differ from planktonic cells by increased resistance to the host immune system and antibacterial drugs. The available acellular pertussis vaccines (aPV) containing antigens isolated from planktonic cultures of B. pertussis protect from severe forms of whooping cough, but do not effectively influence circulation of virulent strains in the subclinical forms of the disease and asymptomatic carriage. It is promising to create new generation aPV based on antigens isolated from biofilm cultures of B. pertussis capable of more effectively controlling the entire infectious cycle of whooping cough, including colonization, persistence, and transmission of the pathogen. From antigenic complexes isolated from the culture medium of biofilm and planktonic cultures of the strain B. pertussis No. 317 (serotype 1.2.3), experimental aPV were made: aPV-B and aPV-P, respectively. In intracerebral infection of mice with a virulent strain of B. pertussis, aPV-B demonstrated 2.5-fold higher protective activity than aPV-P and also more effectively reduced colonization of the lungs by B. pertussis cells in mice after intranasal infection with a virulent strain. Both vaccine preparations were safe and did not cause death in mice after administration of histamine. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of COVID-19 on immunization coverage and delayed vaccination among tribal children in the Khordha district of Odisha state. Methods: A cross-sectional rapid epidemiological survey was conducted using a standard WHO (30 × 7) cluster survey with 30 tribal villages under the Community Health Centre (CHC), Mendhasala, Odisha, as clusters and seven children from each cluster. A total of 14 children from each cluster; seven each born in 2019 (2019 cohort) and 2020 (2020 cohort), amounting to 420 children were included. The dates of vaccination and related details were obtained from the mother and child protection cards alongside a pretested, semi-structured questionnaires administered to the mothers or primary caregivers. Immunization coverage and delayed vaccination rates were compared between the two cohorts. Results: Full immunization coverage was 81.9% and 77.6% in the 2019 and 2020 cohorts, respectively. A significant decline in full immunization coverage was seen for 14 weeks (Pentavalent-3) vaccine in 2020 cohort (P = 0.01). The proportion of delayed vaccination for scheduled vaccines at birth, 6 weeks, 10 weeks, 14 weeks, and 9–12 months for 2019 cohort and 2020 cohort were 8.6%, 6.7%, 18.1%, 19.5%, 22.4%, and 21.9%, 26.7%, 30.5%, 19%, 16.2%, respectively. However, delayed vaccination rates among the 2019 and 2020 cohorts were not statistically significant. Conclusion: Our study findings showed a little decline in immunization coverage in tribal areas during the pandemic. [ABSTRACT FROM AUTHOR]

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11–17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06–1.13) and completion (APR:1.16, 95%CI:1.08–1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01–1.07) and completion (APR:1.12, 95%CI:1.05–1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand the impact of community mobilization initiatives on citizens' health-seeking behavior through the lens of COVID-19 vaccination in the state of Madhya Pradesh, India. This study follows a case study approach to understand community mobilization initiatives that led to increased COVID-19 vaccination uptake. The study delineates the process to increase community mobilization to improve the uptake of COVID-19 vaccination. It highlights the key components of community mobilization that were adopted: the involvement of local leadership (at district, block, and village level), support of vaccination/mobilizer team, the role of in-person communication, involvement of influential community heads and social workers, localized strategies and IEC materials, and support from the state administration. Additionally, the key communication themes that played a crucial role in increasing COVID-19 vaccination coverage are identified. The findings of this study will help the policymakers and practitioners in the domains of Health and Medical Humanities, Health Policy and Services, and Social Sciences to clarify the roles of community mobilization activities and initiatives in increasing vaccination coverage. Furthermore, the study provides evidence for the adaptation, integration, and enhancement of these activities based on the four case studies discussed. [ABSTRACT FROM AUTHOR]

Italy implemented two-dose universal varicella vaccination (UVV) regionally from 2003 to 2013 and nationally from 2017 onwards. Our objective was to analyze regional disparities in varicella outcomes resulting from disparities in vaccine coverage rates (VCRs) projected over a 50-year time-horizon (2020–2070). A previously published dynamic transmission model was updated to quantify the potential public health impact of the UVV program in Italy at the national and regional levels. Four 2-dose vaccine strategies utilizing monovalent (V) and quadrivalent (MMRV) vaccines were evaluated for each region: (A) MMRV-MSD/MMRV-MSD, (B) MMRV-GSK/MMRV-GSK, (C) V-MSD/MMRV-MSD, and (D) V-GSK/MMRV-GSK. Costs were reported in 2022 Euros. Costs and quality-adjusted life-years (QALYs) were discounted 3% annually. Under strategy A, the three regions with the lowest first-dose VCR reported increased varicella cases (+ 34.3%), hospitalizations (+ 20.0%), QALYs lost (+ 5.9%), payer costs (+ 22.2%), and societal costs (+ 14.6%) over the 50-year time-horizon compared to the three regions with highest first-dose VCR. Regions with low first-dose VCR were more sensitive to changes in VCR than high first-dose VCR regions. Results with respect to second-dose VCR were qualitatively similar, although smaller in magnitude. Results were similar across all vaccine strategies. [ABSTRACT FROM AUTHOR]

With growing recognition of the importance of community engagement in addressing public health challenges, its role in promoting healthy behaviors and preventing infectious diseases has gained attention. However, vaccination coverage remains a significant concern in many developing countries. While previous studies have linked community engagement to positive health outcomes, there is a gap in understanding its influence on individual vaccination choices, particularly in the context of developing countries. Utilizing data from the 2021 Chinese General Social Survey (CGSS), this study examines the impact of community engagement on COVID-19 and flu vaccination uptake among 7281 individuals. Community engagement, measured by community vaccination notifications, serves as the key independent variable. The study employs Ordinary Least Squares (OLS) regression and Propensity Score Matching (PSM) methods to analyze the relationship between community engagement and vaccination behavior. The analysis reveals a positive association between community engagement and vaccination rates. Specifically, individuals receiving notifications were more likely to get the COVID-19 vaccine compared to non-recipients (vaccination rates: 100% vs. 53.3%), and flu vaccination rates were also significantly higher among those notified (2.7% vs. 1.9%). Mechanism analysis suggests that individuals receiving community notifications are more aware of the benefits of vaccination, leading to higher vaccination rates among this group. This study underscores the effectiveness of community engagement strategies in promoting positive vaccination behavior among individuals in China. By enhancing awareness and trust in immunization, community engagement initiatives play a crucial role in shaping health behaviors and improving vaccination uptake. These findings emphasize the importance of integrating community engagement approaches into public health interventions to address vaccination challenges. [ABSTRACT FROM AUTHOR]

Vaccines are a remarkable medical achievement, protecting against diseases and saving lives. Lack of confidence and misinformation challenge vaccine acceptance. Blockchain provides a solution to establish trust. This study aims to develop a comprehensive application adaptable for public and private networks, enhancing the vaccination process. Existing research has gaps in coverage and testing of vaccine solutions. Thus, this study aims to develop a blockchain application for comprehensive traceability of vaccine batches and reliable maintenance of certificates, addressing these limitations. The study follows design science principles, creating, testing, and benchmarking a prototype. It includes a Smart Contract developed in Solidity, rigorous testing with Mocha, and benchmarking with Hyperledger Caliper. The Next.js application interacts with the Smart Contract using Metamask and web3.js for effective communication. Deployment and testing are conducted across two local networks, namely Ganache and Hyperledger Besu, along with four test networks-Rinkeby, Ropsten, Goerli, and Kovan. Thorough benchmarking is performed in these networks, enabling comparisons of each method in terms of throughput, latency, and success rate. Remarkably, all benchmarked methods achieved success. When compared, the majority of methods demonstrated high throughput in the Ganache local network and the Ropsten test network. The successful deployment and testing of the developed application in various networks suggest its suitability for deployment in the main network. Upon adoption, this application has the potential to significantly enhance trust in the entirety of the vaccination process, yielding substantial benefits for public health initiatives. [ABSTRACT FROM AUTHOR]

Cervical cancer is a significant public health concern in Ethiopia. It is mainly caused by persistent infection with the human papillomaviruses. The aim of this study was to assess the relationship between carcinogenic risk of probable, possible and low risk HPV infection and those of cervical intraepithelial neoplasia (CIN) and cervical cancer. A cross sectional study nested from prospective cohort study was conducted in Bahir Dar, northwest Ethiopia. Statistical analyses were performed using SPSSversion 26.0. HPV-16 was associated with a relatively higher risk of CIN II+, (AOR = 15.42; 95% CI 6.81–34.91). In addition, HPV-52, -18, -53 and -58, were significantly associated with an increased risk of CIN II+, (AOR = 7.38 (1.73–31.54), 5.42 (1.61–18.31), 4.08 (1.53–10.87), and 3.17 (1.00–10.03)), respectively. The current study shows high rate of HPV with predominance of HPV-16, -53, -58, -18, -35, and -52. The quadrivalent and nonavalent vaccine had only covered 27.1% and 45% of the circulating HPV genotypes. Ethiopia may need to consider introduction of nonavalent vaccine into the national public health strategy. Polyvalent vaccine which includes the genotypes not covered by existing approved vaccines should be considered. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccination is a promising step toward cervical cancer elimination. This study was conducted to investigate the knowledge, attitude, and HPV vaccine uptake among female adults in mainland China based on a large e-commerce platform. Methods: We conducted a cross-sectional online survey of female adults between March 4 to April 20, 2022. The survey consisted of sociodemographic information, related knowledge, vaccination uptake, and attitudes toward vaccination. We included women aged 18–45 years in the final analysis. Logistic regressions were conducted to explore influencing factors associated with related knowledge, HPV vaccination uptake, and willingness to be vaccinated. Results: In total, 3,572 female adults (34 years, IQR 30–39) were included in the analysis. The majority of the participants were highly educated (78.7%) with a high monthly family income (79.0%). The median HPV knowledge score was 8.25 out of 11. More than 75% of respondents were unvaccinated, while 95.8% of unvaccinated female adults are willing to be vaccinated. Variables such as age, insurance, vaccination history, and whether one had heard of the HPV vaccine influence HPV vaccination practice (all p-values < 0.05). The main barriers to vaccination were vaccine inaccessibility and the high cost of the vaccine. Conclusion: The findings of our study highlight a moderate knowledge level, poor vaccination rate, and strong willingness to be vaccinated among Chinese female adults who were better educated and wealthier. Targeted health education and practical support should be provided in the future, to reduce gaps between vaccine uptake and vaccine acceptance. Significance: What is already known on this subject?: Sustained high human papillomavirus (HPV) vaccination coverage is crucial for cervical cancer prevention. People's knowledge and acceptance of HPV vaccination largely influence vaccination uptake. Previous studies have indicated a lack of awareness, knowledge, and low vaccine uptake in mainland China. What this study adds?: The findings of our study highlight a moderate knowledge level, poor vaccination rate, and strong willingness to vaccination among Chinese female adults who were better educated and wealthier. This national-level survey may guide future health education and accelerate the HPV vaccination program's further roll-out targeting women at different social levels in mainland China. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic is a global threat, challenging health services' provision and utilization. This study aimed to assess compulsory vaccination coverage in 12 Sub-Saharan African countries two years following the COVID-19 pandemic using the Health Belief Model. A cross-sectional survey was conducted from November 1 to December 15, 2022. Multivariate logistic regression was conducted to identify the determinants of vaccination coverage. Among the 5032 respondents, 73.1% reported that their children received compulsory vaccination. The lowest coverage was observed in Ghana (36.5%), while the highest was in Burkina Faso and Congo (92.0%). Factors associated with non-vaccination included older mothers (adjusted odds ratio (AOR) = 1.04, 95%CI: 1.03–1.05), lower mothers' education, older children (AOR = 0.76, 95%CI: 0.60–0.96), children with chronic illnesses (AOR = 0.55, 95%CI: 0.45–0.66), and difficult accessibility to healthcare facilities (AOR = 11.27, 95%CI: 9.48–13.44). Low perceived risk, in which non-vaccinated children were believed to be at no higher risk for infectious diseases and the disease severity would not worsen among non-vaccinated children, increased the likelihood of non-vaccination (AOR = 2.29, 95%CI: 1.75–2.99 and AOR = 2.12, 95%CI: 1.64–2.73, respectively). Perceiving vaccines as unnecessary, and needless for breastfed babies increased the probability of non-vaccination (AOR = 1.38, 95%CI: 1.10–1.73 and AOR = 1.69, 95%CI: 1.31–2.19, respectively). Higher odds of non-vaccination were found when the provision of vaccine information did not motivate parents to vaccinate their children (AOR = 4.29, 95%CI: 3.15–5.85). Conversely, believing that vaccines were safe for children decreased the odds of non-vaccination (AOR = 0.72, 95%CI: 0.58–0.88). Parental perceptions and concerns should be considered in interventions aiming to increase compulsory vaccine acceptance and coverage. [ABSTRACT FROM AUTHOR]

The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage. [ABSTRACT FROM AUTHOR]

Children face unique risks resulting from disasters and conflicts. Broadly, complex emergencies create new and augment existing health risks to children. Direct, conflict-related injuries and deaths–such as those resulting from exposure to chemical weapons and blast injuries–not only have immediate impact but also have long-term impacts on the health and wellbeing of children. Lapses in vaccination coverage, changes in vector patterns, and widespread malnutrition, contribute to new and re-emerging infectious diseases among children. Understanding risks resulting from disasters and conflicts is critical for implementing timely and appropriate public health programs to reduce the negative health effects on children. [ABSTRACT FROM AUTHOR]

Multiple COVID-19 vaccines were proven to be safe and effective in curbing severe illness, but despite vaccine availability, vaccination rates were relatively low in the United States (U.S.). To better understand factors associated with low COVID-19 vaccine uptake in the U.S., our study provides a comprehensive, data-driven population-level statistical analysis at the county level. We find that political affiliation, as determined by the proportion of votes received by the Republican candidate in the 2020 presidential election, has the strongest association with our response variable, the percent of the population that received no COVID-19 vaccine. The next strongest association was median household income, which has a negative association. The percentage of Black people and the average number of vehicles per household are positively associated with the percent unvaccinated. In contrast, COVID-19 infection rate, percentage of Latinx people, postsecondary education percentage, median age, and prior non-COVID-19 childhood vaccination coverage are negatively associated with percent unvaccinated. Unlike previous studies, we do not find significant relationships between cable TV news viewership or Twitter misinformation variables with COVID-19 vaccine uptake. These results shed light on some factors that may impact vaccination choice in the U.S. and can be used to target specific populations for educational outreach and vaccine campaign strategies in efforts to increase vaccination uptake. [ABSTRACT FROM AUTHOR]

In this study, we modelled the incidence of COVID-19 cases and hospitalisations by basic health areas (ABS) in Catalonia. Spatial, temporal and spatio-temporal incidence trends were described using estimation methods that allow to borrow strength from neighbouring areas and time points. Specifically, we used Bayesian hierarchical spatio-temporal models estimated with Integrated Nested Laplace Approximation (INLA). An exploratory analysis was conducted to identify potential ABS factors associated with the incidence of cases and hospitalisations. High heterogeneity in cases and hospitalisation incidence was found between ABS and along the waves of the pandemic. Urban areas were found to have a higher incidence of COVID-19 cases and hospitalisations than rural areas, while socio-economic deprivation of the area was associated with a higher incidence of hospitalisations. In addition, full vaccination coverage in each ABS showed a protective effect on the risk of COVID-19 cases and hospitalisations. [ABSTRACT FROM AUTHOR]

In response to the imperatives of universal health coverage, structural factors that may hinder the effectiveness of increased spending in sub-Saharan Africa (SSA) need attention. This study assessed the mediating role of these factors in domestic general government health expenditure (DGGHE) effects to propose solutions for improving population health outcomes (PHO). The analysis used the Latent Growth Curve Mediation Model (LGCMM) approach within the structural equation model (SEM) framework for panel data from 42 SSA countries from 2015 to 2018. The findings were that malaria and female education formed a channel through which DGGHE imparted its effects on DALY in SSA, and these effects were achieved via the specific path from the DGGHE slope to the DALY slope, via malaria and female education slopes. However, the paper found no evidence of immunization coverage mediating the relationship between DGGHE and DALY in SSA. The paper concludes that structural factors affect the effectiveness of DGGHE on PHO, implying that governments should emphasize existing programs to fight against malaria and increase immunization coverage. Highlights: • Sub-Saharan Africa has many mediating factors acting as barriers to the effect of investments in health. • The Latent Growth Curve Mediation Model is used to assist the understanding of such factors. • The mediation effect (transmission mechanisms) of these factors must be understood for proper policymaking in favour of universal health coverage. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has highlighted the urgent need to address vaccine coverage inequality. Despite calls from scientists and national organizations, progress in ensuring equitable access to vaccines has been slow. This study aims to reveal the COVID-19 vaccine coverage inequality and investigate the predictive effect of attitudes toward science and religion on real-word vaccination uptake. We draw on three high-quality, large-scale databases to unveil real-world vaccine coverage, which stood at an average of 53% of the population by mid-2022. The vaccination rate varies based on a country's income, with higher-income nations having higher vaccination rates and faster vaccination speed. Regression models and a multiverse analysis reveal that both country-level attitudes towards science and religion, as well as religious faith, are linked to vaccination rate at the country level. Countries where a higher proportion of the population prioritize religious beliefs over scientific evidence when the two come into conflict tend to have lower vaccination coverage rates and slower vaccination speeds. These findings suggest that scientists and policymakers must take into account social and cultural characteristics of populations when addressing vaccine inequality. [ABSTRACT FROM AUTHOR]

Quite strikingly, there is significant variation in Covid-19 vaccine coverage around the world. Some countries do not progress from around 2-3% while others are close to 100% coverage. In addition to some already known economic, health and sociodemographic predictors, the present research is interested in emotional factors that may predict a significant part of this cross-country variation. We examined the personality factor Neuroticism, which corresponds to the relatively stable tendency to experience negative emotions, anxiety and low tolerance for stress. Results confirm that gross domestic product represents around 50 percent of cross-country variation. Neuroticism added 6 to 9 percent of inter-country variation in vaccination coverage. The results are discussed in relation to the associations between Neuroticism, increased worry, greater attention to Covid-19 related information and confidence, as well as lower vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Aim: To examine experiences and attitudes of a diverse sample of clinical and non-clinical healthcare workers regarding COVID-19 vaccines and boosters for themselves, their patients, and their communities. Subject and methods: We conducted a sequential exploratory mixed methods study; 52 healthcare workers participated in qualitative interviews between April 22 and September 7, 2021, and 209 healthcare workers completed surveys between February 17 and March 23, 2022. Interviews and survey questions asked about personal attitudes toward COVID-19 vaccination and boosters and experiences discussing vaccination with patients. Results: Participants were predominantly White (56% and 73%, respectively) and female (79% and 81%, respectively). Factors motivating healthcare workers to take the vaccine were the belief that vaccination would protect themselves, their families, patients, and communities. Healthcare workers were accepting of and had high receipt of the booster, though some had diminished belief in its effectiveness after becoming infected with SARS-CoV-2 after initial vaccination. Race related mistrust, misinformation related to vaccine safety, and concerns about vaccine effects during pregnancy were the most common barriers that providers encountered among their patients and communities. Conclusions: Healthcare workers' primary motivation to receive COVID-19 vaccines was the desire to protect themselves and others. Healthcare workers' perception was that concerns about safety and misinformation were more important barriers for their patients than themselves. Race-related medical mistrust amplified concerns about vaccine safety and hindered communication efforts. [ABSTRACT FROM AUTHOR]

To a certain extent, the development and vaccination of COVID-19 vaccine have reduced the alarming rate of transmission speed and mortality rate. At present, vaccine coverage is quite high in countries around the world. Since individual differences are unavoidable, it is necessary to assess the efficacy of the vaccine in each vaccinated person in order to reflect the protective effect of the vaccine in different populations. In this study, we developed a novel COVID-19 neutralizing antibody detection kit combining lateral flow immunochromatography and novel quantum dot technology with 85.23% sensitivity, 92.50% specificity. The novel QD-ICA could achieve an accurate detection of SARS-CoV-2 neutralizing antibodies with 10 minutes, two steps, small equipment size, and broad testing application, suggesting its capability to assess vaccine effectiveness on a large scale in areas of world that currently affected by the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: The second most deadly gynecological cancer worldwide, cervical cancer is steadily on the rise in sub-Saharan Africa, while vaccination programs are struggling to get off the ground. This systematic review's aim was to assess the prevalence and distribution of high- and low-risk HPV genotypes in West African women. Methods: Original studies were retrieved from PubMed/Medline, Embase, Scopus, Google Scholar, and Science Direct. In these studies, Human papillomavirus (HPV) DNA was assessed in cervical samples by polymerase chain reaction (PCR), Hybrid capture, and sequencing. The quality of the articles was assessed and the results were extracted and reviewed. Results: Thirty-nine studies from 10 West African countries were included for the systematic review including 30 for the pooled analysis. From an overall of 17358 participants, 5126 of whom were infected with at least one HPV genotype, the systematic review showed a prevalence varying from 8.9% to 81.8% in the general population. In contrast, the pooled prevalence of infection was 28.6% (n = 3890; 95% CI 27.85–29.38), and HPV-52 (13.3%), HPV-56 (9.3%), and HPV-35 (8.2) were the most frequent. Quadrivalent and nonavalent vaccines covered 18.2% and 55.8% of identified genotypes respectively. Conclusion: Faced with this growing public health challenge in West Africa, it would be necessary for all its countries to have reliable data on HPV infection and to introduce the nonavalent vaccine. A study of the genotypic distribution of HPV in high-grade precancerous lesions and cervical cancer would be very useful in West Africa. [ABSTRACT FROM AUTHOR]

Background: Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana. Methods: Using baseline and end-line household survey data collected from mothers, the effect of GEHIP's community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures. Results: At end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment. Conclusion: DPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident. [ABSTRACT FROM AUTHOR]

In a survey and four preregistered experiments, we examined if implementing a vaccine-promoting policy is likely to encourage vaccination by shaping the norms of a society. By combining state-level policy data with a longitudinal survey, we found that vaccine-supportive policies and laws are associated with more positive social norms. To establish a causal effect, we conducted four preregistered experiments to gauge the impact of policies, including the government recommendation for children to receive the COVID-19 vaccine and changes in funding for immunization programs. We find that vaccine-supportive policies strengthen the intention to receive an additional recommended COVID-19 booster shot and the intention to vaccinate children against COVID-19. We also find that these effects are mediated by the promotion of social norms supportive of vaccination. In this context, communicating about laws and policies in favor of vaccination may create a culture of vaccination and increase vaccination coverage. [ABSTRACT FROM AUTHOR]

Racially minoritized groups are more likely to experience COVID-19 vaccine hesitancy and have lower vaccination rates. As part of a multi-phase community-engaged project, we developed a train-the-trainer program in response to a needs assessment. "Community vaccine ambassadors" were trained to address COVID-19 vaccine hesitancy. We evaluated the program's feasibility, acceptability, and impact on participant confidence for COVID-19 vaccination conversations. Of the 33 ambassadors trained, 78.8% completed the initial evaluation; nearly all reported gaining knowledge (96.8%) and reported a high confidence with discussing COVID-19 vaccines (93.5%). At two-week follow-up, all respondents reported having a COVID-19 vaccination conversation with someone in their social network, reaching an estimated 134 people. A program that trains community vaccine ambassadors to deliver accurate information about COVID-19 vaccines may be an effective strategy for addressing vaccine hesitancy in racially minoritized communities. [ABSTRACT FROM AUTHOR]

We intend to evaluate the relationship between the rates of global SARS-CoV-2 vaccination and the number of COVID-19 confirmed cases, as well as the mortality rate after the declaration of a pandemic. Of the data from 191 countries at the time of data retraction, we selected 111 countries that have SARS-CoV-2 vaccination reports. We stratified countries into high-income and non-high-income countries (HIC and non-HIC) based on World Bank income-group. We used a fixed-effects model (FEM) and performed a longitudinal analysis. The number of confirmed cases decreased as the vaccination rates increased in both non-HICs (B = − 0.027, T = − 2.0) and HICs (B = − 0.207, T = − 17.5). The number of deaths decreased as the vaccination rates increased in both non-HICs (B = − 0.151, T = − 2.3) and HICs (B = − 0.230, T = − 40.9). For full vaccination, this measure had a negative association with daily confirmed cases and daily deaths in both non-HICs and HICs. In non-HICs, daily cases and daily deaths decreased as the first vaccination and full vaccination coverages increased. However in HICs, daily cases and daily deaths decreased as the first vaccination and full vaccination coverages increased in the early phase, but after a certain period, they tended to increase again. We observed a significant association between the increase in vaccination coverage in the real world and reduced daily confirmed cases and deaths. However, as the confirmed cases and deaths have rebounded in HICs, our findings indicate that COVID-19 is not completely prevented through vaccine distribution. [ABSTRACT FROM AUTHOR]

In all Western countries, the vaccination campaign against COVID-19 encountered some resistance. To overcome vaccine inertia and hesitancy, governments have used a variety of strategies and policy instruments. These instruments can be placed on a 'ladder of intrusiveness', starting from voluntary tools based on simple information and persuasion, through material incentives and disincentives of varying nature and magnitude, to highly coercive tools, such as lockdown for the unvaccinated and the introduction of the vaccination mandate. Italy's experience during the vaccination campaign against Covid provides an ideal observational point for starting to investigate this issue: not only was Italy among the top countries with the highest percentage of people vaccinated at the beginning of 2022, but—at least compared to other European countries—it was also one of the countries that had gradually introduced the most intrusive measures to increase vaccination compliance. In the article the different steps of the 'intrusiveness ladder' are presented, providing examples from various countries, and then tested on the Italian Covid-19 vaccination campaign between 2021 and the first months of 2022. For each phase of the campaign, the instrument mixes adopted by the Italian government are described, as well as the contextual conditions that led to their adoption. In the final section, an assessment of the composition and evolution of the Italian vaccination strategy is provided, based on the following criteria: legitimacy, feasibility, effectiveness, internal consistency and strategic coherence. Conclusions highlight the pragmatic approach adopted by the Italian government and underline the effects—both positive and negative—of scaling up the intrusiveness ladder. [ABSTRACT FROM AUTHOR]

The global invasive meningococcal disease (IMD) landscape changed considerably during the COVID-19 pandemic, as evidenced by decreased incidence rates due to COVID-19 mitigation measures, such as limited social contact, physical distancing, mask wearing, and hand washing. Vaccination rates were also lower during the pandemic relative to pre-pandemic levels. Although policymakers may have shifted their focus away from IMD vaccination programs to COVID-19 vaccination programs, strong arguments support implementation and prioritization of IMD vaccination programs; IMD cases have increased in some countries and IMD rates may even have exceeded pre-pandemic levels. Additional concerns include increased susceptibility due to vaccination coverage gaps, increased incidence of other respiratory pathogens, immunity debt from lockdown restrictions, and increased IMD epidemiologic variability. The full range of benefits of widely available and effective meningococcal vaccines needs to be considered, especially in health technology assessments, where the broad benefits of these vaccines are neither accurately quantified nor captured in implementation policy decisions. Importantly, implementation of meningococcal vaccination programs in the current IMD climate also appeals to broader healthcare principles, including preparedness rather than reactive approaches, generally accepted benefit–risk approaches to vaccination, historical precedent, and the World Health Organization's goal of defeating meningitis by 2030. Countries should therefore act swiftly to bolster existing meningococcal vaccination strategies to provide broad coverage across age groups and serogroups given the recent increases in IMD incidence. [ABSTRACT FROM AUTHOR]

Management of free-roaming dog populations is required to mitigate the threat of pathogens like rabies, minimize conflict with people, wildlife, and livestock and improve dog welfare however there are multiple strategies currently employed including sterilization, vaccination, and lethal removal. This work describes an agent-based stochastic model, 'StreetDogSim' that can be used as a planning tool to investigate the predicted impact of different strategies with variable implementation approaches and adjustable parameters to match local conditions. Here, we explore the effects of different management strategies with additional variation in their duration, intensity, and vaccine quality on important population metrics such as overall size, demographics, vaccination coverage, time until effective population suppression, and duration of suppression. Under most model parameterizations, a strategy that targets females for sterilization with vaccination outperforms all other options with respect to population control and demographic changes. [ABSTRACT FROM AUTHOR]

Background and Objective: In Germany, influenza vaccination is mainly advised for persons aged 60 years and over and individuals with health risks. Since 2021, an inactivated, quadrivalent high-dose influenza vaccine (IIV4-HD) has been recommended for persons aged 60 years and over. The aim of this study was to calculate the impact of vaccinating the German population aged 60 years and over with IIV4-HD compared to standard-dose influenza vaccines (IIV4-SD) with regard to health outcomes and costs. Methods: An age-stratified deterministic compartment model was built to simulate the course of influenza infection for the German population in the season 2019/20. Probabilities for health outcomes and cost data were searched from the literature and were used to compare the influenza-related health and economic effects for different scenarios. Perspectives were those of the statutory health insurance and the society. Deterministic sensitivity analyses were conducted. Results: From the statutory health insurance perspective, vaccinating the German population aged 60 years and over with IIV4-HD would have prevented 277,026 infections (− 1.1%) with an increase of overall direct costs of €224 million (+ 40.1%) compared with IIV4-SD. A separate analysis showed that increased vaccination of 75% (World Health Organization recommendation for older age groups) in persons aged 60 years and over using IIV4-SD only would prevent 1,289,648 infections (− 5.1%) and would save costs from a statutory health insurance perspective of €103 million (− 13.2%) compared with IIV4-HD at actual vaccination rates. Conclusions: The modeling approach offers important insights into the epidemiological and budgetary impact of different vaccination scenarios. Achieving a higher vaccination coverage with IIV4-SD in persons aged 60 years and over would result in lower costs and fewer influenza infections compared with the scenario with IIV4-HD and actual vaccination rates. [ABSTRACT FROM AUTHOR]

Aim: Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates. Subject and methods: International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to pool estimate vaccine acceptance rates. Results: The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1–70.1; P < 0.001, I2 = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5–74.5; P < 0.001, I2 = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8–64.1; P < 0.001, I2 = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1–57.0)), and the highest coverage rate was (85% (71–99.1)) in South America. Conclusion: COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate. [ABSTRACT FROM AUTHOR]

The mortality impact of COVID-19 in Africa remains controversial because most countries lack vital registration. We analysed excess mortality in Kilifi Health and Demographic Surveillance System, Kenya, using 9 years of baseline data. SARS-CoV-2 seroprevalence studies suggest most adults here were infected before May 2022. During 5 waves of COVID-19 (April 2020-May 2022) an overall excess mortality of 4.8% (95% PI 1.2%, 9.4%) concealed a significant excess (11.6%, 95% PI 5.9%, 18.9%) among older adults (≥ 65 years) and a deficit among children aged 1–14 years (−7.7%, 95% PI −20.9%, 6.9%). The excess mortality rate for January 2020-December 2021, age-standardised to the Kenyan population, was 27.4/100,000 person-years (95% CI 23.2-31.6). In Coastal Kenya, excess mortality during the pandemic was substantially lower than in most high-income countries but the significant excess mortality in older adults emphasizes the value of achieving high vaccine coverage in this risk group. SARS-CoV-2-associated mortality estimates for sub-Saharan Africa are uncertain due to lack of comprehensive surveillance systems. Here, the authors analyse data from a detailed surveillance system in Kilifi, Kenya and find that excess mortality rates were relatively low, except for older adults. [ABSTRACT FROM AUTHOR]

Vaccination is a well-known method to protect the public against an epidemic outbreak, e.g., COVID-19. To this end, the government of a country or region would strive to achieve its target of vaccination coverage. Limited by the total vaccine capacity of public hospitals, the government may need to cooperate with private hospitals or clinics for more vaccination. Exploring in this paper government coordination of public and private resources for vaccination, we model a vaccine system consisting of a public hospital, a profit-maximizing private clinic, and self-interested individuals, under three scenarios: (1) without information sharing (concerning vaccine inventory and vaccine price), (2) with information sharing and subsidy, and (3) with information sharing and allocation. We find that, under scenario (1), the vaccine demand is fully satisfied by the public hospital and the private clinic cannot make any profit. Under scenario (2), the private clinic is willing to enter the vaccine market with a positive profit-maximizing vaccination coverage. Under scenario (3), the socially optimal vaccination coverage may be lower than that under scenario (1). Moreover, we conduct a sensitivity analysis to generate practical implications of the research findings for vaccination policy-making. Our results provide both theoretical and managerial insights on vaccine supply decision, government intervention, and vaccination coverage. [ABSTRACT FROM AUTHOR]

Purpose: Influenza infections have substantial impact on healthcare institutions. While vaccination is the most effective preventive measure against influenza infection, vaccination coverage in healthcare workers is low. The study investigates the impact of an intensified influenza vaccination campaign in a maximum-care hospital on influenza vaccination coverage in healthcare workers during the COVID-19 pandemic in 2020/21. Methods: Building on findings from our previously published review Schumacher et al. (Infection 49(3): 387, 2021), an intensified influenza vaccination campaign comprising a mobile vaccination team providing on-site vaccination and vaccination at a recurring central vaccination site in addition to promotional measures was performed and analysed regarding vaccination coverage. A survey querying vaccination motivation was performed. Campaign strategies and vaccination coverage of influenza seasons between 2017/18 and 2019/20 were analysed. Results: The influenza vaccination campaign 2020/21 led to a significant 2.4-fold increase yielding an overall vaccination coverage of 40% among healthcare workers. A significant increase in vaccination coverage was observed across all professional fields; especially among nurses, a 2.7-fold increase, reaching a vaccination coverage of 48%, was observed. The COVID-19 pandemic positively influenced vaccination decision in 72% of first time ever or first time in over ten years influenza vaccinees. Vaccination coverage during prior vaccination campaigns focusing on educational measures did not exceed 17%. Conclusion: A mobile vaccination team providing on-site vaccination and vaccinations at a central vaccination site in addition to promotional measures can be implemented to increase influenza vaccination coverage in healthcare workers. Our concept can inform influenza and other vaccination campaigns for healthcare workers. [ABSTRACT FROM AUTHOR]

Background: HPV vaccination has been recommended and reimbursed for girls in Germany since 2007. In June 2018 the German Standing Committee on Vaccination (STIKO) recommended the gender-neutral vaccination of adolescents aged 9 to 14 years with catch-up through age 17. Objectives of this study were to describe the uptake of vaccination in boys before and during the COVID-19 pandemic. Methods: The study used data from a proprietary electronic medical record database and a database with information on nationally dispensed vaccine doses. The monthly number of first doses of HPV vaccinations in boys and girls aged 9–17 years in the period from 01/2018 to 12/2021 was determined. In addition, for boys the cumulative vaccination rates were calculated for initiated and completed vaccination series. Results: Four months after the introduction of mandatory reimbursement for boys, the monthly numbers of first doses were comparable to that of girls. Compared to the same month in 2019, the number of first doses declined by up to 49% (girls) in 2020 and 71% (boys) in 2021. At the end of 2021, the vaccination rate for 15-year-old boys (2006 birth cohort) reached 44.4% for initiated and 26.4% for completed series. Conclusion: After an initial dynamic increase in HPV vaccinations in boys, the impact of COVID-19 was particularly strong in the second year of the pandemic. At the end of 2021 vaccination rates were still low. Efforts are needed to catch-up on adolescents that missed doses during the pandemic and to increase uptake. [ABSTRACT FROM AUTHOR]

Over the past two years, the COVID-19 pandemic has seen multiple waves with high morbidity and mortality. Lockdowns and other prompt responses helped India's situation become less severe. Although Malegaon in the Indian state of Maharashtra has a high population density, poor hygienic standards, and oppositional local community views toward national pandemic addressing measures, it is nevertheless reasonably safe. To understand the possible reasons serosurvey was conducted to estimate the anti-SARS-CoV-2 neutralizing antibody levels in the Malegaon population. Also, we did SUTRA mathematical modeling to the Malegaon daily data on COVID-19 attributable events and compared it with the National and state level. The case fatality rate (CFR) in Malegaon city for the first, second, and third waves was 3.25%, 2.25%, and 0.39%, respectively. The crude death rate (CDR) for Maharashtra ranked first for the initial two waves and India for the third wave. Malegaon, meanwhile, finished second in the first two waves but fared best in the third. The Vaccination coverage for the first dose before the second wave was only 0.34% but had risen to 64.46% by 12 Oct 2022. By then, the second and booster dose coverage was 27.55% and 2.38%, respectively. Serosurvey did between 12 and 18 Jan 2022 showed a 93.93% anti-SARS-CoV-2 neutralizing antibody presence. SUTRA modeling elucidated the high levels of antibodies due to the pandemic-reach over 102% by the third wave. The serosurvey and the model explain why the pandemic severity in terms of duration and CFR during the subsequent waves, especially third wave, was milder compared to the first wave in spite of low vaccination rates. [ABSTRACT FROM AUTHOR]

Global Human papillomavirus (HPV) vaccination rates remain low despite available WHO-approved vaccines. Digital interventions for promoting vaccination uptake offer a scalable and accessible solution to this issue. Here we report a systematic review and meta-analysis examining the efficacy of digital interventions, comparing educational and reminder approaches, for promoting HPV vaccination uptake (HVU). This study also identifies factors influencing the effectiveness of these interventions. We searched PubMed, PsycInfo, Web of Science, and the Cochrane Library from each database's inception to January 2023. Three raters independently evaluate the studies using a systematic and blinded method for resolving disagreements. From 1929 references, 34 unique studies (281,280 unique participants) have sufficient data. Client reminder (OR, 1.41; 95% CI, 1.23–1.63; P < 0.001), provider reminder (OR, 1.39; 95% CI, 1.11–1.75; P = 0.005), provider education (OR, 1.18; 95% CI, 1.05–1.34; P = 0.007), and client education plus reminder interventions (OR, 1.29; 95% CI, 1.04–1.59; P = 0.007) increase HVU, whereas client education interventions do not (OR, 1.08; 95% CI, 0.92–1.28; P = 0.35). Digital intervention effectiveness varies based on participants' gender and the digital platform used. Interventions targeting male or mixed-gender participants demonstrate greater benefit, and reminder platforms (SMS, preference reminders, or electronic health record alerts) are more effective in increasing HVU. Digital interventions, particularly client and provider reminders, along with provider education, prove significantly more effective than client education alone. Incorporating digital interventions into healthcare systems can effectively promote HPV vaccination uptake. Reminder interventions should be prioritized for promoting HVU. [ABSTRACT FROM AUTHOR]

The causal impact of COVID-19 vaccine coverage on effective reproduction number R(t) under the disease control measures in the real-world scenario is understudied, making the optimal reopening strategy (e.g., when and which control measures are supposed to be conducted) during the recovery phase difficult to design. In this study, we examine the demographic heterogeneity and time variation of the vaccine effect on disease propagation based on the Bayesian structural time series analysis. Furthermore, we explore the role of non-pharmaceutical interventions (NPIs) and the entrance of the Delta variant of COVID-19 in the vaccine effect for U.S. counties. The analysis highlights several important findings: First, vaccine effects vary among the age-specific population and population densities. The vaccine effect for areas with high population density or core airport hubs is 2 times higher than for areas with low population density. Besides, areas with more older people need a high vaccine coverage to help them against the more contagious variants (e.g., the Delta variant). Second, the business restriction policy and mask requirement are more effective in preventing COVID-19 infections than other NPI measures (e.g., bar closure, gather ban, and restaurant restrictions) for areas with high population density and core airport hubs. Furthermore, the mask requirement consistently amplifies the vaccine effects against disease propagation after the presence of contagious variants. Third, areas with a high percentage of older people are suggested to postpone relaxing the restaurant restriction or gather ban since they amplify the vaccine effect against disease infections. Such empirical insights assist recovery phases of the pandemic in designing more efficient reopening strategies, vaccine prioritization, and allocation policies. [ABSTRACT FROM AUTHOR]

Test negative studies have been used extensively for the estimation of COVID-19 vaccine effectiveness (VE). Such studies are able to estimate VE against medically-attended illness under certain assumptions. Selection bias may be present if the probability of participation is associated with vaccination or COVID-19, but this can be mitigated through use of a clinical case definition to screen patients for eligibility, which increases the likelihood that cases and non-cases come from the same source population. We examined the extent to which this type of bias could harm COVID-19 VE through systematic review and simulation. A systematic review of test-negative studies was re-analysed to identify studies ignoring the need for clinical criteria. Studies using a clinical case definition had a lower pooled VE estimate compared with studies that did not. Simulations varied the probability of selection by case and vaccination status. Positive bias away from the null (i.e., inflated VE consistent with the systematic review) was observed when there was a higher proportion of healthy, vaccinated non-cases, which may occur if a dataset contains many results from asymptomatic screening in settings where vaccination coverage is high. We provide an html tool for researchers to explore site-specific sources of selection bias in their own studies. We recommend all groups consider the potential for selection bias in their vaccine effectiveness studies, particularly when using administrative data. [ABSTRACT FROM AUTHOR]

To date, few reports have evaluated the pneumococcal vaccination status in cirrhotic patients. No data are available for European countries. We have explored this topic and the potential independent predictors motivating lack of vaccination in Italy. Between January 1st and June 30th 2022, 1419 cirrhotic patients of any etiology were consecutively enrolled in an observational, prospective study at 8 referral centers in Italy. Adjusted odds ratios (ORs) for the association with lack of vaccination were evaluated by multiple logistic regression analysis. Overall vaccine coverage was 17.9% (8.9% in patients < 65 years of age and 27.1% in those aged ≥ 65 years; p < 0.001). Among the 1165 unvaccinated patients, 1068 (91.7%) reported lack of information regarding vaccination as the reason for not having undergone vaccination. Independent predictors associated with lack of vaccination were age < 65 years (OR 3.39, CI 95% 2.41–4.76) and a higher number of schooling years (OR 2.14, CI 95% 1.58–2.91); alcoholic etiology resulted only marginally associated (OR 1.91, CI 95% 1.03–3.52). These findings establish evidence on how pneumococcal vaccination status in Italy is largely suboptimal among cirrhotic patients. These results raise concern, considering the severe outcomes of pneumococcal infection in patients with chronic liver diseases. [ABSTRACT FROM AUTHOR]

Introduction: Vaccination against human papillomavirus (HPV) is considered the most effective strategy to protect women from cervical cancer. Three HPV vaccines are currently licensed in Europe and, although they are generally supported by favorable health economic outcomes, current models fall short in predicting vaccination benefits. Here, we aim to re-evaluate the health benefits of HPV vaccination, using updated long-term effectiveness data and emphasizing quality of life losses related to pre-cancer disease and treatment. Methods: We used a static Markov model that compared "only screening" (includes unvaccinated girls) and "vaccination" (assumes 100% vaccination coverage with the bivalent HPV vaccine). A lifetime cohort of 100,000 uninfected 12-year-old girls was included, in which the number of cases with cervical intraepithelial neoplasia grade 2 or higher/3 (CIN2+, CIN3), cervical cancer, and cervical cancer deaths per scenario were determined. Furthermore, the reduction in major excisional procedures, the preterm deliveries averted, and the related gain in quality-adjusted life years (QALYs) due to vaccination were estimated. Results: The bivalent vaccine showed larger reductions in CIN2+, CIN3, cervical cancer cases, cervical cancer deaths, and major excisional treatments, after including long-term efficacy and effectiveness data, compared to previous data. Moreover, we observed an increased amount of QALYs gained due to prevention of major excisional treatment and the negative side effects related to it. Conclusions: Updated health economic models for HPV vaccination, using updated and long-term effectiveness data and including prevention of treatment-related side effects, demonstrate a substantial additional positive effect on vaccination outcomes. Indeed, extrapolation of the bivalent HPV vaccine's updated long-term effectiveness data against HPV-related cervical diseases shows that the positive effects of vaccination may be more substantial than previously estimated. There is a graphical abstract available for this article. Plain Language Summary: Cervical cancer is one of the most common cancers among women, and the most effective strategy for its prevention is vaccination against HPV infection. Several studies have predicted the benefits of vaccination; however, most of them fall short due to a lack of long-term data and treatment impact. The aim of this study is to re-evaluate the benefits of vaccination with the bivalent vaccine in the Netherlands using updated longer-term data and benefits from preventing treatment. We used a cost-effectiveness model to compare two scenarios: only screening and vaccination plus screening. We included 100,000 12-year-old girls in the model and compared the following outcomes: number of individuals with benign cervical lesions, number of individuals with cervical cancer, number of deaths, reduction in treatment after vaccination, premature births avoided after vaccination, and quality of life gains. We found that the bivalent vaccine showed larger reductions in pre-cancerous lesions (CIN2+, CIN3), cervical cancer cases, cervical cancer deaths, and major excisional treatments, compared to the results of previously published cost-effectiveness analyses when new longer-term data were included. The prevention of treatment for the lesions represents a significant added value for vaccination. Our modeling study confirms the protective effect of the bivalent vaccine on cervical cancer. Moreover, it reflects a substantial additional value of vaccination compared to the benefits of vaccination that have been shown before. [ABSTRACT FROM AUTHOR]

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling. [ABSTRACT FROM AUTHOR]

We understand clinical quality governance (CQG) as quality management in the clinical domain. In 2020, presumably due to the coronavirus pandemic, more patients requested to be vaccinated against influenza as compared to previous years so that it became apparent that there would be a shortage for high-risk patients. To meet the problem, we started a CQG process. This article is explicitly not a research article but an exemplary description of a CQG process intended as a stimulus and for discussion. We initiated the following process: (1) evaluation of the present state, (2) patients who already had requested a vaccination were prioritized and vaccinated first, and (3) contacting via telephone and vaccination of high-risk patients not on the list. We chose patients with chronic obstructive pulmonary disease (COPD) older than 60 years as an indicator for the group of highest priority. In the beginning only 3 (8%) of our 38 patients with COPD were vaccinated against influenza. After prioritization and vaccination of the high-risk collective in the list of those who had requested to be vaccinated, 25 (66%) of our 38 patients with COPD were vaccinated. After a phone call of high-risk patients not on the list, 28 (74%) patients were vaccinated. This represents an increase of vaccination coverage from 8% to 74% which is close to the rate recommended by the World Health Organization (WHO). In times of a pandemic, family physicians occasionally have to deal with a scarcity of resources and have to develop strategies for fair resource allocation. Not only in this context is CQG worth the effort. The generation of list queries could be improved by the providers of electronic patient records. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand. Methods: An age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model. Results: COVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines. Conclusion: COVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy. [ABSTRACT FROM AUTHOR]