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Background: The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines., Methods: An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar., Results: A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox., Conclusions: Vaccines can be used to prevent mpox and effectively control its spread.

Seasonal influenza vaccine is the most effective strategy for reducing influenza incidence and severity. Parental decision-making regarding childhood vaccination is influenced by one's vaccine-related beliefs. A cross-sectional study was conducted to determine the role of the Health Belief Model (HBM) in predicting parental intention to vaccinate their children against influenza in the Eastern Mediterranean Region (EMR). An anonymous online survey was distributed to parents of children aged 6 months to 18 years in 14 EMR countries. Out of the 5964 participants, 28.2% intended to vaccinate their children against influenza. Urban residents (OR = 0.55, 95%CI: 0.35-0.85), decision-making regarding child's health by the father alone (OR = 0.43, 95%CI: 0.34-0.55) or the mother alone (OR = 0.78, 95%CI: 0.65-0.93), having a child with a chronic illness (OR = 0.45, 95%CI: 0.38-0.53), reporting high perceived severity, susceptibility, and benefits (OR = 0.35, 95%CI: 0.30-0.40), and cues to action (OR = 0.45, 95%CI: 0.39-0.51) were inversely associated with parental unwillingness to vaccinate their children against influenza. While parents with a higher number of children in the household (OR = 1.08, 95%CI:1.03-1.12) and higher perceived barriers (OR = 2.92, 95%CI: 2.56-3.34) showed an increased likelihood of unwillingness to vaccinate their children. Interventions targeting parental beliefs and perceptions are necessary to improve influenza vaccination acceptance and coverage among children.

Introduction: Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination., Methods: Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot., Results: A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769)., Conclusion: The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2023 Ghazy, Waheed Elkhadry, Abdel-Rahman, Taha, Youssef, Elshabrawy, Assem Ibrahim, Al Awaidy, Al-Ahdal, Padhi and Fadl.)

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR)., Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH., Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p  = 0.006), rural residents (53.6%, p  < 0.001), high-income countries residents (50.6%, p  < 0.001), and mothers with higher educational levels (52.1%, p  < 0.001). Parents of school-aged children (5-9 years) (55.6%, p  < 0.001), children free from any comorbidities (52.5%, p  < 0.001), children who did not receive routine vaccination at all (51.5%, p  = 0.03), children who were not vaccinated against COVID-19 (54.3%, p  < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p  < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH., Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fadl, Al Awaidy, Elshabrawy, Makhlouf, Ibrahim, Abdel-Rahman, Tookhy, Alsalmani, Al-Saeedi, Al-Sawalha, El-Din, Saad, Ayoob, Rourou, Ali, Tawati, Gadain, Al-saidi, Hassan, Alsanafi, Sandouk, Youssef, Alothman, Yazbek, Al-Ansi, Mehdad, Adam, Gebreal and Ghazy.)

Children with cerebral palsy (CP) are at a greater risk of respiratory complications from coronavirus disease 2019 (COVID-19). Therefore, this study aimed to assess COVID-19 vaccine hesitancy (VH) among parents of CP children in Egypt, using the Arabic version of the Parental Attitude about Childhood Vaccination (PACV) questionnaire. This cross-sectional survey study was conducted at the outpatient clinics of two hospitals in Cairo, Egypt. Parents of children with CP were recruited using a simple random sampling technique. A total of 321 parents were enrolled; more than half of them were mothers of the children (61.37%); and the majority were Egyptians (87.23%) and living in urban areas (84.42%). Nearly 70% of the parents were hesitant to administer the COVID-19 vaccine to their children. A multiple linear regression model revealed that the PACV mean scores were lower among the following categories: (1) parents who could pay back loans, compared to those who could not pay back loans and who reported insufficient income (β = -2.39, p = 0.030); (2) non-Egyptian parents (β = -1.54, p = 0.002); (3) those who were fully vaccinated against COVID-19 themselves or had the intention to receive the complete COVID-19 vaccination (β = -6.28, p < 0.001); (4) those who had the intention to give the COVID-19 vaccination to their children (β = -3.04, p < 0.001); and (5) parents whose children received routine vaccines (β = -2.86, p < 0.045). After adjusting for other covariates, the parental COVID-19 vaccine status (β = -6.28, p < 0.001) and parents who experienced a COVID-19-related death in the family (β = -1.75, p < 0.001) showed significantly lower mean PACV scores. However, higher mean PACV scores were reported among parents who had a COVID-19 infection (β = 2.77, p < 0.001) or who were not sure (β = 2.94, p < 0.001). Our findings suggest the need to increase COVID-19 vaccine acceptance among parents of vulnerable children to reduce the negative consequences of COVID-19.

Background: The rise in caesarean deliveries constitutes a major public health concern in low- and middle-income countries (LMICs). Evidence on the influence of caesarean delivery on breastfeeding practices in LMICs is currently lacking., Aims: To examine the association between mode of delivery and breastfeeding initiation and prelacteal feeding practices in a nationally representative sample of Egyptian women., Methods: A cross-sectional study was carried out on 3773 women from the 2014 Egypt Demographic and Health Survey. The outcomes of interest were the timing of breastfeeding initiation and prelacteal feeding practices. Descriptive statistics and multivariable logistic regression models were performed., Results: Overall, 25.1% of mothers initiated breastfeeding within 1 hour of birth and 63.5% practised prelacteal feeding within 3 days of birth. Mothers who had caesarean delivery had higher odds of delayed breastfeeding initiation [adjusted odds ratio (AOR) 2.25; 95% confidence interval (CI): 1.84-2.74] and were more likely to engage in prelacteal feeding (AOR: 1.44; 95% CI, 1.19-1.74). Moreover, the relationship between caesarean delivery and delayed breastfeeding initiation varied by parity with stronger association among multiparous (AOR: 2.57; 95% CI, 2.04-3.24) compared with primiparous mothers (AOR: 1.52; 95% CI, 1.03-2.25)., Conclusion: Caesarean delivery significantly increased the likelihood of delayed breastfeeding initiation and increased prelacteal feeding practices. Breastfeeding support and guidance should target women considering caesarean delivery., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Acne vulgaris is the most common dermatoses affecting adolescents with significant impact on their quality of life (QoL). The current study aimed to estimate the prevalence of acne, severity, and its impact on QoL and self-esteem among Egyptian adolescents., Methods: A cross-sectional study was conducted. A total of 787 students were selected using multistage stratified random sampling from 12 secondary schools in Alexandria, Egypt. Data was collected using a self-reported questionnaire, and clinical examination was performed. Severity of acne and its impact on QoL and self-esteem were assessed using the Global Acne Grading System (GAGS), Cardiff Acne Disability Index (CADI), and Coopersmith self-esteem scale, respectively., Results: Prevalence of self-reported acne was 34.7%. Females significantly reported acne more frequently than males (39.1% vs. 30.3%, p = 0.009). Prevalence of clinically confirmed acne was 24.4%, with higher rates among females (28.6%) than males (20.2%, p = 0.006). The majority of students had mild acne (75.5%). CADI showed that 11.4% had severe disability. A significant medium positive correlation between GAGS and CADI was found (r = 0.338, p < 0.01). Among acne group, low self-esteem was more prevalent among females (67.0%) than males (45.0%, p = 0.004)., Conclusions: Acne is a common problem among Egyptian school-aged adolescents with higher prevalence and impact in females. Our findings should alert health professionals and school authorities to timely identify, manage, and educate adolescents with acne.

Background: Pneumonia is among the top causes of morbidity and mortality among the under-fives worldwide., Aims: A cross-sectional study was conducted to assess health-seeking behaviour and first medical management of pneumonia among children aged under 5 years in Alexandria, Egypt from the mothers' perspectives., Methods: Using a pre-designed questionnaire, we interviewed 507 mothers of pneumonic children aged under 5 years who had been admitted at 4 governmental children's hospitals. The study was conducted during August-November 2017., Results: We found that 57.2% of children received home treatment before seeking medical advice. Around 26% of mothers waited ≥ 2 days before seeking medical advice; insufficient knowledge about the disease was their main contention (89%). Factors significantly associated with the delay were: rural residence (P = 0.006); low income (P = 0.002); home treatment given before seeking medical advice (P < 0.001) and previous episodes of pneumonia (P = 0.002). Diagnosis of pneumonia had not been made by more than half of the first consulted sources (52.7%)., Conclusion: There is an urgent need to improve mothers' knowledge and train physicians for appropriate management of pneumonia in children under 5 years., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Pneumonia among under-five children constitutes a major public health concern. Studies examining risk factors for pneumonia in Egypt are limited., Aim: To identify risk factors of pneumonia among under-five children in Alexandria, Egypt., Methods: An observational case-control study was conducted over a 5-month period (September 2017-January 2018) in three main pediatric hospitals in Alexandria. A predesigned questionnaire was used to interview 660 mothers of under-five children (330 pneumonia cases and 330 control). The questionnaire included potential risk factors for pneumonia which were categorized into child-related factors, socio-demographic factors, and environmental factors., Results: The mean age of the children was 23.14 ± 18.61 months with a range of 1-59 months. Nearly two-thirds (58.5%) were boys. Nine factors were found to be independently associated with pneumonia: age ≤ 12 months (OR = 1.925; 95% CI, 1.356-2.733; P < 0.001), male gender (OR = 1.646; 95% CI, 1.162-2.332; P = 0.005), birth order ≥ 4 (OR = 2.154; 95% CI, 1.282-3.617; P = 0.004), low birth weight (OR = 2.562; 95% CI, 1.718-3.821; P < 0.001), prematurity (OR = 2.019; 95% CI, 1.154-3.531; P = 0.014), place of delivery either at home (OR = 5.669; 95% CI, 1.063-30.237; P = 0.042) or at a public hospital (OR = 1.616; 95% CI, 1.131-2.310; P = 0.008), presence of concomitant illness (OR = 1.902; 95% CI, 1.043-3.469; P = 0.036), poor home aeration (OR = 3.586; 95% CI, 1.971-6.522; P < 0.001), and exposure to outdoor air pollution (OR = 2.403; 95% CI, 1.417-4.076; P = 0.001)., Conclusion: Several risk factors were significantly related to pneumonia among under-five children. Identifying such factors is important for developing interventions to reduce pneumonia burden among under-five in Egypt.

Novel metal(II) complexes derived from 2-hydroxy-N'-((Z)-3-(hydroxyimino)-4-oxopentan-2-ylidene)benzohydrazide ligand (H2L) were synthesized and characterized by elemental and thermal analyses (DTA and TGA), IR, UV-VIS, (1)H-NMR, ESR and mass spectroscopy, magnetic susceptibilities, and conductivities measurements. The complexes adopt distorted octahedral geometry. The ESR spectra of the solid copper(II) complexes are characteristic to d(9) configuration and have an axial symmetry type of a d(x (2)-y (2)) ground state. The g values confirmed the tetragonal octahedral geometry with a considerably ionic or covalent environment. The cytotoxic activity of the ligand and its metal complexes showed potent cytotoxicity effect against growth of human liver cancer HepG2 cell lines compared to the clinically used Sorafenib (Nexavar).