Seroprevalence, vaccination coverage and associated factors of hepatitis B and C infections among pregnant women in Azare, Bauchi State, Northeast Nigeria

Exploring determinants of acceptance of the pandemic influenza A (H1N1) 2009 vaccination in nurses

Hepatitis B Virus (HBV) remains a major global health challenge, particularly in developing countries where vaccination coverage is low. This study aimed to assess the prevalence of HBV infection, knowledge, attitudes, and vaccine uptake among patients in Katagum Local Government Area Bauchi State, Nigeria. A total of 385 patients were recruited for the study. Blood samples were collected and tested for HBV surface antigen (HbsAg) using a rapid detection kit. Demographic data, vaccination status, and knowledge of HBV were obtained through structured questionnaires. Data were analyzed using descriptive and inferential statistics. The overall prevalence of HBV was 3.9%, with a higher rate in males (2.6%) compared to females (1.3%). Adults aged 25–64 years had the highest prevalence (2.6%), while no cases were recorded among individuals above 65 years. Rural residents had a higher prevalence (2.34%) than urban residents (1.56%). Vaccination coverage was 43.38%, with higher uptake among urban residents (23.38%) and males (35.06%). Marital status (p = 0.049) and place of residence (p = 0.000) were significantly associated with vaccine uptake. Knowledge of HBV was significantly linked to vaccination status (p = 0.031), as were attitudes toward the disease and its prevention (p < 0.001). The main barriers to vaccination were lack of awareness (42.20%), fear of side effects (22.94%), and negative attitudes toward vaccination (20.64%). The study highlighted a moderate HBV prevalence and suboptimal vaccination coverage in Katagum LGA, Bauchi State. There is a need for intensified awareness campaigns, improved vaccine accessibility, and targeted interventions to increase HBV vaccination rates, particularly in rural areas and among vulnerable groups.

Although modest improvements were seen for tetanus–diphtheria–acellular pertussis (Tdap) and human papillomavirus (HPV) vaccine coverage from 2010 to 2011, the number of U.S. adults getting recommended vaccines remains far too low, reported Carolyn Bridges, MD, Associate Director for Adult Immunizations, CDC, during a late-January telebriefing describing key findings from the 2011 National Health Interview Survey (NHIS; www.cdc.gov/nchs/nhis.htm).

The development and implementation of COVID-19 vaccines have been a breakthrough in controlling the pandemic. However, the vaccination coverage in most low-income countries remains very low due to critical vaccine shortage and profound hesitancy. In this scoping review, we aimed to assess COVID-19 vaccine uptake, acceptance, and hesitancy in Ethiopia and Tanzania. The search was made in PubMed, Scopus, Embase, and Web of Science. Only original research articles focusing on vaccine acceptance and hesitancy were included. The studies selected for a full read were analysed using a thematic analysis approach. A total of 76 articles were included in the study, with 74 of them coming from Ethiopia. The study found an increasing trend in vaccine uptake over time. However, there was also an increase in hesitancy and a decline in willingness to receive the vaccine. The willingness to receive the COVID-19 vaccine in Ethiopia ranged from 18.5 to 88%. The main reasons for "vaccine hesitancy" included fear of side effects, concerns about long-term safety, doubts about vaccine effectiveness, lack of information, vaccine fast-tracking, and religious beliefs. The study also found that younger individuals, females, and pregnant women were less willing to receive the vaccine. The adverse events reported among vaccinated individuals were mostly mild. Most of the studies operationalised vaccine acceptance-hesitancy as dichotomous variables. However, the historical, political, and socio-cultural context in which vaccine acceptance and hesitancy occur was not given any attention. While there is a good amount of data from Ethiopia describing patterns of vaccine acceptance and hesitancy among different populations over time, there is limited information from Tanzania due to the late arrival of the vaccine and limited published articles. We have observed a paradox involving two seemingly conflicting trends: an increase in vaccination rates/coverage and "anti-vax." Most studies have simplified vaccine acceptance-hesitancy as an "either-or" incident, without considering its dynamic nature and occurrence within a broader political, social, and cultural context. Therefore, it is crucial to explore approaches that can enhance our understanding of the vaccine acceptance-hesitancy phenomenon, in order to improve vaccine trust and uptake.

Introduction: Immunization is one of the most cost-effective nursing interventions aimed at reducing ill health and premature death among children. Despite tremendous efforts by governments, vaccination coverage remains low, especially in developing countries. Masvingo district is one of the districts with low vaccination coverage in the country. Objectives: This study sought to assess immunization coverage, identify determinants of vaccination coverage and assess factors associated with low full immunization coverage in Masvingo district, Zimbabwe. Methods: An analytical cross-sectional study design was conducted between January 2019 and February 2019. Masvingo province was purposively selected due to its low vaccination coverage (60.3%) according to the Zimbabwe Demographic and Health Survey 2015. WHO cluster sampling was used to select households. A total of 354 children and their mothers residing in Masvingo district were recruited for the study. Pre-tested interviewer-administered questionnaires were used to collect data. Bivariate analysis was employed to assess factors associated with low vaccination coverage. Results: An estimated 89.5% of children aged 12-23 months were fully vaccinated by card or mothers’ recall. Factors significantly associated with full vaccination coverage rates (P<0.001) included birth order, distance to the nearest health facility, waiting time, place of birth, number of Antenatal care visits, possession of a vaccination card, place of residence, mother/caregiver’s highest level of education, household expenditure per month, and overall knowledge of the vaccination schedule. After controlling for all these factors, only household expenditure per month (P=0.001), having a vaccination card (P=0.047), and overall knowledge of the vaccination schedule (P=0.002) were statistically significant predictors of full vaccination coverage rates. Conclusion: Although full vaccination coverage is improving, it is still below the Global Vaccine Action Plan target. Factors associated with low full vaccination coverage include marital age, marital status, level of education, religion, household expenditure, distance to the health center, waiting time, and Antenatal Care and Post-natal Care care utilization. There is no single factor solely responsible for low vaccination coverage; rather, it is influenced by a combination of multiple factors. Nursing interventions at community level should focus on increasing community mobilization strategies that foster saturation coverage to achieve herd immunity for all vaccine preventable child diseases.

Introduction: Spatial analysis on vaccination coverage is a theoretical and methodological technological innovation that allows the identification of low and high vaccination coverage clusters. The transformative potential of vaccination coverage spatialization makes it possible to direct decision-making in a hasty manner and with a great impact on the regions of the greatest vulnerability and to assess the areas in which herd immunity is at risk, with the possibility of returning vaccine-preventable diseases. Science has already validated vaccination as a preventive health measure with a great impact on reducing population morbidity and mortality and excellent cost-effectiveness. Despite this, vaccination coverage in Brazil has been on a downward trend since 2015, including the return of a measles outbreak, even in the face of an internationally recognized National Immunization Program (PNI) that offers a wide national vaccination schedule for free at all ages. Innovative approaches can contribute to facing this scenario and guide evidence-based public policies. Objective: Spatial analysis of the vaccination coverage of Diphtheria-Tetanus-Pertussis Vaccine, Poliovirus Vaccine, and Measles-Mumps-Rubella Vaccine, in 2016, seeking to identify the areas of the greatest vulnerability associated with low vaccination coverage in the 5,570 municipalities of Brazil. Method: Mixed ecological study, using secondary data of applied doses of vaccine obtained from the National Immunization Program, live births from the Information System of live births and infant deaths obtained from the mortality information system of the Informatics Department of the Unified Health System (DATASUS). The vaccination coverage of Diphtheria-Tetanus-Pertussis Vaccine, Poliovirus Vaccine, and Measles-Mumps-Rubella Vaccine, in 2016, was calculated for each of the 5,570 municipalities. Descriptive analysis and spatial analysis were performed through autocorrelation using the Global Moran Index, Local Moran Index, using the software R Core Team and Qgis 3.4. The significance level was 5%. Results: Moran Map identifies the 5,570 municipalities in Brazil, for the Vaccine Coverage of Diphtheria-Tetanus-Pertussis, Measles-Mumps-Rubella, and Polio for the year 2016, where vaccine coverage shows significant spatial dependence (p < 0.05). It is possible to observe the municipalities with high Diphtheria-Tetanus-Pertussis vaccination coverage surrounded by their neighbors who also have the same situation (high-high), located in the states of Ceará, Minas Gerais, São Paulo, Mato Grosso, Mato Grosso do Sul, Paraná, and Santa Catarina. It is observed a cluster of municipalities with low vaccination coverage and with a similarity between their neighbors (low-low) are present in municipalities in the states of Amazonia, Pará, Amapá, Maranhão, Piauí, Rio Grande do Norte, Bahia, Southwest Goiás. These are the municipalities that deserve more attention from public managers so that they can identify the possible causes of this low coverage. With regard to Measles-Mumps-Rubella vaccination coverage, there is a cluster of municipalities that have high coverage with a positive influence on their neighbors (high-high) in the Midwest and South regions and the states of Ceará, Minas Gerais, and São Paulo. The municipalities that form a cluster with low vaccination coverage and negative influence on their neighbors (low-low) are concentrated in the Northeast of Brazil, except for the state of Ceará, in the West of Acre, Southwest of the Amazon, and North of Pará. As for the Polio vaccination coverage, a high spatial autocorrelation (high-high) was found in the municipalities of the states of Roraima, Rondônia, Mato Grosso do Sul, Mato Grosso, Brasília (Federal District), São Paulo, Pernambuco, and Ceará, which present high vaccination coverage and positive influence on its neighbors. Low-low autocorrelation, in other words, municipalities with low vaccination coverage and negative influence on their neighbors are distributed in the states of Amazonia, Amapá, Pará, Maranhão, Piauí, Rio Grande do Norte, Bahia, and Mato Grosso do Sul. Conclusion: In addition to its innovative character, spatial analysis is a tool that allows, in a simple and precise way, the identification of municipalities or regions of the greatest vulnerability, enabling a quick and effective intervention maintaining the logic of equity in health, allowing to guide both public policies and quick decision-making.

BackgroundInequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities.Methods and findingsWe conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015–2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state’s population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics.We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in “percent college educated” was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher “percent Black/Latino/Indigenous” and higher “percent essential workers” had lower vaccine coverage (−0.8, 95% CI −1.3 to −0.3, p < 0.01; −5.5, 95% CI −7.3 to −3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between “median household income” and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data.ConclusionsEighteen months into MA’s general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015-2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state's population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in "percent college educated" was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher "percent Black/Latino/Indigenous" and higher "percent essential workers" had lower vaccine coverage (-0.8, 95% CI -1.3 to -0.3, p < 0.01; -5.5, 95% CI -7.3 to -3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between "median household income" and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. Eighteen months into MA's general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

Background Over the last years, vaccine hesitancy has been increasing globally, leading to a decrease in vaccination coverage in several Countries, mostly in Europe. Several systematic reviews were conducted to assess the determinants of hesitancy and of vaccination choices, but none of them focused on pregnant women, which would represent an ideal population to promote correct information on vaccines. Methods We conducted a systematic review of studies assessing knowledge and attitudes on paediatric vaccinations, vaccination choices and their determinants among pregnant women. We searched Medline, Scopus and Web of Science, adapting search terms to the different databases, following PRISMA Statement criteria. No time limits were set. Results A total of 5,309 records were retrieved. After duplicates removal and title/abstract selection, 15 full texts were included in the narrative synthesis. Most studies (14/15) were quantitative surveys, 2 focused only on specific vaccines (rotavirus and HPV), 4 studies were conducted in European countries (Germany and Italy). The main factors associated with vaccine hesitancy or refusal were the fear of side effects, in particular for the most recent vaccines, the perception of a greater importance of natural immunity and a low perception of utility of vaccines, the lack of trust in health professionals, having obtained information on vaccines not from a doctor, primiparity and a low level of education (for these two last factors, with inconsistent results between studies). Conclusions Available evidence shows that the perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers, and that the determinants of hesitancy may vary in different contexts. Pregnant women represent a key population for the implementation of interventions aimed at increasing knowledge and acceptance of vaccinations, which should be based on an analysis of the specific context. Key messages The perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers. Interventions aimed at increasing knowledge and acceptance of vaccinations should be based on an analysis of the specific context.

Vaccination against influenza and pertussis in pregnant women protects the mother and child through the transfer of protective antibodies across the placenta. However, pregnant women's vaccine hesitancy is a major barrier to achieve satisfactory vaccination coverage in many developed countries. Greek pregnant women's vaccination knowledge, attitudes, and practices were recorded. Structured questionnaires were administered to mothers of infants under the age of 12 months through their pediatricians. Sampling across the country's districts was applied to achieve geographic representativeness. Questionnaires from 474 mothers were collected. Their mean age was 34 (±5) years. Vaccination uptake was 16.8% and 45.7%, for pertussis and influenza, respectively. During their recent pregnancy, 68.9% and 27.1% of the responders had been informed by their gynecologists regarding influenza and pertussis maternal immunization, respectively, indicating that gynecologists miss out on informing a significant rate of pregnant women. According to multiple logistic regression, women who gave birth during spring (OR: 2.29 vs. winter delivery, p = 0.042) and those with an MSc or PhD (OR: 2.93 vs. school graduates, p = 0.015) were more likely to receive influenza vaccination. Factors favoring influenza vaccination included doctor's recommendation (OR: 18.86, p < 0.001), being not/somewhat afraid of potential vaccine side effects during pregnancy (OR: 2.09, p = 0.012), considering the flu as relatively/very dangerous during pregnancy (OR: 8.05, p < 0.001), and considering the flu vaccine as relatively/completely safe (OR: 4.37, p < 0.001). Doctor's recommendation (OR: 29.55, p < 0.001) and considering pertussis a relatively/very serious risk to the mother's health during pregnancy (OR: 6.00, p = 0.002) were factors associated with pertussis vaccination during pregnancy. The education of both expectant mothers and obstetricians is urgently needed in order to increase immunization coverage during pregnancy. The low influenza vaccination coverage among women delivering during winter and low pertussis immunization rates, in combination with low recommendation rates for both vaccines, strongly indicate that Greek obstetricians focus on maternal health alone. Their perspectives play an instrumental role in vaccine acceptance during pregnancy, shaping the immunization inclusion maps.

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

Vaccination is the most effective means of preventing the spread of infectious diseases. Despite the proven benefits of vaccination, vaccine hesitancy keeps many people from getting vaccinated. We conducted a large-scale cluster randomized controlled trial in Finland to test the effectiveness of centralized written reminders (distributed via mail) on influenza vaccination coverage. The study included the entire older adult population (aged 65 years and above) in 2 culturally and geographically distinct regions with historically low (31.8%, n = 7,398, mean age 75.5 years) and high (57.7%, n = 40,727, mean age 74.0 years) influenza vaccination coverage. The study population was randomized into 3 treatments: (i) no reminder (only in the region with low vaccination coverage); (ii) an individual-benefits reminder, informing recipients about the individual benefits of vaccination; and (iii) an individual- and social-benefits reminder, informing recipients about the additional social benefits of vaccination in the form of herd immunity. There was no control treatment group in the region with high vaccination coverage as general reminders had been sent in previous years. The primary endpoint was a record of influenza vaccination in the Finnish National Vaccination Register during a 5-month follow-up period (from October 18, 2018 to March 18, 2019). Vaccination coverage after the intervention in the region with historically low coverage was 41.8% in the individual-benefits treatment, 38.9% in the individual- and social-benefits treatment and 34.0% in the control treatment group. Vaccination coverage after the intervention in the region with historically high coverage was 59.0% in the individual-benefits treatment and 59.2% in the individual- and social-benefits treatment. The effect of receiving any type of reminder letter in comparison to control treatment group (no reminder) was 6.4 percentage points (95% CI: 3.6 to 9.1, p < 0.001). The effect of reminders was particularly large among individuals with no prior influenza vaccination (8.8 pp, 95% CI: 6.5 to 11.1, p < 0.001). There was a substantial positive effect (5.3 pp, 95% CI: 2.8 to 7.8, p < 0.001) among the most consistently unvaccinated individuals who had not received any type of vaccine during the 9 years prior to the study. There was no difference in influenza vaccination coverage between the individual-benefit reminder and the individual- and social-benefit reminder (region with low vaccination coverage: 2.9 pp, 95% CI: -0.4 to 6.1, p = 0.087, region with high vaccination coverage: 0.2 pp, 95% CI: -1.0 to 1.3, p = 0.724). Study limitations included potential contamination between the treatments due to information spillovers and the lack of control treatment group in the region with high vaccination coverage. In this study, we found that sending reminders was an effective and scalable intervention strategy to increase vaccination coverage in an older adult population with low vaccination coverage. Communicating the social benefits of vaccinations, in addition to individual benefits, did not enhance vaccination coverage. The effectiveness of letter reminders about the benefits of vaccination to improve influenza vaccination coverage may depend on the prior vaccination history of the population. AEA RCT registry AEARCTR-0003520 and ClinicalTrials.gov NCT03748160.

BackgroundVaccination is the most effective means of preventing the spread of infectious diseases. Despite the proven benefits of vaccination, vaccine hesitancy keeps many people from getting vaccinated.Methods and findingsWe conducted a large-scale cluster randomized controlled trial in Finland to test the effectiveness of centralized written reminders (distributed via mail) on influenza vaccination coverage. The study included the entire older adult population (aged 65 years and above) in 2 culturally and geographically distinct regions with historically low (31.8%, n = 7,398, mean age 75.5 years) and high (57.7%, n = 40,727, mean age 74.0 years) influenza vaccination coverage. The study population was randomized into 3 treatments: (i) no reminder (only in the region with low vaccination coverage); (ii) an individual-benefits reminder, informing recipients about the individual benefits of vaccination; and (iii) an individual- and social-benefits reminder, informing recipients about the additional social benefits of vaccination in the form of herd immunity. There was no control treatment group in the region with high vaccination coverage as general reminders had been sent in previous years. The primary endpoint was a record of influenza vaccination in the Finnish National Vaccination Register during a 5-month follow-up period (from October 18, 2018 to March 18, 2019). Vaccination coverage after the intervention in the region with historically low coverage was 41.8% in the individual-benefits treatment, 38.9% in the individual- and social-benefits treatment and 34.0% in the control treatment group. Vaccination coverage after the intervention in the region with historically high coverage was 59.0% in the individual-benefits treatment and 59.2% in the individual- and social-benefits treatment. The effect of receiving any type of reminder letter in comparison to control treatment group (no reminder) was 6.4 percentage points (95% CI: 3.6 to 9.1, p < 0.001). The effect of reminders was particularly large among individuals with no prior influenza vaccination (8.8 pp, 95% CI: 6.5 to 11.1, p < 0.001). There was a substantial positive effect (5.3 pp, 95% CI: 2.8 to 7.8, p < 0.001) among the most consistently unvaccinated individuals who had not received any type of vaccine during the 9 years prior to the study. There was no difference in influenza vaccination coverage between the individual-benefit reminder and the individual- and social-benefit reminder (region with low vaccination coverage: 2.9 pp, 95% CI: −0.4 to 6.1, p = 0.087, region with high vaccination coverage: 0.2 pp, 95% CI: −1.0 to 1.3, p = 0.724). Study limitations included potential contamination between the treatments due to information spillovers and the lack of control treatment group in the region with high vaccination coverage.ConclusionsIn this study, we found that sending reminders was an effective and scalable intervention strategy to increase vaccination coverage in an older adult population with low vaccination coverage. Communicating the social benefits of vaccinations, in addition to individual benefits, did not enhance vaccination coverage. The effectiveness of letter reminders about the benefits of vaccination to improve influenza vaccination coverage may depend on the prior vaccination history of the population.Trial registrationAEA RCT registry AEARCTR-0003520 and ClinicalTrials.gov NCT03748160

Chronic diseases such as HIV, hypertension, and diabetes increase the risk of severe coronavirus disease 2019 (COVID-19) and death. Thus, COVID-19 vaccine uptake data among these priority populations are needed to inform immunization programs. We assessed COVID-19 vaccine uptake among people living with HIV (PLWH) and those with hypertension/diabetes without HIV (PWoH) in Southwestern and Southcentral Uganda and determined factors influencing vaccination. We conducted a cross-sectional study from January to April 2023. We enrolled a random sample of participants aged 18 years and older seeking HIV, hypertension, or diabetes care at two regional referral hospitals (RRHs) in Mbarara and Masaka in Uganda. Using vaccination records abstraction and interviewer-administered questionnaires, we collected data on COVID-19 vaccine uptake, sociodemographic data, and reasons for non-uptake in unvaccinated persons. We compared COVID-19 vaccination uptake between PLWH and PWoH and applied modified Poisson regression to determine sociodemographic factors associated with vaccine uptake. The reasons for non-vaccine uptake were presented as percentages. Of the 1,376 enrolled participants, 65.6% were fully vaccinated against COVID-19. Vaccination coverage was 65% among PWLH versus 67% among PWoH. Higher education attainment and older age were associated with COVID vaccination. Participants with secondary education and those aged ≥50 years achieved >70% coverage. Fear of side effects was the most cited reason (67%) for non-vaccination among 330 unvaccinated participants, followed by vaccine mistrust (24.5%). People with chronic diseases in Southwestern Uganda had slightly lower than 70% COVID-19 vaccine coverage as recommended by WHO. Higher educational attainment and older age were linked to increased vaccine uptake. However, mistrust and fear of vaccine side effects were the main reasons for non-vaccination. To increase COVID-19 vaccine uptake, programs must reach those with lower educational attainment and younger age groups, and address the fear of vaccine side effects and mistrust among persons with underlying diseases in Uganda.

Context: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are growing public health concerns and are responsible for most cases of chronic liver disease worldwide.Aims: This study evaluated the prevalence and associated sociocultural factors in HBV and HCV infections among pregnant women in our hospital.Settings and Design: Cross-sectional hospital-based study.Materials and Methods: Two thousand four hundred and sixty-two pregnant women were recruited for the study with a mean age of 26.4 ± 5.6 years. Screening for hepatitis B surface antigen was done using latex rapid agglutination slide tests and samples that were reactive were further confirmed using enzyme linked immunosorbent assay (ELISA, Bio-Rad, France). Anti-HCV antibody was evaluated using a third generation ELISA (DRG International Inc., USA).Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (SPSS Inc., Chicago, Illinois, USA).Results: Seroprevalence of HBV and HCV infections in this study was 14.6 and 2.0%, respectively. Percentages of pregnant women who were positive for HBV increased progressively with age. Seroprevalence of HBV was significantly higher among participants with below secondary (20%) than those with secondary and tertiary education (13.1%), P = 0.001. Significant positive correlation was observed between HBV and scarifications (P = 0.001), and negative correlation was observed between educational level and HBV (P = 0.001). Significant positive correlation was seen between previous blood transfusion and HCV (P = 0.002).Conclusion: There is a high prevalence of HBV and HCV infections among the participants. HBV and HCV infections are associated with age, scarifications, blood transfusion, low level of education, and multiple sexual partners among the participants. There is a need for infants of HBV-positive mothers to receive hepatitis B immune globulin in addition to hepatitis B vaccine within 12 h of birth.