Adequate Vaccination Research Articles

Modification of Sympathetic and Hypothalamic Responses to Prevent Complications of COVID-19: “Dam and Wall Concept”

We are in the midst of the COVID-19 pandemic. Since December 2019, severe acute respiratory coronavirus (SARS-CoV-2) has infected more than half a billion people, killing nearly 7 million people worldwide. Now various variants of SARS-CoV-2 are causing mayhem and driving the global surge. Epidemiologists are aware of the fact that this virus is capable of escaping immunity and likely to infect the same person multiple times despite adequate vaccination status. Elderly people and those with underlying health conditions who are considered high-risk are likely to suffer complications. While it is tempting to frame complications and mortality from COVID-19 as a simple matter of too much of a virulent virus in too weak of a host, much more is at play here. Framing the pathophysiology of COVID-19 in the context of the Chrousos and Gold model of the stress response system can shed insight into its complex pathogenesis. Understanding the mechanisms of pharmacologic modification of the sympathetic and hypothalamic response system via administration of clonidine and/or dexamethasone may offer an explanation as to why a viral pathogen can be well tolerated and cleared by one host while inflaming and killing another.

RABIES DIAGNOSIS AND RESPONSE TO VACCINATION IN SOUTHERN TAMANDUA (TAMANDUA TETRADACTYLA).

Rabies has rarely been described in Xenarthra, and rabies vaccine response has not been documented. A southern tamandua (Tamandua tetradactyla) presented with nonspecific clinical signs and was euthanatized. Subsequently, immunohistochemistry and RT-PCR confirmed a rabies diagnosis. Following these tests, a group of eight captive tamanduas were vaccinated with a killed rabies vaccine, and titers were measured at the time of vaccination and 23 d later. One animal had day 0 titers suggestive of previous vaccination or exposure. All animals had detectable neutralizing rabies virus antibody titers after vaccination, but one animal failed to meet the World Organization for Animal Health's definition for adequate vaccination (≥0.5 IU/ml), and two other animals had low antibody titers (0.56 and 0.6 IU/ml). Rabies should be considered as a possible cause of illness in tamanduas, and rabies vaccination may be a useful preventative measure when anthropic interaction through medical care or ambassador roles is occurring.

Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency.

To analyze the coverage of MMR and polio vaccines, the temporal trend and spatial dependence, in children up to one year of age in Brazil, between 2011 and 2021. Ecological study with secondary data on vaccination coverage rates, made available by the National Immunization Program Information System. Trend analysis was carried out using the joinpoint method, according to geographic regions, estimating the annual percentage change (APC) and its respective confidence interval (95%CI). Choropleth maps of distribution by health region were constructed and, subsequently, the spatial dependence was verified using Moran's statistics. Between 2011 and 2021, vaccination coverage declined in Brazil, both for MMR (APC: -6.4%; 95%CI -9.0; -3.8) and for poliomyelitis (APC: -4. 5%; 95%CI -5.5; -3.6). There was a decline in coverage of both vaccines in all geographic regions over the years of the study, except in the South and Midwest for the MMR vaccine. Since 2015, few health regions in the country have achieved adequate vaccination coverage (≥95.0% to <120.0%). The North and Northeast health regions showed low-low clusters in the univariate analysis for both immunobiological. It is urgent to consider studies like this one for the planning of more effective strategies for immunizing children, especially in areas with higher falls. In this way, barriers to access to immunization can be broken, given Brazil's heterogeneity, and access to reliable information that increases confidence in vaccine efficacy can be expanded.

Kanser hastalarında aşılanma durumu ve aşılanmayı etkileyen faktörlerin değerlendirilmesi

Aim: Coronavirus disease 2019 (COVID-19) pandemic increased the mortality of cancer patients by causing direct infection or collateral damage to the healthcare system. After the development of effective vaccines against COVID-19 infection, mortality rates declined. In this study, we try to investigate the vaccination among cancer patients.Methods: A survey was applied to patients with cancer in order to investigate the attitudes towards vaccination and the factors effecting vaccination in two medical oncology centers in Turkey.Results: 271 patients were included in the study. No difference was observed in the attitudes of patients towards vaccination according to cancer type. 83% of the patients were vaccinated against COVID-19. In 75% of the study population, vaccine was administered in the earliest available time. Receiving chemotherapy was the most significant reason to avoid vaccination among the study group (p=0,002). There was no significant difference in terms of treatment type for COVID-19 between patients with or without adequate vaccination. The most negative factor affecting vaccination was active chemotherapy treatment. Social relations and traditional media were the most positive factors for vaccination.Discussion: Vaccination is of vital importance for patients who are treated or on remission. Even if patients are to receive chemotherapy, they should be informed about vaccination and should be encouraged for vaccination.

Recent Advances in Genomics-Based Approaches for the Development of Intracellular Bacterial Pathogen Vaccines.

Infectious diseases continue to be a leading cause of morbidity and mortality worldwide. The majority of infectious diseases are caused by intracellular pathogenic bacteria (IPB). Historically, conventional vaccination drives have helped control the pathogenesis of intracellular bacteria and the emergence of antimicrobial resistance, saving millions of lives. However, in light of various limitations, many diseases that involve IPB still do not have adequate vaccines. In response to increasing demand for novel vaccine development strategies, a new area of vaccine research emerged following the advent of genomics technology, which changed the paradigm of vaccine development by utilizing the complete genomic data of microorganisms against them. It became possible to identify genes related to disease virulence, genetic patterns linked to disease virulence, as well as the genetic components that supported immunity and favorable vaccine responses. Complete genomic databases, and advancements in transcriptomics, metabolomics, structural genomics, proteomics, immunomics, pan-genomics, synthetic genomics, and population biology have allowed researchers to identify potential vaccine candidates and predict their effects in patients. New vaccines have been created against diseases for which previously there were no vaccines available, and existing vaccines have been improved. This review highlights the key issues and explores the evolution of vaccines. The increasing volume of IPB genomic data, and their application in novel genome-based techniques for vaccine development, were also examined, along with their characteristics, and the opportunities and obstacles involved. Critically, the application of genomics technology has helped researchers rapidly select and evaluate candidate antigens. Novel vaccines capable of addressing the limitations associated with conventional vaccines have been developed and pressing healthcare issues are being addressed.

Knowledge, attitude and practice of COVID-19 preventive measures among pregnant women in antenatal clinics in western Kenya.

Coronavirus disease 2019 (COVID-19) infection among pregnant women can lead to an increased risk of adverse pregnancy outcomes. Preventive measures are essential as there is no definite cure. This study determined the knowledge, attitude and practice of COVID-19 preventive measures including COVID-19 vaccine uptake, among pregnant women attending antenatal clinics in western Kenya. A mixed-methods study was conducted during the fourth wave of COVID-19 in Kisumu and Siaya counties in Kenya from December 2021 to January 2022. Fishers' Exact/Chi-square tests were used to determine the association between variables, and multinomial logistics regression were used to identify the predictors of knowledge, attitude and practice. Thematic analyses were used to describe qualitative findings. Of the 385 women interviewed, 99.7% and 100%, had good and above knowledge and attitude respectively, while 23%, had adequate practices. COVID-19 vaccine uptake was 28%. Respondents from households with 3-5 and 6-8 members were 2.11 and 2.58 times more likely to have poor practices, whereas respondents with tertiary level of education were 0.48 times less likely to have poor practices. Focus group discussions revealed that poor COVID-19 vaccine uptake was caused by vaccine myths and misconceptions, whereas the cost of masks, the smell of soaps and sanitizers and inadequate space in the clinics and workplaces were identified as barriers to COVID-19 prevention practices. Although knowledge and attitude scores towards COVID-19 preventive measures were high, this did not reflect in pregnant women engaging in adequate preventive practices and vaccine uptake.

Esitazione vaccinale: maneggiare con cura

Vaccine hesitancy is an increasing phenomenon in many high-income countries, including Italy. It significantly undermines the first indicator for the monitoring of a vaccination strategy that consists in achieving and maintaining adequate vaccination coverage levels. Such a phenomenon is more and more complex and context-specific and varies in time, according to the place and type of vaccine. To implement a proactive prevention concept, the final aim for all the professionals involved in the vaccination programme, namely to accompany parents in a free and conscious choice, must not be underestimated. Actions should be taken coordinately and with the contributions of different healthcare workers and should be based on accountability, collaboration, interdisciplinarity and intersectoriality. Only in this way can health alphabetization, accountability and citizens’ emancipation be achieved.

Summary of the National Advisory Committee on Immunization (NACI) Rapid Response: Updated interim guidance on Imvamune in the context of ongoing monkeypox outbreaks.

During the period of monkeypox community transmission and restricted vaccine supply in the summer of 2022, Canadian provinces and territories and a number of vaccine stakeholders indicated the need for consistent national guidance on pre-exposure vaccination (including the identification of priority populations for pre-exposure vaccination programs) and guidance on the potential use of dose-sparing strategies. The National Advisory Committee on Immunization (NACI) High Consequence Infectious Disease Working Group reviewed data on the status of the monkeypox outbreak along with additional published and non-published evidence regarding the safety, immunogenicity and protection offered by Imvamune®. NACI approved updated recommendations on September 16, 2022, and on September 23, 2022 it released updated interim guidance on the use of Imvamune in the context of the ongoing monkeypox outbreak. During periods of adequate vaccine supply, NACI recommended that Imvamune pre-exposure vaccination should be offered as a two-dose primary series, with at least 28 days between the two sub-cutaneous doses. When supply is limited, guidance was provided for the use of dose sparing strategies, including extended dosing intervals and fractional intradermal dosing to maximize vaccine coverage for those at highest risk of exposure to the monkeypox virus. The updated NACI recommendations provide additional guidance on the use of Imvamune for the management of the 2022 monkeypox outbreak in Canada and may be considered to maximize vaccine coverage in outbreak settings when supply is limited.

Confirmation of the Rabbit Hemorrhagic Disease Virus Type 2 (GI.2) Circulation in North Africa

Abstract Rabbit hemorrhagic disease (RHD) is a highly contagious viral disease that causes fatal acute hepatitis in domestic and wild lagomorphs. It has taken on major economic importance in countries like Morocco. In addition to the classical virus (RHDV), a novel emerged genotype (RHDV2) is circulating, especially in the north shore of the Mediterranean basin since 2010. Many small animal farmers reported clinical cases from several rabbitries in Agadir (Morocco) despite systematic vaccination against the RHDV. The main objective was to characterize the current RHDV strains circulating in the studied area to help to choose an adequate vaccine. For that, we extracted viral RNA from rabbit livers, carried out the PCR analyses, and we sequenced the viral structural capsid protein (VP60) of the RHDV. The phylogenetic analysis results allowed us to state that the novel genotype (RHDV2) is circulating in the studied geographical area, and to characterize the isolated sequences. As a conclusion, we recommend updating RHD epidemiological relating data and reviewing the vaccine protocols by both targeting RHDV (GI.1) and RHDV2 (GI.2) in any future preventive program.

Effectiveness of heterologous third and fourth dose COVID-19 vaccine schedules for SARS-CoV-2 infection during delta and omicron predominance in Thailand: a test-negative, case-control study

The Coronavirus disease 2019 (COVID-19) pandemic has evolved quickly, with numerous waves of different variants of concern resulting in the need for countries to offer continued protection through booster vaccination. To ensure adequate vaccination coverage, Thailand has proactively adopted heterologous vaccination schedules. While randomised controlled trials have assessed homologous schedules in detail, limited data has been reported for heterologous vaccine effectiveness (VE). Utilising a unique active surveillance network established in Chiang Mai, Northern Thailand, we conducted a test-negative case control study to assess the VE of heterologous third and fourth dose schedules against SARS-CoV-2 infection among suspect-cases during Oct 1-Dec 31, 2021 (delta-predominant) and Feb 1-Apr 10, 2022 (omicron-predominant) periods. After a third dose, effectiveness against delta infection was high (adjusted VE 97%, 95% CI 94-99%) in comparison to moderate protection against omicron (adjusted VE 31%, 95% CI 26-36%). Good protection was observed after a fourth dose (adjusted VE 75%, 95% CI 71-80%). VE was consistent across age groups for both delta and omicron infection. The VE of third or fourth doses against omicron infection were equivalent for the three main vaccines used for boosting in Thailand, suggesting coverage, rather than vaccine type is a much stronger predictor of protection. Appropriately timed booster doses have a high probability of preventing COVID-19 infection with both delta and omicron variants. Our evidence supports the need for ongoing national efforts to increase population coverage of booster doses. This research was supported by the National Research Council of Thailand (NRCT) under The Smart Emergency Care Services Integration (SECSI) project to Faculty of Public Health Chiang Mai University.

COVID-19 Infection After Vaccination Among Healthcare Workers at a Tertiary Level Health Care Center in Northern India: A Cross-Sectional Study.

COVID-19 vaccines are now accessible to all Indian citizens. Infection with COVID-19, on the other hand, continues to spread constantly. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID-19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India. We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution from 16 January 2021 to 30th June 2021. During this period, 5273 (90.3%) HCWs received two doses of the COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211 (89.2%) were AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%, confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections. 274 (5.19% of total vaccinated HCWs) breakthrough infections and 149 non-breakthrough COVID-19 infections were reported in HCWs who had previously received a single dose of the COVID-19 vaccination. Viral infections, especially breakthrough infections, following adequate vaccination, are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.

REDUCED COVID-19 VACCINE RESPONSE IN PATIENT TREATED WITH DUPILUMAB FOR IGG4 RELATED DISEASE.

<h3>Introduction</h3> Dupilumab is a novel anti-interleukin-4 (IL-4) receptor-α monoclonal antibody that targets the signaling pathways of IL-4 and IL-13. There there has been limited data about adequate humoral immune response after vaccination to SARS-CoV-2 in patients on dupilumab. <h3>Case Description</h3> We previously reported the case of a 71-year-old man with IgG4 related-disease (IgG4-RD) that we successfully treated with dupilumab. This patient was followed while his IgG4-RD remained well controlled on dupilumab which he remained on during this pandemic. He received two Pfizer SARS-CoV-2 mRNA vaccinations on March 24 and June 18, 2021. On July 24, 2021, result of SARS-CoV-2 Total-Antibody was non-reactive. As such, a third booster vaccination on November 10, 2021 and timing of holding dupilumab was made to optimize his potential immune response. Dupilumab was held for 1 month prior to his third vaccination and was re-initiated two weeks post-vaccination. On December 3, 2021, his SARS-CoV-2 Total-Antibody was repeated and found to be 2282 U/ml while his SARS-CoV-2-NPROT Total-Antibody was negative, implying immune response through vaccination and not natural exposure. <h3>Discussion</h3> To our knowledge, this is the first case report on a patient with IgG4-RD controlled on dupilumab who was found to have adequate vaccine response after his dupilumab was held for 1 month after failing to mount a response to the first two vaccination doses while on therapy. As there is evidence that lower vaccine-specific titers afford less protection against COVID-19, this report highlights this approach as one possible strategy for protecting these individuals who may remain at high risk.

Physicians' Agreement on and Implementation of the 2019 European Alliance of Associations for Rheumatology Vaccination Guideline: An International Survey.

To evaluate the perspective of healthcare professionals towards the 2019 European Alliance of Associations for Rheumatology (EULAR) vaccination guideline in patients with autoimmune inflammatory rheumatic diseases (AIIRD). Healthcare professionals who care for patients with AIIRD were invited to participate in an online survey regarding their perspective on the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. Level of agreement and implementation of the 6 overarching principles and 9 recommendations were rated on a 5-point Likert scale (1~5). Survey responses of 371 healthcare professionals from Asia (42.2%) and North America (41.6%), Europe (13.8%), and other countries were analyzed. Only 16.3% of participants rated their familiarity with the 2019 EULAR guideline as 5/5 ("very well"). There was a high agreement (≥4/5 rating) with the overarching principles, except for the principles applying to live-attenuated vaccines. There was a high level of agreement with the recommendations regarding influenza and pneumococcal vaccinations; implementation of these recommendations was also high. Participants also reported a high level of agreement with the remaining recommendations but did not routinely implement these recommendations. The 2019 update of EULAR recommendations for the vaccination of adult patients with AIIRD is generally thought to be important by healthcare professionals, although implementation of adequate vaccination is often lacking. Better education of healthcare providers may be important to optimize the vaccination coverage for patients with AIIRD.

Determinants of COVID-19 vaccine uptake among healthcare workers and the general population in Cyprus

Abstract Background Vaccination is a critical intervention in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Various levels of COVID-19 vaccination acceptance have been observed around the world. However, a high percentage of the general population and healthcare professionals (HCPs), refuse the COVID-19 vaccination. This study aims to examine the factors influencing COVID-19 vaccine uptake among HCPs and the general population in Cyprus. Methods An online cross-sectional study was conducted, using a self-administered questionnaire to collect information covering various potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information, and general vaccination knowledge. Results A total of 2582 participants completed the survey, with 53.5% of individuals in the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by one year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00-1.03, p-value=0.035), whilst those with increased trust in national healthcare authorities’ guidelines (OR = 3.96, 95% CI: 3.41-4.61) and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05-1.18) were significantly more likely to be vaccinated. Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01-3.59), and those who reported increased trust in national healthcare authorities’ guidelines (OR = 5.38, 95% CI: 3.65-7.95) were significantly more likely to be vaccinated. Conclusions Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and educate and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavorable scenarios, such as future pandemics. Key messages • Our results revealed the importance of vaccination knowledge and trust in healthcare system in respect to COVID-19 vaccination uptake. • The urgent need for national campaigns and long-term planning to build public trust in national healthcare authorities.

Outcome of COVID-19 in Kidney Transplant Recipients Through the SARS-CoV-2 Variants Eras: Role of Anti-SARS-CoV-2 Monoclonal Antibodies.

Kidney transplant recipients (KTR) are at increased risk for COVID-19-associated complications. We aimed to describe the evolving epidemiology and outcome of PCR-documented SARS-CoV-2 infection in KTR followed at our institution from March 2020 to May 2022. The primary endpoint was hospitalization for COVID-19-related symptoms or death within 28 days from diagnosis. Overall, 243 cases were included of which 68 (28%) developed the primary outcome. A significant decrease in the incidence of the primary outcome was observed (p < 0.001, r −0.342) during the study period. Anti-Spike monoclonal antibodies (mAbs) were administered as early treatment (within 5–7 days of onset of symptoms) in 101 patients (14 with casirivimab/imdevimab and 87 with sotrovimab). Among 145 patients who had received at least one vaccination dose before infection, 109 patients were considered as adequately vaccinated. Multivariate analysis revealed that the Charlson Comorbidity Index (P 0.001; OR 1.28, CI 1.11–1.48) was associated with the primary outcome, while early administration of mAbs (P 0.032; OR 0.39, CI 0.16–0.92) was associated with a better outcome, but not infection during the period of the omicron variant predominance or adequate vaccination.

P076: Pneumococcal infection in splenectomised Hodgkin lymphoma patients: Do they pose a problem today and what is the best long-term strategy?

Purpose: Diagnostic laparotomy and splenectomy (DLS) were introduced for Hodgkin lymphoma (HL) patients in Sweden in the late 1960s/early-70s. It was soon established that splenectomised and functional hyposplenic (following irradiation) HL patients carried an increased risk of overwhelming infections, Streptococcus pneumoniae being the major causative agent. Despite this, DLS remained as a staging procedure for more than two decades. The purpose of this study was to compare incidence and outcome of pneumococcal infections between splenectomised (spl+) and non-splenectomised (spl-) HL patients. Material and Methods: HL patients diagnosed 1973–1995 were identified in the Swedish Cancer Register. Information on splenectomies and severe pneumococcal infections was retrieved from the National Inpatient Register. Follow-up started a diagnosis and ended on date of infection, emigration, death, or December 31, 2010, whichever came first. Splenectomy was analysed as a time-varying covariate, i.e., patients were considered unexposed before the date of splenectomy and exposed after the date of splenectomy. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) comparing infection rates between spl+/spl- patients. Results: A total of 4,237 HL patients were included, among whom 735 (17%) underwent a splenectomy, with a median time from splenectomy to infection of 6.8 years (range 0.1–30.8 years). The number of patients experiencing a severe pneumococcal infection was 39 (3.2 per 1,000 person-years) among spl+ and 60 (1.7 per 1,000 person-years) among spl- patients. The relative rate of severe pneumococcal infection comparing spl+/spl- HL patients was 2.43 (95% CI: 1.55–3.81), adjusted for diagnosis year, diagnosis age, and sex. The 30-day post-infection mortality proportion was 9/39 (23%) among the spl+ and 18% (11/60) among the spl- patients. Broken down by calendar period of infection, the 30-day post-infection mortality proportion among splenectomised patients was 44% (1973–1985), 23% (1986–1998), and 0% (1999–2010). Conclusion: Severe pneumococcal disease is a serious event that is more likely to appear in splenectomised HL patients compared to non-splenectomised, possibly many years after diagnosis. However, the low proportion of deaths in later decades is reassuring, and likely a result of adequate pneumococcal vaccination together with patient and doctor education about the infection risk.

Modeling the impact of mitigation policies in a pandemic: A system dynamics approach

In the absence of effective and adequate vaccines, healthcare decision-makers must rely on non-pharmaceutical interventions (NPIs), such as lockdown, testing, hospital capacity building, and increasing the number of medical staff to control the outbreak of an infectious disease like COVID-19. This manuscript presents a System Dynamics (SD) model to analyze the healthcare system performance under various NPIs during a pandemic. The proposed model, which extends the commonly-used Susceptible-Exposed-Infectious-Recovered (SEIR) model, comprises four sub-models: outbreak, hospital performance, medicine supply, and staff functionality. These sub-models work in harmony to stimulate the impact of NPIs on the disease outbreak pattern and the healthcare system's response to demand surge. The proposed model considers the uncertainty about the nature of the disease, the public's behavior, medicine availability, and medical staff efficiency. The proposed model was applied for the ex-ante evaluation of candidate NPIs adoptable against the COVID-19 outbreak in Iran. Consistent with the reported statistics, the results show that the peak demand can significantly exceed the healthcare system's initial capacity if no action is taken. If simultaneously implemented, lockdown and testing can considerably delay the peak of infections, reduce its magnitude, dampen the hospital demand, and decrease mortality. The proposed model is unique as it determines the extent to which system components (e.g., community, healthcare system, and medicine supply chain) impact the observed outcomes (e.g., morbidity and mortality rates). Its structure is generic and flexible, which facilitates the extension and application of the model to evaluate candidate mitigation policies in various geographical contexts.

COVID-19 Vaccine Acceptance among Vulnerable Groups: Syrian Refugees in Jordan.

Despite the wide distribution of COVID-19 vaccines, refugees remain last in line for the intake of vaccines. Syrian refugees in Jordan reach up to 700,000 registered and almost up to 700,000 unregistered refugees. This study aims to assess the willingness of Syrian refugees in Jordan to take the COVID-19 vaccine. Participants in the Zaatari refugee camp in Jordan were invited through social media to complete the survey between January and March 2022. A total of 230 refugees participated in our study, with almost half the participants of male gender. The majority of the participants had secondary school as their highest education level and were unemployed, being below the social poverty line. Interestingly, Syrian refugees showed a high vaccine acceptance rate, as 89.6% were willing to take the vaccine. Moreover, they showed high knowledge regarding the vaccine, the disease, and the virus. Our findings highlight the importance of knowledge and awareness of the COVID-19 vaccine to increase the acceptance rate. This is very important as refugees represent a vulnerable group to infection and complications and require close attention, especially with their significant numbers in Jordon and challenges of providing adequate vaccine supplies at their camps. We hope that, with proper dissemination of knowledge and awareness and with easy accessibility to the vaccines, it will ensure high immunization to reach herd immunity in Jordan.

Determining critical gaps in implementation of WHO and UNICEF's 7-point plan in diarrhoea control and prevention strategy: A cross sectional study in District Swabi, Pakistan.

To determine the critical gaps in knowledge and practices of mothers/caregivers in the management of diarrhoea in children at home. The descriptive cross-sectional study was conducted from September 2019 to August 2020 at primary health centres across Swabi district of the Khyber Pakhtunkhwa province of Pakistan, and comprised mothers/caregivers presenting with children aged <5 years suffering from diarrhoea. Barriers to childhood diarrhoea prevention and control were identified in accordance with the 7-point plan adopted by the federal government in 2009. Data was analysed using SPSS 23. There were 287 mothers with a mean age of 26.8±5.39 years (range: 17-42 years). The mean age of the children was 24.85±12.72 months (range: 2-55 months). Among the mothers, 145 (51.5%) had received no schooling, 83(29%) had primary level schooling, 56(19.5%) secondary level and 3(1%) had received higher-level education. Only 63(22%) were aware of the use of oral rehydration salts and 32(11%) knew about the need of using zinc in diarrhoea. Safe water was available in 14(5%) households. Hand hygiene awareness was low, as 169(59%) mothers were washing hands with soap. Household access to toilet facility was 247(86%). Preventive health services were good with overall breastfeeding practices 204(71%) and children vaccination 244(85%.). Majority of mothers were found to be well aware of breastfeeding practices and the children had adequate vaccination coverage. There was a wide gap in direct awareness and practices of mothers about sanitation and hygiene and also home-based management of diarrhoeal diseases in children.

Vaccination hesitancy: To be vaccinated, or not to be vaccinated, that is the question in the era of COVID-19.

COVID‐19 vaccine hesitancy poses serious challenges in achieving adequate vaccine coverage in the general population. While most studies on vaccine hesitance determinants during the COVID‐19 pandemic were quantitative, qualitative research on the reasons for vaccine resistance is still lacking. To fill this gap, this study aims to qualitatively investigate cognitive and emotional factors associated with COVID‐19 vaccine hesitancy. This qualitative pilot study was conducted between October and November 2021 in Italy. A total of 40 COVID‐19 vaccine‐hesitant (“hesitant not vaccinated” or “hesitant but vaccinated”) individuals completed anonymous questionnaires with open‐ended questions. Data were analysed using the Interpretive Description approach. The central theme that emerged about vaccine hesitancy was the lack of control. This construct included four different sub‐categories: distrust of the government, infodemic, influence of family, and general anti‐vaccine opinions. The results also showed that the most important emotional and cognitive factors associated with hesitancy were anger related to a perceived sense of oppression; emotional avoidance to minimize risk; anxiety related to potential vaccine side effects. Identifying and understanding factors influencing COVID‐19 vaccination hesitancy is crucial to improving communication strategies that will ultimately result in increased confidence and vaccine acceptance.