Decrease In Vaccination Coverage Research Articles

Has COVID-19 Affected DTP3 Vaccination in the Americas?

In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Overall, America saw a decrease in vaccine coverage during this period, with an APC of -1.4 (95% CI -1.8; -1.0). This trend varied across regions. In North America, the decrease was negligible (-0.1% APC). South America showed the steepest decrease, with an APC of -2.5%. Central America also declined, with an APC of -1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was -4% between 2019 and 2022, with the most important drop being in Central America (-7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being -7.37%. This decline poses an important challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

COVID-19 Vaccination Coverage and Associated Factors in Patients with Multiple Sclerosis.

Our objective was to know the COVID-19 vaccination coverage in multiple sclerosis (MS) patients and its factors associated. A retrospective cohort study was carried out. Patients seen at the MS unit of the University Clinical Hospital of Zaragoza between 2017 and 2021 were included. Variables were obtained by reviewing the specialized and primary care records. Associations between receiving COVID-19 full primo-vaccination, as well as one booster dose since autumn 2022, and the other variables were analyzed using bivariate analysis and multiple logistic regression models. Of the 359 included patients, 90.3% received the COVID-19 full primo-vaccination. Having been born in Spain (aOR = 3.40) and having received the 2020-2021 influenza vaccine (aOR = 6.77) were associated with receiving the COVID-19 full primo-vaccination. Vaccination with a COVID-19 booster dose was detected in 141 patients (39.3%). Sex (man) (aOR = 2.36), age (60 years or over) (aOR = 6.82), type of MS (Primary Progressive/Secondary Progressive) (aOR = 3.94), and having received the 2022-2023 influenza vaccine (aOR = 27.54) were associated with receiving such a booster dose. The COVID-19 booster dose was administered at the same time as the 2022-2023 influenza vaccine in 57.8% (67/116) of the patients vaccinated with both vaccines. The COVID-19 full primo-vaccination coverage is higher than in other countries. However, the decrease in vaccination coverage with the booster dose makes it necessary to develop strategies to improve it that are not limited to administering the flu vaccine together with the COVID-19 booster dose. Such strategies should be in focus, especially for women under 60 years of age.

Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis.

Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.

Polio outbreak response, Yemen.

A decrease in vaccine coverage in conflict-affected areas has placed Yemen at higher risk of polio outbreaks caused by vaccine-derived poliovirus strains. In response to polio outbreaks, the Yemeni health ministry and partners initiated multiple vaccination campaigns to deliver vaccines to children. We also implemented several measures to enhance communication, education, health promotion and hygiene, especially in camps for internally displaced people. In 2009, Yemen achieved polio-free status and maintained it until 2019. However, the ongoing political conflict since 2015, coupled with challenges in delivering the polio vaccine to conflict-affected areas, resulted in two polio outbreaks: 35 cases caused by vaccine-derived poliovirus strain 1 between 2019 and 2021, and 230 cases due to vaccine-derived poliovirus strain 2 between November 2021 and December 2022. In response to the first outbreak, by the end of 2020, we vaccinated 7.2 million children through nationwide vaccination campaigns, except in Sa'ada governorate due to a ban by the authorities. By the end of 2021, 3 800 313 children younger than 5years had received polio vaccines. For the second outbreak, by the end of 2022, 4 463 389 vaccines had been given to children younger than 10years, and 1 217 423 to those younger than 5years. Vaccination campaigns in conflict-affected areas with low vaccine coverage remain crucial in eradicating polio. Efforts are needed to reach vulnerable groups such as displaced populations. Advocacy, communication and social mobilization actions help ensure broader public inclusion and participation in vaccination efforts to prevent polio outbreaks.

Internal and external factors affecting vaccination coverage: Modeling the interactions between vaccine hesitancy, accessibility, and mandates.

Society, culture, and individual motivations affect human decisions regarding their health behaviors and preventative care, and health-related perceptions and behaviors can change at the population level as cultures evolve. An increase in vaccine hesitancy, an individual mindset informed within a cultural context, has resulted in a decrease in vaccination coverage and an increase in vaccine-preventable disease (VPD) outbreaks, particularly in developed countries where vaccination rates are generally high. Understanding local vaccination cultures, which evolve through an interaction between beliefs and behaviors and are influenced by the broader cultural landscape, is critical to fostering public health. Vaccine mandates and vaccine inaccessibility are two external factors that interact with individual beliefs to affect vaccine-related behaviors. To better understand the population dynamics of vaccine hesitancy, it is important to study how these external factors could shape a population's vaccination decisions and affect the broader health culture. Using a mathematical model of cultural evolution, we explore the effects of vaccine mandates, vaccine inaccessibility, and varying cultural selection trajectories on a population's level of vaccine hesitancy and vaccination behavior. We show that vaccine mandates can lead to a phenomenon in which high vaccine hesitancy co-occurs with high vaccination coverage, and that high vaccine confidence can be maintained even in areas where access to vaccines is limited.

COVID-19 Vaccination Policies: Ethical Issues and Responsibility

The World Health Organization (WHO) declared coronavirus 2 (SARS-CoV-2, COVID-19) a global pandemic on 11 March 2020. The emergence of the reliability of vaccines, the fear of possible vaccination-related side effects, and mass-media information created situations in which families and even health professionals developed hesitations regarding the need for vaccines, with a consequent decrease in vaccination coverage. This study discusses ethical issues and responsibility for the possible side effects of SARS-CoV-2 vaccination raised by vaccination policies.

Flu and COVID-19 Vaccination: What Happens to the Flu Shot When the Campaigns Overlap? Experience from a Large Italian Research Hospital.

Influenza represents a threat to global health and health care workers (HCWs) have an increased risk of contracting the influenza virus in the workplace. The COVID-19 pandemic has brought back the importance of influenza vaccination, as the influenza virus can circulate together with SARS-CoV-2. The aim of this report is to describe the actual flu vaccination coverage among healthcare workers of a research hospital and the trend changes, with respect to the past flu vaccination campaigns, in light of the present pandemic and COVID-19 vaccination. A Pearson’s χ2 test was used to test the correlation of flu vaccination coverage, across all professional categories, between the last two years. A linear regression model was adopted to predict the total vaccination coverage of this year. A statistically significant decrease (p < 0.01) was observed in vaccination coverage among all the professional categories with a 50% reduction in vaccination trends between the last two years. Analyzing the data from the previous six flu vaccination campaigns, the expected value, according to the linear regression model, was estimated to be 38.5% while the observed value was 24%. The decrease in vaccination coverage may be due to the fear of the pandemic situation and especially to the uncertainty related to the consequences of a concurrent administration which may overload the immune system or may be more reactogenic. The COVID-19 pandemic represents an opportunity to promote and support large-scale influenza vaccination among HCWs through structured programs, adequate funding, and tailored communication strategies.

Unpacking linguistic devices and discursive strategies in online social movement organizations: Evidence from anti-vaccine online communities

This study investigates linguistic devices and discursive strategies employed by online social movement organizations (SMOs) in attempts to deinstitutionalize long-standing, institutionalized behaviors. The research draws from an in-depth analysis of public discourse within anti-vaccine online communities in Italy and contributes to the social movement literature on framing and the theory of discursive institutionalization. It employs semi-automated text-analysis methods and interpretive analysis of textual data from seven anti-vaccine social media communities, before and subsequent to the 2017 regulatory intervention of the Italian government to increase vaccination rates. This intervention followed a phase of intense debate centered on the decrease in vaccination coverage and the spread of anti-vaccine ideas in social media as well as in the broader public discourse. The study analyzes the discursive strategies and linguistic devices of community leaders (moderators) and followers (members), and investigates shifts in micro-level online anti-vaccine discursive strategies that developed after the government regulation. The findings suggest that anti-vaccine online SMOs employ specific sets of linguistic devices, namely rhetorical fallacies, that support well-defined discursive strategies such as those aiming to delegitimize actors that endorse vaccines. Furthermore, the evidence shows that these linguistic devices and discursive strategies, after the government regulation, shift from an evidence-based stance towards values and emotions-based argumentations.

Establishing a Dialogue with a Patient on Vaccination (Scientific Review)

Relevance. Vaccine prophylaxis is the most cost-effective and affordable means of controlling infectious diseases. At the same time, there is a great regional diversity in the number of people who refuse vaccination. In our country, according to several large studies, there is a relatively low adherence to vaccination compared to other European countries. It is common to have doubts and questions about immunization in adult patients or parents who vaccinate their children. A decrease in vaccination coverage of the population can lead to an increase in the incidence of infections preventable by immunization. At the same time, measures to promote vaccination used by preventive health care systems in various countries are insufficient. This increases the likelihood for doctors of various specialties to meet in their daily activities with patients' questions and concerns about vaccination.The purpose of this work was to highlight the practical aspects of building a dialogue with patients who have doubts about vaccination. Conclusions. Successful communication is based on the doctor's ability to build a confidential dialogue based on confidence in the decency and goodwill of all its participants. Based on the study, the following conclusions can be drawn. An alarming trend in recent years is the increasing number of patients who doubt the effectiveness of vaccination. For hesitant patients, the doctor is one of the most important sources of information about vaccines. The doctor's ability to clearly and confidently build a dialogue about vaccination helps to dispel the patient's doubts and is the most effective means of increasing adherence to immunization of the population.

Impact of the COVID-19 pandemic over the perception of the population about vaccines

OBJECTIVE: Evaluate how the COVID-19 pandemic affected the opinion of the population about vaccines and if there was a decrease in the vaccine coverage during the pandemic. METHODS: A self-applied questionnaire was used with the internet with questions about de impact of the pandemic about the perception and adhesion of the population to the vaccine campaigns and about the probability to vaccinate to COVID-19 once there is an approved and available vaccine and de majority believe the vaccines should be mandatory. RESULTS: We reached 475 answers to the questionnaire that showed an increase of the importance that the population gives to vaccines in general after the pandemic, a decrease of the vaccine coverage during the pandemic and high probability that the population get vaccinated against COVID-19 once there is an available vaccine and most of the population consider that the vaccine should be mandatory, however a decreased vaccination coverage was detected during the pandemic. CONCLUSION: The results show a tendency of appreciation of the vaccines and a tendency of the population to get vaccinated as soon as there is an approved one, especially those that had or are having an education in the healthcare area, showing how the education in health contribute to the adhesion of the population to the vaccines, however the decrease in vaccine coverage is worrying. Also, it is possible to conclude that the population intend to vaccinate against COVID-19 as soon there is an approved vaccine in the country.

Sustained Vaccination Coverage during the Coronavirus Disease 2019 Epidemic in the Republic of Korea.

Amid the COVID-19 pandemic, vaccination coverage may decline due to limited accessibility to healthcare. We assessed the impact of the COVID-19 pandemic on vaccination coverage and the incidence of vaccine-preventable diseases (VPDs) in the Republic of Korea. National vaccination coverage of 10 essential vaccines administered to children between January–June 2019 and January–June 2020 was analyzed. The national incidence of selected VPDs was compared for the corresponding periods. During the COVID-19 outbreak, the vaccination rate in children aged 0–35 months in Korea did not decrease significantly, whereas the vaccination rate for children aged 4–6 years decreased by 1.4–1.9%. The overall incidence of VPDs decreased by 10–50% between 2019 and 2020, especially with varicella. Thus, the COVID-19 pandemic did not result in a decrease in vaccination coverage among Korean children, which prevented a surge in VPD incidence. Maintaining essential vaccination coverage without interruption is important during the response to the COVID-19 pandemic.

Reduction of vaccinal coverage of measles in Brazil and the resurgence of the disease between 2017 and 2019: an epidemiological alert

Introduction: Measles a disease caused by Paramixovirus is an infectious disease with high transmissibility through the dispersion of salivary secretions from infected people. Clinically, it presents with fever, dry cough, coryza, tarsal conjunctivitis, enanthema (Koplik’s spots), maculopapular rash craniocaudally disseminated, leukopenia and other changes in blood tissue. In Brazil, the National Immunization Program (PNI), that aims vaccination coverage (CV) - population immunized against a certain disease – of 95% brought several remarkable advances for public health, such as the elimination of measles circulation in 2016, certified by the Pan American Health Organization. However, in recent years, measles has again become a serious public health problem, whose outbreaks have generated alarming data suggestive of a deficit in the integration of surveillance, prevention and promotion actions of health. Objectives: To analyze measles vaccination coverage in Brazil, during the period of 2017 to 2019; tabulate epidemiological data and identify the probable causes of measles recurrence in Brazil. Methods: Ecological retrospective study with data obtained from DataSUS (TabNet), Epidemiological Reports and Bulletins from the Health Ministry. For the analysis of the possible causes for the reintroduction of the virus, a literature review was carried out in the SciELO and PubMed databases, using the boolean operators “Vaccine” and “measles”. Articles were selected whose research location was Brazil. Articles whose methodology was not clear or well described were excluded. Results: Between 2017 and 2019, 23,751 cases in Brazil were confirmed. In 2017 vaccination coverage was 68.05%, a number that dropped to 66.95% in 2018. From 2017 to 2018, 10,262 cases were confirmed, 9,783 cases in Amazonas; 389 in Roraima; 54 in Pará; 45 in Rio Grande do Sul; 19 in Rio de Janeiro; while Sergipe, Pernambuco, São Paulo, Rondônia, Bahia and the Federal District registered four cases or less. The decline in 2019 was even more abrupt: 42.68% CV. That year 13,489 cases were confirmed in Brazil; 12,296 in São Paulo; 429 in Paraná; 155 in Rio de Janeiro; 151 in Pernambuco; 115 in Minas Gerais and 35 in Bahia. During these years, 27 deaths were confirmed in five national states: Roraima, Amazonas, Pará, Pernambuco and São Paulo. Discussion and Conclusions: The population’s lack of information regarding the severity of the disease led to a decrease in vaccination coverage (CV), this coupled with the entry of the Venezuelan genotype D8 virus into Brazilian territory, culminating in the reintroduction of measles in Brazil. In order to minimize the emergence of new cases and achieve the elimination of this pathology once more it is necessary to increase vaccination coverage to values above 95% (national vaccination coverage target according to PNI for the eradication of the disease) and to improve the integration of internal political-preventive actions so that they include the entire Brazilian population and immigrants in the fight against this disease. Key-words: Measles; Immunization; Vaccination coverage.

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

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

Invasive Haemophilus influenzae type b (Hib) disease in children in Italy, after 20 years of routine use of conjugate Hib vaccines

Haemophilus influenzae serotype b (Hib) was the leading cause of bacterial meningitis in children before the implementation of infant immunization with conjugate Hib vaccines. Despite the effectiveness of the vaccine, invasive Hib disease cases (i.e. isolation of Hib from a normally sterile site) are still reported in children.All invasive Hib disease cases in children ≤ 15 years reported through the National Surveillance System of Invasive Bacterial Disease, during 2012–2018 in Italy, were analyzed. Hib PCR-confirmed isolates were subjected to MLST and PFGE analysis. The number of copies of the capb locus, a virulence factor potentially contributing to true vaccine failures (TVFs), was determined by Southern blot analysis. Vaccine effectiveness (VE) was determined using a multiple Poisson regression model.31 cases of invasive Hib disease in children were reported. Fourteen children were vaccinated (TVFs), 14 were unvaccinated and 2 partially vaccinated (vaccination status was unknown for 1 case). The median age of children was 12 months (range 3 months-15 years). A decrease in vaccination coverage was observed in 2014–2016 (source Ministry of Health), and a rise in incidence was documented from 2016 until 2018, especially in children < 5 years. Vaccine effectiveness was estimated to be 83% (95% CI:45–95).24 isolates were available. The predominant ST was ST6 (70.8%). Cluster analysis of ST6 isolates by PFGE identified five variants. Six isolates (25%) contained multiple copies of the capb locus distributed among TVFs (30%) and unvaccinated children (16.7%).Our data show that both failures to vaccinate and TVFs are associated with invasive Hib disease in children in Italy, during the vaccination era. Most cases in children ≤ 2 years were vaccine-preventable, since they occurred in unvaccinated subjects (13/21 cases, 62%). No host predisposing factors for TVF were recognized. TVFs were not significantly associated with either specific genotypes or amplification status of the capb locus.

Приверженность врачей-педиатров иммунопрофилактике инфекционных болезней: современное состояние проблемы

In 2019, the World Health Organization (WHO) for the first time included refusal of vaccination in the list of ten global threats to humanity, since a decrease in vaccination coverage can trigger breakouts of many preventable infectious diseases. Aim: to clarify the causes for insufficient doctors’ adherence to immunoprophylaxis of infectious diseases and to develop measures for eliminating these causes. Patients and Methods: an open pilot online survey of 175 pediatricians working in medical institutions of the Khanty-Mansiysk Autonomous Okrug–Yugra (KMAO-Yugra) was conducted. The questionnaire contained 14 questions about the respondents’ attitude to various aspects of vaccinal prevention, as well as the level of respondent training on this topic. At the same time, a point scale was used to evaluate the provisions offered to the respondent for analysis (the minimum score is 0 points, the maximum score is 5 points). Results: 71–76% of respondents were convinced of the vaccination efficacy and safety. The main reasons for the lack of adherence to immunoprophylaxis of infectious diseases among the surveyed pediatricians were the insufficient level of knowledge due to the lack of continuous medical education on vaccinal prevention during the entire period of professional activity (25% of hospital-based physicians, 20% of doctors of educational institutions, 16% of health officials and 9% of general practitioners) and the use of information obtained from unofficial sources presented in the global Internet (25% of respondents). The study found that 13% of the physicians surveyed were not familiar with the recommendations for vaccination of pregnant women against influenza, and 24% were not informed about the possibilities, efficacy and safety of pregnant women vaccination against pertussis. Methods to increase the pediatricians’ adherence level to vaccination are outlined, the key among which is mandatory periodic professional development in immunoprophylaxis of infectious diseases in the system of continuing professional education. Conclusion: almost every fifth pediatrician of the KMAO-Yugra surveyed has an insufficient adherence level to immunoprophylaxis of infectious diseases. The article outlines the methods to increase the pediatricians’ adherence level to vaccination. KEYWORDS: vaccination, pediatrician, immunoprophylaxis, continuing professional education, vaccination coverage, continuing education, adherence to vaccination. FOR CITATION: Girina A.A., Petrovski F.I., Zaplatnikov A.L. Pediatricians adherence to immunoprophylaxis of infectious diseases: current state of the problem. Russian Journal of Woman and Child Health. 2020;3(4):290–294. DOI: 10.32364/2618-8430-2020-3-4-290-294.

New challenges in vaccination policies: the role of General Practitioners

New challenges in vaccination policies: the role of General Practitioners. The phenomenon of “Vaccine Hesintacy” and the consequent decrease in vaccination coverage with the re-ignition of some epidemic outbreaks has led Italian national and regional authorities to set a new vaccination plan (PNPV 2017-19) and even coercive measures such as the the Law n.119/2017. In addition, there have been initiatives by scientific societies also in order to increase involvement of professionals in information and education campaigns. Among the professional figures involved, the general practitioners represents the starting point from which to regain the citizen’s trust. This article assesses their important role in the implementation of vaccination policies in Italy by identifying the essential points of the campaigns carried out on their patients.

A systematic review of factors influencing pregnant women’s future vaccination choices

Abstract 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.

Pertussis Outbreak Analysis in Republic of Moldova

There are analyzed the incidence of whooping cough for the period of 1993 - 2016 in Republic of Moldova in this article. 210 from 280 cases of pertussis reported in 2016 and. Specific IgM antibodies of 174 patients were investigated. The epidemic process of pertussis is cyclical, with a period of 3 - 4 years, with a higher incidence in urban areas and in children up to two years, with a tendency to increase the proportion among the patients of school-age children and adults. The decrease in vaccination coverage from 95.4% in 2008 to 89.7% in 2015 led to an increased incidence. From total number of cases, 68.1% were children aged from 0 to 6 years old. The age structure of registered cases in 2016 included: 22.4% under one year old; 44.3% between 1 - 2 years, 27.1% school age children between 7 -17 years and 4.8% adults. A later uptake of medical care was registered, with an average of 10.5 days after onset of the disease, but in age group of children under one year it was 9.6 days. The bases of the diagnosis of whooping cough in 10.7% of cases were clinical data, in 16.2% were clinical - epidemiological data and in 73.1% were laboratory data. Specific IgM antibodies were detected in 77.0 ± 6.4% of patients. Among patients under one year old, 14.9% were under the age of vaccination, 34.0% received from 1 to 3 doses of vaccine, 19.1% are not vaccinated by false contraindications and 27.6% due to refusal. Among patients from the age group of 3-6 years, 56.0% received 3 - 4 doses of vaccine, 18.0% were not vaccinated because of false contraindications and 40.0% due to the failure of the vaccination. From children patients who received a full course of vaccination against pertussis, 25.0% had been vaccinated 1 - 2 years ago and other 25.0% became ill after three or four years after immunization.

Parents’ attitude toward multiple vaccinations at a single visit with alternative delivery methods

Last decades, the number of routine childhood vaccinations has increased considerably, which consequently has led to multiple vaccine injections per consultation. Implementation of additional vaccines will probably lead to more than 2 vaccine injections per consult, which might be a barrier for parents to vaccinate their child. A decrease in vaccination coverage, however, increases the risk of disease outbreaks. Less stressful alternative methods for vaccine delivery might lead to an increased acceptance of multiple childhood vaccinations by parents. The present questionnaire study was set up to explore the maximum number of vaccine injections per visit that is acceptable for parents, as well as to gauge parents’ attitude toward alternative needle-free methods for vaccine delivery. For this purpose, the parents’ opinion toward a jet injector, a patch, a microneedle system, and nasal spray device as methods for vaccine delivery was assessed. The majority of the 1154 participating parents indicated that 3 vaccine injections per visit was perceived as too much. Most participants had a positive attitude with respect to the jet injector and the patch as alternative vaccine delivery method, whereas the microneedle device and an intranasal spray device were not perceived as better than the conventional syringe by the parents. Parents indicated that both the jet injector and the patch might increase their acceptance of giving their children more than 2 vaccinations at the same time. This should encourage vaccine developers and manufacturers to put efforts in developing these delivery methods for their vaccines.

Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany

BackgroundIn Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged ≥60 years, chronically ill persons, healthcare workers (HCW)). In season 2009/10, vaccination against pandemic influenza A(H1N1)pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11) and pandemic influenza (season 2009/10), to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany.MethodsWe analysed data from the ‘German Health Update’ (GEDA10) telephone survey (n=22,050) and a smaller GEDA10-follow-up survey (n=2,493), which were both representative of the general population aged ≥18 years living in Germany.ResultsOverall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were ‘fear of side effects’ and the opinion that ‘vaccination was not necessary’. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged ≥60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively).ConclusionsSeasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.