Low Vaccination Research Articles

Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review.

Although the COVID-19 pandemic has caused the need for the largest mass vaccination campaign ever undertaken to date, African, Caribbean, and Black (ACB) populations have shown both a disproportionately high degree of negative impacts from the pandemic and the lowest willingness to become vaccinated. This scoping review aims to investigate low vaccine uptake in ACB populations relative to public health in high-income countries. A search was conducted in MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), the Cochrane Central Register of Controlled Trials (OvidSP), the Cochrane Database of Systematic Reviews (OvidSP), the Allied and Complimentary Medicine Database (Ovid SP), and the Web of Science following the Joanna Briggs Institute (JBI) framework for scoping reviews, supplemented by PRISMA-ScR. Theoretical underpinnings of the intersectionality approach were also used to help interpret the complexities of health inequities in the ACB population. The eligibility criteria were based on the population, concept, context (PCC) framework, and publications from 2020-19 July 2022 which discussed vaccine uptake amongst ACB people in high-income countries were included. Analysis was carried out through thematic mapping and produced four main themes: (1) racism and inequities, (2) sentiments and behaviors, (3) knowledge and communication, and (4) engagement and influence. This study has contributed to the identification and definition of the issue of low vaccine uptake in ACB populations and has illustrated the complexity of the problems, as vaccine access is hampered by knowledge, psychological, socioeconomic, and organizational barriers at the individual, organizational, and systemic levels, leading to structural inequities that have manifested as low vaccine uptake.

Highlighting models of Indigenous leadership and self-governance for COVID-19 vaccination programmes

The COVID-19 pandemic has disproportionately impacted Indigenous populations worldwide placing much importance on rapid and equitable vaccination. Nevertheless, many Indigenous communities have reported high vaccine hesitancy and low COVID-19 vaccine uptake. This may be attributed to various factors, including a lack of support for Indigenous leadership efforts to protect their communities and the pervasive infodemic targeting First Nations Peoples. In August 2022, we hosted an international symposium to bring together Indigenous and non-Indigenous community leaders, clinicians, and researchers to discuss pandemic experiences and lessons learnt. This commentary highlights examples of harnessing Indigenous leadership and self-governance to design and deliver tailored community-based and culturally appropriate COVID-19 vaccination programmes that improved vaccine uptake in Australia and Canada. These case studies demonstrate that Indigenous social-governance systems need to be valued, respected, and upheld if we are to make meaningful efforts to address health inequities among Indigenous communities during future pandemics.

Clinical, Laboratory and Neurodevelopmental Findings in Children from the Yanomami-Ninam Population Chronically Exposed to Methylmercury.

Despite legal safeguards, the Yanomami community faces challenges such as unauthorized incursions by gold miners, resulting in environmental degradation, particularly from mercury. This jeopardizes the health and food security of indigenous individuals, especially due to the consumption of contaminated fish. Ethnic and racial disparities persist in indigenous healthcare, marked by troubling health indicators such as malnutrition, anemia, and infectious diseases. This cross-sectional study, conducted in October 2022 in the Yanomami Indigenous Territory in the Amazon Forest, Brazil, presented clinical, laboratory, and neurodevelopmental findings in Yanomami children chronically exposed to methylmercury. The results revealed that Yanomami children exhibited weights and heights below expectations (median Z-scores of -1.855 for weight for age and -2.7 for height for age), a high prevalence of anemia (25%), low vaccination coverage (15%), and low IQ (average 68.6). The Total Hair Mercury (Total Hg) levels ranged from 0.16 µg/g to 10.20 µg/g (mean: 3.30 µg/g; median: 3.70 µg/g). Of 117 children tested, 93 children (79.4%) had levels ≥ 2.0 µg/g (had no significant difference between sex). Among the 58 children for whom it was possible to estimate the Total Intelligence Quotient (TIQ), the average value was 68.6, ranging from 42 to 92 points (median: 69.5; standard deviation: 10.5). Additionally, the lowest score on the IQ test was associated with 5 times the risk of having high levels of mercury in their hair, 2,5 fold the risk of having an older age, and almost 8 times the risk of consuming fish, adjusting for nut consumption. Notwithstanding the study's limitations, results suggest that mercury contamination from illegal mining activities on indigenous lands may negatively impact neurodevelopment in older indigenous children, particularly those fish consumers, despite the inherent benefits of fish consumption. Addressing other socio-environmental concerns is crucial for enhancing the overall health of the population.

Evaluation of Knowledge, Attitudes, and Practices towards Vaccination among Patients with Spina Bifida in Ukraine

Patients with spina bifida (SB) face an increased risk of infection due to frequent exposure to medical procedures and visits to healthcare centers, including rehabilitation centers. Infection can lead to complications in kidneys and urinary bladder, disrupt rehabilitation efforts, and reduce the quality of life. Purpose - to assess the knowledge, attitudes, and practices related to vaccination among patients with SB and identify the reasons for the low vaccination rates in this group of children. Materials and methods. An anonymous online survey was conducted among 56 parents of patients with SB. The questionnaire evaluates the knowledge (10 questions), attitudes and practices (4 questions) towards vaccination among parents of patients with SB in Ukraine. The results were analyzed using standard procedures with Statistica StatSoft 6.0 software package. Continuous variables were expressed as a mean and standard deviation (SD). The comparison of frequency parameters was performed using the Chi-square test. The differences between the parameters were statistically significant at p<0.05. Results. Overall, parents demonstrated good knowledge about the role of vaccines in preventing serious diseases (61.7% gave correct answers), and the percentage of correct answers did not significantly differ between vaccinated, partially vaccinated, or unvaccinated groups of children. However, only 12.5% of SB patients were fully vaccinated and 51.8% were completely unvaccinated. Among the unvaccinated, the majority (55.2%) indicated non-recommendation by specialist doctors (neurosurgeon, neurologist, etc.) as the main reason. Primary care physicians were less likely to not recommend vaccination. Delayed vaccination was primarily due to fear of adverse reactions (40%). Despite low vaccination rates, parents generally had a positive attitude towards vaccination (only 5.4% against). Doctors remained the most influential source of information (63.4%). Conclusions. A study suggests a need to enhance knowledge among healthcare professionals, increase public awareness, and provide education within patient groups to improve immunization coverage and protect SB children from preventable infectious diseases. No conflict of interests was declared by the authors.

Understanding COVID-19 vaccine hesitancy in Meghalaya, India: Multiple correspondence and agglomerative hierarchical cluster analyses.

Meghalaya, a state in the northeastern region of India, had a markedly low vaccine uptake compared to the other states in the country when COVID-19 vaccines were being rolled out in 2021. This study aimed to characterize the distinct vaccine-hesitant subpopulations in healthcare and community settings in Meghalaya state in the early days of the vaccination program. We used data from a cross-sectional survey that was administered to 200 healthcare workers (HCWs) and 200 community members, who were a priori identified as 'vaccine-eligible' and 'vaccine-hesitant,' in Shillong city, Meghalaya, in May 2021. The questionnaire collected information on participants' sociodemographic characteristics, COVID-19 history, and presence of medical comorbidities. Participants were also asked to provide a dichotomous answer to a set of 19 questions, probing the reasons for their hesitancy towards COVID-19 vaccines. A multiple correspondence analysis, followed by an agglomerative hierarchical cluster analysis, was performed to identify the distinct clusters of vaccine-hesitant participants. We identified seven clusters: indecisive HCWs (n = 71), HCWs skeptical of COVID-19 and COVID-19 vaccines (n = 128), highly educated male tribal/clan leaders concerned about infertility and future pregnancies (n = 14), less educated adults influenced by leaders and family (n = 47), older adults worried about vaccine safety (n = 76), middle-aged adults without young children (n = 56), and highly educated ethnic/religious minorities with misinformation (n = 8). Across all the clusters, perceived logistical challenges associated with receiving the vaccine was identified as a common factor contributing to vaccine hesitancy. Our study findings provide valuable insights for local and state health authorities to effectively target distinct subgroups of vaccine-hesitant populations with tailored health messaging, and also call for a comprehensive approach to address the common drivers of vaccine hesitancy in communities with low vaccination rates.

Health Belief Model for Public Acceptance of Implementing COVID-19 Vaccination in Singkawang City, Indonesia

Background: The efficacy of immunization is contingent upon public acceptance. Using the behavioral theory of the Health Belief Model (HBM), this study seeks to determine intervention strategies against the most influential factor towards the acceptance of the COVID-19 vaccination program among the societies of Singkawang City. Methods: This investigation involved a cross-sectional design. The perceived severity, susceptibility, barriers, benefits, cues to action, and self-efficacy were the independent variables. The dependent variable was the adoption of the COVID-19 vaccine by the public. Mann-Whitney, Chi-square and Multivariate tests were used to present vaccine acceptance differences, relationships and impacts of each variable towards COVID-19 vaccine acceptance. Results: There was a total of 461 participants in this study. For the majority of respondents (56.40%), COVID-19 vaccine acceptance among them remains modest. The difference between the low and high vaccination acceptance groups (p-value < 0.05) was revealed. Except for perceived severity, this study demonstrated that all HBM constructs had a significant relationship with vaccination acceptance (p-value < 0.05). In addition, the results of the logistic regression test indicated that the cues-to-action construct was the most influential factor in vaccine acceptance (OR= 7.156; CI, 95%= 4.107 – 12.469), followed by self-efficacy (OR=3.218; CI, 95%=1.819 – 5.694). Conclusion: Thus, health policymakers should focus on cues-to-action and self-efficacy factors for developing a strategy to increase vaccine acceptance among the Indonesian population by using current study results among the Singkawang population as a model to start the persuasion techniques.

A population level study on the determinants of COVID-19 vaccination rates at the U.S. county level

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

Low Influenza Vaccine Uptake; What is the Impact in Hospitalised Children

Seasonal influenza is an RNA virus spread by droplets. The burden of disease is significant, particularly in children under five, and in those with underlying health conditions. Vaccination against influenza is effective and recommended for all children aged 2-16, and those from 6 months of age with underlying health conditions. We completed a retrospective study examining the notes of all patients presenting to a large tertiary children’s hospital in the UK with confirmed seasonal influenza over the 2022/2023 season. 238 children were included in this study. 88/238 (37.0%) children in our cohort were under 2. 112/238 (47.1%) were discharged from ED. 41/238 (17.2%) were admitted for observation for 24 hours. 41/238(17.2%) stayed 3 days or longer. 1 child passed away. Overall 73/238 (30.6%) had a significant comorbidity, in those under 2 13/88 (14.8%) had a comorbidity. 13/238 (5.4%) were admitted to PICU or HDU. 30/238 (12.6%) received Oseltamivir, 114/238 (47.8%) children were given antibiotic therapy at presentation for a presumed secondary bacterial infection. 13/238 (5.4%) were vaccinated 14 days or more prior to presentation. 0 children admitted to HDU or PICU were vaccinated. Due to delays and vaccine availability and hesitancy we had very low rates of vaccination. Our results show the impact of influenza on an unvaccinated cohort. Just under half of all children were given antibiotics for a presumed secondary bacterial infection. We highlight that a significant number did not have an underlying comorbidity. This is most notable in the under 2 cohort. This reinforces data supporting the importance of vaccination in children and raises the question of whether we should extend our vaccination program to cover all children over 6 months of age.

The impact of alternate HPV vaccination and cervical screening strategies in Japan: a cost-effectiveness analysis

The Japanese 2020 cervical screening guidelines recommend conventional cervical cytology screening every 2-years for women aged 20-69 years. The nonavalent human papillomavirus (HPV) vaccine has also recently been approved in Japan. We therefore evaluated the cost-effectiveness of cervical cancer screening strategies alongside universal nonavalent HPV vaccination of girls (12-16 years). A cost-effectiveness analysis was performed using an age-specific Markov microsimulation model for Japan to evaluate total costs, quality adjusted life-years (QALYs) gained, incremental cost-effectiveness ratios (ICER), colposcopies, biopsies, precancer and cervical cancer treatments for 29 combined vaccination and screening strategies (conventional cytology, liquid-based cytology (LBC), HPV testing, and HPV self-collection). A cohort of 100,000 girls (12-16 years old) over a lifetime offered the nonavalent HPV vaccine was used (current vaccination coverage=0.08%, current screening coverage=43.7%). A discount rate of 3% was applied to costs and QALYs. Univariate and probabilistic sensitivity analysis was performed to assess robustness of the findings. Costs were reported in US dollars (2023). Compared with conventional cytology, evaluated strategies would incur an additional cost of US$839,280-738,182,669 and gain 62,755-247,347 quality-adjusted-life-years. HPV testing distinguishing HPV16/18 with reflex LBC (3-yearly) would be most cost-effective (ICER= US$7511 per QALY gained). At a willingness-to-pay (WTP) of 1-times gross domestic product (GDP) per capita, the probability of it being cost-effective was 70%. At historically high vaccination coverage (70%) ICERs decreased overall but did not affect the ranking of the most cost-effective strategy. While a 5-yearly interval became more cost-effective than a 3-yearly interval. Including HPV self-collection for under-screened women made all strategies more cost-effective. At current cervical screening participation (43.7%) and low vaccination coverage (<1.0%), HPV testing distinguishing HPV16/18 with reflex LBC (3-yearly) would be the most cost-effective screening strategy compared to conventional cytology (2-yearly). Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (17H03589) and Grants of the National Cancer Center Japan (Gan Kenkyu Kaihatsuhi 31-A-20 and 2023-A-23).

Improving Childhood Vaccination Rates with Process Innovation in Central Zone, Alberta.

This project aimed to accurately assess the current state of routine immunization program delivery in a Central Zone community in Alberta and provide actionable recommendations supported by literature review. Engaging with frontline public health nurses responsible for immunization program delivery in the community, contributing factors to low vaccination rates, process inefficiencies and policy gaps were identified. Based on additional literature, strategies to mitigate these gaps with the goal of increasing vaccination rates were proposed and validated. Although in this case, strategies to mitigate process inefficiencies were the most supported given program funding, a multi-pronged approach is still recommended to drive long-term improvements in vaccination rates.

Inherent Attitudes or Misplaced Policies? Explaining COVID-19 Vaccine Hesitancy in Romania

hesitancy toward COVID-19 vaccines was not particularly high in Romania at the beginning of the vaccination campaign. Nevertheless, the country became one of the laggards in the European Union in terms of vaccination rates. We aim to provide an empirical explanation for this phenomenon based on a representative survey conducted in November–December 2021. We test the influence of various factors on vaccine hesitancy, such as personal experiences with the disease, trust in relevant institutions, general worldviews, and the contact with certain institutions, such as the Romanian Orthodox Church, and general practitioners. Furthermore, we find that three COVID-specific cognitive factors played a crucial role in this respect, namely the evaluation of anti-COVID state measures, belief in COVID-related conspiracy theories, and, especially, fears of negative effects of COVID-19 vaccines. The high explanatory power of these three factors also shows that low vaccination rates were not inevitable consequences of some “inherent” attitudinal characteristics widespread in the Romanian society; on the contrary, vaccine hesitancy has developed as an unfortunate side effect of weak crisis management, as the government and relevant state institutions failed to properly utilize key organizational resources, such as the national network of general practitioners, and proved to be unable to dissipate fears and countervail the spread of conspiracy theories, while emergency measures did not resonate enough among the Romanian public.

Synthetic modified vaccinia Ankara vaccines confer cross-reactive and protective immunity against mpox virus

BackgroundAlthough the mpox global health emergency caused by mpox virus (MPXV) clade IIb.1 has ended, mpox cases are still reported due to low vaccination coverage and waning immunity. COH04S1 is a clinically evaluated, multiantigen COVID-19 vaccine candidate built on a fully synthetic platform of the highly attenuated modified vaccinia Ankara (MVA) vector, representing the only FDA-approved smallpox/mpox vaccine JYNNEOS. Given the potential threat of MPXV resurgence and need for vaccine alternatives, we aimed to assess the capacity COH04S1 and its synthetic MVA (sMVA) backbone to confer MPXV-specific immunity.MethodsWe evaluated orthopoxvirus-specific and MPXV cross-reactive immune responses in samples collected during a Phase 1 clinical trial of COH04S1 and in non-human primates (NHP) vaccinated with COH04S1 or its sMVA backbone. MPXV cross-reactive immune responses in COH04S1-vaccinated healthy adults were compared to responses measured in healthy subjects vaccinated with JYNNEOS. Additionally, we evaluated the protective efficacy of COH04S1 and sMVA against mpox in mpox-susceptible CAST/EiJ mice.ResultsCOH04S1-vaccinated individuals develop robust orthopoxvirus-specific humoral and cellular responses, including cross-reactive antibodies to MPXV-specific virion proteins as well as MPXV cross-neutralizing antibodies in 45% of the subjects. In addition, NHP vaccinated with COH04S1 or sMVA show similar MPXV cross-reactive antibody responses. Moreover, MPXV cross-reactive humoral responses elicited by COH04S1 are comparable to those measured in JYNNEOS-vaccinated subjects. Finally, we show that mice vaccinated with COH04S1 or sMVA are protected from lung infection following challenge with MPXV clade IIb.1.ConclusionsThese results demonstrate the capacity of sMVA vaccines to elicit cross-reactive and protective orthopox-specific immunity against MPXV, suggesting that COH04S1 and sMVA could be developed as bivalent or monovalent mpox vaccine alternatives against MPXV.

The role of vaccine status homophily in the COVID-19 pandemic: a cross-sectional survey with modelling

BackgroundVaccine homophily describes non-heterogeneous vaccine uptake within contact networks. This study was performed to determine observable patterns of vaccine homophily, as well as the impact of vaccine homophily on disease transmission within and between vaccination groups under conditions of high and low vaccine efficacy.MethodsResidents of British Columbia, Canada, aged ≥ 16 years, were recruited via online advertisements between February and March 2022, and provided information about vaccination status, perceived vaccination status of household and non-household contacts, compliance with COVID-19 prevention guidelines, and history of COVID-19. A deterministic mathematical model was used to assess transmission dynamics between vaccine status groups under conditions of high and low vaccine efficacy.ResultsVaccine homophily was observed among those with 0, 2, or 3 doses of the vaccine. Greater homophily was observed among those who had more doses of the vaccine (p < 0.0001). Those with fewer vaccine doses had larger contact networks (p < 0.0001), were more likely to report prior COVID-19 (p < 0.0001), and reported lower compliance with COVID-19 prevention guidelines (p < 0.0001). Mathematical modelling showed that vaccine homophily plays a considerable role in epidemic growth under conditions of high and low vaccine efficacy. Furthermore, vaccine homophily contributes to a high force of infection among unvaccinated individuals under conditions of high vaccine efficacy, as well as to an elevated force of infection from unvaccinated to suboptimally vaccinated individuals under conditions of low vaccine efficacy.InterpretationThe uneven uptake of COVID-19 vaccines and the nature of the contact network in the population play important roles in shaping COVID-19 transmission dynamics.

Molecular Determinants of Drug Resistance and Mutation Patterns in Influenza Viruses Circulating in Poland Across Multiple Epidemic Seasons: Implications for Vaccination Strategies.

BACKGROUND According to the WHO, up to 650 000 people die each year from seasonal flu-related respiratory illnesses. The most effective method of fighting the virus is seasonal vaccination. However, if an infection does occur, antiviral medications should be used as soon as possible. No studies of drug resistance in influenza viruses circulating in Poland have been systematically conducted. Therefore, the aim of the present study was to investigate the drug resistance and genetic diversity of influenza virus strains circulating in Poland by determining the presence of mutations in the neuraminidase gene. MATERIAL AND METHODS A total of 258 clinical specimens were collected during the 2016-2017, 2017-2018, and 2018-2019 epidemic seasons. The samples containing influenza A and B were analyzed by RT-PCR and Sanger sequencing. RESULTS Differences were found between the influenza virus strains detected in different epidemic seasons, demonstrating the occurrence of mutations. Influenza A virus was found to be more genetically variable than influenza B virus (P<0.001, Kruskal-Wallis test). However, there was no significant difference in the resistance prevalence between the influenza A subtypes A/H1N1/pdm09 (4.8%) and A/H3N2/ (6.1%). In contrast, more mutations of drug-resistance genes were found in the influenza B virus (P<0.001, chi-square test). In addition, resistance mutations appeared en masse in vaccine strains circulating in unvaccinated populations. CONCLUSIONS It seems important to determine whether the influenza virus strains tested for drug resistance as part of global influenza surveillance are equally representative of viruses circulating in populations with high and low vaccination rates, for all countries. Our results suggest that countries with low levels of influenza immunization may constitute reservoirs of drug-resistant influenza viruses.

Human Papillomavirus (HPV) Vaccine Coverage and Confidence in Italy: A Nationwide Cross-Sectional Study, the OBVIOUS Project.

Human Papillomavirus (HPV) vaccination rates are still below the target due to vaccine refusal or delay, lack of knowledge, and logistical challenges. Understanding these barriers is crucial for developing strategies to improve HPV vaccination rates. This cross-sectional study used a questionnaire to investigate social and behavioral factors influencing decision making about the HPV vaccine. The survey was conducted from 11 April to 29 May 2022 and involved 10,000 Italian citizens aged ≥ 18 years. The sample was stratified based on region of residence, gender, and age group. 3160 participants were surveyed about themselves, while 1266 respondents were surveyed about their children's vaccine uptake. Among females aged ≥ 26 years, the national average HPV vaccine uptake was 21.7%, with variations across different regions. In the 18-25 age group, females had a vaccine uptake (80.8%) twice as much as males (38.1%), while vaccine uptake among male and female children aged 9-11 was similar. The OBVIOUS study in Italy reveals factors influencing low HPV vaccine uptake, suggesting targeted approaches, tailored information campaigns, heightened awareness of eligibility, promoting early vaccination, addressing low-risk perception among males, addressing safety concerns, and enhancing perceived accessibility to improve vaccine uptake and mitigate health risks.

"Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine.

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

Epidemiology of suspected rabies cases in Ethiopia: 2018–2022

Rabies is a zoonotic disease affecting both public health and the livestock industry in Ethiopia. However, there is limited national-level information on the extent of the disease. Therefore, we studied the national burden and distribution of Rabies on both humans and animals. We conducted a retrospective descriptive study on rabies by obtaining five years (2018–2022) data from the Ethiopian Public Health Institute (EPHI) and the Ministry of Agriculture. We analyzed the incidence, mortalities, temporal and spatial patterns. Microsoft Excel and ArcGIS version 10.2 were used for descriptive and spatial analysis respectively. A total of 37,989 Rabies suspected human exposure cases and 297 deaths were reported with a mean annual number of 7,598 human exposure cases and 59 deaths. The exposure case and mortality incidence rates were 6 and 0.05 per 100,000 populations respectively. Suspected human exposure cases significantly increased from 5,217 (2018) to 11,298 (2022) at a rate of 2.2. In the same period, 2,094 animal suspected rabies cases and 1,682 deaths were reported predominantly in dogs (71.2%), followed by cattle (27.8%) and other domestic animals (1%). There is high rabies suspected human exposure cases at national level. Suspected rabid dogs were the major source of infection in humans. There were gaps in the reporting of animal cases and low dog vaccination coverage. Hence, it is important to strengthen One Health collaboration to enhance surveillance, information sharing, and diagnostic capacity and improve mass dog vaccination coverage.

Vaccine Attitudes and Uptake Among Latino Residents of a Former COVID-19 Hotspot

Abstract: Early in the COVID-19 pandemic, the Centers for Disease Control and Prevention identified Prince William County (PWC), Va. as a hotspot with a high disease rate among Latinos. This study uses spatial, survey, and qualitative data to understand attitudes towards vaccine uptake among PWC Latinos. A quantitative analysis (n=266) estimates the association for vaccine acceptance among Latinos. Next, qualitative interviews with Latinos (n=37) examine vaccine attitudes. Finally, a spatial analysis identifies clusters of social vulnerability and low vaccine uptake in PWC and adjacent counties. Our findings show that a substantial proportion of PWC Latinos had low vaccination rates as of December 2022, two years after the vaccine's release. Side effects and safety and approval concerns were cited in both the quantitative and qualitative studies. Persistent vaccine disparities are concerning given the high hospitalization and mortality rates that prevailed among Latinos early in the pandemic.

Changes of influenza vaccination rate and associated influencing factors after the COVID-19 pandemic in Shanghai, China

ABSTRACT The vaccination rate for seasonal influenza remains low in most regions of China. It is essential to understand the factors that associated with the low influenza vaccination rate in various populations after the COVID-19 pandemic. A cross-sectional survey was conducted with residents in Pudong New Area, Shanghai, China. Respondents’ vaccination condition during the 2021–2022 flu season and the reasons for receiving or not receiving influenza vaccine were investigated. Binary logistic regression was conducted to explore potential factors influencing vaccination uptake. 2,476 of 14,001 respondents received an influenza vaccine, with a total coverage of 17.68% (95% CI: 17.05%, 18.32%). Children had the highest vaccination coverage (35.68%; 95% CI: 34.02, 37.33), followed by adults (12.75%; 95% CI: 11.91%, 13.58%) and elderly individuals (11.70%, 95% CI: 10.78%, 12.62%). For children, lower household income was an significant promoting factor. For adults, factors significantly associated with vaccination were household income, sex, and education level. For elderly, factors significantly associated with vaccination were household income, education level, living state, and having underlying diseases. (P < .05)The main reason for vaccine hesitancy among children was worried about side effects (21.49%), for adults and elderly was self-rated good health (adults: 37.14%, elderly people: 30.66%). The overall influenza vaccination coverage rate in Shanghai, especially among elderly individuals, is lower than many developed countries. Appropriate strategies and programs targeting different populations need to be implemented to enhance influenza vaccine coverage.

Using the Health Belief Model to Predict Vaccination Intention in Unvaccinated Adults in Latvia During the COVID-19 Pandemic

Abstract Vaccination is a global health development success story that saves millions of lives every year and reduces the risk of getting various infectious diseases, including COVID-19. At the end of 2021, a rapid increase in the size of the population infected with COVID-19 and a low vaccination coverage were observed in Latvia (Centre for Disease Prevention and Control, 2021). Also, despite the available vaccines, by the beginning of May 2022, only 60.6% of the population of Latvia had completed the full course of vaccination against COVID-19. According to the Ministry of Health, the vaccination process is characterised by variability and flexibility, and in general, vacci-nation rates have declined in recent years. Therefore, the aim of the study was to investigate the vaccination predicting factors of unvaccinated adults in Latvia using the Health Belief Model (HBM) during the COVID-19 pandemic. The study sample consisted of 539 respondents aged 18 to 75 years (M = 45.35, SD = 15.70), who were not vaccinated against COVID-19 and who had to make a decision to vaccinate or not, and who were part of a representative sample of Latvian residents (n = 1017). The data was collected in September and were analysed using Spearman’s rank correlation coefficient and multivariate linear regression analysis. A statistically significant moderate strong positive correlation was shown between vaccination intention and all six vaccination motives as perceived benefits (r = 0.40–0.44, p &lt; 0.01); statistically significant but weak positive correlation between vaccination intention and risk appraisal as perceived threat (r = 0.20, p &lt; 0.01) and COVID-19 experience as cues to action (r = 0.20, p &lt; 0.01); and statistically significant negative but weak correlation for vaccination intention and fear of vaccination as perceived barriers (r = –0.21, p &lt; 0.01). The results revealed a statistically significant positive association of vaccination intention and the components of HBM: perceived threats, perceived benefits and cues to action, as well as a statistically significant negative association with perceived barriers. The results revealed several factors that predict vaccination intention, explaining 32% of the variation in vaccination intention: education level, perceived threats, perceived benefits, perceived barriers, and cues to action. Higher levels of education, higher perceived threat of contracting COVID-19, many different social motives for vaccination (e.g., to be able travel), confidence that the vaccine will not cause significant side effects and long-term consequences, and experience with COVID-19 are factors that predicts an individual’s intention to vaccinate against COVID-19.