Low Vaccination Research Articles

Investigation of non-National Immunization Program vaccination intentions in rural areas of China

BackgroundChina’s current immunization program was revised in 2007. Some common childhood vaccines such as those for influenza, pediatric pneumonia, Haemophilus influenzae, varicella, and rotavirus have not been included in the National Immunization Program (NIP) and need to be purchased by children’s guardians at their own expense. Rural areas, constrained by economic development and vaccine awareness, have a low non-NIP vaccination rate and more family medical expenses and social burden. This study aims to examine the awareness and attitude of rural parents about non-NIP vaccines and relevant factors influencing their vaccination intention to provide strategic suggestions for expanding and improving the Chinese government’s NIP policy.MethodsA qualitative method of in-depth interviews were conducted for this study. We interviewed 30 rural parents in a central Chinese village to investigate their awareness of non-NIP vaccines and their vaccination intention and behavior. All the interview data were analyzed through the Colaizzi seven-step data analysis method.ResultsThis study summarized the individual and social level factors influencing the non-NIP vaccination intention of rural parents. The individual level factors include four themes: perceived severity with physical harm, treatment consumption (cost of the treatment of the subject diseases), psychological burden, and social consequences being subthemes; perceived vulnerability with age vulnerability, medical history, immune quality (children’s underlying immune status), and environmental vulnerability (sanitary condition of the rural environment) as subthemes; perceived efficacy with effect perception, psychological comfort, protective strength, and functional compensation (functions of non-NIP vaccines unreplaceable by NIP vaccines) being subthemes; and perceived cost consisting of two subthemes cost burden and adverse reaction. The social level influencing factors include the vaccination opinions in rural social networks, the accessibility of health services and vaccine products, and the guidance and promotion of vaccination policies. These factors act outside of individuals’ subjective awareness and influence decisions regarding non-NIP vaccination in rural areas.ConclusionBased on these influencing factors, this study constructs a structural model for non-NIP vaccination decision-making process in rural areas of China. The results play a guiding role in directing attention to children’s health, promoting non-NIP vaccination, facilitating the dissemination of vaccine knowledge in rural areas, and improving NIP policies and practices in China.

“A vaccine that nonetheless remains apart”: Papillomavirus and vaccination in France

Vaccination against the human papillomavirus (HPV) is currently not widespread in France, where the vaccination rate is one of the lowest in Europe. However, this virus is encountered by 80% of the population and causes 3000 new cases of cancer per year. This vaccination constitutes a real lever for action. Using a qualitative approach (semi-directive interviews), we documented the perceptions, reluctance, and obstacles of sixteen general practitioners in Ile de France. The objective was to understand the low vaccination rate and to propose sustainable solutions to increase adherence to this vaccine. The HPV vaccine is different from other vaccines, which makes it more difficult for the public to understand. Firstly, because it affects the privacy of patients from a very young age. Secondly, because it has long been dedicated to a female public and the opening of vaccination to boys of the same age leads to a change in discourse and a break with its gendered image. Finally, this vaccination is taking place in a context where there is a marked reluctance to vaccinate in France, with a rapid circulation of more or less reliable information that often places the medical profession in difficulty. Health professionals play a key role in convincing and encouraging patients to adhere to the vaccine, and a majority of doctors are still in favor of vaccination. Relying on a wider group of health professionals could help to increase adherence to the vaccine in France.

Knowledge, attitudes, and practices toward seasonal influenza vaccination among healthcare workers and pregnant women in Pakistan: A mixed methods approach

ABSTRACT Vaccine hesitancy is a significant public health issue globally. We aim to document the barriers toward seasonal influenza vaccine uptake among healthcare workers (HCWs) and pregnant women (PW) in Pakistan. We performed a concurrent mixed methods study in four cities (Karachi, Islamabad, Quetta, and Peshawar) across Pakistan from September to December 2021. The quantitative component consisted of independent cross-sectional surveys for PW and HCWs, and the qualitative component comprised of in-depth interviews (IDIs) and focus group discussions (FGDs) among HCWs. Simple linear regression was used to determine the association of sociodemographic variables with knowledge, attitudes, and practices. Overall, 750 PW and 420 HCWs were enrolled. Among the PW, 44% were willing to receive the vaccine if available free of cost. Only 44% of the HCWs were vaccinated; however, 86% intended to get vaccinated and were willing to recommend the vaccine to their patients. HCWs refused vaccine due to side-effects (65%), cost (57%), and allergies (36%). An education level of secondary school and above was predictive of higher attitude and knowledge scores while having received the COVID-19 vaccine was associated with higher practice scores for both PW and HCWs. Several themes emerged from the interviews: 1) HCWs’ knowledge of influenza and its prevention, 2) HCWs’ perception of motivators and barriers to influenza vaccine uptake and 3) HCWs’ attitudes towrd vaccine promotion. We report low influenza vaccine coverage among HCWs and PW in Pakistan. Educational campaigns addressing misconceptions, and improving affordability and accessibility through government interventions, can improve vaccine uptake.

Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study.

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions.

Nationwide analysis of the impact of COVID-19 in patients with a cardiovascular, oncological or chronic pulmonary disease in the context of an Eastern European country with a low vaccination rate, Bulgaria: March 2020–April 2022

ObjectiveThis study focused on Bulgarian patient cohorts harbouring a single documented chronic comorbidity–cardiovascular pathology, an oncological disease or a chronic pulmonary diseases (CPD) comparing the outcomes in fully vaccinated and...

Monitoring the COVID-19 Vaccine Acceptance Trend and its Determinants Among Iranian Adults.

Vaccination seems to be the most critical means of halting the COVID-19 pandemic. It is crucial to understand the factors that influence COVID-19 vaccine acceptance to avoid low vaccination rates. This study intended to monitor the COVID-19 vaccine acceptance and its association with socio-demographic factors and prior diagnosis of COVID-19 in Iranian adults during the COVID-19 pandemic. The study utilized data from the COVID-19 Population Survey of Iran (COPSIR), a repeated national survey designed to monitor COVID-19-related behavioral insights. From April 2020 to November 2021, thirteen iterations of a series of cross-sectional studies involving computer-assisted telephone interviews were conducted. The COVID-19 vaccine acceptance rate remained above 80% until the ninth wave in February 2021, when it dropped to 62.9%. However, throughout the next four surveys, it rose gradually from 72.0% to 85.7%. The multilevel regression model revealed that the COVID-19 vaccine acceptance was significantly and positively linked with age and education. Despite the relatively high COVID-19 vaccine acceptance rate among Iranian adults, after the emergence of vaccines on the global market and controversies about their safety in Iran, the initially high vaccine acceptance rate dropped significantly, and then increased over time and returned to its peak level (85%). According to the Commodity Theory, this rise in vaccine acceptance can be attributed to the COVID-19 vaccine shortage in the country between January and July 2022. For Iranian adults to accept vaccines more readily, health promotion programs should target the youth and the less literate adults.

Beyond the numbers: An in-depth look at Cameroon's fifth national COVID-19 vaccination campaign through geographical and gender lenses

BackgroundCameroon has been struggling with low Covid-19 vaccination coverage, with only 4.5 % of the population receiving the primary series as of November 2022. The COVID-19 Vaccine Delivery Partnership (CoVDP) conducted a high-level mission to Cameroon to assess progress and advocate for actions to address bottlenecks. The objective of the mission was to administer at least 3,000,000 doses of vaccines during the 5th Mass vaccination campaign. This study examines the factors contributing to the success of the campaign and uses a geographical and gender lens to assess the results. MethodsThe study is a secondary analysis of data from the DHIS2 collected during the 5th mass vaccination campaign for Covid-19. Descriptive statistics were used to assess coverages per location and gender expressed in OR. sccess factors, and chi-squared tests were used to assess differences in vaccine distribution across regions and by gender. ResultsThis 5th vaccination campaign benefitted from a strong political commitment facilitated by CoVDP's mission, international support, collaboration, planning, supervision, and demand generation.The campaign recorded 2 019 118 administered vaccine doses, a staggering 46-fold increase in vaccinated individuals relative to the first round, with vaccination coverage reaching 10.1 % of the general population. However, the study reveals regional and gender disparities in vaccination coverage. Men had higher odds of being vaccinated than women in the three Sahel regions. Among individuals with comorbidities, the national coverage rate was only 14 %, and the Far North and East regions exhibited the lowest coverage rates. Janssen was the most used vaccine, and the total AEFI cases reported were 2 per 1000 vaccine doses. ConclusionThe 5th COVID-19 vaccination campaign in Cameroon saw a strong political commitment and was the most successful so far. Despite the gains, there was gender disparity in coverage in some regions. It is important to continue the established momentum, ensure equitable access in the Sahel regions, and reach high-priority groups with primary series and booster doses.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study.

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

COVID-19 Vaccination Hesitancy in Autoimmune Disease Patients: Policy Action and Ethical Considerations.

As COVID-19 vaccination guidelines were issued by Advisory Committee on Immunization Practices (ACIP) and the Centers for Diseases Control and Prevention (CDC) across the US, each state and clinical provider instituted vaccine implementation and education policies and protocols for high-risk populations. However, current research has shown that while people with autoimmune diseases were listed by ACIP and CDC as a COVID-19 high-risk population, the rate of adherence to implementation and education protocols, as well as the prioritization of this sub-population as a high-risk group, varied among the clinicians and vaccinators thus impacting the hesitancy towards the COVID-19 vaccine and a correlation to low vaccination rates. The purpose of this review was to explore factors of COVID-19 vaccination hesitancy in people living with autoimmune diseases in relation to current implementation and education policies and protocols, as well as ethical and contextual factors, while providing possible implications. COVID-19 vaccine hesitancy in people living with autoimmune disease was greater than in the general population, as demonstrated by increased levels of overall mistrust and fear of potential risk and harmful side effects. Evidence has shown that COVID-19 vaccination is safe and effective for patients with autoimmune diseases. Additionally, the benefits of COVID-19 vaccination outweigh its potential risks and adverse effects in this population. However, the non-adherence to policy and protocols, especially community education protocols, by those providing the vaccination have a negative impact on the overall perception of the vaccine and needs to be addressed at local and state levels in order to protect this population. Future research should provide strategies to guide collaborative efforts between government and local agencies in providing tailored vaccination campaigns to this population. In parallel with policy, COVID-19 vaccination intervention implementation and educational protocols should be developed with evidence-based guidelines for public health and clinical professionals that are targeted at this vulnerable high-risk population.

Wearing masks to prevent one epidemic may mask another.

With attempts at lifting most COVID-19 pandemic-related restrictions, other common respiratory viruses have caused more health concern than in earlier seasons in pediatric populations. To explore the role of non-pharmaceutical interventions (NPIs) in a rebound in other respiratory viral pathogens, especially in light of general vaccination fatigue, COVID-19 boosters, and operational challenges in the healthcare system. A research-based commentary supported with recent literature review. Pandemic-related lockdowns in Europe, Australia, and New Zealand have created a significant population of susceptible young children without preexisting immunity due to lack of exposure during the colder months. Relying on NPIs for a prolonged period due to low vaccination rates may lead to increased respiratory infection susceptibility, especially among young children less than 5years old. The key public health question is whether NPIs should be implemented in the long run and what are the long-term implications on the dynamics of endemic infections and population immunity. Prevention cannot be the only cure for any infectious disease, and long-term impact of NPIs depends on the dynamics of population susceptibility. The SARS-CoV-2 pandemic has reinforced the importance of vaccination and the knowledge on vaccine use combined with NPIs will be of great value in controlling other known and unknown respiratory pathogens. Combining NPIs and vaccination is paramount in disease control, and the discussion on how to prevent collateral damage to sensitive populations while relaxing NPI-related measures should also merit attention.

Cholera and COVID-19 pandemic prevention in multiple hotspot districts of Uganda: vaccine coverage, adverse events following immunization and WASH conditions survey

BackgroundBetween March, 2020 and December, 2021 due to cholera and coronavirus disease 2019 (COVID-19) pandemics, there were 1,534 cholera cases with 14 deaths and 136,065 COVID-19 cases with 3,285 deaths reported respectively in Uganda. This study investigated mass vaccination campaigns for the prevention of the two pandemics namely: oral cholera vaccine (OCV) and COVID-19 vaccine coverage; adverse events following immunization (AEFI); barriers and enablers for the vaccine uptake and assessed water, sanitation and hygiene (WASH) conditions in the six cholera and COVID-19 hotspot districts of Uganda.MethodsA household survey was conducted between January and February, 2022 in the six cholera hotspot districts of Uganda which had recently conducted OCV mass vaccination campaigns and had ongoing COVID-19 mass vaccination campaigns. The survey randomly enrolled 900 households with 4,315 persons of whom 2,085 were above 18 years. Data were collected using a data entry application designed in KoBoToolbox and analysed using STATA version 14. Frequencies, percentages, odds ratios, means, confidence intervals and maps were generated and interpreted.ResultsThe OCV coverage for dose one and two were 85% (95% CI: 84.2—86.4) and 67% (95% CI: 65.6—68.4) respectively. Among the 4,315 OCV recipients, 2% reported mild AEFI, 0.16% reported moderate AEFI and none reported severe AEFI. The COVID-19 vaccination coverage for dose one and two were 69.8% (95% CI: 67.8–71.8) and 18.8% (95% CI: 17.1–20.5) respectively. Approximately, 23% (478/2,085) of COVID-19 vaccine recipient reported AEFI; most 94% were mild, 0.6% were moderate and 2 cases were severe. The commonest reason for missing COVID-19 vaccine was fear of the side effects. For most districts (5/6), sanitation (latrine/toilet) coverage were low at 7.4%—37.4%.ConclusionThere is high OCV coverage but low COVID-19 vaccine and sanitation coverage with high number of moderate cases of AEFI recorded due to COVID-19 vaccines. The low COVID-19 vaccine coverage could indicate vaccine hesitancy for COVID-19 vaccines. Furthermore, incorporation of WASH conditions assessment in the OCV coverage surveys is recommended for similar settings to generate data for better planning. However, more studies are required on COVID-19 vaccine hesitancy.

“Figuring stuff out myself” – a qualitative study on maternal vaccination in socially and ethnically diverse areas in England

BackgroundMaternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.MethodsIn 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.ResultsThe sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.ConclusionsOur study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.

A Systematic Review of Behaviour Change Techniques within Interventions to Increase Vaccine Uptake among Ethnic Minority Populations.

COVID-19 caused significant morbidity and mortality amongst ethnic minority groups, but vaccine uptake remained lower than non-minoritised groups. Interventions to increase vaccine uptake among ethnic minority communities are crucial. This systematic review synthesises and evaluates behaviour change techniques (BCTs) in interventions to increase vaccination uptake in ethnic minority populations. We searched five databases and grey literature sources. From 7637 records identified, 23 studies were included in the review. Interventions were categorised using the Behaviour Change Wheel (BCW) and Behaviour Change Taxonomy v1. Vaccines included influenza, pertussis, tetanus, diphtheria, meningitis and hepatitis. Interventions were primarily delivered in health centres/clinics and community settings. Six BCW intervention functions and policy categories and 26 BCTs were identified. The main intervention functions used were education, persuasion and enablement. Overall, effective interventions had multi-components and were tailored to specific populations. No strong evidence was observed to recommend specific interventions, but raising awareness and involvement of community organisations was associated with positive effects. Several strategies are used to increase vaccine uptake among ethnic minority communities; however, these do not address all issues related to low vaccine acceptance. There is a strong need for an increased understanding of addressing vaccine hesitancy among ethnic minority groups.

Human papillomavirus vaccine knowledge and conspiracy beliefs among secondary school students in Lebanon

BackgroundHuman Papillomavirus (HPV) is widely prevalent across the globe. In Lebanon, the society is transitioning from traditional conservatism to a more open attitude. Although previous studies have examined the knowledge of adults in Lebanon with regard to HPV and its vaccine, there is a lack of research on secondary school students. Moreover, HPV is considered a worldwide public health matter that needs to be addressed. Therefore, the objective of our study is to assess factors associated with knowledge and conspiracy beliefs towards HPV vaccine among a sample of Lebanese adolescents.MethodsBetween December 2022 and February 2023, we conducted a cross-sectional study on Lebanese adolescents aged 15 to 18 years old. Parental approval was needed in order to participate. We used a questionnaire to collect data, which included the HPV-knowledge questionnaire (HPV-KQ) and the Vaccine Conspiracy Belief Scale (VCBS).ResultsOf the 406 participants who filled the survey, 64.8% were female, with a mean age of 16.62 ± 1.01. Results showed that 31.0% of students had high knowledge about HPV, while 27.6% had high conspiracy beliefs, and 48% of participants relied on the internet to access information on HPV. Students who had previously heard of HPV, received sexual education at school or outside, and had received at least one dose of the HPV vaccine demonstrated significantly higher knowledge of HPV. Additionally, students with high knowledge had a lower mean House Crowding Index, and those whose fathers had a university education had lower conspiracy beliefs. Females had a higher vaccination rate than males, while no significant difference was found between those who had engaged in sexual activity and those who had not. The multivariate analysis indicated that previous awareness of HPV and receiving sexual education outside school were significantly associated with higher knowledge.ConclusionOur study brings to light the urgent need for action to increase HPV awareness and vaccination among Lebanese secondary school students. The prevalence of vaccine misconceptions and conspiracy beliefs and the limited knowledge of HPV underscore the importance of more comprehensive sexual education in schools and the dissemination of accurate information about HPV and its vaccine. Furthermore, given the low vaccination rate among males, efforts should be made to promote HPV vaccination among this population. Addressing these issues can improve public health and help prevent the spread of HPV and its related diseases.

Lessons From an Implementation Evaluation of a Real-World Multi-City Initiative to Address COVID-19 Vaccination Inequities.

Background: The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color.Purpose: To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles.Design and sample: In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes).Conclusions: Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis.

Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011–2021

BackgroundLow polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021. Methods: This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level. Results: From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05). Conclusions: The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Muslim parents’ beliefs and factors influencing complete immunization of children aged 0–5 years in a Thai rural community: a qualitative study

PurposeVaccine-preventable diseases have decreased globally. However, measles and diphtheria outbreaks still occur in Southern Thailand, where Muslims are predominant with a documented low vaccine coverage. The purpose of this study was to investigate Muslim parents’ beliefs and factors influencing them to complete immunization of children aged 0–5 years in Y.L. province, Thailand.MethodA descriptive qualitative study was conducted, using focus group discussion with 26 participants. They are parents whose children had complete or incomplete vaccination and community/religious leaders. Data were analyzed using content-analysis and triangulation method was used to ensure trustworthiness.ResultsFour major themes emerged from the analysis: (1) positive vaccine beliefs, which included knowledge and awareness of vaccination, trust in vaccine efficacy, and religious beliefs; (2) positive factors influencing positive beliefs and vaccine acceptance, which were accessibility of reliable sources, and imitation of leaders and health-community-network; (3) negative vaccine beliefs, including bias in vaccine efficacy and safety, personal beliefs about sources of vaccines, and religious misconceptions regarding the value of vaccines and Halal concerns; and (4) negative factors influencing negative beliefs and refusal of vaccination, which were perception of disadvantages of vaccines spread by word-of-mouth, trust in person over empirical evidence, religious views based on self-interpretation, and lack of public information on Halal vaccines.ConclusionBoth positive and negative factors influencing complete immunization were found in this study. To enhance vaccine acceptance, health care providers should understand Muslim cultural beliefs by offering parents a chance to express their attitudes and encourage vaccination via religious leaders and community role models.

Retrospective analysis and modern spatiotemporal characteristics of tularemia in the territory of the West Kazakhstan and North Kazakhstan regions

Rationale. An important task is to monitor the incidence of tularemia among the population of Kazakhstan. Natural foci of this infection occupy large areas. In some regions with large numbers of rodents and ectoparasites and low vaccination coverage, human cases of tularemia have been reported.The aim of the study. To carry out retrospective analysis and to study modern spatiotemporal characteristics of tularemia in the West Kazakhstan and North Kazakhstan regions in order to improve the effectiveness of preventive measures.Materials and methods. In our work, we used public records, the results of an epizootological survey of tularemia natural foci and the official data from the Departments of Sanitary and Epidemiological Control of two regions on the human cases of tularemia in 2000–2021. We used descriptive statistics methods, relative and absolute indicators of the tularemia incidence in the population for the analysis. The phenotypic and genetic properties of the strains isolated in 2000–2021 were studied according to the guidelines.Results. A retrospective analysis of the tularemia incidence among the population of the North Kazakhstan and West Kazakhstan regions showed an improvement in the epidemic situation. Over the past 20 years, 4 human cases of tularemia have been registered in the West Kazakhstan region, while the epizootic potential was quite high; more than 300 strains of the tularemia microbe were isolated during the studied period. In the North Kazakhstan region from 2000 to 2021, 11 human cases of tularemia were registered; when studying rodents, mammals and environmental objects, single positive samples for specific tularemia antibodies and antigens were detected; no strains of tularemia microbe were isolated.Conclusion. An analysis of long-term data on the epizootic and epidemic activity of tularemia natural foci, processed using descriptive statistics and GIS technology, made it possible to identify places of long-term persistence of the tularemia agent in the natural focus of the North Kazakhstan and West Kazakhstan regions and to create an electronic map of the territories endemic for tularemia to determine the scope of preventive measures.

Monkeypox-Related Stigma and Vaccine Challenges as a Barrier to HIV Pre-Exposure Prophylaxis among Black Sexual Minority Men.

The U.S. monkeypox (mpox) outbreak of 2022 was a unique emergent public health crisis disproportionately affecting Black sexual minority men (BSMM). Similar to other stigmas, mpox-related stigma may have adverse effects on BSMM, including deterring HIV prevention such as PrEP. Our study investigated the experiences and perceptions of BSMM related to mpox, including mpox-associated stigma, and PrEP engagement among BSMM. We conducted qualitative interviews of 24 BSMM attending HIV prevention-related events in the greater D.C. Metropolitan area. In-depth interviews were conducted via phone, and responses to questions specific to the mpox outbreak were analyzed using thematic analysis. We identified three key themes from the analysis: Mpox-related stigma, Mpox vaccine availability concerns, and Mpox vaccine hesitancy. Participants also described relationships between each of these three themes and PrEP use. Mpox stigma was particularly relevant as it is related to sexual stigma and is a deterrent to PrEP use. A sense of health system neglect of BSMM, especially related to low mpox vaccine availability, was also described. We identified mpox stigma and challenges related to mpox vaccination as key themes among BSMM, with implications for PrEP use. Future research exploring medical mistrust among BSMM, particularly related to HIV prevention, is recommended.

Was lockdown worth it? community perspectives and experiences of the Covid-19 pandemic in remote southwestern Haiti

Public experiences of COVID-19 pandemic lockdown differed dramatically between countries and socio-economic groups. Low-income countries raise unique empirical and ethical concerns about (1) the balance between benefits and social harms and (2) how explanatory disease models and everyday life realities influenced the experience and interpretation of lockdown itself. In this paper, we present qualitative data on community perceptions and experiences of the pandemic from a remote area of Haiti, with a focus on the 2020 lockdown. We conducted in-depth interviews with 30 community leaders in Grand’Anse Department, southwest Haiti, at two time periods: May 2020 and October–December 2021. We divide our results into five sections. First, our analysis showed that lockdown was widely considered ineffective at controlling COVID-19. Despite the lack of testing, community leaders believed most of the local population had caught COVID-19 in the first half of 2020, with limited reported mortality. Public concern about the pandemic largely ended at this time, overtaken by other socio-economic and political crises. Second, we found that popular explanations for the low fatality rate were related to various coping strategies: the strength of people's immune systems, use of natural prophylactic folk teas, beliefs about the virus, spiritual protections and the tropical weather. Third, we found that lockdown was widely seen to have not been appropriate for the Haitian context due to various challenges with compliance in the face of socio-economic vulnerability. Fourth, we found strong negative feelings about the social consequences of lockdown measures, which lasted from March–August 2020, including adverse effects on: food security, household income, education, health, and psychosocial well-being. Finally, these perceptions and experiences reinforced popular ideas that lockdown had been imposed by elites for financial and/or political gain, something that was also reflected in the discourse about the low vaccine acceptance rate. Our study showed that pandemic respiratory virus response in Haiti should better balance restrictive non-pharmaceutical interventions (NPIs) with existing socio-economic vulnerability. Local socio-behavioral dynamics and risk perceptions decrease the overall effectiveness of NPIs in fragile states and alternatives to lockdown, such as shielding the most vulnerable, are likely to be a more appropriate strategy.