Medical Exemptions Research Articles

Provisional Entrants, Exemptions, and Kindergarteners Up-to-Date on Vaccination Before and After a Regulatory Change in Pennsylvania, 2015-2019.

Before the 2017-2018 school year, Pennsylvania shortened the grace period for provisional entrants-kindergarteners who are not up-to-date on vaccination and do not have medical or nonmedical exemption-from 8 months to 5 days. We analyzed the impact of this change on school-entry vaccination status. Using data from the Pennsylvania Department of Health for school years 2015-2016 through 2018-2019, we examined state-level trends in Pennsylvania kindergarteners' vaccination status, including the percentage who were up-to-date on each required vaccine, provisionally enrolled, medically exempted from vaccination, and nonmedically exempted from vaccination. Using the Spearman correlation coefficient, we assessed associations at the school level among changes in kindergarteners' vaccination status after the grace period was shortened. From 2016-2017 to 2017-2018, the provisional entrance rate of kindergarteners in Pennsylvania decreased substantially after the change in the grace period (from 8.1% to 2.2%), the medical exemption rate remained stable, and the nonmedical exemption rate increased slightly (from 1.8% to 2.5%). The percentage of kindergarteners up-to-date on required vaccines increased or remained stable across the study period except for polio, which decreased from 97.9% in 2015-2016 to 96.2% in 2018-2019. The change in provisional entrance rate was negatively associated with change in kindergarteners up-to-date on required vaccines (ρ range, -0.30 to -0.70) but not with change in medical or nonmedical exemptions (ρ range, -0.01 to -0.08). Efforts to reduce provisional entrants may increase the percentage of kindergarteners up-to-date on vaccinations at school entry without a corresponding increase in exemptions.

Modern immunological tests for early detection of tuberculosis infection in children in the Yaroslavl Oblast

Objective. To evaluate the efficacy of immunological tests for early detection of tuberculosis infection in children in the Yaroslavl Oblast (Russia).Material and methods. Medical records of 354 children and adolescents examined by ELISPOT (Enzyme-Linked ImmunoSpot) assay (T-SPOT.TB) in the Yaroslavl Oblast in 2020–2022 were studied. Four groups of children were distinguished: group 1 included children with active tuberculosis (n = 3); group 2 included children under 7 with altered tuberculin sensitivity (conversion of the tuberculin test) or children over 8 first-time tested positive for RTA, who were under the supervision of a phthisiatrician in the VI A group of dispensary registration (n = 52); group 3 included children with medical exemptions from screening immunodiagnostics (n = 49); and group 4 included children with refusals of their parents or legal representatives from skin tests (n = 250).Results. The sensitivity of both RTA and T-SPOT.TB tests achieved 100%, with the concordance level of 100%. When assessing discordant results (positive result for RTA and negative for T-SPOT.TB) in the VI A dispensary registration group, the majority of children were found to have an aggravated allergic anamnesis and somatic pathology. The maximum number of children examined by the laboratory method included those whose parents or legal representatives refused from skin test administration (70.6%).Conclusions. T-SPOT.TB is an optimal method for early detection of latent TB infection and TB in children at risk, including those with medical contraindications for skin tests or whose parents refused from screening immunodiagnostics.

Противопневмококковая иммунизация у детей раннего возраста с хронической сердечной недостаточностью

Aim: To determine the coverage, efficacy and tolerability of pneumococcal vaccination in young children with cardiovascular disease associated with chronic heart failure. Design: Retro- and prospective randomized comparative study. Materials and methods. The study included 250 patients at the age of 2 months to 5 years with confirmed chronic cardiac failure caused by cardiomyopathy or congenital heart disorder. Within the scope of a specialised laboratory and instrumental examination, all children underwent an assessment of specific immunoglobulin (Ig) levels to the most common pneumococcal serotypes (1-5, 6B, 7F, 8, 9N, 9V, 10A, 11A,12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F) using VaccZyme Anti-PCP IgG test system. During consultations and vaccination schedule development, pneumococcal vaccination coverage and the reasons for long-term medical exemptions or refusals were analysed. Provided the primary disease was stable, there were no contraindications and a parent gave their consent, patients were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV13). Results. When questioning the parents of patients, it was revealed that before admission to the department, only 97 (38.8%) patients received at least 1 dose of pneumococcal vaccine, while the remaining 153 (61.2%) were not vaccinated. During hospitalization, 65 (42.5%) of 153 unvaccinated patients under 5 years of age who had not received a single pneumococcal vaccine received the first dose (V1) of PCV13; of 97 children vaccinated, 20 (20.6%) received a second dose, 18 (18.6%) — pneumococcal booster. There was a significant difference in the levels of antibodies to Streptococcus pneumoniae between the group of patients who received a full course of immunization according to age and the group of unvaccinated children: 108.1 ± 58.4 vs. 12.14 ± 7.8 mg/l (p < 0.05). In children with an incomplete course of vaccination, the levels of specific IgG to pneumococcal serotypes were lower. In groups of children who received only one dose of the vaccine in the first or second year of life, they amounted to 42.2 ± 11.7 and 40.2 ± 16.2 mg/l, respectively. Children who received at least two doses of vaccine without revaccination (starting before 12 months) had a relatively higher level of 68.2 ± 6.3 mg/L. But, despite a clear trend, there was no significant difference between these groups in our study. In the post-vaccination period, no serious complications were recorded in the examined children. Conclusion. Vaccination against pneumococcal infection in children with chronic heart failure is effective, safe and should be carried out as close as possible to the schedule of the national vaccination calendar, with a limited set of contraindications. Keywords: vaccination, 13-valent pneumococcal conjugate vaccine, immunoglobulin G, chronic heart failure.

433. COVID-19 Vaccination Uptake Among Health Care Workers (HCW) Requesting Medical Exemptions to Vaccination.

Abstract Background New York State adopted a COVID-19 vaccination requirement for all healthcare workers in September 2021, but they allowed medical exemptions. We examined reasons and frequency of medical exemption requests in an academic medical center. Methods We conducted active surveillance of all medical exemption requests in a tertiary care academic center in Central NY. Age, gender, reason for request, prior acceptance of other required vaccines, letter of support from employee provider, adjudication of the request, and impact of the decision on COVID-19 vaccine acceptance were collected prospectively since the mandate became effective. Results Among 8,776 HCWs, 108 requested medical exemptions, among those 57 (53%) were denied, 39 (36%) were granted temporary exemption, and 12 (11%) were permanent (Table). Females were more likely to request medical exemptions compared to males, 92 (85%) versus 16 (15%), respectively. Overall, 94 (87%) of the HCWs had a letter from their provider in support of their exemption. Nevertheless, only 47% of those qualified for permanent or temporary exemption using CDC guidelines. The most common reasons for requesting exemption included: having natural immunity, receiving monoclonal antibodies, experiencing a common reaction to previous COVID-19 vaccination, and having an underlying medical condition (Figure 1). The majority of individuals who had a request denied or who received a temporary medical exemption were subsequently vaccinated, 63% and 79%, respectively (Figure 2). Demographic and other characteristics among health care workers (HCW) requesting medical exemptions. Table Reasons for requesting medical exemption from COVID-19 vaccination requirement by request determination. Figure 1 COVID-19 vaccine uptake among health care workers (HCW) requesting medical exemptions to COVID-19 vaccination. *One HCW received alternative COVID-19 vaccine. Figure 2 Conclusion Females were more likely to request a medical exemption to vaccination and their requests were often supported by their providers. Future efforts should focus on educating both health care providers and the public about actual medical contraindications or precautions to vaccination to improve overall vaccination rates. Disclosures Jana Shaw, MD,MS,MPH, Pfizer: Advisor/Consultant Stephen J. Thomas, MD, Clover: case adjudication committee (compensated for time)|EdJen: Advisor/Consultant|Icosavax: data monitoring (compensated for time)|Island Pharma: Ownership Interest|Merck: Advisor/Consultant|Moderna: chair, safety monitoring committee (compensated for time)|New Day Diagnostics: Honoraria|Pfizer: Advisor/Consultant|PrimeVax: Ownership Interest|Sanofi Pasteur: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: case adjudication committee (compensated for time)|Vaxxinity: data monitoring committee (compensated for time).

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

USING COVID VACCINE SKIN TESTING IN SHARED DECISION MAKING TO ADDRESS VACCINE HESITANCY

<h3>Introduction</h3> COVID-19 vaccine hesitancy among healthcare workers (HCW) remains due to misconceptions. Our study attempts to improve vaccination rates among vaccine-hesitant healthcare workers as part of COVID-19 Vaccine Allergy Program. <h3>Methods</h3> We enrolled 38 vaccine-hesitant HCWs in the COVID-19 Vaccine Allergy program. A questionnaire assessed their risk and concerns. They were then offered COVID-19 vaccine evaluation and skin prick testing(SPT). <h3>Results</h3> Among 38 participants, reasons for vaccine refusal included: side effects(47%), fear of an allergic reaction(26%), underlying medical conditions(18%), and previous COVID-19 infection(18%). If there were no mandatory orders for COVID-19 vaccination towards HCW, 71% of participants definitely would not get the COVID-19 vaccine, 21% were not likely to get the vaccine, and 8% would likely get the vaccine. 89% of the participant expressed interest in getting the COVID-19 SPT, and 11% showed no interest. Out of 31 participants who had SPT, 97% were negative and 3%(n=1) were positive. Upon follow-up, 71% received COVID-19 vaccine, 23% rejected COVID-19 vaccine, and 6% were lost to follow-up. Regarding those who declined COVID-19 vaccine, 86% refused due to religious exemptions, while 14% had medical exemptions. Of individuals that were either not likely or definitely not likely to receive the COVID-19 vaccine, 69% ultimately received the vaccine. <h3>Conclusions</h3> : Our study showed a preponderance of HCW who were unlikely to get the vaccine, and subsequently agreed to receive it after negative SPT. Thus COVID-19 Vaccine Allergy Program can be used to dispel misinformation and help HCW in the shared decision-making process to improve vaccination rates.

Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

ABSTRACT Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach’s alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents’ primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents’ concerns are required to reduce vaccine hesitancy and improve vaccine uptake.

“The Army of Exempts”: Medical Examinations and the Challenges of Mobilization in Civil War Connecticut

“The Army of Exempts”: Medical Examinations and the Challenges of Mobilization in Civil War Connecticut

From the Editor's Desk

Hello and welcome to the Fall 2022 issue! I hope you are reading this while enjoying good health for you and your loved ones. Our health, along with the cost of living, has been foremost on many people's minds this season. There's a small amount of comfort in knowing that people of the past had similar concerns. As you'll read about in our three articles this issue, they also lived in interesting times. This is exemplified in the lives of three men: Dr. Josiah Beckwith, a Litchfield doctor in the Civil War; Jared Ingersoll, a tax collector in pre-Revolutionary New Haven; and Thomas Thornton, a Puritan during the witch-crazes of seventeenth-century Connecticut.The first article, Peter C. Vermilyea's “The Army of Exempts,” is also the inspiration for the cover art. Both illustrate the treatment of Civil War medical exemptions in Connecticut. How did the past treat people with medical conditions and disabilities? What does this say about manhood and patriotism? How does society treat doctors who perform necessary medical duties with little appreciation? Vermilyea's article covers it all.This article leads nicely to Jon Kukla's treatment of “The Weathersfield Affair.” Going back in time, from the Civil War to the pre-Revolutionary period, Kukla's article covers more societal anxiety, this time around the rising concerns over British taxation, particularly the Stamp Tax in 1765. This societal anxiety was displaced onto a single figure, Jared Ingersoll. Questions of patriotic action, individual choice, duty, and the cost of living loom large Kukla's narrative article.And a hundred years earlier, anxieties over health and duty led to Thomas Thornton's obsession with witchcraft. His presence at many of the New England witchcraft trials have long been overlooked by other historians. As Katherine Hermes and Beth Caruso reveal, Thornton was a linchpin figure for the anxieties of the time. In a way, all three men were.Rounding out this issue, we have Gregg Mangan, Director of Digital Humanities at Connecticut Humanities, and Emma Wiley the Digital Humanities Assistant, guiding us through “Teach It,” a digital primary source resource for the social studies classroom. This goes beyond regular digital primary resources and is an entirely new way of thinking about Digital Humanities, and how to get Connecticut students engaging in critical thinking, digital literacy, historical reasoning, and having fun.As in each Fall issue, this issue also includes a report from Connecticut History Day. Despite the continuing pandemic, Connecticut History Day 2022 virtually brought together over a thousand middle and high school students, with many students continuing to the National Competition. The projects, as always, illustrate that history will be in good hands. Congratulations to all the students.Tying in nicely with the articles and archival holdings are a book review, and an exhibit review. The first is a review of Michael P. Winship's Hot Protestants: A History of Puritanism in England and America. Puritanism as a subject of historical inquiry is still going strong- as this review, and Hermes and Caruso's article show, there's a great deal more to learn. The second is a review of the Orange Historical Society's exhibit on SNET Telephones, offering a window into the lives of people during another technological shift.

Support for HPV vaccine school-entry requirements in the United States: The role of exemption policies

In the United States (U.S.), only five states or territories require human papillomavirus (HPV) vaccination for school attendance, even though almost all U.S. jurisdictions have debated adopting this type of policy. In this U.S. based study, we sought to estimate the level of support for HPV vaccine school-entry requirements with varying exemption policies and documentation procedures to obtain exemptions. Between July and August 2019, we conducted a web-based survey with a national sample of 1,109 U.S. parents of 11- to 17-year-olds. The survey assessed support for four school-entry vaccine requirement policies: without exemption or with exemption for medical, religious or philosophical reasons. Analyses used multivariable logistic regression to assess correlates of support for each policy. Overall, 38% of parents agreed with laws requiring HPV vaccination for school attendance without exemptions. When including exemption provisions, agreement increased to 45% for philosophical reasons, 50% for religious reasons, and 59% for medical reasons. Parents more often agreed on requirements without any exemptions if they were female (OR = 1.37, 95% CI:1.01–1.87), their child had initiated HPV vaccination (OR = 2.05, 95% CI:1.50–2.87), reported high levels of vaccine confidence (OR = 2.41, 95% CI:1.77–3.27), or reported having values similar to those of the people in their community (OR = 1.85, 95% CI:1.39–2.47). Parents more often agreed with requirements that included religious or philosophical exemptions if they reported having values similar to their community or high levels of psychological reactance (all p <.05). Many parents also supported requiring a written notice signed by a health care provider (40%) or religious leader (49%) to obtain a medical or religious exemption, respectively. In conclusion, exemption policies greatly increase parent support of school-entry requirements for HPV vaccination but may decrease their impact in practice. A large number of U.S. parents support strict documentation to obtain exemptions, signaling a promising area of policymaking to strengthen vaccine policies for school attendance.

AAP Publications Reaffirmed.

Clinical report. Recognition and management of medical complexity. Pediatrics. 2016;138(6):e20163021. Available at: https://doi.org/10.1542/peds.2016-3021. Reaffirmed June 2021Policy statement. Medical countermeasures for children in public health emergencies, disasters, or terrorism. Pediatrics. 2016;137(2):e20154273. Available at: https://doi.org/10.1542/peds.2015-4273. Reaffirmed May 2022Clinical report. Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics. 2016;138(3);e20161889. https://doi.org/10.1542/peds.2016-1889. Reaffirmed June 2022Policy statement. Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics. 2016;138(3):e20162145. https://doi.org/10.1542/peds.2016-2145. Reaffirmed February 2022Policy statement. Providing care for children and adolescents facing homelessness and housing insecurity. Pediatrics. 2013;131(6):1206–1210. https://doi.org/10.1542/peds.2013-0645. Reaffirmed February 2022Clinical report. Procedures for the evaluation of the visual system by pediatricians. Pediatrics. 2016;137(1):e20153597. https://doi.org/10.1542/peds.2015-3597. Reaffirmed February 2022Clinical report. Evaluation and management of children and adolescents with acute mental health or behavioral problems. Part I: Common clinical challenges of patients with mental health and/or behavioral emergencies. Pediatrics. 2016;138(3):e20161570. https://doi.org/10.1542/peds.2016-1570. Reaffirmed February 2022Clinical report. Evaluation and management of children with acute mental health or behavioral problems. Part II: Recognition of clinically challenging mental health related conditions presenting with medical or uncertain symptoms. Pediatrics. 2016;138(3):e20161573. https://doi.org/10.1542/peds.2016-1573. Reaffirmed February 2022

“Proper Medical Purpose”: Reviewing Consent and the Medical Exemption to Offences Against the Person

“Proper Medical Purpose”: Reviewing Consent and the Medical Exemption to Offences Against the Person

COVID-19 vaccine hesitancy, chemical retraumatization, and madness

Protecting the Section 7 autonomy rights of Canadian consumers/survivors/ex-patients and the mad (c/s/x/m), as enshrined in the Canadian Charter of Rights and Freedoms, with past experiences of enduring intrusive procedures forced upon them, to decline immunization against COVID-19 is a mad liberation issue, to which Mad Studies must not shut its eyes. To some c/s/x/m, vaccine mandates mirror traumatic moments from their psychiatric past, when they had their autonomy stripped, and their right to legal consent infringed upon by physicians of the mind claiming diminished capacity. In this article, I propose expanding categories of medical exemptions to consider mental health contexts, and accommodations be provided to those with diverging minds who are vaccine skeptic. I conclude with a clarion call to madvocates to stand against the violence of coercing vaccinations.

Moral Sick Notes: Medical Exemptions to Religious Fasting in the Eighteenth-Century Spanish World

Eighteenth-century moral theologians in Spain expressed concern that many Catholics were obtaining permission to avoid fasting and abstinence from meat by claiming that they were ill and required medical dispensations. This article examines the theological and medical debate which occurred over a series of treatises and essays in which physicians and moral theologians sought to come to a common understanding of when a Spaniard was infirm enough to be medically excused from fasting and, perhaps more importantly, who had the authority to make this decision. Throughout the eighteenth century in Spain, this responsibility continued to be shared by priests and physicians. The debate highlights the contest for medical authority, mitigated by doubt. It also suggests that any understanding of early modern medical pluralism must include members of the theological community as well as health professionals.

The Impact of Australian Childhood Vaccination Mandates on Immunization Specialists and Their Interactions With Families.

Recent global outbreaks of vaccine-preventable diseases, both before and since the coronavirus disease 2019 pandemic, have led to the introduction or strengthening of vaccine mandate policies to target vaccine refusal. Globally, there is wide variation in how governments and jurisdictions implement and enforce mandatory vaccination as well as the financial and educational consequences to those who fail to comply. We explored the impact of mandate vaccination policies on Australian Immunization Specialists who work in Specialist Immunization Clinics (SIC) for approving vaccine exemptions outside of the mandated criteria. In particular, their interactions with patients and families. A national, prospective, mixed methods, survey-based study conducted with members of the Australian Adverse Event Following Immunisation Clinical Assessment Network between February 2020 and June 2020. Sixteen Immunization physicians and nurse practitioner specialists working in a SIC completed the survey. All sixteen respondents had been requested by parents to provide a Medical Exemptions at least once. 88% of respondents felt pressure to provide an exemption that was not medically justified according to legislation. Seventy-five percent of SIC consultants felt that the "No Jab" policies created a moderate or extreme amount of stress to both themselves and parents. All respondents reported experiencing hostility from parents with three respondents having received threats of violence. Mandatory vaccination policies are associated with increased vaccination coverage but can result in widened financial and social inequity, and may harm families' relationships with health care providers. Countries considering the implementation of vaccination mandates should use the least restrictive health policies to ensure a balance between the public health and individual benefit whilst minimizing burdens on health care professionals, children and their parents.

Review of Vaccination Coverage Assessed by the Kindergarten Immunization Survey in Delaware

Vaccinations are the primary means used in public health to avert morbidity and mortality from preventable diseases and are crucial for reducing the development of infectious disease outbreaks. To ensure a high level of vaccine coverage, the State of Delaware requires that all children receive specific vaccinations against dangerous pathogens prior to enrolling in a school. By requiring all children to be vaccinated against certain diseases, individuals who have religious or medical exemptions for receiving vaccines are also protected. The percentage of vaccine coverage among kindergarten students is surveyed annually by the Delaware Immunization Program and the Centers for Disease Control and Prevention (CDC), via random sampling. Data acquired during the period from 2016 to 2021 shows that vaccine coverages have a declining trend, which may be due in part to the COVID-19 pandemic and increased vaccine hesitancy. Reviewing these data allows for a more robust understanding of disease trends and provides an indication as to where resources may need to be allocated to address lagging vaccine rates.

Approaches to healthcare personnel exemption requests from coronavirus disease 2019 (COVID-19) vaccination: Results of a national survey.

Although a growing number of healthcare facilities are implementing healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) vaccination requirements, vaccine exemption request management as a part of such programs is not well described. Cross-sectional survey. Infectious disease (ID) physician members of the Emerging Infections Network with infection prevention or hospital epidemiology responsibilities. Eligible persons were sent a web-based survey focused on hospital plans and practices around exemption allowances from HCP COVID-19 vaccine requirements. Of the 695 ID physicians surveyed, 263 (38%) responded. Overall, 160 respondent institutions (92%) allowed medical exemptions, whereas 132 (76%) allowed religious exemptions. In contrast, only 14% (n = 24) allowed deeply held personal belief exemptions. The types of medical exemptions allowed varied considerably across facilities, with allergic reactions to the vaccine or its components accepted by 145 facilities (84%). For selected scenarios commonly used as the basis for religious and deeply held personal belief exemption requests, 144 institutions (83%) would not approve exemptions focused on concerns regarding right of consent or violations of freedom of personal choice, and 140 institutions (81%) would not approve exemptions focused on introducing foreign substances into one's body or the sanctity of the body. Most respondents noted plans for additional infection prevention interventions for HCP who received an exemption for COVID-19 vaccination. Although many respondent institutions allowed exemptions from HCP COVID-19 vaccination requirements, the types of exemptions allowed and how the exemption programs were structured varied widely.

Your ID, please? The effect of facemasks and makeup on perceptions of age of young adult female faces.

During the COVID‐19 pandemic, wearing facemasks was mandatory in the United Kingdom except for individuals with medical exemptions. Facemasks cover the full lower half of the face; however, the effect of facemasks on age perception is not yet known. The present study examined whether age estimation accuracy of unfamiliar young adult women is impaired when the target is wearing a facemask. This study also examined whether makeup, which has previously been shown to increase error bias, further impairs age estimation accuracy when paired with a facemask. The findings indicate that both facemasks and makeup tend to result in overestimation of the young women's age compared to neutral faces, but the combination of both is not additive. Individual level analysis also revealed large individual differences in age estimation accuracy ranging from estimates within 1 year of the target's actual age, and age estimates which deviated by up to 20 years.

Assessing Vaccine Hesitancy Among Pediatric Healthcare Providers.

Vaccine compliance has fallen short of national and international targets, generating preventable disease outbreaks. While vaccine hesitancy in the general public is a factor in under-vaccination, vaccine hesitancy among healthcare providers remains an underrecognized obstacle to pediatric vaccine completion. The aim of this quality improvement study was to assess provider attitudes and practices regarding vaccine efficacy, safety, adverse effects, and recommendations. To assess for changes in their vaccine confidence, a convenience sample of three physicians and seven advanced practice registered nurses (APRNs) from a pediatric primary care clinic anonymously completed a self-administered survey, participated in an educational intervention, and then completed another survey. All eight providers denied personal vaccine hesitancy. However, one APRN did not fully vaccinate their child due to a medical exemption and another APRN reported concerns about influenza vaccine efficacy. While the mean confidence score for educating vaccine-hesitant parents increased from pre (8.75) to post intervention (9.13), the increase was not statistically significant. The pre-intervention survey affirmed the presence of parental vaccine hesitancy, but not provider vaccine hesitancy. Further study is needed to identify and address provider vaccine hesitancy to improve their vaccine confidence and, ultimately, pediatric vaccine completion.

Вакцинопрофилактика недоношенных новорожденных: реальная клиническая практика

Objective. To analyze the vaccination coverage and adherence to the vaccination schedule among premature newborns with a birthweight of &lt;2,500 g. Patients and methods. This study included 119 children aged 5 to 6 years followed up within the "National prospective multicenter cohort study of newborns" in Tomsk. The experimental group comprised 96 children born prematurely, including 36 low-birthweight (LBW), 25 very low-birthweight (VLBW), and 36 extremely low-birthweight (ELBW) children. The control group included 23 healthy children born full-term. We analyzed their clinical data and information on vaccination. Results. The number of children who had completed their vaccination by the age of 5 years varied across the groups: 34.8% of controls; 16.7% of LBW children; 28% of VLBW children; and 17.1% of ELBW children (p &gt; 0.05). Thirteen percent of controls and 5.6% of LBW children were timely vaccinated, whereas none of the VLBW and ELBW children had their vaccination in time. We observed no differences in the vaccination profiles (types of administered vaccines) between the VLBW children and controls; vaccination profiles of the LBW and ELBW children were similar. ELBW children were less likely to be vaccinated against tuberculosis, pertussis, diphtheria, tetanus, and polio than controls (p &lt; 0.01). None of the ELBW children received vaccines against hepatitis B, pertussis, diphtheria, and tetanus, as well as third vaccine against polio at birth. In the rest of the groups, the proportion of timely vaccinated children did not exceed 20%. Parents in the control group were less likely to refuse vaccination for their children than those in the experimental group. Non-adherence to the vaccination schedule was more common in the LBW children. VLBW and ELBW children had medical exemptions more frequently than LBW children and controls. Conclusion. We observed low vaccination coverage among premature newborns for all vaccines caused both by medical exemption and non-adherence to the vaccination schedule. Key words: vaccination, premature newborns, extremely low birth weight