Public Vaccination Research Articles

HostNet: improved sequence representation in deep neural networks for virus-host prediction

BackgroundThe escalation of viruses over the past decade has highlighted the need to determine their respective hosts, particularly for emerging ones that pose a potential menace to the welfare of both human and animal life. Yet, the traditional means of ascertaining the host range of viruses, which involves field surveillance and laboratory experiments, is a laborious and demanding undertaking. A computational tool with the capability to reliably predict host ranges for novel viruses can provide timely responses in the prevention and control of emerging infectious diseases. The intricate nature of viral-host prediction involves issues such as data imbalance and deficiency. Therefore, developing highly accurate computational tools capable of predicting virus-host associations is a challenging and pressing demand.ResultsTo overcome the challenges of virus-host prediction, we present HostNet, a deep learning framework that utilizes a Transformer-CNN-BiGRU architecture and two enhanced sequence representation modules. The first module, k-mer to vector, pre-trains a background vector representation of k-mers from a broad range of virus sequences to address the issue of data deficiency. The second module, an adaptive sliding window, truncates virus sequences of various lengths to create a uniform number of informative and distinct samples for each sequence to address the issue of data imbalance. We assess HostNet's performance on a benchmark dataset of “Rabies lyssavirus” and an in-house dataset of “Flavivirus”. Our results show that HostNet surpasses the state-of-the-art deep learning-based method in host-prediction accuracies and F1 score. The enhanced sequence representation modules, significantly improve HostNet's training generalization, performance in challenging classes, and stability.ConclusionHostNet is a promising framework for predicting virus hosts from genomic sequences, addressing challenges posed by sparse and varying-length virus sequence data. Our results demonstrate its potential as a valuable tool for virus-host prediction in various biological contexts. Virus-host prediction based on genomic sequences using deep neural networks is a promising approach to identifying their potential hosts accurately and efficiently, with significant impacts on public health, disease prevention, and vaccine development.

Health policy, price regulation, and innovation: Evidence from China’s vaccine industry

This paper investigates the effect of policy-induced market incentives on pharmaceutical innovation in the context of developing countries, where substantial health challenges persist but research and development (R&D) efforts remain limited. We exploit the quasi-experimental setting of a major reform in China’s public vaccine system, which involved expanding vaccine coverage while imposing price controls on affected products. Using newly collected data on vaccine clinical trials and revenues, we estimate that China’s public vaccine program expansion in 2008–2009 led to an 83% decrease in new vaccine clinical trials for the policy-affected diseases. This decrease can be attributed to the government’s price regulation, which greatly reduced the market revenue of the affected vaccines. Our welfare analysis indicates that for some affected diseases, reducing innovation is welfare-enhancing as the reform has curbed potentially wasteful R&D spending. However, for one disease, the policy-induced reduction in innovation is socially harmful because continued innovation can lead to long-run social benefits by generating more effective products.

1778. Same Story, Different Outbreak: Lessons from a Survey Study Investigating JYNNEOS Mpox Public Vaccination Clinic Establishment in New Hampshire

Abstract Background The 2022-2023 mpox outbreak necessitated rapid distribution of JYNNEOS vaccines from the US Strategic National Stockpile to protect at-risk persons. New Hampshire’s centralized public health structure requires partnership with healthcare facilities to administer vaccines during public health responses. We reached out to 67 organizations; only seven were able to establish a community JYNNEOS vaccine clinic. Methods To identify barriers and resources needed for emergency public vaccination, surveys were sent to seven participating and 20 non-participating organizations. Results Seven (100%) participating organizations (“vaccine-partners”) and seven (35%) non-participating organizations responded. Two out of seven non-participating respondents were non-clinical and lacked facilities and staff to conduct vaccination clinics. Of the remaining five non-participating respondents, all identified lack of staffing, provider time, and clinical resources as barriers to establishing community vaccination clinics. Vaccine-partners and non-participating organizations reported needing or utilizing the following staff positions to conduct public vaccination clinics: administrators (0.15-1.5 Full Time Equivalents [FTE]), physicians or advanced practice providers (0.2-1 FTE), registered nurses (0.17-1.5 FTE), medical/licensed nursing assistants (0.2-1 FTE), and communications outreach staff (0.5 FTE). In addition to staffing, additional funding needs estimated by all survey respondents averaged $2,057 per month (range $0-$7,500).Figure 1.Consort flow diagram. *Public mpox vaccination clinics were intended to be clinics open to the general public (i.e., open points of distribution, or PODS) serving both the organizations existing patient population, new patients, and referrals from other providers or public health for both post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) vaccination. Public mpox vaccination clinics were advertised on the NH DHHS website and in the media as a resource for all NH residents and providers. ** These clinics went through initial "onboarding" process to be able to receive and administer mpox vaccine, but they either didn't complete the process to be a public clinic, only served as a PEP provider as needed, or only chose to administer vaccine to their patient population which was allowed in select circumstances (e.g., with FQHCs) to increase equitable access.Figure 2.Barriers to establishing public mpox vaccine clinic Conclusion A minority of NH healthcare facilities elected to establish public JYNNEOS vaccination clinics. Insufficient staffing was the primary barrier. Additional resources and funding were minimal. The repeated need for public health vaccination clinics requires sustained advocacy, support, and partnership to ensure an efficient and effective emergency response for the next outbreak. Disclosures Benjamin P. Chan, MD, MPH, General Electric (GE): Stocks/Bonds

2308. Exploring the Seasonality of COVID-19 with Machine Learning: A Distinct Bimodal Pattern?

Abstract Background Respiratory viruses, such as influenza and RSV, occur annually during the winter season in temperate regions. It is essential to determine if SARS-CoV-2 exhibits seasonal patterns for public health planning and vaccination policies. Although winter spikes in COVID-19 cases have been observed, the higher transmissibility of SARS-CoV-2 suggests its seasonality may have a different pattern. Methods We plotted the time-series data on COVID-19, Influenza, and RSV from January 2020-February 2023 at Stanford Healthcare, to compare seasonal patterns. We then modeled predictions for COVID-19 cases in the United States for the next 913 days, using data from January 2020-February 2023. This data was split into a training set and a test set, then Facebook Prophet machine learning library was used to fit a model to the training set and generate forecasts for the test set and future time periods. Cross-validation of the model was performed by calculating the root mean squared error (RMSE) and mean absolute percentage error (MAPE). Results The time-series data of cases for Influenza, RSV, and COVID-19 were plotted from January 1, 2020, to February 28, 2023, revealing bimodal peaks for COVID-19 during the winter (December - February) and summer (July - September) months (Figure 1). This differed from the unimodal patterns observed for Influenza and RSV cases (Figures 2 and 3, respectively). The Prophet model for COVID-19 cases over the next 913 days in the United States demonstrated an additional peak during the summer months (Figure 4). However, other external factors that may influence seasonality, such as the stochastic development of new SARS-CoV-2 variants, weaning of immunity, and testing intensity were not modeled.Figure 1.COVID-19 time-series at Stanford Healthcare during January 2020–February 2023Time-series of COVID-19 cases demonstrates bimodal peaks during the winter (December - February) and summer (July - September) months.Figure 2.Influenza time-series at Stanford Healthcare during January 2020–February 2023Time-series of Influenza cases demonstrates one peak during the winter (December - February) months.Figure 3.RSV time-series at Stanford Healthcare during January 2020–February 2023Time-series of RSV cases demonstrates one peak during the winter (December - February) months. Conclusion COVID-19 may exhibit distinct bimodal seasonal patterns that are not observed for other respiratory viruses. Future public health interventions should consider the distinct seasonal patterns of COVID-19 when developing prevention and control strategies.Figure 4.Prophet Model forecasting COVID-19 peaks in the United States for the next 3 years Cross-validation results for the Prophet model's performance in predicting COVID-19 cases in the United States over a 5-day horizon. The model's RMSE was 110,342.81, indicating an average deviation from the actual values. The MAPE was 0.486, reflecting the model's average percentage error. The coverage was 0.35, indicating that the actual value fell within the 80% prediction interval of the model only 35% of the time, which may suggest limitations for longer-term forecasting. Disclosures All Authors: No reported disclosures

Identification of organizational barriers to HPV vaccination uptake in medical students in southern Italy: a cross-sectional study.

Despite proven efficacy, HPV vaccination coverage is still suboptimal. Factors influencing vaccination uptake are education attainment, socio-economic position, and knowledge about HPV. This study aimed to assess HPV vaccination uptake and its correlates among medical students and identify logistic-organizational barriers, knowledge, and attitudes with regard towards HPV vaccination to improve current public health vaccination strategies. Medical students, with their acquired biological knowledge, were selected as a low-risk groups for HPV vaccination uptake. This cross-sectional study was conducted using a validated questionnaire. Students in their the first 3 years of study students were preferentially invited. Eventually, the invitation was extended to every medical student. Logistic multivariable regression was used to assess determinants of HPV vaccination uptake. Additional analysis explored determinants of knowledge of and attitude toward HPV vaccination. Finally, a sensitive analysis was conducted to further assess the effect of knowledge and attitude on the HPV vaccination rate. A total of 882 medical students participated, with 74.5% enrolled in the first 3 years of their training. HPV vaccination uptake was 55.5%, ranging from 78.5% for females to 16.5% for males. Male sex and increasing age were consistently associated with a lower vaccination uptake (males sex: OR 0.03, CI 0.02-0.05; age: OR 0.77, CI 0.68-0.88), whereasilst progress in their academic career was associated with a to higher likelihood of being vaccinated (6th year: OR 3.45, CI 1.24-9.57). These associations were confirmed when considering the knowledge of and attitude towards HPV. Additionally also, an active outreach from healthcare institutions was associated with a higher likelihood of receiving HPV vaccination (OR 1.70, CI 1.09-2.65. HPV vaccination in medical students was higher than in the general population; however, it was still suboptimal. An active and up-to-date call strategy and extending the free-of-charge offer are essential measures for to improvinge vaccination uptake. The findings support the need to improve public health strategies and increase awareness and knowledge ofregarding HPV vaccination.

Reminder design and childhood vaccination coverage

A major policy concern across public vaccination programs is non-compliance. Exploiting Danish population data and three national reforms in regression discontinuity designs, we document the effects of reminders for childhood vaccination coverage. Retrospective reminders are primarily effective for families with small children and when sent out close to the recommended vaccination age. Digital and postal reminders are equally effective. Prospective reminders increase timely vaccinations in later childhood and help reaching high coverage for new vaccines in increasingly complex vaccination programs. While reminders prompt additional preventive care for focal children, we find no spillovers to other health behaviors or relatives.

Relative Risk of COVID-19 Reinfection by Demographic and Vaccination Factors During the Period March 2020-October 2022.

The risk of reinfection has been difficult to quantify throughout the pandemic, making the case for COVID-19 vaccination and receipt of booster doses to the public difficult for the public health community. To address this question, Michigan statewide COVID-19 infection and vaccination data was utilized in this cross-sectional study to determine the risk of reinfection by vaccination status. Cases were divided into subgroups by vaccination status, and the risk of reinfection in the various vaccination categories was then calculated by dividing the cumulative incidence of reinfection in a vaccine category by the cumulative incidence of reinfection of those not in that category Within this population, the risk of becoming reinfected was 1.6 times higher for those who were unvaccinated than those who were vaccinated; those with a primary series saw a 27% reduced risk of reinfections compared to those without a primary series. Those with an additional booster dose had a modest improvement, with 35% reduced risk of reinfection when compared to the other groups combined. These results provide population level data to support current public health vaccination recommendations.

Effectiveness of the Modified Vaccinia Ankara Vaccine Against Mpox in Men Who Have Sex With Men: A Retrospective Cohort Analysis, Seattle, Washington.

Data on modified Vaccinia Ankara (MVA) vaccine effectiveness against mpox in real-world settings are limited. We performed a retrospective cohort analysis using Cox proportional hazards regression to estimate the association between vaccination and laboratory-confirmed mpox incidence. Study subjects included all men who have sex with men seen in a sexual health clinic in Seattle, Washington, between 1 January 2020 and 31 December 2022. Subjects' receipt of vaccine and diagnosis with mpox were ascertained from public health vaccine registry and surveillance data. Analyses were adjusted for demographic factors, human immunodeficiency virus (HIV) status, and sexual risk behaviors. The incidence of mpox per 100 person-years was 8.83 among patients with 0 doses, 3.32 among patients with 1 dose, and 0.78 among patients with 2 doses of MVA vaccine. Mpox diagnosis was significantly associated with age category 30-39 and 40-51 years, HIV positivity, syphilis diagnosis in the prior year, >10 sex partners in the last year, and having a clinic visit in the last year. In the multivariate model adjusting for these factors, vaccine effectiveness was 81% for 1 dose and 83% for 2 doses. These data support the effectiveness of the MVA vaccine-including a single dose of the vaccine-in preventing mpox disease and highlight the appropriateness of risk factor-based prioritization of immunization early in the epidemic. The durability of MVA vaccine-induced immunity is unknown, and at-risk persons should receive 2 doses of MVA.

County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.

County-level vaccination barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, history of low vaccination) may partially explain COVID-19 vaccination intentions among U.S. adults. This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S. and were associated with willingness to receive the COVID-19 vaccine. In addition, this study assessed whether these associations differed across racial/ethnic groups. This study used data from the REACH-US study, a large online survey of U.S. adults (N = 5,475) completed from January 2021-March 2021. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Ordinal logistic regression estimated associations between race/ethnicity and county-level vaccination barriers and between county-level vaccination barriers and willingness to receive the COVID-19 vaccine. Models adjusted for covariates (age, gender, income, education, political ideology, health insurance, high-risk chronic health condition). Multigroup analysis estimated whether associations between barriers and willingness to receive the COVID-19 vaccine differed across racial/ethnic groups. American Indian/Alaska Native, Black/African American, Hispanic/Latino ELP [English Language Preference (ELP); Spanish Language Preference (SLP)], and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers [Adjusted Odd Ratios (AORs):1.63-3.81]. Higher county-level vaccination barriers were generally associated with less willingness to receive the COVID-19 vaccine, yet associations were attenuated after adjusting for covariates. Trends differed across barriers and racial/ethnic groups. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine (AOR:0.78, 95% CI:0.64-0.94), whereas higher irregular care-seeking behavior was associated with greater willingness to receive the vaccine (AOR:1.20, 95% CI:1.04-1.39). Greater history of low vaccination was associated with less willingness to receive the COVID-19 vaccine among Black/African American adults (AOR:0.55, 95% CI:0.37-0.84), but greater willingness to receive the vaccine among American Indian/Alaska Native and Hispanic/Latino ELP adults (AOR:1.90, 95% CI:1.10-3.28; AOR:1.85, 95% CI:1.14-3.01). Future public health emergency vaccination programs should include planning and coverage efforts that account for structural barriers to preventive healthcare and their intersection with sociodemographic factors. Addressing structural barriers to COVID-19 treatment and preventive services is essential for reducing morbidity and mortality in future infectious disease outbreaks.

Did the COVID-19 pandemic change the weight reduction in patients with obesity after bariatric surgery?

BackgroundThe COVID-19 pandemic has significantly impacted healthcare services worldwide, including bariatric surgery. There is a concern that the pandemic-induced stay-at-home orders and social restrictions may negatively affect weight reduction outcomes post-bariatric surgery. This study aimed to examine the impact of the COVID-19 on weight loss up to six months after three types of bariatric surgeries including One-Anastomosis Gastric Bypass (OAGB), RY Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) before and two time periods during the COVID-19 pandemic.MethodsWe conducted a retrospective study using data from a comprehensive database of bariatric surgery patients in Iran. We recruited 882 patients who underwent bariatric surgery from the initiation of COVID-19 to 6 months before public vaccination (Time period 3); among them, 311 patients underwent surgery in the first six months of the pandemic (Time period 2). These patients were compared with 1368 ones in the control group who completed their 6 months follow-up before the pandemic. The study compared the BMI reduction, excess weight loss (EWL), and total weight loss (TWL) outcomes between these groups using Generalized Estimating Equations (GEE) with gamma distribution to adjust for factors that were unevenly distributed across the groups.ResultsThe age of participants in time periods 2 and 3 had a mean (standard deviation) of 38.97 (10.99) and 38.84 (10.71), respectively. In all groups, the majority of patients were females, accounting for 76.02%, 71.06%, and 75.74% for the control group and time periods 2 and 3, respectively. There was no significant difference between the groups in terms of weight reduction, as measured by BMI reduction, EWL, and TWL (related P values: 0.283, 0.465 and 0.169). Regression analysis indicated that higher baseline BMI values were associated with greater BMI reduction (0.04, 95% CI: 0.03–0.05), but this did not translate to higher EWL or TWL. Males showed greater BMI reduction (0.33, 95% CI: 0.18–0.49) and EWL (1.58, 95% CI: 0.79–2.37) than females, while females achieved higher TWL compared to males. Among different types of surgery, the OAGB resulted in more weight reduction among patients in the study.ConclusionIn conclusion, our study reveals that bariatric surgery remains effective for weight reduction during the first 6 months of the pandemic in Iran. Implementation of pandemic protocols ensures comparable efficacy to non-pandemic times. However, caution is needed in generalizing results beyond our specific context due to study limitations. Further research is essential to comprehensively assess the pandemic's broader impact on bariatric surgery outcomes under varying conditions.

China’s pandemic-time public diplomacy in the Balkans and the challenge to the EU’s regional leadership

This paper explores how China’s assistance to countries in the Western Balkans during the pandemic boosted their reputation in the region, through the case studies of Serbia, Macedonia, and Albania. The COVID-19 crisis has tested EU’s reputation of solidarity and partnership to the Western Balkans, with Balkan political leaders accusing the bloc of selfishness due to its decision in 2020 to restrict exports of medical equipment to candidate states and the perceived neglect of the region during the vaccine distribution in early 2021. Simultaniously, China sent planes containing tonnes of medical supplies, respirators, medical personnel, and later vaccines, that would be received with great pomp and live media coverage, in a powerful public diplomacy and vaccine diplomacy offensive. This paper argues that this helped improve public opinion and reshape narratives on China in the Western Balkans. Still, attitudes vary between states, with Serbians having the most favourable views on China as a foreign partner. On the other hand, while public perceptions on China have seen a positive shift in Macedonia and Albania, this has not translated in a change in their pro-EU stance.

Factors influencing vaccination against SARS-CoV-2 among patients with inflammatory bowel disease

Vaccination against SARS-CoV-2 is a major public health challenge and vaccination coverage is still unsatisfactory, especially for patients with inflammatory bowel disease (IBD). To improve vaccination adherence, it is very important to know current SARS-CoV-2 vaccination rate.

Determining the impact of vaccination on SARS-CoV-2 RT-PCR cycle threshold values and infectious viral titres.

As the COVID-19 pandemic continues, efforts to better understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding and transmission in both unvaccinated and vaccinated populations remain critical to informing public health policies and vaccine development. The utility of using real time RT-PCR cycle threshold values (CT values) as a proxy for infectious viral litres from individuals infected with SARS-CoV-2 is yet to be fully understood. This retrospective observational cohort study compares quantitative infectious viral litres derived from a focus-forming viral titre assay with SARS-CoV-2 RT-PCR CT values in both unvaccinated and vaccinated individuals infected with the Delta strain. Nasopharyngeal swabs positive for SARS-CoV-2 by RT-PCR with a CT value <27 collected from 26 June to 17 October 2021 at the University of Vermont Medical Center Clinical Laboratory for which vaccination records were available were included. Partially vaccinated and individuals <18 years of age were excluded. Infectious viral litres were determined using a micro-focus forming assay under BSL-3 containment. In total, 119 specimens from 22 unvaccinated and 97 vaccinated individuals met all inclusion criteria and had sufficient residual volume to undergo viral titring. A negative correlation between RT-PCR CT values and viral litres was observed in both unvaccinated and vaccinated groups. No difference in mean CT value or viral titre was detected between vaccinated and unvaccinated groups. Viral litres did not change as a function of time since vaccination. Our results add to the growing body of knowledge regarding the correlation of SARS-CoV-2 RNA levels and levels of infectious virus. At similar CT values, vaccination does not appear to impact an individual's potential infectivity when infected with the Delta variant.

Global Health Security

To reduce the risk and effect of sudden incidents of public health that put people at risk across national and international boundaries, it is necessary to take both preventive and reactive measures. These measures are referred to as global health security. Discussions on health security in scientific gatherings have become more prevalent in recent years after the Covid pandemic. Health security is for the whole world, irrespective of age, race, gender, or financial stability. However, it has been noted that there are many different concepts of health security, that the whole purpose of this is to accommodate only the upper-class societies. The disturbed equilibrium of the microbial world due to rapid urbanization, population increase, environmental deterioration, and the improper use of antimicrobials makes people realize the importance of health security that requires a collaborative approach focused on preparedness for any future pandemics and equal access to health care products. &#x0D; The covid-19 pandemic has had a great influence on people’s lives and their ability to think. Now the main race is not about defence systems; it has shifted towards more and better health security and the ability to deal with any future pandemics. The coronavirus outbreak was associated with severe acute respiratory syndrome, the Middle East respiratory syndrome coronavirus outbreak in 2012, the swine flu pandemic in 2009, and the West African Ebola virus disease epidemic in 2013–2016. All these epidemics are primarily caused by the significant travel of infected people across borders. This highlights the need for global health security, which helps coordinate surveillance and policymaking. This limits disease transmission and reduces the damage.&#x0D; While infectious diseases have no limits, inadequate health systems in poor nations make them worse and more out of control. Africa and other third-world states face many problems in securing global security. The spread of infectious diseases among susceptible areas is due to inadequate public healthcare fundings, vaccine coverage, poverty, armed conflict, and climate-related disasters, which damage developing countries. This only serves to increase susceptibility to the disease. The continuous transmission of polio and measles in different parts of Africa and Asia, as well as recent Ebola outbreaks in West Africa, highlights the need to overcome this in order to stop the spread of diseases to other areas. No nation can be completely protected from the spread of diseases due to a lack of social services and a strong health infrastructure; hence, global security demands global equality and progress towards health for everyone. &#x0D; To advance global health security in all nations, there is a need for multi-stakeholders and governance, justifiable finance through the proposed pandemic funds, and common goods for health. Future outbreaks can be efficiently managed by funding basic healthcare and enhancing the response systems. Equity in pandemic preparedness and response measures depends on high-level political commitment and global leadership irrespective of colour and gender. False contradictions between countries can be dismissed by focused investments in strengthening health emergency infrastructure, particularly through primary healthcare, ensuring that the world is better prepared to handle complex public health emergencies.

Acceptance of the COVID-19 Vaccine by Prisoners and Staff in Spanish Prisons.

The COVID-19 vaccination of prisoners and prison staff represents a public health intervention to reduce the impact of the pandemic in conglomerate settings. In Spanish prisons, the road map of the Ministry of Health was followed to protect the population at risk. We conducted a cross-sectional study to assess the acceptance of COVID-19 vaccination by prisoners and prison staff in a prison in Alicante, Spain. We analyzed data obtained through a standardized, self-administered, and anonymous questionnaire; 1016 prisoners and 288 prison staff responded to the survey. The majority of inmates and staff reported no history of symptomatic COVID-19, 90.15% and 91.66%, respectively. Respondents reported that 88.72% agreed to be vaccinated and 89.64% would recommend the vaccine to others. Approximately 89% believe that the benefit of getting vaccinated against COVID-19 is greater than the risk, and 70.55% reported that vaccination should be mandatory for inmates and staff to participate in some activities. The acceptance of COVID-19 vaccination among prisoners and prison staff is high in a Provincial Prison in Spain. Elevated acceptance of COVID-19 vaccination in prisons is a major factor in public health intervention and vaccine equity.

Lessons learned from COVID-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy

BackgroundEnhancing the public's vaccine literacy is critical for curbing vaccine hesitancy and enhancing society's pandemic preparedness, particularly in an era of infodemic. Evidence on vaccine literacy as an influencing factor of hesitancy is scarce. Lessons could be learned from COVID-19 vaccination implementation. Taking the COVID-19 vaccines as an example, the current study aimed to examine the relationship between vaccine literacy and hesitancy and the mediating role of psychological antecedents of vaccination on the relationship. MethodsA baseline online questionnaire survey among the general public in China based on quota sampling was conducted in April 2021 to measure participants' vaccine literacy, psychological antecedents of vaccination, COVID-19 vaccination status, and vaccine hesitancy. A follow-up online survey tracked the updated COVID-19 vaccination status among those who hadn't taken COVID-19 vaccines at the baseline survey. Structural equation modeling has been applied to examine the direct and indirect effect of vaccine literacy on vaccine hesitancy. Time-to-event analysis was used to explore the effect of vaccine hesitancy on vaccination behavior. ResultsLower vaccine hesitancy was associated with higher vaccine literacy. The "3Cs" psychological antecedents were important mediators between vaccine literacy and vaccine hesitancy. The pathway between critical/interactive vaccine literacy and vaccine hesitancy through the "3Cs" psychological antecedents played a more important role. Time-to-event analysis showed participants with a higher vaccine hesitancy were prone to have a longer delay in vaccination. ConclusionsImproving the public's ability to obtain and evaluate vaccination information can fix the public's psychological determinants of vaccination, reducing vaccine hesitancy and promoting vaccination. Governments need to put more effort into guiding and regulating the media to disseminate evidence-based information, rectifying misinformation, and improving the public's vaccine literacy through education, especially the public's capability to critically discern mixed information.

Strategies of (De)Legitimation of COVID-19 Vaccines in Tanzanian Political Speeches

The COVID-19 pandemic sparked worldwide efforts to combat the health crisis, including vaccine development and distribution. However, varying political responses to vaccination policies complicated public discourse and influenced vaccine acceptance. This research paper employs critical discourse analysis (CDA) to compare (de)legitimation strategies used in Tanzanian political speeches by two presidents: late President Magufuli and current President Samia Suluhu Hassan. The study focuses on their approaches to legitimizing or delegitimizing COVID-19 vaccines in 2021. Two speeches were purposefully selected based on their relevance to vaccination decisions. President Magufuli employed strategies such as discrediting experts, discrediting others, denial, conspiracy theories, and making accusations to delegitimize vaccines. In contrast, President Samia justified vaccine acceptance using strategies such as authorization, moral evaluation, emotional appeals, and rationalization. These differences in approach can be attributed to their respective ideologies. President Magufuli, a populist leader, displayed scepticism towards Western medicine and promoted local solutions, while President Samia presented herself as a pragmatic leader who prioritizes scientific solutions and international cooperation in addressing health crises. The findings shed light on the complexities of public health communication and vaccine acceptance in Tanzania.

The Social Ecological Model: A Framework for Understanding COVID-19 Vaccine Uptake among Healthcare Workers-A Scoping Review.

Vaccination plays a crucial role in combating the global COVID-19 pandemic. Immunizing all healthcare workers (HCWs) is essential for increasing vaccine confidence and acceptance within the general population. Understanding the factors that hinder or facilitate vaccine uptake among HCWs is of utmost importance, considering they are among the first to be vaccinated. This review follows Arksey and O'Malley's five-stage methodological framework. We searched PubMed, Web of Science, ProQuest, WorldCat Discovery, and Google Scholar for peer-reviewed articles published from 2020 to 2023. A descriptive analysis and narrative synthesis approach were employed to collect and synthesize data. Using the social-ecological model as a framework, the literature was categorized into themes at the intrapersonal, interpersonal, organizational, community, and policy levels. We reviewed a total of fifty-three published academic articles, with the majority of studies conducted in Ethiopia and Nigeria. The intention for vaccine uptake resulted in an unsatisfactory (52%) overall uptake rate among HCWs. Individual-level determinants associated with vaccine uptake included being male, middle-aged, being a physician, having a higher level of education, and having a chronic illness. This review identified significant barriers at each level, such as safety concerns, perceived scientific uncertainty, vaccine ineffectiveness, lack of trust in stakeholders, and religious beliefs. Additionally, we identified facilitators at each level, with the most common factors promoting intention to uptake being the desire to protect oneself and others and a high perceived susceptibility to contracting COVID-19. This review highlights the existence of significant barriers to vaccine uptake on the African continent. Given that HCWs play a crucial role in guiding the public's vaccination decisions, it is imperative to prioritize education and training efforts about the safety and effectiveness of COVID-19 vaccines.

Evolution of the Viral Genomes of SARS-CoV-2 in Association with the Changes in Local Condition: A Genomic Epidemiological Study of a Suburban City of Japan.

Understanding the factors driving the spread and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the local, regional, national, and international levels is important in protecting against future pandemics. By exploring their viral genomes, we attempted to analyze the spread of SARS-CoV-2 and its evolutionary convergence in Kashiwa City, as an example of a representative commuter town in Japan. From September 2020 to January 2023, a total of 47,134 nasopharyngeal swab and saliva specimens were collected from patients in 38 local clinics and hospitals, covering the vast majority of healthcare facilities. All SARS-CoV-2-positive samples were subjected to whole genome sequencing. Based on analysis of 5,536 identified genomes, all major strains were represented. Unique regional mutations were occasionally identified in each strain. Inspection of these mutations revealed that the overall base substitution rate increased with progressive waves of the pandemic, at an overall rate of 2.56 bases/year. Interestingly, the spread and evolutionary patterns appeared to be distinct between regions and between individual clinics. Further analysis of the synonymous base substitution rate showed that the speed of viral evolution accelerated coincident with the beginning of public vaccination. Comprehensive genomic epidemiological studies, as presented here, should be useful in precisely understanding the pandemic and preparing for possible future pandemics.

REAL-TIME MECHANISTIC BAYESIAN FORECASTS OF COVID-19 MORTALITY.

The COVID-19 pandemic emerged in late December 2019. In the first six months of the global outbreak, the U.S. reported more cases and deaths than any other country in the world. Effective modeling of the course of the pandemic can help assist with public health resource planning, intervention efforts, and vaccine clinical trials. However, building applied forecasting models presents unique challenges during a pandemic. First, case data available to models in real time represent a nonstationary fraction of the true case incidence due to changes in available diagnostic tests and test-seeking behavior. Second, interventions varied across time and geography leading to large changes in transmissibility over the course of the pandemic. We propose a mechanistic Bayesian model that builds upon the classic compartmental susceptible-exposed-infected-recovered (SEIR) model to operationalize COVID-19 forecasting in real time. This framework includes nonparametric modeling of varying transmission rates, nonparametric modeling of case and death discrepancies due to testing and reporting issues, and a joint observation likelihood on new case counts and new deaths; it is implemented in a probabilistic programming language to automate the use of Bayesian reasoning for quantifying uncertainty in probabilistic forecasts. The model has been used to submit forecasts to the U.S. Centers for Disease Control through the COVID-19 Forecast Hub under the name MechBayes. We examine the performance relative to a baseline model as well as alternate models submitted to the forecast hub. Additionally, we include an ablation test of our extensions to the classic SEIR model. We demonstrate a significant gain in both point and probabilistic forecast scoring measures using MechBayes, when compared to a baseline model, and show that MechBayes ranks as one of the top two models out of nine which regularly submitted to the COVID-19 Forecast Hub for the duration of the pandemic, trailing only the COVID-19 Forecast Hub ensemble model of which which MechBayes is a part.