Vaccine Uptake Research Articles

Trend of RTS,S vaccine uptake in the malaria vaccine implementing programme (MVIP) pilot regions, Ghana; 2019–2022

IntroductionThe uptake trend of a new vaccine is unpredictable and may reflect the quality of introduction process and community acceptance. The objective of this study was to conduct a trend analysis of RTS,S malaria vaccine uptake in the seven pilot regions of Ghana from 2019 to 2022. The findings are envisaged to strengthen malaria vaccine introductions in the future. MethodsA retrospective analysis was conducted on routine childhood immunisation data for 2019–2022. Coverages for the first (RTS,S1), second (RTS,S2), third (RTS,S3) and fourth (RTS,S4) doses of malaria vaccine; third dose of diphtheria, tetanus, pertussis-containing vaccine (DTP3/Penta3); first dose measles-rubella (MR1) and second dose measles-rubella (MR2) vaccines were calculated. Dropout rates and uptake gaps were estimated to assess variations in the uptake of consecutive RTS,S schedules; and the differences in the uptake of RTS,S and the comparator vaccines, respectively. ResultsNationally, the coverages of the first three doses of the RTS,S malaria vaccine rose sharply from 2019 (RTS,S1 = 54.9 %; RTS,S2 = 54.6 %; RTS,S3 = 38.6 %) through 2020 (RTS,S1 = 70.7 %; RTS,S2 = 67.4 %; RTS,S3 = 66.3 %) to peaks in 2021 (RTS,S1 = 76.0 %; RTS,S2 = 73.1 %; RTS,S3 = 74.2 %), and declined marginally in 2022 (RTS,S1 = 74.0 %; RTS,S2 = 69.9 %; RTS,S3 = 71.3 %). For the fourth dose, the low uptake in 2020 (7.5 %) was followed by a steep rise in 2021 (46.9 %) that continued, but at a reduced rate to 50.6% in 2022. The dropout rates and uptake gaps were initially high but declined consistently over the study period. Generally, the trends in vaccination coverages, and dropout rates and uptake gaps at the national level were reflected in the respective regions. ConclusionThe coverage of RTS,S malaria vaccine improved consistently over the study period despite the low uptake in the early phase of the pilot. While the decreasing dropout rates and uptake gaps may indicate improved community acceptance, strengthening immunisation service delivery is crucial in sustaining the observed trajectory.

Social determinant of health and COVID-19 vaccine uptake among US cancer survivors.

369 Background: According to the National Comprehensive Cancer Network Guidelines, all individuals with cancer survivors should receive COVID vaccination. However, the extent to which social determinants of health (SDoH) influence the uptake of COVID-19 vaccines in this specific population remains an area of exploration. We aim to examine the potential impact of SDoH on COVID-19 vaccine uptake in cancer survivors. Methods: Cancer survivors with known COVID-19 vaccination status and SDoH information including food insecurity, housing insecurity and transportation barriers were extracted from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). We employed chi-square tests to compare baseline demographics and COVID-19 vaccine uptake by SDoH factors. Logistic regression model was used to calculate the association between SDoH factors and COVID-19 vaccine uptake among cancer survivors, after adjusting for potential confounders. All analyses were weighted. The significance level was set at 2-sided p<0.05. Results: A total of 13025 cancer survivors were included (weighted N=4,620,447) with 85.9% reporting having at least 1 dose of COVID-19 vaccine in the past. After adjusting for confounders, we found that cancer survivors experiencing food insecurity (odds ratio [OR]:0.63, 95% confidence interval [CI]: 0.44-0.90), housing insecurity (OR: 0.63; 95%CI: 0.42-0.96), transportation insecurity (OR: 0.51; 95%CI: 0.31-0.81) and any of the above barriers (OR: 0.58; 95%CI: 0.41-0.82) were significantly less likely to have received at least one dose of the COVID-19 vaccine. Conclusions: 15% cancer survivors reported never having received COVID-19 vaccine. Additionally, we found that having food, housing and transportation insecurity is independently associated with decreased COVID-19 vaccine uptake among US cancer survivors. Prior studies have shown that cancer survivors who with COIVD infections had a higher mortality and hospitalization rate than non-cancer population. These findings emphasize the importance of addressing SDoH in public health efforts to ensure equitable access to vaccines, particularly for a population at increased risk. SDoH Factors COVID-19 Vaccine Uptake (weighted % 95%CI) p-values OR 95%CI* Food insecurity No 88.9 (87.6-90.2) <0.0001 Ref Yes 75.4 (70.4-80.5) 0.63 (0.44-0.90) Housing insecurity No 88.4 (87.1-89.6) <0.0001 Ref Yes 71.2 (63.9-78.5) 0.63 (0.42-0.96) Transportation insecurity No 87.6 (86.3-88.9) <0.01 Ref Yes 71.4 (61.7-81.0) 0.51 (0.31-0.81) Any of above No 89.4 (88.1-90.7) <0.0001 Ref Yes 76.1 (71.8-80.3) 0.58 (0.41-0.82) *Model adjusted for age, sex, race/ethnicity, marital status, education, income, insurance status, heavy drinking, smoking, BMI, number of comorbidities, had routine check-up last year, self-reported health status, US region, flu vaccine status, whether had COVID infection, type of cancer, and current cancer treatment status.

Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.

280 Background: Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%. Methods: A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations. Results: Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation. Conclusions: The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution. Influenza vaccine administration vs outpatient visits in the ID clinic. Month/Year # Outpatient visits # Vaccines administered in clinic % of vaccines administered Influenza Sep-Dec 2022 1827* 54 2.95% Influenza Sept 2023-March 2024 2682 251 9.36% *Includes video and telephone visits.

Assessing the Importance of Theory-Based Correlates of Future HIV Vaccine Intentions Among Black Men Who Have Sex With Men.

In the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding the factors that may adversely affect HIV vaccine acceptance among BMSM is critical. We conducted two online surveys with BMSM; one recruited 432 respondents, and another recruited 204. Respondents completed a demographic assessment and questions derived from health behavior change theories and the relevant empirical literature. The two surveys yielded similar results. The findings indicate that vaccine uptake self-efficacy, perceived likelihood of important others receiving the vaccine, and susceptibility to HIV were related to intentions to receive a future HIV vaccine. Other potentially important variables include perceived HIV stigma, response efficacy, how much one conceals one's sexual orientation, and perceived HIV discrimination. Future research and health communication campaigns should consider these factors in potential HIV vaccine programs.

Association of the belief in conspiracy narratives with vaccination status and recommendation behaviours of German physicians

Vaccine hesitancy has been identified as one of the top ten threats to global health by the World Health Organization (WHO). The belief in conspiracy narratives is repeatedly discussed as a major driver of vaccine hesitancy among the general population. However, there is a lack of research investigating the role of the belief in conspiracy narratives in vaccination decisions and recommendation behaviours of physicians. This is particularly relevant as physicians are one of the major and trusted sources of information for patients’ vaccination decisions. This study therefore investigated the association between believing in COVID-19-related conspiracy narratives and physicians’ own COVID-19 vaccination status and their recommendation behavior for COVID-19 and other vaccines (e.g., HPV or flu). In a cross-sectional survey among German physicians (N = 602, April 2022) two conspiracy narratives were assessed, stating that the coronavirus is a hoax or that it is human-made. Additional control variables included trust in health institutions, the rejection of complementary and alternative medicine (CAM), the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility) and demographic variables. Hierarchical regressions indicated that greater belief in the conspiracy narrative claiming that the coronavirus is a hoax was associated with lower COVID-19 vaccination uptake and fewer COVID-19 vaccination recommendations among physicians. The results for recommendation behavior remain robust even when controlling for other variables. Contrary to our assumption, believing that the coronavirus is human-made was not related to vaccination status nor vaccine recommendation behavior. In conclusion, believing in conspiracy narratives that question the existence and thus also the danger of the virus is an important independent predictor of vaccine hesitancy among physicians that should be addressed in future public health interventions.

Time to COVID-19 Vaccination by Language and Country of Origin

Disparities in COVID-19 vaccination rates by race and ethnicity are well documented. Less is known about primary language and COVID-19 vaccine uptake. To describe the time to COVID-19 primary series vaccination and booster doses by primary language and country of origin. This retrospective cohort study included patients aged 6 months or older with at least 1 health encounter from July 1, 2019, to June 30, 2023, at a single health care system serving patients across Minnesota and western Wisconsin. Primary language and country of origin documented in the electronic health record. Three COVID-19 vaccine coverage outcomes were evaluated: (1) primary series (1 Ad26.COV.S vaccine or 2 mRNA COVID-19 vaccines), (2) first-generation booster (primary series Ad26.COV.S vaccine plus 1 Ad26.COV.S or mRNA COVID-19 vaccine at least 2 months after the second dose or primary series mRNA vaccine plus 1 mRNA vaccine at least 5 months after the second dose), and (3) bivalent booster. Vaccine coverage was described by patient characteristics. Associations of primary language, race and ethnicity, and other patient characteristics with COVID-19 vaccine uptake were evaluated using time-to-event analysis in multivariable Cox proportional hazards regression models, and adjusted hazard ratios (AHRs) with 95% CIs were reported. There were 1 001 235 patients included (53.7% female). Most patients reported English as a primary language (94.1%) and were born in the US (91.8%). Primary series coverage was 63.7%; first-generation booster coverage, 64.4%; and bivalent booster coverage, 39.5%. Coverage for all outcomes was lower among those with a non-English primary language compared with English as the primary language (56.9% vs 64.1% for primary series; 47.5% vs 65.3% for first-generation booster; 26.2% vs 40.3% for bivalent booster). Those with a non-English primary language had lower COVID-19 vaccine uptake for the primary series (AHR, 0.85; 95% CI, 0.84-0.86), first-generation booster (AHR, 0.74; 95% CI, 0.73-0.75), and bivalent booster (AHR, 0.65; 95% CI, 0.64-0.67) compared with patients with English as their primary language. Non-US-born patients had higher primary series uptake compared with US-born patients (AHR, 1.19; 95% CI, 1.18-1.20) but similar first-generation booster (AHR, 1.01; 95% CI, 0.99-1.02) and bivalent booster (AHR, 1.00; 95% CI, 0.98-1.02) uptake. In this retrospective cohort study, patients with a non-English primary language had both lower coverage and delays in receiving COVID-19 vaccines compared with those with English as their primary language. Reporting on language may identify health disparities that can be addressed with language-specific interventions.

Rural community pharmacists' willingness to receive, administer, and recommend COVID-19 vaccines after the First U.S. vaccine rollout

IntroductionVaccines remain the cornerstone for prevention of COVID-19. Particularly in rural areas, community pharmacists are among the most accessible healthcare professionals. Their advocacy for immunization can help overcome patients' vaccine hesitancy and close the disparity gap between rural and urban regions. This study explored factors influencing the willingness to recommend and administer COVID-19 vaccines among rural community pharmacists after the first U.S. vaccine rollout. MethodsA convenience sample of rural community pharmacists completed a selfadministered, validated paper/online survey (n = 86, 23.4% response rate). Measures included COVID-19 vaccination status, perceived benefits of offering COVID-19 immunization services at the pharmacy, and willingness to recommend and administer COVID-19 vaccines. Descriptive, bivariate, and multivariate statistics were used to analyze potential nonresponse bias, survey responses, and associations between variables as appropriate. Alpha was set at 0.05. ResultsThe proportion of pharmacists who were vaccinated against COVID-19 was 79.1%. Over 75% of participants were in favor of recommending COVID-19 immunizations to eligible family members and patients and almost 85% agreed that they would administer COVID-19 vaccines to their patients. Most pharmacists perceived COVID-19 immunization services to be beneficial, such as attracting more patients into the pharmacy (81.2%), increasing pharmacy revenue (75.3%), and enhancing relationships with local clinics/public health agencies (74.1%). COVID-19 vaccination status and the perceived benefit of offering immunization services at the pharmacy were significantly associated with pharmacists' willingness to recommend and administer COVID-19 vaccines. ConclusionThe relatively high rates of COVID-19 vaccination uptake and the strong willingness of rural community pharmacists to recommend and administer COVID-19 vaccines, after the first national vaccine rollout, were encouraging. The findings underscore the importance of engaging rural community pharmacists in efforts to prepare for and respond to future pandemics and public health crises.

Influenza vaccine effectiveness against influenza-associated hospitalizations in children, Hong Kong, November 2023 to June 2024

We conducted a test negative study from November 2023 to June 2024, enrolling 4,367 children hospitalized with acute respiratory illness in Hong Kong. Among the children who tested negative for influenza virus and SARS-CoV-2, 56.8 % had received influenza vaccination. Between November 2023 and March 2024, influenza A(H3N2) predominated and the VE against influenza A(H3N2) was estimated as 55 % (95 % CI: 29.6 %, 71.8 %). VE point estimates were higher for younger children than older children. In February to June 2024 influenza A(H1N1) predominated and VE against influenza A(H1N1) was 54 % (95 % CI: 33 %, 69 %) during this period. Influenza B/Victoria circulated at low intensity throughout the 2023/24 season and VE against influenza B was 66 % (95 % CI: 42 %, 80 %). Since its introduction in 2018/19 the school-based influenza vaccination program has substantially increased vaccine uptake in children in Hong Kong and prevented influenza-associated hospitalizations.

Side Effects of COVID-19 Vaccines in Iraqi Kurdistan: A Population-Based Study.

Background and aim The COVID-19 pandemic has globally impacted all sectors. Early vaccine development was crucial to curb the spread of the virus. However, concerns about vaccine safety and side effects have led to hesitancy. This study aims to examine and compare side effects associated with Pfizer/BioNTech, Oxford/AstraZeneca, and Sinopharm vaccines in Iraqi Kurdistan. Materials and methods A population-based study was conducted in the Kurdistan Region of Iraq from September 2022 to April 2023, involving 1,340 participants recruited through face-to-face interviews and online forms. The questionnaire collected demographic data and information on COVID-19 infection and vaccination status. Results Among the participants, 52.76% were females, with a mean age of 29.21 years (±13.09 SD). Of these, 67.84% received the Pfizer/BioNTech vaccine, and 60.9% had a prior COVID-19 infection. About 76.94% experienced post-vaccination side effects, lasting an average of 2.8 days (±1.92 SD). Notably, 60% reported no or mild side effects. Common side effects across all vaccines included injection site pain, fever, headache, and fatigue. Side effects were more frequent after the first dose and were highest with Oxford/AstraZeneca, followed by Pfizer/BioNTech and Sinopharm (p = 0.001). Higher rates of side effects were observed in participants aged 36-60, females, married individuals, those with chronic conditions, previously infected individuals, and those who contracted COVID-19 post-vaccination (p = 0.001). Conclusions This study reveals that most of the participants experienced either no side effects or only mild reactions following vaccination, with none of the side effects being serious. These findings are expected to boost public confidence and increase vaccine uptake, especially with booster doses now available.

SARS-CoV-2, Tdap, and influenza vaccination during pregnancy from 2019 to 2022 in Ontario, Canada: a population-based retrospective cohort study.

Hesitancy about vaccination during pregnancy posed challenges to SARS-CoV-2 vaccination efforts. We aimed to examine rates of SARS-CoV-2 vaccination among Ontario residents who gave birth in early 2022, and to compare rates of SARS-CoV-2 vaccine uptake with rates of tetanus, diphtheria, and pertussis (Tdap) and influenza vaccination during pregnancy in 2019, 2021, and 2022. We conducted a population-based retrospective cohort study to describe vaccination rates among pregnant and comparable nonpregnant populations in Ontario using linked administrative data. Provincially insured females who had a live, in-hospital birth from Jan. 1 to Mar. 31 in 2019, 2021, or 2022 were our primary cohort. Using log-binomial regression, we tested associations between SARS-CoV-2 (2022) and Tdap and influenza (2019, 2021, 2022) vaccination status, with birth group and covariates. We compared SARS-CoV-2 vaccination status with the status of a matched cohort of nonpregnant females and conducted subgroup analyses by age and prenatal clinician type. Among birthing people, 78.7% received their first SARS-CoV-2 vaccine dose and 74.2% received a second dose. The rate was significantly higher among nonpregnant comparators (dose 1: relative risk [RR] 0.94, 95% confidence interval [CI] 0.93-0.94; dose 2: RR 0.91, 95% CI 0.90-0.91). However, the rate of SARS-CoV-2 vaccination uptake among birthing people was higher than uptake of Tdap or influenza vaccination. Tetanus, diphtheria, and pertussis vaccination increased over time from 22.2% in 2019 to 32.6% in 2022, and influenza vaccination rose to 35.3% in 2021 but returned to prepandemic levels in 2022 (27.7%). Vaccination rates were lower among pregnant people who were young, multiparous, or residents of rural or economically deprived areas for all 3 vaccines. Rates of SARS-CoV-2 vaccination were lower among pregnant people than among nonpregnant comparators but were higher than rates of routinely recommended Tdap and influenza vaccinations. Pandemic urgency may have overcome a great deal of hesitancy about vaccinating against SARS-CoV-2 during pregnancy in 2022, but uptake of routinely recommended vaccines in pregnancy remains a challenge. Clinicaltrials.gov, no. NCT05663762.

CHALLENGES IN DEVELOPING VACCINE FOR CANINE DISTEMPER

The Canine Distemper Virus (CDV) represents a considerable risk to domestic and wild carnivore populations globally, notwithstanding the existence of vaccinations. This study examines the significant obstacles in creating successful CDV vaccines, especially regarding virus evolution, immune evasion, cross-species transmission, and vaccine reluctance. This review aims to consolidate existing research on CDV vaccine development, emphasizing emerging technologies, such as nanoparticle and DNA vaccines, and their capacity to address present challenges in immunogenicity and cross-species protection. Through the analysis of recent findings, this review delineates significant gaps in the comprehension of CDV's genetic variety of CDVs, the sustainability of wildlife reservoirs, and the obstacles to attaining extensive vaccination coverage. This review evaluates the influence of public health infrastructure and socioeconomic factors on vaccination distribution and uptake constraints, particularly in developing areas. These findings highlight the significance of a One Health approach, which amalgamates veterinary, wildlife, and public health viewpoints to address CDV epidemics more efficiently. Future research should focus on augmenting vaccine efficacy in non-domestic species, increasing public awareness of immunization initiatives, and creating thermostable vaccines for improved distribution accessibility. This review offers critical insights into the intricacies of the CDV vaccination and presents a framework for enhancing worldwide initiatives to combat this destructive virus.

KNOWLEDGE AND ATTITUDE OF URBAN AND RURAL MOTHER IN AL MUKALLA CITY ABOUT VACCINATION, 2023

Vaccination is a critical public health strategy for preventing infectious diseases in children, yet vaccine hesitancy remains a significant challenge, particularly among mothers who influence their children's health decisions. This study aims to evaluate the knowledge and attitudes of mothers in urban and rural areas of Al-Mukalla, Yemen, regarding childhood vaccinations. A total of 581 women with at least one child under five participated, with data collected on their knowledge, sources of information, and attitudes towards vaccination. Results indicated that urban mothers had a higher level of awareness regarding the importance of vaccination compared to their rural counterparts, with 76% of rural mothers lacking knowledge about its significance. Urban mothers primarily relied on media (71%) and doctors (56%) as information sources, while rural mothers depended more on societal channels. Moreover, urban mothers demonstrated a more positive attitude towards vaccination, in contrast to the skepticism observed among rural mothers, influenced by cultural beliefs and misinformation. The findings highlight a critical need for targeted educational interventions to address knowledge gaps and enhance vaccine uptake, particularly in rural communities, ultimately aiming to improve child health outcomes in the region.

Predictors of measles-rubella vaccination status in the Savannah Region, Ghana: A cross-sectional study among caregivers of children aged 18–59 months

IntroductionSavannah Region witnessed a decline in measles-rubella (MR) vaccination coverage prior to the measles outbreak in 2022. This study aimed to assess contributory factors of the low routine MR vaccination coverage and proffer recommendations to improve vaccination uptake. MethodsA cross-sectional study was conducted in two districts (Bole and Central Gonja) of Savannah Region from December 2022 to June 2023. Caregivers of children 18–59 months were randomly selected and interviewed using a structured questionnaire. Bivariate and multivariate logistic regression were performed to assess predictors of MR vaccination status. ResultsChildren of caregivers with inadequate knowledge of MR vaccination (AOR = 0.58, 95 %CI: 0.47–0.72), travelled more than five km to access health services (AOR = 0.48, 95 %CI: 0.39–0.59), described health workers attitude as poor (AOR = 0.44, 95 %CI: 0.26–0.74), and those who sought treatment for adverse events following immunization (AEFI) from the pharmacy (AOR = 0.65, 95 %CI: 0.51–0.84) were less likely to complete MR vaccination. On the contrary, children of female sex (AOR = 1.27, 95 %CI: 1.05–1.53), aged 24–59 month (AOR = 2.56, 95 %CI: 1.05–1.53), caregivers with primary or secondary education (AOR = 1.43, 95 %CI: 1.11–1.84; and AOR = 2.23, 95 %CI: 1.64–3.03 respectively), and those who did not experience rescheduling of vaccination sessions (AOR = 1.61, 95 % CI: 1.25–2.01) were more likely to complete routine MR vaccination schedule. ConclusionInadequate caregiver knowledge, poor geographical access to health services, poor healthcare worker attitude, and non-institutional management of AEFI significantly contributed to the low MR vaccination uptake in the Savannah Region. Adopting tailored approaches to addressing these factors could improve vaccination coverage.

Occupational Risks Prevention Practices Among Medical Waste Handlers in Ogun State, Nigeria

Background: Medical waste handlers are at immediate risk of needle stick injuries and exposure to infectious materials from medical waste. Adequate knowledge and safe practices on the part of the workers are essential for the prevention of nosocomial infections. Objective: To assess and compare the factors involved in occupational risk prevention practices among medical waste handlers in two tertiary hospitals in Ogun State, Nigeria. Methods: This descriptive, cross-sectional study compared medical waste handlers and the risk prevention measures available in a specialist hospital and a teaching hospital. The 100 participants were randomly selected and surveyed using an interviewer-administered questionnaire. Results: The prevalence of needle stick injury at the teaching hospital and specialist hospital were 38% and 28%, respectively. Hepatitis B vaccine uptake was 6% in the teaching hospital compared to 70% at the specialist hospital. There was a significant difference concerning the provision of safety equipment (p<0.001), personal protective equipment (PPE) (p<0.001), Hepatitis vaccine (p<0.001), training (p<0.001) and availability of waste management policy (p = 0.015) but no significant difference concerning the regular supply of water and soap (p = 0.494) between both institutions. Conclusion: The waste handlers at the specialist hospital were better equipped for safety than those at the teaching hospital. A safer environment, equipment, and training for medical waste handlers are needed to enable them to practise occupational risk prevention more effectively.

Modelling the Non-linear Associations between Age and Health: Implications for Care

Abstract Background Ageing is a complex biological process that weakens the body's defences against various health problems and diseases. This decline is not uniform or linear; rather, it varies significantly among individuals. Understanding the non-linear progression of ageing is crucial for identifying critical periods where intervention might be most beneficial. This study aimed to explore nonlinearities in the association between age and health outcomes. Methods Using generalised additive models, we analysed data from the 2020 wave of the United States Health and Retirement Study. This modelling approach allows for the detailed examination of nonlinearities in health outcomes across different ages. Our sample consisted of adults aged over 50 (n = 1338; mean = 68; range = 50 – 95). We assessed seven health outcomes (heart conditions, diabetes, cholesterol, blood pressure, fatigue, back pain, and headaches) and seven protective behaviours (prostate exams, mammograms, cholesterol screenings, pap smears, flu vaccinations, dental check-ups, and smoking patterns) reflecting various aspects of health status and behaviour. Results The analysis indicated a significant and pronounced non-linear relationship between age and certain health outcomes, namely headaches, blood pressure, diabetes, and heart conditions. Additionally, ageing was non-linearly associated with specific health behaviours, including the uptake of prostate exams, mammograms, flu vaccinations, and smoking prevalence. Notably, distinct patterns emerged concerning health behaviours in relation to age-specific screening policies. Conclusion The findings of this study reveal that the probability of developing health problems or engaging in health protective behaviours do not increase/decrease linearly in direct proportion to age. Rather, the probability curve exhibits fluctuations, presenting periods of heightened odds interspersed with phases of relative stability. Such non-linearity may be partially attributed to policy decisions but could also reflect a complex interplay of factors such as weakened immune systems, access to healthcare, personal health beliefs, and the evolving perception of risk as one grows older.

Validation of the Chinese version of the vaccine conspiracy beliefs scale during COVID-19 pandemic and its correlates

ObjectiveTo validate the Chinese version of the vaccine conspiracy beliefs scale (VCBS) and to investigate and compare its correlates among healthcare workers and non-healthcare workers during COVID-19 pandemic. MethodsFrom March 19 to April 05, 2021, a nationwide cross-sectional online survey was administered to Chinese individuals aged 16 and above. The study aimed to assess the reliability and validity of the Chinese version of the VCBS. A binary logistic or linear regression model, along with mediation analysis, was employed to explore the relationship between vaccine conspiracy beliefs and its correlates among healthcare workers. ResultsThe VCBS demonstrated robust psychometric properties, showing satisfactory results from both exploratory and confirmatory factor analyses, strong internal consistency (KR-20 = 0.947), and calibration validity. Measurement invariance (MI) was also observed. Additionally, individuals' vaccine conspiracy beliefs, as measured by the VCBS, mediate the relationship between occupation and COVID-19 vaccine hesitancy (95 % CI [−2.229, −1.060]), as well as COVID-19 (95 % CI [0.096, 0.304]), influenza (95 % CI [0.075, 0.304]), and HPV (95 % CI [0.009, 0.236]) vaccination uptakes. ConclusionThe Chinese adaptation of the VCBS proves adept at assessing vaccine conspiracy beliefs among Chinese individuals aged 16 and above. Notably, the healthcare workers are less likely to exhibit COVID-19 vaccine hesitancy and are more likely to receive COVID-19, influenza, and HPV vaccines. This tendency is partly related to their weaker conspiracy beliefs about vaccination.

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study

ObjectivesMobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies. Study designThe study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022. MethodsPrisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models. ResultsThe MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare. ConclusionsThe high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

Has Ghana's Rotavirus Vaccine Switch Met Programmatic Expectations? An Analysis of National Surveillance Data; 2018-2022.

Ghana introduced a 2-dose schedule rotavirus vaccine, Rotarix, into childhood immunization in 2012 but switched to a 3-dose schedule vaccine, Rotavac, in 2020 on account of programmatic advantages offered by the latter, including lower cost per fully immunized child and lower cold chain volume requirement. The objective of the study was to assess the effect of the vaccine switch on the trends of rotavirus vaccine uptake and health facility outpatient department (OPD) attendance due to diarrhea among children aged 1-11 months. A retrospective analysis was conducted on childhood immunization and diarrhea surveillance data for 2018-2022. The uptake of the different rotavirus vaccine products and the proportion of health facility OPD attendance attributed to diarrhea, respectively, were compared between the pre- and postswitch study periods. The uptake of rotavirus vaccine was sustained following the switch. There were no significant differences in vaccination coverages (rota1, Rotarix coverage [94.3%], vs rota1, Rotavac coverage [95.3%]; P = .757; rota2, Rotarix coverage [91.3%], vs rota2, Rotavac coverage [92.7%]; P = .789). The proportions of health facility OPD attendance due to diarrhea were comparable (preswitch [12.4%] vs postswitch [12.1%]; P = .838). Ghana's rotavirus vaccine switch yielded expected programmatic benefits without any untoward effects. The trends of vaccine uptake and reduction in diarrhea morbidity were sustained. These experiences and lessons from the rotavirus vaccine switch are vital for potential switches for other vaccines in the current immunization schedule to mitigate the annual vaccine expenditure.

The equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study

BackgroundIn China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health.MethodsBetween July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data.ResultsNon-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination.ConclusionRelying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.

Factors influencing the first dose of measles vaccination uptake in 42 low- and middle-income countries

ObjectivesVaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. Study designThis was a cross-sectional study. MethodsThis study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). ResultsThe prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. ConclusionThe first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished.