Vaccination Delay Research Articles

Timeliness of 24 childhood immunisations and evolution of vaccination delay: Analysis of data from 54 low- and middle-income countries.

Vaccination timeliness is often not considered among standard performance indicators of routine vaccination programmes, such as vaccination coverage, yet quantifying vaccination delay could inform policies to promote in-time vaccination and help design vaccination schedules. Here, we analysed vaccination timeliness for 24 routine childhood immunisations for 54 countries. We extracted individual vaccination status and timing from Demographic and Health Surveys data from 54 countries with surveys from 2010 onwards. Individual data was used to estimate age at vaccination for <5 year-old children. Recommended age of vaccination for each country and vaccine was compared to the age at vaccination to determine vaccination delay. The evolution of vaccination delay over time was described using estimates from different birth cohorts. To identify socio-demographic indicators associated with delayed vaccination, we used multivariable Cox regression models with country as random effect and estimated the Hazard Ratio for vaccination with each vaccine-dose for each week post recommended vaccination age. Vaccine coverage at the recommended age was highest for birth and first doses (e.g. 50.5% BCG, 18.5% DTP-D1) and lowest for later doses (e.g. 5.5% DTP-D3, 16.3% MCV-D1, 8.2% MCV-D2). Median delay was lowest for birth doses, e.g. BCG (1 week (IQR: 0 to 4)), and it increased with later doses in vaccination courses: 1 (0, 4) week for DTP-D1 versus 4 (2, 9) weeks for DTP-D3. Although the median delay for each vaccine-dose remained largely constant over time, the range of delay estimates moderately decreased. Children living in rural areas, their countries' poorer wealth quintiles and whose mothers had no formal education were more likely to received delayed vaccinations. Although we report most children are vaccinated within the recommended age window, we found little reduction on routine immunisation delays over the last decade and that children from deprived socioeconomic backgrounds are more likely to receive delayed vaccinations.

Optimal Annual COVID-19 Vaccine Boosting Dates Following Previous Booster Vaccination or Breakthrough Infection.

COVID-19 booster vaccinations mitigate transmission and reduce the morbidity and mortality associated with infection. However, the optimal date for booster administration remains uncertain. Geographic variation in infection rates throughout the year makes it challenging to intuit the best yearly booster administration date to effectively prevent infection, and also challenging to provide best guidance on how to alter booster administration in response to a breakthrough infection. We leveraged longitudinal antibody and reinfection probabilities with spatiotemporal projections of COVID-19 incidence to develop a geographically informed approach to optimizing the timing of booster vaccination. We assessed the delay in booster vaccination that is warranted following breakthrough infections whenever they occur during the year, enabling a personalized assessment of optimal timing that acknowledges and respects diversity of COVID-19 immune status, addressing a substantial barrier to uptake. Yearly booster vaccination on any date is beneficial to prevention of infection. However, each location exhibits as much as a 3-4-fold range in degree of protection by date of uptake. Optimal COVID-19 booster vaccination dates are location-specific, typically in early autumn in the Northern Hemisphere. Infection late in the interval between boosts substantially alters the optimal boosting date. Considerable benefit accrues from aptly timing COVID-19 booster vaccination campaigns, which can be tailored to specific locations. Individuals can acquire the greatest benefit from booster vaccination by timing it optimally, including delaying in cases of infection late in the interval between boosts. These results provide location-specific guidance for public health policy, healthcare provider recommendations, and individual decision-making.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Effects of metaphorical communication on vaccine confidence in the adolescent population

Abstract Vaccine hesitancy, defined as delay or refusal of vaccination despite the availability of vaccination services, has been included by WHO among the top 10 global health threats. Individual decision-making process can be strongly affected by communication. The use of metaphors is common in public health communication and increased during the COVID19 pandemic. Although some evidence has supported the persuasive potential of metaphorical language over scientific language, further research is needed. Our study aimed at comparing the effects of neutral scientific talk with war and protective metaphors on health communication. An online survey was conducted on a convenience sample of Italian teenagers randomly allocated to three study arms. Each participant was invited to watch a specific version of an informative video on infections and vaccines (group 1: neutral-scientific approach, group 2: metaphorical-war, and group 3: metaphorical-protective approach). After watching the video, each participant responded to an ad-hoc questionnaire. A total of 2681 subjects were randomly allocated to the three groups. No significant differences regarding age, sex and geographical area were detected between groups. Median age of the sample was 17 years (mean 16,8) and 56.8% were girls. The general attitude towards vaccination in group 2 and 3 was largely positive, with the majority agreeing (strongly or tend to agree) on the fact that vaccination is important (group 2: 89%; group 3: 92%), safe (group 2: 91%; group 3: 92,5%), effective (group 2: 85%; group 3: 88%), and does not generate anxiety (group 2: 80%; group 3: 83%). Higher level of distrust against vaccines was found in group 1, where 32% of participating adolescents are strongly or tend to be anxious about getting vaccinated. The results of our survey suggest that emotional involvement evoked through the use of metaphorical language may have, at least in the short run, some positive effect on vaccine confidence. Key messages • Use of metaphors can be successfully used in public health communication. • Messages evoking either war or protecting concepts are more efficacious than plain scientific language.

Parental childhood vaccine hesitancy and the National Vaccination Programme, in Portugal

Abstract Background Despite the invaluable contribution of vaccination to Public Health, vaccine hesitancy is increasing in the European Union. Several factors are associated with parental childhood vaccine hesitancy (PCVH). In Portugal, there are no known studies specifically addressing vaccine delay in infants. Objectives We aimed to estimate the proportion of parental childhood vaccine hesitancy (PCVH) up to 12 months of age in Portugal, and to determine vaccination (confidence and information) and National Vaccination Programme (NVP) associated factors. Methods We performed a cross-sectional study on a convenience sample, using an anonymous online questionnaire directed to parents of children up to 17 months old, living in Portugal. We performed an exploratory factor analysis, followed by logistic regression. We obtained crude (OR) and parental vaccination status’ adjusted odds ratios (aOR). Results PCVH proportion was estimated at 1.8% (95%CI: 1.0%-3.0%; n = 790). The exploratory factor analysis resulted in five dimensions: 1. vaccine confidence; 2. access to enough/reliable information about vaccines; 3. access to NVP; 4. vaccination schedule; 5. trust in healthcare professionals’ information about vaccines. Vaccine confidence (aOR=0.29, 95%CI: 0.14-0.54), vaccination schedule (aOR=0.31, 95%CI: 0.15-0.58) and trust in information about vaccines provided by health professionals (aOR=0.30, 95%CI: 0.16-0.53) were protective dimensions of PCVH. Conclusions The low proportion of PCVH observed is consistent with the high immunisation coverage in Portugal. Vaccination schedule, trust in vaccines, and in the information provided by healthcare professionals are factors associated with lower vaccine hesitancy. This highlights the importance of trust and healthcare professionals in maintaining high vaccination coverage in Portugal. Key messages • Parental childhood vaccine hesitancy (PCVH) proportion was 1.8%. Vaccine confidence, vaccination schedule and trust in information provided by health professionals were protective factors of PCVH. • Trust in vaccines and in healthcare professionals seem to play a key role in keeping a high immunisation coverage in Portugal.

Understanding Factors Responsible for Delay and Non-Compliance in COVID-19 Vaccination at a Tertiary Care Hospital in Mumbai, India

Background: Despite extensive first-dose coverage, delays in second doses and late first doses prompted a study on vaccine hesitancy and non-compliance. Methods: In 2022, a cross-sectional survey was conducted at a Mumbai vaccination center, involving 504 individuals who had received either the first or second dose of the COVID-19 vaccine. The study, conducted from February to April 2022, included interviews using a pre-validated schedule to assess vaccine acceptance, refusal, socio-demographics, and reasons for hesitancy. Data analysis was performed using IBM SPSS Statistics software 23.0 to understand factors influencing vaccine delay and non-compliance. Result: The study interviewed 504 participants at a Mumbai vaccination center. Most were male (63.9%), aged 18-44 (80%), and skilled workers (22.6%). Of those surveyed, 64 had received only the first vaccine dose. The delay in receiving the second dose was 37.4% for BBV152 and 41% for ChAdOx1 nCoV-19. The primary reason for delay was lack of time (50.6%), followed by fear of the vaccine (14.8%). Reasons for getting vaccinated later included resolving constraints (40.5%) and compulsion (25.8%). Vaccine choice reasons varied significantly (p &lt; 0.0005), but delay proportions were similar across vaccines (p = 0.531). Conclusion: Even after many efforts by the government, large numbers of people have not taken vaccine on time. One of the reasons, as seen in the study is a busy work schedule which has hindered timely vaccination in individuals. Making vaccine available at work place may address this issue to some extent, besides ownership of the program by the public.

Vaccination Coverage by Age 24 Months Among Children Born During 2017-2021 - U.S.-Affiliated Pacific Islands.

Childhood vaccination is one of the most successful public health interventions to improve life expectancy, decrease health care costs, and reduce the spread of preventable diseases. Using data from jurisdictional immunization information systems, vaccination coverage by age 24 months among children born during 2017-2021 in the U.S.-affiliated Pacific Islands was estimated for all vaccines included in jurisdictional programs. Progress toward the U.S. Healthy People 2030 and World Health Organization Immunization Agenda 2030 vaccination goals of ≥90% coverage by age 24 months with recommended vaccines was inconsistently met across jurisdictions. For example, coverage by age 24 months with ≥1 dose of measles, mumps, and rubella vaccine ranged from 68.2% to 91.6% by birth cohort in Federated States of Micronesia and from 87.4% to 96.6% in Palau; coverage with ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) ranged from 39.6% to 60.6% in Federated States of Micronesia and from 73.4% to 85.4% in Palau. Coverage as of June 1, 2024, increased for all vaccines across all jurisdictions and birth cohorts, indicating catch-up vaccination after age 24 months. For example, coverage with ≥4 doses of DTaP by June 1, 2024, ranged from 74.0% to 84.4% in American Samoa by birth cohort and from 91.6% to 94.8% in Palau. This report is the first comprehensive analysis of trends in childhood vaccination coverage in the U.S.-affiliated Pacific Islands; data in this report can be used to determine where additional efforts are needed to assess reasons for delayed vaccination of children and strategies to mitigate vaccination delays, specific to each jurisdiction.

Vaccine hesitancy among parents of children in their first two years of life.

Vaccine hesitancy is considered a primary cause of outbreaks of vaccine-preventable infectious diseases. The Austrian vaccination plan includes 24 vaccinations in the first 2 years of life, 12 for free and 12 subject to a fee. Since preterm babies are more susceptible to severe infections, immunization is a vital protection strategy. This study examines the routine immunization schedule recommended for children in Austria, the number of timely vaccinations, and the number of delayed and rejected vaccinations. Possible reasons for vaccination delays and rejection and potential influencing factors (preterm birth, COVID-19 pandemic, information sources) are also analyzed. We included children aged 2 to 5 years who presented to Vienna's largest pediatric center with an Austrian mother-child pass and spent the first 2 years of their lives in Austria. Data was collected using questionnaires about the vaccination status, parents' reasons for any rejections or delays in the recommended vaccination regimen, the impact of the COVID-19 pandemic on individuals' vaccination behavior, and child-specific influencing factors such as preterm birth and socioeconomic factors. 90% of the 150 study subjects follow the recommendations on routine vaccinations, while 40-62% accept vaccinations subject to a fee. Preterm infants received less fee-based (53%) as well as gratuitous (88%) vaccinations. While free vaccinations tend to be delayed, more fee based vaccinations are rejected. With free vaccinations, delays and refusals occur due to illness or missed appointments. In the case of fee- required vaccinations, however, fears of side effects are also one of the main reasons. Due to the COVID-19 pandemic, about a quarter of parents have become more skeptical about vaccines. However, the vaccination rate of premature babies is usually just below that of full-term babies. Physicians remain the most trustworthy source of information about vaccinations. Free vaccinations are more accepted by parents than fee based vaccinations. Preterm babies, which are a high risk group for vaccination preventable diseases, show a lower or delayed vaccination rate, which must be prevented through intensive doctor education. In addition, vaccination hesitancy changed during the COVID-19 pandemic, which needs to be addressed during the medical consultation.

Contributions and Impact of Health Communication Research to Vaccination Efforts and Acceptance

ABSTRACT Vaccines (a medical product) and vaccination recommendations (expert advice on who should receive, when, and how often) have grown in importance and prominence in the past 15 years, including because of a recent COVID-19 pandemic. This essay highlights contributions from vaccine and vaccination-related health communication research since 2010. This research has had significant impacts – that is, visible and discernible positive effects – on the ways health communication is undertaken broadly (e.g. at the campaign level) and at the health care provider-patient level (e.g. conversations with parents and patients regarding vaccine benefits, risks, and safety). As this essay illustrates, health communication research has resulted in greater use of formative research to guide vaccination campaign and education efforts, better identification and understanding of the factors behind vaccination delay and declination, and greater recognition that communication efforts can fail to achieve desired outcomes or generate unintended consequences. Health communication research has also documented the powerful influence of healthcare provider communication on parent and patient understanding and compliance with immunization recommendations. Importantly, this research has also shown the characteristics of provider-patient communication matter much. Healthcare providers must have or establish a high degree of trust, be well-versed in vaccine efficacy and safety, and be adept at using their personal experiences, information tailoring/personalization, and evidence-based communication strategies to increase the likelihood of success.

Are we really hesitant toward routine immunization: Findings from a cross-sectional study in urban area in the tribal dominant state of India.

Vaccine hesitancy has been inching up and its root cause lies in the factors that influence the vaccination. The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for routine childhood vaccinations in the slum population. A community-based cross-sectional study was carried out among 210 children between the age group of 0 and 59 months residing in the urban slums of Ranchi in 2021. Data were collected during the household visit by interviewing the parents using a predesigned pretested interview schedule which was developed based on the validated version of the vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts' working group on vaccine hesitancy. Associations between variables were analyzed using logistic regression. A total of 210 children whose parents had given consent were included in our study. The majority of the families, 188 (89.5%), were not hesitant while only 22 (10.5%) were vaccine hesitant. Tribal children and unreserved category children had adjusted odds ratio of 4.41 (95% CI, 1.61-45.46) and 7.75 (95% CI, 1.07-56.08) for the delay as against their reference category. Most of the children were vaccinated in our study area and the families have shown confidence in vaccines. Although there were delays in vaccination and the reasons for the delays must be addressed to prevent these vaccine-hesitant populations from turning into vaccine-refusal population. Uniformity in vaccination days in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mother's education can help address the issue of vaccine hesitancy.

A delay differential equation model on covid-19 with vaccination strategy

In this paper, we have extended SEIR model of COVID-19. The model incorporates two vital aspects in the form of vaccine compartment and constant time delay. The vaccination and time delay provide the information about immune protection and actual existence of the infection among the individuals, respectively. The model is analysed numerically and numerical simulation are executed for three different initial histories and constant time delays which affirm the biological relevance of the system. The analysis includes disease-free equilibrium (DFE), endemic equilibrium, and the basic reproduction number. The stability analysis is performed which reveal the asymptotic stability of the DFE when the basic reproduction number R0 &lt; 1. The study addresses the boundedness and positivity of the solution as the time delay approaches zero. In addition, sensitivity analysis and contour plots for R0 with different parameters offer deeper insights into the model. The impact of vaccination and vaccine inefficacy on the model dynamics is explored.

Evaluating Vaccination Delay in Infants during COVID-19 Outbreak in Yazd

Background: One of the potential consequences of COVID-19 is the interruption of childhood vaccination. The aim of this study is to investigate the frequency of vaccination delay in children during the COVID-19 outbreak in Yazd, Iran. Methods: In this cross-sectional study in 2020, 667 children living in Yazd were enrolled through multi-stage sampling method. Date of birth, vaccination dates of 2-, 4-, and 6- months of age, gender, family size, birth order and municipal area were extracted from the Integrated System Information Block (SIB) system. Data were analyzed using SPSS software version 22. Results: among 667 infants, 322 (48.3%) were girls and 345 (51.7%) were boys. In total, 53.5% of children had delay in vaccination at 2-month of age, 54%, at 4-month, and 45% at 6-month regarding vaccination appointment. Moreover, the dangerous delay was 3% in vaccination rounds for 2-month-olds, 5.4% for 4-month-olds, and 1.7% for 6-month-olds. At all the three appointments, there was a statistically significant difference between both the family size (P-value: 0.025, 0.017 and 0.004, respectively) and birth order (P-value: 0.015, 0.007 and 0.013, respectively) regarding vaccination delay. Conclusion: Despite the high frequency of one or more than one day delay for 2-, 4-, and 6-month-old infants regarding vaccination appointments, dangerous delay in the mentioned times was relatively infrequent. Meanwhile, family size and birth order were two influential factors respecting vaccination delay in children. It is essential to raise awareness among families, particularly those with larger size and higher number of children about the importance of timely vaccination.

COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review

ObjectivesWe conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can...

Analysis of a fractional endemic SEIR model with vaccination and time delay

Analysis of a fractional endemic SEIR model with vaccination and time delay

Exploring influential factors in childhood vaccine delays in Riyadh, Saudi Arabia.

Infectious diseases present a substantial worldwide health challenge, yet vaccines have played a crucial role in significantly decreasing illness rates. Despite their effectiveness, global vaccination coverage stands at 85%, leaving a considerable number of infants without routine immunization. Our study seeks to examine the occurrence of delayed primary vaccination and the factors influencing it in Riyadh, Saudi Arabia addressing a critical void in current research. A cross-sectional investigation was carried out in the primary care facilities of the first health cluster in Riyadh, Saudi Arabia. Information was gathered utilizing a well-structured questionnaire, modified from a prior study. The study encompassed children aged two years and younger, accompanied by their parents who brought their vaccination cards for the visit. Non-probability convenience sampling was employed for data collection. Subsequently, the data underwent thorough cleaning in Excel (Microsoft Excel) and was subjected to analysis using IBM SPSS 29 (IBM SPSS Statistics 29). The study involved 402 participants, primarily over 12 months old, with a balanced gender distribution. Noteworthy findings indicate a 20.9% prevalence of childhood vaccine delays, with reasons such as high-grade fever (33.3%) and travel (26.2%). Significant associations were found in children aged 6-12 months (25.8%, P = 0.039), families with over four children (31%, P = 0.010), perceptions of vaccine harm (50.0%, P = 0.013), and acknowledgment of neglect (96.4%, P = 0.001). The research illuminates the complex factors influencing childhood vaccine delays in Saudi Arabia. Stressing the significance of personalized interventions, it underscores the necessity to tackle challenges specific to age, parental perspectives, and access issues for improved vaccination outcomes.

Description of COVID-19 Vaccination Behavior in Rural and Urban Communities in Serang District

Public health status in Indonesia can be influenced by the implementation of healthy behavior in the community. There are differences in behavior between people in rural and urban areas and factors that can cause vaccine delays that have the potential to affect COVID-19 vaccination coverage in Indonesia. This study aims to determine the behavior of COVID-19 vaccination in rural and urban communities in Serang Regency. This study used a descriptive research design with a quantitative approach which was conducted in October−November 2021 with a sample of 334 people aged 18−59 years. The results showed that the vaccination status of the respondents was complete dose (rural 65.3% and urban 70.3%), waiting for dose 2 (rural 22.4% and urban 18.6%), and dose 1 had been received but the dosing schedule 2 had passed (rural 12.3% and urban 11.1%). Three perceptions that are still low in percentage are perceptions of vulnerability, perceptions of obstacles, and cues to act. Some of the reasons for stopping the termination of COVID-19 in the community are not yet feeling that they will have severe symptoms if exposed to COVID-19, feeling confused about information related to COVID-19, not being able to carry out COVID-19 vaccinations because the schedule for COVID-19 vaccination program coincides with other activities, did not receive an invitation from the local government to vaccinate against COVID-19, vaccinate because people in their environment had vaccinated against COVID-19, did not receive support from cadres or religious leaders for the COVID-19 vaccination. Improved policy behavior can be improved by changing perceptions of vulnerability to COVID-19, reducing barriers, and also providing cues according to education through social media with the key message of spending the full dose of vaccine.

Clinical characteristics of COVID-19 in children: a large multicenter study from Iran.

During the COVID-19 pandemic, pediatric cases typically exhibit milder symptoms and lower mortality rates. However, the delay in pediatric vaccination poses major risks for children. This multicenter study aimed to comprehensively analyze demographic characteristics, clinical features, disease severity, and risk factors for ICU admission in Iran. This observational study enrolled children aged 0-21 years with confirmed or probable COVID-19 diagnoses, referred from selected hospitals across 17 counties in Mazandaran province, Iran, between February 19 and August 14, 2021. Patients were categorized into mild, moderate, severe, or critical cases based on clinical and radiographic criteria. Data were extracted from medical records and analyzed using statistical methods. Logistic regression analysis was performed to identify factors associated with ICU admission and disease severity. Among the 1,031 children included in the study, 61 were diagnosed with MIS-C. The distribution of patients by severity was 156 mild, 671 moderate, and 204 severe/critical cases. Age distribution significantly differed across severity groups (P < 0.001), with 55.19% aged over 5 years and 54% being male. 11.44% had underlying diseases. Fever (71.97%) was the most common symptom, followed by cough (34.43%) and dyspnea (24.83%). Within the inpatient group, 19.77% required ICU admission, with 0.91% mortality, including 3 MIS-C cases. Children with underlying diseases, gastrointestinal symptoms, and obesity had 4.16, 3.10-, and 2.17-times higher likelihood of ICU admission, respectively. Our study emphasized the importance of recognizing pediatric COVID-19 severity and symptoms. While fever, cough, and dyspnea prevailed, mortality rates were relatively low. However, comorbidities, obesity, and gastrointestinal symptoms linked to ICU admission, stressing early intervention. BMI also impacted disease severity and admission rate. Vaccination and targeted interventions are essential for protecting vulnerable children and easing healthcare strain.

Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study

BackgroundMaternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines.MethodsIn this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates.ResultsIn multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74–1.82), MMR/MMRV (OR 1.03, 95% CI 0.72–1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86–2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77–1.53), MMR/MMRV (OR 1.07, 95% CI 0.82–1.40), or all vaccines combined (OR 1.00, 95% CI 0.80–1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers.ConclusionHealth care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.

Peer education as a strategy to promote vaccine acceptance: A randomized controlled trial within New York community healthcare practices

BackgroundEffective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination. MethodsFrom March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child’s pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment. Results144 parent–child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09–4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22–5.86), p = 0.009). ConclusionsPeer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).

Nurses' attitudes towards COVID-19 vaccines: A qualitative study (PROACTIVE-study).

To explore the attitudes of healthcare workers towards COVID-19 vaccines. A qualitative descriptive design was used. Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts. Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat. Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies. Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal. Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns. The study is reported using the Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.