Benefits Of Vaccination Research Articles

Live-attenuated vaccines for multiple sclerosis patients living in regions with endemic infections: A complex decision.

Live-attenuated vaccines provide robust immunity against diseases like tuberculosis, measles, mumps, rubella, polio, yellow fever, dengue, typhoid fever, and varicella, with just one or a few doses. However, concerns arise regarding potential pathogen reversion to virulence, which is particularly risky for immunocompromised individuals, contraindicating their administration in multiple sclerosis (MS) patients under modified disease treatments due to the possibility of triggering infections, or stimulating the immune system, precipitating new exacerbations. On the contrary, these vaccines offer enduring immunity that is crucial for protecting MS patients from endemic infectious diseases, leading to severe complications if contracted. These concerns underscore the complex balance between vaccination benefits and the risks of exacerbating MS in patients residing in regions with endemic diseases. This review explores the challenges and considerations associated with their use in MS patients, aiming to maximize benefits while minimizing risks.

Behaviors and willingness to support HPV vaccination for women: a cross-sectional study of young adult men in China

BackgroundMen’s involvement in and support for women’s decision-making concerning human papillomavirus (HPV) vaccination is crucial. However, the support provided by men to promote HPV vaccination among women, as a crucial part of intimate relationships has received limited attention. This study examined the behaviors and willingness of young Chinese adult men to support HPV vaccination in women and explored potential factors influencing supportive behaviors and willingness.MethodsFrom December 2020 to January 2021, a cross-sectional study was conducted among 1014 young men from eight universities in Zhejiang Province, China. The survey questionnaire assessed behaviors and willingness to support HPV vaccination, HPV-related knowledge, information seeking for male HPV vaccination, attitudes toward women’s vaccination benefits, and sociodemographic variables. Multivariable logistic regression analyses adjusting for all covariates were used to identify factors associated with supportive behaviors and willingness.ResultsOnly 48.4% of respondents reported having acquired and shared information about HPV vaccination with loved ones, whereas 41.3% recommended HPV vaccination. Approximately 80% of the participants without supportive behaviors reported a willingness to support the vaccination. Positive attitudes toward the benefits of women’s HPV vaccination, active seeking of information on male HPV vaccination, and relevant sociodemographic and health-related variables were associated with vaccination-supportive behaviors or willingness.ConclusionsYoung men expressed a relatively low level of support for female HPV vaccination. Promoting active information seeking regarding HPV vaccination among men and emphasizing the benefits of HPV vaccination for women could potentially foster more supportive behaviors. Targeted health education should include men to promote their involvement in shared decision-making regarding female HPV vaccinations.

American COVID: An Econometric Analysis of Variants

BACKGROUND: Immunity to a disease arises from previous infection as well as vaccinations against it. However, it is important to know which cause has the most prophylactic benefit. Medical research so far has been unable to provide a definitive answer to this question. METHODS: This paper uses time series econometric techniques to analyze American COVID 19 data from February 2020 to the end of October 2022. Distributed lag models are employed to uncover the unobservable effects that occur when uninfected individuals come in contact with other individuals whose COVID status is unknown. The purpose of the study is to compare the immunological benefits of vaccinations with those that arise from a previous infection. RESULTS: The main results obtained here is that this relation depends on the variant being considered: earlier variants produced similar benefits whereas the benefits from being previously infected by the Delta and Omicron varieties provided considerably less protection against further infection. CONCLUSIONS: The benefits from infection by earlier variants are small for the current variant. This casts doubt on the idea that herd immunity might be possible. The best form of protection is vaccination.

Vaccine Hesitancy Toward COVID-19 Vaccines Among Humanitarian Healthcare Workers in Lebanon, 2021

Refusals and delay in receiving COVID-19 vaccines due to vaccine hesitancy present major barriers to optimal vaccine uptake and thus epidemic control, with crisis-affected populations facing additional challenges. International Medical Corps conducted a cross-sectional survey to evaluate knowledge, attitudes, and perceptions regarding COVID-19 and identify determinants of COVID-19 vaccine hesitancy among 413 healthcare workers (HCW) working at 90 national primary healthcare centers in Lebanon, just prior to widespread vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health belief Model. More than half (56.9%) of HCWs were categorized as being vaccine-hesitant, while 43.1% reported they would receive a vaccine when available. Perceived benefits, cues to action, and social norms were positively associated with vaccine acceptance. More than half (56.4%) believed the national health system was not capable of ensuring safe administration of the COVID-19 vaccine. Targeted interventions that emphasize the benefits of COVID-19 vaccination, highlight cues to vaccinate, and promote vaccination as a social norm are critical in motivating HCWs to get vaccinated. Increasing HCW trust in Lebanon’s national health system is critical to building confidence toward COVID-19 vaccines and has implications for the success of future responses to infectious disease outbreaks.

Lupus and SARS-CoV-2: What have we learned after the pandemic?

After the end of the COVID-19 public health emergency, we analysed the relationship between Systemic Lupus Erythematosous (SLE) and COVID-19 from the virologist's perspective based on recent findings. SLE and COVID-19 co-morbidity present unique challenges, as individuals with SLE may be at increased risk for severe COVID-19 illness due to immune system abnormalities and ongoing therapies. Effective management of both diseases requires careful monitoring, adherence to vaccination programs, preventive measures and approved and patient-tailored therapies. This review covers various aspects, including the clinical outcome of SLE patients infected by SARS-CoV-2, the impact of this infection on SLE onset or flare-ups and the benefits of vaccination for this population. Furthermore, this review presents the most recent recommendations on clinical management of COVID-19 in rheumatic patients, including those with SLE, discussing the currently available therapeutic options. Finally, we explore the most effective tools for SARS-CoV-2 diagnosis in autoimmune conditions and examine prognostic biomarkers in COVID-19 rheumatic patients with potential implications on their clinical oversight. By adopting a comprehensive approach, we address these complexities from the virologist's perspective, aiming to improve health care for this vulnerable population.

Health, beliefs, and faith: HPV vaccine uptake intent among Catholic, Evangelical, and mainline protestant parents

ABSTRACT The HPV vaccine has the potential to prevent nearly 92% of HPV-related cancer cases, yet its uptake remains suboptimal. While well-documented barriers to HPV vaccine uptake include inadequate knowledge and lack of provider recommendation, religious preferences have emerged as another crucial factor influencing vaccination decisions. This study examined the interrelatedness of religion, beliefs, and HPV vaccination uptake among children among Catholic, Evangelical, and Mainline Protestant parents. A nationally representative survey was conducted among 1,068 U.S. parents from one of three major Christian denominations: Catholic, Evangelical, or Mainline Protestant. We examined the extent to which demographic factors, constructs from the Health Belief Model (perceived severity, susceptibility, benefits, barriers, self-efficacy, and cues to action), and faith-based support variables contributed to HPV vaccination decisions among parents from the specified religious denominations. Among the surveyed parents, 72.3% indicated that their child had received the HPV vaccine, revealing a substantial but incomplete uptake rate. Notably, no statistically significant differences were observed in vaccination rates across the three denominational groups. Perceived HPV vaccine benefits (p < .001), perceived barriers (p < .001) and perceived self-efficacy (p = .013) were strongly associated. Parents reporting that their child’s healthcare provider asked them about the vaccine (p < .001) and those more receptive to faith-based support for HPV vaccination (p = .049) were more likely to report child HPV vaccine uptake. To enhance HPV vaccine uptake among the examined religious denominations, strengthening provider-parent communication regarding the HPV vaccine and fostering partnerships between healthcare providers and supportive religious congregations can serve as powerful levers for promoting vaccination acceptance and compliance.

The effect of coronavirus disease 2019 vaccination on pregnant women: A scoping review

Background: Globally, reports have shown that pregnant women refuse to receive the coronavirus disease 2019 (COVID-19) vaccine. This has posed a significant concern given the global impact of the COVID-19 pandemic.Aim: This study aims to explore the current evidence on the effect of COVID-19 vaccination on pregnant women.Method: A scoping review was conducted using Levac et al.’s five-stage framework. Relevant articles were searched in the Web of Science, PubMed, Scopus and EBSCOhost (CINAHL) databases. The identified articles were screened based on predetermined inclusion and exclusion criteria. Data from the selected articles were charted and summarised into meaningful units.Results: Twelve articles from developed countries were included in the review. Studies have reported that COVID-19 vaccination during pregnancy is generally safe and does not increase the risk of pregnancy complications. There was no significant difference in delivery outcomes between vaccinated and unvaccinated women. Neonatal outcomes were not affected by the vaccination. However, one study identified a potential risk of spontaneous abortion between 6 and 9 weeks of gestation among vaccinated women.Conclusion: Coronavirus disease 2019 vaccination is considered safe during pregnancy. While some studies have identified potential associations with certain conditions, the overall benefits of vaccination outweigh the risks. Continued monitoring of the safety and effectiveness of COVID-19 vaccines during pregnancy is recommended. Pregnant women should consult healthcare providers to make informed decisions regarding vaccination.Contribution: The findings of this review may assist in alleviating anxiety and reducing vaccine hesitancy among pregnant women.

SARS-CoV-2 antibodies in breast milk of women given one and two doses of COVID-19 vaccine

Background &amp; objectives The COVID-19 pandemic underscores the significance of vaccination in mitigating disease spread, with Covishield and Covaxin serving as pivotal vaccines in India. Breast milk, rich in vital antibodies like IgA and IgG, plays a crucial role in enhancing the immune defence of breastfeeding infants. However, limited research exists on the antibody responses in breast milk among individuals receiving single versus double doses of the COVID-19 vaccine. This study aimed to bridge this gap by exploring IgA and IgG antibody levels in breast milk and assessing the correlation with COVID-19 vaccination status. Methods This hospital-based descriptive study aimed to assess the relationship between COVID-19 vaccination and the presence of anti-SARS-CoV-2 IgA/IgG antibodies in breast milk. Breast milk samples were collected using a sterile, closed-system electric breast pump and stored at -20°C. ELISA testing, utilizing commercially available kits, was utilized to assess anti-SARS-CoV-2 IgA and IgG antibodies. Results Among the 151 women participants, 76 (50.3%) received COVID-19 vaccination. Of these vaccinated women, 70 (92.1%) received Covishield, and 6 (7.9%) received Covaxin. Within the vaccinated cohort, 32 (42.1%) completed the recommended double-dose regimen, while 44 (57.9%) received a single dose. While no significant association was found between vaccination status and IgA positivity (P=0.491), a notable association emerged for IgG positivity (P&lt;0.001). Notably, individuals who completed the recommended double-dose regimen exhibited higher IgA (63.6%) and IgG (65.4%) positivity compared to those receiving a single dose. Interpretation &amp; conclusions This study underscores the significance of COVID-19 vaccination in impacting IgA and IgG antibody presence in breast milk. Completing the double-dose regimen correlated with higher IgA and IgG levels, emphasizing the benefits of complete vaccination. These findings contribute to understanding vaccination’s impact on maternal-infant health.

Doctors for the truth: Latin American antivaccine oppositional cultures on Telegram

The antivaccine hesitancy movement represents a challenge to public policy and platform regulations. During COVID-19, various Latin American antivaccine groups clashed with official sanitary initiatives. Despite many responses, little progress has been made in reaching these groups to transform their perceptions about the benefits of the COVID-19 vaccine. During the pandemic in Latin America, the antivaccine network Médicos por la Verdad (Doctors for the Truth) gained prominence in various countries. Finding itself limited by legal and technical restrictions, this network used alternative media such as Telegram to disseminate messages. This study argues that such groups may be considered an antivaccination culture that opposes government measures. This focus emphasizes narrative construction and allows us to understand the phenomenon from the collective meaning-making perspective. This study analyzed 232,638 Telegram messages from 14 public channels associated with the Médicos por la Verdad network. Our findings indicate that this antivaccine network builds an oppositional culture expressed and reinforced through multimodal, trans-media, fragmented narratives and suspends disbelief that constructs a world where the community enacts a truth pact. These narrative methods foster building a resilient network of oppositional cultures, decreasing the effectiveness of policies. We conclude that research beyond the framework of misinformation and the analysis of conventional platforms is needed to understand the antivaccine oppositional cultures.

Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia

BackgroundVaccination is a critical public health intervention that significantly reduces morbidity and mortality from vaccine preventable diseases. Despite the proven benefits of vaccines, missed opportunities for vaccination (MOV) remain a significant challenge in many low-income countries, including Somalia. This study aimed to determine the prevalence and identify the factors contributing to MOV in Mogadishu, Somalia. MethodsA cross-sectional study was conducted at various healthcare facilities in Mogadishu, Somalia, from January to March 2024. A total of 234 caregivers of children under five years of age were interviewed using a structured questionnaire. Data on sociodemographic characteristics, health service utilization, and reasons for missed vaccinations were collected. Logistic regression analysis was used to identify factors associated with MOV. Results: The prevalence of MOV in Mogadishu was 26%. Key factors contributing to MOV included low socioeconomic status, lack of caregiver awareness about vaccination schedules, logistical challenges within the healthcare system, and misconceptions about vaccine safety and efficacy. Knowledge and beliefs of mothers about vaccination significantly affected the MOVs in children. Not knowing if all children should be vaccinated is associated with higher probability of (MOVs), (AOR =13.006, 95% CI = 1.175-143.924, p = 0.003). ConclusionThe study highlighted a significant prevalence of missed opportunities for vaccination in Mogadishu, Somalia. Addressing these missed opportunities requires a multifaceted approach, including enhancing public awareness about the importance of vaccination, improving healthcare infrastructure, and ensuring consistent vaccine supply and proper storage.

Influenza Vaccine Effectiveness Against Symptomatic Influenza in Primary Care: A Test Negative Case Control Study Over Two Influenza Seasons 2022/2023 and 2023/2024 in Ireland.

Live attenuated influenza vaccine (LAIV) is recommended in Ireland for all children aged 2-17 years. Quadrivalent influenza vaccine (QIV) is recommended for all others eligible for vaccination, including those ≥ 18 years with underlying medical conditions and all aged ≥ 65 years. We aimed to estimate influenza vaccine effectiveness (IVE) against acute respiratory infection (ARI) presentations to primary care due to influenza over two influenza seasons in Ireland, to inform vaccination recommendations and communication campaigns. We undertook a test-negative case control study within the Irish sentinel general practice surveillance network as part of the Vaccine Effectiveness Burden and Impact Studies (VEBIS) network. We compared influenza vaccination status among influenza PCR positive cases with influenza PCR negative controls, both with ARI presentations, of all ages. We estimated IVE using logistic regression adjusting for age, onset time, medical conditions and sex. In 2022/2023, there were 288 cases and 765 controls. In 2023/2024, there were 567 cases and 1832 controls. In 2022/2023, overall IVE was 42% (95% CI 9 to 64) and 50% (95% CI -30 to 83) in 2- to 17-year-olds. Overall IVE in 2023/2024 was 35% (95% CI 15 to 51) and 68% (95% CI 30 to 87) in 2- to 17-year-olds. Influenza vaccination reduced the risk of influenza among ARI patients presenting to general practice, demonstrating the benefits of vaccination, particularly among children. Promotion of the seasonal influenza vaccine to recommended groups, should remain a public health priority. Targeted vaccination campaigns for children promoting LAIV should emphasise the effectiveness of LAIV in children.

Perception Analysis of Breastfeeding Mother Behavior in Implementing the Covid-19 Vaccine at the Campurejo Health Center

Perception is a model of individual health beliefs in determining whether or not to carry out health behavior. This could be one of the reasons why breastfeeding mothers do not want to be vaccinated. In addition, the lack of understanding of breastfeeding mothers regarding the purpose and benefits of vaccination will cause breastfeeding mothers not to want to be vaccinated. The aim of the study was to determine the effect of Perception on the Behavior of Breastfeeding Mothers in implementing the Covid-19 Vaccine. The research design used was analytical observational with a cross sectional approach. The population in this study were all breastfeeding mothers at Campurejo health centers. The sample size is 30 respondents. Sample selectedusing purposive sampling technique. Then analyzed using the ordinal regression test withα ≤ 0.05.

The Role of Law in Regulating Compulsory Vaccination: Between Human Rights and State Obligations during the Pandemic

Public health protection is one of the main obligations of the state in an effort to maintain the welfare of its citizens. One of the policies implemented is mandatory vaccination to reduce the spread of infectious diseases and maintain collective health. However, this policy raises challenges in terms of balancing between the state's responsibility to protect the community and individual human rights, especially the right to determine which medical interventions to accept. This research aims to examine the role of law in regulating mandatory vaccination in Indonesia, as well as how the policy can be implemented without violating human rights. This study uses a normative juridical approach by exploring various regulations that form the basis for the implementation of mandatory vaccination in Indonesia, including Law Number 36 of 2009 concerning Health and Presidential Regulation Number 99 of 2020 concerning Vaccine Procurement and Vaccination Implementation. The analysis shows that compulsory vaccination has a strong legal footing to protect public health, but it must still respect individual rights, especially the right to choose medical interventions. The state is also required to ensure that this policy is implemented in a fair and non-discriminatory manner, especially for vulnerable groups such as children, the elderly, and individuals with special health conditions. This study also found that adequate education and socialization are important factors to increase public acceptance of mandatory vaccination. Public opposition is generally caused by a lack of proper understanding of the benefits of vaccines, as well as the spread of inaccurate information about vaccine safety. Therefore, a more persuasive approach, involving community leaders and related institutions, is needed to provide better understanding and increase public trust in vaccination policies. Mandatory vaccination policies need to be implemented while maintaining a balance between the state's obligation to protect public health and human rights. Not only does the state need to strengthen the legal basis for vaccination, but it must also ensure that this policy is implemented in a fair and inclusive manner.

Assessment of Placental Antioxidant Defense Markers in Vaccinated and Unvaccinated COVID-19 Third-Trimester Pregnancies

Background: Pregnancy has been identified as a risk factor for severe COVID-19, leading to maternal and neonatal complications. The safety and effects of the SARS-CoV-2 vaccination during pregnancy, particularly on placental function and oxidative stress (OxS), remain underexplored. We investigated the impact of vaccination on third-trimester placental antioxidant defense markers. Methods: Ninety full-term pregnant women were divided into the following groups: vaccinated (n = 27) and unvaccinated (n = 25) COVID-19-positive pregnant women; control subgroups were composed of vaccinated (n = 19) or unvaccinated (n = 19) COVID-19-negative women with a healthy term singleton pregnancy with no signs of COVID-19. Placental samples were collected after delivery. Lipid peroxidation (TBARS), gene expression of HIF-1α, and catalase (CAT), superoxide dismutase-1 (SOD1) and CAT-SOD1 enzymatic activity were measured. Results: COVID-19-positive placentae exhibited significantly higher TBARS and HIF-1α levels compared to controls, regardless of vaccination status. Vaccination significantly increased placental CAT and SOD1 expression and activity in COVID-19-positive women, suggesting enhanced antioxidant defense. Unvaccinated women showed a higher incidence of COVID-19 symptoms and lower antioxidant enzyme activity. Conclusions: SARS-CoV-2 infection induced placental OxS, which is countered by a placental adaptive antioxidant response. Vaccination during pregnancy enhances placental defense, further supporting the safety and benefits of COVID-19 vaccination in preventing complications and protecting fetal development.

Influenza hospitalizations among working age adults (18-64 years) and the potential benefit of recombinant vaccines: USA, 2012-13 through 2022-23

Influenza hospitalizations among working age adults (18-64 years) and the potential benefit of recombinant vaccines: USA, 2012-13 through 2022-23

Public Health Impact of Introducing a Pentavalent Vaccine Against Invasive Meningococcal Disease in the United States.

Invasive meningococcal disease (IMD) is primarily associated with five Neisseria meningitidis serogroups: A, B, C, W, or Y. In the United States (US), available vaccines protect against serogroups B (MenB), A, C, W, and Y (MenACWY), and A, B, C, W, and Y (MenABCWY). The Advisory Committee on Immunization Practices is re-evaluating the adolescent meningococcal vaccination schedule with varying recommendation formats. This analysis aimed to predict which schedule could avert the most IMD cases and have the most positive public health impact (PHI). An epidemiological model compared the 15-year PHI of vaccination schedules using MenB, MenACWY, and/or MenABCWY vaccines versus current US standard of care (SoC). Varying coverage rates reflected routine, shared clinical decision making, and risk-based recommendations. Sensitivity analyses assessed robustness of the results to different inputs/assumptions. The most positive PHI compared with SoC was observed with one dose of MenACWY at 11 years of age and two doses of MenABCWY (6 months apart) at 16 years of age, assuming routine recommendation and coverage reflecting real-world uptake of MenACWY. This strategy resulted in 123 IMD cases averted (MenB: 59, MenACWY: 64), 17 deaths prevented, 574 life-years saved, and 757 quality-adjusted life-years gained versus SoC. Eliminating MenACWY vaccination at 11 years was found to result in an additional IMD burden. A routinely recommended two-dose pentavalent vaccine, with doses administered 6 months apart at 16 years of age, alongside the routinely recommended MenACWY vaccine at 11 years of age, would improve the PHI and benefits of IMD vaccination to society.

Deaths Related to New-Onset Seizures After Vaccination.

Background: Adverse effects following vaccination are well-known. While most effects are mild and transient, some may be severe or even lethal. Particularly with regard to coronavirus disease 2019 (COVID-19) vaccinations, which were "fast-tracked," it is incumbent upon the medical community to be diligent in identifying potential vaccine-associated adverse events so that physicians and patients can make truly informed decisions when considering the risks versus benefits of vaccination. Objective: To provide an in-depth discussion about post-vaccination seizures, particularly with regard to COVID-19 vaccinations. Research Design: Retrospective review of two cases where death was deemed to be the result of new-onset seizures; in each case, the seizures began shortly following vaccination. Subjects: In one case, death was certified by the primary care physician, without implicating the recent COVID-19 vaccination. In the other case, certified by the medical examiner, recent simultaneous vaccination with a COVID-19 vaccine and an influenza vaccine were considered to be contributory to death. Measures: The case specifics are presented for each case, including clinical work-up (both cases) and autopsy findings (one case). Conclusions: When attempting to determine whether or not a seizure-related death is due to a vaccine-induced new-onset seizure disorder, forensic pathologists need to rule-out other explanations for the seizures. Although a temporal association between seizures and vaccination is not sufficient, in and of itself, to prove causality, the temporal association, in combination with the absence of another explanation for seizures, and knowledge of similar cases in the medical literature, is sufficient to ascribe a causal role to the vaccination.

Vaccine hesitancy and other challenges to sexually transmitted infection vaccine acceptance

Purpose of review Development of vaccines that protect against sexually transmitted infections (STIs), including for chlamydia, gonorrhea, and syphilis, has progressed greatly over the past decade. However, little research has been conducted to examine STI vaccine acceptance and hesitancy and how these factors may impact future uptake. This review examines literature that could provide additional insights into factors that would impact STI vaccine acceptance and hesitancy. Recent findings Vaccine hesitancy remains a threat to the uptake of future STI vaccines despite recent findings that highlight high levels of acceptability. Vaccine characteristics including side effects postvaccination and cost could impact future uptake of these vaccines. Accurate information about the benefits of vaccination and the vaccine development process could help to improve vaccine acceptance. Summary STI vaccine development is progressing, leading to great promise that a chlamydia, gonorrhea, or syphilis vaccine will one day be available. However, data is limited on factors that could impact vaccine acceptance, hesitancy, and uptake. This research is instrumental in creating policies, programming and vaccination campaigns that could impact acceptance and uptake along with affordability and accessibility. Additional research is needed to better promote STI vaccines.

Attitudes and Experiences Regarding Communication About Maternal Vaccination: Qualitative Findings from Non-Hispanic Black Pregnant People.

Comprehensive prenatal care incorporates recommended vaccines to help protect the mother, the pregnancy, and the infant from adverse health outcomes and severe illness from vaccine preventable diseases (VPDs). However, vaccinations during pregnancy remain underutilized, often influenced by concerns about vaccine safety and low perception of disease risk. Self-reported vaccine hesitancy among pregnant people in the United States has significantly increased in the last few years, and influenza and Tdap (tetanus, diphtheria, and pertussis) vaccination rates have declined. Furthermore, the number of vaccines routinely recommended during pregnancy has expanded. Communication strategies tailored to pregnant people may help build vaccine confidence among pregnant people and their health care providers. While characteristics and perceptions associated with hesitancy to vaccinate during pregnancy are documented in existing literature, more information is needed on promising communication practices preferred by subgroups of pregnant persons, particularly Black pregnant people who have higher rates of illness from VPDs and greater risk of pregnancy-related complications. This article summarizes literature on the current landscape of prenatal vaccination, discusses qualitative findings from focus groups with non-Hispanic Black pregnant people, and describes promising practices for communicating with this group about vaccination. Promising practices include specifying the benefits of vaccination for both the pregnant person and the infant, outlining potential risks, and emphasizing the overall importance of vaccination during pregnancy, while also acknowledging that many non-Hispanic Black pregnant people may have health concerns they perceive as superseding vaccination.

Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction

Influenza vaccination in patients with acute myocardial infarction (AMI) reduces major adverse cardiac events and is strongly recommended in clinical practice guidelines. Effective strategies to improve vaccination are needed in these high-risk patients. To evaluate whether electronically delivered behavioral nudges improve influenza vaccine uptake in patients with AMI across 3 nationwide implementation randomized clinical trials (RCTs). Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake (NUDGE-FLU), Nationwide Utilization of Danish Government Electronic Letter System for Confirming the Effectiveness of Behavioral Nudges in Increasing Influenza Vaccine Uptake Among Older Adults (NUDGE-FLU-2), and Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake Among Adults With Chronic Disease (NUDGE-FLU-CHRONIC) were RCTs conducted during the 2022 to 2023 and 2023 to 2024 influenza seasons in Denmark. Participants were randomized to either usual care or various behaviorally informed, electronically delivered, letter-based nudges. In a prespecified participant-level pooled meta-analysis, interaction of AMI status on the effects of letter-based nudges vs usual care was examined. Pooled treatment effects were estimated using binomial regression models with identity link, adjustment for trial, and 2-way clustered SEs at the household and participant levels. Effect modification by recency of AMI as a continuous variable was assessed using restricted cubic spline modeling in NUDGE-FLU-CHRONIC. Behaviorally informed, electronically delivered, letter-based nudges or usual care. The primary end point was influenza vaccination receipt. Of 2 146 124 individual randomizations (mean [SD] age, 71.1 [11.6] years; 1 114 725 female [51.9%]) across all 3 trials, 59 458 (2.8%) had a history of AMI. Improvement in vaccine uptake was similar in patients with vs without a history of AMI who received any nudge letter compared with usual care (+1.81 vs +1.32 percentage points; P for interaction by AMI status = .09). A letter highlighting the cardiovascular benefits of vaccination (ie, cardiovascular-gain frame) resulted in larger improvements in vaccine uptake among patients with (vs without) a history of AMI (+3.91 vs +2.03 percentage points; P for interaction by AMI status = .002). Among patients with AMI, the benefits of the cardiovascular-gain frame letter were more pronounced in those not vaccinated in the prior season (+13.7 vs +1.48 percentage points; P for interaction <.001). Among younger participants with chronic disease, the cardiovascular-gain frame letter was particularly effective in patients with more recent AMI (P for interaction by continuous recency of AMI <.001). Across 3 nationwide RCTs of Danish citizens, messaging emphasizing the cardiovascular benefits of vaccination improved influenza vaccination uptake, with greater benefits observed in patients with a history of AMI. This low-cost, scalable implementation strategy should be considered to encourage influenza vaccination in high-risk patients. ClinicalTrials.gov Identifiers: NCT05542004, NCT06030726, NCT06030739.