Vaccination Requirements Research Articles

Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2021–22 School Year

State and local school vaccination requirements protect students and communities against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage and exemptions to vaccination among children in kindergarten in 49 states† and the District of Columbia and provisional enrollment or grace period status for kindergartners in 27 states§ for the 2021-22 school year. Nationwide, vaccination coverage with 2 doses of measles, mumps and rubella vaccine (MMR) was 93.5%¶; with the state-required number of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) doses was 93.1%**; with poliovirus vaccine (polio) was 93.5%††; and with the state-required number of varicella vaccine doses was 92.8%.§§ Compared with the 2020-21 school year, vaccination coverage decreased 0.4-0.9 percentage points for all vaccines. Although 2.6% of kindergartners had an exemption for at least one vaccine,¶¶ an additional 3.9% who did not have an exemption were not up to date with MMR. Although there has been a nearly complete return to in-person learning after COVID-19 pandemic-associated disruptions, immunization programs continued to report COVID-19-related impacts on vaccination assessment and coverage. Follow-up with undervaccinated students and catch-up campaigns remain important for increasing vaccination coverage to prepandemic levels to protect children and communities from vaccine-preventable diseases.

Owning the Libs: Symbolic Negation of #mybodymychoice as a Conservative Rhetorical Strategy

ABSTRACT The anti-vaccine movement’s appropriation of the reproductive rights mantra #MyBodyMyChoice has been remarkably successful despite overwhelming evidence in favor of vaccines and the historical precedent for vaccine requirements. I argue that this appropriation of #MyBodyMyChoice constitutes a symbolic negation which is indicative of a new conservative rhetorical strategy of Owning the Libs. This strategy emphasizes affective resonance over political reason and operates through three rhetorical moves. It first paints liberals as hypocrites while blaming them for conservatives’ own skepticism about the COVID-19 vaccine. It then elicits an affective response which manifests via right-wing arrogance and superiority on Twitter. Finally, it reconstitutes conservatives as the “true” patriots who are uniquely able to see through government corruption. This research speaks to a new form of right-wing advocacy that forefronts emotion and personal experience as the basis for group formation and sidesteps traditional political and deliberative norms.

Standing in the Gap.

FigureFigure“So I sought for a man among them who would make a wall, and stand in the gap before me on behalf of the land, that I should not destroy it; but I found no one” (Ezekiel 22:30, NKJV). I'm sure everyone is familiar with this lament from God through the Old Testament prophet Ezekiel about how the leaders of God's people abused their power and oppressed the people in ancient Israel. The same is true around the world today. Leaders are supposed to shepherd those under their care and in their sphere of influence; abuse of power is common, whereas true loving kindness and compassionate care are rare. However, in Haiti, nurses under the leadership of NCF-Haiti chapter leaders have taken on the challenge to “stand in the gap” for their people. Recognizing the tremendous need for education and guidance in face of the COVID-19 pandemic, a team of nurses led by NCF-Haiti vice president Vanessa Roland and her colleagues began providing health education in churches and other venues where people could gather. Nurses handed out masks and taught about health and hygiene, especially in relation to prevention of COVID-19. INITIATING HEALTH BOOTHS Moreover, the nurses initiated the practice of street corner “health booths” to provide hand sanitation and masks which are hard for the general public to obtain. This effort spread among nurses and college students as well as the Scouts organization that had done this kind of outreach all across Haiti in 2010 during the cholera epidemic. Efforts by nurses and other public health-minded leaders and individuals have mitigated the spread of coronavirus even though the vaccine is not readily available in Haiti. Another way NCF-Haiti nurse leaders stood in the gap for individuals and communities in Haiti was after the 2021 earthquake and hurricane that devastated southern Haiti; these nurse leaders gathered a team of nurses, doctors, and other healthcare personnel. Even though vicious gangs prowled along the main roads in the affected areas, these courageous nurses led their group by back roads to the town nearest to the epicenter where there was much suffering and great need. This team provided healthcare, food, and help with rescue efforts, clearing viable shelters that could protect people from the elements. EDUCATING AND PROMOTING HEALTH Today, NCF-Haiti nurse leaders continue to provide health education and promotion among the Haitians. Currently, they see a need to explain the odd behaviors of Americans and others who are opposed to mask mandates and vaccination requirements. With the Internet and telephone communication, multiple opinions from the world are readily available, producing confusion and lessening the positive health impact of education on people's behaviors. Nurses in Haiti now need to counteract misinformation as well as provide accurate information. According to the International Council of Nurses (ICN), compassionate care is mandated by The ICN Code of Ethics for Nurses (ICN, 2021). This kind of care requires nurses to be creative and to think outside the box to give the best care possible. Solutions are not always easy and may require sacrifice on our part, as shown by the nurse leaders of NCF-Haiti and their colleagues. Additionally, loving kindness is promoted throughout the Bible as the practice of kind attitudes and actions that flow out of the well of love within us who are followers of Jesus Christ. Christ in us is not only the “hope of glory” (Colossians 1:27) but also the fountain or wellspring from which flow life and light and love (Psalm 36:9). This is the basis for the kindness and compassion that should characterize all of our service as nurses in a hurting world. God calls all nurses to stand in the gap wherever he has placed us. This means that we need to sacrificially do our part in the great effort to alleviate suffering and to promote health. How this looks in practice may be different for each of us, but it is required of all nurses in our role as workers in God's Kingdom and ministers of health and healing.

Assessing the Knowledge, Attitudes, and Vaccination Practices Towards COVID-19 Vaccination Among Mainland Chinese Nursing Students and Interns: A Multicenter Cross-Sectional Study.

This study investigated factors influencing the knowledge, attitudes, practice profiles, and vaccination intentions among Chinese nursing students and nursing interns toward the coronavirus disease (COVID-19) vaccination. The multicenter cross-sectional study was based on a self-reported questionnaire collecting information among nursing students and nursing interns from three major geographic regions of China, and the sample was selected by consecutive sampling. The questionnaire was developed by knowledge, attitudes, and practice (KAP) theory. Univariate and multivariate logistic regression were used for statistical analysis. A total of 3180 nursing students and interns (effective rate: 99.8%) from six Chinese provinces were polled. The vaccine hesitation rate was 9.65% (307/3180), 2230 participants (70.1%) had gotten at least one dose of the vaccine, and 643 participants (67.7%) had indicated a readiness to be vaccinated. The results showed that older age, higher academic background, perfect vaccine management, others' recommendations, influenza vaccination history, epidemic under control, knowledge of vaccines or intervals, and vaccine knowledge training were associated with higher vaccination rates. Conversely, vaccine hesitancy was caused by a perceived lack of physical need, uncertainty about vaccination requirements, and fear of vaccination. This study provided population-based estimates of COVID-19 vaccine uptake intention among mainland Chinese nursing students and interns. Factors such as age, education, vaccine knowledge, and attitudes influence COVID-19 vaccine behaviour. Relevant authorities should understand the barriers to COVID-19 vaccination from knowledge, attitude and practice, which is significant for formulating effective response strategies in future global public health crises.

Abstract A129: National assessment of the HPV acceptance: Public attitudes and policy climate

Abstract Background: Human Papillomavirus (HPV) is a common sexually transmitted infection that has been associated with the development of cancers, most of them preventable if the HPV vaccine is administered before exposure. HPV school-entry policies could affect the HPV rates at a population level, hence the need for monitoring nationally the support of policies to assess acceptance at different levels. Objective: This study describes the state-level immunization program managers’ (IPMs) perception of the degree of the general public and policymakers’ acceptance or opposition to the HPV vaccine policies to increase HPV vaccination across their state or territory. Methods: As part of the study entitled Implementation of School-Entry Policies for Human Papilloma Virus Vaccination (HPV-PIVac), IPMs were surveyed about their perception regarding the acceptance or opposition of either (1) the public and (2) policymakers towards HPV vaccine policies. Five questions inquired about the degree of public concern towards HPV-related cancers, public hesitancy towards the HPV vaccine, public opposition towards HPV policies, and acceptance or resistance from policymakers regarding HPV vaccine policies using a five-item scale transformed into a three-item scale. Descriptive statistics were used to assess the managers perception about HPV vaccine policies. Fisher’s exact test was conducted to assess regional differences and the relationship between perception items from the public and policymakers. Results: 49 IPMs from 32 different states and territories participated in this study. In relation to the public concern towards HPV-related cancers, 93.8% of IPMs perceived that the public from their participant states and territories had moderate/mild concern. In comparison, only 6.3% perceived strong/overwhelming concern. For public hesitancy towards the HPV vaccine, 81.3% of IPMs perceived that the public had moderate/mild hesitancy, while 18.8% perceived strong/overwhelming reluctance. For public opposition towards HPV vaccine policies, 21.9% of IPMs perceived strong/overwhelming opposition. On the other hand, 40.6% of IPMs reported that the policymakers were resistant to education policies that promote the HPV vaccine. Similarly, 59.4% of IPMs reported that policymakers were resistant to HPV-school entry vaccination policies. No significant differences between regions were observed in the items analyzed (p>0.05). Fisher’s exact test indicated a significant association between the public opposition towards the HPV vaccine policies and the posture of policymakers towards HPV education policies (p<0.05). Conclusion: Results highlight that IPM’s perceive moderate/mild hesitancy and moderate/mild opposition by the public towards HPV vaccines and HPV policies; these attitudes could translate into resistance towards HPV policies by policymakers in the US. Findings support the need for active public engagement strategies to increase policymakers' support for promoting HPV vaccine policies and requirements. Funding: NCI Grant #R01CA232743. Citation Format: Yiana G. Toro-Garay, Alondra K. Mercado-Andino, Olga L. Diaz-Miranda, Diana T. Medina-Laabes, Ana P. Ortiz, Katelyn Wells, Erick Suárez, Vivian Colón-López. National assessment of the HPV acceptance: Public attitudes and policy climate [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A129.

Sometimes Your Heart Says 'I Don't Know': Insights From Parents of Undervaccinated Children.

To explore drivers of suboptimal vaccination rates by understanding why parents without strong antivaccine beliefs do not fully vaccinate their children. Four focus groups were conducted in Washington state with 41 parents of children aged 24 to 48 months who delayed, declined, or missed some but not all vaccines. During the focus groups, parents were asked about reasons their child was undervaccinated, information that might address their concerns, and additional support they needed. Transcripts were analyzed using template analysis with deductive and inductive codes. Focus groups identified multiple reasons for parents deciding to delay or decline vaccines for their children, including issues of individualism and control. The groups emphasized the impact of personal circumstances, such as changes in insurance, on whether children were vaccinated. Our data also shed light on the reasons that parents do vaccinate their children, including school vaccination requirements, negative experiences with vaccine-preventable diseases, and a family tradition of vaccinating. Focus group participants offered suggestions for improving vaccine communication with parents such as having more parent/patient-friendly vaccine information, providing forums to discuss their concerns, and offering vaccination information in advance of well-child appointments. To achieve the full benefit of vaccines on individual and community health, we need better ways to address vaccine hesitancy and decrease barriers. We suggest that many hesitant parents would benefit from more dialog with health care providers about vaccines, more approachable educational materials, and enforcement of existing policies requiring vaccines in schools and childcare facilities.

Abstract A096: Stakeholders’ perceptions on the impact of the COVID-19 pandemic on the implementation of the HPV vaccine school-entry requirement in Puerto Rico

Abstract Background: The human papillomavirus (HPV) vaccine is a cancer prevention tool, yet vaccination coverage among adolescents remains suboptimal in the United States. Research shows significant disparate incidence and mortality rates of HPV-related cancers in Puerto Rico (PR). In 2018, the PR Department of Health (DOH) enacted an HPV vaccine school-entry requirement for adolescents 11 to 12 years old, and on August 2020 extended the requirement to include adolescents up to 16 years old. Amid the COVID-19 pandemic in the US, during March-August 2020, national data showed that HPV vaccine uptake rates decreased about 75%. Public health measures, such as stay-at-home orders, may have caused this decline by limiting access to preventive services. Our study explored, using a qualitative assessment, the impact of the COVID-19 pandemic on the implementation of the HPV vaccine school-entry requirement in PR. Methods: We conducted 26 interviews with stakeholders from schools, DOH employees, Department of education staff, health providers, and community-based organizations from 08/2021-03/2022. Interviews were recorded and transcribed in Spanish. Data were analyzed using applied thematic techniques by two trained coders using Atlas-ti 8. We discussed eight of these interviews among the team to identify major barriers related to the HPV school-entry implementation during the pandemic. Results: Our analysis identified the following preliminary emergent themes including: (1) lockdown limitations and access barriers to the vaccine and (2) shifting immunization priorities. Most participants noted that the March 2020 lockdown limited parents’ ability to get their kids vaccinated and for schools to monitor the vaccine requirements; however, as vaccination centers and schools re-opened, gradually, vaccination processes increased. Participants described how during the pandemic, public health agencies prioritized the COVID-19 vaccine missing other vaccines that are required for school-entry, including the HPV vaccine. Discussion: Continuation of the implementation of the HPV vaccine school-entry requirement was challenging during early stages of the pandemic due to public health measures enacted to stop the spread of COVID-19. Moreover, once the COVID-19 vaccine was available, public heath vaccination priorities shifted. Nonetheless these barriers, efforts to increase HPV vaccine to pre-pandemic rates should continue, including providing educational support to parents, increase vaccine promotion, and creating community collaborations. As new guidelines recommend COVID-19 boosters, for everyone ages 5 years and older, this opportunity could serve to vaccinate against HPV as part of the bundling implementation of the HPV vaccine school-entry requirement. Citation Format: Coralia Vázquez-Otero, Diana T. Medina-Laabes, Derick Pérez-Guzmán, Olga L. Díaz-Miranda, VOCES PR, Vivian Colón-Lopez. Stakeholders’ perceptions on the impact of the COVID-19 pandemic on the implementation of the HPV vaccine school-entry requirement in Puerto Rico [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A096.

Estimating the cost of university-based outbreaks of serogroup B meningococcal disease with different pre-matriculation vaccination policies in the United States

Objective: We developed an Excel-based cost calculator to assess the economic burden of university-based Neisseria meningitidis serogroup B (MenB) outbreaks. Participants: Hypothetical university with 6,354 students. Methods: Total societal costs of outbreak were estimated for three MenB pre-matriculation immunization policies—vaccination required, vaccination recommended, and no vaccine policy—under three different cost assumptions (low/mid-range/high cost). Results: Mid-range cost estimates of an outbreak under “no policy” were $2.60 and $2.70 million (of which 35% were incurred by the university) if targeting all undergraduates for mass vaccination with a two-/three-dose vaccine, respectively. The “required” and “recommended” policies lowered the burden to $2.17–$2.18 million and $2.34–$2.39 million, respectively. For a larger university with 40,000 students, costs were almost $9 million for a two-dose vaccine with “no policy” in place. Conclusions: The economic burden of a university MenB outbreak is substantial, but could be mitigated by a pre-matriculation MenB vaccination requirement or recommendation.

Newspaper Coverage of COVID-19 Vaccination Requirement for Organ Transplant

This qualitative study summarizes newspaper reporting on views supporting or opposing policies requiring COVID-19 vaccination for organ transplant candidates in the US, the UK, and Canada.

Lessons Learned from In-Person Conferences in the Times of COVID-19

Scientific societies and conference secretariats have recently resumed in-person meetings after a long pause owing to the COVID-19 pandemic. Some safety measures continue to be implemented at these in-person events to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With increased numbers of waves of infection, caused by the emergence of SARS-CoV-2 variants, additional information is needed to ensure maximal safety at in-person events. The MEX-DART case study was conducted at the in-person Hep-DART 2021 conference, which was held in Los Cabos, Mexico, in December 2021. Many COVID-19 safety measures were implemented, and incidence of SARS-CoV-2 infection during the conference was tested onsite. In this study, we highlight the specific conditions and safety measures set in place at the conference. In addition to vaccination requirements, social distancing, and mask wearing, daily rapid testing was implemented for the duration of the conference. At the end of the 4-day meeting, none of the 166 delegates (and family members attending the conference) had tested antigen positive for SARS-CoV-2. Two delegates tested positive in the week after the conference; the timing of their positive test result suggests that they contracted the virus during their travels home or during postconference vacationing. We believe that this model can serve as a helpful template for organizing future in-person meetings in the era of COVID-19 and any other respiratory virus pandemics of the future. While the outcomes of this case study are encouraging, seasonal surges in respiratory virus infections such as SARS-CoV-2, RSV, and influenza virus incidence suggest that continued caution is warranted.

INTERDISCIPLINARY DEMENTIA CARE WORKFORCE TRAINING AND QI IMPLEMENTATION: LEARNINGS FROM 25 HOSPICES

Abstract To build and sustain a dementia-capable clinical workforce and care delivery organizations, it is essential to systematically disseminate evidence-based, interdisciplinary dementia care programs. The outbreak of COVID-19, clinical staff shortages, and competing priorities experienced by healthcare organizations including staff vaccination and other regulatory requirements, pose significant challenges to the continuation of agency-wide, interdisciplinary dementia care workforce training and quality improvement. In this symposium, we present our experience Implementing Aliviado Dementia Care, a comprehensive, interdisciplinary dementia care workforce training and quality improvement program amid COVID-19 across 25 U.S. hospice agencies, as part of an embedded pragmatic clinical trial. Aliviado Dementia Care consists of interdisciplinary dementia care workforce training, treatment algorithms, assessments, care plans, caregiver education, and clinical workflow changes. The symposium begins with a discussion of the training, knowledge improvement, turnover, and replenishing strategies of hospice champions during COVID-19. We then discuss how we tailored dementia care training for each of the skilled hospice disciplines (i.e., medicine, nursing, social work, spiritual care) and provide two case studies elucidating how additional tailoring was performed to fit local agency culture and needs during COVID-19. Furthermore, we discuss how we developed and iterated training for home health/hospice aides, the usability and training results, and specific considerations for training aides during COVID-19. Lastly, we conclude the symposium with a discussion of salient strategies and technologies that help sustain our nationwide implementation despite the ongoing COVID-19. Throughout each of these abstracts we also discuss how COVID-19 affected, and created differential implementation of components of the intervention.

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

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

A limited defence of public health exit restrictions

AbstractExit restrictions are viewed with suspicion in the literature related to migration, citizenship, and human rights. The international human rights project is devoted to defending the minimal proposition that a person should be able to leave their own country, with few exceptions. Public health emergencies constitute one of the few limits on this mobility right in Article 12 of the International Covenant on Civil and Political Rights. Here, I offer a limited legal and normative defence of pandemic travel restrictions, with a focus on Australia's COVID‐19 exit control measures. I argue that public health emergency exit controls do not constitute a violation of a traveller's mobility rights, so long as they are temporary, narrowly tailored, and proportionate to the health risk posed by the traveller in question. They should be lifted when alternative measures become widely available, such as vaccination and testing requirements.

HPB P64 An audit on the appropriate prescribing of antimicrobial prophylaxis and vaccinations in patients who underwent a splenectomy by the hepatobiliary department at University Hospital Southampton between January 2020 and April 2022

Abstract Background Patients who have an absent or dysfunctional spleen are at risk of overwhelming post splenectomy infection (OPSI), a condition associated with high mortality rates. The incidence of OPSI ranges from 0.1% to 8.5% (1). This is most commonly from Streptococcus pneumoniae but also from Haemophilus influenzae type b (Hib) and Neisseria meningitidis (2). These infections can have a sudden onset and run a fulminant course. The highest risk of infection is in childhood, age over 50 years old and in the first two years post splenectomy (3). Indications for splenectomy include trauma and malignancy. It is strongly advised that these patients have antibiotic prophylaxis and appropriate vaccinations administered to reduce the risk of OPSI. In University Hospital Southampton (UHS), the hepatobiliary department carry out elective splenectomies usually together with distal pancreatectomies and also do emergency splenectomies due to trauma (4). An audit was carried out at UHS to assess prescribing of antimicrobial prophylaxis and vaccinations in patients undergoing elective and emergency splenectomies by the hepatobiliary department at University Hospital Southampton between January 2020 and April 2022. Methods Patients who underwent a splenectomy at UHS between January 2020 and April 2022 were selected. The hospital inpatient record (CHARTs), e-prescribing record (JAC) and GP record (CHIE) were used to evaluate if patients received appropriate antimicrobial prophylaxis and appropriate vaccinations as per national and local guidelines detailed below. For patients undergoing an elective splenectomy, the pneumococcal vaccine (Pneumovax) should be given at least two weeks prior to surgery (2, 5). If this is not possible, and in emergency scenarios, patients should be given Pneumovax, the meningococcal ACWY vaccine (Menveo) and the meningococcal group B vaccine (Bexsero) two weeks post-surgery. A second dose of Bexsero should be given one month after this. Patients should have a booster dose of Pneumovax every five years and the Influenza vaccine yearly. Patients should receive intravenous benzylpenicillin or clarithromycin twice a day until the patient can take oral medication. This can be switched to phenoxymethylpenicillin twice a day or erythromycin twice a day. This should continue for two years or lifelong if they are in the ‘at risk’ group which includes; over 50 years old or under 16 years old, history of previous invasive pneumococcal disease and patients previously treated for haematological malignancy. Results 88 patients underwent a splenectomy between January 2020 and April 2022. 3% of patients had emergency surgery; the rest were elective cases. Indications for splenectomy included pancreatic cancer, intraductal papillary mucinous neoplasm (IPMN), splenic B cell lymphoma, pancreatitis, gastric varices, metastatic ovarian cancer and metastatic renal carcinoma. 21% of patients did not receive Pneumovax and 22% of patients did not receive Bexsero two weeks post-surgery. 23% of patients did not receive ACWY and 34% of patients did not receive the second dose of Bexsero 4 weeks post discharge. 30% of patients did not receive their yearly Influenza vaccination. Overall, 21% of patients received no vaccinations. 1% of patients did not receive prophylactic antibiotics on discharge. 39% of patients’ discharge paperwork did not have appropriate documentation about when vaccinations needed to be administered. Conclusions Compliance rates of vaccinations and antimicrobial prophylaxis should be 100% to prevent overwhelming post splenectomy infection. Data collection on patients who do not have a CHIE record proved difficult. While collecting data, it was noted that there has been guideline change between 2020 and 2021; In 2020, the ACWY vaccination was recommended to be administered 4 weeks post splenectomy. In 2021, this changed to 2 weeks later. In 2021, the requirement for the Hib vaccination was removed. A recurring issue during the audit process was a lack of documentation in patient discharge summaries. Whilst there are a proportion of patients who have not received their post-splenectomy vaccinations, it is reassuring to note that none of these patients had subsequent admissions to hospital with overwhelming infections based on their CHARTs records. We have created a proforma that can be brought up on CHARTs during follow up appointments for documentation of compliance with vaccinations. GPs can be easily contacted about missing vaccinations. We also recommended that all discharge paperwork have clear documentation of when vaccinations should be administered and that a re-audit should be done in 2023.

Mandatory vaccination requirements and the green Covid-19 certificate: a fundamental rights perspective in Italy

Since the Covid-19 pandemic outbreak in March 2020, governments worldwide have resorted to various measures to manage and contain the spread of the virus. In Italy, for example, severe restrictions on freedom of movement were enforced from the very beginning, and they lasted until the vaccination campaign picked up in Spring 2021. At that point, the executive started to lift the most severe measures progressively, and, at the same time, it began to use other legal instruments. For instance, besides progressively enforcing a compulsory vaccination requirement for some categories of people only, the executive introduced a novelty in the Italian legal system: the Green Covid-19 Certificate (or ‘Green Pass’), which not only became a condition to access venues and make use of services, but it also became a condition for the enjoyment or exercise of fundamental rights, including the rights to education and work. The aim of this paper is to assess the Italian Government’s decisions through the lenses of liberal democratic constitutionalism, reflecting upon the balance that was struck between public health and individual fundamental rights. This kind of assessment is especially important in times of emergency, as they are typically defined by fast-tracked and temporary decisions which may, nevertheless, “inadvertently” become embedded in the constitutional legal order.

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs).

Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance. We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar's funnel plot and Egger's test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282). Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%-97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%-99.0%) and among mothers, it was 94.4% (95% CI:90.8%-97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine's requirement for multiple injections, and poor level of awareness. Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

MICROBIOLOGICAL CONTROL OF WATER QUALITY FOR THE PRODUCTION OF BIOLOGICAL PRODUCTS

One of the main requirements for the new vaccines being created is their safety in use, including their sterility, the index of hydrogen ions and the content of bacterial endotoxins (BE), which are among the main indicators of quality and safety. Compliance of these parameters to the standards of the GF RK is directly related to the quality of water used in the production line. This article presents the results of work on determining one of the main safety parameters of biological products, such as sterility, bacterial endotoxin content and hydrogen ion index.The sterility of the biological product was determined by filtration with subsequent inoculation on specific bacterial culture media. As a result, it was found that the samples of purified and injected water are free of extraneous microflora, colony growth was not observed for 5-7 days. Abundant colony growth on bacterial nutrient media is observed in tap and wastewater samples, which confirms the presence of coprophytic microorganisms. A LAL test was used to determine bacterial endotoxins. As a result of the work carried out to determine the content of BE, it was found that in samples of purified and injection water, the concentration of BE is 0.15 IU/ml, while the concentration of BE in wastewater samples is 15 IU/ml, and in tap water 1.5 IU/ml, which also does not exceed the norm. When studying the indicators of hydrogen ions in the tested samples, the pH value of injection water is 7.16, purified water – 6.84, tap water – 7.93, wastewater - 7.03. The obtained indicators indicate that the microbiological parameters of the tested water samples comply with the norms and requirements of the GF RK.

Modeling vaccination and control strategies for outbreaks of monkeypox at gatherings.

The monkeypox outbreak in non-endemic countries in recent months has led the World Health Organization (WHO) to declare a public health emergency of international concern (PHEIC). It is thought that festivals, parties, and other gatherings may have contributed to the outbreak. We considered a hypothetical metropolitan city and modeled the transmission of the monkeypox virus in humans in a high-risk group (HRG) and a low-risk group (LRG) using a Susceptible-Exposed-Infectious-Recovered (SEIR) model and incorporated gathering events. Model simulations assessed how the vaccination strategies combined with other public health measures can contribute to mitigating or halting outbreaks from mass gathering events. The risk of a monkeypox outbreak was high when mass gathering events occurred in the absence of public health control measures. However, the outbreaks were controlled by isolating cases and vaccinating their close contacts. Furthermore, contact tracing, vaccinating, and isolating close contacts, if they can be implemented, were more effective for the containment of monkeypox transmission during summer gatherings than a broad vaccination campaign among HRG, when accounting for the low vaccination coverage in the overall population, and the time needed for the development of the immune responses. Reducing the number of attendees and effective contacts during the gathering could also prevent a burgeoning outbreak, as could restricting attendance through vaccination requirements. Monkeypox outbreaks following mass gatherings can be made less likely with some restrictions on either the number and density of attendees in the gathering or vaccination requirements. The ring vaccination strategy inoculating close contacts of confirmed cases may not be enough to prevent potential outbreaks; however, mass gatherings can be rendered less risky if that strategy is combined with public health measures, including identifying and isolating cases and contact tracing. Compliance with the community and promotion of awareness are also indispensable to containing the outbreak.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Can You Spare 100 Days? The Allogeneic Hematopoietic Cell Transplant Caregiver Requirement

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for patients diagnosed with blood cancers (e.g., acute myeloid leukemia), and blood disorders (e.g., sickle cell disease). It is a resource intensive treatment that generally requires a long hospital stay and recovery period. Patients are often required to have a caregiver to proceed with alloHCT, and if continuous caregiver support is not available, alloHCT likely will not be a treatment option. Few studies have described caregiver requirements or looked at the effect of these requirements on access to alloHCT. To learn more about caregiver requirements and perspectives on those requirements, we conducted web-based focus groups with alloHCT social workers who worked with adult patients at United States (US) transplant centers (TCs) from May-July 2022. Web-based interviews with adult alloHCT recipients, caregivers of adult alloHCT recipients, and physicians/advanced practice professionals (APPs) will also be conducted. Twenty-two social workers from TCs across the US (Midwest [n=8]; West [n=5]; Northeast: [n=5]; South, [n=4]) and with varying alloHCT volumes (median: 97 alloHCTs performed per year [range: 25-487]). All of the social workers noted their TC required a caregiver to proceed to alloHCT. However, there was variation across TCs around the length of time a recipient was required to have a caregiver. Other variations included the distance/time needed to stay near the center post-alloHCT and COVID-19 vaccination requirements for patients/caregivers. The majority of participants noted variance among the transplant team in allowing exceptions for caregiver requirements. The majority of participants noted their TC either did not allow patients to hire caregivers from an agency or discouraged this practice; and if it was allowed, noted it rarely occurs due to the large cost. Some of the participants noted that the requirements were developed by quality or legal teams with input from the transplant team, but some of the participants did not know where the requirements originated. All participants noted it would be helpful to have a 'gold standard’ of requirements across TCs, though there was discussion about what these standards would include, and the importance of flexibility to account for different patient and TC needs. Participants noted the number of patients that do not proceed to an alloHCT due to lack of a caregiver is generally 1-2/year; one participant noted, "I do have worries that patients aren't being referred who don't have caregivers, and we just don't know about them and they're falling through the cracks.” Social workers were also asked to identify patient barriers to meeting the caregiver requirement; common barriers included patients feeling they did not have anyone to ask to be a caregiver, the need for housing/relocation close to the TC, and financial barriers. They also noted the impact of the COVID-19 pandemic (e.g., vaccination requirements of the TC or lodging options, and increased telework which allowed for more flexibility for caregivers). Finding a caregiver is one of many barriers patients face in getting to transplant. In analysis of the first of four populations interviewed in this study, social workers reported variation in caregiver requirements across TCs. This study focused on those who received a transplant, but further research is necessary to learn about barriers faced by patients who are unable to get to alloHCT. Results from this and the other cohorts will describe current practices and help inform the development of new programs at the National Marrow Donor Program/Be The Match focused on reducing caregiver-related barriers to alloHCT.