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Mahamadou D, Bara Abdoul-Aziz A, Mahaman Moustapha L, Hassane D, Adoum Fils S, Hamsatou B, Thomas Abraham G, Sahada M, Idrissa H, Ousmane S, Zaratou A, Abdoul Aziz G, Abdoulaye O, Eric A, Paul Eholié S. The resurgence of diphtheria in Zinder, Niger. Infect Dis Now 2024:104979. [PMID: 39313157 DOI: 10.1016/j.idnow.2024.104979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/15/2024] [Accepted: 09/18/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Diphtheria is a re-emerging bacterial disease in developing countries with low vaccination coverage. OBJECTIVES This is a descriptive cross-sectional study of diphtheria cases reported to the DRSP/Zinder from March 14, 2022 through June 26, 2023. METHODS It includes cases reported through epidemiological surveillance and data on patients hospitalized in the infectious and tropical diseases department of the Zinder National Hospital (SMIT). RESULTS A total of 32 patients were included in this study. The median age was 12 years [4-22 years]. Key symptoms included dysphagia and odynophagia (100 %), false membranes (84.4 %), fever (46.9 %), thrombocytopenia (39.3 %), cervical lymphadenopathy (37 %), respiratory distress (15.6 %), epistaxis (12.5 %), gingival bleeding (9.4 %), agitation (6.2 %) and paresis (3.1 %). Renal function was altered in 74 % of cases. Diagnostic confirmation was procured through culture on oropharyngeal swabs. Corynebacterium diphtheriae was isolated in 26.31 % (5/19) of cases. Patients were treated with macrolides and diphtheria antitoxin. The case fatality rate was 31.2 %. Poor prognostic factors included gingival bleeding (p = 0.0262), respiratory distress (p = 0.0374), and thrombocytopenia below 50,000 platelets/mm3 (p = 0.0020). CONCLUSION Diphtheria is a deadly re-emerging disease. The fight against this condition necessitates improved vaccination coverage.
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Affiliation(s)
- Doutchi Mahamadou
- Faculty of Medical Science André Salifou University, Zinder, Niger; Zinder National Hospital, Niger.
| | | | - Lamine Mahaman Moustapha
- Zinder National Hospital, Niger; Faculty of Sciences and Technology of André Salifou University, Zinder, Niger
| | - Diongolé Hassane
- Faculty of Medical Science André Salifou University, Zinder, Niger; Zinder National Hospital, Niger
| | | | | | | | - Moussa Sahada
- Faculty of Medical Science of Abdou Moumouni Niamey University, Niger
| | | | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire de Niamey, Niger
| | - Ali Zaratou
- Faculty of Medical Science of Abdou Moumouni Niamey University, Niger
| | | | | | - Adehossi Eric
- Faculty of Medical Science of Abdou Moumouni Niamey University, Niger
| | - Serge Paul Eholié
- Faculty of Medicine, University Felix Houphouet Boigny, Abidjan, Ivory Coast
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Winters M, Sochoń-Latuszek A, Nurzhynska A, Yoruk K, Kukuła K, Bahruddinov M, Kusek A, Kleszczewska D, Dzielska A, Maciejewski T, Mazur J, Melchinger H, Kinsman J, Kramarz P, Christie S, Omer SB. "Vaccinating your child during an emergency is more important than ever": a randomised controlled trial on message framing among Ukrainian refugees in Poland, 2023. Euro Surveill 2024; 29. [PMID: 39328159 DOI: 10.2807/1560-7917.es.2024.29.39.2400159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Abstract
BackgroundSince February 2022, the start of the full-scale war in Ukraine, millions of women and children have fled the country. Vaccination of refugee children is important to protect this vulnerable population from disease.AimWe investigate the determinants of vaccination intention in refugee mothers from Ukraine residing in Poland and test the effect of three message frames.MethodsParticipants were randomised into either a control group or one of three intervention groups encouraging vaccination using a specific frame: (i) trust in the Polish health system, (ii) ease of access to vaccination or (iii) risk aversion. Primary outcomes were intention to vaccinate a child in Poland and clicking on a vaccination scheduling link.ResultsThe study was completed by 1,910 Ukrainian refugee mothers. Compared with the control group, the risk aversion message significantly increased vaccination intention (adjusted odds ratio (AOR): 2.35, 95% confidence interval (CI): 1.25-4.42) and clicking on the vaccine scheduling link (AOR: 1.53, 95% CI: 1.12-2.09). Messages around trust and ease of access did not have an effect. Important determinants of vaccination intention were perceived importance of vaccination (AOR: 1.12 95% CI: 1.01-1.25) and trusting vaccination information official health institutes (AOR: 1.40 95% CI: 1.06-1.83) and social media (AOR: 2.09 95% CI: 1.33-3.27).DiscussionUsing a risk aversion frame highlighting the vulnerability to infection that refugees face resulted in increased vaccination intention and clicks on a vaccination scheduler. Health workers who interact with Ukrainian refugees could use this frame in their vaccination communication.
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Affiliation(s)
- Maike Winters
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | - Kseniia Yoruk
- UNICEF Refugee Response Office in Poland, Warsaw, Poland
| | | | | | | | | | - Anna Dzielska
- Institute of Mother and Child, Department of Child and Adolescent Health, Warsaw, Poland
| | - Tomasz Maciejewski
- Institute of Mother and Child, Clinic of Obstetrics and Gynaecology, Warsaw, Poland
| | - Joanna Mazur
- Collegium Medicum, University of Zielona Góra, Department of Humanization of HealthCare and Sexology, Collegium Medicum, Zielona Góra, Poland
| | - Hannah Melchinger
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, USA
| | - John Kinsman
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Sarah Christie
- Yale School of Public Health, Yale University, New Haven, USA
| | - Saad B Omer
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, USA
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Cherri Z, Lau K, Nellums LB, Himmels J, Deal A, McGuire E, Mounier-Jack S, Norredam M, Crawshaw A, Carter J, Seedat F, Clemente NS, Bouaddi O, Friedland JS, Edelstein M, Hargreaves S. The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis. J Travel Med 2024; 31:taae033. [PMID: 38423523 DOI: 10.1093/jtm/taae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. METHODS We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). FINDINGS Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% confidence interval (CI): 43.1-71.7%] I2 = 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2 = 99% vs HIT 93-95%) and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2 = 99% vs HIT 88-93%) and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2 = 99% vs HIT 83-94%), with high heterogeneity across studies. INTERPRETATION Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.
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Affiliation(s)
- Zeinab Cherri
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Karen Lau
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Lancet Migration European Regional Hub
| | - Laura B Nellums
- Faculty of Medicine and Heath Sciences, University of Nottingham, Nottingham, UK
| | - Jan Himmels
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma McGuire
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Alison Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Farah Seedat
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Nuria Sanchez Clemente
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Oumnia Bouaddi
- Lancet Migration European Regional Hub
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Jon S Friedland
- Institute for Infection and Immunity, St Georges, University of London, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Lancet Migration European Regional Hub
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McGranahan M, Augarde E, Schoenaker D, Duncan H, Mann S, Bick D, Boardman F, Oyebode O. Preconception health among migrant women in England: A cross-sectional analysis of maternity services data 2018-2019. J Migr Health 2024; 10:100250. [PMID: 39156886 PMCID: PMC11327935 DOI: 10.1016/j.jmh.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/17/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Background Perinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women. Methods This national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (n = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and probable non-migrants not in vulnerable situations (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20; and/or experiencing domestic abuse. Findings We identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (n = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06-2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity. Interpretation Inequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes. Funding Medical Research Council.
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Affiliation(s)
- Majel McGranahan
- University of Warwick Medical School, Medical School Building, Coventry CV4 7HL, UK
| | - Elizabeth Augarde
- Office for Health Improvement and Disparities (OHID), 39 Victoria Street, Westminster, London SW1H 0EU, UK
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Tremona Road SO16 6YD, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 6YD, Southampton, UK
| | - Helen Duncan
- Office for Health Improvement and Disparities (OHID), 39 Victoria Street, Westminster, London SW1H 0EU, UK
| | - Sue Mann
- NHS England and Improvement, Wellington House, London SE1 8UG, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Felicity Boardman
- University of Warwick Medical School, Medical School Building, Coventry CV4 7HL, UK
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ, UK
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Gleditsch RN, Hynek K, Hansen BT, Ofitserova TS, Winje BA, Skogheim TS. Childhood vaccination among Polish immigrants in Norway: a qualitative study. BMC Public Health 2024; 24:1978. [PMID: 39049037 PMCID: PMC11267864 DOI: 10.1186/s12889-024-19426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Confidence in childhood vaccination is high in Norway and the Norwegian Childhood Immunization Programme (NCIP) achieves high overall coverage rates. However, lower coverage has been observed for some immigrant groups, including Polish immigrants who represent the largest immigrant group in Norway. Anti-vaccine sentiments and increased refusal of mandatory childhood vaccination has been on the rise in Poland, but it is unknown whether such attitudes also apply to Polish immigrants in Norway, as they experience a different vaccination policy and perhaps also different attitudes to vaccines. This qualitative study aims to explore attitudes towards childhood vaccination in Norway among Polish immigrants. METHODS We interviewed 15 Polish parents living in Norway in 2022. We recruited the participants by purposive sampling and analyzed the interviews by reflexive thematic analysis. RESULTS Three themes were identified: views of childhood vaccination, vaccine hesitancy, and differences in childhood vaccination between Poland and Norway. Overall, the participants favored childhood vaccination and viewed most of the vaccines included in the NCIP as safe and reliable. Human papilloma virus, meningococcal and pneumococcal vaccines were declined by some of the parents. Comparisons of childhood vaccination in Poland and Norway was evident in many of the interviews, especially among parents whose children had received vaccines in both countries. The participants were well acquainted with the NCIP, favored voluntary childhood vaccination, and the majority expressed a high level of trust in Norwegian health authorities. CONCLUSIONS Polish immigrants to Norway generally expressed positive views about childhood vaccination. Non-vaccination was related to lack of knowledge and/or unfamiliarity with certain vaccines and not with anti-vaccine sentiments or conspiracy theories. The study highlights how parents' knowledge, in combination with norms and trends from both birth country and country of residence, influence parents' decision making about vaccination.
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Affiliation(s)
- Rebecca Nybru Gleditsch
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo NO-0213, Norway
- Fafo Institute for Labour and Social Research, PO Box 2947, Tøyen, Oslo NO-0608, Norway
| | - Kamila Hynek
- Verian, Lakkegata 23, Oslo, NO-0130, Norway
- Cluster for Health Services Research, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, N-0213, Norway
| | - Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo NO-0213, Norway.
| | - Trine Skogset Ofitserova
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo NO-0213, Norway
| | - Brita Askeland Winje
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo NO-0213, Norway
- Oslo Meteropolitan University, St. Olavs plass, PO Box 4, Oslo, NO-0130, Norway
| | - Thea Steen Skogheim
- Cluster for Health Services Research, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, N-0213, Norway
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Spreco A, Dahlström Ö, Nordvall D, Fagerström C, Blomqvist E, Gustafsson F, Andersson C, Sjödahl R, Eriksson O, Hinkula J, Schön T, Timpka T. Integrated Surveillance of Disparities in Vaccination Coverage and Morbidity during the COVID-19 Pandemic: A Cohort Study in Southeast Sweden. Vaccines (Basel) 2024; 12:763. [PMID: 39066401 PMCID: PMC11281347 DOI: 10.3390/vaccines12070763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to use the digital platform maintained by the local health service providers in Southeast Sweden for integrated monitoring of disparities in vaccination and morbidity during the COVID-19 pandemic. The monitoring was performed in the adult population of two counties (n = 657,926) between 1 February 2020 and 15 February 2022. The disparities monitored were relocated (internationally displaced), substance users, and suffering from a psychotic disorder. The outcomes monitored were COVID-19 vaccination, SARS-CoV-2 test results, and hospitalization with COVID-19. Relocated residents displayed an increased likelihood of remaining unvaccinated and a decreased likelihood of testing as well as increased risks of primary SARS-CoV-2 infection and hospitalization compared with the general population. Suffering from a major psychiatric disease was associated with an increased risk of remaining unvaccinated and an increased risk of hospitalization but a decreased risk of SARS-CoV-2 infection. From the digital monitoring, we concluded that the relocated minority received insufficient protection during the pandemic, suggesting the necessity for comprehensive promotion of overall social integration. Persons with major psychiatric diseases underused vaccination, while they benefitted from proactively provided testing, implying a need for active encouragement of vaccination. Further research is warranted on legal and ethical frameworks for digital monitoring in vaccination programs.
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Affiliation(s)
- Armin Spreco
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Örjan Dahlström
- Department of Behavioral Sciences and Learning, Linköping University, 58183 Linköping, Sweden;
| | - Dennis Nordvall
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | | | - Eva Blomqvist
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
| | - Fredrik Gustafsson
- Department of Electrical Engineering, Linköping University, 58183 Linköping, Sweden;
| | - Christer Andersson
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Rune Sjödahl
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Olle Eriksson
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | - Jorma Hinkula
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
- Department of Infectious Diseases, County of Östergötland and Kalmar, Linköping University, 58183 Linköping, Sweden
| | - Toomas Timpka
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
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7
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Reda S, Weishaar H, Akhter S, Karo B, Martínez J, Singh A, Jackson C. Health service providers' views on barriers and drivers to childhood vaccination of FDMN/Rohingya refugees: a qualitative study in Cox's Bazar, Bangladesh. Front Public Health 2024; 12:1359082. [PMID: 39045160 PMCID: PMC11265221 DOI: 10.3389/fpubh.2024.1359082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
Background Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting. Methods Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles. Findings Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration. Discussion For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.
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Affiliation(s)
- Sarah Reda
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Heide Weishaar
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sadika Akhter
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Basel Karo
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Jorge Martínez
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Aarti Singh
- World Health Organization Emergency Sub-Office, Cox's Bazar, Bangladesh
| | - Cath Jackson
- Valid Research Ltd, Wetherby, Leeds, United Kingdom
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8
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Yazdani Y, Pai P, Sayfi S, Mohammadi A, Perdes S, Spitzer D, Fabreau GE, Pottie K. Predictors of COVID-19 vaccine acceptability among refugees and other migrant populations: A systematic scoping review. PLoS One 2024; 19:e0292143. [PMID: 38968187 PMCID: PMC11226018 DOI: 10.1371/journal.pone.0292143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/18/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE This study aimed to map the existing literature to identify predictors of COVID-19 vaccine acceptability among refugees, immigrants, and other migrant populations. METHODS A systematic search of Medline, Embase, Scopus, APA PsycInfo and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted up to 31 January 2023 to identify the relevant English peer-reviewed observational studies. Two independent reviewers screened abstracts, selected studies, and extracted data. RESULTS We identified 34 cross-sectional studies, primarily conducted in high income countries (76%). Lower vaccine acceptance was associated with mistrust in the host countries' government and healthcare system, concerns about the safety and effectiveness of COVID-19 vaccines, limited knowledge of COVID-19 infection and vaccines, lower COVID-19 risk perception, and lower integration level in the host country. Female gender, younger age, lower education level, and being single were associated with lower vaccine acceptance in most studies. Additionally, sources of information about COVID-19 and vaccines and previous history of COVID-19 infection, also influence vaccine acceptance. Vaccine acceptability towards COVID-19 booster doses and various vaccine brands were not adequately studied. CONCLUSIONS Vaccine hesitancy and a lack of trust in COVID-19 vaccines have become significant public health concerns within migrant populations. These findings may help in providing information for current and future vaccine outreach strategies among migrant populations.
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Affiliation(s)
- Yasaman Yazdani
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Poojitha Pai
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shahab Sayfi
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, Canada
- Michael G. DeGroote Cochrane Canada and GRADE Centres, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arash Mohammadi
- Department of Family Medicine, Western University, London, Ontario, Canada
| | | | - Denise Spitzer
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Gabriel E. Fabreau
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Pottie
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Rubio Maturana C, Guerrero M, Casas Claramunt M, Ayala-Cortés SN, López V, Martínez-Vallejo P, Treviño B, Sulleiro E, Esperalba J, Rando A, Pou D, Aznar ML, Bosch-Nicolau P, Salvador F, Oliveira-Souto I, Molina I, Serre-Delcor N. Seroprevalence status of vaccine-preventable diseases in migrants living in shelter centers in Barcelona, Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00152-7. [PMID: 38902155 DOI: 10.1016/j.eimce.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Almost 281 million people were living in a foreign country in 2022, and more than 100 million were displaced because of war conflicts and human right violations. Vaccination coverage of infectious diseases in migrants from some disadvantaged settings could be lower than reception countries populations, consequently seroprevalence studies and better access to vaccination could contribute to reducing these differences. METHODS A descriptive retrospective cross-sectional study was conducted including migrants, living ≤5 years in the reception country and ≥16 years old, who requested a medical exam between January 1st, 2020 and January 31st, 2021. Seroprevalence assessment was performed, and vaccination was offered to those individuals without immunity to hepatitis B, hepatitis A, varicella, measles, mumps, and rubella. RESULTS A total of 315 migrants were attended during the study period. Immunity protection at arrival was 252/296 (85.1%) for measles, 274/295 (92.9%) for rubella, 257/296 (86.8%) for mumps, 264/295 (89.5%) for varicella, 267/313 (85.3%) for hepatitis A, and 104/300 (34.6%) for hepatitis B. The final immunity protection after full vaccination schedules was 278/296 (93.9%) for measles, 287/295 (97.3%) for rubella, 274/296 (92.6%) for mumps, 276/295 (93.6%) for varicella, 280/313 (89.5%) for hepatitis A, and 139/300 (46.3%) for hepatitis B. CONCLUSIONS The vaccination intervention has increased immunity rates for the studied diseases in the attended migrants in our center, however, such interventions should be maintained to reach local population immunization levels. Moreover, the collaboration between shelter and reference specialized health centers is fundamental to implement such vaccination programs.
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Affiliation(s)
- Carles Rubio Maturana
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain.
| | | | - Maria Casas Claramunt
- EAP d'Alcarràs, ICS Lleida, Spain; Centre Vacunacions Internacional Lleida, ICS Lleida, Spain
| | - Susana Nuria Ayala-Cortés
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Victoria López
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Patricia Martínez-Vallejo
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain
| | - Begoña Treviño
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ariadna Rando
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Univesitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Pou
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Luisa Aznar
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Oliveira-Souto
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Knights F, Carter J, Deal A, Crawshaw A, Bouaddi O, Sanchez-Clemente N, Seedat F, Vanderslott S, Eagan R, Holt DE, Ciftci Y, Orcutt M, Seale H, Severoni S, Hargreaves S. Strengthening life-course immunisation in migrant populations: access, equity, and inclusion. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100806. [PMID: 39119098 PMCID: PMC11306209 DOI: 10.1016/j.lanepe.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 08/10/2024]
Abstract
Adult and adolescent migrants worldwide, and those arriving in Europe, are an under-immunised group for routine vaccinations due to missed childhood vaccines and doses in their countries of origin, and their subsequent marginalisation from health and vaccination systems. Declining population-level coverage for routine vaccines across Europe, which has accelerated post-pandemic, places these and other under-immunised populations at even greater risk of vaccine-preventable diseases. However, despite clear guidelines around the importance of delivering 'catch-up' vaccination throughout the life-course, migrants are rarely effectively incorporated into routine vaccination programmes on arrival to Europe. These populations have subsequently been involved in outbreaks, including measles and diphtheria, and are missing opportunities to receive more recently introduced vaccines such as HPV to align them with European vaccine schedules. WHO's new Immunization Agenda 2030 places a renewed emphasis on equitable access to vaccine systems and integrating catch-up vaccination for missed vaccines and doses throughout the life-course. In addition, lessons learned and innovations from the COVID-19 pandemic merit further consideration in the design and delivery of more inclusive vaccination programmes. We describe current gaps in policy and practice around life-course vaccination in migrant populations, key factors that drive low vaccine uptake and coverage, and explore the benefits of participatory approaches to designing and delivering interventions with impacted communities, to define new strategies to advance vaccine equity across the Region.
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Affiliation(s)
- Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Alison Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Oumnia Bouaddi
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- The Lancet Migration European Regional Hub, UK
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Nuria Sanchez-Clemente
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Farah Seedat
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Sam Vanderslott
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Rachel Eagan
- The Vaccine Confidence Project, LSHTM, London, UK
| | | | - Yusuf Ciftci
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
| | - Miriam Orcutt
- The Health and Migration Programme, World Health Organization, Geneva, Switzerland
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Santino Severoni
- The Health and Migration Programme, World Health Organization, Geneva, Switzerland
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
- The Lancet Migration European Regional Hub, UK
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11
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Crawshaw AF, Goldsmith LP, Deal A, Carter J, Knights F, Seedat F, Lau K, Hayward SE, Yong J, Fyle D, Aspray N, Iwami M, Ciftci Y, Wurie F, Majeed A, Forster AS, Hargreaves S. Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study. BMC Med 2024; 22:186. [PMID: 38702767 PMCID: PMC11068568 DOI: 10.1186/s12916-024-03378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. METHODS The 'Vacc on Track' study (May 2021-September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. RESULTS Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. CONCLUSIONS Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Farah Seedat
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Karen Lau
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally E Hayward
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Joanna Yong
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Desiree Fyle
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Nathaniel Aspray
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Michiyo Iwami
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yusuf Ciftci
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Fatima Wurie
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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12
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Hashemi L, Ghasemi M, Bartley A, Fenaughty J, Pirouzi M, Grant C. Migration and infant immunization timeliness in New Zealand: Evidence from the Growing Up in New Zealand study. Vaccine 2024; 42:2229-2238. [PMID: 38472065 DOI: 10.1016/j.vaccine.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Migration has been recognized as an important determinant of child health outcomes including childhood vaccination status. This paper aims to examine the association between parental migration status and a less studied aspect of child immunization outcomes, namely timeliness, within the context of New Zealand (NZ), a country characterized by a substantial proportion of its resident population born overseas. Additionally, the study explored the impact of residential duration on children's immunization timeliness. METHODS The data was taken from a large, representative population-based cohort study in NZ (Growing Up in NZ study). A total of 6156 children and their parents, comprising 2241 foreign-born and 3915 NZ-born mothers and a sub-group of their partners were included in the analysis. The survey data was linked with the National Immunization Register dataset. Timely immunization was defined as receiving two vaccines at each scheduled vaccination point (at six-week, three-month, and five-month, totaling six doses of vaccines) within 30 days of their due date. We examined the associations between parental migration status, maternal residential duration, and child immunization timeliness while controlling for socio-economic variations. The results were presented as adjusted odds ratios (AORs) with 95 % confidence intervals (CIs). RESULTS The findings revealed that after adjustment for socioeconomic differences, children of foreign-born mothers exhibited higher odds of receiving all six studied vaccine doses on time compared to children of native-born mothers (AOR 1.51, 95 %CI:1.27-1.78). Similarly, having a foreign-born father was also significantly associated with timely completion of all six vaccine doses. Children of recent immigrants who had resided in the country for less than five years demonstrated higher odds of timely vaccination of all six vaccine doses compared to children of settled immigrants who had lived in the country for five or more years (AOR 1.65, 95 %CI: 1.25-2.19). CONCLUSION This study revealed a significant pattern in NZ where immigrants exhibited higher rates of timely immunization for their children compared to native-born parents. However, the findings also underscore the importance of providing support to settled immigrants, as their children experienced declines in timely vaccination rates compared to children of recent immigrants and even those born to NZ-born parents.
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Affiliation(s)
- Ladan Hashemi
- Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Maryam Ghasemi
- Faculty of Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand.
| | - Allen Bartley
- Faculty of Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand.
| | - John Fenaughty
- Faculty of Counselling, Human Services and Social Work, University of Auckland, Auckland, New Zealand.
| | - Maryam Pirouzi
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Cameron Grant
- Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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13
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Aghajafari F, Wall L, Weightman AM, Ness A, Lake D, Anupindi K, Moorthi G, Kuk B, Santana M, Coakley A. An exploration of COVID-19 vaccination models for newcomer refugees and immigrants in Calgary, Canada. Arch Public Health 2024; 82:33. [PMID: 38468290 DOI: 10.1186/s13690-024-01255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The World Health Organization stresses the need for tailored COVID-19 models of vaccination to meet the needs of diverse populations and ultimately reach high rates of vaccination. However, little evidence exists on how COVID-19 models of vaccination operated in the novel context of the pandemic, how vulnerable populations, such as refugees, experience COVID-19 vaccination systems in high-income countries, and what lessons may be learned from vaccination efforts with vulnerable populations. To address this gap, this study explored COVID-19 vaccine delivery models available to newcomer refugees and immigrants, and refugee experiences across different COVID-19 vaccine delivery models in Calgary, Canada, and surrounding area in 2021 and 2022, to understand the barriers, strengths, and strategies of models to support access to COVID-19 vaccination for newcomer refugees and immigrants. METHODS Researchers conducted structured interviews with Government Assisted Refugees (n = 39), and semi-structured interviews with Privately Sponsored Refugees (n = 6), private refugee sponsors (n = 3), and stakeholders involved in vaccination systems (n = 13) in 2022. Thematic analysis was conducted to draw out themes related to barriers, strengths, and strategies of vaccine delivery models and the intersections with patient experiences. RESULTS Newcomer refugee and immigrant focused vaccination models and strategies were explored. They demonstrated how partnerships between organizations, multi-pronged approaches, and culturally responsive services were crucial to navigate ongoing and emergent factors, such as vaccine hesitancy, mandates, and other determinants of under-vaccination. Many vaccination models presented through interviews were not specific to refugees and included immigrants, temporary residents, ethnocultural community members, and other vulnerable populations in their design. CONCLUSIONS Increasing COVID-19 vaccine uptake for newcomer refugees and immigrants, is complex and requires trust, ongoing information provision, and local partnerships to address ongoing and emerging factors. Three key policy implications were drawn. First, findings demonstrated the need for flexible funding to offer outreach, translation, cultural interpretation, and to meet the basic needs of patients prior to engaging in vaccinations. Second, the research showed that embedding culturally responsive strategies within services ensures community needs are met. Finally, collaborating with partners that reflect the diverse needs of communities is crucial for the success of any health efforts serving newcomers.
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Affiliation(s)
- Fariba Aghajafari
- Department of Family Medicine, University of Calgary, Calgary, Canada.
| | | | | | - Alyssa Ness
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, Canada
| | - Krishna Anupindi
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | | | - Bryan Kuk
- Habitus Consulting Collective, Calgary, Canada
| | - Maria Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Annalee Coakley
- Department of Family Medicine, University of Calgary, Calgary, Canada
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14
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Fong WLE, Nguyen VG, Burns R, Boukari Y, Beale S, Braithwaite I, Byrne TE, Geismar C, Fragaszy E, Hoskins S, Kovar J, Navaratnam AMD, Oskrochi Y, Patel P, Tweed S, Yavlinsky A, Hayward AC, Aldridge RW. The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study. J Migr Health 2024; 9:100218. [PMID: 38559897 PMCID: PMC10978526 DOI: 10.1016/j.jmh.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/11/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Migrants in the United Kingdom (UK) may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran mixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and mixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results Of 30,276 adults in the analyses, 26,492 (87.5 %) were UK-born and 3,784 (12.5 %) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95 % CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusion Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.
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Affiliation(s)
- Wing Lam Erica Fong
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Vincent G Nguyen
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Isobel Braithwaite
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Thomas E Byrne
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ellen Fragaszy
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Annalan MD Navaratnam
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London NW1 2DA, UK
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15
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Ouzounidou Z, Maltezou HC, Chrysoula K, Polysiou E, Christofilea O, Dounias G, Pavli A. Knowledge and attitudes of healthcare personnel about vaccination of migrant and refugee children and adolescents. J Migr Health 2024; 9:100219. [PMID: 39263377 PMCID: PMC11390178 DOI: 10.1016/j.jmh.2024.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 09/13/2024] Open
Abstract
Background The number of migrants to Greece has increased considerably the last decade. This study assessed the knowledge and attitudes of healthcare personnel (HCP) toward vaccination of newly-arrived children and adolescents in the Aegean islands, a major port of entry of migrants and refugees to Europe. Methods The study was conducted from September 2020 to January 2021. All (166) HCP employed in the public health sector of the Aegean islands were invited to participate. A structured questionnaire was used to collect demographic data and data about their knowledge and attitudes toward vaccinations for migrant and refugees. Results A total of 120 HCP participated (72 % response rate), including 54 (45 %) physicians, 43 nurses (35.8 %), and 23 health visitors (19.2 %). Sixty-seven (55.8 %) HCP were aware of the national vaccination guidelines. Health visitors had higher rates of knowledge about the national vaccination guidelines, compared with nurses and physicians (87% versus 44,2% and 51,9%; p-value-0.001). Overall, 73 (60.8 %) HCP were aware of vaccinations during the first examination upon arrival. Primary-healthcare physicians were more likely to be aware about the time of vaccine administration compared with hospital-based physicians (74 % versus 50 %; p-value = 0.006). Out of 120 HCP, 45 % knew that vaccination guidelines apply to all newly-arrived migrant and refugees and 65 % that vaccinations are free-of-charge. Overall, 67.5 % of participants supported no serology testing before vaccination, 21.8 % were against free-of-charge vaccinations, and 55 % recommended only priority vaccinations. Conclusions There is a need to increase HCP' awareness and knowledge through training programs and tailored protocols focusing on vaccinations for newly-arrived migrant and refugee children and adolescents in order to promote effective vaccination of this vulnerable population.
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Affiliation(s)
- Z Ouzounidou
- Regional Department of Public Health of Cyclades, Greece
| | - H C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - K Chrysoula
- School of Law, National Kapodistrian University of Athens, Greece
| | | | - O Christofilea
- Department of Public Policy, Public Health School, University of West Attica, Athens, Greece
| | - G Dounias
- Department of Public Policy, Public Health School, University of West Attica, Athens, Greece
| | - A Pavli
- Department of Travel Medicine, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece
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16
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Gogoi M, Martin CA, Bird PW, Wiselka MJ, Gardener J, Ellis K, Renals V, Lewszuk AJ, Hargreaves S, Pareek M. Risk of vaccine preventable diseases in UK migrants: A serosurvey and concordance analysis. J Migr Health 2024; 9:100217. [PMID: 38455071 PMCID: PMC10918253 DOI: 10.1016/j.jmh.2024.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/03/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Background Vaccine preventable diseases (VPDs) such as measles and rubella cause significant morbidity and mortality globally every year. The World Health Organization (WHO), reported vaccine coverage for both measles and rubella to be 71 % in 2019, indicating an immunity gap. Migrants in the EU/EEA may be at high risk of VPDs due to under-immunisation and poor living conditions. However, there are limited data on VPD seroprotection rates amongst migrants living in the United Kingdom (UK). Methods We conducted an exploratory cross-sectional serosurvey amongst a sample of adult migrants living in Leicester, UK to: (a) determine seroprotection rates for measles, varicella zoster, and rubella in this group; (b) identify risk factors associated with seronegativity and, (c) understand if self-reported vaccine or diseases history is an effective measure of seroprotection. Participants gave a blood sample and completed a questionnaire asking basic demographic details and vaccine and disease history for the three VPDs. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used logistic regression to establish predictors of seroprotection against these diseases. We examined the reliability of self-reported vaccination/disease history for prediction of seroprotection through a concordance analysis. Results 149 migrants were included in the analysis. Seroprotection rates were: varicella zoster 98 %, rubella 92.6 % and measles 89.3 %. Increasing age was associated with seroprotection (OR 1.07 95 % CI 1.01-1.13 for each year increase in age). Migrants from Africa and the Middle East (aOR 15.16 95 % CI 1.31 - 175.06) and South/East Asia and Pacific regions (aOR 15.43 95 %CI 2.38 - 100.00) are significantly more likely to be seroprotected against measles as compared to migrants from Europe and Central Asia. The proportions of migrants unsure about their vaccination and disease history combined were 53.0 % for measles; 57.7 % for rubella; 43.0 % for varicella. There was no agreement between self-reported vaccination/disease history and serostatus. Conclusion Our findings suggest lower levels of seroprotection against measles in migrants living in Leicester, UK, with younger migrants and those from Europe and Central Asia more likely to lack seroprotection. A high proportion of surveyed migrants were unaware of their vaccination/disease history and self-reported vaccine/disease was a poor predictor of seroprotection against VPDs which is important for clinical decision-making regarding catch-up vaccination in this population. Our results, although derived from a small sample, suggest that there may be gaps in seroimmunity for certain VPDs in particular migrant populations. These findings should inform future qualitative studies investigating barriers to vaccine uptake in migrants and population-level seroprevalence studies aimed at determining individualised risk profiles based on demographic and migration factors.
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Affiliation(s)
- Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, UK
- Development Centre for Population Health, University of Leicester, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, UK
- Development Centre for Population Health, University of Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Paul W. Bird
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin J. Wiselka
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Judi Gardener
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kate Ellis
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Valerie Renals
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam J. Lewszuk
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
- Development Centre for Population Health, University of Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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17
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Aghajafari F, Wall L, Weightman A, Ness A, Lake D, Anupindi K, Moorthi G, Kuk B, Santana M, Coakley A. COVID-19 Vaccinations, Trust, and Vaccination Decisions within the Refugee Community of Calgary, Canada. Vaccines (Basel) 2024; 12:177. [PMID: 38400160 PMCID: PMC10891815 DOI: 10.3390/vaccines12020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders.
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Affiliation(s)
- Fariba Aghajafari
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Laurent Wall
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Amanda Weightman
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Alyssa Ness
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, AB T2E 3K8, Canada
| | - Krishna Anupindi
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Gayatri Moorthi
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Bryan Kuk
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Maria Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Annalee Coakley
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Mosaic Refugee Health Clinic, Calgary, AB T2A 5H5, Canada
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Burns R, Wyke S, Eyre MT, Boukari Y, Sørensen TB, Tsang C, Campbell CNJ, Beale S, Zenner D, Hargreaves S, Campos-Matos I, Harron K, Aldridge RW. COVID-19 vaccination coverage for half a million non-EU migrants and refugees in England. Nat Hum Behav 2024; 8:288-299. [PMID: 38049560 PMCID: PMC10896718 DOI: 10.1038/s41562-023-01768-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
Despite evidence suggesting that some migrants are at risk of under-immunization and have experienced severe health inequities during the pandemic, data are limited on migrants' COVID-19 vaccine coverage globally. Here we linked data from non-European Union migrants and resettled refugees to the national COVID-19 vaccination dataset in England. We estimated patterns in second and third dose delays and overdue doses between 12 December 2020 and 20 April 2022 by age, visa type and ethnicity. Of the 465,470 linked records, 91.8% (427,073/465,470) of migrants received a second dose and 51.3% (238,721/465,470) received a third. Refugees had the highest risk of delayed second (adjusted odds ratio 1.66; 95% confidence interval 1.55-1.79) and third dose (1.55; 1.43-1.69). Black migrants were twice as likely to have a second dose delayed (2.37; 2.23-2.54) than white migrants, but this trend reversed for the third dose. Older migrants (>65 years) were four times less likely to have received their second or third dose compared with the general population in England aged >65 or older. Policymakers, researchers and practitioners should work to understand and address personal and structural barriers to vaccination for diverse migrant populations.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Sacha Wyke
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Max T Eyre
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Tina B Sørensen
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Camille Tsang
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Colin N J Campbell
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Infection and Population Health Department, Institute of Global Health, University College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace London, London, UK
| | - Ines Campos-Matos
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
- UK Health Security Agency, London, UK
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
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19
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Contoli B, Tosti ME, Asta F, Minardi V, Marchetti G, Casigliani V, Scarso S, Declich S, Masocco M. Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems. Vaccines (Basel) 2024; 12:124. [PMID: 38400108 PMCID: PMC10893094 DOI: 10.3390/vaccines12020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.
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Affiliation(s)
- Benedetta Contoli
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Federica Asta
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Valentina Minardi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Giulia Marchetti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Salvatore Scarso
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
- Department of Public Health and Infectious Diseases, Sapienza Università di Roma, 00185 Rome, Italy
| | - Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Maria Masocco
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
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20
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Chitre SD, Crews CM, Tessema MT, Plėštytė-Būtienė I, Coffee M, Richardson ET. The impact of anthropogenic climate change on pediatric viral diseases. Pediatr Res 2024; 95:496-507. [PMID: 38057578 PMCID: PMC10872406 DOI: 10.1038/s41390-023-02929-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.
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Affiliation(s)
- Smit D Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Cecilia M Crews
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mesfin Teklu Tessema
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
- International Rescue Committee, New York, NY, USA.
| | | | - Megan Coffee
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- International Rescue Committee, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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21
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Nomah DK, Díaz Y, Bruguera A, Moreno-Fornés S, Aceiton J, Reyes-Urueña J, Llibre JM, Falcó V, Imaz A, Fanjul FJ, Peraire J, Deig E, Domingo P, Inciarte A, Casabona J, Miró JM. Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis. Open Forum Infect Dis 2024; 11:ofad693. [PMID: 38221982 PMCID: PMC10785217 DOI: 10.1093/ofid/ofad693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors. Methods Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression. Results The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants. Conclusions MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.
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Affiliation(s)
- Daniel K Nomah
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
| | - Yesika Díaz
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Andreu Bruguera
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Moreno-Fornés
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Jordi Aceiton
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
| | - Juliana Reyes-Urueña
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
| | - Josep M Llibre
- Fight Against Infections Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicenç Falcó
- Infectious Disease Division, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, L’Hospitalet de Llobregat, Spain
| | | | - Joaquim Peraire
- Hospital Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Deig
- Infectious Diseases Unit, Hospital General de Granollers, Granollers, Spain
| | - Pere Domingo
- Department of Infectious Diseases, HIV Infection Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alexy Inciarte
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José M Miró
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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22
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Picchio CA, Nomah DK, Rando-Segura A, Buti M, Lens S, Forns X, Tajes SR, Fernández E, Pamplona Portero J, Nuñez CL, van Selm L, MacKinnon M, Araujo SG, Martró E, Rodríguez-Frías F, Lazarus JV. Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain. COMMUNICATIONS MEDICINE 2023; 3:182. [PMID: 38097770 PMCID: PMC10721926 DOI: 10.1038/s43856-023-00420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain. METHODS This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed. RESULTS In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days. CONCLUSIONS This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.
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Affiliation(s)
- Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Daniel K Nomah
- Center for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
| | - Ariadna Rando-Segura
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Maria Buti
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Hospital Campus, Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sabela Lens
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sergio Rodriguez Tajes
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Emma Fernández
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marina MacKinnon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Silvia G Araujo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord (LCMN), Hospital Universitario Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Instituto Carlos III, Madrid, Spain
| | - Francisco Rodríguez-Frías
- Liver Pathology Unit, Biochemistry and Microbiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
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Rothoeft T, Brinkmann F, Maier C, Selzer D, Dings C, Kuehn A, Möhler E, Grote H, Nonnenmacher A, Wenning M, Zemlin M, Richter U, Lehr T, Lücke T. Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1890. [PMID: 38136092 PMCID: PMC10742286 DOI: 10.3390/children10121890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.
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Affiliation(s)
- Tobias Rothoeft
- University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (F.B.); (C.M.); (H.G.); (T.L.)
| | - Folke Brinkmann
- University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (F.B.); (C.M.); (H.G.); (T.L.)
- University Children’s Hospital, 23562 Lübeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Christoph Maier
- University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (F.B.); (C.M.); (H.G.); (T.L.)
| | - Dominik Selzer
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany; (D.S.); (C.D.); (A.K.); (T.L.)
| | - Christiane Dings
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany; (D.S.); (C.D.); (A.K.); (T.L.)
| | - Anna Kuehn
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany; (D.S.); (C.D.); (A.K.); (T.L.)
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany;
| | - Hanna Grote
- University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (F.B.); (C.M.); (H.G.); (T.L.)
| | - Alexandra Nonnenmacher
- School of Education and Psychology, Siegen University, 57076 Siegen, Germany; (A.N.); (U.R.)
| | - Markus Wenning
- Medical Association, Westfalen-Lippe, 48151 Münster, Germany;
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Hospital, 66421 Homburg, Germany;
| | - Ulf Richter
- School of Education and Psychology, Siegen University, 57076 Siegen, Germany; (A.N.); (U.R.)
| | - Thorsten Lehr
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany; (D.S.); (C.D.); (A.K.); (T.L.)
| | - Thomas Lücke
- University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (F.B.); (C.M.); (H.G.); (T.L.)
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Nasiri A, Farshidi H, Rezaei F, Dehdari T, Kazemi A, Rezapour H, Goshtaei M. Perceived barriers of migrants and refugees to vaccinate their children against Measles and polio: a study in Iran. Int J Equity Health 2023; 22:253. [PMID: 38057773 DOI: 10.1186/s12939-023-02075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study examined the perceived barriers of migrants and refugees to vaccinating their children against measles and polio in Iran. METHODS First, an instrument was developed and validated through several steps. Next, 1,067 parents who had not vaccinated their children against polio and measles or had delayed receiving any dose of these two vaccines until the age of 15 were selected from 16 provinces and completed the instrument. Finally, the data were analyzed. RESULTS The results of the explanatory factor analysis showed that the perceived barriers affecting vaccination against polio and measles vaccines were categorized into five factors: low knowledge, negative attitude, communication challenges, lack of participation in vaccination programs, and problems related to migration and refugees. Additionally, the results indicated a significant difference in the mean score of perceived barriers based on participants' level of education, economic status, and nationality. CONCLUSION The identified barriers may provide a perspective for developing effective efforts in this area. Interventions should focus on parents with low education and poor economic status.
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Affiliation(s)
- Amir Nasiri
- Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Farshidi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Rezaei
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Tahereh Dehdari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Afrouzeh Kazemi
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Hamid Rezapour
- Health Education and Promotion Department, Deputy of Public Health, MOHME, Tehran, Iran
| | - Massomeh Goshtaei
- Health Education and Promotion Department, Deputy of Public Health, Iran University of Medical Sciences, Tehran, Iran
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25
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Cacciani L, Cesaroni G, Calandrini E, Davoli M, Agabiti N. Covid-19 vaccination among migrants in Rome, Italy. Sci Rep 2023; 13:20890. [PMID: 38017018 PMCID: PMC10684578 DOI: 10.1038/s41598-023-48273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
Migrants may be susceptible to vaccine barriers and hesitancy. We evaluated the association between migrant status, as measured by the citizenship from a High Migratory Pressure Country (HMPC), and COVID-19 vaccination uptake in the resident population in Rome, Italy. We also investigated sex differences. We followed participants for vaccination against COVID-19 in 2021. We calculated crude- and adjusted-vaccination rates and Cox hazard ratios of vaccination for migrants compared to Italians. Among migrants from HMPCs, we estimated HRs for females compared to males, stratifying by geographical area of origin. Models were adjusted for age and deprivation index and stratified by infection history. In 2021, among 1,731,832 18-64-year-olds, migrants were 55% less likely to uptake at least one COVID-19 vaccine dose than their Italian counterpart. Past SARS-CoV-2 infection reduced the difference between migrants and Italians to 27%. Among migrants from HMPCs, we observed a slight excess of vaccination uptake among females compared to males. Focusing on geographical areas, we observed that only females from central-western Asia were 9% less likely to uptake vaccination than males. Health communication strategies oriented to migrants and considering their different languages, cultures, and health literacy should be adopted for prevention before emergencies.
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Affiliation(s)
- Laura Cacciani
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy.
| | - Giulia Cesaroni
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Enrico Calandrini
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of the Regional Health Service of Lazio, Asl Roma 1, Rome, Italy
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26
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Klapproth H, Klapproth L, Ruegamer T, Uhl F, Jantsch J, Fabri M. [Bacterial infections of the skin in the context of climate change and migration]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:851-857. [PMID: 37812206 DOI: 10.1007/s00105-023-05231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND In the context of climate change and migration, both common and previously less common pathogens are gaining importance as cutaneous bacterial infections. OBJECTIVE To inform medical professionals about challenges to dermatology posed by climate change and migration. MATERIALS AND METHODS Review of the current literature on emerging antimicrobial resistance and emerging pathogens in general and on the epidemiological situation in Germany in particular. RESULTS Climate change has a direct impact on microbiological ecosystems in Germany's warming coastal waters leading to an increase of marine V. vulnificus counts and human infections. Secondary to global warming, transmitting vectors of, for example, Lyme disease, rickettsioses and tularemia are also increasing. In addition, infectious diseases like cutaneous diphtheria and mycobacteriosis have been diagnosed in migrants, mostly likely acquired before migration or on the migration route and first diagnosed in Germany. In this context, antimicrobial resistance (e.g. methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant gram-negative bacteria) is gaining importance. CONCLUSION Due to progressive changes in global climate and ongoing migration, the aforementioned pathogens of infectious skin diseases and changes in antimicrobial resistance patterns have to be expected. Physicians should be aware of these developments in order to offer appropriate diagnostics and treatment. Epidemiological and biogeographic monitoring will be indispensable for managing emerging changes.
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Affiliation(s)
- Henning Klapproth
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland.
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Laurenz Klapproth
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Tamara Ruegamer
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
| | - Florian Uhl
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Jonathan Jantsch
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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27
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Wurie FB, Zhang C, Ciftci Y, Hurley C, Campos-Matos I. What NHS services are migrants entitled to? BMJ 2023; 382:1875. [PMID: 37775128 DOI: 10.1136/bmj.p1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Fatima B Wurie
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care
- Institute of Health Informatics, University College London
| | - Claire Zhang
- Institute of Health Informatics, University College London
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford
| | | | - Cherstyn Hurley
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency
| | - Ines Campos-Matos
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care
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28
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Naranjo L, Williams Y, Levy J, Obando R, González JA, Pachar M, Chen R, Franco-Paredes C, Higuita NA, Henao-Martínez A, Diaz Y, Suárez JA. The Endless Vulnerability of Migrant Children In-Transit across the Darién Gap. Am J Trop Med Hyg 2023; 109:515-519. [PMID: 37487560 PMCID: PMC10484268 DOI: 10.4269/ajtmh.22-0765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/22/2023] [Indexed: 07/26/2023] Open
Abstract
Many people from poverty-stricken countries are migrating across South and Central America to reach the México-United States border, a movement exacerbated by the COVID-19 pandemic. Migrant people who begin their northbound journey in South America must transit across a significant geographic bottleneck, the Darién Gap, a mountainous rainforest region between Colombia and Panama. Most migrant people crossing this region originate from Cuba, Haiti, and Venezuela. Other people reach the shores of South American countries from west and central Africa or central and southeastern Asia and continue to the Darién Gap. Poverty and violence drive families with children to flee their homes and endure incalculable risks in their path. Children traveling with their families or as unaccompanied minors across the Darién Gap are exposed to life-threatening situations and human rights violations, including abuse, exploitation, malnourishment, and limited access to medical care. In addition to experiencing untreated medical illnesses, children experience mental health disorders during migration and after they reach their destination as a result of victimization and adverse traumatic experiences. Therefore, providing migrants, especially children, with rapid medical screenings and mental health support when they arrive at their destination is critical to reduce health inequities. Furthermore, making these interventions available during their transit and ensuring their safety may prevent further human rights abuses in children and families. Latin American governments must address the ongoing humanitarian crisis endured by migrants throughout their migratory path by offering access to essential healthcare services and safeguarding the rights and security of children and vulnerable groups.
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Affiliation(s)
- Laura Naranjo
- GlaxoSmithKline Vaccines CARICAM, Panama City, Republic of Panama
- Sistema Nacional de Investigación, SNI-Senacyt, Panama City, Republic of Panama
| | - Yesenia Williams
- Hospital de Niños José Renán Esquivel, Panama City, Republic of Panama
| | - Jacqueline Levy
- Hospital de Niños José Renán Esquivel, Panama City, Republic of Panama
| | - Rosela Obando
- Caja del Seguro Social, Panama City, Republic of Panama
| | - José A. González
- Hospital Irma De Lourdes Tzanetato, Panama City, Republic of Panama
| | - Mónica Pachar
- Hospital Santo Tomás, Panama City, Republic of Panama
- Hospital Oncológico, Panama City, Republic of Panama
| | - Roderick Chen
- Instituto Conmemorativo Gorgas, Panama City, Republic of Panama
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, Mexico DF, Mexico
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Nelson Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrés Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Yamilka Diaz
- Instituto Conmemorativo Gorgas, Panama City, Republic of Panama
| | - José A. Suárez
- Sistema Nacional de Investigación, SNI-Senacyt, Panama City, Republic of Panama
- Facultad de Ciencias Exactas, Universidad de Panama, Panama City, Republic of Panama
- Facultad de Ciencias de la salud, Uisek, Ecuador
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Sana S, Fabbro E, Zovi A, Vitiello A, Ola-Ajayi T, Zahoui Z, Salami B, Sabbatucci M. Scoping Review on Barriers and Challenges to Pediatric Immunization Uptake among Migrants: Health Inequalities in Italy, 2003 to Mid-2023. Vaccines (Basel) 2023; 11:1417. [PMID: 37766094 PMCID: PMC10537267 DOI: 10.3390/vaccines11091417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
In the aftermath of the COVID-19 pandemic, asylum seekers, refugees, and foreign-born migrants are more likely to suffer from physical, mental, and socioeconomic consequences owing to their existing vulnerabilities and worsening conditions in refugee camps around the world. In this scenario, the education of migrants and newcomers about immunization is critical to achieving health equity worldwide. Globally, it is unclear whether government vaccination policies are prioritizing the health information needs of migrants. We searched for studies investigating the vaccination uptake of migrant children settled in Italy that were published between January 2003 and 25 June 2023. Following Arksey and O'Malley's five-stage method for scoping reviews, all potentially relevant literature published in English was retrieved from SciSearch, Medline, and Embase. This search resulted in 88 research articles, 25 of which met our inclusion criteria. Our findings indicate unequal access to vaccination due to a lack of available information in the native language of the immigrants' country of origin, vaccine safety concerns or lack of awareness, logistical difficulties, and fear of legal consequences. The findings strongly encourage further government and political discourse to ensure migrants have fair, equitable, ethical, and timely access to essential medicines.
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Affiliation(s)
- Samina Sana
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; (S.S.); (T.O.-A.); (Z.Z.); (B.S.)
| | - Elisa Fabbro
- Internationalization Staff Unit, Institutional Services Area, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy
- Area Science Park, Padriciano, 99, 34149 Trieste, Italy
| | - Andrea Zovi
- Directorate General for Hygiene, Food Safety and Nutrition, Ministry of Health, Viale Giorgio Ribotta 5, 00144 Rome, Italy; (A.Z.)
| | - Antonio Vitiello
- Directorate General for Hygiene, Food Safety and Nutrition, Ministry of Health, Viale Giorgio Ribotta 5, 00144 Rome, Italy; (A.Z.)
| | - Toluwani Ola-Ajayi
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; (S.S.); (T.O.-A.); (Z.Z.); (B.S.)
| | - Ziad Zahoui
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; (S.S.); (T.O.-A.); (Z.Z.); (B.S.)
| | - Bukola Salami
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; (S.S.); (T.O.-A.); (Z.Z.); (B.S.)
- Directorate General for Health Prevention, Ministry of Health, Viale Giorgio Ribotta 5, 00144 Rome, Italy
| | - Michela Sabbatucci
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, AB T6G 1C9, Canada
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30
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Scarso S, Marchetti G, Russo ML, D’Angelo F, Tosti ME, Bellini A, De Marchi C, Ferrari C, Gatta A, Caminada S, Papaevgeniou N, Dalma N, Karnaki P, Marceca M, Declich S. Access to Vaccination for Newly Arrived Migrants: Developing a General Conceptual Framework for Understanding How to Improve Vaccination Coverage in European Countries. Int J Public Health 2023; 68:1605580. [PMID: 37609078 PMCID: PMC10440383 DOI: 10.3389/ijph.2023.1605580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Objectives: Access to vaccination for newly arrived migrants (NAMs) is a relevant concern that requires urgent attention in EU/EEA countries. This study aimed to develop a General Conceptual Framework (GCF) for understanding how to improve vaccination coverage for NAMs, by characterizing and critically analyzing system barriers and possible strategies to increase vaccination. Methods: A theoretical conceptualization of the GCF was hypothesized based on conceptual hubs in the immunization process. Barriers and solutions were identified through a non-systematic desktop literature review and qualitative research. The GCF guided the activities and facilitated the integration of results, thereby enriching the GCF with content. Results: The study explores the vaccination of NAMs and proposes strategies to overcome barriers in their vaccination process. It introduces a framework called GCF, which consists of five interconnected steps: entitlement, reachability, adherence, achievement, and evaluation of vaccination. The study also presents barriers and solutions identified through literature review and qualitative research, along with strategies to enhance professionals' knowledge, improve reachability, promote adherence, achieve vaccination coverage, and evaluate interventions. The study concludes by recommending strategies such as proximity, provider training, a migrant-sensitive approach, and data collection to improve vaccination outcomes for NAMs. Conclusion: Ensuring equitable access to healthcare services, including vaccination, is crucial not only from a humanitarian perspective but also for the overall public health of these countries.
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Affiliation(s)
- Salvatore Scarso
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Giulia Marchetti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Laura Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Franca D’Angelo
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Maria Elena Tosti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Arianna Bellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Caterina Ferrari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Nikoletta Papaevgeniou
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Nadia Dalma
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Pania Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Silvia Declich
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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Alimoradi Z, Sallam M, Jafari E, Potenza MN, Pakpour AH. Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis. Vaccine X 2023; 14:100308. [PMID: 37223070 PMCID: PMC10163798 DOI: 10.1016/j.jvacx.2023.100308] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/07/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Objectives Understanding COVID-19 vaccine hesitancy among migrant and refugee groups is critical for achieving vaccine equity. Therefore, we aimed to estimate the prevalence of COVID-19 vaccine acceptance among migrant and refugee populations. Methods A systematic review (PROSPERO: CRD42022333337) was conducted (December 2019-July 2022) using PubMed, Scopus, Web of Science, ProQuest and Google Scholar. Results Nineteen studies from 12 countries were included. The pooled estimated prevalence of COVID-19 vaccine willingness among migrant and refugee groups was 70% (19 studies, 95% CI: 62.3-77.4%, I2: 99.19%, τ2: 0.03). Female and male participants did not differ significantly with each other (p = 0.64). Although no individual variable contributed statistically significantly in multivariable meta-regression analysis, the multivariable model that considered methodological quality, mean age of participants, participant group and country of origin explained 67% of variance. Discussion Proportions of migrant/refugee groups receiving COVID-19 vaccinations approximated those observed among general populations. Additional studies are needed to examine factors relating to vaccine willingness to identify the most significant factors that may be targeted in interventions.
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Elahe Jafari
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and the Child Study Center and Wu Tsai Institute, Yale School of Medicine / Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Fernández-Sánchez H, Zahoui Z, Jones J, Marfo EA. Access, acceptability, and uptake of the COVID-19 vaccine among global migrants: A rapid review. PLoS One 2023; 18:e0287884. [PMID: 37390085 PMCID: PMC10313028 DOI: 10.1371/journal.pone.0287884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To conduct a rapid review and determine the acceptability, access, and uptake of the COVID-19 vaccine among global migrants. MATERIALS AND METHODS A rapid review was conducted May 2022 capturing data collected from April 2020 to May 2022. Eight databases were searched: PubMed, Ovid Medline, EMBase, CINAHL, SCOPUS, Google Scholar, LILACS, and the Web of Science. The keywords "migrants" AND COVID-19" AND "vaccine" were matched with terms in MeSH. Peer-reviewed articles in English, French, Portuguese, or French were included if they focused on COVID-19 immunization acceptability, access, or uptake among global migrants. Two independent reviewers selected and extracted data. Extracted data was synthesized in a table of key characteristics and summarized using descriptive statistics. RESULTS The search returned 1,186 articles. Ten articles met inclusion criteria. All authors reported data on the acceptability of the COVID-19 vaccine, two on access, and one on uptake. Eight articles used quantitative designs and two studies were qualitative. Overall, global migrants had low acceptability and uptake, and faced challenges in accessing the COVID-19 vaccine, including technological issues. CONCLUSIONS This rapid review provides a global overview of the access, acceptability, and uptake of the COVID-19 vaccine among global migrants. Recommendations for practice, policy, and future research to increase access, acceptability, and uptake of vaccinations are discussed.
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Affiliation(s)
- Higinio Fernández-Sánchez
- Research Department, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ziad Zahoui
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Jones
- Research Department, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Ahmed N, Ishtiak ASM, Rozars MFK, Bonna AS, Alam KMP, Hossan ME, Das R, Khan J, Mishu TZ, Afrin S, Sultana N, Rubel MRAM, Khan MAS, Kakoly NS. Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox's Bazar, Bangladesh. PLoS One 2023; 18:e0283881. [PMID: 37027452 PMCID: PMC10081790 DOI: 10.1371/journal.pone.0283881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Immunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed. METHODS A cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox's Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA). RESULTS Total 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41-6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32-15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45-9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34-10.27), and in makeshift settlements, father's employment (aOR: 2.33; 95%CI: 1.34-6.72), father's education (aOR: 3.00; 95%CI: 1.34-6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96-16.84) were significant determinants of good childhood immunization practice. CONCLUSION Health education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.
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Affiliation(s)
| | - A. S. M. Ishtiak
- National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | | | | | | | | | - Rajib Das
- North South University, Dhaka, Bangladesh
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Ayorinde A, Ghosh I, Ali I, Zahair I, Olarewaju O, Singh M, Meehan E, Anjorin SS, Rotheram S, Barr B, McCarthy N, Oyebode O. Health inequalities in infectious diseases: a systematic overview of reviews. BMJ Open 2023; 13:e067429. [PMID: 37015800 PMCID: PMC10083762 DOI: 10.1136/bmjopen-2022-067429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities. METHODS We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis. RESULTS We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews. CONCLUSION We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.
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Affiliation(s)
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ifra Ali
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Iram Zahair
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Olajumoke Olarewaju
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Megha Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Meehan
- School of Public Health and Prevention Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Suzanne Rotheram
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Noel McCarthy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
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Perry M, Cottrell S, Gravenor MB, Griffiths L. Determinants of Equity in Coverage of Measles-Containing Vaccines in Wales, UK, during the Elimination Era. Vaccines (Basel) 2023; 11:vaccines11030680. [PMID: 36992264 DOI: 10.3390/vaccines11030680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
In the context of the WHO’s measles and rubella elimination targets and European Immunization Agenda 2030, this large cross-sectional study aimed to identify inequalities in measles vaccination coverage in Wales, UK. The vaccination status of individuals aged 2 to 25 years of age, alive and resident in Wales as of 31 August 2021, was ascertained through linkage of the National Community Child Health Database and primary care data. A series of predictor variables were derived from five national datasets and all analysis was carried out in the Secure Anonymised Information Linkage Databank at Swansea University. In these 648,895 individuals, coverage of the first dose of measles-containing vaccine (due at 12–13 months of age) was 97.1%, and coverage of the second dose (due at 3 years and 4 months) in 4 to 25-year-olds was 93.8%. In multivariable analysis, excluding 0.7% with known refusal, the strongest association with being unvaccinated was birth order (families with six or more children) and being born outside of the UK. Living in a deprived area, being eligible for free school meals, a lower level of maternal education, and having a recorded language other than English or Welsh were also associated with lower coverage. Some of these factors may also be associated with refusal. This knowledge can be used to target future interventions and prioritise areas for catch up in a time of limited resource.
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Affiliation(s)
- Malorie Perry
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK
| | - Michael B Gravenor
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Lucy Griffiths
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea SA2 8PP, UK
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Khalid A, Babry JA, Vearey J, Zenner D. TURNING UP THE HEAT: A CONCEPTUAL MODEL FOR UNDERSTANDING THE MIGRATION AND HEALTH IN THE CONTEXT OF GLOBAL CLIMATE CHANGE. J Migr Health 2023; 7:100172. [PMID: 37034244 PMCID: PMC10074782 DOI: 10.1016/j.jmh.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
Background The triangular relationship between climate change-related events, patterns of human migration and their implications for health is an important yet understudied issue. To improve understanding of this complex relationship, a comprehensive, interdisciplinary conceptual model will be useful. This paper investigates relationships between these factors and considers their impacts for affected populations globally. Methods A desk review of key literature was undertaken. An open-ended questionnaire consisting of 11 items was designed focusing on three themes: predicting population migration by understanding key variables, health implications, and suggestions on policy and research. After using purposive sampling we selected nine experts, reflecting diverse regional and professional backgrounds directly related to our research focus area. All responses were thematically analysed and key themes from the survey were synthesised to construct the conceptual model focusing on describing the relationship between global climate change, migration and health implications and a second model focusing on actionable suggestions for organisations working in the field, academia and policymakers. Results Key themes which constitute our conceptual model included: a description of migrant populations perceived to be at risk; health characteristics associated with different migratory patterns; health implications for both migrants and host populations; the responsibilities of global and local governance actors; and social and structural determinants of health. Less prominent themes were aspects related to slow-onset migratory patterns, voluntary stay, and voluntary migration. Actionable suggestions include an interdisciplinary and innovative approach to study the phenomenon for academicians, preparedness and globalized training and awareness for field organisations and migrant inclusive and climate sensitive approach for policymakers. Conclusion Contrary to common narratives, participants framed the impacts of climate change-related events on migration patterns and their health implications as non-linear and indirect, comprising many interrelated individual, social, cultural, demographic, geographical, structural, and political determinants. An understanding of these interactions in various contexts is essential for risk reduction and preventative measures. The way forward broadly includes inclusive and equity-based health services, improved and faster administrative systems, less restrictive (im)migration policies, globally trained staff, efficient and accessible research, and improved emergency response capabilities. The focus should be to increase preventative and adaptation measures in the face of any environmental changes and respond efficiently to different phases of migration to aim for better "health for all and promote universal well-being" (WHO) (World Health Organization 1999).
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Ioannidou C, Galanis P, Voulgari-Kokota A, Dikalioti SK, Papachristidou S, Bozas E, Mentis A, Tsoumakas K, Pavlopoulou ID. Suboptimal Serologic Immunity Against Poliomyelitis Among New Migrant Children in Greece Calls for Organized Action. J Immigr Minor Health 2023; 25:96-103. [PMID: 35441972 DOI: 10.1007/s10903-022-01363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 01/10/2022] [Accepted: 03/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Migration-flows pose the risk of poliovirus reintroduction from endemic countries to Greece. This study aims to evaluate serologic-immunity/vaccination against poliomyelitis in newly-arriving migrant children. METHODS Demographic-immunisation data and blood-serum were obtained from migrants 1-14years-old, referred to a hospital-clinic in Athens-Greece within three months from arrival. Immunity to polioviruses-1-3 was determined by serum-neutralizing-antibodies(WHO guidelines). Titers ≥ 1:8 were considered positive. RESULTS From 9/2010 to 9/2013, 274 children(150 refugees/124 immigrants), mean age 7.1years-old, were enrolled. Only 57(20.8%) of them presented with vaccination-records. Children originated mainly from Asia(n = 198), Eastern Europe(n = 28), Middle East(n = 24) and Africa(n = 24) with 160(58.4%) from polio-endemic-countries(Afghanistan-112(40.8%), Pakistan-24(8.8%) and India-24(8.8%)). Seropositivity against polio-1-2&3 was 84.3%, 86.1% and 74.5%, respectively. Immigrants, had higher seroprotective rates against polioviruses-1-2&3 than refugees(polio-1:p = 0.002;polio-2:p = 0.004,polio-3:p < 0.001). Seronegativity to 1PVs-2PVs and all three polio serotypes was found in 37(13.5%),12 (4.4%), and 30 children(10.9%) respectively. Increasing number of vaccine-doses, and younger-age, were positively-associated with seropositivity. DISCUSSION A remarkable fraction of newly-arrived migrant-children were seronegative to one or more polioviruses.
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Affiliation(s)
- Christina Ioannidou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece
| | - Petros Galanis
- Department of Public Health Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, 11527, Goudi, Athens, Greece
| | - Androniki Voulgari-Kokota
- The National Polio- Enteroviruses Laboratory, Hellenic Pasteur Institute, 127 Vasilissis Sophias Ave, 11521, Athens, Greece
| | - Stavroula K Dikalioti
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece. .,Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece.
| | - Smaragda Papachristidou
- Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
| | - Evangelos Bozas
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece
| | - Andreas Mentis
- The National Polio- Enteroviruses Laboratory, Hellenic Pasteur Institute, 127 Vasilissis Sophias Ave, 11521, Athens, Greece
| | - Konstantinos Tsoumakas
- Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
| | - Ioanna D Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece.,Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi S, Knights F, Ciftci Y, Goldsmith LP, Vandrevala T, Forster AS, Hargreaves S. Codesigning an intervention to strengthen COVID-19 vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory qualitative study protocol. BMJ Open 2023; 13:e063462. [PMID: 36639215 PMCID: PMC9842599 DOI: 10.1136/bmjopen-2022-063462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Migrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration. METHODS AND ANALYSIS LISOLO MALAMU ('Good Talk') is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community-academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022. ETHICS AND DISSEMINATION Ethics approval was granted by the St George's University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum, Hackney Council for Voluntary Service, London, UK
| | | | | | - Sarah Nkembi
- Hackney Congolese Women Support Group, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | | | - Lucy Pollyanna Goldsmith
- Institute for Infection and Immunity and Population Health Research Institute, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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Torre C, Storer E. COVID-19 vaccines, mobility, and pandemic bureaucracies: Undocumented migrants' perspectives from Italy's Alpine border. J Migr Health 2023; 7:100189. [PMID: 37155498 PMCID: PMC10118066 DOI: 10.1016/j.jmh.2023.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023] Open
Abstract
While scholars have noted the deeply unequal effects of the pandemic containment, there has been limited attempt to map the socio-political lives of vaccination policies, particularly from the perspective of undocumented persons moving at state margins. This paper explores how undocumented migrants, who were predominantly male travellers attempting to cross Italy's Alpine borders, encountered Covid-19 vaccines and contemporary legislation. Based on ethnographic observations and qualitative interviews with migrants, doctors, and activists at safehouses both on the Italian and French sides of the Alpine border, we trace how mobility centred decisions to accept or reject vaccines were significantly shaped by exclusionary border regimes. We move beyond the exceptional focus of the Covid-19 pandemic to show how centring visions of health connected to viral risk diverted attention from migrants' wider struggles to move to obtain safety. Ultimately, we argue for a recognition of how health crises are not merely unequally experienced, but may result in the reconfiguration of violent governance practices at state borders.
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Logie CH, Okumu M, Berry I, McAlpine A, Musoke DK, Hakiza R, Perez-Brumer A, Baral S, Kyambadde P. Multi-method findings on COVID-19 vaccine acceptability among urban refugee adolescents and youth in Kampala, Uganda. Glob Public Health 2023; 18:2185800. [PMID: 36883681 DOI: 10.1080/17441692.2023.2185800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACTScant studies have explored COVID-19 vaccine acceptability among refugees. However, contexts of forced migration may elevate COVID-19 vulnerabilities, and suboptimal refugee immunisation rates are reported for other vaccine-preventable diseases. We conducted a multi-methods study to describe COVID-19 vaccine acceptability among urban refugee youth in Kampala, Uganda. This study uses cross-sectional survey data from a cohort study with refugees aged 16-24 in Kampala to examine socio-demographic factors associated with vaccine acceptability. A purposively sampled cohort subset (n = 24) participated in semi-structured in-depth individual interviews, as did key informants (n = 6), to explore COVID-19 vaccine acceptance. Among 326 survey participants (mean age: 19.9; standard deviation 2.4; 50.0% cisgender women), vaccine acceptance was low (18.1% reported they were very likely to accept an effective COVID-19 vaccine). In multivariable models, vaccine acceptance likelihood was significantly associated with age and country of origin. Qualitative findings highlighted COVID-19 vaccine acceptability barriers and facilitators spanning social-ecological levels, including fear of side effects and mistrust (individual level), misinformed healthcare, community and family attitudes (community level), tailored COVID-19 services for refugees (organisational and practice setting), and political support for vaccines (policy environment). These data signal the urgent need to address social-ecological factors shaping COVID-19 vaccine acceptability among Kampala's young urban refugees.Trial registration: ClinicalTrials.gov identifier: NCT04631367.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,United Nations University Institute for Water, Environment & Health, Hamilton, Canada.,Centre for Gender & Sexual Health Equity, Vancouver, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda.,Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
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Debela MS, Garrett APN, Charania NA. Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand. Hum Vaccin Immunother 2022; 18:2131336. [PMID: 36315907 PMCID: PMC9746517 DOI: 10.1080/21645515.2022.2131336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach's alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents' primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents' concerns are required to reduce vaccine hesitancy and improve vaccine uptake.
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Affiliation(s)
- Mulisa Senbeta Debela
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A. P. Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nadia A. Charania
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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42
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Farmakioti E, Pylli M, Giannakou K. Access to Healthcare Services and Essential Medicines in GREEK Migrant Camps: an Online Cross-Sectional Study. J Immigr Minor Health 2022; 25:580-588. [PMID: 36401713 PMCID: PMC9676798 DOI: 10.1007/s10903-022-01425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
During the last years, Greece has become the entry point of a high number of migrants and asylum seekers. The aim of this study was to assess the access to selected fields of primary healthcare, to emergency medical care, secondary healthcare and essential medicines among populations living in reception, temporary accommodation, and detention centres (migrant camps) in Greece. An online cross-sectional survey was conducted based on a self-administered questionnaire. Participants included indviduals working or volunteering in migrant camps in Greece. 64 individuals participated in this study. The most common health problem among people residing in migrant camps was mental health conditions. The access to each field of primary healthcare was assessed as minimum to non-existent by most of the participants. 47.2% assessed the access to emergency medical care as minimum/non-satisfactory, while 60.8% assessed the access to secondary healthcare as minimum to non-existent. Most participants assessed the access to all the medicines categories as minimum or moderate. Access to both primary and secondary health was given a lower grade in the East-Aegean islands compared to the mainland. Major health inequalities among populations residing in Greek migrant camps were highlighted in this study. A change in the current migration policies of Greece and the European Union is urgently needed.
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Affiliation(s)
- Evangelia Farmakioti
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Magdalini Pylli
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
- HIV Surveillance Department, Hellenic National Public Health Organization, Marousi, Greece
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus.
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43
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Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Farah Y, Goldsmith LP, Wurie F, Ciftci Y, Majeed A, Hargreaves S. "We don't routinely check vaccination background in adults": a national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care. BMJ Open 2022; 12:e062894. [PMID: 36216433 PMCID: PMC9557795 DOI: 10.1136/bmjopen-2022-062894] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Explore primary care professionals' views around barriers/facilitators to catch-up vaccination in adult migrants (foreign-born; over 18 years of age) with incomplete/uncertain vaccination status and for routine vaccines to inform development of interventions to improve vaccine uptake and coverage. DESIGN Qualitative interview study with purposive sampling and thematic analysis. SETTING UK primary care. PARTICIPANTS 64 primary care professionals (PCPs): 48 clinical-staff including general practitioners, practice nurses and healthcare assistants; 16 administrative-staff including practice managers and receptionists (mean age 45 years; 84.4% women; a range of ethnicities). RESULTS Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters and not be aligned with the UK's vaccine schedule, from both personal and service-delivery levels, with themes including: lack of training and knowledge of guidance among staff; unclear or incomplete vaccine records; and lack of incentivisation (including financial) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. Where delivery models existed, they were diverse and fragmented, but included a combination of opportunistic and proactive programmes. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal, with specific nationality groups reported as more hesitant about specific vaccines, including measles, mumps and rubella (MMR). CONCLUSIONS WHO's new Immunization Agenda 2030 calls for greater focus to be placed on delivering vaccination across the life course, targeting underimmunised groups for catch-up vaccination at any age, and UK primary care services therefore have a key role. Vaccine uptake in adult migrants could be improved through implementing new financial incentives or inclusion of adult migrant vaccination targets in Quality Outcomes Framework, strengthening care pathways and training and working directly with local community-groups to improve understanding around the benefits of vaccination at all ages.
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Affiliation(s)
- Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- LSHTM, London, UK
| | - Alison F Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Yasmin Farah
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Lucy Pollyanna Goldsmith
- Infection and Immunity Research Institute, and Population Health Research Institute, St George's University of London, London, UK
| | | | | | - Azeem Majeed
- Primary Care, Imperial College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
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Elharake JA, Omer SB, Schwartz JL. Country immunization policies for refugees across 20 low-middle income and 20 high-income countries. Vaccine 2022; 40:6017-6022. [PMID: 36123257 DOI: 10.1016/j.vaccine.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
In 2020, 26 million refugees resettled in a new country-fleeing their homes due to conflict and persecution. Due to low immunization coverage and underlying health conditions, refugees commonly face an increased risk of contracting vaccine-preventable diseases. We collected and analyzed existing routine immunization policies for refugees across 20 low- and middle-income countries (LMICs) and 20 high-income countries (HICs), each with the highest number of refugees per 1000 residents. Primary and secondary data sources were used to collect policy evidence. Across 20 LMICs, 13 countries specified standing nationwide routine immunization policies for refugees, while 14 out of the 20 HICs included refugees in their national routine immunization programs. LMICs and HICs should include refugees in their national routine immunization policies and provide accessible and affordable immunizations. Such efforts would reduce vaccine-preventable diseases and protect the health of refugee populations-especially during the COVID-19 pandemic.
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Affiliation(s)
- Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT 06510, USA; Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, CT 06510, USA; Yale School of Nursing, Orange, CT 06477, USA; Yale School of Public Health, New Haven, CT 06510, USA
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45
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Kheirallah KA, Ababneh BF, Bendak H, Alsuwaidi AR, Elbarazi I. Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 Infection on Syrian Refugees in Jordan: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912588. [PMID: 36231888 PMCID: PMC9566814 DOI: 10.3390/ijerph191912588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 06/01/2023]
Abstract
Migrants and refugees are among the vulnerable populations that suffered disproportionately from the COVID-19 crisis. However, their experiences with COVID-19 positivity status have not been investigated. This study explored the physical, mental, and psychosocial impacts of a positive COVID-19 diagnosis on Syrian refugees living in Jordan. Using a qualitative approach, twenty phone interviews were conducted with ten adult Syrian refugees living within the camp and ten refugees living in non-camp (host community) settings in Jordan. Follow-up interviews with five health care providers at a refugee camp were conducted to explore the services and support provided to the refugees with COVID-19 infection. The findings were thematically analyzed and grouped into major themes, subthemes, and emerging themes. Refugees living within camp settings had better access to testing, healthcare, and disease management and did not experience fear of being deported. Refugees in both settings suffered mental and psychosocial health impacts, social isolation, fear of death, and disease complications. COVID-19 infection has negatively impacted refugees' well-being with noticeable disparities across the different living conditions. Refugees living within host community settings may need more support for managing their condition, accessibility to free testing, as well as treatment and healthcare services.
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Affiliation(s)
- Khalid A. Kheirallah
- Department of Public Health, Medical School of Jordan, University of Science and Technology, Irbid 22110, Jordan
| | - Bayan F. Ababneh
- Department of Public Health, Medical School of Jordan, University of Science and Technology, Irbid 22110, Jordan
| | - Heba Bendak
- Clinical Psychology Department, Swinburne University of Technology, Melbourne 3122, Australia
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine & Health Science, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine & Health Science, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
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46
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Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage. THE LANCET PUBLIC HEALTH 2022; 7:e876-e884. [DOI: 10.1016/s2468-2667(22)00174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
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47
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Tjaden J, Haarmann E, Savaskan N. Experimental evidence on improving COVID-19 vaccine outreach among migrant communities on social media. Sci Rep 2022; 12:16256. [PMID: 36171245 PMCID: PMC9518941 DOI: 10.1038/s41598-022-20340-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Studies from several countries suggest that COVID-19 vaccination rates are lower among migrants compared to the general population. Urgent calls have been made to improve vaccine outreach to migrants, however, there is limited evidence on effective approaches, especially using social media. We assessed a targeted, low-cost, Facebook campaign disseminating COVID-19 vaccine information among Arabic, Turkish and Russian speakers in Germany (N = 888,994). As part of the campaign, we conducted two randomized, online experiments to assess the impact of the advertisement (1) language and (2) depicted messenger (government authority, religious leader, doctor or family). Key outcomes included reach, click-through rates, conversion rates and cost-effectiveness. Within 29 days, the campaign reached 890 thousand Facebook users. On average, 2.3 individuals accessed the advertised COVID-19 vaccination appointment tool for every euro spent on the campaign. Migrants were 2.4 (Arabic), 1.8 (Russian) and 1.2 (Turkish) times more likely to click on advertisements translated to their native language compared to German-language advertisements. Furthermore, findings showed that government representatives can be more successful in engaging migrants online compared to other messengers, despite common claims of lower trust in government institutions among migrants. This study highlights the potential of tailored, and translated, vaccination campaigns on social media for reaching migrants who may be left out by traditional media campaigns.
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Affiliation(s)
- Jasper Tjaden
- Department of Economic and Social Sciences, University of Potsdam, Potsdam, Germany.
| | - Esther Haarmann
- International Organization for Migration, Global Migration Data Analysis Centre, Berlin, Germany
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48
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Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves S. Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. THE LANCET. INFECTIOUS DISEASES 2022; 22:e254-e266. [PMID: 35429463 DOI: 10.1101/2021.11.08.21266058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 05/18/2023]
Abstract
Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.
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Affiliation(s)
- Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yasmin Farah
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Fatima Wurie
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Helen Bedford
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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49
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Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves S. Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. THE LANCET. INFECTIOUS DISEASES 2022; 22:e254-e266. [PMID: 35429463 PMCID: PMC9007555 DOI: 10.1016/s1473-3099(22)00066-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.
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Affiliation(s)
- Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yasmin Farah
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Fatima Wurie
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK; UK Health Security Agency, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Helen Bedford
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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50
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Führer A, Pacolli L, Yilmaz-Aslan Y, Brzoska P. COVID-19 Vaccine Acceptance and Its Determinants among Migrants in Germany-Results of a Cross-Sectional Study. Vaccines (Basel) 2022; 10:1350. [PMID: 36016238 PMCID: PMC9413826 DOI: 10.3390/vaccines10081350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccinations are a core element of infection control. Migrants have been reported to have low vaccination rates for many infectious diseases, including COVID-19. Still, determinants of migrants' uptake of COVID-19 vaccinations are not sufficiently clear. The present study addresses this gap and examines the respective influence of three potential determinants: barriers to access, attitude towards vaccinations in general, and towards COVID-19 vaccines. The study uses a cross-sectional online survey among migrants in Germany. The questionnaire assessed the aforementioned determinants using standardized tools. Information on 204 individuals was available. The vaccination rate in the sample was 80%. Vaccinated as compared to unvaccinated respondents reported more often the absence of financial barriers (71% (95%CI: 64-73%) vs. 45% (95%CI: 28-63%)), short waiting times (51% (95%CI: 43-59%) vs. 22% (95%CI: 5-38%)), and the presence of a vaccination center close-by (91.5% (95%CI: 87-96%) vs. 69.7% (95%CI: 54-85%)). Concerning COVID-19 vaccine acceptance, the majority of respondents (68%) agreed that the vaccine is important. Unvaccinated respondents more often feared side effects, were convinced that the vaccine is not safe, and assumed that COVID-19 is not dangerous. Correspondingly, acceptance of vaccinations in general was higher among vaccinated respondents. In line with findings from previous studies, our survey found that all three determinants seem to influence migrants' vaccination status while their overall vaccination rate was comparable to the general population. Hence, migration background per se does not sufficiently explain vaccine acceptance and further research is needed to identify subgroups of migrants that should be specifically addressed to increase their vaccination rate.
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Affiliation(s)
- Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Latife Pacolli
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Yüce Yilmaz-Aslan
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Deptartment of Health Services Research and Nursing, Faculty of Health Sciences, Bielefeld University, 33615 Bielefeld, Germany
| | - Patrick Brzoska
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
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