Knowledge, attitudes and practices of caregivers regarding Japanese encephalitis in Shaanxi Province, China

Trends in temporal and spatial changes of Japanese encephalitis in Chinese mainland, 2004-2019: A population-based surveillance study

BACKGROUND

Japanese encephalitis (JE) is a serious health concern in China, with approximately 80 % of global infections occurring in China. To develop effective prevention and control strategies, this study explored the epidemiological characteristics of JE in China based on spatiotemporal data, to understand the patterns and trends of JE incidence in different regions and time periods.

METHOD

The incidence and mortality rates of JE were extracted from the Public Health Data Center, the official website of the National Health Commission of the People's Republic of China, and the National Notifiable Infectious Disease Surveillance System from 2004 to 2019. Joinpoint regression was applied to examine the spatiotemporal patterns and annual percentage change in incidence and mortality of the JE.

RESULTS

From 2004 to 2019, a total of 43,569 cases of JE were diagnosed, including 2081 deaths. The annual incidence rate of JE decreased from 0.4171/100,000 in 2004 to 0.0298/100,000 in 2019, with an annual percentage change (APC) of -13.5 % (P < 0.001). The annual mortality rate of JE showed three stages of change, with inflection points in 2006 and 2014. The incidence and mortality rates of JE have declined in all provinces of China, and more cases were reported in 0-14 years of age, accounting for nearly 80 % of all patients.

CONCLUSIONS

The morbidity and mortality rates of JE in China are generally on a downward trend, and emphasis should be placed on strengthening disease surveillance in special areas and populations, popularizing vaccination, and increasing publicity.

Contextual Pathways Linking Cumulative Experiences of Racial Discrimination to Black American Men's COVID Vaccine Hesitancy

The COVID-19 pandemic has revealed and widened racialized health disparities, underscoring the impact of structural inequities and racial discrimination on COVID-19 vaccination uptake. A sizable proportion of Black American men report that they either do not plan to or are unsure about becoming vaccinated against COVID-19. The present study investigated hypotheses regarding the mechanisms by which experiences of racial discrimination are associated with Black American men's COVID-19 vaccine hesitancy. Hypotheses were tested using structural equation modeling with 4 waves of data from 242 Black American men (aged ~ 27) living in resource-poor communities in the rural South. Study findings revealed that racial discrimination was indirectly associated with COVID-19 vaccine hesitancy via increased endorsement of COVID-19 conspiratorial beliefs. Findings also demonstrated that increased levels of ethnic identity strengthen the association between experiences of racial discrimination and COVID-19 conspiratorial beliefs. In contrast, increased levels of social support weakened the association between cumulative experiences of racial discrimination and COVID conspiratorial beliefs. Taken together, these results suggest that racial discrimination may promote conspiratorial beliefs which undermine Black American men's willingness to be vaccinated. Future interventions aimed towards promoting vaccine uptake among Black American men may benefit from the inclusion of targeted efforts to rebuild cultural trust and increase social support.

Bibliometric and visual analysis of vaccination hesitancy research from 2013 to 2022

Although vaccination is regarded as one of the most significant achievements of public health, there also exists the phenomenon of vaccination hesitancy which refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. In this study, we conducted a bibliometric analysis to provide a comprehensive overview of vaccination hesitancy research from 2013 to 2022. All related publications were retrieved from the Web of Science Core Collection Database. Information on annual publications, countries, organizations, journals, authors, keywords, and documents was analyzed adopting the bibliometix R-package, VOSviewer, and CiteSpace software. A total of 4042 publications were enrolled. The annual publications increased slightly before 2020 but had an extremely dramatic increase from 2020 to 2022. The United States contributed the most articles and had the greatest collaboration with other countries and organizations. The London School of Hygiene & Tropical Medicine was the most active institution. Vaccine was the most cited and influential journal while Vaccines was the most productive journal. It was Dube E who was the most productive authors with the highest h-index. The most frequent keywords were "vaccine hesitancy," "COVID-19," "SARS-CoV2," "immunization," "attitudes," and "willingness." Vaccination hesitancy to some extent hinders the achievement of global public health. The influencing factors vary across time, space, and vaccines. The COVID-19 pandemic and the development of COVID-19 vaccines have made this issue the focus of interest. The complexity and specific contexts of influencing factors of vaccination hesitancy require further study and will potentially be the focus of future research direction.

Identifying gaps in vaccination perception after mandating the COVID-19 vaccine in Saudi Arabia

OBJECTIVE

The burden of COVID-19 pandemic affected the globe, and it is unclear how it has impacted the general perception of other vaccines. We aimed to investigate the public awareness, knowledge, and attitude towards other complementary vaccines after the mandate of the COVID-19 vaccine.

METHODS

A cross-sectional study was conducted in Saudi Arabia using a survey distributed via several social media platforms in June 2022. The questionnaire had three main sections; awareness; attitudes; and demographic information. Descriptive analysis was mainly used and supplemented with Chi-square test for correlation. All individuals over the age of 18 were eligible to participate in the study.

RESULTS

A total of 1,045 participants from Saudi Arabia completed the survey. Of the respondents, 55.9% were female, and 95% were Saudi citizens. Public awareness towards vaccines after the mandate of COVID-19 vaccine was the highest with the influenza vaccine (98.2%), followed by human papillomavirus (HPV) (40.7%), tetanus, diphtheria, and pertussis (Tdap) (37.2%), and lastly, pneumococcal vaccine (17%). More than 50% of the participants expressed their willingness to receive any of the four vaccines if they knew about the benefits related to these vaccines.

CONCLUSION

The study showed that participants were willing to receive the vaccination if they were aware of the general benefits of vaccinations. Therefore, health education and campaigns toward recommended vaccines for high-risk group are essential and needed.

Socioeconomic Inequalities and Vaccine Uptake: An Umbrella Review Protocol

The effectiveness of immunization is widely accepted: it can successfully improve health outcomes by reducing the morbidity and mortality associated with vaccine-preventable diseases. In the era of pandemics, there is a pressing need to identify and understand the factors associated with vaccine uptake amongst different socioeconomic groups. The knowledge generated from research in this area can be used to inform effective interventions aimed at increasing uptake. This umbrella systematic review aims to determine whether there is an association between socioeconomic inequalities and rate of vaccine uptake globally. Specifically, the study aims to determine whether an individual's socioeconomic status, level of education, occupation, (un)-employment, or place of residence affects the uptake rate of routine vaccines. The following databases will be searched from 2011 to the present day: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane CENTRAL, Science Citation Index (Web of Science), DARE, SCOPUS (Elsevier), and ASSIA (ProQuest). Systematic reviews will be either included or excluded based on a priori established eligibility criteria. The relevant data will then be extracted, quality appraised, and narratively synthesised. The synthesis will be guided by the theoretical framework developed for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Equity extension (PRISMA-E) guidance will be followed. This protocol has been registered on PROSPERO, ID: CRD42022334223.

Mothers' Opinions on Vaccinations and Penal Responsibility for Vaccination Avoidance in Nine Selected European Countries: Findings from a Cross-Sectional Survey

Aim

Relations between penal responsibility and vaccination obligation can be essential for raising the vaccination rate. Social media play a vital role in distributing information. The attitude towards vaccination consists of many factors, including the criminal law situation in the field of vaccination in a given country. The aim of the study was to assess the impact of criminal law liability and other social factors such as age and education on mothers’ desire to vaccinate their children.

Methods

Survey target: mothers from nine European countries (Poland, Germany, Slovakia, France, Norway, Serbia, Romania, Greece, Italy). Response count: 2205. Questionnaire content: adjusted to country-specific legal regulations concerning vaccinations - considering whether vaccines are mandatory, recommended, additional, and how to cover costs. The way of dissemination of the questionnaire: general parental groups on Facebook.

Results

The respondents: Poles (30%), Italians, Germans, Slovaks, Greeks (10% each), Norwegians, Frenchwomen, Romanians, Serbians (5% each). The average respondent age: highest: Norway (38.14±10.08) and Italy (37.35±8.12), lowest: Slovakia (30.22±6.19). Respondents with higher, secondary, vocational, primary education represent 58%, 27%, 12%, 3%, respectively, of the group. Countries with above 90% rate of answers that they vaccinate their children: Greece, Norway, Slovakia, France. The lowest rate (55%) recorded for Romania. Sixty-seven percent aware of the existence of anti-vaccination movements. High rates were recorded for Norway (88%), Romania (82%), Poland (78%), Serbia (71%), Greece (67%), Germany (66%). The lowest rate for France (31%). Countries without vaccination at all (Germany, Norway, Romania, Greece), the rest of the countries mentioned above – have some mandatory, recommended and additional vaccinations.

Conclusion

In countries with mandatory vaccinations parents have their children vaccinated less willingly than in countries with voluntary vaccinations. The rising level of education and providing information about complications following infectious diseases appear to increase the vaccination rate.

Public Knowledge, Attitudes, and Practices toward Seasonal Influenza Vaccine in Saudi Arabia: A Cross-Sectional Study

Objectives: Increasing national influenza vaccination rates continues to be a challenge for Saudi Arabia. Therefore, the purpose of this study was to explore the Saudi public perceptions toward seasonal influenza vaccination and their association with the rate of vaccination. Methods: Individuals aged 15 years and older were surveyed about their knowledge, attitudes, and practices toward the seasonal influenza vaccine using a previously developed and validated 19-item online questionnaire. The impact of the participants’ perceptions toward the seasonal influenza vaccine on their past influenza vaccination history was assessed using multiple linear regressions. Results: The rate of regular vaccination among the 790 surveyed participants was 12.65%, and those who were aged <24 years had the highest rate (57%). The vast majority of the participants with chronic diseases (>90%) reported irregular vaccination histories against seasonal influenza. Participants who believed that the influenza vaccine is safe (β = 3.27; 95% CI: 2.067 to 5.171; p <0.001), efficacious (β = 2.87; 95% CI: 1.834 to 4.498; p <0.001), should be given during a specific time in the year (β = 1.821; 95% CI: 1.188 to 2.789; p = 0.0059), and were aware of their need to get vaccinated against the seasonal influenza (β = 2.781; 95% CI: 1.254 to 6.188; p = 0.0119) were more likely to have received the vaccine. Conclusion: The findings of this study suggest that the rate of seasonal influenza vaccination is low among the Saudi population, which necessitates the launching of public awareness campaigns about the importance of the seasonal influenza vaccine.

Elderly caregiver: knowledge, attitudes and practices about falls and its prevention

OBJECTIVE

investigate the knowledge, attitudes and practices of informal elderly caregivers about falls and its prevention.

METHOD

this is a descriptive cross-sectional study conducted with 97 informal elderly caregivers residents in areas covered by five Health Strategy Units (ESF) in Cuiabá.

RESULTS

more than half of the participants are aware of falls and identify them as a problem, as well as they identify some risk factors and prevention measures. Regarding attitudes, more than half of the caregivers do not seem to act effectively to prevent falls. Most of them report adopting practices to prevent falls of the elderly, supervising the activities of their daily lives.

CONCLUSION

caregivers know about falls and its prevention, but in a superficial way, and it seems to influence their attitudes and practices regarding the prevention of this event.

Influence of Host and Environmental Factors on the Distribution of the Japanese Encephalitis Vector Culex tritaeniorhynchus in China

Culex tritaeniorhynchus is an important vector that transmits a variety of human and animal diseases. Japanese encephalitis (JE), an endemic disease in the Asia-Pacific region, is primarily transmitted by Cx. tritaeniorhynchus. Insufficient monitoring of vector mosquitoes has led to a poor understanding of the distribution of Cx. tritaeniorhynchus in China. To delineate the habitat of Cx. tritaeniorhynchus and any host and environmental factors that affect its distribution, we used a maximum entropy modeling method to predict its distribution in China. Our models provided high resolution predictions on the potential distribution of Cx. tritaeniorhynchus. The predicted suitable habitats of the JE vector were correlated with areas of high JE incidence in parts of China. Factors driving the distribution of Cx. tritaeniorhynchus in China were also revealed by our models. Furthermore, human population density and the maximum NDVI were the most important predictors in our models. Bioclimate factors and elevation also significantly impacted the distribution of Cx. tritaeniorhynchus. Our findings may serve as a reference for vector and disease control.

The Effect of Vaccine Literacy on Parental Trust and Intention to Vaccinate after a Major Vaccine Scandal

Health literacy, and more specifically vaccine literacy, might be an important factor in reducing the negative effects of exposure to misleading reports on vaccination. This study explores the association between vaccine literacy and vaccination-related outcomes after misleading reports on a scandal concerning locally produced childhood vaccines had emerged in 2016 in China. Data for this study came from a cross-sectional survey, which was conducted in April 2016 in Hangzhou, China. Data were collected in kindergartens and community health centers among parents of children up to 6 years of age. Data were analyzed for 1864 participants. Binary logistic regression models showed that, after controlling for socio-demographics and children's age, parents who had better vaccine literacy (<0.05) were more likely to trust and choose domestically produced vaccines, which account for about 95% of the total vaccinations in China. This study provides evidence on a still largely understudied relationship between vaccine literacy and vaccination-related outcomes. Findings might suggest that higher literacy levels could reduce some of the negative effects of being exposed to misleading information on vaccination, eventually leading to less vaccination hesitancy.

Dengue vaccine acceptance and associated factors in Indonesia: A community-based cross-sectional survey in Aceh

BACKGROUND

The first dengue vaccine (DV) has been licensed in some countries, but an assessment of the public's acceptance of DV is widely lacking. This study aimed to explore and understand DV acceptance and its associated explanatory variables among healthy inhabitants of Aceh, Indonesia.

METHODS

A community-based cross-sectional survey was conducted from November 2014 to March 2015 in nine regencies of Aceh that were selected randomly. A set of validated questionnaires covering a range of explanatory variables and DV acceptance was used to conduct the interviews. A multi-step logistic regression analysis and Spearman's rank correlation were employed to assess the role of explanatory variables in DV acceptance.

RESULTS

We included 652 community members in the final analysis and found that 77.3% of them were willing to accept the DV. Gender, monthly income, socioeconomic status (SES), attitude toward dengue fever (DF) and attitude toward vaccination practice were associated with DV acceptance in bivariate analyses (P<0.05). A correlation analysis confirmed that attitude toward vaccination practice and attitude toward DF were strongly correlated with DV acceptance, rs=0.41 and rs=0.39, respectively (P<0.001). The multivariate analysis revealed that a high monthly income, high SES, and a good attitude toward vaccination practice and toward DF were independent predictors of DV acceptance.

CONCLUSION

The acceptance rate of the DV among inhabitants of Aceh, Indonesia was relatively high, and the strongest associated factors of higher support for the DV were a good attitude toward vaccination practices and a good attitude toward DF.

Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers' Understanding to Improve Health Care

INTRODUCTION

Japanese encephalitis (JE) is a major cause of high morbidity and mortality in several states across India. However, in 2014, a sharp rise was observed in the number of cases of JE in north-eastern Assam state, and 51% of the total cases of JE in India were reported from the Assam in the same year. In this regard, a study was conducted to evaluate the knowledge and attitudes of healthcare workers in Darrang, a district of Assam highly affected by JE.

METHODS

A cross sectional study was conducted for 2 months among HCWs in the major district hospital of Darrang, Assam. A pre-tested, self-administered questionnaire was used to collect data from the participants. Convenience sampling approach was used to collect data from different departments of the hospitals. Descriptive and logistic regression analyses were used to express the results.

RESULTS

The knowledge of HCWs regarding JE was poor with a mean knowledge score of 11.02±2.39 (out of 17), while their attitudes were positive with a mean attitudes score of 43.16± 2.47 (ranging from 13 to 52). Overall, 40.4% and 74.3% of participants demonstrated good knowledge and positive attitudes respectively. Cut-off score for good knowledge and positive attitudes toward JE was set as ≥12 and >40 respectively. Older participants (40-49 years) and experienced workers (>10 years) were significantly associated with good knowledge as compared to their referent group (p<0.05), while knowledge of nurses and other orderlies were significantly lower than physicians (p<0.01). Similar factors were associated with the positive attitudes of the participants with the exception of experience. Television was the major source of information regarding JE reported by HCWs (79%).

CONCLUSION

Although the knowledge was not optimized, HCWs exhibited positive attitudes towards JE. Future research is required to design, implement and evaluate interventions to improve the knowledge of JE among HCWs.

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012

Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines.

The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.

Recurrence of Japanese encephalitis epidemic in Wuhan, China, 2009-2010

BACKGROUND

Japanese encephalitis (JE) was once epidemic in most areas of China, including Wuhan, a city located in the central part of China. The incidence of JE dramatically decreased due to nationwide immunization with the live attenuated JE virus (JEV) vaccine, and no JE cases were reported during 2005-2008 in Wuhan. In 2009 and 2010, 31 JE cases reoccurred in this area. In this study, we investigated the causes of JE recurrence.

METHODS AND FINDINGS

All JE cases were laboratory-confirmed by detecting the JEV-specific IgM antibody with an IgM-capture enzyme-linked immunosorbent assay (ELISA). All patients were children between 2 months and 9 years of age with a median age of 2 years. Of the 31 cases, 9 had received one or two doses of the JEV vaccine, 11 had not been immunized previously with the JEV vaccine, and 11 had an unclear immunization history. Through reverse transcription polymerase chain reaction (RT-PCR), sequencing, and phylogenetic analysis, two new strains of JEV were isolated from Culex tritaeniorhynchus and identified as genotype 1 JEV, rather than genotype 3, which circulated in this area previously.

CONCLUSIONS

Vaccine failure or missed vaccination may have caused JE recurrence. Local centers for disease control and prevention need to improve immunization coverage, and the efficacy of the JE vaccine needs to be reevaluated in a population at risk for disease.