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Blazek ES, Bucher A. Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study. JMIR Form Res 2024; 8:e50181. [PMID: 38502179 PMCID: PMC10988372 DOI: 10.2196/50181] [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: 06/21/2023] [Revised: 11/21/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. OBJECTIVE The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. METHODS As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (κ=0.81). RESULTS A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). CONCLUSIONS Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors.
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Affiliation(s)
- E Susanne Blazek
- Behavioral Reinforcement Learning Lab (BReLL), Lirio, Knoxville, TN, United States
| | - Amy Bucher
- Behavioral Reinforcement Learning Lab (BReLL), Lirio, Knoxville, TN, United States
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Dyson EH, Simpson AJH, Gwyther RJ, Cuthbertson H, Patient DH, Matheson M, Gregg A, Hepburn MJ, Hallis B, Williamson ED. Serological responses to Anthrax Vaccine Precipitated (AVP) increase with time interval between booster doses. Vaccine 2022; 40:6163-6178. [PMID: 36153153 DOI: 10.1016/j.vaccine.2022.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
We undertook a Phase 4 clinical trial to assess the effect of time interval between booster doses on serological responses to AVP. The primary objective was to evaluate responses to a single booster dose in two groups of healthy adults who had previously received a complete 4-dose primary course. Group A had received doses on schedule while Group B had not had one for ≥2 years. Secondary objectives were to evaluate the safety and tolerability of AVP booster doses, and to gain information on correlates of protection to aid future anthrax vaccine development. Blood samples were taken on Day 1 before dosing, and on Days 8, 15, 29 and 120, to measure Toxin Neutralisation Assay (TNA) NF50 values and concentrations of IgG antibodies against Protective Antigen (PA), Lethal Factor (LF) and Edema Factor (EF) by ELISA. For each serological parameter, fold changes from baseline following the trial AVP dose were greater in Group B than Group A at every time-point studied. Peak responses correlated positively with time since last AVP dose (highest values being observed after intervals of ≥10 years), and negatively with number of previous doses (highest values occurring in individuals who had received a primary course only). In 2017, having reviewed these results, the Joint Committee on Vaccination and Immunisation (JCVI) updated UK anthrax vaccination guidelines, extending the interval between routine AVP boosters from one to 10 years. Booster doses of AVP induce significant IgG responses against the three anthrax toxin components, particularly PA and LF. Similarly high responses were observed in TNA, a recognised surrogate for anthrax vaccine efficacy. Analysis of the 596 TNA results showed that anti-PA and anti-LF IgG make substantial independent contributions to neutralisation of anthrax lethal toxin. AVP may therefore have advantages over anthrax vaccines that depend on generating immunity to PA alone.
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Affiliation(s)
- E Hugh Dyson
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK.
| | - Andrew J H Simpson
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK.
| | - Robert J Gwyther
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK.
| | - Hannah Cuthbertson
- UK Health Security Agency (UKHSA), formerly Public Health England (PHE), Porton Down, Salisbury, UK.
| | - Dawn H Patient
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK.
| | - Mary Matheson
- UK Health Security Agency (UKHSA), formerly Public Health England (PHE), Porton Down, Salisbury, UK.
| | - Anya Gregg
- UK Health Security Agency (UKHSA), formerly Public Health England (PHE), Porton Down, Salisbury, UK.
| | - Matthew J Hepburn
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK; US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, USA.
| | - Bassam Hallis
- UK Health Security Agency (UKHSA), formerly Public Health England (PHE), Porton Down, Salisbury, UK.
| | - E Diane Williamson
- Defence Science and Technology Laboratory (DSTL), Porton Down, Salisbury, UK.
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Runge CE, Moss KM, Dean JA, Waller M. What Did We Miss? Analysis of Military Personnel Responses to an Open-Ended Question in a Post-Deployment Health Survey. Mil Med 2022; 188:usab565. [PMID: 35024868 DOI: 10.1093/milmed/usab565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Post-deployment health surveys completed by military personnel ask about a range of deployment experiences. These surveys are conducted to determine if there are links between experiences and poor health. Responses to open-ended questions in these surveys can identify experiences that might otherwise go unreported. These responses may increase knowledge about a particular deployment and inform future surveys. This study documented deployment experiences described by Australian Defence Force personnel who were deployed to the Middle East. MATERIALS AND METHODS A survey completed by 14,032 personnel examined health outcomes and over 100 experiences relating to their Middle East deployment. Responses to two open-ended questions captured additional experiences. Descriptive statistics reveal the characteristics of those who did and did not describe additional experiences, and a content analysis details the nature and frequency of the experiences reported. The study was approved by an Institutional Review Board. RESULTS Five percentage (n = 692) of personnel who completed the survey described additional deployment experiences. The most frequently reported experiences were specific Navy experiences; experiences of poor leadership; administrative or organizational issues; the anthrax vaccine; and traumatic events/potentially morally injurious experiences. CONCLUSIONS The findings suggest that post-deployment health surveys should have questions about certain deployment experiences tailored by military service (i.e., Air Force, Army, and Navy). Researchers could consider including questions about personnel experiences of leadership for its impact on health and about potentially morally injurious experiences that may help explain adverse mental health. Clear wording of open-ended questions and participant instructions may improve response rates and reduce response biases.
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Affiliation(s)
- Catherine E Runge
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Katrina M Moss
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Judith A Dean
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Michael Waller
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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Williamson V, Blamey H, Sharpley J, David A, Greenberg N. Mefloquine for malaria prophylaxis in military personnel. BMJ Mil Health 2020; 166:e1-e2. [PMID: 32086266 DOI: 10.1136/jramc-2019-001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - H Blamey
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - J Sharpley
- Department of Community Mental Health, HM Naval Base, Portsmouth, UK
| | - A David
- Division of Psychiatry, UCL, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, King's College London, London, UK
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Green MS, LeDuc J, Cohen D, Franz DR. Confronting the threat of bioterrorism: realities, challenges, and defensive strategies. THE LANCET. INFECTIOUS DISEASES 2018; 19:e2-e13. [PMID: 30340981 PMCID: PMC7106434 DOI: 10.1016/s1473-3099(18)30298-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 01/30/2023]
Abstract
Global terrorism is a rapidly growing threat to world security, and increases the risk of bioterrorism. In this Review, we discuss the potential threat of bioterrorism, agents that could be exploited, and recent developments in technologies and policy for detecting and controlling epidemics that have been initiated intentionally. The local and international response to infectious disease epidemics, such as the severe acute respiratory syndrome and west African Ebola virus epidemic, revealed serious shortcomings which bioterrorists might exploit when intentionally initiating an epidemic. Development of new vaccines and antimicrobial therapies remains a priority, including the need to expedite clinical trials using new methodologies. Better means to protect health-care workers operating in dangerous environments are also needed, particularly in areas with poor infrastructure. New and improved approaches should be developed for surveillance, early detection, response, effective isolation of patients, control of the movement of potentially infected people, and risk communication. Access to dangerous pathogens should be appropriately regulated, without reducing progress in the development of countermeasures. We conclude that preparedness for intentional outbreaks has the important added value of strengthening preparedness for natural epidemics, and vice versa.
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Affiliation(s)
- Manfred S Green
- School of Public Health, University of Haifa, Haifa, Israel.
| | - James LeDuc
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - David R Franz
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
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Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, Ho A, Hunter M, Ladhani S, Lawton M, MacMahon E, McSorley J, Pozniak A, Rodger A. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2018; 17 Suppl 3:s2-s81. [PMID: 27568789 DOI: 10.1111/hiv.12424] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | | | | | - Mark Lawton
- Royal Liverpool University Hospital, Liverpool, UK
| | - Eithne MacMahon
- Guy's & St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
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