Arguments and sources on Italian online forums on childhood vaccinations: Results of a content analysis

Exploring barriers to influenza vaccine uptake and recommendation among healthcare providers in the community in China: A qualitative study

Healthcare providers (HCPs) are recommended for priority influenza vaccination due to their high risk of contracting influenza. HCPs greatly aid in targeted population immunization campaigns. Therefore, understanding the factors that influence HCPs' decisions to get vaccinated and to recommend influenza vaccination is essential. However, there currently needs to be more evidence on this topic in China. Qualitative interviews using a semi-structured interview method were conducted with 180 HCPs from urban community hospitals and town hospitals in four cities in Shandong Province during August 2023. The interview content was analyzed using thematic analysis to identify the variables impacting the vaccination and recommendation practices of HCPs, as well as their suggestions for improving vaccination services. The results will help support the future development of precise intervention measures as well as focused education and training.

A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.

Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers

Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.

Tick-Talk: Parental online discourse about TBE vaccination

This study aimed to understand parental discourse about vaccination, and to provide guidance for communication that addresses the needs of parents. We analyzed parental discourse on child vaccination in general and tick-borne encephalitis (TBE) specifically in a Swiss parental online community. For this purpose, a data set containing 105k posts written by parents between 2007 and 2019 was analyzed using a combination of linguistic discourse analysis and qualitative content analysis. Results show that parents enter into a multidimensional decision-making process, characterized by elaborate practices of negotiation, consideration of vaccination recommendations as well as six distinct influencing thematic factors (vaccination safety, development and control, effectiveness, epidemiology, necessity, alternatives or additional prevention methods). The study shows a clear pattern of seasonality, with parents talking about TBE vaccination mostly triggered by events such as tick bites in spring and summer. From a public health perspective, the study emphasizes the need for sufficient, balanced, and tailored information about TBE vaccination. Online forums provide valuable information about what matters to parents and when, which can help public health authorities and practitioners provide information according to these concerns and enhance health literacy among parents.

Direct and Indirect Associations of Media Use with COVID-19 Vaccine Hesitancy: Cross-sectional Web-Based Survey in South Korea

BACKGROUND

Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Although vaccines are available, the high prevalence of vaccine hesitancy represents a significant challenge to public health and raising vaccine acceptance among the public is critical. While media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public's vaccine hesitancy warrants exploration.

OBJECTIVE

This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors.

METHODS

A cross-sectional online survey took place over six days (January 20-25, 2021), a month ago before COVID-19 vaccination was initiated in South Korea. This study included 1016 subjects, and a logit model for regression analyzed associations between socio-demographic factors, health-related factors, psychological factors, and media use toward one's COVID-19 vaccine hesitancy. Additionally, path analysis to examine the indirect effects of media use on vaccine hesitancy via psychological factors (i.e., perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination) were conducted.

RESULTS

Among the respondents (n=1,016), 53.3% hesitated COVID-19 vaccination, while 46.7% of the respondents would accept the vaccine. Out of the socio-demographic factors, female (OR, 1.967; 95% CI, 1.36-2.86; P < .001), age in 50s (OR, .47; 95% CI, .23-.96; P= .004), and over 60s (OR, .49; 95% CI, .24 - 0.99; P= .04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR, .69; 95% CI, .52 - .91; P= .01) and perceived benefits of vaccination (OR, .69; 95% CI, .52 - .91; P= .01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR, 1.63; 95% CI, 1.29 - 2.07; P < .001) and lower trust in government (OR, .72; 95% CI, .53 - 0.98; P= .04) were related to vaccine hesitancy. The use of offline and online media was associated with vaccine hesitancy through perceived benefits of vaccination, resulting in a lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy.

CONCLUSIONS

Findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. While the use of media has a positive or negative effect on the population's vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confront misinformation or disinformation for successive implementation of vaccine programs during pandemics.

CLINICALTRIAL

Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania

BACKGROUND

Albania is facing decreasing childhood immunisation coverage and delay in timeliness of vaccination despite a growing economy and universal health insurance. Our aim is to estimate childhood immunisation timeliness and vaccine confidence associated with health information source, maternal, socioeconomic, and geographic characteristics in Albania.

METHODS

We used the 2017-2018 Albania Demographic and Health Survey to analyse childhood immunisation timeliness and vaccine confidence among 2113 and 1795 mothers of under-5-year-old children respectively using simple and multivariable logistic regression.

RESULTS

Among mothers of under-5-year-old children in Albania, 78.1% [95% CI: 74.3, 81.5] never postponed or rejected childhood vaccines. Immunisation delay was reported by 21.3% [18.0, 25.1] of mothers, but a majority (67.0%) were caused by the infant's sickness at the time of vaccination, while a minority (6.1%) due to mothers' concerns about vaccine safety and side effects. Vaccine confidence was high among the mothers at 92.9% [91.0, 94.4] with similar geographical patterns to immunisation timeliness. Among 1.3% of mothers who ever refused vaccination of their children, the main concerns were about vaccine safety (47.8%) and side effects (23.1%). With respect to childhood immunisation timeliness, after controlling for other background characteristics, mothers whose main health information source was the Internet/social media had 34% (adjusted odds-ratio AOR = 0.66 [0.47, 0.94], p = 0.020) lower odds in comparison to other sources, working mothers had 35% (AOR = 0.65 [0.47, 0.91], p = 0.013) lower odds in comparison to non-working mothers, mothers with no education had 86% (AOR = 0.14 [0.03, 0.67], p = 0.014) lower odds compared to those who completed higher education, and mothers living in AL02-Qender and AL03-Jug regions had 62% (AOR = 0.38 [0.23, 0.63], p < 0.0001) and 64% (AOR = 0.36 [0.24, 0.53], p < 0.0001) lower odds respectively in comparison to those residing in AL01-Veri region (p < 0.0001).   With respect to vaccine confidence, mothers whose main health information source was the Internet/social media had 56% (AOR = 0.44 [0.27, 0.73], p = 0.002) lower odds in comparison to other sources, single mothers had 92% (AOR = 0.08 [0.01, 0.65], p = 0.019) lower odds compared to those married/living with a partner, mothers of specific ethnicites (like Roma) had 61% (AOR = 0.39 [0.15, 0.97], p = 0.042) lower odds in comparison to mothers of Albanian ethnicity, and mothers living in AL03-Jug region had 67% (AOR = 0.33 [0.19, 0.59], p ≤ 0.0001) lower odds compared to mothers residing in AL01-Veri region.

CONCLUSIONS

Reinforcement of scientific evidence-based online communication about childhood immunisation in combination with tracking and analysis of vaccine hesitancy sentiment and anti-vaccination movements on the Internet/social media would be beneficial in improving immunisation timeliness and vaccine confidence in Albania. Since parents tend to search online for information that would confirm their original beliefs, traditional ways of promoting vaccination by healthcare professionals who enjoy confidence as trusted sources of health information should be sustained and strengthened to target the inequities in childhood immunisation timelines and vaccine confidence in Albania.

Lack of Informations about COVID-19 Vaccine: From Implications to Intervention for Supporting Public Health Communications in COVID-19 Pandemic

Lack of knowledge and mistrust towards vaccines represent a challenge in achieving the vaccination coverage required for population immunity. The aim of this study is to examine the opinion that specific demographic groups have about COVID-19 vaccination, in order to detect potential fears and reasons for negative attitudes towards vaccination, and to gain knowledge on how to prepare strategies to eliminate possible misinformation that could affect vaccine hesitancy. The data collection approach was based on online questionnaire surveys, divided into three groups of questions that followed the main postulates of the health belief theory—a theory that helps understanding a behaviour of the public in some concrete surrounding in receiving preventive measures. Ordinary least squares regression analyses were used to examine the influence of individual factors on refusing the vaccine, and to provide information on the perception of participants on the danger of COVID-19 infection, and on potential barriers that could retard the vaccine utility. There was an equal proportion of participants (total number 276) who planned on receiving the COVID-19 vaccine (37%), and of those who did not (36.3%). The rest (26.7%) of participants were still indecisive. Our results indicated that attitudes on whether to receive the vaccine, on how serious consequences might be if getting the infection, as well as a suspicious towards the vaccine efficacy and the fear of the vaccine potential side effects, may depend on participants’ age (<40 vs. >40 years) and on whether they are healthcare workers or not. The barriers that make participants‘ unsure about of receiving the vaccine, such as a distrust in the vaccine efficacy and safety, may vary in different socio-demographic groups and depending on which is the point of time in the course of the pandemic development, as well as on the vaccine availability and experience in using certain vaccine formulas. There is a pressing need for health services to continuously provide information to the general population, and to address the root causes of mistrust through improved communication, using a wide range of policies, interventions and technologies.

Pro-Vaxxers Get Out: Anti-Vaccination Advocates Influence Undecided First-Time, Pregnant, and New Mothers on Facebook

Social media has revolutionized health information-seeking behavior with crowd-based medical advice. Decreased vaccination uptake and subsequent disease outbreaks have generally occurred in localized clusters based on social norms; however, geographically unrestricted Facebook networks promote parental vaccination refusal congruent with digital identity formation. Interactions within the largest closed Facebook group for vaccination choice were analyzed through the lens of Social Influence Theory. Anti-vaccination advocates impacted first-time mothers' expressed vaccination intentions through both informational and normative influence processes. Six overarching themes were identified as strategies used by these individuals to persuade fence sitting parents to delay or decline vaccinations, including: natural solutions, maternal empowerment, distrust of conventional medicine establishment, fear appeals, 'Russian Roulette' risk benefit analysis, and misinformation and misunderstandings.

Detecting adherence to the recommended childhood vaccination schedule from user-generated content in a US parenting forum

Vaccine hesitancy is considered as one of the leading causes for the resurgence of vaccine preventable diseases. A non-negligible minority of parents does not fully adhere to the recommended vaccination schedule, leading their children to be partially immunized and at higher risk of contracting vaccine preventable diseases. Here, we leverage more than one million comments of 201,986 users posted from March 2008 to April 2019 on the public online forum BabyCenter US to learn more about such parents. For 32% with geographic location, we find the number of mapped users for each US state resembling the census population distribution with good agreement. We employ Natural Language Processing to identify 6884 and 10,131 users expressing their intention of following the recommended and alternative vaccination schedule, respectively RSUs and ASUs. From the analysis of their activity on the forum we find that ASUs have distinctly different interests and previous experiences with vaccination than RSUs. In particular, ASUs are more likely to follow groups focused on alternative medicine, are two times more likely to have experienced adverse events following immunization, and to mention more serious adverse reactions such as seizure or developmental regression. Content analysis of comments shows that the resources most frequently shared by both groups point to governmental domains (.gov). Finally, network analysis shows that RSUs and ASUs communicate between each other (indicating the absence of echo chambers), however with the latter group being more endogamic and favoring interactions with other ASUs. While our findings are limited to the specific platform analyzed, our approach may provide additional insights for the development of campaigns targeting parents on digital platforms.

The importance and effectiveness of vaccines is generally high, but concerns toward vaccination contribute to eroding confidence in vaccination. Recently, alternative vaccination schedules are becoming popular as they allow parents to selectively delay or refuse certain vaccines depending on their specific concerns. Not being expressly anti-vaccination, these parents are challenging to identify on social media, however understanding the determinants of their hesitancy toward vaccines could help addressing parents’ concerns through targeted interventions. In this work, we create a Natural Language Processing pipeline to automatically identify parents who state their adherence to the recommended or alternative vaccination schedule on a popular parenting forum, BabyCenter US. We find that these users have distinct interests and different experiences with vaccination, although they frequently share similar sources of information (e.g., .gov websites). Differently from what is observed on most popular digital platforms like Facebook or Twitter, where users communicate mainly with like-minded users, Babycenter users communicate between each other independently of the vaccination schedule they adopt. These observations suggest that parenting fora may be a more suitable medium to develop intervention aiming to influence positively the vaccination behavior of parents.

Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review

Background

Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring.

Objective

The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations.

Methods

A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles’ titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses.

Results

This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes).

Conclusions

Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design.

The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

Psychological and social characteristics of individuals are important determinants of their health choices and behaviors. Social networks represent "pipes" through which information and opinions circulate and spread out in the social circle surrounding individuals, influencing their propensity toward important health care interventions. This paper aims to explore the relationship between students' vaccination health choices and their social networks. We administered a questionnaire to students to collect data on individual students' demographics, knowledge, and attitudes about vaccinations, as well as their social networks. Forty-nine pupils belonging to 4 classrooms in an Italian secondary school were enrolled in the study. We applied a logistic regression quadratic assignment procedure (LR-QAP) by regressing students' positive responsive behavior similarity as a dependent variable. LRQAP findings indicate that students' vaccination behavior similarity is significantly associated with after-school social ties and related social mechanisms, suggesting that pupils are more likely to share information and knowledge about health behaviors through social relationships maintained after school hours rather than through those established during the school day. Moreover, we found that vaccination behaviors are more similar for those students having the same ethnicity as well as for those belonging to the same class. Our findings may help policymakers in implementing effective vaccination strategies.

Obstacles to the spread of unintuitive beliefs

Many socially significant beliefs are unintuitive, from the harmlessness of GMOs to the efficacy of vaccination, and they are acquired via deference toward individuals who are more confident, more competent or a majority. In the two-step flow model of communication, a first group of individuals acquires some beliefs through deference and then spreads these beliefs more broadly. Ideally, these individuals should be able to explain why they deferred to a given source - to provide arguments from expertise - and others should find these arguments convincing. We test these requirements using a perceptual task with participants from the US and Japan. In Experiment 1, participants were provided with first-hand evidence that they should defer to an expert, leading a majority of participants to adopt the expert's answer. However, when attempting to pass on this answer, only a minority of those participants used arguments from expertise. In Experiment 2, participants receive an argument from expertise describing the expert's competence, instead of witnessing it first-hand. This leads to a significant drop in deference compared with Experiment 1. These experiments highlight significant obstacles to the transmission of unintuitive beliefs.

Content and source analysis of popular tweets following a recent case of diphtheria in Spain

Background

Despite major progress in global vaccination coverage, immunization rates are falling, resulting in outbreaks of vaccine-preventable diseases. This study analyses content and source of the most popular tweets related to a recent case in Spain where an unvaccinated child contracted and later died from diphtheria. Understanding the characteristics of these tweets in the context of vaccination could inform efforts by health promotion professionals to increase their reach and impact.

Methods

We extracted tweets containing keywords related to the diphtheria case (from 1 May to 15 July 2015). We explored the prevalence of terms relating to policy and misinformation and manually coded the 194 most popular tweets (retweeted 100 or more times) with regard to source, topic, tone and sentiment.

Results

A total of 722 974 tweets were collected. Prevalence of terms relating to policy and misinformation increased at the onset of the case and after the death of the child. Popular tweets (194) were either pro-vaccination (58%) or neutral, with none classified as anti-vaccination. Popular topics included criticism towards anti-vaccination groups (35%) and effectiveness of immunization (22%). Popular tweets were informative (47%) or opinions (53%), which mainly expressed frustration (24%) or humour/sarcasm (23%). Popular Twitter accounts were newspaper and TV channels (15%), as well as individual journalists and authors of popular science (13.4%).

Conclusions

Healthcare organizations could collaborate with popular journalists or news outlets and employ authors of popular science to disseminate health information on social media, while addressing public concerns and misinformation in accessible ways.

Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland

Switzerland has not yet reached the measles vaccination coverage of 95 percent that is recommended by the World Health Organization to achieve herd immunity. Within the overall objective of informing effective ways to promote the combined Measles, Mumps, Rubella (MMR) vaccination in Switzerland, the aim of this study was to identify predictors of parents' intention to adhere to official MMR vaccination recommendations. Between October 2012 and January 2013, we surveyed 554 parents of middle school students aged 13 to 15 in Ticino, Switzerland. Guided by Protection Motivation Theory (PMT), the survey covered predictors related to threat and coping appraisal with regards to measles and the MMR vaccine, MMR-related social attitudes and social norms, past experience with the disease and the vaccine, and information sources in the MMR vaccine context. Data were analyzed using Structural Equation Modelling. Among central PMT concepts describing people's threat and coping appraisal, only response (vaccination) efficacy showed to be directly related to parents' intention to adhere to MMR vaccination recommendations (B = .39, p < .001). In addition, social attitudes (B = .38, p < .001) were a direct predictor. Furthermore, social attitudes, social norms, knowing somebody who experienced MMR vaccination side effects, and having sought MMR information from public health institutions, all indirectly predicted parents' intention to adhere to MMR recommendations by activating different threat and coping appraisal mechanisms. To conclude, future communication measures from public health institutions should highlight the altruistic aspect (herd immunity) of the immunization practice as well as present evidence on the high effectiveness of the vaccination in reducing the risk at both the individual and collective levels of getting infected with measles.

Challenges of Vaccinations in the Era of New Media Communication

Active discussions are underway on whether or not the absence or insufficiency of communication is a decisive factor affecting hesitancy with regard to vaccines. Low-quality services such as insufficient communication can lead to an increase in the population postponing vaccinations in countries without deficiencies in vaccine procurement. This study examines the strategies and tasks of health communication in relation to vaccinations. Social networking services (SNSs) are major channels of health communication in responding to infectious diseases. New videos posted on the Internet attract considerable amounts of attention from SNS users and increase traffic to certain Web sites. However, most of these videos are produced and uploaded by nonexperts. Although medical institutions have striven to convey key messages concerning infectious diseases to the public, in the SNS space, contents differing from scientific evidence acknowledged as the established theory have been disseminated as well. Social networking services can also amplify any unnecessary anxiety about infectious diseases. In addition, as false information about vaccines is circulated or conflicting information surfaces, the confusion of the general public is aggravated and the phenomenon of vaccine hesitancy can be intensified. Therefore, it is necessary to improve vaccination acceptance through strategies that integrate new and old media. At the same time, we need to establish customized public health education for the public, vulnerable groups, and experts.

Science and Politics in the Polio Vaccination Debate on Facebook: A Mixed-Methods Approach to Public Engagement in a Science-Based Dialogue

This study examines the ways in which the public discusses and debates the scientific issue of vaccinations in the online social media environment of Facebook. We apply a mixed-methods approach, where a qualitative analysis is combined with a quantitative analysis of the characteristics of the debate on polio vaccinations in a Facebook group dedicated to parental and professional dialogue. The qualitative analysis suggested that dialogue became more political than scientific overall, yet the quantitative analysis showed that the discussants did not abandon the scientific nature of the issue at hand.

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.

Validation of a scale to measure parental psychological empowerment in the vaccination decision

Background and aims.

Parents’ empowerment is advocated to promote and preserve an informed and autonomous decision regarding their children’ immunization. The scope of this study is to develop and evaluate the psychometric properties of an instrument to measure parents’ psychological empowerment in their children’s vaccination decision and propose a context-specific definition of this construct.

Materials and methods.

Grounding in previous qualitative data, we generated an initial pool of items which was later content and face validated by a panel of experts. A pretest allowed us to reduce the initial pool to 9 items. Convergent and discriminant validity measures included the General Self-Efficacy Scale, a Psychological Empowerment Scale, and the Control Preference Scale. Vaccination-related outcomes such as attitude and intention were also included.

Results.

Principal Component Analysis revealed a 2-factor structure, with each factor composed of 2 items. The first factor concerns the perceived influence of one’s personal and family experience with vaccination, while the second factor represents the desire not to ask other parents about their experience with vaccination and their lack of interest in other parents’ vaccination opinion.

Conclusions

In light of its association with positive immunization-related outcomes, public health efforts should be directed to reinforce parents’ empowerment.

Communication about vaccination: A shared responsibility

Vaccine hesitancy is an important issue to be addressed, due to the risk of decrease of vaccination coverage and consequent control of preventable diseases. While it is not considered a specific determinant, poor or inadequate communication can contribute to vaccine hesitancy and negatively influence vaccination uptake. As a contribution to the ongoing discussion regarding this theme and in the perspective of the implementation of the upcoming national vaccination plan in Italy, the Erice Declaration was drafted by experts in the field of immunization following a 5-day residential, independent workshop regarding communication topics in vaccinology. The aim of the current letter is to present to the broader international audience such a contribution, proposing the identification of the main actions that should be taken into account and prioritized in order to improve communication in the domain of vaccination.

Immunisation practices in centres caring for children with perinatally acquired HIV: A call for harmonisation

BACKGROUND

Current national immunisation schedules differ between countries in terms of vaccine formulation, timing of vaccinations and immunisation programme funding and co-ordination. As a result, some HIV infected paediatric population may be left susceptible to vaccine preventable infections. Vaccines used in healthy population should be subjected to high quality ethical research and be explicitly validated for use in children with special vaccination needs such as those infected with HIV. This survey was completed to assess current vaccination practices and attitudes toward vaccination among pediatricians who care for vertically HIV infected children.

METHODS

An online questionnaire was completed by 46 experts in paediatric HIV-infection from the Paediatric European Network for Treatment of AIDS (PENTA). Data were collected between November 2013 and March 2014.

RESULTS

46units looking after 2465 patients completed the questionnaire. The majority of units (67%) reported that common childhood immunisation were administered by the family doctor or local health services rather than in the HIV specialist centre. Vaccination histories were mostly incomplete and difficult to obtain for 40% of the studied population. Concerns were reported regarding the use of live attenuated vaccines, such as varicella and rotavirus, and these were less frequently recommended (61% and 28% of the units respectively). Monitoring of vaccine responses was employed in a minority of centres (41%). A range of different assays were used resulting in diverse units of measurement and proposed correlates of protection.

CONCLUSION

Vaccination practices for perinatally HIV-infected children vary a great deal between countries. Efforts should be made to improve communication and documentation of vaccinations in healthcare settings and to harmonise recommendations relating to additional vaccines for HIV infected children and the use of laboratory assays to guide immunisation. This will ultimately improve coverage and vaccine induced immunity in this vulnerable patient group.

Waning of vaccine-induced immunity to measles in kidney transplanted children

Vaccine-preventable diseases are a significant cause of morbidity and mortality in solid organ transplant recipients who undergo immunosuppression after transplantation. Data on immune responses and long-term maintenance after vaccinations in such population are still limited.We cross-sectionally evaluated the maintenance of immune response to measles vaccine in kidney transplanted children on immunosuppressive therapy. Measles-specific enzyme-linked immunosorbent assay and B-cell enzyme-linked immunosorbent spot were performed in 74 kidney transplant patients (Tps) and in 23 healthy controls (HCs) previously vaccinated and tested for humoral protection against measles. The quality of measles antibody response was measured by avidity test. B-cell phenotype, investigated via flow cytometry, was further correlated to the ability of Tps to maintain protective humoral responses to measles over time.We observed the loss of vaccine-induced immunity against measles in 19% of Tps. Nonseroprotected children showed signs of impaired B-cell distribution as well as immune senescence and lower antibody avidity. We further reported as time elapsed between vaccination and transplantation, as well as the vaccine administration during dialysis are clinical factors affecting the maintenance of the immune memory response against measles.Tps present both quantitative and qualitative alterations in the maintenance of protective immunity to measles vaccine. Prospective studies are needed to optimize the vaccination schedules in kidney transplant recipients in order to increase the immunization coverage over time in this population.

Vaccine criticism on the Internet: Propositions for future research

Research on vaccine criticism on the Internet is now at a crossroads, with an already important body of knowledge published on the subject but also a continuous and even growing interest in the scientific community. In this commentary, we reflect on the published literature from the standpoint of sociologists interested in social movements and their activists and the influence they can have on vaccination behaviors. We suggest several avenues of research for future studies of vaccine criticism on the Internet: 1) paying more attention to the actors who publish vaccine critical contents and to their use of the Internet in relationship to the other means through which they try to mobilize the population - the production of vaccine critical information on the Internet, and not only its nature and its reception, should therefore become one of the main objects of this strand of research -; 2) paying closer attention to what distinguishes the different strands of vaccine criticism regarding both what they dislike about vaccines (or about a given vaccine) and how this fight is integrated in a more general political or cultural struggle; 3) investigating further how the new forms of social interactions allowed by the Internet affect the transmission of vaccine related information and the capacity of vaccine critical actors to enroll members of the public in their political or cultural struggle.