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Han Y, Wang X, Li X, Zhong Z. The willingness of healthcare workers to be vaccinated against monkeypox and their knowledge about monkeypox: A systematic review and meta-analysis. Heliyon 2024; 10:e35196. [PMID: 39170212 PMCID: PMC11336476 DOI: 10.1016/j.heliyon.2024.e35196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/25/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background Vaccination is an important method to address the monkeypox epidemic. We aimed to analyze the knowledge of healthcare workers (HCWs) about human monkeypox and their attitudes toward vaccination.MethodsWe searched PubMed, Embase and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 34 studies with 43,226 HCWs were included in this meta-analysis. The results showed that 54 % (95 % CI: 0.39-0.69) of the HCWs were willing to be vaccinated against monkeypox, and only 40 % (95 % CI: 0.29-0.50) of the HCWs had good knowledge of monkeypox. By analyzing the vaccination history of HCWs, we found that history of smallpox vaccination did not significantly affect the willingness of HCWs to receive another vaccination (OR = 0.53, 95 % CI: 0.23-1.26), whereas HCWs who had been vaccinated with the influenza vaccine (OR = 2.80, 95 % CI: 1.29-6.11) or COVID-19 vaccine (OR = 3.10, 95 % CI: 2.00-4.81) showed greater willingness to receive the monkeypox vaccine. In terms of income, low-income HCWs were less willing to be vaccinated against monkeypox (OR = 0.69, 95 % CI: 0.54-0.89), whereas middle-income HCWs were more willing (OR = 1.45, 95 % CI: 1.04-2.02). Notably, although HCWs with education related to monkeypox had better knowledge of monkeypox than HCWs without education related to monkeypox, the difference was not statistically significant (OR = 1.83, 95 % CI: 0.80-4.18). Conclusions Publicity and education on monkeypox should be strengthened so that more people, especially HCWs, can have a good understanding of monkeypox and be willing to be vaccinated.
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Affiliation(s)
- Yingying Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, Postcode: 130000, China
| | - Xin Wang
- Infection Management Department of Hospital, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, Postcode: 130000, China
| | - Xingzhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, Postcode: 130000, China
| | - Zhuan Zhong
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, Postcode: 130000, China
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Wade J, Poit ST, Lee A, Ryman S, McCain D, Doss C, Shrestha S, Morgan AA. Navigating a Pandemic: A Qualitative Study of Knowledge, Sources of Information, and COVID-19-Related Precautions Taken by HBCU Students. J Racial Ethn Health Disparities 2023; 10:193-204. [PMID: 35032009 PMCID: PMC8760116 DOI: 10.1007/s40615-021-01210-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
The coronavirus (COVID-19) has spread quickly across the nation with a disproportionate impact on Black Americans. Many college-aged students receive their COVID-19-related information through social media and television even though research suggests that social media sources are more likely to be incorrect. Some students report trusting these sources over government sources such as the CDC and WHO. The purpose of this study was to understand Historically Black College and University (HBCU) students' COVID-19 knowledge, sources of information, and planned precautions. There were 21 in-depth interviews conducted with students attending a large southern HBCU during Spring 2020. Themes regarding knowledge included the following: it is a flu-like condition, it has international roots, there is inaccurate and changing information, and it is a pandemic. Themes regarding sources included: the news, US government and related officials, social media, interactions with family, and other social interactions. Themes regarding severity included the following: statistics, a distrust for hospital reporting, a belief that COVID-19 deaths were conflated with baseline health, peer influence, and familial influence. Themes regarding precautions included the following: proper mask use, hand washing/ sanitizing, avoiding large crowds/small crowds only, physical distancing, COVID-19 testing/symptom monitoring, and COVID-19 vaccination.
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Affiliation(s)
- Jeannette Wade
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA.
| | | | - Anna Lee
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Sally Ryman
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Dextiny McCain
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Christopher Doss
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Smriti Shrestha
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Adrienne Aiken Morgan
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Frings D, Wills J, Sykes S, Wood KV, Albery IP. Multiple Group Membership, Optimistic Bias, and Infection Risk in the Context of Emerging Infectious Diseases. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2023. [DOI: 10.1027/2512-8442/a000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract. Background: Understanding psychosocial factors which impact responses to emerging infectious diseases (EIDs) is vital in managing epidemics and pandemics. Two under-researched areas in this field are the interactive roles of optimistic bias (underestimation of the likelihood of negative events occurring to the self, relative to others) and group membership (a factor observed to be psychologically protective, but infection risk enhancing). Aims: The current study aimed to test the relationships between optimistic bias and membership of multiple groups upon EID-related emotional and psychological responses and behavioral intentions. Methods: Participants from the UK and US ( N = 360) rated how they would evaluate and respond to a fictitious EID immediately before the 2020 COVID-19 lockdowns in a correlational study. Results: Negative relationships were observed between optimistic bias and perceived infection vulnerability, infection prevention strategies, and perceived EID severity. Multiple group membership correlated negatively with germ avoidance, but positively with emotional responses such as disgust and increased perceived vulnerability to infection – factors linked to avoiding infection. Multiple group memberships and optimistic bias were unrelated. Limitations: The study focussed on a fictitious disease and relies on cross-sectional data and behavioral intentions. Conclusions: These findings build upon the small evidence base on the role of optimistic bias in EID management and suggest that multiple group membership is unlikely to increase optimistic bias. The theoretical and practical implications of the findings for EID management are discussed.
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Affiliation(s)
- Daniel Frings
- School of Applied Sciences, London South Bank University, London, UK
| | - Jane Wills
- School of Health and Social Care, London South Bank University, London, UK
| | - Susie Sykes
- School of Health and Social Care, London South Bank University, London, UK
| | - Kerry V. Wood
- School of Applied Sciences, London South Bank University, London, UK
| | - Ian P. Albery
- School of Applied Sciences, London South Bank University, London, UK
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Devchand R, Koehler L, Hook S, Marx GE, Hooks H, Schwartz A, Hinckley A. Understanding consumer and clinician perceptions of a potential Lyme disease vaccine. HEALTH EDUCATION RESEARCH 2022; 36:494-504. [PMID: 34529775 PMCID: PMC10911045 DOI: 10.1093/her/cyab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.
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Affiliation(s)
| | - Laura Koehler
- Hager Sharp, 1030 15th Street NW, Washington, DC 20005, USA
| | - Sarah Hook
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Grace E. Marx
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Holley Hooks
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Amy Schwartz
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
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5
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Elkashif A, Alhashimi M, Sayedahmed EE, Sambhara S, Mittal SK. Adenoviral vector-based platforms for developing effective vaccines to combat respiratory viral infections. Clin Transl Immunology 2021; 10:e1345. [PMID: 34667600 PMCID: PMC8510854 DOI: 10.1002/cti2.1345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023] Open
Abstract
Since the development of the first vaccine against smallpox over two centuries ago, vaccination strategies have been at the forefront of significantly impacting the incidences of infectious diseases globally. However, the increase in the human population, deforestation and climate change, and the rise in worldwide travel have favored the emergence of new viruses with the potential to cause pandemics. The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a cruel reminder of the impact of novel pathogens and the suboptimal capabilities of conventional vaccines. Therefore, there is an urgent need to develop new vaccine strategies that allow the production of billions of doses in a short duration and are broadly protective against emerging and re-emerging infectious diseases. Extensive knowledge of the molecular biology and immunology of adenoviruses (Ad) has favored Ad vectors as platforms for vaccine design. The Ad-based vaccine platform represents an attractive strategy as it induces robust humoral and cell-mediated immune responses and can meet the global demand in a pandemic situation. This review describes the status of Ad vector-based vaccines in preclinical and clinical studies for current and emerging respiratory viruses, particularly coronaviruses, influenza viruses and respiratory syncytial viruses.
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Affiliation(s)
- Ahmed Elkashif
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | - Marwa Alhashimi
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | - Ekramy E Sayedahmed
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
| | | | - Suresh K Mittal
- Department of Comparative PathobiologyPurdue Institute for Inflammation, Immunology and Infectious Disease, and Purdue University Center for Cancer ResearchCollege of Veterinary MedicinePurdue UniversityWest LafayetteINUSA
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Harapan H, Setiawan AM, Yufika A, Anwar S, Wahyuni S, Asrizal FW, Sufri MR, Putra RP, Wijayanti NP, Salwiyadi S, Maulana R, Khusna A, Nusrina I, Shidiq M, Fitriani D, Muharrir M, Husna CA, Yusri F, Maulana R, Itoh N, Andalas M, Wagner AL, Mudatsir M. Physicians’ willingness to be vaccinated with a smallpox vaccine to prevent monkeypox viral infection: A cross-sectional study in Indonesia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020; 8:1259-1263. [PMID: 36245638 PMCID: PMC9533989 DOI: 10.1016/j.cegh.2020.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/26/2020] [Indexed: 11/15/2022] Open
Abstract
Background Although there is no licensed vaccine for monkeypox, smallpox vaccine has been shown to be 85% effective in preventing the monkeypox. This study was conducted to assess the willingness of frontline healthcare providers to be vaccinated with smallpox vaccine to prevent monkeypox. Methods A cross-sectional study was conducted in Indonesia. The willingness was assessed under two scenarios: fully subsidized and non-subsidized vaccine. Explanatory variables such as sociodemographic profile, workplace and professional characteristics, and knowledge of monkeypox were collected. A logistic regression assessed the influence of these explanatory variables on participants’ willingness. Results Out of 510 received participants’ responses, 407 (79.8%) were analyzed. With a fully subsidized vaccine scenario, 381 (93.6%) of the participants were willing to be vaccinated and in an unadjusted analysis, gender, education, monthly income, and type of workplace were associated with willingness. With a non-subsidized vaccine (i.e. the vaccine price was US$ 17.9), the proportion who were willing to be vaccinated decreased to 71.9%. In adjusted analyses for both scenarios, gender was the only independent predictor for willingness; men were less willing to be vaccinated than women, adjusted odds ratio (aOR): 0.37; 95% confidence interval (CI): 0.16, 0.87 and aOR: 0.42; 95%CI: 0.27, 0.67, respectively for subsidized and non-subsidized scenario. Conclusion Vaccine price and gender are important factors for physicians' willingness to be vaccinated for smallpox vaccine prevent monkeypox in Indonesia. These findings indicate that achieving high vaccine converge may require partially or fully subsidized vaccines, along with a clear guideline and recommendation from authorities.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Abdul M Setiawan
- Department of Microbiology, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim State Islamic University of Malang, Malang, East Java, 65144, Indonesia
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Sri Wahyuni
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh, 24531, Indonesia
| | | | - Muhammad R Sufri
- Banda Aceh Port Health Office, Ministry of Health, Aceh Besar, Aceh, 23352, Indonesia
| | - Reza P Putra
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | | | - Salwiyadi Salwiyadi
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala Banda Aceh, Aceh, 23111, Indonesia
| | - Razi Maulana
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | | | - Ina Nusrina
- Department of Health Service, District Health Office, Aceh Besar, Aceh, 23912, Indonesia
| | - Muhammad Shidiq
- Nusa Jaya Public Health Center, Halmahera Timur, North Maluku, 97863, Indonesia
| | - Devi Fitriani
- Teunom Public Health Center, Aceh Jaya, Aceh, 23653, Indonesia
| | - Muharrir Muharrir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Cut A Husna
- Department of Microbiology, Universitas Malikussaleh, Lhokseumawe, Aceh, 24531, Indonesia
| | - Fitria Yusri
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh, 24531, Indonesia
| | - Reza Maulana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya, 464-868, Japan
| | - Mohd Andalas
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, MI 48109, USA
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
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Stafford M, Prabhu S, Acosta Egea S, Garcia Gonzalez MDC, Shetty AK. Knowledge and Attitudes about Zika Virus Infection and Vaccine Intent among Medical Students in Costa Rica. Am J Trop Med Hyg 2020; 103:2453-2459. [PMID: 33146106 DOI: 10.4269/ajtmh.19-0748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Zika virus (ZIKV) infection is a public health problem in the Americas. We assessed ZIKV knowledge, attitudes, and future ZIKV vaccine intent among medical students. In this cross-sectional study, a convenience sample of medical students in San José, Costa Rica, were surveyed to assess knowledge, attitudes, vaccine intent, and sources of information about ZIKV. Knowledge and attitude scores were calculated. Factors associated with vaccine intent were determined by bivariate analysis using a chi-square test. Of 468 participants surveyed, majority were females (299, 63.8%) and lived in urban areas (411, 87%). The participant mean knowledge score was 12.2 (SD: 3.65) out of a possible 20. Students residing in suburban or rural areas (odds ratio [OR]: 0.432; CI: 0.24-0.78), first- or second-year students (OR: 0.423; CI: 0.27-0.67), and aged < 20 years (OR: 0.586; CI: 0.36-0.97) had significantly lower knowledge scores. The participant mean attitude score was 30.2 (SD: 4.76) on a scale of 13-65, with lower numbers indicating a concern for ZIKV severity. A majority of the participants indicated they would be likely or extremely likely to receive a ZIKV vaccine (420, 89.7%) and recommend the vaccine to their patients (439, 93.8%). Vaccine intent was not influenced by demographics, total knowledge, and attitude scores. Students (388, 83%) identified the Internet as their primary source of ZIKV information. A majority of students demonstrated a positive attitude toward ZIKV and willingness to accept and recommend a vaccine. Low knowledge scores underscore the need for ZIKV education, especially in the early years of medical school. Use of the Internet should be considered in dissemination of ZIKV education.
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Affiliation(s)
- Morgan Stafford
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sumathi Prabhu
- Department of Mathematics, Manipal Institute of Technology, Manipal, India
| | | | | | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Kim KM, Choi JS. Factors influencing preventive behaviors for Zika virus infection in female nursing students: A cross-sectional study. Contemp Nurse 2020; 56:466-476. [PMID: 33121360 DOI: 10.1080/10376178.2020.1844578] [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: 10/23/2022]
Abstract
Backgrounds: Zika virus infection may cause severe complications in women of childbearing age. Female nursing college students, in the role of future nurses and women of childbearing age, can be effective educators and health supporters by stimulating preventive behaviors.Objectives: The purpose of this study was to identify the level of knowledge, attitudes, and preventive behaviors for Zika virus infection and determine the factors that influence this behavior in female nursing students.Methods: This cross-sectional study sample consisted of 335 nursing studentsfrom three nursing colleges in Korea.Results: Preventive behaviors for Zika virus infection were significantly affected by information seeking (β = 0.252, p < .01), perceived severity (β = 0.167, p < .05), intention to receive Zika virus vaccination (β = 0.135, p < .05), intent to travel to countries endemic for Zika virus (β = -0.122, p < .05), and intention to travel overseas (β = 0.122, p < .05). These five variables explained 20.6% of the variance in preventive behaviors for Zika virus infection.Conclusions: The provision of accurate and reliable information on Zika virus infection is essential, and education and publicity are needed to raise awareness about the disease severity. Moreover, preventive behaviors should focus on vaccination and precautions while traveling overseas.Impact Statement: The findings of this study highlight the importance of enhancing nursing students' preventive behaviors to prevent Zika virus infection.
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Affiliation(s)
- Kyung Mi Kim
- Department of Nursing Science, Chungbuk National University, Cheongju, South Korea
| | - Jeong Sil Choi
- College of Nursing, Gacheon University, 191 Hambakmoe-ro, Incheon, 21936, South Korea
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Marbán-Castro E, Villén-Gonzalvo A, Enguita-Fernàndez C, Romero-Acosta KC, Marín-Cos A, Arrieta GJ, Mattar S, Menéndez C, Maixenchs M, Bardají A. Acceptability of a Hypothetical Zika Vaccine among Women from Colombia and Spain Exposed to ZIKV: A Qualitative Study. Vaccines (Basel) 2020; 8:vaccines8040580. [PMID: 33022907 PMCID: PMC7711833 DOI: 10.3390/vaccines8040580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022] Open
Abstract
Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015-2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women's willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child's health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-227-1851
| | - Ana Villén-Gonzalvo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Cristina Enguita-Fernàndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Kelly Carolina Romero-Acosta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
| | - Anna Marín-Cos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Germán J. Arrieta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
| | - Salim Mattar
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Córdoba, Colombia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
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Hubner AY, Hovick SR. Understanding Risk Information Seeking and Processing during an Infectious Disease Outbreak: The Case of Zika Virus. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:1212-1225. [PMID: 32067244 DOI: 10.1111/risa.13456] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
This study draws on the Planned Risk Information Seeking Model (PRISM) to assess Zika virus information seeking and systematic processing, paying particular attention to the relationship between perceived knowledge and knowledge insufficiency. Novel risks, such as Zika, provide an interesting context for examining whether information-seeking models, such as PRISM, are able to predict information seeking when available information is limited or scarce. A cross-sectional, online study of men and women of childbearing age (N = 494) residing in the state of Florida was conducted. Our results provide some support for the PRISM for predicting Zika information seeking intention, as well as systematic processing of information. We also found that individuals with high levels of perceived knowledge were more likely to report high level of knowledge insufficiency, illustrating that contextual factors may impact the fit of risk information seeking models.
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Affiliation(s)
- Austin Y Hubner
- School of Communication, The Ohio State University, Columbus, OH, USA
| | - Shelly R Hovick
- School of Communication, The Ohio State University, Columbus, OH, USA
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11
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University Students' Knowledge, Attitudes, and Sources of Information About Zika Virus. J Community Health 2019; 43:647-655. [PMID: 29318503 DOI: 10.1007/s10900-017-0463-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Colleges and universities are valuable partners for community health education outreach targeted to young adults. After the outbreak of Zika virus infection in the Americas was declared to be a Public Health Emergency of International Concern on February 1, 2016, postsecondary institutions played an important role in educating at-risk communities about health promotion and disease prevention strategies. In April 2016, we recruited 613 undergraduate students from a large public university to complete a survey about their Zika-related knowledge, attitudes, and information seeking behaviors. We standardized the results so that the participants' reports would be representative of the age, sex, major (course of study), and other characteristics of the university's student population. Most students knew that Zika virus is spread by mosquitoes (88.1%), but only about half knew that the virus could be transmitted through sexual intercourse (56.8%). Students perceived Zika to be a health risk for pregnant women in Zika-affected countries (83.0%), but did not personally feel at risk (12.1%). Many students (43.8%) reported not knowing where to get accurate information about Zika. Identifying gaps in scientific knowledge, misperceptions about personal susceptibility, and opportunities for behavioral risk reduction is an important foundation for designing community-based health interventions when future emerging infectious disease events occur.
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12
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Thompson EL, Vamos CA, Jones J, Liggett LG, Griner SB, G Logan R, Daley EM. Perceptions of Zika Virus Prevention Among College Students in Florida. J Community Health 2019; 43:673-679. [PMID: 29380211 DOI: 10.1007/s10900-018-0468-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Zika virus in Florida prompted a strong public health response, due to its causal association with birth defects. While primarily spread by mosquitos, Zika can be transmitted sexually. The spread of Zika may influence reproductive behaviors among sexually active persons in Florida. This study examined factors associated with willingness to change birth control method use in response to Zika virus among college women and men in Florida. Women and men ages 18-44 at a Florida university (N = 328) were surveyed about Zika knowledge, beliefs about Zika, use of contraceptives and condoms, and socio-demographics between November 2016-April 2017. The outcome variable was willingness to change birth control method were Zika in their area. Logistic regression models in SAS 9.4 were used. Most participants were women (80%), and 47% were 20-22 years old. Only 27% of participants said they would change their birth control method if Zika were in their area. Participants who knew that Zika was sexually transmitted were more likely to be willing to change their birth control method (aOR = 1.71, 95%CI 1.01-2.91). Participants who agreed or strongly agreed that they were fearful of being infected with Zika virus were more likely to be willing to change their birth control methods (aOR = 1.98, 95%CI 1.07-3.67). This study found that, among Florida college students, Zika beliefs and knowledge were associated with a willingness to change birth control method in response to Zika. Understanding the factors that motivate individuals to change reproductive behaviors during an emerging health issue can help tailor preventative messages.
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Affiliation(s)
- Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA. .,Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Julianna Jones
- Department of Global Health and Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Langdon G Liggett
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Stacey B Griner
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Rachel G Logan
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC 56, Tampa, FL, 33612, USA
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13
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Perafán-Ledezma AL, Martínez-Dueñas WA. knowledge, perceptions and practices regarding zika virus of university students in northern Colombia (Santa Marta, 2016). DUAZARY 2019. [DOI: 10.21676/2389783x.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study focuses on 171 university students’ level of knowledge, perceptions and practices regarding Zika virus and its vector in Santa Marta (Colombia) in 2016. A survey was conducted and answers about causative agent and mode of transmission were classified into three levels of knowledge. 32.1% of the students stated that they had suffered from Zika. A 60% stated that they knew what the disease was, however, only 29.2% knew what the causative agent was and 45.6% knew the mode of transmission. Regarding the level of knowledge, only 14.6% knew the causative agent and the mode of transmission (Level 2). In general, the students recognize Zika’s symptoms, and 53.8% consider Zika to be very serious and more than half consider that they, the community and the government are responsible for controlling the vector. Even though more than half the students know the most important strategies as regards on how to control the vector, they do not practice them; this may be explained by the characteristics of their daily live dynamics, the lack of community organization, deficiency in the system of public health and climate change. It is recommended to implement permanent vector control strategies that consider the sociocultural characteristics of at-risk populations.
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14
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Harapan H, Rajamoorthy Y, Utomo PS, Anwar S, Setiawan AM, Alleta A, Bambang A, Ramadana MR, Ikram I, Wahyuniati N, Maulana R, Ichsan I, Indah R, Wagner AL, Kuch U, Groneberg DA, Rodríguez-Morales AJ, Andalas M, Müller R, Mudatsir M, Imrie A. Knowledge and attitude towards pregnancy-related issues of Zika virus infection among general practitioners in Indonesia. BMC Infect Dis 2019; 19:693. [PMID: 31387537 PMCID: PMC6683397 DOI: 10.1186/s12879-019-4297-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/18/2019] [Indexed: 03/20/2023] Open
Abstract
Background The aim of this study was to assess the knowledge and attitudes towards pregnancy-related issues of Zika virus (ZIKV) infection among general practitioners (GPs), a frontline healthcare worker group, in Indonesia. Methods A cross-sectional, online survey assessing knowledge and attitudes towards ZIKV infection on multiple-item scales was sent to GPs in the Sumatra and Java islands of Indonesia. The associations between independent factors and either knowledge or attitude were assessed with logistic regressions. The correlation and association between knowledge and attitude were estimated. Results We included 457 (53.7%) out of 850 responses in the analysis. Among these, 304 (66.5%) and 111 (24.2%) respondents had a good knowledge and attitude, respectively. No demographic, workplace, professional development, or experiential characteristics related to ZIKV infection were associated with knowledge. In the multivariate analysis, only contact experience was associated with attitude. There was a significant, positive correlation between knowledge and attitude scores. Conclusions Although knowledge of pregnancy-related complications of ZIKV infection is relatively high among GPs in Indonesia, more than 75% of them had a poor attitude towards pregnancy-related issues of Zika. Strategies for enhancing the capacity of GPs to develop positive attitudes and respond to ZIKV infection are needed. Electronic supplementary material The online version of this article (10.1186/s12879-019-4297-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. .,Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. .,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. .,School of Biomedical Sciences, The University of Western Australia, Nedlands, Australia.
| | | | - Prattama S Utomo
- Department of Medical Education, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Abdul M Setiawan
- Department of Microbiology, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim State Islamic University of Malang, Malang, Indonesia
| | - Alma Alleta
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Alfredo Bambang
- Department of Microbiology, School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Muhammad R Ramadana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ikram Ikram
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Nur Wahyuniati
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Reza Maulana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ichsan Ichsan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Rosaria Indah
- Medical Education Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Sydney School of Education and Social Work, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Alfonso J Rodríguez-Morales
- Public Health and Infection Research Incubator and Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.,Research Group Medical and Diagnostic Images (GRIMEID), IPS Imágenes Diagnósticas S.A, Pereira, Risaralda, Colombia
| | - Mohd Andalas
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.,Unit of Medical Entomology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. .,Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia. .,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
| | - Allison Imrie
- School of Biomedical Sciences, The University of Western Australia, Nedlands, Australia
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15
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Gregorio ER, Medina JRC, Lomboy MFTC, Talaga ADP, Hernandez PMR, Kodama M, Kobayashi J. Knowledge, attitudes, and practices of public secondary school teachers on Zika Virus Disease: A basis for the development of evidence-based Zika educational materials for schools in the Philippines. PLoS One 2019; 14:e0214515. [PMID: 30921441 PMCID: PMC6438468 DOI: 10.1371/journal.pone.0214515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/15/2019] [Indexed: 11/24/2022] Open
Abstract
The Philippines is at risk in developing a Zika Virus (ZIKV) Disease Outbreak. One of the possible interventions is health education because students are potential health advocates and influencers to their communities through the knowledge transfers from their teachers. The competency of Filipino teachers on ZIKV Disease is yet to be described. This study aimed to assess the knowledge, attitudes, and practices of public secondary school teachers on ZIKV Disease. A modified version of the Knowledge, Attitudes, and Practices Survey Tool on Zika Virus Disease from the World Health Organization—Pan American Health Organization (WHO-PAHO) was used to assess the knowledge, attitudes, and practices of teachers of eight public secondary schools in five villages in Quezon City, Philippines. Out of the 609 respondents, 87.3% reported that their main source of information about ZIKV is tri-media, which includes television, print, and radio. Majority of the respondents mentioned that ZIKV is transmitted through a mosquito bite (80.3%). However, only half of the participants identified vector control as a preventive strategy. Moreover, only 54% admitted to have cleaned their water containers or water sources within the last week. Only a few identified mother-to-child (23%) and sexual intercourse (8%) as other means of transmission. Half (49.8%) of the respondents felt that it is possible to acquire ZIKV in their community, while 90% perceived that a private doctor (90%) or a public hospital (88%) can effectively treat the disease. Perceived stigma is high at 50%. This study showed there was good knowledge among teachers on vector transmission of ZIKV but poor knowledge on other aspects of the disease. Also, there was a low level of perceived susceptibility and severity of ZIKV which can be explained by the absence of a personal encounter with a Zika patient and the low number of cases in the Philippines. Half of the respondents said that they cleaned the possible mosquito breeding sites within the last week, followed by those who cleaned their water source more than a week ago (19%). None of the socio-demographic characteristics is significantly associated with respondents’ knowledge on Zika. Only income and location of residence were found to be significantly associated with attitudes towards Zika. These findings call for a comprehensive training program that includes development of teaching materials for public secondary school teachers on ZIKV Disease based from this study.
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Affiliation(s)
- Ernesto R. Gregorio
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara City, Japan
- * E-mail:
| | - John Robert C. Medina
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara City, Japan
| | - Marian Fe Theresa C. Lomboy
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
| | - Andre Dominic P. Talaga
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
| | - Paul Michael R. Hernandez
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
| | - Mitsuya Kodama
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara City, Japan
| | - Jun Kobayashi
- Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO-TROPMED Regional Center for Public Health, Hospital Administration, and Environmental and Occupational Health, Manila, Philippines
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara City, Japan
- Japanese Consortium for Global School Health Research, University of the Ryukyus, Nishihara City, Japan
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16
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Harapan H, Mudatsir M, Yufika A, Nawawi Y, Wahyuniati N, Anwar S, Yusri F, Haryanti N, Wijayanti NP, Rizal R, Fitriani D, Maulida NF, Syahriza M, Ikram I, Fandoko TP, Syahadah M, Asrizal FW, Aletta A, Jamil KF, Rajamoorthy Y, Hadisoemarto PF, Wagner AL, Groneberg DA, Kuch U, Sasmono RT, Müller R, Imrie A. Community acceptance and willingness-to-pay for a hypothetical Zika vaccine: A cross-sectional study in Indonesia. Vaccine 2019; 37:1398-1406. [PMID: 30739794 DOI: 10.1016/j.vaccine.2019.01.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Understanding people's perceptions of the economic benefits of a potential Zika vaccine (ZV) is critical to accelerating its introduction into either public sector programs or private market. The aim of this study was to assess the acceptance and willingness-to-pay (WTP) for a hypothetical ZV and the associated explanatory variables in Indonesia. METHODS We conducted a health facility-based cross-sectional study in Aceh and West Sumatra province from 1 February to 13 June 2018. Patients who visited outpatient departments, have had children or were expecting their first child, were approached and interviewed to collect information on acceptance, WTP, demographic and socio-economic variables and attitudes towards childhood vaccines. Associations of explanatory variables influencing acceptance and WTP were assessed using logistic regression and linear regression analysis, respectively. RESULTS In total, 956 respondents were included in the final analysis of acceptance, of whom 338 (35.3%) expressed their WTP. We found that 757 (79.1%) of the respondents were likely to be vaccinated and to recommend their partner to be vaccinated. Higher educational attainment, having a job, having heard about Zika and a good attitude towards childhood vaccination were associated with ZV acceptance in the univariate analyses. In the multivariate analysis, attitude towards childhood vaccination was the strongest predictor for ZV vaccination. We found the geometric mean and median of WTP was US$ 13.1 (95% CI: 11.37-15.09) and US$ 7.0 (95% CI: 4.47-10.98), respectively. In the final model, having heard about Zika, having a job, and higher income were associated with a higher WTP. CONCLUSION Although the acceptance rate of the ZV is relatively high in Indonesia, less than 40% of respondents are willing to pay, underscoring the need for a low-cost, high-quality vaccine and public sector subsidies for Zika vaccinations in the country.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia.
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Yusuf Nawawi
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Nur Wahyuniati
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Fitria Yusri
- School of Medicine, Malikussaleh University, Lhokseumawe, Aceh, Indonesia
| | - Novi Haryanti
- Community Health Centre of Meurah Mulia, North Aceh, Aceh, Indonesia
| | | | - Rizal Rizal
- Bunda Hospital, Lhokseumawe, Aceh, Indonesia
| | - Devi Fitriani
- Community Health Centre of Teunom, Aceh Jaya, Aceh, Indonesia
| | | | - Muhammad Syahriza
- Department of Public Health and Community Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Ikram Ikram
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Try Purwo Fandoko
- Community Health Centre of Gunung, Padang Panjang, West Sumatra, Indonesia
| | - Muniati Syahadah
- Community Health Centre of Lima Kaum, Tanah Datar, West Sumatra, Indonesia
| | | | - Alma Aletta
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Kurnia Fitri Jamil
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia; Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | | | | | | | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | | | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany; Unit of Medical Entomology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Allison Imrie
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
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17
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Park S, Choi JS, Kim Y. Prevention of Zika virus infection: Knowledge, attitudes, and practices of pregnant women in Korea. Health Care Women Int 2018; 39:1209-1220. [PMID: 30592701 DOI: 10.1080/07399332.2018.1506455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was performed to investigate the association of knowledge, attitudes, and preventive practices for the prevention of Zika virus infection. The study sample consisted of 185 pregnant women in Korea. The Zika virus-related knowledge and attitude of pregnant women significantly affected preventive practices. The younger pregnant women and pregnant women who had not taken the influenza vaccine had lesser preventive practices of the Zika virus, thereby necessitating educating them and emphasizing good preventive practices. Our results suggest that systematic education and effective prevention programs for Zika virus will contribute to the prevention of infection.
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Affiliation(s)
- Seungmi Park
- a Hoseo University , College of Nursing , Asan , Republic of Korea
| | - Jeong Sil Choi
- b Gachon University , College of Nursing , Incheon , Republic of Korea
| | - Youngji Kim
- b Gachon University , College of Nursing , Incheon , Republic of Korea
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18
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Jo S, Kim Y, Choi JS. Influencing factors on preventive health behaviours for Zika virus in pregnant women and their partners. J Clin Nurs 2018; 28:894-901. [PMID: 30367529 DOI: 10.1111/jocn.14698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/30/2018] [Accepted: 10/16/2018] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To identify Zika virus-related knowledge, attitudes to Zika virus and health motivations of pregnant women, women preparing for pregnancy and their partners, and to identify factors that influence preventive health behaviours for Zika virus infection. BACKGROUND Prevention of Zika virus infection is becoming a major worldwide public health effort. The high-risk group for Zika virus infection comprises women who are pregnant or preparing for pregnancy. Few studies have addressed preventive health behaviours for Zika virus infection by gender. DESIGN This study was a descriptive cross-sectional survey. METHODS Participants (112 males and 147 females) were selected by convenience sampling from three obstetric clinics located in South Korea. Women and their partners who visited obstetric clinics during pregnancy or preparing for pregnancy were included as subjects. RESULTS Factors associated with preventive health behaviours for Zika virus were checking infection status of Zika virus on destinations when planning a trip and attitudes to Zika virus in males and age, educational level, intention to travel to Zika virus endemic countries, attitudes to Zika virus and health motivation in females. CONCLUSIONS Factors that influence preventive health behaviours for Zika virus were different by gender. However, attitudes to Zika virus were influential to both genders. Gender differences should be considered in development of health policies to improve preventive health behaviours for Zika virus. Younger and less educated women are to be targeted, and health management programmes should be developed to promote health motivation. RELEVANCE TO CLINICAL PRACTICE Pregnant women, women preparing for pregnancy and their partners need education and public health promotion to improve self-management during travel to places where Zika virus is endemic. Health policies and health management programmes considering age and educational background should be developed to promote health motivation in women of childbearing age.
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Affiliation(s)
- Sungho Jo
- Dankook University College of Medicine, Cheonan, Korea
| | - Youngji Kim
- College of Nursing, Gachon University, Incheon, Korea
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19
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Choi JS, Kim KM. Infection-control knowledge, attitude, practice, and risk perception of occupational exposure to Zika virus among nursing students in Korea: A cross-sectional survey. J Infect Public Health 2018; 11:840-844. [PMID: 30049612 PMCID: PMC7102775 DOI: 10.1016/j.jiph.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/23/2018] [Accepted: 07/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background As the number of patients with Zika virus infection increases worldwide, nursing students who conduct clinical practice in hospitals tend to at risk of Zika virus infection. Therefore, this study was conducted to identify nursing students’ knowledge, attitudes, practices, and risk perceptions of infection prevention related to occupational exposure to Zika virus infection, and to identify correlations among the related variables. Methods This cross-sectional study included 249 nursing students from 3 nursing colleges located in 3 Korean cities, with experience in hospital clinical practice. A questionnaire to assess the knowledge, attitudes, practices, and risk perceptions of Zika virus infection was developed through a literature review and was subjected to pilot testing and validation. Results The level of infection-control knowledge for Zika virus was 54.5 of 100 points, and that of practice was 4.5 of 5 points. The infection-prevention attitude score was 4.4 of 5 points, and the risk-perception score was 2.3 of 5 points. Significant differences emerged in infection-prevention attitude toward Zika virus based on Zika virus vaccination intention. Additionally, practice and risk-perception scores differed significantly based on gender and Zika virus vaccination intention. Knowledge significantly correlated with attitude and attitude toward preventive behavior. Conclusion Improvement in infection-control knowledge for Zika virus can help improve nurses’ related attitudes, which in turn could promote effective practice. Considering the characteristics of nursing students, it is necessary to develop and apply an effective and viable education program related to the prevention of Zika virus infection.
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Affiliation(s)
- Jeong Sil Choi
- Gachon University College of Nursing, Incheon, South Korea
| | - Kyung M Kim
- Chungbuk National University Department of Nursing Science, Cheongju, South Korea.
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Thompson EL, Vamos CA, Liggett LG, Griner SB, Daley EM. Using a Health Literacy Analytic Framework to Explore Zika Virus and Reproductive Health. Health Lit Res Pract 2018; 2:e78-e87. [PMID: 31294280 PMCID: PMC6607804 DOI: 10.3928/24748307-20180226-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background: The emergence of Zika virus as sexually transmissible and associated with birth defects may affect reproductive planning and contraception use for people in Florida. Objective: This exploratory study employed a health literacy analytic framework to explore knowledge, attitudes, beliefs, and behaviors related to reproductive health in the context of Zika among reproductive-age women and men in Florida. Methods: Reproductive-age people in Florida (N = 40) were interviewed between September and December 2016 about their knowledge, attitudes, beliefs, and behaviors regarding Zika and reproductive health. Thematic analysis using a health literacy framework was employed. Key Results: Participants reported they would use reputable online sources to access Zika information. Whereas participants generally understood Zika outcomes, transmission, and symptoms, they reported hearing more prevention messages on mosquito transmission compared to sexual transmission. Overall, participants reported Zika was not concerning given their appraisal of personal circumstances. Participants were confident they could prevent Zika via sexual transmission despite not following the recommended guidelines. Participants discussed how their understanding of Zika changed their behaviors related to mosquito control but not through sexual transmission. Conclusions: This study illustrated a disconnect between reproductive-age people's understanding of Zika-related prevention information and their reproductive decision-making behavior. Strategies to promote appraisal of risk for sexual transmission of Zika, infection, and unintended pregnancy are needed. [HLRP: Health Literacy Research and Practice. 2018;2(2):e78–e87.] Plain Language Summary: Men and women of reproductive age in Florida may be at risk for Zika virus and related negative health outcomes. This study assessed how Florida men and women find, understand, and evaluate Zika-related health information, and how that applies to their prevention behaviors. This study used health literacy as an analytic framework for an emerging health issue.
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Affiliation(s)
- Erika L. Thompson
- Address correspondence to Erika L. Thompson, PhD, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107;
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Guerra-Reyes L, Fu TCJ, Williams D, Herbenick D, Dodge B, Reece M, Fortenberry JD. Knowledge of Zika and perception of risk among sexually-active adults in the United States of America: results from a nationally representative sample. Rev Panam Salud Publica 2018; 42:e43. [PMID: 31093071 PMCID: PMC6386031 DOI: 10.26633/rpsp.2018.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/12/2017] [Indexed: 01/05/2023] Open
Abstract
Objective To examine knowledge of Zika transmission and risk perception and to assess variability by condom use in a probability sample of sexually-active adults in the United States. Methods Data for this study came from the 2016 wave of the National Survey of Sexual Health and Behavior, a nationally representative probability sample of adults in the United States. Data were collected in November 2016 via a cross-sectional Internet-based survey administered to members of a Knowledge Panel, an address-based random sample service managed by GfK. A weighted subsample (n = 1 713) of sexually active adults, 18 - 50 years of age, was included in analyses. Results More than 90% of men and women reported low or no perceived risk of Zika. Most participants identified mosquito bite as a route of transmission, while significantly fewer identified sexual intercourse (≈ 40%) and vertical (29% men, 41% women) transmission routes. Conclusion Sexually-active adults in the United States, especially young men, lack awareness of sexual and vertical transmission of Zika Virus. Given the likely endemic nature of Zika, this low-risk perception is an important prevention challenge. Zika prevention messaging should address lesser known transmission routes, emphasize male education, and promote correct and consistent condom use.
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Affiliation(s)
- Lucia Guerra-Reyes
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States
| | - Deana Williams
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, United States
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States
| | - Michael Reece
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, Indiana, United States
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Bloomington, Indiana, United States
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Darrow W, Bhatt C, Rene C, Thomas L. Zika Virus Awareness and Prevention Practices Among University Students in Miami: Fall 2016. HEALTH EDUCATION & BEHAVIOR 2018. [DOI: 10.1177/1090198118760687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In January 2016, the first case of mosquito-borne Zika infection in the mainland United States was confirmed in Miami, Florida. The first locally acquired case was reported 6 months later. Local public health and school officials began warning students of the outbreak on their return to the classroom in August 2016. In November–December 2016, we conducted a survey of students attending a large public university in Miami to determine how well informed they were about Zika. A multistage sampling design was used to contact teaching assistants and ask them for help in recruiting their students. Eligible students had to be 18 years of age or older and enrolled in at least one three-credit course during fall semester. A 25-item questionnaire based on the World Health Organization Zika Knowledge, Attitudes, and Practice Resource Pack was developed, pretested, and approved by the university’s institutional review board before it was made available to eligible students through Blackboard Learn or a survey link. About half (50.4%) of the 139 respondents had heard about Zika prior to 2016. Only one student was unaware of Zika before our survey. Most (47.1%) first learned about Zika through television, 18.8% from family or friends, and 15.2% from the Internet, social media, or university e-mail. Two thirds (66.2%) believed Zika could be prevented, 15.1% thought it might be prevented, and 85.7% had taken some precautions. A high level of awareness of the risk of Zika infection was apparent. Most students reported taking steps to avoid exposure to the Zika virus.
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Fraiz LD, de Roche A, Mauro C, Catallozzi M, Zimet GD, Shapiro GK, Rosenthal SL. U.S. pregnant women's knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition. Vaccine 2017; 36:165-169. [PMID: 29157958 DOI: 10.1016/j.vaccine.2017.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Zika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women's attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae. METHODS Pregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination. RESULTS Most women (91%) were married/living with the baby's father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated. CONCLUSIONS Pregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.
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Affiliation(s)
- Lauren Dapena Fraiz
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Ariel de Roche
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States.
| | - Christine Mauro
- Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States.
| | - Marina Catallozzi
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, United States.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada; Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd., Ste. 400, Chicago, IL 60612, United States.
| | - Susan L Rosenthal
- College of Physicians and Surgeons, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, United States; Mailman School of Public Health, Columbia University Medical College, 722 W 168th St, New York, NY 10032, United States; New York Presbyterian Hospital, 622 W 168th Street, New York, NY 10032, United States.
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Dubaut JP, Agudelo Higuita NI, Quaas AM. Impact of Zika virus for infertility specialists: current literature, guidelines, and resources. J Assist Reprod Genet 2017; 34:1237-1250. [PMID: 28687969 PMCID: PMC5633575 DOI: 10.1007/s10815-017-0988-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 06/16/2017] [Indexed: 01/28/2023] Open
Abstract
In the past 2 years, Zika virus has emerged from obscurity onto the world stage-traversing and transcending clinical specialties, basic science disciplines, and public health efforts. The spread of Zika virus has serious implications for the specialty of reproductive endocrinology and infertility. Our patients, practices, and labs-worldwide and specifically in the USA-have been impacted by this teratogenic, sexually transmitted, largely asymptomatic virus. While the World Health Organization's Public Emergency of International Concern designation has lapsed as major epidemics have subsided and understanding of risks is in part clarified, the acute and long-term threat to pregnant patients is not over. The risk of wider spread in the USA is not insignificant, the subtler and long-ranging consequences beyond microcephaly are not fully known, large geographic areas of risk still contain naïve populations, and whether Zika will continue to be an intermittent risk in endemic areas is uncertain. Staying up to date with the burgeoning research on Zika virus is an important objective for the infertility specialist. Here, we review in detail the most relevant recent developments, discuss applicable guidelines, and propose strategies for contributing to a reduction in the risk and burden of Zika virus.
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Affiliation(s)
- Jamie P Dubaut
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, P.O. Box 26901, COMB 2400, Oklahoma City, OK, 73126-0901, USA.
| | - Nelson I Agudelo Higuita
- Section of Infectious Disease, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73014, USA
| | - Alexander M Quaas
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, P.O. Box 26901, COMB 2400, Oklahoma City, OK, 73126-0901, USA
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