Vaccine risks: real, perceived and unknown

The Effects of the COVID-19 Pandemic on Vaccination Hesitancy: A Viewpoint

Vaccination hesitancy is considered by the World Health Organization as a danger to global health. In recent years, vaccine hesitancy rates to COVID-19 have been studied worldwide. In our study, we aim to provide an overview of the concept of vaccine hesitancy, with regard to the post-COVID era, and to provide prevention and management strategies. A search of the international literature until March 2023 was conducted in the PubMed database. The 5723 papers found were divided into two groups: prior to the COVID-19 era and from 2021 onward. Papers about the vaccine hesitation phenomenon are becoming more common during the SARS-CoV-2 pandemic and following the marketing that the vaccine companies have carried out on the different types of COVID-19 vaccines. It is advisable that healthcare authorities, at the national and international level, as well as healthcare professionals, at the local level, should promote a series of activities to reduce the vaccine hesitancy rate.

Is vaccine hesitancy justified? Benchmarking post-market vaccine risks with five commonly used medicinal products in Canada

Objective

Although vaccines are one of the most cost-effective, low-risk healthcare approaches that save thousands of lives every year, paradoxical fear about vaccine safety is a major roadblock for achieving widespread vaccination coverage. The objective of this study is to change public perception of vaccine safety by presenting real-world incidence of adverse events following immunization (AEFIs).

Methods

In this study, we used Canadian post-market adverse events data to estimate the real-world risk of AEFI and benchmarked them against five commonly used drug types—ACE inhibitors, beta2 adrenergic receptors, penicillins, proton pump inhibitors, and HMG-CoA reductase inhibitors.

Results

Our analysis shows that post-market AEFIs are rare, and vaccination generally carries a significantly lower risk compared to some commonly used medicinal product types.

Conclusion

Despite some limitations with using post-trial adverse events data, we believe that the evidence presented in this study, especially the comparative risk analysis between vaccines and medicinal products, when communicated through proper channels, can help vaccine-hesitant individuals overcome their perceived safety concerns with regard to vaccines.

Listening to vaccine refusers

In bioethics vaccine refusal is often discussed as an instance of free riding on the herd immunity of an infectious disease. However, the social science of vaccine refusal suggests that the reasoning behind refusal to vaccinate more often stems from previous negative experiences in healthcare practice as well as deeply felt distrust of healthcare institutions. Moreover, vaccine refusal often acts like an exit mechanism. Whilst free riding is often met with sanctions, exit, according to Albert Hirschman's theory of exit and voice is most efficiently met by addressing concerns and increasing the quality and number of feedback channels. If the legitimate grievances responsible for vaccine refusal are not heard or addressed by healthcare policy, further polarization of attitudes to vaccines is likely to ensue. Thus, there is a need in the bioethics of vaccine refusal to understand the diverse ethical questions of this inflammable issue in addition to those of individual responsibility to vaccinate.

Vaccine adverse event mentions in social media: Mining the language of Twitter conversations (Preprint)

Background

Traditional monitoring for adverse events following immunization (AEFI) relies on various established reporting systems, where there is inevitable lag between an AEFI occurring and its potential reporting and subsequent processing of reports. AEFI safety signal detection strives to detect AEFI as early as possible, ideally close to real time. Monitoring social media data holds promise as a resource for this.

Objective

The primary aim of this study is to investigate the utility of monitoring social media for gaining early insights into vaccine safety issues, by extracting vaccine adverse event mentions (VAEMs) from Twitter, using natural language processing techniques. The secondary aims are to document the natural language processing techniques used and identify the most effective of them for identifying tweets that contain VAEM, with a view to define an approach that might be applicable to other similar social media surveillance tasks.

Methods

A VAEM-Mine method was developed that combines topic modeling with classification techniques to extract maximal VAEM posts from a vaccine-related Twitter stream, with high degree of confidence. The approach does not require a targeted search for specific vaccine reaction–indicative words, but instead, identifies VAEM posts according to their language structure.

Results

The VAEM-Mine method isolated 8992 VAEMs from 811,010 vaccine-related Twitter posts and achieved an F₁ score of 0.91 in the classification phase.

Conclusions

Social media can assist with the detection of vaccine safety signals as a valuable complementary source for monitoring mentions of vaccine adverse events. A social media–based VAEM data stream can be assessed for changes to detect possible emerging vaccine safety signals, helping to address the well-recognized limitations of passive reporting systems, including lack of timeliness and underreporting.

Vaccines Attitudes, Concerns, and Information Sources Reported by Parents of Young Children among North Palestinian Parents

Parental acceptance of routine childhood immunization is critical to protecting children's health, as high vaccination-coverage rates lead to decreased rates of vaccine-preventable diseases. However, to communicate effectively with parents about vaccines and vaccine-preventable diseases, it is necessary to assess their vaccine-related attitudes and concerns continually. Recently the Palestine Ministry of Health has recorded epidemics of measles and mumps. Poor compliance with vaccination has been attributed to multiple factors including physician inadequacy advocating for vaccination and public mistrust of vaccinations. As a result, this study was conducted to describe the vaccine-related attitudes, concerns, and information sources of North Palestinian parents of young children. A cross-sectional survey was conducted involving parents visiting emergency departments and primary health care centers from different North Palestinian hospitals and centers. 480 surveys were eligible and analyzed. The surveys revealed that although parental confidence in vaccine safety is high, several vaccine-related concerns, such as pain from vaccine administration and the number of vaccines given at once, were common among parents of young children. To maintain and improve the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.

Selection for Favorable Health Traits: A Potential Approach to Cope with Diseases in Farm Animals

Disease is a global problem for animal farming industries causing tremendous economic losses (>USD 220 billion over the last decade) and serious animal welfare issues. The limitations and deficiencies of current non-selection disease control methods (e.g., vaccination, treatment, eradication strategy, genome editing, and probiotics) make it difficult to effectively, economically, and permanently eliminate the adverse influences of disease in the farm animals. These limitations and deficiencies drive animal breeders to be more concerned and committed to dealing with health problems in farm animals by selecting animals with favorable health traits. Both genetic selection and genomic selection contribute to improving the health of farm animals by selecting certain health traits (e.g., disease tolerance, disease resistance, and immune response), although both of them face some challenges. The objective of this review was to comprehensively review the potential of selecting health traits in coping with issues caused by diseases in farm animals. Within this review, we highlighted that selecting health traits can be applied as a method of disease control to help animal agriculture industries to cope with the adverse influences caused by diseases in farm animals. Certainly, the genetic/genomic selection solution cannot solve all the disease problems in farm animals. Therefore, management, vaccination, culling, medical treatment, and other measures must accompany selection solution to reduce the adverse impact of farm animal diseases on profitability and animal welfare.

Vaccine confidence in China after the Changsheng vaccine incident: a cross-sectional study

BACKGROUND

China's achievements in immunization are being threatened by a vaccine crisis. This paper aims to investigate vaccine confidence in China after the Changsheng vaccine incident and attempts to identify the factors contributing to it.

METHODS

An online cross-sectional investigation was conducted from 1 to 25 September 2018. Descriptive analysis and logistic regression were performed to examine the associations between socio-demographic factors, cognition and attitudes towards the Changsheng vaccine incident and vaccine confidence.

RESULTS

We included 1115 respondents in the final analysis, and found that approximately 70% (783) of the respondents did not have vaccine confidence. More than half of the respondents (54.53%) were dissatisfied with the government's response measures to the Changsheng vaccine incident. The logistic regression model indicated that vaccine confidence was positively associated with the degree of satisfaction with the government's response measures (OR = 1.621, 95% CI = 1.215-2.163), attitudes towards the risks and benefits of vaccination (OR = 1.501, 95% CI = 1.119-2.013), concerns about vaccine safety (OR = 0.480, 95% CI = 0.317-0.726), and vaccine efficacy (OR = 0.594, 95% CI = 0.394-0.895).

CONCLUSIONS

A majority of the respondents held negative attitudes towards vaccines after the Changsheng vaccine incident. A coordinated effort is required to restore public confidence in vaccines, especially in China, where a nationwide mandatory immunization policy is implemented. To end dissent towards inoculation, a series of actions is crucial and multiple parties should work together to advance efforts and explore the possibility of establishing an open and transparent regulatory system.

[Psychological antecedents of vaccination: definitions, measurement, and interventions]

Vaccinations are among the safest and most effective ways to prevent morbidity and mortality from severe infectious diseases - both on an individual and societal level. Despite the availability of safe and effective vaccines some people decide against vaccination, which leads to recurrent outbreaks of vaccine-preventable diseases. In order to achieve the common goals of eliminating certain infectious diseases and to protect individual health, it is necessary to understand the antecedents of (non-)vaccination.The 5C model describes five relevant psychological antecedents of vaccination: confidence, complacency (risk perceptions), constraints (barriers), calculation (extent of information search), and collective responsibility (willingness to protect the community). This contribution provides an overview of how these antecedents can be measured on an individual level and how interventions should be designed and evaluated to address the respective antecedents.Data from Germany show that structural changes to reduce practical barriers are important to improve vaccine uptake. Thus, it is also important to address aspects beyond confidence.

Imperfect vaccine and hysteresis

Addressing vaccine compliance problems is of particular relevance and significance to public health. Despite resurgence of vaccine-preventable diseases and public awareness of vaccine importance, why is it so challenging to boost population vaccination coverage to desired levels especially in the wake of declining vaccine uptake? To understand this puzzling phenomenon, here we study how social imitation dynamics of vaccination can be impacted by the presence of imperfect vaccine, which only confers partial protection against the disease. Besides weighing the perceived cost of vaccination with the risk of infection, the effectiveness of vaccination is also an important factor driving vaccination decisions. We discover that there can exist multiple stable vaccination equilibria if vaccine efficacy is below a certain threshold. Furthermore, our bifurcation analysis reveals the occurrence of hysteresis loops of vaccination rate with respect to changes in the perceived vaccination cost as well as in the vaccination effectiveness. Moreover, we find that hysteresis is more likely to arise in spatial populations than in well-mixed populations, even for parameter choices that do not allow for bifurcation in the latter. Our work shows that hysteresis can appear as an unprecedented roadblock for the recovery of vaccination uptake, thereby helping explain the persistence of vaccine compliance problem.

Preparedness and response against diseases with epidemic potential in the European Union: a qualitative case study of Middle East Respiratory Syndrome (MERS) and poliomyelitis in five member states

Background

EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus).

Methods

Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration.

Results

Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State.

Conclusions

Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3326-0) contains supplementary material, which is available to authorized users.

Causality assessment of serious and severe adverse events following immunization in India: a 4-year practical experience

BACKGROUND

India has implemented the World Health Organization's revised Causality Assessment Protocol for adverse events following immunization (AEFI). We describe the number and types of serious/severe AEFIs, including deaths.

RESEARCH DESIGN AND METHODS

Analysis of causality classification of reported serious/severe AEFIs from 1 January 2012 to 7 January 2016 was done. Classification includes (A) consistent with causal association to immunization; (B) indeterminate; (C) coincidental association; or (D) unclassifiable. We present descriptive statistics across each category.

RESULTS

Analysis of causality assessment completed for 1037 reports of serious AEFIs: 499 (48%) were causally associated, 84 (8%) were indeterminate, 323 (31%) were coincidental, and 131 (13%) were unclassifiable. Of the 499 reports in the A category, the events were causally linked to vaccine product for 189 (18%), to immunization error for 135 (13%), and to immunization anxiety for 175 (17%). Among 279 reported deaths, more than half (55%; n = 153) were coincidental events and 37% were unclassifiable.

CONCLUSIONS

Causality assessment of AEFI cases is an important component of vaccination programs and post-marketing surveillance of vaccines. Field reporting and investigation of AEFIs can be improved for many severe or serious reports, most of which are not causally linked to the vaccination program.

Peptide Amphiphile Micelle Vaccine Size and Charge Influence the Host Antibody Response

Vaccines are one of the best health care advances ever developed, having led to the eradication of smallpox and near eradication of polio and diphtheria. While tremendously successful, traditional vaccines (i.e., whole-killed or live-attenuated) have been associated with some undesirable side effects, including everything from mild injection site inflammation to the autoimmune disease Guillain-Barré syndrome. This has led recent research to focus on developing subunit vaccines (i.e., protein, peptide, or DNA vaccines) since they are inherently safer because they deliver only the bioactive components necessary (i.e., antigens) to produce a protective immune response against the pathogen of interest. However, a major challenge in developing subunit vaccines is overcoming numerous biological barriers to effectively deliver the antigen to the secondary lymphoid organs where adaptive immune responses are orchestrated. Peptide amphiphile micelles are a class of biomaterials that have been shown to possess potent self-adjuvanting vaccine properties, but their optimization capacity and underlying immunostimulatory mechanism are not well understood. The present work investigated the influence of micelle size and charge on the materials' bioactivity, including lymph node accumulation, cell uptake ability, and immunogenicity. The results generated provide considerable insight into how micelles exert their biological effects, yielding a micellar toolbox that can be exploited to either enhance or diminish host immune responses. This exciting development makes peptide amphiphile micelles an attractive candidate for both immune activation and suppression applications.

The Role of Risk Perception in Flu Vaccine Behavior among African-American and White Adults in the United States

Seasonal flu vaccination rates are low for U.S. adults, with significant disparities between African and white Americans. Risk perception is a significant predictor of vaccine behavior but the research on this construct has been flawed. This study addressed critical research questions to understand the differences between African and white Americans in the role of risk perception in flu vaccine behavior: (1) What is the dimensionality of risk perception and does it differ between the two races?  (2) Were risk perceptions of white and African-American populations different and how were sociodemographic characteristics related to risk for each group? (3) What is the relation between risk perception and flu vaccine behaviors for African Americans and whites? The sample, drawn from GfK's Knowledge Panel, consisted of 838 whites and 819 African Americans. The survey instrument was developed from qualitative research. Measures of risk perception included cognitive and emotional measures of disease risk and risk of side effects from the vaccine. The online survey was conducted in March 2015. Results showed the importance of risk perception in the vaccine decision-making process for both racial groups. As expected, those who got the vaccine reported higher disease risk than those who did not. Separate cognitive and emotional factors did not materialize in this study but strong evidence was found to support the importance of considering disease risk as well as risk of the vaccine. There were significant racial differences in the way risk perception predicted behavior.

Somatoform and neurocognitive syndromes after HPV immunization are not associated to cell-mediated hypersensitivity to aluminum

Vaccines against human papilloma virus (HPV) have been demonstrated to be very effective to prevent infection-related neoplasms. However, several reports describing heterogeneous post-vaccination phenomena have been published in last few years. The spectrum of these disorders includes both immune-mediated neurological diseases and neuropsychiatric functional disorders. Some researchers speculated about a genetic predisposition, but others hypothesized a role of adjuvants, including some metals and, particularly, aluminum. Here, we tested sixteen young girls developing somatoform and neurocognitive syndromes after the HPV immunization, through MELISA® test, detecting cell-mediated hypersensitivity to several metals. We found no association between these neurocognitive disorders and the results provided by this test; importantly, no patients showed hypersensitivity to aluminum, which is the inorganic adjuvant included in HPV vaccines. Thus, if aluminum played a role in the pathophysiology of musculoskeletal and neurocognitive disturbances occurring in some young girls after HPV immunization, that should recognize other mechanisms than the activation of aluminum-specific lymphocytes.

The media-driven risk society, the anti-vaccination movement and risk of autismo

Marked changes have been seen in the epidemiological profile of infectious diseases among middle-class families in industrialized countries due to beliefs related to the risks of vaccination. These beliefs are proliferating globally due to internet sites, blogs and the influence of celebrities in the mass communication media. Due to the complexity of a cultural phenomenon of this nature, contemporary concepts aligned to the idea of reflexivity in the risk society are analyzed. The concept of a receptive media-driven society in which the announcement of danger and protection in mutual reference and contradiction are also assessed. The frequent emergence of tensions derived from cycles of utterances and baseless comments construed as symbolic "biovalues" are discussed. The persistent effect of threatening biotechnological and fraudulent utterances has influenced virtual networks for almost three decades, supporting the debate about the connection between autism and vaccines. The conclusion reached is that the processes of production of significance interconnect at various levels in which representations circulate that support communication and group identity based on historical and cultural references.

Contributions and challenges for worldwide vaccine safety: The Global Advisory Committee on Vaccine Safety at 15 years

In 1999, the Global Advisory Committee on Vaccine Safety (GACVS) was established by the World Health Organization (WHO) to provide independent scientific advice on issues relating to the safety of vaccines and immunization. Fifteen years onward, we conducted a multi-faceted review to evaluate the impact, reach and challenges facing GACVS, including the role GACVS plays in informing global, regional and WHO member state vaccine policy. The methods included measures of organizational structure, citation impact, themes approached, and a discussion by previous and current members to evaluate past, present and future challenges. Given the increasing range of data sources and the deployment of many new vaccines, the Committee is facing the complex task of identifying the best available evidence for recommendations on vaccine safety. To help meet the increased demand for public transparency in decision making, GACVS-structured methodology for evidence-based decisions is evolving. GACVS also promotes best practices and capacity building for timely and accurate risk assessment; risk communications; outreach to help countries maintain and, if needed, rebuild public trust in vaccines; and advocacy for bridging the major gaps in vaccine safety capacity globally.

A sudden onset of a pseudo-neurological syndrome after HPV-16/18 AS04-adjuvated vaccine: might it be an autoimmune/inflammatory syndrome induced by adjuvants (ASIA) presenting as a somatoform disorder?

In last centuries, vaccines reduced the incidence of several infectious diseases. In last decades, some vaccines aimed at preventing also some cancers, where viruses play a causative role. However, several adverse events have been described after vaccines, but a causal relationship has been established only in a minority of cases. Here, we describe a pseudo-neurological syndrome occurred shortly after the administration of the bivalent HPV vaccine. Some autoimmune disorders, including neurological demyelinating diseases, have been reported after HPV vaccines, but the patient showed no organic lesions. The patient was diagnosed as having a functional somatoform syndrome, which was supposed to be autoimmune/inflammatory syndrome induced by adjuvants (ASIA), seen the temporal link with vaccination and the presence of anti-phospholipid autoantibodies. Immunological mechanisms of vaccines-and of adjuvants-have not been completely elucidated yet, and although there is no evidence of statistical association with many post-vaccination events, a causal link with vaccine cannot be excluded in some individuals.

Source Credibility and the Biasing Effect of Narrative Information on the Perception of Vaccination Risks

Immunization rates are below the Global Immunization Vision and Strategy established by the World Health Organization. One reason for this are anti-vaccination activists, who use the Internet to disseminate their agenda, frequently by publishing narrative reports about alleged vaccine adverse events. In health communication, the use of narrative information has been shown to be effectively persuasive. Furthermore, persuasion research indicates that the credibility of an information source may serve as a cue to discount or augment the communicated message. Thus, the present study investigated the effect of source credibility on the biasing effect of narrative information regarding the perception of vaccination risks. 265 participants were provided with statistical information (20%) regarding the occurrence of vaccine adverse events after vaccination against a fictitious disease. This was followed by 20 personalized narratives from an online forum on vaccination experiences. The authors varied the relative frequency of narratives reporting vaccine adverse events (35% vs. 85%), narrative source credibility (anti-vaccination website vs. neutral health forum), and the credibility of the statistical information (reliable data vs. unreliable data vs. control) in a between-subjects design. Results showed a stable narrative bias on risk perception that was not affected by credibility cues. However, narratives from an anti-vaccination website generally led to lower perceptions of vaccination risks.

Safety of human papillomavirus vaccines: a review

INTRODUCTION

Between 2006 and 2009, two different human papillomavirus virus (HPV) vaccines were licensed for use: a quadrivalent (qHPVv) and a bivalent (bHPVv) vaccine. Since 2008, HPV vaccination programmes have been implemented in the majority of the industrialized countries. Since 2013, HPV vaccination has been part of the national programs of 66 countries including almost all countries in North America and Western Europe. Despite all the efforts made by individual countries, coverage rates are lower than expected. Vaccine safety represents one of the main concerns associated with the lack of acceptance of HPV vaccination both in the European Union/European Economic Area and elsewhere.

AREAS COVERED

Safety data published on bivalent and quadrivalent HPV vaccines, both in pre-licensure and post-licensure phase, are reviewed.

EXPERT OPINION

Based on the latest scientific evidence, both HPV vaccines seem to be safe. Nevertheless, public concern and rumors about adverse events (AE) represent an important barrier to overcome in order to increase vaccine coverage. Passive surveillance of AEs is an important tool for detecting safety signals, but it should be complemented by activities aimed at assessing the real cause of all suspect AEs. Improved vaccine safety surveillance is the first step for effective communication based on scientific evidence.

[Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)]

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.

Proteção individual versus proteção coletiva: análise bioética do programa nacional de vacinação infantil em massa

A vacinação é considerada como uma das políticas de saúde pública mais efetivas e de menor custo-benefício, utilizada no controle e na prevenção de doenças. Mas é também considerada uma das técnicas biomédicas mais polêmicas e controversas, o que torna difícil evitar uma abordagem ética, principalmente quando a vacinação é utilizada de forma compulsória em toda a população. Com efeito, visto que as vacinas não são totalmente seguras e eficazes, há um conflito ético entre o interesse individual e o coletivo, pois as crianças carregam de fato o ônus da vacinação em benefício da saúde pública quando são acometidas com reações adversas graves e que ficam alheias aos cuidados que deveriam ser oferecidos pelo Poder Público. O objetivo deste artigo foi demonstrar que as ferramentas da bioética são relevantes nesta discussão para analisar e compreender criticamente estes conflitos, fornecendo argumentos cogentes para orientar a elaboração de biopolíticas que considerem não apenas, com rigor, a prevenção, mas, também, a responsabilidade solidária de todos como fundamento para uma proteção que seja tanto individual como coletiva.

Overcoming healthcare workers’ vaccine refusal – competition between egoism and altruism

Binary file ES_Abstracts_Final_ECDC.txt matches

[The role of the Internet in eliminating infectious diseases. Managing perceptions and misperceptions of vaccination]

BACKGROUND

The World Health Organization (WHO) has declared the elimination of measles as a global goal. According to the WHO, one critical challenge for countries such as Germany is managing perceptions and misperceptions about vaccination. Criticism and misinformation about vaccines are widespread, e.g., on the Internet, and they support the development of misperceptions, vaccine hesitancy, and fear. By contrast, owing to vaccination the actual incidence of measles is low and hardly anyone is familiar with measles as a severely infectious disease. This may lead to the incorrect perception of measles as a harmless children's disease. Education on the risks of infection and of vaccination should therefore be combined with effective debunking of misperceptions, both of which should govern the management of perceptions and misperceptions.

AIM

The objective of this contribution is to propose and discuss several approaches with respect to the Janus-like role of the Internet: On the one hand, it serves as a source of anti-vaccination misinformation and is therefore responsible for the development of misperceptions. On the other hand, it can serve as the ideal platform for health agencies to educate the public and to debunk misinformation.

CONCLUSION

This contribution suggests how an effective management of perceptions and misperceptions can take place on different levels of communication and how the Internet may be actively used to reach this goal. A collection of Internet links for patients and health-care personnel are recommended.

Formal training in vaccine safety to address parental concerns not routinely conducted in U.S. pediatric residency programs

OBJECTIVE

To determine if U.S. pediatric residency programs provide formal training in vaccine safety to address parental vaccine concerns.

METHODS

An electronic survey was mailed to all members of the Association of Pediatric Program Directors (APPD) to assess (1) if U.S. pediatric residency programs were providing formal vaccine safety training, (2) the content and format of the training if provided, and (3) interest in a training module for programs without training. Two follow-up surveys were mailed at 2 week intervals. Responses to the survey were collected at 4 weeks following the last mailing and analyzed. Logistic regression was used to assess the impact of program size on the likelihood of vaccine safety training. Pearson's chi square was used to compare programs with and without formal vaccine safety training in 5 U.S. regions.

RESULTS

The survey was sent to 199 APPD members; 92 completed the survey (response rate 46.2%). Thirty-eight respondents (41%) had formal training in vaccine safety for pediatric residents at their programs; 54 (59%) did not. Of those that did not, the majority (81.5%) were interested in formal vaccine safety training for their residents. Of all respondents, 78% agreed that training in vaccine safety was a high priority for resident education. Thirty-five percent of all respondents agreed that local parental attitudes about vaccines influenced the likelihood of formal vaccine safety training.

CONCLUSION

Most pediatric residency programs surveyed do not include formal training on vaccine safety; yet, such training is supported by pediatric residency program directors as a priority for pediatric residents.

Silent reintroduction of wild-type poliovirus to Israel, 2013 - risk communication challenges in an argumentative atmosphere

Israel has been certified as polio-free by the World Health Organization and its routine immunisation schedule consists of inactivated poliovirus vaccine (IPV) only. At the end of May 2013, the Israeli Ministry of Health (MOH) has confirmed the reintroduction of wild-type poliovirus 1 into the country. Documented ongoing human-to-human transmission necessitated a thorough risk assessment followed by a supplemental immunisation campaign using oral polio vaccine (OPV). The unusual situation in which ongoing poliovirus transmission was picked up through an early warning system of sewage monitoring without active polio cases, brought about significant challenges in risk communication. This paper reviews the challenges faced by the MOH and the communication strategy devised, in order to facilitate and optimise the various components of the public health response, particularly vaccination. Lessons learned from our recent experience may inform risk communication approaches in other countries that may face a similar situation as global polio eradication moves towards the 'End game'.

Vaccine adverse events reported during the first ten years (1998-2008) after introduction in the state of Rondonia, Brazil

Despite good safety records, vaccines given to young children can cause adverse events. We investigated the reported adverse events following immunization (AEFI) of vaccines given to children of less than seven years of age during the first ten years (1998 to 2008) in the state of Rondonia, Brazil. We worked with the events related to BCG (Bacillus Calmett-Guérin), HB (hepatitis B), DTwP/Hib (diphtheria-tetanus-pertussis+Hemophillus influenza b), DTP (diphtheria-tetanus-pertussis), MMR (mumps, measles, rubella), and YF (yellow fever) vaccines because they were part of the recommended scheme. The number of doses of vaccines given was 3,231,567 with an average of AEFI of 57.2/year during the studied period. DTwP/Hib was responsible for 298 (57.8%), DTP 114 (22.9%), HB 31 (6%), MMR 28 (5.4%), BCG 24 (4.7%), and YF 20 (3.9%) of the reported AEFI. The combination of the AEFI for DTwP/Hib vaccines showed the highest number of systemic (61.4%) and local events (33.8%). Young children (≤1-year old) were more susceptible to AEFI occurring in the 6 hours (54.2%) following vaccine uptake. This study suggests significant differences in reactogenicity of vaccines and that despite limitations of the AEFI Brazilian registry system we cannot ignore underreporting and should use the system to expand our understanding of adverse events and effects.

The Role of Attitudes About Vaccine Safety, Efficacy, and Value in Explaining Parents’ Reported Vaccination Behavior

Objectives. To explain vaccine confidence as it related to parents’ decisions to vaccinate their children with recommended vaccines, and to develop a confidence measure to efficiently and effectively predict parents’ self-reported vaccine behaviors. Method. A sample of parents with at least one child younger than 6 years ( n = 376) was analyzed using data from the HealthStyles 2010 survey. Questions were grouped into block variables to create three confidence constructs: value, safety, and efficacy. Regression equations controlling for demographic characteristics were used to identify the confidence construct(s) that best predicted parents’ self-reported vaccination decisions (accept all, some, or none of the recommended childhood vaccines). Results. Among the three constructs evaluated, confidence in the value of vaccines, that is the belief that vaccines are important and vaccinating one’s children is the right thing to do, was the best predictor of parents’ vaccine decisions, F(2, 351) = 119.199, p < .001. When combined into a block variable for analysis, two survey items measuring confidence in the value of vaccines accounted for 40% of the variance in parents’ self-reported vaccine decisions. Confidence in the safety or efficacy of vaccines failed to account for additional significant variance in parent-reported vaccination behavior. Conclusions. Confidence in the value of vaccines is a helpful predictor of parent-reported vaccination behavior. Attitudinal constructs of confidence in the safety and efficacy of vaccines failed to account for additional significant variance in parents’ vaccination behaviors. Future research should assess the role of vaccine knowledge and tangible barriers, such as access and cost, to further explain parents’ vaccination behaviors.

U.K. parents' decision-making about measles-mumps-rubella (MMR) vaccine 10 years after the MMR-autism controversy: a qualitative analysis

BACKGROUND AND OBJECTIVES

Public concern about an unsubstantiated link between MMR vaccine and autism stemmed from a 1998 paper by Dr Andrew Wakefield and colleagues, and the substantial media coverage which that work attracted. Though the Wakefield paper is now discredited and an MMR-autism link has never been demonstrated empirically, this concern has manifested in over a decade of suboptimal MMR uptake. Few qualitative studies have explored parents' MMR decision-making since uptake began to improve in 2004. This study updates and adds methodological rigour to the evidence base.

METHODS

24 mothers planning to accept, postpone or decline the first MMR dose (MMR1) for their 11-36 month-old children, described their decision-making in semi-structured interviews. Mothers were recruited via General Practice, parents' groups/online forums, and chain referral. MMR1 status was obtained from General Practice records 6 months post-interview. Interview transcripts were coded and interpreted using a modified Grounded Theory approach.

RESULTS

Five themes were identified: MMR vaccine and controversy; Social and personal consequences of MMR decision; Health professionals and policy; Severity and prevalence of measles, mumps and rubella infections; Information about MMR and alternatives. Results indicated that MMR1 acceptors were sympathetic toward Wakefield as a person, but universally rejected his study which sparked the controversy; parents opting for single vaccines expressed the sense that immune overload is not a consideration but that not all three components of MMR are warranted by disease severity; and MMR1 rejectors openly criticised other parents' MMR decisions and decision-making.

CONCLUSIONS

This study corroborated some previous qualitative work but indicated that the shrinking group of parents now rejecting MMR comprises mainly those with more extreme and complex anti-immunisation views, whilst parents opting for single vaccines may use second-hand information about the controversy. In response, policymakers and practitioners should revise their expectations of today's MMR decision-makers, and their methods for supporting them.

Analysis of different DNA vaccines for protection of experimental influenza A virus infection

Influenza viruses cause acute respiratory infections in humans that result in significant excessive morbidity and mortality rates every year. Current vaccines are limited in several aspects, including laborious manufacturing technology, non-sufficient efficacy, and time-consuming adjustments to new emerging virus variants. An alternative vaccine approach utilizes plasmid DNA encoding influenza virus antigens. Previous experiments have evaluated the protective efficacy of DNA vaccines expressing variable as well as conserved antigens. In this present study, several different combinations of influenza A virus (IAV) HA, NA, M1, M2, NS1, NS2, and NP sequences were cloned into the plasmid pVIVO, which allows the independent expression of two genes separately. These DNA vaccines were administered to induce protection against a lethal IAV infection, and to reduce immunopathology in lung tissue of surviving animals. The highest efficacy was provided by vaccines expressing HA and NA, as well as a mixture of plasmids encoding HA, NA, M1, M2, NS1, NS2, and NP (Mix). Three days post-infection, more than a 99.99% reduction of viral load and no inflammation was achieved in lung tissue of pVIVO/HA-NA-vaccinated mice. Animals vaccinated with pVIVO/HA-NA, pVIVO/HA-M2, or vaccine Mix, survived a lethal challenge with minor or no obvious pathologic abnormities in the lungs. All other surviving mice revealed extensive changes in the lung tissue, indicating possibly an ongoing bronchiolitis obliterans. In addition, pVIVO/HA-NA and the vaccine Mix were also protective against a heterologous IAV infection. Taken together, next to all combinations of different DNA vaccines, the intramuscular application of pVIVO/HA-NA was the most efficient procedure to decrease virus replication and to prevent immunopathology in lung tissue of IAV-infected mice.

Publics and vaccinomics: beyond public understanding of science

Vaccines have been among the most effective tools for addressing global public health challenges. With the advent of genomics, novel approaches for vaccine discovery are opening up new opportunities for vaccine development and applications, particularly with the expectation of personalized vaccines and the possibility of addressing a broader range of infectious diseases. In this context, it is useful to reflect on the social contexts of vaccine development as these have been influenced by social, ethical, political challenges. This article discusses the historical context of vaccine controversies and factors that help explain public acceptance and resistance, illustrating that these challenges go well beyond simple public misunderstandings. The broader vaccine challenges evident along the innovation trajectory, from development to commercialization and implementation include problems in research and development, organizational issues, and legal and regulatory challenges that may collectively contribute to public resistance or confidence. The recent history of genomics provides further lessons that the developing field of vaccinomics can learn from.

Surveillance of adverse effects following vaccination and safety of immunization programs

The aim of the review was to analyze conceptual and operational aspects of systems for surveillance of adverse events following immunization. Articles available in electronic format were included, published between 1985 and 2009, selected from the PubMed/Medline databases using the key words "adverse events following vaccine surveillance", "post-marketing surveillance", "safety vaccine" and "Phase IV clinical trials". Articles focusing on specific adverse events were excluded. The major aspects underlying the Public Health importance of adverse events following vaccination, the instruments aimed at ensuring vaccine safety, and the purpose, attributes, types, data interpretation issues, limitations, and further challenges in adverse events following immunization were describe, as well as strategies to improve sensitivity. The review was concluded by discussing the challenges to be faced in coming years with respect to ensuring the safety and reliability of vaccination programs.

Tracking vaccine-safety inquiries to detect signals and monitor public concerns

BACKGROUND

The Centers for Disease Control and Prevention frequently receives inquiries from health care providers, public health officials, and the general public seeking data or guidance on vaccine-safety issues. Past inquiries to public health authorities identified potential problems including viscerotropic illness rarely associated with yellow fever vaccination.

OBJECTIVE

To systematically describe vaccine-safety inquiries received at the Centers for Disease Control and Prevention.

METHODS

External and internal inquiries were recorded in a database from May 1, 2002 to May 31, 2009. Key variables analyzed included the source of the question, the type of information being sought, and the vaccine type(s) associated with the inquiry.

RESULTS

A total of 983 vaccine-safety inquiries were answered and analyzed. Health care workers were the source of 43% of the questions, and the general public accounted for 19% of the questions. Nearly half of the requests (49%) concerned information about the Vaccine Adverse Event Reporting System, and nearly one-fourth (21%) were requests from providers for clinical guidance. The most frequent specific topics of inquiry and vaccines involved were neurologic adverse events (AEs) temporally associated with vaccination (17%) and safety of all vaccines or childhood vaccines (20%), respectively.

CONCLUSIONS

Questions about rare but potentially serious AEs and general concerns about vaccine safety were encountered relatively frequently. The substantial number of clinically focused inquiries may indicate a need for more provider support tools and resources. Tracking of inquiries can supplement information received through vaccine AE reporting and contribute to an enhanced scientific and communications response to vaccine-safety concerns.

Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey

OBJECTIVE

To describe the vaccine-related attitudes, concerns, and information sources of US parents of young children.

METHODS

We calculated weighted proportions and 95% confidence intervals for vaccine-related attitudes, concerns, and information sources of parents with at least 1 child aged 6 years or younger who participated in the 2009 HealthStyles survey.

RESULTS

The overall response rate for the survey was 65% (4556 of 7004); 475 respondents were parents or guardians ("parents") of at least 1 child aged 6 years or younger. Among those respondents, nearly all (93.4%) reported that their youngest child had or would receive all recommended vaccines. The majority of parents reported believing that vaccines were important to children's health (79.8%) and that they were either confident or very confident in vaccine safety (79.0%). The vaccine-related concern listed most often by parents was a child's pain from the shots given in 1 visit (44.2%), followed by a child getting too many vaccines at 1 doctor's visit (34.2%). When asked to list their most important sources of information on vaccines, the most common response was a child's doctor or nurse (81.7%).

CONCLUSIONS

To maintain and improve on the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.

[Suspected adverse reactions after vaccination. Results from the German Health Interview and Examination Survey for Children and Adolescents. Part I: descriptive analyses]

The decreasing incidence of vaccine-preventable infectious diseases and their complications redirects public attention to the safety risks of vaccinations. Collation of resilient vaccine adverse reaction data from passive and active surveillance systems as well as epidemiological studies is indispensable. From 2003-2006, the representative National Health Interview and Examination Survey for Children and Adolescents ("Kinder- und Jugendgesundheitssurvey," KiGGS) retrospectively collected information about vaccines, vaccination dates, and suspected vaccine-related adverse events. A total of 15,958 participants (<17 years of age) were included in the analyses. Parents of 332 (2.1%; 95% CI 1.8-2.5) children and adolescents reported that one or more vaccinations were poorly tolerated. The reported adverse reactions were largely in accordance with information given in the summaries of product characteristics of the respective vaccines. Calculated rates of adverse reactions were below the known rates. KiGGS allowed the retrospective collection of suspected adverse reactions from a large number of vaccinations, thereby providing data even on rare adverse events. No unusual pattern was observed. The information obtained on suspected adverse reactions does not change the positive benefit-risk ratio of vaccinations.

On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes

OBJECTIVES

To determine whether children who received recommended vaccines on time during the first year of life had different neuropsychological outcomes at 7 to 10 years of age as compared with children with delayed receipt or nonreceipt of these vaccines.

METHODS

Publicly available data, including age at vaccination, from a previous VaccineSafety Datalink study of thimerosal exposure and 42 neuropsychological outcomes were analyzed. Vaccine receipt was defined as timely when each vaccine was received within 30 days of the recommended age. Associations between timeliness and each outcome were tested in univariate analyses. Multivariable regression models were constructed for further assessment of the impact of timeliness on neuropsychological outcomes after adjustment for potential confounders. Secondary analyses were performed on a subset of children with the highest and lowest vaccine exposures during the first 7 months of life.

RESULTS

Timely vaccination was associated with better performance on 12 outcomes in univariate testing and remained associated with better performance for 2 outcomes in multivariable analyses. No statistically significant differences favored delayed receipt. In secondary analyses, children with the greatest vaccine exposure during the first 7 months of life performed better than children with the least vaccine exposure on 15 outcomes in univariate testing; these differences did not persist in multivariable analyses. No statistically significant differences favored the less vaccinated children.

CONCLUSIONS

Timely vaccination during infancy has no adverse effect on neuropsychological outcomes 7 to 10 years later. These data may reassure parents who are concerned that children receive too many vaccines too soon.

Global safety of vaccines: strengthening systems for monitoring, management and the role of GACVS

Vaccines have contributed enormously in reducing the impact of many infectious diseases, and the expanded use of new and existing vaccines provides unprecedented potential for further reducing the global burden of infectious diseases. Yet, as with the deployment of other technologies, their use may also sometimes be associated with undesirable effects that need to be identified rapidly, understood and minimized. In this article, we review the models and systems that have been developed to monitor and respond to concerns regarding vaccine safety and we give illustrative examples of real or perceived vaccine safety issues. The Global Advisory Committee on Vaccine Safety (GACVS) was set up 10 years ago and charged to provide the WHO with independent advice on vaccine safety issues. The role of the GACVS is both to analyze and to interpret reports of the adverse effects of vaccines that impact on global vaccination programs and strategies, and to foster the development of improved surveillance systems to detect any adverse effects of vaccines, particularly in low- and middle-income countries. It also monitors the development of new vaccines during clinical testing and advises on the safe use of vaccines in immunization programs. As success is achieved with reducing the burden of vaccine-preventable diseases, there will be increasing attention focused on potential adverse effects, on the development of effective surveillance systems to detect adverse effects, and on improved methods to manage and control any harmful consequences of vaccination.

Development of vaccine risk communication messages using risk comparisons and mathematical modeling

It is important to systematically assess the vaccine information needs of parents in order to maintain or improve childhood immunization coverage. Our objectives were to obtain suggestions for the optimal presentation of vaccine-related information and to determine if an educational intervention affected mothers' vaccine safety attitudes. Focus groups were used to develop messages that then were tested through a randomized, pre- and post-test mail survey of non-Hispanic White mothers who reported vaccine safety concerns (n = 927). Focus groups were analyzed using text analysis software. Increases in attitude scores between the pre- and post-test surveys were calculated, and logistic regression was used to compare intervention groups with a control group. Of survey participants who recalled the test messages, 50% (85/171) who received a "consequences of reduced coverage" message reported an improved opinion of vaccines. A greater proportion of participants receiving one or more intervention messages reported an improved attitude score from pre-to post-test compared with the control group for four of the five variables measured; however, differences were small and none were statistically significant. A mixed method approach was used to develop and test vaccine messages. The message describing potential consequences of reduced vaccination coverage had the greatest impact on improving concerned mothers' opinions of childhood vaccines.