How are we responding to vaccine-hesitant parents?

Childhood vaccination coverage in Australia: an equity perspective

BACKGROUND

This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states.

RESULTS

Vaccination coverage was 3-4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively).

CONCLUSION

Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.

The association of previous influenza vaccination and coronavirus disease-2019

Studies have shown similarities in the structure of influenza and coronaviruses, in their binding receptors and in patterns of immune responses; and that influenza vaccine can induce cross-immunity. We examined the association of previous influenza vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, resulting in coronavirus disease-2019 (COVID-19), among 715,164 members of a health maintenance organization. In a multivariate regression model, the odds ratios for SARS-CoV-2 infection among individuals vaccinated for influenza in 2018-2019, 2019-2020, and in both seasons, compared to non-vaccinated individuals, were 0.82 (95% CI 0.68-0.99, p = .048), 0.79 (95% CI 0.67-0.98, p = .005), and 0.76 (95% CI 0.61-0.97, p = .004), respectively. Based on our findings, administration of influenza vaccine before the influenza season is highly recommended to reduce the burden of influenza, which is critical in scenarios of outbreaks of both influenza and SARS-CoV-2 infections, and also regarding its association with reduced rate of COVID-19.

The relationship between parental source of information and knowledge about measles / measles vaccine and vaccine hesitancy

OBJECTIVES

Based on the hypothesis that sources of information might affect knowledge and vaccine acceptance, our objectives were to study parental characteristics and sources of information regarding measles/measles vaccine, its relationship to correct knowledge and to administration of the measles vaccine.

BACKGROUND

Although measles eradication is potentially achievable, in 2018-2019 a worldwide resurgence of measles and measles-caused deaths occurred. The main driver was incomplete or no vaccination, designated as vaccine hesitancy (VH).

METHODS

A cross-sectional survey of 399 individuals dispersed all over the country was conducted. Research assistants interviewed parents with a 20-question survey which was previously validated. The questionnaire included four sections: demographics, major sources of information on measles/measles vaccine, knowledge about measles/measles vaccine, and status of child's vaccination. Univariate and multivariate analyses explored associations between correct knowledge and VH.

RESULTS

The majority of respondents were between the ages of 25-39 (62%). Of these, 309 (77%) vaccinated their children against measles on time, 32 (8%) vaccinations were incomplete, and 58 (15%) did not vaccinate, for a total VH of 23%. Parents < 30 years-old and those with a single-child vaccinated less frequently (p < 0.001 and p = 0.002, respectively). Internet and social-media were the major source of information for 32% regarding measles/measles vaccine and for 49% regarding the measles outbreak; both sources were negatively associated with correct knowledge (p < 0.001). In the multivariate analysis, knowledge was independently associated with timely vaccine administration (p < 0.001) and internet or social-media as sources with higher VH (OR 2.52, 95%CI 1.18-5.37 and OR 2.44, 95%CI 1.01-5.91, respectively).

CONCLUSIONS

Social-media and internet are a common source of information on measles/measles vaccine (probably on other vaccines as well), and often associated with incorrect knowledge, which relates significantly to VH. Healthcare professionals should be aware of this prevailing behavior and respond accordingly in these platforms, with the aid of experts in social-networking.

Timeliness and completeness of routine childhood vaccinations in young children residing in a district with recurrent vaccine-preventable disease outbreaks, Jerusalem, Israel

BackgroundChildhood vaccination schedules recommend vaccine doses at predefined ages.AimWe evaluated vaccination completeness and timeliness in Jerusalem, a district with recurrent vaccine-preventable disease outbreaks.MethodsVaccination coverage was monitored by the up-to-date method (vaccination completeness at age 2 years). Timeliness of vaccination was assessed in children (n = 3,098, born in 2009, followed to age 48 months, re-evaluated at age 7 years) by the age-appropriate method (vaccine dose timeliness according to recommended schedule). Vaccines included: hepatitis B (HBV: birth, 1 month and 6 months); diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae b (DTaP-IPV-Hib: 2, 4, 6 and 12 months); pneumococcal conjugate (PCV: 2, 4 and 12 months); measles-mumps-rubella/measles-mumps-rubella-varicella (MMR/MMRV: 12 months) and hepatitis A (HAV: 18 and 24 months).ResultsOverall vaccination coverage (2014 cohort evaluated at age 2 years) was 95% and 86% for MMR/MMRV and DTaP-IPV-Hib4, respectively. Most children (94%, 91%, 79%, 95%, 92% and 82%) were up-to-date for HBV3, DTaP-IPV-Hib4, PCV3, MMR/MMRV1, HAV1 and HAV2 vaccines at 48 months, but only 32%, 28%, 38%, 58%, 49% and 20% were vaccinated timely (age-appropriate). At age 7 years, the median increase in vaccination coverage was 2.4%. Vaccination delay was associated with: high birth order, ethnicity (higher among Jews vs Arabs), birth in winter, delayed acceptance of first dose of DTaP-IPV-Hib and multiple-dose vaccines (vs MMR/MMRV). Jewish ultra-Orthodox communities had low vaccination coverage.ConclusionsConsiderable vaccination delay should be addressed within the vaccine hesitancy spectrum. Delays may induce susceptibility to vaccine-preventable disease outbreaks; tailored programmes to improve timeliness are required.