Negative perceptions of hepatitis B vaccination among attendees of an urban free testing center for sexually transmitted infections in France

Hepatitis B vaccine uptake and associated factors among adults of Gulu city in Northern Uganda: A community-based cross-sectional study

BACKGROUND

Hepatitis B virus (HBV) infection is a global public health problem against which vaccination is recommended for all high-risk adults. HBV is highly endemic in Northern Uganda, however, there is a paucity of literature regarding HBV vaccine uptake and associated factors within the community in the region. In this study, we aimed to determine the level of HBV vaccine uptake and associated factors among adults in Gulu city, Uganda.

METHODS

We conducted a community-based, cross-sectional study in Gulu city among eligible adults between March and May 2022. Data on HBV vaccination status and sociodemographic characteristics were collected using an interviewer-administered questionnaire. Full uptake of HBV vaccine was defined as receipt of all 3 recommended doses, and partial uptake for 1 or 2 doses. Multivariable logistic regression analysis was performed using STATA 16.0 to determine factors independently associated with HBV vaccine uptake. P<0.05 was considered statistically significant.

RESULTS

In total, 360 participants were enrolled, of whom 212 (58.9%) were female, 183 (50.8%) were aged 30 years or younger, and 143 (39.7%) had attained tertiary education. Overall, 96 (26.7%) participants had full uptake of HBV vaccine and 73 (20.3%) had partial uptake. Factors that were statistically significantly associated with full uptake of HBV vaccine were good knowledge regarding HBV transmission (aOR = 1.9, 95% Confidence Interval (CI) = 1.03-3.46, p = 0.040) and receiving health education on HBV vaccination (aOR = 4.4, 95% CI = 2.3-8.4, p<0.001).

CONCLUSIONS

There is a low uptake of HBV vaccine in Gulu city, Uganda. The Uganda Ministry of Health should correct misconceptions, create awareness of the severity of HBV infection through health education regarding HBV infection within the community in Gulu City; and set mechanisms to follow-up clients due for next HBV vaccination.

Hepatitis B eradication: vaccine as a key player

OBJECTIVE

Despite the availability of a highly effective and safe vaccine against hepatitis B virus (HBV) infection for 40 years, still almost 300 million persons are estimated to be chronically infected by this virus worldwide. The World Health Organization (WHO) has proposed a plan for hepatitis elimination by 2030. However, several factors, such as the reduction and limitation in vaccination campaigns or vaccine hesitancy (VH) in some regions of the World, might have played a role in limiting the worldwide coverage of hepatitis B prophylaxis. This review aims to describe which factors, such as VH, may be hampering the WHO 2030 goal for hepatitis B eradication.

METHODS

The review describes the development and characteristics of the HBV vaccine, from the first plasma-derived to the recombinant one. Eventual limitations in its effectiveness and particularly VH were reviewed.

RESULTS

The apparent pitfalls of the HBV vaccine, such as long-term effectiveness, vaccine-escape mutants, and adverse effects, were proven not to be a concern for this vaccine. However, VH persists and was even intensified by the COVID-19 pandemic.

CONCLUSIONS

Many barriers still exist, such as vaccine availability, lack of awareness of the benefits of HBV vaccination, and VH. HBV VH seems to be eventually overcome in many settings with active education campaigns and information, stressing the importance of developing these strategies to achieve the 2030 goal of the WHO.

SARS-CoV-2 Vaccination Coverage and Factors Associated with Low Uptake in a Cohort of People Living with HIV

People living with HIV (PLWH) are prioritised for SARS-CoV-2 vaccination due to their vulnerability to severe COVID-19. Therefore, the epidemiological surveillance of vaccination coverage and the timely identification of suboptimally vaccinated PLWH is vital. We assessed SARS-CoV-2 vaccination coverage and factors associated with under-vaccination among PLWH in Catalonia, Spain. As of 11.12.2021, 9945/14942 PLWH (66.6%) had received ≥1 dose of a SARS-CoV-2 vaccine. Non-Spanish origin (adjusted odds ratio (aOR) 0.64, 95% CI 0.59−0.70), CD4 count of 200−349 cells/μL (aOR 0.74, 95% CI 0.64−0.86) or 350−499 cells/μL (aOR 0.79, 95% CI 0.70−0.88), detectable plasma HIV-RNA (aOR 0.61 95% CI 0.53−0.70), and previous SARS-CoV-2 diagnosis (aOR 0.58 95% CI 0.51−0.65) were associated with under-vaccination. SARS-CoV-2 diagnosis (437 [9.5%] vs. 323 [3.5%], p < 0.001), associated hospitalisations (10 [2.3%] vs. 0 [0%], p < 0.001), intensive care unit admissions (6 [1.4%] vs. 0 [0%], p < 0.001), and deaths (10 [2.3%] vs. 0 [0%], p < 0.001) were higher among unvaccinated PLWH. Vaccination coverage was lower among PLWH with a CD4 count >200 cells/μL, detectable plasma HIV-RNA, previous SARS-CoV-2 diagnosis, and migrants. SARS-CoV-2 diagnosis, associated hospitalisations, and deaths among PLWH were lower among the vaccinated compared with the unvaccinated. SARS-CoV-2 vaccination prioritisation has not completely reached vulnerable PLWH with poorer prognosis. This information can be used to inform public health strategies.

O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV – uma revisão integrativa

Resumo Objetivo Identificar evidências na literatura acerca do conhecimento dos profissionais de saúde sobre vacinação das pessoas vivendo com HIV. Método Trata-se de uma revisão integrativa. Para a busca, foram utilizados os descritores: pessoal de saúde (health personnel), conhecimento (knowledge), vacinação (vaccination), HIV e seus sinônimos, sem utilização de filtros, nas bases de dados Pubmed, Biblioteca Virtual em Saúde, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct e Cochrane. Foram incluídos apenas artigos primários analisados por meio do aplicativo RAYYAN. Resultados De 601 publicações iniciais, apenas cinco constituíram a amostra final, todas identificadas no Pubmed publicadas entre 2013 e 2018, sendo nenhum estudo brasileiro. A maioria das publicações estava relacionada a alguma vacina específica e não abordava todo o calendário vacinal. Conclusão e implicações para a prática O déficit de conhecimento dos profissionais de saúde, em relação às vacinas indicadas às pessoas vivendo com HIV, foi o principal aspecto identificado, resultando em insegurança dos profissionais. Há a necessidade de educação permanente das equipes multiprofissionais dos serviços especializados e da atenção primária visando diminuir as barreiras e aumentar a cobertura vacinal desta clientela.

Taking stock of global immunisation coverage progress: the gains, the losses and the journey ahead

Despite the enormous benefits of vaccination, global immunisation coverage progress has stalled and remains suboptimal in many countries. In this commentary, we review the recently published update of the World Health Organization and United Nations Children's Fund Estimates of National Immunization Coverage. We highlight trends in which, despite substantial gains made in improving immunisation coverage at the global level, there remain numerous challenges with reaching and sustaining optimal coverage. We contextualise the trends by exploring plausible supply- and demand-side root causes. Based on these, we stress the need for targeted, context-appropriate strategies for reaching and maintaining optimal immunisation coverage.

Hepatitis B birth dose vaccination for newborns in Uganda: A qualitative inquiry on pregnant women's perceptions, barriers and preferences

BACKGROUND

Sub-Saharan Africa continues with very low hepatitis B (HBV) birth dose vaccination coverage. To guide policy on HBV vaccine for newborns, we explored perceptions, barriers and preferences of pregnant women regarding HBV and the HBV birth dose vaccination.

METHODS

We conducted eight focus groups discussions (FGDs) among 70 pregnant women, stratified by rural-urban residence, age and education level, using a structured focus group discussion guide to explore birth dose awareness, perceptions, barriers and preferences. Data were transcribed, coded and analysed using framework analysis.

RESULTS

Perceptions related to HBV and liver cancer causes and prevention were diverse; most FGD participants did not perceive illnesses as distinctly different. Older women-groups, both urban and rural, had never heard about HBV, but were aware of liver cancer, viewing the disease as fatal. No FGD participants were aware of HBV birth dose. Concerns included vaccine safety, its availability to women who deliver outside the health system and mistrust in health-care worker (HCWs) when handling newborns. Rural-dwelling groups perceived absence of HBV services, while FGDs with young participants believed vaccine side-effects hampered birth dose planning. Most women-groups preferred (i) oral to injectable vaccines; (ii) receiving birth dose education during antenatal, to media-based education; (iii) that newborns receive the birth dose immediately after delivery in the mother's presence.

CONCLUSION

Although the birth dose is acceptable among pregnant women, planners need to continuously engage them as key stakeholders during planning to address concerns, in order to raise confidence, maximize uptake and strengthen HBV eradication efforts.

Predictors of vaccination rates in people living with HIV followed at a specialty care clinic

People Living with HIV (PLWH) remain disproportionately susceptible to vaccine-preventable illnesses due to increased morbidity and mortality from common pathogens, increased transmission related to epidemiologic factors, and decreased vaccination rates. We aimed to describe patient-specific predictive factors that may impact adherence to the CDC's recommended vaccination schedules in PLWH. We retrospectively evaluated adult PLWH in care at the University of Nebraska Medical Center's HIV clinic and collected information related to demographics, clinic visits, vaccination status, and measures of HIV disease control. Patients were categorized as "Adherent" if they had received all vaccinations for which they were eligible and were categorized as "Non-Adherent" if they were deficient or delayed in receiving one or more vaccinations. Participant characteristics were compared between groups by multivariable logistic regression to identify predictors associated with vaccine schedule non-adherence. We evaluated 502 PLWH who met our inclusion criteria; 206 of these (41%) had received all eligible vaccinations, while 296 (59%) were missing one or more vaccinations. The mean age of participants was 48 years old, 76% were male, and 53% were white. Our participants had a median of 2.83 clinic visits per year and missed 8.3% of scheduled clinic visits. Factors associated with non-adherence to vaccination schedules included a high frequency of missed clinic appointments (>10%), men who have sex with men, and a CD4 count <200 cells/mm³. Knowledge of variables associated with vaccination rates may be beneficial in identifying patients at-risk for under-vaccination and designing targeted education programs for providers and patients.

Observational study of vaccination in cancer patients: How can vaccine coverage be improved?

BACKGROUND

Chemotherapy increases the risk of infections, often severe, and some of them are vaccine-preventable infections. We aimed to assess vaccination coverage and associated factors in oncology and hematology patients.

METHODS

Consecutive adult patients followed in a French university hospital for hematological malignancy or solid cancer voluntarily completed an anonymous questionnaire in September and October 2016. It included questions on underlying disease, chemotherapy, flu, and pneumococcal vaccination uptakes, and attitudes toward vaccination. Factors associated with vaccination uptake were assessed by multivariate logistic regression.

RESULTS

The response rate was 41.9% (N=671) among 1,600 questionnaires distributed; 232 patients had underlying hematological malignancy and 439 had solid cancer. Half of the patients were aged over 65 years. Chemotherapy was ongoing or discontinued for less than one year in 74.7% of patients. In patients aged <65 years undergoing chemotherapy, flu vaccination rate was 19.9% whereas patients aged >65 years had coverage of 47%. Pneumococcal vaccine uptake was 7.3%. However, 64.7% of patients were favorable to vaccination. Vaccine uptake was associated with age >65 years (OR 4.5 [2.9-7.0]), information about vaccination delivered by the family physician (OR 12.9 [5.5-30.1]), follow-up in hematology unit (OR 2.0 [1.3-3.1]), and positive opinion about vaccination (OR 2.0 [1.3-3.1]).

CONCLUSION

Despite specific recommendations regarding immunocompromised patients, anti-pneumococcal and flu vaccinations were rarely conducted, even in elderly patients. Targeted information campaigns to family physicians, oncologists, and patients should be implemented to improve vaccine coverage in patients with underlying malignancies.

Image of the new vaccination obligation through the media

INTRODUCTION

Vaccination campaigns always go hand by hand with controversies about their safety and usefulness. The widespread perception of vaccines as dangerous induces a decrease in the population immunization coverage, which led The French Ministry of Health to add 8 new mandatory vaccines to the 3 existing ones. The objective of this study is to analyze the information conveyed by the media and received by the French population about this new legislation.

METHOD

The newspaper articles and television and radio programs were selected from the media with the highest audience rate from January 2016 to May 2018. They were analyzed according to the grounded theory, up to data saturation, with double coding.

RESULTS

The qualitative analysis included 38 written press articles, 18 radio programs and 18 television programs. After coding, several themes emerged. Discussions about the usefulness of vaccination, trust in vaccines, vaccination coverage, and the cost of measure were controversial in the media. Questions about ethics were also mentioned. The description of anti-vaccines by journalists and some doctors conveyed a negative image while reminding their strong mobilization through social media. The law and its implementation details were frequently reminded across the different media.

DISCUSSION-CONCLUSION

Traditional media give opposing views on immunization obligations. Vaccination is supported by a majority of doctors. Parents share their fears and concerns about vaccination and its adverse effects. An effort regarding public communication seems necessary in order to reassure the population. The study of other media, such as the Internet, could help to deepen this study.

Perception of mandatory infant vaccines and trust in vaccination among first-year healthcare students: An opportunity window for the training of future healthcare workers

INTRODUCTION

A high level of vaccine hesitancy is observed in France; to maintain a high level of vaccine coverage, a policy of mandatory vaccines has been applied since January 2019. As vaccine hesitancy has been described among healthcare workers, we aimed to assess the adhesion to vaccination in students enrolled in the first common year of healthcare studies (PACES), and their perceptions regarding the mandatory vaccine policy.

METHODS

We elaborated an anonymous online questionnaire and asked the 35 French universities offering PACES studies to diffuse it to their students; 26 accepted.

RESULTS

Overall, 4326 participants completed the questionnaire (age 18.7 ± 1.5 years, female 76.1%). They evaluated vaccine usefulness and harmfulness at a median of 90 [IQT:80-100] and 25 [IQT:10-50], respectively; on the same scale, their median trust in vaccines was 82 [IQT:70-94]. Among the five main age classes (17 to 21 years), the positive perceptions of vaccination declined with age. A majority declared that making vaccines mandatory was morally and scientifically justified (65.7% and 84.7%, respectively); in response to the questionnaire showing a blatant anti-mandatory vaccine billboard, 52.3% and 28.6%, respectively, strongly disagreed or rather disagreed with it. Again, these proportions declined between 17 and 21 years. Participants were asked whether the mandatory vaccine policy would improve their perceptions of vaccination; those with poorer perceptions were less likely to answer this question positively.

CONCLUSION

The perceptions of vaccination and the recent mandatory vaccine policy are positive in first-year students but better in younger ones, thus suggesting that vaccination should be taught early, during this study year. The mandatory vaccine policy may not improve the perceptions of those with a high level of vaccine hesitancy.

Midwives' perceptions of vaccines and their role as vaccinators: The emergence of a new immunization corps

BACKGROUND

In France, midwives have recently been authorized to administer various vaccines to women (including pregnant women), newborns, and their family members. This is expected to enhance vaccine coverage. However, the French high level of vaccine hesitancy is also observed in some healthcare workers. We thus aimed to determine the perceptions of French midwives concerning vaccines.

METHODS

We distributed an anonymous online questionnaire between September and December 2017, targeting midwives who were still in training or working in the public or private sector.

RESULTS

A total of 917 questionnaires were analyzed (median age 26 years). Almost half of participants (44.5%) were students. On a scale of 0-100, the median perception of the usefulness, safety, and trust of vaccinations were 92, 80, and 85, respectively. The mean scores of students were significantly higher for each perception, whereas in professional midwives, age and perceptions were negatively correlated. When asked whether there were scientific, philosophical, or religious arguments not to vaccinate, 83.2%, 69.8%, and 77.8% of participants disagreed, respectively. The vast majority (91.6%) was very or mostly favorable to the pertussis vaccine after delivery, but only around half (51.5%) to the influenza vaccine during pregnancy; those favorable to the pertussis vaccine were younger. A high proportion of participants (88.3%) considered that midwives were in a good position to vaccinate, with this proportion being even higher among students.

CONCLUSIONS

These results suggest that the recent authorization regarding vaccine administration will result in better vaccine coverage of pregnant women and their families by midwives. The better perceptions of younger participants are also encouraging. However, the level of trust in vaccinations (only 80.1%) and the low number of participants favorable to the influenza vaccine during pregnancy suggest that initial and continuous training should be reinforced.

Strategies implemented to address vaccine hesitancy in France: A review article

Vaccination has been identified many decades ago as an effective means to prevent several diseases. However, in France, there is an emergence of vaccine hesitancy, that has caused a reduction of vaccination coverage rates. This issue reduces the effectiveness of the immunization process, and represents a real threat to public health that should be urgently addressed. The purpose of this review is to present actions that have been taken to fight against vaccine hesitancy and thus enhance vaccine uptake. The results indicate that different strategies have been proposed to reach this goal, mainly by vaccination campaigns. These findings highlight the strong implication of national health authorities and the medical staff of hospitals and health-care centers. However, actions implemented should be part of a long-term approach, and further studies are required to identify the most effective strategies to address vaccine hesitancy.

Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons

AIM

To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.

METHODS

Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).

RESULTS

In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries (P < 0.001), patients with limited healthcare coverage (P = 0.01) and men who have sex with men (P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was “will be vaccinated later” (33.4%), followed by “did not want to vaccinate” (29.8%), and “vaccination was not proposed by the physician” (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.

CONCLUSION

HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.

Hepatitis B vaccination status in an at-risk adult population: long-term immunity but insufficient coverage

In France, hepatitis B (HB) vaccine has been offered to all infants since 1994, and was proposed to all children aged 11 years from 1994 to 1998. Nevertheless, HB vaccine hesitancy may result in low vaccination coverage in present-day at-risk adults. We aimed to determine HB vaccination coverage in adults attending a free testing center for sexually transmitted infections (STI). As part of routine care, three classes of data were anonymously collected from attendees over a 3-month period: results of HB serologic tests; date and number of past anti-hepatitis B virus (HBV) immunization(s) (if any) according to health records; and the risk of STI and blood-transmitted infections (BTI). The study included 735 participants (age 27.9 ± 9.2; 59.9% men). According to available health records (341 participants), 56.6% had received at least three and 67.2% at least one vaccine injection(s); 57.7% had received their last injection between 1994 and 1998, reflecting the strong vaccine policy during these years. Serologic testing (in 705 participants) showed evidence of a past or active HBV infection for 33 participants; of the remaining patients, 55.3% had anti-HBs antibody titers ≥10 IU/L. This rate was not higher in participants considered at risk for STI/BTI. Of the participants who received their last vaccine injection more than 15 years previously, 90.5% had anti-HBs antibody concentrations ≥10 and 60.3% ≥100 IU/mL. HB vaccination coverage is low in this population. Most of the vaccinated participants were immunized between 1994 and 1998, suggesting a failure of catch-up immunization of adolescents and at-risk adults. Long-term seroprotection persisted among vaccinated participants.