1
|
Sacre A, Bambra C, Wildman JM, Thomson K, Bennett N, Sowden S, Todd A. Socioeconomic inequalities in vaccine uptake: A global umbrella review. PLoS One 2023; 18:e0294688. [PMID: 38091273 PMCID: PMC10718431 DOI: 10.1371/journal.pone.0294688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.
Collapse
Affiliation(s)
- Amber Sacre
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | | | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Natalie Bennett
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle, United Kingdom
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle, United Kingdom
| |
Collapse
|
2
|
Abubakari SW, Workneh F, Asante KP, Hemler EC, Madzorera I, Wang D, Ismail A, Assefa N, Azemraw T, Lankoande B, Nuhu AR, Chukwu A, Mapendo F, Millogo O, Olufemi AA, Okpara D, Boudo V, Mwanyika-Sando M, Berhane Y, Baernighausen T, Oduola A, Vuai S, Sie A, Soura A, Killewo J, Tajudeen R, Fawzi WW, Smith ER. Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000713. [PMID: 37450441 PMCID: PMC10348558 DOI: 10.1371/journal.pgph.0000713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/08/2023] [Indexed: 07/18/2023]
Abstract
There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate COVID-19 vaccine hesitancy and other predictors of readiness to get vaccinated. We conducted surveys among adults residing in nine urban and rural areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania in late 2021. Log binomial regression models were used to identify prevalence and factors associated with vaccine hesitancy and beliefs around COVID-19 misinformation. We completed a total of 2,833 interviews. Among all respondents, 9% had never heard of a COVID-19 vaccine, 12% had been vaccinated, and 20% knew someone else who had been vaccinated. The prevalence of vaccine hesitancy varied by country (Ethiopia 29%, Burkina Faso 33%, Nigeria 34%, Ghana 42%, Tanzania 65%), but not by rural or urban context. People who did not think the vaccine was safe or effective, or who were unsure about it, were more likely to be vaccine hesitant. Those who reported they did not have a trusted source of information about the vaccine (aPR: 1.25, 95% CI: 1.18,1.31) and those who thought the vaccine would not be made available to them within the year were more likely to be vaccine hesitant. Women were more likely to be vaccine hesitant (aPR: 1.31, 95% CI: 1.19,1.43) and believe COVID-19 falsehoods (aPR: 1.05, 95% CI: 1.02,1.08). The most commonly believed falsehoods were that the vaccine was developed too fast and that there was not enough information about whether the vaccine was effective or not. Educational campaigns targeted at misinformation and tailored to suit each country are recommended to build trust in COVID-19 vaccines and reduce hesitancy.
Collapse
Affiliation(s)
- Sulemana Watara Abubakari
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Kwaku Poku Asante
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Elena C. Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Temesgen Azemraw
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Bruno Lankoande
- Institut Superieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abdul Razak Nuhu
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | - Adedokun A. Olufemi
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Daniel Okpara
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | | | | | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Abdramane Soura
- Institut Superieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raji Tajudeen
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| |
Collapse
|
3
|
Firman N, Marszalek M, Gutierrez A, Homer K, Williams C, Harper G, Dostal I, Ahmed Z, Robson J, Dezateux C. Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records. BMJ Open 2022; 12:e066288. [PMID: 36456017 PMCID: PMC9723415 DOI: 10.1136/bmjopen-2022-066288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination. DESIGN Longitudinal study using primary care electronic health records. SETTING 285 general practices in North East London. PARTICIPANTS Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort). MAIN OUTCOME MEASURE Receipt of timely MMR vaccination between 12 and 18 months of age. METHODS We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations. RESULTS Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic. CONCLUSIONS The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.
Collapse
Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Milena Marszalek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ana Gutierrez
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Crystal Williams
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Zaheer Ahmed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
4
|
Bianchi FP, Stefanizzi P, Trerotoli P, Tafuri S. Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis. Vaccine 2022; 40:3127-3141. [PMID: 35491343 DOI: 10.1016/j.vaccine.2022.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible. RESULTS Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0-17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83-1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20-3.50). The most recent studies proposed the mandatory vaccination of HCWs. DISCUSSION According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.
Collapse
Affiliation(s)
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
| |
Collapse
|
5
|
Robert A, Kucharski AJ, Funk S. The impact of local vaccine coverage and recent incidence on measles transmission in France between 2009 and 2018. BMC Med 2022; 20:77. [PMID: 35264161 PMCID: PMC8907007 DOI: 10.1186/s12916-022-02277-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Subnational heterogeneity in immunity to measles can create pockets of susceptibility and result in long-lasting outbreaks despite high levels of national vaccine coverage. The elimination status defined by the World Health Organization aims to identify countries where the virus is no longer circulating and can be verified after 36 months of interrupted transmission. However, since 2018, numerous countries have lost their elimination status soon after reaching it, showing that the indicators defining elimination may not be associated with lower risks of outbreaks. METHODS We quantified the impact of local vaccine coverage and recent levels of incidence on the dynamics of measles in each French department between 2009 and 2018, using mathematical models based on the "Endemic-Epidemic" regression framework. After fitting the models using daily case counts, we simulated the effect of variations in the vaccine coverage and recent incidence on future transmission. RESULTS High values of local vaccine coverage were associated with fewer imported cases and lower risks of local transmissions, but regions that had recently reported high levels of incidence were also at a lower risk of local transmission. This may be due to additional immunity accumulated during recent outbreaks. Therefore, the risk of local transmission was not lower in areas fulfilling the elimination criteria. A decrease of 3% in the 3-year average vaccine uptake led to a fivefold increase in the average annual number of cases in simulated outbreaks. CONCLUSIONS Local vaccine uptake was a reliable indicator of the intensity of transmission in France, even if it only describes yearly coverage in a given age group, and ignores population movements. Therefore, spatiotemporal variations in vaccine coverage, caused by disruptions in routine immunisation programmes, or lower trust in vaccines, can lead to large increases in both local and cross-regional transmission. The incidence indicator used to define the elimination status was not associated with a lower number of local transmissions in France, and may not illustrate the risks of imminent outbreaks. More detailed models of local immunity levels or subnational seroprevalence studies may yield better estimates of local risk of measles outbreaks.
Collapse
Affiliation(s)
- Alexis Robert
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK. .,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
6
|
Vojtek I, Larson H, Plotkin S, Van Damme P. Evolving measles status and immunization policy development in six European countries. Hum Vaccin Immunother 2022; 18:2031776. [PMID: 35180372 PMCID: PMC9009904 DOI: 10.1080/21645515.2022.2031776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Developing and implementing new immunization policies in response to shifting epidemiology is a critical public health component. We adopted a mixed-methods approach (via narrative literature review [101 articles] and 9 semi-structured interviews) to evaluate policy development in response to shifting measles epidemiology in six European countries (Italy, Belgium, Germany, Romania, UK, and Ukraine); where policies and strategies have evolved in response to country-specific disease and vaccination patterns. Periodic outbreaks have occurred in all countries against a background of declining measles-containing-vaccine (MCV) uptake and increasing public vaccine hesitancy (with substantial regional or social differences in measles burden and vaccine uptake). Health-care worker (HCW) vaccine skepticism is also seen. While many outbreaks arise or involve specific susceptible populations (e.g., minority/migrant communities), the broader pattern is spread to the wider (and generally older) population; often among incompletely/non-vaccinated individuals as a legacy of previous low uptake. Immunization policy and strategic responses are influenced by political and social factors, where public mistrust contributes to vaccine hesitancy. A strong centralized immunization framework (allied with effective regional implementation and coherent political commitment) can effectively increase uptake. Mandatory vaccination has increased childhood MCV uptake in Italy, and similar benefits could be anticipated for other countries considering vaccine mandates. Although possible elsewhere, socio-political considerations render mandating impractical in other countries, where targeted immunization activities to bolster routine uptake are more important. Addressing HCW skepticism, knowledge gaps, improving access and increasing public/community engagement and education to address vaccine hesitancy/mistrust (especially in communities with specific unmet needs) is critical.
Collapse
Affiliation(s)
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stanley Plotkin
- University of Pennsylvania School of Medicine, Doylestown, PA, USA.,Vaxconsult, Doylestown, PA, USA
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
7
|
Papagiannis D, Malli F, Gourgoulianis KI. Registry Systems for COVID-19 Vaccines and Rate of Acceptability for Vaccination Before and After Availability of Vaccines in 12 Countries: A Narrative Review. Infect Dis Rep 2022; 14:121-133. [PMID: 35200443 PMCID: PMC8872397 DOI: 10.3390/idr14010016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
Registry systems play a key role in promoting vaccination campaigns in the general population. In the present narrative review, we provide data from 12 12 countries for vaccination acceptance before the availability of COVID-19 vaccines and vaccination coverage once it is available. We selected a randomized representative sample of 12 countries from WHO regions and 194 total members by the Open Epi Random Program. We observed the results with different levels of vaccine acceptability between the studies that were performed before the availability of a vaccine against COVID-19 and the vaccination coverage after the availability of the COVID-19 vaccine. All the registry systems that were developed for the recent pandemic achieved the initial functional goals. Twelve months after the vaccination campaign has begun, varying results were reported for vaccination coverage against COVID-19 vaccines with rates as high as 98% (subjects with at least one dose of vaccine) in the United Arabic Emirates, and as low as 24% in South Africa. The United Arabic Emirates stood as the leader of the world with the highest number of vaccinations 88% fully vaccinated citizens followed by Canada with 80% fully vaccinated citizens. The available data suggest that vaccine registry systems could help increase vaccination coverage and aim in the control of future outbreaks.
Collapse
Affiliation(s)
- Dimitrios Papagiannis
- Public Health & Vaccines Lab, Department of Nursing, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
- Correspondence: ; Tel.: +30-2410684610
| | - Foteini Malli
- Respiratory Disorders Laboratory, Faculty of Nursing, University of Thessaly, 41110 Larissa, Greece;
| | | |
Collapse
|
8
|
Eshel Y, Kimhi S, Marciano H, Adini B. Belonging to Socially Excluded Groups as a Predictor of Vaccine Hesitancy and Rejection. Front Public Health 2022; 9:823795. [PMID: 35127631 PMCID: PMC8810499 DOI: 10.3389/fpubh.2021.823795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
The scientific call for vaccination against the COVID-19 pandemic has met hesitancy, postponement, and direct opposition of parts of the public in several countries. Mistrusting the COVID-19 vaccine, distrusting the authorities, and unrealistic optimism, are three major reasons employed in justifying vaccine hesitancy. The present study examines two major issues. First, it strives to identify individuals that are unwilling to adhere to the vaccination process, more strongly question the effectiveness and necessity of the COVID-19 vaccine, and wonder about potential covert reasons for its administration. Second, it investigates associations between such “conspiracy” claims and the actual rejection of the vaccine. We assume that individuals belonging to social groups which are partly excluded by the general society will be less willing to fulfill the demands of this society, more inclined to reject the vaccine and associate it with some hidden conspiracy. A relatively large sample of the Israeli public (N = 2002) has responded to an anonymous questionnaire pertaining, among other things, to vaccine hesitancy and the individual level of vaccine uptake. Previous research has mainly examined the reasons for vaccine hesitancy. The present study's results indicate that three out of four social exclusion criteria (young adulthood, low level of income, and orthodox religiosity) have negatively predicted vaccine uptake and positively predicted three types of reasoning for vaccine hesitancy. Young adulthood was the strongest predictor of vaccine rejection. Attempts at convincing hesitating individuals to uptake this vaccine have often failed in many countries. As varied reasons underlie vaccine refusal, it is suggested that the approach to different vaccine rejecting groups should not be generic but rather tailor-made, in an attempt to influence their perceptions and behavior.
Collapse
Affiliation(s)
- Yohanan Eshel
- Stress and Resilience Research Center, Tel Hai and University of Haifa, Haifa, Israel
| | - Shaul Kimhi
- Multinational Resilience and Well-Being Research Center, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Marciano
- Stress and Resilience Research Center, Tel-Hai College, The Institute of Information Processing and Decision Making (IIPDM), University of Haifa, Haifa, Israel
| | - Bruria Adini
- Department of Emergency and Disaster Management, Multinational Resilience and Well-Being Research Center, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Bruria Adini
| |
Collapse
|
9
|
Cooper S, van Rooyen H, Wiysonge CS. COVID-19 vaccine hesitancy in South Africa: how can we maximize uptake of COVID-19 vaccines? Expert Rev Vaccines 2021; 20:921-933. [PMID: 34252336 DOI: 10.1080/14760584.2021.1949291] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Acceptance of COVID-19 vaccines is critical to personal health, protecting vulnerable populations, reopening socio-economic life, and achieving population health and safety through immunity. The primary aim of this review was to investigate the extent and determinants of COVID-19 vaccine hesitancy in South Africa to inform the development of strategies to address it. A secondary aim was to enhance understandings of and responses to vaccine hesitancy more generally in South Africa, with potential positive effect on vaccination uptake during and beyond the COVID-19 pandemic.Areas covered: We reviewed the findings from surveys conducted in South Africa from February 2020 to March 2021 that investigated acceptance of COVID-19 vaccines. Surveys were identified through searching electronic databases of peer-reviewed and gray literature and contacting experts.Expert opinion: The review reveals the inherently social nature of COVID-19 vaccine hesitancy in South Africa, potentially influenced by age, race, education, politics, geographical location, and employment. Along with the provision of information, COVID-19 vaccine communication strategies need to form part of broader trust-building measures that focus on relationships, transparency, participation, and justice. The pandemic also provides a unique opportunity to positively intervene and reduce vaccine hesitancy trends more generally in South Africa and potentially elsewhere.
Collapse
Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council Francie van Zijl Drive,Parow Valley Cape Town 7501, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heidi van Rooyen
- The Impact Centre, Human Sciences Research, Parow, South Africa.,SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council Francie van Zijl Drive,Parow Valley Cape Town 7501, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
10
|
Abstract
Introduction: Controlling the preventable infectious diseases is the main goal of vaccination. Among the vaccines, combined vaccines are of great importance for their social, public health, and economic values. It is stated that the combined vaccines are as efficient and safe as the monovalent vaccines. However, a concern has raised about the efficacy and safety of the combined vaccines due to the outbreaks of vaccine-preventable diseases and occurrence of serious adverse events. Areas covered: A retrospective literature search was conducted in the Google Scholar and PubMed databases to evaluate the efficacy and safety of the combined vaccines from 1980 to 2020 using appropriate keywords. Expert opinion: Several studies have shown efficacy and safety issues related to the combined vaccines. Different factors contribute to the inefficacy and lack of safety in the vaccines including formulation problems, limited data in the pre-licensure studies and challenges related to imperfection of the post-licensure surveillance systems. For surmounting the mentioned obstacles, there is a need to provide new formulations of the vaccines, revise the vaccines҆ safety and efficacy acceptance standards in the pre-licensure studies, improvement of post-licensure surveillance systems, and education of healthcare staff.
Collapse
|
11
|
Kuylen E, Willem L, Broeckhove J, Beutels P, Hens N. Clustering of susceptible individuals within households can drive measles outbreaks: an individual-based model exploration. Sci Rep 2020; 10:19645. [PMID: 33184409 PMCID: PMC7665185 DOI: 10.1038/s41598-020-76746-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
When estimating important measures such as the herd immunity threshold, and the corresponding efforts required to eliminate measles, it is often assumed that susceptible individuals are uniformly distributed throughout populations. However, unvaccinated individuals may be clustered in a variety of ways, including by geographic location, by age, in schools, or in households. Here, we investigate to which extent different levels of within-household clustering of susceptible individuals may impact the risk and persistence of measles outbreaks. To this end, we apply an individual-based model, Stride, to a population of 600,000 individuals, using data from Flanders, Belgium. We construct a metric to estimate the level of within-household susceptibility clustering in the population. Furthermore, we compare realistic scenarios regarding the distribution of susceptible individuals within households in terms of their impact on epidemiological measures for outbreak risk and persistence. We find that higher levels of within-household clustering of susceptible individuals increase the risk, size and persistence of measles outbreaks. Ignoring within-household clustering thus leads to underestimations of required measles elimination and outbreak mitigation efforts.
Collapse
Affiliation(s)
- Elise Kuylen
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium.
| | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jan Broeckhove
- IDLab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Data Science Institute (DSI), Hasselt University, Hasselt, Belgium
| |
Collapse
|
12
|
Robert A, Kucharski AJ, Gastañaduy PA, Paul P, Funk S. Probabilistic reconstruction of measles transmission clusters from routinely collected surveillance data. J R Soc Interface 2020; 17:20200084. [PMID: 32603651 PMCID: PMC7423430 DOI: 10.1098/rsif.2020.0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Pockets of susceptibility resulting from spatial or social heterogeneity in vaccine coverage can drive measles outbreaks, as cases imported into such pockets are likely to cause further transmission and lead to large transmission clusters. Characterizing the dynamics of transmission is essential for identifying which individuals and regions might be most at risk. As data from detailed contact-tracing investigations are not available in many settings, we developed an R package called o2geosocial to reconstruct the transmission clusters and the importation status of the cases from their age, location, genotype and onset date. We compared our inferred cluster size distributions to 737 transmission clusters identified through detailed contact-tracing in the USA between 2001 and 2016. We were able to reconstruct the importation status of the cases and found good agreement between the inferred and reference clusters. The results were improved when the contact-tracing investigations were used to set the importation status before running the model. Spatial heterogeneity in vaccine coverage is difficult to measure directly. Our approach was able to highlight areas with potential for local transmission using a minimal number of variables and could be applied to assess the intensity of ongoing transmission in a region.
Collapse
Affiliation(s)
- Alexis Robert
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam J. Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul A. Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prabasaj Paul
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
13
|
Andrianou XD, Del Manso M, Bella A, Vescio MF, Baggieri M, Rota MC, Pezzotti P, Filia A. Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, September 2016 to July 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31039836 PMCID: PMC6628759 DOI: 10.2807/1560-7917.es.2019.24.17.1800679] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Measles is still endemic in Italy and outbreaks are frequent. From 2016 to 2018, more than 7,000 measles cases were reported to the national integrated measles and rubella surveillance system, the largest outbreak since implementation of this system. Aim We aimed to describe the characteristics and spatiotemporal distribution of measles cases in Italy and explore determinants of incidence at municipality level. Methods We performed a retrospective observational study, mapping by municipalityall measles cases reported to the national surveillance system with symptom onset between 1 September 2016 and 31 July 2018. We also analysed measles–mumps-rubella (MMR) vaccination coverage (VC) data (2000–2017) for the first and second dose, collected from the Ministry of Health. We used regression analysis to explore factors associated with measles incidence at municipality level. Results We analysed 7,854 cases, 3,927 (50%) female. Median age was 26 years; 475 cases (6%) were younger than 1 year. The outbreak occurred in two epidemic waves. The first started in central/northern regions (end of 2016), the second (mostly within 2018) was concentrated in southern regions. In 2016 and 2017, national VC was below 95% for both MMR doses. In 2017, only one region reported VC above 95% for the first dose. At municipality level, incidence was associated with higher urbanisation, less deprivation and fewer adults. Conclusion The spread of measles between September 2016 and July 2018 in Italy indicates the need to improve VC and to explore further how societal and other parameters might be linked to incidence.
Collapse
Affiliation(s)
- Xanthi D Andrianou
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Martina Del Manso
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Maria Fenicia Vescio
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Melissa Baggieri
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| |
Collapse
|
14
|
Madi N, Altawalah H, Alfouzan W, Al-Nakib W, Al-Roumi E, Jeragh A. Assessment of immune status against measles, mumps, and rubella in young Kuwaitis: MMR vaccine efficacy. J Med Virol 2020; 92:963-970. [PMID: 31919861 DOI: 10.1002/jmv.25665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/06/2020] [Indexed: 11/08/2022]
Abstract
Seroprevalence studies on measles, mumps, and rubella immunoglobulin G (IgG) antibodies after the implementation of the measles-mumps-rubella (MMR) vaccine are lacking in Kuwait. This study is an age-stratified serological study to assess the herd immunity to measles, mumps, and rubella among the young Kuwaiti population to evaluate the effectiveness of the MMR vaccine. IgG antibody titers to mumps, measles, and rubella were determined with commercial immune-assay in serum samples of 1000 Kuwaitis aged 5 to 20 years. The highest level of seropositivity was to measles (94.6%), which was significantly higher in females than in males. The highest seronegativity was for mumps (29%). The percentage of the young Kuwaiti population who were serologically positive for all the components of the MMR vaccine was 47%, and 2% of the individuals were without any protective antibodies to measles, mumps, and rubella. Females aged 5 to 10 years were best protected to rubella; however, seronegativity in 8.2% of 11- to 20-year-old females makes them vulnerable to rubella virus infection and congenital complications during pregnancy. The study provided insight into the effect of the MMR vaccine on seroprevalence of antibodies against measles, mumps, and rubella in Kuwait, which will contribute to the global knowledge base of vaccine coverage and help to inform elimination strategies. The findings strengthen the need for a third dose of MMR vaccine and catch-up campaigns for the young Kuwaiti population to increase vaccination coverage and prevent waning immunity, especially among those who received only one dose of the vaccine during childhood.
Collapse
Affiliation(s)
- Nada Madi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Widad Al-Nakib
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ebtehal Al-Roumi
- Department of Microbiology, Al-Jahra Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ahlam Jeragh
- Department of Microbiology, Al-Adan Hospital, Ministry of Health, Kuwait City, Kuwait
| |
Collapse
|
15
|
Oduwole EO, Pienaar ED, Mahomed H, Wiysonge CS. Current tools available for investigating vaccine hesitancy: a scoping review protocol. BMJ Open 2019; 9:e033245. [PMID: 31831547 PMCID: PMC6924801 DOI: 10.1136/bmjopen-2019-033245] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services is responsible in part for suboptimal levels of vaccination coverage worldwide. The WHO recommends that countries incorporate plans to measure and address vaccine hesitancy into their immunisation programmes. This requires that governments and health institutions be able to detect concerns about vaccination in the population and monitor changes in vaccination behaviours. To do this effectively, tools to detect and measure vaccine hesitancy are required. The purpose of this scoping review is to give a broad overview of currently available vaccine hesitancy measuring tools and present a summary of their nature, similarities and differences. METHODS AND ANALYSIS The review will be conducted using the framework for scoping review proffered by Arksey and O'Malley. It will comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. The broader research question of this review is: what vaccine hesitancy measuring tools are currently available?Search strategies will be developed using controlled vocabulary and selected keywords. PubMed, Web of Science, Scopus and reference lists of relevant publications will be searched. Titles and abstracts will be independently screened by two authors and data from full-text articles meeting the inclusion criteria will be extracted independently by two authors using a pretested data charting form. Discrepancies will be resolved by discussion and consensus. Results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Narrative analysis will be used to summarise the findings of the review. ETHICS AND DISSEMINATION Ethics approval is not required for the review. It will be submitted as part of a doctoral thesis, presented at conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER https://osf.io/x8fjk/.
Collapse
Affiliation(s)
- Elizabeth O Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Elizabeth D Pienaar
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Metro Health Services, Western Cape Government: Health, Cape Town, Western Cape Province, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape Province, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
16
|
Funk S, Knapp JK, Lebo E, Reef SE, Dabbagh AJ, Kretsinger K, Jit M, Edmunds WJ, Strebel PM. Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination. BMC Med 2019; 17:180. [PMID: 31551070 PMCID: PMC6760101 DOI: 10.1186/s12916-019-1413-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns. METHODS We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination. RESULTS We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5-9-year-olds than established previously. CONCLUSIONS The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5-9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.
Collapse
Affiliation(s)
- Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Jennifer K. Knapp
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Emmaculate Lebo
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Susan E. Reef
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Alya J. Dabbagh
- World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | | | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, 61 Colindale Avenue, London, UK
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Hong Kong SAR, China
| | - W. John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Peter M. Strebel
- GAVI Alliance, Chemin du Pommier 40, Le Grand-Saconnex, Switzerland
| |
Collapse
|
17
|
Trentini F, Poletti P, Melegaro A, Merler S. The introduction of 'No jab, No school' policy and the refinement of measles immunisation strategies in high-income countries. BMC Med 2019; 17:86. [PMID: 31096986 PMCID: PMC6524211 DOI: 10.1186/s12916-019-1318-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/01/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, we witnessed a resurgence of measles even in countries where, according to WHO guidelines, elimination should have already been achieved. In high-income countries, the raise of anti-vaccination movements and parental vaccine hesitancy are posing major challenges for the achievement and maintenance of high coverage during routine programmes. Italy and France approved new regulations, respectively in 2017 and 2018, aimed at raising immunisation rates among children by introducing mandatory vaccination at school entry. METHODS We simulated the evolution of measles immunity profiles in seven distinct countries for the period 2018-2050 and evaluated the effect of possible adjustments of immunisation strategies adopted in the past on the overall fraction and age distribution of susceptible individuals in different high-income demographic settings. The proposed model accounts for country-specific demographic components, current immunity gaps and immunisation activities in 2018. Vaccination strategies considered include the enhancement of coverage for routine programmes already in place and the introduction of a compulsory vaccination at primary school entry in countries where universal school enrolment is likely achieved. RESULTS Our model shows that, under current vaccination policies, the susceptible fraction of the population would remain below measles elimination threshold only in Singapore and South Korea. In the UK, Ireland, the USA and Australia either the increase of coverage of routine programmes above 95% or the introduction of a compulsory vaccination at school entry with coverage above 40% are needed to maintain susceptible individuals below 7.5% up to 2050. Although the implementation of mandatory vaccination at school entry would be surely beneficial in Italy, strategies targeting adults would also be required to avoid future outbreaks in this country. CONCLUSIONS Current vaccination policies are not sufficient to achieve and maintain measles elimination in most countries. Strategies targeting unvaccinated children before they enter primary school can remarkably enhance the fulfilment of WHO targets.
Collapse
Affiliation(s)
- Filippo Trentini
- Center for Information Technology, Bruno Kessler Foundation, via Sommarive, 18, 38123, Trento, Italy.
| | - Piero Poletti
- Center for Information Technology, Bruno Kessler Foundation, via Sommarive, 18, 38123, Trento, Italy
| | - Alessia Melegaro
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policies and Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Stefano Merler
- Center for Information Technology, Bruno Kessler Foundation, via Sommarive, 18, 38123, Trento, Italy
| |
Collapse
|
18
|
Lodhi OUH, Imam SF, Umer M, Zafar R. A Rare Coincidence of Measles with Typhoid Fever. Cureus 2017; 9:e1630. [PMID: 29104838 PMCID: PMC5662164 DOI: 10.7759/cureus.1630] [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] [Indexed: 11/06/2022] Open
Abstract
Typhoid, otherwise known as enteric fever, and measles both have a high incidence worldwide. However, a coincidence of both has been only documented twice previously in 1866 and 1949. We present a case of a 24-year-old male who presented with high-grade fever and diffuse abdominal tenderness. He was diagnosed with typhoid initially, but during the course of his illness, he developed a maculopapular rash and pathognomonic Koplik’s spots. Further investigations confirmed measles that was concurrent with typhoid. This highlights the importance of further comprehensive investigations even in diagnosed cases, and that overlapping symptoms should raise the clinical suspicion of concurrent diseases. One should always keep an open mind when assessing a patient, not just at the time of making a diagnosis but throughout the course of illness.
Collapse
Affiliation(s)
- Omair Ul Haq Lodhi
- Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Syed F Imam
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Mahad Umer
- Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Rizwan Zafar
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
| |
Collapse
|