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Williams CT, Saini B, Zaidi STR, Kali C, Moujalli G, Castelino R. Factors Influencing COVID-19 Vaccine Confidence and Uptake in Australian Adults. Vaccines (Basel) 2024; 12:627. [PMID: 38932356 PMCID: PMC11209045 DOI: 10.3390/vaccines12060627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia.
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Affiliation(s)
| | - Bandana Saini
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Syed Tabish R. Zaidi
- School of Pharmacy and Pharmacology, College of Medicine and Health, University of Tasmania, Hobart, TAS 7005, Australia
| | - Christina Kali
- Pharmacy Department, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Grace Moujalli
- Pharmacy Department, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Ronald Castelino
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
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Baxter L, Slater R, Hermany L, Bhatti A, Eiden AL, Mitrovich R, Connolly MP, Vanderslott S, Nyaku M, Bhatt A. Identifying characteristics that enable resilient immunisation programmes: a scoping review. BMJ Open 2024; 14:e072794. [PMID: 38806437 PMCID: PMC11138283 DOI: 10.1136/bmjopen-2023-072794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 02/14/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic highlighted the fragility of immunisation programmes and resulted in a significant reduction in vaccination rates, with increasing vaccine-preventable disease outbreaks consequently reported. These vulnerabilities underscore the importance of resilient immunisation programmes to ensure optimal performance during crises. To date, a framework for assessing immunisation programme resilience does not exist. We conducted a scoping review of immunisation programmes during times of crisis to identify factors that characterise resilient immunisation programmes, which may inform an Immunisation Programme Resilience Tool. DESIGN Scoping review design followed the Arksey and O'Malley framework, and manuscript reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. DATA SOURCES CINAHL, CENTRAL, Embase, Google Scholar, MEDLINE, PsycINFO and Web of Science and databases were searched between 1 January 2011 and 2 September 2023. Citation searching of identified studies was also performed. ELIGIBILITY CRITERIA We included primary empirical peer-reviewed studies that discussed the resilience of immunisation programme to crises, shocks or disruptions. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened records and performed data extraction. We extracted data on study location and design, crisis description, and resilience characteristics discussed, and identified evidence gaps in the literature. Findings were synthesised using tabulation and an evidence gap map. RESULTS Thirty-seven studies met the eligibility criteria. These studies captured research conducted across six continents, with most concentrated in Africa, Asia and Europe. One study had a randomised controlled trial design, while 36 studies had observational designs (15 analytical and 21 descriptive). We identified five characteristics of resilient immunisation programmes drawing on the Health System Resilience Index (Integration, Awareness, Resource Availability and Access, Adaptiveness and Self-regulation) and several evidence gaps in the literature. CONCLUSIONS To our knowledge, no immunisation programme resilience tool exists. We identified factors from the Health System Resilience Index coupled with factors identified through primary empirical evidence, which may inform development of an immunisation programme resilience tool.
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Affiliation(s)
- Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, UK
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Munk C, Reinholdt K, Kjaer AK, Hemmingsen CH, Ørnskov D, Iftner T, Waldstrøm M, Kjaer SK. Prevalence of Human Papillomavirus (HPV) and HPV Type Distribution in Penile Samples in Young Men in Denmark: Results 10 Years After Implementation of a Girls-Only HPV Vaccination Program. J Infect Dis 2024:jiae068. [PMID: 38470214 DOI: 10.1093/infdis/jiae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/09/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND In Denmark, a girls-only human papillomavirus (HPV) vaccination program was initiated in 2008-2009. The study aim was to assess the HPV prevalence and type distribution in younger men prior to HPV vaccination in men. METHODS The study population was younger men who attended information days regarding military service. At random days (2019-2020), 280 men were included. We collected questionnaire data regarding risk factors for HPV infection and a penile swab for HPV testing. We compared results in this study with those from a previous study of young men (2006-2007). RESULTS The majority of participants (94%) were 18-20 years old. The median number of lifetime sexual partners was 4. Altogether, 130 men (46.4%) were HPV positive. No infections with HPV types 6, 11, 16, 18, 31, and 45 were detected. The most frequent type was HPV-51 (detected in 11.1%). Comparison showed that the odds of high-risk HPV type infection were higher in 2019-2020 (prevalence odds ratio [POR], 1.7 [95% confidence interval {CI}, 1.1-2.7]) compared with 2006-2007. In contrast, the odds were lower (POR, 0.3 [95% CI, .1-.6]) for HPV types targeted by the 9-valent HPV vaccine. CONCLUSIONS The multicohort girls-only vaccination program has to a large degree protected young men against the HPV types included in the licensed vaccines. This does not speak against gender-neutral vaccination as the HPV prevalence is still high, although consisting largely of less carcinogenic HPV types.
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Affiliation(s)
- Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen
| | | | - Alexander K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen
| | | | | | - Thomas Iftner
- Institute of Medical Virology, University of Tübingen, Tübingen, Germany
| | | | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Humlum MK, Morthorst MO, Thingholm PR. Sibling spillovers and the choice to get vaccinated: Evidence from a regression discontinuity design. JOURNAL OF HEALTH ECONOMICS 2024; 94:102843. [PMID: 38211459 DOI: 10.1016/j.jhealeco.2023.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
We investigate the effects of introducing population-wide free-of-charge Human Papillomavirus (HPV) vaccination programs on the targeted adolescent cohorts and their siblings. For identification, we rely on regression discontinuity designs and high-quality Danish administrative data to exploit that date of birth determines program eligibility. We find that the programs increased the HPV vaccine take-up of both the targeted children (53.2 percentage points for girls and 36.0 percentage points for boys) and their older same-sex siblings (4.5 percentage points for sisters and 3.5 percentage points for brothers). We show that while the direct effects of the programs reduced HPV vaccine take-up inequality, the spillover effects, in contrast, contributed to an increase in vaccine take-up inequality highlighting the potential importance of spillover effects in the determination of distributional consequences of public health programs. Finally, we find some evidence of cross-vaccine spillovers.
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Affiliation(s)
- Maria Knoth Humlum
- Department of Economics and Business Economics, Aarhus University, Denmark; IZA, Germany.
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Algren MH, Gazibara T, Valentiner-Branth P, Timmermann A, Thygesen LC, Tolstrup JS. Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study. Scand J Public Health 2024:14034948241232462. [PMID: 38418848 DOI: 10.1177/14034948241232462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
AIM The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends. METHODS This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models. RESULTS Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers. CONCLUSIONS Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.
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Affiliation(s)
- Maria H Algren
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tatjana Gazibara
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Amalie Timmermann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Sinuraya RK, Nuwarda RF, Postma MJ, Suwantika AA. Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in Indonesia. Global Health 2024; 20:11. [PMID: 38321478 PMCID: PMC10845639 DOI: 10.1186/s12992-023-00987-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/04/2023] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Indonesia has made progress in increasing vaccine coverage, but equitable access remains challenging, especially in remote areas. Despite including vaccines in the National Immunization Program (NIP), coverage has not met WHO and UNICEF targets, with childhood immunization decreasing during the COVID-19 pandemic. COVID-19 vaccination has also experienced hesitancy, slowing efforts to end the pandemic. SCOPE This article addresses the issue of vaccine hesitancy and its impact on vaccination initiatives amidst the COVID-19 pandemic. This article utilizes the vaccine hesitancy framework to analyze previous outbreaks of vaccine-preventable diseases and their underlying causes, ultimately providing recommendations for addressing the current situation. The analysis considers the differences between the pre-pandemic circumstances and the present and considers the implementation of basic and advanced strategies. KEY FINDINGS AND CONCLUSION Vaccine hesitancy is a significant challenge in the COVID-19 pandemic, and public health campaigns and community engagement efforts are needed to promote vaccine acceptance and uptake. Efforts to address vaccine hesitancy promote trust in healthcare systems and increase the likelihood of individuals seeking preventive health services. Vaccine hesitancy requires a comprehensive, culturally sensitive approach that considers local contexts and realities. Strategies should be tailored to specific cultural and societal contexts and monitored and evaluated.
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Affiliation(s)
- Rano K Sinuraya
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jalan Ir. Soekarno KM 21, Jatinangor, Sumedang, West Java, 45363, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Rina F Nuwarda
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jalan Ir. Soekarno KM 21, Jatinangor, Sumedang, West Java, 45363, Indonesia.
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
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Fallon E, Bargary N, Quinn F, Leavy A, Hannigan A. Words and numbers: a comparative study of medical and journalism students' descriptors of risk, numeracy and preferences for health risk communication. BMC MEDICAL EDUCATION 2024; 24:84. [PMID: 38263114 PMCID: PMC10807177 DOI: 10.1186/s12909-024-05048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Given the complementary roles of health professionals and journalists in communicating health risks to patients and the public, there have been calls for physicians to work with journalists to improve the quality of health information received by the public. Understanding the preferences of medical and journalism students for the way in which health risks are communicated and their understanding of words used to describe risk is an important first step to inform interdisciplinary learning. METHODS Medical and journalism students (n = 203) completed an online survey where they were given qualitative descriptors of risk such as 'a chance', 'probably' and 'unlikely', and asked to assign a number that represents what the word means to them. Different formats of communicating risk (percentages, natural frequency and visual aids) were provided and students were asked to select and explain their preference. A thematic analysis of reasons was conducted. Numeracy and perceived mathematics ability were measured. RESULTS Numbers assigned to the descriptor 'A chance' had the highest variability for medical students. Numbers assigned to the descriptor 'Probably' had the highest variability for journalism students. Using visual aids was the most popular format for risk communication for both courses (56% of medical students and 40% of journalism students). Using percentages was twice as popular with journalism students compared to medical students (36% vs. 18%). Perceived mathematics ability was lower in students with a preference for natural frequencies and in journalism students, however performance on an objective numeracy scale was similar for all three formats (percentages, natural frequency and visual aids). Reasons for choosing a preferred format included good communication, eliciting a response, or learning style. CONCLUSIONS Education on health risk communication for medical and journalism students should emphasize the need for qualitative descriptors of risk to be combined with the best available number. Students are already considering their role as future communicators of health risks and open to tailoring the mode of presentation to their audience. Further research is required on the design and evaluation of interdisciplinary workshops in health risk communication for medical and journalism students to maximise the opportunities for future inter-professional working.
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Affiliation(s)
- Eleanor Fallon
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Fergal Quinn
- School of English, Irish and Communication, University of Limerick, Limerick, Ireland
| | - Aisling Leavy
- Department of STEM Education, Mary Immaculate College, Limerick, Ireland
| | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
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Grage L, Cuellar MJ. Did text-based news-media coverage about the COVID-19 pandemic increase vaccine uptake? A population-based study in Alaska. Int J Circumpolar Health 2023; 82:2213913. [PMID: 37216574 DOI: 10.1080/22423982.2023.2213913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
COVID-19 vaccinations protect against severe infection, hospitalisation, and death. News media can be an important source of information for the public during a health crisis. This study explores the extent to which local or statewide text-based news coverage of the pandemic was related to the uptake of initial doses of COVID-19 vaccines among adults in Alaska. Multilevel modelling was employed to explore the association between news media intensity and vaccine uptake rates across boroughs and census areas, while controlling for relevant covariates. Results suggest that the intensity of news media did not significantly influence vaccine uptake during the majority of this time period and had a negative affect during the Delta-surge in the fall of 2021. However, the political lean and median age of boroughs or census areas were significantly associated with vaccine uptake. Race, poverty, or education were not significant determinants of vaccine uptake suggesting there are unique differences in Alaska compared to the U.S., particularly amongst Alaska Native people. The political environment in Alaska surrounding the pandemic was polarized. Future research in communications and channels that can cut through this polarized and politicized environment, and reach younger adults is needed.
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Affiliation(s)
- Laura Grage
- College of Health, Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Matthew J Cuellar
- College of Health, School of Social Work, University of Alaska Anchorage, Anchorage, Alaska, USA
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Wijayanti KE, Schutze H, Phail CM, Ivers R. Exploring Parents' Decisions Regarding HPV Vaccination for Their Daughters in Jakarta, Indonesia: A Qualitative Study. Asian Pac J Cancer Prev 2023; 24:3993-3998. [PMID: 38019260 PMCID: PMC10772741 DOI: 10.31557/apjcp.2023.24.11.3993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Cervical cancer, caused by the human papillomavirus (HPV), is the fourth most common cancer among women worldwide. Although many countries have introduced national HPV vaccination programs, many girls worldwide remain unprotected. As part of a demonstration project in 2016, the Indonesian government provided the HPV vaccination for free to all year five and six female students in Jakarta and several other cities, with a plan to roll out the program nationally in the future. Understanding parents' decision-making regarding whether they will allow their daughters to receive the HPV vaccine is important to ensure optimum uptake.
Methods: Twenty-four parents in Jakarta were interviewed. Data were analysed thematically using The Theory of Planned Behaviour constructs of attitudes, subjective norms and perceived behavioural control.
Result: Some parents had limited knowledge about cervical cancer and the HPV vaccine; others did not even realise that the free HPV vaccination program had been offered in their daughter's schools. Those who had better knowledge and positive attitudes trusted their health professionals as a source of information. Peer approval, trust in the government and having the vaccine through a school-based program was important for trust, eliminated cost barriers, and increased access.
Conclusion: Parents' attitudes towards cervical cancer and HPV vaccination are influenced in part by their knowledge. Shaping positive initial attitudes is important, as once formed, attitudes are often difficult to change. Our findings suggest that a free school-based vaccine accompanied by sufficient and non-ambiguous information from trusted sources is vital to uptake.
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Affiliation(s)
- Kurnia E Wijayanti
- Department of Physical Education, Faculty of Sport and Health Education, Universitas Pendidikan Indonesia, Bandung, West Java, Indonesia.
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Heike Schutze
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Office of Medical Education, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Catherine Mac Phail
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia.
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
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Hailu G, Wirtu D, Tesfaye T, Getachew M. Human papillomavirus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte city, Western Ethiopia, 2020. BMC Womens Health 2023; 23:560. [PMID: 37898731 PMCID: PMC10612278 DOI: 10.1186/s12905-023-02702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer death in adult women in the developing world including Ethiopia. To combat cervical cancer, the World Health Organization (WHO) recommends that girls aged 9-14 years have to take the human papillomavirus vaccine. However, there is a lack of information regarding the uptake of human papillomavirus vaccine in the study area. Therefore, this study aimed to assess the Human Papilloma Virus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte City, Western Ethiopia, 2020. METHODS A cross-sectional study design was employed among adolescent girls attending grade 9 and age 15 enrolled at schools in Nekemte City from July 15-30, 2020. Six hundred twenty-six (626) randomly selected adolescent girls were interviewed. The data were entered into Epi Info 7 and analyzed by SPSS 25. Multivariable analysis was computed and a P-value < 0.05 was taken as a cut-off point to declare the statistically significant association. RESULT The uptake of the HPV vaccine was 61.2%, 95%CI (57.2%, 65%). The Place where adolescents grow up (AOR = 3.46, 95%CI [1.95,6.15]), having a mobile phone(AOR = 1.71, 95%CI [1.05, 2.79]), ever heard about HPV (AOR = 5.69, 95%CI [1.33, 24.27]), ever heard about HPV vaccine(AOR = 1.917, 95%CI [1.002, 3.667]), Ever had sexual intercourse (AOR = 3.04, 95% [1.49,6.20]) and Perceived risk of towards HPV(AOR = 4.63 [2.49, 8.63]) has shown statistically significant association with Uptake of the HPV vaccine. CONCLUSION Nearly two-thirds of the study participants had taken at least one dose of the HPV vaccine. It is better if health information on HPV is disseminated considering the available technology like mobile phones and reaching rural girls.
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Affiliation(s)
- Genet Hailu
- Department of Public Health, Wollega University Institute of Health Science, P.O. Box 385, Nekemte, Ethiopia.
| | - Desalegn Wirtu
- Department of Public Health, Wollega University Institute of Health Science, P.O. Box 385, Nekemte, Ethiopia
| | - Tariku Tesfaye
- Department of Public Health, Wollega University Institute of Health Science, P.O. Box 385, Nekemte, Ethiopia
| | - Motuma Getachew
- Department of Public Health, Wollega University Institute of Health Science, P.O. Box 385, Nekemte, Ethiopia
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Ozawa S, Schuh HB, Nakamura T, Yemeke TT, Lee YFA, MacDonald NE. How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework. Vaccine 2023; 41:6710-6718. [PMID: 37798209 DOI: 10.1016/j.vaccine.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual. METHODS We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience. RESULTS Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities. CONCLUSIONS Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.
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Affiliation(s)
- Sachiko Ozawa
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tomoka Nakamura
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Nagasaki University, School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Tatenda T Yemeke
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yi-Fang Ashley Lee
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noni E MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Appelqvist E, Danielsson M, Jama A, Ask LS, Stenhammar C, Lindstrand A, Riesbeck K, Roth A. Parental views and the key role of nurses for high vaccine acceptance in Sweden - a focus group study. BMC Public Health 2023; 23:1786. [PMID: 37710197 PMCID: PMC10500778 DOI: 10.1186/s12889-023-16678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND In Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden. METHODS Parents of children aged 1-2 years and 8-12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1-2 years) and older (8-12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis. RESULTS Parents of children aged 1-2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet. For parents to children aged 8-12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation. CONCLUSION Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.
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Affiliation(s)
- Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden.
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Madelene Danielsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Asha Jama
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lina Schollin Ask
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Stenhammar
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, Unit Essential Programme On Immunization, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Adam Roth
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Lubeya MK, Chibwesha CJ, Mwanahamuntu M, Mukosha M, Frank S, Kawonga M. "When you get the HPV vaccine, it will prevent cervical cancer; it will act as a shield": adolescent girls' knowledge and perceptions regarding the human papillomavirus vaccine in Zambia. FRONTIERS IN HEALTH SERVICES 2023; 3:1208458. [PMID: 37780403 PMCID: PMC10534003 DOI: 10.3389/frhs.2023.1208458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
Introduction The human papillomavirus (HPV) vaccination is an important preventive measure for HPV-related conditions such as cervical cancer. In 2019, Zambia introduced a free national HPV vaccination program for 14-year-old girls. However, the adolescents' knowledge and perceptions regarding the HPV vaccine are not well understood. Therefore, this study aimed to understand adolescent girls' knowledge and perceptions regarding the HPV vaccine and discuss its acceptability and uptake implications. Methods We conducted a qualitative study in the Lusaka district between June 2021 and November 2021 using semi-structured interviews with adolescent girls aged 15-18 years regardless of their HPV vaccination status. Interviews were transcribed verbatim, and NVIVO 12 was used for data management and analysis. We coded transcripts deductively and inductively based on emerging themes. Perceptions were coded using the health belief model constructs. Results We interviewed 30 adolescent girls to reach saturation. Seventeen girls reported having received at least one dose of the HPV vaccine. Participants expressed variable knowledge and awareness about HPV and the HPV vaccine. Participants exhibited positive attitudes towards the HPV vaccine and perceived it as beneficial. However, there were multiple perceived barriers to vaccination, such as the need for parental consent, not being in school, concerns about vaccine side effects, and belief in myths and misinformation. Conclusion The adolescent girls in this study showed variable knowledge and positive attitudes toward the HPV vaccine despite the many perceived barriers. To support increased HPV vaccine acceptability and uptake among adolescent girls in Zambia, it is critical to actively engage stakeholders involved in HPV vaccination, such as adolescents and their parents, and debunk myths and misconceptions about HPV vaccination. Health education in schools and communities should be implemented to increase knowledge about HPV and HPV vaccination among adolescents and their parents.
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Affiliation(s)
- Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carla J. Chibwesha
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Zambia, Lusaka, Zambia
- Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Moses Mukosha
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Simone Frank
- School of Medicine, North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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14
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Voss SS, Nørgaard SK, Valentiner-Branth P. Identification of subgroups in the Danish population for targeted human papillomavirus vaccination efforts. Vaccine 2023; 41:3525-3533. [PMID: 37142460 DOI: 10.1016/j.vaccine.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND In the Danish childhood vaccination program, the human papillomavirus (HPV) vaccination coverage is lower than for other vaccines. To tailor a targeted HPV vaccination effort, we aimed to identify girls in Denmark with lower first dose HPV vaccination coverage than girls in general. METHODS A population-based retrospective cohort study was performed of girls born in 2001-2004, residing in Denmark in September 2019 (N = 128,351). Data from the Danish Vaccination Register was linked to sociodemographic data from the Danish Civil Registration System and Statistics Denmark. Cox's proportional hazard regression models were used to compare vaccination uptake rates between subgroups of girls. RESULTS HPV vaccination coverage at 14 years of age varied widely by municipality (53.4-80.6%). Girls living with neither of their parents had a lower chance of being vaccinated compared to girls living with both their parents (HR 0.43; 95% CI 0.41-0.46), likewise for girls attending special need education compared with girls attending public schools (HR 0.50; 95% CI 0.42-0.59). The vaccination uptake among immigrants was lower compared to Danish-born girls (HR 0.51; 95% CI 0.49-0.54), especially among immigrant girls whose parents had not passed any Danish exams. Finally, girls who were DTaP-IPV revaccinated had a 50% greater chance of being HPV vaccinated compared to girls who were not (HR 1.61; 95% CI 1.58-1.64). CONCLUSION To increase the HPV vaccination uptake, we recommend vaccination efforts targeting girls living without any of their parents, girls attending special need education, immigrants, and girls who are not DTaP-IPV revaccinated. When targeting immigrants, the effort should focus on disseminating sufficient and understandable information about the Danish childhood vaccination program to the parents.
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Affiliation(s)
- Sidsel Skou Voss
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Sarah Kristine Nørgaard
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Palle Valentiner-Branth
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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15
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Kojalo U, Tisler A, Parna K, Kivite-Urtane A, Zodzika J, Stankunas M, Baltzer N, Nygard M, Uuskula A. An overview of cervical cancer epidemiology and prevention in the Baltic States. BMC Public Health 2023; 23:660. [PMID: 37029357 PMCID: PMC10080753 DOI: 10.1186/s12889-023-15524-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/25/2023] [Indexed: 04/09/2023] Open
Abstract
AIMS To inform future Baltic States-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Estonia, Latvia and Lithuania. METHODS A structured desk review: we compiled and summarized data on current prevention strategies, population demography and epidemiology (high risk human papillomavirus (HPV) prevalence and cervical cancer incidence and mortality over time) for each Baltic State by reviewing published literature and official guidelines, performing registry-based analyses using secondary data and having discussions with experts in each country. RESULTS We observed important similarities in the three Baltic States: high burden of the disease (high incidence and mortality of cervical cancer, changes in TNM (Classification of Malignant Tumors) stage distribution towards later stage at diagnosis), high burden of high-risk HPV in general population and suboptimal implementation of the preventive strategies as low screening and HPV vaccination coverage. CONCLUSIONS Cervical cancer remains a substantial health problem in the region and the efforts in addressing barriers by implementing a four-step plan for elimination cervical cancer in Europe should be made. This goal is achievable through evidence-based steps in four key areas: vaccination, screening, treatment, and public awareness.
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Affiliation(s)
- Una Kojalo
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kersti Parna
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Jana Zodzika
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Mindaugas Stankunas
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Anneli Uuskula
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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16
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Lavie M, Lavie I, Laskov I, Cohen A, Grisaru D, Grisaru-Soen G, Michaan N. Impact of COVID-19 Pandemic on Human Papillomavirus Vaccine Uptake in Israel. J Low Genit Tract Dis 2023; 27:168-172. [PMID: 36815631 PMCID: PMC10026726 DOI: 10.1097/lgt.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Isolation and school closure during the COVID-19 pandemic could decrease human papillomavirus (HPV) vaccination uptake and potentially increase future HPV-related morbidity among unvaccinated populations. The aim of our study was to investigate HPV vaccination rates in Israel during the pandemic. METHODS The HPV vaccination rates were compared before and during the COVID-19 pandemic years (2020-2021). Data regarding HPV vaccination between 2015 and 2021 were extracted from the Israeli Ministry of Health online reports. Vaccination rates were compared with other childhood vaccines, given at similar ages. Israeli HPV vaccination rates were further compared with England and Australia, which have an established vaccination infrastructure. RESULTS The average Israeli coverage of first-dose HPV vaccine was 60.2%, with significant variations from 2015 to 2021. During the pandemic years, first-dose vaccine coverage increased compared with the 3 previous years. The pandemic had also no apparent influence on other childhood vaccine uptake, even though adolescents in Israel missed many school days during this time. Average vaccine uptake in England and Australia was significantly higher than Israel ( p = .009); however, first-dose vaccination rates decreased considerably in England during 2020, to a nadir of 59%. The pandemic had little effect on HPV vaccination rates in Australia. CONCLUSIONS Despite many school days missed, the COVID-19 pandemic did not result in a decrease in HPV vaccine uptake in Israel. The pandemic could prove a good opportunity to further educate the public regarding the importance of whole-population vaccination programs. Implementing catch-up vaccination programs may bridge "vaccination gaps" that may be caused by future pandemics.
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Affiliation(s)
- Michael Lavie
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Inbar Lavie
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Aviad Cohen
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Galia Grisaru-Soen
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Michaan
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
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17
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Warsi SK, Nielsen SM, Franklin BAK, Abdullaev S, Ruzmetova D, Raimjanov R, Nagiyeva K, Safaeva K. Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan. Vaccines (Basel) 2023; 11:754. [PMID: 37112666 PMCID: PMC10142216 DOI: 10.3390/vaccines11040754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Human papillomavirus (HPV) vaccines effectively prevent cervical cancer, most of which results from undetected long-term HPV infection. HPV vaccine introduction is particularly sensitive and complicated given widespread misinformation and vaccination of young girls before their sexual debut. Research has examined HPV vaccine introduction in lower- and middle-income countries (LMICs), but almost no studies attend to HPV vaccine attitudes in central Asian countries. This article describes the results of a qualitative formative research study to develop an HPV vaccine introduction communication plan in Uzbekistan. Data collection and analysis were designed using the Capability, Opportunity, and Motivation for Behaviour change (COM-B) mode for understanding health behaviours. This research was carried out with health workers, parents, grandparents, teachers, and other social influencers in urban, semi-urban, and rural sites. Information was collected using focus group discussions (FGDs) and semi-structured in-depth interviews (IDIs), and data in the form of participants' words, statements, and ideas were thematically analysed to identify COM-B barriers and drivers for each target group's HPV vaccine-related behaviour. Represented through exemplary quotations, findings were used to inform the development of the HPV vaccine introduction communication plan. Capability findings indicated that participants understood cervical cancer was a national health issue, but HPV and HPV vaccine knowledge was limited among non-health professionals, some nurses, and rural health workers. Results on an opportunity for accepting the HPV vaccine showed most participants would do so if they had access to credible information on vaccine safety and evidence. Regarding motivation, all participant groups voiced concern about the potential effects on young girls' future fertility. Echoing global research, the study results highlighted that trust in health workers and the government as health-related information sources and collaboration among schools, municipalities, and polyclinics could support potential vaccine acceptance and uptake. Resource constraints precluded including vaccine target-aged girls in research and additional field sites. Participants represented diverse social and economic backgrounds reflective of the country context, and the communication plan developed using research insights contributed to the Ministry of Health (MoH) of the Republic of Uzbekistan HPV vaccine introduction efforts that saw high first dose uptake.
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Affiliation(s)
- Sahil Khan Warsi
- Consultant, World Health Organization Regional Office for Europe, DK-2100 Copenhagen Ø, Denmark
| | - Siff Malue Nielsen
- Vaccine-Preventable Diseases and Immunization Programme, World Health Organization Regional Office for Europe, DK-2100 Copenhagen Ø, Denmark
| | | | | | | | | | | | - Kamola Safaeva
- World Health Organization Country Office in Uzbekistan, Tashkent 100100, Uzbekistan
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18
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Beirakdar S, Klingborg L, Herzig van Wees S. Attitudes of Swedish Language Twitter Users Toward COVID-19 Vaccination: Exploratory Qualitative Study. JMIR INFODEMIOLOGY 2023; 3:e42357. [PMID: 37012999 PMCID: PMC9996415 DOI: 10.2196/42357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023]
Abstract
Background
Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people’s attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals.
Objective
The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines.
Methods
This was an exploratory qualitative study that used a social media–listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization’s 3C model (confidence, complacency, and convenience).
Results
Confidence in the safety and effectiveness of the COVID-19 vaccine appeared to be a major concern expressed on Twitter. Unclear governmental strategies in managing the pandemic in Sweden and the belief in conspiracy theories have further influenced negative attitudes toward vaccines. Complacency—the perceived risk of COVID-19 was low and booster vaccination was unnecessary; many expressed trust in natural immunity. Convenience—in terms of accessing the right information and the vaccine—highlighted a knowledge gap about the benefits and necessity of the vaccine, as well as complaints about the quality of vaccination services.
Conclusions
Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions.
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Affiliation(s)
- Safwat Beirakdar
- Karolinska Institute Department of Global Public Health Stockholm Sweden
| | - Leon Klingborg
- Karolinska Institute Department of Global Public Health Stockholm Sweden
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19
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Gehrt L, Laake I, Englund H, Nieminen H, Feiring B, Lahdenkari M, Palmu AA, Trogstad L, Benn CS, Sørup S. Cohort Profile: Childhood morbidity and potential non-specific effects of the childhood vaccination programmes in the Nordic countries (NONSEnse): register-based cohort of children born 1990-2017/2018. BMJ Open 2023; 13:e065984. [PMID: 36764731 PMCID: PMC9923270 DOI: 10.1136/bmjopen-2022-065984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
PURPOSE The aim of the NONSEnse project is to investigate the non-specific effects of vaccines and immunisation programmes on the overall health of children by using information from the extensive nationwide registers on health and sociodemographic factors in Denmark, Finland, Norway and Sweden. PARTICIPANTS The cohort covers 9 072 420 children aged 0-17 years, born 1990-2017/2018 and living in Denmark, Finland, Norway or Sweden. All countries use a unique identification number for its permanent residents, which makes it possible to link individual-level information from different registers. FINDINGS TO DATE Data collection and harmonisation according to a common data model was completed in March 2022. As a prerequisite for comparing the effects of childhood vaccinations on the overall health of children across the Nordic countries, we have identified indicators measuring similar levels of infectious disease morbidity across these settings. So far, studies pertaining to non-specific effects of vaccines are limited to investigations that could be undertaken using aggregated data sets that were available before the NONSEnse cohort with individual-level information was completely set up. FUTURE PLANS We are currently performing several studies of the effects on non-targeted infectious disease morbidity across the countries following vaccination against measles, mumps, rubella, diphtheria, tetanus, pertussis, human papillomavirus, rotavirus and influenza. Multiple studies are planned within the next years using different study designs to facilitate triangulation of results and enhance causal inference. REGISTRATION No clinical trials will be conducted within the NONSEnse project.
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Affiliation(s)
- Lise Gehrt
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Hélène Englund
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Berit Feiring
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Lahdenkari
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Christine Stabell Benn
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Signe Sørup
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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20
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Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden: Healthcare Providers' Perspective. Vaccines (Basel) 2023; 11:vaccines11020310. [PMID: 36851188 PMCID: PMC9962905 DOI: 10.3390/vaccines11020310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges. METHODS Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis. RESULTS Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program. CONCLUSIONS Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.
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Abstract
Immunization implementation in the community relies upon post-licensure vaccine safety surveillance to maintain safe vaccination programs and to detect rare AEFI not observed in clinical trials. The increasing availability of electronic health-care related data and correspondence from both health-related providers and internet-based media has revolutionized health-care information. Many and varied forms of health information related to adverse event following immunization (AEFI) are potentially suitable for vaccine safety surveillance. The utilization of these media ranges from more efficient use of electronic spontaneous reporting, automated solicited surveillance methods, screening various electronic health record types, and the utilization of natural language processing techniques to scan enormous amounts of internet-based data for AEFI mentions. Each of these surveillance types have advantages and disadvantages and are often complementary to each other. Most are "hypothesis generating," detecting potential safety signals, where some, such as vaccine safety datalinking, may also serve as "hypothesis testing" to help verify and investigate those potential signals.
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Affiliation(s)
- Jim P Buttery
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Centre for Health Analytics, Melbourne, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia
| | - Hazel Clothier
- Centre for Health Analytics, Melbourne, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
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22
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Nuwarda RF, Ramzan I, Weekes L, Kayser V. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines (Basel) 2022; 10:vaccines10101595. [PMID: 36298459 PMCID: PMC9612044 DOI: 10.3390/vaccines10101595] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination, despite being recognized as one of the most effective primary public health measures, is viewed as unsafe and unnecessary by an increasing number of individuals. Anxiety about vaccines and vaccination programs leading to vaccine hesitancy results from a complex mix of social and political influences, cultural and religious beliefs, the availability of and ability to interpret health and scientific information, and personal and population experiences of health systems and government policies. Vaccine hesitancy is becoming a serious threat to vaccination programs, and was identified as one of the World Health Organization’s top ten global health threats in 2019. The negative impact of anti-vaccination movements is frequently cited as one of the major reasons for rising vaccine hesitancy amongst the general public world-wide. This review discusses the various issues surrounding vaccine hesitancy and the anti-vaccine movement, starting with the definitions of vaccine hesitancy and the anti-vaccine movement in their early history and in the modern era, before discussing the key drivers of vaccine hesitancy, particularly across different regions of the world, with a focus on various countries with low-, middle-, or high-income economies with different socio-economic populations. The review concludes with the impact of vaccine hesitancy on herd immunity and social, psychological, and public health measures to counter vaccine hesitancy.
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23
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Cordoba-Sanchez V, Lemos M, Tamayo-Lopera DA, Sheinfeld Gorin S. HPV-Vaccine Hesitancy in Colombia: A Mixed-Methods Study. Vaccines (Basel) 2022; 10:1187. [PMID: 35893836 PMCID: PMC9332743 DOI: 10.3390/vaccines10081187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
In Colombia, the uptake rate of the HPV vaccine dropped from 96.7% after its introduction in 2013 to 9% in 2020. To identify the behavioural components of HPV-vaccine hesitancy in females aged 15 and under and their families, we conducted a convergent mixed-methods study in which 196 parents/caregivers responded to an online questionnaire and 10 focus groups were held with 13 of these parents/caregivers, and 50 age-eligible girls. The study is novel as it is the first to explore the factors influencing HPV-vaccine hesitancy alongside the COVID vaccine within an integrative model of behaviour change, the capability-opportunity-motivation-behaviour (COM-B) model. We found that COVID-19 has had an impact on the awareness of HPV and HPV vaccination. Lack of information about the vaccination programs, concerns about vaccine safety and the relationship between HPV and sexuality could be related to vaccine hesitancy. Trust in medical recommendations and campaigns focused on the idea that vaccination is a way of protecting daughters from cervical cancer could improve HPV vaccine uptake.
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Affiliation(s)
- Veronica Cordoba-Sanchez
- Department of Psychology, School of Social Sciences, Institucion Universitaria de Envigado, Envigado 055422, Colombia;
| | - Mariantonia Lemos
- Department of Psychology, School of Arts and Social Sciences, Universidad EAFIT, Medellín 050022, Colombia;
| | - Diego Alfredo Tamayo-Lopera
- Department of Psychology, School of Social Sciences, Institucion Universitaria de Envigado, Envigado 055422, Colombia;
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Yin JDC. Media Data and Vaccine Hesitancy: Scoping Review. JMIR INFODEMIOLOGY 2022; 2:e37300. [PMID: 37113443 PMCID: PMC9987198 DOI: 10.2196/37300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 04/29/2023]
Abstract
Background Media studies are important for vaccine hesitancy research, as they analyze how the media shapes risk perceptions and vaccine uptake. Despite the growth in studies in this field owing to advances in computing and language processing and an expanding social media landscape, no study has consolidated the methodological approaches used to study vaccine hesitancy. Synthesizing this information can better structure and set a precedent for this growing subfield of digital epidemiology. Objective This review aimed to identify and illustrate the media platforms and methods used to study vaccine hesitancy and how they build or contribute to the study of the media's influence on vaccine hesitancy and public health. Methods This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search was conducted on PubMed and Scopus for any studies that used media data (social media or traditional media), had an outcome related to vaccine sentiment (opinion, uptake, hesitancy, acceptance, or stance), were written in English, and were published after 2010. Studies were screened by only 1 reviewer and extracted for media platform, analysis method, the theoretical models used, and outcomes. Results In total, 125 studies were included, of which 71 (56.8%) used traditional research methods and 54 (43.2%) used computational methods. Of the traditional methods, most used content analysis (43/71, 61%) and sentiment analysis (21/71, 30%) to analyze the texts. The most common platforms were newspapers, print media, and web-based news. The computational methods mostly used sentiment analysis (31/54, 57%), topic modeling (18/54, 33%), and network analysis (17/54, 31%). Fewer studies used projections (2/54, 4%) and feature extraction (1/54, 2%). The most common platforms were Twitter and Facebook. Theoretically, most studies were weak. The following five major categories of studies arose: antivaccination themes centered on the distrust of institutions, civil liberties, misinformation, conspiracy theories, and vaccine-specific concerns; provaccination themes centered on ensuring vaccine safety using scientific literature; framing being important and health professionals and personal stories having the largest impact on shaping vaccine opinion; the coverage of vaccination-related data mostly identifying negative vaccine content and revealing deeply fractured vaccine communities and echo chambers; and the public reacting to and focusing on certain signals-in particular cases, deaths, and scandals-which suggests a more volatile period for the spread of information. Conclusions The heterogeneity in the use of media to study vaccines can be better consolidated through theoretical grounding. Areas of suggested research include understanding how trust in institutions is associated with vaccine uptake, how misinformation and information signaling influence vaccine uptake, and the evaluation of government communications on vaccine rollouts and vaccine-related events. The review ends with a statement that media data analyses, though groundbreaking in approach, should supplement-not supplant-current practices in public health research.
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Affiliation(s)
- Jason Dean-Chen Yin
- School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong China (Hong Kong)
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25
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Seangpraw K, Pothisa T, Boonyathee S, Ong-Artborirak P, Tonchoy P, Kantow S, Auttama N, Choowanthanapakorn M. Using the Health Belief Model to Predict Vaccination Intention Among COVID-19 Unvaccinated People in Thai Communities. Front Med (Lausanne) 2022; 9:890503. [PMID: 35721100 PMCID: PMC9204032 DOI: 10.3389/fmed.2022.890503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has become one of the biggest challenges to individual health and the public health system worldwide. COVID-19 morbidity and mortality are increasing, impacting almost every country including Thailand. This study used the Health Belief Model (HBM) as a framework to examine the intention of unvaccinated people living in northern Thailand to receive COVID-19 vaccines. Methods This cross-sectional study was conducted during October and November 2021. A total of 1,024 participants who are currently living in four northern provinces of Thailand, Chiang Mai, Chiang Rai, Lamphun, and Phayao, were recruited to participate in the study. The questionnaire was developed using an HBM structure to obtain information about the perceived severity, perceived susceptibility, self-efficacy, perceived benefits and barriers, cues to action, and preventive behaviors relating to COVID-19 vaccination and the decision to become vaccinated. Multiple linear regression was used to analyze the data. Results The unvaccinated participants were an average of 44.45 ± 16.63 years of age and more than half were women (54.5%). The COVID-19 preventive behavior score used perceived severity (B = 0.26), self-efficacy (B = 0.51), perceived benefits and barriers (B = 0.11), and cues to action (B = 0.18) after adjusting for age, underlying disease, and body mass index (R2 = 42.5%). The COVID-19 vaccination decision score was positively correlated with perceived severity (B = 0.13), perceived susceptibility (B = 0.25), perceived benefits and barriers (B = 0.21), and cues to action (B = 0.27) after adjusting for underlying disease (R2 = 38.7%). Discussion The results demonstrated the usefulness of using the HBM structure to understand individual intention to receive a COVID-19 vaccine. Communities should consider a COVID-19 health campaign and programs that use the HBM model as a framework for altering perceptions and beliefs about the COVID-19 vaccine and improving vaccination rates among unvaccinated people in rural northern Thailand.
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Affiliation(s)
| | | | | | - Parichat Ong-Artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Parichat Ong-Artborirak
| | | | - Supakan Kantow
- School of Public Health, University of Phayao, Phayao, Thailand
| | - Nisarat Auttama
- School of Public Health, University of Phayao, Phayao, Thailand
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Bergman H, Henschke N, Villanueva G, Loke YK, Golder SP, Dwan K, Crosbie EJ, Kyrgiou M, Platt J, Morrison J. Human papillomavirus (HPV) vaccination for the prevention of cervical cancer and other HPV-related diseases: a network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Yoon Kong Loke
- Norwich Medical School; University of East Anglia; Norwich UK
| | - Su P Golder
- Department of Health Sciences; University of York; York UK
| | - Kerry Dwan
- Methods Support Unit, Editorial & Methods Department; Cochrane Central Executive; London UK
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health; University of Manchester; Manchester UK
| | - Maria Kyrgiou
- IRDB, Department of Gut, Metabolism & Reproduction - Surgery & Cancer; Imperial College London; London UK
| | - Joanne Platt
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group; Royal United Hospital; Bath UK
| | - Jo Morrison
- Department of Gynaecological Oncology; Musgrove Park Hospital; Taunton UK
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Schott E, Schaller K, Mons U, Ouédraogo N. [Approaches to increase HPV vaccination rate in Germany - challenges and opportunities. A qualitative study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 170:29-37. [PMID: 35490121 DOI: 10.1016/j.zefq.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In Germany, the prevalence of infections with the human papilloma virus (HPV) among women and men is high. High-risk HPV types can lead to certain types of cancer (e. g., cervical cancer). Vaccination against HPV infections associated with cancer and genital warts was introduced in Germany in 2007. Currently, HPV vaccination is recommended for girls and boys by the German Standing Committee on Vaccination. The vaccination rate, however, remains rather low, with rates below 50% in 15-year-old girls and of about 5% in 15-year-old boys in 2019. This suggests that new approaches are urgently needed to increase HPV vaccination coverage in Germany in the coming years. OBJECTIVES This qualitative study aimed at identifying opportunities and challenges related to the application and implementation of different approaches designed to increase HPV vaccination uptake among male and female adolescents in Germany according to expert views. MATERIALS AND METHODS From April to July 2020, 43 experts from the field of HPV vaccination in Germany were interviewed using a semi-standardized interview guide. The audiotaped interviews were transcribed and analyzed using qualitative content analysis by Udo Kuckartz. RESULTS AND CONCLUSION According to the experts interviewed the following would be the most promising approaches to increase HPV vaccination rates in Germany: educational measures, school vaccination programs, increasing participation in the adolescent health check-up "J1", reminder and recall systems. The most reasonable solution would be to pursue several approaches simultaneously. According to the experts, more political support with implementing strategies and reducing bureaucratic obstacles as well as an increase in cooperation between relevant stakeholders is required to achieve the effective implementation of these strategies.
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Affiliation(s)
- Evelyn Schott
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland; Medizinische Fakultät Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Katrin Schaller
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Ute Mons
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland; Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Nobila Ouédraogo
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.
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Poelman MR, Brand HS, Foppen L, de Visscher JG, Jager DHJ. Evaluation of head and neck cancer education at European dental schools. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:239-247. [PMID: 33982397 PMCID: PMC9291305 DOI: 10.1111/eje.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/26/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
AIM In Europe, approximately 150.000 patients are diagnosed with head and neck cancer annually. Dentists play an important role in prevention and detection at an early stage when survival rates are best. This study aims to evaluate content of head and neck cancer education curricula of European dental schools. MATERIALS AND METHODS A questionnaire, comprising 20 questions about content of curricula and teaching methods, was distributed to the deans of all 234 members of the Association for Dental Education in Europe. RESULTS The response rate was 24%. All dental schools included head and neck cancer screening practices in their curricula, two-thirds had their students perform this screening on all patients routinely and education was mostly divided over various courses (65%). A variation in content of education in screening practices and counselling patients about various risk factors was reported. Alcohol and tobacco use were included in most curricula as risk factors for head and neck cancer (98%), gastro-oesophageal reflux was less frequently included (41%). The human papillomavirus (HPV) as a risk factor for oropharyngeal cancer was included in 94% of curricula and 87% also contained education about strategies to discuss prevention of HPV-related cancer. No association was found between curricula containing strategies about discussing HPV-related cancer and inclusion of the HPV vaccine in national immunisation programmes. CONCLUSION Head and neck cancer teaching programmes show a considerable variation across European dental schools. Development of a unified teaching programme suitable for all European dental schools seems warranted.
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Affiliation(s)
- Marcella R. Poelman
- Centre for Special Care Dentistry (Stichting Bijzondere Tandheelkunde)Amsterdamthe Netherlands
| | - Henk S. Brand
- Department of Oral BiochemistryAcademic Centre for Dentistry Amsterdam (ACTA)Amsterdamthe Netherlands
| | - Laura Foppen
- Department of Oral BiochemistryAcademic Centre for Dentistry Amsterdam (ACTA)Amsterdamthe Netherlands
| | - Jan G.A.M. de Visscher
- Department of Oral and Maxillofacial Surgery and Oral PathologyAmsterdamUMC, location VUmcThe Netherlands
| | - Derk H. Jan Jager
- Centre for Special Care Dentistry (Stichting Bijzondere Tandheelkunde)Amsterdamthe Netherlands
- Department of Oral and Maxillofacial Surgery and Oral PathologyAmsterdamUMC, location VUmcThe Netherlands
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Effect of Different Educational Interventions on Knowledge of HPV Vaccination and Cervical Cancer among Young Women: A Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095191. [PMID: 35564586 PMCID: PMC9105621 DOI: 10.3390/ijerph19095191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
The incidence and mortality rates of cervical cancer are rising among young women in Japan. In November 2021, the Japanese Ministry of Health, Labour, and Welfare reinstated the active recommendation for the human papillomavirus (HPV) vaccine, which was discontinued in June 2013 due to reports of adverse reactions, including chronic pain and motor dysfunction, following vaccination. However, vaccine hesitancy among the younger generation remains, and it is essential to identify the barriers in vaccination uptake. Therefore, we aimed to conduct a randomized study using different methods of providing educational contents to improve health literacy regarding cervical cancer and HPV vaccination among female students in Japan. Here, we present the results of our preliminary report and discuss current topics related to HPV vaccination in Japan. Data were collected from 27 female students—divided into three groups: no intervention, print-based intervention, and social networking service-based intervention—using the health literacy scale and communicative and critical health literacy scale. Our primary results indicate that participants’ knowledge and health literacy improved post-intervention. Therefore, medical professionals must provide accurate scientific knowledge regarding routine HPV vaccination and the risk of cervical cancer to young women to improve their health literacy and subsequently increase the HPV vaccination rates.
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30
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Suzuki Y, Sukegawa A, Ueda Y, Sekine M, Enomoto T, Melamed A, Wright JD, Miyagi E. Effect of a web-based cervical cancer survivor story on the willingness and behavioral change for Human Papillomavirus Vaccination among Japanese parents with at least one daughter aged 11 to 18 years old: Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e34715. [PMID: 35421848 PMCID: PMC9178460 DOI: 10.2196/34715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 04/12/2022] [Indexed: 01/23/2023] Open
Abstract
Background Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf
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Affiliation(s)
- Yukio Suzuki
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Yokohama, JP.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Akiko Sukegawa
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, JP
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, JP
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JP
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JP
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, US
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, JP
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Nordtug M. How Perceptions of Responsibility and Affective Consequences Influence Parents' Digital Media Engagement in Relation to Human Papillomavirus Vaccination. QUALITATIVE HEALTH RESEARCH 2022; 32:683-693. [PMID: 34964686 DOI: 10.1177/10497323211065023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Individuals are expected to be responsible for their own health and that of their families-and act accordingly. Yet, being in a position of responsibility might be undesirable for individuals either unable or reluctant to comply with the expectations this responsibility entails. In this article, I explore how parents experience the process of engaging responsibly with digital media in relation to the question of human papillomavirus vaccination. The study is based on interviews with eighteen Danish parents, and my findings show that these parents not only understand themselves but also other actors in terms of responsibility, and that being positioned in terms of responsibility can have negative affective consequences. I argue that meeting the expectations of biological citizenship should not necessarily be a goal in relation to complex health topics.
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Affiliation(s)
- Maja Nordtug
- 6174University of Southern Denmark, Odense, Denmark
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32
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Fues Wahl H, Wikman Erlandson B, Sahlin C, Nyaku M, Benĉina G. Analysis of vaccine messages on social media (Twitter) in Scandinavia. Hum Vaccin Immunother 2022; 18:2026711. [PMID: 35103579 PMCID: PMC8993101 DOI: 10.1080/21645515.2022.2026711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Vaccine hesitancy is listed as one of the top 10 global health threats by the WHO. Existing studies investigating the relationship between vaccine hesitancy and social media have found that misinformation and vaccine concerns on social media can cause significant declines in vaccine coverage rates. The objective of this study was to provide insight into the dynamics of vaccine messages on Twitter in Scandinavia (Denmark, Norway, Sweden), by analyzing tweets in local languages during 2019. A validated measure, the 5C scale, was used to map relevant predictors of vaccination behavior, capturing the factors confidence (in vaccines and the system that delivers them), complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching) and collective responsibility (willingness to protect others). A total of 1794 tweets met the inclusion criteria (DK: 48%, NO: 15%, SE: 37%), predominantly tweeted by private users (86%). The HPV vaccine was mentioned in 81% of tweets. Tweets were classified as expressing confidence (61%), complacency (18%), constraints (15%), calculation (15%), and collective responsibility (4%). Confidence in vaccines and the system that delivers them was expressed in 57%. A lack of confidence was expressed in 4% of all tweets, in combination with calculation in 39%. Analyzing public sentiment toward vaccination on Twitter is a useful tool to leverage for better understanding of the dynamics behind vaccine hesitancy. This analysis could provide actionable information for healthcare professionals and public health authorities to mitigate online misinformation and public vaccine concerns.
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Affiliation(s)
| | | | - C Sahlin
- Quantify Research, Stockholm, Sweden
| | - M Nyaku
- Merck & CO., Inc, Kenilworth, NJ, USA
| | - G Benĉina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
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Abstract
A year following the initial COVID-19 outbreak in China, many countries have approved emergency vaccines. Public-health practitioners and policymakers must understand the predicted populational willingness for vaccines and implement relevant stimulation measures. This study developed a framework for predicting vaccination uptake rate based on traditional clinical data - involving an autoregressive model with autoregressive integrated moving average (ARIMA) - and innovative web search queries - involving a linear regression with ordinary least squares/least absolute shrinkage and selection operator, and machine-learning with boost and random forest. For accuracy, we implemented a stacking regression for the clinical data and web search queries. The stacked regression of ARIMA (1,0,8) for clinical data and boost with support vector machine for web data formed the best model for forecasting vaccination speed in the US. The stacked regression provided a more accurate forecast. These results can help governments and policymakers predict vaccine demand and finance relevant programs.
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Affiliation(s)
- Xingzuo Zhou
- Department of Economics, University College London, London, UK
| | - Yiang Li
- Social Research Institute, University College London, London, UK
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34
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Wang W, Kothari S, Baay M, Garland SM, Giuliano AR, Nygård M, Velicer C, Tota J, Sinha A, Skufca J, Verstraeten T, Sundström K. Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Rev Vaccines 2021; 21:227-240. [PMID: 34845951 DOI: 10.1080/14760584.2022.2008243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies. AREAS COVERED We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis. EXPERT OPINION The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
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Affiliation(s)
- Wei Wang
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Suzanne M Garland
- Department Obstetrics and Gynaecology, University of Melbourne, Centre Women's Infectious Diseases Research, Royal Women's Hospital, and Infection & Immunity Murdoch Children's Research Institute, Parkville, Australia
| | - Anna R Giuliano
- Center for Immunizaton and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christine Velicer
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Joseph Tota
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Anushua Sinha
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | | | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
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Wijayanti KE, Schütze H, MacPhail C. Parents' attitudes, beliefs and uptake of the school-based human papillomavirus (HPV) vaccination program in Jakarta, Indonesia - A quantitative study. Prev Med Rep 2021; 24:101651. [PMID: 34976699 PMCID: PMC8683993 DOI: 10.1016/j.pmedr.2021.101651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 01/22/2023] Open
Abstract
The Indonesian government has provided free HPV vaccines for female students in years 5–6 in Jakarta since 2016. We examined parents’ beliefs, attitudes and intentions to allow their daughters to receive the HPV vaccine, as well as the uptake of the vaccine. This cross-sectional study was conducted between September and November 2019 in Jakarta. We invited 680 parents or guardians of year 6 female students from 33 primary schools who were offered the free HPV vaccine to complete a questionnaire; 484 (71%) responded. Analysis was done in two groups: the ‘Decided’ Group (those parents who allowed or denied for their daughter to receive the HPV vaccination), and the ‘Undecided’ Group (those parents who did not recall being approached about the HPV vaccine or forgot their response). In the ‘Decided’ group, 295 (83.6%) parents allowed their daughters to receive the vaccination, while 58 (16.4%) parents refused it. In the ‘Undecided’ group, 49 (70%) parents reported a strong intention to allow their daughters to receive the vaccination; 21 (30%) had weak intention. Attitude, subjective norms and perceived behavioural control were shown to be significant predictors of HPV vaccine uptake when multilevel multivariate logistic regression analysis was undertaken. On the contrary, no independent variable was seen as a significant predictor for parents’ intentions to vaccinate their daughter against HPV. No sociodemographic characteristic was significantly associated with parents’ decisions or intentions regarding HPV vaccine for their daughters. Further qualitative research is needed to explore parents’ knowledge and reasons behind their decision-making processes.
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Affiliation(s)
- Kurnia Eka Wijayanti
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Department of Physical Education, Faculty of Sport and Health Education, Universitas Pendidikan Indonesia, Bandung, Indonesia
| | - Heike Schütze
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Catherine MacPhail
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
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Hviid A, Laksafoss A. Quadrivalent human papillomavirus vaccination and non-targeted infectious disease hospitalisation: Population-based self-controlled case series analysis. Lancet Reg Health Eur 2021; 10:100189. [PMID: 34806065 PMCID: PMC8589713 DOI: 10.1016/j.lanepe.2021.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Claims of non-live vaccines having deleterious effects on non-targeted infectious disease and mortality among females persists. The majority of the available evidence is from West Africa and consists of observational studies and the interpretation and implications are controversial. Results from high-income countries have been conflicting. We evaluated the association between a human papillomavirus vaccine, a non-live vaccine primarily administered to pre-adolescent females, and non-targeted infectious disease in a high-income country. Methods We constructed a nationwide cohort of all Danish females 10 to 29 years of age during 2007 to 2016 with information on quadrivalent human papillomavirus vaccination status and infectious disease hospital contacts using national registers. Nested in this cohort, we conducted a self-controlled case series (SCCS) analysis comparing the rates of hospitalisation in a 90-day main risk period following the latest vaccination to reference period rates with adjustment for age and season. Findings We included 853,879 Danish-born females aged 10 to 29 years of age during the 2007 to 2016 study period in the study cohort. We identified a total of 65,293 infectious disease hospitalisations among 50,599 participants; 46,955 cases among 37,003 participants vaccinated during follow-up were included in the SCCS analysis. There was no statistically significantly increased risk of infectious disease hospitalisation in the 90-day main risk period (rate ratio 0.92, 95% CI 0.88 to 0.95). Interpretation Reassuringly, our large well-controlled study does not support that human papillomavirus vaccination increases the risk of non-targeted infectious disease in any clinically meaningful way. While our study does not provide evidence against adverse effects of other non-live vaccines, it does provide evidence against the claim that all non-live vaccines increase risk of heterologous infections in females. Funding The study was supported by the Novo Nordisk Foundation.
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Sherman SM, Sim J, Cutts M, Dasch H, Amlôt R, Rubin GJ, Sevdalis N, Smith LE. COVID-19 vaccination acceptability in the UK at the start of the vaccination programme: a nationally representative cross-sectional survey (CoVAccS - wave 2). Public Health 2021; 202:1-9. [PMID: 34856520 PMCID: PMC8520876 DOI: 10.1016/j.puhe.2021.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/14/2023]
Abstract
Objectives Investigate factors associated with the intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme. Study design An online cross-sectional survey completed by 1500 adults (13th–15th January 2021). Methods Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19 and COVID-19 vaccination and vaccination in general. Participants’ main reasons for likely vaccination (non-)uptake were also solicited. Results 73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% (95% CI 15.4%, 19.3%) were unsure, and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with: having been/intending to be vaccinated for influenza last winter/this winter; stronger beliefs about social acceptability of a COVID-19 vaccine; the perceived need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention. Conclusions Most participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended.
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Affiliation(s)
| | - J Sim
- Keele University, School of Medicine, UK
| | - M Cutts
- Keele University, School of Psychology, UK
| | - H Dasch
- King's College London, Centre for Implementation Science, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - R Amlôt
- Public Health England, Behavioural Science Team, Emergency Response Department Science and Technology, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | - G J Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | - N Sevdalis
- King's College London, Centre for Implementation Science, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - L E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
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Melgaard A, Krogsgaard LW, Lützen TH, Plana-Ripoll O, Bech BH, Hansen LK, Rask CU, Rytter D. Pre-vaccination vulnerability and suspected adverse events following HPV vaccination. A case-control study nested in the Danish national birth cohort. Vaccine 2021; 39:6364-6369. [PMID: 34561141 DOI: 10.1016/j.vaccine.2021.09.041] [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: 06/27/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
Previous studies have indicated that girls experiencing suspected adverse events (AE) following HPV vaccination were more vulnerable prior to vaccination. However, no study has previously investigated differences in vulnerability using prospectively collected self-reported measures of vulnerability. The objective of this study therefore was to describe the distribution of biological and psychosocial indicators of vulnerability in girls referred to a hospital setting due to suspected adverse events and compare it with a sample of non-referred HPV vaccinated girls. The study was conducted as a case control study based within the Danish National Birth Cohort. Cases were defined as HPV vaccinated girls referred to a hospital setting between 2015 and 2017 due to suspected adverse events (n = 80), and 5 controls were randomly selected from the remaining source population, matched to cases on age at vaccination, region of residence and year of vaccination. The final study population consisted of 480 girls. Prior exposures were based on information gathered from an 11 year follow up of the DNBC and included information on self-rated health, frequent health complaints, medication use, bullying, stressful life events and physical activity. Conditional logistic regression analysis was used to estimate the association between each exposure and referral. The percentage of individuals in the exposed category of each exposure was generally higher for cases than controls. Particularly, the odds of being referred were higher for those with low self-rated health compared to high (OR [95%-CI] 2.43 [1.07-5.5]1), those being bullied (OR 3.19 [1.17-8.73]), and those who had taken medication (OR 2.22 [1.32-3.67]). Overall, these results indicated that girls experiencing suspected AE following HPV vaccination were more vulnerable prior to vaccination.
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Affiliation(s)
- Anna Melgaard
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
| | - Lene Wulff Krogsgaard
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
| | - Tina Hovgaard Lützen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark.
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
| | - Louise Krüger Hansen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark
| | - Charlotte Ulrikka Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark.
| | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark.
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Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson HJ. The role of maturity in adolescent decision-making around HPV vaccination in France. Vaccine 2021; 39:5741-5747. [PMID: 34483023 DOI: 10.1016/j.vaccine.2021.08.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents' involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents' capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls' involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents' lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters' own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.
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Affiliation(s)
- E Karafillakis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - P Peretti-Watel
- UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France; Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - P Verger
- UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France; Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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COVID-19 Vaccine Hesitancy and Resistance in India Explored through a Population-Based Longitudinal Survey. Vaccines (Basel) 2021; 9:vaccines9101064. [PMID: 34696172 PMCID: PMC8537475 DOI: 10.3390/vaccines9101064] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The World Health Organization has recommended that individual governments identify vaccine hesitancy areas. It is proposed that the governments, with the aid of local organizations, educate and implement social insights on the vaccination so that high population levels are covered with this safe immune program. METHODS A longitudinal online survey covered 3000 adults from India. We examined the demography, behavioral (socio-economic) attitude, vaccine hesitancy, vaccine resistance for the COVID-19 vaccine. The specific reasons for the COVID-19 vaccine decline were also evaluated. RESULTS Our survey revealed 59% definite response, 29% low-level response, and 7% high-level response for vaccine hesitancy, while 6% had resistant views on the COVID-19 vaccine. Individuals who had higher income levels, lived in a society, maintained social distancing, had downloaded the COVID-19 update app, showed a positive attitude towards their government, and more confidence in their healthcare system were more inclined towards the vaccination. On the contrary, individuals who had overstated the risks of COVID-19 and had a religious and populistic attitude towards vaccination were more hesitant/resistant to vaccination. The respondents who declined vaccine administration were further evaluated for their specific reason for their response. The most common reasons for declining the COVID-19 vaccine were post-vaccine scare of adverse health effects and accepting the information spread by social media. CONCLUSIONS The results in our study show that by identifying population "hot spots" that have negative or unclear information on the COVID-19 vaccination, these "hot spots" can be addressed by involving friendly organizations that can clear their strong disbeliefs and increase the percentage of vaccine-definite people within the population. The role of government-induced COVID-19 vaccine policy measures can always be beneficial to cause this shift from disbelief to confidence within the population.
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Krogsgaard LW, Petersen I, Plana-Ripoll O, Bech BH, Lützen TH, Thomsen RW, Rytter D. Infections in temporal proximity to HPV vaccination and adverse effects following vaccination in Denmark: A nationwide register-based cohort study and case-crossover analysis. PLoS Med 2021; 18:e1003768. [PMID: 34495975 PMCID: PMC8457493 DOI: 10.1371/journal.pmed.1003768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/22/2021] [Accepted: 08/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Public trust in the human papilloma virus (HPV) vaccination programme has been challenged by reports of potential severe adverse effects. The reported adverse symptoms were heterogeneous and overlapping with those characterised as chronic fatigue syndrome (CFS) and have been described as CFS-like symptoms. Evidence suggests that CFS is often precipitated by an infection. The aim of the study was to examine if an infection in temporal proximity to HPV vaccination is a risk factor for suspected adverse effects following HPV vaccination. METHODS AND FINDINGS The study was a nationwide register-based cohort study and case-crossover analysis. The study population consisted of all HPV vaccinated females living in Denmark, born between 1974 and 2006, and vaccinated between January 1, 2006 and December 31, 2017. The exposure was any infection in the period ± 1 month around time of first HPV vaccination and was defined as (1) hospital-treated infection; (2) redemption of anti-infective medication; or (3) having a rapid streptococcal test done at the general practitioner. The outcome was referral to a specialised hospital setting (5 national HPV centres opened June 1, 2015) due to suspected adverse effects following HPV vaccination. Multivariable logistic regression was used to estimate the association between infection and later HPV centre referral. The participants were 600,400 HPV-vaccinated females aged 11 to 44 years. Of these, 48,361 (9.7%) females had a hospital-treated infection, redeemed anti-infective medication, or had a rapid streptococcal test ± 1 month around time of first HPV vaccination. A total of 1,755 (0.3%) females were referred to an HPV centre. Having a hospital-treated infection in temporal proximity to vaccination was associated with significantly elevated risk of later referral to an HPV centre (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.72 to 4.40; P < 0.001). Increased risk was also observed among females who redeemed anti-infective medication (OR 1.56, 95% CI 1.33 to 1.83; P < 0.001) or had a rapid streptococcal test (OR 1.45, 95% CI 1.10 to 1.93; P = 0.010). Results from a case-crossover analysis, which was performed to adjust for potential unmeasured confounding, supported the findings. A key limitation of the study is that the HPV centres did not open until June 1, 2015, which may have led to an underestimation of the risk of suspected adverse effects, but stratified analyses by year of vaccination yielded similar results. CONCLUSIONS Treated infection in temporal proximity to HPV vaccination is associated with increased risk for later referral with suspected adverse vaccine effects. Thus, the infection could potentially be a trigger of the CFS-like symptoms in a subset of the referred females. To our knowledge, the study is the first to investigate the role of infection in the development of suspected adverse effects after HPV vaccination and replication of these findings are needed in other studies.
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Affiliation(s)
- Lene Wulff Krogsgaard
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- * E-mail:
| | - Irene Petersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, United Kingdom
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Tina Hovgaard Lützen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
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Sonawane K, Lin YY, Damgacioglu H, Zhu Y, Fernandez ME, Montealegre JR, Cazaban CG, Li R, Lairson DR, Lin Y, Giuliano AR, Deshmukh AA. Trends in Human Papillomavirus Vaccine Safety Concerns and Adverse Event Reporting in the United States. JAMA Netw Open 2021; 4:e2124502. [PMID: 34533574 PMCID: PMC8449282 DOI: 10.1001/jamanetworkopen.2021.24502] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In the US, safety concern has been identified as a primary barrier to initiating the human papillomavirus (HPV) vaccine. It is unclear if the public's sentiment concerning HPV vaccine safety aligns with postmarketing vaccine safety surveillance data. OBJECTIVE To perform a parallel assessment of trends in HPV vaccine safety concerns and HPV vaccine adverse event (AE) reporting. DESIGN, SETTING, AND PARTICIPANTS This study was a cross-sectional analysis of the National Immunization Survey (NIS) and Vaccine Adverse Event Reporting System (VAERS). Participants in the NIS were adolescents aged 13 to 17 years. AEs were reported to VAERS by patients, health care clinicians, or other sources. Statistical analysis was performed from October 2020 to May 2021. MAIN OUTCOMES AND MEASURES Secular trends in HPV vaccine safety concerns and spontaneous AE reporting for HPV vaccination from 2015 to 2018. RESULTS Caregivers of 39 364 unvaccinated adolescents with a mean (SD) age of 15.57 (0.08) years (26 996 White adolescents [62.9%], 22 707 male adolescents [56.1%], 11 392 privately insured [62.6%], and 32 674 above the poverty level [79.3%]) reported their reasons for not initiating the HPV vaccine series in the 2015-2018 NIS. Citing safety concerns as the primary reason for not initiating the HPV vaccine series increased from 13.0% (95% CI, 12.1%-14.0%) in 2015 to 23.4% (95% CI, 21.8%-25.0%) in 2018 (P for trend < .001), equating to a change from 170 046 to 259 157 US adolescents not initiating the vaccine because of safety concerns. The proportion of parents citing safety concerns as the main reason for HPV vaccine hesitancy increased in 30 states. The largest increases (more than 200%) were observed in California, Hawaii, South Dakota, and Mississippi. During 2015 to 2018, 16 621 AE reports following HPV vaccination were reported to VAERS. The AE reporting rate per 100 000 doses distributed decreased from 44.7 in 2015 to 29.4 in 2018 (P for trend < .001). The serious AE reporting rate, including those leading to hospitalizations, disability, life-threatening condition, or death did not change. CONCLUSIONS AND RELEVANCE In this descriptive cross-sectional study, a rise in citing safety concerns was observed among parents with HPV vaccine hesitancy, contrary to the nonserious and serious AE reporting trends. These findings suggest an urgent need to combat the rising sentiment of safety concerns among caregivers to increase HPV vaccine confidence.
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Affiliation(s)
- Kalyani Sonawane
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Yenan Zhu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, Texas
| | | | - Cecilia Ganduglia Cazaban
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ruosha Li
- Department of Biostatistics and Data Science, School of Public Health, UT Health Science Center at Houston, Houston, Texas
| | - David R Lairson
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ying Lin
- Department of Industrial Engineering, University of Houston, Houston, Texas
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida
| | - Ashish A Deshmukh
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
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Whelan SO, Moriarty F, Lawlor L, Gorman KM, Beamish J. Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population. Eur J Pediatr 2021; 180:2839-2847. [PMID: 33774718 DOI: 10.1007/s00431-021-04039-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022]
Abstract
Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccines, despite availability. It is a complex and context specific phenomenon and identified as a global health priority. The "Parent Attitudes about Childhood Vaccines" (PACV) questionnaire is a validated tool for identifying vaccine hesitancy. Our aim was to use the PACV to assess vaccine hesitancy and its relationship with reported non-vaccination in an Irish population, for the first time. Our participants were parents or caregivers of children attending general pediatric clinics in a tertiary pediatric hospital in Dublin, Ireland, between September and December 2018. In total, 436 participants completed the questionnaire. 5.5% of our population reported non-vaccination. Human papilloma virus and measles, mumps, rubella vaccines were the most commonly cited vaccines of concern (11.5% and 6.7%, respectively), and autism spectrum disorder was the most commonly side effect of concern (4.3%). Mean PACV score was 26.9 (SD 19.1), with a significant difference between non-vaccinators and vaccinators (53.2 vs 25.3, p<0.001). Safety and efficacy concerns were the major contributor to non-vaccination. 14.4% of our population were vaccine-hesitant using the conventional cut-off score, which increased to 22% when using an optimal cut-off which maximized sensitivity and specificity. The accuracy of the PACV score to identify non-vaccination was good (area under the ROC curve = 0.827), and the optimal cut-off had a high negative predictive value (98.5%).Conclusion: PACV identified reported non-vaccination with high accuracy in our population. It may be useful to screen vaccine-hesitant parents who could benefit from interventions to improve uptake. What is Known: • Vaccine hesitancy is a leading threat to global health, with falls in vaccine uptake associated with disease outbreaks worldwide. • The Parent Attitudes about Childhood Vaccines (PACV) questionnaire is a validated measure of vaccine hesitancy and correlates with non-vaccination in many populations. What is New: • This large study in a pediatric outpatient clinic setting represents the first use of the PACV in a Western European population to assess vaccination hesitancy. • The PACV may be an effective way of screening a pediatric clinic population to identify vaccine-hesitant parents or caregivers for targeted vaccine promotion.
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Affiliation(s)
- Sean Olann Whelan
- Department of General Pediatrics, CHI at Temple Street, Dublin, Ireland. .,Department of Pediatrics, Cork University Hospital, Cork, Ireland.
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lisa Lawlor
- Department of General Pediatrics, CHI at Temple Street, Dublin, Ireland
| | - Kathleen Mary Gorman
- Department of Neurology and Clinical Neurophysiology, CHI at Temple Street, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Joanne Beamish
- Department of General Pediatrics, CHI at Temple Street, Dublin, Ireland
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Liu Z, Yang JZ. In the Wake of Scandals: How Media Use and Social Trust Influence Risk Perception and Vaccination Intention among Chinese Parents. HEALTH COMMUNICATION 2021; 36:1188-1199. [PMID: 32264705 DOI: 10.1080/10410236.2020.1748834] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recently, repeated childhood vaccine scandals shook public confidence in vaccine safety in China. This study explores whether media attention, online discussion, and social trust influence Chinese parents' risk perception and vaccination intention. Based on data from a Qualtrics panel (N = 354), results indicate that media attention is positively related to social trust and online discussion is positively related to perceived benefits. Additionally, social trust is negatively associated with perceived risk but positively associated with perceived benefits. Social trust is also positively related to general vaccination intention and intention to get domestic vaccines. Further, social trust mediates the relationship between media attention/online discussion and risk perception. Lastly, parents with higher risk perception are less likely to get domestic vaccines, but more likely to get imported vaccines. Perceived benefits also influence vaccination intention.
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Affiliation(s)
- Zhuling Liu
- Department of Communication, University at Buffalo
| | - Janet Z Yang
- Department of Communication, University at Buffalo
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45
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To Vaccinate or Not to Vaccinate-This Is the Question among Swiss University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179210. [PMID: 34501799 PMCID: PMC8431304 DOI: 10.3390/ijerph18179210] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 12/19/2022]
Abstract
The speed and innovation of the COVID-19 vaccine development has been accompanied by insecurity and skepticism. Young adults’ attitude to vaccination remains under investigation, although herd immunity cannot be reached without them. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate vaccination intention in 1478 students in the sixth survey wave (January 2021), including vaccination intention, psychological antecedents of vaccine hesitancy, trust in government’s vaccination strategy, and vaccination history. Associations with vaccination intention were analyzed with multivariate ordinal regression and predicted margins were calculated adjusting for gender, age, anxiety, health profession, and subjective health status. A third was decided (yes 25.1%, no 7.6%), and 68% were unsure about getting the COVID-19 vaccine when available. Next to demographic characteristics, vaccination history (influenza vaccination OR = 1.39; 95% CI: 1.06–1.83, travel vaccination OR = 1.29; 95% CI: 1.04–1.60), trust in vaccination strategy (OR = 2.40; 95% CI: 1.89–3.05), and 5C dimensions were associated with vaccination intention: confidence (OR = 2.52; 95% CI: 2.09–3.03), complacency (OR = 0.79; 95% CI: 0.66–0.96), calculation (OR = 0.79; 95% CI: 0.70–0.89), constraints (OR = 1.18; 95% CI: 0.99–1.41), and collective responsibility (OR = 4.47; 95% CI: 3.69–5.40). Addressing psychological antecedents and strengthening trust in official strategies through targeted campaigns and interventions may increase decisiveness and result in higher vaccination rates.
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Grandahl M, Nevéus T. Barriers towards HPV Vaccinations for Boys and Young Men: A Narrative Review. Viruses 2021; 13:v13081644. [PMID: 34452508 PMCID: PMC8402923 DOI: 10.3390/v13081644] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men. Methods: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis. Results: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation. Conclusions: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.
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Sukegawa A, Ohshige K, Suzuki Y, Mizushima T, Ueda Y, Sekine M, Enomoto T, Miyagi E. Ten-year questionnaire study on human papillomavirus vaccination targeting new female medical school students: Follow-up to the 2015 report. J Obstet Gynaecol Res 2021; 47:3618-3627. [PMID: 34322951 DOI: 10.1111/jog.14949] [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: 05/01/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to conduct a fixed-point observation questionnaire survey of changes in young women's human papillomavirus (HPV) vaccination status over the course of 10 years. We also investigated the influence of suspension of governmental recommendation for HPV vaccination since June 2013. METHODS During 2011-2020, we conducted a self-completed questionnaire survey among newly enrolled female medical school students in Yokohama, Japan. The questionnaire featured items regarding HPV vaccination status, age, previous sex education, and knowledge about cervical cancer and HPV vaccination. RESULTS HPV vaccine uptake rates in 2011 (5.4%) and 2012 (13.5%), when vaccination was self-funded, increased after 2013 (48.7%), when vaccination fees were subsidized. The rate dropped drastically in 2019 (14.3%) and 2020 (5.1%), after suspension of recommendation by the government. Comparisons between new students in 2015/2016, who had high vaccination rates (65.2%), and new students in 2019/2020, who had low vaccination rates (9.8%), showed decreased levels of HPV vaccination awareness, with fewer students having covered cervical cancer prevention in sex education and with respondents having less knowledge about the details of HPV vaccination. CONCLUSIONS After the suspension of proactive HPV vaccine recommendation, markedly fewer students have been vaccinated against HPV, even those at the vaccination target age. This situation has substantially influenced the lower awareness about cervical cancer prevention, even among medical school students. To protect young women from cervical cancer in Japan, it is crucial for the government to resume proactive recommendation of HPV vaccines as soon as possible.
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Affiliation(s)
- Akiko Sukegawa
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kenji Ohshige
- Center for Health Service Sciences, Yokohama National University, Yokohama, Japan
| | - Yukio Suzuki
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Taichi Mizushima
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
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LaMontagne DS, Manangazira P, Marembo J, Chigodo C, Zvamashakwe C, Tshuma E, Marima E, Chindedza K, Ndlela E, Mooney J. HPV vaccination coverage in three districts in ZIMBABWE following national introduction of 0,12 month schedule among 10 to 14 year old girls. Vaccine 2021; 40 Suppl 1:A58-A66. [PMID: 34275674 DOI: 10.1016/j.vaccine.2021.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Zimbabwe has one of the highest incidence rates of cervical cancer in the world - 61.7 per 100,000 women. The government of Zimbabwe introduced bivalent HPV vaccine with a 0,12 month schedule to all 10-14 year old girls using a pulsed-campaign approach in May 2018 (dose 1) and May 2019 (dose 2). METHODS In August 2019, we conducted a population-based, two-stage cluster survey of households with girls who were eligible for the national HPV vaccination program to determine two-dose HPV vaccination coverage in three districts of Zimbabwe. All households with girls currently aged 11 to 15 years were line-listed through a census conducted in the pre-selected clusters from each district prior to survey administration. A simple random sample of eligible households was selected from these lists to estimate HPV vaccine coverage at sufficient power with a margin of error of +/- 5%. Criteria for district selection included estimated vaccine uptake (low, medium, high), rural/urban/peri-urban, geographic area, estimated number of girls not in school, and recent natural disasters or disease outbreaks. We oversampled households with girls aged 13 or 14 years at the time of dose 1. RESULTS On-time dose 1 uptake ranged from 88 to 94% and two-dose HPV vaccine coverage ranged from 75 to 86% across the three districts. Nearly all vaccinations occurred in schools, and less than 2% of girls did not attend school. There were challenges assessing ages of girls at schools prior to vaccination - 9% of girls vaccinated were less than 10 years old at time of dose 1. DISCUSSION Zimbabwe has demonstrated that high uptake and successful completion of 2-dose HPV vaccination can be achieved with an annual dosing schedule. Efforts going forward will need to focus on minimizing dropout between doses and routinizing annual vaccinations in schools for every subsequent new cohort of eligible girls in the country.
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Affiliation(s)
- D Scott LaMontagne
- PATH, Center for Vaccine Innovation & Access, 2201 Westlake Avenue, Suite 200, Seattle, WA, USA.
| | - Portia Manangazira
- Ministry of Health and Child Care, Epidemiology and Disease Control, Harare, Zimbabwe
| | - Joan Marembo
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Colline Chigodo
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Coscar Zvamashakwe
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Emma Tshuma
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Evelyn Marima
- Zimbabwe National Statistics Agency, Harare, Zimbabwe
| | - Kenneth Chindedza
- World Health Organization, Zimbabwe Country Office, Harare, Zimbabwe.
| | | | - Jessica Mooney
- PATH, Center for Vaccine Innovation & Access, 2201 Westlake Avenue, Suite 200, Seattle, WA, USA.
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Coverage of medical cannabis by Canadian news media: Ethics, access, and policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103361. [PMID: 34252784 DOI: 10.1016/j.drugpo.2021.103361] [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: 04/01/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The use of recreational cannabis by adults was legalized in Canada in 2018 (The Cannabis Act, 17 October 2018). This change in drug policy indirectly opened the doors to broader uses, including those for health-related conditions. As a first step towards understanding ethical, legal, and social shifts on this landscape, we examined messaging surrounding medical cannabis and health in Canadian news media before and after legalization. METHODS We retrieved news articles about medical cannabis and health from Canadian sources (2010-2020). Deductive and inductive content analytic approaches were applied to code eligible articles for both a priori ethical, legal, social, and issues, and emergent themes. Wilcoxon-Mann-Whitney U tests were used to test for thematic changes pre- and post-legalization. RESULTS Two hundred and sixteen (216) articles met inclusion criteria. Analysis yielded three themes and eight subthemes, comprising 4931 coded references. The a priori theme of Ethical, Legal and Social Issues (access, benefits/risks of medical cannabis, public engagement, and conflicts of interest) dominated news media coverage across the decade (coded in 99% of articles). The emergent theme of Medical Applications (therapeutic use of cannabis, consumption considerations, comparisons to other drug and treatment options) was coded in 86% of articles; Resource Issues (research and education) in 50%. We found little discourse on ethics issues specific to exceptional populations. Coverage on aspects of access declined significantly post-legalization. CONCLUSION Capturing the push of Canadian news coverage of medical cannabis is a powerful means of understanding how public opinions on the subject are shaped and then, by extension, inform public policy for well-being and healthcare. Continued examination of these issues, public consultation, engagement with diverse populations such as people with disabilities and neurologic and mental health conditions, and integration of diverse cultural views into the policy discourse are critical steps for future research and action.
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Li AJ, Manzi F, Kyesi F, Makame Y, Mwengee W, Fleming M, Mkopi A, Mmbaga S, Lyimo D, Loharikar A. Tanzania's human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019. Vaccine 2021; 40 Suppl 1:A38-A48. [PMID: 34229889 PMCID: PMC9601816 DOI: 10.1016/j.vaccine.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In April 2018, Tanzania introduced the human papillomavirus (HPV) vaccine nationally to 14-year-old girls, utilizing routine delivery strategies (i.e. vaccinating girls at health facilities and community outreach, including schools). We sought to assess awareness, feasibility, and acceptability of the HPV vaccination program among health workers and community-level stakeholders. METHODS We conducted cross-sectional in-person surveys among health workers, school personnel, community leaders, and council leaders in 18 council areas across six regions of Tanzania in October-November 2019. Regions were purposively selected to provide demographic, geographic, and vaccination coverage variability; sub-regional levels used random or stratified random sampling. Surveys included questions on HPV vaccine training and knowledge, delivery strategy, target population, and vaccine and program acceptability. Descriptive analysis was completed for all variables stratified by respondent groups. RESULTS Across the 18 councils, there were 461 respondents, including health workers (165), school personnel (135), community leaders (143), and council leaders (18). Over half of each respondent group (50-78%) attended a training or orientation on HPV vaccine. Almost 75% of the health workers and school personnel respondent groups, and less than half (45%) of community leaders correctly identified the target age group for HPV vaccine. Most (80%) of the health workers indicated HPV vaccination was available at health facilities and schools; most (79%) indicated that the majority of girls receive HPV vaccine in school. Approximately half (52%) of all respondents reported hearing misinformation about HPV vaccine, but 97% of all respondents indicated that HPV vaccine was either "very accepted" or "somewhat accepted" in their community. CONCLUSION The HPV vaccination program in Tanzania was well accepted by community stakeholders in 18 councils; adequate knowledge of HPV vaccine and the HPV vaccination program was demonstrated by health workers and school personnel. However, continued technical support for integration of HPV vaccination as a routine immunization activity and reinforcement of basic knowledge about HPV vaccine in specific community groups is needed. The Tanzania experience provides an example of how this vaccine can be integrated into routine immunization delivery strategies and can be a useful resource for countries planning to introduce HPV vaccine as well as informing global partners on how to best support to countries in operationalizing their HPV vaccine introduction plans.
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Affiliation(s)
- Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | | | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Monica Fleming
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Anagha Loharikar
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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