Erratum to: Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel

Parents' attitudes toward children's vaccination as a marker of trust in health systems

Children's vaccination is a major goal in health-care systems worldwide; nevertheless, disparities in vaccination coverage expose socio-demographic accessibility gaps, unawareness, physicians' disapproval and parents' incomplete adherence reflecting insufficient public-provider trust. Our goal was to analyze parents' attitude toward children's vaccination in correlation with trust among stakeholders. A total of 1031 parents replied to a "snowball" questionnaire; 72% reported high trust in their physician, 42% trusted the authorities, 11% trusted internet groups. Among minorities, parents who fully vaccinate their children were younger, live in urban areas, eat all kinds of foods and trust the authorities, similar to the general population. Low adherence to children's vaccination was correlated with trusting internet groups. Females complied significantly more to child vaccination, although in our study mothers were more highly educated and trusted authorities more than males. The results enable to draw a profile of the "vaccination compliant parent" (with an academic degree, young, urban, eats all kinds of foods, uses conservative medicine). Trust is a major factor influencing vaccination, yet external forces such as community voices, social trends and opinions of religious leaders may play a role in vaccination adherence, beyond personal beliefs, individual habits and self-care. In Israel, education and "healthy behavior" perception alongside generous coverage encourage most parents to comply with the routine vaccination program. In the shade of pandemic outbreaks, we suggest a social-determinant transparent approach to encourage parents to vaccinate their children. Social and religious leaders can pose as agents of change, especially in the case of less educated parents.

Reintroducing OPV in Israel on the journey to global polio eradication - Estimation at a low rate of contraindicated population

INTRODUCTION

The 2013 reemergence of wild poliovirus in Israel led to the reinstatement of a routine OPV vaccination. Fearing VAPP in immunocompromised, the MOH regulated contraindications for vaccination candidates and household contacts. In this study we estimate the size of the contraindicated population to OPV vaccination.

METHOD

We studied vaccination candidates aged 2-9 and 14-23 months and probable household contacts. Using the rate of contraindications extracted for each study group from a medical records database, a statistical model was built to estimate the probability of contraindications in candidates.

RESULTS

3.9% of the 2-9-month-old study group and 4% of the 14-23-month-old group had contraindications by either self or household contacts.

CONCLUSION

A statistical model can provide an estimation of the contraindicated population and can be used in the future when devising vaccination campaigns. In contrast to concerns raised by the MOH, our findings show a smaller than anticipated contraindicated population.

Lessons learned from the 2009-2010 H1N1 outbreak for the management of the 2013 silent polio outbreak

BACKGROUND

The Israeli Ministry of Health (MoH) encountered two substantial outbreaks during the past decade: the H1N1 swine flu outbreak during 2009-2010 and the silent polio outbreak during 2013. Although both outbreaks share several similar characteristics, the functioning of the Israeli MoH was different for each case. The aim of this study was to identify factors that contributed to the change in the MoH response to the polio outbreak in light of the previous 2009-2010 H1N1 outbreak.

METHODS

We conducted a qualitative research using semi-structured interviews with 18 Israeli policymakers from the MoH, relevant specialists and politicians. Each interview was transcribed and a thematic analysis was conducted independently by two researchers.

RESULTS

Three main themes were found in the interview analysis, which reflect major differences in the MoH management policy during the polio outbreak. 1) clinical and epidemiological differences between the two disease courses, 2) differences in the functioning of the MoH during the outbreaks, 3) differences in the risk communication strategies used to reach out to the local health community and the general public. Most interviewees felt that the experience of the 2009-2010 H1N1 outbreak which was perceived as unsuccessful, fueled the MoH engagement and proactiveness in the later polio outbreak.

CONCLUSION

These findings highlight the importance of learning processes within health care organizations during outbreaks and may contribute to better performance and higher immunization rates.

Modelling and parameter inference of predator-prey dynamics in heterogeneous environments using the direct integral approach

Most bacterial habitats are topographically complex in the micro scale. Important examples include the gastrointestinal and tracheal tracts, and the soil. Although there are myriad theoretical studies that explore the role of spatial structures on antagonistic interactions (predation, competition) among animals, there are many fewer experimental studies that have explored, validated and quantified their predictions. In this study, we experimentally monitored the temporal dynamic of the predatory bacterium Bdellovibrio bacteriovorus, and its prey, the bacterium Burkholderia stabilis in a structured habitat consisting of sand under various regimes of wetness. We constructed a dynamic model, and estimated its parameters by further developing the direct integral method, a novel estimation procedure that exploits the separability of the states and parameters in the model. We also verified that one of our parameter estimates was consistent with its known, directly measured value from the literature. The ability of the model to fit the data combined with realistic parameter estimates indicate that bacterial predation in the sand can be described by a relatively simple model, and stress the importance of prey refuge on predation dynamics in heterogeneous environments.