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Singh P, Fesshaye B, Lee C, Njogu RN, Karron RA, Limaye RJ. Maternal Immunization Decision-Making Among Pregnant and Lactating People in Kenya: A Qualitative Exploration of Peer Influences on Vaccine Decision-Making for a Future RSV Vaccine. Matern Child Health J 2024:10.1007/s10995-024-03982-8. [PMID: 39141202 DOI: 10.1007/s10995-024-03982-8] [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] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in infants globally, with new maternal RSV vaccines on the horizon. Vaccine decision-making during pregnancy is shaped by individual, interpersonal, community, and societal factors. This study explored key interpersonal influences on maternal vaccine decision-making among pregnant and lactating people (PLP) and community members in Kenya. METHODS This qualitative study conducted in-depth interviews with six pregnant people, 18 lactating people, and 10 community members in one rural and one urban county in Kenya. Data were analyzed using a grounded theory approach. RESULTS Participants identified the pregnant person themself, male partners, other family members, peers, and healthcare providers (HCPs) as key influences on the maternal immunization decision-making process. The majority of interviewed PLP believed that decision-making during pregnancy should be left to themselves due to autonomy and their role as the primary caregiver. Community members, including male partners, also identified pregnant people as the key decision-maker. While some PLP said they deferred to male partners to make vaccine decisions, more felt that men were not as informed on maternal and child issues as themselves or other female peers and relatives. HCPs emerged as important influences and information sources for PLP during decision-making. DISCUSSION Understanding who influences vaccine-decision making during pregnancy will help inform demand generation strategies, and in turn, uptake of future maternal vaccines, including RSV vaccines. Given the strong role HCPs and peers have in the decision-making process, targeting key potential influences is essential to improve vaccine acceptance.
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Affiliation(s)
- Prachi Singh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Berhaun Fesshaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Clarice Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Baltimore, MD, 21205, USA
| | - Rosemary N Njogu
- Jhpiego Kenya, 2nd Floor, Arlington Block, 12 Riverside, Off Riverside Drive, P.O. Box 66119-00800, Nairobi, Kenya
| | - Ruth A Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
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Limaye RJ, Sauer M, Njogu R, Singh P, Fesshaye B, Karron RA. Characterizing Attitudes Toward Maternal RSV Vaccines Among Pregnant and Lactating Persons in Kenya: Key Considerations for Demand Generation Efforts for Vaccine Acceptance. J Pediatric Infect Dis Soc 2023; 12:638-641. [PMID: 37944043 DOI: 10.1093/jpids/piad098] [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: 06/23/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
This study examined attitudes toward maternal RSV vaccines among pregnant and lactating persons in Kenya. First pregnancy was associated with higher vaccine hesitancy among pregnant and lactating people, and social norms were associated with higher vaccine hesitancy among lactating people. Understanding maternal RSV attitudes is critical for vaccine acceptance.
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Affiliation(s)
- Rupali J Limaye
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior & Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Njogu
- Department of International Health, Jhpiego, Nairobi, Kenya
| | - Prachi Singh
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Berhaun Fesshaye
- Department of International Health, International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruth A Karron
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Du Y, Yan R, Wu X, Zhang X, Chen C, Jiang D, Yang M, Cao K, Chen M, You Y, Zhou W, Chen D, Xu G, Yang S. Global burden and trends of respiratory syncytial virus infection across different age groups from 1990 to 2019: A systematic analysis of the Global Burden of Disease 2019 Study. Int J Infect Dis 2023; 135:70-76. [PMID: 37567553 DOI: 10.1016/j.ijid.2023.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Understanding the global patterns of respiratory syncytial virus (RSV) is crucial for developing effective prevention and control strategies. METHODS Data on RSV-related burden were extracted from the Global Burden of Disease 2019. Joinpoint regression models were used to assess the global temporal trends of RSV and further stratified analyses were conducted according to the Socio-demographic Index (SDI), which is a composite measure of income, education, and total fertility. Age-period-cohort model was used to evaluate age, period, and cohort effects. RESULTS In 2019, the global age-standardized rate of mortality (ASMR) and disability-adjusted life years (ASR-DALYs) of RSV were 4.79/100,000 (95% uncertainty interval [95% UI]: 1.82/100,000-9.32/100,000) and 218.34/100,000 (95% UI: 92.06/100,000-376.80/100,000), respectively. The burden of RSV was higher in men than women. The highest ASMR (10.26/100,000, 3.80/100,000-20.16/100,000) and ASR-DALYs (478.71/100,000, 202.40/100,000-840.85/100,000) were reported in low-SDI region. Although mortality and DALYs rates in all age groups declined globally, the pace of decline was not uniform across age groups. Mortality rate in the elderly over 70 years surpassed that in children under 5 years in 2019. CONCLUSION This study highlights the need for targeted interventions to reduce the burden of RSV, particularly in low-SDI region, and among the elderly over 70 years.
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Affiliation(s)
- Yuxia Du
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Yan
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Xiaoyue Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Can Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Daixi Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengya Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Kexin Cao
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengsha Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue You
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenkai Zhou
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingmo Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shigui Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
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Limaye RJ, Fesshaye B, Singh P, Karron RA. RSV awareness, risk perception, causes, and terms: Perspectives of pregnant and lactating women in Kenya to inform demand generation efforts for maternal RSV vaccines. Hum Vaccin Immunother 2023; 19:2258580. [PMID: 37807864 PMCID: PMC10563615 DOI: 10.1080/21645515.2023.2258580] [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: 07/03/2023] [Accepted: 09/10/2023] [Indexed: 10/10/2023] Open
Abstract
Respiratory syncytial virus (RSV) causes a substantial proportion of acute lower respiratory tract infections (LRTI) among infants. In low- and middle-income countries, RSV may be responsible for approximately 40% of all hospital admissions of infants less than one year. A safe and immunogenic RSV vaccine, given to pregnant persons, is imminent. In this qualitative study, we sought to understand factors that could inform maternal vaccine decision-making to inform future demand generation strategies in Kenya. We conducted in-depth interviews with 24 pregnant and lactating persons from two counties, with two communities in each county. Four key themes emerged, including terms used for RSV, awareness of and risk perception related to RSV, causes of RSV, and questions about future maternal RSV vaccines. Regarding terms, no participant used the term RSV to describe the disease. Most participants associated RSV with cold things such as cold weather and cold food/drink. Most participants believed that RSV was caused by the cold or an unclean environment. Finally, key questions related to a maternal RSV vaccine were related to vaccine safety, and more specifically side effects. Questions arose related to vaccine effectiveness as well as timing of administration and dosing. A maternal RSV vaccine is on the horizon. However, vaccines do not save lives; vaccination does. As such, it is critical to develop and implement demand generation approaches to ensure that once a maternal RSV vaccine is available, communities are sensitized and willing to accept it.
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Affiliation(s)
- Rupali J. Limaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Berhaun Fesshaye
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prachi Singh
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth A. Karron
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nyawanda BO, Opere VA, Nyiro JU, Vodicka E, Fleming JA, Baral R, Khan S, Pecenka C, Ayugi JO, Atito R, Ougo J, Bigogo G, Emukule GO, Otieno NA, Munywoki PK. Respiratory Syncytial Virus (RSV) Disease and Prevention Products: Knowledge, Attitudes, and Preferences of Kenyan Healthcare Workers in Two Counties in 2021. Vaccines (Basel) 2023; 11:1055. [PMID: 37376444 DOI: 10.3390/vaccines11061055] [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: 04/25/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) among infants under 6 months of age. Yet, in Kenya, little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions around RSV disease and the prevention products under development. Between September and October 2021, we conducted a mixed methods cross-sectional survey to assess HCWs' knowledge, attitudes, and perceptions of RSV disease and RSV vaccinations in two counties. We enrolled HCWs delivering services directly at maternal and child health (MCH) departments in selected health facilities (frontline HCWs) and health management officers (HMOs). Of the 106 respondents, 94 (88.7%) were frontline HCWs, while 12 were HMOs. Two of the HMOs were members of the Kenya National Immunization Technical Advisory Group (KENITAG). Of the 104 non-KENITAG HCWs, only 41 (39.4%) had heard about RSV disease, and 38/41 (92.7%) felt that pregnant women should be vaccinated against RSV. Most participants would recommend a single-dose vaccine schedule (n = 62, 58.5%) for maximal adherence and compliance (n = 38/62, 61.3%), single dose/device vaccines (n = 50/86, 58.1%) to prevent wastage and contamination, and maternal vaccination through antenatal care clinics (n = 53, 50%). We found the need for increased knowledge about RSV disease and prevention among Kenyan HCWs.
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Affiliation(s)
- Bryan O Nyawanda
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Victor A Opere
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Joyce U Nyiro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi P.O. Box 230-80108, Kenya
| | - Elisabeth Vodicka
- Program for Appropriate Technology in Health-PATH, Seattle, WA 98121, USA
| | - Jessica A Fleming
- Program for Appropriate Technology in Health-PATH, Seattle, WA 98121, USA
| | - Ranju Baral
- Program for Appropriate Technology in Health-PATH, Seattle, WA 98121, USA
| | - Sadaf Khan
- Program for Appropriate Technology in Health-PATH, Seattle, WA 98121, USA
| | - Clint Pecenka
- Program for Appropriate Technology in Health-PATH, Seattle, WA 98121, USA
| | - Jorim O Ayugi
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Raphael Atito
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - James Ougo
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Gideon O Emukule
- US Centers for Disease Control and Prevention, Nairobi P.O. Box 606-00621, Kenya
| | - Nancy A Otieno
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu P.O. Box 1578-40100, Kenya
| | - Patrick K Munywoki
- US Centers for Disease Control and Prevention, Nairobi P.O. Box 606-00621, Kenya
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