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Arora KS, Morris J, Jacobs AJ. Refusal of Vaccination: A Test to Balance Societal and Individual Interests. THE JOURNAL OF CLINICAL ETHICS 2018. [DOI: 10.1086/jce2018293206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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RICCÒ M, CATTANI S, VERONESI L, COLUCCI ME. Knowledge, attitudes, beliefs and practices of construction workers towards tetanus vaccine in Northern Italy. INDUSTRIAL HEALTH 2016; 54:554-563. [PMID: 27251030 PMCID: PMC5136613 DOI: 10.2486/indhealth.2015-0249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 05/26/2023]
Abstract
Construction workers (CWs) are both more exposed to tetanus and at higher risk to be inadequately immunized. Our aim was to evaluate tetanus immunization status and knowledge/attitudes towards tetanus vaccination in CWs in Italy. In this field report, the immunization status of 554 unskilled CWs (i.e. labourers). Immunization status was assessed recalling immunization booklets/certificates. Attitudes and knowledge were collected through a standardized questionnaire. In 240/554 CWs, immunization status was inadequate/not documented: in 184 subjects (33.2%), the last vaccination shot was older than 10 years, whereas basal immunization was incomplete in 20 cases, more frequently in foreign-born people (FBP) than in Italian born (IBP) (OR=7.116). In 198 cases (35.7%), an Occupational Physician (OPh) performed last booster, usually with monovalent (T, n=173) vaccine. The main reason for inadequate immunization was having forgotten the periodic booster (148/554; 26.7%), whereas 42 subjects (7.6%) deliberately avoided tetanus vaccine because of personal/religious beliefs, more frequently in FBP than in IBP (OR=3.182). In summary, the prevalence of inadequate immunization status was relatively high (43.4%): the high prevalence of "forgotten boosters" enlightens the key role of OPh in recalling and promoting vaccination policies. Moreover, the inappropriate use of Td vaccine points out the opportunity for educational campaigns in OPh.
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Affiliation(s)
- Matteo RICCÒ
- Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento Unità Operativa di Prevenzione e Sicurezza degli Ambienti di Lavoro, Italy
| | - Silvia CATTANI
- Department of Clinical Surgery, General Surgery and Surgical Therapy, School of Nursing Sciences, Parma University Hospital, Italy
| | - Licia VERONESI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
| | - Maria Eugenia COLUCCI
- Department of Biomedical, Biotechnological, and Translational Sciences (SBiBiT), University of Parma, Italy
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Douvoyiannis M, Belamarich PF, Goldman DL. Tetanus After Vaccine Refusal and an Opportunity for the Pediatric Infectious Diseases Specialist. Clin Pediatr (Phila) 2015; 54:513-6. [PMID: 24803630 DOI: 10.1177/0009922814533411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wang E, Clymer J, Davis-Hayes C, Buttenheim A. Nonmedical exemptions from school immunization requirements: a systematic review. Am J Public Health 2014; 104:e62-84. [PMID: 25211732 DOI: 10.2105/ajph.2014.302190] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease. We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk. State laws influence exemption rates, but policy implementation, exemptors' vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions.
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Affiliation(s)
- Eileen Wang
- Eileen Wang is with the Department of the History and Sociology of Science, University of Pennsylvania, Philadelphia. Jessica Clymer is with the School of Nursing, University of Pennsylvania. Cecilia Davis-Hayes is with the Columbia University College of Physicians and Surgeons, New York, NY. Alison Buttenheim is with the School of Nursing, the Leonard Davis Institute, and the Center for Public Health Initiatives, University of Pennsylvania
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Chi DL. Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal. Am J Public Health 2014; 104:1327-33. [PMID: 24832428 PMCID: PMC4056200 DOI: 10.2105/ajph.2014.301927] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. METHODS Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). RESULTS The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). CONCLUSIONS Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.
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Affiliation(s)
- Donald L Chi
- Donald L. Chi is with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle
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Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine 2013; 31:4293-304. [PMID: 23859839 DOI: 10.1016/j.vaccine.2013.07.013] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
Unvaccinated individuals pose a public health threat to communities. Research has identified many factors associated with parental vaccine refusal and hesitancy toward childhood and adolescent immunizations. However, data on the effectiveness of interventions to address parental refusal are limited. We conducted a systematic review of four online databases to identify interventional studies. We used criteria recommended by the WHO's Strategic Advisory Group of Experts on immunization (SAGE) for the quality assessment of studies. Intervention categories and outcomes were evaluated for each body of evidence and confidence in overall estimates of effect was determined. There is limited evidence to guide implementation of effective strategies to deal with the emerging threat of parental vaccine refusal. There is a need for appropriately designed, executed and evaluated intervention studies to address this gap in knowledge.
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Affiliation(s)
- Alina Sadaf
- Medical College, Aga Khan University, Karachi, Pakistan
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What the world's religions teach, applied to vaccines and immune globulins. Vaccine 2013; 31:2011-23. [PMID: 23499565 DOI: 10.1016/j.vaccine.2013.02.026] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 12/21/2012] [Accepted: 02/07/2013] [Indexed: 02/08/2023]
Abstract
For millennia, humans have sought and found purpose, solace, values, understanding, and fellowship in religious practices. Buddhist nuns performed variolation against smallpox over 1000 years ago. Since Jenner developed vaccination against smallpox in 1796, some people have objected to and declined vaccination, citing various religious reasons. This paper reviews the scriptural, canonical basis for such interpretations, as well as passages that support immunization. Populous faith traditions are considered, including Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam. Subjects of concern such as blood components, pharmaceutical excipients of porcine or bovine origin, rubella strain RA 27/3, and cell-culture media with remote fetal origins are evaluated against the religious concerns identified. The review identified more than 60 reports or evaluations of vaccine-preventable infectious-disease outbreaks that occurred within religious communities or that spread from them to broader communities. In multiple cases, ostensibly religious reasons to decline immunization actually reflected concerns about vaccine safety or personal beliefs among a social network of people organized around a faith community, rather than theologically based objections per se. Themes favoring vaccine acceptance included transformation of vaccine excipients from their starting material, extensive dilution of components of concern, the medicinal purpose of immunization (in contrast to diet), and lack of alternatives. Other important features included imperatives to preserve health and duty to community (e.g., parent to child, among neighbors). Concern that 'the body is a temple not to be defiled' is contrasted with other teaching and quality-control requirements in manufacturing vaccines and immune globulins. Health professionals who counsel hesitant patients or parents can ask about the basis for concern and how the individual applies religious understanding to decision-making about medical products, explain facts about content and processes, and suggest further dialog with informed religious leaders. Key considerations for observant believers for each populous religion are described.
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Hamad M. Universal fungal vaccines: could there be light at the end of the tunnel? Hum Vaccin Immunother 2012; 8:1758-63. [PMID: 22922769 DOI: 10.4161/hv.21838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The complex nature of fungal pathogens, the intricate host-pathogen relationship and the health status of subjects in need of antifungal vaccination continue to hamper efforts to develop fungal vaccines for clinical use. That said, the rise of the universal vaccine concept is hoped to revive fungal vaccine research by expanding the pool of vaccine candidates worthy of clinical evaluation. It can do so through antigenic commonality-based screening for vaccine candidates from a wide range of pathogens and by reassessing the sizable collection of already available experimental and approved vaccines. Development of experimental vaccines protective against multiple fungal pathogens is evidence of the utility of this concept in fungal vaccine research. However, universal fungal vaccines are not without difficulties; for instance, development of vaccines with differential effectiveness is an issue that should be addressed. Additionally, rationalizing the development of universal fungal vaccines on health or economic basis could be contentious. Herein, universal fungal vaccines are discussed in terms of their potential usefulness and possible drawbacks.
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Affiliation(s)
- Mawieh Hamad
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Abstract
Switching from conventional strain-specific vaccines to multi-strain or multi-species universal vaccines is both justified and scientifically merited. Long-term cross-protective universal vaccines eliminate the need for repetitive short-term vaccination campaigns and short-notice vaccine redesign during impending epidemics. They also have the potential to be cost-effective, convenient, and amenable to stockpiling. Ongoing advances in genomics and reverse vaccinology along with the perceived ability of vaccines, if properly formulated, to induce cross-protective adaptive immunity and long-term T cell memory are at the heart of this trend. Consequently, the search for universal vaccines against influenza, HIV, and many other viral, bacterial, and fungal pathogens has intensified in recent years. Currently, several universal influenza vaccines are at different phases of clinical evaluation. That said, vaccine-related differential effectiveness, escape mutants, pathogen strain replacement, limited scope of cross-protective immunity, and diminished potential to reach optimal herd immunity thresholds present serious challenges to the concept and applicability of universal vaccines. Herein, the case for and the case against universal vaccines are investigated to realistically appreciate their prospects of success.
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Affiliation(s)
- Mawieh Hamad
- Research and Development Unit, JMS Medicals, Amman, Jordan
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Kennedy JS, Lawrence DA. Coincidental associations do not provide proof for the etiology of autism. J Immunotoxicol 2011; 8:198-203. [PMID: 21675928 DOI: 10.3109/1547691x.2011.584920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Hassan B, Popoola A, Olokoba A, Salawu FK. A survey of neonatal tetanus at a district general hospital in north-east Nigeria. Trop Doct 2011; 41:18-20. [PMID: 21172902 DOI: 10.1258/td.2010.100310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neonatal tetanus (NNT) remains among the leading causes of morbidity and mortality in Nigeria and a huge challenge in achieving the fourth goal of the Millennium Development Goals. We reviewed the morbidity and mortality pattern among neonates with NNT admitted to the District General Hospital in north-east Nigeria from 2006 to 2009. Half of the patients were from rural areas and were delivered at home by untrained traditional birth attendants with no prior antenatal health care. Razor blades and scissors were the instruments used to cut the cord in nonhygienic conditions. Spasticity, lack of sucking, trismus, fever, omphalitis, risus sardonicus and opisthotonus were the most common presenting signs and symptoms. Overall, mortality was 56%. Health education of mothers and traditional birth attendants, the promotion of hospital delivery and antenatal tetanus immunization of all pregnant women, particularly in rural areas, are recommended if NNT is to be prevented.
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Affiliation(s)
- Bala Hassan
- Department of Paediatrics, State Specialist Hospital, Maiduguri, Nigeria
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Postexposure interventions to prevent infection with HBV, HCV, or HIV, and tetanus in people wounded during bombings and other mass casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention and Disaster Medicine and Public Health Preparedness. Disaster Med Public Health Prep 2009; 2:150-65. [PMID: 18677271 DOI: 10.1097/dmp.0b013e318187ac66] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention's Terrorism Injuries: Information, Dissemination and Exchange project. There recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.
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Yé D, Kaboré S, Kouéta F, Tapsoba T, Dao L, Sawadogo A. [Pediatric tetanus continues to be a current issue: 14 cases encountered in the CHUP-CDG pediatric hospital of Ouagadougou, Burkina Faso]. Arch Pediatr 2008; 15:1821-2. [PMID: 18963874 DOI: 10.1016/j.arcped.2008.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 07/23/2008] [Accepted: 09/08/2008] [Indexed: 11/18/2022]
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Giovanetti F. Immunisation of the travelling child. Travel Med Infect Dis 2007; 5:349-64. [PMID: 17983974 DOI: 10.1016/j.tmaid.2007.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 09/13/2007] [Indexed: 11/30/2022]
Abstract
As a direct consequence of the current increase in international mobility, a significant increase in family travel is occurring. Protection against vaccine preventable diseases in the travelling child plays a key role both from an individual and a public health perspective: pre-travel immunisation protects travelling children and, at the same time, prevents the importation of pathogens that can spread throughout the community. Children immunisation presents unique challenges in travel medicine practice: some vaccines cannot be given below a definite age for several reasons and altering the standard schedule of routine vaccines is sometimes needed to ensure early protection. Furthermore, the risk for some travel-related diseases is higher among children. The aim of this review is to analyse the main epidemiological and clinical aspects relevant to immunisation of travelling children and to provide travel medicine practitioners with a practical approach to this issue.
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Affiliation(s)
- Franco Giovanetti
- Azienda Sanitaria Locale Alba Bra, Dipartimento di Prevenzione, via Vida 10, 12051 Alba, Italy.
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Olshen E, Mahon BE, Wang S, Woods ER. The impact of state policies on vaccine coverage by age 13 in an insured population. J Adolesc Health 2007; 40:405-11. [PMID: 17448397 DOI: 10.1016/j.jadohealth.2006.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/12/2006] [Accepted: 12/13/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the impact of state policies on vaccine coverage among adolescents with managed care insurance. METHODS We used the 2003 Health Plan Employer Data and Information Set to determine state-specific hepatitis B and varicella vaccine coverage among children with managed care insurance who turned 13 years in 2002. Our outcomes of interest were receipt of hepatitis B and varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple linear regression models were developed to evaluate the relationship between hepatitis B and varicella vaccine coverage and state policies, while controlling for state sociodemographic variables. RESULTS Across 28 states, adolescent hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate multiple regression models, after adjusting for potentially confounding sociodemographic variables, middle school mandates were significantly associated with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = .024). Other policies, including universal purchase of vaccines and availability of philosophic exemptions, were not associated with vaccine coverage in this insured population. CONCLUSIONS In this population of insured adolescents, middle school vaccine mandates were the only state policy associated with improved hepatitis B and varicella vaccine coverage. Mandates are an effective method for promoting adolescent immunization.
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Affiliation(s)
- Elyse Olshen
- Departments of Pediatrics and Population and Family Health, Columbia University, New York, New York 10032, USA.
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Abstract
UNLABELLED Tetanus has become an exceptional disease in industrialized countries since vaccination. CASE REPORT We report a case of generalized tetanus in a young teenager, with a healthy outcome, but requiring long intensive care support. CONCLUSION Tetanus mortality has decreased, but its morbidity is still severe. The only way to prevent it is vaccination. Almost all pediatric cases concern patients living in families refusing vaccination, because of philosophic or religious beliefs.
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Affiliation(s)
- F-V Valla
- Service de réanimation pédiatrique, hôpital Debrousse, CHU de Lyon, 29 rue Soeur-Bouvier, 69005 Lyon, France.
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Kennedy AM, Brown CJ, Gust DA. Vaccine beliefs of parents who oppose compulsory vaccination. Public Health Rep 2005; 120:252-8. [PMID: 16134564 PMCID: PMC1497722 DOI: 10.1177/003335490512000306] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Our objectives were the following: (1) to describe the sociodemographic factors, vaccine beliefs, and behaviors that are associated with parental opposition to compulsory vaccination, and (2) to determine if the availability of a philosophical exemption in a parent's state of residence is associated with parental opposition to compulsory vaccination. METHODS Data from the 2002 HealthStyles survey were analyzed. Chi-square analysis was used to identify significant associations between belief and behavior questions and opposition to compulsory vaccination for school entry. Multivariate logistic regression was conducted using significant variables from the bivariate analysis to identify independent predictors of opposition to compulsory vaccination among surveyed parents. RESULTS Of respondents with at least one child aged < or = 18 years living in the household (n=1,527), 12% were opposed to compulsory vaccination. Survey results indicate that a parent's belief regarding compulsory vaccination for school entry is significantly associated with beliefs in the safety and utility of vaccines, as well as intention to have the youngest child fully vaccinated. Residence in a state that permits philosophical exemption to vaccination also was significantly associated with a parent's opposition to compulsory vaccination for school entry. CONCLUSIONS Providing basic information to parents regarding vaccines and vaccine-preventable diseases may help reduce opposition to compulsory vaccination by reinforcing the safety and importance of routine childhood vaccinations.
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Abstract
CONTEXT Each year 2.1 million children 19 to 35 months of age are undervaccinated. Among these are children who have received no vaccinations. Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases. OBJECTIVES To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, to monitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children. DESIGN A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001. Vaccination histories were ascertained from children's medical providers. Undervaccinated children had received > or =1 dose of diphtheria-tetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine but were not fully vaccinated. Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations. PARTICIPANTS A total of 151,720 children sampled between 1995 and 2001, 795 of whom were unvaccinated. RESULTS Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding 75,000 dollars, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children. Unvaccinated children were more likely to be male than female. Annually, approximately 17,000 children were unvaccinated. The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan. States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children. CONCLUSIONS Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children. Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.
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Affiliation(s)
- Philip J Smith
- Centers for Disease Control and Prevention, National Immunization Program, Atlanta, Georgia 30333, USA.
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Mari A. Is there a causative role for tetanus toxoid vaccination in the development of allergy-like symptoms and in the increasing prevalence of atopic diseases? Med Hypotheses 2004; 63:875-86. [PMID: 15488663 DOI: 10.1016/j.mehy.2004.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 04/20/2004] [Indexed: 12/21/2022]
Abstract
Allergic diseases are a worldwide health problem. They mainly affect people living in developed countries where an increasing prevalence of allergy symptoms has been recorded in the last 20-30 years. The cause of this increase is still disputed, and, among others, the "hygiene hypothesis" supported the concept that relevant changes in lifestyle could have a relationship with the phenomenon. More recently the recorded parallel increase in autoimmune diseases has suggested to consider the "hygiene hypothesis" as a cause of a more general disregulation of the immune system leading to both allergy and to autoimmunity. Here are reported a series of observations, evidence, and data from the literature leading to a different hypothesis. The key points are: (1) the presence of two subsets of patients having allergy symptoms based on an IgE-mediated mechanism or not; (2) the positive results obtained with the autologous serum skin test in either cutaneous or respiratory affected subjects, mainly in children and adult females; (3) the presence of IgG autoantibodies against the alpha-chain of the high affinity IgE receptor (FcepsilonRIalpha) in non-IgE-mediated urticaria and even in respiratory subjects; (4) the cross-reactivity between epitopes of the tetanus toxoid molecule and the FcepsilonRIalpha detected by means of an alpha-chain affinity purified IgG fraction; (5) the positive skin reactivity obtained using IgG anti-tetanus toxoid preparations in allergic and non-allergic volunteers. The presence of IgG autoantibodies actively generated by the population-based vaccination with tetanus toxoid could induce both mediator release from activated mast cell and Th2 cytokine production early in life. There are epidemiological evidences that tetanus toxoid vaccination could be linked with an increased tendency to have allergy symptoms. The different epidemiological distribution of non-IgE-mediated symptoms, mainly affecting young infants would be in agreement with the present hypothesis. The prevalent mother-to-child relationship in terms of risk for allergy symptoms could be explained with the trans-placenta transfer of IgG. A similar transfer could also take place through the mother milk during breast feeding. It may thus be hypothesized that the increased prevalence of allergic diseases could be caused by the generalized tetanus toxoid immunization procedure, progressively extended to most of the countries worldwide in the last 30-40 years. Both the induction of non-IgE-mediated symptoms caused by the mast cell activation via the anti-FcepsilonRIalpha IgG and the long lasting Th2 inflammation of affected tissues would be the inducing mechanisms. This hypothesis would re-configure part of the allergic diseases as a Th2 phenotypic expression of an autoimmune disease.
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Affiliation(s)
- Adriano Mari
- Allergy Unit, National Health Service, Rome, Italy.
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McIntyre P, Williams A, Leask J. Refusal of parents to vaccinate: dereliction of duty or legitimate personal choice? Med J Aust 2003; 178:150-1. [PMID: 12580738 DOI: 10.5694/j.1326-5377.2003.tb05128.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2002] [Accepted: 02/14/2002] [Indexed: 11/17/2022]
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