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Danilescu CM, Radulescu VM, Delureanu AR, Pirlog MC. Understanding Attitudes Toward Influenza Vaccination: Insights from a Romanian Family Medicine Patient Population. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:517-523. [PMID: 38559830 PMCID: PMC10976203 DOI: 10.12865/chsj.49.04.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial mortality rates. Vaccine hesitancy, characterized by delays or refusals despite vaccine availability, presents a growing challenge in achieving adequate vaccination rates globally. AIM This study aimed to assess the attitudes of Romanian general practitioners' patients toward influenza vaccination during the recommended immunization period. MATERIALS AND METHODS A prospective multi-centered study involving 319 patients across five Family Medicine Offices in Romania was conducted. Participants completed a 12-item Vaccination Attitudes Examination (VAX) scale, assessing factors influencing vaccine acceptance. Statistical analyses were performed to evaluate the impact of demographic variables and attitudes toward vaccination. RESULTS The study revealed significant variations in attitudes influencing influenza vaccine acceptance. Trust in vaccine benefits and confidence in natural immunity emerged as primary motivators for vaccine acceptance/denial, whereas concerns about commercial profiteering held lesser importance. Gender and residential environment impacted specific attitudes toward vaccination, while factors such as education and employment status did not significantly influence vaccine acceptance. DISCUSSION The study underscores the critical role of trust in vaccine benefits as a primary driver for vaccine acceptance, diverging from prevalent conspiracy theories. While gender and residential environment influenced attitudes toward vaccination, education and employment status did not exhibit significant correlations with vaccine acceptance. CONCLUSIONS Understanding public attitudes toward vaccination is crucial in designing effective public health strategies. This study emphasizes the importance of trust in vaccine benefits in driving vaccine acceptance, offering insights to enhance vaccination initiatives regionally.
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Affiliation(s)
- Claudia Monica Danilescu
- Comunity Nursing Department, Faculty of Midwives and Nursing, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Virginia Maria Radulescu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- Department of Automation and Electronics, University of Craiova, Craiova, Romania
| | | | - Mihail Cristian Pirlog
- Department of Medical Sociology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Stein-Zamir C, Shoob H, Abramson N, Brown EH, Zimmermann Y. Pertussis outbreak mainly in unvaccinated young children in ultra-orthodox Jewish groups, Jerusalem, Israel 2023. Epidemiol Infect 2023; 151:e166. [PMID: 37737060 PMCID: PMC10600895 DOI: 10.1017/s0950268823001577] [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: 07/23/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023] Open
Abstract
Despite being a vaccine-preventable disease for decades, pertussis control is still a public health challenge. A pertussis outbreak emerged in Jerusalem (n = 257 cases, January to June 2023). Most cases were young children (median age 1.5 years), and 100 were infants under 1 year. The hospitalisation rate of infants was 24%, which was considerably higher than that of cases aged 1 year and above (3.8%). There was one fatality in an unvaccinated, 10-week-old infant whose mother had not received pertussis vaccination during pregnancy. Most children were unvaccinated and resided in Jewish ultra-orthodox neighbourhoods in Jerusalem district. An intervention programme and vaccination campaign are ongoing.
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Affiliation(s)
- Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
- The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Emilie Hannah Brown
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
- The Hebrew University and Hadassah Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
- School of Public Health, University of Miami, Miami, FL, USA
| | - Yael Zimmermann
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
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Suffel AM, Walker JL, Williamson E, McDonald HI, Warren-Gash C. Timeliness of childhood vaccination in England: A population-based cohort study. Vaccine 2023; 41:5775-5781. [PMID: 37574342 DOI: 10.1016/j.vaccine.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/15/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Vaccine surveillance for children in England focuses on coverage at ages 1, 2, and 5 years. Previous studies exploring vaccine timeliness have used different arbitrary categories to define whether vaccines were received 'late' or 'on time'. This paper aims to provide more detailed and holistic information on timing and patterns of vaccine uptake across the childhood immunisation schedule in England. METHODS We included all children born in England between 2006 and 2014 and registered in the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record. We described vaccine uptake for representative antigens (pertussis, pneumococcus, measles) by age in days and stratified by ethnicity, region and birth cohort. Alluvial diagrams were used to illustrate common journeys through the vaccination schedule, and we applied survival analysis using accelerated failure time models (AFT) to predict age of vaccine receipt based on timing of previous doses. RESULTS 573,015 children were followed up until their fifth birthday, when they had 90.16 % coverage for two doses of measles, mumps, rubella (MMR) vaccine and 88.78% coverage for four doses of diphtheria, tetanus, pertussis (DTP) vaccine. Overall, the later the age at which a vaccine was due, the more delay in vaccination. Children of Black Ethnicity or from London showed deviating uptake patterns. If a child received their third DTP dose more than a year later than recommended, they would receive the next dose 2.7 times later than a child who was vaccinated on time. A smaller delay was found for children who did not receive first MMR dose on time. DISCUSSION We showed that the risk of vaccination delay increased with the age of the child and significant delay of previous doses. Primary care data can help to promptly identify children at higher risk of delayed vaccination.
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Affiliation(s)
- Anne M Suffel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom; Health Protection Research Unit in Vaccines and Immunisation at the London School of Hygiene and Tropical Medicine, United Kingdom.
| | - Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom; Health Protection Research Unit in Vaccines and Immunisation at the London School of Hygiene and Tropical Medicine, United Kingdom; UK Health Security Agency, United Kingdom
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Helen I McDonald
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom; Health Protection Research Unit in Vaccines and Immunisation at the London School of Hygiene and Tropical Medicine, United Kingdom; Department of Life Sciences, University of Bath, United Kingdom
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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Wang Y, Shi N, Wang Q, Yang L, Cui T, Jin H. The association between vaccine hesitancy and pertussis: a systematic review and meta-analysis. Ital J Pediatr 2023; 49:81. [PMID: 37443026 DOI: 10.1186/s13052-023-01495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Robust routine immunization schedules for pertussis-containing vaccines have been applied for years, but pertussis outbreaks remain a worldwide problem. This study aimed to investigate the association between vaccine hesitancy and pertussis in infants and children. METHODS We searched PubMed, Cochrane, Web of Science, Embase, and China National Knowledge Internet for studies published between January 2012 and June 2022. This study included case-control and cohort studies that assessed the association between childhood/maternal vaccine hesitancy and odds ratios (ORs), risk ratios (RRs), and vaccine effectiveness (VE) related to pertussis in infants and children [Formula: see text] 9 years old. ORs/VEs with a 95% confidence interval (CI) were calculated. Random-effects meta-analysis models were used for appropriate pooled estimates, and heterogeneity was assessed using [Formula: see text]. Cumulative meta-analysis and subgroup analyses stratified by study characteristics were performed. RESULTS Twenty-two studies were included, with a mean quality score of 7.0 (range 6.0-9.0). Infants and children with pertussis were associated with higher vaccine hesitancy to all doses (OR = 4.12 [95% CI: 3.09-5.50]). The highest OR was between children who were unvaccinated over four doses and children who were fully vaccinated (OR = 14.26 [95%CI: 7.62-26.70]); childhood vaccine delay was not statistically significantly associated with pertussis risk (OR = 1.18 [95% CI: 0.74-1.89]). Maternal vaccine hesitancy was associated with significantly higher pertussis risk in infants aged 2 and 3 months old, with higher pertussis ORs in infants [Formula: see text] 2 months old (OR = 6.02 [95%CI: 4.31-8.50], OR = 5.14 [95%CI: 1.95-13.52] for infants [Formula: see text] 2 and [Formula: see text] 3 months old, respectively). Maternal and childhood VEs were high in reducing pertussis infection in infants and children. The administration time of maternal vaccination had little effect on VE. CONCLUSION Vaccine hesitancy increased pertussis risks in infants and children. Ensuring that children receive up-to-date pertussis vaccines is essential; short delays in receiving childhood vaccinations may be unimportant. Maternal vaccinations for pertussis should be encouraged.
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Affiliation(s)
- Yuning Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China.
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
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Kasstan B, Mounier-Jack S, Chantler T, Masters N, Flores SA, Stokley S, Meek H, Easton D, De Luna-Evans T, Souto M, Punjabi C, Ruppert PS, Rosenberg E, Routh J. Poliovirus outbreak in New York State, August 2022: qualitative assessment of immediate public health responses and priorities for improving vaccine coverage. Epidemiol Infect 2023; 151:e120. [PMID: 37435800 PMCID: PMC10468811 DOI: 10.1017/s0950268823001127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
In 2022, a case of paralysis was reported in an unvaccinated adult in Rockland County (RC), New York. Genetically linked detections of vaccine-derived poliovirus type 2 (VDPV2) were reported in multiple New York counties, England, Israel, and Canada. The aims of this qualitative study were to: i) review immediate public health responses in New York to assess the challenges in addressing gaps in vaccination coverage; ii) inform a longer-term strategy to improving vaccination coverage in under-vaccinated communities, and iii) collect data to support comparative evaluations of transnational poliovirus outbreaks. Twenty-three semi-structured interviews were conducted with public health professionals, healthcare professionals, and community partners. Results indicate that i) addressing suboptimal vaccination coverage in RC remains a significant challenge after recent disease outbreaks; ii) the poliovirus outbreak was not unexpected and effort should be invested to engage mothers, the key decision-makers on childhood vaccination; iii) healthcare providers (especially paediatricians) received technical support during the outbreak, and may require resources and guidance to effectively contribute to longer-term vaccine engagement strategies; vi) data systems strengthening is required to help track under-vaccinated children. Public health departments should prioritize long-term investments in appropriate communication strategies, countering misinformation, and promoting the importance of the routine immunization schedule.
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Affiliation(s)
- Ben Kasstan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nina Masters
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
| | - Stephen A Flores
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Haillie Meek
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
- New York State Department of Health, Albany, NY, USA
| | - Delia Easton
- New York State Department of Health, Albany, NY, USA
| | | | - Maria Souto
- Rockland County Department of Health, Pomona, NY, USA
| | | | | | - Eli Rosenberg
- New York State Department of Health, Albany, NY, USA
| | - Janell Routh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Omale UI, Ewah RL, Amuzie CI, Ikegwuonu CO, Nkwo GE, Iwegbulam CC, Ekwuazi LC. Study protocol for a cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal routine childhood immunisation coverage in the communities of Ebonyi state, Nigeria: the AGINTOPIC trial protocol. BMJ Open 2023; 13:e068953. [PMID: 37438066 DOI: 10.1136/bmjopen-2022-068953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Vaccine-preventable infectious diseases (VPDs) are major causes of morbidity/mortality among children under 5 years of age worldwide and in Nigeria/Ebonyi state. Routine childhood immunisation is an invaluable prevention strategy for many VPDs. Due to suboptimal coverage and untimely receipt/delay in receipt of vaccinations, outbreaks of VPDs such as measles, yellow fever, diphtheria and others continue to reoccur around the world and in Nigeria/Ebonyi state. This study aims to evaluate the effectiveness of hybrid parents and health workers adaptive intervention in increasing the optimal/timely (cumulative age-appropriate) routine childhood immunisation coverage in the communities in Ebonyi state, Nigeria. METHODS AND ANALYSES A two-arm, parallel, open label, covariate-constrained cluster-randomised controlled trial with 1:1 allocation of 16 geographical clusters (the nearest catchment areas for at least one public primary healthcare (PHC) facility with at least 500 households or a population size of 3000) will be used to evaluate the effects of hybrid/combined parents and PHC workers adaptive engagement compared with control. The primary outcomes are the optimal/timely (cumulative age-appropriate) receipt of the recommended vaccines in the routine childhood immunisation schedule by children aged 5-9 completed months and 10-11 completed months and the age-appropriate vaccines receipt score for the recommended vaccines. The outcomes will be measured through a population-based household survey of at least 15 children aged 5-9 and 10-11 months per cluster at baseline and at the end of the study using a structured interviewer-administered questionnaire in KoBoCollect installed in android devices. All analyses will be done using a cluster-level method on as-randomised basis. ETHICS AND DISSEMINATION Ethical approval for the trial was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/01/06/2022-31/05/2023) and verbal consent will be obtained from participants. Study findings will be reported at local/national and international levels as appropriate. TRIAL REGISTRATION NUMBER ISRCTN59811905.
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Affiliation(s)
- Ugwu I Omale
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Richard L Ewah
- Anaesthesia, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
- Surgery, Anaesthesia Unit, Ebonyi State University, Abakaliki, Nigeria
| | - Chidinma I Amuzie
- Community Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
| | - Cordis O Ikegwuonu
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Glory E Nkwo
- Community Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
| | | | - Louisa C Ekwuazi
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
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Pulgaron ER, D’Agostino EM, Johnson SB, Ko LK, Drain PK, Duran MC, Keener Mast D, Kay S, Layer MA, Kenworthy T, Dozier A. Reflections From School Communities in Underserved Populations on Childhood COVID-19 Vaccination. Pediatrics 2023; 152:e2022060352M. [PMID: 37394501 PMCID: PMC10312275 DOI: 10.1542/peds.2022-060352m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Outbreaks in vaccine-preventable diseases among children have increased, primarily among under- or unvaccinated subgroups. The influence and interaction of a child's school community on parental health care decisions, such as vaccination, has not been explored. Our study examined childhood coronavirus disease 2019 (COVID-19) vaccine hesitancy within the context of school communities. METHODS This study combines data from 4 independent research studies funded by the National Institutes of Health Rapid Acceleration of Diagnostics Underserved Populations Return to School Initiative. We examined focus group data to better understand the apprehension surrounding parental and child COVID-19 vaccination among underserved school populations. RESULTS Across all study sites, 7 main themes emerged with regard to COVID-19-related vaccination concerns for children: (1) potential side effects, (2) vaccine development, (3) misinformation (subthemes: content of vaccine and negative intent of the vaccine), (4) vaccine effectiveness, (5) timing of vaccine administration/availability for children, (6) fear of needles, and (7) mistrust. CONCLUSIONS School settings offered unique access to youth and family perspectives in underserved communities. Our studies highlighted several factors contributing to COVID-19 vaccine hesitancy in school communities, which align with existing literature on vaccine hesitancy. These concerns centered primarily on potential harm of vaccines, as well as misinformation, mistrust, and timing of vaccines. Related recommendations for increasing vaccination rates are provided. Developing specific strategies that address parent and child concerns will be critical to reducing health inequities related to COVID-19 vaccination.
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Affiliation(s)
- Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Emily M. D’Agostino
- Departments of Orthopedic Surgery
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Linda K. Ko
- Department of Health Systems and Population Health
| | - Paul K. Drain
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | | | | | | | | | - Tara Kenworthy
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann Dozier
- Public Health Sciences, University of Rochester, Rochester, New York
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Cohen C, Rinot Levavi L. A Game-Theory-Based Approach to Promoting Health Policy among Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4335. [PMID: 36901344 PMCID: PMC10001858 DOI: 10.3390/ijerph20054335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The importance of designing policy measures that government and other public bodies apply to different populations has been escalating in recent decades. This study seeks the best way to induce conservative minority groups to cooperate with healthcare policy. The case study focuses on the Bedouin population of Israel and its willingness to accept COVID-19 vaccination. The study is based on vaccination data from the Israel Ministry of Health for the country's entire Bedouin population, twenty-four semi-structured in-depth interviews with relevant key stakeholders, and the use of game-theory tools to profile the players, the utility functions, and various equilibrium combinations. By comparing the groups and integrating game-theory tools into the process, we reveal variables that may affect healthcare processes among conservative minority communities. Finally, cross-tabulating the results with the interview findings strengthens the insights and allows a culturally adjusted policy to be adopted. The different starting points of different minority populations have implications for the design of requisite policies in both the short and the long terms. The analysis of the game allowed us to indicate the strategy that policymakers should adopt in consideration of variables that should be taken into account in order to improve cooperation and the ability to apply policy. To increase vaccination rates among conservative minority communities in general and the Bedouin population in particular, trust in the government must be increased in the long term. In the short term, trust in the medical profession must be increased, and also health literacy.
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Savitsky B, Shvartsur R, Kagan I. Israeli parents` views on coronavirus (COVID-19) vaccinations for children: A cross-sectional study. J Pediatr Nurs 2023; 68:79-86. [PMID: 36270927 PMCID: PMC9579057 DOI: 10.1016/j.pedn.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/07/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parents play the decisive role in children's vaccination. Our study aimed as assessing attitudes of parents toward the COVID-19 vaccine for children aged 5-18 and to define sources of influence on these attitudes, the barriers and reasons for hesitation. METHODS In this cross-sectional study, 138 Israeli parents of 5-18 aged children completed a self-administered structured questionnaire. FINDINGS More than a quarter of parents reported that they did not intend to vaccinate their children. Independent of other demographic characteristics, parents who do not vaccinate their children accordingly to the routine vaccinations have five-fold significant odds not to vaccinate with COVID-19 vaccine (OR = 4.8, 95% CI: 1.8-12.7). Greater social influence was significantly and negatively associated with intentions not to vaccinate a child. Among parents who do not intend to vaccinate their children, the most frequent reasons were fear of possible side effects (92%), vaccine novelty (92%) and lack of belief in its effectiveness (69%). DISCUSSION This study found that vaccination in the past as part of routine government immunization programs predict a tendency to vaccinate children during the pandemic. Among the factors associated with the intention not to vaccinate, concerns and uncertainty about the necessity of the vaccine, its side effects and reliability have been emphasized. APPLICATION TO PRACTICE Cultural-religious adjustments should be applied when implementing interventions aiming to promote vaccination in routines and emergencies. Social influence is important in adopting a positive attitude toward vaccines. Public health professionals should incorporate those parents who have vaccinated their children and have a positive attitude toward vaccination.
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Affiliation(s)
- Bella Savitsky
- Department of Nursing, School of Health Sciences, Ashkelon Academic College, Ashkelon, Yitshak Ben Zvi 12, Israel.
| | - Rachel Shvartsur
- Department of Nursing, School of Health Sciences, Ashkelon Academic College, Ashkelon, Yitshak Ben Zvi 12, Israel
| | - Ilya Kagan
- Department of Nursing, School of Health Sciences, Ashkelon Academic College, Ashkelon, Yitshak Ben Zvi 12, Israel
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Morozov NG, Dror AA, Daoud A, Eisenbach N, Kaykov E, Barhoum M, Sheleg T, Sela E, Edelstein M. Reasons underlying the intention to vaccinate children aged 5-11 against COVID-19: A cross-sectional study of parents in Israel, November 2021. Hum Vaccin Immunother 2022; 18:2112879. [PMID: 36037533 DOI: 10.1080/21645515.2022.2112879] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination is a key tool to mitigate impacts of the COVID-19 pandemic. In Israel, COVID-19 vaccines became available to adults in December 2020 and to 5-11-year-old children in November 2021. Ahead of the vaccine roll-out in children, we aimed to determine whether surveyed parents intended to vaccinate their children and describe reasons for their intentions. We collected information on parental socio-demographic characteristics, COVID-19 vaccine history, intention to vaccinate their children against COVID-19, and reasons for parental decisions using an anonymous online survey. We identified associations between parental characteristics and plans to vaccinate children using a logistic regression model and described reasons for intentions to vaccinate or not. Parental non-vaccination and having experienced major vaccination side effects were strongly associated with non-intention to vaccinate their children (OR 0.09 and 0.18 respectively, p < .001). Parents who were younger, lived in the socio-economically deprived periphery, and belonged to the Arab population had lower intentions to vaccinate their children. Reasons for non-intention to vaccinate included concerns about vaccine safety and efficacy (53%, 95%CI 50-56) and the belief that COVID-19 is a mild disease (73%, 95%CI 73-79), while a frequent motive for vaccination was the return to normal social and educational life (89%, 95%CI 87-91). Understanding rationales for COVID-19 vaccine rejection or acceptance, as well as parental demographic data, can pave the way for intentional educational campaigns to encourage not only vaccination against COVID-19, but also regular childhood vaccine programming.
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Affiliation(s)
| | - Amiel A Dror
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amani Daoud
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Edward Kaykov
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Masad Barhoum
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tsvi Sheleg
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Hijazi R, Gesser-Edelsburg A, Feder-Bubis P, Mesch GS. Hesitant and anti-vaccination groups: A qualitative study on their perceptions and attitudes regarding vaccinations and their reluctance to participate in academic research- an example during a measles outbreak among a group of Jewish parents in Israel. Front Public Health 2022; 10:1012822. [PMID: 36438238 PMCID: PMC9682119 DOI: 10.3389/fpubh.2022.1012822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Vaccination is widespread in Western countries and, overall, there is a high vaccination rate. However, immunization is still an enduring challenge. In recent years, the number of parents who choose to delay or refuse vaccines has risen. Objectives (1) to identify the perceptions and attitudes of hesitant and anti-vaccination parents regarding vaccination in general, and vaccinating their children in particular and; (2) to describe the responses of potential participants to the request to participate in academic research regarding their perceptions and attitudes on the subject of vaccines. Methods The research employs the qualitative hermeneutic phenomenological method using two research tools: (1) in-depth interviews with 7 hesitant and 11 anti-vaccination Jewish parents in Israel; and (2) the researchers' field notes from this study process, which describe the responses of 32 potential participants to the request to participate in this academic research. Results The main findings indicate that while most of the interviewees admit to the efficacy of vaccines in preventing diseases, they oppose the way in which vaccines are promoted-based on providing partial information and disregarding parents' concerns and questions. Therefore, they demand transparency about the efficacy and safety of vaccines. The findings also point to a paradoxical finding. On the one hand, these groups claim that health organizations do not understand their position, referring to them as "science-deniers", even though they are not. On the other hand, these parents choose to refrain from participating in scientific studies and voicing their opinions, thereby perpetuating the situation of being misunderstood. Conclusion Hesitant and anti-vaccination groups express mistrust in academic institutions and health organizations. Therefore, an effective dialogue that would include hesitant and anti-vaccination groups, the academy, and health organizations may contribute to a better understanding of the barriers that prevent these groups from getting vaccinated or vaccinating their children and promote public health.
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Affiliation(s)
- Rana Hijazi
- School of Public Health, University of Haifa, Haifa, Israel,*Correspondence: Rana Hijazi
| | - Anat Gesser-Edelsburg
- Head of the Health Promotion Program and Head of the Health and Risk Communication Lab, School of Public Health, University of Haifa, Haifa, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beersheba, Israel
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12
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Lin A, Pham D, Rosenthal H, Milanaik R. Birth Order and Up-to-Date Vaccination Status. Pediatrics 2022; 150:e2022056883. [PMID: 36069139 DOI: 10.1542/peds.2022-056883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Allison Lin
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
| | - Duy Pham
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
| | - Hannah Rosenthal
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
| | - Ruth Milanaik
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York
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13
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Khaliq A, Elahi AA, Zahid A, Lassi ZS. A Survey Exploring Reasons behind Immunization Refusal among the Parents and Caregivers of Children under Two Years Living in Urban Slums of Karachi, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11631. [PMID: 36141905 PMCID: PMC9516974 DOI: 10.3390/ijerph191811631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
This study assesses the experiences of parents/caregivers regarding the refusal to childhood immunization. A cross-sectional study was conducted among the parents/caregivers of children under two years old from January 2019 to June 2019 who were residents of either Pathan Colony or Orangi Town, Karachi. In this study, the data collectors targeted parents/caregivers of 440 households who showed a refusal mark "R" in the Expanded Program of Immunization (EPI) H-chalking system. These households were approached using a 30 × 7 multistage-stratified-cluster random sampling technique and were interviewed using a structured questionnaire. The study sample produced two different types of refusals: true refusal (absence) and potential refusal (presence), based on the absence and presence of a vaccination card at the time of the survey. Multivariate logistic regression was used to analyze the data using Jamovi (V-1.6.13). A total of 230 households consented to participate in this study, of which 141 (61.3%) represented true refusals, while 89 (38.7%) represented potential refusals. More than half of the participants from both groups complained about fever and pain at the injection site following immunization. The use of alternative medicines and a history of adverse events following immunization (AEFI) were associated with increasing the odds of immunization refusals by four-to-five fold. However, advanced paternal age, a long distance to the clinic, a lack of trust in government, and the influence of community/religious leaders were associated with lower immunization refusal odds. Thus, an unawareness about self-limiting vaccine-related adverse events, the use of alternative medicines, and an increased concern about the safety and efficacy of vaccines were found to be barriers to immunization, which can be improved by increasing public awareness through media campaigns and policy reform.
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Affiliation(s)
- Asif Khaliq
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Alfaraz Ashraf Elahi
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Asima Zahid
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Zohra S. Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
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14
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Shati AA, Al-Qahtani SM, Alsabaani AA, Mahmood SE, Alqahtani YA, AlQahtani KM, Aldarami MS, AlAmri FD, Alqahtani AS, AlHadi AM, Ahmad A, Riaz FA. Perceptions of Parents towards COVID-19 Vaccination in Children, Aseer Region, Southwestern Saudi Arabia. Vaccines (Basel) 2022; 10:vaccines10081222. [PMID: 36016110 PMCID: PMC9414894 DOI: 10.3390/vaccines10081222] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
Vaccines are an important part of the COVID-19 pandemic response plan. This cross-sectional study aims to assess the attitude and perception levels of parents toward COVID-19 vaccines for children aged 0–18 years in the Aseer region of Saudi Arabia. Data were analyzed using SPSS version 16.0. Out of a total of 1463 parents, 30.6% assumed that COVID-19 vaccination may be more dangerous for children than adults. Nearly 36.5% parents don’t have any concern about children’s vaccination. About 12.8% of children have not received the vaccination, 55% of parents have some sort of hesitation and 32.2% of parents did not hesitate before vaccinating their children against COVID-19. Only 15.4% of parents expect that the COVID-19 vaccine affects their child’s genes. About 23.4% parents strongly agreed and 35.1% agreed about the importance of getting their children vaccinated. About 22.1% of parents strongly agreed and 33.3% agreed regarding their willingness to get their children vaccinated to prevent Coronavirus disease. More than 80% of parents recommended rushing to receive the COVID-19 vaccine. Health professionals and policymakers should implement and support strategies to ensure children are vaccinated for COVID-19. They also need to educate parents and families regarding childhood vaccination.
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Affiliation(s)
- Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia or (A.A.S.); (S.M.A.-Q.); (Y.A.A.)
| | - Saleh M. Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia or (A.A.S.); (S.M.A.-Q.); (Y.A.A.)
| | - Abdullah A. Alsabaani
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (A.A.A.); (F.A.R.)
| | - Syed E. Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (A.A.A.); (F.A.R.)
- Correspondence: ; Tel.: +966-5504-84344
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia or (A.A.S.); (S.M.A.-Q.); (Y.A.A.)
| | - Khalid M. AlQahtani
- Medical Intern, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (K.M.A.); (M.S.A.)
| | - Mohammed S. Aldarami
- Medical Intern, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (K.M.A.); (M.S.A.)
| | - Fahad D. AlAmri
- Medical Student, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (F.D.A.); (A.S.A.); (A.M.A.)
| | - Abdulrahman Saad Alqahtani
- Medical Student, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (F.D.A.); (A.S.A.); (A.M.A.)
| | - Abdulrahman M. AlHadi
- Medical Student, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (F.D.A.); (A.S.A.); (A.M.A.)
| | - Ausaf Ahmad
- Department of Community Medicine, Integral University, Kursi Road, Lucknow 226026, India;
| | - Fatima A. Riaz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (A.A.A.); (F.A.R.)
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15
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Ekezie W, Awwad S, Krauchenberg A, Karara N, Dembiński Ł, Grossman Z, del Torso S, Dornbusch HJ, Neves A, Copley S, Mazur A, Hadjipanayis A, Grechukha Y, Nohynek H, Damnjanović K, Lazić M, Papaevangelou V, Lapii F, Stein-Zamir C, Rath B. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel) 2022; 10:1038. [PMID: 35891201 PMCID: PMC9324407 DOI: 10.3390/vaccines10071038] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.
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Affiliation(s)
- Winifred Ekezie
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
| | - Samy Awwad
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Stanford University, Palo Alto, CA 94305, USA
| | - Arja Krauchenberg
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- European Parents Association, 1000 Brussels, Belgium
| | - Nora Karara
- Young European Academy of Paediatrics, 1000 Brussels, Belgium;
- Evangelical Hospital Queen Elisabeth Herzberge, 10365 Berlin, Germany
| | - Łukasz Dembiński
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zachi Grossman
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Stefano del Torso
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hans Juergen Dornbusch
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Ana Neves
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Sian Copley
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Artur Mazur
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Yevgenii Grechukha
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Kaja Damnjanović
- Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Milica Lazić
- Faculty of Philosophy, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vana Papaevangelou
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Fedir Lapii
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
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16
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Hijazi R, Gesser-Edelsburg A, Feder-Bubis P, Mesch GS. Pro-vaccination Groups Expressing Hesitant Attitudes: A Cross-Sectional Study About the Difference Between Attitudes and Actual Behavior in Israel. Front Public Health 2022; 10:871015. [PMID: 35570981 PMCID: PMC9092369 DOI: 10.3389/fpubh.2022.871015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Vaccines have contributed to the decline in mortality, morbidity, and even the eradication of various infectious diseases. Over time, the availability of information to the public and the request for public involvement in the health decision-making process have risen, and the confidence in vaccines has dropped. An increasing number of parents and individuals are choosing to delay or refuse vaccines. Objectives (1) Identifying hesitant attitudes among pro-vaccination parents; (2) testing the difference between the rate of hesitant attitudes and the rate of hesitancy in practice among pro-vaccination parents; and (3) examining the association of sociodemographic characteristics (gender, age, marital status education and religious affiliation) with the difference between hesitant attitudes and hesitancy in practice among pro-vaccination parents. Methods Descriptive cross-sectional survey using an online survey that measured vaccine hesitancy among pro-vaccination parents (n = 558) whose children were in kindergarten (3–5 years), according to a variety of sociodemographic characteristics. Results A significant difference was found between the rate of hesitant attitudes and the rate of hesitation in actual vaccination among pro-vaccination and hesitant parents, where despite that 26% of the parents had hesitant attitudes, only 19% hesitated in practice [P = 0.0003]. There was also a significant difference between the rate of hesitant attitudes and the rate of hesitancy in practice among women [P = 0.0056] and men [P = 0.0158], parents between 30 and 39 years of age [P = 0.0008], traditional parents [P = 0.0093], Non-academic parents [P = 0.0007] and parents with BA degree [P = 0.0474]. Conclusion Pro-vaccination individuals may have hesitant attitudes regarding vaccines. Therefore, it is very important for health authorities to address the public's fears and concerns, including those who are classified as pro-vaccination.
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Affiliation(s)
- Rana Hijazi
- School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Anat Gesser-Edelsburg
- Head of the Health Promotion Program and Head of the Health and Risk Communication Lab, School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gustavo S Mesch
- Department of Sociology, University of Haifa, Mount Carmel, Haifa, Israel
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17
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Maor Y, Caspi S. Attitudes towards influenza, and COVID-19 vaccines during the COVID-19 pandemic among a representative sample of the Jewish Israeli population. PLoS One 2022; 17:e0255495. [PMID: 35148322 PMCID: PMC8836312 DOI: 10.1371/journal.pone.0255495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vaccine hesitancy is increasing. We assessed attitudes toward influenza and COVID-19 vaccines and the relation between hesitancy to influenza vaccine and hesitancy towards COVID-19 vaccines. Methods A structured questionnaire administered during September 2020 to a representative sample of the Jewish Israeli population assessed attitudes and acceptance of influenza and COVID-19 vaccines. Factors for vaccine hesitancy were determined using logistic regression. Questionnaires were administered prior to the release of clinical data regarding efficacy and safety of COVID-19 vaccines and prior to vaccine rollout. Results We approached 10,625 people, of these 2,080 responded (19%), and 2,024 completed the questionnaire (97.3%), 64.9% aged 15–64 years and 35.1% aged ≥65 years. 37% had co-morbidities. 43.5% experienced financial deterioration due to the pandemic. 65.9% received influenza vaccine ≥1 time in the past. Influenza vaccination rates were higher in the elderly (81.8%). Reasons for influenza vaccine hesitancy were opinions that the vaccine is ineffective (27.1%), and fear of side effects (29.3%). 8.2% of people aged 16–64 and 13.8% of people aged≥65 refused to be vaccinated at least once over the course of one’s lifetime. Percent of responders willing to receive a COVID-19 vaccine were higher than percent of responders willing to receive the influenza vaccine both in people aged 16–64 years (942 (72.3%) vs. 38.4%, respectively) and in people 65 years and older (84.0% vs. 76.8%, respectively). Hesitancy towards COVID-19 vaccine was associated with hesitancy towards other vaccines. Only 26.8% would participate in a COVID-19 vaccine trial. Conclusions Willingness to receive COVID-19 vaccine was higher than willingness to receive influenza vaccine. The results point to areas of fear from influenza vaccines side effects and lack of knowledge regarding influenza vaccines effectiveness that can be addressed to increase acceptance. Hesitancy towards other vaccines was associated with hesitancy towards COVID-19 vaccination.
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Affiliation(s)
- Yasmin Maor
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail: ,
| | - Shaked Caspi
- School of Computer Science and School of Mathematical science, Tel Aviv University, Tel Aviv, Israel
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18
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Popper-Giveon A, Keshet Y. Vaccinated kindergartens: A community-based bottom-up initiative addressing vaccine hesitancy in Israel. Public Health Nurs 2022; 39:806-811. [PMID: 35106803 DOI: 10.1111/phn.13057] [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: 11/08/2021] [Revised: 12/13/2021] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vaccine hesitancy (VH) has grown over recent decades. While most of the strategies implemented to cope with VH are top-down interventions, the present article focuses on a unique community-based bottom-up initiative conducted in Israel: Mehusgan-the vaccinated kindergarten. OBJECTIVE The objective of the study was to learn about the vaccinated kindergarten initiative: its implementation, benefits, and challenges as well as its broader potential impact. METHODOLOGY During 2020, we conducted 13 semi-structured in-depth interviews with parents, kindergarten teachers and managers, and physicians. FINDINGS The interviews revealed that parents are encouraged to complete the vaccination program as recommended; additional kindergartens join the initiative; and additional kindergartens become vaccinated. CONCLUSIONS Mehusgan is a unique and growing initiative that leads to vaccinated kindergartens and, therefore, contributes to public health. This case study can encourage other community-based bottom-up initiatives that seek to raise vaccination rates.
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Affiliation(s)
| | - Yael Keshet
- Department of sociology, Western Galilee Academic College, Akko, Israel
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19
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Wang Q, Xiu S, Yang L, Han Y, Huang J, Cui T, Shi N, Liu M, Wang X, Lu B, Jin H, Lin L. Delays in routine childhood vaccinations and their relationship with parental vaccine hesitancy: a cross-sectional study in Wuxi, China. Expert Rev Vaccines 2021; 21:135-143. [PMID: 34789062 DOI: 10.1080/14760584.2022.2008244] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aimed to examine childhood vaccination delay, explore the association between vaccination delay and parental vaccine hesitancy, and assess childhood vaccination delays during the coronavirus disease (COVID)-19 pandemic in China. METHODS This cross-sectional survey was conducted in Wuxi City. Participants were recruited from local vaccination clinics. Questionnaires were used to collect information about socio-demographics, vaccine hesitancy, and immunization clinic evaluations. Vaccination records were obtained from the Jiangsu Information Management System of Vaccination Cases. RESULTS Overall, 2728 participants were included. The coverage for seven category A vaccines (Expanded Program on Immunization (EPI)) was more than 95% at 24 months. The proportion of children vaccinated in a timely manner was the highest for the first dose of the hepatitis B vaccine (91.6%) and the lowest for the Bacillus-Calmette-Guerin vaccine (44.6%). More than 50% of the planned vaccinations were delayed in February and March 2020. The Vaccine Hesitancy Scale scores were not associated with vaccination delay (P = 0.842). Children's vaccination delays were negatively associated with parents who reported convenient access to clinics and satisfaction with immunization services (P = 0.020, P = 0.045). CONCLUSIONS EPI is highly successful in China. Despite vaccination delays due to the COVID-19 pandemic, coverage was recovered after lockdown restrictions were eased.
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Affiliation(s)
- Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Shixin Xiu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Ying Han
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Jinxin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Minqi Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Xuwen Wang
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Bing Lu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
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20
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Gorelik Y, Anis E, Edelstein M. Inequalities in initiation of COVID19 vaccination by age and population group in Israel- December 2020-July 2021. LANCET REGIONAL HEALTH-EUROPE 2021; 12:100234. [PMID: 34746908 PMCID: PMC8556198 DOI: 10.1016/j.lanepe.2021.100234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background COVID19 vaccination coverage in Israel varies among population groups. Comparing crude coverage between groups is misleading because of different age structures and socio-economic differences. To describe inequalities in COVID19 vaccine initiation in Israel we analysed the interaction of age and population groups in terms of dose 1 vaccine coverage. Methods We calculated cumulative age-specific first COVID19 vaccine coverage by population group (Ultra-Orthodox Jewish, Arab, General Jewish). We calculated the relative differences in vaccine coverage between population groups within each age group, and between age groups within each population, using ANOVA and binomial regression after adjusting for socio-economic status. Findings 8,507,723 individuals in 268 cities were included. Compared with the general Jewish population, coverage was lowest in the Ultra-Orthodox population in all age groups (range -12% among 60+ to -52.8% among 10-19 years olds, p<0.001). In all groups, the proportion of vaccinated individuals in younger age groups relative to those aged 60+ decreased with decreasing age and were smallest in the Ultra-Orthodox groups. For example, within the general Jewish population, people aged 20-29 were 14% less likely to be vaccinated than those aged 60+ while within the Ultra-Orthodox population it was 34.5. Interpretation In all age groups, the Ultra-Orthodox population had the lowest vaccine coverage. Differences persisted after adjusting for socio-economic status. The younger the age group, the more Ultra-Orthodox Jews were diverging from age peers in terms of initiating COVID19 vaccination, suggesting a generational effect. Tailored approaches are urgently required to encourage vaccination among under-immunized groups in Israel. Funding No specific funding was received.
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Affiliation(s)
- Yanay Gorelik
- Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold 8, Safed, Israel
| | - Emilia Anis
- Division of Epidemiology, Ministry of Health, Yirmiyahu 39, Jerusalem, Israel
| | - Michael Edelstein
- Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold 8, Safed, Israel
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21
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Bar-Lev S, Reichman S, Barnett-Itzhaki Z. Prediction of vaccine hesitancy based on social media traffic among Israeli parents using machine learning strategies. Isr J Health Policy Res 2021; 10:49. [PMID: 34425894 PMCID: PMC8381350 DOI: 10.1186/s13584-021-00486-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Vaccines have contributed to substantial reductions of morbidity and mortality from vaccine-preventable diseases, mainly in children. However, vaccine hesitancy was listed by the World Health Organization (WHO) in 2019 as one of the top ten threats to world health. Aim To employ machine-learning strategies to assess how on-line content regarding vaccination affects vaccine hesitancy. Methods We collected social media posts and responses from vaccination discussion groups and forums on leading social platforms, including Facebook and Tapuz (A user content website that contains blogs and forums). We investigated 65,603 records of children aged 0–6 years who are insured in Maccabi’s Health Maintenance Organization (HMO). We applied three machine learning algorithms (Logistic regression, Random forest and Neural networks) to predict vaccination among Israeli children, based on demographic and social media traffic. Results Higher hesitancy was associated with more social media traffic, for most of the vaccinations. The addition of the social media traffic features improved the performances of most of the models. However, for Rota virus, Hepatitis A and hepatitis B, the performances of all algorithms (with and without the social media features) were close to random (accuracy up to 0.63 and F1 up to 0.65). We found a negative association between on-line discussions and vaccination. Conclusions There is an association between social media traffic and vaccine hesitancy. Policy makers are encouraged to perceive social media as a main channel of communication during health crises. Health officials and experts are encouraged to take part in social media discussions, and be equipped to readily provide the information, support and advice that the public is looking for, in order to optimize vaccination actions and to improve public health Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00486-6.
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Affiliation(s)
- Shirly Bar-Lev
- The Dror (Imri) Aloni Research Center for Health Informatics, Ruppin Academic Center, Emek Hefer, Israel. .,School of Engineering, Ruppin Academic Center, Emek Hefer, Israel.
| | - Shahar Reichman
- Coller School of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar Barnett-Itzhaki
- The Dror (Imri) Aloni Research Center for Health Informatics, Ruppin Academic Center, Emek Hefer, Israel.,School of Engineering, Ruppin Academic Center, Emek Hefer, Israel
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22
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Rosen B, Waitzberg R, Israeli A, Hartal M, Davidovitch N. Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel's COVID-19 vaccination program. Isr J Health Policy Res 2021; 10:43. [PMID: 34340714 PMCID: PMC8326649 DOI: 10.1186/s13584-021-00481-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
As of March 31, 2021, Israel had administered 116 doses of vaccine for COVID-19 per 100 population (of any age) - far more than any other OECD country. It was also ahead of other OECD countries in terms of the share of the population that had received at least one vaccination (61%) and the share that had been fully vaccinated (55%). Among Israelis aged 16 and over, the comparable figures were 81 and 74%, respectively. In light of this, the objectives of this article are: 1. To describe and analyze the vaccination uptake through the end of March 2021 2. To identify behavioral and other barriers that likely affected desire or ability to be vaccinated 3. To describe the efforts undertaken to overcome those barriers Israel's vaccination campaign was launched on December 20, and within 2.5 weeks, 20% of Israelis had received their first dose. Afterwards, the pace slowed. It took an additional 4 weeks to increase from 20 to 40% and yet another 6 weeks to increase from 40 to 60%. Initially, uptake was low among young adults, and two religious/cultural minority groups - ultra-Orthodox Jews and Israeli Arabs, but their uptake increased markedly over time.In the first quarter of 2021, Israel had to enhance access to the vaccine, address a moderate amount of vaccine hesitancy in its general population, and also address more intense pockets of vaccine hesitancy among young adults and religious/cultural minority groups. A continued high rate of infection during the months of February and March, despite broad vaccination coverage at the time, created confusion about vaccine effectiveness, which in turn contributed to vaccine hesitancy. Among Israeli Arabs, some residents of smaller villages encountered difficulties in reaching vaccination sites, and that also slowed the rate of vaccination.The challenges were addressed via a mix of messaging, incentives, extensions to the initial vaccine delivery system, and other measures. Many of the measures addressed the general population, while others were targeted at subgroups with below-average vaccination rates. Once the early adopters had been vaccinated, it took hard, creative work to increase population coverage from 40 to 60% and beyond.Significantly, some of the capacities and strategies that helped Israel address vaccine hesitancy and geographic access barriers are different from those that enabled it to procure, distribute and administer the vaccines. Some of these strategies are likely to be relevant to other countries as they progress from the challenges of securing an adequate vaccine supply and streamlining distribution to the challenge of encouraging vaccine uptake.
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Affiliation(s)
- Bruce Rosen
- Myers-JDC-Brookdale Institute, JDC Hill, Jerusalem, Israel
- Hebrew University Paul Baerwald School of Social Work and Social Welfare, Jerusalem, Israel
| | - Ruth Waitzberg
- Myers-JDC-Brookdale Institute, JDC Hill, Jerusalem, Israel
- Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Berlin, Germany
| | - Avi Israeli
- Hebrew University Hadassah Medical School, Jerusalem, Israel
- Ministry of Health, Jerusalem, Israel
| | - Michael Hartal
- Myers-JDC-Brookdale Institute, JDC Hill, Jerusalem, Israel
| | - Nadav Davidovitch
- Faculty of Health Sciences, Ben-Gurion University of the Negev, School of Public Health, Beersheba, Israel
- Taub Center for Social Policy Studies in Israel, Jerusalem, Israel
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23
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Bary-Weisberg D, Stein-Zamir C. Vaccination timeliness and completeness among preterm and low birthweight infants: a national cohort study. Hum Vaccin Immunother 2021; 17:1666-1674. [PMID: 33325771 PMCID: PMC8115750 DOI: 10.1080/21645515.2020.1840255] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/17/2020] [Indexed: 11/01/2022] Open
Abstract
Vaccinating premature and low birthweight (LBW) infants according to chronological age has been found safe and effective. Although these infants are susceptible to infections, vaccinations are often delayed. We estimated vaccination coverage (VC) in preterm and LBW infants compared to term infants in a cohort study (2016 Israel birth cohort, n = 181,543) using the National Immunization Registry. Vaccinations included Hepatitis B, Diphtheria-Tetanus-acellular Pertussis-IPV-Haemophilus influenzae B, Oral Polio Bivalent, Rotavirus, Pneumococcal Conjugate, Measles-Mumps-Rubella-Varicella and Hepatitis A. Inclusion criteria: (1) born in Israel; (2) having a unique identifier (allowing data matching); and (3) surviving to 24 months. VC at 24 months and timeliness of vaccine doses were evaluated according to infants' birthweight (BW) and gestational age (GA). Preterm infants (GA < 37 weeks) comprised 7.0% (n = 12,264); LBW infants (BW< 2500 g) were 7.7% (n = 13,950); BW was 1500-2499 g in 6.8%, 1000-1499 g in 0.6% and below 1000 g in 0.3%. Compared to normal birthweight (NBW) infants (BW≥2500 g), LBW infants showed delayed initiation of vaccinations. Odds ratio (OR) for delay: DTaP-IPV-Hib 1 OR = 1.26 [95%CI 1.19-1.33]; Rota 1, OR = 1.22 [95%CI 1.16-1.29]. Vaccination delay rates were higher among smaller new-borns (below 1000 g). At 24 months there was no significant difference regarding vaccination status. This national cohort VC analysis focused on preterm/LBW infants. Vaccinating preterm and LBW infants according to the recommended schedule induces protection against life-threatening infectious diseases. Vaccination initiation among LBW infants showed considerable delay. Health practitioners and parents should cooperate to improve timely vaccination initiation.
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Affiliation(s)
- Dov Bary-Weisberg
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Chen Stein-Zamir
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public Health and Community Medicine, Jerusalem, Israel
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
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24
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Keshet Y, Popper-Giveon A. "I Took the Trouble to Make Inquiries, So I Refuse to Accept Your Instructions": Religious Authority and Vaccine Hesitancy Among Ultra-Orthodox Jewish Mothers in Israel. JOURNAL OF RELIGION AND HEALTH 2021; 60:1992-2006. [PMID: 33389435 PMCID: PMC7778477 DOI: 10.1007/s10943-020-01122-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
Voluminous scholarship has shown that religious leaders play an important role in helping patients cope with health issues. There is, however, little research on the impact of religious leaders on parents' decision-making processes pertaining to childhood vaccination. Ultra-orthodox Jewish religious leaders (rabbis) are considered authorities on health issues, and most of them encourage parents to vaccinate their children. Yet, there have been several recent outbreaks of measles in the ultra-orthodox population in Israel, as well as in other countries. The aim is to study the role played by rabbis in the decision-making process of Israeli ultra-orthodox Jewish parents with regard to vaccination. In-depth interviews were conducted during 2019 with ten Israeli ultra-orthodox Jewish mothers who do not vaccinate their children. The interviewees acknowledged that rabbis generally advocate vaccination. Yet they do not consult them and at times even disregard their instructions. The interviewees search for information on vaccination for themselves (mostly online) and decide not to vaccinate their children based on their assessment of risk. Contrary to the scholarly literature that points to the central role of religious leaders in dealing with health issues, the ultra-orthodox mothers' decision not to vaccinate their children appears to have been made despite the rabbis' instructions and not for religious reasons. These mothers' decision-making process is similar to that of mothers who do not vaccinate their children in other countries with respect to the aspect of gender, the search for information, and the reasons reported. Contacting the ultra-orthodox mothers directly and addressing their concerns about risk increase vaccination rates among the ultra-orthodox Jewish population.
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25
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Stein-Zamir C, Rishpon S. The National Immunization Technical Advisory Group in Israel. Isr J Health Policy Res 2021; 10:7. [PMID: 33499907 PMCID: PMC7835647 DOI: 10.1186/s13584-021-00442-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
National Immunization Technical Advisory Groups (NITAGs) are defined by the World Health Organization as multidisciplinary groups of health experts who are involved in the development of a national immunization policy. The NITAG has the responsibility to provide independent, evidence-informed advice to the policy makers and national programme managers, on policy issues and questions related to immunization and vaccines.This paper aims to describe the NITAG in Israel. The Israeli NITAG was established by the Ministry of Health in1974. The NITAG's full formal name is "the Advisory Committee on Infectious Diseases and Immunizations in Israel". The NITAG is charged with prioritizing choices while granting maximal significance to the national public health considerations. Since 2007, the full minutes of the NITAG's meetings have been publicly available on the committee's website (at the Ministry of Health website, in Hebrew).According to the National Health Insurance Law, all residents of Israel are entitled to receive universal health coverage. The health services basket includes routine childhood immunizations, as well as several adult and post - exposure vaccinations. The main challenge currently facing the NITAG is establishing a process for introducing new vaccines and updating the vaccination schedule through the annual update of the national health basket. In the context of the annual update, vaccines have to "compete" with multiple medications and technologies which are presented to the basket committee for inclusion in the national health basket. Over the years, the Israeli NITAG's recommendations have proved essential for vaccine introduction and scheduling and for communicable diseases control on a national level. The NITAG has established structured and transparent working processes and a decision framework according to WHO standards, which is evidence-based and country-specific to Israel.The recent global COVID-19 pandemic is a major concern for all countries as well as a challenge for NITAGs. Currently, the NITAGs have a key role in advising both on sustainment of the routine immunization programs and on planning of the COVID-19 vaccination campaigns, with ongoing updates and collaboration with the Ministry of Health and health organizations.
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Affiliation(s)
- Chen Stein-Zamir
- The Israeli NITAG, Jerusalem, Israel.
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public and Community Medicine, Jerusalem, Israel.
| | - Shmuel Rishpon
- The Israeli NITAG, Jerusalem, Israel
- Haifa District Health Office, Ministry of Health, Haifa, Israel
- School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
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26
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Stein-Zamir C, Levine H. The measles outbreak in Israel in 2018-19: lessons for COVID-19 pandemic. Hum Vaccin Immunother 2021; 17:2085-2089. [PMID: 33481632 DOI: 10.1080/21645515.2020.1866918] [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] [Indexed: 02/02/2023] Open
Abstract
During 2018-2019 Israel saw some 4300 measles cases in a country-wide epidemic. Increased measles incidence rates and considerable disease burden have been observed in under-vaccinated communities, predominantly Jewish ultraorthodox. The measles epidemic, despite proper public health handling, revealed susceptible population subgroups as well as gaps and lacking resources in the Israeli public health systems. In the COVID-19 pandemic in Israel, as of December 2020, the number of COVID-19 cases reported nationally was over 300,000 with approximately 3000 fatalities. Notably, minority groups such as the ultraorthodox Jewish community and the Arab community in Israel has been profoundly affected by the COVID-19 pandemic. We believe it is still possible to implement the key lessons from the measles outbreak in Israel that could aid in the COVID-19 response in Israel and elsewhere. These conceptions should include a social-based approach, investment in public health human resources and infrastructure, tackling root causes of inequalities, emphasis on trust and solidarity, proactive communication, need for political will, and proper use of epidemiological data as a basis for decision-making. In parallel to proper use of COVID-19 vaccines, when available, a 'social vaccine' is crucial as well as preparedness and response according to public health principles.
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Affiliation(s)
- Chen Stein-Zamir
- Faculty of Medicine, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Hagai Levine
- Faculty of Medicine, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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27
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Baghdadi LR, Younis A, Al Suwaidan HI, Hassounah MM, Al Khalifah R. Impact of the COVID-19 Pandemic Lockdown on Routine Childhood Immunization: A Saudi Nationwide Cross-Sectional Study. Front Pediatr 2021; 9:692877. [PMID: 34222155 PMCID: PMC8249725 DOI: 10.3389/fped.2021.692877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Routine childhood immunization is the most cost-effective method to prevent infection and decrease childhood morbidity and mortality. The COVID-19 pandemic has affected access to health care in Saudi Arabia, including mandatory vaccinations for young children. We aimed to assess the prevalence of intentionally delayed vaccinations in children aged ≤ 2 years during the COVID-19 pandemic curfew in Saudi Arabia, its relation to the caregivers' fear of infection, and identifying factors affecting the caregivers' decision. Methods: We conducted a cross-sectional study using a self-administered survey that targeted primary caregivers of children aged ≤ 2 years residing in Saudi Arabia during the COVID-19 pandemic curfew (March 4-July 6, 2020). Results: We received responses from 577 caregivers, of whom 90.8% were mothers. The prevalence of intentional vaccination delay was 37%. Upon adjusting the potential confounders, the odds of delaying scheduled childhood vaccination because of COVID-19 pandemic fears were greater among caregivers with higher levels of fear (OR 1.10, 95% CI 1.02-1.11). Common reasons for delaying vaccinations were COVID-19 infection and prevention of exposure to COVID-19 cases. Conclusion: Intentional vaccination delay leaves young children vulnerable to preventable infectious diseases. Identifying these children and offering catch-up vaccinations reduces this risk. Campaigns to increase awareness about the dangers of delaying vaccine-preventable diseases must be promoted to caregivers in addition to the promotion of home vaccination services. In preparation for future pandemics, we recommend countries consider interventions to control the level of fear and anxiety provoked by the pandemics and media, and interventions for improved access to vaccinations.
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Affiliation(s)
- Leena R Baghdadi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Younis
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hessah I Al Suwaidan
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Marwah M Hassounah
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reem Al Khalifah
- Paediatric Endocrinology Division, Paediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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28
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Leventer-Roberts M, Sheffer R, Salama M, Nuss N, Rahmani S, Kornriech T, Mor Z. Pediatric measles cases by residence status in Tel Aviv, Israel. Vaccine 2020; 38:5773-5778. [PMID: 32690425 DOI: 10.1016/j.vaccine.2020.07.006] [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: 01/16/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Measles is a vaccine-preventable infectious disease whose outbreaks generally originate from exposure to populations with low vaccination coverage. METHODS This study compared the rates and morbidity of measles cases in the district of Tel-Aviv during two outbreaks (2012 and 2018-2019) by citizenship and geographic location. RESULTS There were 67 pediatric cases reported in 2012 and 222 in 2018-2019. Cases were more likely to have pneumonia in 2012 as compared to in 2018-2019 (58.2% versus 6.3%) and less likely to report a single vaccination dose (9.5% versus 22.8%, respectively). In 2012, the majority of cases were among children without legal residence (CWLR), while in 2018-2019, they were the minority of cases (N = 54, 80.6% versus N = 51, 23.0%, respectively). In both outbreaks, CWLR were more likely to be less than one year old (the recommended age for the first dose of measles vaccination), unvaccinated or with unknown vaccine status, to be treated in a tertiary care center, and to have pneumonia than children with Israeli citizenship (CC). In both outbreaks, CWLR lived in a concentrated neighborhood in Southern Tel Aviv. CONCLUSION While the two measles outbreaks differed in overall morbidity, in both outbreaks CWLR presented with a more severe clinical presentation and were less likely to be vaccinated (in part due to their younger age) than CC. The geographically concentration of CWLR was distinct from that of the CC in both outbreaks. Healthcare professionals should promote vaccination uptake and increase parents' awareness to early signs of the disease.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Departments of Pediatrics and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Matanelle Salama
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Naama Nuss
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Sarit Rahmani
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Tamar Kornriech
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel; School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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Stein-Zamir C, Abramson N, Shoob H, Libal E, Bitan M, Cardash T, Cayam R, Miskin I. A large COVID-19 outbreak in a high school 10 days after schools' reopening, Israel, May 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32720636 PMCID: PMC7384285 DOI: 10.2807/1560-7917.es.2020.25.29.2001352] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
On 13 March 2020, Israel’s government declared closure of all schools. Schools fully reopened on 17 May 2020. Ten days later, a major outbreak of coronavirus disease (COVID-19) occurred in a high school. The first case was registered on 26 May, the second on 27 May. They were not epidemiologically linked. Testing of the complete school community revealed 153 students (attack rate: 13.2%) and 25 staff members (attack rate: 16.6%) who were COVID-19 positive.
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Affiliation(s)
- Chen Stein-Zamir
- The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public and Community Medicine, Jerusalem, Israel.,Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Erez Libal
- Clalit health services, Jerusalem District, Jerusalem, Israel
| | - Menachem Bitan
- Meuchedet health services, Jerusalem District, Jerusalem, Israel
| | - Tanya Cardash
- Maccabi Healthcare services, Jerusalem and Shfela Region, Israel
| | - Refael Cayam
- Leumit Health Services, Jerusalem District, Jerusalem, Israel
| | - Ian Miskin
- Clalit health services, Jerusalem District, Jerusalem, Israel
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30
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Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health 2020; 20:908. [PMID: 32527248 PMCID: PMC7291496 DOI: 10.1186/s12889-020-08935-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia. METHOD This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs). RESULTS Of the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317-4.343), from richest households (AOR = 2.381; 95% CI: 1.502-3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310-6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377-3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048-0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033-0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities. CONCLUSION In this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
- Health System Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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31
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Stein-Zamir C, Abramson N, Shoob H. Notes from the Field: Large Measles Outbreak in Orthodox Jewish Communities - Jerusalem District, Israel, 2018-2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:562-563. [PMID: 32379730 PMCID: PMC7737952 DOI: 10.15585/mmwr.mm6918a3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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32
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Stein-Zamir C, Abramson N, Edelstein N, Shoob H, Zentner G, Zimmerman DR. Community-Oriented Epidemic Preparedness and Response to the Jerusalem 2018-2019 Measles Epidemic. Am J Public Health 2019; 109:1714-1716. [PMID: 31622151 DOI: 10.2105/ajph.2019.305343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Measles epidemics are still a public health challenge worldwide, necessitating a rapid response. The Jerusalem District Health Office applied a community-oriented intervention during the 2018-2019 epidemic (2150 notified cases). Program development targeted the socioeconomic and cultural characteristics of high-incidence Jewish ultraorthodox communities. Health care and community collaboration led to coverage rates of measles vaccination increasing from 80% to 95% within three months and a significant decline in incidence. Epidemic preparedness calls for maintaining the infrastructure of countermeasures combined with sustaining immunization coverage.
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Affiliation(s)
- Chen Stein-Zamir
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
| | - Nitza Abramson
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
| | - Naomi Edelstein
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
| | - Hanna Shoob
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
| | - Gary Zentner
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
| | - Deena R Zimmerman
- Chen Stein-Zamir, Nitza Abramson, Naomi Edelstein, Hanna Shoob, Gary Zentner, and Deena R. Zimmerman are with the Jerusalem District Health Office, Jerusalem, Israel
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Measles-related hospitalizations and associated complications in Jerusalem, 2018-2019. Clin Microbiol Infect 2019; 26:637-642. [PMID: 31499179 DOI: 10.1016/j.cmi.2019.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The 2018 measles outbreak in Israel affected >2000 people in Jerusalem. The aim of the study was to describe clinical features and complications of hospitalized measles patients in Jerusalem, as related to age group and risk factors. METHODS All individuals hospitalized with measles in the three main hospitals in Jerusalem during March 2018 to February 2019 were included. Demographic, clinical and laboratory data were analysed. RESULTS Of 161 hospitalized individuals, 86 (53.4%) were <5 years old, 16 (10%) were ≥5 years but <20 years old, and 59 (36.6%) were ≥20 years old. Most, 114/135 (85%), were unvaccinated. Immunocompromised state was identified in 12/161 (7.5%) patients, 20/161 (12.4%) had other underlying co-morbidities, and four were pregnant. Hypoxaemia on admission was a common finding in all age groups. Hepatitis was more common among adults ≥20 years old (33/59, 59%). Measles-related complications were noted in 95/161 (59%) patients, and included pneumonia/pneumonitis (67/161, 41.6%), which was more common in young (<5 years) children, diarrhoea (18/161, 11.2%), otitis (18/161, 11.2%), and neurological complications (6/161, 3.7%)-the latter occurring more frequently in the 5- to 20-year age group. Two of the 12 immunocompromised patients died of measles-related complications. A high re-admission rate (19/161, 11.8%) within 3 months was documented among hospitalized measles patients. CONCLUSION The burden of hospitalization, as well as the high rate of short- and long-term complications observed in hospitalized patients, underscore the importance of maintaining a high measles vaccine coverage, with enhanced targeting of unvaccinated population pockets.
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