Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Impact of the COVID-19 pandemic on self-paid vaccination intentions for children: a cross-sectional study in China

OBJECTIVES

While it is widely accepted that COVID-19 has disrupted routine vaccination globally, the long-term impact of COVID-19 on parental vaccination intentions is uncertain. This study aims to estimate whether COVID-19 impacted parental intentions for self-paid vaccines, and provides suggestions for local vaccination policy and intervention strategies accordingly.

METHODS

A questionnaire-based cross-sectional survey was conducted among 2212 caregivers in Zhejiang province between 22 March and 30 June 2023. The following information was collected: sociodemographic characteristics, self-paid vaccination related intentions and behaviours, and vaccine hesitancy measured by the Vaccine Hesitancy Scale. Multiple multinomial logistic regression models were used to analyse the factors influencing the change in vaccination intentions.

RESULTS

In total, 19.32% (n=390) of respondents increased their intention to immunise their children with self-paid vaccines after the COVID-19 epidemic, 9.16% (n=185) decreased their intention, and 71.52% (n=1444) of respondents indicated that the COVID-19 epidemic did not affect their intention. The major reason for increased intentions was 'Vaccines are effective in preventing diseases' (83.89%) and for decreased intentions was 'Worried about the side effects of vaccines' (65.95%). A higher hesitancy degree (OR=2.208, p=0.0001), reduced trust in vaccines after COVID-19 (OR=16.650, p<0.0001), doctors' recommendation of Expanded Programme on Immunization vaccines (OR=2.180, p=0.0076), and non-perfect satisfaction with vaccine information (all OR>1, all p<0.05) were considered to be drivers of decreased intention.

CONCLUSION

Although the intentions of self-paid vaccinations were not largely influenced, nearly 30% of caregivers' vaccination intentions changed after the COVID-19 pandemic and most of them increased their intentions. In addition, vaccination history of self-paid vaccines, vaccine information, vaccine trust and doctors' recommendations were the active factors for self-paid vaccination. Therefore, education on the knowledge of self-paid vaccines for caregivers should be implemented to increase their vaccination intentions and decrease the threat of infectious diseases to children's health.

TikTok content on measles-rubella vaccine in Jordan: A cross-sectional study highlighting the spread of vaccine misinformation

Social media platforms, including TikTok, have become influential sources of health information. However, they also present as potential sources for the spread of vaccine misinformation. The aim of this study was to assess the quality of measles-rubella (MR) vaccine-related contents on TikTok in Jordan and to analyze factors associated with vaccine misinformation. A systematic search for MR vaccine-related TikTok contents in Jordan was conducted using pre-defined keywords and a specified time range. Content metrics (likes, comments, shares, and saves) were collected while the content quality of health information was evaluated using a modified version of the DISCERN, a validated instrument by two expert raters. The average modified DISCERN score ranged from 1, denoting poor content, to 5, indicating excellent content. A total of 50 videos from 34 unique content creators formed the final study sample. The majority of MR vaccine-related content was created by lay individuals (61.8%), followed by TV/news websites/journalists (23.5%), and healthcare professionals (HCPs) (14.7%). The Cohen κ per modified DISCERN item was in the range of 0.579-0.808, p<0.001), indicating good to excellent agreement. The overall average modified DISCERN score was 2±1.2, while it was only 1.3±0.52 for lay individuals' content, which indicated poor content quality. For the normalized per number of followers for each source, content by lay individuals had a significantly higher number of likes, saves, and shares with p=0.009, 0.012, and 0.004, respectively. Vaccine misinformation was detected in 58.8% of the videos as follows: lay individuals (85.7%), TV/news websites/journalists (25.0%), and HCPs content had none (p<0.001). Normalized per the number of followers for each source, videos flagged as having MR vaccine misinformation reached a higher number of likes, saves, and shares (p=0.012, 0.016, and 0.003, respectively). In conclusion, substantial dissemination of TikTok MR vaccine-related misinformation in Jordan was detected. Rigorous fact-checking is warranted by the platform to address misinformation on TikTok, which is vital to improve trust in MR vaccination and ultimately protect public health.

Increasing vaccinations through an on-site school-based education and vaccination program: A city-wide cluster randomized controlled trial

Vaccination rates for mumps, measles, and rubella (MMR) and tetanus, diphtheria, pertussis, and polio (Tdap-IPV) fall short of global targets, highlighting the need for vaccination interventions. This study examines the effectiveness of a city-wide school-based educational vaccination intervention as part of an on-site vaccination program aimed at increasing MMR and Tdap-IPV vaccination rates versus on-site vaccination alone among sociodemographically diverse students from Berlin, Germany. The study was a 1:1 two-arm cluster randomized controlled trial, with schools randomly assigned to either the Educational Class Condition (ECC) or the Low-Intensity Information Condition (LIIC). Both received an on-site vaccination program, while students in the ECC received an additional educational unit. Primary outcomes were MMR and Tdap-IPV vaccination rates. In total, 6512 students from 25 randomly selected urban area secondary schools participated. For students providing their vaccination documents on the day of the intervention (2273, 34.9%), adjusted Poisson mixed models revealed significant between-group differences in favor of the ECC (MMR: logRR = 0.47, 95%CI [0.01,0.92], RR = 1.59; Tdap-IPV: logRR = 0.28, 95%CI [0.10,0.47], RR = 1.32). When adjusting for socioeconomic and migration background, between-group differences became non-significant for MMR but remained significant for Tdap-IPV. Findings suggest that educational, school-based on-site vaccination appears to be a promising strategy for increasing vaccination uptake in adolescents.

The Role of Healthcare Leaders in Promoting Vaccine Acceptance in Saudi Arabia

Background

Several vaccines have been recommended by the health authorities in recent years and have been opposed by debates, lack of public trust, and variable levels of hesitance that resulted in increased anti-vaccination advocacy and a subsequent reduction in vaccination rates worldwide.

Purpose

This study aimed to explore the community's perceptions of the role of healthcare leadership in promoting vaccine acceptance.

Methods

This cross-sectional study used a validated questionnaire designed according to the study's objectives for a heterogeneous purposive sample of individuals over 18 years old in Saudi Arabia. Participants completed the questionnaire online via a link provided by multiple social media platforms.

Results

The study included 7159 participants with various demographical features. On a five-point Likert scale, the average level of agreement on the role of healthcare executives in promoting vaccines was 3.76. The average level of agreement about the role of healthcare leaders in promoting vaccines was 3.76 out of five. Men were more likely than women to agree on healthcare worker's influence, 63.6% and 58.6%, respectively (P < 0.001). The ages of participants showed a favorable correlation with their level of agreement on the role of healthcare leaders in promoting vaccines (P < 0.001). The level of agreement on healthcare leader's role in promoting vaccines was inversely proportional to the education level (P < 0.001). The retired group reported the highest score, followed by the employed ones (P < 0.001).

Conclusion

Unlike other political and religious leaders, this study indicates that healthcare professionals significantly impact vaccine hesitancy and uptake. Despite rising vaccine hesitancy, healthcare leaders remain more trustworthy providers of guidance and influence over vaccination decisions than others. In addition, the health leader's factual message boosts people's self-esteem and helps them decide to be vaccinated.

The Impact of COVID-19 Vaccine Controversy on Parents' Perceptions of Routine Vaccinations

Background The COVID-19 pandemic has significantly influenced public perceptions and behaviors related to vaccination. Understanding parental attitudes, knowledge gaps, and vaccination practices post-pandemic is crucial for informing effective public health strategies. This study aimed to investigate parental attitudes, knowledge, and practices toward routine childhood vaccination in the post-COVID-19 era, emphasizing shifts in perspectives and implications for vaccination strategies. Methodology A cross-sectional survey was conducted among 498 parents to assess their attitudes, knowledge, and practices regarding vaccination. Data were analyzed using descriptive statistics, chi-square tests, and t-tests where applicable, with p-values <0.05 considered statistically significant. Results The study revealed diverse parental attitudes toward vaccination post-COVID-19. While a majority (72.9%) maintained positive attitudes toward vaccination schedules and benefits, concerns regarding vaccine safety and efficacy were noted. Knowledge gaps persisted, with 16.5% strongly agreeing that children's vaccinations are weak and have no impact on disease prevention. Despite high adherence to vaccination schedules (68.9%), motivations behind vaccine administration were questioned, as 48.2% strongly disagreed that vaccination was solely for regulatory purposes. Conclusions Post-COVID-19, parental attitudes toward vaccination have evolved, reflecting increased concerns about safety and efficacy. Addressing knowledge gaps, combating misinformation, and enhancing trust in vaccination programs are imperative. Tailored communication strategies, education campaigns, and policy interventions are essential to promote vaccination acceptance and safeguard public health resilience in the post-pandemic era.

Epidemiologic and clinical updates on viral infections in Saudi Arabia

In the past two decades, the world has witnessed devastating pandemics affecting the global healthcare infrastructure and disrupting society and the economy worldwide. Among all pathogens, viruses play a critical role that is associated with outbreaks due to their wide range of species, involvement of animal hosts, easily transmitted to humans, and increased rates of infectivity. Viral disease outbreaks threaten public health globally due to the challenges associated with controlling and eradicating them. Implementing effective viral disease control programs starts with ongoing surveillance data collection and analyses to detect infectious disease trends and patterns, which is critical for maintaining public health. Viral disease control strategies include improved hygiene and sanitation facilities, eliminating arthropod vectors, vaccinations, and quarantine. The Saudi Ministry of Health (MOH) and the Public Health Authority (also known as Weqayah) in Saudi Arabia are responsible for public health surveillance to control and prevent infectious diseases. The notifiable viral diseases based on the Saudi MOH include hepatitis diseases, viral hemorrhagic fevers, respiratory viral diseases, exanthematous viral diseases, neurological viral diseases, and conjunctivitis. Monitoring trends and detecting changes in these viral diseases is essential to provide proper interventions, evaluate the established prevention programs, and develop better prevention strategies. Therefore, this review aims to highlight the epidemiological updates of the recently reported viral infections in Saudi Arabia and to provide insights into the recent clinical treatment and prevention strategies.

A Review of the Resurgence of Measles, a Vaccine-Preventable Disease, as Current Concerns Contrast with Past Hopes for Measles Elimination

On 22 February 2024, the World Health Organization (WHO) stated that, following the recent resurgence of measles cases in Europe, more than half the world's countries could expect significant measles outbreaks this year. Measles is a highly infectious virus with a primary case reproduction number (R0) of 12-18. Measles infection can be severe, resulting in pneumonia, and also more rarely in subacute sclerosing panencephalitis (SSPE), which occurs in 1 child out of every 1,000 and can be fatal. Until the 1990s, the hope of eliminating measles seemed possible following the successful development of effective vaccines, given individually or in the combined measles, mumps, and rubella (MMR) vaccine. Vaccine hesitancy due to misinformation about possible vaccine side effects, reduced vaccine uptake during and after the COVID-19 pandemic, and lack of awareness of the severe consequences of measles infection have contributed to low vaccine uptake, resulting in vulnerable communities. This article aims to review the recent resurgence of measles cases in the US, Europe, and the UK, to provide a reminder of the potential severity of measles, and to consider the causes of the failure to eliminate this vaccine-preventable viral infection.

Exploring First Responder Beliefs and Decisions to Vaccinate Against SARS-COV-2

As frontline providers, first responders are not always thought of as patients with unique health beliefs. During early and continued distribution, many first responders in the United States chose to refuse vaccination. Guided by the health belief model and emerging research related to SARS-COV-2, the aim of this study was to further explore the complex message conditions that contributed to first responders' early vaccination decisions. An online survey was conducted between March 1 and March 31 2021, among first responders in the state of Kentucky, which has lagged behind most states in the percentage of the population who are fully vaccinated. The first responder sample included Firefighters, Emergency Medical Technicians (EMTs), and paramedics who completed a Qualtrics survey that included measures aimed at assessing health beliefs about SARS-COV-2, beliefs about SARS-COV-2 vaccines, source trustworthiness, and vaccine motivation. First responders were also asked to rank the importance of various information sources about SARS-COV-2 and its vaccines. Findings suggest significant differences exist among first responders who have chosen to receive SARS-COV-2 vaccines and those who have refused, including source preference, conspiracy beliefs, and perceived risk. Future directions, including the exploration of institutional mistrust as a health belief are discussed. These findings offer practical insights that may improve continuing approaches to discover and use preferred communication sources to reach the vaccine-hesitant.

Effects of an online tailored decision aid to promote informed decision making about maternal pertussis vaccination in the Netherlands: A randomized controlled trial

INTRODUCTION

In 2019, maternal pertussis vaccination (MPV) during pregnancy was introduced in the Netherlands. New interventions to promote informed decision making (IDM) about vaccinations are highly needed, especially for new vaccinations. Decision aids (DAs) have the potential to support IDM. This study evaluates the effects of an online DA on IDM and MPV uptake.

METHODS

Pregnant individuals, recruited for the randomized controlled trial (RCT), who gave informed consent (N = 1,236) were randomly assigned to the control (N = 650; no information) or intervention condition (N = 586; DA at 18 weeks pregnancy). MPV uptake and IDM were primary outcomes, decisional certainty and psychological determinants of MPV uptake were secondary outcomes. Measures were taken at 18 weeks of pregnancy (baseline) and at 20 weeks of pregnancy (post-test); intervention use was logged. Data were analysed using intention-to-treat analyses, logistic regression, and linear mixed regression models.

RESULTS

Uptake of MPV was high in our sample (92.3 %). No significant effect of the DA condition on MPV uptake was found compared to the control condition. We found that the DA increased IDM (β = 0.24, p < .004) and one of its components level of knowledge about MPV (β = 0.31, p < .004). We also found an increase in decisional certainty (β = 0.24, p < .004), perceived susceptibility (β = 0.24, p < .004), severity of pertussis (β = 0.41, p < .004), and positive affect about MPV (β = 0.15, p < .004). There was a positive association between dose of the intervention and MPV uptake (β = 0.05, p < .004).

DISCUSSION

The DA seemed effective in promoting IDM about and determinants of MPV uptake. No main effect was found on MPV uptake, but MPV uptake was related to the level of exposure to the DA. People with high intentions towards MPV were overrepresented in the sample. However, effects on IDM were consistent among participants with different levels of MPV intention at baseline.

The multidimensional nature of attitudes towards preventive vaccinations - a cross-sectional survey among Poles aged 15-39 years

OBJECTIVES

Vaccination skepticism and vaccination refusal both constitute global public health concerns. Systematic monitoring of public attitudes towards vaccination is crucial for maintaining a high vaccination coverage rate. The study aimed to identify and characterize homogenous social groups distinguished by attitudes toward preventive vaccinations.

MATERIAL AND METHODS

Between October and November of 2021, a nationwide representative cross-sectional survey was conducted on a representative sample of 1560 inhabitants of Poland aged 15-39 years. The study questionnaire included 60 questions on public attitudes towards vaccines, vaccination, and the COVID-19 pandemic. Factor analysis was applied to identify the main dimensions of vaccination attitudes.

RESULTS

Factor analysis included 22 variables and yielded 3 factors or dimensions that accounted for 48.5% of the model's variability. Young adults were assigned into 6 homogeneous groups based on these factors: 1) general trust in vaccination, 2) vaccine safety concerns, 3) trust in fake medical news regarding COVID-19 vaccination, and denying the COVID-19 pandemic. Groups I-IV differed by sociodemographic factors and vaccination coverage rates. Nearly 60% of the respondents expressed concern regarding various aspects of vaccination.

CONCLUSIONS

Most of Poland's young adults lack clearly defined attitudes towards vaccination. Attitudes towards vaccination can be divided into 6 heterogeneous groups. Int J Occup Med Environ Health. 2023;36(2):214-28.

Is the COVID-19 bad news game good news? Testing whether creating and disseminating fake news about vaccines in a computer game reduces people's belief in anti-vaccine arguments

Improving vaccination eagerness is crucial, especially during the ongoing COVID-19 pandemic and establishing new procedures to achieve that goal is highly important. Previous research (Roozenbeek & van der Linden, 2019a, 2019b) has indicated that playing the "Bad News" game, in which a player spreads fake news to gain followers, reduces people's belief in fake news. The goal of the present paper was to test an analogous new game called "COVID-19 Bad News (CBN)" to improve one's eagerness to vaccinate against coronavirus. CBN was constructed to examine whether creating and disseminating fake news focused on vaccinations and the COVID-19 pandemic has a similar effect and improves people's attitudes toward vaccination. Two experiments were conducted where participants played CBN or Tetris and afterwards evaluated the credibility of statements about vaccines against COVID-19 and finally filled out a questionnaire concerning their attitudes toward vaccination. The results show that playing CBN does not reduce evaluations of the credibility of all statements that are unfavorable to vaccines (false as well as true). Additionally, it does not enhance readiness to vaccinate. Future research and limitations are discussed.

Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England

Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.

The Effects of Offering Freedom to Comply by Pediatricians and Nurses, Using the But-You-Are-Free (BYAF) Technique, on Vaccination Compliance on 185 Parents of Newborn Babies Conducted in Outpatient Clinics in Poland Between January 2022 and July 2022

BACKGROUND This study aimed to evaluate, in outpatient clinics in Poland between January 2022 and July 2022, the effectiveness of the But-You-Are-Free (BYAF) social influence technique by healthcare professionals during interaction with 185 parents deciding about vaccinating (eg, Hexacima, Prevenor 13, Synflorix, Rotateq, Act Hib, Boostrix, Pentaxim, DTP, Imovax, Priorix, MMR, Tetracim, Adacel, Euvax B, Fuvax, FSME, Varilix, Nimenrix, Bexero vaccines) their babies. MATERIAL AND METHODS During an interaction with pediatricians or nurses, the parents were encouraged to vaccinate their babies. In experimental condition (111 interactions), the BYAF technique was employed, and the phrase "But you are free" was added at the end of the conversation. In the control condition (74 interactions), it was not employed. RESULTS In the experimental condition, 71 (64%) participants declared intention to vaccinate their children. In the control condition, it 61 (84%) participants declared intention to vaccinate (the difference in percentages was significant: P=0.006). The number of parents who actually vaccinated their babies in the experimental condition was 92 (83%) and in the control condition it was 70 (95%; P=0.018). CONCLUSIONS The findings showed that participants who were exposed to the BYAF technique declared lower intentions to vaccinate their babies, and vaccinated them less often than those in the control condition. This result critically highlights that this technique should not be employed in the medical settings of pediatric vaccination.

Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic

BACKGROUND

Vaccine hesitancy presents an obstacle to the campaign to control COVID-19. It has previously been found to be associated with youth, female gender, low income, low education, low medical trust, minority ethnic group membership, low perceived risk from COVID-19, use of certain social media platforms and conspiracy beliefs. However, it is unclear which of these predictors might explain variance associated with others.

METHODS

An online survey was conducted with a representative sample of 4343 UK residents, aged 18-75, between 21 November and 21 December 2020. Predictors of vaccine hesitancy were assessed using linear rank-order models.

RESULTS

Coronavirus vaccine hesitancy is associated with youth, female gender, low income, low education, high informational reliance on social media, low informational reliance on print and broadcast media, membership of other than white ethnic groups, low perceived risk from COVID-19 and low trust in scientists and medics, as well as (to a much lesser extent) low trust in government. Coronavirus conspiracy suspicions and general vaccine attitudes appear uniquely predictive, jointly explaining 35% of variance. Following controls for these variables, effects associated with trust, ethnicity and social media reliance largely or completely disappear, whereas the effect associated with education is reversed.

CONCLUSIONS

Strengthening positive attitudes to vaccination and reducing conspiracy suspicions with regards to the coronavirus may have a positive effect on vaccine uptake, especially among ethnic groups with heightened vaccine hesitancy. However, vaccine hesitancy associated with age and gender does not appear to be explained by other predictor variables tested here.

Factors influencing healthcare professionals' confidence in vaccination in Europe: a literature review

Health-care professionals (HCPs) have a fundamental role in vaccination, their own beliefs and attitudes affecting both their uptake and recommendation of vaccines. This literature review (n = 89) summarises evidence on HCPs’ perceptions of the risks and benefits of vaccination, trust, and perceptions of mandatory vaccination in Europe. HCPs across studies believed that vaccination is important to protect themselves and their patients. However, beliefs that some diseases such as influenza are less risky were reported by some HCPs as a reason for not getting vaccinated. Concerns about both short- and long-term side effects were identified among HCPs in most studies, such as those affecting the immune or neurological system. Mistrust toward health authorities and pharmaceutical industry was reported in some studies. The question of mandatory vaccination revealed mixed opinions, with some favoring self-determination and others viewing vaccination as a duty. This review highlights key factors influencing HCPs’ confidence in vaccination in Europe.

Moral Foundations Predict COVID-19 Vaccine Hesitancy: Evidence from a National Survey of Black Americans

In this study we examine the role of moral values in predicting COVID-19 vaccine hesitancy among Black Americans. Guided by moral foundations theory, we assess the associations between six moral foundations (care, fairness, loyalty, authority, purity, liberty) and attitudes and intentions toward COVID-19 vaccination. Results of a national survey of Black Americans (N = 1,497) indicate that the care and loyalty moral foundations consistently predicted less vaccine hesitancy with overall more favorable attitudes and intentions toward COVID-19 vaccination, whereas the purity and liberty moral foundations were consistently associated with greater vaccine hesitancy. Relationships between the foundations and vaccine hesitancy were mediated by perceived vaccine effectiveness and safety. Implications of the findings for COVID-19 vaccine communication are discussed.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

Parental health beliefs, intention, and strategies about covid-19 vaccine for their children: A cross-sectional analysis from five Arab countries in the Middle East

BACKGROUND

The issue around vaccination of children has brought divergent opinions among the populations across the globe and among the Arab population. There has been a low response rate to the calls for vaccination of children and this is reflective of the sentiments which parents may have towards their children being vaccinated. This study aims to explore the parents' health beliefs, intentions, and strategies towards the COVID-19 vaccine for their children among Arab population.

METHODS

A cross-sectional study using an online survey from October to December 2021, was carried out in five Arab countries in the Middle East. A reliable health belief model (HBM) including five domains: severity, susceptibility, benefits, barriers and cues to action, was adopted. Chi-square, Mann-Whitney test, and multivariable logistic regression were performed for data analysis.

RESULTS

The survey response rate was 58 % (1154/2000). Only 56 % of Arab parents are intended to vaccinate their children against COVID-19. The mean scores of parental health belief are largely driven by their concern over the vaccine's side effect (p = 0.001) followed by its efficacy, safety (p < 0.001), and scheduling difficulty (p = 0.029). However, strategies that were statistically encouraged parents to vaccinate their children included doctor's recommendation, adequate information being provided, and acceptance of the vaccine by public (p < 0.001). Parents with one child were almost three times most likely to vaccinate their children (OR = 2.660, 95 %CI = 1.572-4.504, p < 0.001). Parents' desire to vaccinate their children is also influenced by other factors such as job loss owing to COVID-19 and the presence of a health worker in the family.

CONCLUSION

Intention of Arab parents to vaccinate their children via COVID-19 vaccine is still limited. Thus, it is essential for health care authorities to avail the information which will debunk the erroneous beliefs which some parents have developed towards the vaccination of children against COVID-19.

Drivers of the Intention to Receive a COVID-19 Booster Vaccine: Insights from the UK and Australia

As the global pandemic perpetuates, keeping the population vaccinated will be imperative to maintain societal protection from the SARS-CoV-2 (COVID-19) virus. However, while empirical evidence regarding predictors of the intention to receive a first COVID-19 vaccine has amassed, our understanding regarding the psychological and behavioral drivers of continued COVID-19 vaccination remains limited. In this pre-registered study (UK: AsPredicted#78370|Australia: AsPredicted#81667), factors predicting the intention to receive a COVID-19 booster vaccine were investigated in two adult samples from the UK (N = 1222) and Australia (N = 1197) that were nationally representative on factors of age, gender, and geographic location. High levels of booster intent were found (73% and 67%, respectively). Exploratory Structural Equation Modelling (ESEM) revealed three key predictors of the intention to receive a booster vaccine that emerged across both UK and Australian samples: concern regarding the COVID-19 virus, positive perceptions of the COVID-19 vaccines, and the perceived severity of side effects experienced to the last COVID-19 vaccine dose. Several additional factors (age, months since the last COVID-19 vaccine, familiarity with side effects, and regularly receiving the influenza vaccine) were present in the Australian dataset. These findings provide important evidence that targeting psychological perceptions of the COVID-19 vaccine and virus may serve to maintain participation in the COVID-19 vaccination programme, paving the way for future behavioural research in this area.

Worldwide Evolution of Vaccinable and Nonvaccinable Viral Skin Infections: Google Trends Analysis

BACKGROUND

Most common viral skin infections are not reportable conditions. Studying the population dynamics of these viral epidemics using traditional field methods is costly and time-consuming, especially over wide geographical areas.

OBJECTIVE

This study aimed to explore the evolution, seasonality, and distribution of vaccinable and nonvaccinable viral skin infections through an analysis of Google Trends.

METHODS

Worldwide search trends from January 2004 through May 2021 for viral skin infections were extracted from Google Trends, quantified, and analyzed.

RESULTS

Time series decomposition showed that the total search term volume for warts; zoster; roseola; measles; hand, foot, and mouth disease (HFMD); varicella; and rubella increased worldwide over the study period, whereas the interest for Pityriasis rosea and herpes simplex decreased. Internet searches for HFMD, varicella, and measles exhibited the highest seasonal patterns. The interest for measles and rubella was more pronounced in African countries, whereas the interest for HFMD and roseola was more pronounced in East Asia.

CONCLUSIONS

Harnessing data generated by web searches may increase the efficacy of traditional surveillance systems and strengthens the suspicion that the incidence of some vaccinable viral skin infections such as varicella, measles, and rubella may be globally increasing, whereas the incidence of common nonvaccinable skin infections remains stable.

Echo chambers and opinion dynamics explain the occurrence of vaccination hesitancy

Vaccination hesitancy is a major obstacle to achieving and maintaining herd immunity. Therefore, public health authorities need to understand the dynamics of an anti-vaccine opinion in the population. We introduce a spatially structured mathematical model of opinion dynamics with reinforcement. The model allows as an emergent property for the occurrence of echo chambers, i.e. opinion bubbles in which information that is incompatible with one's entrenched worldview, is probably disregarded. We scale the model both to a deterministic limit and to a weak-effects limit, and obtain bifurcations, phase transitions and the invariant measure. Fitting the model to measles and meningococci vaccination coverage across Germany, reveals that the emergence of echo chambers dynamics explains the occurrence and persistence of the anti-vaccination opinion in allowing anti-vaxxers to isolate and to ignore pro-vaccination facts. We predict and compare the effectiveness of different policies aimed at influencing opinion dynamics in order to increase vaccination uptake. According to our model, measures aiming at reducing the salience of partisan anti-vaccine information sources would have the largest effect on enhancing vaccination uptake. By contrast, measures aiming at reducing the reinforcement of vaccination deniers are predicted to have the smallest impact.

A scoping review of literature exploring factors affecting vaccine uptake within Roma communities across Europe

INTRODUCTION

Vaccine hesitancy is described by the WHO as one of the top threats to global health. The trajectory of the current COVID-19 pandemic depends upon the vaccination of a global population; therefore, barriers to routine vaccination within marginalized groups considered vaccine hesitant are of critical importance. Consistently, vaccination levels within Roma communities across Europe rate very poorly in comparison with general population coverage, and a number of measles and hepatitis outbreaks over the past 10 years have included Roma communities. This study aims to identify barriers to Roma vaccination in general with a view to informing analysis of potential low levels of vaccination within Roma communities for COVID-19.

AREAS COVERED

The research question explores factors and barriers affecting general vaccine (non-COVID-19 vaccine) uptake within Roma communities across Europe. This scoping review was conducted using the Arksey & O'Malley framework, complying with PRISMA-SR for Scoping Review guidelines.

EXPERT OPINION

Using Thomson's 5A's Taxonomy, access was identified as the greatest barrier to vaccination within Roma communities. Access factors had the greatest number of references in this scoping review and were considered the most relevant in terms of increasing vaccination uptake. Important access themes identified are health system issues, socioeconomic conditions, and mobility.

A model-based opinion dynamics approach to tackle vaccine hesitancy

Uncovering the mechanisms underlying the diffusion of vaccine hesitancy is crucial in fighting epidemic spreading. Toward this ambitious goal, we treat vaccine hesitancy as an opinion, whose diffusion in a social group can be shaped over time by the influence of personal beliefs, social pressure, and other exogenous actions, such as pro-vaccine campaigns. We propose a simple mathematical model that, calibrated on survey data, can predict the modification of the pre-existing individual willingness to be vaccinated and estimate the fraction of a population that is expected to adhere to an immunization program. This work paves the way for enabling tools from network control towards the simulation of different intervention plans and the design of more effective targeted pro-vaccine campaigns. Compared to traditional mass media alternatives, these model-based campaigns can exploit the structural properties of social networks to provide a potentially pivotal advantage in epidemic mitigation.

Factors Influencing COVID-19 Vaccine Uptake among Nepali People in the UK: A Qualitative Study

Vaccination saves lives and can be an effective strategy for preventing the spread of the COVID-19, but negative attitudes towards vaccines lead to vaccine hesitancy. This study aimed to explore the factors influencing the uptake of the COVID-19 vaccine in the Nepali community in the United Kingdom (UK). This qualitative study included in-depth interviews with 20 people from Nepal living in the UK. Interviews were conducted by a native-Nepali speaker and all interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Our study found that attitudes towards COVID-19 are generally positive. Nine overlapping themes around barriers to COVID-19 vaccination were identified: (a) rumours and mis/disinformation; (b) prefer home remedies and yoga; (c) religion restriction; (d) concern towards vaccine eligibility; (e) difficulty with online vaccine booking system; (f) doubts of vaccine effectiveness after changing the second dose timeline; (g) lack of confidence in the vaccine; (h) past bad experience with the influenza vaccine; and (i) worried about side-effects. Understanding barriers to the uptake of the COVID-19 vaccine can help in the design of better targeted interventions. Public health messages including favourable policy should be tailored to address those barriers and make this vaccination programme more viable and acceptable to the ethnic minority communities in the UK.

COVID-19 vaccine hesitancy in eight European countries: Prevalence, determinants, and heterogeneity

We examine heterogeneity in COVID-19 vaccine hesitancy across eight European countries. We reveal striking differences across countries, ranging from 6.4% of adults in Spain to 61.8% in Bulgaria reporting being hesitant. We experimentally assess the effectiveness of different messages designed to reduce COVID-19 vaccine hesitancy. Receiving messages emphasizing either the medical benefits or the hedonistic benefits of vaccination significantly increases COVID-19 vaccination willingness in Germany, whereas highlighting privileges contingent on holding a vaccination certificate increases vaccination willingness in both Germany and the United Kingdom. No message has significant positive effects in any other country. Machine learning-based heterogeneity analyses reveal that treatment effects are smaller or even negative in settings marked by high conspiracy beliefs and low health literacy. In contrast, trust in government increases treatment effects in some groups. The heterogeneity in vaccine hesitancy and responses to different messages suggests that health authorities should avoid one-size-fits-all vaccination campaigns.

Intervention studies to encourage vaccination using narrative: a systematic scoping review protocol

INTRODUCTION

Vaccine hesitancy is a global problem, impeding uptake of vaccines against measles, mumps, and rubella and those against human papillomavirus and COVID-19. Effective communication strategy is needed to address vaccine hesitancy. To guide the development of research in the field and the development of effective strategies for vaccine communication, this scoping review aims to analyse studies of interventions using narrative to encourage vaccination.

METHODS AND ANALYSIS

We will search the following databases: MEDLINE, CINAHL, PsycINFO and PsycARTICLES. We will identify additional literature by searching the reference lists of eligible studies. Eligible studies will be those that quantitatively examined the persuasiveness of narrative to encourage vaccination. Two independent reviewers will screen the titles, abstracts and full texts of all studies identified. Two independent reviewers will share the responsibility for data extraction and verification. Discrepancies will be resolved through consensus. Data such as study characteristics, participant characteristics, methodology, main results and theoretical foundation will be extracted. The findings will be synthesised in a descriptive and a narrative review.

ETHICS AND DISSEMINATION

This work does not warrant any ethical or safety concerns. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.

Types of anticipated affect that encourage and discourage vaccination: a scoping review protocol

INTRODUCTION

Various cognitive behavioural models and theories have been used to address vaccine hesitancy. However, those models and theories have been criticised for focusing on cognitive influences on health behaviours at the expense of affective influences. Recent studies have highlighted the importance of affective elements as complementary predictors of health behaviours. Anticipated affect (ie, an expectation of one's affective response to the target behaviour) has received the most scrutiny. This scoping review will analyse studies of anticipated affect that aimed to encourage vaccination and organise implications for future research and practice in vaccine communication. Our report will focus on exploring the usefulness of affective influence in terms of a comparison with the cognitive influence on vaccination.

METHODS AND ANALYSIS

We will search several databases (MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, Embase, Scopus, Web of Science and Google Scholar) and identify additional literature by searching the reference lists of eligible studies. Eligible studies are those that quantitatively or qualitatively examined anticipated affect and aimed to encourage vaccination. Only papers written in English will be included. We will include all eligible publications from database inception up to the date of the final database search. Two independent reviewers will screen the titles, abstracts and full texts of all identified studies. Two independent reviewers will share responsibility for data extraction and verification. Discrepancies will be resolved through discussion to reach consensus. We will extract data such as study characteristics, type of vaccine, type of anticipated affect, participant characteristics, methodology and main results. Data will be extracted using a customised extraction template on Covidence. The findings will be synthesised in a descriptive, narrative review.

ETHICS AND DISSEMINATION

This work does not warrant any ethical or safety review. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.

Measles Vaccination and Outbreaks in Croatia from 2001 to 2019; A Comparative Study to Other European Countries

Due to the current burden of COVID-19 on public health institutions, increased migration and seasonal touristic traveling, there is an increased risk of epidemic outbreaks of measles, mumps and rubella (MMR). The aim of the present study was to analyze the epidemiological data on MMR immunization coverage and the number of measles cases in 2001−2019 in Croatia and a number of European countries. Results revealed a decreasing trend in vaccination in 2001−2019 throughout Europe. However, Croatia and Hungary still have the highest primary and revaccination coverage, compared to other analyzed countries. The highest number of measles cases was in 2017 in Romania. There was no significant correlation between the percentage of primary vaccination and the number of measles cases (r = −0.0528, p = 0.672), but there was a significant negative correlation between the percentage of revaccination and the number of measles cases (r = −0.445, p < 0.0001). In conclusion, the results of the present study emphasize the necessity to perform a full protocol of vaccination to reach appropriate protection from potential epidemic outbreaks. Furthermore, in the light of present migrations, documenting the migrants’ flow and facilitating vaccination as needed is of utmost importance to prevent future epidemics.

Trust and experiences of National Health Service healthcare do not fully explain demographic disparities in coronavirus vaccination uptake in the UK: a cross-sectional study

OBJECTIVE

To test whether demographic variation in vaccine hesitancy can be explained by trust and healthcare experiences.

DESIGN

Cross-sectional study.

SETTING

Data collected online in April 2021.

PARTICIPANTS

Data were collected from 4885 UK resident adults, of whom 3223 had received the invitation to be vaccinated against the novel coronavirus and could therefore be included in the study. 1629 included participants identified as female and 1594 as male. 234 identified as belonging to other than white ethnic groups, while 2967 identified as belonging to white ethnic groups.

PRIMARY AND SECONDARY OUTCOME MEASURES

Uptake of coronavirus vaccination.

RESULTS

Membership of an other than white ethnic group (adjusted OR (AOR)=0.53, 95% CI 0.35 to 0.84, p=0.005) and age (AOR=1.61, 95% CI 1.39 to 1.87, p<0.001 for a 1 SD change from the mean) were the only statistically significant demographic predictors of vaccine uptake. After controls for National Health Service (NHS) healthcare experiences and trust in government, scientists and medical professionals, the effect associated with membership of an other than white ethnic group appears more marginal (AOR=0.61, 95% CI 0.38 to 1.01, p=0.046), while the effect associated with age remains virtually unchanged. Exploratory analysis suggests that NHS healthcare experiences mediate 24% (95% CI 8% to 100%, p=0.024) of the association between ethnicity and uptake, while trust mediates 94% (95% CI 56% to 100%, p=0.001) of the association between NHS healthcare experiences and uptake.

CONCLUSIONS

Members of other than white ethnic groups report inferior NHS healthcare experiences, potentially explaining their lower reported trust in government, scientists and medical professionals. However, this does not fully explain the ethnic gap in coronavirus vaccination uptake.

Evolving measles status and immunization policy development in six European countries

Developing and implementing new immunization policies in response to shifting epidemiology is a critical public health component. We adopted a mixed-methods approach (via narrative literature review [101 articles] and 9 semi-structured interviews) to evaluate policy development in response to shifting measles epidemiology in six European countries (Italy, Belgium, Germany, Romania, UK, and Ukraine); where policies and strategies have evolved in response to country-specific disease and vaccination patterns. Periodic outbreaks have occurred in all countries against a background of declining measles-containing-vaccine (MCV) uptake and increasing public vaccine hesitancy (with substantial regional or social differences in measles burden and vaccine uptake). Health-care worker (HCW) vaccine skepticism is also seen. While many outbreaks arise or involve specific susceptible populations (e.g., minority/migrant communities), the broader pattern is spread to the wider (and generally older) population; often among incompletely/non-vaccinated individuals as a legacy of previous low uptake. Immunization policy and strategic responses are influenced by political and social factors, where public mistrust contributes to vaccine hesitancy. A strong centralized immunization framework (allied with effective regional implementation and coherent political commitment) can effectively increase uptake. Mandatory vaccination has increased childhood MCV uptake in Italy, and similar benefits could be anticipated for other countries considering vaccine mandates. Although possible elsewhere, socio-political considerations render mandating impractical in other countries, where targeted immunization activities to bolster routine uptake are more important. Addressing HCW skepticism, knowledge gaps, improving access and increasing public/community engagement and education to address vaccine hesitancy/mistrust (especially in communities with specific unmet needs) is critical.

Readability assessment of vaccine information: A systematic review for addressing vaccine hesitancy

OBJECTIVE

Vaccine hesitancy is a problem attracting growing attention and concern. Communication can be an effective tool to counteract vaccine hesitancy and promote optimal vaccine uptake. Readability has been recognized as one of the more important aspects of health communication for achieving good health literacy. We reviewed studies of readability assessment in the area of vaccine communication.

METHODS

We conducted a systematic literature search in September 2020, using four online databases (Medline, CINAHL, PsycArticles, and PsycINFO). We included studies that assessed the readability level of online and offline vaccine information materials.

RESULTS

We found 12 articles that were appropriate for inclusion. Ten of the studies were published after 2016. The readability levels of the majority of the materials assessed were found to be difficult and higher than 8th-grade level.

CONCLUSION

Readability assessments of vaccine information are scarce. The limited evidence shows that the readability level of vaccine information supplied by health care providers is more difficult to read than recommended. More studies on the readability of vaccine information are recommended.

PRACTICE IMPLICATIONS

Difficulty reading vaccine information may influence attitudes toward acceptance of or hesitancy to take vaccines. It is recommended that health care professionals use guidelines and tools to create easy-to-read vaccine information.

The impact of misinformation on the COVID-19 pandemic

Since the inception of the current pandemic, COVID-19 related misinformation has played a role in defaulting control of the situation. It has become evident that the internet, social media, and other communication outlets with readily available data have contributed to the dissemination and availability of misleading information. It has perpetuated beliefs that led to vaccine avoidance, mask refusal, and utilization of medications with insignificant scientific data, ultimately contributing to increased morbidity. Undoubtedly, misinformation has become a challenge and a burden to individual health, public health, and governments globally. Our review article aims at providing an overview and summary regarding the role of media, other information outlets, and their impact on the pandemic. The goal of this article is to increase awareness of the negative impact of misinformation on the pandemic. In addition, we discuss a few recommendations that could aid in decreasing this burden, as preventing the conception and dissemination of misinformation is essential.

Vaccine hesitancy in Western and Eastern Europe: The significance of contextual influences

Using the example of Eastern and Western Europe, the paper points out the importance of contextual influences on decisions and behaviour regarding vaccines and vaccination. Contextual determinants have been identified as important in theorizing the concept of vaccine hesitancy that allows for a comprehensive understanding of the reasons why the public questions vaccines. Therefore, the paper first presents the theoretical elaboration of the aforementioned concept, and then discusses the contextual influences on vaccine hesitancy within the European region in order to showcase the differences that exist in this respect between Western and Eastern Europe, as well as between certain minority communities and the majority population in some Western European countries. In all cases, vaccine hesitancy appears to be a matter of trust which has been further eroded by social, political and economic experiences characteristic for the post-socialist context in Eastern Europe and the conditions in which some minority communities live in Western Europe. The theoretical framework of the concept of vaccine hesitancy is presented according to the report of the SAGE Working Group on Vaccine Hesitancy, while the presentation of contextual determinants is based on the results of quantitative and qualitative research in different European countries and reviews of studies that focus on these influences.

Multi-perspectives systematic review on the applications of sentiment analysis for vaccine hesitancy

A substantial impediment to widespread Coronavirus disease (COVID-19) vaccination is vaccine hesitancy. Many researchers across scientific disciplines have presented countless studies in favor of COVID-19 vaccination, but misinformation on social media could hinder vaccination efforts and increase vaccine hesitancy. Nevertheless, studying people's perceptions on social media to understand their sentiment presents a powerful medium for researchers to identify the causes of vaccine hesitancy and therefore develop appropriate public health messages and interventions. To the best of the authors' knowledge, previous studies have presented vaccine hesitancy in specific cases or within one scientific discipline (i.e., social, medical, and technological). No previous study has presented findings via sentiment analysis for multiple scientific disciplines as follows: (1) social, (2) medical, public health, and (3) technology sciences. Therefore, this research aimed to review and analyze articles related to different vaccine hesitancy cases in the last 11 years and understand the application of sentiment analysis on the most important literature findings. Articles were systematically searched in Web of Science, Scopus, PubMed, IEEEXplore, ScienceDirect, and Ovid from January 1, 2010, to July 2021. A total of 30 articles were selected on the basis of inclusion and exclusion criteria. These articles were formed into a taxonomy of literature, along with challenges, motivations, and recommendations for social, medical, and public health and technology sciences. Significant patterns were identified, and opportunities were promoted towards the understanding of this phenomenon.

COVID-19 Vaccine Hesitancy among Italian University Students: A Cross-Sectional Survey during the First Months of the Vaccination Campaign

Achieving high levels of vaccination coverage against COVID-19 may be hindered by vaccine hesitancy. We quantified over time the prevalence of COVID-19 vaccine hesitancy among university students, investigated its determinants, and analyzed student attitudes, risk perceptions and compliance with preventive measures. The survey was administered online from 1 March to 30 June 2021. A multivariable logistic regression model was built to identify predictors of hesitancy. Overall, we collected 5369 questionnaires that were grouped into three survey periods (March, April-May, and May-June). The response rate ranged from 81.2% to 76.4%, whereas vaccine hesitancy ranged from 22% to 29%. Multivariable analysis showed that April-May participants had higher odds of hesitancy than March respondents. Other positive predictors were being male, not being a healthcare student, having a lower academic level, and not disclosing a political position. Conversely, higher levels of perceived COVID-19 severity, concern for the emergency, confidence in vaccine safety and effectiveness, and self-reported adherence to mask wearing indoors and outdoors were negatively associated with hesitancy. We found that vaccine hesitancy changed over time and in relation to several factors. Strategies aimed at increasing the students' awareness and engagement, restoring confidence in health authorities, and limiting disinformation around the vaccines should be devised.

Bereitschaft zur Impfung mit einem COVID‑19-Vakzin – Risikoeinschätzung, Impferfahrungen und Einstellung zu Behandlungsverfahren

Hintergrund

Impfungen stellen eine bedeutende Präventionsmaßnahme dar. Grundlegend für die Eindämmung der Coronapandemie mittels Durchimpfung der Gesellschaft ist eine ausgeprägte Impfbereitschaft.

Ziel der Arbeit

Die Impfbereitschaft mit einem COVID‑19-Vakzin (Impfstoff gegen das Coronavirus) und deren Einflussfaktoren werden anhand einer Zufallsstichprobe der Gesamtbevölkerung in Deutschland untersucht.

Material und Methoden

Die Studie basiert auf einer telefonischen Zufallsstichprobe und berücksichtigt ältere und vorerkrankte Personen ihrem Bevölkerungsanteil entsprechend. Die Ein-Themen-Bevölkerungsbefragung zur Impfbereitschaft (n = 2014) wurde im November/Dezember 2020 durchgeführt.

Ergebnisse

Die Impfbereitschaft in der Stichprobe liegt bei rund 67 %. Vorerfahrungen mit Impfungen moderieren die Impfbereitschaft. Sie steigt bei Zugehörigkeit zu einer Risikogruppe. Der Glaube an die Wirksamkeit alternativer Heilmethoden und Befürwortung alternativer Behandlungsverfahren geht mit geringerer Impfbereitschaft einher. Ältere Menschen sind impfbereiter, kovariierend mit ihrer Einschätzung höherer Gefährdung bei Erkrankung. Ebenso ist die Ablehnung einer Impfung mit der Überschätzung von Nebenwirkungen assoziiert.

Schlussfolgerung

Die Impfbereitschaft hängt mit Impferfahrungen und Einstellungen zu Gesundheitsbehandlungsverfahren allgemein zusammen. Die Überschätzung der Häufigkeit ernsthafter Nebenwirkungen bei Impfungen weist auf weit verbreitete Fehlinformationen hin.

Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews

INTRODUCTION

Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool.

METHODS

We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions.

RESULTS

We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence.

CONCLUSIONS

A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.

Explicit and Intrinsic Intention to Receive COVID-19 Vaccination among Heterosexuals and Sexual Minorities in Taiwan

The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through a Facebook advertisement. The participants' explicit and intrinsic intentions to receive COVID-19 vaccination and their risk perception of COVID-19 were measured. We discovered that sexual minority individuals had higher levels of explicit and intrinsic intention to receive vaccination relative to heterosexual individuals. Intrinsic intention was positively associated with explicit intention after the effects of demographic characteristics and risk perception of COVID-19 were controlled for. Sexual orientation did not moderate the association between explicit and intrinsic intentions. The present study determined the relationship between sexual orientation and intention to receive COVID-19 vaccination.

Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review

Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.

Vaccine hesitancy in migrant communities: a rapid review of latest evidence

By refusing or delaying vaccination, vaccine hesitant individuals and communities undermine the prevention, and ultimately, elimination of communicable diseases against which safe and effective vaccines are available. We reviewed recent evidence of vaccine hesitancy within migrant communities in the context of increased human mobility and widespread anti-immigrant sentiment and manifest xenophobia. Among many immigrant parents and families, vaccine hesitancy is largely associated with fears and misinformation about vaccine harms, limited knowledge of both preventable diseases and vaccines, distrust of host countries' health systems and their attendant intentions, language barriers, and perceived incompatibility between vaccine uptake and migrants' religion. Hesitancy toward measles, influenza, and human papillomavirus vaccines are most discernible, and main migrant populations involved include Somalis and Poles.

Seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants in Spain

BACKGROUND

Updated seroprevalence studies of infections in migrants may aid the design of tailored vaccination and prevention programmes. The objective of this study was to describe the seroprevalence rates for potentially transmissible viral infections in migrants attended at a referral centre in a major European city.

METHODS

Descriptive analysis of seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants attended at a centre in Madrid, Spain (2018-19). Recorded variables included age, gender, country of birth/continent of origin, time from arrival to Spain until first clinic visit, rubella, measles, mumps, varicella (VZV), hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis C virus (HCV) and HIV serology.

RESULTS

In total, 468 patients were included, 135 females (28.8%) and 333 males (71.2%), mean age 30.4 years. The majority of patients were from Africa (52.5%, of which 88.2% from sub-Saharan Africa), followed by Latin America (38.5%) and other areas (9%). Seroprevalence for tested migrants for rubella, measles and mumps was < 95% in the group overall (91% rubella, 88% measles, 83% mumps) and lower rates were observed in migrants >20 years (compared with those ≤ 20 years). Over 10% of females were potentially susceptible (negative/indeterminate serology) to rubella (11.4%), measles (12.7%) or mumps (10.3%). Lowest rates of rubella seropositivity were in Latin American migrants (over 12% potentially susceptible); measles and mumps seropositivity was lowest in migrants from areas other than Africa/Latin America (74% and 68%, respectively). Seroprevalence rates were 91% for VZV, 90% overall for HAV, ~6% for HBV chronic infection (~50% of migrants tested susceptible), 2% for HCV and 6% for HIV.

CONCLUSIONS

Differences in seroprevalence for vaccine-preventable and transmissible infections according to gender, age range and area of origin were observed. Tailored screening, vaccination and prevention strategies in potentially vulnerable migrant groups should be designed.

Impact of COVID-19 and intensive care unit capacity on vaccination support: Evidence from a two-leg representative survey in the United Kingdom

Background

Overcoming coronavirus disease (COVID-19) will likely require mass vaccination. With vaccination scepticism rising in many countries, assessing the willingness to vaccinate against COVID-19 is of crucial global health importance.

Objective

The goal of this study was to examine how personal and family COVID-19 risk and ICU (intensive care unit) availability just before the pandemics influence the acceptance of future COVID-19 vaccines.

Methods

A two-leg survey was carried out for comparing vaccination attitudes pre-and post-COVID-19. UK residents were surveyed in October 2019 about their vaccination attitudes, and again in a follow-up survey in April 2020, containing the previous questions and further ones related to COVID-19 exposure and COVID-19 vaccine attitudes. The study combined survey results with local COVID-19 incidence and pre-COVID-19 measures of ICU capacity and occupancy. Regression analysis of the impact of individual and public health factors on attitudes towards COVID-19 vaccination was performed.

Results

The October 2019 survey included a nationally representative sample of 1653 UK residents. All of them were invited for the follow-up survey in April 2020, and 1194 (72%) participated. The April 2020 sample remained nationally representative. Overall, 85% of respondents (and 55% of vaccine sceptics) would be willing to be vaccinated against COVID-19. Higher personal and family risk for COVID-19 was associated with stronger COVID-19 vaccination willingness, whereas low pre-COVID-19 ICU availability was associated with lower trust in medical experts and lower COVID-19 vaccine support. Further, general vaccination support has risen during the COVID-19 pandemic.

Conclusion

Support for COVID-19 vaccination is high amongst all groups, even vaccine sceptics, boding well for future vaccination take-up rates. Vaccination willingness is correlated with health care availability during the COVID-19 crisis, suggesting a powerful synergy between health care system performance during crisis and the general population's trust in the medical profession - as reflected in vaccination support.

MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review

This review critically assesses the body of research about Measles-Mumps-and-Rubella (MMR) vaccine attitudes and uptake in the United Kingdom (UK) over the past 10 years. We searched PubMed and Scopus, with terms aimed at capturing relevant literature on attitudes about, and uptake of, the MMR vaccine. Two researchers screened for abstract eligibility and after de-duplication 934 studies were selected. After screening, 40 references were included for full-text review and thematic synthesis by three researchers. We were interested in the methodologies employed and grouped findings by whether studies concerned: (1) Uptake and Demographics; (2) Beliefs and Attitudes; (3) Healthcare Worker Focus; (4) Experimental and Psychometric Intervention; and (5) Mixed Methods. We identified group and individual level determinants for attitudes, operating directly and indirectly, which influence vaccine uptake. We found that access issues, often ignored within the public "anti-vax" debate, remain highly pertinent. Finally, a consistent theme was the effect of misinformation or lack of knowledge and trust in healthcare, often stemming from the Wakefield controversy. Future immunisation campaigns for children, including for COVID-19, should consider both access and attitudinal aspects of vaccination, and incorporate a range of methodologies to assess progress, taking into account socio-economic variables and the needs of disadvantaged groups.

A study of ethnic, gender and educational differences in attitudes toward COVID-19 vaccines in Israel - implications for vaccination implementation policies

Background

Vaccines for COVID-19 are currently available for the public in Israel. The compliance with vaccination has differed between sectors in Israel and the uptake has been substantially lower in the Arab compared with the Jewish population.

Aim

To assess ethnic and socio-demographic factors in Israel associated with attitudes towards COVID-19 vaccines prior to their introduction.

Methods

A national cross-sectional survey was carried out In Israel during October 2020 using an internet panel of around 100,000 people, supplemented by snowball sampling. A sample of 957 adults aged 30 and over were recruited of whom 606 were Jews (49% males) and 351 were Arabs (38% males).

Results

The sample of Arabs was younger than for the Jewish respondents. Among the men, 27.3% of the Jewish and 23.1% of the Arab respondents wanted to be vaccinated immediately, compared with only 13.6% of Jewish women and 12.0% of Arab women. An affirmative answer to the question as to whether they would refuse the vaccine at any stage was given by 7.7% of Jewish men and 29.9% of Arab men, and 17.2% of Jewish women and 41.0% of Arab women. Higher education was associated with less vaccine hesitancy. In multiple logistic regression analysis, the ethnic and gender differences persisted after controlling for age and education. Other factors associated with vaccine hesitancy were the belief that the government restrictions were too lenient and the frequency of socializing prior to the pandemic.

Conclusions

The study revealed a relatively high percentage reported would be reluctant to get vaccinated, prior to the introduction of the vaccine. This was more marked so for Arabs then Jews, and more so for women within the ethnic groups. While this was not a true random sample, the findings are consistent with the large ethnic differences in compliance with the vaccine, currently encountered and reinforce the policy implications for developing effective communication to increase vaccine adherence. Government policies directed at controlling the pandemic should include sector-specific information campaigns, which are tailored to ensure community engagement, using targeted messages to the suspected vaccine hesitant groups. Government ministries, health service providers and local authorities should join hands with civil society organizations to promote vaccine promotion campaigns.

Measles epidemic in pediatric population in Greece during 2017-2018: Epidemiological, clinical characteristics and outcomes

Background and aim

A measles outbreak occurred in Greece during 2017–2018 affecting mainly pediatric population. The aim of the study was to describe the epidemiological and clinical characteristics of the cases diagnosed in the major pediatric tertiary hospital of Athens, where 26.5% of national pediatric measles cases were diagnosed and treated.

Methods

This is a retrospective study of children 0–16 years old, who presented at the emergency department and/or were hospitalized with clinical presentation compatible with measles and diagnosis was confirmed with molecular detection of the measles RNA in pharyngeal swabs. Epidemiological, clinical and laboratory characteristics were retrieved from medical records and analyzed.

Results

A total of 578 children with measles were identified during the study period. 322 (55.7%) were male with median age 36 months (range:1–193), while the largest number of documented cases (251; 43.4%) were children aged 1–5 years. Most children (429/578; 74.2%) belonged to the Roma minority and only 64 (11.1%) had Greek origin. 497 (91.5%) children were unvaccinated and 37 (6.8%) were partially vaccinated with measles vaccine. Hospitalization was required for 342 (59.2%) children, whereas one or more complications were reported in 230 (67.2%) of them. Most frequent complications were elevated transaminases (139; 40.6%), acute otitis media (72; 21%), dehydration (67; 19.6%) and pneumonia (58; 16.9%). 11 children (3.2%) required intensive care admission for altered mental status/status epilepticus (3), sepsis (2) and ARDS (6). 119/342 (34.8%) children were treated with antibiotics because of possible or confirmed bacterial coinfection. One death was reported, concerning an 11-month-old unvaccinated infant, with underlying dystrophy, who died of sepsis.

Conclusion

Measles is not an innocent viral infection, as it is still characterized by high morbidity and complications rates. Unvaccinated or partially vaccinated populations could trigger new outbreaks, resulting in significant cost in public health. To avoid future measles outbreaks, high vaccination coverage should be achieved, as well as closing immunity gaps in the population and ensuring high-quality measles surveillance.

Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies

A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.

Vaccine Hesitancy and Demand for Immunization in Eastern Europe and Central Asia: Implications for the Region and Beyond

Immunization is a global success story. It has saved millions of lives and prevented disease worldwide and millions more have been spared the permanent disabilities caused by diseases such as polio and the long-term morbidity caused by other diseases such as measles. Despite the compelling evidence of the public health and economic value of vaccines, vaccine hesitancy has become a growing concern globally. By calling into question the safety and efficacy of vaccines, vaccine hesitancy threatens the progress made in combating morbidity and mortality including efforts to introduce COVID-19 vaccines. This paper a) examines key factors that drive limited demand for vaccines and vaccine hesitancy, (b) highlights the role of demand promotion for immunization and of risk communication and community engagement to address those challenges, (c) discusses vaccine demand and hesitancy in Eastern Europe and Central Asia, and (d) makes recommendations for public health policy and programming for the introduction of the COVID-19 vaccine and beyond.Recommendations include strengthen social listening and digital engagement to address the concerns of caregivers and healthcare professionals, improve the availability and use of social data for evidence-based programming, reinforce public trust in health institutions and service providers, mainstream demand for immunization, strengthen the communication competencies of health service providers, test and apply solutions based on behavioral insights to reinforce demand, engage regularly with local governments and local actors, and strengthen resilience and response capacities for diseases outbreaks and public health emergencies.

The relationship between parental source of information and knowledge about measles / measles vaccine and vaccine hesitancy

OBJECTIVES

Based on the hypothesis that sources of information might affect knowledge and vaccine acceptance, our objectives were to study parental characteristics and sources of information regarding measles/measles vaccine, its relationship to correct knowledge and to administration of the measles vaccine.

BACKGROUND

Although measles eradication is potentially achievable, in 2018-2019 a worldwide resurgence of measles and measles-caused deaths occurred. The main driver was incomplete or no vaccination, designated as vaccine hesitancy (VH).

METHODS

A cross-sectional survey of 399 individuals dispersed all over the country was conducted. Research assistants interviewed parents with a 20-question survey which was previously validated. The questionnaire included four sections: demographics, major sources of information on measles/measles vaccine, knowledge about measles/measles vaccine, and status of child's vaccination. Univariate and multivariate analyses explored associations between correct knowledge and VH.

RESULTS

The majority of respondents were between the ages of 25-39 (62%). Of these, 309 (77%) vaccinated their children against measles on time, 32 (8%) vaccinations were incomplete, and 58 (15%) did not vaccinate, for a total VH of 23%. Parents < 30 years-old and those with a single-child vaccinated less frequently (p < 0.001 and p = 0.002, respectively). Internet and social-media were the major source of information for 32% regarding measles/measles vaccine and for 49% regarding the measles outbreak; both sources were negatively associated with correct knowledge (p < 0.001). In the multivariate analysis, knowledge was independently associated with timely vaccine administration (p < 0.001) and internet or social-media as sources with higher VH (OR 2.52, 95%CI 1.18-5.37 and OR 2.44, 95%CI 1.01-5.91, respectively).

CONCLUSIONS

Social-media and internet are a common source of information on measles/measles vaccine (probably on other vaccines as well), and often associated with incorrect knowledge, which relates significantly to VH. Healthcare professionals should be aware of this prevailing behavior and respond accordingly in these platforms, with the aid of experts in social-networking.

Are the Objectives Proposed by the WHO for Routine Measles Vaccination Coverage and Population Measles Immunity Sufficient to Achieve Measles Elimination from Europe?

Background: The World Health Organization (WHO) proposed two-dose measles vaccination coverage of at least 95% of the population and percentages of measles immunity in the population of 85%−95% in order to achieve measles elimination in Europe. The objectives of this study were: (1) to determine the measles vaccination coverage required to establish herd immunity against measles viruses with basic reproduction numbers (Ro) ranging from 6 to 60, and (2) to assess whether the objectives proposed by the WHO are sufficient to establish herd immunity against measles viruses. Methods: The herd immunity effects of the recommended objectives were assessed by considering the prevalence of protected individuals required to establish herd immunity against measles viruses with Ro values ranging from 6 to 60. Results: The study found that percentages of two-dose measles vaccination coverage from 88% to 100% could establish herd immunity against measles viruses with Ro from 6 to 19, assuming 95% measles vaccination effectiveness. The study found that the objective of 95% for two-dose measles vaccination coverage proposed by the WHO would not be sufficient to establish herd immunity against measles viruses with Ro ≥ 10, assuming 95% measles vaccination effectiveness. By contrast, a 97% measles vaccination coverage objective was sufficient to establish herd immunity against measles viruses, with Ro values from 6 to 13. Measles immunity levels recommended in individuals aged 1−4 years (≥85%) and 5−9 years (≥90%) might not be sufficient to establish herd immunity against most measles viruses, while those recommended in individuals aged 10 or more years (≥95%) could be sufficient to establish herd immunity against measles viruses with Ro values from 6 to 20. Conclusion: To meet the goal of measles elimination in Europe, it is necessary to achieve percentages of two-dose measles vaccination coverage of at least 97%, and measles immunity levels in children aged 1−9 years of at least 95%.

Implementation of the Greek national immunization program among nursery attendees in the urban area of Thessaloniki

BACKGROUND

The growing phenomenon of vaccine hesitancy and the severe economic crisis may have affected compliance with the National Immunization Program (NIP) in Greece over the last years. We investigated compliance with the NIP among children attending nurseries in the urban area of Thessaloniki.

METHODS

A cross-sectional study was conducted, including nursery attendees born between 01/01/2014-01/10/2015 in each of the municipalities of Thessaloniki urban area. Public and private nurseries were randomly selected. Immunization data were anonymously collected from the child's health booklet. Both coverage and timeliness of immunization were recorded for all recommended vaccines according to the NIP.

RESULTS

In total, 432 children with a mean age of 2.9 years were studied, of which 245 (57 %) were attending private nurseries. Full coverage was >90 % for most of the recommended vaccines except for pneumococcal (81 %), meningococcal serogroup C (68.3 % and 82 % for 2011 and 2015 schedule, respectively), hepatitis A (38.9 %) and rotavirus (25.9%) vaccine. Delay rates for one or more doses ranged between 21-90.3 % for all vaccines; time of median delay ranged between 3.8-6.7 months. Lower coverage and higher delay rates were observed for Roma children.

CONCLUSIONS

While high coverage appears to be sustained for most of the recommended vaccines, delay of scheduled shots may compromise age-appropriate protection. Suboptimal immunization against pneumococcal, meningococcal serogroup C, hepatitis A, and rotavirus infections may increase morbidity in this age group and needs to be addressed. HIPPOKRATIA 2019, 23(4): 147-153.