Highly Educated Mother's Perception of Childhood Vaccination Hesitancy in Kazakhstan: A Thematic Analysis

Background

Vaccine hesitancy among parents directly affects the child's vaccination status since they are the legal decision-makers regarding vaccinating their children. The study aimed to describe the perceptions of highly educated Kazakhstani mothers about childhood vaccination hesitancy.

Methods

The study utilized a thematic analysis to explore the mothers' perceptions. A sample of 95 participants comprehensively answered the free-text questions in an online questionnaire from January to February 2023. The analysis of the free-text responses followed a semantic thematic analysis approach. The data were coded manually.

Results

From the in-depth analysis of the data, 285 initial codes were extracted. The combination of similar meanings and concept codes led to 14 sub-themes and finally yielded four significant themes: misconceptions about childhood vaccination, fear of the effect of vaccine on children, distrust of the healthcare system, and social learning factors.

Conclusion

The perceptions of Kazakh mothers about childhood vaccination hesitancy may lead to behaviors of delaying and refusing some or all childhood vaccines. Therefore, motivational and educational strategies can be used by healthcare providers to instill trust in parents about childhood vaccines and their safety and effectiveness.

A History of Smallpox Vaccination in Modern China: Vaccine Techniques, Instruments, and Localization

This paper examines how smallpox vaccination has been implemented in China from a technological perspective. It is an attempt not only to investigate the impact of technology and instruments on medical advances, but also to deepen the understanding of modern Chinese society through smallpox vaccination. Smallpox vaccination helps people develop immunity to smallpox by inoculating into them pus from cowpox which is an infectious disease that affects cows. In 1805, Alexander Pearson succeeded in smallpox vaccination using the arm-to-arm transfer method for the first time in China thanks to the arrival of the vaccine in Macao. As Pearson and Quixi, who followed in the footsteps of Pearson, used the arm-to-arm method, they did not have much interest in vaccine containers. However, the vaccine administration technique changed: the vaccine obtained from people was inoculated into cows, and then again, into people. It thus resulted in the manufacturing of various vaccine containers including glass vials and tubes. The development of tools contributed to the expansion of cowpox vaccination. In addition, cowpox vaccines were imported directly from foreign countries. Advertisements which remain to date indicate that vaccines were widely imported. Pharmacies promoted vaccines, contending that the sale and import of vaccines was for the Chinese people. On the other hand, there were voices against imported vaccines, saying that they were expensive and foreign-made. Under the banner of patriotism and nationalism, people demanded that vaccines be made in China, which led to the production of vaccines in large cities such as Shanghai and Beijing. Along with the aforementioned efforts to obtain vaccines, techniques for smallpox vaccination can also be understood in the Chinese context. For example, traditional Chinese medicine maintains that acupuncture can be used as a vaccination lancet. Since traditional Chinese medicine already embraced the use of cowpox for protection against smallpox, they advocated using acupuncture instead of western instruments in order to expand the influence of traditional Chinese medicine. The belief that inoculation should be done into acupuncture points in the upper arms shows the significant influence of traditional Chinese medicine. On the other hand, Chinese people being reluctant to leave vaccine marks show the general view of what was considered as beautiful at the time, rather than the Chinese traditional perspective. Consequently, smallpox vaccine techniques in China, while following the technological advancement in general, could not help but be adapted to the Chinese context under the influence of modern Chinese society. Thus, smallpox vaccine techniques provide clues for understanding modern Chinese society. As such, historians who conduct research mainly with literature should also take interest in medical technology and instruments as well.

Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 and Its Vaccination: A Narrative Review

Coronavirus disease 2019 (COVID-19) is a current pandemic caused by SARS-CoV-2 that has vastly affected the whole world. Although respiratory disease is the most common manifestation of COVID-19, the virus can affect multiple organs. Neurotropic aspects of the virus are increasingly unfolding, in so far as some respiratory failures are attributed to brainstem involvement. The neuro-ophthalmic manifestations of COVID-19 and the neuro-ophthalmic side effects of vaccination were reviewed. The major findings are that the SARS-CoV-2 infection commonly causes headaches and ocular pain. It can affect the afferent and efferent visual pathways by ischemic or inflammatory mechanisms. Optic nerve may be the origin of transient or permanent visual loss from papillophlebitis, idiopathic intracranial hypertension, or optic neuritis. Cerebrovascular strokes are not uncommon and may lead to cortical visual impairment or optic nerve infarction. SARS-CoV-2 may affect the pupillomotor pathways, resulting in tonic pupil (Adie's syndrome) or Horner's syndrome. Cranial neuropathies including third, fourth, sixth, and seventh nerve palsies have all been reported. Rhino-orbital mucormycosis superinfections in COVID-19 patients receiving steroids or other immunosuppressive therapies may result in unilateral or bilateral visual loss and ophthalmoplegia. Autoimmune conditions such as Guillain-Barré, Miller-Fisher syndrome, and ocular myasthenia have been reported.

[Apexxnar®, 20-valent pneumococcal conjugate vaccine]

Streptococcus pneumoniae infections cause bacteremic and non-bacteremic community-acquired pneumonia and invasive pneumococcal diseases (IPD) such as bacteremia, sepsis and acute meningitis. They are potentially lethal. Although polysaccharide vaccines (PPV23, Pneumovax 23®) have already provided protection in at-risk individuals, they have been imperfect, mainly because the development of anti-polysaccharide antibodies occurs without the help of T cells. The introduction of immunogenic protein conjugate vaccines (ICVs) has overcome this problem and provided better and longer lasting protection. The first available vaccine of this type for adults was Prevenar 13®, targeting 13 polysaccharides of S. pneumoniae (PCV13). A new vaccine, Apexxnar®, targeting 20 polysaccharides (PCV20), the 13 of Prevenar 13®, to which 7 other serotypes considered to be equally responsible for invasive infections have been added, has recently been launched. Clinical studies have demonstrated a good immunogenic response against all 20 serotypes in adult patients who are either vaccine-naive or previously vaccinated with PPV23 and/or PCV13. Furthermore, the tolerance of the PCV20 vaccine was found to be comparable to that of Prevenar 13®. Vaccination with PCV20 involves a single injection. The Belgian Superior Health Council has recently reiterated the importance of vaccinating at-risk individuals against S. pneumoniae (a vaccination that is still under-performed). It now recommends vaccination with PCV20 (Apexxnar®) as the preferred primary vaccination regimen in high-risk adults with co-morbidities or in good health aged between 65 and 85 years.

Preparation of an Inactivated Peste des Petits Ruminants Vaccine and Its Comparative Immunogenicity Evaluation in an Animal Model

Peste des petits ruminants (PPR) is a highly contagious disease that is considered a major threat to the small livestock industry. Although vaccination via live-attenuated PPR vaccine is a main controlling strategy in the endemic area, during PPR eradication process, the inactivated PPR vaccine (iPPRV) is recommended. This study aimed to compare the inactivation kinetics of the PPR virus via different inactivants and immunogenicity evaluations of the iPPRV formulated vaccine in mice. The vaccinal live PPR virus was inactivated by either H2O2 or binary ethylenimine (BEI (at two concentrations of 1 or 4 mM. Thereafter, the inactivated virus was formulated with different adjuvants, including aluminum hydroxide (AH), aluminum phosphate (AP), and a mixture of AH and AP that were intraperitoneally (IP) administrated (0.1 mL) to 90 BALB/c mice in a completely randomized design and 3×3 factorial arrangement (9 animals per group). The booster vaccination was carried out in all animals 21 days after the primary vaccination. Results showed that the PPR virus was successfully inactivated by all the inactivation agents; however, the time of complete virus inactivation was estimated to be 482, 295, and 495 min post-treatment initiation for 1 mM BEI, 4 mM BEI, and H2O2, respectively. The main effect of inactivant on antibody titers against PPR virus that was measured after 42days post-immunization in mice was significant (P<0.05); however, the adjuvant and interaction effect of inactivator×adjuvant were not effective(P>0.05). Inactivation by 1 mM BEI was associated with a higher antibody titer against PPR virus (P<0.05) in comparison with both 4 mM BEI and H2O2 (2.51 vs. 2.25 and 2.22, respectively). Meanwhile, there were no significant differences among the used adjuvants in terms of eliciting antibody response against PPR virus. In conclusion, the use of 1 mM BEI in combination of AH, AP, or a mixture of AH and AP was associated with a higher immune response against PPR virus in mice. However, the appropriate inactivation kinetic of the virus and immunogenicity associated with the use of H2O2, as well as its biocompatibility property and better cost-benefit, nominated H2O2 to be used in iPPR preparation; however, more investigations are required in target animals.

Smallpox Vaccine and Resident Responses in Modern Shanghai: Focusing on Regional and Cultural Comparison

In modern Shanghai, smallpox was one of the most threatening diseases with its mortality rate going up to 30 percent. In response to the disease, Dr. William Lockhart, a medical missionary of the London Missionary Society, introduced vaccination to the Chinese people in Shanghai. He built the first western style hospital in Shanghai, Renji Hospital, in 1843. At this time, native doctors also played a very important role. For example, Huang Chun-pu was in charge of the dispensary in the Chinese City in Shanghai, and he was the one who introduced vaccination under Dr. Lockhart's direction. In 1868, the Health Office of Shanghai Municipal Council began to implement a vaccination program. Around the turn of the 20th century, the Health Office of Shanghai Municipal Council managed several sub-district offices, hospitals, dispensaries, gaol, and even the traditional place like simiao for the free vaccinations. Urban residents benefited from a sanitary system, such as wide and free vaccination, compared to people who lived in rural areas. Moreover, Shanghai possessed the advantage of having the vaccine as a staple product of the Municipal Laboratory. The number of units of the vaccine issued from the Laboratory in sequence of years from 1898 to 1920 has been 115,351 on average. Unlike the International Settlement, where systematic inoculation was conducted under the leadership of the Municipal Council, the Chinese City was still reliant on charity organizations in the early 1900s. The foreign residence in the International Settlement had a strong influence from the foreign governments, and foreign doctors were well-aware of the need for the vaccination. However, the Chinese City was a Chinese enclave that was still under the traditional rule of the Qing Dynasty. In addition, the people of Shanghai had different perceptions of the smallpox vaccination, and this became an obstacle to the establishment of urban sanitation systems. Some Chinese people still relied on the traditional Chinese variolation and Chinese custom. For example, Chinese people still applied for inoculation in the spring and avoided summer and fall following traditional Chinese variolation, even though the best time to get vaccinated was in early winter before the spread of smallpox. In addition, foreigners were often more problematic than Chinese because they often overlooked the importance of vaccines and relied on drugs instead. The municipal authority, therefore, provided a wide range of free vaccinations for the poor and needy people regardless of their nationalities, and with such measures, sought to establish a stable urban sanitation system. This had been the key to the success of hygiene policies.

WITHDRAWN:Development of Dot Enzyme Linked Immuno Sorbent Assay Using Recombinant Hexon Protein for Detecting Antibodies to Hydropericardium Syndrome Disease Virus

Ahead of Print article withdrawn by publisher.