Experts' opinion for improving global adolescent vaccination rates: a call to action

Meningococcal Vaccination of Adolescents in the United States: Past Successes and Future Considerations

Invasive meningococcal disease (IMD) is a rare but serious illness, and adolescents and young adults in the United States are at increased risk. Here, we discuss US IMD history and how successful disease prevention through routine vaccination against the most common disease-causing serogroups (A, B, C, W, and Y) can inform future recommendations. Before the introduction of quadrivalent meningococcal conjugate (MenACWY) vaccines, most US cases of IMD were caused by serogroups B, C, and Y. After recommendation by the Advisory Committee on Immunization Practices for routine MenACWY vaccination of 11-12-year-olds in 2005, followed by a 2010 booster recommendation, MenCWY disease incidence declined dramatically, and vaccine coverage remains high. Two serogroup B (MenB) vaccines are licensed in the United States, but uptake is low compared with MenACWY vaccines, likely because Advisory Committee on Immunization Practices recommends MenB vaccination subject to shared clinical decision-making rather than routinely for all adolescents. The proportion of adolescent IMD caused by MenB has now increased. Pentavalent vaccines that protect against serogroups A, B, C, W, and Y may provide an optimal strategy for improving vaccination rates to ultimately reduce MenB incidence while maintaining the historically low rates of IMD caused by serogroups A, C, W, and Y.

Vaccine Conspiracy Beliefs Scale: Validation and Measurement Invariance in a Youth Sample

The Vaccine Conspiracy Beliefs Scale (VCBS) is a widely used measure of conspiracy beliefs about vaccines, but evidence of its validity and measurement invariance, especially in youth samples, is still largely missing. The present study examined VCBS scores' factor structure, measurement invariance, convergent and discriminant validity, and incremental predictive validity. A sample of 803 Serbian youths (age range 15-24; 59.2% females) was recruited for the study. A modified single-factor model of the VCBS was supported, and showed evidence of full scalar invariance across gender, age, vaccination status, and personal history of COVID-19. Evidence of the VCBS scores' convergent and discriminant validity was obtained by examining associations with general conspiracy beliefs, vaccination attitudes, vaccination knowledge, intentions to get vaccinated against COVID-19, paranoia worries, fear of injections and blood draws, importance of God, self-rated health, and self-rated family's financial situation. The VCBS scores predicted a unique variance in the intention to get vaccinated against COVID-19, over and above vaccination attitudes and vaccination knowledge. The results suggest that the VCBS is a valid measure of vaccine conspiracy beliefs in youth.

Vaccination Attitudes Examination (VAX) Scale: a Bifactor-ESEM approach in a youth sample (15-24 years)

BACKGROUND

The Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX's structural, convergent, and discriminant validity is still limited, especially in youth samples.

METHODS

The present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (Mage = 18.23, SDage = 2.66, age range = 15-24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria.

RESULTS

The results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors' contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry.

CONCLUSIONS

The present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes.

Human papillomavirus vaccine communication materials for young people in English-speaking countries: A content analysis

OBJECTIVE

To undertake a content analysis of human papillomavirus (HPV) vaccine communication materials available to young people.

DESIGN

Content analysis.

SETTING

Majority English-speaking countries.

METHODS

Between March and April 2020, a web engine was utilised to search for and retrieve relevant communication materials. Content analysis was used to describe how the following key issues were covered: (1) side effects, (2) safety, (3) practicalities related to receiving the HPV vaccine and (4) gender-specific information.

RESULTS

A total of 44 separate communication materials were retrieved, predominantly videos, webpages and leaflets. There was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%) and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%).

CONCLUSION

A variety of different communication tools were retrieved encompassing a wide variety of formats and content, reflective of different vaccination programmes and the varied priorities of organisations producing the materials. Findings will inform the co-production of a tailored educational package to improve access to information by populations of young people identified as having lower HPV vaccine uptake.

[Vaccination Gaps of Employees in Institutions of Preschool Childcare before Introduction of the Measles Protection Act]

AIM OF THE STUDY

The measles protection act and the updated recommendations of the permanent commission of vaccination (STIKO) include the obligatory proof of a double vaccination against measles for employees (born after 1970) in childcare. In addition, the standard and professional recommendations for vaccinations should be respected. A retrolective evaluation of vaccination gaps of employees in institutions for preschool childcare was performed.

METHODS

The database of 2018 and 2019 of the B·A·D-Health center Erlangen have 1300 recorded cases of occupational medical consultations in preschool childcare. Double consultations and consultations with insufficient data were excluded. 1016 contacts were analyzed with regard to vaccination gaps of measles, mumps, rubella, varicella, pertussis, hepatitis A+B and early summer meningoencephalitis. The evaluation was primarily based on the employees' vaccination cards. Vaccination gaps were assumed in case of missing, commenced or incomplete vaccination protection.

RESULTS

In this cohort of 1016 employees, the vaccination gap for measles increased from 16.2% to 20.6%, when applying the updated STIKO recommendation and the resulting change of definition of complete vaccination protection from measles. Further gaps were 22.7% for mumps, 18.9% for rubella, 2.3% for varicella, 27.8% for pertussis, 61.1% for hepatitis A and 60.5% and tick-borne encephalitis. The age group <30 years showed less vaccination gaps than the age group ≥30 years.

CONCLUSION

The evaluation of the health center in Erlangen showed considerable age-dependent vaccination gaps in the cohort of employees of preschool childcare. The measles protection act that makes vaccination against measles mandatory contributes to closing this gap. There is room for counselling as well as for action regarding vaccine-preventable diseases in occupational medicine.

COVID Vaccines in Adolescents and Young Adults

Worldwide, a number of COVID-19 vaccines have been approved or granted Emergency Use Authorization (EUA) or Emergency Use Listing for adolescents and young adults (AYA), which has brought hope to many across the globe. Extension of the EUA for a COVID-19 vaccine to children and adolescents aged 5 through 15 years is exciting news for children, adolescents, parents, and providers of AYA. Many countries around the globe have extended immunization against COVID-19 to younger age groups. At the same time, the COVID-19 pandemic has led to a decrease globally in administration of other adolescent vaccines. This highlights that vaccine recommendations do not necessarily lead to successful and equitable vaccine distribution, and overcoming barriers to vaccination is critical. Certain subpopulations of AYA, particularly those who are marginalized/underrepresented, do not receive appropriate health care. AYA should be offered protection against all vaccine-preventable illnesses at every opportunity. Creating innovative strategies to improve vaccine uptake among AYA should be encouraged.

Prevalence and risk factors associated with rural women's protected against tetanus in East Africa: Evidence from demographic and health surveys of ten East African countries

Background

Tetanus is a deadly bacterial infection caused by Clostridium tetani wound contamination characterized muscular spasms and autonomic nervous system dysfunction. Maternal and neonatal tetanus occurs under improper hygiene practices during childbirth. Globally, an estimated 3.3 million newborn deaths occur every year, and about 9,000 babies die every day in the first 28 days of life. This study sought to identify risk factors associated with the immunization of rural women against tetanus in rural areas in ten East African countries.

Method

The data used in this study were taken from the Demographic and Health Survey (DHS) of ten East African countries (Ethiopia, Burundi, Comoros, Zimbabwe, Kenya, Malawi, Ruanda, Tanzania, Uganda and, Zambia). Multivariable binary logistic regression is used to determine the risk factors associated with tetanus-protected women in east Africa.

Results

The weighted total samples of 73735 rural women were included in the analysis. The combined prevalence of tetanus immunization among protected rural women in ten East African countries was 50.4%. Those women with age of 24–34 (AOR = 0.778; 95%CI: 0.702–0.861), higher educational level (AOR = 4.010; 95%CI: 2.10–5.670), rich women (AOR = 3.097;95%CI: 2.680–3.583), mass media coverage (AOR = 1.143; 95%CI: 1.030–1.269), having above three antenatal care follow up (AOR = 1.550; 95% CI: 1.424–1.687), big problem of distance to health facility (AOR = 0.676; CI: 0.482–0.978) and place of delivery health facility (AOR = 1.103; 95% CI: 1.005–1.210) had a significant effect on women’s protected from tetanus.

Conclusion

The coverage of tetanus immunization in East Africa was very low. Public health programs target rural mothers who are uneducated, poor households, longer distances from health facilities, mothers who have the problem of media exposure, and mothers who have not used maternal health care services to promote TT immunization.

Crisis of confidence in vaccination and the role of social media

INTRODUCTION

The aim of this paper is to review the current situation of vaccine hesitancy, with emphasis on children with neurological disorders, and to present the role social media plays in this situation.

METHODS

A literature review using the following search words was performed: vaccine∗ OR immune∗ AND hesitancy OR confidence AND social media.

RESULTS

The search retrieved 277 results; 17 duplicates and 234 irrelevant articles were excluded. 43 articles were fully analyzed.

CONCLUSIONS

An increasing number of parents are becoming vaccine hesitant. Their motives are complex and nuanced and involve factors related to vaccine safety and efficiency, perceived personal risks and benefits, socio-demographic and psychological characteristics. Attitudes toward vaccination differ in adolescents from their parents. In children with neurological disorders, factors involved in vaccination decision included physicians' knowledge of neurological diseases and parents' concerns that vaccination would exacerbate the chronic disorder. Unfortunately, the current pandemic is associated with an increase in vaccine hesitancy and brought forward unique determinants. The social media platforms can be a tool for the anti-vaccine movement to spread misinformation, but it can also be valued as a way for promoting health and pro-vaccine information.

COVID-19 prevention behaviors, trust, and intent to vaccinate among youth at risk for HIV

The current study examines COVID-19 prevention behaviors and vaccine intentions among 83 youth at high risk for HIV. Most youth self-identified as Latinx (52%), cisgender men (84%), and homosexual (66%). Youth self-reported COVID-19 prevention behaviors and intentions to vaccinate. Participants reported wearing face masks, washing hands, and staying six feet apart, but fewer reported leaving home only for essential needs. About one-third reported that they would not get a vaccine, and lack of trust in their doctors and the government were significantly associated with non-intention. To improve efforts towards herd immunity, interventions to improve health messaging from trusted sources for at-risk youth may be necessary to achieve higher vaccine uptake.

Tanzania's human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019

BACKGROUND

In April 2018, Tanzania introduced the human papillomavirus (HPV) vaccine nationally to 14-year-old girls, utilizing routine delivery strategies (i.e. vaccinating girls at health facilities and community outreach, including schools). We sought to assess awareness, feasibility, and acceptability of the HPV vaccination program among health workers and community-level stakeholders.

METHODS

We conducted cross-sectional in-person surveys among health workers, school personnel, community leaders, and council leaders in 18 council areas across six regions of Tanzania in October-November 2019. Regions were purposively selected to provide demographic, geographic, and vaccination coverage variability; sub-regional levels used random or stratified random sampling. Surveys included questions on HPV vaccine training and knowledge, delivery strategy, target population, and vaccine and program acceptability. Descriptive analysis was completed for all variables stratified by respondent groups.

RESULTS

Across the 18 councils, there were 461 respondents, including health workers (165), school personnel (135), community leaders (143), and council leaders (18). Over half of each respondent group (50-78%) attended a training or orientation on HPV vaccine. Almost 75% of the health workers and school personnel respondent groups, and less than half (45%) of community leaders correctly identified the target age group for HPV vaccine. Most (80%) of the health workers indicated HPV vaccination was available at health facilities and schools; most (79%) indicated that the majority of girls receive HPV vaccine in school. Approximately half (52%) of all respondents reported hearing misinformation about HPV vaccine, but 97% of all respondents indicated that HPV vaccine was either "very accepted" or "somewhat accepted" in their community.

CONCLUSION

The HPV vaccination program in Tanzania was well accepted by community stakeholders in 18 councils; adequate knowledge of HPV vaccine and the HPV vaccination program was demonstrated by health workers and school personnel. However, continued technical support for integration of HPV vaccination as a routine immunization activity and reinforcement of basic knowledge about HPV vaccine in specific community groups is needed. The Tanzania experience provides an example of how this vaccine can be integrated into routine immunization delivery strategies and can be a useful resource for countries planning to introduce HPV vaccine as well as informing global partners on how to best support to countries in operationalizing their HPV vaccine introduction plans.

Factors associated with births protected against neonatal tetanus in Africa: Evidences from Demographic and health surveys of five African countries

INTRODUCTION

Maternal and neonatal tetanus remains a global public health problem affecting mainly the poorest and most marginalized subpopulations. In spite of the problem, studies conducted on the associated factors of births protected against neonatal tetanus are scarce in Africa. Therefore, this study aimed to identify both individual and community-level factors associated with births protected against neonatal tetanus in the region.

METHODS

The most recent Demographic and Health Survey datasets of five African countries (Ethiopia, Burundi, Comoros, Zimbabwe and Zambia) were used to investigate the associated factors of births protected from neonatal tetanus. STATA Version 14 statistical software was used for the analysis. The data were weighted before doing any statistical analysis and deviance was used for model comparison. Multilevel binary logistic regression was used to identify the associated factors of births protected against neonatal tetanus. Finally, the adjusted odds ratio (AOR) with its 95% confidence interval (CI) was calculated for each potential factors included in the multivariable multilevel logistic regression model.

RESULTS

A total weighted sample of 30897 reproductive age women who had a birth within 5 years preceding the survey were included in the analysis. Those women with age of 20-34 (AOR = 1.32, 95%CI: 1.18-1.48) and 35-49 years (AOR = 1.26, 95% CI: 1.10-1.44), high community level of women education (AOR = 1.13, 95%CI: 1.04-1.23), being from poorer(AOR = 1.23, 95% CI: 1.14-1.33), middle (AOR = 1.31, 95%CI: 1.21-1.43), richer (AOR = 1.21, 95%CI: 1.11-1.32) and richest households (AOR = 1.59, 95%CI: 1.44-1.74), having antenatal care follow up (AOR = 9.62, 95% CI: 8.79-10.54), not perceiving distance to health facility as a big problem (AOR = 1.18, 95% CI: (1.11-1.25) had higher odds of having births protected against neonatal tetanus.

CONCLUSION

Both individual and community level factors were found to be associated with births protected against neonatal tetanus in Africa. This suggests that a variety of factors are affecting births protected against neonatal tetanus in the region. Hence, the impact of these factors should be recognized while developing strategies to reduce neonatal tetanus in the region.

Cumulative annual coverage of meningococcal B vaccination in Australian general practice for three at-risk groups, 2014 to 2019

Neisseria meningitidis serogroup B (MenB) is the most common cause of meningococcal disease in adolescents and young adults. In Australia, MenB vaccination has been available through private prescription since 2014 and has been recommended for at-risk groups including adolescents, young adults who smoke and people medically at risk. For each of these at-risk groups, we estimated cumulative annual coverage of MenB vaccination between 2014 and 2019. We also evaluated factors associated with vaccination coverage in 2019. Our analyses used electronic health records in the national MedicineInsight database for people regularly attending general practices. Cumulative vaccination coverage increased among the at-risk groups between 2014 and 2019: from 0.09% to 1.65% for adolescents, from 0.01% to 0.15% for young adults who smoke, and from 0.35% to 12.09% for people medically at risk. However, vaccination coverage in 2019 remained very low across these groups. Data sparsity prevented the evaluation of factors associated with vaccination coverage for smokers. We observed variation in the relative risk of being vaccinated by age, sex, socioeconomic and clinical factors for adolescents and people medically at risk. Still, the absolute magnitude of coverage was low across all subgroups examined, and indicates a need for strategies to increase vaccination uptake among at-risk groups irrespective of patient and practice characteristics. Our study provides baseline data for monitoring menB vaccination uptake among recommended groups in light of limited national data, especially for medically at-risk groups.