Pertussis vaccine for adults: Knowledge, attitudes, and vaccine receipt among adults with children in the household

Seroepidemiological Assessment of Bordetella pertussis in Jahrom, Southern Iran: A Cross-Sectional Study

Background

Bordetella pertussis, the causative agent of whooping cough, is a significant contributor to recurrent persistent cough across all age groups, including vaccinated individuals. This seroepidemiological study aims to address the gap in understanding pertussis incidence by investigating its occurrence in individuals with persistent cough and describing the characteristics of affected patients admitted to clinical centers in Jahrom, Southwest Iran.

Methods

This cross-sectional study enrolled 110 patients with a cough persisting for at least 2 weeks, admitted to clinical centers in Jahrom, Iran. Blood samples were collected at baseline and on day 21 of follow-up. Serum samples were analyzed for anti-pertussis toxin immunoglobulin G (anti-PT-IgG) levels using an enzyme-linked immunosorbent assay. Demographic factors, including age, gender, occupation, area of residence, and family size, were also evaluated.

Results

Among the 110 participants, 77 (70%) were female, and seven patients (6.4%) tested seropositive for anti-PT-IgG. No significant associations were observed between pertussis incidence and the analyzed variables, including age, gender, occupation, area of residence (urban vs. rural), and family size (p > 0.05). These findings underscore the importance of enhancing vaccination coverage to reduce the prevalence of B. pertussis in the community.

Conclusion

This study highlights the occurrence of pertussis in individuals presenting solely with a persistent cough, absent of classic symptoms. The findings emphasize the need for healthcare providers to conduct detailed assessments and utilize rapid diagnostic methods for timely detection. This is particularly crucial in regions with high vaccination rates but limited awareness of pertussis recurrence.

Prevention of chronic diseases in middle-age women: a cross-sectional study on an Italian large sample

BACKGROUND

The age around 50 years represents a crucial point for women: menopause leads to biological changes and it begins breast and colon-rectal cancer screening. This study aimed at assessing frequencies of cardiovascular risk factors and analyzing participation in screening and vaccination.

METHODS

In 2017, a cross-sectional study was performed in Northern Italy. Totally, 12 249 women, aged between 50 and 54 years, were enrolled by General Practitioners (GPs). It was used a 21-item form, with information about: socio-demographic, anamnestic and clinical data, execution of a booster shot of tetanus-diphtheria-acellular pertussis (Tdap) vaccine in the last decade and of PAP-test, mammography and faecal occult blood test in the last 2 years. Descriptive and crosstab χ2 analyses were performed with STATA MP13. The significance level was P ≤ 0.05.

RESULTS

Our findings showed the presence of cardiovascular risk factors, such as obesity (10.95%), hypertension (13.76%), hyperlipidaemia (11.57%), glycaemia ≥ 100 mg dl-1 (16.97%), poor physical activity (73.49%), smoking (18.28%), cardiovascular family history (FH) (51.70%). There were a lower participation in colo-rectal cancer screening (45.09%) compared with breast (85.06%) and cervical (77.16%) cancer screening and an insufficient Tdap booster dose compliance (17.56%). Chi-square analyses showed correlations between cardiovascular FH and body mass index, hypertension, hyperlipidaemia, glycaemia and smoking, and between cancer FH and participation in breast and colo-rectal cancer screening (P < 0.05).

CONCLUSIONS

Women with cardiovascular disease FH represent a priority target of educational interventions considering the prevalence of concomitant risk factors. Programmes aimed at increasing screening and vaccination participation should be implemented.

Attributes influencing parental decision-making to receive the Tdap vaccine to reduce the risk of pertussis transmission to their newborn - outcome of a cross-sectional conjoint experiment in Spain and Italy

Pertussis vaccination of parents and household contacts (‘cocooning’) to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged ≤6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was ‘reduction in source of infection’ in Spain (23.1%) and ‘vaccination location’ in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89–98%; applying vaccine costs (25€ per person) would reduce the probability of uptake by 7–20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option.

Child-parent immunization survey: How well are national immunization recommendations accepted by the target groups?

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Most of the time gynecologists had not recommended vaccinations to pregnant women.

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Only 3% of mothers were vaccinated against pertussis and influenza in pregnancy.

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Misconceptions led to non-compliance of pregnant women with recommended vaccinations.

Background

Pertussis disease rates are high in Switzerland, especially in infants and young infants. To protect newborns from this serious disease, EKIF, the Swiss National Immunization Technical Advisory Group, has recommended vaccination against pertussis during pregnancy (2nd or 3rd trimester) since 2013. Also, since 2009, EKIF has recommended vaccination against influenza during pregnancy.

We conducted this study to assess acceptance and implementation of these recently introduced recommendations.

Methods

We performed standardized interviews with parents of children born on or after 01.01.2013, hospitalized at the University of Basel Children’s Hospital, Switzerland, between January and June 2017. If participation was declined, partial consent was sought for four questions regarding age, education level, attitudes towards vaccinations in general and availability of vaccination records.

Results

In 193 of 398 eligible children the mother participated. Five (3%) of 172 mothers had received both pertussis and influenza vaccines during pregnancy, 15 (9%) only against pertussis and 12 (7%) only against influenza. Very few mothers had received vaccination recommendation during pregnancy: 17 (10%) for both pertussis and influenza and 15 (9%) each for pertussis and influenza only. Main reasons for refusal of vaccination despite recommendation were that they were not deemed useful (59% for influenza and 37% for pertussis) and safety concerns for the child (18% for influenza and 26% for pertussis).

Conclusions

Recommendation for and immunization rates against pertussis and influenza during pregnancy are low and need to be improved. As recommendations from health care personnel have been shown to have the most significant impact on immunization rates, we propose to focus on improving awareness and acceptance for immunization in pregnancy among health care personnel involved in the care of pregnant women.

Trends in Tdap vaccination among privately insured pregnant women in the United States, 2009-2016

BACKGROUND

Infants younger than 6 months are at increased risk of complications and mortality from pertussis infection. In October 2012, the Advisory Committee on Immunization Practices revised its recommendation to include a Tdap dose during each pregnancy, ideally between 27 and 36 weeks gestation.

OBJECTIVE

Assess trends in Tdap vaccination coverage among privately insured pregnant women from 2009 to 2016 including timing of Tdap vaccination (before, during, or after pregnancy), trimester of vaccination for women vaccinated during pregnancy, and missed vaccination opportunities for unvaccinated women. Identify factors associated with vaccination during the optimal period of 27-36 weeks gestation.

STUDY DESIGN

Retrospective analysis of privately insured women 15-49 years who delivered live births during 2009-2016 conducted using 2009-2016 MarketScan data. Tdap vaccination coverage and the timing of Tdap vaccine administration were assessed for women continuously enrolled from 6 months before pregnancy to 1 month after delivery. Multivariable logistic regression was performed to identify factors independently associated with receipt of Tdap vaccine at 27-36 weeks gestation.

RESULTS

Tdap vaccination coverage during pregnancy increased from 0.4% in 2009 to 6.2% in 2012 and to 53.2% in 2016. The proportion of vaccinated women receiving Tdap at 27-36 weeks gestation increased from <10% in 2009 to nearly 90% in 2016, with most vaccination occurring at 27-32 weeks gestation. Women of older age, residing in a metropolitan statistical area, residing outside the South, and having a capitated health insurance plan were more likely to receive Tdap at 27-36 weeks gestation than their counterparts. Among women not vaccinated during pregnancy, 77.7% had a pregnancy-related medical claim between 27 and 36 weeks gestation.

CONCLUSION

Tdap vaccination coverage during pregnancy increased significantly from 2009 to 2016, with the greatest increase occurring after the revised Advisory Committee on Immunization Practices recommendation. Most women who did not receive Tdap vaccine had a missed vaccination opportunity during pregnancy, indicating potential for much higher vaccination coverage and consequent infant protection against pertussis.

Factors Related to Pertussis and Tetanus Vaccination Status Among Foreign-Born Adults Living in the United States

Pertussis is a common vaccine-preventable disease (VPD) worldwide. Its reported incidence has increased steadily in the United States, where it is endemic. Tetanus is a rare but potentially fatal VPD. Foreign-born adults have lower tetanus-diphtheria-pertussis (Tdap) and tetanus-diphtheria (Td) vaccination coverage than do U.S.-born adults. We studied the association of migration-related, socio-demographic, and access-to-care factors with Tdap and Td vaccination among foreign-born adults living in the United States. The 2012 and 2013 National Health Interview Survey data for foreign-born respondents were analyzed. Multivariable logistic regression was conducted to calculate prevalence ratios and 95% confidence intervals, and to identify variables independently associated with Tdap and Td vaccination among foreign-born adults. Tdap and Td vaccination status was available for 9316 and 12,363 individuals, respectively. Overall vaccination coverage was 9.1% for Tdap and 49.8% for Td. Younger age, higher education, having private health insurance (vs. public insurance or uninsured), having visited a doctor in the previous year, and region of residence were independently associated with Tdap and Td vaccination. Among those reporting a doctor visit, two-thirds had not received Tdap. This study provides further evidence of the need to enhance access to health care and immunization services and reduce missed opportunities for Tdap and Td vaccination for foreign-born adults in the United States. These findings apply to all foreign-born, irrespective of their birthplace, citizenship, language and years of residence in the United States. Addressing vaccination disparities among the foreign-born will help achieve national vaccination goals and protect all communities in the United States.

Advocating for Childcare Employee Single-Dose Tdap Vaccination to Combat Infant Pertussis

Incidence rates of pertussis have been higher over the past 5 years than at any time since the first pertussis vaccine became widely available, with infants younger than 12 months old being particularly vulnerable. Once infected, infants may experience severe respiratory symptoms and incur high rates of hospitalization, and they account for the vast majority of pertussis-related deaths each year. With the diminished effectiveness of herd immunity, experts increasingly rely on cocooning to protect at-risk populations against infectious diseases such as pertussis. Cocooning calls for vaccination of all close contacts of vulnerable individuals, including childcare employees. Despite government recommendations, only 11 states address employee tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination in their childcare regulations. Advanced practice nurses can play a significant role in protecting infants younger than 12 months old through initiating and supporting advocacy efforts at the state level for childcare employee Tdap vaccination. This article explores initial advocacy steps to be taken by advanced practice registered nurses to address this important issue.

Assessing determinants of the intention to accept a pertussis cocooning vaccination: A survey among Dutch parents

INTRODUCTION

Pertussis cocooning is one of the strategies aiming to prevent the potential harm of pertussis in infants by vaccinating (among others) their parents. Several countries adopted this strategy, but uptake is a problem. Determinants of parental uptake are important in the design of an effective vaccination programme. Therefore, this study aims to assess parents' intention to accept a pertussis cocooning vaccination and its determinants.

METHODS

A 98 item questionnaire was developed based on a theoretical framework, assessing parents' intention to accept a pertussis cocooning vaccination and its personal and psychosocial determinants. In addition, beliefs underlying parents' attitude towards pertussis cocooning vaccination were assessed. Both logistic and linear regression analysis were used to assess univariate and multivariate associations amongst study variables.

RESULTS

Parents returned 282 questionnaires. The majority of the parents (78%) reported a positive intention to accept a pertussis cocooning vaccination. Attitude (OR 6.6, p<.001), anticipated negative affect in response to non acceptance (OR 1.65, p<.001), anticipated negative affect in response to acceptance (OR 0.55, p .040) and decisional uncertainty (OR 0.52, p .002) were significantly associated with intention. General vaccination beliefs (β 0.58, p<.001), moral norm (β 0.22, p<.001), perceived susceptibility of pertussis in children (β 0.10, p.004), and efficacy outcome expectations (β 0.15, p.011) were significant correlates of attitude towards pertussis cocooning vaccination.

CONCLUSION

The parental intention to accept a pertussis cocooning vaccination in this study is rather high. Targeting the identified determinants of parents' acceptance in a pertussis cocooning vaccination programme is crucial to secure that intention is translated into actual vaccination uptake.

Influenza Vaccination Coverage Rates, Knowledge, Attitudes, and Beliefs in Jordan: A Comprehensive Study

Influenza vaccination is the most effective method in preventing influenza and its complications. This study's objectives were to investigate the vaccination coverage and frequency and to assess knowledge, attitudes, and practices toward influenza vaccination in Jordan during the year 2012 and the 5 years preceding it. Additionally, it aimed at identifying the barriers and motivations to receive the vaccine and the factors contributing to its uptake. In May 2012, a self-administered cross-sectional survey was distributed to 3,200 adults conveniently selected across Jordan to explore influenza vaccination status, knowledge, attitudes, and practices toward the influenza vaccine. The survey response rate was 98.3%. The overall coverage rate of seasonal influenza vaccination ranged from 9.9% to 27.5%. Results of the univariate analysis revealed that males, participants older than 45 years, business owners, and university students or graduates were more likely to take the vaccine. Healthcare workers (HCW) showed higher rates than non-HCW and those with concomitant chronic diseases were more committed to receive the vaccine. Knowledge about the influenza vaccine is considered high in the Jordanian population. Fear from side effects was the major barrier, while the fear of the virus spread and outbreak was the major reason to receive the vaccine. The coverage rates were low in Jordan compared to other countries. The need for influenza vaccine campaigns and on-going education in Jordan health schools is crucial to increase the rate and remove misconceptions and negative attitudes toward vaccination.

Intention to Accept Pertussis Vaccination for Cocooning: A Qualitative Study of the Determinants

Context

Several countries have reported a resurgence of pertussis in the last decades. This puts infants (especially <6 months) at risk of severe complications, because they are too young to be fully protected by vaccination. The global pertussis initiative has proposed pertussis vaccination of young infants’ close contacts, in order to reduce pertussis transmission and the burden of the disease on infants. Our aim is to explore the perceived determinants (barriers and facilitators) of intention to accept vaccination among the possible target groups of pertussis vaccination for cocooning. Consideration of these determinants is necessary to optimise the uptake of the vaccination.

Methods

We conducted 13 focus groups and six individual semi-structured interviews with members of possible target groups for pertussis cocooning (i.e. parents, maternity assistants, midwives, and paediatric nurses) in the Netherlands. Here, both maternal pertussis vaccination as well as pertussis cocooning has not been implemented. The topic list was based on a literature review and a barrier framework. All interviews were transcribed verbatim and two researchers performed thematic content analysis.

Findings

The participants’ risk perception, outcome expectations, general vaccination beliefs, moral norms, opinion of others, perceived autonomy, anticipated regret, decisional uncertainty, and perceived organisational barriers were all factors that influenced the intention to accept pertussis vaccination for cocooning.

Discussion

This study has identified nine perceived determinants that influence the intention to accept pertussis cocooning vaccination. We add the following determinants to the literature: perceived cost-effectiveness (as a concept of outcome expectations), justice (as a concept of moral norms), anticipated regret, and decisional uncertainty. We recommend considering these determinants in vaccination programmes for pertussis cocooning vaccination. Experience, information and trust emerged as predominant themes within these determinants. These themes require particular attention in future research on vaccination acceptance, especially with regard to their role in use and implementation in policy and practice.

Student HPV vaccine attitudes and vaccine completion by education level

PURPOSE

We describe HPV vaccine attitudes among students of different education levels.

METHODS

High school, college, and graduate-level health care professional students were surveyed regarding HPV vaccine knowledge, attitudes, and receipt. Relationships between categorical variables were analyzed using chi-square tests of independence and z-tests for proportions. Means for quantitative variables were compared using t-tests and one-way analysis of variance.

RESULTS

57% and 42% of the 889 students reported starting and completing HPV vaccine series, respectively, with no statistical difference by education level. 61% of students who reported receiving a provider recommendation had completed the series, compared to 6% of those who did not receive recommendation (p<0.001). The belief that HPV vaccine prevents cancer was strongly associated with vaccine completion (p=0.003).

CONCLUSION

HPV vaccine coverage rates remain suboptimal. Future interventions should focus on improving provider recommendation and patient belief that HPV vaccine prevents cancer.

The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers

OBJECTIVES

Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza).

DESIGN

We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups.

RESULTS

Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-to-date. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1-91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers.

CONCLUSIONS

Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required.

Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What the Canadian public knows and wants to know

Tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in Canada but uptake is low. This study measured the knowledge, attitudes, beliefs, and behaviors of Canadian adults to identify potential barriers and facilitators to Tdap uptake. A survey was undertaken on a geographically representative sample of Canadian adults (n=4023) and 8 focus groups (62 participants) were conducted nationwide. The survey revealed that knowledge about pertussis and Tdap was low (38.3% correct answers). Only 36.0% of respondents reported being aware that all adults were recommended to receive Tdap and only 10.7% reported being immunized; 36.7% did not know whether they had received Tdap. Respondents who were aware of the immunization recommendations were twice as likely to be immunized (16.6% vs. 8.3%; p<0.001). Only 9.3% believed that their health care provider thought that Tdap was important for adults. The focus group data supported the survey results. Participants wanted information about pertussis and Tdap communicated through multiple modalities, but a recommendation by their family physician was most important to their decision to be immunized or not. This study demonstrates that current recommendations for universal adult vaccination with Tdap are not reaching the general public in Canada and an alternative strategy will be required to improve Tdap vaccine uptake.

Prevention of pertussis through adult vaccination

Pertussis is a vaccine preventable respiratory infection. Young infants are at high risk of developing severe complications from infection. Despite high rates of pediatric vaccine uptake, there continues to be increases in pertussis cases, likely due to waning immunity from childhood vaccine and increased transmission through adults. Currently, pertussis booster vaccine (Tdap) is recommended for unimmunized adults and for women in the third trimester of each pregnancy; yet adult Tdap coverage remains low. Administering Tdap vaccine at non-traditional vaccination clinics and at sites where adults are accessing care for their children are effective in improving adult Tdap uptake. While most are willing to receive vaccine when recommended by their provider, lack of provider recommendation is a major obstacle to immunization. Future studies to understand barriers to provider vaccine recommendations need to be undertaken to develop interventions to improve adult Tdap vaccine uptake and reduce pertussis infection in the susceptible population.