Role of healthcare practitioners in rotavirus disease awareness and vaccination - insights from a survey among caregivers

The role of health systems in shaping vaccine decisions: Insights from Italy, Mexico, the United Kingdom, and the United States

BACKGROUND

The demographic drivers of vaccine uptake and confidence have been well-documented in diverse contexts. However, the role of health systems in improving vaccine uptake and confidence has been less discussed particularly in the post-pandemic period.

METHODS

Using nationally representative surveys of adults conducted between December 2022 and April 2023 in Italy, Mexico, the United Kingdom (UK), and the United States (US), we examined demographic, health, and health system determinants of vaccine confidence and uptake of four vaccines for adult respondents or their children: COVID-19, influenza, human papillomavirus (HPV), and measles, mumps, and rubella (MMR). Logistic and linear regression models explored associations between predictors of interest and vaccine outcomes, with coefficients reported on the risk difference and risk ratio scales.

FINDINGS

A total of 5180 respondents were surveyed, one-third of whom had at least one child aged 1-18 years. Having received at least three other preventive health services in the last year was associated with COVID-19 and Flu vaccination in all countries (Risk ratio (RR) 1.04-1.54) and with vaccine confidence in the US (RR 1.10). Having at least three health care visits in the last year and having a regular health provider were also associated with a higher likelihood of vaccine uptake and confidence in some countries. Being confident in one's ability to obtain and afford quality care (i.e. "health security") had a positive association with at least one outcome in all countries except Mexico (RR 1.07-1.36) and with children COVID vaccination in multi-country regression. Having a regular provider was associated with a higher probability of HPV vaccination for children. Health system engagement and health security showed stronger associations with Flu than COVID-19 vaccination and with vaccine uptake compared to vaccine confidence, although these associations varied across countries. Trust in scientists and trusting the national public health agency were also strongly correlated with several vaccine outcomes.

INTERPRETATION

Our findings highlight the links between health system engagement, health security, and vaccination rates. Health system engagement may be particularly important to mitigate barriers to vaccination related to 'complacency' and 'convenience'.

Gastroenteritis hospitalizations over 19 years before and after introduction of rotavirus vaccine in Japan: A nationwide claims database

BACKGROUND

Rotavirus is a major cause of pediatric gastroenteritis worldwide, leading to severe health outcomes. Rotavirus vaccines (RV) have introduced grobally, in Japan, introduced in 2010 as self-payment and in 2020 as public funding vaccine. This study evaluates the change of gastroenteritis hospitalization and intussusception.

METHODS

The descriptive study utilized JMDC claims database, focusing on 3 million children under 12 years from January 2005 to July 2023. The primary outcome was the incidence of all-cause gastroenteritis and rotavirus enteritis hospitalizations per 1000 person-year, with secondary outcomes including intussusception. Data were extracted using ICD-10 codes, and hospitalization rates were categorized into three periods: pre-vaccine (before October 2011), post-vaccine introduction (November 2011 to September 2020), and post-public funding (from October 2020). Statistical analyses included descriptive epidemiology, and interrupted time series (ITS) design.

RESULTS

The study included 3,085,932 children (51 % male, 49 % female), with a mean age of 4.16 years. The gastroenteritis hospitalization per 1000 person-year under five year old age was 12.0 pre-vaccine period to 4.8 post-public funding period with a 60 % decrease (p < 0.001). Under the same conditions, hospitalization for rotavirus enteritis was 5.8 pre-vaccine period to 2.5 post-public funding period with a 58 % decrease (p < 0.01). ITS analysis showed a further -0.2 % monthly decrease in rotavirus enteritis hospitalizations post-vaccine introduction (p = 0.007). No significant changes were found for intussusception trends before and after RV.

CONCLUSION

In this study, gastroenteritis hospitalizations and rotavirus enteritis hospitalizations in children significant decreased. Intussusception rate were unchanged throughout the study period.

Multidisciplinary expert group: communication measures to increase vaccine compliance in adults

The WHO categorized vaccine hesitancy as one of the greatest threats to global health worldwide. Vaccination of elderly persons is of increasing relevance, given that they represent a growing segment in the population and considering the burden diseases pose to them. Many factors leading to vaccine hesitancy are related to inadequate communication. In the present report, experts from various academic fields present recommendations to support communication strategies that may help to initiate targeted communication measures to enhance vaccination compliance in adults.

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.

A mixed methods study of health care professionals’ attitudes towards vaccination in 15 countries

Background

Health care professionals are widely considered to be the most trusted source of information on vaccine-related topics. However, several are reporting their own hesitancy around certain vaccines, influencing their intention to vaccinate themselves as well as influencing their recommendations to their patients and target population.

Methods

A mixed-methods approach was used including an online survey (n = 1,504) in 15 countries which aimed to determine drivers of HCPs vaccine confidence and examine how these drivers vary across nations. Thirty in-depth semi-structured interviews were conducted with 10 HCPs in a subset of three countries (France, Greece and Hungry) to explore barriers to HCPs vaccine uptake and their role in addressing vaccine hesitancy among patients.

Findings.

The survey’s regression analysis identified that nurses/midwives and HCPs from Hungary, Italy, Romania and Switzerland were less confident in the safety, importance or effectiveness of vaccines in general. Morocco (35%), Turkey (53%) and Greece (69%) reported the lowest influenza vaccination coverage among HCPs. Morocco also reported the lowest rates of HCPs who were “highly likely” to recommend MMR vaccine (34%), HPV vaccine (31%) and Covid-19 vaccines (29%). More than third of HCPs reported a lack of trust in health authorities and in the information they provide. Thematic analysis revealed that concerns over the risk of side-effects associated with vaccines, preference for natural immunity, whether it was necessary to be vaccinated against influenza every year, not having any chronic disease risk factors, and vaccines mandates as the key barriers to HCPs vaccination against influenza and Covid-19.

Conclusion

HCPs have an important role in vaccination and their confidence in vaccination and health authorities must be improved as this may affect their uptake of vaccines and influence their recommendations to their patients. Investigating the impact of political, socio-economic and cultural contexts on concerns about vaccination among HCPs is also necessary.

Maternal knowledge and attitudes towards rotavirus diarrhea and vaccine acceptance in Yogyakarta, Indonesia: a qualitative study

Abstract Background Rotavirus is a leading cause of hospitalized diarrhea cases in Indonesia. Despite the rotavirus vaccine being recommended by the Indonesian Pediatric Society since 2011, it has yet to be been included in the Indonesian national immunization program (NIP) schedule. Objective To explore maternal knowledge of and attitudes towards rotavirus diarrhea, as well as barriers to vaccine acceptance in Yogyakarta, Indonesia. Methods We conducted 26 in-depth interviews in two districts (rural and urban areas) of Yogyakarta Province, Indonesia. Participants included women in their third trimester of pregnancy and mothers of infants younger than 14 weeks. We then proceeded with thematic analysis. Results Participants did not perceive diarrhea as being a priority health problem. Very few had heard of rotavirus diarrhea or were aware of vaccine availability. While participants would accept vaccinating their children against rotavirus, some key barriers impacted vaccine use. As the rotavirus vaccine is not included in the Indonesian NIP, parents perceived it as not essential. Parents were concerned about the safety and benefit of the vaccine due to its perceived newness. Other concerns were cost and halal status. Participants expressed a need for more information on the vaccine's effectiveness and safety, with their primary healthcare providers (HCPs) considered to play the most important role in vaccine acceptance. Conclusions In Yogyakarta, Indonesia, awareness of the seriousness of rotavirus disease and the availability of the rotavirus vaccine is low. Its newness, safety, efficacy, and cost, and doubts about its halal status, were barriers to vaccine acceptance. Information and recommendations from HCPs play an essential role in vaccine acceptance.

Insights into Predictors of Vaccine Hesitancy and Promoting Factors in Childhood Immunization Programs-A Cross-Sectional Survey in Cameroon

Background: Vaccination is claimed to be a key intervention against the COVID-19 pandemic. A major challenge today is to increase vaccine acceptance as vaccine hesitancy has delayed the eradication of polio. This study aimed to identify predictors associated with vaccine acceptance in the context of the Expanded Program on Immunization among parents of children between the ages of 12 to 23 months in the Foumbot district, Cameroon. Methods: The design of this study is a cross-sectional survey. A total of 160 mothers of children between the ages of 12 to 23 months were selected using a simple random sampling technique. A pre-tested structured questionnaire was used for data collection. Incomplete vaccination status was considered “vaccine hesitancy”. Data was analyzed along with 95% confidence intervals and the p-value < 0.05. The results showed 60% vaccine acceptance and 40% vaccine hesitancy. Factors such as age-appropriate vaccination, knowledge of vaccine-preventable diseases (VPD), and religion were associated with vaccine acceptance. Conclusion: Poor knowledge of VPDs is a matter of concern as it contributes to vaccine hesitancy. The study findings provide the basis to heighten health education, the public perceived threat of the VPDs, and the consequences if no measures are taken to ensure health.

Child health professionals' experiences of the introduction and successful implementation of rotavirus vaccination in Sweden

AIM

To explore child health professionals' experiences of the early implementation of the rotavirus vaccination in the two regions that first introduced this vaccination in Sweden.

METHODS

A descriptive and repeated cross-sectional study based on a digital study-specific questionnaire with a baseline in 2014 and with a 2-year follow-up in 2016. The study population consisted of nurses and doctors working in child health centres in the health care regions of Stockholm and Jönköping.

RESULTS

In Stockholm, a larger proportion of the respondents (n = 355) had concerns in 2014, in comparison with the respondents in Jönköping (n = 101), mostly about the vaccination being a new and time-consuming task (60% versus 23%). In 2016, the overall attitude to vaccination was more positive in both regions and the levels of concern about increased workload were reduced (Stockholm, n = 519, 39%, versus Jönköping, n = 96, 10%). Challenges before and after the introduction in both regions were particularly related to how to give information about the vaccine's potential increased risk of intussusception.

CONCLUSION

The gap between respondents' knowledge, attitudes and concerns pre- and post-vaccination introduction was larger in Stockholm compared to Jönköping. In both regions, overall, the implementation of the rotavirus vaccination was perceived as being easier than expected.

Assessment of episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age

Objective:

To assess the episodes of pneumonia and diarrhea in vaccinated and unvaccinated children under 60 months of age.

Methods:

This descriptive cross-sectional study was carried out at Darul Sehat Hospital and SESSI, Karachi in the Department of Pediatrics from 1^st November 2018 to 3^rd February 2019. An interview based questionnaire was administered and selection of participants was done by convenience sampling. Total of 196 participants were selected for interview.

Results:

Total 196 participants were interviewed which included mothers of children between the age group of 1- 60 months. The questions were entered on the questionnaire after taking consent from the mothers. Among them, males were 98 (52.7%) and females were 88(47.3%). One hundred seventy two (88.7%) children were vaccinated for pneumococcal and rotavirus whereas unvaccinated children were 22(11.3%). There was an incidence of 66(63.5%) for loose watery diarrhea. In vaccinated children, grading of diarrhea was found to be severe cases as 30 (34.9%), moderate cases as 27 (31.4%) and mild cases as 29(33.7%). For unvaccinated children, severe cases were 12 (66.7%) and for mild and moderate cases were (11.1%) and 04(22.2%) respectively with p value of 0.035. As compared to their unvaccinated counterparts, the frequency of severe pneumonia was far less than cough and cold in vaccinated children (p<0.001).

Conclusion:

There is significant reduction in cases of severe pneumonia in children receiving pneumococcal vaccine as compared to children receiving Rota vaccine there is moderate reduction in cases of severe diarrhea. The overall coverage of Pneumococcal and Rota vaccines was higher in our sample population. Efforts should be made to increase the awareness of Rotavirus vaccination in order to have better coverage in future.

Vaccine confidence: the keys to restoring trust

During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.