Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020

OBJECTIVES

Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States.

METHODS

We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics.

RESULTS

In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined.

CONCLUSIONS

These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.

Socio-demographic determinants of influenza vaccination uptake behavior: A nationwide cross-sectional study in Saudi Arabia

OBJECTIVES

To investigate the sociodemographic determinants of flu vaccine uptake among the Saudi population.

METHODS

A nationwide cross-sectional study was carried out in Saudi Arabia in December 2020, and 1,650 participants took the survey. Data were collected electronically using a structured questionnaire. Logistic regression analysis was carried out to establish the association between vaccine uptake behavior and sociodemographic characteristics of the study participants.

RESULTS

Out of the 1650 participants, 31.5% reported having received the flu vaccine during the 2019-2020 flu season. The logistic regression analysis showed that age above 45 years (adjusted odds ratio [aOR]=2.20, 95% confidence interval [CI]: [1.15-3.05], p=0.002), being married (aOR=1.75, 95% CI: [1.28-3.51], p=0.001), and having a postgraduate degree (aOR=1.51, 95% CI: [1.05-2.23], p=0.044) were significant factors associated with higher vaccine uptake. The study also showed that the perceived risk of getting the flu (aOR=2.15, 95% CI: [1.30-5.72], p=0.001) and knowledge regarding the vaccine (aOR=1.71, 95% CI: [1.08-4.22], p=0.001) were significant factors associated with vaccine uptake.

CONCLUSION

The findings suggest that efforts to increase flu vaccine uptake should focus on increasing awareness and education regarding the benefits of vaccination, particularly among young individuals.

Intratumoral injection of the seasonal flu shot converts immunologically cold tumors to hot and serves as an immunotherapy for cancer

Immunotherapy has revolutionized cancer treatment, yielding unprecedented long-term responses and survival. However, a significant proportion of patients remain refractory, which correlates with the absence of immune-infiltrated (“hot”) tumors. Here, we observed that FDA-approved unadjuvanted seasonal influenza vaccines administered via intratumoral injection not only provide protection against active influenza virus lung infection, but also reduce tumor growth by increasing antitumor CD8⁺ T cells and decreasing regulatory B cells within the tumor. Ultimately, intratumoral unadjuvanted seasonal influenza vaccine converts immunologically inactive “cold” tumors to “hot,” generates systemic responses, and sensitizes resistant tumors to checkpoint blockade. Repurposing the “flu shot” may increase response rates to immunotherapy, and based on its current FDA approval and safety profile, may be quickly translated for clinical care.

Reprogramming the tumor microenvironment to increase immune-mediated responses is currently of intense interest. Patients with immune-infiltrated “hot” tumors demonstrate higher treatment response rates and improved survival. However, only the minority of tumors are hot, and a limited proportion of patients benefit from immunotherapies. Innovative approaches that make tumors hot can have immediate impact particularly if they repurpose drugs with additional cancer-unrelated benefits. The seasonal influenza vaccine is recommended for all persons over 6 mo without prohibitive contraindications, including most cancer patients. Here, we report that unadjuvanted seasonal influenza vaccination via intratumoral, but not intramuscular, injection converts “cold” tumors to hot, generates systemic CD8⁺ T cell-mediated antitumor immunity, and sensitizes resistant tumors to checkpoint blockade. Importantly, intratumoral vaccination also provides protection against subsequent active influenza virus lung infection. Surprisingly, a squalene-based adjuvanted vaccine maintains intratumoral regulatory B cells and fails to improve antitumor responses, even while protecting against active influenza virus lung infection. Adjuvant removal, B cell depletion, or IL-10 blockade recovers its antitumor effectiveness. Our findings propose that antipathogen vaccines may be utilized for both infection prevention and repurposing as a cancer immunotherapy.

Does Loneliness Predict Subsequent Use of Flu Vaccination? Findings from a Nationally Representative Study of Older Adults in Germany

There is a lack of studies investigating whether loneliness predicts subsequent use of flu vaccination. Therefore, we aimed to clarify this relationship. Data were drawn from two waves (second wave took place in 2002, third wave took place in 2008) of a nationally representative cohort of community-dwelling individuals in Germany. The sample was restricted to individuals ≥60 years for whom flu vaccination is recommended. Loneliness was quantified using the De Jong Gierveld Loneliness Scale (second wave). Flu vaccination in the past 12 months was assessed (third wave). Consequently, older individuals that participated in the second wave and reported flu vaccination in the third wave were included (n = 970). The other waves (e.g., first wave) were excluded for reasons of data availability. Increased loneliness was associated with subsequent decreased use of the flu vaccine. Moreover, the probability of flu vaccination in the third wave was positively associated with being retired (ref.: employed), having a lower income, and the number of physical illnesses in the second wave. Findings stressed the importance of loneliness in the decreased use of the flu vaccine. Preventing loneliness may also help to increase flu vaccination rates.

Should Governments Invest More in Nudging?

Governments are increasingly adopting behavioral science techniques for changing individual behavior in pursuit of policy objectives. The types of “nudge” interventions that governments are now adopting alter people’s decisions without coercion or significant changes to economic incentives. We calculated ratios of impact to cost for nudge interventions and for traditional policy tools, such as tax incentives and other financial inducements, and we found that nudge interventions often compare favorably with traditional interventions. We conclude that nudging is a valuable approach that should be used more often in conjunction with traditional policies, but more calculations are needed to determine the relative effectiveness of nudging.

Tweeting influenza vaccine to cardiovascular health community

Globally, among infectious diseases, influenza is one of the leading causes of morbidity and mortality. Individuals with chronic conditions, including cardiovascular disease and diabetes, are particularly vulnerable to complications of an influenza infection. The European Society of Cardiology recommended annual influenza vaccinations for patients with cardiovascular disease. Numerous studies have suggested a link between influenza and increased risk of cardiovascular events. Despite its proven benefits, little is known about the reason for the underutilization of influenza vaccination. We present the findings of an assessment of patients' perception of the influenza vaccine and the reason for its underutilization, by data mining from Twitter.

To Vaccinate or to Procrastinate? That is the Prevention Question

Invoking Yaari's dual theory, we develop a model of individual vaccination decisions that incorporates quasi-hyperbolic discounting, risk aversion, and information. We test the resulting hypotheses for the flu season 2010/2011 using a representative German data set. We find a significant impact of time preferences on immunization decisions. The impact of the discount factor is significantly negative for exponential discounters. While present-biased individuals' demand for vaccination is not statistically different from the one of exponential discounters, future-biased individuals have a significantly higher probability to vaccinate. Stratification by gender reveals that these effects are entirely driven by men. That is, time preferences have no explanatory power for the vaccination decisions of women. This also applies to risk aversion, where more risk aversion implies a significantly higher probability to vaccinate for men but not women. All information measures turn out significant. Well-informed individuals have a much higher propensity to vaccinate than poorly informed individuals. If policy makers aim at improving immunization rates, then our results suggest that public policy should concentrate on providing easily accessible and concise information on the flu and the flu shot. Our results on time preferences and risk preferences imply a rather inactive role for public policy. Copyright © 2015 John Wiley & Sons, Ltd.