To quantify the prevalence of parental vaccine hesitancy (VH) in the United States and examine the association of VH with sociodemographics and childhood influenza vaccination coverage.
A 6-question ...VH module was included in the 2018 and 2019 National Immunization Survey-Flu, a telephone survey of households with children age 6 months to 17 years.
The percentage of children having a parent reporting they were "hesitant about childhood shots" was 25.8% in 2018 and 19.5% in 2019. The prevalence of concern about the number of vaccines a child gets at one time impacting the decision to get their child vaccinated was 22.8% in 2018 and 19.1% in 2019; the prevalence of concern about serious, long-term side effects impacting the parent's decision to get their child vaccinated was 27.3% in 2018 and 21.7% in 2019. Only small differences in VH by sociodemographic variables were found, except for an 11.9 percentage point higher prevalence of "hesitant about childhood shots" and 9.9 percentage point higher prevalence of concerns about serious, long-term side effects among parents of Black compared with white children. In both seasons studied, children of parents reporting they were "hesitant about childhood shots" had 26 percentage points lower influenza vaccination coverage compared with children of parents not reporting hesitancy.
One in 5 children in the United States have a parent who is vaccine hesitant, and hesitancy is negatively associated with childhood influenza vaccination. Monitoring VH could help inform immunization programs as they develop and target methods to increase vaccine confidence and vaccination coverage.
Parental vaccine hesitancy can be a barrier to routine childhood immunization and contribute to greater risk for vaccine-preventable diseases. This study examines the impact of parental vaccine ...hesitancy on childhood vaccination rates.
This study assessed the association of parental vaccine hesitancy on child vaccination coverage with ≥4 doses of diphtheria, tetanus toxoid, and acellular pertussis vaccine; ≥1 dose of measles, mumps, and rubella vaccine; up-to-date rotavirus vaccine; and combined 7-vaccine series coverage for a sample of children aged 19–35 months using data from the 2018 and 2019 National Immunization Survey-Child (N=7,645). Adjusted differences in multivariable analyses of vaccination coverage were estimated among vaccine hesitant and nonhesitant parents and population attributable risk fraction of hesitancy on undervaccination, defined as not being up to date for each vaccine.
Almost a quarter of parents reported being vaccine hesitant, with the highest proportion of vaccine hesitancy among parents of children who are non-Hispanic Black (37.0%) or Hispanic (30.1%), mothers with a high school education or less (31.9%), and households living below the poverty level (35.6%). Childhood vaccination coverage for all vaccines was lower for children of hesitant than nonhesitant parents, and the population attributable fraction of hesitancy on undervaccination ranged from 15% to 25%, with the highest percentage for ≥1 dose of measles, mumps, and rubella vaccine.
Parental vaccine hesitancy may contribute up to 25% of undervaccination among children aged 19–35 months. Implementation of strategies to address parental vaccine hesitancy is needed to improve vaccination coverage for children and minimize their risk of vaccine-preventable diseases.
Plasmodium falciparum (Pf) is the dominant malaria parasite in Nigeria though P. vivax (Pv), P. ovale (Po), and P. malariae (Pm) are also endemic. Blood samples (n = 31,234) were collected from ...children aged 0-14 years during a 2018 nationwide HIV survey and assayed for Plasmodium antigenemia, Plasmodium DNA, and IgG against Plasmodium MSP1-19 antigens. Of all children, 6.6% were estimated to have Pm infection and 1.4% Po infection with no Pv infections detected. The highest household wealth quintile was strongly protective against infection with Pm (aOR: 0.11, 95% CI: 0.05-0.22) or Po (aOR= 0.01, 0.00-0.10). Overall Pm seroprevalence was 34.2% (95% CI: 33.3-35.2) with lower estimates for Po (12.1%, 11.6-12.5) and Pv (6.3%, 6.0-6.7). Pm seropositivity was detected throughout the country with several local government areas showing >50% seroprevalence. Serological and DNA indicators show widespread exposure of Nigerian children to Pm with lower rates to Po and Pv.
•Over 40% of surveyed US health care personnel worked with self-reported ILI.•By occupation, pharmacists and physicians were most likely to work with ILI.•By work setting, hospital-based personnel ...were the most likely to work with ILI.•Interventions should target misconceptions on working while ill and paid sick leave.
Health care personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in health care settings. Studies focused on certain HCP occupations or work settings have demonstrated that some HCP often continue to work while ill.
Using a national nonprobability Internet panel survey of 1,914 HCP during the 2014-2015 influenza season, we calculated the frequency of working with self-reported ILI (ie, fever and cough or sore throat) and examined reasons for working with ILI by occupation and work setting.
Overall, 414 (21.6%) HCP reported ILI, and 183 (41.4%) reported working with ILI (median, 3 days; range, 0-30 days). Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with ILI. By work setting, hospital-based HCP had the highest frequency of working with ILI (49.3%). The most common reasons for working while ill included still being able to perform job duties and not feeling bad enough to miss work. Among HCP at long-term care facilities, the most common reason was inability to afford lost pay.
More than 40% of HCP with ILI work while ill. To reduce HCP-associated influenza transmission, potential interventions could target HCP misconceptions about working while ill and paid sick leave policies.
Accurate SARS-CoV-2 serological assays are critical for COVID-19 serosurveillance. However, previous studies have indicated possible cross-reactivity of these assays, including in areas where malaria ...is endemic. We tested 213 well-characterized prepandemic samples from Nigeria using two SARS-CoV-2 serological assays, Abbott Architect IgG and Euroimmun NCP IgG assay, both targeting SARS-CoV-2 nucleocapsid protein. To assess antibody binding strength, an avidity assay was performed on these samples and on plasma from SARS-CoV-2 PCR-positive persons. Thirteen (6.1%) of 212 samples run on the Abbott assay and 38 (17.8%) of 213 run on the Euroimmun assay were positive. Anti-
IgG levels were significantly higher among false positives for both Abbott and Euroimmun; no association was found with active Plasmodium falciparum infection. An avidity assay using various concentrations of urea wash in the Euroimmun assay reduced loosely bound IgG: of 37 positive/borderline prepandemic samples, 46%, 86%, 89%, and 97% became negative using 2 M, 4 M, 5 M, and 8 M urea washes, respectively. The wash slightly reduced avidity of antibodies from SARS-CoV-2 patients within 28 days of PCR confirmation; thereafter, avidity increased for all urea concentrations except 8 M. This validation found moderate to substantial cross-reactivity on two SARS-CoV-2 serological assays using samples from a setting where malaria is endemic. A simple urea wash appeared to alleviate issues of cross-reactivity.
Pregnant women are at risk for severe influenza-related complications; however, only 52% reported receiving an influenza vaccination during the 2013–2014 influenza season. Text4baby, a free national ...text service, provides influenza vaccination education and reminders to pregnant women. This study examined reported influenza vaccination during pregnancy among Text4baby participants who reported receiving influenza messages and women who reported never participating in Text4baby.
Opt-in Internet Panel Surveys (April 2013 and 2014) of pregnant women collected demographic and other characteristics; influenza vaccination knowledge, attitudes, and behaviors; and Text4baby participation. Women aged 18–49 years, pregnant anytime from October to January (N=3,321) were included. Text4baby influenza message recallers reported receiving Text4baby influenza messages during their current/most recent pregnancy (n=377). Text4baby non-participants reported never receiving Text4baby messages (n=2,824). Multivariable logistic regression was performed (2014–2016) controlling for demographic and other characteristics, high-risk conditions, and provider recommendation and offer to vaccinate. Adjusted prevalence ratios (APRs) were calculated. Random sampling was assumed for this non-probability sample.
Text4baby recallers were more likely than non-participants to report influenza vaccination regardless of receipt of provider recommendation and/or offer to vaccinate (provider recommendation/offer APR=1.29, 95% CI=1.21, 1.37, provider recommendation/no offer APR=1.52, 95% CI=1.07, 2.17). Among women receiving neither a provider recommendation nor offer to vaccinate, Text4baby recallers were more than three times as likely to report influenza vaccination compared with non-participants (APR=3.39, 95% CI=2.03, 5.67).
Text4baby status was associated with higher influenza vaccination, especially among women whose provider did not recommend or offer the vaccine. Encouraging Text4baby enrollment may help ensure influenza vaccination is given to protect mothers and infants.
Background
Plasmodium falciparum
malaria is a leading cause of child mortality in Nigeria. Neonates are born with maternal antibodies from placental transfer which may protect against malaria ...infection in the first months of life. The IgG dynamics of the transition from passively transferred antimalarial antibodies to actively acquired IgG from natural exposure have not been well elucidated.
Methods
Blood samples collected during a 2018 Nigeria nationwide HIV/AIDS household survey were available for 9,443 children under 5 years of age, with a subset of infants under 2 months of age having maternal samples available (n=41). Samples were assayed for the
P. falciparum
HRP2 antigen and anti-malarial IgG antibodies. LOESS regression examined the dynamics in IgG response in the first 5 years of life. Correlation with maternal IgG levels was assessed for mother/child pairs.
Results
Consistent decreases were observed in median IgG levels against all
Plasmodium
spp. antigen targets for the first months of life. At a population level,
P. falciparum
apical membrane antigen-1 (AMA1) and merozoite surface protein-1 19kD (PfMSP1) IgG decreased during the first 12 months of life before reaching a nadir, whereas IgGs to other targets only declined for the first 4 months of life. Seropositivity showed a similar decline with the lowest seropositivity against AMA1 and PfMSP1 at 10-12 months, though remaining above 50% during the first 2 years of life in higher transmission areas. No protective association was observed between IgG positivity and
P. falciparum
infection in infants. Maternal antibody levels showed a strong positive correlation with infant antibody levels for all
P. falciparum
antigens from birth to 2 months of age, but this correlation was lost by 6 months of age.
Discussion
Maternally transferred anti-malarial IgG antibodies rapidly decline during the first 6 months of life, with variations among specific antigens and malaria transmission intensity. From 3-23 months of age, there was a wide range in IgG levels for the blood-stage antigens indicating high individual variation in antibody production as children are infected with malaria. Non-
falciparum
species-specific antigens showed similar patterns in waning immunity and correlation with paired mother’s IgG levels compared to
P. falciparum
antigens.
Prevalence estimates are critical for malaria programming efforts but generating these from non-malaria surveys is not standard practice. Malaria prevalence estimates for 6-59-month-old Nigerian ...children were compared between two national household surveys performed simultaneously in 2018: a Demographic and Health Survey (DHS) and the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). DHS tested via microscopy (n = 8298) and HRP2-based rapid diagnostic test (RDT, n = 11,351), and NAIIS collected dried blood spots (DBS) which were later tested for histidine-rich protein 2 (HRP2) antigen (n = 8029). National Plasmodium falciparum prevalence was 22.6% (95% CI 21.2- 24.1%) via microscopy and 36.2% (34.6- 37.8%) via RDT according to DHS, and HRP2 antigenemia was 38.3% (36.7-39.9%) by NAIIS DBS. Between the two surveys, significant rank-order correlation occurred for state-level malaria prevalence for RDT (Rho = 0.80, p < 0.001) and microscopy (Rho = 0.75, p < 0.001) versus HRP2. RDT versus HRP2 positivity showed 24 states (64.9%) with overlapping 95% confidence intervals from the two independent surveys. P. falciparum prevalence estimates among 6-59-month-olds in Nigeria were highly concordant from two simultaneous, independently conducted household surveys, regardless of malaria test utilized. This provides evidence for the value of post-hoc laboratory HRP2 detection to leverage non-malaria surveys with similar sampling designs to obtain accurate P. falciparum estimates.
•Two in five adults were hesitant to receive an influenza vaccination.•Hesitancy was negatively associated with vaccination.•Females and non-Hispanic Black adults were more likely to be hesitant.•31% ...of the non-vaccination among unvaccinated adults is attributable to hesitancy.
The role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination.
A four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs.
Overall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18–49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy.
Among the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance.
Introduction Healthcare personnel (HCP) are at risk for pertussis infection exposure or transmitting the disease to patients in their work settings. The Advisory Committee on Immunization Practices ...recommends tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for HCP to minimize these risks. This study assessed Tdap vaccination coverage among U.S. HCP by sociodemographic and occupation-related characteristics. Methods The 2012, 2013, and 2014 Internet Panel Surveys were analyzed in 2015 to assess HCP Tdap vaccination. Effective sample sizes for 2012, 2013, and 2014 survey years were 2,038, 1613, and 1633, respectively. Missing values were assigned using multiple imputation. Multivariable logistic regression identified factors independently associated with HCP Tdap vaccination. Statistical measures were calculated with an assumption of random sampling. Results Overall, Tdap vaccination coverage among HCP was 34.8% (95% CI=30.6%, 39.0%); 40.2% (95% CI=36.1%, 44.4%); and 42.4% (95% CI=38.7%, 46.0%) in 2012, 2013, and 2014, respectively. Nurse practitioners/physician’s assistants, physicians, nurses, and HCP working in hospitals and ambulatory care settings had higher Tdap coverage. Having contact with an infant aged ≤6 months and influenza vaccination receipt were associated with increased Tdap vaccination. Non-Hispanic black race/ethnicity, having an associate/bachelor’s degree, being below poverty, non-clinical personnel status, and working in a long-term care setting were associated with decreased Tdap vaccination. Conclusions HCP Tdap vaccination coverage increased during 2012–2014; however, coverage remains low. Vaccination coverage varied widely by healthcare occupation, occupational setting, and sociodemographic characteristics. Evidence-based employer strategies used to increase HCP influenza vaccination, if applied to Tdap, may increase Tdap coverage.
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