2,507 Matching Annotations
  1. Jul 2021
    1. 2021-06-31

    2. Rimmer, A. (2021). Covid-19: GP staff have faced threats and abuse during vaccination programme, poll finds. BMJ, 373, n1665. https://doi.org/10.1136/bmj.n1665

    3. Over half (52%) of GP practice staff have received threats of physical abuse while working on the covid-19 vaccination programme, a survey has found.The poll of 222 GP practice staff by the Medical Protection Society (MPS) also found that over half (53%) of staff said that their surgery or vaccination centre had been defaced by anti-vaccination material. The survey included GPs, nurses, …
    4. 10.1136/bmj.n1665
    5. Covid-19: GP staff have faced threats and abuse during vaccination programme, poll finds
    1. 2021-06-30

    2. Kaplan, J., Vaccaro, A., Henning, M., & Christov-Moore, L. (2021). Moral reframing of messages about mask-wearing during the COVID-19 pandemic. PsyArXiv. https://doi.org/10.31234/osf.io/gfa5r

    3. Despite evidence in support of the benefits of wearing masks, attitudes about mask-wearing during the COVID-19 pandemic became politicized, and therefore tied with political values and group identities. When communicating about political issues, messages targeted to resonate with the core values of the receiver may be effective, an approach known as moral reframing. We first tested the relationships between moral values and mask-wearing in a sample (N=540) of self-identified liberals, conservatives, and moderates in the United States. Anti-mask attitudes were stronger in conservatives, and were associated with increased concerns for in-group loyalty, national identity, and personal liberty. We then crafted messages about the benefits of mask-wearing framed to resonate with these moral concerns, and in a pre-registered study of N=597 self-identified U.S. conservatives, tested the effect of moral reframing on anti-mask attitudes and behaviors. We found that messages framed in terms of loyalty, with appeals to the protection of the community and America, were effective in reducing anti-mask beliefs, compared with unrelated control messages and messages delivering purely scientific information, and that these changes in belief persisted for at least one week. Exploratory analyses showed that participants who saw loyalty-framed messages reported wearing masks in public more frequently in the subsequent week. These data provide evidence that moral reframing of messages about politicized issues can be effective, and specifically that framing messages about health behaviors in terms of group loyalty may be the most productive way of communicating with conservative audiences.
    4. 10.31234/osf.io/gfa5r
    5. Moral reframing of messages about mask-wearing during the COVID-19 pandemic
    1. 2021-06-30

    2. Markowitz, D. M., Song, H. (Jin), & Taylor, S. H. (2021). Tracing the Adoption and Effects of Open Science in Communication Research. PsyArXiv. https://doi.org/10.31234/osf.io/dsf67

    3. 10.31234/osf.io/dsf67
    4. A significant paradigm shift is underway in communication research as open science practices (e.g., preregistration, open materials) are becoming more prevalent. The current work identified how much the field has embraced such practices and evaluated their impact on authors (e.g., citation rates). We collected 10,517 papers across 26 journals from 2010-2020, observing that 5.1% of papers used or mentioned open science practices. Communication research has seen the rate of non-significant p-values (ps > .055) increasing with the adoption of open science over time, but p-values just below p < .05 have not reduced with open science adoption. Open science adoption was unrelated to citation rate at the article level; however, it was inversely related to the journals’ h-index. Our results suggest communication organizations and scholars have important work ahead to make open science more mainstream. We close with suggestions to increase open science adoption for the field at large.
    5. Tracing the Adoption and Effects of Open Science in Communication Research
    1. 2021-06-30

    2. Lemey, P., Ruktanonchai, N., Hong, S. L., Colizza, V., Poletto, C., Van den Broeck, F., Gill, M. S., Ji, X., Levasseur, A., Oude Munnink, B. B., Koopmans, M., Sadilek, A., Lai, S., Tatem, A. J., Baele, G., Suchard, M. A., & Dellicour, S. (2021). Untangling introductions and persistence in COVID-19 resurgence in Europe. Nature, 1–8. https://doi.org/10.1038/s41586-021-03754-2

    3. 10.1038/s41586-021-03754-2
    4. Following the first wave of SARS-CoV-2 infections in spring 2020, Europe experienced a resurgence of the virus starting in late summer 2020 that was deadlier and more difficult to contain1. Relaxed intervention measures and summer travel have been implicated as drivers of the second wave2. Here, we build a phylogeographic model to evaluate how newly introduced lineages, as opposed to the rekindling of persistent lineages, contributed to the COVID-19 resurgence in Europe. We inform this model using genomic, mobility and epidemiological data from 10 European countries and estimate that in many countries over half of the lineages circulating in late summer resulted from new introductions since June 15th. The success in onward transmission of newly introduced lineages was negatively associated with local COVID-19 incidence during this period. The pervasive spread of variants in summer 2020 highlights the threat of viral dissemination when restrictions are lifted, and this needs to be carefully considered by strategies to control the current spread of variants that are more transmissible and/or evade immunity. Our findings indicate that more effective and coordinated measures are required to contain spread through cross-border travel even as vaccination begins to reduce disease burden. Download PDF
    5. Untangling introductions and persistence in COVID-19 resurgence in Europe
  2. Jun 2021
    1. 2020-10

    2. Systematic review of the efficacy, effectiveness and safety of newer and enhanced seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals aged 18 years and over
    3. Background Seasonal influenza is an infectious respiratory disease which circulates annually and is associated with a considerable health and economic burden globally. The most effective means of preventing seasonal influenza is through strain-specific vaccination. For many decades, only trivalent influenza vaccines (that include two influenza A strains and one influenza B strain) have been available. In recent years, quadrivalent (two influenza A strains and two influenza B strains) have been authorised and are increasingly available. Traditional influenza vaccines have limitations in terms of immune response and the substrate used in their manufacturing which can reduce overall effectiveness. Newer and enhanced influenza vaccines have been developed, both in trivalent and quadrivalent forms, in an attempt to counteract these limitations. Objective The objective of this systematic review is to assess and synthesise the literature on the efficacy, effectiveness and safety of newer and enhanced inactivated seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals aged 18 years or older, namely: MF59® adjuvanted, cell-based, high-dose, and recombinant haemagglutinin (HA) influenza vaccines. MethodsA systematic literature search was conducted in electronic databases (MEDLINE, Embase, CINAHL and The Cochrane Library) and grey literature sources up to 7 February 2020. No restrictions were placed on date or language. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were eligible for inclusion. Returned records were screened for relevance and the full-text of potentially relevant articles assessed, applying predefined eligibility criteria. Two reviewers independently extracted data, and pooling was considered where two or more studies reported an outcome. Study results were pooled using both fixed and random effects meta-analysis. Two reviewers independently assessed the risk of bias of included studies using standardised tools. Certainty of evidence for key outcomes was assessed using the GRADE methodology.Main results The collective search returned 28 846 records. Removal of duplicates and screening resulted in 868 full-texts being assessed for relevance with 110 studies being included. Of these 110 studies, 48 possessed results relevant to adjuvanted influenza vaccines, 36 to high-dose influenza vaccines, 19 to cell-based influenza vaccines, and 10 to recombinant HA influenza vaccines. The primary outcomes of interest to this review are presented below, with consideration towards the hierarchy of evidence whereby only the highest available level is presented. No studies were identified which compared any, or all, of these newer and enhanced vaccines to each other. No efficacy data were identified for adjuvanted influenza vaccines for any comparator (another vaccine, placebo or ‘no vaccination’). In terms of relative vaccine effectiveness, there was no significant difference in vaccine effectiveness reported by included studies that compared adjuvanted trivalent vaccine with either non-adjuvanted trivalent or quadrivalent vaccines in adult or older adult (aged ≥65 years) populations. Adjuvanted trivalent influenza vaccines displayed a significant effect in preventing laboratory-confirmed influenza in older adults (aged ≥65 years) when compared with no vaccination for any influenza subtype (vaccine effectiveness (VE) = 45%, 95% CI 23 to 61, five NRSIs across three influenza seasons, random effects model (REM), I2=63%, low-certainty evidence), influenza A(H1N1) (VE=61%, 95% CI 44 to 73, four NRSIs across two influenza seasons, REM, I2=14.5%, low-certainty evidence) and influenza B (VE=29%, 95% CI 5 to 46, five NRSIs across three influenza seasons, REM, I2=0%, low-certainty evidence), but not for influenza A(H3N2) (VE=11%, 95% CI -25 to 36, 8 NRSIs across five influenza seasons, REM, I2=49%, very-low certainty evidence).
    4. Pooled analyses of effectiveness data comparing adjuvanted with non-adjuvanted vaccines was restricted by limited study numbers and statistical and clinical heterogeneity. Compared with traditional trivalent influenza vaccines, adjuvanted trivalent influenza vaccines were associated with a greater number of combined local adverse events (risk ratio (RR)= 1.90, 95% CI 1.50 to 2.39, four RCTs, REM, I2=0%, moderate-certainty evidence), pain at injection site (RR=2.02, 95% CI 1.53 to 2.67, 12 RCTs, REM, I2=75%, moderate-certainty evidence), combined systemic reactions (RR=1.18, 95% CI 1.02 to 1.38, five RCTs, REM, I2=8%, moderate-certainty evidence), myalgia (RR=1.71, 95% CI 1.09 to 2.69, 10 RCTs, REM, I2=31%, moderate-certainty evidence), fever (RR=1.97, 95% CI 1.07 to 3.61, nine RCTs, REM, I2=31%, low-certainty evidence) and chills (RR=1.70, 95% CI 1.20 to 2.40, seven RCTs, REM, I2=0%, moderate-certainty evidence). High-dose trivalent influenza vaccination was shown to have higher relative vaccine efficacy in preventing influenza compared with standard-dose trivalent influenza vaccines in older adults aged 65 years and over (VE=24%, 95% CI 10 to 37, one RCT, moderate-certainty evidence). One NRSI demonstrated significant effect for high-dose trivalent vaccine against influenza B (VE=89%, 95% CI 47 to 100), but not for influenza A(H3N2) (VE=22%, 95% CI -82 to 66) when compared with no vaccination in older adults (aged ≥65 years). Based on pooled estimates, high dose trivalent and quadrivalent vaccines were associated with significantly higher rates of a range of local and systemic adverse events compared with their standard dose trivalent and quadrivalent equivalents. Specifically, they were associated with significantly higher rates of combined local reactions (RR=1.40, 95% CI 1.20 to 1.64, three RCTs, FEM, I2=25%, low-certainty evidence), pain at injection site (RR=1.56, 95% CI 1.26 to 1.93, seven RCTs, REM, I2=57%, moderate-certainty evidence), swelling (RR=2.20, 95% CI 1.12 to 4.32, I2=46%, six RCTs, low-certainty evidence), induration (RR=1.63 95% CI 1.10 to 2.39, FEM, I2=68%, two RCTS, low-certainty evidence), headache (RR=1.35, 95% CI 1.02 to 1.77, REM, I2=0%, seven RCTs, moderate-certainty evidence), chills (RR=1.73, 95% CI 1.07 to 2.81, REM, I2=0%, four RCTs, low-certainty evidence), and malaise (RR=1.28, 95% CI 1.08 to 1.51, REM, I2=0%, seven RCTs, moderate-certainty evidence). No relative efficacy data were identified for the direct comparison of cell-based vaccines compared with traditional vaccines. Efficacy data were available comparing cell-based trivalent influenza vaccines with placebo in adults (aged 18-49 years), against any influenza (VE=70%, 95% CI 61% to 77%, two RCTS, fixed effects model (FEM), I2=0%, moderate-certainty evidence), influenza A(H1N1) (VE=82%, 95% CI 71% to 89%, two RCTs, FEM, I2=62%, moderate-certainty evidence), influenza A(H3N2) (VE=72%, 95% CI 39% to 87%, two RCTs, FEM, I2= 0%, moderate-certainty evidence) and influenza B (VE=52%, 95% CI 30% to 68%, two RCTs, FEM I2=0%, moderate-certainty evidence). Limited and heterogeneous data were presented for effectiveness when compared with no vaccination. One NRSI compared cell-based trivalent and quadrivalent vaccination with traditional trivalent and quadrivalent influenza vaccines which highlighted no significant difference in effect for any influenza or specific strains in older adults. The safety profile of cell-based trivalent vaccines was comparable to traditional trivalent influenza vaccines with higher rates of ecchymosis in cell-based vaccine recipients being the only significant difference (RR=1.27, 95% CI 1.03 to 1.56, three RCTs, FEM, I2=47%, low-certainty evidence).One study found that the quadrivalent recombinant HA influenza vaccine had higher relative vaccine efficacy in preventing influenza compared with traditional quadrivalent influenza vaccination in adultsaged ≥50 years (VE=30%, 95% CI 10 to 47, one RCT, moderate-certainty evidence). Another study found that the trivalent recombinant HA vaccine had higher efficacy compared with placebo (VE=45%, 95% CI 19 to 63, one RCT) in adults aged 18-55 years. No effectiveness data were identified for comparison with no vaccination or traditional influenza vaccines. Pooled estimates indicate that, with the exception of a higher rate of chills (RR=1.33, 95% CI 1.03 to 1.72, three RCTs, FEM, I2=46%, low-certainty evidence), the safety profile of the recombinant HA trivalent and quadrivalent influenza vaccines was comparable to that of their traditional trivalent and quadrivalent vaccine equivalents.Conclusions The evidence base for the efficacy and effectiveness of newer and enhanced influenza vaccines is limited at present. Based on reviewed evidence, it is probable that these vaccines provide greater protection than no vaccination. Evidence regarding the comparability of these vaccines with traditional seasonal influenza vaccines is uncertain due to a dearth of available literature, clinical and statistical heterogeneity. A large body of evidence was presented for the safety of these influenza vaccines, with the safety profiles found to be largely in keeping with that expected when considering their individual compositions. Reporting within individual studies limited the data coverage of this review. Recommendations are provided to enhance research conduct and reporting regarding these newer and enhanced influenza vaccines which are anticipated to improve data coverage overall. A large number of potentially relevant studies were identified as ongoing, highlighting a need for this review to be updated in the near future.
    5. ECDC (2020) Systemic review of the efficacy, effectiveness and safety of newer and enhanced seasonal influenza vaccines for the prevention of lab-confirmed flu in individuals aged 18 and over Available at: https://www.ecdc.europa.eu/sites/default/files/documents/seasonal-influenza-vaccines-systematic-review-efficacy.pdf

    1. 2019-07-15

    2. 20 million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018. (n.d.). Retrieved June 24, 2021, from https://www.who.int/news/item/15-07-2019-20-million-children-miss-out-on-lifesaving-measles-diphtheria-and-tetanus-vaccines-in-2018

    3. 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF. Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine has stalled at around 86 percent. While high, this is not sufficient. 95 percent coverage is needed – globally, across countries, and communities - to protect against outbreaks of vaccine-preventable diseases.
    4. 20 million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018
    1. 2020-04

    2. Nandi, A., Kumar, S., Shet, A., Bloom, D. E., & Laxminarayan, R. (2020). Childhood vaccinations and adult schooling attainment: Long-term evidence from India’s Universal Immunization Programme. Social Science & Medicine (1982), 250, 112885. https://doi.org/10.1016/j.socscimed.2020.112885

    3. Routine childhood vaccines are among the most cost-effective life-saving interventions. In addition, vaccines have been linked with reduced stunting and improved health and other outcomes in later life. However, evidence on such long-term benefits remain inadequate. In this study, we examined the associations between the initiation and implementation of the Universal Immunization Programme (UIP) in India and schooling attainment among adults. We obtained district-level data on the rollout of the UIP in 1985–1990 and matched those with data from the National Family Health Survey of India, 2015–2016. Adults who were born in the five years before and after the rollout period (1980–1995) and always lived in the same location were included in the analysis (n=109,908). We employed household, village or city ward, district, and state fixed-effects linear regression models, which incorporated a wide range of socioeconomic and demographic indicators and community-level infrastructure, amenities, and access to healthcare. We compared schooling attainment in years among individuals who were born during or after the UIP was implemented in their districts (intervention group) with those who were born before UIP implementation (control group). In household fixed-effects analysis, intervention group adults attained 0.18 (95% confidence interval [CI]: 0.02, 0.33; p<0.05) more schooling grades as compared with control group adults from the same household. In village or city ward, district, and state fixed-effects analysis, intervention group adults attained 0.23 (95% CI: 0.13, 0.32; p<0.001), 0.29 (95% CI: 0.19, 0.38; p<0.001), and 0.25 (95% CI: 0.1, 0.39; p<0.01) additional schooling grades, respectively, compared to the control group. In subgroup analyses, positive associations between UIP implementation and schooling grades were observed among women and among rural, urban, and richer households. Our results support the association of vaccines with improved school attainment.
    4. 10.1016/j.socscimed.2020.112885
    5. Childhood vaccinations and adult schooling attainment: Long-term evidence from India's Universal Immunization Programme
    1. 2019-12-05

    2. Immunization. (n.d.). Retrieved June 24, 2021, from https://www.who.int/news-room/facts-in-pictures/detail/immunization

    3. Immunization is one of modern medicine’s greatest success stories. Time and again, the international community has endorsed the value of vaccines and immunization to prevent and control a large number of infectious and, increasingly, cancers and other chronic diseases. Expanding access to immunization is crucial to achieving the Sustainable Development Goals (SDGs). Not only do vaccinations prevent sickness and death associated with infectious diseases such as diarrhoea, measles, pneumonia, polio and whooping cough, they also hold up broader gains in education and economic development.
    4. Immunization
    1. 2017-01-06

    2. Penţa, M. A., & Băban, A. (2018). Message Framing in Vaccine Communication: A Systematic Review of Published Literature. Health Communication, 33(3), 299–314. https://doi.org/10.1080/10410236.2016.1266574

    3. 10.1080/10410236.2016.1266574
    4. Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O’Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.
    5. Message Framing in Vaccine Communication: A Systematic Review of Published Literature
    1. 2018-09-17

    2. Parsons, J. E., Newby, K. V., & French, D. P. (2018). Do interventions containing risk messages increase risk appraisal and the subsequent vaccination intentions and uptake? – A systematic review and meta‐analysis. British Journal of Health Psychology, 23(4), 1084–1106. https://doi.org/10.1111/bjhp.12340

    3. 10.1111/bjhp.12340
    4. PurposeThere is good evidence that for many behaviours, increasing risk appraisal can lead to a change in behaviour, heightened when efficacy appraisals are also increased. The present systematic review addressed whether interventions presenting a risk message increase risk appraisal and an increase in vaccination intentions and uptake.MethodA systematic search identified randomized controlled trials of interventions presenting a risk message and measuring risk appraisal and intentions and uptake post‐intervention. Random‐effects meta‐analyses investigated the size of the effect that interventions had on vaccination risk appraisal and on vaccination behaviour or intention to vaccinate, and the size of the relationship between vaccination risk appraisal and vaccination intentions and uptake.ResultsEighteen studies were included and 16 meta‐analysed. Interventions overall had small significant effects on risk appraisal (d = 0.161, p = .047) and perceptions of susceptibility (d = 0.195, p = .025), but no effect on perceptions of severity (d = −0.036, p = .828). Interventions showed no effect on intention to vaccinate (d = 0.138, p = .195) and no effect on vaccination behaviour (d = 0.043, p = .826). Interventions typically did not include many behaviour change techniques (BCTs), with the most common BCT unique to intervention conditions being ‘Information about Health Consequences’. Few of the included studies attempted to, or successfully increased, efficacy appraisals.ConclusionsOverall, there is a lack of good‐quality primary studies, and existing interventions are suboptimal. The inclusion of additional BCTs, including those to target efficacy appraisals, could increase intervention effectiveness. The protocol (CRD42015029365) is available from http://www.crd.york.ac.uk/PROSPERO/.
    5. Do interventions containing risk messages increase risk appraisal and the subsequent vaccination intentions and uptake? – A systematic review and meta‐analysis
    1. 2021-06-04

    2. Serbia and Argentina start producing Russia’s Sputnik V vaccine. (2021, June 4). Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/serbia-argentina-start-producing-russias-sputnik-v-vaccine-2021-06-04/

    3. ST PETERSBURG, June 4 (Reuters) - Argentina and Serbia gave an official start to the industrial production of Russia's Sputnik V vaccine against coronavirus, Russian state TV channel Rossiya 24 reported on Friday.Russian President Vladimir Putin was shown on TV watching the start of vaccine production in both countries via videolink.The Russian vaccine produced in Argentina and Serbia will meet their domestic needs first and is expected to be exported at a later stage, the Russian Direct Investment Fund (RDIF) which is marketing the vaccine said in a statement.
    4. Serbia and Argentina start producing Russia's Sputnik V vaccine
    1. 2021-05-30

    2. Calster, B. V., Wynants, L., Riley, R. D., Smeden, M. van, & Collins, G. S. (2021). Methodology over metrics: Current scientific standards are a disservice to patients and society. Journal of Clinical Epidemiology, 0(0). https://doi.org/10.1016/j.jclinepi.2021.05.018

    3. Covid-19 research made it painfully clear that the scandal of poor medical research, as denounced by Altman in 1994, persists today. The overall quality of medical research remains poor, despite longstanding criticisms. The problems are well known, but the research community fails to properly address them. We suggest most problems stem from an underlying paradox: although methodology is undeniably the backbone of qualitative and responsible research, science consistently undervalues methodology. The focus remains more on the destination (research claims and metrics) than on the journey. Notwithstanding, research should serve society more than the reputation of those involved. While we notice that many initiatives are being established to improve components of the research cycle, these initiatives are too disjointed. The overall system is monolithic and slow to adapt. We assert that a top-down action is needed from journals, universities, funders and governments to break the cycle and put methodology first. These actions should involve the widespread adoption of registered reports, balanced research funding between innovative, incremental and methodological research projects, full recognition and demystification of peer review, mandatory statistical review of reports, adherence to reporting guidelines, and investment in methodological education and research. Currently, the scientific enterprise is doing a major disservice to patients and society.
    4. 10.1016/j.jclinepi.2021.05.018
    5. Methodology over metrics: Current scientific standards are a disservice to patients and society
    1. 2021-02-22

    2. Hall, V. J., Foulkes, S., Saei, A., Andrews, N., Oguti, B., Charlett, A., Wellington, E., Stowe, J., Gillson, N., Atti, A., Islam, J., Karagiannis, I., Munro, K., Khawam, J., Group, T. S. S., Chand, M. A., Brown, C., Ramsay, M. E., Bernal, J. L., & Hopkins, S. (2021). Effectiveness of BNT162b2 mRNA Vaccine Against Infection and COVID-19 Vaccine Coverage in Healthcare Workers in England, Multicentre Prospective Cohort Study (the SIREN Study) (SSRN Scholarly Paper ID 3790399). Social Science Research Network. https://doi.org/10.2139/ssrn.3790399

    3. Background: BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK. We determined the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in our healthcare worker (HCW) cohort study of staff undergoing regular asymptomatic testing.Methods: The SIREN study is a prospective cohort study among staff working in publicly funded hospitals. Baseline risk factors, vaccination status (from 8/12/2020-5/2/2021), and symptoms are recorded at 2 weekly intervals and all SARS-CoV-2 polymerase chain reaction (PCR) and antibody test results documented. A mixed effect proportional hazards frailty model using a Poisson distribution was used to calculate hazard ratios to compare time to infection in unvaccinated and vaccinated participants to estimate the impact of the BNT162b2 vaccine on all (asymptomatic and symptomatic) infection.Findings: Vaccine coverage was 89% on 5/2/2021. Significantly lower coverage was associated with prior infection (aOR 0.59 95% confidence interval [CI] 0.54-0.64), female (aOR 0.72, 95% CI 0.63-0.82), aged under 35 years, being from minority ethnic groups (especially Black, aOR 0.26, 95% CI 0.21-0.32), porters/security guards (aOR 0.61, 95% CI 0.42-0.90),or midwife (aOR 0.74, 95% CI 0.57-0.97), and living in more deprived neighbourhoods (IMD 1 (most) vs. 5 (least) (aOR 0.75, 95% CI 0.65-0.87). A single dose of BNT162b2 vaccine demonstrated vaccine effectiveness of 72% (95% CI 58-86) 21 days after first dose and 86% (95% CI 76-97) seven days after two doses in the antibody negative cohort.Conclusion: Our study demonstrates that the BNT162b2 vaccine effectively prevents both symptomatic and asymptomatic infection in working age adults; this cohort was vaccinated when the dominant variant in circulation was B1.1.7 and demonstrates effectiveness against this variant.Trial Registration: IRAS ID 284460, REC reference 20/SC/0230 Berkshire Research Ethics Committee, Health Research Authority and Health and Care Research Wales approval granted 22 May 2020. Trial registered with ISRCTN, Trial ID: ISRCTN11041050. https://www.isrctn.com/ISRCTN11041050Funding: The study is funded by the United Kingdom’s Department of Health and Social Care and Public Health England, with contributions from the Scottish, Welsh and Northern Irish governments. Funding is also provided by the National Institute for Health Research (NIHR) as an Urgent Public Health Priority Study (UPHP). SH, VH are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) (NIHR200915). AC is supported by NIHR HealthProtection Research Unit in Behavioural Science and Evaluation at University of Bristol in partnership with Public Health England. MR, NA, AC are supported by NIHR HealthProtection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England.Conflict of Interest: The Immunisation and Countermeasures Division has provided vaccine manufacturers(including Pfizer) with post-marketing surveillance reports on pneumococcal andmeningococcal infection which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports.Ethical Approval: The study was approved by the Berkshire Research Ethics Committee, Health Research Authority (IRAS ID 284460, REC reference 20/SC/0230) on 22 May 2020; the vaccine amendment was approved on 12/1/2021.
    4. Effectiveness of BNT162b2 mRNA Vaccine Against Infection and COVID-19 Vaccine Coverage in Healthcare Workers in England, Multicentre Prospective Cohort Study (the SIREN Study)
    1. 2018-12-06

    2. Crocker-Buque, T., & Mounier-Jack, S. (2018). Vaccination in England: A review of why business as usual is not enough to maintain coverage. BMC Public Health, 18(1), 1351. https://doi.org/10.1186/s12889-018-6228-5

    3. 10.1186/s12889-018-6228-5
    4. BackgroundThe vaccine system in England underwent radical changes in 2013 following the implementation of the Health and Social Care Act. There have since been multi-year decreases in coverage of many vaccines. Healthcare professionals have reported finding the new system fragmented and challenging. This study aims to produce a logic model of the new system and evaluate the available evidence for interventions to improve coverage.MethodsWe undertook qualitative document analysis to develop the logic model using process evaluation methods. We performed a systematic review by searching 12 databases with a broad search strategy to identify interventions studied in England conducted between 2006 and 2016 and evaluated their effectiveness. We then compared the evidence base to the logic model.ResultsWe analysed 83 documents and developed a logic model describing the core inputs, processes, activities, outputs, outcomes and impacts of the new vaccination system alongside the programmatic assumptions for each stage. Of 9,615 unique articles, we screened 624 abstracts, 45 full-text articles, and included 16 studies: 8 randomised controlled trials and 8 quasi-experimental studies. Four studies suggest that modifications to the contracting and incentive systems can increase coverage, but changes to other programme inputs (e.g. human or capital resources) were not evaluated. Four multi-component intervention studies modified activities and outputs from within a GP practice to increase coverage, but were part of campaigns or projects. Thus, many potentially modifiable factors relating to routine programme implementation remain unexplored. Reminder/recall systems are under-studied in England; incentive payments to adolescents may be effective; and only two studies evaluated carer information.ConclusionsThe evidence base for interventions to increase immunisation coverage in the new system in England are limited by a small number of studies and by significant risk of bias. Several areas important to primary care remain unexplored as targets for interventions, especially modification to organisational management.
    5. Vaccination in England: a review of why business as usual is not enough to maintain coverage
    1. Evidenzbasierte / evidenzinformierteGesundheitskommunikation (1. Auflage). (2018). Nomos. https://doi.org/10.5771/9783845291963

    2. 10.5771/9783845291963
    3. This volume discusses the relevance of evidence-based practice in health communication. Evidence-based medicine has largely established itself as a criterion of good practice, which means the conscientious, explicit and judicious use of the current best evidence in making decisions about healthcare. Similar attempts can be observed in health communication. However, health communication not only examines what kind of information is spread, but also how information has to be displayed in order for it to be perceived and processed adequately. The 19 chapters in this volume are partly theoretical and partly empirical illustrations of how evidence is reflected on in medicine, psychology and communication science. They deal, for example, with the criteria of evidence-based health communication, medical evidence in journalism and evidence-based campaigns.
    4. Evidenzbasierte | evidenzinformierte Gesundheitskommunikation
    1. Betsch, C., Böhm, R., Korn, L., & Holtmann, C. (2017). On the benefits of explaining herd immunity in vaccine advocacy. Nature Human Behaviour, 1(3), 1–6. https://doi.org/10.1038/s41562-017-0056

    2. 2017-03-06

    3. 10.1038/s41562-017-0056
    4. Most vaccines protect both the vaccinated individual and the community at large by building up herd immunity. Even though reaching disease-specific herd immunity thresholds is crucial for eliminating or eradicating certain diseases1,2, explanation of this concept remains rare in vaccine advocacy3. An awareness of this social benefit makes vaccination not only an individual but also a social decision. Although knowledge of herd immunity can induce prosocial vaccination in order to protect others, it can also invite free-riding, in which individuals profit from the protection provided by a well-vaccinated society without contributing to herd immunity themselves. This cross-cultural experiment assesses whether people will be more or less likely to be vaccinated when they know more about herd immunity. Results show that in cultures that focus on collective benefits, vaccination willingness is generally higher. Communicating the concept of herd immunity improved willingness to vaccinate, especially in cultures lacking this prosocial cultural background. Prosocial nudges can thus help to close these immunity gaps.
    5. On the benefits of explaining herd immunity in vaccine advocacy
    1. 2013-02

    2. Betsch, C., & Sachse, K. (2013). Debunking vaccination myths: Strong risk negations can increase perceived vaccination risks. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 32(2), 146–155. https://doi.org/10.1037/a0027387

    3. 10.1037/a0027387
    4. Objective: Information about risks is often contradictory, especially in the health domain. A vast amount of bizarre information on vaccine-adverse events (VAE) can be found on the Internet; most are posted by antivaccination activists. Several actors in the health sector struggle against these statements by negating claimed risks with scientific explanations. The goal of the present work is to find optimal ways of negating risk to decrease risk perceptions. Methods: In two online experiments, we varied the extremity of risk negations and their source. Perception of the probability of VAE, their expected severity (both variables serve as indicators of perceived risk), and vaccination intentions. Results: Paradoxically, messages strongly indicating that there is "no risk" led to a higher perceived vaccination risk than weak negations. This finding extends previous work on the negativity bias, which has shown that information stating the presence of risk decreases risk perceptions, while information negating the existence of risk increases such perceptions. Several moderators were also tested; however, the effect occurred independently of the number of negations, recipient involvement, and attitude. Solely the credibility of the information source interacted with the extremity of risk negation: For credible sources (governmental institutions), strong and weak risk negations lead to similar perceived risk, while for less credible sources (pharmaceutical industries) weak negations lead to less perceived risk than strong negations. Conclusions: Optimal risk negation may profit from moderate rather than extreme formulations as a source's trustworthiness can vary.
    5. Debunking vaccination myths: strong risk negations can increase perceived vaccination risks
  3. May 2021
    1. 2015-11-17

    2. Attwell, K., & Freeman, M. (2015). I Immunise: An evaluation of a values-based campaign to change attitudes and beliefs. Vaccine, 33(46), 6235–6240. https://doi.org/10.1016/j.vaccine.2015.09.092

    3. 10.1016/j.vaccine.2015.09.092
    4. This paper presents results of a study determining the efficacy of a values based approach to changing vaccination attitudes. It reports an evaluation survey of the “I Immunise” campaign, conducted in Fremantle, Western Australia, in 2014. “I Immunise” explicitly engaged with values and identity; formulated by locals in a community known for its alternative lifestyles and lower-than-national vaccine coverage rates. Data was collected from 304 online respondents. The campaign polarised attitudes towards vaccination and led some to feel more negatively. However, it had an overall positive response with 77% of participants. Despite the campaign only resonating positively with a third of parents who had refused or doubted vaccines, it demonstrates an important in-road into this hard-to-reach group.
    5. I Immunise: An evaluation of a values-based campaign to change attitudes and beliefs
    1. 2015-11-30

    2. Lytras, T., Kopsachilis, F., Mouratidou, E., Papamichail, D., & Bonovas, S. (2015). Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis. Human Vaccines & Immunotherapeutics, 12(3), 671–681. https://doi.org/10.1080/21645515.2015.1106656

    3. Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08–0.45), followed by “soft” mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45–0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71–0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78–1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ2 = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.
    4. 10.1080/21645515.2015.1106656
    5. Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis
    1. 2018-12-01

    2. Maltezou, H. C., Theodoridou, K., Ledda, C., Rapisarda, V., & Theodoridou, M. (2019). Vaccination of healthcare workers: Is mandatory vaccination needed? Expert Review of Vaccines, 18(1), 5–13. https://doi.org/10.1080/14760584.2019.1552141

    3. 10.1080/14760584.2019.1552141
    4. Introduction: Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational acquisition of vaccine-preventable diseases (VPDs) and to indirectly protect their patients and the essential healthcare infrastructure. However, outbreaks due to VPDs continue to challenge healthcare facilities and HCWs are frequently traced as sources of VPDs to vulnerable patients. In addition, HCWs were disproportionately affected during the current measles outbreak in Europe.Areas covered: We reviewed the recent published information about HCWs vaccinations with a focus on mandatory vaccination policies.Expert commentary: Although many countries have vaccination programs specifically for HCWs, their vaccination coverage remains suboptimal and a significant proportion of them remains susceptible to VPDs. The increasing vaccination hesitancy among HCWs is of concern, given their role as trusted sources of information about vaccines. Mandatory vaccinations for HCWs are implemented for specific VPDs in few countries. Mandatory influenza vaccination of HCWs was introduced in the United States a decade ago with excellent results. Mandatory vaccinations for VPDs that may cause significant morbidity and mortality should be considered. Issues of mistrust and misconceptions about vaccinations should also be addressed.
    5. Vaccination of healthcare workers: is mandatory vaccination needed?
    1. 2018-09-18

    2. MacDonald, N. E., Harmon, S., Dube, E., Steenbeek, A., Crowcroft, N., Opel, D. J., Faour, D., Leask, J., & Butler, R. (2018). Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine, 36(39), 5811–5818. https://doi.org/10.1016/j.vaccine.2018.08.042

    3. 10.1016/j.vaccine.2018.08.042
    4. Globally, infant and childhood vaccine uptake rates are not high enough to control vaccine preventable diseases, with outbreaks occurring even in high-income countries. This has led a number of high-, middle-and low income countries to enact, strengthen or contemplate mandatory infant and/or childhood immunization to try to address the gap. Mandatory immunization that reduces or eliminates individual choice is often controversial. There is no standard approach to mandatory immunization. What vaccines are included, age groups covered, program flexibility and rigidity e.g. opportunities for opting out, penalties or incentives, degree of enforcement, and whether a compensation program for causally associated serious adverse events following immunization exists vary widely. We present an overview of mandatory immunization with examples in two high- and one low-income countries to illustrate variations, summarize limited outcome data related to mandatory immunization, and suggest key elements to consider when contemplating mandatory infant and/or child immunization. Before moving forward with mandatory immunization, governments need to assure financial sustainability, uninterrupted supply and equitable access to all the population. Other interventions may be more effective and less intrusive than mandatory. If mandatory is implemented, this needs to be tailored to fit the context and the country’s culture.
    5. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps
    1. 2016-06-01

    2. Lee, C., & Robinson, J. L. (2016). Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations. Journal of Infection, 72(6), 659–666. https://doi.org/10.1016/j.jinf.2016.04.002

    3. Purpose The efficacy of immunization mandates for childcare or school entry is a long-standing controversy. The United States (US) adopted school entry immunization mandates in the 1800s, while most countries still do not have mandates. The objective of this systematic review was to analyze the evidence that immunization uptake increases with mandates. Methods A search was conducted for studies that compared immunization uptake in a population prior to and after mandates, or in similar populations with one group having and the other not having mandates. Data were extracted and synthesized qualitatively due to the heterogeneity of study design. Results Eleven before-and-after studies and ten studies comparing uptake in similar populations with and without mandates were included. Studies were from the US (n = 18), France (n = 1) and Canada (n = 2). Eleven of the 21 studies looked at middle school mandates. All but two studies showed at least a trend towards increased uptake with mandates. Higher uptake was associated with a more long-standing mandate. Conclusions Immunization mandates have generally led to increased short-term and long-term uptake in the group to whom the mandate applies. Many studies have centered around middle school mandates in the US and there is a paucity of studies of childcare mandates or of studies of mandates in other countries or in settings with relatively high baseline immunization uptake.
    4. 10.1016/j.jinf.2016.04.002
    5. Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations
    1. 2009-10-14

    2. Djibuti, M., Gotsadze, G., Zoidze, A., Mataradze, G., Esmail, L. C., & Kohler, J. C. (2009). The role of supportive supervision on immunization program outcome—A randomized field trial from Georgia. BMC International Health and Human Rights, 9(Suppl 1), S11. https://doi.org/10.1186/1472-698X-9-S1-S11

    3. 10.1186/1472-698X-9-S1-S11
    4. BackgroundOne of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.MethodsA pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.ResultsThe results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.ConclusionProvider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.
    5. The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia
    1. 2003-12

    2. Childrenís Vaccine Program at PATH. Guidelines for Implementing Supportive Supervision:A step-by-step guide with tools to support immunization. Seattle: PATH (2003)

    3. Many institutionsí response to poor performance is to provide in-service training. Long-term capacity building takes time and planning, and should include a needs assessment, in-service training based on results of the assessment, supervision, and continuing education. Supervision is an excellent opportunity to provide follow-up training, improve performance, and solve other systemic problems that contribute to poor immunization coverage. Though there are many examples and case studies where supportive supervision has been used to improve health worker performance and immunization coverage, long-term and sustainable results have not been thoroughly documented. The following guidelines focus on supportive supervisionóa process that promotes sustainable and efficient program management by encouraging effective two-way communication, as well as performance planning and monitoring.
    4. Guidelines for Implementing Supportive Supervision A step-by-step guide with tools to support immunization
    1. 2015-09-25

    2. Reducing pain at the time of vaccination: WHO Position Paper – September 2015. Weekly epidemiological record. 2015;90(39):505–16 (www.who.int /immunization/policy/position_papers /reducing_pain_vaccination/en/)

    3. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact, and on vaccination-related policy questions particularly concerning the use of vaccines in large-scale immunization programmes. They summarize essential background informa-tion and conclude with the current WHO position. This position paper addresses a cross-cutting issue which is relevant for all injectable vaccines
    4. Reducing pain at the time of vaccination: WHO position paper – September 2015
    1. 2015-09-22

    2. Taddio, A., McMurtry, C. M., Shah, V., Riddell, R. P., Chambers, C. T., Noel, M., MacDonald, N. E., Rogers, J., Bucci, L. M., Mousmanis, P., Lang, E., Halperin, S. A., Bowles, S., Halpert, C., Ipp, M., Asmundson, G. J. G., Rieder, M. J., Robson, K., Uleryk, E., … Bleeker, E. V. (2015). Reducing pain during vaccine injections: Clinical practice guideline. CMAJ : Canadian Medical Association Journal, 187(13), 975–982. https://doi.org/10.1503/cmaj.150391

    3. 10.1503/cmaj.150391
    4. The current guideline expands on and updates the 2010 guideline with recommendations across the lifespan. This enhanced scope led to a revised team name of HELPinKids&Adults. The intended audience is all health care providers who administer vaccine injections. Recommendations for the management of fear in individuals with high levels of needle fear (i.e., individuals with persistent, intense apprehension of or fear in response to a needle procedure, who may endure needles with intense distress or avoidance) are reported separately, as they require knowledge and skills beyond those of practitioners who usually give vaccinations (C.M.M., unpublished data, 2015). Delayed pain (hours to days after injection) was not considered in this guideline.Go to:
    5. Reducing pain during vaccine injections: clinical practice guideline
    1. Vaccination Programs: Home Visits to Increase Vaccination Rates Archived Review. (2014, April 17). The Guide to Community Preventive Services (The Community Guide). https://www.thecommunityguide.org/findings/vaccination-programs-home-visits-increase-vaccination-rates-archive

    2. The Community Preventive Services Task Force recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. However, the Task Force also notes that home visits can be resource-intensive and costly relative to other options for increasing vaccination rates. Evidence on effectiveness was considered strong based on a body of evidence that included studies of home visits delivered to all clients or only to those unresponsive to other interventions, home visits focused on vaccination alone or in combination with other health concerns, and home visits that provided vaccinations on-site or referred clients to vaccination services outside the home.
    3. Vaccination Programs: Home Visits to Increase Vaccination Rates Archived Review
    1. 2017-02

    2. Ames, H. M., Glenton, C., & Lewin, S. (2017). Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: A synthesis of qualitative evidence. The Cochrane Database of Systematic Reviews, 2017(2). https://doi.org/10.1002/14651858.CD011787.pub2

    3. BackgroundChildhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two‐way, for example face‐to‐face discussions between parents and healthcare providers, or one‐way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate.ObjectivesThe specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination.Search methodsWe searched MEDLINE (OvidSP), MEDLINE In‐process and Other Non‐Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search.Selection criteriaWe included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed.Data collection and analysisWe used maximum variation purposive sampling for data synthesis, using a three‐step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE‐CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination.Main resultsWe included 38 studies, mostly from high‐income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives.Authors' conclusionsWe have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low‐ to middle‐income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.
    4.  10.1002/14651858.CD011787.
    5. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence
    1. 2020-02-21

    2. Sato, R., & Fintan, B. (n.d.). Women’s understanding of immunization card and its correlation with vaccination behaviors. Human Vaccines & Immunotherapeutics, 16(10), 2408–2414. https://doi.org/10.1080/21645515.2020.1726682

    3. Background: Despite the proven effectiveness of vaccinations, vaccination uptake is limited in Nigeria. According to the Multiple Indicator Cluster Survey (MICS), one of the main barriers is the lack of accurate knowledge of the vaccination schedule. This study evaluates caregivers’ knowledge of the vaccination schedule and their ability to read the immunization card.Methods: The study evaluated the knowledge of caregivers in 11 settlements in the Jada local government area of Adamawa State in September 2019. The change in knowledge among caregivers before and after referring to the immunization card was evaluated using a simple statistical hypothesis testing (chi-square test). We also used logistic regression analysis to evaluate the determinants of vaccination knowledge, as well as the correlation between knowledge and actual vaccination behaviors.Results: More than half of the women had correct knowledge of the vaccination schedule for critical vaccines. However, the knowledge of the caregivers did not improve after referring to the immunization card which contained the information. Caregivers who brought their children to the clinic for vaccination recently were more likely to know the vaccination schedule correctly. Accurate knowledge was highly correlated with the actual vaccination behaviors.Conclusion: Reference to the immunization card did not improve the knowledge of vaccination schedule, especially among the less-educated population. To increase the demand for vaccinations, one potential policy is to target the uneducated population and help them increase their knowledge.
    4. 10.1080/21645515.2020.1726682
    5. Women’s understanding of immunization card and its correlation with vaccination behaviors
    1. 2018-05-08

    2. Kaufman, J., Ryan, R., Walsh, L., Horey, D., Leask, J., Robinson, P., & Hill, S. (2018). Face‐to‐face interventions for informing or educating parents about early childhood vaccination. The Cochrane Database of Systematic Reviews, 2018(5). https://doi.org/10.1002/14651858.CD010038.pub3

    3. BackgroundEarly childhood vaccination is an essential global public health practice that saves two to three million lives each year, but many children do not receive all the recommended vaccines. To achieve and maintain appropriate coverage rates, vaccination programmes rely on people having sufficient awareness and acceptance of vaccines.Face‐to‐face information or educational interventions are widely used to help parents understand why vaccines are important; explain where, how and when to access services; and address hesitancy and concerns about vaccine safety or efficacy. Such interventions are interactive, and can be adapted to target particular populations or identified barriers.This is an update of a review originally published in 2013.ObjectivesTo assess the effects of face‐to‐face interventions for informing or educating parents about early childhood vaccination on vaccination status and parental knowledge, attitudes and intention to vaccinate.Search methodsWe searched the CENTRAL, MEDLINE, Embase, five other databases, and two trial registries (July and August 2017). We screened reference lists of relevant articles, and contacted authors of included studies and experts in the field. We had no language or date restrictions.Selection criteriaWe included randomised controlled trials (RCTs) and cluster‐RCTs evaluating the effects of face‐to‐face interventions delivered to parents or expectant parents to inform or educate them about early childhood vaccination, compared with control or with another face‐to‐face intervention. The World Health Organization recommends that children receive all early childhood vaccines, with the exception of human papillomavirus vaccine (HPV), which is delivered to adolescents.Data collection and analysisWe used standard methodological procedures expected by Cochrane. Two authors independently reviewed all search results, extracted data and assessed the risk of bias of included studies.Main resultsIn this update, we found four new studies, for a total of ten studies. We included seven RCTs and three cluster‐RCTs involving a total of 4527 participants, although we were unable to pool the data from one cluster‐RCT. Three of the ten studies were conducted in low‐ or middle‐ income countries.All included studies compared face‐to‐face interventions with control. Most studies evaluated the effectiveness of a single intervention session delivered to individual parents. The interventions were an even mix of short (ten minutes or less) and longer sessions (15 minutes to several hours).Overall, elements of the study designs put them at moderate to high risk of bias. All studies but one were at low risk of bias for sequence generation (i.e. used a random number sequence). For allocation concealment (i.e. the person randomising participants was unaware of the study group to which participant would be allocated), three were at high risk and one was judged at unclear risk of bias. Due to the educational nature of the intervention, blinding of participants and personnel was not possible in any studies. The risk of bias due to blinding of outcome assessors was judged as low for four studies. Most studies were at unclear risk of bias for incomplete outcome data and selective reporting. Other potential sources of bias included failure to account for clustering in a cluster‐RCT and significant unexplained baseline differences between groups. One cluster‐RCT was at high risk for selective recruitment of participants.We judged the certainty of the evidence to be low for the outcomes of children's vaccination status, parents' attitudes or beliefs, intention to vaccinate, adverse effects (e.g. anxiety), and immunisation cost, and moderate for parents' knowledge or understanding. All studies had limitations in design. We downgraded the certainty of the evidence where we judged that studies had problems with randomisation or allocation concealment, or when outcomes were self‐reported by participants who knew whether they'd received the intervention or not. We also downgraded the certainty for inconsistency (vaccination status), imprecision (intention to vaccinate and adverse effects), and indirectness (attitudes or beliefs, and cost).Low‐certainty evidence from seven studies (3004 participants) suggested that face‐to‐face interventions to inform or educate parents may improve vaccination status (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.04 to 1.37). Moderate‐certainty evidence from four studies (657 participants) found that face‐to‐face interventions probably slightly improved parent knowledge (standardised mean difference (SMD) 0.19, 95% CI 0.00 to 0.38), and low‐certainty evidence from two studies (179 participants) suggested they may slightly improve intention to vaccinate (SMD 0.55, 95% CI 0.24 to 0.85). Low‐certainty evidence found the interventions may lead to little or no change in parent attitudes or beliefs about vaccination (SMD 0.03, 95% CI ‐0.20 to 0.27; three studies, 292 participants), or in parents’ anxiety (mean difference (MD) ‐1.93, 95% CI ‐7.27 to 3.41; one study, 90 participants). Only one study (365 participants) measured the intervention cost of a case management strategy, reporting that the estimated additional cost per fully immunised child for the intervention was approximately eight times higher than usual care (low‐certainty evidence). No included studies reported outcomes associated with parents’ experience of the intervention (e.g. satisfaction).Authors' conclusionsThere is low‐ to moderate‐certainty evidence suggesting that face‐to‐face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate.Face‐to‐face interventions may be more effective in populations where lack of awareness or understanding of vaccination is identified as a barrier (e.g. where people are unaware of new or optional vaccines). The effect of the intervention in a population where concerns about vaccines or vaccine hesitancy is the primary barrier is less clear. Reliable and validated scales for measuring more complex outcomes, such as attitudes or beliefs, are necessary in order to improve comparisons of the effects across studies.
    4. 10.1002/14651858.CD010038.pub3
    5. Face‐to‐face interventions for informing or educating parents about early childhood vaccination
    1. Jacobson Vann, J. C., Jacobson, R. M., Coyne‐Beasley, T., Asafu‐Adjei, J. K., & Szilagyi, P. G. (2018). Patient reminder and recall interventions to improve immunization rates. The Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.CD003941.pub3

    2. 2018-01

    3. BackgroundImmunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine‐preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population‐based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient‐oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review.ObjectivesTo evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.Search methodsWe searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017.Selection criteriaWe included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization‐focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no‐intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media‐based activities aimed at promoting immunizations, or simple practice‐based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period.Data collection and analysisWe used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before‐after studies. We present pooled results for randomized trials using the random‐effects model.Main resultsThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).Authors' conclusionsPatient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
    4.  10.1002/14651858.CD003941.pub3
    5. Patient reminder and recall interventions to improve immunization rates
    1. Schmitt, H.-J., Booy, R., Aston, R., Van Damme, P., Schumacher, R. F., Campins, M., Rodrigo, C., Heikkinen, T., Weil-Olivier, C., Finn, A., Olcén, P., Fedson, D., & Peltola, H. (2007). How to optimise the coverage rate of infant and adult immunisations in Europe. BMC Medicine, 5, 11. https://doi.org/10.1186/1741-7015-5-11

    2. 2007-05-29

    3. BackgroundAlthough vaccination has been proved to be a safe, efficacious, and cost-effective intervention, immunisation rates remain suboptimal in many European countries, resulting in poor control of many vaccine-preventable diseases.DiscussionThe Summit of Independent European Vaccination Experts focused on the perception of vaccines and vaccination by the general public and healthcare professionals and discussed ways to improve vaccine uptake in Europe.Despite the substantial impact and importance of the media, healthcare professionals were identified as the main advocates for vaccination and the most important source of information about vaccines for the general public. Healthcare professionals should receive more support for their own education on vaccinology, have rapid access to up-to-date information on vaccines, and have easy access to consultation with experts regarding vaccination-related problems. Vaccine information systems should be set up to facilitate promotion of vaccination.SummaryEvery opportunity to administer vaccines should be used, and active reminder systems should be set up. A European vaccine awareness week should be established.
    4. 10.1186/1741-7015-5-11
    5. How to optimise the coverage rate of infant and adult immunisations in Europe
    1. 2008-07

    2. Cooper, L. Z., Larson, H. J., & Katz, S. L. (2008). Protecting Public Trust in Immunization. Pediatrics, 122(1), 149–153. https://doi.org/10.1542/peds.2008-0987

    3. Public trust in the safety and efficacy of vaccines is one key to the remarkable success of immunization programs within the United States and globally. Allegations of harm from vaccination have raised parental, political, and clinical anxiety to a level that now threatens the ability of children to receive timely, full immunization. Multiple factors have contributed to current concerns, including the interdependent issues of an evolving communications environment and shortfalls in structure and resources that constrain research on immunization safety (immunization-safety science). Prompt attention by public health leadership to spreading concern about the safety of immunization is essential for protecting deserved public trust in immunization.
    4. 10.1542/peds.2008-0987
    5. Protecting Public Trust in Immunization
    1. 2016-07

    2. Ventola, C. L. (2016). Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance. Pharmacy and Therapeutics, 41(7), 426–436.

    3. This is the first in a series of two articles about childhood and adult immunization in the United States. Part 2 will discuss adult vaccination, the role of pharmacists, and considerations for P&T committees.
    4. Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance
    1. 2013

    2. Temoka, E. (2013). Becoming a vaccine champion: Evidence-based interventions to address the challenges of vaccination. South Dakota Medicine: The Journal of the South Dakota State Medical Association, Spec no, 68–72.

    3. The incidence, prevalence, morbidity and mortality rates of vaccine-preventable diseases have decreased drastically since the advent of modern vaccination by Edward Jenner at the end of the 18th century. In recent years, however, a growing number of parents have been refusing or delaying vaccination for their children for socioeconomical, medical, religious and/or philosophical reasons. This has resulted in a loss of herd immunity that has caused a resurgence of many infectious diseases. This article describes evidence-based methods by which a pediatric clinic can become a vaccine champion by aiming at vaccination rates of 100 percent. This goal can be attained by a team effort that addresses the challenges of vaccination by using every visit as a chance to vaccinate, educate, address the fears and the concerns of the parents and provide articles and other written documentations on the benefits and side effects of vaccines. A standardized system that identifies and tracks patients who need vaccines is also essential to find those who are seldom brought to medical attention. A consistent and systematic use of these evidence-based methods by a dedicated staff is essential to attain vaccination rates close to 100 percent.
    4. Becoming a vaccine champion: evidence-based interventions to address the challenges of vaccination
    1. 2018-11-01

    2. Jama, A., Ali, M., Lindstrand, A., Butler, R., & Kulane, A. (2018). Perspectives on the Measles, Mumps and Rubella Vaccination among Somali Mothers in Stockholm. International Journal of Environmental Research and Public Health, 15(11). https://doi.org/10.3390/ijerph15112428

    3. 10.3390/ijerph15112428
    4. Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision of Somali parents living in the Rinkeby and Tensta districts of Stockholm, Sweden, on whether or not to vaccinate their children with the measles, mumps and rubella (MMR) vaccine. Method: Participants were 13 mothers of at least one child aged 18 months to 5 years, who were recruited using snowball sampling. In-depth interviews were conducted in Somali and Swedish languages and the data generated was analysed using qualitative content analysis. Both written and verbal informed consent were obtained from participants. Results: Seven of the mothers had not vaccinated their youngest child at the time of the study and decided to postpone the vaccination until their child became older (delayers). The other six mothers had vaccinated their child for MMR at the appointed time (timely vaccinators). The analysis of the data revealed two main themes: (1) barriers to vaccinate on time, included issues surrounding fear of the child not speaking and unpleasant encounters with nurses and (2) facilitating factors to vaccinate on time, included heeding vaccinating parents’ advice, trust in nurses and trust in God. The mothers who had vaccinated their children had a positive impact in influencing other mothers to also vaccinate. Conclusions: Fear, based on the perceived risk that vaccination will lead to autism, among Somali mothers in Tensta and Rinkeby is evident and influenced by the opinions of friends and relatives. Child Healthcare Center nurses are important in the decision-making process regarding acceptance of MMR vaccination. There is a need to address mothers’ concerns regarding vaccine safety while improving the approach of nurses as they address these concerns.
    5. Perspectives on the Measles, Mumps and Rubella Vaccination among Somali Mothers in Stockholm
    1. 2015-09-06

    2. Sobo, E. J. (2015). Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents. Medical Anthropology Quarterly, 29(3), 381–399. https://doi.org/10.1111/maq.12214

    3. 10.1111/maq.12214
    4. U.S. media reports suggest that vastly disproportionate numbers of un‐ and under‐vaccinated children attend Waldorf (private alternative) schools. After confirming this statistically, I analyzed qualitative and quantitative vaccination‐related data provided by parents from a well‐established U.S. Waldorf school. In Europe, Waldorf‐related non‐vaccination is associated with anthroposophy (a worldview foundational to Waldorf education)—but that was not the case here. Nor was simple ignorance to blame: Parents were highly educated and dedicated to self‐education regarding child health. They saw vaccination as variously unnecessary, toxic, developmentally inappropriate, and profit driven. Some vaccine caution likely predated matriculation, but notable post‐enrollment refusal increases provided evidence of the socially cultivated nature of vaccine refusal in the Waldorf school setting. Vaccine caution was nourished and intensified by an institutionalized emphasis on alternative information and by school community norms lauding vaccine refusal and masking uptake. Implications for intervention are explored.
    5. Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents
    1. Cameron, R. L., Kavanagh, K., Watt, D. C., Robertson, C., Cuschieri, K., Ahmed, S., & Pollock, K. G. (2017). The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: Reducing the gap. J Epidemiol Community Health, 71(10), 954–960. https://doi.org/10.1136/jech-2017-209113

    1. Andre, F., Booy, R., Bock, H., Clemens, J., Datta, S., John, T., Lee, B., Lolekha, S., Peltola, H., Ruff, T., Santosham, M., & Schmitt, H. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization, 86(2), 140–146. https://doi.org/10.2471/BLT.07.040089