Trust and COVID-19 vaccine hesitancy in the Dominican Republic: a national cross-sectional household survey, June-October 2021.

OBJECTIVE: This study investigates the role of trust in shaping COVID-19 vaccine acceptance in the Dominican Republic (DR) during the COVID-19 pandemic. DESIGN: Cross-sectional household survey. SETTING: Randomly selected households across 134 clusters in the DR, from 30 June 2021 to 12 October 2021. PARTICIPANTS: 5999 participants ≥16 years of age were enrolled. OUTCOME MEASURES: COVID-19 vaccine hesitancy (CVH) data were collected from participants ≥16 years of age and analysed as both an ordinal and binary variable. RESULTS: Overall, CVH was low (5.2% (95% CI 4.6% to 5.8%)), but more common among younger individuals, women and individuals of Mestizo ethnicity. Higher trust in local government, national government, scientists and local doctors (considered official sources) was associated with lower odds of CVH (OR 0.89 (95% CI 0.72 to 0.88), 0.89 (95% CI 0.81 to 0.98), 0.87 (95% CI 0.80 to 0.94) and 0.70 (95% CI 0.62 to 0.80), respectively). Higher trust in religious leaders, social media and traditional media (considered unofficial sources) was associated with higher odds of CVH, with respective ORs of 1.32 (95% CI 1.18 to 1.47), 1.30 (95% CI 1.19 to 1.41) and 1.08 (95% CI 0.97 to 1.22). CONCLUSION: We report findings on CVH from a national household survey in the DR and identify overall low rates of CVH but marked heterogeneity by age, gender and ethnicity. Trust in unofficial versus official sources of information is associated with increased CVH. These findings highlight and quantify the importance of trust as a key parameter when considering public health communication strategies.

Clinical Effectiveness of Lyme Vaccine: A Matched Case-Control Study.

We conducted a matched case-control study to assess the effectiveness of Lyme vaccine (LYMErix) as it was used in clinical practice. We found ≥3 doses to be 71% effective against Lyme disease. This is the first study to show that the Lyme vaccine is effective in a real-world setting.

Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare, and respond to COVID-19.

The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID-19 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle-income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time-based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short- and long-term interventions to manage outbreaks at the international, national, and subnational levels in the region.

Group Well-Child Care and Health Services Utilization: A Bilingual Qualitative Analysis of Parents' Perspectives.

Objective Alternative primary care structures such as group well-child care (GWCC) may enhance care for families, particularly those subject to structural vulnerabilities such as poverty or restrictive immigration policies. The purpose of this study was to characterize how group dynamics in GWCC impact the perceptions of low-income, immigrant, and/or Spanish-speaking parents of health services. Methods Using Spanish and English interview guides that were conceptually identical, we conducted semi-structured interviews with parents who elected to participate in GWCC at an urban academic center. We drew from directed content analysis, grounded theoretically in the Andersen model of health services utilization. Modeling a bilingual, multicultural analytic strategy, we preserved the narrative of participants in the source language through all stages of analysis. Results From March through August 2017, we interviewed 22 caregivers in their preferred language. Most (82%) were mothers and half spoke Spanish only. Three themes emerged: participants perceived that (1) GWCC facilitates their and their peers' discovery of inherent expertise, which moderates parents' use of health services, (2) GWCC encourages rearrangements of hierarchies of knowledge, professional roles and genders; and (3) in the context of structural vulnerabilities, relationships formed in GWCC facilitate collective efficacy. Conclusions for Practice By considering the self and peer as sources of health-related expertise, GWCC may extend current theoretical models of health services utilization. GWCC provides opportunities to impact health services utilization among families subject to structural vulnerabilities.

Clinical Progress in the Management of Tetralogy of Fallot in the Dominican Republic: A Case Series.

BACKGROUND: Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. METHODS: We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. RESULTS: According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. CONCLUSIONS: Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional "mission model" to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.

Zoster vaccine-associated primary varicella infection in an immunocompetent host.

A 64-year-old immunocompetent man developed a widespread pruritic and vesicular rash 2 weeks after receiving the zoster vaccine (Zostavax). He had fever, bandaemia with normal total white blood cell count and mild transaminitis. PCR testing of serum and skin was positive for varicella zoster virus (VZV), while serum VZV IgG was negative. The analysis of single nucleotide polymorphism by PCR and sequencing from the skin swab was consistent with the vaccine strain. The patient received 1 week of intravenous acyclovir and was discharged after all lesions had crusted. He continues to do well on follow-up with no significant complications.

Characterization of a triple-recombinant, reassortant rotavirus strain from the Dominican Republic.

We report the genome of a novel human triple-recombinant G4P[6-8_R] mono-reassortant strain identified in a stool sample from the Dominican Republic during routine facility-based rotavirus strain surveillance. The strain was designated as RVA/Human-wt/DOM/2013840364/2013/G4P[6-8_R], with a genomic constellation of G4-P[6-8_R]-I1-R1-C1-M1-(A1-A8_R)-N1-(T1-T7_R)-E1-H1. Recombinant gene segments NSP1 and NSP3 were generated as a result of recombination between genogroup 1 rotavirus A1 human strain and a genotype A8 porcine strain and between genogroup 1 rotavirus T1 human strain and a genotype T7 bovine strain, respectively. Analyses of the RNA secondary structures of gene segment VP4, NSP1 and NSP3 showed that all the recombinant regions appear to start in a loop (single-stranded) region and terminate in a stem (double-stranded) structure. Also, the VP7 gene occupied lineage VII within the G4 genotypes consisting of mostly porcine or porcine-like G4 strains, suggesting the occurrence of reassortment. The remaining gene segments clustered phylogenetically with genogroup 1 strains. This exchange of whole or partial genetic materials between rotaviruses by recombination and reassortment contributes directly to their diversification, adaptation and evolution.

Safety of second-generation rotavirus vaccines, intussusception.

PURPOSE OF REVIEW: This article discusses new data available on the safety of the second-generation rotavirus vaccines both in the United States and internationally. RECENT FINDINGS: Second-generation rotavirus vaccines are both highly effective against rotavirus disease. Recent data from passive and active surveillance systems in the United States indicate that RV1 and RV5 vaccines may possibly cause a small increase in the risk of intussusception; an estimated 1-3 US infants out of 100 000 might develop intussusception within 7 days of getting their first dose of rotavirus vaccine. Parents and health providers should be aware of the small risk of intussusception, the signs and symptoms of intussusception, and the need for prompt care. SUMMARY: Taking into consideration available data on the benefits and risks, Centers for Disease Control and Prevention (CDC) continues to recommend that all US infants receive rotavirus vaccine based on the age and precaution/contraindication criteria. The benefits of RV5 and RV1 outweigh the small excess risk of intussusception. Safety monitoring will continue, both in the United States and internationally, to further quantitate the intussusception risk following each vaccine.

Maternal influenza vaccination: evaluation of a patient-centered pamphlet designed to increase uptake in pregnancy.

We developed and tested a theoretically-based pamphlet entitled 'Influenza in Pregnancy,' specifically designed to increase pregnant women's knowledge, reduce barriers to maternal vaccination, and subsequently improve vaccine uptake. A randomized control trial was conducted on pregnant women (n = 135) at three locations in Connecticut during the 2011-2012 season to evaluate the impact of the patient-centered pamphlet. The women were randomized to one of three groups: the pamphlet; pamphlet/benefit statement (vaccinating the pregnant woman also benefits the young infant); or control. A Chi square analysis compared the intervention with control using the primary outcome of vaccination. A secondary outcome of the perceptions of health beliefs of maternal vaccination were measured through General Linear Model/ANOVA model for repeated measures. Overall 66.9% (89/133) were vaccinated. Both the pamphlet group 72.9% (35/48) (χ² = 6.81, df = 1 p = .009), and the pamphlet/benefit statement group 86.1% (31/36) (χ² = 13.74, df = 1, p < .001), had significantly higher vaccine uptake than the control group 46.9% (23/49). The potential barrier, perception of vaccine safety (F = 4.973, df = 2, p < .01), and benefit of vaccination to mother and infant (F = 6.690, df = 2, p < .01) significantly improved for the intervention groups compared to control group. The pamphlet significantly increased the pregnant women's perceptions of the safety and benefit of the vaccine, and the overall uptake.

Effectiveness of monovalent and pentavalent rotavirus vaccine.

OBJECTIVE: Previous US evaluations have not assessed monovalent rotavirus vaccine (RV1, a G1P[8] human rotavirus strain) effectiveness, because of its later introduction (2008). Using case-control methodology, we measured the vaccine effectiveness (VE) of the 2-dose RV1 and 3-dose pentavalent vaccine (RV5) series against rotavirus disease resulting in hospital emergency department or inpatient care. METHODS: Children were eligible for enrollment if they presented to 1 of 5 hospitals (3 in Georgia, 2 in Connecticut) with diarrhea of ≤10 days' duration during January through June 2010 or 2011, and were born after RV1 introduction. Stools were collected; immunization records were obtained from providers and state electronic immunization information system (IIS). Case-subjects (children testing rotavirus antigen-positive) were compared with 2 control groups: children testing rotavirus negative and children selected from IIS. RESULTS: Overall, 165 rotavirus-case subjects and 428 rotavirus-negative controls were enrolled. Using the rotavirus-negative controls, RV1 VE was 91% (95% confidence interval [CI] 80 to 95) and RV5 VE was 92% (CI 75 to 97) among children aged ≥8 months. The RV1 VE against G2P[4] disease was high (94%, CI 78 to 98), as was that against G1P[8] disease (89%, CI 70 to 96). RV1 effectiveness was sustained among children aged 12 through 23 months (VE 91%; CI 75 to 96). VE point estimates using IIS controls were similar to those using rotavirus-negative controls. CONCLUSIONS: RV1 and RV5 were both highly effective against severe rotavirus disease. RV1 conferred sustained protection during the first 2 years of life and demonstrated high effectiveness against G2P[4] (heterotypic) disease.

Reasons why women accept or reject the trivalent inactivated influenza vaccine (TIV) during pregnancy.

The aim of the study was to gain an in-depth understanding of the reasons why pregnant women accept or reject the seasonal influenza vaccine. The qualitative descriptive design used a face-to-face semi-structured interview format. Sixty pregnant and postpartum women at two hospitals in the Northeastern United States participated. Content analysis was the inductive method used to code the data and identify emergent themes. Six themes emerged from the data: differing degrees of influence affect action to vaccinate; two-for-one benefit is a pivotal piece of knowledge that influences future vaccination; fear if I do (vaccinate), fear if I don't; women who verbalize 'no need' for the vaccine also fear the vaccine; a conveniently located venue for vaccination reduces barriers to uptake; H1N1-a benefit and barrier to the seasonal vaccine. Our study supports previous findings and reveals a deeper understanding and interpretation of the behavior and decision-making to accept or reject the influenza vaccine. Understanding the reasons behind the behavior of vaccine rejection gives us the chance to change it.

Seroepidemiology of human bocavirus infection in Jamaica.

BACKGROUND: Human bocavirus (HBoV) is a newly identified human parvovirus. HBoV is associated with upper and lower respiratory tract infections and gastroenteritis in children. Little is known about the seroepidemiology of HBoV in populations in the Caribbean. METHODS: In a cross-sectional study conducted at the University Hospital of the West Indies in Kingston, Jamaica, 287 blood samples were collected from pediatric patients and tested for the presence of HBoV-specific antibody using a virus-like-particle based enzyme-linked immunosorbent assay (ELISA). RESULTS: HBoV-specific antibodies were found to be present in 220/287 (76.7%) of samples collected from the pediatric population. Seroprevalence of HBoV was highest in those ≥2 years old. The seroepidemiological profile suggests that most children are exposed to HBoV during the first two years of life in Jamaica. CONCLUSION: HBoV infection is common in children in Jamaica. HBoV seroprevalence rates in the Caribbean are similar to those previously reported in other areas of the world.

Cocooning: a concept to protect young children from infectious diseases.

PURPOSE OF REVIEW: Despite focused efforts aimed at preventing infectious diseases among infants, recent years have seen a surge of infections among this population, particularly in pertussis, reminiscent of the 1940s prevaccine era. Given these trends, this review serves to discuss cocooning for infants against pertussis and its more recent application in influenza, and the barriers to and facilitators of this important strategy. RECENT FINDINGS: Infection with pertussis and influenza remains a significant cause of hospitalization among infants aged less than 1 year. Simultaneously, uptake of both tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines is very low among adults reporting close contact with an infant. To date, widespread implementation of cocooning has been thwarted by both individual-level and system-level issues, although general acceptance of vaccination is high in settings in which cocooning is encouraged. SUMMARY: Better characterization and improvement of the cocooning strategy are necessary. Additionally, longitudinal research evaluating the effectiveness of cocooning against pertussis and influenza is essential. Ultimately, the effectiveness of cocooning to produce sustained control of infections will be dependent on healthcare provider advocacy, patient education, implementation and enforcement of policies, and the development of cost-effective programs.

Effectiveness of 2 doses of varicella vaccine in children.

BACKGROUND: Because of ongoing outbreaks of varicella, a second dose of varicella vaccine was added to the routine immunization schedule for children in June 2006 by the Centers for Disease Control and Prevention. METHODS: We assessed the effectiveness of 2 doses of varicella vaccine in a case-control study by identifying children ≥4 years of age with varicella confirmed by polymerase chain reaction assay and up to 2 controls matched by age and pediatric practice. Effectiveness was calculated using exact conditional logistic regression. RESULTS: From July 2006 to January 2010, of the 71 case subjects and 140 matched controls enrolled, no cases (0%) vs 22 controls (15.7%) had received 2 doses of varicella vaccine, 66 cases (93.0%) vs 117 controls (83.6%) had received 1 dose, and 5 cases (7.0%) vs 1 control (0.7%) did not receive varicella vaccine (P < .001). The effectiveness of 2 doses of the vaccine was 98.3% (95% confidence level [CI]: 83.5%-100%; P < .001). The matched odds ratio for 2 doses vs 1 dose of the vaccine was 0.053 (95% CI: 0.002-0.320; P < .001). CONCLUSION: The effectiveness of 2 doses of varicella vaccine in the first 2.5 years after recommendation of a routine second dose of the vaccine for children is excellent. Odds of developing varicella were 95% lower for children who received 2 doses compared with 1 dose of varicella vaccine.

The changing face of pediatric respiratory tract infections: how human metapneumovirus and human bocavirus fit into the overall etiology of respiratory tract infections in young children.

Lower respiratory tract infections are one of the leading causes of morbidity and mortality in children worldwide. Recent technological advances in the field of molecular biology have allowed virologists to detect many previously undetected viral pathogens. Two of these, human metapneumovirus (hMPV) and human bocavirus (HBoV), are of particular clinical interest to pediatric health care providers. This review discusses the most common viral respiratory infections in children, explores the role of newly discovered respiratory pathogens, and describes techniques for the diagnosis of viral respiratory infections.

Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants.

BACKGROUND: Infants aged <12 months are at high risk of hospitalization for influenza. Influenza vaccine is recommended for pregnant women and for most children; however, no vaccine is approved for infants aged <6 months. Effective approaches are needed to protect this vulnerable population. Vaccination of women during pregnancy may protect the infant through transfer of antibodies from the mother. Few studies have examined the effectiveness of this strategy, and those studies produced mixed results. METHODS: In a matched case-control study, case patients were infants aged <12 months admitted to a large urban hospital in the northeastern United States because of laboratory-confirmed influenza from 2000 to 2009. For each case, we enrolled 1 or 2 control subjects who were infants who tested negative for influenza and matched cases by date of birth and date of hospitalization (within 4 weeks). Vaccine effectiveness was calculated on the basis of matched odds ratios and was adjusted for confounding. RESULTS: The mothers of 2 (2.2%) of 91 case subjects and 31 (19.9%) of 156 control subjects aged <6 months, and 1 (4.6%) of 22 case subjects and 2 (5.6%) of 36 control subjects aged ≥6 months, had received influenza vaccine during pregnancy. The effectiveness of influenza vaccine given to mothers during pregnancy in preventing hospitalization among their infants, adjusted for potential confounders, was 91.5% (95% confidence interval [CI], 61.7%-98.1%; P = .001) for infants aged <6 months. The unadjusted effectiveness was 90.7% (95% CI, 59.9%-97.8%; P = .001). CONCLUSIONS: Influenza vaccine given to pregnant women is 91.5% effective in preventing hospitalization of their infants for influenza in the first 6 months of life.

Effectiveness of rotavirus vaccine in preventing hospitalization due to rotavirus gastroenteritis in young children in Connecticut, USA.

Rotavirus vaccine was recommended for use in US infants to prevent rotavirus gastroenteritis (RGE) in February 2006. This matched case control study assessed the effectiveness of rotavirus vaccine in preventing hospitalization of young. Cases were vaccine-eligible children 8 weeks-3 years of age, hospitalized due to laboratory-confirmed RGE. Cases (n=42) were matched to 2 control groups: (a) hospitalized controls (n=80): children hospitalized for reasons other than RGE, matched to the cases by age and time of presentation and (b) community controls (n=73): non-hospitalized children matched by age and medical practice. Adjusted vaccine effectiveness against hospitalization with RGE in vaccine eligible children receiving at least one dose of vaccine was 94.3% (95% C.I.: 55.4%-99.3%; p=0.006) for hospitalized controls and 96.9% (95% C.I.: 59.4%-99.8%; p=0.008) for community controls.

Risk factors for invasive pneumococcal disease in children in the era of conjugate vaccine use.

OBJECTIVE: We conducted a case-control study to evaluate risk factors for invasive pneumococcal disease (IPD) among children who were aged 3 to 59 months in the era of pneumococcal conjugate vaccine (PCV7). METHODS: IPD cases were identified through routine surveillance during 2001-2004. We matched a median of 3 control subjects to each case patient by age and zip code. We calculated odds ratios for potential risk factors for vaccine-type and non-vaccine-type IPD by using multivariable conditional logistic regression. RESULTS: We enrolled 782 case patients (45% vaccine-type IPD) and 2512 matched control subjects. Among children who received any PCV7, children were at increased risk for vaccine-type IPD when they had underlying illnesses, were male, or had no health care coverage. Vaccination with PCV7 did not influence the risk for non-vaccine-type IPD. Presence of underlying illnesses increased the risk for non-vaccine-type IPD, particularly among children who were not exposed to household smoking. Non-vaccine-type case patients were more likely than control subjects to attend group child care, be male, live in low-income households, or have asthma; case patients were less likely than control subjects to live in households with other children. CONCLUSIONS: Vaccination with PCV7 has reduced the risk for vaccine-type IPD that is associated with race and group child care attendance. Because these factors are still associated with non-vaccine-type IPD risk, additional reductions in disparities should be expected with new, higher valency conjugate vaccines.