Evaluation of the Epidemic Situation of Anthrax in Armenia Over the Last Decade.

INTRODUCTION: Anthrax is a World Organisation for Animal Health (WOAH)-listed disease that must be reported upon confirmation based on the Terrestrial Animal Health Code. Anthrax poses a serious health issue for unvaccinated livestock, is a threat to humans through interaction with contaminated livestock and animal products and is endemic in many areas throughout the world, including the Transcaucasian Region. Despite several control and eradication efforts that have been implemented by the government of the Republic of Armenia (RA), sporadic cases of anthrax are still reported. We sought to understand the epidemic situation of anthrax in RA during the last 10 years (2012-2023) based on analysis of outbreaks and reported cases in cattle and humans. METHODS: We collected and evaluated officially reported data from human and animal cases, such as time, location, animal species, disease intensity and spread radius. The data and various parameters were mapped using ArcGIS to prepare a viable risk assessment. RESULTS: Based on the officially available data and reports, there have been 80 human cases and 55 animal cases of anthrax confirmed in RA from 2012 to 2023. We also identified the presence of anthrax spores in soil and environmental samples near animal burial sites in RA in 2015-2017 through polymerase chain reaction (PCR) testing. Upon comparing the human and animal cases by frequency and intensity, the human cases are directly proportional to the animal husbandry practices performed in RA. CONCLUSION: The detection of the anthrax pathogen at the burial sites highlights the continued threat in these areas. Thus, it is imperative to secure and monitor any areas that have been used for anthrax burial and limit the movement of animals in these areas. In the future, legislation should be updated to prioritise incineration of anthrax-infected carcasses instead of burial to limit further exposure to animals and humans.

Early onset of protection of the TAK-003 dengue vaccine: Data from the DEN-301 clinical trial.

Exploring time-to-onset of efficacy of the live-attenuated dengue vaccine TAK-003 is important for individuals living in, or traveling to, dengue-endemic areas. This protocol-defined exploratory analysis of the Tetravalent Immunization against Dengue Efficacy Study (TIDES) investigated TAK-003's onset of efficacy after the first and before the second dose, administered 3 months later, in healthy participants aged 4-16 years randomly assigned 2:1 to receive TAK-003 or placebo. The number of virologically confirmed dengue (VCD) cases between first and second vaccinations and the time-to-onset of vaccine efficacy (VE) were assessed in the safety population. Fifty VCD cases occurred between the first and second doses (placebo = 37, TAK-003 = 13). The VE against VCD up to 3 months after the first dose was 82.1 %, with an estimated time-to-onset of ∼14 days. TAK-003 provides rapid onset of protection after the first dose and may be useful in the context of a dengue outbreak or as a travel vaccine.

Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study.

BACKGROUND: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. OBJECTIVE: We aimed to explore the effects of COVID-19-related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. METHODS: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. RESULTS: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media-driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. CONCLUSIONS: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale.

Hepatitis B vaccination status among patients with end-stage kidney disease on haemodialysis in Ethiopia: a multi-center cross-sectional study.

BACKGROUND: Chronic kidney disease patients, especially those on hemodialysis, are at increased risk of developing hepatitis B virus (HBV) infection. Guidelines suggest that all patients with chronic kidney disease patients should be vaccinated against HBV, but these guidelines are sub-optimally implemented. Notably, there is a lack of studies in Ethiopia examining the hepatitis B vaccination status among patients with end-stage renal disease. OBJECTIVE: To assess the vaccination status of hepatitis B and associated factors among people with end-stage renal disease who were on hemodialysis. METHODS: A multi-center cross-sectional observational study was conducted in six randomly selected dialysis centers in Ethiopia, from May 2023 to September 2023. Logistic regression analysis was used to evaluate factors associated with vaccination status. A person is considered to be vaccinated against hepatitis B if he/ she has taken at least one dose of HBV. Vaccination status was determined by patient's recall and verification from medical record. RESULTS: Only 16% of patients with end-stage renal disease on hemodialysis were vaccinated against hepatitis B virus (16.6%; with CI = 12.18, 21.83), of which 30% had received one dose, 57.5% had two doses, 12.5% had three doses, and only five had a booster dose. Post-secondary education (AOR = 5.47; 95% CI = 1.41, 21.2; P < 0.014) and dialysis for more than three years (AOR = 19.75; 95% CI = 4.06, 96.1; P < 0.001) were significant factors associated with having received hepatitis B vaccination. CONCLUSION: Only a small minority of Ethiopian hemodialysis patients have received hepatitis B vaccination. The level of education of patients and the duration of time on dialysis were significant associated factors that affected the vaccination status of patients with end-stage renal disease. So, strong intervention is needed according to the identified factors to raise the vaccination status of patients.

Exploring influential factors in childhood vaccine delays in Riyadh, Saudi Arabia.

Introduction: Infectious diseases present a substantial worldwide health challenge, yet vaccines have played a crucial role in significantly decreasing illness rates. Despite their effectiveness, global vaccination coverage stands at 85%, leaving a considerable number of infants without routine immunization. Our study seeks to examine the occurrence of delayed primary vaccination and the factors influencing it in Riyadh, Saudi Arabia addressing a critical void in current research. Methodology: A cross-sectional investigation was carried out in the primary care facilities of the first health cluster in Riyadh, Saudi Arabia. Information was gathered utilizing a well-structured questionnaire, modified from a prior study. The study encompassed children aged two years and younger, accompanied by their parents who brought their vaccination cards for the visit. Non-probability convenience sampling was employed for data collection. Subsequently, the data underwent thorough cleaning in Excel (Microsoft Excel) and was subjected to analysis using IBM SPSS 29 (IBM SPSS Statistics 29). Results: The study involved 402 participants, primarily over 12 months old, with a balanced gender distribution. Noteworthy findings indicate a 20.9% prevalence of childhood vaccine delays, with reasons such as high-grade fever (33.3%) and travel (26.2%). Significant associations were found in children aged 6-12 months (25.8%, P = 0.039), families with over four children (31%, P = 0.010), perceptions of vaccine harm (50.0%, P = 0.013), and acknowledgment of neglect (96.4%, P = 0.001). Conclusion: The research illuminates the complex factors influencing childhood vaccine delays in Saudi Arabia. Stressing the significance of personalized interventions, it underscores the necessity to tackle challenges specific to age, parental perspectives, and access issues for improved vaccination outcomes.

COVID-19 epidemic investigation study of a follow-up cohort of patients with diabetic kidney disease.

Introduction: The impact of coronavirus disease 2019 (COVID-19) on diabetic kidney disease (DKD) patients in China is not fully understood. This study aimed to investigate infection status in a DKD cohort post-renal biopsy and analyze vaccination and infection rates, as well as symptom severity, across various renal pathologies in DKD patients. Methods: This epidemiological survey, centered on COVID-19, employed a Chinese DKD and renal puncture follow-up cohort. A customized questionnaire enabled standardized data gathering. It collected data on clinical characteristics, vaccination and infection statuses, and diverse pathological types. The study analyzed the relationship between vaccination and infection statuses across various pathological types, evaluating characteristics and treatment outcomes in patients with infections. Results: In total, 437 patients with DKD from 26 Chinese provinces were followed up for a median of 44.6 ± 20 months. COVID-19 infection, vaccination, and novel coronavirus pneumonia (NCP) rates were 73.68%, 59.3%, and 6.63%, respectively. Ten patients with NCP had severe pneumonia or died of COVID-19. Renal pathology revealed that 167 (38.22%) patients had diabetic nephropathy (DN), 171 (39.13%) had non-diabetic renal disease (NDRD), and 99 had DN and NDRD (22.65%). The DN group had the lowest vaccination (54.5%), highest all-cause mortality (3.6%), and highest endpoint rates (34.10%). Compared to patients who were not vaccinated pre-infection (117 cases), vaccinated patients (198 cases) had reduced NCP (6.6% vs. 13.7%), severity (1.0% vs. 3.4%), and endpoint (9.10% vs. 31.60%) rates. Conclusion: Vaccination can prevent infection and diminish COVID-19 severity in patients with DKD; therefore, increasing vaccination rates is particularly important. Clinical Trial registration: ClinicalTrails.gov, NCT05888909.

Pediatric Human Papillomavirus Vaccination Rates Within a Tertiary Military Medical Center.

Objective: To determine our center's human papillomavirus (HPV) vaccination rate and identify common negative perceptions surrounding the vaccine to guide more effective HPV vaccine counseling. Methods: We reviewed immunization records for patients ages 11 to 26 that receive care at Brooke Army Medical Center. Vaccine uptake rate was determined by dividing the number of patients who had completed the HPV vaccine series by the total target population. From October 2021 to December 2022, a clinic survey was distributed to parents (for patients ages 11-17) or patients themselves (ages 18-26) during otolaryngology visits to poll vaccination status and attitudes toward the vaccine. Results: A total of 3038 patients ages 11 to 26 are enrolled for primary care at Brooke Army Medical Center, but only 962 (32%) are vaccine complete. Thirty-five surveys were collected during the study period. Twenty-two surveys (63%) from patients/parents reported they/their child had received the HPV vaccine. Concerns about vaccine safety, sexual behaviors, lack of immunization requirement for school, and difficulty getting scheduled were the most common reasons patients were unvaccinated. Discussion: Counseling patients on the HPV vaccine can be difficult given the common misconceptions surrounding vaccination, but understanding these attitudes will allow otolaryngologists to educate patients more effectively. This matters since patients more knowledgeable about HPV are more likely to receive the vaccine. Implications for Practice: Our clinic has developed new strategies in partnership with primary care departments to facilitate more streamlined vaccination for eligible patients, and moving forward we plan to trend HPV vaccination rates over time to determine our impact on uptake.

Lessons from a school-based vaccination response following a Diphtheria outbreak in eThekwini district, SA.

Diphtheria is a life-threatening respiratory tract infection that causes outbreaks in susceptible populations. Between April and May 2018, an outbreak of diphtheria occurred in the eThekwini district. A school-based outbreak vaccination response was initiated to target vulnerable children and adolescents. Contribution: This study adds to the limited data describing a school-based vaccination in an outbreak response and highlights successes and challenges. School-based outbreak vaccination response can rapidly increase vaccine coverage; however, additional community engagement may be required in vaccine-hesitant populations.

Determinants of Parental Vaccine Hesitancy During the COVID-19 Era in Saudi Arabia: A Cross-Sectional Survey.

Background Despite the success of childhood vaccination in reducing vaccine-preventable diseases (VPDs), vaccine hesitancy remains a significant challenge in several countries, such as Saudi Arabia, both during and beyond the COVID-19 era. Furthermore, the pandemic may have impacted vaccine hesitancy trends, potentially affecting parents' intentions to adhere to scheduled childhood vaccination programs. Aim This article aims to assess the extent of parents' hesitancy toward childhood vaccination, determine if it increased or decreased due to the COVID-19 pandemic, highlight the factors and determinants that influenced this hesitancy, whether positively or negatively, during the COVID-19 era, and estimate the acceptance of COVID-19 vaccination in relation to the acceptance of scheduled childhood vaccination. Methods A cross-sectional study was conducted in Saudi Arabia through a snowball sampling technique. Data were collected between September 2022 and October 2022 using an online survey using Google Forms. The inclusion criteria were parents or guardians in Saudi Arabia with a child up to 18 years of age. Responses were analyzed using SPSS V25 (IBM Corp., Armonk, NY, US), with chi-square tests and logistic regression performed to compare hesitancy and vaccination status. Results Among the 1,209 parents and care providers who participated, the prevalence of parents' vaccine hesitancy was 374 (30.9%). The educational level of the parents was not significantly associated with hesitancy status (p 0.490). The most refused vaccine was Mpox (345; 28.5%), whereas the one that caused the most hesitancy was the COVID-19 vaccine (352; 29.1%). Regarding the parents' concerns, the main reason for their hesitancy was the influence of their negative perceptions from social media content, including false or misleading information and negative allegations about vaccines, reported by 449 (18.98%) of the participants. Logistic regression analysis indicated that negative social media perceptions significantly increased the likelihood of vaccine hesitancy (OR = 2.15, 95% CI = 1.78-2.60, p < 0.001). Conclusion Our study highlights the prevalence of parental vaccine hesitancy during the COVID-19 era; the most significant hesitancy was observed toward the COVID-19 vaccine, and the mpox vaccine was the most rejected. Negative social media was the main reason for parental hesitancy; public health efforts should focus on providing accurate and easily accessible information through educational campaigns on social media and other platforms.

Political Party Affiliation and COVID-19 Vaccination Status in Japan, 2022.

INTRODUCTION: An association has been reported between political affiliations and vaccination worldwide. In Japan, a significant proportion of the population are non-partisans, and major political parties advocate COVID-19 vaccination. The association between supporting political parties and COVID-19 vaccination coverage in Japan remains unclear. This study aims to investigate the relationship between political party affiliation and COVID-19 vaccination status in Japan.  Methods: This study utilized data from large-scale nationwide internet surveys conducted in Japan in 2022, with a sample size of 21,162 participants. The surveys collected information on participants' COVID-19 vaccination status and political party affiliation. The political parties included in the analysis were the Liberal Democratic Party, the Constitutional Democratic Party, the Komeito, the Japanese Communist Party, the Japan Innovation Party (Nippon Ishin no Kai), and the Reiwa Shinsengumi, as well as non-partisans. Logistic regression analysis was performed to examine the relationship between political partisanship and COVID-19 vaccine status. The analysis controlled for potential confounding variables such as age, gender, socioeconomic status, and geographic location. RESULTS: The odds of being unvaccinated were lower for supporters of large political groups (e.g. Liberal Democratic Party {OR 0.6; 95% CI, 0.5-0.7}), while higher for small political groups (e.g. Reiwa Shinsengumi {OR 2.6; 95% CI, 1.9-3.6}), in comparison with non-partisan. CONCLUSION: Political affiliation may be associated with vaccination disparities in Japan. Supporters of minor parties were more likely to be unvaccinated than those of the larger parties. However, this study has several limitations, including self-reporting bias and selection bias due to the Internet survey methodology.

Patient-reported daily functioning after SARS-CoV-2 vaccinations in autoimmune neuromuscular diseases.

BACKGROUND AND PURPOSE: There are concerns for safety regarding SARS-CoV-2 vaccines for patients with autoimmune neuromuscular disease. We compared daily functioning using disease-specific patient-reported outcome measures (PROMs) before and after SARS-CoV-2 vaccinations. METHODS: In this substudy of a prospective observational cohort study (Target-to-B!), patients with myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), and idiopathic inflammatory myopathy (IIM) vaccinated against SARS-CoV-2 were included. Surveys of daily functioning (Myasthenia Gravis Activities of Daily Living, Inflammatory Rasch-Built Overall Disability Scale, Multifocal Motor Neuropathy Rasch-Built Overall Disability Scale, and Health Assessment Questionnaire-Disability Index) were sent before first vaccination and every 60 days thereafter for up to 12 months. Regression models were constructed to assess differences in PROM scores related to vaccination, compared to scores unrelated to vaccination. We also assessed the proportion of patients with deterioration of at least the minimal clinically important difference (MCID) between before first vaccination and 60 days thereafter. RESULTS: We included 325 patients (median age = 59 years, interquartile range = 47-67, 156 [48%] female sex), of whom 137 (42%) had MG, 79 (24%) had CIDP, 43 (13%) had MMN, and 66 (20%) had IIM. PROM scores related to vaccination did not differ from scores unrelated to vaccination. In paired PROMs, MCID for deterioration was observed in three of 49 (6%) MG patients, of whom none reported a treatment change. In CIDP, MCID for deterioration was observed in eight of 29 patients (28%), of whom two of eight (25%) reported a treatment change. CONCLUSIONS: SARS-CoV-2 vaccination had no effect on daily functioning in patients with autoimmune neuromuscular diseases, confirming its safety in these patients.

Influence of commercial inactivated or modified-live virus vaccination at time of AI on corpus luteum development and function in beef cattle.

Our objective was to evaluate the effect of vaccination with an inactivated virus vaccine (IVV) or modified-live virus (MLV) vaccine on the corpus luteum (CL). On d0, synchronized beef cows were treated with MLV (n = 70; BoviShield Gold FP5VL5), IVV (n = 16; ViraShield 6VL5HB), or were unvaccinated controls (n = 5). Plasma was collected from treated animals on d0 and every other day through d22. Plasma was analyzed for concentrations of progesterone and 15 cytokines. Between d10 and d13, selected females (n = 13) were ovariectomized; controls were slaughtered on d15/16 to obtain CL for histological evaluation. There were reduced numbers of large luteal cells (LLC) in MLV compared to IVV and controls (P < 0.0001), but IVV were similar to controls (P = 0.11). MLV had decreased LLC percentage compared to controls, and IVV were intermediate (P < 0.0001, MLV: 1.57 ± 0.33 %, IVV: 2.99 ± 0.30 %, Control: 6.45 ± 0.33 %). Based on progesterone concentrations, 24 % MLV and 0 % IVV had an abnormal cycle following vaccination. Overall, MLV had reduced progesterone concentrations (P = 0.02; MLV: 3.61 ± 0.22; IVV: 4.81 ± 0.46 ng/mL). The new CL that formed following an abnormal cycle in MLV had the greatest percentage (35.56 ± 5.5 %) of apoptotic cells. Treatment by cycle status interaction, and time significantly affected IFN-γ, IP-10, MIP-1ß, and MCP-1 (P < 0.03), with several time points having elevated concentrations in abnormally cycling MLV animals. Collectively, this demonstrates MLV vaccination around estrus negatively influenced LLC, progesterone, and increased luteal apoptosis and pro-inflammatory cytokines.

Building a Prevention Clinic at the Northport VA to Improve Pneumonia Vaccination Numbers.

Introduction: Pneumonia vaccination rates have increased to >60% over the last 20 years. At the Long Island, New York, Northport VA Hospital, pneumonia vaccination data from 2021 showed a vaccination rate of 68.55%. The goal is a pneumonia vaccination rate of 85%. Pneumonia vaccines prevent invasive pneumococcal disease and pneumococcal pneumonia. The authors aimed to increase vaccination rates at Northport. Methods: The authors established a weekly vaccine and prevention clinic aiming to vaccinate as many veterans as possible. Preventive medicine residents performed outreach, scheduling, vaccine administration, and Brief Action Planning. Motivational interviewing techniques were used in outreach calls and clinic visits to encourage behavioral change. Results: From an outreach list >7,000 patients, 506 patients were contacted and counseled on pneumonia vaccination. A total of 130 patients were scheduled for clinic visits. Of these 130, 91 kept their appointments and were seen in the clinic, and 87 vaccines were administered, of which 56 were pneumonia vaccines. Data were collected and analyzed in 2022. Conclusions: Implementing a dedicated vaccine and prevention clinic using motivational interviewing techniques in outreach and clinical visits allows for optimized patient vaccinations, enhanced information sharing, increased primary care retention, and increasing visibility of preventive medicine among patients and colleagues within the Veterans Affairs medical system.

Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis.

BACKGROUND: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. OBJECTIVE: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. METHODS: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. RESULTS: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. CONCLUSIONS: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.

Digital Gamification Tool (Let's Control Flu) to Increase Vaccination Coverage Rates: Proposal for Algorithm Development.

BACKGROUND: Influenza represents a critical public health challenge, disproportionately affecting at-risk populations, including older adults and those with chronic conditions, often compounded by socioeconomic factors. Innovative strategies, such as gamification, are essential for augmenting risk communication and community engagement efforts to address this threat. OBJECTIVE: This study aims to introduce the "Let's Control Flu" (LCF) tool, a gamified, interactive platform aimed at simulating the impact of various public health policies (PHPs) on influenza vaccination coverage rates and health outcomes. The tool aligns with the World Health Organization's goal of achieving a 75% influenza vaccination rate by 2030, facilitating strategic decision-making to enhance vaccination uptake. METHODS: The LCF tool integrates a selection of 13 PHPs from an initial set proposed in another study, targeting specific population groups to evaluate 7 key health outcomes. A prioritization mechanism accounts for societal resistance and the synergistic effects of PHPs, projecting the potential policy impacts from 2022 to 2031. This methodology enables users to assess how PHPs could influence public health strategies within distinct target groups. RESULTS: The LCF project began in February 2021 and is scheduled to end in December 2024. The model creation phase and its application to the pilot country, Sweden, took place between May 2021 and May 2023, with subsequent application to other European countries. The pilot phase demonstrated the tool's potential, indicating a promising increase in the national influenza vaccination coverage rate, with uniform improvements across all targeted demographic groups. These initial findings highlight the tool's capacity to model the effects of PHPs on improving vaccination rates and mitigating the health impact of influenza. CONCLUSIONS: By incorporating gamification into the analysis of PHPs, the LCF tool offers an innovative and accessible approach to supporting health decision makers and patient advocacy groups. It enhances the comprehension of policy impacts, promoting more effective influenza prevention and control strategies. This paper underscores the critical need for adaptable and engaging tools in PHP planning and implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/55613.

Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey.

BACKGROUND: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death. OBJECTIVE: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors. METHODS: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves. RESULTS: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents. CONCLUSIONS: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases.

Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study.

HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.

Bacille Calmette-Guérin (BCG) osteomyelitis: a rare complication of BCG vaccination.

The BCG vaccine is considered a safe and efficacious vaccine in the prevention of severe forms of tuberculosis. BCG osteomyelitis is a rare complication of the BCG vaccine that occurs in vaccinated young children. We report a case of BCG osteomyelitis in a male toddler, presenting with painful left wrist swelling without preceding fever or systemic symptoms. Radiographic evidence of osteomyelitis in the left wrist was observed. Initial treatment with conventional antibiotics for acute haematogenous osteomyelitis showed no improvement. The diagnosis of Mycobacterium bovis BCG osteomyelitis was confirmed via tissue samples for histopathological examination and mycobacterial cultures. The patient responded well to treatment with oral antituberculous therapy. This case highlights the importance of considering BCG osteomyelitis in the differential diagnosis of unexplained joint swelling in BCG-vaccinated young children.

Immunization status and factors influencing hepatitis B vaccination of preterm infants in three provinces of China, 2019 to 2021.

BACKGROUND: Premature infants have less physiologic reserve and often delayed vaccination compared to full-term infants. The birth dose of hepatitis B vaccine (HepB-BD) is an essential measure to achieve the goal of "zero infections" of hepatitis B virus in all newborns. However, there are few investigations of hepatitis B vaccination of preterm infants, leading to uncertainty of coverage and insufficient knowledge of factors influencing timely vaccination of this important population. METHODS: We obtained hepatitis B vaccine (HepB) vaccination histories of premature infants born during 2019-2021 in three provinces from the respective provincial immunization information systems. Extracted data included date of birth, sex, region, and dates of HepB administration. We conducted descriptive analyses that included basic characteristics of the study subjects, HepB-BD administration, and full-series HepB vaccination. Factors potentially influencing HepB-BD and full series vaccination were analyzed by logistic regression. RESULTS: There were 1623 premature infants included in the analytic data set. Overall HepB-BD coverage was 71.41%; coverage among premature infants born to mothers with unknown hepatitis B surface antigen (HBsAg) status was 69.57%; coverage was higher at county-level-and-above hospitals (72.02%) than hospitals below county level (61.11%). Full-series HepB coverage was 94.15%; full-series coverage among preterm infants weighing less than 2000 g at birth was 76.92%. Logistic regression showed that the HepB-BD vaccination rate was positively associated with being born to an HBsAg-positive mother and being preterm with high birth weight. Regression analysis for factors influencing full-series HepB coverage showed that being born prematurely was positively associated with full-series coverage and being premature with a very low birth weight was negatively associated with full-series coverage. CONCLUSIONS: HepB-BD coverage levels in three provinces of China were less than the target of 90%, especially among premature infants born to mothers with unknown HBsAg status and at hospitals below the county level. Screening of pregnant women should be a universal normal standard. Hepatitis B vaccination training should be strengthened in hospitals to improve the HepB-BD vaccination rate of premature infants and to effectively prevent mother-to-child transmission of hepatitis B virus.