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BACKGROUND: Adolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability. OBJECTIVE: To identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake. METHODS: Qualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF 'Journey to Immunization' model. RESULTS: 32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program. CONCLUSIONS: Our study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake.
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Vacunas contra Papillomavirus , Investigación Cualitativa , Humanos , Victoria , Adolescente , Femenino , Masculino , Vacunas contra Papillomavirus/administración & dosificación , Padres/psicología , Participación de los Interesados/psicología , Vacunación/estadística & datos numéricos , Vacunación/psicología , Entrevistas como Asunto , Servicios de Salud Escolar , Programas de Inmunización , Infecciones por Papillomavirus/prevención & control , Instituciones Académicas , Personas con Discapacidad/psicología , Conocimientos, Actitudes y Práctica en Salud , Trastorno Autístico/psicología , Discapacidad IntelectualRESUMEN
Globally, respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in young children, and the association between severe RSV disease and later recurrent wheeze and asthma is well established. Whilst a causal link between RSV and wheeze/asthma is not yet proven, immunological evidence suggests skewing towards a Th2-type response, and dampening of IFN-γ antiviral immunity during RSV infection underpins airway hyper-reactivity in a subset of susceptible children after RSV infection. Age at primary RSV infection, viral co-infection and genetic influences may act as effect-modifiers. Despite the significant morbidity and mortality burden of RSV disease in children, there is currently no licensed vaccine. Recent advancements in RSV preventatives, including long-acting monoclonal antibodies and maternal vaccinations, show significant promise and we are on the cusp of a new era in RSV prevention. However, the potential impact of RSV preventatives on subsequent wheeze and asthma remains unclear. The ongoing COVID-19 pandemic and associated public health measures have disrupted the usual seasonality of RSV. Whilst this has posed challenges for health-care services it has also enhanced our understanding of RSV transmission. The near absence of RSV cases during the first year of the pandemic in the context of strict public health measures has provided a rare opportunity to study the impact of delayed age of primary RSV infection on asthma prevalence. In this review, we summarise current understanding of the association between RSV, recurrent wheeze and asthma with a focus on pathophysiology, preventative strategies and future research priorities.
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Asma , COVID-19 , Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Virosis , Anticuerpos Monoclonales , Antivirales/uso terapéutico , Asma/epidemiología , Asma/etiología , Asma/prevención & control , Niño , Preescolar , Humanos , Lactante , Pandemias , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Virosis/complicacionesRESUMEN
AIM: Ensuring children with special risk medical conditions (SRMC) are protected from influenza is important. The study objective was to describe influenza vaccination practices of medical professionals caring for children with SRMC and explore characteristics associated with a vaccine recommendation. METHODS: Design: Cross-sectional survey. SETTING/PARTICIPANTS: Treating paediatric specialists and general practitioners of children with confirmed SRMCs. Postal questionnaire administered from March to September 2018 (option for online response). Characteristics associated with providing a recommendation were explored using univariable and multivariable analyses. RESULTS: Overall response rate of 24.8% with the sample representative of the eligible population in terms of practice location and years practicing medicine. There was a higher response from females and sub-specialists. Of the 198 completed survey responders, 97.8% were aware of the recommendation, yet only 38.4% reported they 'always' routinely recommended influenza vaccine and fewer (19.5%) were very confident in understanding all 'medically at risk' conditions. Medical professionals were more likely to provide a recommendation always or mostly, if they received annual influenza vaccination themselves (adjusted odds ratio (aOR) 3.96, confidence interval (CI) 1.12-14.03), had confidence in understanding all 'medically at risk' conditions (aOR 1.82, CI 1.04-3.17) and perceived ownership of the responsibility to provide the recommendation (aOR 7.35, CI 1.67-32.26). Regional practising medical professionals were less likely to provide a recommendation (aOR 0.25 CI 0.10-0.70). CONCLUSIONS: We need to improve medical professionals' knowledge through reminders and access to consistent and concise information about what constitutes a SRMC. Increasing medical professionals' engagement in the influenza vaccination programme could also provide a sense of responsibility fostering provider endorsement.
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Vacunas contra la Influenza , Gripe Humana , Niño , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Gripe Humana/prevención & control , Políticas , Estaciones del Año , Encuestas y Cuestionarios , VacunaciónAsunto(s)
COVID-19/prevención & control , Vacunación Masiva/organización & administración , Pandemias/prevención & control , Sistema de Registros , Poblaciones Vulnerables , Australia/epidemiología , COVID-19/epidemiología , Vacunas contra la COVID-19 , Humanos , Notificación Obligatoria , Factores de Riesgo , SARS-CoV-2Asunto(s)
COVID-19 , SARS-CoV-2 , Niño , Personal de Salud , Hospitales Pediátricos , Humanos , Estudios SeroepidemiológicosRESUMEN
BACKGROUND: Catch-up vaccination is a personalised process through which children with missing recommended vaccinations or incomplete vaccination records are brought up to date with the Australian vaccination schedule. Navigating childhood catch-up vaccination can be difficult for migrant parents with inadequate health system knowledge and competing priorities during settlement. This study aimed to understand the experiences of migrant parents with childhood catch-up vaccination and co-design an intervention to improve the process. METHODS: We recruited migrant parents who had attended the City of Melbourne Immunisation Service in Melbourne, Australia to participate in a qualitative co-design study between June and August 2022. Expression of interest emails were sent by the service, and we recruited eligible participants. In Phase One, we conducted group interviews with parents to understand their experiences and preferences for an intervention, these were analysed using inductive and framework analysis. In Phase Two, we designed prototype interventions based on parents' preferences and suggestions. In Phase Three, parents shared their feedback on each prototype. RESULTS: Fourteen migrant parents participated in the study. Most parents did not discover the need for catch-up vaccination until childcare or kindergarten enrolment. The lack of information received about vaccination requirements and difficulty navigating the health system made the process challenging and time-consuming. Based on these Phase One themes, we designed a printout, mobile application, and website prototype. All three were well-received in Phase Three. Overall, parents' top three considerations for any intervention were 1) digital and online accessibility, 2) inclusion of step-by-step processes outlining catch-up vaccination; and 3) inclusion of a checklist. CONCLUSIONS: Migrant parents lack information about childhood catch-up vaccination in Australia. A relatively simple intervention could help parents more easily navigate the process, thereby saving time and stress. The next steps are to seek funding to pilot such an intervention to assess practicality and usefulness.
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BACKGROUND: An asymptomatic COVID-19 rapid antigen testing (RAT) screening program was implemented in Victorian schools in January 2022, to support keeping schools open throughout the pandemic. This study explored compliance with the program among caregivers from priority populations in Victorian mainstream and specialist schools. METHODS: We conducted semi-structured interviews between 7-31 March 2022 with caregivers of school-aged children participating in the RAT program in Victoria. Participants were asked about awareness, acceptability, compliance, frequency, and barriers to testing. Recordings were transcribed and deductively analysed using a framework approach. RESULTS: Fifty caregivers participated. They expressed confusion about the 'recommended' program, assuming it was mandatory. Caregivers wanted notification from schools of positive cases to increase motivation for compliance. Culturally and linguistically diverse (CALD) families were compliant; however, in-language resources were limited. Aboriginal or Torres Strait Islander (Koori) families tested less regularly and received information from their community rather than school. Caregivers of children living with disabilities reported behavioural challenges to testing, resulting in distress or non-compliance, and received non-specific information for their children. CONCLUSIONS: To increase engagement with future surveillance programs, caregivers need clarity about optionality, conducting tests, reporting results, and timely notification of cases. Requirements unique to each priority population include: accurate in-language information for CALD caregivers, community-led communication for Koori caregivers, tailored information, less testing, and flexibility for caregivers of children living with a disability. Keeping schools open and having tailored strategies to ensure equitable access for priority populations are essential for future pandemic management.
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Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.
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Padres , Vacunación , Humanos , Australia , Padres/psicología , Femenino , Lactante , Preescolar , Masculino , Vacunación/psicología , Vacunación/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto , Cobertura de Vacunación/estadística & datos numéricos , Reproducibilidad de los Resultados , Vacilación a la Vacunación/estadística & datos numéricos , Vacilación a la Vacunación/psicología , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Vacunas/administración & dosificaciónRESUMEN
INTRODUCTION: Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. METHODS AND ANALYSES: Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. ETHICS AND DISSEMINATION: The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. TRIAL REGISTRATION NUMBER: NCT05613751.
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COVID-19 , Vacunas contra la Influenza , Gripe Humana , Ensayos Clínicos Controlados Aleatorios como Asunto , SARS-CoV-2 , Humanos , COVID-19/prevención & control , Gripe Humana/prevención & control , Niño , Vacunas contra la Influenza/administración & dosificación , Australia , Vacunación , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/uso terapéutico , Enfermedad Crónica , Femenino , Envío de Mensajes de Texto , Adolescente , Instituciones de Atención Ambulatoria , Conductas Relacionadas con la Salud , Sistemas Recordatorios , Preescolar , Aceptación de la Atención de Salud/estadística & datos numéricos , MasculinoRESUMEN
INTRODUCTION: This study aimed to understand barriers and enablers, future strategies, communication approaches and resources needed for COVID-19 vaccination among migrant communities in Melbourne, Australia. MATERIAL AND METHODS: We interviewed 24 immunisation providers who deliver immunisation services to migrant populations in Melbourne. We used the WHO Behavioural and Social Drivers framework (underlined) to organise barriers and enablers to COVID-19 vaccination. RESULTS: Participants believed migrants had concerns about vaccine safety and efficacy and saw vaccines as minimally beneficial in the 'low COVID-19' environment of Australia (what people think and feel). Healthcare providers with established relationships within migrant communities played key roles in vaccine advocacy (social processes). Migrants' vaccine motivation was mediated by health literacy, institutional trust and previous experiences with health services. Practical issues included perceived lack of information on vaccine booking process and accessibility challenges. CONCLUSIONS: Strategies to increase migrant vaccine coverage should utilise immunisation providers with community links and trusted local vaccine ambassadors to engage and address community vaccine concerns.
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COVID-19 , Migrantes , Vacunas , Humanos , Vacunas contra la COVID-19 , Victoria , COVID-19/prevención & control , Vacunación , Inmunización , Investigación CualitativaRESUMEN
OBJECTIVE: This systemic review aimed to evaluate the effectiveness of interventions for increasing the uptake of immunisation in healthcare workers (HCWs) compared to no or alternative interventions. METHODS: A systematic review was undertaken (until March 2022) using a search strategy established a priori to capture studies that examined the effect of interventions on vaccination levels in HCWs. We included randomised controlled trials (RCT), cluster RCTs, controlled before-after (CBA) studies and interrupted time-series (ITS) studies. We described studies descriptively and synthesized results with a fixed-effect or random-effects model meta-analysis, where appropriate. The risk of bias was assessed for each study; the quality evidence per comparison was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We identified three RCTs, six cluster RCTs and four ITS studies. There was a diverse range of interventions; many included an educational component. Based on the evidence examined the following may be effective strategies in increasing the proportion of HCWs vaccinated: policy interventions, targeted and multicomponent strategies, tailored programs directed at management, physician delivered education with a vaccine 'champion' and individual decision analysis. Limited eligible studies restricted synthesis and interpretation of findings. No studies evaluated the effectiveness of legislation. Nor did we find studies evaluating the effectiveness of incentives on their own or studies focusing solely on improving access to vaccination. We judged all the studies as either unclear or high risk of bias. CONCLUSION: Few robust studies that evaluate interventions to increase vaccination in HCWs are available. A limitation of this systematic review is that interventions are diverse, poorly reported and few were sufficiently alike to combine in an evaluation. More research on the effects of interventions to increase vaccination in HCWs is required, this should address a variety of vaccines and not just influenza vaccination.
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Inmunización , Médicos , Humanos , Educación en Salud/métodos , Personal de Salud , VacunaciónRESUMEN
Importance: Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal. Objective: To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs. Design, Setting, and Participants: This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021. Interventions: Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years). Main Outcomes and Measures: The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register. Results: A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002). Conclusions and Relevance: Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone. Trial Registration: ANZCTR Identifier: ACTRN12621000463875.
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Vacunas contra la Influenza , Gripe Humana , Envío de Mensajes de Texto , Humanos , Niño , Femenino , Adolescente , Gripe Humana/prevención & control , Sistemas Recordatorios , Australia , Padres , Vacunación , Enfermedad CrónicaRESUMEN
BACKGROUND: Influenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women. METHODS: Pregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group (n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI. DISCUSSION: Behavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.
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COVID-19 , Vacunas contra la Influenza , Gripe Humana , Envío de Mensajes de Texto , Lactante , Femenino , Embarazo , Humanos , Vacunas contra la Influenza/efectos adversos , Gripe Humana/prevención & control , Vacunas contra la COVID-19 , Mujeres Embarazadas , COVID-19/prevención & control , Victoria , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND AND OBJECTIVES: General practitioners (GPs) are often the first source of vaccine information for expectant parents. A multicomponent intervention package (P3-MumBubVax) has been designed for midwives, but interventions to support GPs' vaccine discussions are limited. This qualitative study explored Australian GPs' attitudes, practices and educational needs to inform adaptation of the P3-MumBubVax intervention for primary care. METHOD: Semi-structured interviews with 30 GPs explored attitudes towards recommending maternal vaccines, vaccine communication approaches and training preferences. Data were analysed using thematic template analysis. RESULTS: Vaccination was central to the role of GPs and most felt confident discussing vaccines. GPs had opportunities to discuss maternal vaccines before and during pregnancy using a variety of communication techniques. GPs preferred convenient, interactive training with examples and up-to-date maternal vaccine resources. DISCUSSION: Findings informed adaptation of the P3-MumBubVax intervention, which offers GPs tailored vaccine resources, online communication training and interactive quizzes for individual or group learning.
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Médicos Generales , Vacunas , Australia , Femenino , Humanos , Embarazo , Investigación Cualitativa , VacunaciónRESUMEN
BACKGROUND: Current models of immunisation service delivery in Australia are not meeting the needs of migrant children, who experience a higher burden of vaccine preventable disease and lower immunisation rates compared to non-migrant children. Understanding the experiences of immunisation providers is critical for designing effective and tailored interventions to improve this service. This study aimed to identify the facilitators and barriers to providers delivering a comprehensive catch-up immunisation service to migrant children in Melbourne, Australia. METHODS: Semi-structured interviews with council and general practice immunisation providers were conducted. Recorded interviews were transcribed and coded inductively using thematic analysis. Identified themes were then deductively categorised according to the Capability, Opportunity and Motivation of Behaviour (COM-B) model. RESULTS: Twenty-four providers (five practice nurses, six general practitioners, six council nurses and seven council administration officers) were interviewed between March and June 2021. Fourteen themes were identified that contributed to the delivery of an effective catch-up immunisation service. Capability themes included training, experience and skills to perform the service and communicate with families. Opportunity themes incorporated time, workplace norms, traits of migrant families, costs, systems and resources. Themes related to motivation were provider responsibility, beliefs about migrant health, and immunisation prioritisation. CONCLUSIONS: Key barriers for providers to deliver a comprehensive catch-up immunisation service were related to opportunity. Developing an online tool to support catch-up schedule development and reporting, and funding provider time to calculate the schedule are primary actions that could overcome opportunity barriers. Capability and motivation barriers for general practitioners included limited time, skills, and motivation compared to nurses. These barriers may be overcome with improvements to training that focus on upskilling nurses to deliver the catch-up service. Service delivery challenges are multifactorial, requiring a range of strategies to optimise this service and increase immunisation coverage in migrant children.
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Accesibilidad a los Servicios de Salud , Migrantes , Niño , Humanos , Inmunización , Vacunación , Australia , Investigación CualitativaRESUMEN
BACKGROUND: Over the years, countries reformed their pandemic plans but still healthcare systems were unprepared to handle the COVID-19 pandemic. Throughout the COVID-19 pandemic, healthcare workers (HCWs) raised issues around shortage of personal protective equipment (PPE), inadequate occupational infection prevention and control (IPC) training, lack of guidance regarding reuse/extended use of PPE and absence of HCWs. OBJECTIVE: The objective of this scoping review was to compare national and transnational pandemic plans and COVID-19 guidelines for the inclusion of recommendations regarding pandemic-specific occupational IPC training for HCWs, as well as strategies for managing the surge in PPE needs and staffing. INCLUSION CRITERIA: From each of the six WHO defined world regions, four countries with the highest burden of COVID-19 cases (as of mid-2020) were selected and attempted to locate the relevant pandemic plans and COVID-19 guidelines. METHODS: Searches were undertaken of 1: National Guidelines Clearinghouse, 2: websites of international public healthcare agencies such as WHO, the European Centre for Disease Prevention and Control (ECDC) and, 3: in-country health departments/Ministry of Health/Department of Public Health, between June 2020 and July 2021. The data were summarised under six themes drawn from publicly available pandemic plans and COVID-19 (IPC) guidelines of WHO, ECDC and 23 countries. RESULTS: The WHO, ECDC and 14 countries reported pandemic-specific IPC training; however, only four discussed training HCWs on correct PPE use; six countries listed strategies to manage the surge in demand of HCWs, while only five discussed managing the shortage of PPE. None of the COVID-19 guidelines recommended training HCWs for correct reuse or extended use of PPE and only one country's guideline outlined mandatory HCWs attendance and delivery of training in a regional language. CONCLUSION: Pandemic plans should be revised to include guiding principles regarding the delivery of pandemic specific IPC training. There is also a need to provide guidance on when countries should consider reuse and extended use of PPE. This discourse should also be reflected in disease-specific pandemic guidelines, like COVID-19 (IPC) guidelines. The aim of this review is to assist international health agencies in generating evidence-based guideline updates.
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COVID-19 , Pandemias , COVID-19/epidemiología , COVID-19/prevención & control , Personal de Salud , Humanos , Control de Infecciones , Pandemias/prevención & control , Equipo de Protección Personal , SARS-CoV-2RESUMEN
OBJECTIVE: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.