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1.
Cochrane Database Syst Rev ; 7: CD013706, 2021 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-34282603

RESUMEN

BACKGROUND: Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent infectious diseases, including against seasonal influenza, pneumococcal diseases, herpes zoster and COVID-19. However, the uptake of vaccination among older adults varies across settings and groups. Communication with healthcare workers can play an important role in older people's decisions to vaccinate. To support an informed decision about vaccination, healthcare workers should be able to identify the older person's knowledge gaps, needs and concerns. They should also be able to share and discuss information about the person's disease risk and disease severity; the vaccine's effectiveness and safety; and practical information about how the person can access vaccines. Therefore, healthcare workers need good communication skills and to actively keep up-to-date with the latest evidence. An understanding of their perceptions and experiences of this communication can help us train and support healthcare workers and design good communication strategies. OBJECTIVES: To explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination. SEARCH METHODS: We searched MEDLINE, CINAHL and Scopus on 21 March 2020. We also searched Epistemonikos for related reviews, searched grey literature sources, and carried out reference checking and citation searching to identify additional studies. We searched for studies in any language. SELECTION CRITERIA: We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perceptions and experiences of healthcare workers and other health system staff towards communication with adults over the age of 50 years or their informal caregivers about vaccination. DATA COLLECTION AND ANALYSIS: We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined criteria. We extracted and assessed data regarding study authors' motivations for carrying out their study. We used a thematic synthesis approach to analyse and synthesise the evidence. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We examined each review finding to identify factors that may influence intervention implementation and we developed implications for practice. MAIN RESULTS: We included 11 studies in our review. Most studies explored healthcare workers' views and experiences about vaccination of older adults more broadly but also mentioned communication issues specifically. All studies were from high-income countries. The studies focused on doctors, nurses, pharmacists and others working in hospitals, clinics, pharmacies and nursing homes. These healthcare workers discussed different types of vaccines, including influenza, pneumococcal and herpes zoster vaccines. The review was carried out before COVID-19 vaccines were available. We downgraded our confidence in several of the findings from high confidence to moderate, low or very low confidence. One reason for this was that some findings were based on only small amounts of data. Another reason was that the findings were based on studies from only a few countries, making us unsure about the relevance of these findings to other settings. Healthcare workers reported that older adults asked about vaccination to different extents, ranging from not asking about vaccines at all, to great demand for information (high confidence finding). When the topic of vaccination was discussed, healthcare workers described a lack of information, and presence of misinformation, fears and concerns about vaccines among older adults (moderate confidence). The ways in which healthcare workers discussed vaccines with older adults appeared to be linked to what they saw as the aim of vaccination communication. Healthcare workers differed among themselves in their perceptions of this aim and about their own roles and the roles of older adults in vaccine decisions. Some healthcare workers thought it was important to provide information but emphasised the right and responsibility of older adults to decide for themselves. Others used information to persuade and convince older adults to vaccinate in order to increase 'compliance' and 'improve' vaccination rates, and in some cases to gain financial benefits. Other healthcare workers tailored their approach to what they believed the older adult needed or wanted (moderate confidence). Healthcare workers believed that older adults' decisions could be influenced by several factors, including the nature of the healthcare worker-patient relationship, the healthcare worker's status, and the extent to which healthcare workers led by example (low confidence). Our review also identified factors that are likely to influence how communication between healthcare workers and older adults take place. These included issues tied to healthcare workers' views and experiences regarding the diseases in question and the vaccines; as well as their views and experiences of the organisational and practical implementation of vaccine services. AUTHORS' CONCLUSIONS: There is little research focusing specifically on healthcare workers' perceptions and experiences of communication with older adults about vaccination. The studies we identified suggest that healthcare workers differed among themselves in their perceptions about the aim of this communication and about the role of older adults in vaccine decisions. Based on these findings and the other findings in our review, we have developed a set of questions or prompts that may help health system planners or programme managers when planning or implementing strategies for vaccination communication between healthcare workers and older adults.


Asunto(s)
Comunicación , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Vacunación/psicología , Vacunas/administración & dosificación , Factores de Edad , Anciano , Cuidadores , Toma de Decisiones , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Vacunas contra la Influenza/administración & dosificación , Persona de Mediana Edad , Comunicación Persuasiva , Vacunas Neumococicas/administración & dosificación , Relaciones Profesional-Familia , Investigación Cualitativa , Vacunación/estadística & datos numéricos
2.
AAPS PharmSciTech ; 22(5): 175, 2021 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-34114100

RESUMEN

A trivalent influenza split vaccine was formulated at high concentration for coating on the transdermal microneedle system. Monovalent vaccine bulks of three influenza strains, two influenza A strains, and one B strain were diafiltrated, concentrated, and lyophilized. The lyophilized powder of each vaccine strain was separately reconstituted and subsequently combined into a coating formulation of high concentration trivalent vaccine. The formulation process converted the monovalent vaccine bulks with low hemagglutinin (HA) concentrations 0.1 mg/mL into a viscous, emulsion containing HA at ~50 mg/mL. This physically stable emulsion demonstrated viscosity 1 poise and 30° contact angle for effective, homogeneous coating on each microneedle. Evaluation of the vaccine antigen HA by SRID and SDS-PAGE/Western blot showed that HA remained stable throughout the vaccine transdermal microneedle system manufacturing process and 1-year ambient storage (25°C). Anti-influenza antibody responses were evaluated by ELISA and hemagglutination inhibition (HAI) assay after primary and booster immunization with the vaccine-coated transdermal microneedle systems at either 25-µg or 40-µg total HA. The results showed the induction of serum anti-influenza IgG and anti-HA neutralizing antibodies after primary immunization and significant titer rises after booster immunization for both doses, indicating the dry-coated trivalent vaccine delivered by transdermal microneedle system elicited both primary and recall antibody responses against all three antigen strains. The study demonstrates that the transdermal microneedle system provides an attractive alternative for influenza vaccine delivery with key advantages such as preservative-free and room-temperature storage.


Asunto(s)
Sistemas de Liberación de Medicamentos/instrumentación , Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/síntesis química , Agujas , Parche Transdérmico , Administración Cutánea , Animales , Sistemas de Liberación de Medicamentos/métodos , Femenino , Cobayas , Vacunación/instrumentación , Vacunación/métodos
3.
JAMA ; 325(22): 2285-2293, 2021 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-34100870

RESUMEN

Importance: Seasonal influenza vaccination in pregnancy can reduce influenza illness among pregnant women and newborns. Evidence is limited on whether seasonal influenza vaccination in pregnancy is associated with adverse childhood health outcomes. Objective: To assess the association between maternal influenza vaccination during pregnancy and early childhood health outcomes. Design, Setting, and Participants: Retrospective cohort study, using a birth registry linked with health administrative data. All live births in Nova Scotia, Canada, between October 1, 2010, and March 31, 2014, were included, with follow-up until March 31, 2016. Adjusted hazard ratios (HRs) and incidence rate ratios (IRRs) with 95% confidence intervals were estimated while controlling for maternal medical history and other potential confounders using inverse probability of treatment weighting. Exposures: Seasonal influenza vaccination during pregnancy. Main Outcomes and Measures: Childhood outcomes studied were immune-related (eg, asthma, infections), non-immune-related (eg, neoplasms, sensory impairment), and nonspecific (eg, urgent or inpatient health care utilization), measured from emergency department and hospitalization databases. Results: Among 28 255 children (49% female, 92% born at ≥37 weeks' gestation), 10 227 (36.2%) were born to women who received seasonal influenza vaccination during pregnancy. During a mean follow-up of 3.6 years, there was no significant association between maternal influenza vaccination and childhood asthma (incidence rate, 3.0 vs 2.5 per 1000 person-years; difference, 0.53 per 1000 person-years [95% CI, -0.15 to 1.21]; adjusted HR, 1.22 [95% CI, 0.94 to 1.59]), neoplasms (0.32 vs 0.26 per 1000 person-years; difference, 0.06 per 1000 person-years [95% CI, -0.16 to 0.28]; adjusted HR, 1.26 [95% CI, 0.57 to 2.78]), or sensory impairment (0.80 vs 0.97 per 1000 person-years; difference, -0.17 per 1000 person-years [95% CI, -0.54 to 0.21]; adjusted HR, 0.82 [95% CI, 0.49 to 1.37]). Maternal influenza vaccination in pregnancy was not significantly associated with infections in early childhood (incidence rate, 184.6 vs 179.1 per 1000 person-years; difference, 5.44 per 1000 person-years [95% CI, 0.01 to 10.9]; adjusted IRR, 1.07 [95% CI, 0.99 to 1.15]) or with urgent and inpatient health services utilization (511.7 vs 477.8 per 1000 person-years; difference, 33.9 per 1000 person-years [95% CI, 24.9 to 42.9]; adjusted IRR, 1.05 [95% CI, 0.99 to 1.16]). Conclusions and Relevance: In this population-based cohort study with mean follow-up duration of 3.6 years, maternal influenza vaccination during pregnancy was not significantly associated with an increased risk of adverse early childhood health outcomes.


Asunto(s)
Vacunas contra la Influenza/efectos adversos , Gripe Humana/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación/efectos adversos , Adulto , Asma/epidemiología , Preescolar , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Infecciones/epidemiología , Vacunas contra la Influenza/administración & dosificación , Nacimiento Vivo/epidemiología , Masculino , Edad Materna , Neoplasias/epidemiología , Nueva Escocia/epidemiología , Evaluación de Resultado en la Atención de Salud , Embarazo , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Estaciones del Año , Trastornos de la Sensación/epidemiología , Vacunación/estadística & datos numéricos , Adulto Joven
5.
Rev Esp Salud Publica ; 952021 May 20.
Artículo en Español | MEDLINE | ID: mdl-34014226

RESUMEN

OBJECTIVE: Influenza vaccination rates among adults over 65 years have not reached the minimum levels recommended by the health authorities in Asturias during previous vaccination campaigns. The objective of this study is to describe the characteristics of an influenza vaccination strategy and its effectiveness. METHODS: Strategy developed during the 2019-2020 influenza vaccination campaign in the Área Sanitaria VII in the Servicio de Salud of the Principado de Asturias. The target population were people over 65 years. The strategy consisted of training sessions for professionals and the general population, information dissemination through the media, overt recommendations for the vaccination of hospital personnel and social recognition of the professionals involved. The vaccination rates were described and a two-tailed hypothesis test was used to determine the differences in the vaccination percentages. RESULTS: The percentage of vaccination in the Área Sanitaria VII went from 56.29% in the 2018-2019 campaign to 65.82% in the 2019-2020 campaign (+9.53; p<0.001). During the same campaign, the percentage of vaccination in Asturias was 57,38%, that is, 8,44% less than in the intervened Área Sanitaria. CONCLUSIONS: The strategy proved effective in increasing the rates of influenza vaccination among adults over 65 years in the Área Sanitaria VII of the Principado de Asturias.


Asunto(s)
Programas de Inmunización/métodos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , Anciano , Humanos , Gripe Humana/epidemiología , Evaluación de Programas y Proyectos de Salud , España/epidemiología
6.
Biochem Biophys Res Commun ; 554: 166-172, 2021 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-33798943

RESUMEN

Although influenza vaccines are effective for reducing viral transmission and the severity of clinical symptoms, influenza viruses still induce considerable morbidity and mortality worldwide. Seasonal influenza viruses infect the upper respiratory tract initially but then often induce severe pulmonary complications in the lower respiratory tract. Therefore, influenza vaccines that prevent viral infection at both the upper and lower respiratory tracts are highly anticipated. Here, we examined whether using different vaccination routes for priming and boosting achieved protection in both regions of the respiratory tract. To this end, we used inactivated whole-virion influenza vaccines to immunize mice either subcutaneously or intranasally for both priming and boosting. Regardless of the route used for boosting, the levels of virus-specific IgG in plasma were higher in mice primed subcutaneously than those in control mice, which received PBS only. In addition, intranasal priming followed by subcutaneous boosting induced higher levels of virus-specific IgG in plasma than those in control mice. The levels of virus-specific nasal IgA were higher in mice that were primed intranasally than in control mice or in mice primed subcutaneously. Furthermore, intranasal priming but not subcutaneous priming provided protection against viral challenge in the upper respiratory tract. In addition, when coupled with subcutaneous boosting, both subcutaneous and intranasal priming protected against viral challenge in the lower respiratory tract. These results indicate that intranasal priming followed by subcutaneous boosting induces both virus-specific IgG in plasma and IgA in nasal washes and protects against virus challenge in both the upper and lower respiratory tracts. Our results will help to develop novel vaccines against influenza viruses and other respiratory viruses.


Asunto(s)
Anticuerpos Neutralizantes/inmunología , Vacunas contra la Influenza/administración & dosificación , Infecciones por Orthomyxoviridae/prevención & control , Orthomyxoviridae/inmunología , Infecciones del Sistema Respiratorio/prevención & control , Administración Intranasal , Animales , Anticuerpos Antivirales/sangre , Modelos Animales de Enfermedad , Vacunas contra la Influenza/inmunología , Inyecciones Subcutáneas/métodos , Masculino , Ratones , Ratones Endogámicos C57BL , Orthomyxoviridae/aislamiento & purificación , Infecciones por Orthomyxoviridae/patología , Infecciones por Orthomyxoviridae/virología , Infecciones del Sistema Respiratorio/patología , Infecciones del Sistema Respiratorio/virología , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunología
8.
Front Public Health ; 9: 570098, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33842415

RESUMEN

The first cases of unexplained pneumonia were reported in Wuhan, China, in December of 2019. Later, a novel coronavirus (SARS-CoV-2) was identified as the causal agent of pneumonia. This virus has since spread to more than 180 countries and has been declared a pandemic by the World Health Organization. Herein, we aimed to determine the epidemiological and clinical characteristics of symptomatic patients with coronavirus disease 2019 (COVID-19) and the relationship between the influenza vaccine with a lower risk of severe COVID-19 infection in the state of Sinaloa. We collected demographic and clinical data of 4,040 patients with acute respiratory infections across Sinaloa state hospitals from February 28 to May 15, 2020. The prevalence of COVID-19 among hospitalized patients with respiratory symptoms in Sinaloa showed 45.2% of men were more affected than women (p < 0.001), and people aged 40-49 years were the most affected. The main symptoms of COVID-19 infection were cough and fever (p < 0.001), while hypertension, obesity, and type 2 diabetes were the chronic diseases associated with COVID-19 than non-COVID-19 (p < 0.003). Healthcare workers were most likely to be infected compared to other occupations (p < 0.001). The general lethality rate was 14.1%, and males >62 years were the ones who had a higher lethality rate (p < 0.001); the aforementioned chronic diseases were related to higher lethality of COVID-19 (p < 0.001). Likewise, higher lethality was seen in housewives and patient retirees/pensioners compared with other occupations (p < 0.001). Finally, we found there was a relationship between influenza vaccination and a lower risk of severe COVID-19 infection and mortality (p < 0.001). These findings showed that healthcare workers, men >62 years with chronic diseases, and retired people were most affected. Furthermore, the influenza vaccine could decrease the severeness of COVID-19 cases.


Asunto(s)
COVID-19/epidemiología , Vacunas contra la Influenza/administración & dosificación , Adulto , COVID-19/mortalidad , Comorbilidad , Tos/virología , Diabetes Mellitus Tipo 2 , Femenino , Fiebre/virología , Humanos , Hipertensión , Masculino , México/epidemiología , Persona de Mediana Edad , Obesidad , Análisis de Supervivencia
9.
Rev Bras Epidemiol ; 24: e210014, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33825774

RESUMEN

OBJECTIVE: To investigate sociodemographic factors associated with the willingness to take the pandemic influenza vaccine. METHODS: This is a cross-sectional study of Brazilian civil servants participating in the fourth wave (2012-2013) of the longitudinal Pró-Saúde Study. Associations were expressed as odds ratios (OR) and 95% confidence intervals (95%CI), estimated by multivariate logistic regression models. RESULTS: Among 2,828 participants, 15.9% would not be willing to vaccinate in the future if the Brazilian Ministry of Health promoted a new vaccination campaign against pandemic influenza. Not willing to vaccinate in the future was strongly associated with not taking the pandemic influenza vaccine in 2010 (OR = 9.0, 95%CI 6.9 - 11.6). Among the unvaccinated, females, those aged > 60 years, and non-health care workers were less willing to vaccinate in the future. Again, in the vaccinated group, females were less willing to vaccinate. CONCLUSION: Multidisciplinary efforts should be encouraged in order to identify reasons for refusing vaccination, focusing on the individual and group perceptions of susceptibility, severity, benefits, and barriers to vaccination. Such information is needed to identify target groups for the delivery of customized interventions towards preventing emerging pandemics, such as avian influenza and COVID-19.


Asunto(s)
Empleados de Gobierno , Subtipo H1N1 del Virus de la Influenza A , Vacunas contra la Influenza , Gripe Humana , Aceptación de la Atención de Salud , Vacunación , Brasil/epidemiología , Estudios Transversales , Femenino , Empleados de Gobierno/psicología , Empleados de Gobierno/estadística & datos numéricos , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/psicología
10.
Front Immunol ; 12: 584299, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33746943

RESUMEN

Parenteral administration of killed/inactivated swine influenza A virus (SwIAV) vaccine in weaned piglets provides variable levels of immunity due to the presence of preexisting virus specific maternal derived antibodies (MDA). To overcome the effect of MDA on SwIAV vaccine in piglets, we developed an intranasal deliverable killed SwIAV antigen (KAg) encapsulated chitosan nanoparticles called chitosan-based NPs encapsulating KAg (CS NPs-KAg) vaccine. Further, to target the candidate vaccine to dendritic cells and macrophages which express mannose receptor, we conjugated mannose to chitosan (mCS) and formulated KAg encapsulated mCS nanoparticles called mannosylated chitosan-based NPs encapsulating KAg (mCS NPs-KAg) vaccine. In MDA-positive piglets, prime-boost intranasal inoculation of mCS NPs-KAg vaccine elicited enhanced homologous (H1N2-OH10), heterologous (H1N1-OH7), and heterosubtypic (H3N2-OH4) influenza virus-specific secretory IgA (sIgA) antibody response in nasal passage compared to CS NPs-KAg vaccinates. In vaccinated upon challenged with a heterologous SwIAV H1N1, both mCS NPs-KAg and CS NPs-KAg vaccinates augmented H1N2-OH10, H1N1-OH7, and H3N2-OH4 virus-specific sIgA antibody responses in nasal swab, lung lysate, and bronchoalveolar lavage (BAL) fluid; and IgG antibody levels in lung lysate and BAL fluid samples. Whereas, the multivalent commercial inactivated SwIAV vaccine delivered intramuscularly increased serum IgG antibody response. In mCS NPs-KAg and CS NPs-KAg vaccinates increased H1N2-OH10 but not H1N1-OH7 and H3N2-OH4-specific serum hemagglutination inhibition titers were observed. Additionally, mCS NPs-KAg vaccine increased specific recall lymphocyte proliferation and cytokines IL-4, IL-10, and IFNγ gene expression compared to CS NPs-KAg and commercial SwIAV vaccinates in tracheobronchial lymph nodes. Consistent with the immune response both mCS NPs-KAg and CS NPs-KAg vaccinates cleared the challenge H1N1-OH7 virus load in upper and lower respiratory tract more efficiently when compared to commercial vaccine. The virus clearance was associated with reduced gross lung lesions. Overall, mCS NP-KAg vaccine intranasal immunization in MDA-positive pigs induced a robust cross-reactive immunity and offered protection against influenza virus.


Asunto(s)
Quitosano/inmunología , Inmunidad/inmunología , Vacunas contra la Influenza/inmunología , Manosa/inmunología , Infecciones por Orthomyxoviridae/inmunología , Enfermedades de los Porcinos/inmunología , Animales , Anticuerpos Antivirales/inmunología , Células Cultivadas , Quitosano/metabolismo , Perros , Femenino , Inmunidad/efectos de los fármacos , Vacunas contra la Influenza/administración & dosificación , Células de Riñón Canino Madin Darby , Manosa/metabolismo , Nanopartículas/administración & dosificación , Infecciones por Orthomyxoviridae/prevención & control , Infecciones por Orthomyxoviridae/virología , Embarazo , Porcinos , Enfermedades de los Porcinos/prevención & control , Enfermedades de los Porcinos/virología , Vacunación/métodos , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunología
11.
J Infect Dis ; 224(1): 49-59, 2021 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-33755731

RESUMEN

BACKGROUND: We investigated frequency of reinfection with seasonal human coronaviruses (HCoVs) and serum antibody response following infection over 8 years in the Household Influenza Vaccine Evaluation (HIVE) cohort. METHODS: Households were followed annually for identification of acute respiratory illness with reverse-transcription polymerase chain reaction-confirmed HCoV infection. Serum collected before and at 2 time points postinfection were tested using a multiplex binding assay to quantify antibody to seasonal, severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins and SARS-CoV-2 spike subdomains and N protein. RESULTS: Of 3418 participants, 40% were followed for ≥3 years. A total of 1004 HCoV infections were documented; 303 (30%) were reinfections of any HCoV type. The number of HCoV infections ranged from 1 to 13 per individual. The mean time to reinfection with the same type was estimated at 983 days for 229E, 578 days for HKU1, 615 days for OC43, and 711 days for NL63. Binding antibody levels to seasonal HCoVs were high, with little increase postinfection, and were maintained over time. Homologous, preinfection antibody levels did not significantly correlate with odds of infection, and there was little cross-response to SARS-CoV-2 proteins. CONCLUSIONS: Reinfection with seasonal HCoVs is frequent. Binding anti-spike protein antibodies do not correlate with protection from seasonal HCoV infection.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Composición Familiar , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Síndrome Respiratorio Agudo Grave/epidemiología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , COVID-19/epidemiología , COVID-19/virología , Coinfección/epidemiología , Coronavirus/clasificación , Coronavirus/genética , Coronavirus/inmunología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Reacciones Cruzadas/inmunología , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/virología , Estimación de Kaplan-Meier , Michigan/epidemiología , Modelos de Riesgos Proporcionales , Vigilancia en Salud Pública , Reinfección/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Estaciones del Año , Estudios Seroepidemiológicos , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/inmunología , Síndrome Respiratorio Agudo Grave/virología , Carga Viral
12.
BMJ Open Respir Res ; 8(1)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33664123

RESUMEN

INTRODUCTION: Recent evidence suggests that influenza vaccination may offer protection against COVID-19 severity. Our aim was to quantify the association between influenza vaccination status and risk of hospitalisation or all-cause mortality in people diagnosed with COVID-19. METHODS: A retrospective cohort study using routinely collected health records from patients registered to a General Practitioner (GP) practice in South West England within the Electronic Care and Health Information Analytics database. The cohort included 6921 people with COVID-19 during the first wave of the pandemic (1 January-31 July 2020). Data on influenza vaccination, hospitalisation and all-cause mortality were ascertained through linked clinical and demographic records. We applied propensity score methods (stabilised inverse probability of treatment weight) to quantify the association between influenza vaccination status and COVID-19 outcomes (hospitalisation or all-cause mortality). RESULTS: 2613 (38%) participants received an influenza vaccination between 1 January 2019 and COVID-19 diagnosis. Receipt of influenza vaccination was associated with a significantly lower odds of hospitalisation or all-cause mortality (adjusted OR: 0.85, 95% CI 0.75 to 0.97, p=0.02), and 24% reduced odds of all-cause mortality (adjusted OR: 0.76, 95% CI 0.64 to 0.90). DISCUSSION: Influenza vaccination was associated with a 15%-24% lower odds of severe COVID-19 outcomes. The current UK influenza vaccination programme needs urgent expansion as an integral component of the ongoing response plans to the COVID-19 pandemic.


Asunto(s)
COVID-19/mortalidad , Causas de Muerte , Hospitalización/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/mortalidad , Gripe Humana/prevención & control , Estudios de Cohortes , Inglaterra , Humanos , Oportunidad Relativa , Probabilidad , Puntaje de Propensión , Estudios Retrospectivos
13.
Blood Adv ; 5(5): 1535-1539, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33683337

RESUMEN

Patients with plasma cell dyscrasias (PCDs) experience an increased burden of influenza, and current practice of single-dose annual influenza vaccination yields suboptimal protective immunity in these patients. Strategies to improve immunity to influenza in these patients are clearly needed. We performed a randomized, double-blind, placebo-controlled clinical trial comparing tandem Fluzone High-Dose influenza vaccination with standard-of-care influenza vaccination. Standard-of-care vaccination was single-dose age-based vaccination (standard dose, <65 years; high dose, ≥65 years), and patients in this arm received a saline placebo injection at 30 days. A total of 122 PCD patients were enrolled; 47 received single-dose standard-of-care vaccination, and 75 received 2 doses of Fluzone High-Dose vaccine. Rates of hemagglutinin inhibition (HAI) titer seroprotection against all 3 strains (H1N1, H3N2, and influenza B) were significantly higher for patients after tandem high-dose vaccination vs control (87.3% vs 63.2%; P = .003) and led to higher seroprotection at the end of flu season (60.0% vs 31.6%; P = .04). These data demonstrate that tandem high-dose influenza vaccination separated by 30 days leads to higher serologic HAI titer responses and more durable influenza-specific immunity in PCD patients. Similar vaccine strategies may also be essential to achieve protective immunity against other emerging pathogens such as novel coronavirus in these patients. This trial was registered at www.clinicaltrials.gov as #NCT02566265.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/inmunología , Gripe Humana/inmunología , Paraproteinemias/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Humanos , Persona de Mediana Edad
14.
BMC Cardiovasc Disord ; 21(1): 129, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750304

RESUMEN

BACKGROUND: Annual influenza vaccination is an important public health measure to prevent influenza infections and is strongly recommended for cardiovascular disease (CVD) patients, especially in the current coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to develop a machine learning model to identify Korean adult CVD patients with low adherence to influenza vaccination METHODS: Adults with CVD (n = 815) from a nationally representative dataset of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V) were analyzed. Among these adults, 500 (61.4%) had answered "yes" to whether they had received seasonal influenza vaccinations in the past 12 months. The classification process was performed using the logistic regression (LR), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGB) machine learning techniques. Because the Ministry of Health and Welfare in Korea offers free influenza immunization for the elderly, separate models were developed for the < 65 and ≥ 65 age groups. RESULTS: The accuracy of machine learning models using 16 variables as predictors of low influenza vaccination adherence was compared; for the ≥ 65 age group, XGB (84.7%) and RF (84.7%) have the best accuracies, followed by LR (82.7%) and SVM (77.6%). For the < 65 age group, SVM has the best accuracy (68.4%), followed by RF (64.9%), LR (63.2%), and XGB (61.4%). CONCLUSIONS: The machine leaning models show comparable performance in classifying adult CVD patients with low adherence to influenza vaccination.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Cumplimiento de la Medicación , Máquina de Vectores de Soporte , Vacunación , Adulto , Factores de Edad , Anciano , Enfermedades Cardiovasculares/diagnóstico , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , República de Corea/epidemiología , Medición de Riesgo , Factores de Riesgo , Adulto Joven
15.
J Med Internet Res ; 23(3): e25977, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33651709

RESUMEN

BACKGROUND: Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. OBJECTIVE: The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. METHODS: A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. RESULTS: A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. CONCLUSIONS: Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well.


Asunto(s)
COVID-19/epidemiología , Vacunas contra la Influenza/administración & dosificación , Medios de Comunicación Sociales/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Internet , Israel/epidemiología , Masculino , Pandemias , Reproducibilidad de los Resultados , SARS-CoV-2/aislamiento & purificación , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricos , Adulto Joven
16.
Vaccine ; 39(14): 1892-1896, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33714656

RESUMEN

While seasonal influenza vaccines (SIV) remain the best method to prevent influenza-associated illnesses, implementing SIV programs may benefit countries beyond disease reduction, strengthening health systems and national immunization programs, or conversely, introduce new challenges. Few studies have examined perceived impacts of SIV introduction beyond disease reduction on health systems; understanding such impacts will be particularly salient in the context of COVID-19 vaccine introduction. We collected qualitative data from key informants-Partnership for Influenza Vaccine Introduction (PIVI) contacts in six middle-income PIVI vaccine recipient countries-to understand perceptions of ancillary benefits and challenges from SIV implementation. Respondents reported benefits associated with SIV introduction, including improved attitudes to SIV among risk groups (characterized by increased demand) and perceptions that SIV introduction improved relationships with other ministries and collaboration with mass media. Challenges included sustaining investment in SIV programs, as vaccine supply did not always meet coverage goals, and managing SIV campaigns.


Asunto(s)
Países en Desarrollo , Programas de Inmunización , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Humanos , Vacunación
17.
Vaccine ; 39(14): 1921-1928, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33715898

RESUMEN

INTRODUCTION: Decisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did. METHODS: In May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome. RESULTS: Among participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23-2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88-2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49-2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03-1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36-0.999; and AOR = 0.45; 95% CI = 0.24-0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45-2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15-1.90). CONCLUSIONS: The COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación/estadística & datos numéricos , Adulto , COVID-19 , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Encuestas y Cuestionarios , Estados Unidos
18.
JMIR Public Health Surveill ; 7(4): e26734, 2021 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-33651708

RESUMEN

BACKGROUND: In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. OBJECTIVE: The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. METHODS: Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination. RESULTS: Among 6641 respondents, 945 (14.2%) were previously eligible but were not vaccinated; of these, 536 (56.7%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49%) stated they would decline vaccination in 2020-2021. CONCLUSIONS: In this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs.


Asunto(s)
COVID-19/epidemiología , Vacunas contra la Influenza/administración & dosificación , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Vacunas contra la COVID-19/administración & dosificación , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Intención , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Medicina Estatal , Reino Unido/epidemiología , Vacunación/psicología , Adulto Joven
19.
Rheumatol Int ; 41(5): 895-902, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33661331

RESUMEN

To assess non-compliance and potential changes in seasonal flu vaccination coverage before and during the Covid-19 pandemic in patients with autoimmune rheumatic diseases (ARDs). Consecutive patients with ARDs followed-up in 2 tertiary hospitals were telephone-interviewed (December 12-30, 2020) regarding seasonal flu vaccination during the 2019/20 and 2020/21 time periods. Self-reported disease flares that occurred after flu vaccination, as well as reasons for non-vaccination were recorded. One thousand fifteen patients were included. The rate of flu vaccination increased from 76% before to 83% during the COVID-19 pandemic (p = 0.0001). The rate of self-reported disease flares was < 1% among vaccinated patients. Reasons for not vaccination in both periods, respectively, included: 'was not recommended by their rheumatologists' (35.0vs.12.2%, p < 0.0001), 'did not feel that they would have any benefit' (36.9 vs. 32.6%), felt unsafe to do so (27.5 vs. 30.2%), or other reasons (18.9 vs. 23.8%). By multivariate analysis, age [OR = 1.03 (95% CI 1.02-1.04)] vs. [1.04 (95% CI 1.02-1.05)] and treatment with biologics [OR = 1.66 (95% CI 1.22-2.24) vs. [1.68 (95% CI 1.19-2.38)] were independent factors associated with vaccination in both periods. These findings, although are temporally encouraging, emphasize the need for continuous campaigns aiming at increasing patients' and physicians' awareness about the benefits of vaccination.


Asunto(s)
Enfermedades Autoinmunes/psicología , Vacunas contra la Influenza/administración & dosificación , Enfermedades Reumáticas/psicología , Cobertura de Vacunación/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/epidemiología , COVID-19/epidemiología , Estudios Transversales , Femenino , Humanos , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Pandemias , Cooperación del Paciente/estadística & datos numéricos , Enfermedades Reumáticas/epidemiología , SARS-CoV-2 , Adulto Joven
20.
Am J Physiol Heart Circ Physiol ; 320(5): H1762-H1773, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33710926

RESUMEN

Acute elevations in inflammatory cytokines have been demonstrated to increase aortic and left ventricular stiffness and reduce endothelial function in healthy subjects. As vascular and cardiac functions are often transiently reduced following prolonged exercise, it is possible that cytokines released during exercise may contribute to these alterations. The a priori aims of this study were to determine whether vaccine-induced increases in inflammatory cytokines would reduce vascular and left ventricular function, whether vascular alterations would drive cardiac impairments, and whether this would be potentiated by moderate exercise. In a randomized crossover fashion, 16 male participants were tested under control (CON) and inflammatory (INF) conditions, wherein INF testing occurred 8 h following administration of an influenza vaccine. On both days, participants underwent measures of echocardiography performed during light cycling (stress-echocardiography), carotid-femoral pulse wave velocity (cf-PWV), and superficial femoral flow-mediated dilation (FMD) before and after cycling for 90 min at ∼85% of their first ventilatory threshold. IL-6 increased significantly (Δ1.9 ± 1.3 pg/mL, P < 0.001), whereas TNFα was nonsignificantly augmented (Δ0.05 ± 0.11 pg/mL, P = 0.09), 8 h following vaccination. Vascular function was unaltered following cycling or inflammation (all P > 0.05). The use of echocardiography during light cycling revealed cardiac alterations traditionally expected to occur only with greater exercise loads, with reduced systolic (e.g., longitudinal strain CON: Δ3.3 ± 4.4%, INF: Δ1.7 ± 2.7%, P = 0.002) and diastolic function (e.g., E/A ratio CON: Δ-0.32 ± 0.34 a.u., INF:Δ-0.25 ± 0.27 a.u., P = 0.002) following cycling, independent of inflammation. The vaccine reduced stroke volume (SV) (main effect of condition P = 0.009) before-and-after cycling. These findings indicate that reduced cardiac function following exercise occurs largely independent of additional inflammatory load.NEW & NOTEWORHTHY This experimental investigation sought to determine the role of inflammation on the occurrence of cardiovascular alterations following exercise. Despite successfully stimulating systemic inflammation via vaccination, vascular and cardiac functions were largely unaltered. Prolonged exercise itself reduced cardiac function assessed via echocardiography performed during light exercise stress. This demonstrates a potential advantage to using stress-echocardiography for measuring exercise-induced cardiac fatigue, as typical resting measures following similar exercise exposures commonly suggest no effect.


Asunto(s)
Sistema Cardiovascular/fisiopatología , Ejercicio Físico , Inflamación/fisiopatología , Vacunas contra la Influenza/administración & dosificación , Rigidez Vascular , Función Ventricular Izquierda , Adaptación Fisiológica , Adulto , Ciclismo , Sistema Cardiovascular/diagnóstico por imagen , Sistema Cardiovascular/metabolismo , Velocidad de la Onda del Pulso Carotídeo-Femoral , Estudios Cruzados , Citocinas/sangre , Ecocardiografía de Estrés , Prueba de Esfuerzo , Voluntarios Sanos , Humanos , Inflamación/sangre , Inflamación/diagnóstico por imagen , Mediadores de Inflamación/sangre , Masculino , Distribución Aleatoria , Factores Sexuales , Factores de Tiempo , Vacunación , Adulto Joven
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