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1.
Artigo em Inglês | MEDLINE | ID: mdl-33818843

RESUMO

OBJECTIVE: To estimate the proportion of influenza vaccines administered in non-medical settings in Australia in 2019 and identify factors associated with vaccination site. METHODS: We surveyed 1,444 Australian adults online in October 2019. To identify factors associated with vaccination site, we used Pearson's chi-square test. We used thematic analysis to describe responses to the question, 'Please explain why you chose to get vaccinated there'. RESULTS: Most participants (73%) received the influenza vaccine in a medical setting, while 13% received it at a pharmacy and 14% at their workplace. Being vaccinated in pharmacy was associated with being under 65 years of age (p<0.01), marital status (p=0.01), and not having a high-risk comorbidity (p<0.01). Workplace vaccination was associated with being under 65 (p<0.01), household income (p<0.01), not having a regular general physician/practice (p=0.01), having private insurance (p<0.01), and not having a high-risk comorbidity (p<0.01). There was no association between site of vaccination and first-time vaccination (p=0.71, p=0.22). CONCLUSIONS: Despite new policies allowing pharmacists to administer influenza vaccines, most Australian adults are still vaccinated in medical settings. Pharmacy and workplace vaccination settings were more common among younger adults without high-risk comorbidities. Implications for public health: Workplaces, pharmacies and other non-medical settings may provide an opportunity to increase influenza vaccination among healthy, working-age adults who might otherwise forego annual vaccination. Pharmacies may also provide a convenient location for the rollout of the COVID-19 vaccine, particularly in medically underserved areas.

2.
Open Heart ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33811137

RESUMO

OBJECTIVE: We aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms. METHODS: We conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. Samples were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method. RESULTS: We enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%); p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8-46 vs 27 days, IQR: 7-44; p=0.378). CONCLUSION: We found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.


Assuntos
/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Doenças não Diagnosticadas , Adulto , Idoso , Bangladesh/epidemiologia , /mortalidade , Progressão da Doença , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo
3.
Emerg Infect Dis ; 27(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33756100

RESUMO

A monkeypox outbreak in Nigeria during 2017-2020 provides an illustrative case study for emerging zoonoses. We built a statistical model to simulate declining immunity from monkeypox at 2 levels: At the individual level, we used a constant rate of decline in immunity of 1.29% per year as smallpox vaccination rates fell. At the population level, the cohort of vaccinated residents decreased over time because of deaths and births. By 2016, only 10.1% of the total population in Nigeria was vaccinated against smallpox; the serologic immunity level was 25.7% among vaccinated persons and 2.6% in the overall population. The substantial resurgence of monkeypox in Nigeria in 2017 appears to have been driven by a combination of population growth, accumulation of unvaccinated cohorts, and decline in smallpox vaccine immunity. The expanding unvaccinated population means that entire households, not just children, are now more susceptible to monkeypox, increasing risk of human-to-human transmission.

4.
Circ Cardiovasc Qual Outcomes ; 14(3): e007411, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33663224

RESUMO

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an epidemiological coupling appreciated with advancing age, cardiometabolic risk factors, and structural heart disease. This has resulted in a significant public health burden over the years, evident through increasing rates of hospitalization and AF-related clinical encounters. The resultant gap in health care outcomes is largely twinned with suboptimal rates of anticoagulation prescription and adherence, deficits in symptom identification and management, and insufficient comorbid cardiovascular risk factor investigation and modification. In view of these shortfalls in care, the establishment of integrated chronic care models serves as a road map to best clinical practice. The expansion of integrated chronic care programs, which include multidisciplinary team care, nurse-led AF clinics, and use of telemedicine, are expected to improve AF-related outcomes in the coming years. This review will delve into current gaps in AF care and the role of integrated chronic care models in bridging fragmentations in its management.

5.
Sci Total Environ ; 778: 146040, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33711597

RESUMO

From June 11, 2020, a surge in new cases of coronavirus disease 2019 (COVID-19) in the largest wholesale market of Beijing, the Xinfadi Market, leading to a second wave of COVID-19 in Beijing, China. Understanding the transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the personal behaviors and environmental factors contributing to viral transmission is of utmost important to curb COVID-19 rise. However, currently these are largely unknown in food markets. To this end, we completed field investigations and on-site simulations in areas with relatively high infection rates of COVID-19 at Xinfadi Market. We found that if goods were tainted or personnel in market was infected, normal transaction behaviors between sellers and customers, daily physiological activities, and marketing activities could lead to viral contamination and spread to the surroundings via fomite, droplet or aerosol routes. Environmental factors such as low temperature and high humidity, poor ventilation, and insufficient hygiene facilities and disinfection practices may contribute to viral transmission in Xinfadi Market. In addition, precautionary control strategies were also proposed to effectively reduce the clustering cases of COVID-19 in large-scale wholesale markets.

7.
BMC Cardiovasc Disord ; 21(1): 85, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568047

RESUMO

BACKGROUND: There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. METHODS: We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of all-cause death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE. RESULTS: A total of 601 patients, mean age 51.6 ± 10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8 ± 2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI 1.64-13.23). CONCLUSIONS: A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.

8.
Artigo em Inglês | MEDLINE | ID: mdl-33586871

RESUMO

BACKGROUND: Each year tens of thousands of Australians become ill with influenza, resulting in thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up to date, population-specific data on the predictors and barriers of seasonal influenza vaccination. METHODS: We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the theoretical constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. RESULTS: Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64 and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95% CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74) and preferring to develop immunity "naturally" (APR = 0.38; 95% CI = 0.32-0.45). CONCLUSION: Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high-risk groups.

9.
J Am Coll Health ; : 1-6, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33605837

RESUMO

Background: Universities are at risk for COVID-19 and Fall semester begins in August 2020 for most campuses in the United States. The Southern States, including Mississippi, are experiencing a high incidence of COVID-19. Aims: The objective of this study is to model the impact of face masks and hybrid learning on the COVID-19 epidemic on Mississippi State University (MSU) campus. Methods: We used an age structured deterministic mathematical model of COVID-19 transmission within the MSU campus population, accounting for asymptomatic transmission. We modeled facemasks for the campus population at varying proportions of mask use and effectiveness, and Hyflex model of partial online learning with reduction of people on campus. Results: Facemasks can substantially reduce cases and deaths, even with modest effectiveness. Even 20% uptake of masks will halve the epidemic size. Facemasks combined with Hyflex reduces epidemic size even more. Conclusions: Universal use of face masks and reducing the number of people on campus may allow safer universities reopening.

10.
Water Res ; 193: 116854, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33550171

RESUMO

An Australian water utility has developed a Legionella High Level Risk Assessment (LHLRA) which provides a semi-qualitative assessment of the risk of Legionella proliferation and human exposure in engineered water systems using a combination of empirical observation and expert knowledge. Expanding on this LHLRA, we propose two iterative Bayesian network (BN) models to reduce uncertainty and allow for a probabilistic representation of the mechanistic interaction of the variables, built using data from 25 groundwater treatment plants. The risk of Legionella exposure in groundwater aeration units was quantified as a function of five critical areas including hydraulic conditions, nutrient availability and growth, water quality, system design (and maintenance), and location and access. First, the mechanistic relationship of the variables was conceptually mapped into a fishbone diagram, parameterised deterministically using an expert elicited weighted scoring system and translated into BN. The "sensitivity to findings" analysis of the BN indicated that system design was the most influential variable while elemental accumulation thresholds were the least influential variable for Legionella exposure. The diagnostic inference was used in high and low-risk scenarios to demonstrate the capabilities of the BNs to examine probable causes for diverse conditions. Subsequently, the causal relationship of Legionella growth and human exposure were improved through a conceptual bowtie representation. Finally, an improved model developed the predictors of Legionella growth and the risk of human exposure through the interaction of operational, water quality monitoring, operational parameters, and asset conditions. The use of BNs modelling based on risk estimation and improved functional decision outputs offer a complementary and more transparent alternative approach to quantitative analysis of uncertainties than the current LHLRA.


Assuntos
Água Subterrânea , Legionella , Austrália , Teorema de Bayes , Humanos , Medição de Risco , Microbiologia da Água , Qualidade da Água , Abastecimento de Água
11.
Int J Nurs Stud ; 114: 103811, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33352440

RESUMO

INTRODUCTION: There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. METHODS: We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25th and July 8th, 2020. A line list of HCW related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for HCW were calculated per state, by comparing overall cases to HCW cases. To investigate the sources of infection amongst HCW, transmission data were collated and graphed to show distribution of sources. RESULTS: We identified 36 hospital outbreaks or HCW infection reports between January 25th and July 8th, 2020. According to our estimates, at least 536 HCW in Australia had been infected with COVID-19, comprising 6.03% of all reported infections. The rate of HCW infection was 90/100000 and of community infection 34/100,000. HCW were 2.69 times more likely to contract COVID-19 (95% CI 2.48 to 2.93; P < 0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 HCW across 21 outbreaks led to 1656 HCW being furloughed for quarantine. In one outbreak, one hospital was closed and 1200 HCW quarantined. CONCLUSION: The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.


Assuntos
/epidemiologia , Surtos de Doenças , Pessoal de Saúde/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Austrália , Efeitos Psicossociais da Doença , Hospitais , Humanos , Programas Nacionais de Saúde , Doenças Profissionais/virologia , Exposição Ocupacional , Pandemias , Prevalência , Fatores de Risco
13.
BMJ Open ; 10(12): e038480, 2020 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318109

RESUMO

OBJECTIVES: To estimate the impact of a smallpox attack in Mumbai, India, examine the impact of case isolation and ring vaccination for epidemic containment and test the health system capacity under different scenarios with available interventions. SETTING: The research is based on Mumbai, India population. INTERVENTIONS: We tested 50%, 70%, 90% of case isolation and contacts traced and vaccinated (ring vaccination) in the susceptible, exposed, infected, recovered model and varied the start of intervention between 20, 30 and 40 days after the initial attack. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated and incorporated in the model the effect of past vaccination protection, age-specific immunosuppression and contact rates and Mumbai population age structure in modelling disease morbidity and transmission. RESULTS: The estimated duration of an outbreak ranged from 127 days to 8 years under different scenarios, and the number of vaccine doses needed for ring vaccination ranged from 16 813 to 8 722 400 in the best-case and worst-case scenarios, respectively. In the worst-case scenario, the available hospital beds in Mumbai would be exceeded. The impact of a smallpox epidemic may be severe in Mumbai, especially compared with high-income settings, but can be reduced with early diagnosis and rapid response, high rates of case finding and isolation and ring vaccination. CONCLUSIONS: This study tells us that if smallpox re-emergence occurs, it may have significant health and economic impact, the extent of which will depend on the availability and delivery of interventions such as a vaccine or antiviral agent, and the capacity of case isolation and treatment. Further research on health systems requirements and capacity across the diverse states and territories of India could improve the preparedness and management strategies in the event of re-emergent smallpox or other serious emerging infections.

14.
Eur J Clin Invest ; : e13428, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33043453

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide resulting in significant morbidity and mortality. Arrhythmias are prevalent and reportedly, the second most common complication. Several mechanistic pathways are proposed to explain the pro-arrhythmic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A number of treatment approaches have been trialled, each with its inherent unique challenges. This rapid systematic review aimed to examine the current incidence and available treatment of arrhythmias in COVID-19, as well as barriers to implementation. METHODS: Our search of scientific databases identified relevant published studies from 1 January 2000 until 1 June 2020. We also searched Google Scholar for grey literature. We identified 1729 publications of which 1704 were excluded. RESULTS: The incidence and nature of arrhythmias in the setting of COVID-19 were poorly documented across studies. The cumulative incidence of arrhythmia across studies of hospitalised patients was 6.9%. Drug-induced long QT syndrome secondary to antimalarial and antimicrobial therapy was a significant contributor to arrhythmia formation, with an incidence of 14.15%. Torsades de pointes (TdP) and sudden cardiac death (SCD) were reported. Treatment strategies aim to minimise this through risk stratification and regular monitoring of corrected QT interval (QTc). CONCLUSION: Patients with SARS-CoV-2 are at an increased risk of arrhythmias. Drug therapy is pro-arrhythmogenic and may result in TdP and SCD in these patients. Risk assessment and regular QTc monitoring are imperative for safety during the treatment course. Further studies are needed to guide future decision-making.

15.
Artigo em Inglês | MEDLINE | ID: mdl-33026149

RESUMO

BACKGROUND: The 2017 A/H3N2 influenza season was the most severe season since the 2009 influenza pandemic. There were over 591 influenza outbreaks in institutions across the state of New South Wales (NSW) in Australia. AIM: To describe the epidemiology of influenza outbreaks in nine Sydney aged care facilities in 2017. METHODS: Study data were collected from nine Sydney aged care facilities for 2017 influenza season. Descriptive epidemiological analysis was conducted. RESULTS: From the nine sites included, with a total of 716 residents, four sites reported laboratory-confirmed influenza outbreaks during the study period, with an attack rate in residents ranging from 6% to 29%. The outbreaks resulted in lockdowns in two facilities and hospitalisation of seven residents. No deaths were reported as a result of influenza infection. Influenza A was the most common influenza type reported across the facilities. The duration of outbreak lasted for 1-4 weeks varied by site. CONCLUSION: The 2017 season was a severe influenza season recorded in Australia. About half of the facilities studied experienced outbreaks of influenza, with a high attack rate among residents. Infection prevention and control measures and outbreak management plans are crucial for aged care facilities, including vaccination of staff and visitors to prevent outbreaks among the vulnerable residents.

16.
Clin Infect Dis ; 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32945338

RESUMO

Choral singing has become a major risk during COVID-19 pandemic due to high infection rates. Our visualisation and velocimetry results reveal that majority of droplets expelled during singing follow the ambient airflow pattern. These results points toward the possibility of COVID-19 spread by small airborne droplets during singing.

18.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32913005

RESUMO

Face masks and respirators are the most widely used intervention measures for respiratory protection. In the wake of COVID-19, in response to shortages and lack of availability of surgical masks and respirators, the use of cloth masks has become a research focus. Various fabrics have been promoted with little evidence-based foundation and without guidelines on design principles for optimal performance. In these circumstances, it is essential to understand the properties, key performance factors, filter mechanisms and evidence on cloth masks materials. The general community might also need to decontaminate and reuse disposable, single-use devices as a last resort. We present an overview of the filter materials, filter mechanisms and effectiveness, key performance factors, and hydrophobicity of the common disposable masks, as well as cloth masks. We also reviewed decontamination methods for disposable respiratory devices. As an alternative to surgical masks and respirators, we recommend a cloth mask made of at least three layers (300-350 threads per inch) and adding a nylon stocking layer over the mask for a better fit. Water-resistant fabrics (polyesters/nylon), blends of fabrics and water-absorbing fabrics (cotton) should be in the outside layer, middle layer/layers and inside layer, respectively. The information outlined here will help people to navigate their choices if facing shortages of appropriate respiratory protection during the COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Descontaminação , Máscaras , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/instrumentação , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Descontaminação/métodos , Descontaminação/normas , Desenho de Equipamento , Humanos , Máscaras/normas , Máscaras/provisão & distribução , Eliminação de Resíduos de Serviços de Saúde/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
19.
Infect Dis Health ; 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32868204

RESUMO

BACKGROUND: The COVID-19 pandemic has highlighted the role of international travel in spreading infections. Travellers visiting friends and relatives (VFR) are at higher risk of acquiring infections than other travellers, therefore improving the travel health behaviour of these travellers is important. Ethnic Chinese are one of the largest migrant groups in many countries, yet there have been no published studies regarding this population as VFR travellers. We present findings of a study of Australian Chinese VFR travellers relevant to the pandemic response. METHODS: In 2013, five focus groups were conducted with Australian Chinese VFR travellers, exploring topics such as vaccines, face masks, outbreaks and travel health seeking behaviour. Participants were aged 18 years or older and had travelled to China for VFR purposes in the preceding 18 months. Sessions were recorded and transcribed, and thematic analysis was undertaken. RESULTS: Participants viewed VFR travel as low risk, and underestimated the risks associated with travelling during an outbreak. However, they were generally willing to receive pre-travel vaccination specifically for an outbreak, but not otherwise. Attitudes towards face masks and other infection control measures were mixed. Multiple factors influenced their travel health behaviour, including low risk awareness, misconceptions, and cultural barriers to seeking health care. CONCLUSION: Our research found that Chinese VFR travellers undertake suboptimal precautions related to VFR travel, associated with an underestimation of risks. While they share many characteristics with other VFR travellers, unique cultural health beliefs should be taken into account when developing risk communication and educational interventions as part of a pandemic response.

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