Family still matters: Human social motivation across 42 countries during a global pandemic.

The COVID-19 pandemic caused drastic social changes for many people, including separation from friends and coworkers, enforced close contact with family, and reductions in mobility. Here we assess the extent to which people's evolutionarily-relevant basic motivations and goals-fundamental social motives such as Affiliation and Kin Care-might have been affected. To address this question, we gathered data on fundamental social motives in 42 countries (N = 15,915) across two waves, including 19 countries (N = 10,907) for which data were gathered both before and during the pandemic (pre-pandemic wave: 32 countries, N = 8998; 3302 male, 5585 female; M age  = 24.43, SD = 7.91; mid-pandemic wave: 29 countries, N = 6917; 2249 male, 4218 female; M age  = 28.59, SD = 11.31). Samples include data collected online (e.g., Prolific, MTurk), at universities, and via community sampling. We found that Disease Avoidance motivation was substantially higher during the pandemic, and that most of the other fundamental social motives showed small, yet significant, differences across waves. Most sensibly, concern with caring for one's children was higher during the pandemic, and concerns with Mate Seeking and Status were lower. Earlier findings showing the prioritization of family motives over mating motives (and even over Disease Avoidance motives) were replicated during the pandemic. Finally, well-being remained positively associated with family-related motives and negatively associated with mating motives during the pandemic, as in the pre-pandemic samples. Our results provide further evidence for the robust primacy of family-related motivations even during this unique disruption of social life.

How to Increase Vaccination Acceptance Among Apostolic Communities: Quantitative Results from an Assessment in Three Provinces in Zimbabwe.

A worldwide increasing trend toward vaccine hesitancy has been reported. Measles outbreaks in southern Africa in 2009-2010 were linked to objections originating from Apostolic gatherings. Founded in Zimbabwe in the 1950s, the Apostolic church has built up a large number of followers with an estimated 3.5 million in Zimbabwe in 2014. To inform planning of interventions for the 2015 measles-rubella vaccination campaign, we assessed vaccination status and knowledge, attitudes and practices among purposive samples of Apostolic caregivers in three districts each in Harare City, Manicaland and Matabeleland South in Zimbabwe. We conducted structured interviews among 97 caregivers of children aged 9-59 months and collected vaccination status for 126 children. Main Apostolic affiliations were Johanne Marange (53%), Madida (13%) and Gospel of God (11%) with considerable variation across assessment areas. The assessment also showed considerable variation among Apostolic communities in children ever vaccinated (14-100%) and retention of immunization cards (0-83%) of ever vaccinated. Overall retention of immunization cards (12%) and documented vaccination status by card (fully vaccinated = 6%) were low compared to previously reported measures in the general population. Mothers living in monogamous relationships reported over 90% of all DTP-HepB-Hib-3, measles and up to date immunizations during the first life year documented by immunization card. Results revealed opportunities to educate about immunization during utilization of health services other than vaccinations, desire to receive information about vaccinations from health personnel, and willingness to accept vaccinations when offered outside of regular services. Based on the results of the assessment, specific targeted interventions were implemented during the vaccination campaign, including an increased number of advocacy activities by district authorities. Also, health workers offered ways and timing to vaccinate children that catered to the specific situation of Apostolic caregivers, including flexible service provision after hours and outside of health facilities, meeting locations chosen by caregivers, using mobile phones to set up meeting locations, and documentation of vaccination in health facilities if home-based records posed a risk for caregivers. Coverage survey results indicate that considerable progress has been made since 2010 to increase vaccination acceptability among Apostolic communities in Zimbabwe. Further efforts will be needed to vaccinate all Apostolic children during routine and campaign activities in the country, and the results from our assessment can contribute toward this goal.

Polio outbreak among nomads in Chad: outbreak response and lessons learned.

BACKGROUND: In response to the 2011 and 2012 polio epidemic in Chad, Chad's Ministry of Public Health, with support from Global Polio Eradication Initiative partners, took steps to increase vaccination coverage of nomadic children with targeted polio campaigns. This article describes the strategies we used to vaccinate nomads in 3 districts of Chad. METHODS: Our targeted interventions involved using mobile vaccination teams, recruiting local nomads to identify settlements, using social mobilization, and offering vaccinations to children, women, and animals. RESULTS: Vaccination coverage of nomadic children 0-59 months of age increased, particularly among those never before vaccinated against polio. These increases occurred mostly in the intervention districts of Dourbali, from 2956 to 8164 vaccinated children, and Kyabe, from 7319 to 15 868. The number of first-time vaccinated nomadic children also increased the most in these districts, from 60 to 131 in Dourbali and from 1302 to 2973 in Kyabe. Coverage in the Massaguet district was only 37.7%. CONCLUSIONS: Our success was probably due to (1) appointment of staff to oversee implementation, (2) engagement of the national government and its partners, (3) participation of nomadic community leaders, (4) intersectoral collaboration between human and animal health services, and (5) flexibility and capacity of vaccinators to vaccinate when and where nomads were available.

Military affected by the first wave of COVID-19 in Senegal: stress and resilience factors during care.

COVID-19 had a psychological impact on the population, particularly those affected. Our objective was to investigate stress and resilience factors in the Senegalese soldiers affected during the first wave of COVID-19. Our retrospective and qualitative study included military personnel listed as contacts, suspects, or positive cases and supported by the Armed Forces Psychological Support Program during the period of isolation. The stress factors were health-related, sociological, and occupational. The conditions and the experience of isolation, stigmatization, and suspension of their professional projects were concerns for the soldiers. They had relied on personal, familial, and professional resources to cultivate resilience during the quarantine. Isolation during the pandemic showed psychological consequences, the foundations of which have been found in our study.

Community and health worker perceptions and preferences regarding integration of other health services with routine vaccinations: four case studies.

BACKGROUND: Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration. METHODS: Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon). RESULTS: Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times). CONCLUSIONS: Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services.

Assessment of Suspected COVID-19 Deaths in Nonhealthcare Settings in Côte d'Ivoire, March 11 to July 31, 2020.

According to hospital records, 5 months after reporting its first case of COVID-19, Côte d'Ivoire reported only 102 deaths. We conducted a community mortality survey in the 13 districts where 95% of COVID-19 cases were reported to assess COVID-19 mortality in nonhealthcare settings. To identify suspected COVID-19 deaths in communities, we used data from social and administrative institutions, such as police and fire departments, funeral homes, and places of worship, whose functions include providing services related to deaths. Our survey identified 54 (17.6%) suspected COVID-19 deaths, which is more than half of the official reported number. Our study showed that in areas with low access to healthcare and poorly functioning death notification and registration systems, community-based data sources could be used to identify suspected COVID-19 deaths outside of the health sector. They can provide early warning data on events, such as an unusual number of community deaths or diseases.

Vaginal Carriage of Group B Streptococcus (GBS) in Pregnant Women, Antibiotic Sensitivity and Associated Risk Factors in Dakar, Senegal.

The eradication of neonatal Group B Streptococcus (GBS) infections, considered as a major public health priority, necessarily requires a mastery of the data on vaginal carriage in pregnant women. The aims of this study were to determine the prevalence of vaginal carriage of GBS in pregnant women, antibiotic susceptibility, and associated risk factors. This was a cross-sectional, descriptive study conducted over a period of 9 months (July 2020 to March 2021) in pregnant women between 34 and 38 weeks of gestation (WG) followed at the Nabil Choucair health center in Dakar. Identification and antibiotic susceptibility of GBS isolates were performed on the Vitek 2 from vaginal swabs cultured on Granada medium. Demographic and obstetric interview data were collected and analyzed on SPSS (version 25). The level of significance for all statistical tests was set at P < .05. The search of GBS vaginal carriage had involved 279 women aged 16 to 46 years, with a median pregnancy age of 34 (34-37) weeks' gestation. GBS was found in 43 women, for a vaginal carriage rate of 15.4%. In 27.9% (12/43) of volunteers screened, this carriage was monomicrobial, while in 72.1% (31/43) of women, GBS was associated with other pathogens such as Candida spp. (60.5%), Trichomonas vaginalis (2.3%), Gardnerella vaginalis (34.9%) and/or Mobiluncus spp. (11.6%). The level of resistance was 27.9% (12/43) for penicillin G, 53.5% (23/43) for erythromycin, 25.6% (11/43) for clindamycin and 100% for tetracycline. However, the strains had retained fully susceptible to vancomycin and teicoplanin. The main risk factor associated with maternal GBS carriage were ectocervical inflammation associated with contact bleeding (OR = 3.55; P = .005). The high rate of maternal vaginal GBS carriage and the levels of resistance to the various antibiotics tested confirm the importance of continuous GBS surveillance in our resource-limited countries.

Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo, 2010.

BACKGROUND: Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, Republic of Congo, in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. METHODS: Polio cases were defined as acute flaccid paralysis (AFP) cases reported from 7 October to 7 December 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. RESULTS: A total of 369 polio cases occurred in Pointe Noire between 7 October and 7 December 2010. Median age was 22 years for nonsurvivors and 18 years for survivors (P = .01). Small home size, as defined by ≤2 rooms, use of a well for drinking water during a water shortage, and age ≥15 years were risk factors for death in multivariate analysis. CONCLUSIONS: Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning.

COVID-19 au Sénégal: réflexion d´un microbiologiste.

Les maladies respiratoires particulièrement le COVID-19 constituent un problème majeur de santé publique dans le monde. Depuis mars 2020, le Sénégal a enregistré 299 cas de COVID-19 dont 183 guéris et seulement deux cas sévères. Aussi environ 20000 personnes en contact étroit avec les malades ont été testés négatifs. Ces résultats sur l´absence de cas sévère, le taux élevé de guérison et la négativité des tests chez les personnes en contact étroit avec les malades pourraient s´expliquer par un portage de coronavirus non viable ou à charge virale très faible (non détectable). En effet, certains facteurs tels que le climat, les prédispositions génétiques pourraient jouer un rôle très important sur la viabilité de SARS CoV-2. Les autres virus respiratoires tels qu´Influenza virus, VRS, rhinovirus, entérovirus, métapneumovirus, para influenza virus causant les mêmes symptômes que le SARS CoV-2, leur détection devrait être faite ensemble pour l´imputabilité de la maladie à un tel virus respiratoire. En conclusion, au Sénégal, le nombre de personnes supposées malades de COVID-19 est très faible et le taux de guérison très élevé. Ainsi, les efforts déployés contre le COVID-19 devraient être réorientés vers la prise en charge des autres pathologies prioritaires des sénégalais.

Community-Based Surveillance in Côte d'Ivoire.

Community-based surveillance can be an important component of early warning systems. In 2016, the Côte d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts (p < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles.

Influenza vaccine for high-risk non-elderly adults: a national survey of subspecialists.

Despite long-standing recommendations for non-elderly adults with certain chronic pulmonary, cardiovascular and metabolic conditions to receive influenza vaccine, vaccination rates remain low. Visits to subspecialists represent an important vaccination opportunity, but little is known regarding subspecialists' perceptions related to influenza vaccination. In February 2003, we conducted a cross-sectional mail survey of a random sample (N = 2,007) of board-certified cardiologists, endocrinologists and pulmonologists from the entire United States who provided outpatient care to adults aged 18-64 years, to assess their patterns of and attitudes toward administering influenza vaccine to high-risk, non-elderly patients. The overall response rate was 33%. Among 621 eligible respondents, 483 stocked influenza vaccine in their practice (Stockers) and 138 did not stock the vaccine (Non-Stockers). Pulmonologists were most likely to stock vaccine and strongly recommend vaccination; cardiologists were least likely. Among Stockers, barriers to vaccination varied by subspecialty. Among Non-Stockers, the most common factor in the decision to not stock vaccine was the perception that patients will receive the vaccine elsewhere. Most subspecialists who provide care to a large proportion of high-risk, non-elderly persons recommend influenza vaccination to some degree, particularly pulmonologists. To reduce missed opportunities overall, subspecialists should be encouraged to vaccinate patients who say that they plan to get the vaccine elsewhere. For cardiologists in particular, barriers to stocking influenza vaccine and recommending vaccination more strongly must be addressed.

Global Health Security Agenda Implementation: A Case for Community Engagement.

In today's interconnected world, infectious diseases can spread rapidly within and between countries. The 2014-2016 Ebola epidemic in Guinea, Liberia, and Sierra Leone underscored the inability of countries with limited capacities and weak public health systems to respond effectively to outbreaks. To mitigate future health threats, nations and international organizations launched the Global Health Security Agenda (GHSA) to accelerate compliance with the WHO's International Health Regulations, so as to enhance global protection from infectious disease threats. To advance GHSA's mandate to build capacity to prevent, detect, and respond to infectious diseases, and thereby contain threats at their source, community engagement is needed. This article advocates for community engagement in GHSA implementation, using examples from 3 GHSA action packages. A country's ability to prevent a local disease outbreak from becoming an epidemic often rests with the level of knowledge about the situation and the actions taken at the community level.

Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services.

The Task Force on Community Preventive Services conducted systematic reviews to evaluate the effectiveness of interventions to improve targeted vaccination coverage (i.e., coverage with vaccines recommended for some but not all persons in an age range on the basis of risk for exposure or disease) among adults aged <65 years at high risk when implemented alone (single-component interventions) and in combination with other interventions (multicomponent interventions). A 1999 report by the Task Force examined the effectiveness of interventions to increase coverage with universally recommended vaccinations (i.e., vaccines recommended for all persons in particular age groups). Three targeted vaccinations recommended for populations at risk are addressed in this review: influenza, pneumococcal polysaccharide, and hepatitis B. The Task Force identified evidence that certain combinations of interventions have improved vaccination coverage. To increase targeted vaccination coverage, the Task Force recommends a combination of interventions that include selected interventions from two or three categories of interventions (i.e., increasing community demand for vaccinations, enhancing access to vaccination services, and provider- or system-based interventions). The Task Force also recommends provider reminders, when implemented alone, to improve targeted vaccination coverage. This report provides additional information about population-based interventions to improve the coverage of influenza, pneumococcal polysaccharide, and hepatitis B vaccines among populations at risk, briefly describes how the reviews were conducted, and provides information that can help in applying the interventions locally.

National availability of influenza vaccine among medical subspecialty practices.

BACKGROUND: Influenza vaccination rates fall short of national goals, particularly among individuals whose chronic conditions predispose them to complications of influenza. Availability of influenza vaccine in medical subspecialists' practices may affect vaccination rates among adults with chronic illness. METHODS: The practice sites of a national random sample of medical cardiology, endocrinology, and pulmonology physicians were contacted by telephone in February 2003 to March 2003 to determine which of them had influenza vaccine available to their patients during the 2002-2003 influenza season. The number of physicians in the practice and geographic location were also obtained. RESULTS: Office staff at the practices of 1683 of 2013 eligible physicians were successfully contacted, and 1473 provided information about vaccine availability. Overall, 1094 (74%) of practices had influenza vaccine available during the 2002-2003 season. Availability differed significantly by subspecialty: 54% cardiology, 78% endocrinology, and 90% pulmonology (p<0.001). Influenza vaccine was more often available at subspecialists' practices in the Northeast (80%) than in the South (74%), Midwest (71%), and West (70%; p<0.005). In multivariate analyses, pulmonology practices in all census regions and sizes were significantly more likely to have influenza vaccine available than was the reference cardiology practice. Several endocrinology practice types also had significantly higher influenza vaccine availability than those in cardiology practice, particularly in multi-physician practices. CONCLUSIONS: Influenza vaccine availability varies widely across practices in the three medical subspecialties that provide care to the largest numbers of individuals with an indication for the vaccine in the United States. These findings have implications for the accessibility of influenza vaccine to individuals at high risk for morbidity and mortality associated with influenza.

Effect of the frequency of delivery of reminders and an influenza tool kit on increasing influenza vaccination rates among adults with high-risk conditions.

OBJECTIVE: To evaluate the incremental effect of a second client reminder postcard or an influenza tool kit targeted toward employers on increasing influenza vaccination rates among adults age < 65 years at high risk for complications from influenza illness. METHODS: In this demonstration study, enrollees of 3 managed care organizations (n = 8881) were randomized at the employer level into 4 arms: 1 postcard, 2 postcards, 1 postcard + tool kit, and 2 postcards + tool kit. The postcards and tool kits were mailed during the fall of 2001, and their effect on influenza vaccination rates was assessed through a survey. RESULTS: Compared with a single postcard, 2 postcards increased vaccination rates by 4 percentage points (adjusted relative risk = 1.05; P < .05) among persons aged 50 to 64 years but did not have any effect among younger adults. Older adults had a greater burden of disease and reported more favorable knowledge and attitudes toward the influenza vaccine. The influenza tool kit did not appear to have any incremental effect on vaccination rates. CONCLUSIONS: Our findings underscore the necessity of evaluating the effectiveness of interventions in different population subgroups and of identifying factors that modify the effectiveness of interventions. Rigorous assessment of intervention effectiveness in managed care settings will enable decision makers to optimize use of scarce healthcare dollars for improving the health and well-being of enrollees.

Measles outbreak in Burkina Faso, 2009: a case-control study to determine risk factors and estimate vaccine effectiveness.

OBJECTIVE: We investigated a large measles outbreak that occurred in 2009 in Burkina Faso in order to describe the epidemic, assess risk factors associated with measles, and estimate measles vaccine effectiveness. METHODS: We reviewed national surveillance and measles vaccine coverage data, and conducted a case-control study in three geographic areas. Case-patients were randomly selected from the national case-based measles surveillance database or, when a case-patient could not be traced, were persons in the same community who experienced an illness meeting the WHO measles clinical case definition. Controls were matched to the same age stratum (age 1-14 years or age 15-30 years) and community as case-patients. Risk factors were assessed using conditional logistic regression. RESULTS: Lack of measles vaccination was the main risk factor for measles in all three geographic areas for children aged 1-14 years (adjusted matched odds ratio [aMOR] [95% confidence interval (CI)], 19.4 [2.4-155.9], 5.9 [1.6-21.5], and 6.4 [1.8-23.0] in Bogodogo, Zorgho, and Sahel, respectively) and persons aged 15-30 years (aMOR [95% CI], 3.2 [1.1-9.7], 19.7 [3.3-infinity], 8.0 [1.8-34.8] in Bogodogo, Zorgho, and Sahel, respectively). Among children aged 1-14 years, VE of any measles vaccination prior to 2009 was 94% (95% CI, 45-99%) in Bogodogo, 87% (95% CI, 37-97%) in Zorgho, and 84% (95% CI, 41-96%) in Sahel. Main reasons for not receiving measles vaccination were lack of knowledge about vaccination campaigns or need for measles vaccination and absence during vaccination outreach or campaign activities. CONCLUSION: These results emphasize the need for improved strategies to reduce missed opportunities for vaccination and achieve high vaccination coverage nationwide in order to prevent large measles outbreaks and to continue progress toward measles mortality reduction.

The value of community participation in disease surveillance: a case study from Niger.

A team of researchers, including one behavioral scientist (S.M.N.) and three epidemiologists (L.Q., O.S. and S.N.) conducted community analyses to assess the social and cultural factors that affect the detection and reporting of disease cases in a surveillance system, using acute flaccid paralysis (AFP) surveillance in Niger as a case study. Over a 60-day period in the country, the research team reviewed written field reports and interviewed epidemiologists, nurses, community members and persons in governmental and non-governmental organizations. Overall, we found that the logistical difficulties of travel and communication, which are common in developing countries, constrain the conventional surveillance system that relies on epidemiologists visiting sites to discover and investigate cases, particularly in rural areas. Other challenges include: community members' lack of knowledge about the possible link between a case of paralysis and a dangerous, communicable disease; lack of access to health care, including the low number of clinics and health care workers; cultural beliefs that favor seeking a local healer before consulting a nurse or physician; and health workers' lack of training in AFP surveillance. The quality of surveillance in developing countries can improve if a community-based approach is adopted. Such a system has been used successfully in Niger during smallpox-eradication and guinea worm-control campaigns. In a community-based system, community members receive basic education or more extensive training to motivate and enable them to notify health care staff about possible cases of disease in a timely fashion. Local organizations, local projects and local leaders must be included to ensure the success of such a program. In Niger we found sufficient quantities of this type of social capital, along with enough local experience of past health campaigns, to suggest that a community-based approach can improve the level of comprehensiveness and sensitivity of surveillance.

One-year uptake of pneumococcal conjugate vaccine: a national survey of family physicians and pediatricians.

BACKGROUND: Pneumococcal conjugate vaccine (PCV7) was recommended by June 2000 for administration to all US children 25% of cases of otitis media. In multivariable logistic regression analyses of adoption of PCV7, FP who have higher proportions of African American patients and patients on Medicaid, see greater numbers of newborns, work in practices of >/=4 physicians, and are willing to consider administering at least 4 vaccine injections at 1 visit are significantly more likely to have adopted PCV7. Concerns about vaccine cost and reimbursement were the most commonly cited factors in physicians' decisions not to adopt PCV7 recommendations. CONCLUSIONS: One year after PCV7 was recommended, nearly all pediatricians and a majority of family physicians had incorporated this vaccine into their practices. Barriers to higher rates of uptake-especially among family physicians-must be addressed to achieve immunization goals with this new vaccine.