A new dedicated clinic for HCWs’ counseling and vaccination: experience of an academic hospital

Abstract Issue Despite low healthcare workers (HCWs) vaccination coverage being a risk for hospital outbreaks, vaccine hesitancy is not unusual among HCWs. In Italy vaccinations are strongly recommended for HCWs, but there are few occasions for a dedicated counseling. Aim of the study is to evaluate the effectiveness of a new vaccination service in the academic hospital of Udine (northern Italy) in tackling vaccine hesitancy among HCWs. Description of the problem Available data on HCWs specific antibody titers revealed that in high-risk units, 25% of HCWs were certainly unprotected for at least 1/6 of the vaccine preventable diseases (VPDs): measles, rubella, mumps, varicella, pertussis, hepatitis B; only varicella coverage reached the herd immunity target. Periodic occupational health visit was the only moment to screen for VPDs protection and suggest vaccination, but the following inconvenient procedure of HCWs contacting the vaccination office outside the hospital, often lead to delays or loss. In order to improve vaccination adherence, since June 2019 a dedicated clinic has been set up inside the hospital, making vaccination counseling and administration available every two weeks, with appointments directly given by the occupational doctor. Results From June 2019 to February 2020, a total of 362 appointments were booked for the dedicated vaccination clinic, 69.7% of which actually took place as 252 HCWs actually accessed the service. Hours dedicated to the service activity were 76 hours, distributed over 19 days. Administered vaccination were 322, including 107 MMR (measles, rubella, mumps), 4 MMRV (MMR+varicella), 20 varicella, 64 hepatitis B, 127 DTPa (diphtheria, tetanus, pertussis). Lessons Making the access to vaccination more convenient in term of service location within the hospital and giving the appointment when performing the occupational health visit seems to be helpful in filling the VPDs protection among HCWs gap. Key messages Monitoring immunological status of HCWs and promoting vaccination at occupational health visit would sustain herd immunity protection for susceptible individuals in healthcare settings. The dedicated hospital vaccination clinic and the effective procedure of giving the appointment during the occupational health visit could be helpful in improving HCWs vaccine adherence.

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Seroprotection rates of vaccine-preventable diseases among newly arrived Eritrean asylum seekers in Switzerland: a cross-sectional study

Journal of Travel Medicine ◽

10.1093/jtm/taz035 ◽

2019 ◽

Vol 26 (6) ◽

Cited By ~ 4

Author(s):

Cornelia Staehelin ◽

Afona Chernet ◽

Véronique Sydow ◽

Rein J Piso ◽

Franziska Suter-Riniker ◽

...

Keyword(s):

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Herd Immunity ◽

Age Groups ◽

Cross Sectional Study ◽

World Health ◽

Serum Samples ◽

Cross Sectional ◽

Exact Test ◽

Vaccine Preventable Diseases

Abstract Background According to 2016 World Health Organization and United Nations Children’s Fund country estimates, Eritrea has overall high vaccination coverage with immunization rates for three doses of diphtheria/tetanus/pertussis and polio vaccine of 95%, for two doses measles vaccine of 85% and for three doses hepatitis B vaccine of 85%. If confirmed, this could imply that routine basic vaccination of newly arrived Eritreans could be safely omitted. Methods We used stored serum samples from two cross-sectional studies that screened newly arrived Eritrean refugees for infectious diseases. Consenting refugees aged 16 years and older who registered in one of three neighbouring cantons in northwestern Switzerland were enrolled between January 2016 and December 2017. Antibody titers against the following vaccine-preventable diseases were measured (applied thresholds for seroprotection in brackets): diphtheria (>0.1 IU/ml), tetanus (>0.1 IU/ml), measles (>150 mIU/ml), rubella (only for women, >11 IU/ml), varicella (>50 mIU/ml), hepatitis B [hepatitis B surface antigen (HBsAg) Index >0.9, Hepatitis B core antibody (anti-HBc) Index >0.9 and antibodies to HBsAg (anti-HBs) >10 IE/L]. Differences between sex and age groups (≤25 and >25 years) were measured by Fisher’s exact test. Results We analysed samples of 133 study participants (20 women, 15%) with a median age of 25 years (range 16–61). Rates of seropositivity were as follows for women/men, respectively: diphtheria 57.9%/74.8% (difference non-significant), tetanus 94.8%/41.1% (P < 0.001), measles 73.7%/76.6% (non-significant), rubella in women 78.9%, varicella 89.5%/95.3% (non-significant), anti-HBc 15.8%/26.2% (non-significant) and anti-HBs 15.8%/17.8% (non-significant). Conclusion Seroprevalence for vaccine-preventable infections did not meet levels required to confer herd immunity in any of the human-to-human transmissible diseases that were studied. In general, the strategy proposed by the Federal Office of Public Health to offer basic immunization to all newly arrived refugees, including newly arriving Eritrean refugees, is justified.

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Towards the Development of IT-Enabled Immunization Monitoring Framework

Epidemiological Research Applications for Public Health Measurement and Intervention - Advances in Human Services and Public Health ◽

10.4018/978-1-7998-4414-3.ch004 ◽

2021 ◽

pp. 54-68

Author(s):

Suma Dawn ◽

Ankur Jain ◽

Shivam Agrawal ◽

Shresth Pandey

Keyword(s):

Vaccine Hesitancy ◽

Government Agencies ◽

Remedial Measures ◽

Reminder System ◽

Vaccine Preventable Diseases ◽

Storage And Retrieval ◽

Grass Roots ◽

Set Up ◽

Instance Analysis ◽

Statistical Results

In this chapter, the authors present a system that uses smart immunization and develops structures to allow collaboration between parents, healthcare workers, and government agencies to cooperate at a grass-roots level to help spread immunization, collect and upload demographics, and allow for its multi-instance analysis. This system will enhance the spread of vaccination and reduce vaccine hesitancy. Information is coagulated and presented as statistical results that are presented in an engaging visualization form. Further, a reminder system has been set up to enable automated email service for parents by reminding them of proper and timely vaccinations. It collates the immunization data to present usable demographics for timely interventions, as may be necessary. The immunization perspective is retrained by easy storage and retrieval and quick remedial measures to contain the spread of vaccine-preventable diseases and reduction in child mortality. Statistical analysis has been done to predict immunization spread among different regions and detect any possible epidemic.

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Assessing the distribution and determinants of vaccine underutilization in the United States

10.1101/113043 ◽

2017 ◽

Cited By ~ 1

Author(s):

Sandra Goldlust ◽

Elizabeth C. Lee ◽

Murali Haran ◽

Pejman Rohani ◽

Shweta Bansal

Keyword(s):

United States ◽

Large Scale ◽

Herd Immunity ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Economic Determinants ◽

Vaccine Preventable Diseases ◽

Coverage Rates ◽

Public Health Strategies

AbstractDespite advances in sanitation and immunization, vaccine-preventable diseases remain a significant cause of morbidity and mortality worldwide. In high-income countries such as the United States, coverage rates for vaccination against childhood infections remains high. However, the phenomenon of vaccine hesitancy makes maintenance of herd immunity difficult, impeding global disease eradication efforts. Reaching the ‘last mile’ will require early detection of vaccine hesitancy (driven by philosophical or religious choices), identifying pockets of susceptibility due to underimmunization (driven by vaccine unavailability, costs ineligibility), determining the factors associated with the behavior and developing targeted strategies to ameliorate the concerns. Towards this goal, we harness high-resolution medical claims data to geographically localize vaccine refusal and underimmunization (collectively, ‘underutilization’) in the United States and identify the socio-economic determinants of the behaviors. Our study represents the first large-scale effort for vaccination behavior surveillance and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.

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Efficacy and Safety of a 3-Antigen (Pre-S1/Pre-S2/S) Hepatitis B Vaccine: Results of a Phase 3 Randomized Clinical Trial in the Russian Federation

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1649 ◽

2020 ◽

Author(s):

Elena V Esaulenko ◽

Aleksey A Yakovlev ◽

Genady A Volkov ◽

Anastasia A Sukhoruk ◽

Kirill G Surkov ◽

...

Keyword(s):

Hepatitis B ◽

Geometric Mean ◽

Serious Adverse Events ◽

Double Blind ◽

Antigen Vaccine ◽

Single Antigen ◽

Antibody Titers ◽

The Russian Federation ◽

The Difference ◽

Mean Concentration

Abstract Background This study compares the immunogenicity and safety of a 3-antigen (S/pre-S1/pre-S2) hepatitis B (HepB) vaccine (3AV), to a single antigen vaccine (1AV) in adults to support the registration of 3AV in Russia. Methods We conducted a randomized, double-blind, comparative study of 3-dose regimens of 3AV (10 μg) and 1AV (20 µg) in adults aged 18–45 years. We evaluated immunogenicity based on hepatitis B surface (HBs) antibody titers at days 1, 28, 90, 180, and 210, adverse and serious adverse events (SAEs) to study day 210. The primary outcome was based on the difference in rates of seroconversion at day 210 (lower bound 95% confidence interval [CI]: > − 4%). Secondary outcomes were seroprotection rates (SPR), defined as anti-HBs ≥10 mIU/mL and anti-HBs geometric mean concentration (GMC). Results Rate of seroconversion in 3AV (100%) was noninferior to 1AV (97.9%) at study day 210 (difference: 2.1%, 95% CI: −2.0, 6.3%]) but significantly higher at study day 28. SPR at study day 210 was >97% in both arms. Anti-HBs titers were significantly higher at study days 90 (P = .001) and 180 (P = .0001) with 3AV. Sex, age, and body mass index (BMI) had no impact on anti-HBs titers. The rates of local reactions related to vaccination were similar between vaccine arms (3AV vs 1AV) after the first (30% vs 18.8%, P = .15), second (20.0% vs 14.6%, P = .33), and third vaccination (14.9% vs 23.4%, P = .22). No SAEs were reported. Conclusions 3AV was noninferior to 1AV. 3AV induced high SPR, and there were no safety concerns. Clinical Trials Registration. NCT04209400.

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Are We Ready for the Arrival of the New COVID-19 Vaccinations? Great Promises and Unknown Challenges Still to Come

Vaccines ◽

10.3390/vaccines9020173 ◽

2021 ◽

Vol 9 (2) ◽

pp. 173

Author(s):

Davide Gori ◽

Chiara Reno ◽

Daniel Remondini ◽

Francesco Durazzi ◽

Maria Pia Fantini

Keyword(s):

Herd Immunity ◽

The Elderly ◽

Vaccine Hesitancy ◽

Current Crisis ◽

Complex Issue ◽

The Public ◽

The Social ◽

To Come ◽

Vaccination Campaigns ◽

The Eu

While the SARS-CoV-2 pandemic continues to strike and collect its death toll throughout the globe, as of 31 January 2021, the vaccine candidates worldwide were 292, of which 70 were in clinical testing. Several vaccines have been approved worldwide, and in particular, three have been so far authorized for use in the EU. Vaccination can be, in fact, an efficient way to mitigate the devastating effect of the pandemic and offer protection to some vulnerable strata of the population (i.e., the elderly) and reduce the social and economic burden of the current crisis. Regardless, a question is still open: after vaccination availability for the public, will vaccination campaigns be effective in reaching all the strata and a sufficient number of people in order to guarantee herd immunity? In other words: after we have it, will we be able to use it? Following the trends in vaccine hesitancy in recent years, there is a growing distrust of COVID-19 vaccinations. In addition, the online context and competition between pro- and anti-vaxxers show a trend in which anti-vaccination movements tend to capture the attention of those who are hesitant. Describing this context and analyzing its possible causes, what interventions or strategies could be effective to reduce COVID-19 vaccine hesitancy? Will social media trend analysis be helpful in trying to solve this complex issue? Are there perspectives for an efficient implementation of COVID-19 vaccination coverage as well as for all the other vaccinations?

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Circulating Tfh cell and subsets distribution are associated with low‐responsiveness to hepatitis B vaccination

Molecular Medicine ◽

10.1186/s10020-021-00290-7 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Mingjuan Yin ◽

Yongzhen Xiong ◽

Dongmei Liang ◽

Hao Tang ◽

Qian Hong ◽

...

Keyword(s):

Hepatitis B ◽

Hepatitis B Vaccine ◽

Hepatitis B Vaccination ◽

Cellular Mechanisms ◽

Immunological Responses ◽

Follicular Helper ◽

Low Responders ◽

Specific Subset ◽

Antibody Titers

Abstract Background An estimated 5–10 % of healthy vaccinees lack adequate antibody response following receipt of a standard three-dose hepatitis B vaccination regimen. The cellular mechanisms responsible for poor immunological responses to hepatitis B vaccine have not been fully elucidated to date. Methods There were 61 low responders and 56 hyper responders involved in our study. Peripheral blood samples were mainly collected at D7, D14 and D28 after revaccinated with a further dose of 20 µg of recombinant hepatitis B vaccine. Results We found low responders to the hepatitis B vaccine presented lower frequencies of circulating follicular helper T (cTfh) cells, plasmablasts and a profound skewing away from cTfh2 and cTfh17 cells both toward cTfh1 cells. Importantly, the skewing of Tfh cell subsets correlated with IL-21 and protective antibody titers. Based on the key role of microRNAs involved in Tfh cell differentiation, we revealed miR-19b-1 and miR-92a-1 correlated with the cTfh cell subsets distribution and antibody production. Conclusions Our findings highlighted a decrease in cTfh cells and specific subset skewing contribute to reduced antibody responses in low responders.

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Would Parents Get Their Children Vaccinated Against SARS-CoV-2? Rate and Predictors of Vaccine Hesitancy According to a Survey over 5000 Families from Bologna, Italy

Vaccines ◽

10.3390/vaccines9040366 ◽

2021 ◽

Vol 9 (4) ◽

pp. 366

Author(s):

Marco Montalti ◽

Flavia Rallo ◽

Federica Guaraldi ◽

Lapo Bartoli ◽

Giulia Po ◽

...

Keyword(s):

Online Survey ◽

Vaccination Campaign ◽

Herd Immunity ◽

Vaccine Hesitancy ◽

Web Based ◽

Safe School ◽

Efficacy Trials ◽

Adolescent Vaccination ◽

Web Social ◽

Mandatory Vaccination

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.

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Herd immunity drives the epidemic fadeout of avian cholera in Arctic-nesting seabirds

Scientific Reports ◽

10.1038/s41598-020-79888-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jacintha G. B. van Dijk ◽

Samuel A. Iverson ◽

H. Grant Gilchrist ◽

N. Jane Harms ◽

Holly L. Hennin ◽

...

Keyword(s):

Colony Size ◽

Pasteurella Multocida ◽

Herd Immunity ◽

Reproductive Number ◽

Somateria Mollissima ◽

Common Eiders ◽

Serological Status ◽

Antibody Titers ◽

Avian Cholera

AbstractAvian cholera, caused by the bacterium Pasteurella multocida, is a common and important infectious disease of wild birds in North America. Between 2005 and 2012, avian cholera caused annual mortality of widely varying magnitudes in Northern common eiders (Somateria mollissima borealis) breeding at the largest colony in the Canadian Arctic, Mitivik Island, Nunavut. Although herd immunity, in which a large proportion of the population acquires immunity to the disease, has been suggested to play a role in epidemic fadeout, immunological studies exploring this hypothesis have been missing. We investigated the role of three potential drivers of fadeout of avian cholera in eiders, including immunity, prevalence of infection, and colony size. Each potential driver was examined in relation to the annual real-time reproductive number (Rt) of P. multocida, previously calculated for eiders at Mitivik Island. Each year, colony size was estimated and eiders were closely monitored, and evaluated for infection and serological status. We demonstrate that acquired immunity approximated using antibody titers to P. multocida in both sexes was likely a key driver for the epidemic fadeout. This study exemplifies the importance of herd immunity in influencing the dynamics and fadeout of epidemics in a wildlife population.

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Coverage with Timely Administered Vaccination against Hepatitis B Virus and Its Influence on the Prevalence of HBV Infection in the Regions of Different Endemicity

Vaccines ◽

10.3390/vaccines9020082 ◽

2021 ◽

Vol 9 (2) ◽

pp. 82

Author(s):

Karen K. Kyuregyan ◽

Vera S. Kichatova ◽

Olga V. Isaeva ◽

Ilya A. Potemkin ◽

Elena Yu. Malinnikova ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Birth Cohort ◽

Herd Immunity ◽

Hepatitis B Vaccination ◽

Core Antigen ◽

Infection Prevalence ◽

Belgorod Oblast ◽

Medical Specialties ◽

B Virus

Universal hepatitis B vaccination of newborns was implemented in Russia starting from 1998. From 1998 to 2019, the incidence of acute hepatitis B reduced from 43.8 to 0.57 cases per 100,000 population. Here, we assessed the timely coverage of newborns with the birth dose (HepB-BD), second dose (HepB-2nd), and three vaccine doses (HepB3) in two remote regions of Russia with low (Belgorod Oblast) and high (Yakutia) levels of hepatitis B virus (HBV) endemicity. Vaccination data were obtained from the medical records of 1000 children in Yakutia and 2182 children in Belgorod Oblast. Sera of healthy volunteers from Belgorod Oblast (n = 1754) and Yakutia (n = 1072) across all age groups were tested for serological markers of HBV to assess the infection prevalence and herd immunity. Average HepB-BD coverage was 99.2% in Yakutia and 89.4% in Belgorod Oblast (p < 0.0001) and in both regions varied significantly, from 66% to 100%, between medical centers. The principal reason for the absence of HepB-BD was parent refusal, which accounted for 63.5% of cases of non-vaccination (83/123). While timely HepB-2nd coverage was only 55.4%–64.7%: HepB3 coverage by the age of one year exceeded 90% in both study regions. HBV surface antigen (HBsAg) prevalence in the 1998–2019 birth cohort was 0.2% (95% CI: 0.01–1.3%) in Belgorod Oblast and 3.2% (95% CI: 1.9–5.2%) in Yakutia. The proportion of persons testing negative for both antibodies to HBsAg (anti-HBs) and antibodies to HBV core antigen (anti-HBc) in the 1998–2019 birth cohort was 26.2% (125/481) in Belgorod Oblast and 32.3% (162/501) in Yakutia. We also assessed the knowledge of and attitude towards vaccination among 782 students and teachers of both medical and non-medical specialties from Belgorod State University. Only 60% of medical students knew that hepatitis B is a vaccine-preventable disease. Both medical and nonmedical students, 37.8% and 31.3%, respectively, expressed concerns about safety and actual necessity of vaccination. These data indicate the need to introduce a vaccine delivery audit system, improve medical education with respect to vaccination strategies and policies, and reinforce public knowledge on the benefits of vaccination.

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Factors Influencing SARS-CoV-2 Vaccine Acceptance and Hesitancy in a Population-Based Sample in Italy

Vaccines ◽

10.3390/vaccines9060633 ◽

2021 ◽

Vol 9 (6) ◽

pp. 633

Author(s):

Marco Del Riccio ◽

Sara Boccalini ◽

Lisa Rigon ◽

Massimiliano Alberto Biamonte ◽

Giuseppe Albora ◽

...

Keyword(s):

Online Survey ◽

Adult Population ◽

Herd Immunity ◽

Population Based ◽

Vaccine Hesitancy ◽

Convenience Sample ◽

Major Barrier ◽

Trust In Institutions ◽

General Adult Population ◽

High Level

Vaccination against SARS-CoV-2 represents an effective and safe tool to protect the population against the disease; however, COVID-19 vaccine hesitancy could be a major barrier to achieving herd immunity. Despite the severity of the current pandemic, the population’s intention to get vaccinated against COVID-19 is still not clear. The aim of this study was to evaluate the intention to get vaccinated against COVID-19 among a convenience sample of the general population resident in Italy and the factors associated with hesitancy and acceptance of the vaccine in the context of the current pandemic before the rolling out of COVID-19 vaccines. An anonymous online survey was diffused among a general adult population living in Italy. Participants aged 18 or older and living in Italy were considered eligible. Incomplete questionnaires were excluded. Overall, 7605 valid questionnaires were collected. Most of the participants (81.9%) were inclined to get vaccinated; male sex (OR 1.38, 95% CI 1.12–1.71), a high level of trust in institutions (OR 3.93, 95% CI 2.04–7.83), and personal beliefs about high safety of COVID-19 vaccines (OR 56.33, 95% CI 31.57–105.87) were found to be among the significant predictors of COVID-19 acceptance. These data could help design larger studies to address the problem of COVID-19 vaccine hesitancy in the current pandemic.

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