Influenza vaccination coverage in a population-based cohort of Australian-born Aboriginal and non-Indigenous older adults

2019 ◽  
Vol 43 ◽  
Author(s):  
Amalie Dyda ◽  
Surendra Karki ◽  
Marlene Kong ◽  
Heather F Gidding ◽  
John M Kaldor ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Torres Strait Islander ◽  
Vaccine Coverage ◽  
Vaccine Uptake ◽  
P Value ◽  
Healthy Weight ◽  
Medical Risk ◽  
Torres Strait

Background: There is limited information on vaccination coverage and characteristics associated with vaccine uptake in Aboriginal and/or Torres Strait Islander adults. We aimed to provide more current estimates of influenza vaccination coverage in Aboriginal adults. Methods: Self-reported vaccination status (n=559 Aboriginal and/or Torres Strait Islander participants, n=80,655 non-Indigenous participants) from the 45 and Up Study, a large cohort of adults aged 45 years or older, was used to compare influenza vaccination coverage in Aboriginal and/or Torres Strait Islander adults with coverage in non-Indigenous adults. Results: Of Aboriginal and non-Indigenous respondents aged 49 to <65 years, age-standardised influenza coverage was respectively 45.2% (95% CI 39.5–50.9%) and 38.5%, (37.9–39.0%), p-value for heterogeneity=0.02. Coverage for Aboriginal and non-Indigenous respondents aged ≥65 years was respectively 67.3% (59.9–74.7%) and 72.6% (72.2–73.0%), p-heterogeneity=0.16. Among Aboriginal adults, coverage was higher in obese than in healthy weight participants (adjusted odds ratio (aOR)=2.38, 95%CI 1.44–3.94); in those aged <65 years with a medical risk factor than in those without medical risk factors (aOR=2.13, 1.37–3.30); and in those who rated their health as fair/poor compared to those who rated it excellent (aOR=2.57, 1.26–5.20). Similar associations were found among non-Indigenous adults. Conclusions: In this sample of adults ≥65 years, self-reported influenza vaccine coverage was not significantly different between Aboriginal and non-Indigenous adults whereas in those <65 years, coverage was higher among Aboriginal adults. Overall, coverage in the whole cohort was suboptimal. If these findings are replicated in other samples and in the Australian Immunisation Register, it suggests that measures to improve uptake, such as communication about the importance of influenza vaccine and more effective reminder systems, are needed among adults.

scholarly journals An Internet-Based Survey of Influenza Vaccination Coverage in Healthcare Workers in China, 2018/2019 Season

Vaccines ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 6 ◽  
Author(s):  
Haitao Liu ◽  
Yayun Tan ◽  
Muli Zhang ◽  
Zhibin Peng ◽  
Jiandong Zheng ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
Online Survey ◽  
Vaccine Coverage ◽  
National Level ◽  
Influence Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Vaccine Uptake

Influenza vaccination coverage was low among healthcare workers (HCWs) in China. In October 2018, the National Health Commission of China began to require all hospitals to provide free influenza vaccination for HCWs to increase vaccine uptake, and no study on vaccine coverage among HCWs at the national level after the announcement of new policy. This evaluation aims to investigate self-reported influenza vaccination coverage among HCWs and factors that may affect vaccine receipt during the 2018/2019 influenza season. We delivered an opt-in internet panel survey among registered HCWs of DXY forum (the biggest online forum for HCWs in China). The survey was self-administered using a standard questionnaire to collect information on demographics, occupational characteristics, policy implementation, influenza vaccination and influence factors. We conducted multivariate logistic regression analysis to assess factors associated with receipt of influenza vaccine. The response rate of this online survey was 3.6%. The seasonal influenza vaccine coverage reported among HCWs surveyed during the 2018/2019 season was 11.6% (472/4078). Only 19.0% (774/4078) of HCWs surveyed reported free policy in their workplace. Combing free policy and workplace requirement proved to be effective to improve influenza vaccination coverage in HCWs (PR = 6.90, 95% CI: 6.03–7.65). The influenza vaccination coverage among surveyed HCWs in China was low during the 2018/2019 season. To increase future vaccination uptake, we recommend a multi-faceted strategy that include free policy, workplace requirement and promotion, on-site vaccination, and monitoring.

scholarly journals 2761. Interventions to Improve Influenza Vaccination Coverage in Children with Medical Comorbidities: A Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S973-S974
Author(s):  
Daniel Norman ◽  
Rosanne Barnes ◽  
Margie Danchin ◽  
Holly Seale ◽  
Hannah C Moore ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Meta Analysis ◽  
Parental Knowledge ◽  
Vaccine Uptake ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical Comorbidities

Abstract Background Influenza vaccination is the most effective influenza prevention tool for children with medical comorbidities. Despite this, coverage remains inadequate. Numerous interventions to improve vaccination coverage have been assessed, yet there remains a paucity of data comparing the relative efficacy and effectiveness of different interventions. Methods We searched MEDLINE, PubMed, Scopus, Embase, CINAHL, CENTRAL, and Web of Science (1980 to March 2019) for studies evaluating interventions which sought to improve influenza vaccine coverage in children with medical comorbidities. Interventions were divided into those targeting parents, targeting vaccination providers, and targeting the hospital, clinic or ward. Screening and data extraction from publications meeting inclusion criteria was performed by two reviewers. Results were pooled and meta-analyses were performed using Mantel–Haenszel random-effects models in Review Manager 5. Results 35 articles met inclusion criteria; 14 cross-sectional, 12 randomized trials, and 9 cohort studies, 25 articles had sufficient data for pooled analysis. Of the included interventions, 17 were based within primary care or community-based settings, 17 were based in hospitals or tertiary clinics, and 1 intervention was conducted across both primary and tertiary settings. Interventions overall increased influenza vaccination likelihood by 33% (RR = 1.33: 95% CI 1.31, 1.35). Interventions targeting providers’ influenza vaccine knowledge increased vaccine coverage (RR = 1.42: 95% CI 1.36, 1.49) greater than those targeting parental knowledge (RR = 1.23: 95% CI 1.21, 1.26). Conversely, vaccination reminders targeting parents increased vaccine coverage (RR = 1.53: 95% CI 1.49, 1.58) greater than reminders targeting providers (RR = 1.23: 95% CI 1.20, 1.27). Interventions targeting hospitals, clinics or ward processes had the weakest impact on coverage (RR = 1.15: 95% CI 1.13, 1.17). Conclusion Interventions targeting parents, providers, and places individually have all shown to improve influenza vaccination in children with medical comorbidities. However, specifically targeting providers’ vaccine knowledge and parental reminders appear to have the greatest impact on vaccine uptake. Disclosures All authors: No reported disclosures.

scholarly journals Factors associated with childhood influenza vaccination in Israel: a cross-sectional evaluation

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Aharona Glatman-Freedman ◽  
Kanar Amir ◽  
Rita Dichtiar ◽  
Hila Zadka ◽  
Ifat Vainer ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccine Coverage ◽  
Population Group ◽  
Vaccine Uptake ◽  
Arab Population ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Factors Associated ◽  
Beneficial Effects

Abstract Background Vaccinating children against influenza has shown both direct and indirect beneficial effects. However, despite being offered free of charge, childhood influenza vaccine coverage in Israel has been low. Our objective was to evaluate the factors associated with childhood influenza vaccination in Israel. Methods A cross-sectional language-specific telephone survey was conducted among adults 18 years or older, to examine childhood influenza vaccination practices and their associations with socio-demographic and relevant health variables. We further explored the reasons for these practices among parents. Multivariate logistic regression was used to identify factors associated with childhood influenza vaccine acceptance. Results Of a total of 6518 individuals contacted by mobile phone, 1165 eligible parents, ≥18 years old with children 1–18 years of age, were interviewed, and 1040 of them completed the survey successfully. Overall, factors associated with childhood influenza vaccination were younger child’s age, influenza vaccination of other family members and belonging to the Arab population group. No association was found between childhood influenza vaccination and routine childhood vaccine uptake. Several of the parents’ reasons for vaccine acceptance - preventing influenza or its transmission, awareness regarding the need for influenza vaccination and receipt of invitation to get vaccinated - differed significantly between Jewish and Arab parents. Several reasons reported by parents for not vaccinating children against influenza, indicated a likelihood to accept influenza vaccine outreach efforts. Such reasons were reported by 27.5% of Jewish parents and 37.5% of Arab parents. Conclusions We found that certain demographic factors were associated with childhood influenza vaccination in Israel. Several reasons described by the parent for not vaccinating their children indicate that outreach efforts are likely to increase childhood influenza vaccination. Addressing population group-specific needs is recommended to optimize the success of influenza vaccine outreach efforts.

scholarly journals Immunisation Coverage Annual Report 2018

2021 ◽  
Vol 45 ◽  
Author(s):  
Brynley Hull ◽  
Alexandra Hendry ◽  
Aditi Dey ◽  
Peter McIntyre ◽  
Kristine Macartney ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Torres Strait Islander ◽  
Vaccine Coverage ◽  
Rotavirus Vaccine ◽  
Immunisation Coverage ◽  
National Immunisation ◽  
Vaccine Schedule ◽  
National Immunisation Program ◽  
Indigenous Children ◽  
Torres Strait

Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in coverage at key milestone ages (12, 24 and 60 months) between 2017 and 2018, while also documenting longer term trends. Fully vaccinated coverage increased at the 12- and 60-months milestones to 93.9% and 94.0%, respectively, but, in the context of additional antigens required, decreased to 90.1% at 24 months. Following the move to a two-dose rotavirus vaccine schedule across Australia from mid-2017, rotavirus vaccine coverage increased from 86.8% to 90.9%. In 2018, most jurisdictions funded influenza vaccine for non-Indigenous children aged 6 months to < 5 years; the National Immunisation Program has funded influenza vaccine for Aboriginal and Torres Strait Islander children and medically at-risk children since 2015 and 2010, respectively. Recorded influenza vaccine coverage in Aboriginal and Torres Strait Islander children doubled from 14.9% to 31.4%, and increased fivefold in non-Indigenous children from 5.0% to 25.9% in 2018. The timeliness of fully vaccinated coverage was also examined at earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by area of residence. For all children, coverage among those living in the least advantaged residential area quintile was 3–4% lower than that for those in the most advantaged quintile at the 9-, 15- and 21-month milestones. Importantly, although Aboriginal and Torres Strait Islander children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (91.8% versus 93.1% for non-Indigenous), coverage increased to 98.5% at 60 months; coverage was also high in non-Indigenous children at 96.2%, above the 95% target critical to measles control. These data demonstrate continuing improvements in immunisation coverage and suggest potential new coverage targets for earlier protection in the first two years of life.

scholarly journals Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Cherif ◽  
G Kharroubi ◽  
L Bouabid ◽  
A Gharbi ◽  
A Boukthir ◽  
...  
Keyword(s):  
Health Care ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Health Care Workers ◽  
Influenza Season ◽  
Vaccine Uptake ◽  
Influenza Immunization ◽  
Knowledge And Attitudes ◽  
Care Workers

Abstract Background Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination. Methods A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions. Results A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV. Conclusions Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community. Key messages Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.

scholarly journals 2733. Association Between Influenza Vaccination Coverage and Ambulatory Antibiotic Prescription Rates in Children in South Carolina

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S962-S962 ◽  
Author(s):  
Mariam Younas ◽  
Julie Royer ◽  
Hana Rac ◽  
Sharon Weissman ◽  
Katie Waites ◽  
...  
Keyword(s):  
South Carolina ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Influenza Season ◽  
Antibiotic Prescription ◽  
Vaccine Coverage ◽  
Prescription Rate ◽  
Prescription Rates ◽  
Carolina Population

Abstract Background Prior studies demonstrated an increase in ambulatory antibiotic prescription rates during the peak of Influenza virus activity, which often occurs during the first 4 months of the year in Southeastern United States. However, the impact of Influenza vaccination coverage on antibiotic prescription rates remains undefined. The purpose of this retrospective cohort study is to examine the association between Influenza vaccination coverage and ambulatory antibiotic prescription rates in children in South Carolina from 2012 to 2017. Methods Medicaid and State Employee Health Plan pharmacy claims for outpatient oral antibiotics were utilized for estimation of community antibiotic prescription rates in South Carolina population 6 months to 17 years of age from January 1, 2012 to December 31, 2017, which represents approximately 60% of the South Carolina population in this age group. Linear regression was used to examine the association between antibiotic prescription rates in January to April of each year and Influenza vaccine coverage in children 6 months to 17 years old after adjustments for Influenza vaccine effectiveness in that season as obtained from Centers for Disease Control and Prevention (CDC). Results During the 6-year study period, the mean antimicrobial prescription rate in children in South Carolina declined from 103 to 79 per 1000 person-months for the months January through April indicating a 26% decline (P < 0.0001). Influenza vaccine coverage also increased from 50.6% during the first Influenza season of the study and peaked at 60.7% in 2014–2015 Influenza season (Figure 1). After adjusting for the vaccine effectiveness, the decline in antibiotic prescription rate was significantly associated with an increase in vaccine coverage in children (P-value < 0.01). Antibiotic prescription rates declined by 3 per 1,000 person-months for each 1% increase in Influenza vaccine coverage in children. Conclusion There is a temporal association between the increase in Influenza vaccination coverage and the decline in ambulatory antibiotic prescription rates in children in South Carolina. Achieving the CDC’s set target Influenza vaccination coverage of 70% of the population may be associated with greater decline in ambulatory antibiotic prescription rates in children in the future. Disclosures All authors: No reported disclosures.

scholarly journals Influenza Vaccination Coverage and Intention to Receive Hypothetical Ebola and COVID-19 Vaccines among Medical Students

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 709
Author(s):  
Ewa Talarek ◽  
Joanna Warzecha ◽  
Marcin Banasiuk ◽  
Aleksandra Banaszkiewicz
Keyword(s):  
Medical Students ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Vaccination Status ◽  
Vaccine Uptake ◽  
Cross Sectional ◽  
Medical University ◽  
Influenza Vaccinations ◽  
To Receive

The study aimed to determine influenza vaccine uptake among medical students and their intention to receive a hypothetical Ebola or COVID-19 vaccine. This cross-sectional questionnaire-based study was performed in 2015 and 2020 on 675 medical students at the Medical University of Warsaw, Poland. In 2020, the influenza vaccination coverage was 36.5%, and students were almost five times more likely to be vaccinated than in 2015 (OR = 4.8; 95% CI: 3.1–7.5). In 2020, the survey was conducted during the first university campaign targeted at free influenza vaccinations for all students, as well as during the first lockdown in Poland due to the COVID-19 pandemic. In 2020, clinical students (4th–6th study year) were significantly more often vaccinated than preclinical students (p < 0.001), in contrast to 2015. A majority—67.0% and 94.6%—of students expressed their intention to receive a hypothetical Ebola or COVID-19 vaccine, respectively. Among the medical students, influenza vaccination status was a predictor of the intention to receive a COVID-19 vaccine. Influenza vaccine uptake among medical students has increased significantly, but it is still not optimal; thus, further educational efforts are needed to convince those who are hesitant regarding vaccines. A high number of students reported their intention to receive a COVID-19 vaccine, and it is crucial to support their positive attitude about it.

scholarly journals Immunisation Coverage Annual Report 2018

2021 ◽  
Vol 45 ◽  
Author(s):  
Brynley Hull ◽  
Alexandra Hendry ◽  
Aditi Dey ◽  
Peter McIntyre ◽  
Kristine Macartney ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Torres Strait Islander ◽  
Vaccine Coverage ◽  
Rotavirus Vaccine ◽  
Immunisation Coverage ◽  
National Immunisation ◽  
Vaccine Schedule ◽  
National Immunisation Program ◽  
Indigenous Children ◽  
Torres Strait

Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in coverage at key milestone ages (12, 24 and 60 months) between 2017 and 2018, while also documenting longer term trends. Fully vaccinated coverage increased at the 12- and 60-months milestones to 93.9% and 94.0%, respectively, but, in the context of additional antigens required, decreased to 90.1% at 24 months. Following the move to a two-dose rotavirus vaccine schedule across Australia from mid-2017, rotavirus vaccine coverage increased from 86.8% to 90.9%. In 2018, most jurisdictions funded influenza vaccine for non-Indigenous children aged 6 months to < 5 years; the National Immunisation Program has funded influenza vaccine for Aboriginal and Torres Strait Islander children and medically at-risk children since 2015 and 2010, respectively. Recorded influenza vaccine coverage in Aboriginal and Torres Strait Islander children doubled from 14.9% to 31.4%, and increased fivefold in non-Indigenous children from 5.0% to 25.9% in 2018. The timeliness of fully vaccinated coverage was also examined at earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by area of residence. For all children, coverage among those living in the least advantaged residential area quintile was 3–4% lower than that for those in the most advantaged quintile at the 9-, 15- and 21-month milestones. Importantly, although Aboriginal and Torres Strait Islander children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (91.8% versus 93.1% for non-Indigenous), coverage increased to 98.5% at 60 months; coverage was also high in non-Indigenous children at 96.2%, above the 95% target critical to measles control. These data demonstrate continuing improvements in immunisation coverage and suggest potential new coverage targets for earlier protection in the first two years of life.

scholarly journals Stagnating influenza vaccine coverage rates among high-risk groups in Poland and Sweden in 2003/4 and 2004/5

2007 ◽  
Vol 12 (4) ◽  
pp. 1-2 ◽  
Author(s):  
M Kroneman ◽  
G A van Essen
Keyword(s):  
High Risk ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Chronic Diseases ◽  
Vaccine Coverage ◽  
Risk Groups ◽  
Vaccine Uptake ◽  
World Health ◽  
High Risk Population ◽  
Coverage Rates

This paper examines influenza vaccine coverage rates (VCR) in Poland and Sweden during the 2003/4 and 2004/5 influenza seasons. An average sample of 2,500 persons was interviewed in each country and each season. Questions regarded age and possible chronic diseases, as well as information on whether they had had an influenza vaccination in the given season. Those who had not received the vaccine were also asked to give reasons for non-vaccination. About one in four (Sweden) to one in three (Poland) of the persons surveyed belonged to high-risk groups (>=65 years of age or suffering from chronic diseases). In the 2004/5 season, 17% (CI 12-19%) of the Polish elderly and 45% (CI 39-50%) of the Swedish elderly were vaccinated. In Poland, 9% (CI 7-12%) of respondents younger than 65 years of age with a chronic condition were vaccinated, whereas in Sweden the corresponding rate was 12% (CI 9-16%). In both countries, the VCR did not change significantly from the previous season. Personal invitations resulted in a higher VCR. In Sweden, the most frequently mentioned reasons for not being vaccinated were the assumption of not qualifying for a vaccination and perceived resistance. In Poland in both years, perceived resistance to flu and the cost of the vaccination were the most often mentioned reasons. The influenza vaccination rates in Poland and Sweden remain far below World Health Organization (WHO) recommendations for the high-risk population. No increase in VCR as demonstrated in this study may indicate that these two countries will not be able to meet the 2010 WHO target, if no further action is taken concerning vaccine uptake.

scholarly journals A Tool for Early Estimation of Influenza Vaccination Coverage in Spanish General Population and Healthcare Workers in The 2018-19 Season. The Gripómetro

2021 ◽  
Author(s):  
Javier Díez-Domingo ◽  
Esther Redondo Marguello ◽  
Raúl Ortiz Lejarazu Leonardo ◽  
Ángel Gil Miguel ◽  
José María Guillén Ortega ◽  
...  
Keyword(s):  
General Population ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Real Time ◽  
Vaccination Coverage ◽  
Health Care Professionals ◽  
Vaccine Coverage ◽  
Vaccination Campaign ◽  
Risk Groups ◽  
Time Data

Abstract Background: Electronic vaccine registries are not yet widely established. There is a need to real-time monitor influenza vaccine coverage, which may raise awareness to risk groups and professionals, and eventually allow to adopt tailored measures during the vaccination campaign. To evaluate the utility of the “Gripómetro”, a demographic study designed to monitor national and regional influenza vaccine coverage on a weekly basis in Spain. Methods: Quantitative study based on surveys of the Spanish population between 18-80 years and a sample of primary care doctors and nurses randomly selected. Pre-proportional fixation has been established by Autonomous Communities and age group to guarantee the representativeness of all the autonomies. Results: Interviews were conducted in 3400 households of general population and 807 respondents among health care professionals. We found that the results of influenza vaccination coverage obtained by the Gripómetro for 2018-2019 season were mostly comparable with the official data presented by the Ministry of Health after the end of the vaccination campaign. Conclusions: The Gripómetro is a robust research method that provides real-time data and trends for influenza vaccine coverage along with other useful information related to vaccination such as intention to vaccinate, motivation and barriers to vaccination.

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