Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey

BackgroundHIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA.ObjectiveThe aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China.MethodsThis cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis.ResultsOut of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001).ConclusionsAs compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA’s perceptions and willingness to receive COVID-19 vaccination.     

Predictors of Minimum Acceptable Diet among Children Aged 6–23 Months in Nepal: A Multilevel Analysis of Nepal Multiple Indicator Cluster Survey 2019

Background: Minimum Acceptable Diet (MAD), developed by the WHO and UNICEF, is a binary indicator of infant and young child feeding practice that assesses the quality and sufficiency of a child’s diet between the ages of 6 and 23 months. Identifying factors associated with MAD among children can inform policymakers to improve children’s nutritional status. Methods: We extracted data of 1930 children aged 6–23 months from the Nepal Multiple Indicator Cluster Survey 2019. Multilevel analysis was performed to identify factors associated with MAD. Results: Only 30.1% of the children received MAD. Children aged 13–18 months [aOR (Adjusted odds ratio): 2.37, 95% CI (95% Confidence Interval): 1.77, 3.17] and 19–23 months (aOR: 2.6, 95% CI: 1.95, 3.47) were more likely to receive MAD than children aged 6–12 months. Early breastfed children (aOR: 1.34, 95% CI: 1.05, 1.72), those currently breastfeeding (aOR: 4.13, 95% CI: 2.21, 7.69) and children without siblings aged under five (aOR: 1.33, 95% CI: 1.03, 1.73) were more likely to receive MAD. Younger maternal age (aOR: 0.97, 95% CI: 0.95–1.0), higher level of mother’s education (aOR: 1.04, 95% CI: 1.0–1.08) and more media exposure among mothers (aOR: 1.66, 95% CI: 1.24, 2.21) were positive predictors of MAD. Relatively disadvantaged ethnicity/caste (aOR: 0.71, 95% CI: 0.53, 0.94), rural residence (aOR: 1.45, 95% CI: 1.06, 2.00) and residing in Madhesh province (aOR: 0.61, 95% CI: 0.37, 1.0) were also significant predictors of MAD. Conclusions: Children aged 6–12 months, without appropriate breastfeeding, having under-five years siblings, with older mother or mother without media exposure or low education, from relatively disadvantaged ethnicity/caste, from urban areas and residing in Madhesh Province were less likely to receive MAD. Our findings can inform infant and young child feeding policies and practices in Nepal.     

Associations of Nutritional Status with Full Immunization Coverage and Safe Hygiene Practices among Thai Children Aged 12–59 Months

Prevailing prevention measures against morbidity, such as vaccination and safe hygiene practices, vary among local cultural contexts, and little is known about the extent to which these behaviors mitigate poor nutritional status in young children in Southeast Asia. We examined the associations between nutrition status with full immunization coverage, and water, sanitation and hygiene status among children aged 12–59 months in the 2015–2016 Thailand Multiple Indicator Cluster Survey (n = 9060). When adjusted for confounding factors, children with incomplete immunization status were more likely to be stunted (adjusted odds ratio (aOR) 1.47; 95% confidence interval (CI): 1.24–1.75, p < 0.001), wasted (aOR 1.67, 95% CI: 1.31–2.12, p < 0.001), and overweight (aOR 1.24, 95% CI: 1.01–1.51, p < 0.05), whereas children who used unimproved water sources were more likely to be overweight (aOR 2.43, 95% CI: 1.27–4.64, p < 0.01). The further implementation of simple and cost-effective health promotion activities and practices at the household level may be important interventions for healthy child growth and development, particularly under restricted living conditions due to COVID-19.     

COVID-19 related immunization disruptions in Rajasthan,India: A retrospective observational study

IntroductionGovernments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up vaccinations. This paper evaluated immunization disruptions during India’s March-May 2020 lockdown and the extent to which subsequent catch-up efforts reversed them in Rajasthan, India.MethodsIn this retrospective observational study, we conducted phone surveys to collect immunization details for 2,144 children that turned one year old between January and October 2020. We used logistic regressions to compare differences in immunization timeliness and completed first-year immunization status among children that were due immunizations just before (unexposed), during (heavily exposed), and after (post-exposure) the lockdown.ResultsRelative to unexposed children, heavily exposed children were significantly less likely to be immunized at or before 9 months (OR 0.550; 95% CI 0.367–0.824; p = 0.004), but more likely to be immunized at 10–12 months (OR 1.761; 95% CI 1.196–2.591; p = 0.004). They were also less likely to have completed their key first-year immunizations (OR 0.624; 95% CI 0.478–0.816; p = 0.001) by the time of survey. In contrast, post-exposure children showed no difference in timeliness or completed first-year immunizations relative to unexposed children, despite their younger age. First-year immunization coverage among heavily exposed children decreased by 6.9 pp to 10.4 pp (9.7% to 14.0%). Declines in immunization coverage were larger among children in households that were poorer, less educated, lower caste, and residing in COVID red zones, although subgroup comparisons were not statistically significant.ConclusionDisruptions to immunization services resulted in children missing immunization during the lockdown, but catch-up efforts after it was eased ensured many children were reached at later ages. Nevertheless, catch-up was incomplete and children due their immunizations during the lockdown remained less likely to be fully immunized 4–5 months after it lifted, even as younger cohorts due immunizations in June or later returned to pre-lockdown schedules.     

Physician clinical decision support system prompts and administration of subsequent doses of HPV vaccine: A randomized clinical trial

BackgroundHPV vaccine is effective in preventing several cancers and anogenital warts, yet rates of HPV vaccination series completion in the United States are low. A primary reason identified by parents for vaccinating children against HPV is a health care provider’s recommendation. Although most clinicians embrace vaccine recommendations, they are not always carried out evenly and subsequent HPV vaccines are missed.MethodsUsing an electronic health records-based decision support system (CHICA) clinicians were randomized to either usual practice or to receive an automated reminder to recommend the 2nd or 3rd dose of HPV vaccine. The reminder was delivered to clinicians of all intervention group eligible adolescents who had already initiated the vaccine series. Logistic regression models with generalized estimating equations were used for data analysis.ResultsA total of 1285 clinical encounters were observed across 29 randomized pediatric providers over a 13-month time frame (50.7% control group, 49.3% intervention group). Overall, patients were 44.9% female, 59.4% Black, 22.1% Hispanic, and 48.8% were ages 11–12 yrs. Within the control group, 421 (64.7%) received a subsequent HPV vaccine, compared to 481 (75.9%) (OR: 1.72, (95% CI 1.35–2.19)). Adjusted analysis showed no difference between the groups (aOR 1.52 (95% CI 0.88–2.62)) or when examined by age (11-12yrs aOR 1.66, (95% CI 0.79–3.48)) and 13-17yrs (aOR 1.19, (95% CI 0.76–1.85)) or gender female (aOR 1.39 (95% CI 0.71–2.72)) and males (aOR 1.67 (95% CI 0.95–2.92)). When results were stratified by both age and gender, there was similarly no statistically significant effect between the two groups.ConclusionsAutomated physician reminders for subsequent 2nd and 3rd doses of HPV vaccination were used. Despite increased rates of vaccination in the intervention group, the differences did not reach the level of statistical significance. Future studies with multifaceted approaches may be needed to examine the efficacy of computer-based reminders.Clinical Trial Registration: NCT02558803, “HPV Vaccination: Evaluation of Reminder Prompts for Doses 2 & 3”.     

The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial

BackgroundProviding adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters.ObjectiveThe aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters.MethodsIn this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect.ResultsOf 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group.ConclusionsA cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination.Trial RegistrationUMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf     

Determinants of Depression in Indonesian Youth: Findings From a Community-based Survey

ObjectivesThis study investigated the determinants of depression in adolescents and young adults.MethodsThe present study analyzed data from the 2018 Indonesia Basic Health Survey (Riset Kesehatan Dasar; RISKESDAS). The study subjects were adolescents (15-17 years old) and young adults (18-24 years old). In total, 64 179 subjects were included. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between youths’ characteristics, risky behavior, chronic disease, parents’ health, and youths’ depression.ResultsThe prevalence of depression was 5.1% in adolescents and 5.6% in young adults. The risk factors for depression in adolescents were being women (adjusted odds ratio [aOR], 3.53; 95% confidence interval [CI], 2.89 to 4.30; p<0.001), an ex-smoker (aOR, 2.99; 95% CI, 2.10 to 4.25; p<0.001), or a current smoker (aOR, 2.60; 95% CI, 1.97 to 3.44; p<0.001); consuming alcohol (aOR, 2.00; 95% CI, 1.33 to 3.01; p=0.001), having a chronic disease (aOR, 2.64; 95% CI, 1.41 to 4.96; p=0.002); maternal depression (aOR, 2.47; 95% CI, 1.97 to 3.09; p<0.001); and paternal depression (aOR, 2.63; 95% CI, 1.98 to 3.50; p<0.001). In young adults, the risk factors were being women (aOR, 2.23; 95% CI, 1.82 to 2.75; p<0.001) or an ex-smoker (aOR, 2.47; 95% CI, 1.67 to 3.67; p<0.001), consuming alcohol (aOR, 2.42; 95% CI, 1.89 to 3.09; p<0.001), maternal depression (aOR, 3.12; 95% CI, 2.54 to 3.84; p<0.001), and paternal depression (aOR, 2.80; 95% CI, 2.17 to 3.63; p<0.001).ConclusionsBeing women, smoking, drinking alcohol, having a chronic disease, and having a parent with depression were crucial factors associated with youth depression. Mental health screening, prevention, and treatment should involve collaboration among primary healthcare, schools, universities, professionals, and families.     

Use of an adapted participatory learning and action cycle to increase knowledge and uptake of child vaccination in internally displaced persons camps (IVACS): A cluster-randomised controlled trial

BackgroundVaccination is a key public health intervention that can reduce excess mortality in humanitarian contexts. Vaccine hesitancy is thought to be a significant problem requiring demand side interventions. Participatory Learning and Action (PLA) approaches have proven effective in reducing perinatal mortality in low income settings and we aimed to apply an adapted approach in Somalia.MethodsA randomised cluster trial was implemented in camps for internally displaced people near Mogadishu, from June to October 2021. An adapted PLA approach (hPLA) was used in partnership with indigenous ‘Abaay-Abaay’ women’s social groups. Trained facilitators ran 6 meeting cycles that addressed topics of child health and vaccination, analysed challenges, and planned and implemented potential solutions. Solutions included a stakeholder exchange meeting involving Abaay-Abaay group members and services providers from humanitarian organisations. Data was collected at baseline and after completion of the 3 month intervention cycle.ResultsOverall, 64.6% of mothers were group members at baseline and this increased in both arms during the intervention (p = 0.016). Maternal preference for getting young children vaccinated was >95% at baseline and did not change. The hPLA intervention improved the adjusted maternal/caregiver knowledge score by 7.9 points (maximum possible score 21) compared to the control (95% CI 6.93, 8.85; p < 0.0001). Coverage of both measles vaccination (MCV1) (aOR 2.43 95% CI 1.96, 3.01; p < 0.001) and completion of the pentavalent vaccination series (aOR 2.45 95% CI 1.27, 4.74; p = 0.008) also improved. However, adherence to timely vaccination did not (aOR 1.12 95% CI 0.39, 3.26; p = 0.828). Possession of a home-based, child health record card increased in the intervention arm from 18 to 35% (aOR 2.86 95% CI 1.35, 6.06; p = 0.006).ConclusionA hPLA approach, run in partnership with indigenous social groups, can achieve important changes in public health knowledge and practice in a humanitarian context. Further work to scale up the approach and address other vaccines and population groups is warranted.     

The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada

ObjectiveTo examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness.MethodsParticipants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures were intervention group (HF vs. treatment as usual), Axis I mental health diagnoses, emergency department (ED) visit, and history of traumatic brain injury (TBI). Logistic regression was used to examine the association between exposures and incarceration.ResultsOf 508 participants, 220 (43.3%) were incarcerated at least once during the study period. Among those incarcerated, 81.9% were male, 52.7% had been diagnosed with alcohol dependence/abuse, 60.9% had been diagnosed with substance dependence/abuse, 65.1% reported having visited an ED within the last 6 months, and 66.4% had a history of TBI. After adjusting for demographic covariates, substance dependence/abuse (aOR: 2.06; 95% CI: 1.40, 3.03), alcohol dependence/abuse (aOR: 1.52, 95% CI: 1.04, 2.22), ED visit (aOR: 1.54; 95% CI: 1.02, 2.32), and history of TBI (aOR: 2.60; 95% CI: 1.75, 3.85) were associated with incarceration. We found no significant effect of the HF intervention on incarceration outcome (aOR: 1.08; 95% CI: 0.76, 1.55).ConclusionsAmong adults with experiences of homelessness and severe mental illness, those with substance and alcohol dependence/abuse disorders, history of TBI, and recent ED visits were at increased odds of incarceration. Strategies are needed to prevent and reduce incarceration for this population, including treatment of mental illness in the community.Supplementary InformationThe online version of this article (10.17269/s41997-020-00433-z) contains supplementary material, which is available to authorized users.     

Effectiveness of mindfulness parent training on parenting stress and children’s ADHD-related behaviors: A systematic review and meta-analysis

Background/ObjectiveLiterature shows that there is a circular relationship between children’s ADHD-related behaviors and parenting stress. This systematic review and meta-analysis aimed to understand if mindfulness parent trainings have benefits for both parenting stress and the problem behaviors in children with ADHD.MethodsFive databases, CINAHL, Embase, PsycINFO, PubMED, and Web of Science, were searched. Within-group effects at post-treatment and follow-up assessment, and between-group effects at post-treatment were analyzed. Effect sizes (Hedges’ g) were also calculated.ResultsTen studies (5 RCTs and 5 non-RCTs) met the selection criteria and were selected for systematic review, and nine of them were included for meta-analysis. Among these 10 studies, five studies involved mindfulness training for both parents and children, while the other five studies involved mindfulness training for parents only. Within-group effects at post-treatment were small-to-large for all outcomes. Hedges’ g ranged between −0.17 [95% CI (−0.98, 0.64)] and 4.70 [95% CI (3.59, 5.81)] for parenting stress; 0.17 [95% CI (−0.03, 0.37)] and 4.03 [95% CI (2.97, 5.09)] for children’s problem behaviors; and 0.20 [95% CI (−0.10, 0.50)] and 2.98 [95% CI (2.16, 3.80)] for children’s ADHD symptoms. Between-group comparisons showed mindfulness parent training was superior to other active controls on all outcomes.ConclusionFindings suggest that mindfulness parent training may be beneficial for parenting stress and children’s ADHD-related behaviors, and due to the small number of studies reviewed, cautions should be taken when interpreting the results.     

Tuberculosis treatment outcomes and patient support groups,southern India

ObjectiveTo assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India.MethodsTuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients’ participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings.FindingsOf 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10–2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age ≥ 60 years (aOR: 3.19; 95% CI: 2.26–4.51); female sex (aOR: 3.33; 95% CI: 2.46–4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91–4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76–7.93); tuberculosis retreatment (aOR: 1.69; 1.22–2.33); and drug-resistant tuberculosis (aOR: 1.93; 95% CI: 1.21–3.09).ConclusionParticipation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level.     

湖北省2004年常规免疫监测结果评价

目的评价湖北省2004年常规免疫接种率监测结果。方法对湖北省2004年常规免疫监测报表进行估计接种率、差值评价、比值评价和报表及时性、完整性分析。结果湖北省2004年常规免疫监测报表及时性、完整性较以往明显提高;四苗基础和加强免疫报告接种率为92．34％（麻疹疫苗,MV2）～98．98％（口服脊髓灰质炎疫苗,OPV）,（乙型肝炎疫苗,HBV）报告接种率为98．67％;四苗基础免疫估计接种率为78．73％（卡介苗,BCG）～83．65％（MV）,HBV为74．57％;加强免疫估计接种率分别为7．35％（MV2）～73．05％（白喉、百日咳、破伤风混合疫苗,DPT）。结论差值评价说明湖北省报告接种率可信性较低,比值评价说明数据可疑;今后需加强常规免疫规范化管理。     

Socioeconomic drivers of vaccine uptake: An analysis of the data of a geographically defined cluster randomized cholera vaccine trial in Bangladesh

BackgroundEvaluations of oral cholera vaccines (OCVs) have demonstrated their effectiveness in diverse settings. However, low vaccine uptake in some settings reduces the opportunity for prevention. This paper identifies the socioeconomic factors associated with vaccine uptake in a mass vaccination program.MethodsThis was a three-arm (vaccine, vaccine plus behavioral change, and non-intervention) cluster randomized trial conducted in Dhaka, Bangladesh. Socio-demographic and vaccination data were collected from 268,896 participants. A geographical information system (GIS) was used to design and implement the vaccination program. A logistic regression model was used to assess the association between vaccine uptake and socioeconomic characteristics.ResultsThe GIS supported the implementation of the vaccination program by identifying ideal locations of vaccination centres for equitable population access, defining catchment areas of daily activities, and providing daily coverage maps during the campaign. Among 188,206 individuals in the intervention arms, 123,686 (66%) received two complete doses, and 64,520 (34%) received one or no doses of the OCV. The vaccine uptake rate was higher in females than males (aOR: 1.80; 95% CI = 1.75–1.84) and in younger (<15 years) than older participants (aOR: 2.19; 95% CI = 2.13–3.26). Individuals living in their own house or having a higher monthly family expenditure were more likely to receive the OCV (aOR: 1.60; 95% CI = 1.50–1.70 and aOR: 1.14; 95% CI = 1.10–1.18 respectively). Individuals using treated water for drinking or using own tap as the source of water were more likely to receive the OCV (aOR: 1.23; 95% CI = 1.17–1.29 and aOR: 1.14; 95% CI = 1.02–1.25 respectively) than their counterpart. Vaccine uptake was also significantly higher in participants residing farther away from health facilities (aOR: 95% 1.80; CI = 1.36–2.37).ConclusionThe GIS was useful in designing field activities, facilitating vaccine delivery and identifying socioeconomic drivers of vaccine uptake in the urban area of Bangladesh. Addressing these socioeconomic drivers may help improve OCV uptake, thereby effectiveness of the OCV in a community.     

The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018

The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). This rapid surveillance report describes the sixth cycle of data collection (September-December 2018; AMIS 2018). The key indicators were the same as those previously reported for past AMIS cycles. The AMIS methodology has not substantively changed since AMIS 2017. MSM were recruited from a variety of websites using banner advertisements and email blasts. In addition, participants from AMIS 2017 who agreed to be recontacted for future research were emailed a link to AMIS 2018. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants’ self-reported HIV status. The AMIS 2018 round of data collection resulted in 10,129 completed surveys from MSM representing every US state, Puerto Rico, and Guam. Most participants were non-Hispanic White, aged between 15 and 24 years, living in urban areas in the southern United States, and recruited from general social networking websites. The plurality (4230/10,129, 41.76%) of participants was in the youngest age group, 15-24 years, followed by the 40 years and older age group (3088/10,129, 30.49%). The self-reported HIV prevalence was 6.08% (616/10,129). Compared with HIV-negative or unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (adjusted odds ratio [aOR] 2.02, 95% CI 1.63-2.50) and more likely to have had anal sex without a condom with a serodiscordant or an unknown status partner (aOR 3.90, 95% CI 3.27-4.66). The reported use of marijuana in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 1.39, 95% CI 1.15-1.68). The reported use of methamphetamines and other illicit substances in the past 12 months was higher among HIV-positive participants than among HIV-negative or unknown status participants (aOR 3.42, 95% CI 2.41-4.87 and aOR 1.90, 95% CI 1.56-2.32, respectively). Most HIV-negative or unknown status participants (6838/9513, 71.88%) reported ever taking an HIV test previously, and 52.51% (4995/9513) of the participants reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative or unknown status participants (aOR 3.50, 95% CI 2.89-4.24 and aOR 2.61, 95% CI 2.10-3.25, respectively).     

Engaging religious leaders to promote safe burial practices during the 2014–2016 Ebola virus disease outbreak,Sierra Leone

ObjectiveTo quantify the potential impact of engaging religious leaders in promoting safe burial practices during the 2014–2016 Ebola virus disease outbreak in Sierra Leone.MethodsWe analysed population-based household survey data from 3540 respondents collected around the peak of the outbreak in Sierra Leone, December 2014. Respondents were asked if in the past month they had heard an imam or pastor say that people should not touch or wash a dead body. We used multilevel logistic regression modelling to examine if exposure to religious leaders’ messages was associated with protective burial intentions if a family member died at home and other Ebola protective behaviours.FindingsOf the respondents, 3148 (89%) had been exposed to faith-based messages from religious leaders on safe Ebola burials and 369 (10%) were unexposed. Exposure to religious leaders’ messages was associated with a nearly twofold increase in the intention to accept safe alternatives to traditional burials and the intention to wait ≥ 2 days for burial teams (adjusted odds ratio, aOR: 1.69; 95% confidence interval, CI: 1.23–2.31 and aOR: 1.84; 95% CI: 1.38–2.44, respectively). Exposure to messages from religious leaders was also associated with avoidance of traditional burials and of contact with suspected Ebola patients (aOR: 1.46; 95% CI: 1.14–1.89 and aOR: 1.65; 95% CI: 1.27–2.13, respectively).ConclusionPublic health messages promoted by religious leaders may have influenced safe burial behaviours during the Ebola outbreak in Sierra Leone. Engagement of religious leaders in risk communication should be prioritized during health emergencies in similar settings.     

Impact of elementary school-located influenza vaccinations: A stepped wedge trial across a community

BackgroundInfluenza vaccination rates among children are low and novel strategies are needed to raise coverage. We measured the impact of school-located influenza vaccination (SLIV) on coverage, examined whether SLIV substitutes for practice-based influenza vaccination (“substitution”), and estimated whether a second year of experience with SLIV increases its impact.MethodsWe implemented a stepped wedge study design with schools as clusters. In Year 1, we randomly allocated schools to SLIV or control. In Year 2, all schools performed SLIV. We used emails (suburban schools) or backpack fliers (both urban and suburban schools) to notify parents, and offered web-based (suburban) or paper-based vaccination (urban) consent forms. Local health department nurses administered SLIV vaccinations and billed insurers. We analyzed state immunization registry data to measure influenza vaccination rates.Results42 schools (38,078 children) participated over 2 years. Overall vaccination rates were 5 and 7 percentage points higher among SLIV- school children versus control-school children in suburban (aOR 1.36, 95% CI 1.25–1.49 in Years 1–2 SLIV vs. Year 1 control schools) and urban schools (aOR 1.22, 95% CI 1.10–1.36), respectively, adjusting for prior year’s vaccination and other covariates. While no substitution occurred among children attending suburban schools, some substitution occurred among children attending urban schools, although overall vaccination rates were still higher in urban schools due to SLIV. Compared to an initial year of SLIV, more children were vaccinated in a second year of SLIV at urban (8.3% vs. 6.8%, aOR 1.24, 95% CI 1.04–1.47) but not suburban schools (3.5% vs. 2.7%, aOR 1.24, 95% CI 0.98–1.57).ConclusionsIn this stepped wedge trial, SLIV increased overall influenza vaccination rates in suburban and urban schools. Some substitution for primary care vaccination occurred in urban settings. A second year of SLIV expanded its reach slightly in urban schools.     

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia,Spain

BackgroundElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine.MethodsCross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations.ResultsA total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI 1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity.ConclusionsThe higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases.     

Direct and indirect effect of 10 valent pneumococcal vaccine on nasopharyngeal carriage in children under 2 years of age in Matiari,Pakistan

BackgroundPakistan introduced Ten-valent pneumococcal-conjugate-vaccine PCV10 in 2012 as a 3 + 0 schedule without catch-up.MethodsChildren <2 years old in Matiari, Sindh provided nasopharyngeal swabs between 2014 and 2018, which were cultured for pneumococcus and serotyped through multiplex PCR at the Aga Khan University Hospital. Carriage rates over time for Vaccine-Type (VT) and Non-VT (NVT) serotypes were used to estimate direct, indirect, total and overall effects of vaccination. Regression analysis was used to determine factors associated with VT carriage.ResultsPneumococcus was detected in 2370/3140 (75%). VT carriage decreased overall, 16.1–9.6% (p-trend <0.001); vaccinated (all 3 doses of PCV10 received) 11.3–8.1% (p-trend 0.031) and unvaccinated (no PCV10 dose received) 17.4–10.3% (p-trend 0.003) with a decline in serotypes 6B, 9V/9A and 19F. Immunization increased from 41.0% to 68.4% (p-trend 0.001). Direct effect of vaccine was 32.8% (95% CI 14.7–47.0%) and indirect effect 44.6%(95% CI 40.6–48.6%). Factors associated with decreased VT colonization were education 1–5 years (aOR 0.7, 95%CI 0.6–1.0), history of difficulty breathing (aOR 0.7, 95%CI 0.5–1.0), exposure to smoke (aOR 0.8, 95% CI 0.6–1.0), child fully immunized (aOR 0.7, 95%CI 0.5–1.0) and enrolled in 3rd (aOR 0.6, 95%CI 0.4–0.8) and 4th (aOR 0.6, 95%CI 0.5–0.9) year of the study whereas history of runny nose (aOR 1.5, 95% CI 1.2–1.9) was positively associated.ConclusionsDecrease in VT pneumococcal carriage in vaccinated and unvaccinated children indicates herd immunity. Sustained increase in vaccine coverage and close long-term surveillance is warranted.     

Immunization disparities in older Americans: determinants and future research needs

BACKGROUND: Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. This study sought to assess the contribution that patient, physician, health system, and area-level characteristics make to these racial disparities in immunization. METHODS: Cross-sectional and decomposition analyses were performed on a nationally representative sample of 18,013 non-institutionalized Medicare beneficiaries who responded to the Medicare Current Beneficiary Survey (MCBS) in 2000 to 2002. The physician characteristics of interest included specialty type, accessibility, information-giving skills, perceived quality, and continuity of care. Health system characteristics included HMO enrollment and numbers of primary care physicians per elderly. The outcomes were receipt of influenza vaccine in the past year and ever having received a pneumococcal vaccine. RESULTS: Immunization rates were below recommended levels for all Medicare beneficiaries. Disparities between white and black beneficiaries in the receipt of vaccinations were large-an absolute 17% difference for each vaccine. After adjusting for patient, physician, health system, and area-level characteristics, white beneficiaries had significantly higher odds of vaccination than did black beneficiaries: adjusted odds ratio (aOR) = 1.52 (95% confidence interval [CI] = 1.35-1.71) for influenza vaccination, and aOR = 1.82 (95% CI = 1.61-2.07) for pneumococcal vaccination. Beneficiaries with a usual physician that they rated as having good information-giving skills and whose practice was more accessible, had higher immunization rates. Beneficiaries with a primary care generalist as their usual physician had higher odds of immunization than those with a specialist as their usual physician. At the county level, a higher number of primary care physicians per elderly resident was associated with higher odds of immunization. Only 7% of the racial disparity in influenza immunization was explained by the measured characteristics of beneficiaries and their health systems. CONCLUSIONS: Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive influenza and pneumococcal vaccinations. The implications for future research are discussed, including the need for system-based interventions that make the offering and discussion of vaccination routine.