Introducción: Las vacunas son una de las medidas de salud pública más costo-efectivas. A pesar de que el esquema de vacunación de Perú es completo y accesible, su cobertura permanece baja. Objetivo: Evaluar los determinantes, tendencias y distribución espacial de la cobertura completa de vacunación en niños de 13 a 59 meses en el periodo 2010-2019 en Perú. Métodos: Se realizó un análisis secundario de la Encuesta Nacional de Demografía y Salud Familiar (DHS) del 2010 y 2019. Se definió cobertura completa de vacunación como haber recibido las vacunas: Bacilo de Calmette–Guérin (BCG); tres dosis de DPT (difteria, tetanos, pertussis) y de polio; y una dosis de sarampión. Se empleó el análisis de descomposición multivariada para identificar factores que contribuyeron al cambio en la cobertura completa de vacunación. La distribución espacial de la cobertura completa de vacunación en 2019 se evaluó mediante la prueba I de Morán Global, interpolación Kriging y escaneo espacial puramente estadístico basado en el modelo de Bernoulli. Resultados: La cobertura incrementó de 54.62% en 2010 a 76.39% en 2019. La mayor parte (69.47%) se atribuyó a las diferencias en los efectos de las características. El tamaño familiar, visita del personal de salud, lugar de nacimiento y los controles prenatales contribuyeron a este cambio. Se observó un patrón espacial por clusters. Conclusiones: A pesar del incremento de la cobertura de vacunación en Perú, permanece baja y existe alta heterogeneidad, con presencia de clusters de alto riesgo. Se deben redirigir las intervenciones para reducir estas disparidades geográficas. / Introduction: Vaccines are one of the most cost-effective public health measures worldwide. Although the Peruvian vaccination schedule is complete and accessible, vaccination coverage remains low. Objective: To evaluate the trend, determinants and spatial distribution of full vaccination coverage in infants aged 13 to 59 months in the period 2010-2019 in Peru. Methods: A secondary analysis of the 2010 and 2019 National Demographic and Family Health Surveys (DHS) was conducted. Full vaccination coverage was defined as having completely received the following vaccines: Bacillus Calmette–Guérin (BCG); three doses of DPT (diphtheria, tetanus, pertussis) and polio vaccine; and a dose of measles vaccine. Multivariate decomposition analysis was used to identify factors that contributed to the change in complete vaccination coverage. The spatial distribution of complete vaccination coverage in 2019 was evaluated using the Global Moran I test, Kriging interpolation and Bernoulli-based purely spatial scan statistic. Results: Coverage increased from 54.62% in 2010 to 76.39% in 2019. Most of the increase (69.47%) was attributed to differences in the effects of characteristics. Family size, visit by health workers, place of delivery and antenatal care follow-up were all significantly associated with this change. A clustered pattern was observed. Conclusions: Despite the increase in vaccination coverage in Peru, it remains low and there was high spatial heterogeneity, with the presence of high-risk clusters. Interventions must be redirected to reduce these geographic disparities. / Tesis

Measles is resurging around the world, and large outbreaks have been observed in several parts of the world. In 2019 the Philippines suffered a major measles outbreak partly due to low immunization rates in certain parts of the population. There is currently limited research on how to identify and reach pockets of unvaccinated individuals effectively. This thesis aims to find important factors associated with non-vaccination against measles using a machine learning approach, using data from the 2017 Philippine National Demographic and Health Survey. In the analyzed sample (n = 4006), 74.84% of children aged 9 months to 3 years had received their first dose of measles vaccine, and 25.16% had not. Logistic regression with all 536 candidate features was fit with the regularized regression method Elastic Net, capable of automatically selecting relevant features. The final model consists of 32 predictors, and these are related to access and contact with healthcare, the region of residence, wealth, education, religion, ethnicity, sanitary conditions, the ideal number of children, husbands’ occupation, age and weight of the child, and features relating to pre and postnatal care. Total accuracy of the final model is 79.02% [95% confidence interval: (76.37%, 81.5%)], sensitivity: 97.73%, specificity: 23.41% and area under receiver operating characteristic curve: 0.81. The results indicate that socioeconomic differences determine to a degree measles vaccination. However, the difficulty in classifying non-vaccinated children, the low specificity, using only health and demographic characteristics suggests other factors than what is available in the analyzed data, possibly vaccine hesitation, could have a large effect on measles non-vaccination. Based on the results, efforts should be made to ensure access to facility-based delivery for all mothers regardless of socioeconomic status, to improve measles vaccination rates in the Philippines.

Seasonal influenza outbreaks are associated with morbidity and mortality in the United States. Though children are the most susceptible to influenza infection and are most likely to transmit the illness to others, many children are not vaccinated. The purpose of this study was to examine the relationship between seasonal influenza vaccination Advisory Committee on Immunization Practices (ACIP) recommendations, demographic characteristics, socioeconomic factors, and vaccine type among children over 3 consecutive flu seasons. This quantitative cross-sectional study was guided by the social ecology of health model. Secondary data from 3 consecutive flu seasons (2014-2015, 2015-2016, and 2016-2017) provided by the National Health Interview Survey was used for this study. Binary logistic regression and chi-square were used to analyze the data. A relationship between socioeconomic status, demographics (age, race, and family income) and vaccine type (live-attenuated influenza vaccine [LAIV]/inactivated influenza vaccine) was established among U.S. children; those who received LAIV were most likely to be White elementary school age children with a higher family income. Demographic and socioeconomic status was not considered influential in LAIV uptake for race, health insurance status, or family income. ACIP recommendations by age and year had the greatest impact on flu vaccine choice for this sample population. The results of this study can lead to social change by providing information for policy that can increase vaccine uptake, which can result in lower health cost and reduced illness and death rates associated with the flu, especially for those most at risk.

No description available.

Introduktion: Vaccin har blivit en global framgång för folkhälsan. Vaccinationer har bidragit till att flera barnsjukdomar blivit så sällsynta att de inte längre utgör hot mot samhället. Trots detta finns fortfarande en tveksamhet hos föräldrar kring barnvaccinationer. Vaccintveksamhet finns med som en punkt i WHO:s lista över tio hot mot den globala folkhälsan. Distriktssköterskor inom barnhälsovården och elevhälsovården har en viktig roll i vaccinationsarbetet. Syfte: Syftet var att belysa orsaker till föräldrars tveksamhet eller val att avstå barnvaccination. Metod: Systematisk litteraturstudie utifrån Polit & Becks niostegsmodell. Databaserna som användes var Cinahl och Pubmed. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes för att analysera de 16 artiklarna som användes i studien. Resultat: Består av fyra huvudkategorier; Rädsla att barnet tar skada av vaccinet, Uppfattningar om immunisering, Misstro till auktoriteter och Alternativa livstilsåskådningar. Konklusion: Det är av stor vikt att distriktssköterskan känner till varför föräldrar är osäkra eller väljer helt att avstå att vaccinera sina barn. Det finns en utmaning i att bemöta dessa föräldrar samtidigt som det kräver en bred kompetens grundat i evidens kring vaccination och folkhälsa. Målet är att bemöta barn och föräldrar på ett respektfullt och stödjande sätt när det gäller osäkerhet kring vaccinering.

While adenovirus (Ad) vectors have been shown to elicit potent antigen-specific T cell responses, the kinetics and nature of antigen-specific mucosa! and systemic T-cell responses has rarely been examined, especially following mucosal administration of Ad-based vectors. In the present studies, the phenotypic and functional characterization of antigen-specific CD8+ T cell responses following intrarectal (i.r.) vaccination with an Ad vector expressing Gallus gallus ovalbumin (OVA) was conducted. The frequencies of OVA-specific CD8+ T cells was maximal at 2 weeks post-vaccination in all tissues examined and then declined, demonstrating normal expansion and contraction kinetics. CD8+ T cells induced in the course of immunization exhibited phenotypic characteristics of effector memory T cells including up-regulation of the cell surface molecules CD43, CD44 and a low level of expression of CD127 at both local and systemic sites. While the discordance between the number of tetramer-reactive and cytokine-producing OVA-specific CD8+ T cells was observed, CD8+ T cells appeared to be fully functional in vivo. Upon secondary antigen exposure, the CD8+ T cell population expanded dramatically, particularly at the mucosa! surfaces. In addition, the CD8+ T cell response generated in the course of i.r. priming protected mice from intravaginal (i. vag.) vaccinia virus one month after immunization, thus underscoring the importance of inducing a tissue-resident effector memory T cell subset for protection against pathogens at mucosal surfaces. In developing future vaccines for mucosal diseases, the induction of a tissue-resident effector memory T cell subset should be one of the immunization objectives. Lentiviral vectors represent an attractive mode of genetic vaccination. Most commonly used, vesicular stomatitis virus glycoprotein (VSVG)-pseudotyped lentiviral vectors do not efficiently infect epithelial cells from the apical side, and, therefore, are not suitable as mucosa! vaccines. In the present studies, Ebola Zaïre strain glycoprotein (EboZ)-pseudotyped lentiviral vectors, which have been previously used to deliver transgene to the lung epithelium, were delivered i.r. and evaluated as a mucosal booster vaccine. Rectal delivery of EboZ-pseudotyped lentiviral vectors expressing β-galactosidase (β-gal) had resulted in low, but detectable levels of β-gal expression 2 weeks after administration. When delivered on its own, EboZ-pseudotyped lentivirus did not prime detectable antigen-specific immune response. However, when delivered i.r. 30 days after i.r. Adβ-gal immunization, a significant enlargement (boost) of β-gal-specific CD8+ T cell responses, especially in the colonic lamina propria (LP), was observed as compared to the delivery of EboZ-pseudotyped vector encoding different transgenes or VSVG-pseudotyped lentivirus expressing β-gal. When these animals were i. vag. challenged with vaccinia virus expressing β-gal, a dramatic expansion of β-gal-specific CD8+ T cells, especially in the vaginal tract, was observed. In addition, this prime and boost strategy protected the mice from i. vag. vaccinia virus challenge. Therefore, i.r. Ad-based priming followed by i.r. EboZ-pseudotyped lentiviral boosting was an effective strategy for eliciting protective mucosal CD8+ T cell responses. / Thesis / Doctor of Philosophy (PhD)

This review explores and positions the value of serology testing to support current immunization policies and the broader policy response to the coronavirus disease 2019 (COVID-19) crisis in Europe. We applied an exploratory approach to analysing existing evidence, international recommendations, and national policies using desk research from secondary sources, document analysis, and expert information. Regional and country-level resources from five focus countries were included: France, Germany, Italy, Spain, and the United Kingdom. Seven experts in the fields of COVID-19 immunization, serology testing, seroepidemiology, and vaccine safety and effectiveness studies contributed to the review and convened in two online panel sessions. The paper includes an overview of (1) the impact of the pandemic to date, (2) testing strategies, (3) COVID-19 vaccination policies, (4) lessons on using serology testing to support immunization, (5) current policies and recommendations on the use of a serology testing strategy, and (6) implementation barriers and challenges. Finally, this paper also provides a set of knowledge-based recommendations to advance the effective and timely inclusion of serology testing and resolve impeding knowledge gaps. The recommendations herein are intended to support timely decision-making, raise awareness, guide advocacy initiatives, and inspire future studies.

Objetivo: Identificar los factores influyentes en la postura ante la inmunización SARSCoV-2 en estudiantes de medicina de una universidad de Lambayeque en el año 2021. Materiales y métodos: Se realizó un estudio tipo observacional transversal analítico. Se tomó a toda la población elegible,que constó de aproximadamente 160 estudiantes y se distribuyó con un muestreo probabilístico tipo estratificado. El cuestionario elaborado se basó en la encuesta online de la Organización de Consumidores y Usuarios (OCU) titulada “Encuesta OCU: los españoles y la vacuna” que fue realizada en España. Para el análisis estadístico se empleó la herramienta estadística IBM SPSS Statistics 25.0.0.0. Se tabularon las variables categóricas para la distribución de frecuencia y porcentajes, y se realizó un análisis bivariado entre las variables de interés y las variables de desenlace, mediante la prueba exacta de Fisher. Resultados: Se encuestó a 155 de 160 universitarios, el 94,8% fueron jóvenes (18-25 años). El semestre académico que representó mayor porcentaje fue octavo ciclo. La mayoría de los ítems del cuestionario obtuvieron el puntaje de 3 puntos según la escala de Likert. El 96,8% de universitarios manifestaron que sí se vacunarían tan pronto como pudieran. Se obtuvo que el factor influyente en la postura ante la inmunización SARS-CoV-2 fue el de la efectividad de la vacuna reduciendo la mortalidad por COVID – 19. Conclusiones: Se concluye que la mayoría de los estudiantes se encontraron a favor de la vacunación. Además, la efectividad de la vacuna reduciendo la mortalidad por COVID-19, fue el único factor influyente. / Objective: To identify the influential factors in the posture before SARS-CoV-2 immunization in medical students of a Lambayeque university in the year 2021. Materials and methods: An analytical cross-sectional observational study was carried out. The entire eligible population was taken, which consisted of approximately 160 college students and was distributed with a stratified probabilistic sampling. The questionnaire prepared was based on the online survey of the Organization of Consumers and Users (OCU) entitled "OCU Survey: Spaniards and the vaccine" that was carried out in Spain. For the statistical analysis, the statistical tool IBM SPSS Statistics 25.0.0.0 was used. Categorical variables were tabulated for frequency distribution and percentages, and a bivariate analysis was performed between the variables of interest and the outcome variables, using Fisher's exact test. Results: 155 of 160 university students were surveyed, 94.8% were young (18-25 years). The semester of studies that represented the highest percentage was eighth cycle. Most of the ítems in the questionnaire obtained a score of 3 points according to the Likert scale. 96.8% of university students stated that they would get vaccinated as soon as they could. It was found that the influential factor in the posture before SARS-CoV-2 immunization was the effectiveness of the vaccine in reducing mortality from COVID-19. Conclusions: It is concluded that the majority of students were in favor of vaccination. Also, the effectiveness of the vaccine in reducing mortality from COVID-19 was the only influential factor.

No description available.

La vaccination figure parmi les interventions sanitaires les plus efficaces et les plus rentables connues. Pourtant, des inégalités de couverture persistent entre les régions et les pays. Les interventions visant à améliorer la couverture vaccinale sont généralement regroupées soit comme interventions pour améliorer l’offre ou la prestation des services de santé, soit comme interventions pour stimuler la demande pour les services de vaccination. L’objectif de cette étude est d’évaluer si les interventions du côté de la demande qui visent à améliorer la couverture vaccinale peuvent accroître la vaccination de routine des enfants dans les pays en développement. Nous avons effectué une revue systématique et une méta-analyse des essais randomisés contrôlés ainsi que d’autres types d’études scientifiques réalisées dans des pays en développement. La population ciblée comprenait les parents et les gardiens d'enfants de moins de deux ans qui sont exposés à une intervention visant à accroître la demande de vaccination de routine des enfants. La recherche des études originales dans les différentes bases de données a été limitée aux études publiées avant septembre 2013 (dernière mise à jour le 25 Mars 2014) dans 6 langues. Onze études ont été sélectionnées puis classifiées dans deux catégories: (a) éducation ou transfert de connaissances (7 études) et (b) incitations (4 études). Les résultats de la métaanalyse ont démontré un impact positif des interventions sur la demande de vaccination des enfants dans les pays en développement (RR 1.30; 95% CI 1.17, 1.44). Ces impacts positifs ont été constatés autant pour les interventions qui comprennent l’éducation ou transfert de connaissances (RR 1.40; 95% CI1.20, 1.63) que pour les interventions de type incitation (RR 1.28; 95% CI 1.12, 1.45). Les résultats suggèrent que diverses stratégies visant à accroître la demande peuvent conduire à une augmentation de la couverture vaccinale dans différents pays en développement. / Vaccination is one of the most cost effective health interventions known. However, inequalities of the vaccination coverage persist between regions and countries. The interventions to improve the vaccination coverage are usually grouped either as interventions to improve the supply or the delivery of health services, or as interventions to stimulate the demand for immunization services. The objective of this study is to evaluate whether demand-side interventions can increase routine immunization of children in developing countries. We conducted a systematic review and a meta-analysis of randomized controlled trials and other types of scientific studies conducted in developing countries. The targeted population consisted of parents and guardians of children under two years of age which are exposed to an intervention designed to increase demand for routine immunization of children. Research studies in different databases were restricted to primary studies published before September 2013 (last update on March 25th, 2014) in 6 languages. Eleven studies were selected and classified into two categories: (1) education and knowledge transfer (7 studies) and (2) incentives (4 studies). The results of the meta-analysis demonstrated a positive impact of demand-side intervention for vaccination of children in developing countries (RR 1.30, 95% CI 1.17, 1.44). These positive impacts were found as well in the interventions that include education and knowledge transfer (RR 1.40, 95% CI1.20, 1.63) that in the interventions using incentives (RR 1.28, 95% CI 1.12, 1.45). The results suggest that strategies to increase demand are effective in improving uptake of childhood vaccines in developing countries.