Master's degree research report submitted to the Faculty of Humanities, in partial fulfilment of the requirements for the MA degree in Demography and Population Studies, 2016. / BACKGROUND: Childhood vaccination has proved to be one of the most successful and cost-effective health interventions in the world. However, one in eleven children in Ethiopia die before their fifth birthday, mostly as a result of vaccine preventable diseases and childhood immunisation coverage remains very low by any standard in the country. Little is known about the linkage between family structure and child health-seeking behaviour in Ethiopia where polygyny is common. This study examines the association between the type family structure with a particular interest in polygynous family structure and childhood immunisation among children aged 12 to 60 months in Ethiopia. METHODOLOGY: Data from the 2011 Ethiopia Demographic and Health Survey, containing a sample of 3 188 children aged 12-60 months were analysed and the vaccination history of children in relation to selected mother and child characteristics were examined. Bivariate tests as well as binary logistic regression models were used to examine the levels of childhood immunisation and the association between family structure and immunisation in Ethiopia. RESULTS: The data analysis revealed that 27% of Ethiopian children were immunised, 17.4% of children from polygynous households, and 27% of children in single-parent and monogamous households were immunised. Overall family structure was not found to be significantly associated with childhood immunisation. Geographical region, poverty status, mother’s age, parity, antenatal care and mother’s place of delivery were found to be significant determinants of child immunisation in Ethiopia. CONCLUSION: Complete immunisation coverage among children aged 12-60 months remains very low by any standard in Ethiopia. Findings show that although a polygynous family structure is not a significant determinant of childhood immunisation it has a positive effect on it. Improved awareness of child immunisation services among mothers would greatly increase immunisation coverage. / GR 2017

Vaccination aims to prevent infectious disease, and is internationally acclaimed as a major contributor to public health. Although vaccines have many benefits, there are people who claim that they or their infant children have been injured, often permanently and severely, by the powerful biological agents introduced into their bodies by vaccination. The object of this thesis is to determine whether the law in England and Wales relating to vaccine damage is in need of reform. The answer to this question is determined by a moral and legal analysis of current vaccination policy and practice. The existing literature consists primarily of medical papers discussing the possibility of vaccine damage and legal discourses concerning compensation and consent to treatment. Detailed background information comes from in-depth semi-structured interviews with a consultant epidemiologist at the Public Health Laboratory Service and three organisers of Justice Awareness Basic Support (JABS), a vaccine information and support group. The main originality of the thesis is the information provided by approximately 360 responses to each of two surveys. Parents of pre-school children were surveyed about their experiences of, and views on, current vaccination policy and practice. Members of JABS who believe their children to be vaccine-damaged provided information about the vaccines which appear to have caused harm, as well as their experiences of, and views on, the legal routes to financial redress. The findings provide evidence of a dearth of reliable medical data about vaccine safety, and of some ethically unacceptable practices associated with infant vaccination. They also reveal that, theoretically and in the view of users, legal provision for the victims of vaccine damage in England and Wales is unsatisfactory. These factors combine to indicate that the law relating to compensation for vaccine damage is in need of reform. The thesis therefore concludes with suggestions for further research and some modifications to current law and policy. There should be a statutory scheme awarding compensatory, rather than token, payments to victims. Awards should be made subject to a generous test of causation, such as that which exists in respect of the US Vaccine Injury Compensation Program. Incentive payments to GPs should be discontinued, parents should be offered choices of vaccine, and vaccine promotional literature for healthcare workers and parents should present a balanced view of all available research. Above all, it is essential that these measures be supported by large-scale, independent medical research into the nature of possible links between vaccines and damage.

Thesis (MPH)--University of Limpopo, 2009. / BACKGROUND AND AIM: Hepatitis B virus (HBV) is the major cause of hepatitis in South Africa (SA), with an estimated 4 million carriers. It is transmitted by infected blood and other body fluids, placing health care workers (HCWs) at high risk of infection. The SA Department of Health strongly recommends that all HCWs be vaccinated against HBV, but studies have shown that uptake of the vaccine is sub-optimal. This study aimed to estimate HB vaccination coverage levels among nurses, and describe the demographics and characteristics of the HB vaccination policies associated with different levels of coverage, at private and public hospitals in Tshwane. METHODS: This was a questionnaire-based cross-sectional study on 300 randomly selected nurses and 12 chief infection control officers (CICOs) from 13 hospitals (6 public and 7 private) in Tshwane performing high risk procedures. CICOs were asked questions about HB vaccination policies and coverage, while nurses were asked about demographics, HB vaccination status, and the HB vaccination policies of their institutions. RESULTS: The response rate was 84.3% (253/300) for nurses, and 75% (9/12) for CICOs. Of the nurses, 68.0% (172/253) were vaccinated, and logistic regression analysis found that those statistically significantly most likely to be vaccinated were: 30 years and younger (odds ratio [OR]=2.9; 95% CI: 1.11–7.59); employed in private hospitals (OR=3.0; 95% CI: 1.24–7.32); and graduated after 1990 (OR=2.6; 95% CI: 1.10–6.19). Also, logistic regression analysis found two statistically significant policy-related predictor for vaccination uptake, which was the presence of HB vaccination program (OR=4.6; 95% CI: 2.11-10.06); and compulsory HB vaccination (OR=2.8; 95% CI: 1.37-5.70. CONCLUSION: There is a need for a national policy on HB vaccination of HCWs which should include compulsory vaccination, to increase the vaccination coverage level amongst nurses.

Vaccination is one of the most efficacious public health interventions1 and has been increasingly used to combat non-infectious diseases. Mechanisms underlying vaccine responses overlap with those regulating immune responses in health and disease. Therefore, an understanding of mechanisms underpinning these responses will have broad implications. Variation in immune response genes contributes to impaired vaccine responses2-4. Understanding the contribution of genetic variants to vaccine responses is likely to be particularly important in early life given the generalized functional immaturity of the immune system in infants and the highly variable kinetics of its maturation over the first few years of life5-7. However, studies of genetic influences on early childhood vaccine responses are scarce. Since a number of genes from several pathways are likely to be important, a targeted approach is necessary. This thesis explored the effects and interactions of genes associated with atopy, as atopy, or the genetic risk for it, has been associated with modulation of early childhood vaccine responses. This thesis aimed to: 1) investigate genetic variants associated with atopy on early childhood vaccine responses; 2) examine interactions between these genetic variants and non-genetic factors; 3) approach developmental genetic influences on genetic effects and their interactions; and 4) extend findings on vaccine responses to other immunological phenotypes and disease outcomes.

Graduation date: 1995

Syftet var att belysa kvinnliga sjuksköterskestuderandes kännedom om och inställning till HPV vaccination, samt att ta reda på hur de resonerade kring sitt eget val rörande HPV-vaccination. Metod: Kvalitativ studie med semistrukturerade intervjuer där åtta sjuksköterskestudenter deltog. Resultat: Studenterna hade en god kännedom gällande HPV-vaccination. Samtliga studenter var positivt inställda till HPV-vaccin. Däremot framkom en viss misstänksamhet mot HPV-vaccin då de uppfattade det som nytt och obeprövat. Studenterna ansåg att det är orättvist att inte pojkar erbjuds HPV-vaccin inom barnvaccinationsprogrammet. En del av studenterna menade även att det kan finnas risk för att HPV-vaccinerade känner en falsk säkerhet, vilket kan leda till att de inte använder kondom och går på cellprovskontroller i lika stor utsträckning som ovaccinerade. De studenter som inte hade vaccinerat sig mot HPV uppgav orsaker som otydlig information gällande kriterier för vaccination, att de hade en stadig partner, att de redan hade haft sex, var för gamla samt att vaccinet är för dyrt. De studenter som valt att vaccinera sig nämnde som främsta skäl, att de själva inte stått för kostnaden. Slutsats: Sjuksköterskestudenterna tycktes ha en god kännedom och huvudsakligen positiv inställning gällande HPV och HPV-vaccination. De visade även ett visst kritiskt tänkande gentemot vaccinet, då de menade att det kan vara svårt att veta långtidseffekterna, då det fortfarande är relativt nytt. Den ekonomiska aspekten, samt vilken information de fått, visade sig spela roll i studenternas beslut om vaccinering. Tydligare information från hälso- och sjukvård skulle kunna leda till att fler väljer att vaccinera sig.

The principal objective of this investigation was to evaluate coccidiosis vaccination, with or without probiotic administration, for effects on broiler performance and clinical indices of infection due to field strain Eimeria challenge during pen trials of commercially applicable durations. During trials 1 and 2, body weights of vaccinated broilers were reduced (P<0.05) compared to other experimental groups during rearing through the grower phase. Final body weights, however, were not different among experimental groups at the termination of each trial. Similarly, feed conversion in trials 1 and 2 was increased (P<0.05) in vaccinated broilers during rearing through the grower phase when compared to non-vaccinated broilers. Significant improvements (P<0.05) in feed conversion were measured in trials 1 and 2 in vaccinated broilers during the withdrawal phase of grow-out. Probiotic administration significantly reduced (P<0.05) feed conversion during the withdrawal phase of trial 2. During trial 3, body weights of broilers in the vaccine with probiotic (water) group were higher (P<0.05) at termination (d 44) than all other experimental groups and equivalent to the ionophore alone and ionophore with probiotic groups. Similarly, cumulative mortality corrected feed conversion ratio (FCR) was lower (P<0.05) in broilers from the vaccine with probiotic (water) group compared to negative controls, and not different from FCR in ionophore administered broilers. Trial 2 observations revealed body weight gains among vaccinated broilers that were significantly increased (P<0.05) during a seven day clinical field strain Eimeria challenge period compared to non-vaccinated broilers. Both probiotic and vaccine significantly decreased (P<0.05) gross lesion scores in upper and mid-intestinal regions. A significant reduction (P<0.05) in gross lower intestinal lesion score was also observed in the vaccine alone group. In Trial 3 general observations showed, broilers in the ionophore alone group were associated with higher (P<0.05) microscopic mid and lower intestine lesion scores when compared to broilers receiving vaccine or vaccine + probiotic. These data suggest that co-administration of probiotic during coccidiosis vaccination results in performance parameters that are improved when compared to vaccination alone and indistinguishable from protection conferred by feeding an ionophore in the presence of field strain Eimeria.

This research program included a series of experiments to investigate the effect of starter diet protein level on the performance of broilers vaccinated with Coccivac®-B and subsequently challenged with a mixed species Eimeria challenge compared to nonvaccinated broilers. Pre-challenge performance data indicates that vaccination may decrease body weights and increase feed conversion ratio (FCR) with vaccination. The time period associated with the observed effects is between 13 to 17 d of age. This reduction in performance of vaccinated broilers versus non-vaccinated broilers was eliminated by the conclusion of the experiments (27 d) in the higher protein diets. Vaccination was effective at generating protective immunity against the Eimeria challenge evidenced by significantly increased body weight gains, improved feed conversions, reduced post-challenge mortality, and reduced lesion development in vaccinated broilers compared to non-vaccinated. The final experiment included the comparison of Coccivac®-B to Bio-Cox® (salinomycin) for controlling field strain Eimeria in broilers reared on two different dietary rations varying in protein concentration. Diet A had a lower protein concentration than Diet B. On day 14, Eimeria collected from commercial broiler farms in Texas were spray applied to the litter in all pens. Broilers reared on Diet B were heavier at Day 40 while body weights at day 50 were similar for all groups. Broilers fed Diet B had lower FCR during the starter and finisher diets. Broilers fed salinomycin had lower FCR for the starter and grower diets while vaccinated broilers had lower FCR during the withdrawal period. Cumulative FCR for the entire grow out period were similar for all groups. These data indicate that vaccination can be utilized as an anticoccidial preventive and are suggestive that reduced protein concentration of starter diets can lead to significant losses in broiler performance when utilizing a vaccination program to prevent coccidiosis. Feeding an appropriately formulated diet while vaccinating broilers with Coccivac®-B as an alternative to the use of salinomycin yields at least equivalent if not elevated performance in the presence of field-strain Eimeria during grow-out with no effect on the cost of production.

Research Objectives : Studies indicated that influenza vaccination is a cost-effective clinical prevention for elderly persons. Higher influenza vaccination rate will reduce disease threat and related health care utilizations in a health care system. From 2001, Taiwan provided free influenza vaccine for all of its elderly persons. Nevertheless, the influenza vaccination rate was lower than the expected goal and less than 50%. Therefore, this study aims to evaluate the key factors which affect elderly persons receiving influenza vaccination in Taiwan. Study Design : This is a retrospective study using national representative data from year 2000 to 2004. The vaccination information was linked with outpatient and inpatient records in individual level. The data was also linked with medical institution¡¦s characteristics. We modified Health Belief Model and threat-responsiveness theory to hypothesize previous experiences on vaccination and medical utilization were important factors affecting individual¡¦ s probability of receiving influenza vaccination. Population-based descriptive analysis was conducted to assess the demography characteristics, health status, and health care utilizations. We tested the significance by t-test and Chi-Square test. Moreover, we applied multivariate logistic regression to analyze the associations between controlled factors and the probability of receiving influenza vaccination. Population Studied : People aged 65 years and older were drawn from Taiwan¡¦s national health insurance database from 2000 to 2004. The total sample size is 23,023 elderly persons. Principle Finding: The study results indicated that the most important factor affect elderly persons continue to receive influenza vaccination is whether the person had received influenza vaccination during last flu season or not. Elderly persons who had received influenza vaccination in last flu season were significantly seven times more likely to receive influenza vaccination in this year (OR: 7.66 [95%CI:7.34-8.00]). Other key affecting factors include age, health status, flu-related inpatient and outpatient utilizations in last year, locations of receiving influenza vaccination, and the health care organizations¡¦ levels. Conclusion : This research combines Health Belief Model and threat-responsiveness theory as framework to analyze the national dataset of four year¡¦s elderly influenza vaccination rate change in Taiwan. We found that lagged effects such as vaccination status and flu-related health care use in previous flu season significantly affect the volition of influenza vaccination. Therefore, further research on how to adopt this critical finding and promote higher vaccination rate are in great needs. Implications for Policy, Delivery or Practice: Free coverage and easy access does not guarantee high influenza vaccination rate in Taiwan, even it is under universal health insurance program. This study provides empirical investigations on key factors that might affect the elderly persons¡¦ intention to receive influenza vaccination. Elderly persons¡¦ responses to regular clinical prevention and disease threat were positively associated with probability of having influenza vaccination. By focusing on the major factors and conducting related promotion programs, effective prevention policy can be reinforced. Moreover, this study result could serve as valuable reference for other countries which also has or plans to have free influenza vaccination policy, particularly for those countries also with national health insurance program.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2008. / Bibliogr.