Syftet med denna studie är att undersöka motiven bakom, processen fram till, samt konsekvenserna av olika individers beslut att ta eller avstå covid-19-vaccin i en svensk kontext. Studien baserades på grundad teori och datainsamling har skett genom ostrukturerade, öppna intervjuer av 14 deltagare, vilka rekryterades och valdes ut från forskarnas sociala nätverk och genom snöbollsurval. Deltagarnas ålder varierade från 25 till 74 år, majoriteten var i 20- och 30-årsåldern. Av deltagarna var 4 kvinnor och 10 män, 10 deltagare var vaccinerade mot covid-19 och 4 var ovaccinerade. Deltagarna var sysselsatta som studenter, pensionär, serviceanställda och vård- och omsorgsanställda. Resultat: Kärnkategorin – som hade en central roll i deltagarnas beslutsprocess var: Upplevt hot mot den egna personen. Underkategorierna som identifierades var: Vaccin mot covid-19 som upplevt hot, Covid-19 som upplevt hot, Upplevt integritetshot och Samhällsdiskussion, samt förklarar hur underkategorierna samspelar och påverkar varandra under beslutsprocessen. Diskussion: Resultatet bekräftar delvis tidigare forskning kring bidragande faktorer till vaccinationsvilja och -intention. Resultatet motsäger andra tidigare forskningsresultat; att tidigare vaccinationserfarenheter påverkar vaccinationsviljan. Studien bekräftar också variationen kring om kunskap om vaccinet bidrar till vaccinationsviljan. Studien bidrar meden unik inblick i individers subjektiva uppfattningar om sina egna beslutsprocesser.

Many interesting behaviours in the animal and human world involve cooperation among individuals. Yet, cooperating individuals are often susceptible to exploitation by cheaters. Because cheaters do better than the cooperators they exploit, the evolution and persistence of cooperation has been a challenging topic of study in biology, sociology and economics. Studies often abstract from real cooperative interactions, and construct simple games in which players can choose either cooperation with other players, or defection, e.g., the well known prisoner’s dilemma and the snowdrift game. In these games and other social dilemmas, mutual cooperation yields greater payoffs than mutual defection, but individuals are still tempted to defect (because of the possibility that if they cooperate, the other player will defect). Similar dilemmas also arise in situations where multiple individuals may be affected by the actions of one (such as volunteering for community service or evading taxes), and the main theme of this thesis is cooperation in groups. In chapter 2, we analyze pre-emptive vaccination for an outbreak of smallpox (following a bioterrorist attack or accidental release), from the public health (i.e., group) and individual perspectives. Chapters 3 and 4 deal with an extension of the snowdrift game to n interacting players and continuous strategy sets (where individuals decide on their degree of cooperation): in chapter 3, we analyze global evolutionary stability of cooperative strategies in a large class of n-player snowdrift games in infinite populations; chapter 4 analyzes general continuous n-person snowdrift games in finite populations, and compares the evolutionary dynamics with their infinite population analogues. In chapter 5, we present a general framework to model selection processes in finite populations, necessary for the analysis in chapter 4. / Thesis / Doctor of Philosophy (PhD)

STUDY AIMS: This qualitative study aims to evaluate the hypothesis that vaccination attitudes, knowledge, and factors of influence differ between pregnant teen and young adults and pregnant adults. The study explores these themes in efforts to offer insight on ways in which vaccine uptake and strategies can be improved. METHODS: Participants that were at least 18 years of age, pregnant, and English or Spanish speaking were recruited from the study sites and interviewed. Qualitative interviews consisted of topics including childhood vaccination importance, adult vaccination importance, vaccine information and trust, influenza vaccination and Tdap vaccination in pregnancy, and COVID vaccination. Data collected from interviews were collaboratively coded and analyzed using content analysis. RESULTS: A total of 13 pregnant teens and young adults and 19 pregnant adults participated. Some topics and questions indicated significant differences that supported the hypothesis and rejected the null that there were no significant differences in vaccine attitudes, knowledge, and influence, between pregnant teens and young adults and pregnant adults. These topics and questions included adult vaccine refusal, knowledge of flu vaccine preventing complications in pregnancy, knowledge of Tdap vaccine during in general, knowledge of maternal Tdap vaccination, knowledge of Tdap vaccine during protecting babies against whooping cough, Public Service Announcement influence, and COVID-19 impact on other vaccines. Compared with adults, teens and young adults were less knowledgeable about some vaccinations, more likely to refuse specific vaccinations, and more likely to say that the COVID pandemic negatively affected their views of vaccinations. Despite these differences, vaccination rates were similar. CONCLUSION: Vaccine attitudes and uptake amongst pregnant teens and young adults did not generally differ in most instances from pregnant adults. However, a huge knowledge gap between the two groups were evident. Despite vaccine adherence with limited knowledge in pregnant teens and young adults, their most trusted sources, like health care providers, should put forth greater efforts to provide teens and young adults with vaccine knowledge through suitable platforms and sources.

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The immense global tuberculosis (TB) burden highlights the shortcomings of current vaccination and antibiotic regimens. Novel prophylactic TB vaccines that can either boost or replace BCG entirely remains an active area of research. Additionally, the success of current antibiotic therapies against TB is hindered by their complexity and duration, with large percentages of patients failing to complete treatment. Multi-armed approaches are required to properly and efficiently combat diseases. Besides prophylactic vaccines, development of therapeutic vaccine strategies as an adjunct to antibiotic treatment would represent another major step in TB control. To achieve such a goal, vaccines must consider the pathogen’s life cycle, the immunological responses which they drive, and the populations in which they will ultimately be administered. As such, the purpose of this dissertation is to utilize state-of-the-art molecular cloning techniques to construct novel chimpanzee adenovirus-vectored vaccines that provide prophylactic and therapeutic immunity against pulmonary TB. By considering different phases of the pathogen’s life cycle, we aim to select a collection of antigens that are protective, regardless of disease state. Development of such platforms would lay and bolster the groundwork for improved vaccine strategies against TB. / Dissertation / Doctor of Philosophy (PhD)

no / One of the major shifts in the form and experience of contemporary family life has been the increasing insertion of the ‘expert’ voice into the relationship between parents and children. This paper focuses on an exploration of mothers’ engagement with advice around the combined measles, mumps and rubella (MMR) vaccine. Much of the previous literature utilises a ‘decision-making’ framework, based on ‘risk assessment’ whereby mothers’ decisions are conceptualised as rooted in complex belief systems, and supposes that that by gaining an understanding of these systems, beliefs and behaviour can be modified and uptake improved. However, less attention has been paid to the ways in which mothers negotiate such advice or the ways in which advice is mediated by positionings, practices and relationships. Analysis of data from a focus group with five mothers identified three themes: (i) Sourcing advice and information, (ii) Constructing ‘Mother knows best’ and (iii) Negotiating agency. Despite the trustworthiness of advice and information being questioned, an awareness of concerns about the MMR, and health professionals being constructed as remote, ultimate conformity to, and compliance with, the ‘system’ and ‘society’ were described as determining MMR ‘decisions’. / Full text was made available at the end of the publisher's embargo period: 1st Aug. 2015

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13607号 / 論医博第2317号 / 新制||医||1073(附属図書館) / その他リバプール熱帯医学研究科国際公衆衛生学コース / (主査)教授 長尾 美紀, 教授 川上 浩司, 教授 近藤 尚己 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background/Significance: Vaccines are essential to decrease the harmful effects of illness. The COVID-19 vaccination reduces mortality and hospitalizations from the COVID-19 virus. On August 11, 2021, the Centers for Disease Control and Prevention (CDC) strengthened its recommendation for all people ages 12 years and older who are pregnant, lactating, or trying to get pregnant to receive the COVID-19 vaccination. Despite the recommendation, pregnant women appeared to be vaccine hesitant. This qualitative descriptive study explored this hesitancy. Purpose: The purpose of this study was to explore pregnant women’s perceptions regarding COVID-19 vaccination during pregnancy and to identify information sources pregnant women used to guide their decision to forgo or receive COVID-19 vaccination during pregnancy. Method: A qualitative descriptive study was employed. Researchers used a semi- structured interview guide to conduct interviews. Participants included 41 women living in Salt Lake and Utah Counties, Utah, U.S.A. who had been pregnant any time after the CDC strengthened the recommendation for COVID-19 vaccination in pregnancy. Interviews were transcribed and coded separately by members of the research team. Team members came to a consensus regarding themes related to vaccine acceptance and hesitancy, as well as themes regarding information sources pregnant women used to guide their decisions regarding COVID- 19 vaccination. Results: The primary influence on COVID-19 vaccination during pregnancy was healthcare provider recommendations. A lack of belief in COVID-19 vaccine safety and efficacy contributed to vaccine hesitancy. Fear of unknown maternal and fetal complications from COVID-19 vaccinations was the primary reason pregnant women chose to forgo a COVID-19 vaccine during pregnancy. Fear of adverse side effects from COVID-19 viral infections was a significant reason for COVID-19 vaccine uptake in pregnant women. The CDC was used as an information source for decision-making by the majority of women, and they frequently mentioned conducting their own internet queries, both to obtain and clarify information. Further research is warranted to better understand COVID-19 vaccine hesitancy in pregnant women.

La vaccination est une des meilleures procédures de prévention coût-efficaces. Des couvertures vaccinales non adéquates présentent des problèmes de Santé publique considérables. Réduire ou éliminer les occasions manquées de vaccination (OMV) dans les régions les plus vulnérables permettrait d’y augmenter la couverture vaccinale. L’Inde a un des plus grands programmes de vaccination dans le monde, cependant il y existe d’importants gradients de couvertures vaccinales d’une région à l’autre. Objectifs : Cette étude visait à estimer la prévalence des OMV chez des jeunes enfants en zone rurale de Hardoi en Inde et identifier les potentiels déterminants et facteurs prédictifs des OMV. Méthodes : Les données secondaires d’une étude pré-post ont été utilisées pour mener une étude transversale. Les OMV ont été définies selon la définition de l’Organisation mondiale de la santé. Deux sources d’information sur le statut vaccinal ont été considérées : mémoire des mère ou carnet de vaccination (M/C) pour les analyses principales; et carnet de vaccination seulement (CS) en analyse de sensibilité. La prévalence des OMV dans la première année de vie (OMV-1AV) chez les enfants de 12 à moins de 24 mois et celle des OMV pendant la période optimale de vaccination (OMV-PO) chez les 0 à moins de 24 mois ont été calculées par sexe et bloc administratif. Les potentiels déterminants des OMV ont été identifiés à l’aide de modèles hiérarchiques. Des modèles prédictifs ont été construits pour identifier les facteurs qui permettraient de mieux cibler les enfants plus à risque d’OMV: leur pouvoir prédictif a été évalué avec la statistique c. Résultats : La prévalence des OMV-1AV selon la source M/C est de 19,3% ; celle selon CS est de 76,0%. La prévalence des OMV-PO selon M/C est de 14,6% alors qu’elle est de 65,7% selon CS. Pour les OMV-1AV et les OMV-PO, la prévalence variait d’un vaccin à l’autre mais seulement selon CS. Les déterminants des OMV varient selon la source d’information sur le statut vaccinal. Les principaux potentiels déterminants selon M/C sont: problèmes logistiques (OMV-1AV Rapport de cotes (RC) = 3,38; OMV-PO RC = 2,59); malaise ressenti chez l’enfant (OMV-1AV RC = 0,37; OMV-PO RC = 0,52); refus des vaccinateurs de vacciner sans avoir le carnet de vaccination (OMV-1AV RC = 5,66; OMV-1AV RC = 5,23); effets secondaires (OMV RC = 8,24; OMV-PO RC = 5,62); et le fait qu’un membre de la famille s’oppose à la vaccination de l’enfant; (OMV-1AV RC = 4,03; OMV-PO RC = 4,61). Des modèles prédictifs efficaces ont été construits et présentaient des statistiques c variant entre 0,72 et 0,79. Certains facteurs permettaient d’améliorer le pouvoir prédictif des modèles sans être nécessairement des potentiels déterminant des OMV tel que le temps de déplacement à pied entre le ménage et le centre de vaccination. Retombées : Les résultats suggèrent que la situation des OMV est complexe que ce soit du point de vue de la source d’information sur le statut vaccinal, de l’identification de leurs potentiels déterminants ou sur la capacité à cibler les individus les plus à risque. Les divergences au niveau des estimations de la prévalence selon la source d’information soulignent l’importance d’assurer un meilleur contrôle de la validité des sources d’information afin de maximiser l’exactitude des informations fournies. / Introduction: Missed opportunities for vaccination (MOV) affect vaccination coverages and contribute to create considerable vaccination gradient between and within regions. In India, despite major vaccination accomplishments, important vaccination gradients persist. MOV have been reported but the situation is not well known in many parts of the country. Aim: Quantify MOV in children in rural Hardoi district and identify potential determinants and predictive factors. Methods: We defined MOV using the definition of the World Health Organization. Our outcomes were missed opportunities for vaccination in first year of life (MOV-FYL) and missed opportunities for on-time vaccination (MO-OTV). We used a cross-sectional design. Vaccination status was verified according to two sources: by mothers’ recalls OR children vaccination card for the main analysis; and by vaccination card only for sensitivity analysis. We calculated the prevalence of both outcomes in a clustered population of 0 to under 24month-old children recruited in a census-like manner from rural area in Hardoi, India. We used multilevel binary logistic regression to identify potential determinants of MOV and multivariable logistic regression to built prediction models. Results: The prevalence was 19.30% and 14.39% for MOV-FYL and MO-OTV respectively. There were little variations across child sex and vaccines. However, among vaccination cardholders, the prevalence was 75.99% and 65.73% for MOV-FYL and MO-OTV respectively and varied across vaccines. Marked potential determinants using the main source of information about vaccination status were: logistics problems (MOV-FYL Odds Ratio (OR) = 3.38; MO-OTV OR = 2.59); child feeling unwell (MOV-FYL OR = 0.37; MO-OTV OR = 0.52); the refusal of health provider to vaccinate without the vaccination card (MOV-FYL OR = 5.66; MO-OTV OR = 5.23); side effects (MOV-FYL OR = 8.24; MO-OTV OR = 5.62); and family member not allowing vaccination (MOV-FYL OR = 4.03; MO-OTV OR = 4.61). Predictive models for MOV-FYL and MO-OTV yielded c statistics around 0.72 and 0.79 respectively and had the best sensitivity/specificity balance when used in a population with 15%-20% probability of MOV. Conclusion: Our study revealed that quantifying the prevalence of MOV is rather complexed. The source of information about vaccination status is key to obtain the best estimates, hence the knowledge on the reliability of the information from the card or obtained from recalls is a must. Many potential modifiable determinants should be explored and there is potential for predictability: interventions should be developed to reduce risks of MOV in targeted individuals, increase vaccination coverage and reduce vaccination gradients.

Yes / A study was conducted to determine the seroprevalence of chronic hepatitis B virus (HBV) infection among children and their mothers on Kwajalein Atoll in the Marshall Islands two decades after routine vaccination was introduced in the 1990s. Mothers’ knowledge and attitudes towards HBV disease and vaccination were also assessed. Methods: Results of a national seroprevalence survey conducted in 2016–2017 and antenatal records were used to determine the prevalence of HBV seropositivity in children aged 6–8 years and their biological mothers. The associations between demographic, social and vaccination-related factors and seropositivity were explored using Fisher’s exact tests. Results: HBV seroprevalence was 0.3% in children and 6.8% in their mothers (during pregnancy). Coverage of timely HBV vaccination was 90.3% for the birth dose and was significantly associated with factors related to place of residence (P < 0.001), place of birth (P < 0.001) and number of antenatal visits (P < 0.001). Maternal attitudes towards infant vaccination and antenatal screening were largely positive (95.8% and 96.7%, respectively) despite low vaccination rates (20.9%) among mothers. Knowledge levels were low for disease complications, treatment and transmission. Discussion: Prevalence of HBV in children and mothers residing on Kwajalein Atoll in 2016–2017 was lower than the national average for the Marshall Islands. Timely birth dose administration appears to have been effective in preventing mother-to-child transmission of HBV in this setting and should be promoted in remote settings where antiviral therapy is not available. Provision of out-of-cold-chain HBV vaccines should be considered to improve access in remote settings.