Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2009. / Härtill 4 uppsatser.

Thesis (M.S. in Management)--Naval Postgraduate School, December 2009. / Thesis Advisor(s): Apte, Aruna. Second Reader: Ferrer, Geraldo. "December 2009." Description based on title screen as viewed on January 27, 2010. Author(s) subject terms: Pandemic Influenza, Vaccine Distribution, Vaccine Distribution with DoD Assets, DoD Pandemic Influenza Response Plan. Includes bibliographical references (p. 63-64). Also available in print.

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Jeanne Flannery, Florida State University, School of Nursing, Dept. of Graduate Studies. Title and description from dissertation home page (viewed June 21, 2004). Includes bibliographical references.

Background The pandemic of influenza A (H1N1-2009) virus was particularly widespread among children. Children and young adults were more likely to be infected than older adults, and infection among infants tended to lead to a higher risk of severe complications than among older children and adults. Vaccination against the virus was thus recommended as an effective countermeasure to protect these susceptible age strata from influenza infection and subsequent complications. Parental perception, attitudes and beliefs would thus play a major role in mitigating the pandemic influenza because these factors underlie the degree of vaccination uptake among children. Objective The primary aim of this study is to understand factors that are associated with parental acceptance of pediatric vaccination against influenza (H1N1-2009). The secondary aim is to consider the effective future vaccination campaign in the event of a pandemic and to increase child vaccination coverage. Methods We conducted a systematic literature search of the electronic databases, PubMed and the Web of Science. We identified and examined published literatures associated with parental acceptance dating back to the beginning of the 2009 pandemic. We extracted key datasets from these literatures, summarized the evidence systematically and determined the relationship amongst the aforementioned parental characteristics and acceptance of pandemic influenza vaccines. Results We included a total of 14 studies in this review. Our systematic review indicates that parents were more willing to accept H1N1 pandemic influenza vaccination if 1) their children had previous experience with seasonal influenza; 2) they have had the pandemic influenza vaccine themselves; or 3) they intended to have their children vaccinated against seasonal influenza vaccine. We also founded that parental perceptions and attitudes towards both the influenza pandemic itself and the pandemic influenza vaccine are significantly associated with acceptance. Our study identified misperceptions and distrust in vaccine safety as the main reason for parents to refuse pandemic influenza vaccination for their children. In addition, we found that parents usually received negative appraisal on pediatric influenza vaccination from the media and tended to regard health care workers as the most reliable source of information on pediatric influenza vaccination. . Conclusions Parental perceptions are influential on pandemic influenza vaccine acceptance of their children. We affirm the importance of the role of health care workers in delivering appropriate information on influenza vaccines to parents in increasing pediatric vaccination uptake. We recommend public health officials to employ effective strategies for risk communication regarding pediatric influenza vaccines in order to increase the coverage and hence effectiveness of vaccination program against a future influenza pandemic. / published_or_final_version / Public Health / Master / Master of Public Health

Objective: To evaluate the impact of rubella vaccination strategies on rubella and CRS incidence and to offer public health suggestions for vaccination strategy in China. Methods: A systematic research of studies was conducted via the United States National Library of Medicine and the National Institutes of Health Medical Database (PubMed) and Google Scholar database. Terms- rubella AND (vaccin* AND coverage AND (reproduct* OR transmiss*) were used as key words in the research via PubMed. “Rubella vaccination strategies” and “rubella and congenital rubella syndrome” and “incidence” were used to search via Google Scholar. A systematic review of literature was conducted. The effectiveness of rubella vaccination strategies on the control and elimination of rubella and CRS incidence was used as primary inclusion criteria. Results: 5 articles were selected according to inclusion criteria. They were two cohort studies, two ecological studies, one mathematical modeling study. From the experience in Canada, around 99% decline of rubella and CRS incidence happened after vaccination strategy with selective approach for children. However, it led to a shift of infection to susceptible groups, and couldn’t interrupt rubella virus circulation. A combined vaccination with adults could control CRS incidence but was not effective for CRS elimination. A vaccination strategy with universal approach for children, males and females in Brazil could prevent child-bearing women from re-infection, thus helped to eliminate CRS cases. Conclusion: Vaccination strategy with universal approach was most effective for CRS control in a short time period with the evidence of a huge reduction of rubella and CRS incidence. As part of national immunization program in China, routine vaccination strategy for rubella should consider both epidemic and demographic factors to assess the effectiveness of children vaccination strategy. / published_or_final_version / Public Health / Master / Master of Public Health

Objectives To understand the acceptability of adult males, high-risk male population (MSM and bisexual men) and parents of adolescent sons and explore factors correlated with HPV vaccination acceptability Methods A systematic searching process for literatures related to men’s HPV vaccination acceptability and published from 2000 to July, 2013 in PubMed, MEDLINE, CINAHL, Cochrane Library and Google Scholar was performed. After screening based on inclusion and exclusion criteria, qualities of all eligible studies were assessed based on the modified STROBE guideline. Results Of 15 studies were included in this systematic review, 6 focused on adult males, 4 explored the high-risk males, five reported the parental acceptability. The HPV vaccination acceptability of adult males, high-risk male population and parents of adolescent sons was moderate or high in most reviewed studies. Knowledge about HPV and HPV vaccination, perceived susceptibility, perceived benefits and healthcare provider’s recommendation were positively correlated with HPV vaccination acceptability among adult males, high-risk males and parents of adolescent sons while high expense, side effects, safety, uncertain effectiveness and hassle of receiving a 3-shots series of HPV vaccination could diminish people’s vaccination interest. Conclusion HPV vaccination acceptability among adult males, high-risk males and parents of adolescent sons is moderate or high. Further HPV vaccine campaign should focus on bridging the gap between the high vaccination acceptability and the low vaccination uptake among males. / published_or_final_version / Public Health / Master / Master of Public Health

Objectives: To identify factors that are important for parental decisions on vaccinating their children against seasonal influenza based on a modified health belief model. Study design: Cross-sectional study Subjects: A total of 325 parents who had at least one child aged between 6 months and 3 years were recruited from a women and children’s hospital in Guangzhou, China Methods: Eligible subjects were identified by doctors when parents took their children to the outpatient clinic for regular body examination. Each eligible subject was invited for a face-to-face interview based on a standardized questionnaire. Hierarchical logistic regression models were conducted to identify factors associated with parents' intention to vaccinate their children and children’s actual vaccination uptake against seasonal influenza on the basis of a modified health belief model. Results: Uptake of seasonal influenza within the preceding 12 months among the target children who aged between 6 and 36 months was 47.7%. Around 62.4% parents indicated as being “likely/very likely” to take their children for seasonal influenza vaccination in the next 12 months. The hierarchical logistic regression model showed that children’s age (OR=2.59, 95%CI: 1.43-4.68), social norm (OR=2.08, 95%CI: 1.06-4.06) and perceived control (OR=2.96, 95%CI: 1.60-5.50) were significantly and positively associated with children’s vaccination uptake within the preceding 12 months; children with a history of taking seasonal influenza vaccine (OR=2.50, 95%CI: 1.31-4.76), perceived children’s health status (OR=3.36, 95%CI: 1.68-6.74), worry/anxious about their children influenza infection (OR=2.31, 95%CI: 1.19-4.48) and perceived control (OR=3.21, 95%CI: 1.65-6.22) were positively association with parental intention to vaccinate their children in the future 12 months. However, anticipated more regret about taking children for the vaccination was associated with less likely to vaccinate children within the preceding 12 months (OR=0.21, 95%CI: 0.08-0.52). Conclusions: The modified health belief model provided a good theoretical basic for understanding factors associated with parents’ decisions on their children's vaccination against seasonal influenza. It is important to provide sufficient information related to influenza vaccination benefit and improve parents' confidence to access the seasonal influenza vaccine to promote parents' intention to vaccinate their children against seasonal influenza. Providing information cues such as advice from other parents whose children have been vaccinated to increase adherence to positive social norms would be effective to encourage seasonal influenza vaccination uptake among children. Information communication should also target on reducing anticipated regret about the negative consequence of vaccinating children. / published_or_final_version / Public Health / Master / Master of Public Health

abstract / Public Health / Doctoral / Doctor of Philosophy

Introduction: China has about 120 million hepatitis B virus (HBV) carriers and a 7.2% hepatitis B surface antigen (HBsAg) prevalence in 2006.This creates a huge disease burden and also leads to significant economic losses. Since 2002, a free universal infant hepatitis B vaccination programme has provideda 3-dose primary vaccination for all infants. Although some economic evaluations of this programme have been conducted, a comprehensive cost-effectiveness analysis (CEA) to estimate long-term benefit using mathematical modeling would aid understanding of population strategies for hepatitis B control in large populations. Moreover, the most common mode of infection is perinataltransmission at birth. However the more effective immunization programme involving screening women during pregnancy for HBV-carrier status and providing passive-active vaccination for newborns has not been implemented in China. Aims: To identify the most cost-effective universal infant hepatitis B vaccination strategy for China. Method: A hospital-based survey was conducted during 2010-2011 in a general hospital in Shenzhen, China, in order to obtain costing data to estimate the economic burden of chronic hepatitis B patients. Annual direct and indirect costs from this study were used as cost parameters in the CEA models. Mathematical models were developed to simulate perinatal transmission, vaccination programmes and disease progression using Markov modeling and decision trees. Quality-adjusted life year (QALYs) as well as health and monetary outcomes were also assessed. Univariate sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation were performed to test parameter uncertainty. Two programmes of screening of pregnant women for both HBsAg and/or HBeAg and the infant passive-active vaccination were compared with the current vaccine-only programme in one CEA, while the other CEA estimated the effect of the current infant programme compared with no vaccination. Findings: The estimated total economic burden including annual direct and indirect cost among hepatitis B patients of RMB 43104.5 (US$6340.8). The economic burdens of associated disease states of hepatitis B infection were highest for hepatocellular carcinoma (HCC) (RMB 77297.1), decompensated cirrhosis (RMB 50725.7), chronic active hepatitis B (CAH) (RMB 37449.5) and finally compensated cirrhosis (RMB 37276.9). The average total economic burden per hepatitis B patient amounted to 46% of Shenzhen GDP per capitain 2010, and 5.4% of the city’s annual per capita income. The current vaccine-only infant vaccination programme was justified by costsavings, from both a societal and health care payer’s perspective, reducing new HBV infections by about 76%. This has produced a gain of 743,000 life-years and 620,000 QALYs given current numbers and savings of US$2~3billion saved over the lifetime of a national cohortof 10,000,000 newborns. A universal control programme involving the screening of pregnant women for HBsAg and passive-active vaccination, would reduce new infections by 13%, saving 436,000 life years and gaining 121,000 QALYs for a saving of about US$546 million compared with current vaccine-only programme. Implications: The universal infant hepatitis B vaccination programme is currently a cost-effective strategy for hepatitis B control in China.A beneficial amendment to the current strategy wouldinclude screening of all pregnant women for HBsAg and vaccinating newborns in a passive-active way. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

Influenza (IV) and pneumococcal polysaccharide vaccination (PPV) may reduce hospitalization and mortality but the effectiveness of these vaccines in older adults (≥65 years) is controversial. This thesis includes seven parts with a total of ten studies studying different aspects regarding IV and PPV in institutionalized older adults - the group with the highest infection-related morbidity and mortality. 　　 　　In Part I, we presented the controversies about effectiveness of influenza and pneumococcal vaccination in institutionalized older adults. 　　 　　In Part II, we studied a retrospective cohort of 1737 older adults showing that nursing home residence is independent risk factor of infection-related mortality and hospitalization. 　　 　　In Part III, the second and third studies were systematic reviews showing that IV and PPV could reduce pneumonia and death.. 　　 　　In Part IV, we evaluated the effectivenss of IV and PPV through prospective cohorts. The fourth study was a prospective cohort study of 1859 institutionalized older adults showing that IV significantly reduced mortality and hospitalization. The fifth study was a prospective cohort study of 532 institutionalized older adults showing that when the IV strain does not match the circulating strain, PPV provided additional protection in reducing mortality. 　　 　　In Part V, the sixth study was a randomized controlled trial of 100 institutionalized older adults showing that intradermal IV has better immunogenicity than intramuscular vaccination without compromising safety. 　　 　　In Part VI, we identified factors that may affect clinical effectiveness of IV. The seventh and eighth studies were prospective cohort studies of 711 institutionalized older adults showing that vaccine efficacy declined with increasing impaired functional status and renal function. 　　 　　In Part VII, we identified determinants of receiving IV and PPV in institutionalized older adults. The ninth study was a cross-sectional study of 155 institutionalized older adults showing that encouragement from nHCWs was a major facilitator of receiving vaccination. The tenth study was a cross-sectional study of 1300 nHCWs showing that 40.2% of nHCWs had encouraged residents to receive vaccination. 　　 　　In conclusion, ten studies from this thesis demonstrated that IV and PPV are effective in preventing hospitalization and reducing mortality in institutionalized older adults. Different strategies in improving its effectivenss and acceptance were suggested. / published_or_final_version / Medicine / Master / Doctor of Medicine