Introduction : La vaccination est l’une des interventions de santé publique les plus efficaces et les plus efficientes. Comme dans la plupart des pays de la région Ouest africaine, le programme national de vaccination a bénéficié du soutien de nombreuses initiatives internationales et nationales dans le but d’accroître la couverture vaccinale. La politique vaccinale du Burkina Faso s’est appuyée sur différentes stratégies à savoir: la vaccination-prospection, la «vaccination commando», le Programme élargi de vaccination (PEV) et les Journées nationales de vaccination. La couverture vaccinale complète des enfants de 12 à 23 mois a certes augmenté, mais elle est restée en deçà des attentes passant de 34,7% en 1993, à 29,3% en 1998 et 43,9% en 2003. Objectif : Le but de cette thèse est d’analyser à plusieurs périodes et à différents niveaux, les facteurs associés à la vaccination complète des enfants de 12 à 23 mois en milieu rural au Burkina Faso. Méthodes : Nous avons utilisé plusieurs stratégies de recherche et quatre sources de données : - les enquêtes démographiques et de santé (EDS) de 1998-1999 et de 2003 - les annuaires statistiques de 1997 et de 2002 - des entretiens individuels auprès de décideurs centraux, régionaux et d’acteurs de terrain, œuvrant pour le système de santé du Burkina Faso - des groupes de discussion et des entretiens individuels auprès de populations desservies par des centres de santé et de promotion sociale (niveau le plus périphérique du système de santé) et du personnel local de santé. Des approches quantitatives (multiniveau) et qualitatives ont permis de répondre à plusieurs questions, les principaux résultats sont présentés sous forme de trois articles. Résultats : Article 1: « Les facteurs individuels et du milieu de vie associés à la vaccination complète des enfants en milieu rural au Burkina Faso : une approche multiniveau ». En 1998, bien que la propension à la vaccination s’accroisse significativement avec le niveau de vie des ménages et l’utilisation des services de santé, ces 2 variables n’expliquent pas totalement les différences de vaccination observées entre les districts. Plus de 37 % de la variation de la vaccination complète est attribuable aux différences entre les districts sanitaires. A ce niveau, si les ressources du district semblent jouer un rôle mineur, un accroissement de 1 % de la proportion de femmes éduquées dans le district accroît de 1,14 fois les chances de vaccination complète des enfants. Article 2: « Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998 - 2003) ». Entre 1998 et 2003, la couverture vaccinale complète a augmenté en milieu rural, passant de 25,90% à 41,20%. Alors que les ressources du district n’ont présenté aucun effet significatif et que celui de l’éducation s’est atténué avec le temps, le niveau de vie et l’expérience d’utilisation des services de santé par contre, restent les facteurs explicatifs les plus stables de la vaccination complète des enfants. Mais, ils n’expliquent pas totalement les différences de vaccination complète qui persistent entre les districts. Malgré une tendance à l’homogénéisation des districts, 7.4% de variation de la vaccination complète en 2003 est attribuable aux différences entre les districts sanitaires. Article 3: « Cultures locales de vaccination : le rôle central des agents de santé. Une étude qualitative en milieu rural du Burkina Faso ». L’exploration des cultures locales de vaccination montre que les maladies cibles du PEV sont bien connues de la population et sont classées parmi les maladies du «blanc», devant être traitées au centre de santé. Les populations recourent à la prévention traditionnelle, mais elles attribuent la régression de la fréquence et de la gravité des épidémies de rougeole, coqueluche et poliomyélite à la vaccination. La fièvre et la diarrhée post vaccinales peuvent être vues comme un succès ou une contre-indication de la vaccination selon les orientations de la culture locale de vaccination. Les deux centres de santé à l’étude appliquent les mêmes stratégies et font face aux mêmes barrières à l’accessibilité. Dans une des aires de santé, l’organisation de la vaccination est la meilleure, le comité de gestion y est impliqué et l’agent de santé est plus disponible, accueille mieux les mères et est soucieux de s’intégrer à la communauté. On y note une meilleure mobilisation sociale. Le comportement de l’agent de santé est un déterminant majeur de la culture locale de vaccination qui à son tour, influence la performance du programme de vaccination. Tant dans la sphère professionnelle que personnelle il doit créer un climat de confiance avec la population qui acceptera de faire vacciner ses enfants, pour autant que le service soit disponible. Résultats complémentaires : le PEV du Burkina est bien structuré et bien supporté tant par un engagement politique national que par la communauté internationale. En plus de la persistance des inégalités de couverture vaccinale, la pérennité du programme reste un souci de tous les acteurs. Conclusion : Au delà des conclusions propres à chaque article, ce travail a permis d’identifier plusieurs facteurs critiques qui permettraient d’améliorer le fonctionnement et la performance du PEV du Burkina Faso et également de pays comparables. Le PEV dispose de ressources adéquates, ses dimensions techniques et programmatiques sont bien maîtrisées et les différentes initiatives internationales soutenues par les bailleurs de fonds lui ont apporté un support effectif. Le facteur humain est crucial : lors du recrutement du personnel de santé, une attention particulière devrait être accordée à l’adoption d’attitudes d’ouverture et d’empathie vis-à-vis de la population. Ce personnel devrait être en nombre suffisant au niveau périphérique et surtout sa présence et sa disponibilité devraient être effectives. Les liens avec la population sont à renforcer par une plus grande implication du comité de gestion dans l’organisation de la vaccination et en définissant plus clairement le rôle des agents de santé villageois. Ces différents points devraient constituer des objectifs du PEV et à ce titre faire l’objet d’un suivi et d’une évaluation adéquats. Finalement, bien que la gratuité officielle de la vaccination ait réduit les barrières financières, certaines entraves demeurent et elles devraient être levées pour améliorer l’accès aux services de vaccination. / Introduction: Vaccination is one of the most effective and efficient public health interventions. As in most West African countries, Burkina Faso’s national program of vaccination has benefited from the support of numerous international and national initiatives aimed at increasing vaccination coverage. Burkina Faso’s immunization policy has relied on a variety of strategies, such as door-to-door canvassing for vaccination, the “Vaccination Commando” campaign, the Expanded Program of Immunization (EPI), and National Immunization Days. While vaccination coverage of children ages 12–23 months has increased, it has nevertheless remained well below expectations, going from 34.7% in 1993 to 29.3% in 1998 and subsequently rising to 43.9% in 2003. Objective: The purpose of this thesis is to analyze, at several points in time and on different levels, the factors associated with complete vaccination of children ages 12–23 months in rural areas of Burkina Faso. Methods: To conduct this research we employed several research approaches and four sources of data: - the Demographic and Health Surveys (DHS) of 1998–1999 and 2003; - the Statistical Yearbooks of 1997 and 2002; - individual interviews with decision-makers at the central and regional levels, as well as with field workers in Burkina’s healthcare system; - focus groups and individual discussions with people served by the health centres, or centres de santé et de promotion sociale (the most peripheral level of the health system) and with local health workers. Quantitative (multilevel) and qualitative approaches provided answers to several questions; our key results are presented in three articles. Results: Article 1: “Individual and living environment factors associated with complete vaccination of children in rural areas of Burkina Faso: a multilevel approach”. In 1998, although the tendency toward vaccination rose significantly with household standard of living and the use of health services, these two variables did not fully explain the differences in vaccination observed between districts. More than 37% of the variation in complete vaccination was attributable to differences between health districts. At this level, even though district resources appeared to play a minor role in vaccination, a 1% increase in the proportion of educated women in the health district increased children’s chances of being completely vaccinated by a factor of 1.14. Article 2: “Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998–2003)”. Between 1998 and 2003, complete vaccination coverage in rural areas rose from 25.9% to 41.2%. While district resources showed no significant impact on complete vaccination, and that of education diminished over time, the standard of living and the experience of using health services, on the other hand, remained the most stable explanatory factors of complete vaccination of children. However, they did not fully explain the differences in complete vaccination that persisted among districts. Despite a trend toward homogenization of districts, 7.4% of the variation in complete vaccination in 2003 was still attributable to differences between health districts. Article 3: “Local vaccination cultures: the role of health workers. A qualitative study in rural areas of Burkina Faso”. Exploration of local vaccination cultures shows that the diseases targeted by the EPI are well known to the population and are classified among diseases of the “white people” that must be treated in the health centre. People use traditional preventive measures, but they attribute the decline in frequency and seriousness of measles, whooping cough and poliomyelitis epidemics to vaccination. Post-vaccination fever and diarrhoea may be perceived either as sign of success or as a contraindication for further vaccination, depending on the views of the local vaccination culture. The two health centres in the study applied the same strategies and faced the same barriers to accessibility. In one of the health zones, vaccination is the best organized, the management committee is committed, and the health worker is more available, interacts better with mothers and makes efforts to be part of the community; this zone exhibits stronger social involvement. The health worker’s behaviour is a major determinant of local vaccination culture, which in turn influences the performance of the vaccination program. Both professionally and personally, he needs to build a relationship of trust with people that promotes their acceptance of children’s vaccination, as long as the service is available. Supplementary results: Burkina Faso’s EPI is well structured and supported by both a national political commitment and the international community. In addition to persistent disparities in immunization coverage, the program’s sustainability remains a concern shared by all the actors. Conclusion: Beyond the conclusions specific to each article, this research has enabled us to identify several critical factors that would help to improve EPI performance in Burkina Faso, as well as in comparable countries. The EPI has adequate resources, its technical and programmatic resources are well controlled, and various international initiatives backed by funding agencies have provided effective support. The human factor is crucial: when recruiting health workers, particular attention should be given to having open and empathetic attitudes toward people. There should be enough personnel at the peripheral level, and they must have an effective presence and availability. Relationships with the community should be strengthened by having management committees be more involved in organizing vaccination and by defining more clearly the role of village health workers. These points should become EPI objectives and be subject to appropriate monitoring and evaluation. Lastly, even though making vaccinations free has reduced financial barriers, there are still certain constraints that should be removed to improve access to vaccination services.

This dissertation examines vaccination rates for Human Papillomavirus (HPV) among college women 18-26 years of age who participated in the American College Health Association’s National College Assessment (ACHA-NCHA). Utilizing secondary data, this research sought to report HPV vaccination rates among a racially diverse population and to identify potential barriers to vaccination. The ACHA-NCHA survey provided a large sample size (N=68,193) in which to perform a binary logistic regression analysis. Demographic characteristics were analyzed as potential barriers to HPV vaccination. Additionally, lack of certain health behaviors were explored as potential barriers to HPV vaccination. In this study, White/non-Hispanic women had a higher HPV vaccination rate when compared to minority women. The binary regression analysis demonstrated that minority women were less likely to receive the HPV vaccine. Furthermore, it was determined that as the age of the respondents increased, the likelihood of receiving the vaccine decreased. Health behaviors that were predictive of receiving the HPV vaccine included receiving the Hepatitis B and Influenza vaccine, number of sexual partners and receiving sexually transmitted disease information. Women who received a gynecological exam were almost twice as likely to receive the vaccine, as were women who had parental health insurance coverage. One aim of The Affordable Care Act (2010) is to decrease disparities in health care. Drawing attention to potential barriers to HPV vaccination allows policy makers to make informed decisions regarding future activities to reduce disparities. Health promotion activities should be targeted to specific populations in an effort to increase HPV vaccination rates.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

This thesis deals with the development of Western medicine in Japan, especially in the second half of the Tokugawa period. The first part briefly outlines the situation at the beginning of the Tokugawa period, especially how Western medicine got into Japan and how was received. The following passage more focuses on medicine and its place in the Japanese ideology. Emphasis is placed on intellectual and economic transformation in the 18th century and the clash of Western medicine with Neo-Confucianism. Some space is dedicated to significant medical names, Japanese and European. The whole work is finished with fairly extensive passage about vaccination, which was extremely important for the successful adoption of Western medicine in the early Meiji period. Keywords: rangaku, medical sciences, Western medicine, vaccination, the Tokugawa period

Parents of preschool children and vaccination I. Author: Monika Miklasová Supervisor of thesis PharmDr. Helena Marešová Department of social and clinic pharmacy, Charles University in Prague, faculty of Pharmacy in Hradec Králové. Introduction:In the Czech Republic is vaccination of children one of the most argue topic. Children`s vaccination is very important, because they are endangering the most of health and life. Periodically vaccination lead to reach high collective immunity. High vaccination is requirement. Objective: Purpose of my thesis was find out, what are actual parent`s opinions on faith, effectivity and safety of vaccination system, which depend on parent`s age and education - in this case help me questionnaires gave out in kindergartens of the Zlín region. I investigate parents knowledge about this issue, side effects and number of children, which are vaccinaciton with optionally vaccines. Methodology: In research was used method of questionnaires. Data were collected from october 2012 to april 2013. Questionnaires were distributed in kindergarten of Zlín region to parents, which have preschool children. Received questionnaires were processed method of frequency analysis. They were divided by age, education, software evaluated Microsoft Office Excel. Results were recorded as...

Student: Michaela Klozová Tutor: PharmDr. Helena Marešová Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic Background: This thesis deals with the attitude of Czech parents of preschool children for vaccination. From this perspective, the issue of vaccination was not in the Czech Republic yet rated. The work provides an overview of basic knowledge about vaccination. Aim: The main objective of the study was to assess the attitudes of parents to vaccinate their children, to map their knowledge and experience with vaccination and their views on the legitimacy, efficacy and safety of vaccination in the Czech Republic. The operational objective was to determine what changes would be welcomed in this system. Finally, I was interested in whether parents let children vaccinated beyond the compulsory vaccination. Methods: A targeted survey of parents of preschool children, regardless of age and education. For data acquisition method was used questionnaires. The processing of the results was used a computer program Microsoft Office Excel 2007. The data were subjected to frequency analysis and confidence interval was calculated. The survey was conducted from September 2012 to November 2013 questionnaire was completed by 182 parents...

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Author: Petra Formánková Supervisor: PharmDr. Helena Marešová Title: Parents of the Pre-School Children and Vaccination III. Key words: vaccination, adverse effects, non-compulsory vaccines, immunization calendar Introduction: Vaccination has always been controversial and highly debated issue. There are its supporters, but also strict opponents. However, vaccination is still the most effective and most economical form of fight against various diseases. Vaccination annually saves several million lives. Aim: The main aim of my thesis is to evaluate the results obtained from the questionnaires and determine whether respondents' age or higher education have an impact on the belief in the legitimacy, safety and efficacy of vaccination. Then I watched the risk of adverse effects on the child's sex and the most frequent type of adverse reactions, which occurred after vaccination. The aim was also to determine whether children were vaccinated by non-compulsory vaccines, further as their parents knew about vaccination and what changes in vaccination they desired for their children. Methodology: The research was conducted by questionnaire survey. Questionnaires were distributed to parents of...

The school project to theme vaccination to second grade of primary school and secondary school This thesis deals with the theme vaccination, its history and principles. The process of immunization is typically made by the administration of vaccines, given in certain time intervals that are determined in accordance with the rules of law. Before vaccine administration, vaccine should be thoroughly checked to protect security of patient's health. Ongoing research and advanced development projects help fight against diseases to protect the human organism. One of the themes that plays role in the vaccination is the financing of research and development as well as financing immunizations itself. As vaccination is as important for adults as it is for children, providing all informations to students is very necessary. To reach this point succesfully, the teching project (described more specifically in this work) is one of the possible ways. However, as project itself has its advantages as well as disadvantages, specific attitude of students and teachers is required accordingly. There are three different projects on vaccinations topics described in the thesis. These three projects were realized in three types of schools: secondary grammar school, third class of central medical lyce and eight class of...

A knowledge about infectious diseases and vaccination is very important in this time. The questionnaire, which is part of this thesis, is designated for 1st to 4th grade high school students and the upper grade grammar school pupils. The questionnaire was used to analyse pupils' knowledge and attitudes about infectious diseases and vaccination. Pupils' knowledge and attitudes are quite good and students are able to voice their opinion. Females have better knowledge than males and older students are better too. The thesis is further focusing on how are the infectious diseases included in the National Curriculum and examine the prevention programmes for schools. The other purpose is to follow up the threat of pandemic diseases and present state of knowledge and awareness about this topic.

Doctor of Philosophy / Department of Diagnostic Medicine/Pathobiology / Manuel Borca / Stephen Higgs / African swine fever (ASF) is a lethal hemorrhagic disease of swine caused by a double-stranded DNA virus. ASFV is endemic in Sardinia and Saharan Africa and has been recently expanded from the Caucasus to Eastern Europe. There is no vaccine to prevent the disease and current control measures are limited to culling and restricted animal movement. Swine infected with attenuated strains are protected against challenge with a homologous virulent virus, but there is limited knowledge of the host immune mechanisms generating that protection. Swine infected with Pret4 virus develop a fatal severe disease, while a derivative strain lacking virulence-associated gene 9GL (Pret4Δ9GL virus) is completely attenuated. Swine infected with Pret4 Δ9GL virus and challenged with the virulent parental virus at 7, 10, 14, 21, and 28 dpi showed a progressive acquisition of protection (from 40% at 7 dpi to 80% at 21 and 28 dpi). This animal model was used to associate the presence of host immune response and protection against the challenge. Anti-ASFV antibodies and cytokines in serum, as well as ASFV-specific IFN-γ production in PBMCs, were assessed in each group. Interestingly, with the exception of ASFV-specific antibodies in the surviving swine challenged at 21 and 28 dpi, no solid association between any of the parameters assessed and the extent of protection could be established. These results were corroborated using a similar model based on the use of a rationally attenuated derivative of the highly virulent strain Georgia 2007. These results, encompassing data from 114 immunized swine, underscore the complexity of the system under study where it is very plausible that protection against disease or infection relies heavily on the concurrence and or interaction of different host immune mechanisms.