Parents are historically the decision makers related to vaccinations with infants and children. Over the past few years, healthcare providers have been facing a growing number of parents who are questioning the safety and the need for routine vaccinations. Studies conducted in Saudi Arabia revealed that not all Saudi-born parents support childhood vaccination and eventually delay their children vaccination. Understanding the cultural influences on parents in Saudi Arabia about the adherence to childhood vaccination program is crucial for health and safety of the whole society. The purpose of this study was to explore experiences of Saudi-born parents who have delayed vaccinations for their children prior to school age. Through a Heideggerian hermeneutic interpretive phenomenological method and the lens of caring theory, this research sought to uncover the essence of Saudi-born parents’ lived experiences where they were allowed to speak and provide their perspectives in their own words. Leininger’s Culture Care Diversity and Universality Theory was used as the theoretical framework guiding this study. Leininger’s Sunrise Enabler-Model provided a framework for assessing the sociocultural aspects of Saudi-born parents that may have influence the vaccine delays for their children. The nine participants provided a rich and thick description of the phenomenon in this study from which three essential themes emerged. The three essential themes were: 1) struggling with barriers, 2) seeking vaccine information (Formal and Informal) and their influence on participants’ decision, and 3) hesitating to vaccinate. Study findings explored cultural factors such as knowledge, access to healthcare centers, work responsibilities, and social media that influenced vaccinating children prior to school in Saudi Arabia. Greater understanding of delays in child vaccination by Saudiborn parents equips nurses in addressing cultural perspectives to reduce communicable diseases amongst children. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2021. / FAU Electronic Theses and Dissertations Collection

Bakgrund: I mitten av 1900-talet började vaccin ges på rutin till barn för att förebygga sjukdom, vilket ses som den främsta medicinska insatsen som gjorts för folkhälsan. I Sverige är vaccinationstäckningen hög, men vissa föräldrar väljer att avstå från vaccinationer som det svenska barnvaccinationsprogrammet erbjuder. I tidigare forskning uppmärksammas det att mötet med föräldrar som avstår upplevs som svårt för sjuksköterskan. För att förstå varför föräldrar tackar nej samt hur sjuksköterskor kan bemöta dessa föräldrar behövs mer kunskap. Syfte: Att beskriva sjuksköterskans uppfattning om varför föräldrar tackar nej till att vaccinera sina barn samt hur sjuksköterskan bemöter dessa föräldrar. Metod: Webbaserad enkät med 15 frågor skickades ut till sjuksköterskor inom barnhälsovården samt elevhälsan. Enkäten som innehöll både öppna och slutna frågor har sammanställts med beskrivande statistik samt analyserats med kvalitativ innehållsanalys. Resultat: I resultatet framkom tre huvudkategorier: Påverkan på barnet, Misstro till vaccination och Sjuksköterskans strategier, vilka är uppbyggda av totalt 10 underkategorier. Slutsats: Resultatet visar att sjuksköterskan känner sig osäker vid dessa möten. För att minska osäkerhet belyser sjuksköterskorna vikten av att fråga om orsaken till föräldrarnas beslut och ta sig tid för samtal. Vikten av att hitta en struktur för samtalet belystes där motiverande samtal lyftes fram. Genom individanpassade samtal utifrån varje förälder kan en trygg miljö skapas och vården blir personcentrerad. / Background: In the mid-20th century, vaccines began to be routinely administered to children in order to prevent illness. This is seen as the foremost medical effort made for public health. The vaccination coverage in Sweden is high, but some parents choose to refuse the Swedish childhood vaccination program. Previous research shows that meeting with parents who refuse vaccination is perceived as difficult for nurses. In order to understand why parent´s refuse and how nurses best can meet them more knowledge is needed. Aim: To describe the nurse's idea of why parents refuse to vaccinate their children and how the nurse responds to these parents. Method: Web-based questionnaire with 15 questions, both open-ended and closed, was used and sent to nurses working in the child health care sector and in primary school. The questionnaire was analyzed with qualitative content analysis and descriptive statistics. Results: In the result, three main categories emerged: Influence on the child, Mistrust of vaccination and The specialist nurse's strategies. The main categories are made up of a total 10 subcategories. Conclusion: The result showed that nurses felt insecure meeting parents who refuse vaccinations. In order to reduce insecurity, nurses highlighted the importance of asking about the cause of the parents' decision and make time for these conversations. Finding a structure for the conversation was important and one example was motivational conversations. Individualizing the conversation and the questions after each parent created a safe environment and an approach of a person-centered care.

Swaziland is a British Protectorate of approximately 6,700 square miles. It is a subtropical country, border in the East by Mozambique and in the North, West and South by the Transvaal. There are approximately 270,000 Africans and 10,000 persons of other races living in the Territory. The country is divided into Highveld, Middleveld and Lowveld regions. The work described here was carried out in the South Western highveld. This is mountainous terrain, with an approximate altitude of 3,500 feet and an annual rainfall of about 30". The terrain is a succession of mountains and valleys, with several perennial streams and rivers coursing through it. The climate is variable, with hot summers and cold winters, with rainfall predominantly in the summer. Large man made forests are scattered throughout the area, and there is some cutting and processing of timber, but industries as such are not found in that part of the Territory.

Streptococcus pneumoniae is a bacterium responsible for a spectrum of diseases including lobar pneumonia, meningitis, otitis media, and sinusitis. Invasive pneumococcal disease is responsible for significant morbidity and mortality across the world. Concerted efforts led to the development of two vaccinations, Pneumova × 23 and Prevnar 13, for the prevention of pneumococcal disease. The Advisory Committee on Immunization Practices of the US Centers for Disease Control and Prevention provides vaccination schedules for predisposed adults, but the proposed schedules remain a challenge to health-care providers. We performed a systematic review in PubMed and these specialty group websites to present the pathophysiology of pneumococcal disease, outline different pneumococcal vaccinations, and condense recommendations for vaccination administration.

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Individuals who work with children are at risk for exposure to vaccine-preventable diseases. School settings can quickly become outbreak centers for communicable infection since school employees are in direct contact with children in confined areas for many hours each day. Therefore, it is important for school employees to be fully vaccinated. There are many reasons school employees may be inadequately vaccinated. One common myth is that adults believe vaccines are only for children. Another reason for inadequate vaccination rates among school employees is that many adults believe vaccinations received during childhood are still effective. Healthcare providers (HCPs) constitute the first line of defense to ensure adults are adequately vaccinated and, when vaccinations are tracked and recommended by HCPs, vaccination uptake is improved among patients. Unfortunately, many HCPs miss opportunities to vaccinate their adult patients. By discussing recommended vaccinations with adult patients, Nurse Practitioners can be instrumental in improving vaccination rates among school employees.

Wastewater surveillance (WWS), included in the field of study of wastewater-based epidemiology (WBE), is the analysis of wastewaters to quantify community disease or use of chemicals by the community, such as pharmaceuticals and illicit drugs. WWS has historically been applied within the context of community public health through monitoring of pathogenic viral outbreaks such as polio and hepatitis A, as well as monitoring of illicit drug consumption. While WWS has been used for several decades, many of its contributions were largely unpopular within the public mainstream prior to the coronavirus disease in 2019 (COVID-19) pandemic. Since the onset of the pandemic, public health resources around the world were significantly afflicted by COVID-19. This elicited a prompt response by researchers to rapidly develop WWS for the application of severe acute respiratory syndrome-2 virus (SARS-CoV-2) WWS as a complementary epidemiological tool for population-wide monitoring of COVID-19 outbreaks. With the novelty of this technology, there are several challenges and gaps of knowledge that remain to be addressed in order to improve the reliability of WWS for SARS-CoV-2. Particularly, the effects of various constituents, endogenous and added, that commonly occur and are applied to wastewaters may result in the significant variability observed in WWS data sets, which in turn results in the uncertainty of the interpretation of WWS data sets of SARS-CoV-2 by various public health agencies throughout the pandemic. This study is aimed to address the critical issue of data variability by investigating the effect of enhanced primary clarification with ferric-based chemical coagulants on the measurements of SARS-CoV-2 and the pepper mild mottle virus (PMMoV) WWS normalizing biomarker. It is believed that the addition of ferric ions via common coagulation treatment of primary sludge would interfere with the quantitative polymerase chain reaction (qPCR) amplification of viral RNA and could cause false-negative results. With 18.1% of the total population in Canada receiving wastewater that undergoes primary treatment including chemical precipitation/flocculation, and with proof of enrichment of SARS-CoV-2 and PMMoV RNA in untreated wastewater and settled primary sludge, it is important to elucidate whether ferric sulfate chemical coagulant is a potential source of data variability for population-wide WWS. With ferric sulfate concentrations ranging from 0 - 60 mg/L as Fe³⁺, the PMMoV-normalized SARS-CoV-2 viral signal measurements were significantly reduced as a result of a significant elevation in the PMMoV viral signal measurements. This is possibly due to the partitioning of PMMoV viral particles from the liquid phase to the solids phase of wastewater samples influenced by ferric sulfate at 60 mg/L as Fe³⁺ compared to the samples that were not treated with ferric sulfate. This thesis also examined the evolving relation of WWS measurements to measurements of public health metrics to improve our current interpretation of SARS-CoV-2 WWS. The statistical correlations between wastewater PMMoV-normalized SARS-CoV-2 viral signal and clinical metrics indicative of disease incidence (laboratory-confirmed COVID-19 positive cases), and metrics indicative of disease burden (hospitalization, intensive care unit (ICU) admissions, and deaths) are investigated from the onset of the wildtype and the Alpha variant of concern (VOC) during limited vaccination immunization, through the onset of the Omicron BA.2 VOC in two strongly characterized sewersheds (Ottawa and Hamilton). WWS demonstrates to be a strong indicator of both disease incidence and disease burden during the period of limited vaccination immunization, and a moderate indicator of disease incidence, while remains a strong indicator of disease burden during the period of peak vaccination immunization (2-4 weeks after reception of 2 doses of the COVID-19 vaccine). Hospitalization-to-wastewater ratio is further shown to be a good indicator of VOC virulence when widespread clinical testing is limited.

En 2005, le comité sur l’immunisation du Québec recommandait de passer du programme de vaccination contre l’hépatite B (HB) des préadolescents à celui des nourrissons lorsqu’un vaccin hexavalent serait disponible. Pour déterminer l’impact d’un tel changement, un bilan épidémiologique de l’HB a été réalisé à partir des cas déclarés au fichier des maladies à déclarations obligatoires. De 2005 à 2009, une vaccination des nourrissons aurait potentiellement pu prévenir 0,0335 (IC 95%: 0.0334-0.0336) cas aigus par 100 000 personnes-années chez les moins de 20 ans. De 2010 à 2013, aucun cas aigu n’a été rapporté dans ce groupe d’âge. Le programme de vaccination actuel des préadolescents est hautement efficace. En 2014, changer ce programme pour une vaccination des nourrissons avec un vaccin hexavalent n’apporterait pas de bénéfice épidémiologique mais permettrait d’augmenter la couverture vaccinale de 8-12%. / In 2005, the Quebec immunization committee recommended to replace the hepatitis B (HB) school-based immunization program by an infant program when an hexavalent vaccine would become available. To estimate the potential impact of such a program change, we summarized the HB epidemiology based on reported cases retrieved from the provincial registry of notifiable diseases. Between 2005 and 2009, 0.0335 (95% CI: 0.0334-0.0336) acute case per 100,000 person-years reported in 0-19 year-olds could have potentially been prevented by an infant immunization program. Between 2010 and 2013, no acute cases were reported in this age group. The current vaccination program is highly effective. In 2014, changing for an infant vaccination program using the hexavalent vaccine can hardly bring additional epidemiological benefit but may increase the vaccine coverage rate by 8-12%.

For many years bovine brucellosis was a zoonosis endemic in large parts of the world. While it is still endemic in some parts, such as the Middle East or India, several countries such as Australia and Canada have successfully eradicated brucellosis in cattle by applying vaccines, improving the hygienic standards in cattle breeding, and slaughtering or quarantining infected animals. The large economical impact of bovine brucellosis and its virulence for humans, coming in direct contact to fluid discharges from infected animals, makes the eradication of bovine brucellosis important to achieve. To achieve this goal several vaccines have been developed in the past decades. Today the two most commonly used vaccines are Brucella abortus vaccine strain 19 and strain RB51. Both vaccines have been shown to be effective, but the mechanisms of immune responses following vaccination with either of the vaccines are not understood yet. In this thesis we analyze the immunological data obtained through vaccination with the two strains using mathematical modeling. We first design a measure that allows us to separate the subjects into good and bad responders. Then we investigate differences in the immune responses following vaccination with strain 19 or strain RB51 and boosting with strain RB51. We develop a mathematical model of immune responses that accounts for formation of antagonistic pro and anti-inflammatory and memory cells. We show that different characteristics of pro-inflammatory cell development and activity have an impact on the number of memory cells obtained after vaccination. / Master of Science

Vaccination is power—power to prevent disease, power to shape populations, power to define sickness and health, and power to compel scientific beliefs into the bodies of people around the globe. It is unsurprising, therefore, that vaccinations have garnered centuries of dissent. Specifically, the conscience—the parent or patient’s perceived right to make vaccination decisions based on personal perceptions of acceptable risks—has been used since vaccination’s inception as a rationale for individual rights to refuse vaccines in the face of the very public health goals that vaccinations aim to achieve. Existing studies of vaccine disputes in medical literature have understood vaccine questions to be a problem of scientific knowledge or literacy, claiming largely that vaccine skepticism arises from a lack of proper comprehension or understanding of the scientific and medical bases for vaccination or statistical evidence proving vaccines are safe and effective. Studies of vaccination controversy in social science, communications, and historical literatures have largely examined the role that alternative notions of risk valuation, sources of trusted health information (such as preferring the advice of friends and neighbors to doctors), or conceptions of uncertainty have played in largely parental decision making about childhood vaccinations. Despite these extensive studies of vaccine sentiment, vaccine skepticism and refusal remains a small, though significant, voice in public debate. This dissertation examines vaccine discourses as object-oriented rhetorics—as rhetorics shaped and defined by the physicality of the vaccine’s operation—as a way of re-conceptualizing the vaccine debate. Using object-oriented theories from computer programming, philosophy, and rhetoric, this research examines the professional and public voices that make up contemporary vaccine controversy. Through three data sets, including interviews with physicians, parent discourses produced on the Internet, and survey responses from young adults, this dissertation observes that vaccines function as objects that have multiple, coexisting operations for different actors across the medical system. Consequently, vaccination controversy can be conceptualized not as accurate versus inaccurate understandings of science or as a conflict of perspectives, but instead as a by-product of multiple ontologies of vaccines at work under competing disease exigencies. / Ph. D.