Magister Public Health - MPH / Immunisation is considered to be amongst the most successful and cost-effective disease prevention interventions available. The Expanded Programme on Immunisation (EPI) in Namibia was established in 1990 to ensure that the immunisation of children takes place within the prescribed age frame. However, continued measles outbreaks, particularly in the Kavango region, are evidence of poor EPI progress, with vaccination coverage being below80% per district. The reasons for the low uptake of measles immunisation in the Nyangana district in the Kavango region are not clearly understood. The aim of this study was, therefore, to investigate the perception of mothers/caregivers of factors that impact on the uptake of measles immunisation in the Nyangana Health District, with a view to improving measles immunisation coverage. Methodology: A qualitative exploratory study design was used to collect data from the study participants. In-depth interviews were conducted with 10 mothers of children under 5 years of age, for both children who received, and those who did not receive measles vaccination. Data was audio-taped and transcribed verbatim. The recorded interviews were translated from the Gciriku language to English. Data was analysed through the use of the Thematic Content Analysis approach. The transcribed interviews and narratives from the research assistant’s notes were organised into codes, sub-themes and main themes. In the final phase, themes were integrated and interpreted, by identifying facilitating factors for those who took their children for immunisation, and barriers for those who did not take theirs. The researcher facilitated assistance to children who did not receive their measles dose, to receive it. Ethical requirements were adhered to throughout the research study process. Results: The study showed that mothers had both positive and negative perceptions about immunisation. The findings revealed that information, and past experience of measles ,irrespective of the level of education, support from a spouse or family members, availabilityof services and convenience of time schedules, increased the uptake of immunisation on thepart of mothers/caregivers. However, it also emerged that supply-side factors, such as lack of information sharing between health care providers and mothers, hindered effective communication. Additionally, inconvenient time schedules and time constraints, staffshortages, health care providers’ attitudes, inaccurate data being kept of children immunisedat other health facilities, inadequate outreach services and perceived lack of supervision in the health facilties all contributed to the low uptake of immunisation. Demand-side factors that affected the uptake of immunisation included: socio-economic constraints that led to an inability to pay transport costs to access immunisation services; lack of support from a spouse; other family members and other support structures in the community also impacted on immunisation uptake, despite the reported awareness and willingness to use immunisation services. Conclusions and recommendations: The study concludes that the relationship between health care providers and mothers/caregivers, and support from other social structures, should be good, in order to motivate mothers to use immunisation services. The study recommends that the following aspects be addressed, as they have the potential to improve the low uptake of measles immunisation: patient/provider relationship, information sharing, and supervision in the health facility, access to services, availability of outreach services, improved data tracking and active involvement of all stakeholders. Laziness was overwhelmingly offered as an explanation for missing measles immunisation, although there are suggestions that there might be underlying causes for what is perceived as laziness, which require further exploration, especially in terms of socio-cultural barriers to immunisation. It is recommended that an in-depth look at the perceptions of health care providers and key informants should be conducted to search for further understanding of contributing factors.

Background and Research Goals. This study aims to see the association between worldviews and HPV vaccine risk perceptions in a sample of Canadian undergraduate students enrolled in Health Sciences and Business programs at the University of Ottawa. It is a follow-up to the Kahan et al. (2010) research in the U.S. that showed the association to be present in a nationally representative U.S. sample. In addition to searching for this association in the Canadian context, this study examines whether worldviews differ between (a) men and women; and (b) students with health sciences and with business degrees. Furthermore, this study tests a set of candidate questions for supplementing the worldview questionnaire of Kahan et al. (2010). Design and Analysis. The data for the study was collected using an Internet-based questionnaire and the study was conducted in two phases. During the first phase, a customized worldview questionnaire was administered. During the second phase, questions related to HPV and Canadian healthcare system were presented. In order to analyze the data, regression models, correlation matrices, and MANOVAs were employed. Results. The findings of this study are that worldviews are related to HPV vaccine risk perceptions. However, though hierarchism was a better predictor then individualism in the Kahan et al. (2010) study, our present research indicates that individualism is a better predictor. Also, our findings, contrary to those of Kahan et al. (2010), suggest that the more individualistic a person is, the more likely he or she is to perceive the vaccine as being safe. With respect to gender, men were more hierarchical. Also, when females in health sciences were compared to women in business, the latter were also more hierarchical. Finally, three healthcare items were identified as possibly benefiting from refinement and inclusion in a worldview instrument more suited for the Canadian context.

Background and Significance: Pertussis infection rates have significantly increased in the United States even though pertussis is a vaccine preventable illness. Alaska has been significantly impacted by this disease and is ranked 3rd highest in the nation for infection rates per capita. Infants less than three months of age suffer the highest proportion of infections. The effects of pertussis are most severe in this age group, sometimes requiring hospitalization and causing death. One theorized contributing factor to the increased pertussis infection rates is the transition to an acellular pertussis vaccine. The acellular component of the Tdap vaccine may wane up to 42% a year, thus decreasing coverage from 10 years to approximately three to five years. The increased infection rate and decreased vaccine efficacy necessitates improved education regarding preventative measures. The cocooning vaccination strategy immunizes all eligible individuals in contact with the infant, thus creating a cocoon of protection.Purpose and Specific Aims: This Doctor of Nursing Practice (DNP) project addresses the need for improved educational material regarding infantile pertussis prevention for Alaskan families having a baby. Throughout this DNP project an educational brochure is developed, emphasizing the importance of pertussis prevention through cocooning vaccination.Methods: The educational brochure was created using the framework of the Health Belief Model (HBM). The HBM was utilized to structure the information included within the brochure to influence individual health behaviors towards immunization of pertussis through cocooning. Evaluation: Three content experts evaluated the brochure utilizing the Patent Education Materials Assessment Tool (PEMAT) auto-scoring tool. Content experts reviewed the brochure and determined the understandability and actionability of the brochure in the form of a percentage. The content expert evaluations all indicated scores of 100%. Conclusion: The brochure created within this DNP Project addresses the educational needs of Alaskan families regarding pertussis infection and the severity of these infections in the infant population. Future implications include brochure production and distribution. The brochure will have the most impact when distributed to maternity units, obstetrical, and gynecological offices in Alaska.

Introduction. The high cost and concern of adverse events, particularly infections, limit the use of biologic disease-modifying anti-rheumatic (bDMARD) therapies. We undertook this retrospective study to document their use for immune-mediated diseases (IMDs) and explore the efficacy, safety, adherence and screening practices prior to initiating bDMARDs in a tertiary referral hospital. Methods. A folder review of all adult and paediatric patients treated for IMDs with bDMARDs at Groote Schuur and Red Cross Hospitals between January 2013 and December 2019. Clinico-demographic particulars, details of bDMARD therapy, and adverse events were collated. Changes in disease activity were measured by diseasespecific tools at 6, 12, 24-months and at the last available visit, and patient adherence to bDMARDs was explored by folder and pharmacy record review. Results. We studied 151 folders, with 182 bDMARDs uses (29 patients used more than 1 bDMARD). Patients were from rheumatology (n= 38: 13 rheumatoid arthritis; 10 spondyloarthritis, 5 Systemic Lupus Erythematosus (SLE) , 5 inflammatory myositis and 5 other conditions); gastroenterology (n=31; 26 Crohn`s and 5 Ulcerative Colitis), dermatology (n=9; psoriasis), neurology (n=4, ophthalmology (n= 25; 6 scleritis, 18 uveitis, 1 optic neuritis), and paediatrics (n= 45, 26 juvenile idiopathic arthritis , 12 SLE, 7 other conditions). The bDMARDs used were TNF inhibitors (112), rituximab (55), tocilizumab (10), anakinra (3), abatacept (1), and tofacitinib (1). The vast majority of patients had an excellent response and were in low disease activity or remission at their last available visit. Adverse events included severe infection (4), tuberculosis (TB) (2), mild infection (4), severe allergic reaction (3), mild skin reaction (14), elevated liver enzymes (2), and worsening interstitial lung disease ILD (1). bDMARD Therapy was discontinued in 18 patients, most commonly due to adverse reaction (9), lack of response (3), poor adherence (2), or remission (1). bDMARD Therapy was changed to alternative therapy in 29 patients, most commonly because of poor response (14), or adverse effects (9) or poor adherence (3). Poor adherence or patients lost to follow-up was noted in 18/182 (9.9%). Complete latent TB infection screening with chest x-ray and TB skin test was performed in only 55 (36.4 %) but INH prophylaxis was given to 51/88 (57.9%) of patients prescribed TNFi therapy. Hepatitis B screening performed in 93 (61.6 %) patients, but most patients (72.2 %) were not tested for Hepatitis B core ab. Hepatitis C screening was performed in 81 (53.6 %) patients. Only 88 (58.3%) patients had a recent HIV test. The majority (17.2%) received the influenza vaccine, but only 24 (15.8 %) received pneumococcal vaccination. Discussion and Conclusion. bDMARD therapy was an effective treatment, and the most common adverse effect was infection (7.2%), with 2 TB infections. Vaccination and screening for TB, viral hepatitis and HIV was suboptimal. Of concern, poor adherence to bDMARDs was frequently encountered.

Background: Little is known about whether there are any longer-term adverse health effects in children following Tdap (tetanus, diphtheria, and acellular pertussis) vaccination during pregnancy. Objective: To assess the association between maternal Tdap vaccination during pregnancy and risk of the following early childhood adverse health outcomes: (1) infections (upper and lower respiratory tract infections, gastrointestinal infections, and otitis media), (2) pediatric asthma, (3) neoplasm, (4) vision or hearing loss, and (5) urgent and in-patient health services utilization. Methods: This retrospective cohort study used multiple linked health administrative databases in the province of Ontario, Canada containing vaccine information in mothers and information on health outcomes in their children up to age 6 years. Infants exposed to prenatal Tdap were matched 1:5 with unexposed infants and outcomes were compared using hazard ratios and incidence rate ratios. Results: No significant adverse associations between prenatal Tdap and our study outcomes were observed. Inverse associations were found with upper respiratory infections (adjusted incidence rate ratio [aIRR]: 0.96, 95% CI: 0.93-0.99), lower respiratory infections (aIRR: 0.93, 95% CI: 0.89-0.98), gastrointestinal infections (aIRR: 0.88, 95% CI: 0.82-0.94), and urgent and in-patient health service utilization (aIRR: 0.95, 95% CI: 0.94-0.97). Conclusions: Our findings support the long-term safety of Tdap administration in pregnancy.

Background: International analyses suggest that routine maternal vaccination with seasonal trivalent influenza vaccine is cost-effective, but few studies have been done in middle- to low- income countries. Method: A decision-tree analysis was modelled for the South African public healthcare setting over one year from a payer's perspective. Direct medical costs and consequences were obtained from published literature. Incremental cost effectiveness ratios (ICERs) and univariate sensitivity analyses were then measured. Discounting was excluded due to the seasonality of influenza, limiting the time horizon to a one year period. Findings: The model predicted that to avert influenza-associated hospitalisations amongst pregnant women and their infants less than six months of age, vaccination of pregnant women was not cost-effective. This was irrespective of whether the universal vaccination or HIV-targeted approach was used. A base model simulating 100% vaccine uptake predicted that seasonal vaccination of 100,000 pregnant women results in an estimated net cost of R69,118,114.05 per neonatal influenza-associated hospitalisation averted. Similarly, the model suggested that vaccinating 100,000 pregnant women would cost R1,197,779.79 per maternal hospitalisation averted. Univariate sensitivity analyses reinforced that influenza vaccination of pregnant women was not cost-effective, except when lower incidence of maternal influenzaassociated hospitalisations associated with antenatal influenza vaccination were simulated where the targeted approach became dominant. The latter analysis predicted savings of R770,530.86 per maternal influenza-associated hospitalisation averted. Interpretation: The ICERs suggest that influenza vaccination amongst pregnant women is not cost-effective in the South African public healthcare sector compared to no vaccination, with respect to averting influenza-associated hospitalisations amongst pregnant women and their infants less than six months of age. However, these estimates should be re-evaluated, pending vaccine effectiveness studies of higher methodological quality for low- and middle- income countries and using cost inputs relevant to South African public healthcare setting. This analysis may provide preliminary information regarding the upscaling of influenza vaccination amongst pregnant women as a priority in the constraints of a limited healthcare budget and careful consideration is required regarding vaccine mobilisation amongst pregnant women. / Dissertation (MSc)--University of Pretoria, 2016. / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Understanding the determinants of COVID-19 vaccine uptake is important to inform policy decisions and plan vaccination campaigns. The aims of this research were to: (1) explore the individual- and country-level determinants of intentions to be vaccinated against SARS-CoV-2, and (2) examine worldwide variation in vaccination intentions. This cross-sectional online survey was conducted during the first wave of the pandemic, involving 6697 respondents across 20 countries. Results showed that 72.9% of participants reported positive intentions to be vaccinated against COVID-19, whereas 16.8% were undecided, and 10.3% reported they would not be vaccinated. At the individual level, prosociality was a significant positive predictor of vaccination intentions, whereas generic beliefs in conspiracy theories and religiosity were negative predictors. Country-level determinants, including cultural dimensions of individualism/collectivism and power distance, were not significant predictors of vaccination intentions. Altogether, this study identifies individual-level predictors that are common across multiple countries, provides further evidence on the importance of combating conspiracy theories, involving religious institutions in vaccination campaigns, and stimulating prosocial motives to encourage vaccine uptake.

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Salmonella is a facultative intracellular bacteria which can grow and replicate within the infected host cells as well as extracellulary. The use of intracellular bacteria that have access to the host cell cytosol may allow a more specific targeting of DNA vaccine vectors to professional Antigen presenting cells (APC). The strategy of using live attenuated Salmonella to deliver plasmid-encoded antigens under the transcriptional control of eukaryotic promoters has been used successfully in vaccination. Another strategy, heterologous antigens can be expressed in Salmonella as fusions with recombinant or native proteins. This approach has been used mainly to direct the expression of the desired antigen to a particular location of the bacterial cell and increase the immunogenicity of foreign antigens by fusing them to proteins that could exert a carrier effect. Salmonella type III secretion system (TTSS)-mediated translocation can be used for efficient delivery of heterologous antigens to the cytosol of antigen-presenting cells leading to prominent both CD4 and CD8 T-cells. In this work we tried SPI2 membranal translocated effectors antigen fusions such as SseJ, SifA, SseL and SteC. Our In-vitro and in-vivo experiments prove that SseJ effector fusion is the best candidate for vaccination. In previous work it was shown that SifB promoter was the most efficient in-vivo inducible promoter. Here we show that SseJ antigen fusion protein under control of SifB is the most efficient in comparison to other effector fusions under control of other invivo inducible promoters. htrA/purD douple mutant S.typhimurium was used as attenuated carrier for vaccination, in this study we find that delta SifA mutant can stimulate in-vitro T-cell proliferation to same level.

Seasonal influenza produces substantial disease within the United States every year. Despite the availability of safe and effective vaccines for influenza, millions of individuals go unvaccinated each flu season, with notable differences across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System (BRFSS), I examine vaccination rates among non-Hispanic whites and Hispanics during the 2000-2009 influenza seasons. After developing a new method that addresses shortcomings of BRFSS vaccination measures, I find that non-Hispanic whites exhibit higher vaccination rates than Hispanics. Through a series of logistic regression models I show that the disparities between non-Hispanic whites and Hispanics narrow after controlling for healthcare coverage and socioeconomic characteristics. This suggests that seasonal influenza vaccination may be improved among U.S. Hispanics by addressing structural barriers in receiving the vaccine, especially access to health care.