Search Results (556)

Political polarization in policy evaluations arises from identity-driven cognitive–affective dynamics, yet the neural mechanisms underlying the real-time processing of policy texts remain unexplored. This study bridges this gap by employing EEG to capture neurobehavioral responses during a COVID-19 vaccine mandate judgment task. The analysis of 70 politically stratified participants revealed significantly elevated gamma1 (30–50 Hz) activity in the right prefrontal cortex among policy supporters, reflecting enhanced attentional engagement and value integration. These topographically specific neural dissociations demonstrate how ideological alignment modulates cognitive–affective processing. Our findings establish EEG as a robust tool for quantifying implicit identity-driven evaluations, offering new pathways to decode polarization in contested policy contexts. Full article

African, Caribbean, and Black (ACB) communities face increased COVID-19 morbidity and mortality, coupled with significant barriers to vaccine acceptance and uptake. Addressing these challenges requires innovative, multifaceted strategies. Peer-led interventions, grounded in critical health literacy (CHL) and critical racial literacy (CRL), and integrating collaborative equity learning processes, can enhance community capacity, empowerment, and health outcomes, contributing to long-term health equity. This paper describes and presents the evaluative outcomes of a peer-led intervention aimed at enhancing COVID-19 vaccine confidence and acceptance. The Peer-Equity Navigator (PEN) intervention consisted of a specialized training curriculum grounded in CHL and CRL. Following training, PENs undertook a 5-month practicum in community or health settings, engaging in diverse outreach and educational activities to promote vaccine literacy in ACB communities. The evaluation utilized a modified Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, using quantitative and qualitative methods to collect data. Sources of data included tracking records with community feedback, and a PEN focus group, to assess program feasibility, outreach, and effectiveness. From 16 September 2022, to 28 January 2023, eight trained PENs conducted 56+ community events, reaching over 1500 community members. Both PENs and community members reported high engagement, endorsing peer-led, community-based approaches and increased vaccine literacy. The PEN approach proves feasible, acceptable, and effective in promoting positive health behaviors among ACB communities. This intervention has clear implications for health promotion practice, policy, and research in equity-deserving communities, including immigrants and refugees, who also face multiple and intersecting barriers to health information and care. Full article

Background/Objectives: Vaccine hesitancy is becoming an increasing concern, leading to preventable outbreaks of infectious diseases. During the COVID-19 pandemic, the United States served as an intriguing case study for exploring how risk perception and trust in health authorities, including scientists, are influenced by government policies and how these factors affect vaccine hesitancy. Methods: We conducted a secondary analysis using the MIT COVID-19 Survey dataset to investigate whether risk perception and trust differ between states governed by Democratic or Republican governors. Results: Our analysis (n = 6119) found that participants did not vary significantly by state political affiliation in terms of their sociodemographic factors (such as age, gender, self-rated health, education, and whether they live in a city, town, or rural area), their perceived risk for the community, or their ability to control whether they become infected. However, there was a difference in the perceived risk of infection, which was higher in states governed by Republicans. Trust also varied by gubernatorial affiliation, with higher levels of trust reported among residents of Democratic-leaning states. We also found a strong mediation effect of trust on vaccine hesitancy, but this was not the case for risk perception. Conclusion: Therefore, it appears that vaccine acceptance relies on trust in health authorities, which is influenced by governmental policies. State officials should work with local health officials to build trust and increase timely responses to public health crises. Full article

Objectives: To confirm a conjecture from year 2020 of the SARS-CoV-2 (COVID-19) pandemic suggesting policy alternatives to substantially reduce mortality burden. Methods: Data from a global COVID-19 database comparing different countries on cumulative mortality and vaccination were analyzed in conjunction with surveys of seropositivity. Predictions of final mortality burden under an alternate policy scenario for Japan were calculated and the COVID-19 outcomes for China were assessed. Results: By 2025, Western countries (US, UK, Brazil and Italy) had cumulative mortality rates in the range of 3339–3548 deaths per million, about 6-fold higher than East Asian and New Zealand ‘zero-COVID’ countries. Moderate virus suppression in Japan produced the lowest cumulative mortality of the countries analyzed; if earlier policies had been maintained, the predicted cumulative mortality rate by 2025 would be one-tenth that of the US, UK, Brazil and Italy and one-half to one-third that of other zero-COVID countries. For China, transitioning from a zero-COVID policy in 2022–2023, the estimated 2025 cumulative mortality was 1607/million, half that of Western countries. Conclusions: To minimize COVID-19 mortality would require: (1) Innovation on systematic sampling of ambient airborne virus exposure to sustain low but non-zero virus levels across entire populations, and (2) seropositivity assessment (instead of mass PCR testing for new cases) for calibrating exposure management, and tracking and protecting high-risk populations. Full article

In Ukraine, SARS-CoV-2 detection and national genomic surveillance have been complicated by full-scale war, limited resources, and varying levels of public health infrastructure impacted across the country. Following the Spring of 2022, only a paucity of data have been reported describing the prevalence and variant dynamics of SARS-CoV-2 in the country. Comparative whole genome analysis has overtaken diagnostics as the new gold standard for detecting and tracing emerging variants while showing utility to rapidly inform diagnostics, vaccine strategies, and health policy. Herein, we provide an updated report characterizing the dynamics and prevalence of SARS-CoV-2 in Ukraine from 1 May 2022 to 31 March 2024. The present study extends previous reports for disease incidence Waves 1–4 in Ukraine with the addition herein of Waves 5, 6, and 7, occurring from August to November 2022 (Wave 5), February to May 2023 (Wave 6), and October 2023 to January 2024 (Wave 7). During the study period, the national Case Fatality Rate (CFR) fluctuated between 0.46% and 1.74%, indicating a consistent yet modest rate when compared to the global average. The epidemiological dynamics of Variants of Concern (VOCs) in Ukraine reflected global patterns over this period, punctuated by the rise of the BA.5 lineage and its subsequent replacement by the Omicron subvariants XBB and JN.1. Our analysis of variant dispersal patterns revealed multiple potential spatiotemporal introductions into Ukraine from Europe, Asia, and North America. Our results highlight the importance of ongoing genomic surveillance to monitor variant dynamics and support global efforts to control and mitigate COVID-19 disease risks as new variants arise. Full article

Background: Influenza is a significant global respiratory infection, and vaccinating reproductive-age women, particularly in densely populated countries like China, cannot be overlooked. In this study, we aimed to determine influenza vaccination coverage, vaccine hesitancy, as well as associated factors among Chinese women aged 18–49 years old. Methods: A cross-sectional survey among women aged 18–49 years was conducted in China from 15 to 30 March 2023. We collected information such as past-year influenza vaccination, demographic characteristics, health-related factors, COVID-19-related factors, and perceived susceptibility and severity of influenza. Influenza vaccine acceptance among participants who did not receive influenza vaccination in the past year was also investigated. Multivariable logistic regression analyses were employed to investigate the influencing factors of vaccine coverage and vaccine hesitancy. Results: A total of 1742 reproductive-aged women were included in the final analysis. The past-year influenza vaccine coverage among women aged 18–49 years old was only 39.32% in China. Age ≥ 35 years (aOR = 0.72, 95% CI: 0.56–0.94), renting accommodation (aOR = 0.57, 95% CI: 0.44–0.75), and history of COVID-19 infection (aOR = 0.65, 95% CI: 0.47–0.89) and COVID-19 vaccine hesitancy (aOR = 0.39, 95% CI: 0.29–0.54) were all identified as negative correlates of influenza vaccine coverage among Chinese reproductive-aged women, while participants with a history of chronic diseases (aOR = 1.57, 95% CI: 1.23–2.01) and noticeable pandemic fatigue due to COVID-19 (aOR = 1.45, 95% CI: 1.05–2.00) were prone to have higher vaccination rates. Among reproductive-aged women who did not receive influenza vaccination in the past year, the hesitancy rate regarding future influenza vaccination was 31.79%. Factors such as older age, urban residence, living with others, poor self-rated health status, absence of chronic diseases, completion of full COVID-19 vaccination, COVID-19 vaccine hesitancy, pandemic fatigue, and failure to perceive the susceptibility and severity of influenza might increase influenza vaccine hesitancy. Discussion: Overall, a lower coverage rate of influenza vaccine was notably observed among Chinese reproductive-age women, as well as the hesitancy regarding future vaccination. To effectively mitigate the impact of influenza and reduce the incidence of associated diseases, it is imperative to devise targeted intervention strategies and policies tailored to reproductive-age women. Full article

Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18–64 years with at-risk medical conditions. Methods: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. Results: We included 44 studies. Multi-component strategies (n = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, p < 0.001). Reminder-based interventions (n = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies (n = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, p < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% (p < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96–2.27; p < 0.001, I² = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53–3.98; p < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33–2.44; p < 0.001, I² = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49–3.92; p < 0.001) with random effects. No publication bias was detected. Conclusions: Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity. Full article

Background: Elderly patients with chronic lower respiratory diseases (CLRDs) demonstrate an increased susceptibility to complications arising from influenza. Influenza vaccination remains the most effective strategy against influenza-related diseases among elderly CLRD patients. This study aimed to evaluate the influenza vaccination status of older CLRD patients and the factors affecting influenza vaccination. Methods: Using population-based health registries, we analyzed the longitudinal uptake of influenza vaccination among elderly patients with CLRDs in Ningbo from the 2018/19 season to the 2022/23 season. A multivariate logistic regression analysis was performed to identify behavioral determinants influencing influenza vaccination among elderly CLRD patients under Ningbo’s post-pandemic free vaccination policy. Results: An average of 487,309 older patients with CLRDs were included in our analysis for each season. The influenza vaccination rate increased from 3.59% in 2018/19 to 43.32% in the 2022/23 influenza season. There was a significant increase in the proportion of timely influenza vaccinations prior to November 15, rising from 3.01% before the COVID-19 pandemic to 33.90% during the pandemic period. The multivariate logistic regression analysis indicated that both the COVID-19 pandemic and free vaccination policy significantly promoted influenza vaccine uptake. Older CLRD patients with comorbidities such as diabetes, hypertension, or cancer exhibited higher influenza vaccination coverage, whereas those who have experienced acute cardiovascular events showed a lower vaccination rate. Additionally, a prior vaccination history significantly influenced uptake. Conclusions: Despite the significant improvement in vaccination rates, coverage among elderly patients with CLRDs remains below the WHO target. Addressing this gap requires integrated interventions that combine expanding the population eligible for free vaccinations, community mobilization efforts, and effective communication regarding cardiovascular safety to mitigate vaccine hesitancy within high-risk groups. Full article

Background/Objectives: Maintaining high childhood vaccination coverage is essential to prevent outbreaks of vaccine-preventable diseases. In Italy, Law No. 119/2017 introduced mandatory childhood immunizations, leading to significant improvements. However, the COVID-19 pandemic disrupted routine services, potentially jeopardizing these gains. This study aimed to evaluate national and regional trends in vaccine coverage across three phases: post-mandate (2015–2016 vs. 2017–2019), pandemic (2017–2019 vs. 2020–2021), and post-pandemic recovery (2020–2021 vs. 2022–2023). Methods: National and regional administrative data on vaccination coverage at 24 months of age were obtained from the Italian Ministry of Health. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs), and absolute changes in coverage (Δ) were calculated across defined periods. Pearson correlation coefficients were used to assess associations between baseline coverage and subsequent changes. Results: After the 2017 mandate, coverage increased significantly for varicella (APC = +28.6%), MenB (+22.6%), and measles (+3.4%). Regionally, varicella coverage rose by up to +58.4% in Emilia-Romagna and measles by +11.1% in Campania. During the pandemic, coverage declined for polio (−2.4% in the South) and measles (−6.2% in Abruzzo), while MenB increased in regions with lower initial uptake (r = −0.918, p < 0.001). Post-pandemic, coverage rebounded, with varicella improving by +20.1% in central regions and measles by +13.9% in Abruzzo. A strong inverse correlation between baseline coverage and improvement was observed for varicella across all periods (r from −0.877 to −0.915). Conclusions: Mandatory vaccination policies led to substantial coverage improvements, and despite the disruption caused by the pandemic, recovery trends were observed for most vaccines. The consistent association between low baseline coverage and stronger gains highlights the resilience of the system, but also the ongoing need for regionally tailored strategies to reduce geographic disparities and ensure equitable immunization across Italy. Full article

Background/Objectives: Despite significant advancements in vaccine development and distribution, the optimal timing and integration of COVID-19 vaccination in Canada remain crucial to public health. As the SARS-CoV-2 virus continues to evolve, determining effective timing strategies for booster doses is necessary to sustain immunity, especially in high-risk populations. This systematic review aims to critically evaluate the timing and co-administration strategies of COVID-19 vaccines in Canada, comparing them with approaches in other G7 nations. Methods: The review seeks to identify best practices to inform national vaccination policies, with a particular focus on synchronizing COVID-19 and seasonal influenza vaccinations. We systematically searched Scopus, PubMed, Medline, and Web of Science (17 August 2021 to 7 July 2024) using the PECOS framework. Two independent reviewers screened titles/abstracts, extracted key data on immunogenicity, efficacy, and safety, and performed a narrative synthesis on timing and co-administration outcomes. Results: Evidence summarized across G7 countries reveals that most nations are converging on annual or flexible booster schedules tailored to high-risk groups, often aligning COVID-19 vaccination with influenza campaigns. Countries like Canada, the UK, and the US have integrated these efforts, while others maintain more independent or heterogeneous approaches. In addition, timely booster doses, whether administered annually or more frequently in high-risk settings, consistently reduce infection rates and hospitalizations. Conclusions: These findings collectively support the continued evolution of COVID-19 vaccination programs toward integrated, seasonally aligned strategies. Future public health efforts can build on these lessons not only to sustain protection against SARS-CoV-2 but also to strengthen preparedness for other respiratory infections. Full article

Background/Objectives: In addition to classical transmission routes, hepatitis A (HA) outbreaks were, for the first time, linked to sexual activity in the late 1970s, particularly among men who have sex with men (MSM). Since then, outbreaks have continued to emerge globally among adults engaging in high-risk sexual behaviors, reinforcing the ongoing public health significance of this transmission route. Although the COVID-19 pandemic temporarily reduced HA cases, outbreaks reemerged following the relaxation of pandemic measures. This study aims to report the HA outbreak registered at Romania’s tertiary infectious diseases hospital during the first half of 2022. Methods: We retrospectively analyzed all HA cases admitted to the National Institute for Infectious Diseases from 1 January to 1 August 2022. Results: Among 51 cases, eight children (under 14) were excluded from further analyses. Of the 43 remaining cases, 37 (86%) were male, with 20/37 (54.05%) identified as MSM. Twenty-two of the males (59.45%) were previously or concomitantly diagnosed with sexually transmitted diseases (STDs), notably syphilis and HIV. A marginal finding: 14 out of 29 patients screened for hepatitis E tested positive for IgM. The MSM patients exhibited significantly higher transaminase levels (ALT median level 3404 U/L [IQR 2608–5448] vs. 2066 U/L [IQR 1393–3682]) and more severe liver impairment (INR median level 1.37 [IQR 1.18–1.78] vs. 1.18 [IQR 1.11–1.43] compared to non-MSM patients. While direct bilirubin levels were higher in MSM (7.4 mg/dL vs. 5.5 mg/dL), the difference was not statistically significant. Conclusions: An HA outbreak occurred at the beginning of 2022 among Romanian young MSM, with a more severe acute liver injury. High-risk sexual practices may be a potential risk factor for severe HA. This emphasizes the need to screen for STDs in young males with HA and review vaccination policies for at-risk individuals. Full article

Coronavirus disease 2019 (COVID-19) resulted in significant morbidity and mortality globally. Despite the efficacy of COVID-19 vaccines in reducing morbidity and mortality, uptake in South Africa was sub-optimal due to a number of factors which remain not fully understood, particularly in mandatory vaccination workplace settings. This quantitative, cross-sectional study aimed to understand determinants of COVID-19 vaccination uptake among clinical and non-clinical workers, aged 18 years and older, employed at a large organisation with a mandatory workplace COVID-19 vaccination policy in South Africa. Workers completed a one-off, self-administered, online questionnaire that explored determinants of COVID-19 vaccination, barriers and enablers to accessing vaccines, and perspectives regarding the mandatory workplace vaccine policy. Among the 88 workers enrolled in the study, the frequent reasons for COVID-19 vaccination included preventing the spread of COVID-19 (71%, n = 62), fear of contracting COVID-19 (64%, n = 56), protecting colleagues and patients (63%, n = 55), and the mandatory workplace policy (65%, n = 57). Just under two-thirds of workers (63%, n = 55) were supportive/very supportive of the mandatory COVID-19 vaccine policy. Reasons for support included the fact that vaccination would create a safer work environment, protecting oneself/others from acquiring COVID-19, and receiving support from their employer. Only 15% (n = 13) of workers were not supportive/against the policy. The findings of this study could inform occupational health policy and counselling and support in workplaces in future pandemics. Full article

Background/Objectives: Cervical cancer is a significant issue in Indonesia, with many cases diagnosed at advanced stages. Although the human papillomavirus (HPV) vaccination has long been recommended by the WHO, it was only recently included in Indonesia’s immunization program in 2023. This study aimed to examine the existing prevention strategies and their effectiveness through systematic review of the existing literature. Methods: We searched for cost-effectiveness studies of HPV vaccination in Asia Pacific countries from inception until 23 July 2023, using MEDLINE, Embase, and the Cochrane Library databases. The search strategy included keywords and subject terms for primary prevention, HPV vaccination, cervical cancer, and selected Asia Pacific Countries (Thailand, Vietnam, China, Singapore, Malaysia, Philippines, Korea, Japan, Taiwan, Australia, New Zealand, and Hong Kong). Studies selected were limited to original research articles with full text published in English in peer-reviewed journals, describing the cost-effectiveness of HPV vaccination in cervical cancer prevention in the Asia Pacific countries. Studies were excluded if there were no full text was available, if it was the wrong study design, non-English, or not based in the specific Asia Pacific countries selected. The titles and abstracts were screened, followed by full-text reviews using Covidence software, and analyzed using Excel. Results: Forty-three studies were included for review: 51% in high-income countries (HICs), 37% in upper-middle-income countries (UMICs), and 12% in low-middle-income countries (LMICs). All studies concluded that HPV vaccination is more cost-effective than screening alone. Nonavalent HPV vaccines were more cost-effective in HICs (80%), bivalent vaccines were more cost-effective in UMICs (66%), and gender-neutral vaccination was cost-effective compared to screening in all studies conducted. Conclusions: HPV vaccination is a cost-effective prevention strategy for cervical cancer across all resource settings, offering greater value compared to screening alone. Selecting the most economically viable vaccine type and expanding to gender-neutral vaccination could enhance early prevention efforts. These findings offer guidance for Indonesia in designing evidence-based HPV vaccination policies as a part of national cancer control efforts. Further investigation is necessary to determine the optimal strategy for HPV vaccination in Indonesia. Full article

Background/Objectives: This retrospective observational study investigated coronavirus disease 2019 (COVID-19)-related mortality trends in the US throughout the pandemic. Methods: We performed a retrospective, descriptive analysis between 2020 and 2024 using data from the US National Center for Health Statistics. Results: The total number of COVID-19 deaths rose by 19% from 2020 to 2021, followed by a significant decline in the subsequent years, with an average reduction factor of 0.44. Mortality rates remained higher in males compared to females, with a gender disparity between 52 and 62%. Age-specific crude mortality rates increased with advancing age, with higher mortality observed in older populations. However, crude death rates significantly declined across all ages except for the 1–4 years group, which experienced a 33% increase. The majority of fatalities occurred in medical facilities (63–80%), but this proportion gradually decreased over time, while the percentage of deaths occurring at home nearly doubled from 2020 to 2024 (6% to 11%). Conclusions: The initial mortality peak for COVID-19 was followed by a substantial decline, likely influenced by the widespread availability of vaccines, improvements in clinical management, and the emergence of less virulent variants. The persistent gender and age disparities, alongside the fluctuating distribution of the places of death, offer insights for refining healthcare policies and optimizing resource allocation in this and other future pandemics. Full article

Background: Maternal vaccination is a critical primary preventive approach and an integral part of life-course immunization strategy, influencing the infection-associated morbidity and mortality in pregnant women, foetuses, and young infants. Despite clear guidelines for the administration of vaccines against tetanus, diphtheria, pertussis (Tdap), influenza, and COVID-19 during pregnancy, maternal vaccination rates remain suboptimal in Ireland as per the National Immunisation Office of the Health Service Executive (HSE). Aim: This review explores the prevailing status, uptake factors, and maternal immunization-specific vaccine hesitancy in Ireland. Method: A scoping review was conducted, searching nine electronic databases, including the Irish health research repository Lenus. The search strategy utilised a Population–Concept–Context framework (pregnant women—vaccine uptake/hesitancy—Ireland). Key factors identified and categorised according to the 5A framework: access, affordability, awareness, acceptance, and activation. Results: Searches yielded 2457 articles, and 12 eligible studies were included for review. Influencing factors were identified in each of the 5A dimensions, with the majority relating to acceptance and awareness. Positively associated factors included healthcare provider (HCP) recommendation and knowledge of vaccine safety. Potential antenatal barriers were maternal lack of knowledge of vaccine-preventable illness severity, infection risks, and vaccine safety concerns. A pregnant woman’s primary motivation for antenatal immunization was protection of her infant; however, the reluctance of HCPs to prescribe all recommended antenatal vaccines, inadequate immunization-specific discussion during antenatal consultations, and suboptimal knowledge of pregnancy-specific vaccine safety hampered potential positive influences. The Irish national immunization policy was a facilitator of affordability. Activation can be achieved through public health awareness campaigns and interdisciplinary promotion of maternal vaccination uptake. Conclusions: Maternal vaccination uptake in Ireland remains suboptimal, and a coordinated, targeted approach updating HCP recommendations, enhancing maternal awareness, and highlighting vaccine safety in pregnancy would be required to meet the life-course immunization goals recommended by WHO. By adopting a life-course immunization approach for healthy living, with maternal vaccination as the pivotal central point, vaccination programmes could close immunity gaps at various life stages. Full article