Search Results (573)

Background/Objective: Maternal immunization is highly recommended, particularly in developed countries. However, its awareness among pregnant women in Japan remains low. This study aimed to assess the awareness and attitudes toward maternal immunization among pregnant women in Japan and to identify the factors that may promote its acceptance. Methods: We conducted a cross-sectional questionnaire survey among pregnant women attending antenatal checkups at nine facilities in Kanagawa Prefecture, Japan, from August 2024 to January 2025. The survey assessed knowledge and intention regarding maternal immunization for influenza, pertussis, respiratory syncytial virus (RSV), and group B streptococcus (GBS) as well as attitudes toward vaccination costs and information sources. Results: Overall, 523 respondents were included in this study. The overall awareness of maternal immunization was 16%. Willingness to receive vaccinations during pregnancy was reported for influenza (68%), pertussis (58%), RSV (59%), and GBS (71%). A common reason for vaccine hesitancy included uncertainty about its effects on the fetus. The key factors associated with vaccine acceptance were higher educational attainment and prior knowledge of maternal immunization. Regarding costs, most respondents were willing to pay up to JPY 5000 (approximately USD 35). The most frequently prioritized sources were explanations from physicians, followed by explanations from midwives. Conclusions: Despite low awareness, vaccination intention was comparable to that reported in other countries. Points that may contribute to improved vaccine uptake were also identified. These findings may lead to the prevention of infectious diseases in newborns and infants in Japan and possibly improve public health. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

Background: Human papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers, yet vaccination rates remain suboptimal, particularly in Florida. Social influence, including family and peer support, may shape parental decisions to vaccinate their children. In this study, we examined the role of social networks (online and offline) in parental intention to vaccinate their 11- to 12-year-old children against HPV. Methods: We conducted a cross-sectional survey among 746 parents in Florida as part of the Text & Talk trial (2022–2023). Among other questions, parents reported on their intention to vaccinate, perceived social norms, and support received from up to three reported confidants. We performed logistic regression and multivariable analyses to assess the relationship between network support, social norms, and vaccination intent. Results: Seventy percent of parents intended to vaccinate their children. Greater support from the first reported confidant was significantly associated with higher vaccination intention (OR = 1.30, p < 0.0001). Perceived norms among friends (p = 0.01) and higher overall network support (p < 0.0001) were also predictive of intent. The higher the percentage of reported family members, the higher the support received for the vaccine (p = 0.04). Conclusions: Social support, particularly from close confidants and peers, plays a critical role in shaping parental HPV vaccination decisions while accounting for perceived social norms. Public health interventions can leverage peer networks alongside family support to enhance HPV vaccine uptake. Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Background/Objectives: Influenza vaccination plays a crucial role in reducing morbidity and mortality among older adults; however, uptake remains suboptimal, particularly in the post-COVID-19 pandemic. In many settings, countries have not recovered their influenza vaccine coverage rates to the same level as pre-COVID. Therefore, this scoping review systematically identified the behavioral and social drivers (BeSD) influencing influenza vaccination among older adults using the BeSD framework. Methods: A systematic search across five databases included quantitative, qualitative, and mixed-methods studies involving individuals aged 60 years and older. Data were charted across four BeSD domains: thinking and feeling, social processes, motivation, and practical issues. Results: Thirty-nine studies from 24 countries were included. Key barriers encompassed safety concerns, misinformation, financial burdens, logistical challenges, and cultural and language barriers. While motivation was positively associated with vaccination intentions, the transition from intention to behavior remains underexplored, and practical issues have received comparatively limited research attention. Conclusions: These findings underscore the need for multifaceted, behaviorally informed interventions and greater inclusion of under-resourced settings to support equitable influenza vaccination strategies for healthy aging. Full article

Objectives: The Human papillomavirus (HPV) vaccine is a cornerstone of cancer prevention, yet uptake remains suboptimal in many countries. This study analyzed the factors influencing HPV vaccine acceptance among adults, including a focused analysis of parental behaviors. Methods: Data were collected through a web-based survey using a questionnaire. We performed univariable analysis and three logistic regression analyses to investigate the determinants in the overall sample and among parents. Results: A total of 1821 participants were surveyed. HPV vaccination uptake was low, with only 6.9% of the total sample and 7.6% of young adults (18–35 yo) vaccinated. Among parents, 47.9% had vaccinated children aged 12–17, and 21.1% those aged 18 and over. Higher health literacy was associated with positive attitudes (OR 2.03, 95% CI 1.48–2.79), while receiving information from pediatricians or gynecologists was linked to children’s vaccination status (OR 7.30, 95% CI 2.29–23.31) and parents’ intentions for future HPV vaccination (OR 5.86, 95% CI 1.85–18.50). Adequate knowledge emerged as a strong predictor of positive attitudes (OR 6.50, 95% CI 4.91–8.61) and parents’ intentions (OR 4.89, 95% CI 2.21–10.84). Vaccination status was a key factor influencing parental decisions and overall vaccine acceptance. Conclusions: These findings highlight the critical role of health professionals and the need for targeted communication to address persistent knowledge gaps and promote HPV vaccine confidence within general population. Full article

Background: Despite the significant global disease burden associated with HPV infection, the vaccination coverage among female college students in China remains suboptimal. This study aimed to examine HPV vaccination coverage, knowledge levels, and determinants influencing vaccination behavior among female college students in northern China, utilizing the Health Belief Model (HBM) as a theoretical framework. Methods: A cross-sectional online survey was conducted from December 2024 to January 2025, involving 4076 female students from six universities in Jinan, China. The participants were categorized into three groups: vaccinated (VG), willing-to-vaccinate (WTG), and unwilling-to-vaccinate (UTG). Data on sociodemographic characteristics, HPV knowledge, health beliefs, and vaccination behavior were analyzed using ANOVA, chi-square tests, correlation analysis, and multivariate logistic regression. Results: The vaccination rate was 18.11%, with 40.19% expressing willingness to vaccinate and 41.71% expressing unwillingness. Vaccinated students demonstrated higher levels of HPV knowledge (6.66 ± 2.67 compared to 4.76 ± 3.10 in the UTG, p < 0.001) and were predominantly from urban areas (OR = 0.64, p < 0.001). The key determinants of vaccination uptake included perceived benefits (OR = 1.54, p < 0.001), perceived barriers (OR = 3.34, p < 0.001), self-decision-making ability (OR = 1.80, p < 0.001), and social motivation (OR = 0.21, p < 0.001). Notably, increased knowledge was associated with vaccine hesitancy in the WTG group (OR = 0.45, p < 0.001), indicating that information overload may adversely affect decision-making processes. Structural barriers, such as cost (42.63%), safety concerns (46.59%), and misconceptions (e.g., 57.76% cited “no sexual activity” as a reason for refusal), significantly impeded vaccine uptake. Conclusions: The low coverage of HPV vaccination is indicative of deficiencies in knowledge, socioeconomic disparities, and cultural perceptions. Tailored interventions should focus on educational efforts to correct misconceptions, provide subsidized access to vaccines, and implement empowerment strategies that enhance self-efficacy and informed decision-making. Policymakers should incorporate these findings into national cervical cancer prevention programs to address the gap between vaccination intention and behavior among young women in China. Full article

Objectives: Human papillomavirus (HPV) is a leading cause of several cancers, yet HPV vaccination rates among U.S. young adults remain low. This study evaluated the effect of a brief educational video, co-developed with college students, in increasing HPV vaccination intention among unvaccinated college-aged individuals. Methods: A two-group randomized controlled trial was conducted among 215 college students aged 18–26 who had not received the HPV vaccine. Participants were randomly assigned to two interventions: a video group (n = 111) or a leaflet group that viewed a CDC-based educational sheet (n = 104). Pre- and post-intervention surveys assessed HPV knowledge, perceived risk, facilitators and barriers to vaccination, cultural beliefs, and vaccination intention. Data were analyzed using descriptive statistics, t-tests, Wilcoxon Signed-Rank, and Mann–Whitney U tests. Results: At baseline, approximately 56% of the sample (n = 215; mean age = 23.5, 71.2% male) have learned about HPV in the past. Although both groups improved in HPV knowledge, perceived lower risk, and cultural beliefs, between-group differences in these theoretical mediators were not statistically significant. Vaccination intention (those who responded “Yes” or “Maybe”) increased by 10.8% in the video group but decreased by 11.6% in the leaflet group following the intervention; the difference between the two groups was statistically significant (p = 0.03). Conclusions: A brief, participatory, and theory-based video significantly increased HPV vaccination intent among unvaccinated college students. Compared to the leaflet intervention, the video intervention offers a promising and scalable public health strategy for promoting HPV vaccination in this high-risk population. Full article

Background/Objectives: Hispanic immigrants (HIs) in the U.S.A. are disproportionately affected by cervical cancer compared to other groups, at least partly due to low HPV vaccination rates. The aim of this study was to investigate strategies to improve HPV vaccine attitudes and intent of HIs in the U.S.A. by developing and testing the effectiveness of video-based interventions. Methods: This study employed a two-phase mixed-methods approach. In the first phase, focus groups with new and established HIs explored perspectives, concerns about HPV vaccination, types of information to include in a video intervention, and how an effective intervention should be designed. Findings from the focus groups guided the creation of seven short educational videos, including a summary video and a testimonial-based video, addressing key questions about HPV and its vaccine. The second phase, which involved a nationwide survey of 1500 Spanish-speaking HIs, revealed a significant change in overall HPV vaccine attitude generally, and a significant increase in both HPV vaccine intent and attitudes among parents of unvaccinated children. Results: Regression analysis revealed general vaccine attitudes (β = 0.620, p < 0.001), English proficiency (β = 0.066, p = 0.01), and gender (β = −0.072, p = 0.002), as significant predictors of attitudinal changes. Notably, females exhibited less favorable post-intervention attitudes compared to males. Additionally, perceived care from video creators was a strong predictor of normalized gains in vaccine attitudes (β = 0.270, p < 0.001). Video content effectiveness varied; the video addressing vaccine side effects demonstrated the highest impact on attitude improvement. Testimonials and the summary video were also effective in fostering positive changes in attitudes. Despite differences in trust levels between new and established immigrants, both groups valued culturally tailored, Spanish-language information from credible sources. Conclusion: Addressing language and cultural barriers can improve trust in healthcare interventions among Hispanic immigrants in the U.S.A. Public health initiatives should consider these factors to more effectively reduce HPV vaccine hesitancy in this population. Full article

Background/objectives: Influenza vaccines are recommended and free in Australia for children aged <5 years, but uptake remains low at 25.8% compared to the targets of 40% and 50%. National data on barriers hindering paediatric influenza vaccination can inform strategies to improve uptake. The aim of this study was to measure barriers to influenza vaccination in Australian children aged <5 years. Methods: A national, cross-sectional survey of parents of children aged <5 years was conducted in March/April 2024. Parents were recruited using an online panel and asked about their intention to get an influenza vaccine for their youngest child in the upcoming influenza season. An adapted version of the validated Vaccine Barriers Assessment Tool measured 14 influenza vaccination barriers. Analysis assessed the prevalence of barriers and differences between parents intending to and those unsure or not intending to vaccinate by calculating the prevalence difference and 95% confidence interval. Results: A total of 2000 parents were recruited nationally. The most common barrier was parents feeling distressed when thinking about vaccinating their child against influenza (66.1% of intending parents, 65.6% of unsure/not intending parents). The barrier with the largest difference between intending and not intending/unsure parents was not prioritising their child’s influenza vaccination (47.2% vs. 6.1%, PD = 41.1 ppts, 95% CI: 35.9%, 46.3%). Other barriers with large differences were parents not feeling guilty if their unvaccinated child got influenza (41.5% vs. 7.5%, PD = 34.0 ppts, 95% CI: 28.8%, 39.1%) and parents not believing that influenza vaccines are effective (31.3% vs. 3.0%, PD = 28.2 ppts, 95% CI: 23.6%, 32.9%). Conclusions: Parents should be encouraged and supported to prioritise influenza vaccination alongside routine childhood vaccines in campaigns that emphasise disease risk and the importance, safety and effectiveness of influenza vaccination, and by optimising access to influenza vaccination. We recommend conducting similar surveys regularly to monitor trends in parental barriers to childhood influenza vaccination. Full article

Background/Objectives: The Tropis^® ID device (PharmaJet^®), a needle-free injection system, is a World Health Organization prequalified, hand-held device, which delivers intradermal injections without the use of needles and has previously been used for the delivery of fractional doses of inactivated polio vaccine (fIPV) in campaign and house-to-house settings. This implementation research study aimed to comparatively evaluate the vaccine coverage, cost, feasibility, and acceptability of using Tropis for fIPV for routine immunizations in two states in Nigeria (Kano and Oyo). Methods: The study included: (i) a cluster randomized trial (22 intervention facilities using Tropis for fIPV and 30 control facilities using the standard of care [SoC—full-dose IPV]) to assess the effectiveness in terms of improving the coverage of two doses of IPV, using a coverage survey involving 3433 children (aged 3–12 months); (ii) a pre- and post-implementation micro-costing evaluation involving the intervention facilities to estimate the costs; and (iii) mixed methods assessments (post-training assessment, provider survey, key informant interviews, and focus group discussions) to assess the feasibility and acceptability of fIPV delivery using Tropis. Results: The intention-to-treat analysis among the 3433 children surveyed did not show any difference between the intervention and control groups, primarily due to low compliance (approximately 50% of target beneficiaries reported Tropis use). The more relevant per protocol analysis, adjusting for lower compliance, showed that among those vaccinated with Tropis, second dose IPV coverage was 11.2% higher than the SoC. The delivery of fIPV using Tropis compared to the SoC resulted in incremental program cost savings, ranging from USD 0.07 to USD 1.00 per dose, administered across the scenarios evaluated. High acceptability was seen amongst caregivers (94%), and 95% of healthcare workers preferred Tropis over the SoC. Conclusions: Tropis is effective, feasible, acceptable, and saves costs when used as part of routine immunization programs. Full article

Infectious diarrhea caused by Shigella remains a significant global health concern, and several vaccine candidates are approaching phase III clinical studies in the target population of young children in low- and middle-income countries. The World Health Organization (WHO) has published preferred product characteristics (PPCs) for Shigella vaccines to provide strategic guidance that aids in advancing product development and highlights policy considerations for use in LMIC settings where the vaccine is most needed. However, the selection of appropriate clinical endpoints was not clearly defined within the PPCs and remains an important issue for phase III study design. Previously, an expert panel identified areas of alignment and consensus on many clinical study design components while also recognizing that further discussions and data were required to solidify recommendations on key study design aspects. Therefore, WHO convened a diverse range of stakeholders, including manufacturers, regulators, and policymakers across national, regional, and global levels, with the aim of achieving consensus and soliciting inputs from the regulatory community surrounding vaccine phase III study design considerations. The intent of this report is to outline the key points from those discussions to inform the phase III design strategies and investment decisions of product developers and donors and to share recommendations for next steps. Full article

Research on vaccination hesitancy has been extensive, but the role of information processing in decision making still needs to be explored. The study examines the alignment between parents’ COVID-19 vaccination intentions and actual behavior, focusing on the impact of different kinds of information processing on the consistency or inconsistency of these behaviors. It analyzes parents’ reliance on health information sources, and education levels, with institutional trust, ability to critically evaluate conspiracy theories and scientific knowledge as moderators. A total of 1118 Israeli parents participated in digital surveys and were classified into the following 4 groups based on their initial vaccination intentions and actual behaviors: (1) consistent—pro-vaccine and vaccinated; (2) inconsistent—pro-vaccine but unvaccinated; (3) inconsistent—anti-vaccine but vaccinated; and (4) consistent—anti-vaccine and unvaccinated). The results show that consistent parents process information using system 1, i.e., heuristic information processing, reliance on health information sources, moderated by institutional trust and education. However, inconsistent parents used systems 1 and 2, namely heuristic–systematic information processing, influenced by knowledge of COVID-19 and the ability to assess conspiracy theories critically. Full article

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related mortality in the United States, with poor overall survival across all stages. Less than 20% of patients are eligible for curative surgical resection at diagnosis, and despite adjuvant chemotherapy, most will experience disease recurrence within two years. The incorporation of immune-based strategies in the adjuvant setting remains an area of intense investigation with unrealized promise. It offers the potential of providing durable disease control for micro-metastatic disease following curative intent surgery and enabling personalized treatments based on mutational neoantigen profiles derived from resected specimens. However, most of these attempts have failed to demonstrate significant clinical success, likely due to the immunosuppressive tumor microenvironment (TME) and individual genetic heterogeneity. Despite these challenges, immune-based strategies, such as therapeutic vaccines targeted towards neoantigens, have demonstrated promise via immune activation and induction of T-cell tumor infiltration. In this review, we will highlight the foundational lessons learned from previous clinical trials of adjuvant immunotherapy, discussing the knowledge gained from analyses of trials with disappointing results. In addition, we will discuss how these data have been incorporated to design new agents and study concepts that are proving to be exciting in more recent trials, such as shared antigen vaccines and combination therapy with immune-checkpoint inhibitors and chemotherapy. This review will evaluate novel approaches in ongoing and future clinical studies and provide insight into how these immune-based strategies might evolve to address the unique challenges for treatment of PDAC in the adjuvant setting. Full article

Background/Objectives: In 2022, the full-scale invasion in Ukraine forced over 6 million Ukrainians, primarily mothers and children, to seek safety outside of the country. This massive influx has posed a significant challenge to the Polish healthcare system, particularly regarding routine vaccination for children. This study aims to examine the vaccination intentions of displaced Ukrainian mothers, their compliance with the Polish National Immunisation Programme (PNIP), and the factors that influence these intentions. Methods: A web-based survey (June–July 2023) was conducted among Ukrainian mothers in Poland. The questionnaire assessed the importance placed on vaccination, knowledge of PNIP, and concerns related to displacement and vaccination. Hierarchical logistic regression identified key determinants. Results: Among 2572 respondents, 64.5% reported that their children had received only some or none of the recommended vaccines. Key barriers included unfamiliarity with PNIP, limited knowledge of vaccines, and concerns about vaccine side effects. Of mothers whose children had not followed PNIP, 41.7% intended to vaccinate, 33.1% refused, and 25.2% were undecided. Regression analysis identified perception of vaccination importance as the strongest predictor. Partial adherence to PNIP doubled vaccination likelihood, while a firm plan to return to Ukraine reduced it 2.4 times. Mistrust in vaccines increased refusal risk tenfold. The final model confirmed mothers’ attitudes towards vaccination and future plans (return to Ukraine) as dominant factors. Conclusions: This study underscores the complex determinants shaping vaccination decisions in conflict-displaced communities. It provides insights for public health strategies to enhance vaccine uptake by reducing access barriers, restoring trust, and strengthening vaccine literacy. Full article