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Fulltext Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

Ghazy RM, Abdou MS, Awaidy S, Sallam M, Elbarazi I, Youssef N, et al.

Int J Environ Res Public Health, 2022 Sep 25;19(19).
PMID: 36231447 DOI: 10.3390/ijerph191912136

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

Matched MeSH terms: Immunization, Secondary
Fulltext Socioecological Challenges of Polio Supplementary Immunization Activities (SIAs) in the Asia-Pacific Region: A Systematic Review

Ahmad H, Sanef SA, Shahabudin WZ, Mohtar N, Hassan MR, Jeffree MS, et al.

J Environ Public Health, 2023;2023:4801424.
PMID: 36747498 DOI: 10.1155/2023/4801424

BACKGROUND: Polio supplementary immunization activities (SIAs) are one of the polio eradication pillars in the Global Polio Eradication Initiative (GPEI) that increased the immunization coverage and made progress towards polio eradication. However, socioecological challenges faced during SIAs contribute to suboptimal campaign quality. The aim of this review is to identify the reported challenges during polio supplementary immunization activities (SIAs) and associated improvement strategies based on the socioecological model (SEM).
METHODS: Articles were searched from three databases which were WOS, Scopus, and PubMed. The systemic review identified the primary articles related to SIA that focused on the impact of immunization coverage, challenges, and improvement strategies. The inclusion criteria were open access English articles that were published between 2012 and 2021 and conducted in the Asia region.
RESULTS: There are nine articles described and explained regarding some form of supplementary immunization activities (SIAs) in their findings across Asia region. The majority of studies selected reported on post vaccination coverage and revealed a multifaceted challenge faced during SIAs which are widely diverse range from the microlevel of interpersonal aspects up to the macrolevel of government policy. Upon further analysis, the intervention at community level was the most dominant strategies reported during the SIA program.
CONCLUSIONS: An effective SIAs program provides the opportunity to increase the national capacity of the polio immunization program, reducing inequities in service delivery and offering additional public health benefits in controlling polio outbreaks in both endemic and nonendemic countries. Strengthening routine immunization (RI) programmes is also important for the sustainability of SIA's programs. Despite the challenges and hurdles, many Asian countries exhibited great political willingness to boost polio immunization coverage through SIA efforts.

Matched MeSH terms: Immunization
Fulltext Awareness, knowledge, disease prevention practices, and immunization attitude of hepatitis E virus among food handlers in Klang Valley, Malaysia

Rajendiran S, Li Ping W, Veloo Y, Syed Abu Thahir S

Hum Vaccin Immunother, 2024 Dec 31;20(1):2318133.
PMID: 38433096 DOI: 10.1080/21645515.2024.2318133

Concern about the zoonotic Hepatitis E virus (HEV) is rising. Since, food handlers are at greater risk in contracting HEV, the present study aims to determine awareness, knowledge, prevention practices against HEV, and immunization attitudes. A cross sectional study was conducted among 400 food handlers in Klang Valley, Malaysia from December 2021 to March 2022. A structured questionnaire was employed for data collection and analysis with Statistical Package for Social Science (SPSS) version 29. Approximately 4.5% of the respondents (18) reported having heard of HEV, while the median scores for the knowledge and practice domains were 0/10 and 1/5, respectively. A total of 316 (79%) respondents expressed willingness to obtain vaccination if made available. This study also found that those respondents who completed their tertiary education were significantly possessed better knowledge of the disease [odd ratio (OR) = 8.95, and 95% confidence interval (CI) 4.98-16.10]. Respondents with HEV awareness reported considerably better practices (OR = 8.24, 95% CI 1.72-39.63). Food handlers with one to five years of experience in the industry expressed notable willingness to take vaccination (OR = 7.71, 95% CI 1.79-33.18). Addressing poor HEV awareness and knowledge and poor practices against the disease is crucial in enlightening the policy makers about awareness among food handlers and general population. Nonetheless, a good immunization attitude, significant acceptance toward vaccination even with the vaccine being unavailable in Malaysia, and limited awareness of HEV highlight a promising development.

Matched MeSH terms: Immunization
Estimation of immunization providers' activities cost, medication cost, and immunization dose errors cost in Iraq

Al-lela OQ, Bahari MB, Al-abbassi MG, Salih MR, Basher AY

Vaccine, 2012 Jun 6;30(26):3862-6.
PMID: 22521848 DOI: 10.1016/j.vaccine.2012.04.014

The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors.

Matched MeSH terms: Immunization/economics*; Immunization/utilization*
Fulltext Current issues facing the introduction of human papillomavirus vaccine in China and future prospects

Wong LP, Han L, Li H, Zhao J, Zhao Q, Zimet GD

Hum Vaccin Immunother, 2019;15(7-8):1533-1540.
PMID: 31017500 DOI: 10.1080/21645515.2019.1611157

The introduction of human papillomavirus (HPV) vaccination in China aims to prevent HPV infection in all women. The issues that China might face include high cost of vaccines made in other countries, shortage in HPV vaccine supply, negative events attributed to vaccination (whether justified or not) that jeopardizes the general public's confidence in the HPV vaccine, cultural and literacy barriers, and sensitivity to receiving a vaccine for a sexually transmitted disease. Ensuring the effective delivery of the HPV vaccine in China, a country with vast economic, geographical, and cultural complexities, will require a commitment of significant resources. In light of the high price of imported vaccines, the availability of locally manufactured HPV vaccines would greatly facilitate the national HPV vaccination program. New evidence supporting the efficacy of a two-dose regime in younger adolescents would also be advantageous in terms of affordability and logistical simplicity of vaccine administration. Furthermore, it would potentially enhance the compliance and uptake, especially for hard to reach women in remote regions.

Matched MeSH terms: Immunization Programs/economics; Immunization Programs/organization & administration*
The "built-in failure-rate" of immunisation at infant-health clinics

Dugdale AE

Lancet, 1969 Feb 22;1(7591):409-11.
PMID: 4179241 DOI: 10.1016/S0140-6736(69)91371-3
Matched MeSH terms: Immunization; Immunization Schedule*
Systematic review of cost-effectiveness studies of human papillomavirus (HPV) vaccination: 9-Valent vaccine, gender-neutral and multiple age cohort vaccination

Ng SS, Hutubessy R, Chaiyakunapruk N

Vaccine, 2018 05 03;36(19):2529-2544.
PMID: 29625764 DOI: 10.1016/j.vaccine.2018.03.024

BACKGROUND: The success of human papillomavirus (HPV) national immunization program depends on effective strategies in optimizing the uptake of HPV vaccine. Given the increasing number of economic evaluations, this review was conducted to update the economic evidence on HPV vaccination, by focusing on: (i) 9-valent vaccine compared to bi- or quadrivalent vaccine; (ii) gender-neutral vaccination compared to female only vaccination; and (iii) multiple age cohort immunization compared to single age cohort immunization.
METHODS: Searches were performed until June 2016 using 4 databases: PubMed; Embase; Cochrane Library; and LILACS. The combined WHO, Drummond and CHEERS checklist were used to evaluate the quality of included studies.
RESULTS: Thirty-four studies were included in the review and most of them were conducted in high-income countries. The inclusion of adolescent boys in vaccination program was found to be cost-effective if vaccine price and coverage was low. When coverage for female was above 75%, gender-neutral vaccination was less cost-effective than when targeting only girls aged 9-18 years. Current evidence does not show conclusive proof of greater cost-effectiveness of 9-valent vaccine compared to the older HPV vaccines as the price for 9-valent vaccine was still uncertain. Multicohort immunization strategy was cost-effective in the age range 9-14 years but the upper age limit at which vaccination was no longer cost-effective needs to be further investigated. Key influential parameters identified were duration of vaccine protection, vaccine price, coverage, and discounting rates.
CONCLUSIONS: These findings are expected to support policy-makers in making recommendations for HPV immunization programs on either switching to the 9-valent vaccine or inclusion of adolescent boys' vaccination or extending the age of vaccination.

Matched MeSH terms: Immunization Programs/economics*; Immunization Programs/organization & administration
Fulltext Iraqi parents' views of barriers to childhood immunization

Al-Lela OQ, Bahari MB, Al-Abbassi MG, Salih MR, Basher AY

East Mediterr Health J, 2013 Mar;19(3):295-7.
PMID: 23879083

Deficiencies in knowledge about immunization among parents often leads to poor utake or errors in immunization dosage and timing. The aims of this study were to determine Iraqi parents' views of barriers to immunization and beliefs about ways to promote immunization. A questionnaire survey was carried out among 528 Iraqi parents with children who had incomplete immunization status. The main barriers to immunization agreed by the parents were lack of vaccine availability (51.5% of parents) and parents' lack of education (42.4%), while 88.4% of parents thought that lack of funding was not an important barrier. More than 60% of the parents suggested promoting childhood immunization via the media, and 77.5% thought that an increase in funding would not remove barriers to childhood immunization. Better vaccine availability in public health clinics and improving parents' literacy might enhance immunization uptake in Iraq.

Matched MeSH terms: Immunization/economics; Immunization/utilization*
Fulltext Hepatitis B immunisation status among health care workers in two Kuala Lumpur hospitals

Hesham R, Zamberi S, Tajunisah ME, Ariza A, Ilina I

Med J Malaysia, 2005 Oct;60(4):407-10.
PMID: 16570700

Health care workers (HCW) are at higher risk of acquiring blood borne infections such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus from patients. To minimise exposure, Universal Precautions Policy guidelines were introduced. This study looked into one of the aspects of hepatitis B prevention among HCW in the Malaysian context. The objective of this study was to assess hepatitis B vaccine coverage among HCW. A cross sectional study involving pre-tested questionnaires was undertaken from February 2001 to August 2001. Hospital staff in Hospital Kuala Lumpur and Hospital Universiti Kebangsaan Malaysia as well as undergraduate students undergoing clinical attachments were randomly chosen. A total of 625 subjects were enrolled. Only 58.4% had taken a complete hepatitis B vaccination. However, 82.2% have taken at least one dose of the hepatitis B vaccine and were supposed to complete the schedule in due course. Not all HCW were protected against hepatitis B. Preventing hepatitis B in HCW should be one of the priorities of the hospital management as it is definitely cheaper than managing chronic hepatitis B cases.

Matched MeSH terms: Immunization Schedule; Immunization Programs/utilization*
Fulltext Viral Aetiology of Acute Flaccid Paralysis Surveillance Cases, before and after Vaccine Policy Change from Oral Polio Vaccine to Inactivated Polio Vaccine

Saraswathy Subramaniam TS, Apandi MA, Jahis R, Samsudin MS, Saat Z

J Trop Med, 2014;2014:814908.
PMID: 24772175 DOI: 10.1155/2014/814908

Since 1992, surveillance for acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of the National Poliovirus Laboratory at the Institute for Medical Research. In 2008, the Ministry of Health, Malaysia, approved a vaccine policy change from oral polio vaccine to inactivated polio vaccine (IPV). Eight states started using IPV in the Expanded Immunization Programme, followed by the remaining states in January 2010. The objective of this study was to determine the viral aetiology of AFP cases below 15 years of age, before and after vaccine policy change from oral polio vaccine to inactivated polio vaccine. One hundred and seventy-nine enteroviruses were isolated from the 3394 stool specimens investigated between 1992 and December 2012. Fifty-six out of 107 virus isolates were polioviruses and the remaining were non-polio enteroviruses. Since 2009 after the sequential introduction of IPV in the childhood immunization programme, no Sabin polioviruses were isolated from AFP cases. In 2012, the laboratory AFP surveillance was supplemented with environmental surveillance with sewage sampling. Thirteen Sabin polioviruses were also isolated from sewage in the same year, but no vaccine-derived poliovirus was detected during this period.

Matched MeSH terms: Immunization
Fulltext Parental refusal to diphtheria vaccine: a fatal outcome

Syafinaz Amin N, Faridah I, Rukman AH, Fathinul Fakri AS, Malina O, Fadzillah G, et al.

Med J Malaysia, 2013 Oct;68(5):435-6.
PMID: 24632874 MyJurnal

We present a case of a four-year-old boy who succumbed to diphtheria following incomplete course of immunisation, which included diphtheria vaccine. This case report focuses on the issues of parental refusal to vaccines and the development of "halal" vaccines for the prevention of infectious diseases.

Matched MeSH terms: Immunization
The traveling athlete: issues relating to the Commonwealth Games, Malaysia, 1998

Young M, Fricker P, Maughan R, MacAuley D

Clin J Sport Med, 1998 Apr;8(2):130-5.
PMID: 9641444
Matched MeSH terms: Immunization
The travelling athlete: issues relating to the Commonwealth Games, Malaysia, 1998

Young M, Fricker P, Maughan R, MacAuley D

Br J Sports Med, 1998 Mar;32(1):77-81.
PMID: 9562173
Matched MeSH terms: Immunization
Problems with rabies postexposure management: a survey of 499 public hospitals in Thailand

Kositprapa C, Wimalratna O, Chomchey P, Chareonwai S, Benjavongkulchai M, Khawplod P, et al.

J Travel Med, 1998 Mar;5(1):30-2.
PMID: 9772313

Rabies is still a major public health problem in Asia. The incidence of known annual human cases in India alone has recently been revised from 20,000 to 30,000, and over 500,000 patients are given some form of postexposure rabies treatment. Only China, Peninsular Malaysia, Singapore, and Thailand are reporting a significant decrease in the prevalence of this disease in humans. Over 150,000 courses of postexposure treatment (PET) are given in Thailand every year. To determine remaining barriers to further reduction of the number of human rabies deaths, we carried out a questionnaire study of government hospitals throughout the Kingdom.

Matched MeSH terms: Immunization, Passive
Fulltext A training module to empower marginalised Northern Borneo islanders for tuberculosis control

Jeffree MS, Ahmedy F, Ibrahim MY, Awang Lukman K, Ahmed K, Giloi N, et al.

J Public Health Res, 2020 Jul 28;9(3):1757.
PMID: 33117755 DOI: 10.4081/jphr.2020.1757

Empowering marginalised urban islanders with limited health accessibility through knowledge transfer program for controlling pulmonary tuberculosis (PTB) requires a specific training module. The study was aimed to develop this training module by adapting and modifying the IMCI (Integrated Management of Childhood Illness) framework. Structuring the content for the knowledge and skills for PTB control in the module was based on the National Strategic Plan for Tuberculosis Control 2016-2020. A total of five knowledge and skills were structured: i) PTB disease and diagnosis, ii) PTB treatment, iii) preventive PTB measures, iv) prevention of malnutrition, and v) psychosocial discrimination. The IMCI framework was modified through 3 ways: i) identifying signs and symptoms of PTB, ii) emphasising the IMCI's 5 steps of integrated management: assess, diagnose, treat, counsel and detect, and iii) counseling on BCG immunisation, malnutrition, environmental modifications and stigma on PTB.

Matched MeSH terms: Immunization
A Case of Severe Falciparum Malaria in a Returned Traveler

Low QJ, Lau WK, Lim TH, Lee RA, Cheo SW

Malays Fam Physician, 2020;15(3):86-89.
PMID: 33329868

Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient's travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.

Matched MeSH terms: Immunization
Fulltext The feasibility and acceptability of self-sampling and HPV testing using Cepheid Xpert® HPV in a busy primary care facility

Woo YL

Journal of virus eradication, 2019 Mar 04;5(Suppl 1):10-11.
PMID: 30997147

Malaysia's approach to reducing the burden of HPV-related disease has centred on adolescent vaccination and cervical screening with Pap smears. While the vaccination programme has been broadly successful, Pap smear screening has been less successful. In an effort to improve screening uptake, the ROSE 1.0 pilot aimed to create more efficient screening, with improved quality and lower total cost.

Matched MeSH terms: Immunization Programs
Fulltext Vaccine knowledge, awareness, and hesitancy among Malaysian parents attending health clinics in Sandakan, Sabah

James Yau Hon Voo, Baharudin Ibrahim, Mohamed Azmi Hassali, Foong Ming Moy

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):21-21.
MyJurnal

Introduction: There has been a resurgence of vaccine-preventable diseases in Malaysia over the recent years. In overcoming this issue, parents as the main caregiver of their children play a major role, which is to protect their children against diseases via vaccinations. This study aimed to examine the parents’ vaccine knowledge, aware-ness, and hesitancy in relation to their children’s immunisation status and to determine the association between the parents’ vaccine knowledge, awareness, and hesitancy. Methods: A cross-sectional study with a sample size of 405 parents was conducted in the Sandakan health clinics from February 2018 to April 2018 by employing validated questionnaires adapted from two studies. Results: The median ± IQR of the total vaccine knowledge and awareness scores (ranging from 0-10) were 7.00±3.00 and 8.00±4.00, respectively. Meanwhile, the median ± IQR of the total vaccine hesitancy scores (ranging from 0-100) was 16.67±20.00, with only 27 (6.8%) parents being vaccine-hesitant (scores >50). Most of the children (n=376, 92.8%) were immunised in the study. It observed a significant association between the children’s immunisation status and the parents’ vaccine knowledge scores (p = 0.005). Nevertheless, the children’s immunisation status was not significantly associated with the parents’ vaccine awareness and hesitancy scores. The positive Spearman correlation value (r = 0.551) signified that the parents’ vaccine knowledge was posi-tively associated with their vaccine awareness. On the other hand, both the vaccine knowledge and awareness were negatively correlated to the vaccine hesitancy as indicated by the negative Spearman correlation value (r = -0.397 and r = -0.351 respectively). Conclusion: The study established that the parents with a better understanding about vaccinations were more likely to keep their children’s immunisation up-to-date. It was also revealed that improving the parents’ knowledge and raising their awareness about the importance of vaccination are vital in reducing their vaccine hesitancy.

Matched MeSH terms: Immunization
Fulltext Pertussis resurgence in children: a cross-sectional, single centre study in North-west Malaysia

Salwana Ku Md Saad, Karniza Khalid, Abdul Nasir Mohamed Abdul Kadher

Malaysian Journal of Paediatrics and Child Health, 2017;23(2):0-0.
MyJurnal

Introduction: Vaccine-preventable diseases such as pertussis are re-emerging in Malaysia during recent years.

Objective: This research aims to study the local incidence of clinical pertussis among paediatric patients admitted to Hospital Tuanku Fauziah, Perlis over two-year period.

Method: A cross-sectional study was designed in Department of Paediatrics, Hospital Tuanku Fauziah, Perlis from 1 January 2013 till 31 January 2015. Data were collected from medical and laboratory record of cases admitted for clinical pertussis. Analyses for descriptive data were done using frequency and percentage; Pearson chi-square or Fisher exact was used to test association.

Results: 81 cases of clinical pertussis were included in the study. Out of this, there were a total of 28 confirmed cases of pertussis. There was a steady increment in the incidence of pertussis throughout the study period. Cyanosis emerged as the only clinical sign significantly associated with pertussis (p = 0.011). Majority of the confirmed pertussis cases were too young to be immunized (n = 13, 46.4%).

Conclusion: Reappraisal of local health system to strengthen herd immunity in the community is warranted to control disease spread.

Matched MeSH terms: Immunization
Fulltext Recent advances in delivery of veterinary DNA vaccines against avian pathogens

Jazayeri SD, Poh CL

Vet Res, 2019 Oct 10;50(1):78.
PMID: 31601266 DOI: 10.1186/s13567-019-0698-z

Veterinary vaccines need to have desired characteristics, such as being effective, inexpensive, easy to administer, suitable for mass vaccination and stable under field conditions. DNA vaccines have been proposed as potential solutions for poultry diseases since they are subunit vaccines with no risk of infection or reversion to virulence. DNA vaccines can be utilized for simultaneous immunizations against multiple pathogens and are relatively easy to design and inexpensive to manufacture and store. Administration of DNA vaccines has been shown to stimulate immune responses and provide protection from challenges in different animal models. Although DNA vaccines offer advantages, setbacks including the inability to induce strong immunity, and the fact that they are not currently applicable for mass vaccination impede the use of DNA vaccines in the poultry industry. The use of either biological or physical carriers has been proposed as a solution to overcome the current delivery limitations of DNA vaccines for veterinary applications. This review presents an overview of the recent development of carriers for delivery of veterinary DNA vaccines against avian pathogens.

Matched MeSH terms: Immunization

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