Relevant bibliographies by topics / Influenza vaccination

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Influenza vaccination'

Author: Grafiati
Published: 4 June 2021
Last updated: 7 July 2024

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Journal articles on the topic "Influenza vaccination"

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Gates, Dana M., Steven A. Cohen, Kelly Orr, and Aisling R. Caffrey. "Pharmacist-Administered Influenza Vaccination in Children and Corresponding Regulations." Vaccines 10, no. 9 (August 28, 2022): 1410. http://dx.doi.org/10.3390/vaccines10091410.

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In our retrospective cohort study, we evaluated trends in pharmacist-administered pediatric influenza vaccination rates in the United States and corresponding state-level pharmacist pediatric vaccination authorization models, including minimum age requirements, vaccination protocols, and/or prescription requirements. An administrative health claims database was used to capture influenza vaccinations in children less than 18 years old with 1 year of continuous enrollment and joinpoint regression was used to assess trends. Of the 3,937,376 pediatric influenza vaccinations identified over the study period, only 3.2% were pharmacist-administered (87.7% pediatrician offices, 2.3% convenience care clinics, 0.8% emergency care, and 6.0% other locations). Pharmacist-administered pediatric influenza vaccination was more commonly observed in older children (mean age 12.65 ± 3.26 years) and increased significantly by 19.2% annually over the study period (95% confidence interval 9.2%-30.2%, p < 0.05). The Northeast, with more restrictive authorization models, represented only 2.2% (n = 2816) of all pharmacist-administered pediatric influenza vaccinations. Utilization of pharmacist-administered pediatric influenza vaccination remains low. Providing children with greater access to vaccination with less restrictions may increase overall vaccination rates. Due to the COVID-19 pandemic and the Public Readiness and Emergency Preparedness Act, pharmacists will play a major role in vaccinating children.
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Zhou, F., M. C. Lindley, J. T. Lee, and T. C. Jatlaoui. "Association Between Influenza Vaccination During Pregnancy and Infant Influenza Vaccination." Obstetric Anesthesia Digest 44, no. 1 (February 22, 2024): 42. http://dx.doi.org/10.1097/01.aoa.0001005436.35108.8c.

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(Obstet Gynecol. 2023;141:563–569) Vaccines are safe and effective in preventing illness, including in mildly immunosuppressed individuals such as pregnant women. Influenza vaccines have been in use for decades and have been shown to be safe and effective at preventing illness in both mother and child, providing protection through the transplacental transfer of antibodies to infants too young to receive their own vaccination. Influenza presents increased risks to pregnant individuals as well as adverse outcomes for fetuses and infants. Annual influenza vaccinations are recommended for everyone 6 months and older, but rates of annual vaccinations are chronically low. This study was designed to evaluate the association between influenza vaccination during pregnancy and infant influenza vaccination.
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Sienicka, Agnieszka, Agata Pisula, Katarzyna Karina Pawlik, Agnieszka Dobrowolska-Redo, Joanna Kacperczyk-Bartnik, and Ewa Romejko-Wolniewicz. "The Obstetrician’s Role in Pregnant Women’s Decision-Making Process Regarding Influenza and COVID-19 Vaccination." Vaccines 11, no. 10 (October 18, 2023): 1608. http://dx.doi.org/10.3390/vaccines11101608.

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Pregnant women are considered to be a population vulnerable to influenza and COVID-19 infections, and the latest guidelines consistently recommend that they receive influenza and COVID-19 vaccinations. A cross-sectional questionnaire-based study was conducted among pregnant women in Poland to determine which factors have the greatest impact on their decision to vaccinate against influenza and COVID-19. A total of 515 pregnant women participated in the study. Among them, 38.4% (n = 198) demonstrated a positive attitude toward influenza vaccination, and 64.3% (n = 331) demonstrated a positive attitude toward COVID-19 vaccination. Logistic regression analysis revealed that the strongest influence on positive attitudes toward COVID-19 vaccination is having it recommended by an obstetrician–gynecologist (OR = 2.439, p = 0.025). The obstetrician–gynecologist’s recommendation to vaccinate against influenza also significantly influences the decision to vaccinate (OR = 5.323). The study results also show a strong correlation between the obstetrician–gynecologist as a source of information on influenza and vaccination and participants’ positive attitudes toward vaccination (OR = 4.163). Obstetricians have a significant influence on pregnant women’s decisions regarding vaccinations. Further recommendations to vaccinate and awareness-raising among obstetricians may be needed to increase the vaccination rate of pregnant women in Poland.
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Han, Kaiyi, Zhiyuan Hou, Shiyi Tu, Qian Wang, Simeng Hu, Yuting Xing, Jing Du, Shujie Zang, Tracey Chantler, and Heidi Larson. "Childhood Influenza Vaccination and Its Determinants during 2020–2021 Flu Seasons in China: A Cross-Sectional Survey." Vaccines 10, no. 12 (November 23, 2022): 1994. http://dx.doi.org/10.3390/vaccines10121994.

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Young children aged 6–59 months are recommended as one of the priority groups for seasonal influenza vaccination in China. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among children in three Chinese provinces. In September 2021, 2081 caregivers with children <5 years completed self-administered questionnaires as part of a cross-sectional survey. Logistic regression was used to assess determinants of childhood influenza vaccination. A total of 43.63% of respondents reported vaccinating their children against influenza during the 2020–2021 flu season. Caregivers who lived in Anhui province, had a bachelor degree or above, and an annual household income <20,000 RMB were more likely to vaccinate their children against influenza. Confidence in the importance (OR: 2.50; 95%CI: 1.77–3.54), safety (OR: 1.60; 95%CI: 1.29–1.99), and effectiveness (OR: 1.54; 95%CI: 1.23–1.93) of influenza vaccine was significantly associated with childhood vaccine acceptance. Respondents who saw that other caregivers were vaccinating their children had significantly higher odds of vaccinating their own children. Caregivers’ receiving positive influence from healthcare workers (OR: 1.33; 95%CI: 1.00–1.77), family members, or friends (OR: 1.30; 95%CI: 1.14–1.49) were also significantly associated with childhood influenza vaccination. Poor access, including conflicts between caregivers’ availability and vaccination service schedules and inconvenient transportation to the vaccination site were negatively associated with childhood flu vaccination. To promote childhood influenza vaccination, public health information campaigns need to target wealthier and less educated caregivers to enhance caregivers’ confidence in influenza vaccination. Targeted interventions are also needed to optimize access to vaccination services, including extending vaccination service hours and increasing the number of vaccination sites close to residential areas. Interventions are also needed to encourage primary care providers to play a greater role in promoting vaccination. Finally, the dissemination of related information and the public response need to be monitored for the timely understanding of public perceptions.
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Uma, A., and P. Thirumalaikolundusubramanian. "Influenza Vaccination." Annals of Saudi Medicine 19, no. 1 (January 1999): 62. http://dx.doi.org/10.5144/0256-4947.1999.62.

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Cook, Rosemary. "Influenza vaccination." Nursing Standard 12, no. 1 (September 24, 1997): 49–56. http://dx.doi.org/10.7748/ns.12.1.49.s55.

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Foster, Donna. "Influenza Vaccination." AAOHN Journal 56, no. 10 (October 2008): 409–11. http://dx.doi.org/10.3928/08910162-20081001-07.

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N/A. "Influenza Vaccination." Biological Therapies in Dentistry 18, no. 02 (2002): 005. http://dx.doi.org/10.2310/7040.2002.28194.

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Schofield, Irene. "Influenza vaccination." Nursing Older People 12, no. 9 (December 2000): 21–24. http://dx.doi.org/10.7748/nop2000.12.12.9.21.c2164.

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Wilson, R. "Influenza vaccination." Thorax 49, no. 11 (November 1, 1994): 1079–80. http://dx.doi.org/10.1136/thx.49.11.1079.

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Dissertations / Theses on the topic "Influenza vaccination"

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King, Catherine. "Influenza and influenza vaccination: examining parental perspectives and practices to inform vaccination policy and programs." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18937.

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Influenza is a potentially serious disease, causing hospitalisations and deaths, particularly in children and the elderly. Traditionally immunisation efforts targeted the elderly and those at high risk from the disease. As awareness of the paediatric burden of influenza disease and potential population benefits of vaccinating children grew, immunisation efforts expanded, but coverage among children remains low. Expansion of influenza vaccine funding to include all Australian children is being considered, but there is little information about whether parents accept or support this. This thesis examines preventive health beliefs, knowledge, attitudes and practices of parents, both generally and in relation to influenza and influenza vaccination of children, and explores which information sources parents value, trust and use. Methods include a systematic review, qualitative interviews and a quantitative survey. The timing of two influenza-related health scares – the 2009 influenza A H1N1 pandemic, and the 2010 suspension of influenza vaccination for children under 5 due to high numbers of adverse events – allowed examination of the impact of health scares on parents’ views and information needs. The findings revealed that parental beliefs about health and illness, and decision-making about vaccination risk, are complex, incorporating both scientific and ‘folk’ beliefs and interacting with contextual variables. Parents trust healthcare workers as information sources, and are positively influenced by vaccination recommendations from them. Pre-existing beliefs about influenza and influenza vaccine influence parents’ interpretations of influenza-related health scares. Health scares affect parents’ trust and information needs. This thesis provides practical recommendations for public health practitioners and policymakers to assist in developing appropriate influenza vaccination campaigns and information materials that meet the needs of parents.
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Yao, Mianzhi, and 姚绵志. "Human swine influenza vaccination in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45175093.

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Mamani, Hamed. "Supply chain coordination and influenza vaccination." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45944.

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Thesis (Ph. D.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2008.
Includes bibliographical references (p. 125-129).
Annual influenza outbreaks incur great expenses in both human and monetary terms, and billions of dollars are being allocated for influenza pandemic preparedness in an attempt to avert even greater potential losses. Vaccination is a primary weapon for fighting influenza outbreaks. The influenza vaccine supply chain has characteristics that resemble the Newsvendor problem, but possesses several characteristics that distinguish it from many other supply chains. Differences include a nonlinear value of sales (caused by the nonlinear health benefits of vaccination that are due to infection dynamics) and vaccine production yield issues. In this thesis we present two models in the interface of operations and supply chain management and public health policy. In the first model, we focus on a supply chain with a government and a manufacturer. We show that production risks, taken currently by the vaccine manufacturer, lead to an insufficient supply of vaccine. Several supply contracts that coordinate buyer (governmental public health service) and supplier (vaccine manufacturer) incentives in many other industrial supply chains can not fully coordinate the influenza vaccine supply chain. We design a variant of the cost sharing contract and show that it provides incentives to both parties so that the supply chain achieves global optimization and hence improves the supply of vaccines. In the second mode, we consider the influenza vaccine supply chain with multiple countries.
(cont.) Each government purchases and administers vaccines in order to achieve an efficient cost-benefit tradeoff. Typically different countries have different economics sensitivities to public outcomes of infection and vaccination. It turns out that the initiating country, while having a significant role in the spread of the disease, does not receive enough vaccine stockpiles. Our model indicates that lack of coordination results in vaccine shortfalls in the most needed countries and vaccine excess in the regions where are not as effective, if the governments in the model act rationally. We show the role of contracts to modify monetary flows that purchase vaccination programs, and therefore modify infectious disease flows.
by Hamed Mamani.
Ph.D.
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Miller, Julie A. "Factors Influencing Influenza Vaccination of Children." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1377872672.

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Adedokun, Amos. "Perceptions of Healthcare Workers Toward Influenza Vaccination." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4992.

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Even though influenza vaccinations were provided free to all healthcare workers in the United States, healthcare workers were not 100% compliant. The non-compliance with influenza vaccinations may expose their patients, their families, and the public at large to a high-risk source of influenza infection. This study's research questions included how registered nurses perceived influenza and influenza vaccination; registered nurses' self-reported incidents with influenza vaccination; and factors that contributed to registered nurses' non-compliance with influenza vaccination. Guided by the theory of reasoned action and the theory of planned behavior, the purpose of this qualitative study was to determine the factors that contributed to the non-compliance of registered nurses with receiving the influenza vaccination. Twenty participants from a healthcare facility in Florida were interviewed using an interview guide. Audio data was transcribed to text data; text data was coded and thematically analyzed by using ATLAS.ti software. Results revealed that 70% of registered nurses were afraid of influenza vaccination, while 80% of them saw influenza vaccination as ineffective; 90% of them had bad experiences or have seen colleagues/friends who have had bad experiences after influenza vaccination. In addition, 40% of registered nurses claimed that they already had good immunity, while 20% of them declined influenza vaccination because of personal choices. Research findings from this study may be utilized to bring positive social change to society at large. The findings may be utilized to enhance existing strategies or policies or even help formulate new policies and strategies that would address the concerns of HCWs, especially registered nurses.
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Hilliman, Cheryl. "Correlates of Influenza Vaccination Uptake Among Older Adults." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3494.

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Seasonal influenza is associated with signiï¬?cant morbidity and mortality among older adults, aged 65 and older. Since vaccination is the single most effective preventive measure against seasonal influenza, clinicians and senior citizen center administrators need a better understanding of the perceptions of older adults concerning the reason for poor influenza vaccine uptake. The purpose of this study was to identify perceived factors that may be associated with poor influenza vaccination uptake among older adults. The health belief model (HBM) guided the study. The research questions examined perceptions predicting the odds of influenza vaccination uptake among older adults. This quantitative cross-sectional study consisted of administration of a newly developed 33-item questionnaire to a convenience sample of 147 older adult participants. A 2-week reliability test-retest on 50 participants indicated the instrument had moderate internal consistency (α -?¥ 0.7). Paired-sample t tests were not significant (p > .05), indicating that participants provided reliable responses across time. Ordinal regression analysis indicated that all HBM constructs were significantly associated (susceptibility, barriers, benefits, cues to action, and self-efficacy p = .000; severity p = .002) with frequency of influenza disease and recency of influenza vaccine uptake within 1 year. The social change implications from this study may help to improve vaccination uptake among older adults by providing senior public health decision makers and direct care clinicians with informed knowledge on perceptions and barriers that may play a role in influenza vaccination decision-making among older adults.
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Meng, Yue, and 孟玥. "Factors influencing parents' decision on their children's vaccination against seasonal influenza : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193841.

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Introduction: Seasonal influenza is believed to be a common attribution of morbidity and mortality in the children population, and it causes huge disease burden worldwide. Although seasonal influenza vaccination is recommended as the most effective prevention by the World Health Organization and vaccination programs for children have been introduced in many countries, vaccination coverage remains low. Parents are primary decision makers for their children's immunization, therefore it is important to understand the determinants that influence parents' decision-making to provide important information for promoting vaccination uptake against seasonal influenza among children. Objective: To synthesize factors that influence parental decision on children's vaccination against seasonal influenza from published literature. Method: Literature reported factors that influenced parental decision on children's vaccination against seasonal influenza published before/on 31th May, 2013 were searched in PubMed and Web of Science databases. Manual searching was also performed for the citations of the retrieved papers. Both qualitative and quantitative articles consistent with the objective were searched from PubMed and Web of Science databases on 31th May, 2013. Records were screened in the sequence of title, abstract and full text to identify eligible studies, and references of eligible studies were also scrutinized to avoid missing important articles. Influencing factors were extracted from included papers, and the identified factors that influenced parental decision making were then discussed based on theoretical behavioral models. Results: Totally 32 articles met the inclusion criteria. Factors associated with parental decision included demographic factors, which consisted of parental and children’s age, parental gender, ethnicity, household income, residence, insurance status, family characters, parental education level, and children’s health history; psychological factors, including attitudes towards influenza vaccination, knowledge of influenza and vaccination, perceived risk of seasonal influenza, and emotional factors; past behaviors comprising previous frequency of using health care services, children’s seasonal influenza vaccination history, previous absenteeism from school or work, social norm referring cues to action and subjective norms; and environmental factors, meaning access to vaccination facilities. Discussion: An integrated framework based on the Health Belief Model, Triandis’ Theory of Interpersonal Behavior and the Theory of Reasoned Action was constructed to explain the findings. The framework proposes that the parents’ intention to vaccinate their children against seasonal influenza is influenced by demographic variables, attitude towards seasonal influenza vaccination, knowledge and perception of influenza/influenza vaccine, social norms (cues to action and subjective norms), emotion, and past behavior/experience; easy access to vaccination providers as a facilitating condition additionally determine the possibility of turning intention into actual behavior. Interventions such as providing positive knowledge relevant to seasonal influenza vaccination, targeting less intended and more influential decision-makers, ensuring sufficient access to vaccination, and creating action cues may be implemented to promote uptake of seasonal influenza vaccination among children.
published_or_final_version
Public Health
Master
Master of Public Health
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Ni, Lihong. "Modeling vaccination for pandemic influenza implication of the race between pandemic dynamics and vaccine production /." Click to view the E-thesis via HKUTO, 2007. http://sunzi.lib.hku.hk/hkuto/record/B40687430.

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Vergara, Alert Júlia. "Immune response to influenza infection and vaccination." Doctoral thesis, Universitat Autònoma de Barcelona, 2012. http://hdl.handle.net/10803/98472.

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Els virus de la influença tipus A (VIA) són patògens zoonòtics que poden infectar un ampli nombre d’hostes incloent-hi les aus, els porcs i els homes, entre altres. Anualment es documenten milions d’infeccions en humans causades per virus de la influença estacionals. Les pandemies causades pel virus influença també tenen una elevada repercussió pel que fa a la sanitat i l’economia. Tot i que determinats subtipus de VIA s’adapten millor en espècies d’aus que en humans, hi ha hagut casos d’infeccions en humans per virus de la influença de tipus aviars. La susceptibilitat dels porcs per infectar-se amb virus de la influença tant d’origen aviar com humà és també important pel que fa a la salut pública. El genoma del virus influença és segmentat in consta de vuit molècules de ARN de cadena senzilla i sentit negatiu que codifiquen per 11 o 12 proteïnes. Per tant, si una cèl·lula s’infecta simultàniament per dos VIA diferents, pot succeir un reagrupament amb la conseqüent generació d’una nova soca de virus. A més, mutacions a les glicoproteïnes de superfícies (sobretot a l’hemaglutinina, HA) són les responsables de l’elevada variabilitat de VIA. Tot i que les vacunes front a les epidèmies estacionals són eficaces, no produeixen resposta immunològica front una amplia varietat de VIA. És a dir, les vacunes estacionals només protegeixen front a les soques virals circulants durant una determinada estació. Aquest fet, junt amb el risc de possibles pandèmies, han fet encara més important i urgent el desenvolupament d’una vacuna universal capaç de produir immunitat front a múltiples subtipus virals. En la present tesis s’ha estudiat la resposta immunitària front a la infecció i vacunació del VIA en el context de VIA d’alta patogenicitat (vIAAP) A/H5N1 i A/H7N1 i el virus pandèmic A/H1N1 (pH1N1). El treball s’ha dividit en tres parts i cada part s’ha subdividit en capítols. Part I (capítols 1 i 2), conté la introducció general i els objectius de la tesi doctoral. L’objectiu d’aquesta primera part és donar una visió global i introduir informació per entendre (i) la infecció pel virus de la influença, (ii) la resposta immunològica provocada després de la infecció per VIA i (iii) un breu resum de les vacunes actuals front a influença. A continuació, s’exposen els objectius a aconseguir. Part II, és el cos de la tesis i conté els quatre treballs (del capítol 3 al 6) duts a terme durant els quatre anys que ha durat el programa de doctorat. Tots els capítols presentats han estat publicats o sotmesos a publicació en revistes indexades internacionals. Per tant, cada estudi manté l’estructura estàndard de: resum, introducció específica, materials i mètodes, resultats i breu discussió. Estudiar el paper dels determinants virals i caracteritzar la infecció pel VIA en diversos hostes pot ser de gran interès a l’hora de dissenyar vacunes òptimes. S’ha descrit la proteïna NS1 com a un dels principals determinants de virulència en mamífers, però no s’ha estudiat gaire el paper d’aquesta en aus. En el capítol 3 es va avaluar la implicació de la proteïna NS1 en la patogenicitat viral en pollets. Es van infectar pollets amb vIAAP H7N1 que contenien el segment NS de vIAAP H5N1. Les manifestacions patològiques i la resposta immunològica conseqüència de la infecció amb cada un dels virus van ser avaluades. També és molt important el paper de la immunitat prèvia durant un brot perquè pot ser determinant de la mort o supervivència de l’animal. En el capítol 4 es van exposar pollets a un virus H7N2 de baixa patogenicitat (vIABP) i a continuació es van infectar amb un vIAAP H7N1. Posteriorment es van infectar amb un vIAAP H5N1. Els animals que havien estat infectats prèviament amb vIABP quedaven protegits a la posterior infecció letal amb el vIAAP H7N1. No obstant, la resposta immunitària produïda no era suficient per a protegir els pollets front a la infecció amb un virus heterosubtípic (vIAAP H5N1). La presència o absència d’anticossos inhibitoris front a H7- i H5- correlacionaven amb la presència o absència de protecció, respectivament. Conèixer els programes de vacunació actuals i la seva eficàcia és útil per a planificar i dissenyar futures estratègies de vacunació. Les aus aquàtiques són el reservori dels VIA; per tant, són extremadament importants pel que fa a l’ecologia del virus. Aprofitant els programes de vacunació es va testar el sèrum de diverses espècies d’aus de zoològics i centres de recuperació d’Espanya (capítol 5). Els sèrums es van utilitzar per a l’avaluació de la resposta humoral deguda a la vacuna. El principal objectiu del treball era determinar l’eficàcia de vacunes disponibles (inactivades en suspensió oliosa) en diverses espècies d’aus i comparar la variabilitat inter- i intra-espècie. Finalment, i tenint en compte el potencial risc del VIA, els esforços es van focalitzar en desenvolupar una vacuna capaç de protegir a un ampli nombre de subtipus de VIA. La pandèmia de 2009 amb el virus H1N1 (pH1N1) és un clar exemple que els porcs poden actuar com a “coctelera” i generar nous virus. En el capítol 6 es van immunitzar porcs amb pèptids derivats de l’HA i a continuació es van infectar amb el virus pH1N1. Tot i que els pèptids-HA produïen una molt bona resposta humoral i cel·lular, no es va detectar activitat neutralitzant i només es va obtenir un efecte parcial en l’eliminació del virus. Part III (Capítols 7 i 8), és la secció on es discuteixen les implicacions dels resultats obtinguts en els diferents estudis i on s’enumeren les conclusions principals. En una secció a part, s’han inclòs totes les referències bibliogràfiques utilitzades per a l’elaboració de la tesi. S’ha inclòs també un apèndix per afegir informació addicional.
Influenza A viruses (IAV) are zoonotic pathogens that can replicate in a wide range of hosts, including birds, pigs and humans, among others. Millions of human infections caused by seasonal influenza virus are reported annually. Influenza pandemics have also a significant health and economic repercussions. Although certain subtypes of IAV are better selected in avian species than in humans, there are reports that evidence cases of human infections with avian influenza viruses (AIV). The susceptibility of pigs to infection with influenza viruses of both avian and human origins is also important for public health. The genome of influenza virus is segmented and consists of eight single-stranded negative-sense ribonucleic acid (RNA) molecules encoding 11 or 12 proteins. Thus, if a single cell is simultaneously infected by two distinct influenza viruses, a reassortment can occur resulting in the generation of a novel virus strain. Moreover, mutations in the surface glycoproteins (mainly in the hemagglutinin, HA) are the responsible of the high variability of IAV. Influenza vaccines against seasonal epidemics, although have good efficacy do not elicit immune response against a wide variety of IAV. Thus, seasonal vaccines only confer protection against the circulating viral strains. This, together with the risk of potential pandemics, has highlighted the importance of developing a universal vaccine able to elicit heterosubtypic immunity against multiple viral subtypes. In this thesis the immune response to IAV infection and vaccination was evaluated in the light of the risk of highly pathogenic AIV (HPAIV) A/H5N1 and A/H7N1, and the pandemic IAV A/H1N1. The work is divided into three parts and each one is further divided into chapters. Part I (chapters 1 and 2) contains the general introduction and the objectives of the thesis. The aim of this first part is to give a global overview and to introduce information to understand (i) the influenza infection, (ii) the immune responses elicited after IAV infection and (iii) a brief summary of current vaccines against influenza. Afterwards, the initial objectives to be achieved are exposed. Part II is the body of the thesis and it contains four studies (from chapter 3 to 6) developed during the four-year period comprising the PhD program. All the chapters are published or submitted to publish in international peer-reviewed journals. Thus, each study contains an abstract, a specific introduction, the materials and methods section, the obtained results and a discussion. To study the role of IAV determinants and to characterize the influenza infection in different hosts could be of great importance to direct the efforts to the formulation of more efficient vaccines. The non structural 1 (NS1) protein is known to be a major determinant of virulence in mammals but little is known about its role in avian species. In chapter 3, the involvement of NS1 in viral pathogenicity was evaluated in chickens. Birds were challenged with two reassortant AIV carrying the NS-segment of H5N1 HPAIV in the genetic background of an H7N1 HPAIV. The pathological manifestations, together with the immunological outcome were evaluated. The role of pre-existing immunity during an outbreak is also important and can determine whether the animals succumbed to infection or not. In chapter 4, chickens pre-exposed to H7N2 low pathogenic AIV (LPAIV) were challenged with H7N1 HPAIV and subsequently infected with H5N1 HPAIV. Pre-exposed animals were protected against the lethal H7N1-challenge whereas naïve animals succumbed. However, pre-existing immunity did not provide protection against HA-heterosubtypic virus (H5N1 HPAIV). The presence or absence of H7- and H5-inhibitory antibodies correlate with the protection (or lack of it) afforded. The control of current vaccination programs and their efficacy is useful to plan and design better vaccines. It is well known that wildfowl are the reservoirs of IAV; thus they are extremely important concerning the ecology of the virus. Sera from several avian species from Spanish zoos and wildlife centers were collected during two successive vaccination programs and were tested to evaluate the vaccine-elicited humoral response (chapter 5). The main objective of this work was to determine the efficacy of current vaccines (inactivated water-in-oil) in several avian species and to compare the differences inter- and intra-specie. Finally, and taking into account the potential risk that IAV represent to our society, the efforts were focused on developing a broadly protective influenza vaccine. The 2009 human H1N1 pandemic (pH1N1) is a clear example that pigs can act as a vehicle for mixing and generating new assortments of viruses. In chapter 6 pigs were immunized with HA-derived peptides and subsequently infected with pH1N1 virus. Although the HA-peptides induced broad humoral and cellular responses no neutralization activity was detected and only a partial effect on virus clearance was observed. Part III (chapters 7 and 8) is where the implications of all the findings from the studies are discussed and the major conclusions are listed. A list of all the references used to develop the thesis is listed after the three parts, in an independent section. An appendix section is also included to give further information.
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Floyd, Zina. "Barriers to the Influenza Vaccination in Veterans." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1514.

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Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to identify and to identify barriers to influenza vaccinations in veterans. The health belief model was utilized to organize the evidence-based practice data obtain from the literature reviews on the barriers to the influenza vaccine. An Influenza vaccination educational pamphlet was developed using data obtained from the literature reviews. No information was obtained from the veterans. The educational pamphlet listed the identified barriers and ways to overcome the barriers to the influenza vaccination. The influenza vaccination educational pamphlet will be utilized by veterans and staff in the outpatient clinic. The pamphlets will to be placed in the veteran's waiting areas, medication rooms, and lobby areas prior to the beginning of the influenza season at the end of September. The organization's outpatient quarterly influenza data report will be utilized to disseminate the results to the educational tool's effectiveness after implementation at the end of the influenza season in May. The social impact of solving this issue is the opportunity to decrease the major infrastructure demands placed on the healthcare system as well as human suffering caused by influenza.
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Books on the topic "Influenza vaccination"

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NHS Centre for Reviews & Dissemination., ed. Influenza vaccination and older people. York: NHS Centre for Reviews and Dissemination, University of York, 1996.

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Febrile seizures following childhood vaccinations, including influenza vaccination: Questions & answers. Atlanta, Ga: Centers for Disease Control and Prevention, 2010.

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Influenza. New York: Cavendish Square, 2015.

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United States. Health Care Financing Administration. Influenza immunizations paid for by Medicare. Baltimore, MD: U.S. Dept. of Health and Human Service, Health Care Financing Administration, 1993.

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Illinois. Department of Public Health. Flu & pneumonia imminization. Springfield, IL: Illinois Dept. of Public Health, Division of Infectious Diseases, Imminization Program, 1994.

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Radovanović, Zoran. Grip. Beograd: Arhipelag, 2010.

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Illinois. Department of Public Health. Flu & pneumonia imminization. Springfield, IL: Illinois Dept. of Public Health, Division of Infectious Diseases, Imminization Program, 1993.

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Lori, Nadig, Altevogt Bruce M, Institute of Medicine (U.S.). Forum on Medical and Public Health Preparedness for Catastrophic Events, and ebrary Inc, eds. The 2009 H1N1 influenza vaccination campaign: Summary of a workshop series. Washington, D.C: National Academies Press, 2010.

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H, Arden Nancy, Kendal Alan P, Patriarca Peter A, Zahniser Christine, and Centers for Disease Control (U.S.), eds. Managing an influenza vaccination program in the nursing home. [Atlanta, Ga.?]: U. S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, 1987.

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Centre for Infectious Disease Prevention and Control (Canada). Immunization and Respiratory Infections Division., ed. Canadian pandemic influenza plan. Ottawa, Ont: Health Canada, Centre for Infectious Disease Prevention & Control, Immunization & Respiratory Infections Division, 2004.

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Book chapters on the topic "Influenza vaccination"

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Wei, Chih-Jen, Damian C. Ekiert, Gary J. Nabel, and Ian A. Wilson. "New approaches to vaccination." In Textbook of Influenza, 327–36. Oxford, UK: John Wiley & Sons, Ltd, 2013. http://dx.doi.org/10.1002/9781118636817.ch21.

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Chambers, Thomas M. "Vaccines and vaccination to control equine influenza." In Animal Influenza, 524–46. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2016. http://dx.doi.org/10.1002/9781118924341.ch21.

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Edwards, Kathryn M. "Influenza and influenza vaccination in children." In Influenza Vaccines for the Future, 95–111. Basel: Birkhäuser Basel, 2008. http://dx.doi.org/10.1007/978-3-7643-8371-8_5.

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Libster, Romina, and Kathryn M. Edwards. "Influenza and Influenza Vaccination in Children." In Influenza Vaccines for the Future, 149–71. Basel: Springer Basel, 2010. http://dx.doi.org/10.1007/978-3-0346-0279-2_7.

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van Boven, M., J. van der Goot, A. R. W. Elbers, G. Koch, G. Nodelijk, M. C. M. de Jong, T. S. de Vries, A. Bouma, and J. A. Stegeman. "Vaccination of poultry against avian influenza: epidemiological rules of thumb and experimental quantification of the effectiveness of vaccination." In Avian Influenza, 85–92. Dordrecht: Springer Netherlands, 2005. http://dx.doi.org/10.1007/1-4020-3441-5_10.

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Swayne, David E., and Darrell R. Kapczynski. "Vaccines and vaccination for avian influenza in poultry." In Animal Influenza, 378–434. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2016. http://dx.doi.org/10.1002/9781118924341.ch15.

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Hara, Megumi. "Influenza and Influenza Vaccination in Japanese Elderly." In Current Topics in Environmental Health and Preventive Medicine, 171–83. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-13-1762-0_12.

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Novakova, Silviya Mihaylova, Plamena Ivanova Novakova, and Maria Toncheva Staevska. "Acute Reaction to Influenza Vaccination." In Pediatric Allergy, 131–34. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-18282-3_25.

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McElhaney, Janet E., and Daniela Frasca. "Influenza Vaccination in Older Adults." In Encyclopedia of Gerontology and Population Aging, 1–12. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-69892-2_69-1.

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McNulty, M. S., and J. B. McFerran. "Avian Influenza: Diagnosis and Vaccination." In Acute Virus Infections of Poultry, 36–44. Dordrecht: Springer Netherlands, 1986. http://dx.doi.org/10.1007/978-94-009-4287-5_4.

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Conference papers on the topic "Influenza vaccination"

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Spencer, Julie, Manhong Smith, David Osthus, Matthew Biggerstaff, and Sara Del Valle. "Influenza Vaccination Timing." In SMB MathEpiOnco 2024 ; 2024-02-18 - 2024-02-19 ;. US DOE, 2024. http://dx.doi.org/10.2172/2337622.

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Semizhon, Sergey, Volha Kardash, and Nikolai Kovshel. "Influence of influenza vaccination on workers’ health." In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa1243.

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Mashkovich, T., S. Marshalkovich, and M. Dubina. "VACCINATION AGAINST SEASONAL INFLUENZA IN CHILDREN." In SAKHAROV READINGS 2020: ENVIRONMENTAL PROBLEMS OF THE XXI CENTURY. Minsk, ICC of Minfin, 2020. http://dx.doi.org/10.46646/sakh-2020-2-134-137.

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FERNANDEZ, GERARDO, Carolina Arráiz de Fernández, Diana Velastegui Hernández, and Gerardo Fernandez A. "Anti-influenza vaccination of health personnel." In 1er Congreso Universal de las Ciencias y la Investigación Medwave 2022;. Medwave Estudios Limitada, 2022. http://dx.doi.org/10.5867/medwave.2022.s2.uta030.

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Foradori, Dana, Huay-ying Lo, and Haijun Wang. "Improving Influenza Vaccination Rates in Hospitalized Asthmatics." In Selection of Abstracts From NCE 2015. American Academy of Pediatrics, 2017. http://dx.doi.org/10.1542/peds.140.1_meetingabstract.2.

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Foradori, Dana, Huay-ying Lo, and Haijun Wang. "Improving Influenza Vaccination Rates in Hospitalized Asthmatics." In Selection of Abstracts From NCE 2015. American Academy of Pediatrics, 2017. http://dx.doi.org/10.1542/peds.140.1_meetingabstract.37.

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Pongsumpun, Puntani. "Local Stability of Influenza Virus with Vaccination." In ICISDM 2020: 2020 the 4th International Conference on Information System and Data Mining. New York, NY, USA: ACM, 2020. http://dx.doi.org/10.1145/3404663.3404684.

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Pankin, Grigory, Clementina Calabria, Nicholas Jackson, Irem Patel, and Amit Patel. "Attitudes of medical students towards the influenza vaccination." In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa2771.

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Akçayöz, Deniz, and Emine Bahar Kurt. "Outcome of influenza vaccination in elderly with pneumonia." In ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.pa2898.

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Roche, Nicolas, Bernard Aguilaniu, Pierre-Régis Burgel, Maeva Zysman, David Hess, El-Hassane Ouaalaya, Thi-Chien Tran, and Chantal Raherison. "Influenza and pneumococcal vaccination in patients with COPD." In ERS International Congress 2020 abstracts. European Respiratory Society, 2020. http://dx.doi.org/10.1183/13993003.congress-2020.2415.

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Reports on the topic "Influenza vaccination"

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Smith, D. J., D. H. Ackley, S. Forrest, and A. S. Perelson. Modeling the effects of annual influenza vaccination. Office of Scientific and Technical Information (OSTI), December 1998. http://dx.doi.org/10.2172/314169.

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Milkman, Katherine, John Beshears, James Choi, David Laibson, and Brigitte Madrian. Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates. Cambridge, MA: National Bureau of Economic Research, June 2011. http://dx.doi.org/10.3386/w17183.

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BROWN, I. High pathogenicity avian influenza and vaccination: application in Europe Region. O.I.E (World Organisation for Animal Health), October 2022. http://dx.doi.org/10.20506/tt.3335.

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The main objectives of the presentation of Technical Item II during the 30th Conference of the WOAH Regional Commission for Europe (Catania, Italy, 3–7 October 2022) are (i) to set the proper framework of questions to make science-based decisions regarding the vaccination policy against infection with highly pathogenicity avian influenza viruses (HPAI) in Europe, and (ii) to organise the mechanism which would support WOAH and Members in addressing these questions. It is not to set specific vaccine choices or recommendations on types of vaccines to apply. This paper presents the state of the art and draws together the key factors that need to be considered as relevant for the Region when defining vaccination policy.
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Perk, Simon, Egbert Mundt, Alexander Panshin, Irit Davidson, Irina Shkoda, Ameera AlTori, and Maricarmen Garcia. Characterization and Control Strategies of Low Pathogenic Avian Influenza Virus H9N2. United States Department of Agriculture, November 2012. http://dx.doi.org/10.32747/2012.7697117.bard.

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The avian influenza virus, subtype H9N2 subtype, defined as having a low pathogenicity, causes extensive economical losses in commercial flocks, probably due to management and synergism with other pathogens. AIV H9N2 was first identified in Israel in the year 2000, and since then it became endemic and widespread in Israel. Control by vaccination of commercial flocks with an inactivated vaccine has been introduced since 2007. In face of the continuous H9N2 outbreaks, and the application of the vaccination policy, we aimed in the present study to provide a method of differentiating naturally infected from vaccinated animals (DIVA). The aim of the assay would be detect only antibodies created by a de-novo infection, since the inactivated vaccine virus is not reproducing, and might provide a simple tool for mass detection of novel infections of commercial flocks. To fulfill the overall aim, the project was designed to include four operational objectives: 1. Evaluation of the genetic evolution of AIV in Israel; 2. Assessment of the diagnostic value of an NS1 ELISA; 3. NS1 ELISA as evaluation criteria for measuring the efficacy of vaccination against H9N2 AIV; 4. Development of an AIV H9 subtype specific ELISA systems. Major conclusion and implications drawn from the project were: 1. A continuous genetic change occurred in the collection of H9N2 isolates, and new introductions were identified. It was shown thatthe differences between the HA proteins of viruses used for vaccine productionand local fieldisolatesincreasedin parallelwith the durationand intensity ofvaccine use, therefore, developing a differential assay for the vaccine and the wild type viruses was the project main aim. 2. To assess the diagnostic value of an NS1 ELISA we first performed experimental infection trials using representative viruses of all introductions, and used the sera and recombinant NS1 antigens of the same viruses in homologous and heterologous NS1 ELISA combination. The NS1 ELISA was evidently reactive in all combinations, and did not discriminate significantly between different groups. 3. However, several major drawbacks of the NS1 ELISA were recognized: a) The evaluation of the vaccination effect in challenged birds, showed that the level of the NS1 antibodies dropped due to the vaccination-dependent virus level drop; b) the applicability of the NS1-ELISA was verified on sera of commercial flocks and found to be unusable due to physico-chemical composition of the sera and the recombinant antigen, c) commercial sera showed non-reactivity that might be caused by many factors, including vaccination, uncertainty regarding the infection time, and possibly low antigen avidity, d) NS1 elevated antibody levels for less than 2 months in SPF chicks. Due to the above mentioned reasons we do not recommend the application of the DIVA NS1 ELISA assay for monitoring and differentiation AIV H9N2 naturally-infected from vaccinated commercial birds.
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Gershoni, Jonathan M., David E. Swayne, Tal Pupko, Shimon Perk, Alexander Panshin, Avishai Lublin, and Natalia Golander. Discovery and reconstitution of cross-reactive vaccine targets for H5 and H9 avian influenza. United States Department of Agriculture, January 2015. http://dx.doi.org/10.32747/2015.7699854.bard.

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Research objectives: Identification of highly conserved B-cell epitopes common to either H5 or H9 subtypes of AI Reconstruction of conserved epitopes from (1) as recombinantimmunogens, and testing their suitability to be used as universal vaccine components by measuring their binding to Influenza vaccinated sera of birds Vaccination of chickens with reconstituted epitopes and evaluation of successful vaccination, clinical protection and viral replication Development of a platform to investigate the dynamics of immune response towards infection or an epitope based vaccine Estimate our ability to focus the immune response towards an epitope-based vaccine using the tool we have developed in (D) Summary: This study is a multi-disciplinary study of four-way collaboration; The SERPL, USDA, Kimron-Israel, and two groups at TAU with the purpose of evaluating the production and implementation of epitope based vaccines against avian influenza (AI). Systematic analysis of the influenza viral spike led to the production of a highly conserved epitope situated at the hinge of the HA antigen designated “cluster 300” (c300). This epitope consists of a total of 31 residues and was initially expressed as a fusion protein of the Protein 8 major protein of the bacteriophagefd. Two versions of the c300 were produced to correspond to the H5 and H9 antigens respectively as well as scrambled versions that were identical with regard to amino acid composition yet with varied linear sequence (these served as negative controls). The recombinantimmunogens were produced first as phage fusions and then subsequently as fusions with maltose binding protein (MBP) or glutathioneS-transferase (GST). The latter were used to immunize and boost chickens at SERPL and Kimron. Furthermore, vaccinated and control chickens were challenged with concordant influenza strains at Kimron and SEPRL. Polyclonal sera were obtained for further analyses at TAU and computational bioinformatics analyses in collaboration with Prof. Pupko. Moreover, the degree of protection afforded by the vaccination was determined. Unfortunately, no protection could be demonstrated. In parallel to the main theme of the study, the TAU team (Gershoni and Pupko) designed and developed a novel methodology for the systematic analysis of the antibody composition of polyclonal sera (Deep Panning) which is essential for the analyses of the humoral response towards vaccination and challenge. Deep Panning is currently being used to monitor the polyclonal sera derived from the vaccination studies conducted at the SEPRL and Kimron.
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Fukuta, Hidekatsu, Hiromi Hagiwara, and Takeshi Kamiya. Influenza vaccination in patients with heart failure: a protocol for meta-analysis of randomized controlled trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2022. http://dx.doi.org/10.37766/inplasy2022.1.0115.

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Fan, Jingchun, Shijie Xu, Xiaoting Ma, Juan Cao, and Shisan Bao. The influencing factors of the influenza vaccination rates among healthcare workers：a systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, May 2023. http://dx.doi.org/10.37766/inplasy2023.5.0051.

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Woods, Rachel, Alison Zhong, and Madelyn Vincent. Factors Associated with Influenza & Tdap Vaccine Uptake in Pregnant Patients at the UT Family Medicine Clinic in Memphis. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/com.lsp.2020.0003.

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INTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (>50,000,000 annual US cases affecting all ages) and pertussis (>15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates. OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family Medicine Clinic at Memphis (UTFMC-M), compare those rates with national pregnancy flu/Tdap vaccination rates, and to generate recommendations based off observed factors associated with vaccine uptake to improve flu/Tdap vaccination rates in UTFMC-M pregnant patients. METHODS: This was a retrospective chart review of UTFMC-M patients who were pregnant from September 1, 2019-April 24, 2020 (included 2019-2020 flu season) (n=465). Variables studied included demographic data (race, age, insurance), immunization history (vaccine status, history of physician encouragement), and prenatal history (parity, number of prenatal visits, trimester at first visit, high risk clinic (HRC) admittance status). Vaccination status was based on ACIP recommendations (Flu shot eligible = any gestational age; Tdap eligible = ≥27 weeks). Positive HRC admittance was noted for patients with ≥2 visits to the UTFMC-M HRC, a clinic that specializes in high risk pregnant patient care. RESULTS: The patient sample was predominantly black (84.3%) and insured by Medicaid programs (88%). Among eligible UTFMC-M pregnant patients, 50.1% were flu-vaccinated (n=465); 73.8% were Tdap-vaccinated (n=317); and 52.1% were Flu+Tdap-vaccinated (n=317). No significant associations were found between vaccine uptake and HRC status, parity, and age. However, statistically significant relationships were found between vaccine uptake and physician encouragement (positive relationship with flu shot: X2(1, N = 465) =131, p < 0.001, Tdap: X2 (6, N = 465) =476, p < 0.001), number of prenatal visits (flu shot group median 8 visits, Tdap group median 9 visits vs. unvaccinated group median 4 visits; p < 0.001), and early trimester age at first prenatal visit (X2(6, N = 465) =47.635 , p CONCLUSION: 2019-2020 UTFMC-M vaccination rates were on par with 2018-2019 US flu vaccine rates and higher than 2018-2019 US Tdap and Flu+Tdap rates. There were statistically significant relationships between vaccine uptake at UTFMC-M and physician encouragement, number of prenatal visits, and early trimester age at first prenatal visit but no significant relationships with UTFMC-M HRC admittance, parity, or age. Recommendations following from our observations to address further vaccine rate improvement include: continue vaccine encouragement, continue booking multiple visits (8 for flu, 9 for Tdap), prioritize Tdap vaccine higher for late trimester intake patients, and focus on flu vaccine encouragement and education.
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Black, Lindsey, Amanda Ng, and Benjamin Zablotsky. Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months to 17 Years: United States, 2019. National Center for Health Statistics, April 2021. http://dx.doi.org/10.15620/cdc:104187.

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Perk, Shimon, Maricarmen Garcia, Alexander Panshin, Caroline Banet-Noach, Irina Gissin, Mark W. Jackwood, and David Stallknecht. Avian Influenza Virus H9N2: Characterization and Control Strategies. United States Department of Agriculture, June 2007. http://dx.doi.org/10.32747/2007.7709882.bard.

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Control of Avian Influenza (AI) infection is a highly topical subject of major economicimportance for the worldwide poultry industry at the national level and for international trade.H9N2 viruses are endemic in poultry throughout Asia and the Middle East, causing major losses inproduction. Moreover, these viruses pose wider threats since they have been isolated from bothswine and humans. At the same time, study of the AI viruses affords an opportunity to explore anumber of problems of intriguing scientific interest. The overall goal of this project was to developa sound control strategy for avian influenza subtype H9N2 viruses (AI H9N2) in commercialpoultry in Israel. The one-year feasibility study focused on two main goals, namely: to study themolecular characteristics of AI H9N2 circulating during the last seven years in Israel and todevelop tools enabling differentiation between the immune response to vaccination and infectionwith H9N2.Genetic and phylogenetic characterization of 29 selected AI H9N2 isolates (2000-2006)was performed by complete sequencing of hemagglutinin (HA), neuraminidase (NA), and all sixinternal genes [nucleoprotein (NP), polymerase basic 1 (PB1), polymerase basic 2 (PB2),polymerase acid (PA), matrix (M), and nonstructural (NS) genes]; comparative phylogenetic andgenetic analyses of these sequences; and comparative genetic analyses of deduced amino acidsequences of the HA, NA, NS1, and NS2 proteins. The major conclusions of the molecularanalyses were: (1) Israeli isolates, together with other H9N2 viruses isolated in Middle Eastcountries, comprise a single regional sublineage related to the G1-lineage. In addition, Israeliisolates subdivided into three different subgroups. Genetic analysis of these viruses suggests thatthey underwent divergent evolution paths.
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