Dissertations / Theses on the topic 'Influenza vaccination'

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.

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.

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.

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.

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

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.

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.

The influenza virus, a member of the Orthomyxoviridae family, causes regular, large-scale morbidity and mortality in birds and humans and significant human suffering and economic loss. The primary aim of this study was to develop a novel influenza vaccine. Vaccines are an essential tool for the control of influenza because they increase resistance to infection, prevent illness and death and help to limit virus transmission to other birds and mammals, including humans. By reducing the environmental contamination of influenza virus in global poultry stocks, the risk of a new pandemic virus being generated by the human-avian link is diminished. Marek’s Disease is a common lymphoproliferative disease of poultry that is readily controlled worldwide using the live attenuated vaccine, CVI988. The Marek’s Disease Virus (MDV) CVI988 viral genome, available as a Bacterial Artificial Chromosome (BAC), forms viable infectious viral particles when transfected into Chicken Embryo Fibroblast (CEF) cells. Using BAC mutagenesis, two non-essential genes in the MDV CVI988 BAC (UL41 and US10), were identified and replaced by the low pathogenic influenza haemagglutinin 10 (H10) gene. These live recombinant MDV-H10 vectors will allow simultaneous vaccination against both pathogens. In addition, the non-essential genes were also replaced with GFP creating MDV-GFP constructs. Both genes were expressed initially using a CMV promoter, although this disrupted the MDV CVI988 BAC; a second promoter, PGK-1, proved more successful. A third MDV gene (UL50) was deleted, but severe attenuation prevented the incorporation of H10 into this open reading frame. Future work to test the MDV-HA constructs in vivo will be carried out in collaboration with the Istituto Zooprofilattico Sperimentale delle Venezie in Italy. In addition, development of MDV constructs containing multiple HA genes (H10 and H5) linked by the 2A polyprotein can be developed with the goal of establishing heterosubtypic immunity.

Seasonal influenza, or the flu, impacts over 3 million people each year. Within the health sector, nosocomial infection and absenteeism are frequently associated with the flu. The Centers for Disease Control and Prevention (CDC) recommend flu vaccination for all eligible individuals, especially health care workers (HCWs). Interventions associated with increased HCW vaccination include educational programs and occupational health campaigns to address misconceptions regarding vaccine safety and efficacy. This project evaluated the impact of a voluntary, web-based education module to encourage registered nurse (RN) vaccination. The logic and health belief models served as the theoretical frameworks. In a nonequivalent group design, an educational program addressing evidence-based barriers to vaccination was delivered at 1 acute-care hospital and was not delivered at a comparison hospital within the health system. A total of 192 surveys (116 at intervention facility) were returned over 3 weeks. Statistically significant differences (x2 = 7.210, p = 0.007) were found for RNs who accepted influenza vaccination after education when compared to the RNs not receiving education. The 15% higher vaccination rate for RNs receiving education (91.1% vs. 76.1%) translates into more than 100 additional vaccinated RNs if applied across both hospitals. This project found that a simple but tailored web-based educational program is effective in converting RNs to vaccination acceptance. Increased vaccination produces societal change by reducing nosocomial and community influenza transmission. Reduced influenza infection improves community health as well as patient safety. Future work should address community-wide HCW education initiatives and evaluate their impact on quality and financial indicators at the hospital and community levels.

Background Influenza causes annual, worldwide epidemics of respiratory disease that affects all segments of the population. Mass vaccination of healthy children, who are playing an important role in the transmission of influenza, is promoted to be a complementary approach in prevention and control of influenza. However, lack of published systemic review evidencing the indirect protection of vaccinating healthy children makes the implementation under uncertainty. Method A systemic review was conducted by computerized bibliographic searches in PubMed and the Cochrane Library identifying the published studies on the effectiveness and cost-effectiveness of vaccinating healthy children to control influenza epidemics by reducing transmission in the community. Any study design with vaccinating healthy children as the intervention versus control group with no influenza vaccine was included. Only outcomes measured on the contacts of children, either the community or household members were considered. Result Twenty-two articles were selected to be reviewed in this project, in which 17 of them covered the public health benefit of vaccinating healthy children to protect others in the community against influenza, and five of them were economic studies. Overall the result suggested that vaccinating health children produces a public health benefit in protecting others in the community against influenza and that it is a cost-effective measure. Discussion Targeting vaccines to healthy children should be promoted for optimal vaccine allocation, maximizing the vaccination effectiveness. Community planning on vaccine delivery infrastructure as well as educational and communicational strategies is necessary to improve influenza vaccine coverage. Further well-designed studies such as RCT with larger sample sizes, as well as studies in Hong Kong or other sub-tropical regions should be carried out and included. Moreover, large and population-based studies should be conducted to examine the overall impact of universal childhood influenza immunization.
published_or_final_version
Public Health
Master
Master of Public Health

Influenza (IV) and pneumococcal polysaccharide vaccination (PPV) may reduce hospitalization and mortality but the effectiveness of these vaccines in older adults (≥65 years) is controversial. This thesis includes seven parts with a total of ten studies studying different aspects regarding IV and PPV in institutionalized older adults - the group with the highest infection-related morbidity and mortality. 　　 　　In Part I, we presented the controversies about effectiveness of influenza and pneumococcal vaccination in institutionalized older adults. 　　 　　In Part II, we studied a retrospective cohort of 1737 older adults showing that nursing home residence is independent risk factor of infection-related mortality and hospitalization. 　　 　　In Part III, the second and third studies were systematic reviews showing that IV and PPV could reduce pneumonia and death.. 　　 　　In Part IV, we evaluated the effectivenss of IV and PPV through prospective cohorts. The fourth study was a prospective cohort study of 1859 institutionalized older adults showing that IV significantly reduced mortality and hospitalization. The fifth study was a prospective cohort study of 532 institutionalized older adults showing that when the IV strain does not match the circulating strain, PPV provided additional protection in reducing mortality. 　　 　　In Part V, the sixth study was a randomized controlled trial of 100 institutionalized older adults showing that intradermal IV has better immunogenicity than intramuscular vaccination without compromising safety. 　　 　　In Part VI, we identified factors that may affect clinical effectiveness of IV. The seventh and eighth studies were prospective cohort studies of 711 institutionalized older adults showing that vaccine efficacy declined with increasing impaired functional status and renal function. 　　 　　In Part VII, we identified determinants of receiving IV and PPV in institutionalized older adults. The ninth study was a cross-sectional study of 155 institutionalized older adults showing that encouragement from nHCWs was a major facilitator of receiving vaccination. The tenth study was a cross-sectional study of 1300 nHCWs showing that 40.2% of nHCWs had encouraged residents to receive vaccination. 　　 　　In conclusion, ten studies from this thesis demonstrated that IV and PPV are effective in preventing hospitalization and reducing mortality in institutionalized older adults. Different strategies in improving its effectivenss and acceptance were suggested.
published_or_final_version
Medicine
Master
Doctor of Medicine

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Background: Rates of influenza vaccination among healthcare workers (HCWs) are low despite the significant morbidity and mortality benefit to the HCWs, their patients and their families. Objective: To examine whether attitudes, perceptions and beliefs of HCWs about influenza and influenza vaccination affect their uptake of the seasonal influenza vaccine. Methods: Telephone interviews were conducted of HCWs during March 2011 to assess seasonal influenza vaccine uptake, attitudes regarding influenza vaccination, and perceptions of risk of influenza infection. Results: Telephone surveys were completed by 1,171 HCWs and of these 903 responded to all questions relevant to this analysis. Logistic regression models of rates for current, 2010-2011,i influenza vaccination season and preceding influenza vaccination seasons were performed. statistically significant (P<0.05) positive odds ratios for vaccination were found among providers, HCWs with more experience, those who favor mandatory workplace vaccination, believing that the vaccine protects family members, believing the average person is somewhat r very likely to be infected with influenza in a given year, not believing that the influenza vaccine will cause illness, and claiming a higher likelihood of vaccination if the vaccine were less costly or free. Of these, the strongest modifiable predictors of seasonal influenza vaccination uptake were a belief that the vaccine provides protection to the HCWs’ family members and a belief that the average person is somewhat or very likely to be infected with influenza in a given year. Conclusion Beliefs about influenza vaccination have significant effects on HCW seasonal influenza vaccine uptake. We recommend targeting these beliefs when designing educational programs for HCW regarding influenza vaccination. Conclusion: Beliefs about influenza vaccination have significant effects on HCW seasonal influenza vaccine uptake. We recommend targeting these beliefs when designing educational programs for HCW regarding influenza vaccination.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Introduction: Thousands of people die from influenza or its complications each year despite the fact that it is one of the few vaccine preventable diseases. Immunocompromised cancer patients are among the most vulnerable to this infection and flu‐related complications, and therefore vaccination is highly recommended in these patients; however, current vaccination rates and attitudes towards vaccination remain unknown. We hypothesize that immunization rates are lower than the 100% recommendation rate, and hope to understand the reasoning behind the discrepancy. The purpose of this study is to assess cancer patient attitudes towards influenza vaccination in an effort to minimize barriers to vaccination and eventually increase vaccination rates in this immunocompromised population. Methods: Cancer patients enrolled in phase I clinical oncology trials at the Virginia G Piper Cancer Center at Scottsdale Healthcare were invited to participate in a voluntary survey. The 15‐item survey consisted of demographic information, knowledge regarding the flu vaccine, vaccination status after cancer diagnosis and while on treatment, and general attitudes towards vaccination. A total of 84 cancer patients completed the survey. Results were stratified by age, gender, education level, and vaccination status. As this was a descriptive study, no statistical analyses were performed. Results: A total of 84 (n=84) advanced cancer patients enrolled in phase I clinical oncology trials completed the survey. Results indicate that although 71% of patients received the vaccine prior to cancer diagnosis, only 58% of patients have received the vaccine since their cancer diagnosis, and only 48% have been vaccinated while on cancer treatment. Of those vaccinated since cancer diagnosis, 94% reported doctor recommendation of the vaccine and most vaccinate to protect themselves from the virus. Of those not vaccinated since cancer diagnosis, only 37% report their doctor recommends the vaccine and the majority avoid vaccination because they believe the vaccine can cause the flu, they do not feel at risk of infection, and they do not believe the vaccine is effective. Conclusion: Our findings suggest that although the CDC strongly recommends influenza vaccination in cancer patients due to the risk of secondary complications and even death in these immunocompromised individuals, vaccination rates remain low. Our data demonstrates that patients who receive a doctor recommendation for the vaccine are more likely to be vaccinated, but not all doctors recommend the vaccine. Furthermore, false information regarding the vaccine, its efficacy, and its ability to cause infection continues to deter patients from vaccination. Together, this information offers profound insight into the cancer patient population and suggests the need for increased physician and patient education regarding the benefits of annual influenza vaccination to improve vaccination rates and decrease influenza infection and complications in the future.

Darbo tikslas. Įvertinti Lietuvos sveikatos priežiūros įstaigų darbuotojų požiūrį į vakcinaciją. Metodika. Kad įvertinti Lietuvos sveikatos priežiūros įstaigų darbuotojų požiūrį į vakcinaciją, buvo atliktas paplitimo tyrimas. Buvo apklausta 1693 respondentai, dirbantys asmens sveikatos priežiūros įstaigose. Duomenys apdoroti SPSS (13) kompiuterine programa. Analizei taikytas Pearson‘o χ2 testas ir statistiniam išvadų tikrinimui pasirinktas reikšmingumo lygmuo 0,05. Rezultatai. Anketinė apklausa parodė, kad Lietuvos sveikatos priežiūros įstaigų darbuotojai teigiamai žiūri į vakcinaciją. Nors skiepijasi 54,8% bendrosios praktikos gydytojų, 55,9% terapeutų ir kitų specialistų bei 51,6% slaugytojų, visgi jie nurodė, kad vakcina žymiai efektyvesnė ir mažiau kainuoja nei kitos medicininės paslaugos – 67,0% bendrosios praktikos gydytojų, 69,1% terapeutų ir kitų specialistų bei 60,3% slaugytojų ir kad skiepai duoda žymiai daugiau naudos nei žalos (84,9% bendrosios praktikos gydytojų, 87,5% terapeutų ir kitų specialistų bei 71,7% slaugytojų). Iš dažniausiai nurodytų nesiskiepijimo priežasčių, dauguma respondentų nurodė, kad nesiskiepija nuo gripo dėl to, kad saugosi nuo gripo stiprindami sveikatą (19,3% bendrosios praktikos gydytojų, 18,9% terapeutų ir kitų specialistų bei 15,8% slaugytojų), niekada gripu neserga (20,0% bendrosios praktikos gydytojų, 17,0% terapeutų ir kitų specialistų bei 15,2% slaugytojų), įgyjamas natūralus imunitetas (22,2% bendrosios praktikos gydytojų, 8,0%... [toliau žr. visą tekstą]
Objective: To determine the Lithuanian health care institutions workers opinion about vaccination. Methods: In order to determine the Lithuanian health care institutions workers opinion about vaccination spread research was performed. Were polled 1693 respondents working in health care institutions. The data was analysed using SPSS computer program. There was used Pearson Chi-Square test and to check statistical reliability was choose the difference statistically insignificant 0,05. Results: Questionnaire date shows positive Lithuanian health care institutions workers opinion about vaccination. Even though only 54,8% of common practice physicians, 55,9% therapeutists and other specialists and 51,6% nurses were vaccinated themselves but they indicated that vaccination is more effective and less expensive than other medical service – 67,0% of common practice physicians, 69,1% therapeutists and other specialists and 60,3% nurses and that vaccination is more useful than harmful (84,9% of common practice physicians, 87,5% therapeutists and other specialists and 71,7% nurses). The major reason why the respondents are against vaccination, especially against influenza virus, is that they strengthen their health to protect themselves against virus (19,3% of common practice physicians, 18,9% therapeutists and other specialists and 15,8% nurses), never have flu (20,0% of common practice physicians, 17,0% therapeutists and other specialists and 15,2% nurses), and acquire natural immunity... [to full text]

Background: Little is known about long-term pediatric health outcomes following influenza vaccination during pregnancy. Objectives: The objectives of this study were to assess the associations between prenatal exposure to maternal pandemic H1N1 (pH1N1) influenza vaccination and pH1N1 illness, with long-term immune-related pediatric health outcomes. Methods: This retrospective cohort study used a province-wide birth registry from Ontario, individually linked with health administrative databases to ascertain study outcomes over five years of follow-up. Results: We found a weak, but statistically significant, increased association between prenatal pH1N1 influenza vaccination and pediatric asthma, and an inverse association with gastrointestinal infections; otherwise, no other significant associations were observed. Conversely, significant increased associations were observed between pH1N1 influenza illness during pregnancy and all study outcomes. Conclusions: The findings of this study support the safety of influenza vaccination during pregnancy; however more research in this area is required, particularly for seasonal influenza vaccine.

This purpose of this quantitative study was to examine health beliefs among Caribbean-born university students regarding acceptance or rejection of influenza vaccination among populations at institutions of higher education. In addition, acculturation was addressed as a factor affecting cultural health beliefs. A survey was completed by 98 students enrolled at Florida International University during the spring 2018 semester. Linear regression was used to analyze whether cultural health beliefs and acculturation were predictive of beliefs about influenza vaccination and beliefs about perceived barriers to influenza vaccination. The study findings showed cultural health beliefs of the students were statistically significant predictors of their beliefs about influenza vaccination and perceived barriers to influenza vaccination. Also, the levels of acculturation were a statistically significant predictor of students' cultural health beliefs and beliefs about perceived barriers to influenza vaccination. After 5+ years of acculturation in the United States, the students surveyed still held cultural beliefs and perceived barriers to influenza vaccination that contributed to their lack of acceptance of the vaccination. The information gained from this study gives credence to the need for designing health interventions and health messages on influenza vaccination that are culture specific for a college-age population if influenza vaccination acceptance is to be promoted.

Background The pandemic of influenza A (H1N1-2009) virus was particularly widespread among children. Children and young adults were more likely to be infected than older adults, and infection among infants tended to lead to a higher risk of severe complications than among older children and adults. Vaccination against the virus was thus recommended as an effective countermeasure to protect these susceptible age strata from influenza infection and subsequent complications. Parental perception, attitudes and beliefs would thus play a major role in mitigating the pandemic influenza because these factors underlie the degree of vaccination uptake among children. Objective The primary aim of this study is to understand factors that are associated with parental acceptance of pediatric vaccination against influenza (H1N1-2009). The secondary aim is to consider the effective future vaccination campaign in the event of a pandemic and to increase child vaccination coverage. Methods We conducted a systematic literature search of the electronic databases, PubMed and the Web of Science. We identified and examined published literatures associated with parental acceptance dating back to the beginning of the 2009 pandemic. We extracted key datasets from these literatures, summarized the evidence systematically and determined the relationship amongst the aforementioned parental characteristics and acceptance of pandemic influenza vaccines. Results We included a total of 14 studies in this review. Our systematic review indicates that parents were more willing to accept H1N1 pandemic influenza vaccination if 1) their children had previous experience with seasonal influenza; 2) they have had the pandemic influenza vaccine themselves; or 3) they intended to have their children vaccinated against seasonal influenza vaccine. We also founded that parental perceptions and attitudes towards both the influenza pandemic itself and the pandemic influenza vaccine are significantly associated with acceptance. Our study identified misperceptions and distrust in vaccine safety as the main reason for parents to refuse pandemic influenza vaccination for their children. In addition, we found that parents usually received negative appraisal on pediatric influenza vaccination from the media and tended to regard health care workers as the most reliable source of information on pediatric influenza vaccination. . Conclusions Parental perceptions are influential on pandemic influenza vaccine acceptance of their children. We affirm the importance of the role of health care workers in delivering appropriate information on influenza vaccines to parents in increasing pediatric vaccination uptake. We recommend public health officials to employ effective strategies for risk communication regarding pediatric influenza vaccines in order to increase the coverage and hence effectiveness of vaccination program against a future influenza pandemic.
published_or_final_version
Public Health
Master
Master of Public Health

Objective: Pregnancy has been recognized as a risk factor for severe pandemic influenza illness and this “vulnerable” group is suggested to be heightened alertness to the disease by WHO. This systemic review aims to identify the factors affecting the uptake of influenza vaccination among pregnant women as the immunization uptake among this particular group of population is low or suboptimal worldwide. Methods: Systematic literature reviews were conducted by using MEDLINE and PubMed with the key words: “influenza vaccination uptake” and “pregnant women” in the period of January 2004 to January 2013. It was further supplemented by a manual search for literatures and articles on the WHO website, Centers for Disease Control and Prevention (CDC) website, Google Scholar, and reference lists of reviews captured by initial searches. Results: Of the 222 articles identified, 10 studies were found to be relevant in this system literature review. Influenza vaccine coverage among pregnant women was highly diverse (6.2-76%) among the 10 studies. Overall, pregnant women were more likely to take the vaccination against influenza if they: (1) believed the benefits of the vaccine outweighed the potential barriers, (2) believed the influenza was severe and they were highly susceptible to the disease, and (3) were influenced by the positive cues to action such as recommendation from health care professionals and the experience of the influenza vaccination uptake. Conclusion: Overall, greater emphasis on vaccine effectiveness and safety, and the recommendation from health care providers is needed to increase the number of pregnant women influenza immunization in the future public health campaigns.
published_or_final_version
Medicine
Master
Master of Public Health

The research aimed to explore beliefs about influenza and influenza vaccination, and the social influences on decisions whether or not to accept the influenza vaccination in a sample of urban-dwelling Thai adults. It also aimed to test the effect of a Health Action Process Approach (HAPA)-based leaflet on influenza vaccination behaviours among these high-risk individuals, and to evaluate the impact of a HAPA-based leaflet on potential mediators of behavioural change. Additional aim was to examine the predictive utility of the HAPA model in relation to both intention and subsequent vaccination behaviour in a certain high risk group. Firstly, a qualitative study was carried out. In-depth interviews were conducted among 20 high-risk individuals who were either (i) aged 65 and over, or (ii) under 65 years with chronic diseases that had clinical indications requiring influenza vaccination. Findings indicate that most participants had insufficient knowledge about influenza and influenza vaccination. Their decisions whether or not to get vaccinated against influenza were based on a number of factors, including salience of risk, influence of others, perception of the need for preventive health care, and the availability of influenza vaccine. Secondly, a controlled before and after trial was conducted. Participants in the intervention (n = 99) received a HAPA-based leaflet and asking them to form an action plan identifying where, when and how they would seek vaccination. Those in the comparison condition (n = 102) received a standard government information leaflet. The HAPA intervention resulted in greater changes on measures of risk perception, outcome expectancies, self-efficacy, and intention than the comparison condition. No significant difference in vaccination rates was observed between two groups. Influenza vaccination was directly predicted by self-efficacy and intention.

Objectives: To identify factors that are important for parental decisions on vaccinating their children against seasonal influenza based on a modified health belief model. Study design: Cross-sectional study Subjects: A total of 325 parents who had at least one child aged between 6 months and 3 years were recruited from a women and children’s hospital in Guangzhou, China Methods: Eligible subjects were identified by doctors when parents took their children to the outpatient clinic for regular body examination. Each eligible subject was invited for a face-to-face interview based on a standardized questionnaire. Hierarchical logistic regression models were conducted to identify factors associated with parents' intention to vaccinate their children and children’s actual vaccination uptake against seasonal influenza on the basis of a modified health belief model. Results: Uptake of seasonal influenza within the preceding 12 months among the target children who aged between 6 and 36 months was 47.7%. Around 62.4% parents indicated as being “likely/very likely” to take their children for seasonal influenza vaccination in the next 12 months. The hierarchical logistic regression model showed that children’s age (OR=2.59, 95%CI: 1.43-4.68), social norm (OR=2.08, 95%CI: 1.06-4.06) and perceived control (OR=2.96, 95%CI: 1.60-5.50) were significantly and positively associated with children’s vaccination uptake within the preceding 12 months; children with a history of taking seasonal influenza vaccine (OR=2.50, 95%CI: 1.31-4.76), perceived children’s health status (OR=3.36, 95%CI: 1.68-6.74), worry/anxious about their children influenza infection (OR=2.31, 95%CI: 1.19-4.48) and perceived control (OR=3.21, 95%CI: 1.65-6.22) were positively association with parental intention to vaccinate their children in the future 12 months. However, anticipated more regret about taking children for the vaccination was associated with less likely to vaccinate children within the preceding 12 months (OR=0.21, 95%CI: 0.08-0.52). Conclusions: The modified health belief model provided a good theoretical basic for understanding factors associated with parents’ decisions on their children's vaccination against seasonal influenza. It is important to provide sufficient information related to influenza vaccination benefit and improve parents' confidence to access the seasonal influenza vaccine to promote parents' intention to vaccinate their children against seasonal influenza. Providing information cues such as advice from other parents whose children have been vaccinated to increase adherence to positive social norms would be effective to encourage seasonal influenza vaccination uptake among children. Information communication should also target on reducing anticipated regret about the negative consequence of vaccinating children.
published_or_final_version
Public Health
Master
Master of Public Health

Class of 2009 Abstract
OBJECTIVES: To determine patient preference for the type of visit for the receipt of the influenza vaccine from the pharmacist and to determine patient preference for contact method for annual notification of the influenza vaccine program. METHODS: This was a descriptive study using a short telephone survey. The first dependent variable was the preferred type of visit comparing appointment-based and predetermined walk-in clinics. The second dependent variable was the preferred method of contact for annual notification of a pharmacist administered influenza vaccination program (telephone, US post mail, email). RESULTS: The telephone survey was completed by 206 patients. Overall, study participants preferred appointment-based visits ( 81.2 %; p < 0.05) compared to a predetermined walk-in clinic (18.8%). Overall, study participants significantly preferred to be contacted for annual notification of a pharmacist administered influenza vaccination program via telephone (75.7%; p< 0.05) compared with US post mail and email. Based on the percentages observed, the second preferred method of contact was email (12.6%) and US post mail was the third preferred method of contact (11.7%). CONCLUSIONS: Patient preference for type of visit for pharmacist-administered influenza vaccine was appointment-based as opposed to predetermined walk-in clinic based. Patient preference for contact method for annual notification was telephone as opposed to email or postal mail.

Class of 2009 Abstract
OBJECTIVES: To evaluate patients’ perceptions of receiving a pharmacist-administered influenza vaccine in the community pharmacy setting. METHODS: All patients receiving a pharmacist-administered influenza vaccine at a Safeway Pharmacy in Tucson, Arizona were invited to participate in the survey. Participants completed the survey in a waiting area outside the pharmacy. At the completion of the study time frame, surveys were collected, and each response was entered into an Excel spreadsheet for data analysis. RESULTS: Seventy-five patients completed the Flu Shot Survey. One hundred percent of patients reported that getting the influenza vaccine at a grocery store pharmacy is convenient. Respondents reported being either very confident (97.3%) or somewhat confident (2.7%) in pharmacists as immunizers. Only 18.7% reported having never received an influenza vaccine from a pharmacist, and 13.3% reported having no prior knowledge that Arizona pharmacists could administer the influenza vaccine. CONCLUSIONS: All patients responded that receiving the influenza vaccine from a community pharmacist was convenient. Patients wanted to receive the vaccine next year from a pharmacist, and the majority of respondents were confident in the pharmacist as an immunizer. Few patients reported never receiving the influenza vaccine from a community pharmacist, and even fewer patients were unaware that pharmacists in Arizona can immunize.

Thesis (M.S. in Management)--Naval Postgraduate School, December 2009.
Thesis Advisor(s): Apte, Aruna. Second Reader: Ferrer, Geraldo. "December 2009." Description based on title screen as viewed on January 27, 2010. Author(s) subject terms: Pandemic Influenza, Vaccine Distribution, Vaccine Distribution with DoD Assets, DoD Pandemic Influenza Response Plan. Includes bibliographical references (p. 63-64). Also available in print.

Pregnant women infected with influenza virus are more likely to experience severe complications compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence and predictors of seasonal influenza vaccine uptake among pregnant women in Hong Kong. Using a multi-centre cross-sectional design, we recruited 2,822 new mothers during their immediate postpartum stay at all eight public obstetric hospitals over a three-month period from April through June 2011. We assessed their antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake. Only 49 (1.7%; 95% CI 1.3% to 2.3%) participants were vaccinated during pregnancy. Fears that the vaccine would harm their foetuses or themselves were the most common reasons for not being vaccinated. Being aware of vaccination recommendations (OR=2.69; 95% CI 1.06, 6.82), being advised by a health care provider (HCP) to be vaccinated (OR=6.30; 95% CI 3.19, 12.46), a history of influenza vaccination (OR=2.47; 95% CI 1.25, 4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64, 8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79, 26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07, 0.40) were strongly associated with failure to vaccinate. A qualitative descriptive design was also used to explore a broad spectrum of health knowledge and beliefs of participants regarding influenza infection and influenza vaccination during pregnancy. An interview guide was developed based on the Health Belief Model. A sub-sample of participants who completed the quantitative study were invited to take part in the qualitative interviews. A total of 32 postpartum women were interviewed and only two had been vaccinated during pregnancy. Following thematic analysis, three themes emerged that further highlighted the pregnant women’s perceptions toward influenza vaccine and their decision-making process, perceived risk of influenza infection, perceived risk of an influenza vaccine, and decision-making cues. Overall, participants held negative impressions about influenza vaccination during pregnancy. This could be because of misconceptions and underestimation of the threats of influenza infection to themselves and their foetuses. They were also confused about the safety and efficacy of the influenza vaccine. Participants were confused about the differences between preventive strategies and treatment for influenza and HCPs did not offer or recommend vaccination. Because of negative media reports about the pros and cons of vaccination, participants were hesitant to receive the vaccine. Nevertheless, findings suggested that motivating forces for vaccine acceptance were a high prevalence of circulating influenza infection during their pregnancy and HCP recommendations and reassurances that the vaccination was safe, effective, and beneficial for the foetus. Vaccination promotion strategies need to focus on encouraging HCPs to discuss vaccination with their pregnant clients and provide accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.
published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing

Class of 2011 Abstract
OBJECTIVES: The purpose of this study was to create and evaluate the usability and credibility of an informational website about the influenza vaccination. METHODS: This was a descriptive study of user’s reactions to a website. Questionnaires administered during a regularly scheduled class collected ratings of the usability and credibility of an informational website about the influenza vaccination; data on vaccination status, year in pharmacy school and plans for future vaccination were also collected. RESULTS: Questionnaires were completed by 8 students. Eighty-eight percent of participants were in their 3rd year of pharmacy school and 62% received the influenza vaccination in the past season. Only one participant had used the internet to access information about vaccines in the past. The means scores for the 9 usability and credibility statements were between 2 to 2.9 indicating agreement with the statements. CONCLUSION: The influenza website is easy to navigate and provides a source of credible information about the influenza vaccination.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

Aim: Thisstudy aimedto investigatethe knowledge and attitudes of healthcareworkers regardinginfluenza, influenza vaccination,and vaccination practicesin emergency departments in Gothenburg, Sweden. Method: This cross-sectional studyuseda self-administered questionnaire distributed tonurses, assistant nurses,and physiciansin three emergency departments atThe Sahlgrenska University Hospital in January–February2014. Results: Among214 participants, 56% were nurses, 27% assistant nurses,and 17% physicians. The response ratewas 77%. A total of 66 participants (31%)werevaccinated against influenza during the previous12 months.The highest vaccination coverage occurredin the oldestage group(56%;P<0.05).Past vaccinationstrongly predicted future vaccinationbehavior (P<0.001). Ourdata revealed nosignificant difference invaccination coverage betweenprofession, work experience, hospital,or gender. The mean knowledge score was higher among vaccinated vs. unvaccinated health care workers (17.9 ± 2.7vs.16.8 ± 2.6, respectively; P< 0.05). Moreover, influenza risk perception was higher among participants who were vaccinated during the previous12 months compared to unvaccinated participants (P< 0.001). Interestingly, more un vaccinated health care workers believed that personal behavior determines health (higher internal locus of control) compared to vaccinated workers(P< 0.05). More than half of vaccinated health care workers stated that they got vaccinated to avoid influenza. Almost half of the unvaccinated workers voiced concern about vaccine side effects. Fourteen percent of all respondents mentioned patient protection as an important factor in their decision to receive influenza vaccination. Conclusion:This study demonstrates a need for improved knowledge about influenza and influenza vaccinationin health care workers. Increased risk perception of influenza can increase vaccination coverage in emergency department personnel,and may reduce the incidence of healthcare-associated influenza.

ISBN 978-91-86739-77-5

Vaccination coverage in adults remains suboptimal. Health organisations have only recently begun to recognise the role of socio-psychological factors in vaccination decisions. These factors are particularly important, given that they are inherently amenable to policy and behaviour change. This thesis employs a mixed-methods approach to investigate the determinants of adult seasonal influenza and tetanus vaccination in the UK general adult population. It focuses on socio-psychological factors and draws upon health behaviour models, heuristics and biases and customer journey mapping theoretical approaches to guide research and elucidate findings. A narrative and a systematic review and meta-analysis reveal there are a number of socio-psychological factors frequently associated with vaccination, particularly influenza and influenza vaccine risk perception, perceived vaccine effectiveness and reported physician recommendation, and show that most of the evidence in this area is produced in the US. They also highlight the importance of some vaccine risk perceptions, such as influenza-like symptoms and unspecific side-effects, and demonstrate that the existing evidence is highly heterogeneous and often lacking in quality, further supporting a case for robust empirical research on this topic. Two qualitative studies show that vaccine uptake is largely driven by people’s risk perception of influenza and tetanus, and that the tetanus vaccine is perceived as safe, unlike the influenza vaccine. They also reveal how specific healthcare ‘touchpoints’ across the immunisation journey can facilitate or hinder uptake. A novel finding is that certain childhood experiences can influence adult vaccination decisions. Two cross-sectional survey studies show that a compact set of variables can predict 91% of influenza and 75% of tetanus vaccination behaviour. They also demonstrate that socio-psychological factors are the most important determinants of vaccination behaviour. This thesis shows that incorporating socio-psychological dimensions in all aspect of immunisation policy, from surveillance systems to policy evaluation, is critical to improve vaccination rates.

Between 1991-1999, the Patient Episode Database for Wales (PEDW) was investigated and an association between influenza A viruses circulating in the community and demand for inpatient management of lower respiratory tract illness demonstrated r=0.73 a finding which supports influenza contributing significantly to the winter bed crises seen in the Welsh NHS in recent years. Once admitted to hospital, the clinical outcomes of influenza and pneumonia are poor the average length of the inpatient stay being 14 days with approximately one third of elderly and high-risk individuals dying during the inpatient period. To assess the effectiveness of the inactivated influenza vaccine in preventing such hospitalisations, a prospective case-control study was undertaken in Gwent, South East Wales during the winter of 1999-2000. After controlling for age, sex, chronic disease status, pneumococcal vaccine uptake, previous inpatient management and primary care consultations in an unconditional logistic model, the inactivated influenza vaccine was found to reduce admissions for acute respiratory illness significantly OR .30 (95% CI: .21 to .44 ) this translating to a 70% reduction in admissions. Furthermore, the risk of death once hospitalised was reduced by 75% in vaccinees OR .25 (95% CI:.l 1 to .60). Vaccination coverage in South East Wales during this season was poor and examination of the determinants of respiratory vaccine uptake suggests that the chronic medical conditions for which vaccination are recommended are not equally weighted. Vaccines appear to be targeted at individuals with chronic pulmonary disease, leaving many other high-risk groups, particularly individuals with cardiovascular disease vulnerable to influenza and its sequelae. Smokers were also significantly less likely to have received the influenza and pneumococcal vaccines, the OR's being .40 (95% CI: .27 to .57) and .57 (95% CI: .36 to .91) respectively. The widespread use of respiratory vaccines in elderly and identified high-risk groups has substantial resource implications for secondary care services in Wales. The review of the literature in Chapters 1 and 2 highlights a paucity of epidemiological data on the impact of influenza and pneumonia within a UK setting. Furthermore, the evidence base for influenza and pneumococcal vaccination, both of which are integral components of primary care prevention strategies, rests on observational studies conducted predominantly in North America. This thesis aims to draw together a number of studies to develop an epidemiological picture of individuals hospitalised with influenza and pneumonia during the 1990s in Wales. Furthermore, specific public health issues, such as the delivery and uptake of respiratory vaccines and the effectiveness of influenza vaccination are examined. The methodologies of the studies are outlined in chapter 3. In Chapter 4, trends of hospitalisations for influenza and pneumonia in Wales are examined and mean annual rates of hospitalisations for influenza, pneumococcal pneumonia and broad sub categories of pneumonia reported. The relationship between surveillance data reporting influenza like illness at primary care level and demand for inpatient management of lower respiratory tract illness is examined. The hypothesis that influenza contributes significantly to the winter bed crisis in the Welsh NHS is also investigated. Potential risk factors for and outcomes of hospitalisation due to influenza and pneumonia are also reported which subsequently inform the planning of the case control study outlined in Chapters 3 and 5. In addition, the missed opportunity for reducing the demand for inpatient management of vaccine preventable respiratory disease is assessed and determinants of influenza and pneumococcal vaccine uptake described. Finally, in Chapter 5, the effectiveness of the inactivated influenza vaccine in reducing admissions for respiratory disease during an influenza outbreak period is reported and the impact of increased acute respiratory admissions on a district general hospital in South East Wales described.

To develop successful vaccination programs for influenza pandemics, it is essential to understand the neighborhood-level factors that influence vaccination. Few studies have used an immunization registry to examine the neighborhood determinants of pandemic influenza vaccination among the general population. Using individual-level vaccination data and census, survey and administrative data to estimate the population at risk, an ecological study of the neighborhood determinants of 2009 pandemic A/H1N1 influenza vaccination in Montreal was conducted. Using logistic regression, accounting for spatial autocorrelation, the neighborhood socioeconomic and demographic determinants of pandemic influenza vaccination were identified among the total population and stratified by priority group. In Montreal, 918,733 (49.9%) residents were vaccinated against pandemic A/H1N1 influenza. Coverage was greater among females compared to males and varied by age with greatest coverage among infants. Coverage also differed by priority group with greatest coverage among healthcare workers. Neighborhood variation in coverage was observed and ranged from 33.6% to 71.0%, with low coverage clustered in neighborhoods in Eastern Montreal. Among the total population, high neighborhood proportions of immigrants and material deprivation were significantly associated with lower neighborhood vaccine coverage. These results will help public health authorities implement priority group specific vaccination strategies to increase vaccination during future influenza pandemics.
Pour bien développer des programmes de vaccination contre les pandémies de grippe, la compréhension des éléments de voisinage qui influence la vaccination est essentielle. Très peu d'études ont été effectuées en utilisant un registre d'immunisation dans le but d'explorer les déterminants du voisinage relatifs à la vaccination. En utilisant des données individuelles, des données de recensement, de sondages et des données administratives pour estimer la population à risque, une étude écologique des déterminants de voisinage lors de la vaccination de la grippe pandémique A/H1N1 fut effectuée. En utilisant la régression logistique, en tenant compte de l'autocorrélation spatiale, les déterminants socio-économiques et démographiques pour la vaccination ont été identifiés et classés par groupe de priorité. À Montréal, un total de 918,733 (49,9%) habitants furent vaccinés contre la grippe A/H1N1. Le taux de vaccination était plus important parmi les femmes comparativement aux hommes. Il a varié selon l'âge, le plus haut taux était parmi les enfants de moins de cinq ans. Le taux a aussi vu une croissance parmi les gens travaillant dans le secteur des soins de santé. Dans les différents quartiers de Montréal, les taux de vaccination ont variés de 33,6% à 71,0%. Les taux les plus bas furent retrouvés dans les quartiers de l'Est de Montréal. Dans la population générale, l'immigration et les milieux défavorisés ont été des facteurs significatifs associés aux bas taux de vaccination. Ces résultats vont aider les autorités des soins de santé à implanter des stratégies spécifiques aux divers groupes de priorité lors des futures pandémies de grippe.

Influenza is a preventable infectious disease, against which vaccination is the primary means of protection. Health care workers (HCW) are among the most vulnerable to the illness and are likely to be sources of infection transmission while caring for patients. Circumstantial evidence suggests higher rates of vaccination coverage by HCW will coincide with a lower incidence of influenza transmission, yet a gap remains in the literature regarding governing health agencies' (i.e., licensing boards, medical and nursing associations) influence on the influenza vaccination practices of their constituents. Moreover, discrepancies exist between governing health agencies' and the National Vaccine Advisory Committee's recommendations on mandatory influenza vaccination for HCW. The main purpose of this quantitative cross-sectional study was to explore the relationship between influenza vaccination uptake by HCW and guidance from governing health agencies to vaccinate. The health belief model and social cognitive theory were used to identify the most influential determinant for HCW to vaccinate against influenza. The sample consisted of 388 HCW who provided direct patient care at the same hospital. Data were analyzed using Fisher's exact test. Study findings suggest that a workplace mandate for influenza vaccination has an influence on HCW uptake of the vaccine and that governing agencies' lack of uniformity on the matter has minimal impact on their constituents' beliefs and behavior. It is recommended that a universal policy be adopted for health agencies' implementation of an influenza vaccine mandate, which could lead to positive social change by supporting preventive self-care practices, minimizing spread of the disease to workers and patients, and maintaining workplace productivity.

The purpose of this educational influenza vaccination project was to increase nurses' influenza vaccination rates. Nationally, 41% of nurses were vaccinated, which is far below the Healthy People 2020 goal of an influenza vaccination rate of 90%. Literature suggests that the low nurses' vaccination rate is responsible for inpatient healthcare associated influenza, mortality, and influenza-like illness. Healthcare facilities will not be reimbursed for treatment of healthcare associated infection. Despite recommendations from the Centers for Disease Control and Prevention for nurses to become vaccinated, only 20% of the 800 nurses at a healthcare facility in Baltimore were vaccinated for the past 2 years. A literature search for evidence-based articles was done electronically. Databases such as CINAHL, PubMed, and Medline identified 450 scholarly articles on attitudes, perceptions, and benefits of vaccination. Twenty-one scholarly articles written from 2006 onward that referenced increasing nurse vaccination rate were selected. Pender's health promotion model provided a conceptual view on beliefs and attitudes while explaining the delay in nurses to becoming vaccinated. Based on these scholarly sources a Power-Point presentation was developed that included 10 educational sessions. Five advisory committee members of experts were contacted via e-mail and telephone to review the educational project for feasibility and content validity. The advisory committee members commented that the educational project was feasible and relevant to the content of influenza vaccination for nurses. Social change will focus on nurses adapting a change in practice, and increasing their vaccination rate as a result of this evidence-based educational project.

Thesis (Ph.D.)--Baylor University, 2008.
In abstract the '2' and '-/-' in NOD-SCID-[beta]2m-/- is superscript. In abstract the '+' after CD34 and CD8 is superscript. In abstract the '-' and '+' in CD45RA-CD27+CD4+ are superscript. Includes bibliographical references (p. 103-123).

Influenza at the present stage is a serious problem, it is the only disease that over the past decade has caused a pandemic. Immunisation is the most important way to contain the infection. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/32145

Background: Influenza is a highly contagious but preventable acute respiratory illness associated with high morbidity. Seasonal influenza affects approximately 20% to 40% of children and adolescents. Annual influenza vaccination is an effective approach to prevent illness but recent studies suggests that adolescents are underutilizing important preventive health services and that influenza vaccination coverage in high risk adolescents is also suboptimal. The purpose of this study was to examine the association between household reported health status and socio-demographic characteristics of U.S. adolescents who reported receiving an influenza vaccination. Methods: Data from the 2008 National Immunization Survey were assessed examining various demographic and socioeconomic characteristics, as well as reported health status of non-institutionalized adolescents in the U.S. The sample was limited adolescents aged 13-17. Odds ratios were calculated and multivariate logistic regression was conducted. P-values of < 0.05 and 95% confidence intervals were used to determine statistical significance. Results: There were 29063 total observations with 18.9% reporting receiving the influenza vaccine. The results of this study indicate that sex, race and ethnicity, poverty status, health insurance status, asthma status, having an underlying health condition, missed school days due to illness or injury, and maternal age are associated with getting immunized against influenza. As one might expect those who reported having health insurance, having asthma, and having an underlying health condition had higher likelihood of vaccine. Interestingly, non-Hispanic other race and multi-race teens in the study were the most likely to receive the influenza vaccine compared with non-Hispanic white teens. Conclusions: This study further examines the impact of socio-demographic disparities and health status on influenza vaccination coverage. Although the current influenza vaccine recommendations now include all individuals ages 6 months and older, it should still be important to recognize disparities and inequalities which contribute to non-vaccination or under-vaccination. Improved understanding of demographic and socioeconomic characteristics, as well as existing underlying health conditions, will facilitate the path to improving interventions, vaccination rates, and subsequent reduction in the burden of this preventable disease.

Problématique : Une évaluation économique, commandée par le ministère de la Santé et des Services sociaux du Québec, vise à évaluer le rendement de deux programmes d'immunisation, soient la vaccination primaire et la vaccination antigrippale. Un des volets de cette étude économique nécessitera l'utilisation d'un questionnaire auto-administré auprès de personnes vaccinées contre l'influenza plusieurs semaines après leur vaccination. Objectif : Vérifier la fiabilité et la validité d'un questionnaire auto-administré sur l'efficacité populationnelle et les coûts assumés lors de la vaccination par les adultes vaccinés contre l'influenza. Cet outil sera utilisé pour une évaluation économique selon une perspective sociétale du programme d'immunisation contre l'influenza chez les adultes. Méthode : Un test-retest a été réalisé en soumettant le questionnaire à un échantillon de convenance de 499 personnes âgées de [supérieur ou égal à]50 ans de la Montérégie. Un premier questionnaire a été administré dans les CLSC en novembre 2004 (test) durant le temps d'attente après l'injection du vaccin. Le deuxième questionnaire a été envoyé 10 semaines plus tard par la poste aux participants en janvier 2005 (retest). Les variables testées sont de nature qualitative (variables sociodémographiques, statut vaccinal, lieu de vaccination, moyen de transport, absence du travail) ou quantitative (date et durée de la vaccination, distance parcourue, revenu annuel, coût du transport, autres coûts). La fiabilité a été évaluée par la comparaison des réponses déclarées entre les deux questionnaires alors que la validité de certaines variables a été évaluée par la comparaison entre les réponses fournies par les participants et des sources de référence. Les principaux tests statistiques utilisés sont: l'accord observé (P[indice inférieur omicron]), le kappa de Cohen ([kappa]) et le coefficient de corrélation intra-classe (CCI). Résultats : Le taux de participation a été de 95%. Les variables sociodémographiques obtiennent un P[indice inférieur omicron] entre les deux questionnaires variant de 82% à 98% et un [kappa] de 0,556 à 0,936. Les autres variables qualitatives affichent un P[indice inférieur omicron] de 89% à 100% mais un [kappa] variant de -0,007 à 0,862. Quant aux variables quantitatives transformées en catégorie, P[indice inférieur omicron] varie de 45% à 100% et [kappa] de 0,031 à 1,000. La divergence entre les indices de concordance [Kappa] et P[indice inférieur omicron] est attribuable aux paradoxes de kappa. Les variables de temps, soient la date de vaccination et la durée de vaccination, présentent une faible fiabilité avec respectivement un P[indice inférieur omicron] de 57% et 49% et un CCI de 0,305 et 0,690. Un grand nombre de réponses manquantes (38%) est constaté pour la variable date de vaccination. La validité des variables sélectionnées (statut vaccinal, lieu et date de vaccination, taille de la ville et moyen de transport) est jugée relativement bonne avec un P[indice inférieur omicron] variant de 58% à presque 100%. Conclusion : À l'exception des variables de temps, le questionnaire est assez fiable. La validité des variables évaluées est bonne. Le taux de participation et l'effectif élevés assurent une puissance statistique adéquate pour les analyses. La participation volontaire des sujets peut être une source de biais de sélection. La fiabilité et la validité étant étroitement liées, elles sont défavorablement influencées par le biais de mémoire. Celui-ci peut être engendré par le délai de réponses entre les deux questionnaires. Malgré tout, ce questionnaire pourra être utilisé dans l'étude économique après quelques modifications.

Thesis (MSc)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Recently, new strains of influenza such as bird flu and swine flu have emerged. These strains have the capacity to infect people on a quite large scale and are characterized by their resistance to existing influenza treatment and their high mortality rates. In this thesis, we consider two models for influenza transmission dynamics that include both sensitive and resistant strains and accounts for disease induced mortality. The first model allows for immigration/migration and does not include any control measure. The second one explores the effects of vaccination and treatment of the sensitive strain but ignores immigration/migration. We studied the two models mathematically and numerically. We started with the model without any control measures; we calculated the basic reproductive numbers, determined the equilibrium points and investigated their stability. Our analysis showed that when the basic reproduction numbers of both strains are less than one then the two strains will die out. When at least one of the basic reproduction numbers is greater than one, then the strain with the higher basic reproduction number is the one that will persist. Numerical simulations were carried out to confirm the stability results and a bifurcation diagram was given. We also studied numerically the impact of the mortality rate of influenza on the dynamics of the disease. Especially, we investigated the effect of the mortality rate on the time needed for the pandemic to reach its peak, the value at the peak for each strain and, when eradication is possible, the time it takes for the disease to be eradicated. For the model with control, we also calculated the control reproductive number and the equilibrium points. The stability analysis was carried out numerically and bifurcation diagrams with vaccination and treatment parameters were given to determine the regions where eradication of the disease is possible. Our results suggest that in the presence of a resistant strain, treating more infected individuals will not eradicate the disease as the resistant strain will always persist. In such a case vaccination and antiviral treatment should be implemented simultaneously.
AFRIKAANSE OPSOMMING: Geen opsomming

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, which measured independent variables such as transformational leadership and attitudes toward evidence-based practice. Vaccination intent was the dependent variable. The results showed that transformational leadership was positively related to vaccination intent r(353) = .16, p < .01. There was no relationship between transactional leadership and vaccination intent r(353) = .01, p > .05 nor between attitudes toward evidence-based practice and vaccination intent r(353) = .09, p > .05. The implication of the study is that the effects of transformational leadership constitute a predictive tool to identify how an organization can increase vaccination rates among RNs. Implementing the recommendations of the study could promote social change by providing nursing leadership with tools to facilitate increased vaccination rates among health care personnel. Increasing vaccination rates for healthcare personnel will decrease vaccine-preventable illnesses and improve outcomes for hospitalized patients.