Although many interventions aim to reduce parents' hesitancy about childhood vaccinations, parents' experiences of vaccine attitude change trajectories remain underexplored. This constructivist grounded theory study examines trajectories of change in vaccine confidence and uptake among mothers in the Greater Vancouver region of Canada. Specifically, we explored what mothers identified as causes and facilitators to these changes, the processes involved, and how they experienced these changes in the contexts of their parenting lives. The study population comprised 23 mothers (mean age 41.3 years), each with at least one child aged 6–12 years. Nine (39%) had become more confident in vaccines, 10 (43%) more hesitant, and four (17%) experienced multiple changes over time. Trajectories of growing vaccine confidence were portrayed by participants as cognitive journeys, moving toward facts and away from fear, and influenced by a participant's growing knowledge and experience. Trajectories of increased hesitancy about vaccination involved underlying concerns about vaccines that were augmented by negative peer attitudes or negative personal experiences with vaccination or health care. In both trajectories, a mother's growing confidence as a parent was perceived as empowering her to make decisions over time. Mothers with multiple changes in vaccine attitudes either had hesitations about specific vaccines, which were allayed over time, or experienced negative vaccine reactions that caused them to pause, then later resume, vaccination.
Successful vertical HIV transmission prevention programmes (VTP) have resulted in an expanding population of HIV-exposed uninfected (HEU) infants whose growth, health and neurodevelopmental outcomes could have consequences for future resource allocation. We compared neurodevelopmental and behavioural outcomes in a prospective cohort of 2–3 year old HEU and HIV-unexposed uninfected (HU) children.Women living with and without HIV and their infants were enrolled within three days of birth from a low-risk midwife obstetric unit in Cape Town, South Africa during 2012 and 2013, under WHO Option A VTP guidelines. HIV-uninfected children aged 30–42 months were assessed using the Bayley scales of Infant Development-Third edition (BSID) and Strengths and Difficulties questionnaire (SDQ).Thirty-two HEU and 27 HU children (mean birth weight 3048g vs 3096g) were assessed. HEU children performed as well as HU children on BSID cognitive, language and motor domains. Mean scores fell within the low average range. Mothers of HEU children reported fewer conduct problems but stunting was associated with increased total difficulties on the SDQ.HEU and HU children's performance on the BSID was similar. In this low-risk cohort, HIV exposure did not confer additional risk. Stunting was associated with increased behavioural problems irrespective of HIV exposure.
Background: A National Ambulatory Network was created in 2009 to rapidly assess the safety of influenza vaccines. In 2012, the network was expanded to monitor the safety of live attenuated influenza vaccine and trivalent inactivated influenza vaccine in children. Methods: We used an online survey administered 7 days after influenza immunization to track new or exacerbated health problems that required medical consultation or prevented daily activities. Parents of immunized children completed the survey. Reported adverse events were followed up by telephone within 48 hours of the online report. A sample of nonresponders was contacted by telephone to ensure the online responder group was representative. Event rates after the 2 influenza vaccines were compared. Results: A total of 1230 parents completed an online or telephone survey, for a participation rate of 83%: 72% responded online and an additional 11% were reached by telephone. The rate of severe events in children immunized with an influenza vaccine was 4.7% (3.5–5.9%). The frequency and types of events reported were similar between online and telephone reports. Reported rates of severe events were similar after trivalent inactivated influenza or live attenuated influenza vaccine (4.0% vs. 5.1%, respectively). The online survey was easy to access and understand. Most respondents (94%) would participate next year. Conclusions: The rate and type of adverse events after immunization with trivalent inactivated influenza versus live attenuated influenza vaccine were similar and did not vary by reporting process (online vs. telephone). The electronic surveillance methodology provided rapid vaccine safety data in children. The electronic survey methodology was acceptable and feasible.
Rotavirus infections are one of the most common hospital acquired infections in pediatric hospitals. Laboratory confirmed hospital acquired rotavirus infections from 12 pediatric hospitals in Canada were documented for a 3 year period, 2005-7. Overall, hospital acquired infections represented one quarter of all rotavirus hospitalizations for an annual rate of 0.45 per 1000 hospital days with a peak of 0.68 per 1,000 hospital days between December and May. Approximately 8% developed symptoms <72 hours after hospital discharge and required admission to hospital for management of rotavirus infection. Sixty percent of cases were less than 1 year of age and 75% had underlying medical illnesses. Given the licensure and increasing use of rotavirus vaccines, baseline data on the incidence and epidemiology of hospital acquired rotavirus infections will be useful in order to determine the potential impact of vaccination on hospital acquired rotavirus.
Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal influenza vaccines in Canada. Aim To provide enhanced surveillance for seasonal influenza and pandemic influenza vaccines. Methods In 2017/18 and 2018/19 influenza seasons, adults (≥ 15 years of age) and parents of children vaccinated with the seasonal influenza vaccine participated in an observational study using web-based active surveillance. Participants completed an online survey for health events occurring in the first 7 days after vaccination. Participants who received the influenza vaccine in the previous season, but had not yet been vaccinated for the current season, were unvaccinated controls. Results In 2017/18, 43,751 participants and in 2018/19, 47,798 completed the online safety survey. In total, 957 of 30,173 participants vaccinated in 2017/18 (3.2%; 95% confidence interval (CI): 3.0–3.4) and 857 of 25,799 participants vaccinated in 2018/19 (3.3%; 95% CI: 3.1–3.5) reported a health problem of sufficient intensity to prevent their normal daily activities and/or cause them to seek medical care (including hospitalisation). This compared to 323 of 13,578 (2.4%; 95% CI: 2.1–2.6) and 544 of 21,999 (2.5%; 95% CI: 2.3–2.7) controls in each respective season. The event rate in vaccinated adults and children was higher than the background rate and was associated with specific influenza vaccines. The higher rate of events was associated with systemic symptoms and migraines/headaches. Conclusion In 2017/18 and 2018/19, higher rates of events were reported following seasonal influenza vaccination than in the pre-vaccination period. This signal was associated with several seasonal influenza vaccine products.
Although pregnant women have increased risks for influenza morbidity and mortality, influenza vaccination rates among pregnant women in Canada are consistently very low. This mixed-methods study investigated the attitudes and behaviour of pregnant women and new mothers regarding seasonal and pandemic influenza vaccination.We conducted a baseline survey and qualitative focus groups with 34 women (26 pregnant women and 8 mothers of newborns), with a follow-up survey to assess outcomes at the end of the subsequent influenza season. Data analysis included descriptive statistics and directed content analysis based on the health belief model.Most women did not consider influenza vaccination to be an important preventative measure to take while pregnant, although some were more willing to consider vaccination during a pandemic. Omission bias played a substantial role as justification for not vaccinating. Participants expressed confusion about recommendations regarding vaccination during pregnancy and frustration with inconsistent messages from health care providers (HCPs), particularly with regard to pandemic vaccines. Women were vaccinated when they perceived themselves and/or their babies to be at increased risk for influenza. Vaccinated women had strong normative influences (usually an HCP or a family member) that affected their decision. Intentions accurately predicted behaviour for women who did and did not intend to be vaccinated.Pregnant women did not perceive themselves to be at increased risk for influenza and did not believe that influenza vaccination was a necessary preventative health measure. A lack of safety information about vaccination during pregnancy and inconsistent messages from HCPs were barriers to vaccine acceptance. Recommendations from maternity care providers and communication about the severity of and susceptibility to influenza for pregnant women would facilitate vaccine uptake.
The COVID-19 pandemic posed a unique set of risks to pregnant women and pregnant people. SARS-CoV-2 infection in pregnancy is associated with increased risk of severe illness and adverse perinatal outcomes. However, evidence regarding the use of COVID-19 vaccines in pregnancy shows safety and efficacy. Despite eligibility and recommendations for COVID-19 vaccination among pregnant women and pregnant people in Canada, uptake remains lower compared to the general population, warranting exploration of influencing factors. The COVERED study, a national prospective cohort, utilized web-based surveys to collect data from pregnant women and pregnant people across Canada on COVID-19 vaccine attitudes, uptake, and hesitancy factors from July 2021 to December 2023. Survey questions were informed by validated tools including the WHO Vaccine Hesitancy Scale (VHS) and the Theory of Planned Behavior (TPB). Of 1093 respondents who were pregnant at the time of the survey, 87.7% received or intended to receive a COVID-19 vaccine during pregnancy. TPB variables such as positive attitudes toward COVID-19 vaccines (OR = 1.11, 95% CI = 1.08–1.14), direct social norms, and indirect social norms were significantly associated with vaccine acceptance. Perceived vaccine risks, assessed by the WHO VHS, were greater in those not accepting of the vaccine. Our study identified several key factors that play a role in vaccine uptake: perceived vaccine risks and safety and social norms. These findings may guide public health recommendations and prenatal vaccine counseling strategies.
Background Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. Objective This study aims to design a web application about community immunity and optimize it based on users’ cognitive and emotional responses. Methods Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants’ cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization’s content and messaging. Results Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users’ emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. Conclusions Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
