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MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | Eskola J.,Finnish National Institute for Health and Welfare | Liang X.,Chinese Center for Disease Control | And 12 more authors.
Vaccine | Year: 2015

The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences. © 2015.


Dube E.,Institute National Of Sante Publique Du Quebec | Gagnon D.,Institute National Of Sante Publique Du Quebec | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | And 13 more authors.
Vaccine | Year: 2015

When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential. © 2015.


Butler R.,Health Security and Environment | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | Eskola J.,Finnish National Institute for Health and Welfare | And 13 more authors.
Vaccine | Year: 2015

Despite relatively high vaccination coverage rates in the European Region, vaccine hesitancy is undermining individual and community protection from vaccine preventable diseases. At the request of its European Technical Advisory Group of Experts on Immunization (ETAGE), the Vaccine-preventable Diseases and Immunization Programme of the WHO Regional Office for Europe (WHO/EURO) developed tools to help countries address hesitancy more effectively. The Guide to Tailoring Immunization Programmes (TIP), an evidence and theory based behavioral insight framework, issued in 2013, provides tools to (1) identify vaccine hesitant population subgroups, (2) diagnose their demand- and supply-side immunization barriers and enablers and (3) design evidence-informed responses to hesitancy appropriate to the subgroup setting, context and vaccine. The Strategic Advisory Group of Experts on Immunization (SAGE) through its Working Group on Vaccine Hesitancy has closely followed the development, implementation, use and evolution of TIP concluding that TIP, with local adaptation, could be a valuable tool for use in all WHO regions, to help address countries' vaccine hesitancy problems. The TIP principles are applicable to communicable, noncommunicable and emergency planning where behavioral decisions influence outcomes. © 2015.


Eskola J.,Finnish National Institute for Health and Welfare | Duclos P.,World Health Organization | Schuster M.,World Health Organization | MacDonald N.E.,Dalhousie University | And 12 more authors.
Vaccine | Year: 2015

Based on the concerns about vaccine hesitancy and its impact on vaccine uptake rates and the performance of national immunization programmes, the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy [1], carried out a review, and proposed a set of recommendations directed to the public health community, to WHO and its partners, and to the World Health Organization (WHO) member states. The final recommendations issued by SAGE in October 2014 fall into three categories: (1) those focused on the need to increase the understanding of vaccine hesitancy, its determinants and the rapidly changing challenges it entails; (2) those focused on dealing with the structures and organizational capacity to decrease hesitancy and increase acceptance of vaccines at the global, national and local levels; (3) and those focused on the sharing of lessons learnt and effective practices from various countries and settings as well as the development, validation and implementation of new tools to address hesitancy. © 2015.


Schuster M.,World Health Organization | Eskola J.,Finnish National Institute for Health and Welfare | Duclos P.,World Health Organization | Liang X.,Chinese Center for Disease Control | And 11 more authors.
Vaccine | Year: 2015

Despite a wide array of safe and effective vaccines in use globally, with major impacts on health worldwide, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization has been repeatedly confronted with reports of hesitancy towards accepting specific vaccines or vaccination programmes. This paper summarizes the rationale for a SAGE review of the issue of vaccine hesitancy, its impact and ways to address it, and the convening of a Vaccine Hesitancy Working Group in March 2012 to prepare for the SAGE review. It describes the methods used and mode of operations, and advances in the relatively new field of research on vaccine hesitancy. It further elaborates and references the work conducted, including a series of products, conclusions and recommendations that emerged from the SAGE review in October 2014. © 2015.


Jarrett C.,London School of Hygiene and Tropical Medicine | Wilson R.,London School of Hygiene and Tropical Medicine | O'Leary M.,London School of Hygiene and Tropical Medicine | Eckersberger E.,London School of Hygiene and Tropical Medicine | And 17 more authors.
Vaccine | Year: 2015

The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts. Methods: A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager. Results: Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions.Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context. © 2015.


News Article | February 16, 2017
Site: phys.org

The National Health and Family Planning Commission said on Wednesday that by the end of January a total of 100 people had died in the current bird flu season, which commonly emerges in winter and continues into the spring. The 79 deaths in China last month compared to just five in January 2016, according to the commission. The surge in fatalities has raised concerns that a severe outbreak looms, though health officials have said the worst has likely passed. H7N9, a subtype of influenza that affects both birds and humans, was first discovered in China in 2013. Most infected patients become severely ill, and nearly one in three cases are fatal. The government is urging people to avoid live poultry markets, where poor sanitation conditions can raise the risk of contamination. Ni Daxin, a top official with the Chinese Center for Disease Control and Prevention, was quoted Thursday by the state-run China Daily as saying the common Chinese preference for live or freshly-slaughtered chickens was contributing to the disease's spread. "If the public buys only frozen poultry, control of the epidemic will be much easier," Ni said. The live poultry trade has been temporarily halted in the cities of Guangzhou in the south, Changsha in central China, and the entire eastern province of Zhejiang, among other areas. Zhejiang alone reported 35 infections in January, state-run Xinhua news agency quoted officials saying. The majority of infections occur through contact with diseased poultry and bird waste at markets and in rural areas. But at least two possible cases of human-to-human transmission have been reported since September. On the popular Chinese social-networking platform Weibo, many users expressed concern over the virus and paranoia over common-cold symptoms, while others said they were swearing off chicken.


Liu N.,Chinese National Institute for Viral Disease Control and Prevention | Yen C.,Centers for Disease Control and Prevention | Fang Z.-Y.,Chinese National Institute for Viral Disease Control and Prevention | Tate J.E.,Centers for Disease Control and Prevention | And 4 more authors.
Vaccine | Year: 2012

Introduction: Two rotavirus vaccines have been licensed globally since 2006. In China, only a lamb rotavirus vaccine is licensed and several new rotavirus vaccines are in development. Data regarding the projected health impact and cost-effectiveness of vaccination of children in China against rotavirus will assist policy makers in developing recommendations for vaccination. Methods: Using a Microsoft Excel model, we compared the national health and economic burden of rotavirus disease in China with and without a vaccination program. Model inputs included 2007 data on burden and cost of rotavirus outcomes (deaths, hospitalizations, outpatient visits), projected vaccine efficacy, coverage, and cost. Cost-effectiveness was measured in US dollars per disability-adjusted life-year (DALY) and US dollars per life saved. Results: A 2-dose rotavirus vaccination program could annually avert 3013 (62%) deaths, 194,794 (59%) hospitalizations and 1,333,356 (51%) outpatient visits associated with rotavirus disease in China. The medical break-even price of the vaccine is $1.19 per dose. From a societal perspective, a vaccination program would be highly cost-effective in China at the vaccine price of $2.50 to $5 per dose, and be cost-effective at the price of $10 to $20 per dose. Conclusions: A national rotavirus vaccination program could be a cost-effective measure to effectively reduce deaths, hospitalizations, and outpatient visits due to rotavirus disease in China. © 2012 Elsevier Ltd.


PubMed | Chinese Center for Disease Control, University of Washington, Institute National Of Sante Publique Du Quebec, World Health Organization and 2 more.
Type: Journal Article | Journal: Vaccine | Year: 2015

In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term vaccine hesitancy, as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.


News Article | October 26, 2016
Site: www.newscientist.com

A DOCTOR in Mumbai, India, puts a spit sample into a handheld device. It whirs away briefly, then a few minutes later a nearby laptop pings. The doctor checks the results to see exactly what kind of drug-resistant tuberculosis the person has, and the precise combination of drugs needed to treat it. “If you can identify drug-resistant TB in less than a day, you will massively improve treatment“ This is the goal of CRyPTIC, a global project run by a team at the University of Oxford. It aims to speed up the diagnosis and treatment of drug-resistant TB, cutting the wait from months to days, or even minutes. The idea is that the software will prescribe the right medication for TB just by looking at its genome. “It’s rapid,” says Sarah Hoosdally at the University of Oxford, who is managing the project. Handheld DNA sequencers will make it even quicker – though it may be a few years before such devices hit clinics around the world. “We’re hoping to extract the DNA directly from the sample,” she says. Tuberculosis is a bacterial infection that kills by attacking the lungs, until the patient dies of respiratory failure. It ranks alongside HIV as the leading cause of death from infectious disease. In 2014, 9.6 million people became ill with TB and 1.5 million died, according to the World Health Organization. The WHO wants to end the epidemic by 2030 but that will mean tackling drug resistance. The last 10 years have seen a dramatic rise in drug-resistant bacteria, which spread easily through densely populated cities in poorer parts of the world. A few years ago there might have been 20 cases of drug-resistant TB a year in Mumbai, says Nerges Mistry, director of the Foundation for Medical Research in the city. That number has shot up. “We now have 3000 to 4000 cases of drug-resistant TB a year – and those are the ones we’re able to catch.” Resistant bacteria can be defeated with the right cocktail of drugs. But finding out what kind of TB someone has – and thus what drugs they need – can take months. Identifying the bacteria by culturing them in the lab and using dyes can take 3 to 5 weeks, says Marco Schito at the Critical Path Institute in Tucson, Arizona. Then you need to test combinations of drugs to see which ones are going to be effective, and that can take another month. In the meantime, a person will be given the standard catch-all medication, which may or may not help them. “The way that TB is diagnosed is the same way we were doing it when the disease was identified over 130 years ago,” says Schito. “Often individuals pass away while they’re waiting for their result.” We need a quicker and smarter way to work out exactly what drugs are required – which is where CRyPTIC comes in. “If you can diagnose someone and know their drug resistance profile in less than a day, you’re going to massively improve treatment,” says Hoosdally. Teams at TB hotspots around the world – including the Chinese Center for Disease Control and Prevention in Beijing, the National Institute for Communicable Diseases in Johannesburg and the Foundation for Medical Research in Mumbai – are collecting data on the TB genomes out there and the specific drugs each mutation responds to. Mistry and her colleagues at Mumbai’s Hinduja Hospital have started sending TB genomes to a lab in Bangalore for sequencing in addition to running their standard culture analyses. The results from this and several other clinics around the world are then fed into a machine learning system at Oxford that is being taught what drugs work for particular strains of TB – to cut out the slow process of testing cultures in a lab. Machine learning helps the team untangle the complexity of TB resistance. For example, two bacterial samples with slight differences in their genomes might resist the same drugs without it being clear which genes are involved. We only know the resistance-conferring gene for a handful of drugs. For example, a gene called katG makes the TB bacterium sensitive to isoniazid, one of the most common drugs used for treatment. With a mutation in katG, TB becomes resistant to the drug. But in most cases, it’s guesswork – something machine learning is good at. The approach works in much the same way as image recognition software. Just as Google has taught its AI to recognise images of dogs, say, by feeding it huge numbers of images that humans have labelled “dog”, CRyPTIC is teaching its AI to recognise drug resistance by feeding it huge numbers of genomes labelled as resistant to a specific drug. When finished, CRyPTIC’s software will be able to recognise different TB genomes and recommend appropriate drugs automatically. CRyPTIC’s primary goal is speeding up diagnosis, but the project will also serve as an early warning system for new strains of tuberculosis – and potentially other infectious diseases. By tracking mutations all over the world, CRyPTIC will provide a bird’s-eye view of the battle between TB and the drugs we throw at it. “The key is getting that catalogue,” says Zamin Iqbal, who works on CRyPTIC’s database in Oxford. “The cherry on top is observation.” It won’t be easy since getting hold of samples and results from drug tests is expensive. Google needed millions of images to recognise dogs, says Iqbal. The more data, the better. With funding from the Bill and Melinda Gates Foundation and the Wellcome Trust they hope to succeed. Still, we must not expect AI alone to eradicate tuberculosis, says Mistry. That will require radical social change to address the socio-economic conditions driving infection. “It’s a firefighting tech at the moment,” says Mistry. “But we may bring it down, and I think that’s the right thing to do.” This article appeared in print under the headline “AI enlists to stop TB”

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