False beliefs about vaccines

Las vacunas constituyen un instrumento esencial para la prevención de enfermedades infecciosas. Sin embargo, las falsas ideas y rumores sin fundamento científico sobre eventuales efectos negativos pueden disuadir de la vacunación, con los consiguientes riesgos para la protección de la población. El objetivo del artículo es evaluar el origen y los argumentos de algunos de los errores y rumores más frecuentes sobre eventuales efectos adversos de las vacunaciones. Se presentan algunos efectos adversos claramente establecidos, así como falsas creencias sobre diversas vacunas y potenciales daños para la salud. Las vacunas, como cualquier fármaco, pueden ocasionar efectos adversos, pero los eventuales efectos adversos de los programas de vacunación son claramente inferiores a sus beneficios individuales (a los vacunados) y colectivos (a los vacunados y a los que no pueden vacunarse por razones médicas). Cualquier efecto indeseable atribuible a las vacunas ha de poderse detectar mediante sistemas de farmacovigilancia potentes y bien estructurados.Vaccines are an essential tool for the prevention of infectious diseases. However, false ideas and rumours with no scientific foundation about their possible negative effects may dissuade people from being vaccinated, with the consequent risks for the health of the population. The objective of this article is to evaluate the origin and the arguments of some of the most frequent mistaken ideas and rumours about the possible adverse effects of vaccines. Some clearly established adverse effects are presented, as well as false beliefs about various vaccines and potential harm to health. Vaccines, like any drug, can cause adverse effects, but the possible adverse effects of vaccination programs are clearly lower than their individual (vaccinated) and collective benefits (those vaccinated and those who cannot be vaccinated for medical reasons). The possible adverse effects attributable to vaccines should be detected by powerful and well-structured pharmacovigilance systems

Validation of the questionnaire on vaccines and hesitancy to be vaccinated in the Spanish Society of Epidemiology

Objetivo: Confeccionar y validar una encuesta dirigida a profesionales de epidemiología para medir factores asociados a la reticencia vacunal. Método: La reticencia a la vacunación se refiere al retraso en la aceptación o el rechazo de la vacunación a pesar de la disponibilidad de ella. La OMS la incluyó entre las diez amenazas a la salud global en 2019. En este marco conceptual propuesto por la OMS, un comité de seis expertos de la Sociedad Española de Epidemiología (SEE) diseñó un cuestionario autoadministrado para estudiar los factores asociados a la reticencia a la vacunación en epidemiólogos/as. Este cuestionario fue aprobado por la Junta de la SEE y se envió on line a todos/as los/las socios/as en 2019. A partir de las respuestas obtenidas se validaron las siguientes características: validez aparente, interna, de constructo y de criterio, fiabilidad, curvas características de cada ítem y función de información por ítem y conjunta. Resultados: El cuestionario mostró dos componentes bien definidos: la percepción sobre las vacunas y la confianza en la transparencia de los datos sobre vacunas con altos grados de ajuste en todos los aspectos de la validación. Ambos componentes han demostrado que cuanto mayor es la reticencia a la vacunación, mejor informa el cuestionario sobre estos aspectos. Conclusiones: El estudio ha permitido elaborar un instrumento validado en español para medir los factores asociados a la reticencia vacunal entre los/las epidemiólogos/as.Objective: To develop and validate a survey aimed at epidemiologists to measure factors associated with vaccine reluctance. Method: Vaccination hesitancy refers to delayed acceptance or refusal of vaccination despite the availability of vaccination services. WHO included vaccination hesitancy among the 10 global health threats in 2019. Within this conceptual framework proposed by WHO, a committee of six experts from the Spanish Society of Epidemiology (SEE) designed a self-administered questionnaire to study factors associated with vaccination hesitancy in epidemiologists. This questionnaire was approved by the SEE Board, and was sent online to all members in 2019. Based on the responses obtained, the following characteristics were validated: face validity, internal validity, construct validity, criterion validity, reliability, as well as the characteristic curves of each item and the information function per item and overall. Results: The final questionnaire showed two well-defined components, perception of vaccines and confidence in the transparency of vaccine data with high degrees of fit in all aspects of validation. Both components have shown that the higher the reluctance to vaccinate the better the questionnaire reports on these aspects. Conclusions: The study has allowed the development of a validated instrument in Spanish to measure the factors associated with vaccine reluctance among epidemiologists

Towards COVID-19 control through vaccination: obstacles, challenges andopportunities. SESPAS Report 2022

En España se inició el programa de vacunación en un contexto de alta transmisión y baja disponibilidad de vacunas. El objetivo de este artículo es revisar el programa de vacunación frente a la COVID-19 (3-3-2022) y valorar los obstáculos, los desafíos y las oportunidades que plantea el control de esta enfermedad. Se dispone actualmente de cinco vacunas: dos basadas en la tecnología ARNm (Comirnaty® y Spikevax®), dos basadas en un vector no replicativo (Vaxzevria® y Janssen) y una basada en la subunidad S (Novavax®). Las autoridades sanitarias han desarrollado estrategias de vacunación priorizando la prevención de hospitalizaciones y defunciones. En marzo de 2022 se superó el 90% de la población diana con vacunación completa y el 95% de cobertura en mayores de 50 años. El nuevo reto es conseguir coberturas similares para una tercera dosis. La vacunación en la infancia y la adolescencia se ha convertido en una prioridad por las implicaciones educativas y sociales que comporta la COVID-19. Se deberán renovar las estrategias comunicativas y eliminar las barreras de acceso para conseguir buenas coberturas. En España se han publicado estudios que muestran una alta efectividad de la vacunación. La principal estrategia para el control de la pandemia y para recuperar la actividad social es la vacunación, pero todo indica que serán necesarios niveles muy altos de cobertura vacunal y seguir con medidas no farmacológicas. En un mundo globalizado, el control de la COVID-19 solo se alcanzará con una estrategia global coordinada y el apoyo a la vacunación en los países con pocos recursos.In Spain, the vaccination program began in a context of high transmission and low availability of vaccines. The objective of this article is to review the vaccination program against COVID-19 in Europe (3/03/2022) and assess the obstacles, challenges and opportunities posed by the control of this disease. Five vaccines are currently available in Europe: two based on mRNA technology (Comirnaty® and Spikevax®); two based on a non-replicative vector (Vaxzevria® and Janssen); and another based on subunit S (Novavax®). Health authorities have developed comprehensive vaccination strategies prioritizing the prevention of hospitalizations and deaths. In January 2022, 90% of the population was exceeded with full vaccination and 95% coverage in people over 50 years of age. The new challenge is to achieve similar coverage in the rest of the age groups. Vaccination in children and adolescents has become a priority due to the educational and social implications derived from COVID-19 in this population. Communication strategies must be renewed and access barriers eliminated to achieve good coverage. In Spain, studies have been published that find a high effectiveness of vaccination. The main strategy for controlling the pandemic and recovering social activity is the vaccination, but everything indicates that very high levels of vaccination coverage will be necessary and to follow with the non-pharmaceutical measures. In a globalized world, COVID-19 control will only be achieved with a coordinated global strategy and technical and economic support for the vaccination strategy in resource-poor countries.P. Godoy, I. Barrabeig, A. Domínguez y J. Castilla participan en el proyecto de investigación «Factores asociados a la transmisión de SARS-CoV-2 en los convivientes de Cataluña y Navarra y efectividad de las vacunas y de las medidas no farmacológicas para reducir la transmisión» (PI21/01883), financiado por el Instituto de Salud Carlos III (PI21/01883) y el European Regional Development Fund (ERDF - A way of making Europe)

Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged 65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged 65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP

The effectiveness of influenza vaccination in preventing hospitalisations of elderly individuals in two influenza seasons: A multicentre case–control study, Spain, 2013/14 and 2014/15

[EN] Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case–control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22–47). VE was 51% (95% CI: 15–71) in patients without high-risk medical conditions and 30% (95% CI: 14–44) in patients with them. VE was 39% (95% CI: 20–53) in patients aged 65–79 years and 34% (95% CI: 11–51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals.S

Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2¿1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders

Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data

When responding to infectious disease outbreaks, rapid and accurate estimation of the epidemic trajectory is critical. However, two common data collection problems affect the reliability of the epidemiological data in real time: missing information on the time of first symptoms, and retrospective revision of historical information, including right censoring. Here, we propose an approach to construct epidemic curves in near real time that addresses these two challenges by 1) imputation of dates of symptom onset for reported cases using a dynamically-estimated "backward" reporting delay conditional distribution, and 2) adjustment for right censoring using the NobBS software package to nowcast cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number (Rt) in real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We evaluate how these real-time estimates compare with more complete epidemiological data that became available later. We explore the impact of the different assumptions on the estimates, and compare our estimates with those obtained from commonly used surveillance approaches. Our framework can help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health systems in other locations.PMD was supported by the fellowship Ramón Areces Foundation. JAH was funded by the National Institute of General Medical Sciences, Award U54GM088558, and the National Institutes of Health Director’s Early Independence, Award DP5-OD028145. ML was supported by the Morris-Singer Fund and by a subcontract from the Carnegie Mellon University under an award from the US Centers for Disease Control and Prevention, Award U01IP001121). MS was supported by the National Institute Of General Medical Sciences, Award R01GM130668-02. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Economic evaluation of health services costs during pandemic influenza A (H1N1) pdm09 infection in pregnant and non-pregnant women in Spain (2009)

Background: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). Methods: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the require-ments in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utili-sation. The mean cost per patient was calculated in this group of women. Results: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher ( 4,689.4/non-pregnant and 2,945.07/pregnant). Conclusions: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning

Knowledge of and attitudes to influenza vaccination in healthy primary healthcare workers in Spain, 2011-2012

Annual influenza vaccination is recommended for healthcare workers, but many do not follow the recommendation. The objective of this study was to investigate the factors associated with seasonal influenza vaccination in the 2011– 2012 season. We carried out an anonymous web survey of Spanish primary healthcare workers in 2012. Information on vaccination, and knowledge and attitudes about the influenza vaccine was collected. Workers with medical conditions that contraindicated vaccination and those with high risk conditions were excluded. Multivariate analysis was performed using unconditional logistic regression. We included 1,749 workers. The overall vaccination coverage was 50.7% and was higher in workers aged ≥ 55 years (55.7%), males (57.4%) and paediatricians (63.1%). Factors associated with vaccination were concern about infection at work (aOR 4.93; 95% CI 3.72–6.53), considering that vaccination of heathcare workers is important (aOR 2.62; 95%CI 1.83–3.75) and that vaccination is effective in preventing influenza and its complications (aOR 2.40; 95% CI 1.56–3.67). No association was found between vaccination and knowledge of influenza or the vaccine characteristics. Educational programs should aim to remove the misconceptions and attitudes that limit compliance with recommendations about influenza vaccination in primary healthcare workers rather than only increasing knowledge about influenza and the characteristics of the vaccine