Disparities in parental awareness of children's seasonal influenza vaccination recommendations and influencers of vaccination

OBJECTIVE: To determine parental awareness of influenza vaccination recommendations for children and explore associations with awareness. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: South Australian parents with a telephone listing in the Electronic White Pages were randomly selected. METHODS: Participants were interviewed using Computer Assisted Telephone Interviewing (CATI) during May-July 2016. Univariable and multivariable analyses explored characteristics associated with awareness; with the survey data weighted to reflect the population of SA and the probability of selection within a household. RESULTS: Of 539 parents, 33% were aware of the recommendation that all children (<5 years) should receive the influenza vaccine annually with 51.9% aware that children with special risk medical conditions (SRMC) should also receive the vaccine annually. Characteristics strongly associated with parental awareness of the recommendation for children aged < 5 years were knowledge of recommendation for children with a SRMC (adjusted Odds Ratio [aOR] 10.46, CI 4.44-24.63) or living in a metropolitan area (aOR 2.91, CI 1.19-7.09). There was lack of awareness in those not working (aOR 0.13, CI 0.04-0.47), with trade level education (compared with high school) (aOR 0.25 CI, 0.09-0.71) and in those born in the UK or Ireland (aOR 0.19, CI 0.04-0.85). Awareness of the recommendation for children with SRMC to receive the vaccine was strongly associated with knowledge of the influenza recommendation for children <5 years (aOR 10.22, CI 4.39-23.77) or not being born in Australia [UK/ Ireland (aOR 7.63, CI 1.86-31.31); other (aOR 3.93, CI 0.94-16.42)]. The most influential cues to future receipt were a general practitioner (GP) recommendation (63.8%) and providing influenza vaccine free for all children (37.6%). More parents who delayed or excluded vaccines believed that their children's vaccinations (in general) were unnecessary, as other children were vaccinated (42.8%) compared to those with no or minor concerns (11.1%) (p<0.0001). CONCLUSIONS: Parental awareness of children's influenza vaccine recommendations is low. Targeted communication strategies and resources are required to establish broader community awareness of recommendations. Healthcare provider endorsement of the vaccine remains key and health care professionals, particularly GPs and paediatric specialists should be encouraged to discuss influenza vaccine with parents at every opportunity. Many parents have vaccine concerns and addressing concerns across the spectrum of hesitancy is crucial.Jane Tuckerman, Nigel W. Crawford, Helen S. Marshal

Ultrafast Optical Response of a High Reflectivity GaAs/AlAs Bragg Mirror

Quantum Matter and Optic

Safety and protective effects of maternal influenza vaccination on pregnancy and birth outcomes: A prospective cohort study

Background Our study aimed to assess the safety and protective effect of maternal influenza vaccination on pregnancy and birth outcomes. Methods The study population comprised 1253 healthy nulliparous pregnant women in South Australia between 2015 and 2018. Participants were followed prospectively, with vaccination status (confirmed by medical records), pregnancy, and birth outcome data collected by midwives. Adjusted relative risks (aRRs) and adjusted hazard ratios (aHRs) were estimated accounting for time-varying vaccine exposure and temporal nature of each outcome. Findings Maternal influenza vaccination (48%, 603 of 1253) reduced the risk for pre-delivery hospitalisation with influenza like illness (aHR 0•61; 95% CI 0•39, 0•97). Maternal influenza vaccination was not associated with spontaneous abortion (aHR 0•42, 95% CI 0•12, 1•45), chorioamnionitis (aRR 0•78, 95% CI, 0•32, 1•88), gestational hypertension (aHR 0•78, 95% CI 0•47, 1•29), pre-eclampsia (aHR 0.84, 95% CI 0•54, 1•27), gestational diabetes (aHR 1•16, 95% CI 0•82, 1•66) nor preterm birth (aHR 0•94, 95% CI 0•59, 1•49). No associations between antenatal influenza vaccination and congenital anomalies, admission to the neonatal care unit, low Apgar scores, and mechanical ventilation were observed. Results were not materially changed after adjustment for pertussis vaccination. We observed a protective effect of maternal influenza vaccination on low birth weight (aHR 0•46, 95% CI 0•23, 0•94) and a marginal protective effect on small for gestational age births (aHR 0•65, 95% CI 0•40, 1•04) during periods of high influenza activity. Interpretation These results support the safety of maternal influenza vaccination and suggest a protective effect in reducing the rates of low birthweight and small for gestational age births. Funding There was no funding for this study.Hassen Mohammed, Claire T.Roberts, Luke E. Grzeskowiak, Lynne C. Giles, Gustaaf A. Dekker ... et al

Attitudes about and access to influenza vaccination experienced by parents of children hospitalised for influenza in Australia

INTRODUCTION:In Australia, influenza hospitalises more children than any other vaccine preventable disease does. Children aged six months or older are recommended to receive annual influenza vaccines, and pregnant women are recommended vaccination to protect infants aged up to six months. However, vaccine uptake is low. This study explored influenza vaccination knowledge and behaviours of parents of children who were hospitalised for influenza, in order to inform strategies that target barriers to uptake. METHODS:We conducted 27 semi-structured interviews with parents/caregivers during or shortly after their child's hospitalisation for laboratory-confirmed influenza in 2017. Questions were guided by the Social Ecological Model exploring all levels of influence on vaccination uptake from the intrapersonal through to policy, via the parents' perspective. Transcripts were inductively analysed. Themes were categorised into the components of the Capability-Opportunity-Motivation-Behaviour (COM-B) model. RESULTS:20/27 children were aged six months or older; 16/20 had not received an influenza vaccine in 2017. Mothers of 4/7 infants aged less than six months were not vaccinated in pregnancy. The themes regarding barriers to influenza vaccination were: (1) Limited Capability - misinterpretations and knowledge gaps, (2) Lack of Opportunity - inconvenient vaccination pathway, missing recommendations, absence of promotion to all, and the social norm, and (3) Missing Motivation - hierarchy of perceived seriousness, safety concerns, a preference for 'natural' ways. Though most parents, now aware of the severity of influenza, intended to vaccinate their child in future seasons, some harboured reservations about necessity and safety. When parents were asked how to help them vaccinate their children, SMS reminders and information campaigns delivered through social media, schools and childcare were suggested. CONCLUSION:Improving parents' and providers' knowledge and confidence in influenza vaccination safety, efficacy, and benefits should be prioritised. This, together with making influenza vaccination more convenient for parents, would likely raise vaccine coverage.Samantha J Carlson, Camilla Scanlan, Helen S Marshall, Christopher C Blythd, Kristine Macartney, Julie Leas

A Novel Culture-Dependent Gesture Selection System for a Humanoid Robot Performing Greeting Interaction

In human-robot interaction, it is important for the robots to adapt to our ways of communication. As humans, rules of non-verbal communication, including greetings, change depending on our culture. Social robots should adapt to these specific differences in order to communicate effectively, as a correct way of approaching often results into better acceptance of the robot. In this study, a novel greeting gesture selection system is presented and an experiment is run using the robot ARMAR-IIIb. The robot performs greeting gestures appropriate to Japanese culture; after interacting with German participants, the selection should become appropriate to German culture. Results show that the mapping of gesture selection evolves successfully

Effects of shoot tipping on development and yield of the tuber crop Plectranthus edulis

Plectranthus edulis (Vatke) Agnew is one of the tuber crops of the genus Plectranthus that is widely cultivated in Africa and Asia. P. edulis produces below-ground tubers on stolons originating from the stems, comparable to the potato (Solanum tuberosum L.). Farmers apply several laborious cultural practices to enhance shoot growth and yield, among which shoot tipping is very common. Tipping (pinching) is the removal of the shoot apex with one or two pairs of leaves from the main stems and branches. The rationale of this practice, especially when repeated more than once during one cropping season, is not fully understood. One similar experiment with two cultivars was carried out at two locations (Awassa and Wondogenet) in Ethiopia to assess and analyse the effects of shoot tipping and its frequency on crop development and tuber production. Tipping treatments included zero tipping, tipping once, tipping twice and tipping thrice, with the first tipping taking place 68 days after planting (DAP), a stage at which most of the stems reached a height of about 0·15 m, and the remainder following at intervals of 44–46 days. Tipping stimulated stem branching; it significantly increased the number of primary, secondary and tertiary stems in both experiments. Soil cover increased with an increase in the frequency of the tipping in Awassa, because of the tipping effects on the different canopy development variables. Tipping also enhanced the soil cover in Wondogenet, but the crop did not gain any extra benefit from a third tipping. Tipping enhanced early stolon formation, but did not consistently affect the number of stolons per hole later in the growing season. The number of tubers increased with an increase in the frequency of tipping in both cultivars in Wondogenet and in one cultivar in Awassa. Tuber dry matter yield increased with an increase in the frequency of tipping at both sites. Fresh tuber yield in the final harvest at 208 DAP was c. 1·9 kg/m2. Tipping on average increased fresh tuber yield by 17% in Wondogenet, whereas the difference was not detectable in Awassa. Because senescence was delayed slightly by tipping, yield effects of tipping might be larger when harvesting later. In general, there was a positive effect of tipping on canopy development and tuber yield

Evaluating the effectiveness of the 4CMenB vaccine against invasive meningococcal disease and gonorrhoea in an infant, child and adolescent program: protocol

Invasive meningococcal disease causes significant morbidity and mortality worldwide, with serogroup B being one of the predominant serogroups in Australia for many years. The South Australian (SA) State Government recently funded the introduction of a 4CMenB vaccination program for infants, children and adolescents. In addition to protecting against invasive meningococcal disease, emerging evidence suggests the 4CMenB vaccine may also be effective against gonorrhoea due to genetic similarities between Neisseria meningitidis and Neisseria gonorrhoeae. The proposed project aims to evaluate the effectiveness of the SA 4CMenB vaccination program against invasive meningococcal disease and gonorrhoea through a combination of observational studies using routine surveillance and research data. The main methodological approaches involve an interrupted time series regression model, screening, and case-control analyses with different sets of controls to estimate vaccine impact and effectiveness. These analyses are designed to minimize potential biases inherent in all observational studies and to provide critical data on the effectiveness of the 4CMenB vaccine against two diseases of major global public health concern.Helen S. Marshall, Prabha H. Andraweera, Bing Wang, Mark McMillan, Ann P. Koehler, Noel Lally ... et al

Complex intervention to promote human papillomavirus (HPV) vaccine uptake in school settings: A cluster-randomized trial

Using a cluster-randomized trial design, we aimed to evaluate a complex intervention to increase uptake of human papillomavirus (HPV) vaccination in schools. The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015 with adolescents aged 12–13 years. Interventions included education, shared decision-making, and logistical strategies. The main outcome was school vaccine uptake. Secondary outcomes included consent forms returned and mean time to vaccinate 50 students. We hypothesised that a complex intervention would increase 3-dose HPV vaccine uptake. We recruited 40 schools (21 intervention, 19 control) with 6, 967 adolescents. There was no difference between intervention and control (3-dose mean 75.7% and 78.9%, respectively). Following adjustment for baseline covariates, absolute differences in coverage in favour of the intervention group were: dose 1, 0.8% (95% CI, − 1.4,3.0); dose 2, 0.2% (95% CI, − 2.7, 3.1); dose 3, 0.5% (95% CI, − 2.6, 3.7). The percentage of returned consent forms in intervention schools (91.4%) was higher than in control schools (difference: 6%, 95% CI, 1.4, 10.7). There was a shorter mean time to vaccinate 50 students at dose 3. The difference for dose 3 was 110 min (95% CI, 42, 177); for dose 2, 90 min (95% CI, − 15, 196); and dose 1, 28 min (95% CI, − 71, 127). Logs revealed the inconsistent implementation of logistical strategies. The intervention had no impact on uptake. Inadequate resourcing for logistical strategies and advisory board reluctance toward strategies with potential financial implications impacted the implementation of logistical components.Cristyn Davies, Helen S. Marshall, Julia M.L. Brotherton, Kirsten McCaffery, Melissa Kang, Kristine Macartney, Suzanne M. Garland, John Kaldorl, Gregory Zimet, S. Rachel Skinner, The HPV.edu Study Grou

National predictors of influenza vaccine uptake in pregnancy: the FluMum prospective cohort study, Australia, 2012–2015

Objective: Ascertain predictors of inactivated influenza vaccine (IIV) uptake in pregnancy in mother–infant pairs from six Australian sites over four consecutive influenza seasons (2012–2015). Methods: Prospective observational cohort study calculating proportions of unvaccinated and vaccinated pregnancies. Multivariable logistic regression calculating adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) to determine demographic, pregnancy and birth characteristics as predictors of IIV uptake in pregnancy. Results: Uptake of IIV was 36% (n=3,651/9,878) with only 3–4% during the first trimester. Validation of IIV receipt was obtained for 77% of vaccinated participants. Predictors of IIV uptake in pregnancy were: healthcare provider recommendation to have IIV during pregnancy (aOR 7.04 [95%CI 5.83-8.50]): GP (aOR 4.12 [95%CI 3.43-4.98]), obstetrician (aOR 4.41 [95%CI 3.45-5.64]), midwife (aOR 1.88 [95%CI 1.51-2.36]); previous IIV within 12 months of their current pregnancy (aOR 2.87 [95%CI 2.36-3.50]); and pertussis vaccination during the current pregnancy (aOR 4.88 [95%CI 4.08-5.83]). Conclusions and implications for public health: Healthcare provider discussions with pregnant women about the risks associated with influenza infection during pregnancy and early infancy and evidence about the safety and effectiveness of IIV are required. Recommending and offering IIV in pregnancy needs to be included in these discussions to improve uptake.Lisa McHugh, Kerry-Ann F. O’Grady, Terry Nolan, Peter C. Richmond, Nicholas Wood, Helen S. Marshall, Stephen B. Lambert, Mark D. Chatfield, Kirsten P. Perrett, Paula Binks, Michael J. Binks, Ross M. Andrew