Measuring vaccine confidence: introducing a global vaccine confidence index.

BACKGROUND: Public confidence in vaccination is vital to the success of immunisation programmes worldwide. Understanding the dynamics of vaccine confidence is therefore of great importance for global public health. Few published studies permit global comparisons of vaccination sentiments and behaviours against a common metric. This article presents the findings of a multi-country survey of confidence in vaccines and immunisation programmes in Georgia, India, Nigeria, Pakistan, and the United Kingdom (UK) - these being the first results of a larger project to map vaccine confidence globally. METHODS: Data were collected from a sample of the general population and from those with children under 5 years old against a core set of confidence questions. All surveys were conducted in the relevant local-language in Georgia, India, Nigeria, Pakistan, and the UK. We examine confidence in immunisation programmes as compared to confidence in other government health services, the relationships between confidence in the system and levels of vaccine hesitancy, reasons for vaccine hesitancy, ultimate vaccination decisions, and their variation based on country contexts and demographic factors. RESULTS: The numbers of respondents by country were: Georgia (n=1000); India (n=1259); Pakistan (n=2609); UK (n=2055); Nigerian households (n=12554); and Nigerian health providers (n=1272). The UK respondents with children under five years of age were more likely to hesitate to vaccinate, compared to other countries. Confidence in immunisation programmes was more closely associated with confidence in the broader health system in the UK (Spearman's ρ=0.5990), compared to Nigeria (ρ=0.5477), Pakistan (ρ=0.4491), and India (ρ=0.4240), all of which ranked confidence in immunisation programmes higher than confidence in the broader health system. Georgia had the highest rate of vaccine refusals (6 %) among those who reported initial hesitation. In all other countries surveyed most respondents who reported hesitating to vaccinate went on to receive the vaccine except in Kano state, Nigeria, where the percentage of those who ultimately refused vaccination after initially hesitating was as high as 76%) Reported reasons for hesitancy in all countries were classified under the domains of "confidence," "convenience," or "complacency," and confidence issues were found to be the primary driver of hesitancy in all countries surveyed

Lord of the Rings: A Kinematic Distance to Circinus X-1 from a Giant X-Ray Light Echo

Circinus X-1 exhibited a bright X-ray flare in late 2013. Follow-up observations with Chandra and XMM-Newton from 40 to 80 days after the flare reveal a bright X-ray light echo in the form of four well-defined rings with radii from 5 to 13 arcminutes, growing in radius with time. The large fluence of the flare and the large column density of interstellar dust towards Circinus X-1 make this the largest and brightest set of rings from an X-ray light echo observed to date. By deconvolving the radial intensity profile of the echo with the MAXI X-ray lightcurve of the flare we reconstruct the dust distribution towards Circinus X-1 into four distinct dust concentrations. By comparing the peak in scattering intensity with the peak intensity in CO maps of molecular clouds from the Mopra Southern Galactic Plane CO Survey we identify the two innermost rings with clouds at radial velocity ~ -74 km/s and ~ -81 km/s, respectively. We identify a prominent band of foreground photoelectric absorption with a lane of CO gas at ~ -32 km/s. From the association of the rings with individual CO clouds we determine the kinematic distance to Circinus X-1 to be $D_{Cir X-1} = 9.4^{+0.8}_{-1.0}$ kpc. This distance rules out earlier claims of a distance around 4 kpc, implies that Circinus X-1 is a frequent super-Eddington source, and places a lower limit of $\Gamma \gtrsim 22$ on the Lorentz factor and an upper limit of $\theta_{jet} \lesssim 3^{\circ}$ on the jet viewing angle.Comment: 20 pages, 21 figures, Astrophysical Journal, in prin

Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion.

Today, according to many public health experts, public confidence in vaccines is waning. The term "vaccine hesitancy" (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people's level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa : a systematic literature review

Abstract: Background Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. Objectives This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. Data sources We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. Study eligibility criteria Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included..

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey.

BACKGROUND: Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. METHODS: We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey - which we believe represents the largest survey on confidence in immunization to date - examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. FINDINGS: Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. CONCLUSIONS: Regular monitoring of vaccine attitudes - coupled with monitoring of local immunization rates - at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes

Venom kinematics during prey capture in Conus: the biomechanics of a rapid injection system

Cone snails use an extensile, tubular proboscis as a conduit to deliver a potent cocktail of bioactive venom peptides into their prey. Previous studies have focused mainly on understanding the venom's role in prey capture but successful prey capture requires both rapid physiological and biomechanical mechanisms

Measuring vaccine hesitancy: The development of a survey tool.

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

Alternative global Cretaceous paleogeography

Plate tectonic reconstructions for the Cretaceous have assumed that the major continental blocks—Eurasia, Greenland, North America, South America, Africa, India, Australia, and Antarctica—had separated from one another by the end of the Early Cretaceous, and that deep ocean passages connected the Pacific, Tethyan, Atlantic, and Indian Ocean basins. North America, Eurasia, and Africa were crossed by shallow meridional seaways. This classic view of Cretaceous paleogeography may be incorrect. The revised view of the Early Cretaceous is one of three large continental blocks— North America–Eurasia, South America–Antarctica-India-Madagascar-Australia; and Africa—with large contiguous land areas surrounded by shallow epicontinental seas. There was a large open Pacific basin, a wide eastern Tethys, and a circum- African Seaway extending from the western Tethys (“Mediterranean”) region through the North and South Atlantic into the juvenile Indian Ocean between Madagascar-India and Africa. During the Early Cretaceous the deep passage from the Central Atlantic to the Pacific was blocked by blocks of northern Central America and by the Caribbean plate. There were no deep-water passages to the Arctic. Until the Late Cretaceous the Atlantic-Indian Ocean complex was a long, narrow, sinuous ocean basin extending off the Tethys and around Africa. Deep passages connecting the western Tethys with the Central Atlantic, the Central Atlantic with the Pacific, and the South Atlantic with the developing Indian Ocean appeared in the Late Cretaceous. There were many island land areas surrounded by shallow epicontinental seas at high sea-level stands

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review.

BACKGROUND: Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. OBJECTIVES: This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. DATA SOURCES: We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. STUDY ELIGIBILITY CRITERIA: Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Included publications were quality assessed using the Hawker method and coded thematically. RESULTS: 10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may-or may not-choose to use prevention interventions. LIMITATIONS: This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings. CONCLUSIONS AND IMPLICATIONS: When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection

Methicillin sensitive Staphylococcus aureus producing Panton-Valentine leukocidin toxin in Trinidad & Tobago: a case report

<p>Abstract</p> <p>Introduction</p> <p>Certain <it>Staphylococcus aureus </it>strains produce Panton-Valentine leukocidin, a toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or severe infection. This report documents a confirmed case of methicillin-sensitive <it>Staphylococcus aureus </it>strain harboring Panton-Valentine leukocidin genes from Trinidad and Tobago. To the best of our knowledge, this is the first time that such a case has been identified and reported from this country.</p> <p>Case presentation</p> <p>A 13-year-old Trinidadian boy of African descent presented with upper respiratory symptoms and gastroenteritis-like syptoms. About two weeks later he was re-admitted to our hospital complaining of pain and weakness affecting his left leg, where he had received an intramuscular injection of an anti-emetic drug. He deteriorated and developed septic arthritis, necrotizing fasciitis and septic shock with acute respiratory distress syndrome, leading to death within 48 hours of admission despite intensive care treatment. The infection was caused by <it>S. aureus</it>. Bacterial isolates from specimens recovered from our patient before and after his death were analyzed using microarray DNA analysis and <it>spa </it>typing, and the results revealed that the <it>S. aureus </it>isolates belonged to clonal complex 8, were methicillin-susceptible and positive for Panton-Valentine leukocidin. An autopsy revealed multi-organ failure and histological tissue stains of several organs were also performed and showed involvement of his lungs, liver, kidneys and thymus, which showed Hassal's corpuscles.</p> <p>Conclusion</p> <p>Rapid identification of Panton-Valentine leukocidin in methicillin-sensitive <it>S. aureus </it>isolates causing severe infections is necessary so as not to miss their potentially devastating consequences. Early feedback from the clinical laboratories is crucial.</p