Cocoon Strategy of Vaccinations: Benefits and Limitations

A cocoon vaccination strategy refers to vaccinations in persons from the immediate environment of those patients who might develop an illness (they are susceptible to illnesses) but cannot be vaccinated due to permanent or temporary medical contraindications to a vaccination (e.g. immunosuppressed patients) or are too young to have a vaccination. Most frequently, a cocoon vaccination strategy is associated with vaccinations in adults aimed at preventing the spread of an illness in children (e.g. pertussis vaccination or influenza vaccination), but it is worth considering whether this strategy should not be understood also as vaccinations in children with the view of protecting adults and the elderly against illnesses (e.g. influenza or pneumococcal diseases). The aim of the cocoon strategy is to minimize the risk of the transmission of pathogens in the environment of a patient who is susceptible to an infection. A vaccinated patient is not a source of infection any more for a non-vaccinated patient. The chapter presents a history, current implementation of the strategy in different countries, its benefits and limitations

Determinants and coverage of seasonal influenza vaccination among women of childbearing age in Poland

Objectives: Vaccination is the most effective method of controlling influenza in the human population, where pregnant women belong to a risk group that is especially vulnerable to influenza-related morbidity and mortality. The objectives of the survey were to report estimates of maternal vaccination coverage and assess reasons for the lack of influenza vaccination among Polish women of childbearing age. Material and methods: The survey analysis included 564 pregnant women who had been surveyed in a self-reported questionnaire during the 2017–2018 influenza season in Warsaw, Poland. Results: Over 95% of Polish women of childbearing age did not vaccinate against influenza due to the low perception of risk and a lack of providing evidence-based information on vaccine by physicians and midwives. General practitioners were most often indicated as healthcare workers who educated women about influenza risk factors and recommended influenza vaccine to them. Conclusions: The results of the survey suggest that women of childbearing age did not vaccinate against influenza due to the low perception of risk and a lack of providing evidence-based information by healthcare workers (including obstetrician-gynaecologists and midwives), while their recommendations appear to be a powerful method of overcoming barriers to influenza vaccination among patients

Vaccination against influenza in pregnant women – safety and effectiveness

Influenza is a major cause of morbidity and mortality worldwide. During seasonal influenza epidemics and pandemics, pregnancy places otherwise healthy women at an increased risk of complications from influenza. The factors believed to increase the susceptibility of complicated influenza infection during pregnancy are linked to the physiologic changes, including immunologic changes (attenuation of the cell-mediated immune responses, selective suppression of T-helper 1 cell mediated immunity while the adaptive humoral immunity remains unimpaired), increased cardiac output and oxygen consumption and tidal volume. Pregnant women have similar incidence of seasonal influenza as the general population, however, because of the physiological changes, they are at an increased risk of complications (including secondary pneumonia, acute respiratory insufficiency, increased risk of stillbirth, premature deliveries) and death. Immunization of pregnant women against influenza is currently recommended in many countries. Vaccination against influenza with trivalent inactivated vaccine (TIV) has been proven to be safe and effective. Lack of harmful effect of TIV on pregnant women and newborns has been demonstrated in several studies: no increased risk of spontaneous abortions, preterm birth, low birth weight, congenital malformations, cesarean section have been reported. Vaccination against influenza has been proven to be effective in reducing rates and severity of the disease in vaccinated mothers and their children. Several studies revealed a decreased risk of influenza-like illnesses among mothers who were vaccinated during pregnancy, but also a decreased risk of laboratory confirmed cases of influenza and hospitalizations due to influenza and its complications among newborns and infants born to vaccinated mothers. Currently available inactivated influenza vaccines are not licensed for use in infants younger than 6 months. Protection of young infants against the infection in early life thus requires a cocooning strategy to reduce the number of vulnerable individuals among care givers and contacts. Neonates and infants may be also protected against influenza directly by antibodies of maternal origin that cross the placenta or are transferred via breast milk. The duration of passively acquired antibodies depends on the initial blood concentration and is probably less than 6 months. Vaccine coverage among pregnant women remains low. Possible explanations include lack of education by health care workers, the feeling among the general public that influenza is not a serious problem, and the failure of prenatal care providers to offer the vaccine. Overall, the most important factor for a woman to decide to be immunized during pregnancy was to have a clear recommendation from the health care provider. Reasons evoked by obstetricians for not providing influenza vaccines included lack sufficient data on safety and efficacy, concerns about the medical legal risks of vaccination during pregnancy and the perception that pregnant women would not want to be vaccinated. Educational intervention targeting health care workers in charge of pregnant women should be primary implemented to provide higher influenza vaccine coverage and to protect pregnant women and young infants from influenza related morbidity

Influenza vaccination in pregnancy — current data on safety and effectiveness

Pregnant women are at risk of severe and complicated influenza, and so are children aged 2-5 years. Despite numerous recommendations, influenza vaccination coverage in pregnant women is still low. The trigger for this article was the development of new quadrivalent influenza vaccines along with the publication of new studies on the safety and effectiveness of inactivated influenza vaccines in pregnant women, administered also in the first trimester of pregnancy. The inactivated quadrivalent influenza vaccine is a safe and effective measure for preventing influenza in both mother and child. Live attenuated influenza vaccines are contraindicated in pregnant women, whereas inactivated influenza vaccines should be recommended to all pregnant women, either healthy or with comorbidities. Influenza vaccines can be administered during any pregnancy trimester, at least two weeks before delivery. The time of vaccination depends on vaccine availability; however, it should not be postponed unless there are significant medical contraindications

Pertussis vaccination in pregnancy — current data on safety and effectiveness

Whooping cough/pertussis is a respiratory infection caused by the bacteria Bordetella pertussis and Bordetella parapertussis. The World Health Organization (WHO) has identified whooping cough as one of the least controlled diseases in all age groups. Clinically, the catarrhal phase manifests itself as flu-like, nonspecific symptoms: cough, runny nose, mild fever, which, regrettably, makes early diagnosis difficult. The severe course is more specific (an audible inspiratory whoop followed by paroxysmal cough and vomiting). Currently, in Poland the highest percentage of cases is observed in children aged 0–4 years, followed by children over 15 years of age, with peaks among teens and seniors. Notably, hospitalization, morbidity and mortality rates are considerable in children (especially infants). Vaccinating pregnant women against pertussis provides approximately 90% protection to infants in their first two months of life. It is an effective form of preventing pertussis in infants. Moreover, it is safe for pregnant women and their children. The Advisory Committee on Immunization Practices (ACIP) recommends Tdap vaccination to every pregnant woman between 27–36 weeks of pregnancy

Primary health care tasks in implementing the main operations of public health

Public health and primary health care are complementary strategies for sustaining the health of a society. There are many analyses in the literature on the subject that deal with the possibility of mutual support between public health and primary health care. There reports from many countries include studies of scientific institutions, presentations of specific solutions used by health protection administrations and self-government bodies, programs of study, and courses. However, this issue is rarely raised in Poland. The aim of this article is to present an up-to-date list of public health operations and to where there is room for primary health care activities. A binding list of public health operations was defined by the World Health Organisation (WHO) in 2012 under the name of Essential Public Health Operations (EPHOs). In order to define public health operations more precisely in this article, a questionnaire self-assessment tool for the evaluation of essential public health operations in the WHO European Region was used. Primary health care plays a significant role in the performance of public health operations (EPHOs), whereas the public health operations connected with health protection (EPHO 3), health promotion (EPHO 4) and disease prevention (EPHO 5), are mostly attributed to primary health care. Primary health care provides the information necessary for the performance of public health operations in the field of monitoring population health and well-being – in particular infectious and chronic diseases (EPHO 1), and for health care management and improvement of health care quality (EPHO 6)

Social marketing in gynecological cancers prevention after the COVID-19 pandemic

Objectives: Assessment of the development and description of the characteristics of social marketing in Poland and the United States with regard to the prevention of gynecological cancers and achievements of these countries. Material and methods: Collective case study based on an analysis of five social campaigns in Poland and five social campaigns in the United States that were focused the gynecological cancers prevention. Results: In the United States, there are more materials available on social campaigns dedicated to the prevention of gynecological cancers, and there are more public organizations that are involved in health promotion activities than in Poland. As opposed to American campaigns, Polish social campaigns did not cover all types of gynecological cancer. The study revealed that Facebook is the most commonly used social media platform by the social campaign organizers. Conclusions: Social marketing tools still have not been fully implemented in the prevention of gynecological cancers either in Poland or in the United States. However, social marketing in the US seems to be more effective in gynecological cancers prevention than Poland