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2.
J Pediatr ; 2021 Aug 17.
Article in English | MEDLINE | ID: covidwho-1610850
3.
Vaccines (Basel) ; 10(1)2021 Dec 21.
Article in English | MEDLINE | ID: covidwho-1580372

ABSTRACT

Healthcare workers' COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February-26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.

4.
Aust N Z J Public Health ; 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1570283

ABSTRACT

OBJECTIVE: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.

6.
Expert Rev Vaccines ; 2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1545817
8.
BMJ Glob Health ; 6(9)2021 09.
Article in English | MEDLINE | ID: covidwho-1504162

ABSTRACT

INTRODUCTION: Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS: We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS: We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS: A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.


Subject(s)
Parents , Vaccination , Child , Child, Preschool , Delivery of Health Care , Humans , Qualitative Research , Systematic Reviews as Topic
9.
Intern Med J ; 2021 Oct 28.
Article in English | MEDLINE | ID: covidwho-1488213

ABSTRACT

The global SARS-CoV-2 pandemic has seen a revolution in both vaccine development and approval processes enabling life-saving vaccines to be implemented at record speed. The resultant vaccines, implemented in Australia under provisional licensure, have used vaccine technologies not used before in Australia. Australia and New Zealand, for much of the pandemic, have been spared the high rates of COVID-19 disease seen elsewhere. Implementing COVID-19 vaccination programs at an entire adult population level has been a complex, evolving series of programs, with recommendations and strategies responding to community confidence, concerns and rare but potentially severe post-licensure adverse events. Understanding our diverse community and their concerns, incentivising immunisation, and responding openly to emergent concerns are key components to maintaining community and health care provider confidence in this critical ongoing COVID-19 vaccine program. This article is protected by copyright. All rights reserved.

10.
J Paediatr Child Health ; 2021 Oct 25.
Article in English | MEDLINE | ID: covidwho-1480193

ABSTRACT

The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern. The acute infection with SARS-CoV-2 is generally mild in children, whilst the post-infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and 'long COVID' in children, are more complex. Given that most research on COVID-19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID-19 in children needs to be prioritised.

11.
J Paediatr Child Health ; 2021 Oct 13.
Article in English | MEDLINE | ID: covidwho-1467589

ABSTRACT

Children globally have been profoundly impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review explores the direct and indirect public health impacts of COVID-19 on children. We discuss in detail the transmission dynamics, vaccination strategies and, importantly, the 'shadow pandemic', encompassing underappreciated indirect impacts of the pandemic on children. The indirect effects of COVID-19 will have a long-term impact beyond the immediate pandemic period. These include the mental health and wellbeing risks, disruption to family income and attendant stressors including increased family violence, delayed medical attention and the critical issue of prolonged loss of face-to-face learning in a normal school environment. Amplification of existing inequities and creation of new disadvantage are likely additional sequelae, with children from vulnerable families disproportionately affected. We emphasise the responsibility of paediatricians to advocate on behalf of this vulnerable group to ensure the longer-term effects of COVID-19 public health responses on the health and wellbeing of children are fully considered.

13.
Vaccine ; 39(40): 5968-5981, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1347848

ABSTRACT

BACKGROUND: In 2010, the Australian seasonal influenza vaccination program for children under 5 years of age was suspended due to an unexpected increase in fever and febrile convulsions causally associated with one particular influenza vaccine brand. A subsequent national review made seven recommendations to improve vaccine pharmacovigilance. Ten years on, in advance of implementing the COVID-19 immunisation program, we evaluated views on the capacity of Australia's vaccine pharmacovigilance system to promptly detect, examine and communicate a signal. METHODS: Semi-structured interviews were conducted between July and October 2020 with individuals with expertise in vaccine safety in Australia using an interview guide informed by key Australian and international frameworks. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was used to code data using a deductive approach. RESULTS: Interviews with seventeen participants enabled six themes to be identified. Participants described improvement and significant innovation within Australia's vaccine pharmacovigilance system over the decade since 2010, particularly through establishment of a new active, cohort event monitoring system using short message service surveys. Participants thought Australia had a good foundation for COVID-19 vaccine safety surveillance; implementation of the COVID-19 immunisation program was seen as a potential driver for ongoing enhancement through: a) improved integration of the active surveillance and spontaneous reporting systems, and; b) development of population-level active surveillance, including through data linkage. Transparent communication was considered essential to address the unprecedented challenges of COVID-19 and broader vaccine safety concerns. CONCLUSIONS: Vaccine safety experts in Australia convey confidence in the innovative pharmacovigilance systems implemented over the past 10 years. While Australia has a multifaceted system incorporating both active surveillance and spontaneous reporting systems, COVID-19 vaccine implementation represents an opportunity to enhance current systems and to develop new, systematic approaches to vaccine pharmacovigilance that should make both a local and global contribution.


Subject(s)
COVID-19 , Influenza Vaccines , Australia , COVID-19 Vaccines , Child , Child, Preschool , Humans , Influenza Vaccines/adverse effects , Pandemics/prevention & control , Pharmacovigilance , SARS-CoV-2 , Vaccination
15.
J Paediatr Child Health ; 57(9): 1362-1369, 2021 09.
Article in English | MEDLINE | ID: covidwho-1261157

ABSTRACT

In 2020, school and early childhood educational centre (ECEC) closures affected over 1.5 billion school-aged children globally as part of the COVID-19 pandemic response. Attendance at school and access to ECEC is critical to a child's learning, well-being and health. School closures increase inequities by disproportionately affecting vulnerable children. Here, we summarise the role of children and adolescents in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and that of schools and ECECs in community transmission and describe the Australian experience. In Australia, most SARS-CoV-2 cases in schools were solitary (77% in NSW and 67% in Victoria); of those that did progress to an outbreak, >90% involved fewer than 10 cases. Australian and global experience has demonstrated that SARS-CoV-2 is predominantly introduced into schools and ECECs during periods of heightened community transmission. Implementation of public health mitigation strategies, including effective testing, tracing and isolation of contacts, means schools and ECECs can be safe, not drivers of transmission. Schools and ECEC are essential services and so they should be prioritised to stay open for face-to-face learning. This is particularly critical as we continue to manage the next phase of the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Adolescent , Child , Child, Preschool , Humans , Pandemics/prevention & control , SARS-CoV-2 , Schools , Victoria
16.
Vaccine ; 38(51): 8075-8077, 2020 12 03.
Article in English | MEDLINE | ID: covidwho-916897
18.
Med J Aust ; 214(4): 189-189.e1, 2021 03.
Article in English | MEDLINE | ID: covidwho-1110638
19.
J Pediatr ; 231: 10-16, 2021 04.
Article in English | MEDLINE | ID: covidwho-1039454

ABSTRACT

Whether children should be vaccinated against coronavirus disease-2019 (COVID-19) (or other infectious diseases such as influenza) and whether some degree of coercion should be exercised by the state to ensure high uptake depends, among other things, on the safety and efficacy of the vaccine. For COVID-19, these factors are currently unknown for children, with unanswered questions also on children's role in the transmission of the virus, the extent to which the vaccine will decrease transmission, and the expected benefit (if any) to the child. Ultimately, deciding whether to recommend that children receive a novel vaccine for a disease that is not a major threat to them, or to mandate the vaccine, requires precise information on the risks, including disease severity and vaccine safety and effectiveness, a comparative evaluation of the alternatives, and the levels of coercion associated with each. However, the decision also requires balancing self-interest with duty to others, and liberty with usefulness. Separate to ensuring vaccine supply and access, we outline 3 requirements for mandatory vaccination from an ethical perspective: (1) whether the disease is a grave threat to the health of children and to public health, (2) positive comparative expected usefulness of mandatory vaccination, and (3) proportionate coercion. We also suggest that the case for mandatory vaccine in children may be strong in the case of influenza vaccination during the COVID-19 pandemic.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Health Policy , Mandatory Programs/ethics , Mass Vaccination/ethics , Child , Coercion , Humans , Influenza Vaccines , Influenza, Human/prevention & control
20.
Australian Journal of General Practice ; 49(10):625-629, 2020.
Article in English | ProQuest Central | ID: covidwho-847463

ABSTRACT

[...]as has been shown in previous mass vaccination programs, planning for vaccine program rollout and community engagement to optimise vaccine confidence and uptake in Australia needs to commence beforehand, not when the vaccines become available.5 Consistent with its existing role in vaccination programs, primary care professional are anticipated to play a key part in educating patients and carers about the vaccine, administering the vaccine, recording uptake and reporting adverse events following immunisation. There are currently 17 vaccines in phase I trials and 10 vaccines in phase II/III clinical trials (28 August 2020).6 Traditional vaccine development is a lengthy process, usually taking 10-15 years or more, with a distinct, linear sequence of steps and high attrition rate.7 The usual steps include pre-clinical development, safety testing (phase I), safety and immunogenicity testing (phase II) and then safety and efficacy testing (phase III), prior to licensure, production at scale and introduction into the population (Figure 1). Comprehensive post-marketing surveillance to track vaccine safety for these expected adverse events, as well as to detect postulated rarer adverse events such as antibody-enhanced disease, will also be essential to maintain vaccine confidence and achieve high vaccine acceptance and uptake. The WHO10 and the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunisation Practice (ACIP)11 are currently advising a risk- and aged-based approach for prioritisation of COVID-19 vaccine target groups.

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