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Abstract: Background: Infectious diseases cause considerable morbidity and mortality in children less than 5 years of age. Children attending childcare centres are at increased risk of contracting infections. It is of public health interest to understand what triggers and underpins parental decisions to send an unwell child to childcare, with the obvious attendant risks to other children and childcare staff as well as the affected child. This study aimed to examine parents' disease prevention health beliefs and practices with a particular focus on how these factors influence childcare attendance decisions. Methods: Semistructured, in‐depth interviews were conducted between June 2009 and May 2011 with parents who had at least one child under 5 years of age enrolled in a childcare centre. Six centres in the metropolitan area of Sydney, Australia, were selected to include parents from a range of demographic and socio‐economic backgrounds. Results: Forty‐two interviews were conducted, recorded, and transcribed. Themes emerging from the data included “vitamin dirt,” contagion, and contagion prevention and control. These interacted with parents' decision‐making about childcare attendance, and parents made choices in a complex context of obligations to their child, social contract obligations to others, peer expectations, and the need to work. Vaccination received only scant mention as a preventive health measure. Decision‐making by parents concerning childcare attendance was made without reference to any external guidelines. Conclusions: This study provides insights into parental disease prevention beliefs, behaviours, and decision‐making. It reveals a need for policies to support parents with unwell children. In addition, resources and educative efforts to raise awareness of vaccination as a preventive health measure, and awareness of infectious disease contagion more broadly, would assist in providing parents with a greater evidence base for making decisions about childcare attendance when their child is unwell. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus ( HCV) is a leading cause of chronic liver disease worldwide. HCV predominates in people who inject drugs; a group in whom anti-viral therapy has previously been withheld on the basis of chaotic lifestyles and associated risks of reinfection. New research has emerged which suggests that by specifically targeting HCV-infected people who inject drugs for treatment, the pool of HCV would deplete, thus reducing overall transmission and eventually leading to HCV eradication. Aim To outline the requirements for HCV eradication and review the evidence that this is achievable. Methods Expert review of the literature. Results The achievement of HCV eradication using 'treatment as prevention' is supported by numerous epidemiological modelling studies employing a variety of models in several contexts including people who inject drugs, men who have sex with men and prisoners. More recent studies also incorporate the newer, more efficacious direct-acting anti-viral drugs. These drugs have been shown to be safe and effective in people who inject drugs in clinical trials. There is no empirical evidence of the impact of treatment as prevention strategies on population prevalence. Conclusions This review highlights the efforts to control HCV and evaluates the possibilities of achieving eradication of HCV. Currently, the technologies required to achieve HCV eradication exist, but the infrastructure to deliver them is not generally available or of insufficient scale outside of specific areas. Such areas are yet to demonstrate that elimination is possible, but results of studies in these areas are awaited. Such a demonstration would be proof of principle for eradication. Although we are aspiring towards HCV eradication, elimination is the more realistic prospect. [ABSTRACT FROM AUTHOR]

As vaccination programs continue to successfully control more and more infectious diseases, and the effects of these diseases become less visible, there has been increased focus on adverse events following immunization. Vaccines have been falsely implicated in the causation of a range of conditions, especially those which affect infants and young children, and whose aetiology is unknown, poorly understood or multifactorial. This paper explores some of the common immunization myths that clinicians may face. It is essential that health professionals have access to accurate information and are able to respond appropriately to parental concerns. This involves good communication; listening, empathy and tailoring advice to the specific concerns of the parent. Finally, health professionals need to provide consistent messages based on solid research evidence. [ABSTRACT FROM AUTHOR]

The declining incidence of vaccine-preventable diseases has led to an increased public focus on the issue of vaccine safety. In an environment of increased consumerism, interest in alternative health practices and anti-vaccination lobbying, media reports that call into question the safety of scheduled vaccines can significantly raise parents' concerns. Recent media coverage of a suggested but unproved link between the measles-mumps-rubella vaccine and autism has highlighted the challenges of providing a consistent and co-ordinated response. For those concerned about effectively communicating the benefits and risks of vaccination, the field of risk communication can provide helpful insights. This paper summarizes the Workshop on Vaccine Communication held in the USA during October 2000. It highlights the perspectives given by consumers, providers, journalists and risk-communication experts and discusses implications for Australia. These centre around how government and health professionals might respond to vaccine safety scares in the public arena, and to parental concerns raised in clinical encounters. Finally, the potential risks and benefits of engaging with the anti-vaccination lobby are outlined. [ABSTRACT FROM AUTHOR]

Issues Addressed: Although current health care policies in theory are moving more towards inclusion of prevention and health promotion approaches alongside curative care, it is questioned whether these policies are being embraced by health care professionals in their practice. One area where providers might take an active health promoting role is in influencing parents' decisions to have their children vaccinated against serious diseases. This pilot exploratory study was undertaken to gain some understanding of attitudes and perceptions among midwives towards administering and promoting the neonatal dose of the hepatitis B vaccine.Method: In-depth interviews were conducted with six key informant midwives recruited through a snowball sampling technique. The interviews were guided by open-ended questions providing a flexible framework for qualitative data collection and analysis.Results: These midwives regarded immunisation primarily as a procedure embedded within many other clinical requirements. They expressed strong deference to consumer sovereignty in immunisation choices. A few held some reservations about safety and necessity with the latter perception underscored by little mention of hepatitis B as a serious and common disease and they expressed little consequent acceptance of the need to take a strong role in prevention and health promotion.Conclusions: This pilot project provides grounds for further exploring how midwives prioritise and conceptualise their health promoting role with regard to infectious disease prevention. [ABSTRACT FROM AUTHOR]

Background: There is a general consensus that another influenza pandemic is inevitable. Although health care workers (HCWs) are essential to the health system response, there are few studies exploring HCW attitudes to pandemic influenza. The aim of this study was to explore HCWs knowledge, attitudes and intended behaviour towards pandemic influenza.Methods: Cross-sectional investigation of a convenience sample of clinical and non-clinical HCWs from two tertiary-referral teaching hospitals in Sydney, Australia was conducted between June 4 and October 19, 2007. The self-administered questionnaire was distributed to hospital personal from 40 different wards and departments. The main outcome measures were intentions regarding work attendance and quarantine, antiviral use and perceived preparation.Results: Respondents were categorized into four main groups by occupation: Nursing (47.5%), Medical (26.0%), Allied (15.3%) and Ancillary (11.2%). Our study found that most HCWs perceived pandemic influenza to be very serious (80.9%, n = 873) but less than half were able to correctly define it (43.9%, n = 473). Only 24.8% of respondents believed their department to be prepared for a pandemic, but nonetheless most were willing to work during a pandemic if a patient or colleague had influenza. The main determinants of variation in our study were occupational factors, demographics and health beliefs. Non-clinical staff were significantly most likely to be unsure of their intentions (OR 1.43, p < 0.001). Only 42.5% (n = 459) of respondents considered that neuraminidase inhibitor antiviral medications (oseltamivir/zanamivir) would protect them against pandemic influenza, whereas 77.5% (n = 836) believed that vaccination would be of benefit.Conclusion: We identified two issues that could undermine the best of pandemic plans - the first, a low level of confidence in antivirals as an effective measure; secondly, that non-clinical workers are an overlooked group whose lack of knowledge and awareness could undermine pandemic plans. Other issues included a high level of confidence in dietary measures to protect against influenza, and a belief among ancillary workers that antibiotics would be protective. All health care worker strategies should include non clinical and ancillary staff to ensure adequate business continuity for hospitals. HCW education, psychosocial support and staff communication could improve knowledge of appropriate pandemic interventions and confidence in antivirals. [ABSTRACT FROM AUTHOR]

The article presents a short report on autism. Fairytales from the British Isles, Germany, and Scandinavia include stories about changelings. They describe a child who exhibits remarkable and sudden changes in behavior and/or appearance, explaining that supernatural folk steal normal children and replace them with one of their own, or some other substitute. The parallels between changeling tales and autism, have been briefly noted by writers on the history of the disorder. Some of the features of these stories, including the initial health and beauty of the human child, the change after some period of normalcy and the specific behaviors of the changeling are well matched to symptoms in some presentations of autism.

Background: In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation.Methods: A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence).Results: The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1-14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7-8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9-3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7-3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6-4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3-2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76-82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31-44) and lower attendance rate (PAR = 37%, 95%CI: 29-46).Conclusion: This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. [ABSTRACT FROM AUTHOR]

Determines the likelihood of finding an antivaccination site on the world wide web. Evidence of authority and scientific rigor; Emotive appeals; Evidence of conspiracy; Antivaccination web sites encountered; Rhetorical appeals and explicit claims; Defuse conspiratorial claims the public should be made of.

Children around the world remain under-vaccinated for many reasons. To develop effective vaccine delivery programmes and monitor intervention impact, vaccine programme implementers need to understand reasons for under-vaccination within their local context. The World Health Organization (WHO) Working Group on the Behavioural and Social Drivers of Vaccination (BeSD) is developing standardised tools for assessing childhood vaccine acceptance and uptake that can be used across regions and countries. The tools will include: (1) a validated survey; (2) qualitative interview guides; and (3) corresponding user guidance. We report a user-centred needs assessment of key end-users of the BeSD tools. Twenty qualitative interviews (Apr-Aug 2019) with purposively sampled vaccine programme managers, partners and stakeholders from UNICEF and WHO country and regional offices. The interviews assessed current systems, practices and challenges in data utilisation and reflections on how the BeSD tools might be optimised. Framework analysis was used to code the interviews. Regarding current practices, participants described a variety of settings, data systems, and frequencies of vaccination attitude measurement. They reported that the majority of data used is quantitative, and there is appetite for increased use of qualitative data. Capacity for conducting studies on social/behavioural drivers of vaccination was high in some jurisdictions and needed in others. Issues include barriers to collecting such data and variability in sources. Reflecting on the tools, participants described the need to explore the attitudes and practices of healthcare workers in addition to parents and caregivers. Participants were supportive of the proposed mixed-methods structure of the tools and training in their usage, and highlighted the need for balance between tool standardisation and flexibility to adapt locally. A user-centred approach in developing the BeSD tools has given valuable direction to their design, bringing the use of behavioural and social data to the heart of programme planning. [ABSTRACT FROM AUTHOR]

Schools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. Initiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015–2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25th percentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. Median initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. This study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage. [ABSTRACT FROM AUTHOR]

Highlights • There is limited research published on Midwives' immunisation attitudes and practice. • The majority of midwives support immunisation, however a spectrum of beliefs and concerns emerged. • The reservations expressed focussed on what is not yet known rather than mistrust of current evidence. • The midwifery focus on the individual and parental choice has implications for immunisation promotion. Abstract Vaccine hesitancy in industrialised countries is an area of concern. Health professionals play a significant role in parental vaccination decisions, however, to date the role of midwives has not been widely explored. This review sought to describe the attitudes and communication practices of midwives in developed countries towards childhood vaccines. Medline, Cinahl, PsychInfo, Embase and the grey literature were searched. Inclusion criteria were qualitative and quantitative studies reporting midwives' beliefs, attitudes and communication practices toward childhood vaccination. The search returned 366 articles, of which 359 were excluded by abstract. Two additional articles were identified from the grey literature and references, resulting in nine studies from five countries included in the review. Across the studies, the majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged. A minority expressed reservations about the scientific justification for vaccination, which focussed on what is not yet known rather than mistrust of current evidence. Most midwives felt that vaccines were safe; a minority were unsure, or believed they were unsafe. The majority of midwives agreed that childhood vaccines are necessary. Among those who expressed doubt, a commonly held opinion was that vaccine preventable diseases such as measles are relatively benign and didn't warrant vaccination against them. Finally, the midwifery model of care was shown to focus on providing individualised care, with parental choice being placed at a premium. The midwifery model care appears to differ in approach from others, possibly due to a difference in the underpinning philosophies. Research is needed to understand how midwives see vaccination, and why there appears to be a spectrum of views on the subject. This information will inform the development of resources tailored to the midwifery model of care, supporting midwives in advocating for childhood vaccination. [ABSTRACT FROM AUTHOR]

Abstract Introduction Maternal and childhood vaccine decision-making begins prenatally. Amongst pregnant Australian women we aimed to ascertain vaccine information received, maternal immunisation uptake and attitudes and concerns regarding childhood vaccination. We also aimed to determine any correlation between a) intentions and concerns regarding childhood vaccination, (b) concerns about pregnancy vaccination, (c) socioeconomic status (SES) and (d) uptake of influenza and pertussis vaccines during pregnancy and routine vaccines during childhood. Methods Women attending public antenatal clinics were recruited in three Australian states. Surveys were completed on iPads. Follow-up phone surveys were done three to six months post delivery, and infant vaccination status obtained via the Australian Childhood Immunisation Register (ACIR). Results Between October 2015 and March 2016, 975 (82%) of 1184 mothers consented and 406 (42%) agreed to a follow up survey, post delivery. First-time mothers (445; 49%) had significantly more vaccine concerns in pregnancy and only 73% had made a decision about childhood vaccination compared to 89% of mothers with existing children (p-value < 0.001). 66% of mothers reported receiving enough information during pregnancy on childhood vaccination. In the post delivery survey, 46% and 82% of mothers reported receiving pregnancy influenza and pertussis vaccines respectively. The mother's degree of vaccine hesitancy and two attitudinal factors were correlated with vaccine uptake post delivery. There was no association between reported maternal vaccine uptake or SES and childhood vaccine uptake. Conclusion First time mothers are more vaccine hesitant and undecided about childhood vaccination, and only two thirds of all mothers believed they received enough information during pregnancy. New interventions to improve both education and communication on childhood and maternal vaccines, delivered by midwives and obstetricians in the Australian public hospital system, may reduce vaccine hesitancy for all mothers in pregnancy and post delivery, particularly first-time mothers. [ABSTRACT FROM AUTHOR]

Background: The Internet is increasingly a source of health information for parents, who use the Internet alongside health care providers for immunisation information. Concerns have been raised about the reliability of online immunisation information, however to date there has been no audit of the quality or quantity of what is available to Australian parents. The objective of this study was to address this gap by simulating a general online search for immunisation information, and assessing the quality and quantity of the web sites returned by the search.Methods: We used Google trends to identify the most common immunisation search terms used in Australia. The ten most common terms were entered into five search engines and the first ten non-commercial results from each search collated. A quality assessment tool was developed using the World Health Organization Global Advisory Committee on Vaccine Safety (GACVS) criteria for assessing the quality of vaccine safety web sites, and used to assess and score the quality of the sites.Results: Seven hundred web pages were identified, of which 514 were duplicates, leaving 186 pages from 115 web sites which were audited. Forty sites did not include human immunisation information, or presented personal opinion about individuals, and were not scored. Of the 75 sites quality scored, 65 (87%) were supportive of immunisation, while 10 (13%) were not supportive. The overall mean quality score was 57/100 (range 14/100 to 92/100). When stratified by pro and anti-vaccination stance, the average quality score for pro-vaccine sites was 61/100, while the average score for anti-vaccine sites was 30/100. Pro-vaccine information could be divided into three content groups: generalist overview with little detail; well-articulated and understandable detail; and lengthy and highly technical explanations. The main area found to be lacking in pro-vaccine sites was lack of transparent authorship.Conclusion: Our findings suggest a need for information which is easily found, transparently authored, well-referenced, and written in a way that is easily understood. [ABSTRACT FROM AUTHOR]

Highlights: [•] Large survey of pregnant women examining attitudes toward pertussis vaccination. [•] 80% of women would have a pertussis vaccine while pregnant, if recommended. [•] 17% of women already had a pertussis vaccine, 33% plan to have post-partum. [•] Provider recommendation associated with intention to vaccinate post-partum. [•] Safety concerns and information needs are barriers to vaccination during pregnancy. [ABSTRACT FROM AUTHOR]