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      Impact of refusal to vaccine in the neonatal period on the implementation of the vaccination calendar in the first year of life

      brief-report
      a , b
      Human Vaccines & Immunotherapeutics
      Taylor & Francis
      Vaccination, neonatology, contraindications to vaccinations, immunization, newborn, infant, vaccination schedule

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          ABSTRACT

          Introduction

          The level of vaccination coverage with obligatory preparations in Poland reaches 98%. This is facilitated by the introduction of the Individual Vaccination Calendar (IVC) compliant with medical contraindications to vaccination.

          Aim

          The aim of the study was to assess whether the refusal of vaccinations after birth has an impact on the proper implementation of the vaccination calendar in the first year of life.

          Methods

          The study involved healthy, term newborns who were born in the Department of Neonatology in 2011–2015. There were 156 patients enrolled to the study. Among them, 133 were in the control group – vaccinated after birth, and 23 constituted the study group – not vaccinated after birth.

          Results

          Not all healthy newborns are vaccinated after birth, statistical significance was obtained between the study and control group ( p < 0,00001).

          Only 48% of patients not vaccinated after birth received TB-vaccine during the first year ( p < 0,00053).

          Parents of 26% of infants in the study and of 2% of infants in the control group declared using the IVC ( p < 0,001).

          Conclusions

          1. Proper implementation of the vaccination schedule in the first year of life results from the initiation of vaccinations after birth.

          2. Unreasonable introduction of the IVC promotes incorrect timing of mandatory vaccinations.

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          Most cited references12

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          A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

          Background The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Methods Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Results Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. Conclusions The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.
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            Communicating with parents about vaccination: a framework for health professionals

            Background A critical factor shaping parental attitudes to vaccination is the parent’s interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination. Methods Literature review to identify a spectrum of parent attitudes or ‘positions’ on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles. Results Five distinct parental groups were identified: the ‘unquestioning acceptor’ (30–40%), the ‘cautious acceptor’ (25–35%); the ‘hesitant’ (20–30%); the ‘late or selective vaccinator’ (2–27%); and the ‘refuser’ of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents’ readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent’s own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used. Conclusions Health professionals have a central role in maintaining public trust in vaccination, including addressing parents’ concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.
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              Qualitative analysis of mothers' decision-making about vaccines for infants: the importance of trust.

              The high visibility of controversies regarding vaccination makes it increasingly important to understand how parents decide whether to vaccinate their infants. The purpose of this research was to investigate decision-making about vaccinations for infants. We conducted qualitative, open-ended interviews. Subjects included mothers 1 to 3 days postpartum and again at 3 to 6 months. We addressed 3 topics: attitudes to vaccination, knowledge about vaccination, and decision-making. Mothers who intended to have their infants vaccinated ("vaccinators," n = 25) either agreed with or did not question vaccination or they accepted vaccination but had significant concerns. Mothers who did not intend to vaccinate ("nonvaccinators," n = 8) either completely rejected vaccination or they purposely delayed vaccinating/chose only some vaccines. Knowledge about which vaccines are recommended for children was poor among both vaccinators and nonvaccinators. The theme of trust in the medical profession was the central concept that underpinned all of the themes about decision-making. Promoters of vaccination included trusting the pediatrician, feeling satisfied by the pediatrician's discussion about vaccines, not wanting to diverge from the cultural norm, and wanting to adhere to the social contact. Inhibitors included feeling alienated by or unable to trust the pediatrician, having a trusting relationship with an influential homeopath/naturopath or other person who did not believe in vaccinating, worry about permanent side effects, beliefs that vaccine-preventable diseases are not serious, and feeling that since other children are vaccinated their child is not at risk. Trust or lack of trust and a relationship with a pediatrician or another influential person were pivotal for decision-making of new mothers about vaccinating their children. Attempts to work with mothers who are concerned about vaccinating their infants should focus not only on providing facts about vaccines but also on developing trusting and positive relationships.
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                Author and article information

                Journal
                Hum Vaccin Immunother
                Hum Vaccin Immunother
                Human Vaccines & Immunotherapeutics
                Taylor & Francis
                2164-5515
                2164-554X
                19 October 2020
                2021
                19 October 2020
                : 17
                : 4
                : 1156-1161
                Affiliations
                [a ]Department of Neonatology, St. Hedwig of Silesia Hospital; , Trzebnica, Poland
                [b ]Department and Clinic of Neonatology, Wroclaw Medical University, University Hospital; , Wrocław, Poland
                Author notes
                CONTACT Agata Więckowska (Pająk) agata_pa@ 123456wp.pl Department of Neonatology, St. Hedwig of Silesia Hospital; , Trzebnica55-100, Poland
                Author information
                https://orcid.org/0000-0001-6227-2974
                https://orcid.org/0000-0002-6493-0333
                Article
                1804246
                10.1080/21645515.2020.1804246
                8018495
                33074768
                1555da75-0afa-42ad-8c67-32439758208a
                © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

                History
                Page count
                Figures: 1, Tables: 5, References: 12, Pages: 6
                Categories
                Brief Report
                Short Report

                Molecular medicine
                vaccination,neonatology,contraindications to vaccinations,immunization,newborn,infant,vaccination schedule

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