A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study

Background Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant.

1177. Vaccinate Lurie (VaLu) a QI Project to Improve Pediatric Pre-Transplant Immunization Rates

Background Immunization prior to transplantation is important due to post-transplant immunosuppression. According to a national study, 15% of pediatric solid organ transplant recipients were hospitalized within 5 years post-transplant for a vaccine preventable illness or RSV. At our large academic pediatric hospital approximately 53% of heart and liver transplant recipients in 2016 -2018 were up to date with tetanus and pneumococcal vaccinations. This QI project was designed to improve our pre-transplant vaccination rates to minimize post-transplant infections. Methods An interdisciplinary team was convened including pharmacists, nurses, nurse practitioners, and physicians from cardiology, hepatology, and infectious diseases. After evaluating our current processes and key drivers, we selected interventions to implement via the PDSA model. Our first intervention was to have team members gain access to our statewide vaccine database (ICARE). Our second cycle was to link ICARE to our electronic medical record system (EPIC) for automatic immunization record integration. Process Map Key Driver Diagram Results Our outcome measure was up to date tetanus and pneumococcal vaccines per the CDC recommendations by age at transplant, as documented in the medical record. We saw an improvement in immunization rates to 100% during the third quarter of 2020 with an overall rate of over 80% for late 2019 - mid 2020. With the understanding that our average wait time for a heart and liver transplant was 2.4 and 3.8 months, respectively, the initiation of our QI project and obtaining access to ICARE by our team members was likely related to the improved vaccination rates. Unfortunately, after the team stopped meeting during the pandemic our immunization completion rates have decreased in 2021, despite implementing institutional access to ICARE. Control Chart Conclusion It is possible to obtain optimal immunization rates for pneumococcal and tetanus vaccines in pediatric heart and liver transplant recipients. Our future interventions include improving vaccinations after catch-up recommendations have been made and sustaining our interventions. Additionally, we look to expand our analysis to include outcomes related to vaccine-preventable diseases after transplantation. Disclosures Jacquie Toia, DNP, RN, APN, QarTek (Board Member) Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial Stipend as Co-editor in Chief, Clinical Therapeutics)Seqirus (Consultant)

Determinants of Vaccine Acceptance against COVID-19 in China: Perspectives on Knowledge and DrVac-COVID19S Scale

Background: This study determined the knowledge and attitudes regarding COVID-19 and assessed the acceptance of the COVID-19 vaccine among the Chinese population. Methods: An online and offline cross-sectional study was conducted from 1 to 18 June 2021 among the Chinese population. Demographic characteristics, attitudes, knowledge, values, impact, and autonomy regarding the COVID-19 vaccine were collected using questionnaire. The variables in our study were analyzed by Mann-Whitney test and chi-square test. Results: A total of 93.8% participants were willing to be vaccinated, 2.7% refused, and 3.5% hesitated. In regards to knowledge about the COVID-19 vaccine, 94.3% citizens surveyed knew about the spread of droplets and 65% had knowledge about surfaces touched by an infected person. In addition, 93.8% of participants had knowledge of the common symptoms related to COVID-19, such as fever and cough (93.8%), shortness of breath/anorexia/fatigue/nausea/vomiting/diarrhea (80.2%), and panic and chest tightness (69.4%). Most participants had a strong self-prevention awareness, such as washing hands regularly (92.1%) and wearing a facemask (94.1%). Besides, over ninety percent of respondents would report exposure to SARS-CoV-2 (96.6%) and exposure to symptoms possibility related to COVID-19 (92.9%). If necessary, most respondents would agree to isolate at home (93.5%) or an isolation in hospital (96.3%). Knowledge of COVID-19, including transmission, symptoms, protective measures, and vaccines itself, is associated with vaccination attitude. Values, perceived impacts, knowledge, and autonomy, assessed by the scale of DrVac-COVID19S, have also been revealed as important determinants to vaccine acceptance. Conclusions: Almost 93% of Chinese people surveyed in this study showed a willing attitude toward COVID-19 vaccination. Based on the above results, government and social workers can take measures from these perspectives to improve the vaccination attitude, so as to increase vaccine immunization rates.

Negativity In Online News Coverage Of Vaccination Rates In Serbia: A Content Analysis

The news media can influence how the public and policymakers feel about vaccination. Perhaps under the impression that such messages can be fear-inducing and thus mobilizing, the media often laments low immunization rates. This could, however, activate a powerful descriptive social norm (“many people are not getting vaccinated”) and may be especially ill-advised in the absence of a herd-immunity explanation (that if enough people have immunity through vaccination, the virus is contained). To identify typical media practices, we analyzed the content of 160 vaccination-related news stories by nine highest-trafficked news websites in Serbia, published July–December 2017, around the start of the measles outbreak. We coded both the news story as a whole and every vaccination-rate mention (N = 339). News stories framed current vaccination rates and changes in vaccination rates in a predominantly negative way (175/241 and 67/98, respectively) (e.g., “only 50% vaccinated”, “fewer parents vaccinating their children”). A total of 24/86 of news stories mentioning vaccination rates did not provide any numerical values. Reference groups for vaccination rates were rarely specified. Out of the 32 news stories mentioning the term herd or collective immunity, 11 explained the effect. We show that even routine communication of vaccination rates can be biased through (often negatively valenced) attribute frames and imprecise descriptions. We provide initial recommendations for news media organizations and journalists, including strategies to promote positive dynamic norms and prescriptive norms and explain benefits of herd immunity.

COVID-19 Vaccine Hesitancy in India: An Exploratory Analysis

Vaccine hesitancy is context specific and varies over time and space. Therefore, strategies to tackle vaccine hesitancy based on evidence from high income countries are unlikely to serve the purpose adequately in LMICs. We use district level evidence on COVID-19 vaccine uptake rates from an LMIC - India to provide evidence of COVID-19 vaccine hesitancy. We argue that vaccination rates during the different phases of COVID-19 vaccination across the districts is likely to be related to vaccine hesitancy. Districts with larger rural population and lower literacy rates had lower vaccination rates. High past child immunization rates were positively correlated with COVID-19 vaccination uptake. Across the four phases of vaccination drive, vaccine hesitancy was the highest during the third phase of the vaccination drive, and therefore the above correlations were strongest during the third and the fourth phase. Measures of family planning indicators too seem to be correlated with vaccine uptakes during the third phase which indicate the regions most susceptible to vaccine hesitancy.

Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign

Vaccinations used to prevent coronavirus disease (COVID-19)—the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060–11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Predictors of Vaccine Hesitancy: Implications for COVID-19 Public Health Messaging

Objectives: Successful immunization programs require strategic communication to increase confidence among individuals who are vaccine-hesitant. This paper reviews research on determinants of vaccine hesitancy with the objective of informing public health responses to COVID-19. Method: A literature review was conducted using a broad search strategy. Articles were included if they were published in English and relevant to the topic of demographic and individual factors associated with vaccine hesitancy. Results and Discussion: Demographic determinants of vaccine hesitancy that emerged in the literature review were age, income, educational attainment, health literacy, rurality, and parental status. Individual difference factors included mistrust in authority, disgust sensitivity, and risk aversion. Conclusion: Meeting target immunization rates will require robust public health campaigns that speak to individuals who are vaccine-hesitant in their attitudes and behaviours. Based on the assortment of demographic and individual difference factors that contribute to vaccine hesitancy, public health communications must pursue a range of strategies to increase public confidence in available COVID-19 vaccines.