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Population Mobility and its Relation to Infectious Diseases

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Population Mobility and its Relation to Infectious Diseases

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This article describes the connection with today's technological innovations in terms of mobility and the prevalence of infectious diseases. The term "mobility" can be in regards to either physical population mobility or even just the transfer of goods from one country to another. Either way, thorough screening and testing need to be incorporated to prevent epidemics from arising.

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The internet can provide users with vast amounts of information at a moment's notice. But, as described in this article, can also provide lots of misinformation. "Around 85% of parents who claimed to get their primary information from their family physician/pediatrician or MOH well-baby center completely vaccinated their children. This was in contrast to over a third of parents who claimed to have no information sources that were VH (p < 0.001). Nearly half of parents whose most trusted opinion was a religious authority (42%) or the internet (45%) were VH (p < 0.001)" (Ashkenazi et. al 2020).

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Highlights

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Correct knowledge about measles was associated with timely vaccine administration.

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Those looking to internet/social media for information had less correct knowledge.

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Those looking to internet/social media for information were more vaccine hesitant.

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Focused interventions using social media and internet platforms are suggested.

Abstract

Objectives

Based on the hypothesis that sources of information might affect knowledge and vaccine acceptance, our objectives were to study parental characteristics and sources of information regarding measles/measles vaccine, its relationship to correct knowledge and to administration of the measles vaccine.

Background

Although measles eradication is potentially achievable, in 2018-2019 a worldwide resurgence of measles and measles-caused deaths occurred. The main driver was incomplete or no vaccination, designated as vaccine hesitancy (VH).

Methods

A cross-sectional survey of 399 individuals dispersed all over the country was conducted. Research assistants interviewed parents with a 20-question survey which was previously validated. The questionnaire included four sections: demographics, major sources of information on measles/measles vaccine, knowledge about measles/measles vaccine, and status of child's vaccination. Univariate and multivariate analyses explored associations between correct knowledge and VH.

Results

The majority of respondents were between the ages of 25-39 (62%). Of these, 309 (77%) vaccinated their children against measles on time, 32 (8%) vaccinations were incomplete, and 58 (15%) did not vaccinate, for a total VH of 23%. Parents < 30 years-old and those with a single-child vaccinated less frequently (p < 0.001 and p = 0.002, respectively). Internet and social-media were the major source of information for 32% regarding measles/measles vaccine and for 49% regarding the measles outbreak; both sources were negatively associated with correct knowledge (p < 0.001). In the multivariate analysis, knowledge was independently associated with timely vaccine administration (p < 0.001) and internet or social-media as sources with higher VH (OR 2.52, 95%CI 1.18-5.37 and OR 2.44, 95%CI 1.01-5.91, respectively).

Conclusions

Social-media and internet are a common source of information on measles/measles vaccine (probably on other vaccines as well), and often associated with incorrect knowledge, which relates significantly to VH. Healthcare professionals should be aware of this prevailing behavior and respond accordingly in these platforms, with the aid of experts in social-networking.

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The relationship between parental source of information and knowledge about measles / measles vaccine and vaccine hesitancy

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Correct knowledge about measles was associated with timely vaccine administration. * Those looking to internet/social media for information had less correct knowledge. * Those looking to internet/social media for information were more vaccine hesitant. * Focused interventions using social media and internet platforms are suggested.

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This image puts into perspective the massive eradication effort of the 1988 WHO initiative. Only 2 more countries remain in this effort. If we were to now prioritize our efforts in these countries, we could achieve global health equity against polio.

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The article describes the 1988 WHO initiative in the eradication of polio. Sadly, the disease is not currently 100% eradicated like smallpox but still, the initiative has caused a 99% decrease in incidence of polio globally. A few countries still remain with some infection but this is mostly due to accessibility issues and local large reservoirs of the disease. Case-on-case interventions have since been tailored to each setting.

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Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988. The GPEI built on many lessons learned from smallpox eradication, including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By the year 2000, the incidence of polio globally had decreased by 99% compared with the estimated >350,000 cases reported from 125 endemic countries in 1988. By 2002, three WHO Regions (the Americas, Western Pacific and European Regions) had been certified polio-free. By 2005, transmission of indigenous wild poliovirus (WPV) had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled. WPV exported from northern Nigeria and northern India subsequently caused >50 outbreaks and paralysed >1500 children in previously polio-free countries across Asia and Africa. In each of the four remaining polio-endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting.

A new 2010-2012 GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication, including the large-scale use of bivalent oral poliovaccine (bOPV) in supplementary immunization activities (SIAs). By the end of 2010, the impact of the new GPEI Strategic Plan 2010-2012 was apparent. Compared to 2009, the number of new polio cases in 2010 fell by 95% in both northern Nigeria and northern India, the world's largest remaining reservoirs of indigenous WPVs. By mid-2011, India had not reported a polio case for more than 5 months, and in Nigeria, endemic transmission appeared to be restricted to the north-east and north-west corners of the country. While polio cases due to WPV type 3 were still being detected in west and central Africa, the overall level of WPV3 transmission globally was at an all-time low. Uncontrolled WPV transmission appeared to be restricted to Chad and Pakistan, which increasingly represented the greatest risks to the GPEI.

Although insufficient financing continued to be a major concern, political support for completing polio eradication in polio-infected countries was stronger than ever by mid-2011. While continued transmission in some areas, particularly in Pakistan and Chad, still had to be controlled as a matter of urgency, there were real opportunities to achieve new landmarks in polio eradication, especially in the key WPV reservoirs of India and Nigeria, setting the stage for polio to soon follow smallpox into the history books.

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The global polio eradication initiative: Lessons learned and prospects for success

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Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988.

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The success story of smallpox eradication has allowed us, as public health officials/researchers, to both learn from and incorporate once more, the methods used for eradication. From a more biological perspective, according to the article, we still own strains of the smallpox causative agent in labs in Russia and the USA. Although heavy considerations need to be made before their use, there is lots of potential that can come from further study and research using these strains.

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Smallpox in the Post-Eradication Era - PubMed

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Widespread vaccination programmes led to the global eradication of smallpox, which was certified by the World Health Organisation (WHO), and, since 1978, there has been no case of smallpox anywhere in the world. However, the viable variola virus (VARV), the causative agent of smallpox, is still kept…

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This image showcases a movement in avocation for the global smallpox vaccination campaign. Most of these people are younger individuals, most likely students. This picture provides a great example of community awareness and education regarding vaccines and its impact on lessening government hesitancy.

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The concept of disease eradication is very limited in its practice due to the many challenges that need to be overcome for it. Challenges include vaccine hesitancy, political boycotts/willingness, accessibility, and today's increased mobility. But even that said, we have seen disease eradication actually occur in the case of smallpox. Only with global coordination and enhanced public education will we be able to add more diseases onto the list of eradications.