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New data indicates declining confidence in childhood vaccines

The perception of the importance of vaccines for children declined by about 25 per cent in the Philippines and by more than a third in the Republic of Korea, Papua New Guinea, Ghana, Senegal, and Japan after the start of the pandemic.

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The public perception of the importance of vaccines for children declined during the COVID-19 pandemic in 52 out of 55 countries studied, UNICEF warned today in a new report on immunization, the State of the World’s Children 2023: For Every Child, Vaccination.

According to the Vaccine Confidence Project and published today by UNICEF, the perception of the importance of vaccines for children declined by about 25 per cent in the Philippines and by more than a third in the Republic of Korea, Papua New Guinea, Ghana, Senegal, and Japan after the start of the pandemic. China, India, and Mexico were the only countries studied where the data indicates the perception of the importance of vaccines held firm or even improved. In most countries, people under 35 and women were more likely to report less confidence about vaccines for children after the start of the pandemic.

Today’s global report warns a total of 67 million children missing out on vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries.

Of the 67 million children globally, who missed out on routine vaccination between 2019 and 2022, 48 million did not receive a single routine vaccine, also known as “zero-dose.” The Philippines has one million zero dose children, the second highest in East Asia and the Pacific Region, and the fifth highest globally.

Vaccine confidence is volatile and time specific. Additional data collection and further analysis will be required to determine if the findings are indicative of a longer-term trend. Despite the falls, overall support for vaccines remains relatively strong. In almost half the 55 countries studied more than 80 per cent of respondents perceived vaccines as important for children.

However, the report warns the confluence of several factors suggest the threat of vaccine hesitancy may be growing. These factors include uncertainty about the response to the pandemic, growing access to misleading information, declining trust in expertise, and political polarisation. In the Philippines, vaccine hesitancy can be attributed to cultural factors, and concerns on vaccine safety.

“At the height of the COVID-19 pandemic, scientists rapidly developed COVID-19 vaccines that saved countless lives. But despite this historic achievement, fear, and disinformation about all types of vaccines circulated as widely as the virus itself,” said Catherine Russell, UNICEF Executive Director. “This data is a worrying warning signal. We cannot allow confidence in routine immunizations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria, or other preventable diseases.”

Alarmingly, the decline in confidence comes amid the largest sustained backslide in childhood immunisation in 30 years, fuelled by the COVID-19 pandemic. The pandemic interrupted childhood vaccination almost everywhere, especially due to intense demands on health systems, the diversion of immunization resources to COVID-19 vaccination, health worker shortages and stay-at-home measures.

Children born just before or during the pandemic are now moving past the age when they would normally be vaccinated, underscoring the need for urgent action to catch up on those who were missed and prevent deadly disease outbreaks.

The pandemic also exacerbated existing inequities. For far too many children, especially in the most marginalised communities, vaccination is still not available, accessible, or affordable. Even before the pandemic, progress on vaccination had stalled for almost a decade as the world struggled to reach the most marginalised children.

The children who are missing out live in the poorest, most remote, and marginalized communities, at times impacted by conflict. New data produced for the report by the International Center for Equity in Health found that in the poorest households, 1 in 5 children are zero-dose while in the wealthiest, it is just 1 in 20. It found unvaccinated children often live in hard-to-reach communities such as rural areas or urban slums. They often have mothers who have not been able to go to school and who are given little say in family decisions. These challenges are greatest in low- and middle-income countries, where about 1 in 10 children in urban areas are zero dose and 1 in 6 in rural areas.

In upper-middle-income countries, there is almost no gap between urban and rural children. To vaccinate every child, it is vital to strengthen primary health care and provide its mostly female front-line workers with the resources and support they need. The report finds women are at the front line of delivering vaccinations, but they face low pay, informal employment, lack of formal training and career opportunities and threats to their security.

To address this child survival crisis, UNICEF is calling on governments to double-down on their commitment to increase financing for immunization and to work with stakeholders to unlock available resources, including leftover COVID-19 funds, to urgently implement and accelerate catch-up vaccination efforts to protect children and prevent disease outbreaks.

The report is urging governments to:

  • Urgently identify and reach all children, especially those who missed vaccinations during the COVID-19 pandemic
  • Strengthen demand for vaccines, including by building confidence
  • Prioritise funding to immunization services and primary health care
  • Build resilient health systems through investment in female health workers, innovation, and local manufacturing

“Immunizations have saved millions of lives and protected communities from deadly disease outbreaks,” said Catherine Russell. “We know all too well that diseases do not respect borders. Routine immunizations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths, and suffering. With resources still available from the COVID-19 vaccination drive, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for every child.”

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Long-term yogurt consumption tied to decreased incidence of certain types of colorectal cancer

Yogurt consumption over time may protect against colorectal cancer through changes in the gut microbiome.

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Yogurt, which contains live strains of bacteria, is thought to protect against many types of diseases, with some reports indicating it could reduce risk of colorectal cancer. A new study led by investigators from Mass General Brigham finds that yogurt consumption over time may protect against colorectal cancer through changes in the gut microbiome.

Using data from studies that have followed participants for decades, researchers found that long-term consumption of two or more servings per week of yogurt was tied to lower rates of proximal colorectal cancer positive for Bifidobacterium, a bacterial species found in yogurt. The study showed that the bacterial species was quite common: about 30 percent of patients with colorectal cancer had detectable Bifidobacterium in their tumor tissue. Their results are published in Gut Microbes.

“Our study provides unique evidence about the potential benefit of yogurt,” said corresponding author Shuji Ogino, MD, PhD, the chief of the Program in Molecular Pathological Epidemiology in the Department of Pathology at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. Ogino is also an American Cancer Society Professor, a Professor at Harvard T.H. Chan School of Public Health, and an Affiliate Member of the Broad Institute of MIT and Harvard. “My lab’s approach is to try to link long-term diets and other exposures to a possible key difference in tissue, such as the presence or absence of a particular species of bacteria. This kind of detective work can increase the strength of evidence connecting diet to health outcomes.”

Ogino and colleagues – team OPTISTIMISTICC – are funded by Cancer Research UK through Cancer Grand Challenges, a research initiative co-founded by Cancer Research UK and the National Cancer Institute in the United States.  OPTIMISTICC aims to transform the understanding of how the microbiome contributes to disease development, progression and response to treatment. As part of this, Ogino’s team aims to define the risk factors and environmental exposures that individuals encounter through life which are behind the rise of early-onset colorectal cancer and ultimately develop strategies to reduce the burden of this type of cancer.

To conduct their study, the researchers used data from two U.S.-wide prospective cohort studies known as the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). The studies have followed more than 100,000 female registered nurses and 51,000 male health professionals, respectively. Participants have been followed since 1976 for the NHS and 1986 for HFPS, answering repeated questionnaires about lifestyle factors and disease outcomes, including questions about average daily intake of plain and flavored yogurt, as well as other dairy products. The researchers also assessed tissue samples for participants with confirmed cases of colorectal cancer, measuring the amount of Bifidobacterium DNA in tumor tissue.

The researchers found 3,079 documented cases of colorectal cancer in the two study populations. Information on Bifidobacterium content was available in 1,121 colorectal cancer cases. Among those, 346 cases (31%) were Bifidobacterium-positive, and 775 cases (69%) were Bifidobacterium-negative. The researchers did not observe a significant association between long-term yogurt intake and overall colorectal cancer incidence, but they did see an association in Bifidobacterium-positive tumors, with a 20 percent lower rate of incidence for participants who consumed two or more servings of yogurt a week. This lower rate was driven by lower incidence of Bifidobacterium-positive proximal colon cancer—a type of colorectal cancer that occurs in the right side of the colon. Studies have found that patients with proximal colon cancer have worse survival outcomes than patients with distal cancers.

“It has long been believed that yogurt and other fermented milk products are beneficial for gastrointestinal health,” said co-senior author Tomotaka Ugai, MD, PhD, of the Department of Pathology at the Brigham and the Department of Epidemiology at the Harvard T.H. Chan School of Public Health. “Our new findings suggest that this protective effect may be specific for Bifidobacterium-positive tumors.”

The researchers hypothesize that long-term yogurt intake may reduce risk of proximal colon cancer by changing the gut microbiome, including Bifidobacterium, but they note that further research that brings together both basic science and population health studies is needed to draw a definitive conclusion.

“This paper adds to the growing evidence that illustrates the connection between diet, the gut microbiome, and risk of colorectal cancer,” said co-author Andrew T Chan, MD, chief of the Clinical and Translational Epidemiology Unit at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system and co-lead for Cancer Grand Challenges team PROSPECT addressing causes of cancer in young adults. “It provides an additional avenue for us to investigate the specific role of these factors in the risk of colorectal cancer among young people.”

In addition to Ogino, Ugai and Chan, Mass General Brigham authors include Satoko Ugai, Hidetaka Kawamura, Kota Arima, Kazuo Okadome, Qian Yao, Kosuke Matsuda, and Yuxue Zhong. Additional authors include Li Liu, Keisuke Kosumi, Tsuyoshi Hamada, Kosuke Mima, Hiroki Mizuno, Wendy S. Garrett, Mingyang Song, Marios Giannakis, Edward L. Giovannucci, and Xuehong Zhang.

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New study finds lower cardiovascular risk in Type 1 diabetes compared to Type 2 diabetes

A lower risk of cardiovascular events for patients with Type 1 diabetes (often called juvenile diabetes) compared to those with Type 2 diabetes. The research highlights the differences between the two types of diabetes and provides new insights that could influence future treatment approaches.

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A study published in JSCAI has revealed a lower risk of cardiovascular events for patients with Type 1 diabetes (often called juvenile diabetes) compared to those with Type 2 diabetes. The research highlights the differences between the two types of diabetes and provides new insights that could influence future treatment approaches. 

“The study’s findings suggest that the cardiovascular risk associated with Type 1 diabetes is lower than previously thought, which has important implications for managing these patients. Our findings indicate that Type 1 diabetes is associated with a significantly lower risk of cardiovascular events compared to Type 2 diabetes, even after adjusting for various confounders such as age, diabetes control, and kidney function,” said Andrew M. Goldsweig, MD, MSc, FSCAI, director of cardiovascular clinical research at Baystate Medical Center in Springfield, MA. “The power of big data amplifies the results: With the enormous population included in this analysis, we were able to identify a large number of people with Type 1 diabetes and compare them to those with Type 2 diabetes, providing a comprehensive understanding of the differences in cardiovascular risk.” 

For the study, Goldsweig collaborated with Baystate pediatric endocrinologist Bracha Goldsweig, MD, to examine the Veradigm Metabolic Registry, operated in collaboration with the American College of Cardiology, which includes longitudinal records of 1.5 million individuals from over 700 facilities. The analysis identified nearly 6,000 people with Type 1 diabetes and compared their cardiovascular event rates to those of people with Type 2 diabetes. When controlling for confounders, the results showed that people with Type 1 diabetes had lower rates of myocardial infarction (MI), percutaneous coronary intervention (PCI), stroke, and limb ischemia compared to people with Type 2 diabetes. There was no significant difference in the rates of bypass surgery between the two groups.  

Dr. Bracha Goldsweig emphasized the importance of distinguishing between patients with each type of diabetes to develop targeted treatment strategies: 

“Type 1 and Type 2 diabetes are fundamentally different diseases. People with Type 1 diabetes do not produce insulin, while people with Type 2 diabetes have insulin insensitivity. Our study shows that it is not appropriate to manage all people with diabetes identically, and dedicated studies for Type 1 diabetes are necessary to understand the best treatment approaches,” Dr. Bracha Goldsweig said. “People with Type 1 diabetes now live normal lifespans, and it is crucial to study this population to ensure they receive the best possible care.” 

This research marks the first time the Doctors Goldsweig, who are spouses, have published together, highlighting the importance of multidisciplinary collaboration. An Early Career Research Grant (ECRG) from the Society for Cardiovascular Angiography and Interventions (SCAI) supported the project. 

“We were excited to work together in this area where our fields overlap,” Dr. Andrew Goldsweig said. “The support from SCAI’s ECRG grant was crucial in making this research possible.” 

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Children of housing loss have more depression, anxiety: Pitt study

“We knew that eviction or housing loss can impact the adults in a household, but we didn’t know as much about what happen to kids in families facing eviction or housing loss” said Jamie Hanson, associate professor in psychology at the University of Pittsburgh and the paper’s primary author.

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At a time when costs are high and social safety nets appear further endangered, the experience of eviction, foreclosure, and housing loss creates a measurable and detrimental impact on families. New research, appearing in JAMA Network Open, now shows the true impact on children and their mental health.

“We knew that eviction or housing loss can impact the adults in a household, but we didn’t know as much about what happen to kids in families facing eviction or housing loss” said Jamie Hanson, associate professor in psychology at the University of Pittsburgh and the paper’s primary author.

In this new studyHanson used data from over 36,000 families and looked at how a parent’s anxiety or stress about eviction, foreclosur, or housing loss was related to mental health issues in their kids. Stress about eviction or housing loss was associated with depression and anxiety disorders. “When a caregiver was really worried, this was related to a major increase, 10% to 35%, in depression,” Hanson said.

Particularly important was the impact on young children, under the age of 9. “Normally, we don’t see high rates of depression in young kids, those younger than 8 or 9; but a parent’s anxiety or stress about housing loss was related to those issues being reported more,” Hanson added.

Of note, stress about housing loss wasn’t related to increases in all mental health issues. “There weren’t major connections with ADHD and behavioral problems. We controlled for lots of other factors and didn’t see strong links,” Hanson said.

In sum, the stress increased the odds that children “will internalize issues, such as depression and anxiety,” the author wrote in the paper titled, “Stress About Eviction or Loss of Housing and Child Mental Health.”

“Notably, eviction and foreclosures are not equally distributed across demographics — it disproportionately affects individuals from minoritized racial and ethnic groups, the economically marginalized, and families with children in their homes,” Hanson wrote in the paper.

He added: “Our findings underscore the urgent need for policies and programs to address housing instability and protect children’s mental well-being. It doesn’t need to be this way. We could do more housing assistance; we could allow court records about eviction to be sealed for a period of time…. We need to do more.”

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