Survey finds high hesitancy toward mpox vaccination in Africa

News brief

Woman receiving vaccine — Andrey Popov / iStock

A survey of African adults found a significant level of hesitancy toward mpox vaccination, both for themselves and for their children, researchers reported this week in eClinicalMedicine.

The survey, conducted among 1,832 adults from Uganda, Nigeria, Morocco, Egypt, Kenya, and South Africa from October 1 to 10, 2024, found that 32.7% (95% confidence interval [CI], 25.4% to 40%) were reluctant to receive the mpox vaccine, and 38.9% (95% CI, 30.2% to 47.6%) of parents were reluctant to have their children vaccinated against mpox. Respondents who had lower education levels, were unemployed or single, had a lower household income, practiced safe sex, had not been infected with mpox, and had no children exhibited higher rates of hesitancy.

After adjusting for covariates, respondents who had never been vaccinated against other diseases had a 2.66-fold (95% CI, 1.67 to 4.26) higher risk of mpox vaccine hesitancy for themselves and 2.16-fold (95% CI, 1.42 to 3.30) higher risk of hesitancy for their children than those who had been vaccinated against other diseases. Compared with respondents with high vaccination readiness (openness) and a history of other vaccinations, populations with low vaccination readiness and no history of other vaccinations exhibited the highest risk of mpox vaccination hesitancy for themselves (pooled odds ratio [OR], 7.83; 95% CI 3.28 to 18.70) and for children (pooled OR, 12.55; 95% CI 7.38 to 21.33).

Vaccination readiness

However, the survey also showed that high vaccination readiness—assessed via the 7Cs model (confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy)—might offset lack of vaccination experience. Populations with high vaccination readiness and no history of other vaccinations demonstrated a 2.28-fold (95% CI, 1.05 to 4.94) higher risk of mpox vaccination hesitancy for themselves but not for children.

Although Africa is the epicenter of an mpox outbreak that began in 2022, a recent meta-analysis found that mpox vaccine uptake in Africa was only 5% in 2023.

"This study suggests that regions in Africa with low immunisation coverage should continue to enhance vaccination education and improve vaccination readiness to reduce mpox vaccination hesitancy and promote the mpox vaccination program," the study authors wrote.

US norovirus outbreaks are up, CDC data show

News brief

Chris Dall, MA

Surveillance data from the Centers for Disease Control and Prevention (CDC) indicate a spike in norovirus outbreaks in the United States.

Data from the CDC's NoroSTAT network, which provides real-time reporting of norovirus outbreak activity in 14 states, show that 91 outbreaks were reported for the week ending December 5, which is the last week data were reported by state health departments. That's up from 69 the previous week and is significantly higher than the maximum average (41) reported for the same week in previous years. It's also higher than the maximum average number of outbreaks (65) reported in early December in the years before the COVID-19 pandemic.

Data from the CDC's National Respiratory and Enteric Virus Surveillance System show that 22% of norovirus tests were positive for the week ending December 21, which is also higher than seen during the same time period in recent years.

Norovirus is a highly contagious virus that causes sudden gastrointestinal symptoms. It's the leading cause of vomiting and diarrhea in the United States, with an estimated 19 million to 21 million illnesses and 2,500 outbreaks reported each year. It's also the leading cause of foodborne illness. Outbreaks can occur year-round but are most common from November to April.

Cruise ship outbreaks

Norovirus outbreaks typically occur when infected people spread the virus to others through direct contact or through shared exposure to contaminated water, food, or surfaces. Hospitals, restaurants, schools and childcare centers, and cruise ships are among the most common settings for outbreaks.

Data released earlier this week by the CDC show that 16 cruise ship norovirus outbreaks were reported in 2024, including 5 in December that sickened 890 passengers and crew members.