The emergence of new digital technologies has 'disrupted' traditional vaccine information communication. This article reviews the impact of the Internet, social media, digital detection and mobile applications on both fueling anti-vaccine sentiment and providing a mechanism by which to address vaccine hesitancy. While the anti-vaccine community has leveraged the Internet and social media to bypass traditional sources of information and communicate with susceptible parents, digital surveillance and mobile apps offer an important opportunity for public health officials to develop new strategies to identify and address concerns in a real-time manner.

IntroductionIn many parts of the developing world procurement of antenatal gestational age estimates is not possible, challenging provision of appropriate perinatal care. This study aimed to develop a model for postnatal gestational age estimation utilizing measures of the newborn hemoglobin levels and other metabolic analyte data derived from newborn blood spot samples.MethodsWe conducted a retrospective cohort analysis of 159,215 infants born January 2012–December 2014 in Ontario, Canada. Multivariable linear and logistic regression analyses were used to evaluate the precision of developed models.ResultsModels derived from a combination of hemoglobin ratios and birthweight were more precise at predicting gestational age (RMSE1·23 weeks) than models limited to birthweight (RMSE1·34). Models including birthweight, hemoglobin, TSH and 17-OHP levels were able to accurately estimate gestational age to ± 2 weeks in 95·3% of the cohort and discriminate ≤ 34 versus > 34 (c-statistic, 0·98). This model also performed well in small for gestational age infants (c-statistic, 0·998).DiscussionThe development of a point-of-care mechanism to allow widespread implementation of postnatal gestational age prediction tools that make use of hemoglobin or non-mass spectromietry-derived metabolites could serve areas where antenatal gestational age dating is not routinely available.

Mobile applications have the potential to influence vaccination behavior, including on-time vaccination. We sought to determine whether the use of a mobile immunization app was associated with the likelihood of reporting on-time vaccination in a cohort of 50 childbearing women. In this pilot study, we describe participant reported app use, knowledge, attitudes or beliefs regarding pediatric vaccination and technology readiness index (TRI) scores. To explore if app use is associated with change in attitudes, beliefs or behavior, participants were instructed complete a baseline survey at recruitment then download the app. A follow up survey followed 6-months later, reexamining concepts from the first survey as well as collecting participant TRI scores. Changes in Likert scores between pre and post survey questions were compared and multivariate logistic regression was used to assess the relationship between TRI score and select survey responses. Thirty-two percent of participants perceived that the app made them more likely to vaccinate on time. We found some individuals' attitudes toward vaccines improved, some became less supportive and in others there was no change. The mean participant TRI score was 3.25(IQR 0.78) out of a maximum score of 5, indicating a moderate level of technological adoption among the study cohort population. While the app was well received, these preliminary results showed participant attitudes toward vaccination moved dichotomously. Barriers to adoption remain in both usability and accessibility of mobile solutions, which are in part dependent on the user's innate characteristics such as technology readiness.

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