Background: Childhood vaccination coverage has increased throughout Europe in recent decades. However, challenges persist in many areas within the European Union (EU), resulting in declining coverage rates in many countries in the period between 2010 and 2021. This general trend requires increased efforts to combat barriers around vaccination uptake. Thus, this article aims to summarise key learnings and trends in paediatric vaccination within the EU, with a focus on current challenges and enablers. Methods: Methodology is based on analysis of primary data, mainly vaccination coverage rates, as well as review and analysis of the select relevant literature, including peer-reviewed articles, academic research papers, official reports, policies, and other publicly available sources. Results: For all vaccines assessed (DTP 1st dose, DTP 3rd dose, Hib3, HepB3, measles 1st dose, measles 2nd dose, and polio 3rd dose), a high degree of variation and fluctuation in coverage can be observed. There is a general trend of declining coverage in 2019 compared to 2010, with lower performing countries, such as Romania and Austria, showing increasingly severe coverage fluctuations between the years examined across the analysed vaccines. Conclusions: Evidence suggests that increasing both accessibility and information regarding vaccines are key enablers to vaccination uptake. Moreover, given the current challenges the EU is facing, crisis preparedness plans are pertinent to ensure immunity gaps do not further exacerbate the disruption of vaccination systems.

INTRODUCTIONThe COVID-19 era highlighted vaccine hesitancy (VH) among health workers (HWs) as a major hurdle to optimum immunization practices. Through the identification of relevant determinants, barriers, and interventions to counteract VH, this literature review examines the impact of the COVID-19 pandemic on HWs' influenza vaccination sentiment. METHODS Studies were identified by searching the PubMed database for articles published between August 2019 and July 2022. The search was restricted to articles in English that were original studies or meta-analyses or reviews. They were included in the review if they covered influenza VH among HWs during the COVID-19 pandemic. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and consideration. Risk of bias was not assessed. RESULTS Of 924 articles identified, 20 were selected. Of these, 15 were conducted in Europe and focused on healthcare staff, primarily in hospital settings. Within the COVID-19 context, physicians and residents were more willing than nurses to adhere to influenza vaccination. Young HWs, particularly males and those with chronic comorbidities, demonstrated the highest acceptance of the influenza vaccine. HWs' immunization history is associated with higher influenza vaccine adherence. Factors determining HW's acceptance of flu immunization were: healthcare staff's knowledge of the influenza vaccine, concerns about protecting themselves or others, and the rising perception of risk and fear from COVID-19 infection. Main barriers were negative perceptions about vaccine safety and effectiveness, insufficient time for vaccine uptake, and confidence in natural or acquired immunity. In the context of the pandemic, awareness campaigns and targeting vaccine affordability and accessibility were the most adopted interventions to increase vaccine acceptance amongst HWs. CONCLUSIONS In the context of COVID-19, confidence in influenza vaccines and the perception of risk from COVID-19 infection have increased among healthcare staff. To further explore the impact of the pandemic on HWs' sentiment toward influenza vaccination, conducting new empirical studies are strongly recommended.

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Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomised, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessing impulsivity and aggression will be collected for up to 1 month following the last tDCS session. Discussion The results of this study may pave the way for developing targeted interventions for impulsivity and aggressive behaviours in people with IDD.