Parental vaccine hesitancy in Italy - Results from a national survey

Parental Willingness for COVID-19 Vaccination among Children Aged 5 to 11 Years in Riyadh City, Saudi Arabia: A Cross-Sectional Study

To manage the COVID-19 outbreak, the WHO recommends adult and child vaccination. Vaccine skepticism has been a major worldwide health concern for decades, and the situation is worsening. The primary purpose of this study was to investigate parental willingness to vaccinate their children (aged 5 to 11 years) against COVID-19 and to describe its relationship with attitude, barriers, facilitators, and sources of knowledge regarding the vaccine. Methods: From February to March 2022, a community-based cross-sectional survey was undertaken among the parents of Riyadh city, Saudi Arabia. We employed a convenient sampling procedure to gather the required sample. Using the Raosoft sample size calculator, a minimum sample size of 385 was determined based on a 95% confidence level, a 5% margin of error, and a 5% precision level. The data were analyzed using version 26 of SPSS. A p-value less than 0.05 was judged statistically significant. The Chi-square test and likelihood ratio were utilized to describe the relationship between socio-demographic characteristics, driving factors, and COVID-19 vaccine hesitancy. Vaccine hesitancy associated factors were identified using multivariate binary logistic regression. A total of 528 replies were received. The majority of respondents were mothers (77.7%), aged 26 to 40 years (67.8%), married (91.5%), Saudi nationals (96.2%), college graduates (70.6%), with a monthly family income of more than SAR 10,000 (46.4%), non-healthcare professionals (84.7%), employed in the government sector (33.7%), with three children (23.3%), and children aged 5 to 11 years (88.7%). A little more than half of the parents (55.7%) exhibited considerable vaccination hesitancy. About 16.28% of parents were willing to vaccinate their children as soon as possible, compared to 38.44% who had no interest whatsoever in vaccination. A greater proportion of mothers and unemployed parents were unwilling to vaccinate their children. Parents with a higher monthly income (above SAR 10,000), who worked as healthcare professionals, and whose children suffered from chronic conditions were significantly more ready to vaccinate their children against COVID-19. Parents who were aware of anti-vaccination campaigns and who vaccinated their children with required childhood vaccines were also much more likely to vaccinate their children against COVID-19. Most parents (66.9%) obtained information on COVID-19 via the Saudi Ministry of Health website, followed by social media (48.1%). The vaccine's novelty and the dearth of reliable information about its safety (65%) and insufficient information about its effectiveness (36.2%) were the primary reasons for not vaccinating children against COVID-19, whereas preventing children from contracting COVID-19 (55.9%) and government mandate (38.8%) were the primary reasons for vaccinating children against COVID-19. Conclusions: There was significant parental hesitancy to immunize their children against COVID-19. To involve and educate parents, multi-component interventions must be developed and implemented.

Shared understandings of vaccine hesitancy: How perceived risk and trust in vaccination frame individuals' vaccine acceptance

Extensive research has framed vaccine hesitancy as a property of a heterogeneous group of individuals, ranging from total acceptance to complete refusal. Nevertheless, not much research has explored this heterogeneity, mainly focusing on central tendencies of single belief-related items. Using data from an original survey on a sample of Italian citizens, this paper examines this heterogeneity, exploiting individuals' cognitive variation to map clusters of individuals who share similar cognitive schemas on vaccine uptake. The results showed the existence three groups, characterized by a different articulation of predictors of vaccine hesitancy, revealing different understandings of vaccine uptake. We then analyzed within-cluster characteristics and showed that cognitive segmentation was connected to different levels of perceived risk, confidence, and support for vaccination. We further showed that cognitive clustering also entailed a mean of social stratification that was correlated with individuals' educational levels, and that the predictors of vaccine hesitancy were articulated differently in each group. This study, adopting a recent perspective in the analysis of systems of beliefs, moves one step further in disentangling the complexity of vaccine acceptance. Results suggested the usefulness of including individuals' cognitive characteristics in vaccine hesitancy research and in the development of interventions addressed at increasing vaccine acceptance.

Resource mobilization for tetanus vaccination in Vietnam: Uptake, demand and willingness to pay among women of reproductive age

Introduction

Tetanus vaccine coverage in Vietnam has been declining in recent years due to a rapid population growth rate, shrinking budget, and inefficient resource mobilization strategy. This study examined the uptake, demand, and willingness to pay (WTP) for tetanus vaccines in Vietnamese women of reproductive age as well as determined associated factors and assessed the feasibility of the long-term tetanus vaccine resource mobilization scheme.

Methods

Cross-sectional data were obtained on 807 women of childbearing age in Hanoi, Vietnam in 2016. Tetanus vaccine uptake, demand, and willingness to pay were collected by using a structured questionnaire. Multivariable logistic and interval regression models were used to examine associated factors with vaccine uptake, demand, and WTP.

Results

Of 807 participants, 42.4 and 64.8% had sufficient tetanus vaccination (i.e., received at least three doses of vaccine) and were willing to pay for tetanus vaccination. The mean amount of WTP for one dose of tetanus was US$ 7.3 (95% CI = 6.7-7.9). Having children or being aware that the tetanus vaccine was free-of-charge were negatively associated with WTP for tetanus vaccine. Having a high school education, living in a rural area, and not being aware of vaccine prices or being aware that vaccines were provided freely reduced the amount of WTP. WTP increased among women receiving information from friends and relatives.

Conclusion

Despite of exemption from the tetanus vaccination programs, this study indicated a low tetanus vaccination coverage and a moderate degree of WTP for tetanus vaccine among Vietnamese women of childbearing age. Target-specific educational and financial support interventions, along with efforts to reduce vaccination costs are critical to improving the vaccine uptake, demand, and WTP for tetanus immunization among women.

Schoolteachers and Vaccinations: A Cross-Sectional Study in the Campania Region

Background: This cross-sectional survey aimed to determine the knowledge, attitudes, and behaviors regarding vaccinations among schoolteachers in Italy. Methods: Data were collected through an online questionnaire from September 2020 to May 2021 from a sample of schoolteachers in the Campania region of southern Italy. Results: Only 27% of the participants had good knowledge about the vaccinations recommended for schoolteachers. Females who had children, who were unsatisfied by their health status, and not needing additional information about vaccinations were more likely to have good knowledge. Moreover, 61.5% perceived that vaccinations are useful in preventing infectious diseases, and 44.5% agreed or strongly agreed that vaccinations should be mandatory for schoolteachers. The results of multivariate logistic regression showed that schoolteachers who perceived that vaccinations are useful in preventing infectious diseases, who considered the recommended vaccinations to be useful to protecting their own and their students’ health, who believed that information received about vaccination was useful, and who needed additional information about vaccinations recommended for schoolteachers, were significantly more likely to agree or strongly agree that vaccinations should be mandatory for schoolteachers. Conclusions: These findings suggest the need for education strategies to ensure that schoolteachers are better informed about vaccinations recommended for their profession.

Parental hesitancy towards vaccinating their children with a booster dose against COVID-19: Real-world evidence from Taizhou, China

INTRODUCTION

Parental vaccine-hesitancy can lead to delays or refusal to vaccinate children despite the availability of vaccines. This is a population-based, cross-sectional study investigating whether parents in China are hesitant to vaccinate their children with a COVID-19 vaccine booster.

METHODS

Parents in Taizhou, China, responded to a self-reported online questionnaire on their hesitancy to vaccinate their children with a COVID-19 vaccine booster. Of the 1252 parents who were invited to answer the structured questionnaire, 514 (41.1%) samples had valid data for data analysis.

RESULTS

A total of 41.8% of participants were hesitant to give their children a COVID-19 vaccine booster. After adjusting for confounders, parental gender (female vs. male parent, OR=0.56 95% CI: 0.32-0.87), parental opinion (yes vs. no, OR=0.17, 95% CI: 0.09-0.30), parental attitudes (yes vs. no, OR=0.28, 95% CI: 0.16-0.50), the presence of people around them who are generally hesitant to receive COVID-19 booster vaccines for children (yes vs. no, OR=0.14, 95%CI: 0.08-0.23), the individual hesitancy of people around them to administer booster COVID-19 vaccines to children (yes vs. no, OR=0.02, 95%CI: 0.02-0.22), and parents' hesitancy to receive a booster vaccine for their children showed significant correlation. The disparity of factors related to booster vaccine-hesitancy for children between fathers and mothers was also found.

CONCLUSIONS

We found that a moderate proportion of parents reported that they were hesitant to give their children a COVID-19 vaccine booster. The results suggest that an in-depth, dynamic assessment and further health education planning are necessary to reduce Chinese parents' hesitancy to vaccinate their children.

Views on COVID-19 vaccination of young children in Ireland, results from a cross-sectional survey of parents

Vaccination of children aged 5 years and older is recommended as part of a multifaceted strategy to protect children against SARS CoV-2 infection and serious disease, and to control the spread of infection. COVID-19 vaccine trials in children aged less than5 years are underway, however, parental acceptance of vaccines for this age group is unknown. Between June and August 2021, a cross-sectional national survey of parental attitudes towards childhood vaccination in Ireland was conducted. Parents of children aged 0–48 months were surveyed to determine their attitudes towards COVID-19 vaccines for their children. A total of 855 parents were surveyed. Overall, 50.6 % reported that they intend to vaccinate their child, 28.7 % reported that they did not intend to vaccinate and 20.2 % were unsure. Among those who stated that they did not intend to vaccinate their child, concern about risks and side effects of vaccination was the primary reason reported (45.6 %). The most frequently reported information needs related to side effects of the vaccine (64.7 %) and vaccine safety (60.3 %). Results of the multivariable analysis showed that believing COVID-19 can be a serious illness in children was a strong predictor of parental intention to vaccinate (aOR 4.88, 95 % CI 2.68, 8.91, p-value < 0.001). In comparison with Irish-born parents, parents born in a Central and Eastern European country were less likely to report intention to vaccinate (aOR 0.21, 95 % CI 0.09, 0.47, p-value, <0.001). Parental belief in vaccine importance and safety and parental trust in official vaccine information sources were associated with increased parental intention to vaccinate. Understanding parental attitudes to vaccination of young children against COVID-19 is important to tailor the provision of information to parents’ needs, and to inform the development of vaccination information and communication campaigns for current and future COVID-19 immunisations programmes for children.

Factors affecting vaccination demand in Indonesia: a secondary analysis and multimethods national assessment

OBJECTIVES

Vaccine hesitancy remains a major barrier to immunisation coverage worldwide. We explored influence of hesitancy on coverage and factors contributing to vaccine uptake during a national measles-rubella (MR) campaign in Indonesia.

DESIGN

Secondary analyses of qualitative and quantitative data sets from existing cross-sectional studies conducted during and around the campaign.

METHODS

Quantitative data used in this assessment included daily coverage reports generated by health workers, district risk profiles that indicate precampaign immunisation programme performance, and reports of campaign cessation due to vaccine hesitancy. We used t-test and χ² tests for associations. The qualitative assessment employed three parallel national and regional studies. Deductive thematic analysis examined factors for acceptance among caregivers, health providers and programme managers.

RESULTS

Coverage data were reported from 6462 health facilities across 395 districts from 1 August to 31 December 2018. The average district coverage was 73%, with wide variation between districts (2%-100%). One-third of districts fell below 70% coverage thresholds. Sixty-two of 395 (16%) districts paused the campaign due to hesitancy. Coverage among districts that never paused campaign activities due to hesitancy was significantly higher than rates for districts ever-pausing the campaign (81% vs 42%; p<0.001). Precampaign adequacy of district immunisation programmes did not explain coverage gaps (p=0.210). Qualitative analysis identified acceptance enablers including using digital health monitoring and feedback systems, increasing caregiver knowledge and awareness, making immunisation social norm, effective cross-sectoral collaboration, conducive service environment and positive experiences for mothers and children. Barriers included misinformation diffusion on social media, halal-haram issues, lack of healthcare provider knowledge, negative family influences and traditions, previous poor experiences and misinformation on adverse events.

CONCLUSION

Barriers to vaccine uptake contributed to coverage gaps during national MR campaign in Indonesia. A range of supply-related and demand-related strategies were identified to address hesitancy contributors. Advancing a portfolio of tailored multilevel interventions will be critical to enhance vaccine acceptance.

Parents'Attitudes, Their Acceptance of the COVID-19 Vaccines for Children and the Contributing Factors in Najran, Saudi Arabia: A Cross-Sectional Survey

Background: The COVID-19 pandemic is still ongoing, so it is critical to immunize the majority of people, including children, to achieve herd immunity against the pandemic. As parents are the ones who ultimately decide whether or not to vaccinate their children, this study was conducted to determine parental acceptance and hesitancy toward vaccinating their children against COVID-19, as well as their knowledge of and concerns regarding vaccination against COVID-19, as well as factors that might influence their willingness to vaccinate in Najran city, Saudi Arabia. Methods: In February 2022, a cross-sectional, questionnaire-based study using a convenientand snowball sampling technique was carried out. Parents of children between the ages of 5 and 11 were given access to an online self-administered survey. The poll was, however, open to parents of children under the age of 5. Using the Raosoft sample size calculator, the minimum necessary sample size was determined to be 384 under the assumptions of a 5% margin of error and a 95% confidence level. A p value of less than 0.05 was deemed significant for the statistical analysis, which was carried out using SPSS version 27. To examine the relationship between demographic factors and how drivers affect parents’ willingness to vaccinate their children against COVID-19, a chi-square test was performed. Through multivariate regression analysis, the predictors of vaccine hesitancy were identified. Results: A total of 464 responses were collected and subjected to data analysis. More than half of the parents were male (56.9%) and between the ages of 26 and 40 (56.7%). Most parents have children aged between 5–11 years (73.5%). Of parents, 72.2% showed vaccine hesitancy and were 9.5 times less likely to immunize their children against COVID-19. About 27.8% of the parents were ready to vaccinate their children against COVID-19 as soon as possible, compared to 15.51% of parents who were not at all interested in vaccinating their children. Parents under 25 (34.48%) and over 41 (37.79%), non-Saudi (40.59%), holding postgraduate and higher degrees (39.5%), earning more than 10,000 SAR per month (34.96%), working as healthcare professionals (40.36%) and in government sectors (33.93%), self-employed (33.33%), with three to five children (35.26%) and male (31.33%) demonstrated significantly high willingness to vaccinate their children against the COVID-19 vaccine compared to their counterparts. Parents who concur that COVID-19 vaccination may have serious adverse effects in children, who believe that COVID-19 is an uncommon disease and does not require vaccination, have had a family member infected withCOVID-19 with severe symptoms, who were unvaccinated and had severe to moderate symptoms after vaccination, showed significantly higher unwillingness to vaccinate their children against COVID-19. Parents who take safety precautions and do not believe that new vaccines provide an increased risk had higher vaccination intentions for their children. A positive impact of mandatory childhood vaccination was noted on the COVID-19 vaccination. Parents with children suffering from any chronic disease exhibited a 9.9 times higher hesitancy to vaccinate their children against COVID-19. A total of 47.8% of parents had come across or heard about anti-COVID-19 vaccination campaigns. A lack of adequate safety data, potential future consequences, and vaccine efficacy were the main concerns with COVID-19 vaccines. The primary information source for COVID-19-related information was the Saudi Ministry of Health (MOH). Conclusions: Parents’ hesitation to get the COVID-19 vaccine at a significant rate may compromise the success of the ongoing vaccination campaign. The development and implementation of multi-component interventions are required. Hospital- and community-based programs must be used to get in touch with parents.

Hesitancy towards Childhood Vaccinations among Parents of Children with Underlying Chronic Medical Conditions in Italy

Background: This study was designed to evaluate vaccination hesitancy and behaviors among parents of children with chronic conditions. Methods: This cross-sectional study was conducted from June to December 2021 in three public hospitals in southern Italy. Data were collected using a face-to-face interview of parents of children up to 17 years of age with at least one chronic condition. Results: Of the 532 parents approached, 444 agreed to participate, with a response rate of 83.4%. Almost half of parents (43%) knew that children with chronic diseases are at greater risk of complications from VPDs, and 21.6% knew all the vaccinations available in Italy. Additionally, 55.9% felt that vaccine-preventable diseases (VPDs) are very dangerous for their children, and 28.7% were very worried about the side effects of vaccines. The result of the Parent Attitudes about Childhood Vaccine (PACV) score indicated that 23.2% of parents were hesitant about vaccinations. Parental vaccine hesitancy was significantly more common among parents who had female children, among those who did not know the recommended vaccinations, among those who had a higher concern of potential side effects of the vaccines, among those who believed that the administration of the vaccinations was not useful, and among who received information on recommended vaccination from the internet, social and mass media. Conclusions: Important efforts by policy makers and healthcare providers must be implemented to counter vaccine hesitancy among parents.

Knowledge and beliefs about vaccination in pregnant women before and during the COVID-19 pandemic

Introduction

Vaccine hesitancy threatens the health of populations and challenges Public Health professionals. Strategies to reduce it aim to improve people's risk perception about vaccine-preventable diseases, fill knowledge gaps about vaccines and increase trust in healthcare providers. During pregnancy, educational interventions can provide a proper knowledge about safety and efficacy of maternal and childhood vaccinations. Fighting hesitancy and clarifying doubts is fundamental during the COVID-19 pandemic, which may have affected people's knowledge and beliefs toward vaccination. This study aimed at assessing if the advent of the pandemic was associated with changes in pregnant women's knowledge and beliefs toward vaccination, and trust in healthcare services.

Methods

A repeated cross-sectional study was conducted through self-reported questionnaires in a Roman teaching hospital, where educational classes about vaccinations are routinely held as part of a birthing preparation course. Data were collected on a sample of pregnant women before and during the pandemic. Free-of-charge flu vaccinations were offered to all course participants and adherence to flu vaccination was assessed.

Results

The proportion of pregnant women reporting that vaccines have mild side effects and that are sufficiently tested increased from 78.6 to 92.0% (p = 0.001) and from 79.4 to 93.2% (p = 0.001), respectively. There was a reduction from 33.0 to 23.3% (p = 0.065) in the proportion of those declaring that healthcare workers (HCWs) give information only on the benefits and not on the risks of vaccines, and a reduction from 27.3 to 12.1% (p = 0.001) in those reporting that vaccines are an imposition and not a free choice of mothers. Trust in National Health Service (NHS) operators slightly decreased. Among participants, the monthly flu vaccination adherence ranged from 50.0% in November to 29.2% January for 2019–20 flu season, and from 56.3% in September to 14.5% in January for 2020–21 flu season, showing a higher vaccination acceptance in the earlier months of 2020-21 flu season.

Conclusions

The pandemic may have positively affected pregnant women's knowledge and opinions about vaccinations and trust in HCWs, despite a possible negative impact on their perceptions about NHS operators. This should inspire Public Health professionals to rethink their role as health communicators.

Countering vaccine hesitancy through medical expert endorsement

Scientists and medical experts are among the professionals trusted the most. Are they also the most suitable figures to convince the general public to get vaccinated? In a pre-registered experiment, we tested whether expert endorsement increases the effectiveness of debunking messages about COVID-19 vaccines. We monitored a sample of 2,277 people in Italy through a longitudinal study along the salient phases of the vaccination campaign. Participants received a series of messages endorsed by either medical researchers (experimental group) or by generic others (control). In order to minimise demand effects, we collected participants' responses always at ten days from the last debunking message. Whereas we did not find an increase in vaccination behaviour, we found that participants in the experimental group displayed higher intention to vaccinate, as well as more positive beliefs about the protectiveness of vaccines. The more debunking messages the participants received, the greater the increase in vaccination intention in the experimental group compared to control. This suggests that multiple exposure is critical for the effectiveness of expert-endorsed debunking messages. In addition, these effects are significant regardless of participants' trust toward science. Our results suggest that scientist and medical experts are not simply a generally trustworthy category but also a well suited messenger in contrasting disinformation during vaccination campaigns.

COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis

INTRODUCTION

Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group.

AREAS COVERED

The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI= 43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education.

Knowledge of University Students in Health Care Settings on Vaccines and Vaccinations Strategies: Impact Evaluation of a Specific Educational Training Course during the COVID-19 Pandemic Period in Italy

Background: Training future healthcare professionals on vaccination through specific courses is important to properly promote active immunization among the general population and to fight fake news and false beliefs on vaccinations. The aim of the study was to assess the impact of an elective course about vaccinations on the knowledge of medical students, pharmacy students, and medical resident in Hygiene and Preventive Medicine in Italy. Methods: The participants were asked to complete an anonymous questionnaire before and after an elective teaching activity (ETA) on vaccination. The two questionnaires contained the same 30 questions and focused on different aspects of vaccines and vaccination. The students who had attended the seminar were allowed to fulfil the post-lecture questionnaire. Both descriptive and inferential analysis were performed on the results; in particular, Student’s t-test for independent samples was used to compare the total score obtained before and after attending the ETA. Results: A total of 449 students participated in the ETA. Overall, the participation in the ETA allowed them to significantly improve their final score (+27.28%, p < 0.001). Good results were obtained even when comparing the three groups (medical students, pharmacy students and medical residents) separately. Females improved more than males, especially among pharmacy students. Discussion: The present study highlights the importance and the impact that extracurricular activities can have in improving knowledge about vaccinations. With vaccination and vaccine hesitancy and acceptance topics with increasing attention paid by the population, especially after the COVID-19 pandemic, it is fundamental to develop new strategies to increase future healthcare professionals’ knowledge about vaccinations.

Do Pediatricians and Nurses Recommend Vaccines for Preterm Infants? A Survey in Italy

OBJECTIVE

To assess the level of knowledge, attitudes, and behaviors regarding vaccination in preterm infants among primary care pediatricians (PCPs) and health care workers (HCWs) in neonatal intensive care units (NICUs).

STUDY DESIGN

Data were collected from PCPs through a confidential questionnaire distributed by email, whereas the research team distributed a self-administered anonymous questionnaire to all HCWs working in the selected NICUs.

RESULTS

Overall, 64.1% of HCWs consider vaccines in preterm infants to be very safe. The majority of HCWs (69.8%) stated that they always recommend that preterm infants' parents vaccinate their children following the same schedule as for term infants. This behavior was significantly more likely among those who know that the vaccination schedule for preterm infants is the same as for term infants, who consider vaccines in preterm infants very effective, and who strongly agree that preterm infants should be vaccinated on the same schedule as term infants. Moreover, PCPs were more likely than NICU pediatricians to always recommend that preterm infants' parents vaccinate their children following the immunization schedule of term infants, whereas this behavior was significantly less frequent among NICU nurses.

CONCLUSIONS

There is a need for physicians and nurses in the NICU and in the community to counteract missed or delayed immunizations. Engagement of HCWs in healthcare quality improvement initiatives focused on the promotion of timely vaccinations in preterm infants should be encouraged.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand

BACKGROUND

The roles of literacy, fear and hesitancy were investigated for acceptance of COVID-19 vaccine (AV) types among village health volunteers (VHVs) in Thailand.

MATERIALS AND METHODS

A cross-sectional study was conducted using an unidentified online questionnaire to assess literacy, fear and hesitancy of COVID-19 vaccine acceptance among Thai VHVs between 1 and 15 October 2021. The questionnaire was developed based on the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano) for vaccine literacy (VL), using an adult Vaccine Hesitancy Scale (aVHS) for COVID-19 vaccine hesitancy (VH) and Fear of COVID-19 scale (FCoV-19S) for the distress of COVID-19 vaccine. The effects of VL, VH and vaccine fear (VF) on AV were estimated using multivariable logistic regression.

RESULTS

A total of 5,312 VHVs completed the questionnaire. After adjustment with variables in the multivariable analysis, the VL score was insignificantly associated with increased vaccination (aOR = 1.002; (95%CI: 0.994-1.01)), while VF and VH significantly decreased the chance of vaccination, aOR = 0.966 (95%CI: 0.953-0.978) and aOR = 0.969; (95%CI: 0.960-0.979), respectively and VF and VH were negatively associated with AV for all types of vaccine preference, with VL showing a reverse relationship only for mRNA-based vaccines.

CONCLUSION

VL may not increase AV among VHVs. To increase attitudes toward receiving COVID-19 vaccination in Thailand, the government and health-related organizations should instigate policies to significantly reduce VF and VH among Thai VHVs.

How the Italian Twitter Conversation on Vaccines Changed During the First Phase of the Pandemic: A Mixed-Method Analysis

In the context of the European Joint Action on Vaccination, we analyzed, through quantitative and qualitative methods, a random sample of vaccine-related tweets published in Italy between November 2019 and June 2020, with the aim of understanding how the Twitter conversation on vaccines changed during the first phase of the pandemic, compared to the pre-pandemic months. Tweets were analyzed by a multidisciplinary team in terms of kind of vaccine, vaccine stance, tone of voice, population target, mentioned source of information. Multiple correspondence analysis was used to identify variables associated with vaccine stance. We analyzed 2,473 tweets. 58.2% mentioned the COVID-19 vaccine. Most had a discouraging stance (38.1%), followed by promotional (32.5%), neutral (22%) and ambiguous (2.5%). The discouraging stance was the most represented before the pandemic (69.6%). In February and March 2020, discouraging tweets decreased intensely and promotional and neutral tweets dominated the conversation. Between April and June 2020, promotional tweets remained more represented (36.5%), followed by discouraging (30%) and neutral (24.3%). The tweets' tone of voice was mainly polemical/complaining, both for promotional and for discouraging tweets. The multiple correspondence analysis identified a definite profile for discouraging and neutral tweets, compared to promotional and ambiguous tweets. In conclusion, the emergence of SARS-CoV-2 caused a deep change in the vaccination discourse on Twitter in Italy, with an increase of promotional and ambiguous tweets. Systematic monitoring of Twitter and other social media, ideally combined with traditional surveys, would enable us to better understand Italian vaccine hesitancy and plan tailored, data-based communication strategies.

COVID-19 Vaccination in Pediatric Population: A Necessity or Obstruction to the Protection of the Right to Health? Biojuridical Perspective

One of the most recently debated topics worldwide is the mass vaccination of children against coronavirus disease 2019 (COVID-19). Next, the risk/benefit ratio of COVID-19 vaccination and infection in children are compared. Nonetheless, the real question in this debate is as follows: Does the vaccine represent a necessary tool or is it an obstacle in protecting the right to health? From a public health point of view, the Supreme Court of Nova Scotia, in Canada, recommends COVID-19 vaccination in the pediatric population. Based on Article 25 of the Draft Articles on State responsibility, vaccination can be considered a social act necessary for protecting the individual's right to health. The 1989 New York Convention on the Rights of the Child and the European Regulation number 219/1111 state that the opinion of a minor aged >12 years is considerable. However, this validity of opinion is related to age and degree of discernment. The onset of adverse events following the administration of the COVID-19 vaccine may lead to compensation in the near future. Recent studies have identified a new COVID-19-related pediatric pathology, known as multisystem inflammatory syndrome. Other studies have demonstrated that myocarditis in the pediatric population might occur following COVID-19 vaccine administration. In June 2021 in the USA, the Center for Control and Prevention of Infectious Diseases Advisory Committee on Immunization Practices declared that the benefits of vaccination against COVID-19 in the pediatric population outweighed the risks. In the meantime, whereas the bioethical debate remains open, monitoring the real risk/benefit ratio of vaccination in the pediatric population is crucial.

Anti-vaccination movements in the world and in Brazil

Over the years, vaccinations have provided significant advances in public health, because they substantially reduce the morbimortality of vaccine-preventable diseases. Nevertheless, many people are still hesitant to be vaccinated. Brazil is a region of many anti-vaccine movements, and several outbreaks of vaccine-preventable diseases, such as yellow fever and measles, have occurred in the country during the last few years. To avoid new outbreaks, immunization coverage must be high; however, this is a great challenge to achieve due to the countless anti-vaccine movements. The World Health Organization has suggested new actions for the next decade via the Immunization Agenda 2030 to control, reduce, or eradicate vaccine-preventable diseases. Nonetheless, the vaccination coverage has decreased recently. To resolve the anti-vaccine issue, it is necessary to propose a long-term approach that involves innovative education programs on immunization and critical thinking, using different communication channels, including social media. Cooperation among biology and health scientists, ethicists, human scientists, policymakers, journalists, and civil society is essential for an in-depth understanding of the social action of vaccine refusal and planning effective education measures to increase the vaccine coverage.

The politics of vaccine hesitancy in Europe

BACKGROUND

Vaccine hesitancy threatens public health. Some evidence suggests that vaccine hesitancy in Europe may be linked with the success of populist parties, but more systematic analysis is needed.

METHODS

We examine the prevalence of individual-level vaccine hesitancy across the European Union (EU) and its association with political orientations. We also analyze whether success of populist parties is linked with vaccine hesitancy and uptake. We draw on individual-level Eurobarometer data from 2019, with a total of 27 524 respondents across the EU. We also rely on national and regional-level populist party vote shares. Finally, for a time-series analysis, we rely on aggregated populist party support as measured in the European Social Survey waves 1-9 (2002-18), and national immunization coverage rates from the WHO from 2002 to 2018.

RESULTS

While vaccine hesitancy is confined to a minority of the population, this group is large enough to risk herd immunity. Political orientations on a left-right dimension are not strongly linked to vaccine hesitancy. Instead, vaccine hesitancy is associated with anti-elite world views and culturally closed rather than cosmopolitan positions.

CONCLUSIONS

Vaccine hesitancy is not only present in all EU member states but also maps on broader dimensions of cultural conflict. Hesitancy is rooted in a broader worldview, rather than misperceptions about health risks. Pro-vaccine interventions need to consider the underlying worldview, rather than simply targeting misperceptions.

Vaccination of Elderly People Affected by Chronic Diseases: A Challenge for Public Health

Elderly people have a limited regenerative capacity and are more susceptible to disease, syndromes, injuries, and illnesses than younger adults [...]

Knowledge, Attitude and Behavior of Families Applying to A Training and Research Hospital Pediatric Clinic About Childhood Vaccinations

ABSTRACT Aim: Our study aimed to determine factors affecting the level of knowledge of families about pediatric vaccination and their attitudes and behaviors towards vaccination. Methods: This study with a descriptive, cross-sectional design included 595 families. The families have completed a 31-items questionnaire. Each correct answer for knowledge questions was rated as 1 point while each incorrect answer or unanswered question was rated as 0 points. The total score was calculated for each participant and compared with demographic data. Results: Mean children’s age was 3.9±0.1 years and 48.2% (n=287) were girls. 77.1% (n=459) participants were mothers. Of the families included, 99% reported that they got their children vaccinated regularly and 85.9% (n=511) reported that they got their children vaccinated in Family Health Centers. The families reported that they were mostly informed by healthcare providers. Based on multivariate regression analysis, it was found that there was a significant correlation between the level of knowledge of participants and child's age, total income level, maternal education level, maternal employment status, presence of chronic disease. Conclusion: Provision of primary healthcare services and in-service training of healthcare providers to maintain continuity of healthcare services are highly important in improving the level of knowledge, attitudes, and behaviors of families. Keywords: family, vaccines, knowledge, attitude, behavior

Dynamic assessment of the COVID-19 vaccine acceptance leveraging social media data

Vaccination is the most effective way to provide long-lasting immunity against viral infection; thus, rapid assessment of vaccine acceptance is a pressing challenge for health authorities. Prior studies have applied survey techniques to investigate vaccine acceptance, but these may be slow and expensive. This study investigates 29 million vaccine-related tweets from August 8, 2020 to April 19, 2021 and proposes a social media-based approach that derives a vaccine acceptance index (VAI) to quantify Twitter users’ opinions on COVID-19 vaccination. This index is calculated based on opinion classifications identified with the aid of natural language processing techniques and provides a quantitative metric to indicate the level of vaccine acceptance across different geographic scales in the U.S. The VAI is easily calculated from the number of positive and negative Tweets posted by a specific users and groups of users, it can be compiled for regions such a counties or states to provide geospatial information, and it can be tracked over time to assess changes in vaccine acceptance as related to trends in the media and politics. At the national level, it showed that the VAI moved from negative to positive in 2020 and maintained steady after January 2021. Through exploratory analysis of state- and county-level data, reliable assessments of VAI against subsequent vaccination rates could be made for counties with at least 30 users. The paper discusses information characteristics that enable consistent estimation of VAI. The findings support the use of social media to understand opinions and to offer a timely and cost-effective way to assess vaccine acceptance.

Acceptance and Factors Influencing Acceptance of COVID-19 Vaccine in a Romanian Population

COVID-19 vaccination has been recognized as one of the most effective ways to overcome the current SARS-CoV-2 pandemic. However, the success of this effort relies on national vaccination programmes. In May 2021, we surveyed 1552 people from Romania to determine acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 39.2% of participants reported that they were vaccinated and 25.6% desired vaccination; nonetheless, 29.5% expressed opposition to vaccination. Concerning vaccination refusal, the top justification given by respondents is that the vaccine is insufficiently safe and there is a risk of serious side effects (84.4%). A higher rate of vaccination refusal was observed among female gender, younger age, and lower educational level. Refusal was also associated with unemployment, being in a relationship, and having a decrease in income during the pandemic. People who are constantly informed by specialized medical staff have a statistically significant higher vaccination rate, while people who choose to get information from friends, family, and co-workers have the strongest intention of avoiding the vaccine. Current levels of vaccine are insufficient to achieve herd immunity of 67%. It is mandatory to understand the aspects that define and establish confidence and to craft nationwide interventions appropriately.

COVID-19 and Seasonal Influenza Vaccination: Cross-Protection, Co-Administration, Combination Vaccines, and Hesitancy

SARS-CoV-2 and influenza are the main respiratory viruses for which effective vaccines are currently available. Strategies in which COVID-19 and influenza vaccines are administered simultaneously or combined into a single preparation are advantageous and may increase vaccination uptake. Here, we comprehensively review the available evidence on COVID-19/influenza vaccine co-administration and combination vaccine candidates from the standpoints of safety, immunogenicity, efficacy, policy and public acceptance. While several observational studies have shown that the trained immunity induced by influenza vaccines can protect against some COVID-19-related endpoints, it is not yet understood whether co-administration or combination vaccines can exert additive effects on relevant outcomes. In randomized controlled trials, co-administration has proved safe, with a reactogenicity profile similar to that of either vaccine administered alone. From the immunogenicity standpoint, the immune response towards four influenza strains and the SARS-CoV-2 spike protein in co-administration groups is generally non-inferior to that seen in groups receiving either vaccine alone. Several public health authorities have advocated co-administration. Different combination vaccine candidates are in (pre)-clinical development. The hesitancy towards vaccine co-administration or combination vaccines is a multifaceted phenomenon and may be higher than the acceptance of either vaccine administered separately. Public health implications are discussed.

Parents' vaccination information seeking, satisfaction with and trust in medical providers in Switzerland: a mixed-methods study

OBJECTIVES

The aim of this study was to better understand parental trust in and satisfaction with information sources and medical providers regarding decision making about childhood vaccines.

SETTING

The study was part of a Swiss national research programme investigating vaccine hesitancy and underimmunisation.

PARTICIPANTS

We conducted qualitative interviews with 37 providers and 30 parents, observed 34 vaccination consultations, and then conducted quantitative surveys with 130 providers (both complementary and alternative medicine (CAM) oriented and biomedically oriented) and 1390 parents.

MAIN OUTCOME MEASURES

Participants' vaccination information sources used in their decision-making process, parents' trust in and satisfaction with these sources and providers.

RESULTS

Based on the Parent Attitudes about Childhood Vaccines scale, we considered 501 parents as vaccine-hesitant (VH) and 889 parents as non-VH. Whereas both groups mentioned providers as the most trusted source of information, VH-parents were less likely to mention paediatricians (N=358 (71%) vs N=755 (85%)) and public health authorities (N=101 (20%) vs N=333 (37%)) than non-VH-parents. VH-parents were more likely to have consulted another provider (N=196 (39%) vs N=173 (19%)) than non-VH-parents, to express less satisfaction with both their primary (N=342 (82%) vs N=586 (91%)) and other providers (N=82 (42%) vs N=142 (82%)) and less trust in their primary (N=368 (88%) vs N=632 (98%)) and other providers (N=108 (55%) vs N=146 (84%)). VH-parents were less likely to be satisfied with their biomedical primary provider than non-VH-parents (100 (69%) vs 467 (91%)). However, when the primary provider was CAM-oriented, there were similar levels of satisfaction among both groups (237 (89%) VH-parents vs 118 (89%) non-VH-parents). All differences were significant (p<0.05).

CONCLUSIONS

While the provider remains the main information source, VH parents turn to additional sources and providers, which is likely related to VH parents being rather dissatisfied with and distrusting in obtained information and their provider.

ETHICS

The local ethics committee (Ethikkommission Nordwest- und Zentralschweiz, EKNZ; project ID number 2017-00725) approved the study.

Impact of Local and Demographic Factors on Early COVID-19 Vaccine Hesitancy among Health Care Workers in New York City Public Hospitals

Despite the development of several effective vaccines, SARS-CoV-2 continues to spread, causing serious illness among the unvaccinated. Healthcare professionals are trusted sources of information about vaccination, and therefore understanding the attitudes and beliefs of healthcare professionals regarding the vaccines is of utmost importance. We conducted a survey-based study to understand the factors affecting COVID-19 vaccine attitudes among health care professionals in NYC Health and Hospitals, at a time when the vaccine was new, and received 3759 responses. Machine learning and chi-square analyses were applied to determine the factors most predictive of vaccine hesitancy. Demographic factors, education, role at the hospital, perceptions of the pandemic itself, and location of work and residence were all found to significantly contribute to vaccine attitudes. Location of residence was examined for both borough and neighborhood, and was found to have a significant impact on vaccine receptivity. Interestingly, this borough-level data did not correspond to the number or severity of cases in the respective boroughs, indicating that local social or other influences likely have a substantial impact. Local and demographic factors should be strongly considered when preparing pro-vaccine messages or campaigns.

Vaccination anxiety when vaccinations are available: The role of existential concerns

This study examined how existential fears are related to COVID-19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness-to-death (SNtD) and death anxiety, to COVID-19 vaccination anxiety during the first month of COVID-19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID-19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID-19 vaccination anxiety while controlling for demographics and for receiving COVID-19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID-19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID-19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID-19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID-19 vaccination anxiety more effectively.

Acceptance of COVID-19 and Influenza Vaccine Co-Administration: Insights from a Representative Italian Survey

Co-administration of coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines has several advantages, has been advocated by various public health authorities and should be seen as an opportunity to increase the uptake of both vaccines. The objective of this survey was to quantify the acceptance of concomitant COVID-19/influenza vaccination and to identify its correlates in a representative sample of Italian adults. Of 2463 participants, a total of 22.9% were favorable to vaccine co-administration, while 16.6% declared their firm unwillingness to receive both vaccines simultaneously. The remaining 60.5% of subjects could be dubbed hesitant to some degree. Compliance with the primary COVID-19 vaccination schedule (adjusted proportional odds ratio (aOR) = 7.78), previous influenza vaccination (aOR = 1.89) and trust in public health institutions (aOR = 1.22) were the main determinants of positive attitudes toward vaccine co-administration. Other significant correlates included age, sex, perceived disease severity and vaccination risk–benefit, being offered a more personalized influenza vaccine and recent seeking for influenza-related information. In Italy, hesitancy toward COVID-19/influenza vaccine co-administration is common and appears to be higher than hesitancy toward either vaccine administered alone. This pattern is multifaceted and requires specific and tailored strategies, with public health institutions playing the central role.

Predictors of the Intention to Be Vaccinated against COVID-19 in a Sample of Italian Respondents at the Start of the Immunization Campaign

COVID-19 vaccines are the most promising means of limiting the pandemic. The present study aims at determining the roles of several psychological variables in predicting vaccination intention in Italy. An online questionnaire was disseminated between 9 March and 9 May 2021. The sample included 971 participants. Results showed that most of the participants were willing to vaccinate. Acceptance rates were correlated with age, marital status, and area of residence. Intention to be vaccinated was positively correlated with perceived risk, pro-sociality, fear of COVID-19, use of preventive behaviors, and trust in government, in science, and in medical professionals. Intention to be vaccinated was negatively associated with belief in misinformation. The degree of acceptance is likely to be a result of the campaign tailored to address people’s negative attitudes towards vaccines. Trust in government and trust in science were among the strongest psychological predictors of vaccination intention. Fear of COVID-19, but not perceived risk, was associated with increased vaccine uptake, suggesting that the affective component of risk perception was more important than the cognitive component in predicting participants’ behaviors. Belief in misinformation was associated with reduced vaccination intention. Future studies will take into consideration these variables, to better understand the multifaceted process underlying vaccination intention.

Parents' Behaviors and Experiences Associated with Four Vaccination Behavior Groups for Childhood Vaccine Hesitancy

Objectives

Increasing vaccine hesitancy and decreasing acceptance of the Centers for Disease Control and Prevention’s (CDC) recommended schedule for childhood vaccines represent a crucial public health issue. The present study directly compares vaccine acceptance behavior across four different groups: those who are fully accepting of the CDC-recommended schedule, those who are accepting but on a delayed schedule, those who only partially vaccinate, and those who do not vaccinate at all.

Methods

A total of 779 adults residing in the United States with at least one child under the age of 18 years participated in an online survey.

Results

Logistic and Ordinary Least Squares regression analyses revealed clear differences between the vaccination behavior groups on a variety of demographic, psychographic, and behavioral metrics. Results suggest financial and insurance-related barriers still hinder full vaccination, and there are differences by race, ethnicity, and educational attainment. Sources of information about vaccines also differed by vaccination behavior group, with those who never vaccinate more likely to rely on friends and family for information. Finally, those whose child experienced what the parent interpreted as an adverse reaction to a previous vaccine, even if that reaction was within the bounds of “normal”, were more likely to report they delay or partially vaccinate.

Conclusions for practice

These results have implications for public health policy and intervention campaigns, in particular that two-step flow campaigns and increased knowledge of normal vaccine side effects may ameliorate some vaccine hesitancy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-021-03336-8.

Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review

Aim:

This review aims are to (1) identify relevant quantitative research on parental childhood vaccine hesitancy with vaccine uptake and vaccination intention being relevant outcomes and (2) map the gaps in knowledge on vaccine hesitancy to develop suggestions for further research and to guide interventions in this field.

Background:

Vaccine hesitancy recognises a continuum between vaccine acceptance and vaccine refusal, de-polarising past anti-vaccine, and pro-vaccine categorisations of individuals and groups. Vaccine hesitancy poses a serious challenge to international efforts to lessen the burden of vaccine-preventable diseases. Potential vaccination barriers must be identified to inform initiatives aimed at increasing vaccine awareness, acceptance, and uptake.

Methods:

Five databases were searched for peer-reviewed articles published between 1998 and 2020 in the fields of medicine, nursing, public health, biological sciences, and social sciences. Across these datasets, a comprehensive search technique was used to identify multiple variables of public trust, confidence, and hesitancy about vaccines. Using PRISMA guidelines, 34 papers were included so long as they focused on childhood immunisations, employed multivariate analysis, and were published during the time frame. Significant challenges to vaccine uptake or intention were identified in these studies. Barriers to vaccination for the target populations were grouped using conceptual frameworks based on the Protection Motivation Theory and the World Health Organization’s Strategic Advisory Group of Experts on Immunization Working Group model and explored using the 5C psychological antecedents of vaccination.

Findings:

Although several characteristics were shown to relate to vaccine hesitancy, they do not allow for a thorough classification or proof of their individual and comparative level of influence. Understudied themes were also discovered during the review. Lack of confidence, complacency, constraints, calculation, and collective responsibility have all been highlighted as barriers to vaccination uptake among parents to different degrees.

Attitudes and perceptions of mothers towards childhood vaccination in Greece: lessons to improve the childhood COVID-19 vaccination acceptance

BACKGROUND

Maternal attitudes and beliefs have been shown to influence childhood vaccination coverage, resulting in under-vaccination, non-vaccination, and vaccination delay. This study aimed to investigate the mothers' attitudes and perceptions about vaccination for their children in Greece.

METHODS

This was an online cross-sectional study, conducted from 4 April to 8 June 2020. A self-administered questionnaire was used to collect information about mothers' and their children's socio-demographic characteristics, previous vaccination behavior, and mothers' attitudes and perceptions about childhood vaccination. Participants included adult mothers with at least one minor child.

RESULTS

One thousand eight hundred eighty-five mothers participated, with the majority (91.7%) believing in the usefulness of vaccines and that vaccines protect children from serious and life-threatening diseases. A larger percentage of mothers with higher educational attainment agreed/absolutely agreed that all vaccinations provided by the National Vaccination Program must be offered to their children (91.6%) (p = 0.02) and that vaccines protect children from serious and life-threatening diseases (92.9%) (p = 0.01). Significant more married/in cohabitation and not single-parent mothers agreed that vaccines are safe (53.5% and 53.4%, respectively). There were also several significant associations between maternal attitudes toward childhood vaccination and previous maternal vaccination practices [(e.g., adherence to recommended vaccination dosages (all p-values < 0.01), vaccination delays (all p-values < 0.05), and vaccination during pregnancy (all p-values < 0.01)].

CONCLUSION

Maternal attitudes and perceptions toward childhood vaccination are significantly influenced by sociodemographic factors and maternal vaccination practices. Revealing those is essential for public health officials in developing future strategies to improve childhood vaccination coverage and acceptance of new vaccines such as the COVID-19 vaccine.

COVID-19 post-vaccination depression in older Israeli adults: the role of negative world assumptions

BACKGROUND

With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the aging population has been shown to be highly vulnerable. As a result, policy makers and the media urged older adults to restrict social interactions, placing them at greater risk of mental health problems, such as depression. However, there has been a little previous attempt to examine coronavirus disease-2019 (COVID-19) vaccine-related risk factors and depressive symptoms amongst older adults.

METHODS

Participants (938 older adults, Mage = 68.99, s.d. = 3.41, range 65-85) answered an online questionnaire at the start of the COVID-19 vaccination program in Israel. Participants completed measures of background characteristics, world assumptions, COVID-19 vaccine-related variables, and symptoms of depression.

RESULTS

Univariate logistic regression revealed that more negative world assumptions were linked with clinical depression levels.

CONCLUSIONS

Older adults in our sample were susceptible to unique factors associated with clinical depression influenced by their world assumptions during their COVID-19 vaccination. The high level of depression following vaccination indicates that it may take time to recover from depression associated with pandemic distress. Cognitive interventions that focus on world assumptions are recommended.

A National Survey Across Primary Care Pediatricians Regarding Immunization Views and Practices in Children With Rheumatic Diseases

METHODS

Cross-sectional survey conducted with an anonymous questionnaire of 34 items distributed to pediatricians via an online platform. Four hundred questionnaires were sent, and 256 were returned and analyzed using STATA 13. Data collection included demographics, questions on knowledge, perceptions, and opinions, as well as advice given to families.

RESULTS

The majority of doctors felt that vaccination in children with RDs is essential. Responders were using a variety of guidelines to reach a clinical decision. Fifty percent were hesitant to adhere to the national vaccination scheme without expert input. Reasons were as follows: not convinced from current literature that the vaccine is safe (32%), afraid to cause disease flare (43%), and unable to deal with parental concerns/refusal (54%). Twelve percent of responders felt that the RD may have been triggered by a vaccine. The majority (82%) of doctors were pro annual influenza vaccination. Seventy percent of doctors were keener to administer booster doses rather than primary ones.

CONCLUSIONS

Variation in opinion and clinical practice exists. Overall, although general pediatricians are informed regarding efficacy and adverse effects of immunizations in patients with RDs, there are steps to be made from principle to practice. Vaccinating these children is of vital importance, and primary care pediatricians should be updated regarding existing guidelines referring to this field.

Knowledge of mothers regarding children's vaccinations in Greece: an online cross-sectional study

BACKGROUND

One of the main reasons that influence parental choice to postpone or avoid children's vaccination is insufficient knowledge. Mothers' knowledge can be considered as an important factor when determining childcare, as they are often the primary decision maker for their children's healthcare issues. This study aimed to assess the level of mothers' knowledge and practice on certain aspects of vaccination for their child/children in Greece.

METHODS

This was an online cross-sectional survey, which collected information about mother's socio-demographic characteristics, vaccination-related information, and vaccine knowledge using a self-administered questionnaire. The survey was conducted between April 2020 and June 2020 and the study population included mothers over 18 years old with at least one child (< 18 years old), living in four broad geographical areas of Greece (Attica, Central Greece, North Greece, and Crete/Aegean Islands).

RESULTS

A total of 1885 Greek mothers participated in the study. The majority stated that they vaccined their child/children (98%), and the most popular source of information about vaccination was their child's pediatrician (89%). About half of participants (52%) have delayed their child/children vaccination with their pediatrician's suggestion being the main driver. The median knowledge score was 11 which indicates a high knowledge level for childhood vaccination among Greek mothers. Multiple linear regression analysis identified an inverse association between education and knowledge score, characterized by higher knowledge scores among individuals with secondary and even higher among those with higher education. Multiple logistic regression analysis showed that the strict adherence to the prescribed dosage as indicated by the local recommendations for each vaccine, was associated with most of the knowledge items included in the study.

CONCLUSIONS

Our findings show that the vast majority of mothers in Greece did vaccinate their child/children, while pediatricians appear to have a very influential role in mothers' decision making. High knowledge around vaccination was associated with mothers' educational attainment, being particularly high among those who completed higher education. Considerable attention is required from public health authorities to promote vaccination through educational programs and campaigns, particularly aimed at people with lower educational attainment. Additionally, improving communication between pediatricians and mothers to reach those women who have not decided to vaccinate or delayed vaccination for their children, may prove to be very beneficial.

The Reliability of Anamnestic Data in the Management of Clostridium Tetani Infection in Elderly

Background: Tetanus infection remains a significant complication of wounds. Because most tetanus treatment guidelines rely on anamnestic data collected directly from patients, the congruence between anamnesis and laboratory evidence must be verified, especially in the elderly population.

Aim: Assess, in both the geriatric population (>65) and the non-geriatric one, the reliability of anamnestic data for managing patients with tetanus-risk wounds, identified categories of populations most exposed to non-vaccination coverage, and assessed the agreement of the Tetanos Quick Stick (TQS) results with the therapy performed (administration of tetanus vaccine or immunoglobulin).

Methods: In this retrospective single-center observational study, patients were asked their immunization status against tetanus vaccination. The decision to administer a vaccine or immunoglobulin was therefore clinical and based on anamnestic criteria. The TQS test was then given to patients who were unaware of their immunity status. Patients who thought they knew it but were not sure were given the TQS test to determine whether the anamnestic collection was supported by the test. The TQS test results were compared with the anamnestic data.

Results: Most patients, geriatric and not geriatric, did not know their immune status. Among those who reported knowing their immune status, there was no agreement between the vaccine coverage declared by patients and the TQS test results (p < 0.001), mainly in geriatric patients but also in the control group. Elderly and women had significantly lower positive TQS test results (p < 0.001). There was a statistically significant discrepancy (p < 0.001) between the therapy based on anamnestic data and the TQS test results.

Conclusion: The reliability of anamnestic data for the management of patients with tetanus-risk wounds is low and decreases with age, becoming minimal in geriatric patients. Elderly and women are less likely to have an effective vaccination status against tetanus.

Prevalence, Trends and Conditions for the DTP3 Vaccine: A 25-Year Historical Perspective

Background

The aim was to verify the prevalence of vaccination coverage, tendency and factors of the third dose of the vaccine against diphtheria, tetanus and pertussis-DTP3 in surveys over the period of 25 years in a state of the Northeast of Brazil.

Methods

Cross-sectional and temporal series, utilizing ad hoc database, were extracted from the Health and Nutrition State Research 1991, 1997, 2006 and 2015/2016. Children from 12 to 23 months of age with proof in the vaccination card were included. The vaccination coverage (outcome) of each year was calculated, the tendency throughout the period was analyzed and the associations through Pearson chi-squared were tested. The results of the first and last survey were compared with a significance level of 5%. The reasons of the crude prevalence and confidence intervals of 95% were estimated.

Results

The vaccination coverage in 1991, 1997, 2006 and 2015/2016 was 77.6%, 82.7%, 89.7% and 72.9%, respectively, with an increasing tendency from 1991 to 2006 (p<0.001) and decreasing between 2006 and 2015/2016 (p<0.001). Factors in 1991: low socioeconomic conditions; lack of access to health service and pre-natal care, nutritional deficit and diarrhea in children (p<0.005). In 2015/2016, low socioeconomic conditions and diarrhea persisted and a larger family size, black, negative self-perception of happiness, both from the mother (p<0.05), were identified.

Conclusion

The factors of the recent decrease of vaccination coverage are complex, multifactorial, dependent of context and even on subjective aspects of the maternal perception. Its identification contributed to the understanding of inadequate vaccination at the state level.

Uptake of Vaccinations among Children with Chronic Diseases Is Affected by Knowledge Gaps and Implementation Challenges in Italy

(1) Background: Children with chronic medical conditions may be at increased risk for severe complications related to vaccine-preventable infections. Therefore, additional booster doses or supplementary vaccines are recommended, over and above the routine immunization schedule for healthy children. The aim of this study was to investigate attitude, knowledge, and practices toward additional vaccinations for children affected by chronic conditions among pediatricians and parents. (2) Methods: This study is based on two surveys: (i) a national cross-sectional survey, targeting pediatrician working in hospitals or in the primary health sector; (ii) a local cross-sectional survey, targeting parents of children with a previous diagnosis of chronic disease. (3) Results: Despite the fact that most of the health professionals and parents interviewed had an overall positive vaccine attitude, most pediatricians did not show an adequate knowledge of additional vaccinations for children affected by chronic diseases. Moreover, the coverage of additional recommended vaccinations in chronic pediatric patients was low. (4) Conclusions: This research highlighted important existing challenges hampering optimal vaccination coverage among pediatric chronic patients, including knowledge gaps on tailored vaccination schedules among pediatricians and organizational issues. The ongoing review of the Italian national immunization plan is a not-to-be-missed-opportunity to include evidence-based, detailed, and comprehensive recommendations on vaccinations for children affected by chronic conditions.

Factors associated with pediatric vaccine hesitancy of parents: a cross-sectional study in Turkey

Aim: This study aims to determine the prevalence and associated factors of vaccine hesitancy in females with children aged 12 months to 6 years who receive service from the antenatal class of a tertiary hospital in Turkey.Method: The study group includes 370 parents receiving service from a tertiary hospital. The data collection tools of the study were a descriptive data form and the Parent Attitudes about Childhood Vaccines survey.The data were analyzed using chi-square analysis and logistic regression analysis.Results: In our study, the prevalence of vaccine hesitancy was determined as 13.8% and vaccine refusal prevalence as 4.8%. In univariate analysis, vaccine hesitancy was found to be significantly higher in mothers with a university education, who got pregnant with treatment, who were not trained about pediatric vaccines in the antenatal follow-up, who followed anti-vaccine groups on social media, and who did not use vitamin D and iron supplements regularly or never used for their child. Vaccine hesitancy was significantly higher in parents who stated that their information sources of vaccines were not scientific, who were worried about vaccine ingredients (aluminum, mercury, pig gelatine) and who used alternative medicine practices (p < .05). In multivariate analysis, the risk of vaccine hesitancy increases 3.05 times in pregnancies with treatment, 3.74 times in those who did not use vitamin D or iron preparations, 3.01 times in those who followed anti-vaccine groups on social media,2.93 times in parents who were worried about the vaccine ingredients.Conclusion: Our findings suggest that the prevalence of vaccine hesitancy and risk factors should be monitored closely in the following years.

Universal Predictors of Dental Students' Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach

BACKGROUND

young adults represent a critical target for mass-vaccination strategies of COVID-19 that aim to achieve herd immunity. Healthcare students, including dental students, are perceived as the upper echelon of health literacy; therefore, their health-related beliefs, attitudes and behaviors influence their peers and communities. The main aim of this study was to synthesize a data-driven model for the predictors of COVID-19 vaccine willingness among dental students.

METHODS

a secondary analysis of data extracted from a recently conducted multi-center and multi-national cross-sectional study of dental students' attitudes towards COVID-19 vaccination in 22 countries was carried out utilizing decision tree and regression analyses. Based on previous literature, a proposed conceptual model was developed and tested through a machine learning approach to elicit factors related to dental students' willingness to get the COVID-19 vaccine.

RESULTS

machine learning analysis suggested five important predictors of COVID-19 vaccination willingness among dental students globally, i.e., the economic level of the country where the student lives and studies, the individual's trust of the pharmaceutical industry, the individual's misconception of natural immunity, the individual's belief of vaccines risk-benefit-ratio, and the individual's attitudes toward novel vaccines.

CONCLUSIONS

according to the socio-ecological theory, the country's economic level was the only contextual predictor, while the rest were individual predictors. Future research is recommended to be designed in a longitudinal fashion to facilitate evaluating the proposed model. The interventions of controlling vaccine hesitancy among the youth population may benefit from improving their views of the risk-benefit ratio of COVID-19 vaccines. Moreover, healthcare students, including dental students, will likely benefit from increasing their awareness of immunization and infectious diseases through curricular amendments.

Factors associated with current posttraumatic stress disorder among COVID-19 vaccinated older adults in Israel

This is the first study to examine COVID-19 vaccine-related stressors in the context of current posttraumatic stress disorder (PTSD) symptoms amongst older adults exposed to traumatic events prior to the COVID-19 outbreak, with particular focus on the associations between ageism, vaccine-related stressors and PTSD. Five hundred and sixty-three participants aged 65 and above reported exposure to at least one traumatic event, their current PTSD level, physical and mental health, ageist attitudes, and vaccine related stressors. Univariate logistic regression revealed that depressive symptoms, ageism, vaccine hesitancy and severity of side effects were the main factors associated with clinical levels of current PTSD. These results suggest that older adults were vulnerable to intensified PTSD symptoms, not only as a result of greater depression, but also as a consequence of other factors, including ageism, vaccination hesitancy and vaccination side effects. Practitioners would benefit from awareness to these factors.

Intention to COVID-19 vaccination and associated factors among health care workers: A systematic review and meta-analysis of cross-sectional studies

OBJECTIVES

To gain insight into willingness and its influencing factors to vaccinate against COVID-19 among health care workers (HCWs), and provide a scientific basis for more reasonable epidemic prevention and control strategies.

METHODS

A comprehensive literature search was conducted in 4 English databases (PubMed, EMBASE, Web of Science and the Cochrane Library) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), the Chongqing VIP Chinese Science (VIP), Wanfang Database and China Biomedical Literature Database (CBM)) to collect the related studies. Quality evaluation was carried out for papers meeting the inclusion criteria using 6 items from the Downs and Black assessment checklist. The STATA statistical software version 15.1 was hired to perform meta-analysis.

RESULTS

Nine records with a total of 24,952 subjects were included in this meta-analysis. The results of this meta-analysis revealed that the pooled effect value of COVID-19 vaccination willingness among HCWs using a random-effects model was 51% (95% confidence interval (CI) 0.41-0.62). Male, aged 30 years or older, having a history of prior influenza vaccination were facilitators for HCWs' intention to vaccinate against COVID-19 (odds ratio (OR) 1.82, 95% CI 1.37-2.41, P = .000, I² = 59.4%; OR 1.32, 95% CI 1.16-1.51, P = .000, I² = 31.7%; OR 2.97, 95% CI 1.82-4.84, P = .000, I² = 88.1%). The impact of occupation on HCWs' intention to get vaccinated could not yet be definitively confirmed (OR 0.85, 95% CI 0.69-1.06, P = .160, I² = 85.5%).

CONCLUSION

COVID-19 vaccination acceptance of HCWs was at moderate level. Strengthening awareness of COVID-19 vaccine among HCWs, particularly female HCWs under 30 years who have no history of prior influenza vaccination, is crucial to eliminate concerns about vaccination and promote the application of COVID-19 vaccine in this population.

Determinants of parental hesitancy to vaccinate their children against COVID-19 in China

Vaccine hesitancy seriously hinders herd immunity. We explored the determinants of parental hesitancy to vaccinate children against Coronavirus Disease 2019 (COVID-19) in China.A population-based self-administered online questionnaire evaluating parental hesitancy in vaccinating their children against COVID-19 was conducted in Taizhou, China. Of the 2463 parents who received the invitation, 1788 (72.6%) responded to the survey.Of the repondents, 52.5% were hesitant. Mothers exhibited a greater proportion of vaccine hesitancy than fathers did (57.5% vs. 41.7%, P < 0.001). Multiple logistic regression analysis indicated that parents with children under 18 years of age (OR = 0.94, 95%CI: 0.90-0.99), lower knowledge scores about COVID-19 vaccination (Q1: OR = 1.92, 95%CI: 1.37-2.69; Q2: OR = 1.51, 95%CI: 1.10-2.08), lower awareness of the permission of vaccinating children (OR = 1.74, 95%CI: 1.36-2.23) and hesitancy to inoculate themselves (OR = 8.18, 95%CI: 6.48-10.33) were associated with parental hesitancy to inoculate their children. Results also revealed the disparity between fathers and mothers regarding associated factors.This study found that a substantial proportion of parents reported being hesitant to vaccinate children against COVID-19, implying the necessity of comprehensive assessment and health education programs for vaccination systems in China.

Quality and Safety of Vaccines Manufacturing: An Online Survey on Attitudes and Perceptions of Italian Internet Users

Background: Vaccination is a worldwide public health practice that requires high uptake levels in order to effectively reduce the incidence of vaccine-preventable diseases. The manufacturing of vaccines is a complex process, and little is known about people’s feelings and opinions on that. Our study aimed at investigating perceptions and attitudes of the general population towards the vaccine production process before the availability of COVID-19 vaccines. Methods: We designed a 15-question online survey in the Italian language which was spread via Facebook and an Italian website "Vaccinarsintoscana" between January and May 2020. We performed a descriptive analysis and applied statistical tests to assess differences in the given answers according to participants’ sociodemographic characteristics. Results: The collected responses (135 participants) about the perceptions on vaccine production process were largely positive: not being concerned about the vaccine production (70.3%); believing the vials did not contain harmful substances (75.6%) and considering the precautionary withdrawal of some batches as highly effective (83.7%). In contrast, a less positive perception was found for the question about the conflict of interest between manufacturing companies and the control systems (48.9%). Moreover, people’s perceptions towards the vaccine components (i.e., microorganism, adjuvants and opinion on batches withdrawal) also showed a good level of confidence and trust. Conclusions: Our study highlighted a generally positive attitude towards the vaccine production process and showed people’s confidence in the control systems, safety and high standards of quality of the vaccine production process.

Pediatric health care professionals' vaccine knowledge, awareness and attitude: a survey within the Italian Society of Pediatric Allergy and Immunology

BACKGROUND

Physicians play a key role in driving vaccine acceptance and their recommendations are crucial to address vaccine hesitancy. The aim of the study was to assess knowledge, awareness and attitude of Italian Pediatric Health Care Professionals (pHCPs) on vaccinations.

METHODS

An anonymous on-line questionnaire was developed within the Vaccine Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP) and spontaneously completed by 231 Pediatricians and Pediatric Nurses (PN).

RESULTS

An accurate vaccine education was reported by 70% of pediatricians and 13% of PN but 11% of pediatricians versus 26% of PN consult social media instead of scientific sources for their vaccine update. The investigation on the pHCPs attitudes to vaccination in a personal and family setting highlights poor adherence to vaccinations. Only 63% of pediatricians versus 16% of PN (p < 0.0001) annually received the Flu vaccine. In their family setting 93% of pediatricians versus 51% of PN recommended all vaccinations (p < 0.0001). Anti-flu, anti-rotavirus, anti-zoster and anti-pneumococcal vaccines were not regularly recommended by all pHCPs due to doubts of uselessness (55% of pediatricians versus 40% of PN) and preference for "natural immunity" (44% of pediatricians versus 40% of PN).

CONCLUSIONS

Our results indicate that pHCPs' attitude and confidence in regards to vaccines remain suboptimal. Current COVID-19 pandemic and the rapid development of vaccines could increase vaccine hesitancy. Due to the documented pHCPs' influence in the parental decision, educational interventions are needed to improve their level of knowledge and counselling skills in order to address parental vaccine hesitancy and to maintain continuity of immunization services.

Attitudes towards COVID-19 vaccine and reasons for adherence or not among nursing students

BACKGROUND

The COVID-19 pandemic has spread widely among healthcare workers. Recently, new effective vaccines against COVID-19 have begun to be administered to healthcare workers in several countries, including Italy.

PURPOSE

Our aim was to evaluate the intentions to be vaccinated against COVID-19 in a population of nursing students, identifying factors associated with the intentions.

METHOD

We conducted an anonymous online survey among 728 nursing students. The questionnaire collected data on demographic and academic characteristics, health status, vaccine attitudes, and specific reasons regarding the intention to get or not get the COVID-19 vaccination.

RESULTS

A total of 422 nursing students completed the survey. Almost 81% of participants wanted to take the vaccine against coronavirus. The intention to adhere to the vaccination program was associated with male gender, a previous flu vaccine uptake, and high school education. The main reason in favor of taking the vaccine was to protect family and friends. The main reason for opposition was the fear of adverse events.

CONCLUSION

It is fundamental to consider vaccine hesitancy in healthcare students and face it properly, since these are the healthcare workers of the future who will have to provide recommendations to patients and promote adherence to vaccination programs.

Scared, powerless, insulted and embarrassed: hesitancy towards vaccines among caregivers in Cavite Province, the Philippines

BACKGROUND

Several studies have highlighted that vaccine hesitancy (VH) is among the most important threats to global health, especially in low- and middle-income countries, including the Philippines. However, there is a dearth of literature exploring family experiences of-or concerns related to-childhood vaccinations that gives voice to vaccine hesitant caregivers (VHCs) of small children. Here, we present insights from VHCs from the Philippines.

METHODS

This research draws on in-depth interviews (IDIs) with 44 VHCs who had previously delayed or refused vaccination for their children in rural and urban communities in Cavite Province, the Philippines. Amid the COVID-19 pandemic, we conducted IDIs via an online platform of the respondents' choosing (ie, Facebook messenger call, Skype and Zoom). All interviews were recorded, transcribed, translated and analysed drawing from the tenets of constructivist grounded theory. We use the social ecological model to structure our results.

RESULTS

Among the reasons for delay or refusal of childhood vaccinations, a fear of side effects emerged as the most salient concern, exacerbated by previous negative experiences (including trauma) from a dengue vaccine controversy in 2017. Respondents cited the dengue vaccine controversy as they expressed reluctance (regarding any new vaccines) and suspicion (towards school-based vaccination, the distribution channel used for the dengue vaccine). Heads of households opposing vaccines, perceptions that vaccines are non-essential and influences from the social and traditional media or neighbours contributed to further refusal and delay. Upon probing, VHCs recounted health system concerns particularly with regards to healthcare workers who are sometimes unable to answer their questions and can be dismissive or disrespectful regarding caregivers' concerns.

CONCLUSION

Understanding VH from the lens of VHCs highlights pathways for interventions to regain trust and bolster confidence towards vaccines. Our findings may serve as linchpins in the development of VH interventions aiming at changing behaviour on a population scale.