Vaccine Safety: Myths and Misinformation

Public acceptance of COVID-19 vaccination among residents of Saudi Arabia: a cross-sectional online study

OBJECTIVES

The acceptance of the COVID-19 vaccine is essential for protecting the world population and stopping the COVID-19 pandemic. This paper aimed to measure public acceptance of the COVID-19 vaccination and the factors that may play an important role in increasing the acceptance of vaccinations in future pandemics.

DESIGN

A cross-sectional, observational study was conducted through a survey designed using the Google Forms platform. In this study, a logistic regression analysis was used to study and detect the variables linked to the acceptance of COVID-19 vaccination. To meet inclusion criteria, participants had to be 18 years or older at the time of collecting the data, reside in Saudi Arabia at the time of the survey, agree to the consent form and be able to complete the survey in Arabic.

SETTING

Randomly selected residents of Saudi Arabia.

NUMBER OF PARTICIPANTS

1658.

RESULTS

In general, the population of Saudi Arabia is supportive of the COVID-19 vaccine (72.0%) and has one of the highest acceptance rates, according to global studies. We found that men (OR 0.73; 95% CI: 0.55 to 0.97) were less likely to hesitate with regard to taking the vaccine, whereas previously infected individuals were more likely to hesitate (OR 1.77; 95% CI: 1.25 to 2.50). Those with a lower monthly income (<3000 Saudi riyal) were more likely to refuse the vaccine (OR 3.54; 95% CI: 1.81 to 6.91), while those living in cities (OR 0.62; 95% CI: 0.39 to 0.99) and the unemployed (OR 0.52; 95% CI: 0.33 to 0.83) were less likely to refuse it. Participants' history of viral infection and trust in the healthcare system were found to be important factors in the public's acceptance of the vaccine.

CONCLUSION

In general, acceptance of the COVID-19 vaccination is high in Saudi Arabia. Several factors have shown a method for predicting those who might reject the vaccine or hesitate to take it; thus, the healthcare system should target those residents throughout the campaign. Based on the conclusions of the current research, the acceptance of vaccinations could be increased.

COVID-19 vaccine acceptance: knowledge and beliefs

Backgrounds

Vaccine acceptance varies across countries, generations, and the perceived personality of individuals. Investigating the knowledge, beliefs, and acceptability of COVID-19 vaccines among individuals is vital to ensuring adequate health system capacity and procedures and promoting the uptake of the vaccines.

Results

A cross-sectional study was conducted from August 2021 to January 2022 in Saudi Arabia. The study included 281 residents to estimate their acceptance to receive COVID-19 vaccination. Around 70% of the included participants had a moderate to high COVID-19 vaccine acceptance rate during the data collection period. The risk increases to about two folds among undergraduates [OR 1.846 (1.034-3.296), p value = 0.036)] and increases to four folds among non-employed [OR 3.944 (2.310-6.737), p value = 0.001]. About 78% of participants with high and 44% with low COVID-19 vaccine acceptance (p value = 0.001) believed the vaccines were safe and effective. The belief that COVID-19 disease will be controlled within two years increased the risk for low vaccine acceptance by about two folds [OR 1.730 (1.035-2.891), p value = 0.035]. Good knowledge about COVID-19 vaccination significantly affected the acceptance rate (p value = 0.001).

Conclusions

Several factors affect the intention of individuals to receive vaccines. Therefore, building good knowledge and health literacy through educational intervention programs, especially vaccine safety and effectiveness, is important for successful vaccination campaigns among the general population and ensuring control of the COVID-19 pandemic.

Predictors of Vaccine Uptake among Migrants in the United States: A Rapid Systematic Review

Evaluating challenges to vaccine uptake in non-US-born individuals is necessary for increasing national vaccination rates. This rapid review was conducted to investigate predictors of vaccine utilization among US migrants. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist was utilized, along with the Rayyan webtool, to facilitate the process of identifying primary research articles. Data were independently extracted by using a piloted, customized form. This was tabulated and the results were reported. Of the 186 abstracts reviewed, nine articles were included. Populations included in this review were refugees (n = 1), undocumented migrants (n = 1), migrants crossing the US-Mexico border (n = 2), Blacks (n = 1), and US-born vs. non-US-born adults (n = 1). Three studies focused on "foreign-born" children. The vaccines included in the literature reviewed were both combined series and individual, with one study addressing immunization instead of specific vaccines. Detailed characteristics of these studies and their quality evaluations were also reported. This review identified gaps in research regarding immunization among different migrant groups. Multilevel interventions should be considered to leverage the existing facilitators and address the known modifiable barriers to creating an accessible and supportive environment for marginalized populations.

COVID-19 vaccine hesitancy and associated factors among infertile couples undergoing assisted reproductive treatment

Although periconception vaccination is important to maternal and neonatal health, little is known about the COVID-19 vaccine hesitancy among infertile couples seeking fertility treatment. Thus, we conducted this survey among infertile patients in a reproductive medicine center, between September 2021 and December 2021, to estimate the prevalence of COVID-19 vaccine hesitancy and its influencing factors. Information was collected through face-to-face interviews among volunteers. Among the 987 included interviewees, 17.33% reported hesitancy in primary vaccination, 25.63% reported hesitancy in booster vaccination, and 32.32% delayed the primary vaccination. Hesitancy in primary vaccination was associated with unexplained infertility (OR: 1.77, 95% CI: 1.05-2.98), ongoing IVF treatment (OR: 2.17, 95% CI: 1.22-3.89), concerns for vaccine safety (OR: 4.13, 95% CI: 2.66-6.42), effectiveness (OR: 1.62, 95% CI: 1.15-2.28), and influence on pregnancy (OR: 2.80, 95% CI: 1.68-4.67). These factors were also associated with hesitancy in booster vaccination. Delay of the primary vaccination was inversely associated with a college or above degree (OR: 0.49, 95% CI: 0.27-0.87), previous history of influenza vaccination (OR: 0.67, 95% CI: 0.46-0.98), and was positively associated with concerns for the influence on pregnancy (OR: 7.78, 95% CI: 5.01-12.07). It is necessary to carry out targeted education program by health professionals to publicize the benefits of periconception vaccination, and to reduce the resistance to COVID-19 vaccine among infertile couples.

Relationship between knowledge, attitudes, and practices and COVID-19 vaccine hesitancy: A cross-sectional study in Taizhou, China

Objective

This study aimed to explore COVID-19 vaccine hesitancy in Chinese adults and analyzed the relationship between knowledge, attitudes, practices (KAP), and COVID-19 vaccine hesitancy.

Methods

A population-based self-administered online survey was conducted in Taizhou, China to evaluate the population's hesitancy to receive COVID-19 vaccination. A total of 2.463 adults received the invitation for the survey through WeChat (A Chinese app that is used for chat, social media, and mobile payment), and 1.788 interviewees answered the structured questionnaire. The overall response rate was 72.6%.

Results

Total 45.2% of people were hesitant about the COVID-19 vaccination. Using binary logistic regression analysis, we found low perception of safety (Model 3: Odds ratio = 2.977, Confidence interval: 2.237–3.963) and efficacy (Model 3: OR = 1.904, 95%CI: 1.462–2.479) of the COVID-19 vaccine in adults is the most important risk factor for COVID-19 vaccine hesitation. People who know more about COVID-19 vaccination are less hesitant (Model 2: OR = 0.967, 95% CI: 0.951–0.983). People who did not seek information independently about the COVID-19 vaccine are more likely to be skeptical (Model 4: OR = 1.300, 95% CI: 1.058–1.598, P = 0.013).

Conclusion

In China, the population had higher levels of COVID-19 vaccine hesitation, and their knowledge of the COVID-19 vaccine, perceptions of safety and efficacy, and physical health status were significantly associated with vaccine hesitation. These results provide ideas for promoting COVID-19 vaccination and intervention and have far-reaching implications for further strengthening research on vaccine hesitancy in COVID-19 and exploring strategies for COVID-19 vaccine promotion.

Vaccine Hesitancy in Pediatrics

Vaccine hesitancy is a growing complex and multifaceted phenomenon. It encompasses a wide spectrum of context-dependent attitudes and beliefs. Multiple factors influence parental decision-making including knowledge, sources of information, risk perception, trust, and individual experiences among others. This review focuses on describing the most common reasons that contribute to vaccine hesitancy among parents. Social media and the Internet have been described as major elements that can negatively influence parental decision-making regarding vaccines. The next focus is describing effective interventions that clinical providers can apply. Nonconfrontational and open discussions along with trusting and strong relationships between parents and providers seem to create a solid foundation toward vaccine acceptance. In addition, motivational interviewing is a helpful tool that has proven to be effective during these discussions. Ultimately, an individualized approach tailored to a specific community will likely be most effective in addressing vaccine hesitancy.

Global caregiver concerns of SARS-CoV-2 vaccination in children with cancer: a cross-sectional mixed-methods study

The objective of this study was to understand global caregiver concerns about SARS-CoV-2 vaccination for children with cancer and to provide healthcare providers with guidance to support parental decision-making. A co-designed cross-sectional mixed-methods survey was distributed to primary caregivers of children with cancer globally between April and May 2021 via several media. Caregivers were asked to rate the importance of vaccine-related questions and the median scores were ranked. Principal Component Analysis was conducted to identify underlying dimensions of caregiver concerns by World Bank income groups. Content analysis of free-text responses was conducted and triangulated with the quantitative findings. 627 caregivers from 22 countries responded to the survey with 5.3% (n = 67) responses from low-and-middle-income countries (LMIC). 184 caregivers (29%) provided free-text responses. Side effects and vaccine safety were caregivers' primary concerns in all countries. Questions related to logistics were of concern for caregivers in LMIC. A small minority of caregivers (n = 17) did not consider the survey questions important; free-text analysis identified these parents as vaccine hesitant, some of them quoting safety and side effects as main reasons for hesitancy. Healthcare providers and other community organizations globally need to provide tailored information about vaccine safety and effectiveness in pediatric oncology settings. Importantly, continued efforts are imperative to reduce global inequities in logistical access to vaccines, particularly in LMIC.

COVID-19 Vaccine for Children: Vaccination Willingness of Parents and Its Associated Factors—A Network Analysis

Different COVID-19 vaccines have been approved for underage children, so parents and caregivers currently face the decision of whether to vaccinate their children against COVID-19 or not. Due to the rather moderate vaccine acceptance among parents across different countries, the objective of the present study was to investigate the relationship between different psychological, demographic, and behavioral factors related to the acceptance of the COVID-19 vaccine for underage children among parents. In particular, vaccination attitudes, whether parents have been vaccinated against COVID-19 themselves, COVID-19 fear, attitude towards COVID-19 policy measures, governmental trust, subjective level of information, perceived risk of disease progression, and perceived risk of vaccine side effects were the variables of interest. The study adopted a cross-sectional study design, and the sample consisted of 2405 participants. A network analysis was conducted to investigate the associations and interconnection among these variables. The results showed that, in particular, compliance, confidence in the safety of vaccines, whether parents have been vaccinated against COVID-19 themselves, trust in the governmental system, fear of COVID-19, and the parents’ age were directly related to the acceptance of the COVID-19 vaccine for children. To increase compliance and confidence in the vaccines’ safety among parents, promotion campaigns should provide more information concerning the vaccines’ safety, particularly for younger parents who are not vaccinated against COVID-19 themselves.

Impact of COVID-19 Vaccine Misinformation on Social Media Virality: Content Analysis of Message Themes and Writing Strategies

BACKGROUND

Vaccines serve an integral role in containing pandemics, yet vaccine hesitancy is prevalent globally. One key reason for this hesitancy is the pervasiveness of misinformation on social media. Although considerable research attention has been drawn to how exposure to misinformation is closely associated with vaccine hesitancy, little scholarly attention has been given to the investigation or robust theorizing of the various content themes pertaining to antivaccine misinformation about COVID-19 and the writing strategies in which these content themes are manifested. Virality of such content on social media exhibited in the form of comments, shares, and reactions has practical implications for COVID-19 vaccine hesitancy.

OBJECTIVE

We investigated whether there were differences in the content themes and writing strategies used to disseminate antivaccine misinformation about COVID-19 and their impact on virality on social media.

METHODS

We constructed an antivaccine misinformation database from major social media platforms during September 2019-August 2021 to examine how misinformation exhibited in the form of content themes and how these themes manifested in writing were associated with virality in terms of likes, comments, and shares. Antivaccine misinformation was retrieved from two globally leading and widely cited fake news databases, COVID Global Misinformation Dashboard and International Fact-Checking Network Corona Virus Facts Alliance Database, which aim to track and debunk COVID-19 misinformation. We primarily focused on 140 Facebook posts, since most antivaccine misinformation posts on COVID-19 were found on Facebook. We then employed quantitative content analysis to examine the content themes (ie, safety concerns, conspiracy theories, efficacy concerns) and manifestation strategies of misinformation (ie, mimicking of news and scientific reports in terms of the format and language features, use of a conversational style, use of amplification) in these posts and their association with virality of misinformation in the form of likes, comments, and shares.

RESULTS

Our study revealed that safety concern was the most prominent content theme and a negative predictor of likes and shares. Regarding the writing strategies manifested in content themes, a conversational style and mimicking of news and scientific reports via the format and language features were frequently employed in COVID-19 antivaccine misinformation, with the latter being a positive predictor of likes.

CONCLUSIONS

This study contributes to a richer research-informed understanding of which concerns about content theme and manifestation strategy need to be countered on antivaccine misinformation circulating on social media so that accurate information on COVID-19 vaccines can be disseminated to the public, ultimately reducing vaccine hesitancy. The liking of COVID-19 antivaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus.

Risk factors for granulomas in children following immunisation with aluminium adsorbed vaccines: A Danish population-based cohort study

BACKGROUND

Aluminium adsorbed vaccines may in some children cause severely itching nodules at the injection site, known as vaccination granulomas.

OBJECTIVE

To investigate vaccine-, child- and maternal level risk factors for the development of vaccination granulomas following immunisation with aluminium adsorbed vaccines.

METHODS

A Danish population-based cohort study with 553 932 children born in Denmark from 1 January 2009 to 31 December 2018, vaccinated with an aluminium adsorbed vaccine during the first year of life, followed until 31 December 2020. Poisson regression was used to estimate granuloma rate ratios according to type of adjuvant, accumulated dose of aluminium, timing of vaccination appointments, sex, gestational age, having siblings with granulomas, maternal age, and maternal ethnicity.

RESULTS

We identified 1 901 vaccination granuloma cases (absolute risk, 0.34%). Among vaccine level factors, revaccination (third vs first vaccination appointment, adjusted rate ratio [RR] 1.26, 95% confidence interval [CI] 1.03-1.55), the specific adjuvant used (aluminium phosphate vs hydroxide, RR 0.58, 95% CI 0.48-0.70) and dosage (≥1.0 mg vs <1.0 mg, RR 1.34, 95% CI 1.19-1.52) were associated with risk of granulomas; the timing of vaccination appointments was not. Among child level factors, female sex (vs males, RR 1.12, 95% CI, 1.02-1.22), prematurity (vs term birth, RR 0.71, 95% CI, 0.54-0.93) and having sibling(s) with granulomas (vs no siblings with granulomas, RR 46.15, 95% CI, 33.67-63.26) were associated with risk of granulomas. Among maternal level factors, non-Danish ethnicity (vs. Danish, RR 0.51, 95% CI, 0.42-0.63) and young maternal age (<20 yrs. vs 20-39 yrs., RR 0.46, 95% CI 0.25-0.83) were associated with risk of granulomas.

CONCLUSIONS

Several risk factors for vaccination granulomas at both the vaccine, child, and maternal level, was identified. Reducing the dose of aluminium or replacing aluminium hydroxide with aluminium phosphate could reduce the risk of granulomas. However, this must be balanced against the potential for reduced immunogenicity.

Distorted Human Decision-Making as a Critical Aspect of Pandemic Planning and Preparedness

The United States continues to experience lower than expected vaccination rates against COVID-19 due to a variety of barriers such as lack of trust, lack of planning, cultural perspectives and issues, suboptimal communication, and political/economic conflicts of interest. In this paper issues of human behavior and decision-making are highlighted as integral to understanding the generally poor US response to the SARS-CoV-2 pandemic. In particular, the US pandemic response was significantly distorted through a combination of cultural and human behavior issues related to conflicting leadership, cultural individualism, the prevalent idea of the democratization of expertise, and a false epistemological lens for decision-making. Including experts from multiple disciplines reveals how to address the human behavioral side of pandemic planning and operations to increase vaccine coverage rates. Including content experts from psychology and the social sciences allows the explicit recognition and preparation for distorted human behavior in planning for future pandemic response.

Predictors of nurses' intention to accept COVID-19 vaccination: A cross-sectional study in five European countries

AIMS AND OBJECTIVES

To investigate nurses' intention in accepting COVID-19 vaccination and the factors affecting their decision.

BACKGROUND

COVID-19 vaccination has started in most European countries with healthcare personnel being the first group receiving the vaccine shots. Their attitude towards vaccination is of paramount significant as their role in the frontline could help in the awareness of general population.

METHODS

A study was conducted in Albania, Cyprus, Greece, Spain and Kosovo with the use of an online questionnaire. The Fear of COVID-19 Scale was used. The STROBE checklist was followed for this cross-sectional study.

RESULTS

Study population consisted of 1135 nurses. Mean age of the participants was 38.3 years, while most of them were female gender (84.7%) and married (53.1%). Acceptance of a safe and effective COVID-19 vaccine was higher among Greek (79.2%) and Spanish (71.6%) nurses, followed by Cypriot (54%), Albanian (46.3%) and Kosovo (46.2%) nurses. Key factors for willingness to get vaccinated were male gender, living in a country with a high mortality rate in comparison with low mortality, being not infected with COVID-19, having high level of knowledge about COVID-19 vaccines and having been vaccinated for influenza in the last 2 years. Moreover, trusting the government and doctors regarding the information about the COVID-19 and having high level of fear about this virus were key factors for willingness to get vaccinated.

CONCLUSION

Vaccination of healthcare personnel is a crucial issue not only for their own safety but also for their patients'. Healthcare acceptance to get vaccinated can work as a role model for general population.

RELEVANCE TO CLINICAL PRACTICE

Gender, country, mortality rate, trust in government and health professionals and the level of fear were key factors that should be managed in clinical practice.

Measles: Moving toward eradication

ABSTRACT

Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention.

Development and Psychometric Properties of the Health Belief Scales toward COVID-19 Vaccine: A Cross-Sectional Study in North-Eastern Poland

In the study, we evaluated the psychometric properties of the Health Belief Scales Toward COVID-19 Vaccine, including the structure, reliability and validity of the scale. Psychometric properties were assessed on a general sample of 472 Polish participants aged between 19 and 69 years (M = 25.43). The procedure consisted of completing the Health Belief Scales Toward COVID-19 Vaccine, the World Health Organization’s 5-item Well-being Index (WHO-5) and demographic questions. The presented research results obtained using the measure indicate that it can be considered to be a reliable and valid research tool. A four-factor solution demonstrated a good fit to the data: χ2/df = 3.90, RMSEA = 0.079, AGFI = 0.913, GFI = 0.951, CFI = 0.960, TLI = 0.941. The reliability measures for the overall index of the Health Belief Scales Toward COVID-19 Vaccine were: Cronbach’s α = 0.88 and McDonald’s ω = 0.87. The Health Belief Scales Toward COVID-19 Vaccine total score correlated negatively and weakly with the WHO-5 score. The Health Belief Scales Toward COVID-19 Vaccine proved to be a valid and a reliable tool to assess attitudes towards vaccination in four dimensions consistent with the HBM.

Influences on Attitudes Regarding COVID-19 Vaccination in Germany

Trust in institutions and democracy may be a major contributor to the willingness to be vaccinated. We investigated these factors and others with regard to COVID-19 vaccine uptake in Germany. Even though effective vaccination is a major contributor to slowing down the current pandemic, vaccine hesitancy remains a major challenge. To analyze attitudes toward vaccine hesitancy, a web-based cross-sectional survey was used to understand and describe the influences of attitudes about vaccination against COVID-19 in the German population. A descriptive analysis for the entire dataset was carried out, and multiple proportional odds regression, path model, and structural equation modeling (SEM) were subsequently used to analyze any relationship between latent variables and COVID-19 vaccine acceptance. In total, 1092 responses from across Germany were analyzed. SEM modeling revealed that trust in institutions, trust in non-pharmaceutical interventions, and various demographic factors were associated with intent to vaccinate. Descriptive analysis and multiple proportional odds regression confirmed that a history of influenza vaccination and level of satisfaction with democratic institutions were highly predictive (p < 0.05) for COVID-19 vaccine acceptance. Additionally, social determinants of health such as gender, age, number of children in the family, and the degree of satisfaction with life were also predictors (p < 0.05) for COVID-19 vaccine acceptance. Results also demonstrated a significant relationship between receiving the flu vaccine and acceptance of the COVID-19 vaccination. Governments that provide COVID-19 vaccines and control messaging should strive for trust and transparency to maximize vaccine uptake. Government-based vaccine measures should also involve measures to communicate trust in democratic and scientific institutions.

Assessment of Oral Human Papillomavirus Prevalence in Pediatric and Adult Patients within a Multi-Ethnic Clinic Population

Introduction: Human papillomavirus (HPV) encompasses a large family of oncogenic viruses responsible for increasing rates of both cervical and oral cancer, particularly among minority and low-income populations. Although this represents an increasingly significant public health risk, few studies have screened for oral HPV within Nevada. Based upon this information, the primary objective of this study was to provide a temporal analysis of oral HPV screening among a primarily low-income, minority patient population. Methods: This retrospective analysis was reviewed and approved by the Institutional Review Board (IRB). In brief, unstimulated saliva samples were previously obtained from clinical patient volunteers who provided informed consent and pediatric assent (if applicable). DNA was isolated and screened using spectrophotometry for quality (A260:A280 ratio > 1.70) and quantity (concentration > 100 ng). Validated qPCR primers were used to screen repository samples for high-risk HPV strains HPV16 and HPV18. Results: A total of N = 930 samples were identified for this study, which involved n = 555 samples from adults and n = 375 from pediatric patients treated between 2011 and 2019. A demographic analysis revealed nearly equal distribution between males and females with most derived from non-White (minority) patients. A qPCR screening revealed an overall increase in high-risk HPV of 3.17-fold from 5.7% in 2011 to 18.1% in 2019 and a coefficient of determination or R2 = 0.764, suggesting a strong, positive correlation between more recent sample years and HPV-positive results, which was observed among both pediatric (R2 = 0.671) and adult (R2 = 0.971) patients. In addition, although the average age among adult patients increased over time, a significant decrease was observed among pediatric patients from an average of 16.0 years to 14.81 years. Conclusions: These data suggest temporal changes and positive increases in the prevalence of oral HPV among both the pediatric and adult patient samples taken from this clinic population. These data are important as considerations are made regarding which HPV vaccination education and awareness programs are introduced and the specific populations most likely to benefit from these interventions.

Assessing public knowledge, attitudes and determinants of third COVID-19 vaccine booster dose acceptance: current scenario and future perspectives

Background

People with weakened immune systems may not develop adequate protection after taking two doses of the mRNA-combined COVID-19 vaccine. The additional dose may improve the level of protection against Covid-19.

Objectives

Current study aimed to evaluate the knowledge, attitude and determents of third COVID-19 vaccine booster dose acceptance among population in the UAE.

Methods and materials

This is online descriptive cross-sectional community-based study conducted among the students and faculty of Ajman University from 25 August to 20 October 2021. The questionnaire, which was in the English language, encompassed two sections containing 22 items. Section one gathered the demographic details of the respondents, while Section two used 13 questions to evaluate the respondents’ knowledge of and attitude to the third COVID-19 vaccine booster dose.

Results

614 respondents participated in this study. The average knowledge score was 44.6% with a 95% confidence interval (CI) of [41%, 49%]. Better knowledge scores were observed in postgraduates (OR 4.29; 95% CI 2.28–8.11), employees in the healthcare sector (OR 1.62; 95% CI 1.05–2.51), participants who had relatives infected with the Covid-19 (OR 1.46; 95% CI 1.05–2.02), participants who had infected with Covid-19 (OR 2.21; 95% CI 1.43–3.43) and participants who had received first two doses of the COVID-19 vaccine (OR 2.08; 95% CI 1.40–3.11). The average attitude score was 70.2% with a 95% confidence interval (CI) of [69.2%, 71.2%].

Conclusion

Necessary steps should be taken by the government and public health authorities, in line with the local culture, to increase vaccination acceptance and foster positive attitudes towards the vaccine. A suitable approach to this would be to develop an educational framework that could demonstrate the risks of vaccine avoidance or delay to the general population. Moreover, health authorities should pay more attention to the false information being disseminated across the internet, especially social media. Also, healthcare workers should be trained in vaccinology and virology to make sure that they are able to understand important developments in these fields and convey the findings to their patients.

Willingness to Receive COVID-19 Booster Vaccine: Associations between Green-Pass, Social Media Information, Anti-Vax Beliefs, and Emotional Balance

The aims of the present investigation were (i) to determine psychological relapses of COVID-19 booster vaccine; (ii) to identify the determining factors affecting willingness to receive COVID-19 vaccine; and (iii) to study the relationship among emotional characteristics (anxiety, stress, depression, optimism), social media information, and the mandatory political choices (i.e., green-pass) in Croatian people. A cross-sectional online survey was conducted for 1003 participants (median age: 40 years) from Croatia during December 2021. Results showed a significant association between vaccinated and unvaccinated participants in all sociodemographic variables, except for gender (p = 0.905). For psychological variables, significant differences were found only for levels of optimism (p < 0.001). People with a postgraduate degree (OR: 2.25, [1.14−4.46], p = 0.020) and PhD (OR: 1.97, [95% CI: 1.01−3.52], p = 0.021) had higher odds of being vaccinated than participants with high school diplomas. Additionally, participants seeking information on TV and radio (OR: 2.35, [1.71−3.23], p < 0.001) or from general practitioner (OR: 2.53, [1.78−3.61], p < 0.001) had higher odds of being vaccinated. Conversely, participants seeking information on social networks (OR: 0.36, [0.27−0.49], p < 0.001), general internet/blogs forums (OR: 0.34, [0.22−0.52], p < 0.001), and from friends or acquaintances (OR: 0.66, [0.48−0.91], p = 0.011) had lower odds of being vaccinated. Additionally, results showed that information policies have failed to fully convince the population to vaccinate and that depression (p = 0.491), anxiety (p = 0.220), and stress (p = 0.521) were not determining factors leading to the decision to receive COVID-19 vaccine. Most of the vaccinated participants perceived the green-pass as potentially useful. In contrast, most unvaccinated participants believed that the green-pass is a form of discrimination and not useful (88%). Further and broader research into possible reasons for continuing or undertaking vaccination is needed. It is recommended to introduce a measure of conformism that represents a change of attitude, belief, or behavior in a narrower sense.

Knowledge and Attitudes toward Autism Spectrum Disorder in Saudi Arabia

Aims: The diagnosis of autism spectrum disorder (ASD) is not easy as there is no direct test that exists to establish such a diagnosis. Increasing community and healthcare professional knowledge of the ASD spectrum is crucial because it will encourage parents of ASD children to seek screening and diagnosis from a specialist, allowing for better early detection and treatment. This study explored the knowledge of the general population in Saudi Arabia regarding ASD and assessed variables associated with an accurate understanding of ASD. Methods: A total of 769 participants were involved in this cross-sectional study, which was conducted in Saudi Arabia between November 2021 and February 2022 using an online survey tool to explore the knowledge of the general population in Saudi Arabia regarding typical child development and ASD. A binary logistic regression analysis was used to determine factors affecting participants’ knowledge of autism. Results: Overall, the study participants showed a weak level of knowledge about autism with a mean score of 5.9 (SD: 3.1), comprising 34.7% of the total maximum obtainable score. Participants with a middle income category of 5000–7500 SR are less likely to be knowledgeable about autism compared to others (OR: 0.60 (95% CI: 0.39–0.92)) (p-value = 0.020). Conclusion: The participants in our study showed limited knowledge about autism. Government funds should be made available to facilitate educational services for ASD children. More funding and resources should be allocated by the government to provide assistance for children with special needs, and changes in public facilities are required to meet the demands of ASD patients. Through an informed educational effort, various media platforms should assist in improving the community’s understanding of ASD and their attitude toward ASD patients. Educational campaigns should focus on enhancing the public’s knowledge about ASD treatment and etiology.

Facilitating Middle School Students' Reasoning About Vaccines

In a pandemic era, it is necessary to equip individuals with the ability to make informed decisions about health issues, especially in relation to viruses and vaccines. In order to achieve this goal, science educators need to explore students' decisions and reasoning about vaccination. The aim of the study reported in the paper, therefore, is to explore eighth graders' reasoning about vaccination throughout a 4-week implementation of small group and plenary discussion of false claims about vaccinations. The implementation consisted of a five-phase procedure including teacher presentation of false claims and related evidence texts about vaccination, small group discussions, a plenary discussion, and finally, an introduction to valid scientific content about vaccination. The explanations of the representatives from each group during the plenary discussion were video-taped and analyzed by the researchers independently to examine student decisions on each claim. Another data source of this study included student interviews in which the researchers videotaped and analyzed eight interviewees' responses. The findings revealed that including well-informed students in small group and plenary discussions may have a positive impact on other students' reasoning. This result indicated the benefit of encouraging students to provide evidence about vaccines during small group and plenary discussions in terms of their reasoning. The implications of this study suggest the necessity of emphasizing on scientific knowledge as well as argumentation for further investigations of students' reasoning on vaccination.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11191-021-00318-8.

The risk factors and pregnant women's willingness toward the SARS-CoV-2 vaccination in various countries: A systematic review and meta-analysis

Introduction

Pregnant women will benefit from research on immunization during pregnancy because they will have more accurate information on the SARS-CoV-2 vaccine. The purpose of this study was to determine the risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries.

Methods

A search of PubMed, ProQuest, and EBSCO for related publications published (January and December 2021) on risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries. The Pooled Odds Ratio (POR) were calculated using fixed and random-effect analysis. The I-squared formula was used to calculate the heterogeneity. Egger's and Begg's tests were used to identify study bias. STATA 16.0 was used for data analysis.

Results

This study revealed good practice has the highest POR (8.99), followed by received influenza vaccine last year (2.72), high perception of SARS-CoV-2 vaccine (2.70), >35 years (2.01), sufficient information about the SARS-COV-2 vaccine (1.94), higher school education (1.84), and third trimester (1.35) with pregnant women's desire toward the SARS-CoV-2 vaccination. The heterogeneity analysis revealed homogenous among risk factors in >35 years, high perception of SARS-CoV-2 vaccine, good practice, and third trimester (I² ≤ 50%). In the articles combined in this study, there was no indication of study bias.

Conclusion

The insights of this study might help the authorities in determining the most effective strategy to deploy SARS-CoV-2 mass immunization campaigns for pregnant women.

Impact of corona-phobia on attitudes and acceptance towards COVID-19 vaccine among cancer patients: a single-center study

Aim: This study aimed to assess the impact of COVID-19 phobia and related factors on attitude towards COVID-19 vaccine in cancer patients. Methods: A prospective cross-sectional descriptive study was conducted with 300 adult patients using a validated COVID-19 Phobia Scale (C19P-S) and related survey to determine the factors affecting vaccine acceptance between May-June 2021. Results: Regarding the COVID-19 vaccine willingness, 86.7% accepted vaccination, 6.3% were hesitant and 7% refused vaccination. Patients that accepted vaccination had significantly higher C19P-S scores in general, and in psychological and psychosomatic subdivisions. Univariate analysis revealed that increased age, being retired, and being married were significantly associated with willingness to be vaccinated against COVID-19. Conclusion: The majority of patients had high 'coronophobia' levels which were associated with increased willingness for the COVID-19 vaccines. Minimizing negative attitudes towards vaccines will most likely be achieved by raising awareness in the cancer population about COVID-19 vaccine.

Knowledge of COVID-19 and Its Relationship with Preventive Behaviors and Vaccination among Adults in Northern Thailand's Community

(1) Background: the 2019 coronavirus disease outbreak (COVID-19) has posed a major threat to public health and had a significant impact on all areas of people's lives. Vaccines against COVID-19 have been developed to control the disease, and an array of personal hygiene measures has been introduced. As a result, information that will support and promote vaccination among populations as well as other health measures against COVID-19 are urgently needed. The goal of this research was to look into the knowledge about COVID-19 and how it relates to preventive behaviors and vaccination among people living in rural areas of northern Thailand. (2) Methods: a cross-sectional study was performed in four upper northern provinces of Thailand. A total of 1524 participants were recruited using the probability sampling technique. Questionnaires were distributed to collect data on general health information, as well as knowledge and preventive behaviors regarding COVID-19. (3) Results: more than half (55.9%) of the participants were female and had not received the COVID-19 vaccine (67.2%). Their mean age was 44.13 years. The majority had moderate COVID-19 knowledge and engaged in preventive behaviors (65.5% and 42.0%, respectively). A linear regression model showed that the COVID-19 knowledge score was related to the COVID-19 preventive behaviors score, with a standardized coefficient of 0.510, after adjusting for age, underlying disease, and body mass index (B = 2.64; 95%CI = 2.42, 2.87). Binary logistic regression revealed that after controlling for age, education, occupation, financial status, and current disease (AOR = 1.87; 95%CI = 1.64-2.13), the score of COVID-19 knowledge was significantly associated with having the COVID-19 vaccine. (4) Discussion: knowledge of COVID-19 is very important for people in rural regions to engage in COVID-19 prevention behaviors and vaccination. Relevant government agencies and health network partners should support proactive education campaigns emphasizing the risk of contracting the disease and its severity in order to promote vaccination against COVID-19 among unvaccinated groups. These campaigns can highlight COVID-19's positive benefit-risk balance in the short and long term and ensure public safety measures against COVID-19.

Perceptions and knowledge of COVID-19 vaccine safety and efficacy among vaccinated and non-vaccinated obstetric healthcare workers

The COVID-19 vaccines are highly effective in preventing COVID-19 illness; however, pregnant people were not included in the original COVID-19 vaccine trials, with resultant conflicting recommendations from health organizations regarding vaccinations for this high-risk population. Pregnant and lactating healthcare workers (HCWs), along with people planning a pregnancy, identified as "obstetric HCWs" in our study, were among the first to make decisions regarding vaccinating themselves against COVID-19. Given that HCWs are key sources of information and access to vaccinations, this study was conducted to understand the perceptions and knowledge of obstetric HCWs regarding the COVID-19 vaccine. An electronic survey to HCWs at a tertiary care institution in Pittsburgh, PA identified 83 obstetric HCWs, of which 65 (78.3%) received at least one dose of the either the Pfizer or Moderna COVID-19 vaccine, and 18 (21.7%) had not received any doses of vaccine. Pregnancy status influenced more people not to receive than to receive the vaccine. We found that both vaccinated and non-vaccinated obstetric HCWs had accurate knowledge regarding the COVID-19 vaccine. However, compared to non-vaccinated obstetric HCWs, vaccinated obstetric HCWs tended to endorse beliefs regarding herd immunity, believed they had a higher chance of acquiring COVID-19, and felt that the COVID-19 vaccine was safe for fetuses and people who were pregnant, lactating, breastfeeding, or planning a pregnancy. This study offers insight into obstetric individuals' perceptions and knowledge of the COVID-19 vaccine, and highlights areas where additional education and outreach may help obstetric individuals make informed decisions on receiving the COVID-19 vaccine.

Vaccine Hesitancy and Exposure to Misinformation: a Survey Analysis

INTRODUCTION

Despite the widespread availability of SARS-CoV-2 vaccines in the USA, vaccine hesitancy continues to represent a significant impediment to the attainment of herd immunity and the end of the COVID-19 pandemic. This survey analysis provides an update for clinical healthcare providers and public health officials regarding current trends in misinformation exposure, as well as common objections to COVID-19 vaccination.

METHODS

We conducted a web-based survey of 600 adults in the state of Florida between June 3 and June 14, 2021. Access to the sample was purchased through an industry-leading market research provider (Prodege MR), and survey respondents were selected using a stratified, quota sampling approach to ensure representativeness. Balanced quotas were determined (by region of the state) for gender, age, race, education, and ethnicity. The survey responses were analyzed using basic descriptive statistics, as well as chi-square testing and a logit regression model.

FINDINGS

High levels of misinformation exposure were observed among participants, with 73% reporting some exposure to misinformation about COVID-19 vaccines in the past 6 months. Exposure to misinformation was directly correlated with vaccine hesitancy. Among those who did not report any exposure to misinformation, 73.8% of respondents were vaccinated. That number fell to 62.9% with exposure to just one misinformation theme and 52.2% for six or more (χ2 = 11.349; φ = 0.138; p ≤ 0.05). Politicization was also found to be a major factor in vaccine hesitancy, with 73.4% of self-identified Democrats being vaccinated, compared to only 58.5% of Republicans and 56.5% of Independents (χ2 = 16.334; φ = 0.165; p ≤ 0.001). Both misinformation exposure and political affiliation were strong predictors of vaccination even after accounting for other demographic predictors.

DISCUSSION

The survey results add to previous research on misinformation and vaccine hesitancy by quantifying exposure to specific misinformation themes and identifying its relationship to vaccine hesitancy. Overcoming these impediments to vaccination will require strategic and targeted messaging on the part of public health professionals, which may be aided by collaboration with political thought leaders. Understanding the volume and nature of misinformation themes the public is exposed to regarding COVID-19 vaccines may aid public health officials in targeting this vaccine messaging to more directly address reasons for vaccine hesitancy.

The myth of vaccination and autism spectrum

BACKGROUND

Among all of the studied potential causes of autism, vaccines have received some of the most scrutiny and have been the topic of many evidence-based studies. These efforts have led the great majority of scientists, physicians, and public health researchers to refute causation between vaccines and autism.

RATIONALE

This presumed association and concern has been a major contributor to parents' refusal to immunize their children and has become a major threat to public health in secluded populations over the last two decades, even prior to the COVID-19 pandemic. With the emergence of COVID-19 immunizations, sentiments towards this topic were addressed as a public health concern that may influence the ability to overcome the Corona virus worldwide.

SCIENTIFIC REVIEW OF DATA

Despite the overwhelming data demonstrating that there is no link between vaccines and autism, many parents are hesitant to immunize their children because of the alleged association. Other contributing factors to the myths and conspiracy theories surrounding the association between vaccines and autism include the fact that the diagnosis of autism is typically made after the age of receiving the main childhood immunizations, as well as the occasional occurrence of regression after the age of first year vaccinations. In spite of vast evidence that the main contribution to the increase in incidence is from improvement of the diagnostic process, this rapid and publicized rise in autism diagnoses feeds parental concerns regarding any medical intervention that may be associated with the health of their children.

RECOMMENDATIONS

It is plausible that with more evidence-based studies linking autism to specific etiologies the myth will diminish and disappear eventually. In an era where conspiracy theories are prevalent on social media, it is critical that evidence-based studies relating autism to specific etiologies be made public, and that information concerning autism diagnosis and causes be made more readily available through social media and parental organizations.

COVID-19 Impact on Disparity in Childhood Immunization in Low- and Middle-Income Countries Through the Lens of Historical Pandemics

Purpose of Review

The COVID-19 pandemic, since 2020, has affected health care services and access globally. Although the entire impact of COVID-19 pandemic on existing global public health is yet to be fully seen, the impact of COVID-19 pandemic on global childhood immunization programs is of particular importance.

Recent Findings

Disruptions to service delivery due to lockdowns, challenges in vaccination programs, vaccine misinformation and hesitancy, and political and social economic inequalities all posed a threat to existing childhood immunization programs. These potential threats were especially critical in LMIC where childhood immunization programs tend to experience suboptimal implementation.

Summary

This review provides an overview of childhood immunizations and discusses past pandemics particularly in LMIC, factors contributing to disparities in childhood immunizations, and reviews potential lessons to be learned from past pandemics. Vaccine hesitancy, social determinants of health, and best practices to help lessen the pandemic's influence are also further elaborated. To address current challenges that hindered the progress made in prevention of childhood illnesses through vaccination campaigns and increased vaccine availability, lessons learned through best practices explored from past pandemics must be examined to mitigate impact of COVID-19 on childhood immunization and in turn conserve health and improve economic well-being of children especially in LMIC.

Parent Attitudes about Childhood Vaccines: Point Prevalence Survey of Vaccine Hesitancy in an Irish Population

Understanding parental attitudes to their children’s vaccination is critical to developing and implementing interventions that address parents’ hesitancy and improve vaccine uptake. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated tool for identifying vaccine hesitancy in parents. We evaluated the rate of vaccine hesitancy and areas of concern regarding childhood vaccinations using an adapted version of the PACV survey, in a convenience sample of parents attending a STEM (Science, Technology, Engineering and Mathematics) outreach event in Ireland, in 2018. A score ≥ 50 identified vaccine hesitant parents. Of 105 parents who completed the survey, the prevalence of vaccine hesitancy was 6.7%, (7/105). Parents had concerns around vaccine side effects (36.2%, n = 38), vaccine safety (20%, n = 21) and the number of vaccines administered (13.3%, n = 14). Parents trusted the vaccine information they received (85.6%, n = 90) and 81.9% (n = 86) believed that the vaccine schedule was good for their child. The findings indicate the presence of vaccine hesitancy in parents in Ireland regarding paediatric vaccines with further research necessary to address parents’ vaccine concerns. Future research should explore further, by qualitative methods, parents’ vaccine concerns. There is also potential to identify vaccine hesitant parents with the PACV survey as a surveillance method in healthcare settings; for example, in community pharmacies, family doctor clinics and out-patient clinics.

Acceptance of COVID-19 vaccination and correlated variables among global populations: A systematic review and meta-analysis

Introduction

The most awaited solution is an efficient COVID-19 vaccine. COVID-19 vaccine acceptance has not been studied in a meta-analysis. The objective of this research was to find the acceptance of COVID-19 vaccination and correlated variables.

Methods

A systematic review of studies on acceptance of COVID-19 vaccination and correlated variables in the ProQuest, PubMed, and EBSCO to find relevant articles published between January 2020 and March 2021. Using fixed and random-effect models, the risk factors Pooled Odds Ratio (POR) were measured. The heterogeneity was calculated using the I-squared formula. Egger's and Begg's tests were utilised to determine publication bias. STATA 16.0 was used for all data processing and analysis.

Results

This study results showed the related factors for COVID-19 vaccination acceptance, high income has the highest odd ratio (POR = 2.36), followed by encountered with COVID-19 (POR = 2.34), fear about COVID-19 (POR = 2.07), perceived benefits (POR = 1.81), flu vaccine during the previous season (POR = 1.69), healtcare workers (POR = 1.62), male (POR = 1.61), married (POR = 1.59), perceived risk (POR = 1.52), trust in health system (POR = 1.52), chronic diseases (POR = 1.47), high education (POR = 1.46), high level of knowledge (POR = 1.39), female (1.39), and older age (POR = 1.07). The heterogeneity calculation showed homogenous among studies in high income, fear about COVID-19, healthcare workers, married, chronic diseases, and female (I² ≤ 50%). For the studies included in this review, there was no apparent publication bias.

Conclusion

The analysis of this review may be useful to the nation in determining the best method for implementing COVID-19 mass vaccination programs based on relevant factors that influence vaccine acceptance.

Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii

Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.

Awareness, Views, and Expectations about COVID-19 Vaccinations: A Cross-Sectional Study of Dental Clinic Patients in India

INTRODUCTION

Several vaccines against coronavirus disease 2019 (COVID-19) have been licensed and are being administered worldwide in various countries. However, the awareness, behaviors, and expectations of COVID-19 vaccines among dental clinic patients are poorly understood.

METHODS

An e-survey was carried out among 1800 patients who visited dental clinics in India. The survey was carried out using a questionnaire of four parts and informed consent (i.e. sociodemographics, knowledge, attitudes, and perceptions). The investigators used Internet methods for data collection during the pandemic.

RESULTS

The mean awareness score was significantly higher among participants who reported having a university/higher level of schooling, being in the upper socioeconomic status community, living in cities, and having previously received all required vaccines. The mean attitude score was slightly higher for participants who reported being female and had a history of getting all required vaccinations. Just over half (52%) of participants felt everyone should be vaccinated. This interpretation was slightly higher among females than males (56.9% vs. 47.9%, P = 0.004).

CONCLUSIONS

The results indicate that patients attending dental clinics in India have insufficient awareness but more optimistic attitudes about the COVID-19 vaccine. Immediate health promotion campaigns must be implemented before vaccine schedules in order to increase awareness.

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh

BACKGROUND

Several vaccines have been approved for use against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh.

METHODS

An exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age = 23.17 ± 6.05 years; age range = 18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations.

RESULTS

The mean scores of knowledge and attitudes were 2.83 ± 1.48 (out of 5) and 9.34 ± 2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, having nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% of respondents believed the vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects.

CONCLUSIONS

The findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination are scheduled.

Tracking the progress in COVID-19 and vaccine safety research - a comprehensive bibliometric analysis of publications indexed in Scopus database

INTRODUCTION

COVID-19 pandemic public health emergency is one of the worse disease outbreaks in the history of infectious disease. The consequence has resulted in over 4 million deaths globally. Therefore, a more in-depth understanding of the dynamics of the disease, vaccine development, and safety has become crucial for the disease eradication.

OBJECTIVE

The study adopted bibliometric analysis to identify the global contribution in COVID-19 and Vaccine Safety and analyzed the current status, development, and research hotspots to reference for future research directions.

METHODS

Studies published between January 1, 2019 and July 11, 2021 were retrieved from the Scopus database. Data analysis and visualization were conducted using VOSviewer ver 1.6.6, Bibliometrix app. (Using R).

RESULTS

A total of 1827 publications with 12.14 average citations per document were identified. These publications were published in 796 journals by 10,243 authors (with 5.61 authors per document) from 80 countries/regions. About 33.75% of the researches were from the developed countries. The USA, China, and India were top contributors for scientific research on COVID-19 and vaccine safety. The "Vaccine" is the most productive journal with 58 articles. Li Y, NA NA, and Liu X were the top three prolific authors. Furthermore, "Human," "Coronavirus disease 2019," and "Drug safety," were the most common frontier topics.

CONCLUSIONS

Our analysis highlights the characteristics of the most influential articles on COVID-19 related to vaccine safety. The findings provided valuable insight into the scientific research progress in this domain and suggest scaling-up research and information dissemination on COVID-19 and vaccine safety.

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.

Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021

INTRODUCTION

Health care workers are the most affected part of the world population due to the COVID-19 pandemic. Countries prioritize vaccinating health workers against COVID-19 because of their susceptibility to the virus. However, the acceptability of the vaccine varies across populations. Thus, this study aimed to determine the health care worker's intentions to accept the COVID-19 vaccine and its associated factors in southwestern Ethiopia, 2021.

METHODS

A facility-based cross-sectional study was conducted among health care workers in public hospitals in southwestern Ethiopia from March 15 to 28, 2021. A simple random sampling method was used to select 405 participants from each hospital. Data were collected using self-administered questionnaires. Descriptive statistics, such as frequency and percentage, were calculated. Multivariable logistic regression was also performed to identify factors associated with health care worker's intention to accept the COVID-19 vaccine. Statistically significant variables were selected based on p-values (<0.05) and the adjusted odds ratio was used to describe the strength of association with 95% confidence intervals.

RESULT

Among the respondents, 48.4% [95% CI: 38.6, 58.2] of health care workers intended to accept COVID-19. Intention to accept COVID-19 vaccination was significantly associated with physicians (AOR = 9.27, 95% CI: 1.27-27.32), professionals with a history of chronic illness (AOR = 4.07, 95% CI: 2.02-8.21), perceived degree of risk of COVID-19 infection (AOR = 4.63, 95% CI: 1.26-16.98), positive attitude toward COVID-19 prevention (AOR = 6.08, 95% CI: 3.39-10.91) and good preventive practices (AOR = 2.83, 95% CI: 1.58-5.08).

CONCLUSION

In this study, the intention of health care workers to accept the COVID-19 vaccine was low. Professional types, history of chronic illness, perceived degree of risk to COVID-19 infection, attitude toward COVID-19 and preventive practices were found to be factors for intention to accept COVID-19 vaccine in professionals. It is important to consider professional types, history of chronic illness, perceived degree of risk to COVID-19, attitude of professionals and preventive behaviors to improve the intention of professionals' vaccine acceptance.

Prevalence and Drivers of COVID-19 Vaccine Hesitancy among Czech University Students: National Cross-Sectional Study

Background: university students are believed to retain the highest levels of health literacy. They are perceived as the opinion leaders within their communities; therefore, their health-related beliefs and attitudes are deemed important for public health campaigns. This study aimed to investigate the COVID-19 vaccine hesitancy drivers among university students in the Czech Republic. Methods: a cross-sectional study using a self-administered questionnaire was carried out in the weeks before the unrestricted vaccine deployment to Czech adults. The questionnaire had 21 multiple-choice items stratified in 4 categories; demographic characteristics, COVID-19-related anamnesis and influenza vaccine experience, attitudes towards COVID-19 vaccination, and the possible drivers of COVID-19 vaccine hesitancy suggested by the WHO-SAGE. Results: out of the 1351 included students, 66.8% were females, 84.5% were Czech nationals, and 40.6% enrolled in healthcare programs. The overall COVID-19 vaccine acceptance level was 73.3%, 19.3% of participants were vaccine-resistant, and only 7.4% were vaccine-hesitant. Trust in the pharmaceutical industry, trust in healthcare providers, and perceived knowledge sufficiency predicted higher odds of vaccine acceptance. In contrast, media and social media, personal beliefs, immunity misconception, previous COVID-19 infection, and suspicions about novel vaccines and the local availability predicted higher odds of vaccine hesitancy. Conclusions: The findings of this study predict a fair probability to achieve community immunity (herd immunity) among the target population group. The primary prevention strategies in the Czech Republic need to be culturally sensitive and inclusive for foreign nationals. As one-quarter of the participating students are dependent on vaccine safety data, this study findings support the call for independent studies evaluating the side effects of COVID-19 vaccines.

Predictors of pregnant women's intention to vaccinate against coronavirus disease 2019: A facility-based cross-sectional study in southwest Ethiopia

OBJECTIVE

Ethiopia is planning to vaccinate 20% of its population against the coronavirus disease 2019 pandemic by the end of 2021-however, there is no single piece of evidence regarding pregnant women's intention to be vaccinated against coronavirus disease 2019; hence, the objective of this study was to investigate predicting factors of intention to be vaccinated against coronavirus disease 2019 among pregnant women in Bench-Sheko Zone, southwest Ethiopia.

METHODS

Facility-based cross-sectional study was undertaken from 1 February to 1 March 2021 in southwest Ethiopia. The study was carried out among pregnant women who came for antenatal care service in the selected public health facilities. Interviewer-administered structured tool was used to collect the data. Data were entered into EpiData (version 3.1) and then analyzed using SPSS (version 20).

RESULTS

The study revealed that only 31.3% (95% confidence interval: 26.7-35.2) of the participants had an intention to be vaccinated against coronavirus disease 2019 when the vaccine will be made available in Ethiopia. Participants' intention to be vaccinated against coronavirus disease 2019 was significantly associated with attaining secondary school and above (adjusted odds ratio = 4.24, 95% confidence interval: 2.23-9.32), residing in urban areas (adjusted odds ratio = 2.57, 95% confidence interval: 1.22-5.40), being compliant with coronavirus disease 2019 guidelines (adjusted odds ratio = 5.86, 95% confidence interval: 3.40-10.09), and having good perception toward coronavirus disease 2019 vaccine (adjusted odds ratio = 3.04, 95% confidence interval: 1.64-5.62).

CONCLUSION

Above all, in this study, pregnant women's intention to vaccinate against coronavirus disease 2019 was very low when compared with previous studies. Hence, before commencing the coronavirus disease 2019 vaccination program in Ethiopia, it is essential to launch a widespread public health education campaign that could improve people's perception of the vaccine. Besides, the upcoming public health intervention programs better put special emphasis on community members with lower educational attainment backgrounds and rural residents.

A Pilot Study of Medical Misinformation Perceptions and Training Among Practitioners in North Carolina (USA)

Medical misinformation (MM) is a problem for both medical practitioners and patients in the 21^st century. Medical practitioners have anecdotally reported encounters with patient-held misinformation, but to date we lack evidence that quantifies this phenomenon. We surveyed licensed practitioners in the state of North Carolina to better understand how often patients mention MM in the clinical setting, and if medical practitioners are trained to engage with patients in these specific conversations. We administered an anonymous, online survey to physicians and physician assistants licensed to practice in the state of North Carolina. Questions focused on demographics, clinical encounters with MM, and training to discuss MM with patients. We received over 2800 responses and analyzed 2183 after removing ineligible responses. Our results showed that most respondents encountered MM from patients (94.2% (2047/2183)), with no significant differences between clinical specialty, time spent in practice, or community type. When asked about specific training, 18% (380/2081) reported formal experiences and 39% (807/289) reported informal experiences. MM has been salient due to the COVID-19 pandemic; however, it was present before and will remain after the pandemic. Given that MM is widespread but practitioners lack training on engaging patients in these conversations, a sustained effort to specifically train current and future practitioners on how to engage patients about MM would be an important step toward mitigating the spread of MM.

Using Machine Learning-Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions

Background

The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion.

Objective

The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)–based methods.

Methods

Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation.

Results

A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99%).

Conclusions

ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion.

Vaccination status, acceptance, and knowledge toward a COVID-19 vaccine among healthcare workers: a cross-sectional survey in China

Healthcare workers (HCWs) are considered both a high-risk population regarding infections and effective vaccine recommenders whose willingness to be vaccinated is the key to herd immunity. However, the vaccination status, acceptance, and knowledge of the 2019 coronavirus disease (COVID-19) vaccine among HCWs remain unknown. Therefore, we conducted an online survey regarding the above among HCWs in China after the vaccine was made available. Questionnaires returned by 1,779 HCWs were analyzed. Among these participants, 34.9% were vaccinated, 93.9% expressed their willingness to receive the COVID-19 vaccine, and vaccine knowledge level was high (89.2%). A bivariate analysis found that participants with a college degree, low level of knowledge, non-exposure to COVID-19 status, and those who are females or nurses have a lower vaccination rate, while participants who are married, with a monthly income of more than 5,000 yuan, and low knowledge levels are less willing to be vaccinated. A multivariate analysis found that participants with a high (OR = 7.042, 95% CI = 4.0918-12.120) or medium (OR = 3.709, 95% CI = 2.072-6.640) knowledge level about COVID-19 vaccines were more willing to be vaccinated. Participants were less likely to accept a COVID-19 vaccine if they were married (OR = 0.503, 95% CI = 0.310-0.815). In summary, Chinese HCWs have a strong willingness to be vaccinated and a high level of knowledge. Measures, such as targeted education for HCWs with low willingness and low level of knowledge, open vaccine review procedures, increased government trust, reduced vaccine costs, and provide vaccination guarantee policies, may improve the vaccination coverage of the at-risk group.

COVID-19 Vaccination Acceptance and Its Associated Factors in Sodo Town, Wolaita Zone, Southern Ethiopia: Cross-Sectional Study

BACKGROUND

Coronavirus disease (COVID-19) pandemic has still affected many countries around the world. The COVID-19 vaccine has been presented as the perfect solution for solving the current pandemic. Understanding the willingness of the community to receive the COVID-19 vaccine will help in the development and implementation of effective COVID-19 vaccination promotion programs. The aim of this study was to assess the COVID-19 vaccination acceptance and its associated factors in Sodo town, Wolaita zone, Southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 415 participants in Wolaita Sodo, from April 1 to 30, 2021. To collect data, structured interviewer administered questionnaire was used. A p-value ≤0.05 in a multivariable logistic regression model was considered statistically significant.

RESULTS

Of 415 participants, 189 (45.5%) of them accepted of COVID-19 vaccines if available. Sex (AOR=2.15, 95% CI: 1.29, 3.56), educational status (AOR=3.09, 95% CI: 1.50, 6.37), mass media (AOR=1.97, 95% CI: 1.06, 3.63), received any vaccination during childhood (AOR=5.16, 95% CI: 2.44, 10.92), family members have been diagnosed with COVID-19 (AOR=4.40, 95% CI: 2.1, 9.25), friends have been diagnosed with COVID-19 (AOR=3.91, 95% CI: 1.52, 10.04), and respondents have tested for COVID-19 (AOR=4.40, 95% CI: 1.70, 11.36) were significantly associated with acceptance of COVID-19 vaccine.

CONCLUSION

The prevalence of COVID-19 vaccination acceptance was law. To enhance the acceptance of COVID-19 vaccine, the government with different stakeholders should strengthen public education using mass media about the advantage of getting COVID-19 vaccination.

Review: Vaccine Myth-Buster - Cleaning Up With Prejudices and Dangerous Misinformation

Although vaccines have already saved and will continue to save millions of lives, they are under attack. Vaccine safety is the main target of criticism. The rapid distribution of false information, or even conspiracy theories on the internet has tremendously favored vaccine hesitancy. The World Health Organization (WHO) named vaccine hesitancy one of the top ten threats to global health in 2019. Parents and patients have several concerns about vaccine safety, of which the ubiquitous anxieties include inactivating agents, adjuvants, preservatives, or new technologies such as genetic vaccines. In general, increasing doubts concerning side effects have been observed, which may lead to an increasing mistrust of scientific results and thus, the scientific method. Hence, this review targets five topics concerning vaccines and reviews current scientific publications in order to summarize the available information refuting conspiracy theories and myths about vaccination. The topics have been selected based on the author's personal perception of the most frequently occurring safety controversies: the inactivation agent formaldehyde, the adjuvant aluminum, the preservative mercury, the mistakenly-drawn correlation between vaccines and autism and genetic vaccines. The scientific literature shows that vaccine safety is constantly studied. Furthermore, the literature does not support the allegations that vaccines may cause a serious threat to general human life. The author suggests that more researchers explaining their research ideas, methods and results publicly could strengthen the general confidence in science. In general, vaccines present one of the safest and most cost-effective medications and none of the targeted topics raised serious health concerns.

A comprehensive overview of vaccines developed for pandemic viral pathogens over the past two decades including those in clinical trials for the current novel SARS-CoV-2

The unprecedented coronavirus disease 2019 (COVID-19) is triggered by a novel strain of coronavirus namely, Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2). Researchers are working around the clock to control this pandemic and consequent waves of viral reproduction, through repurposing existing drugs as well as designing new vaccines. Several countries have hastened vaccine design and clinical trials to quickly address this outbreak. Currently, more than 250 aspirants against SARS-CoV-2 are in progress, including mRNA-replicating or non-replicating viral vectored-, DNA-, autologous dendritic cell-based-, and inactivated virus-vaccines. Vaccines work by prompting effector mechanisms such as cells/molecules, which target quickly replicating pathogens and neutralize their toxic constituents. Vaccine-stimulated immune effectors include adjuvant, affinity, avidity, affinity maturation, antibodies, antigen-presenting cells, B lymphocytes, carrier protein, CD4+ T-helper cells. In this review, we describe updated information on the various vaccines available over the last two decades, along with recent progress in the ongoing battle developing 63 diverse vaccines against SARS-CoV-2. The inspiration of our effort is to convey the current investigation focus on registered clinical trials (as of January 08, 2021) that satisfy the safety and efficacy criteria of international wide vaccine development.

Severe Acute Respiratory Syndrome Coronavirus 2: Vaccine Hesitancy Among Underrepresented Racial and Ethnic Groups With HIV in Miami, Florida

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) disproportionally affect underrepresented ethnoracial groups in the United States. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake.

METHODS

We conducted a cross-sectional study of adults ≥18 years of age with HIV residing in Miami, Florida. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April to August 2020 and followed by a coronavirus disease 2019 (COVID-19) vaccine hesitancy survey from August to November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group of Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of the Fisher exact test.

RESULTS

A total of 94 participants were enrolled; mean age was 54.4 years, 52% were female, 60% were Black non-Latinx, and 40% were non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, P = .009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, P = .029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, P = .002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, P = .049).

CONCLUSIONS

Medical mistrust, vaccine hesitancy, and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.

Vaccine Production Process: How Much Does the General Population Know about This Topic? A Web-Based Survey

Background: Vaccine hesitancy has been recognized as a major global health threat by the World Health Organization. Many studies have investigated vaccine safety as a determinant for vaccine hesitancy; however, not much attention has been paid to vaccine production and quality control during the vaccine production process or whether knowledge about this topic may influence vaccine confidence. The aim of this study was to characterize the common knowledge about the vaccine production process. Methods: A freely accessible online questionnaire was developed on Google Modules and disseminated through social networks. A descriptive analysis of the collected answers was performed, and the chi-square test was used to assess significant differences for the sociodemographic characteristics of the study population (age, gender, work or education and training in the healthcare setting, minor offspring). A binary logistic regression model was performed considering these socio-demographic categories as independent variables. Results: The number of collected questionnaire was 135. Most of the participants (127/135, 94.1%) were aware that quality control measures are carried out during manufacturing, although some knowledge gaps emerged in specific aspects of the vaccine production process, without statistically significant differences between age groups. Working in the healthcare setting or being educated in healthcare may be considered predictors for a better understanding that more than 50% of the production time is spent on quality control (AOR = 3.43; 95% CI: 1.84–8.14, p = 0.01) and that considering quality control performed during the vaccine production process is adequate for avoiding contamination (AOR = 7.90; 95% CI: 0.97–64.34; p = 0.05). Conclusions: This study allowed for a characterization of common knowledge about the vaccine production process. It highlighted the need to implement specific strategies to spread correct information about the vaccine production process. This study may contribute to increased confidence and trust in vaccines and vaccination among the general population.

A comparative assessment of attitudes and hesitancy for influenza vis-à-vis COVID-19 vaccination among healthcare students and professionals in Malta

Introduction

Vaccine hesitancy has been a public health threat for decades, even among healthcare professionals. The study explored vaccination attitudes and hesitancy with regard to seasonal influenza and the anticipated Covid-19 vaccines among healthcare professionals and students.

Methods

Anonymous questionnaires were distributed through electronic mail to healthcare professionals working in Malta's Health Division, at University of Malta, and in community pharmacies, and to members of Malta College of Family Doctors.

Results

The response rate was 18.60% (n = 1802). The percentages of those who took the influenza vaccine last year (2019) and who will take it this year (2020) increased across professionals, highest for family doctors and lowest for trainees in family medicine. The proportion of those likelier to take the Covid-19 vaccine was directly related to likelihood of taking influenza vaccination. Both family doctor trainees and nurses showed the highest Covid-19 vaccine hesitancy. Concerns pertaining to COVID-19 vaccination were mostly related to insufficient knowledge, although pharmacists (community, academic and students) were concerned about the rapid approval of the vaccine.

Conclusion

An increase in influenza vaccine uptake is expected in view of the current Covid-19 pandemic. Of concern is the hesitancy towards Covid-19 vaccine particular within healthcare professionals, a cohort expected to be insightful and potential role models for the community. The associated hesitancy for both COVID-19 and influenza vaccination infers an intrinsic degree of vaccine hesitancy, which brings forward the need for healthcare professionals to be engaged in education, vaccination policies and administration in order to ensure compliance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-021-01585-z.