Why are we vaccinating children against COVID-19?

Determinants of parents' intention to vaccinate their children aged 12-17 years against COVID-19 in North Kivu (Democratic Republic of Congo)

Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. We aimed to investigate parents' willingness to vaccinate their children against COVID-19 in North Kivu province, (Democratic Republic of Congo). A cross-sectional survey between 1 December 2021 to 20 January 2022 in six health zones (Goma, Karisimbi, Butembo, Beni, Kamango, and Katwa) was conducted in the province of North Kivu. In each health zone, we selected five clusters (Health area) using the method of probabilistic selection proportional to population size. In total, 522 parents participated in our study. Results: Overall, 32.8% of parents intended to vaccinate their children. In the multivariate analysis, a younger age of parents (aOR: 2.40, CI: [1.50-3.83]), a higher level of fear that "a member of my family" could contract COVID-19 (aOR: 2.35, CI: [1.38-4.02]), a higher level of perceived vulnerability to COVID-19 within the family (aOR: 1.70, CI: [1.005-2.2881]), a higher level of perceived susceptibility to COVID-19 within the family (aOR: 3.07, CI: [1.80-5.23]), and a history of vaccination against COVID-19 among parents (aOR: 16.47, CI: [8.39-32.33]), were all significantly associated with the intention of parents to have their children or adolescents vaccinated. According to the different explanatory factors of the will to have their children vaccinated, an emphasis on the health education of parents who are prone to refusal or hesitation of the vaccine, by addressing the common reasons for the refusal of the vaccine and highlight the vaccine's benefits.

SEIR models in the light of Critical Realism - A critique of exaggerated claims about the effectiveness of Covid 19 vaccinations

In a recent modeling study Watson et al. (Lancet Infect Dis 2022;3099:1-10) claim that Covid-19 vaccinations have helped to prevent roughly 14-20 million deaths in 2021. This conclusion is based on an epidemiological susceptible-exposed-infectious-recovered (SEIR) model trained on partially simulated data and yielding a reproduction number distribution which was then applied to a counterfactual scenario in which the efficacy of vaccinations was removed. Drawing on the meta-theory of Critical Realism, we point out several caveats of this model and caution against believing in its predictions. We argue that the absence of vaccinations would have significantly changed the causal tendencies of the system being modelled, yielding a different reproduction number than obtained from training the model on actually observed data. Furthermore, the model omits many important causal factors. Therefore this model, similar to many previous SEIR models, has oversimplified the complex interplay between biomedical, social and cultural dimensions of health and should not be used to guide public health policy. In order to predict the future in epidemic situations more accurately, continuously optimized dynamic causal models which can include the not directly tangible, yet real causal mechanisms affecting public health appear to be a promising alternative to SEIR-type models.

The Role of Immunity in the Pathogenesis of SARS-CoV-2 Infection and in the Protection Generated by COVID-19 Vaccines in Different Age Groups

This study aims to review the available data regarding the central role of immunity in combating SARS-CoV-2 infection and in the generation of protection by vaccination against COVID-19 in different age groups. Physiologically, the immune response and the components involved in it are variable, both functionally and quantitatively, in neonates, infants, children, adolescents, and adults. These immunological differences are mirrored during COVID-19 infection and in the post-vaccination period. The outcome of SARS-CoV-2 infection is greatly dependent on the reaction orchestrated by the immune system. This is clearly obvious in relation to the clinical status of COVID-19 infection, which can be symptomless, mild, moderate, or severe. Even the complications of the disease show a proportional pattern in relation to the immune response. On the contrary, the commonly used anti-COVID-19 vaccines generate protective humoral and cellular immunity. The magnitude of this immunity and the components involved in it are discussed in detail. Furthermore, many of the adverse effects of these vaccines can be explained on the basis of immune reactions against the different components of the vaccines. Regarding the appropriate choice of vaccine for different age groups, many factors have to be considered. This is a cornerstone, particularly in the following age groups: 1 day to 5 years, 6 to 11 years, and 12 to 17 years. Many factors are involved in deciding the route, doses, and schedule of vaccination for children. Another important issue in this dilemma is the hesitancy of families in making the decision about whether to vaccinate their children. Added to these difficulties is the choice by health authorities and governments concerning whether to make children's vaccination compulsory. In this respect, although rare and limited, adverse effects of vaccines in children have been detected, some of which, unfortunately, have been serious or even fatal. However, to achieve comprehensive control over COVID-19 in communities, both children and adults have to be vaccinated, as the former group represents a reservoir for viral transmission. The understanding of the various immunological mechanisms involved in SARS-CoV-2 infection and in the preparation and application of its vaccines has given the sciences a great opportunity to further deepen and expand immunological knowledge. This will hopefully be reflected positively on other diseases through gaining an immunological background that may aid in diagnosis and therapy. Humanity is still in continuous conflict with SARS-CoV-2 infection and will be for a while, but the future is expected to be in favor of the prevention and control of this disease.

Recent Advances in Lipid Nanoparticles for Delivery of mRNA

Messenger RNA (mRNA), which is composed of ribonucleotides that carry genetic information and direct protein synthesis, is transcribed from a strand of DNA as a template. On this basis, mRNA technology can take advantage of the body's own translation system to express proteins with multiple functions for the treatment of various diseases. Due to the advancement of mRNA synthesis and purification, modification and sequence optimization technologies, and the emerging lipid nanomaterials and other delivery systems, mRNA therapeutic regimens are becoming clinically feasible and exhibit significant reliability in mRNA stability, translation efficiency, and controlled immunogenicity. Lipid nanoparticles (LNPs), currently the leading non-viral delivery vehicles, have made many exciting advances in clinical translation as part of the COVID-19 vaccines and therefore have the potential to accelerate the clinical translation of gene drugs. Additionally, due to their small size, biocompatibility, and biodegradability, LNPs can effectively deliver nucleic acids into cells, which is particularly important for the current mRNA regimens. Therefore, the cutting-edge LNP@mRNA regimens hold great promise for cancer vaccines, infectious disease prevention, protein replacement therapy, gene editing, and rare disease treatment. To shed more lights on LNP@mRNA, this paper mainly discusses the rational of choosing LNPs as the non-viral vectors to deliver mRNA, the general rules for mRNA optimization and LNP preparation, and the various parameters affecting the delivery efficiency of LNP@mRNA, and finally summarizes the current research status as well as the current challenges. The latest research progress of LNPs in the treatment of other diseases such as oncological, cardiovascular, and infectious diseases is also given. Finally, the future applications and perspectives for LNP@mRNA are generally introduced.

Why do people consent to receiving SARS-CoV-2 vaccinations? A representative survey in Germany

OBJECTIVE

To answer the question: Why do people consent to being vaccinated with novel vaccines against SARS-CoV-2?

DESIGN

Representative survey.

SETTING

Online panel.

PARTICIPANTS

1032 respondents of the general German population.

METHOD

A representative survey among German citizens in November/December 2021 that resulted in 1032 complete responses on vaccination status, sociodemographic parameters and opinions about the COVID-19 situation.

RESULTS

Almost 83% of the respondents were vaccinated. The major motivation was fear of medical consequences of an infection and the wish to lead a normal life again. The major motivation to be not vaccinated was the fear of side effects and scepticism about long-term effectiveness and safety. Sixteen per cent of vaccinated respondents reported some serious side effect, while more than 30% reported health improvements, mostly due to the relief of psychological stress and social reintegration. We also validated a 'Corona Orthodoxy Score-COS' consisting of seven items reflecting opinions on COVID-19. The scale is reliable (alpha=0.76) and unidimensional. The COS was a highly significant predictor of vaccination status and readiness to be vaccinated in a multivariable logistic regression model. Those who were vaccinated were more likely to live in smaller households (OR=0.82, p=0.024), had a higher income (OR=1.27, p<0.001), a higher COS score (OR 1.4, p<0.0001) and used less alternative media (OR=0.44, p=0.0024) and scientific publications (OR=0.42, p=0.011) as information sources.

CONCLUSIONS

The major motives for being vaccinated are fear of medical symptoms and the wish to lead a normal life. Those not wanting to be vaccinated cite a lack of knowledge regarding long-term safety and side effects as reasons. This can likely only be overcome by careful and active long-term efficacy and safety monitoring.

Parents' views on the acceptability of a COVID-19 vaccine for their children: A cross-sectional study in Abu Dhabi-United Arab Emirates

BACKGROUND

The United Arab Emirates had approved the COVID-19 vaccine for children. Assessing parents' acceptance of the vaccine for their children will influence decision-making in the COVID-19 vaccine roll-out.

METHOD

Parents registered inthe AbuDhabiDepartmentofEducation (12,000 families) were invitedtocompleteanonlinequestionnaire from 8th September 2021 to 17th October 2021. Out of the 12,000 families, 2510 (21%) participants answered the survey. The questionnaire investigated the parents' attitudes and beliefs regarding the COVID-19 vaccine.

RESULTS

The vaccination rate among this group of respondents was high, with 2255 (89.9%) having received two doses and 1002 (45.5%) having already received a booster dose. Acceptance of the respondents to vaccinate their children was high, (75.1%) said they would vaccinate their children, with 64.4% reporting that they would immediately vaccinate their children if the vaccine were made available. Determinants of COVID-19 child vaccination acceptance included the respondent's vaccination status-i.e., if the respondent is already vaccinated (OR 4.96 [2.89-8.53]) or has taken the third dose (OR 2.37 [1.4-4.01])-their children's age (OR 1.11 [1.30-1.18] for older children), and their trust in the following information sources: the government (OR 2.53 [1.61-3.98]), health care providers (OR 1.98 [1.2-3.24]), or social media (OR 2.17 [1.22-3.88]). Increased level of education had a negative impact on the acceptance of giving the vaccine to children (OR 0.63 [0.52-0.77]); fear of side effects OR 0.000164 (0.000039-0.001) was another determinant. The main factor that encouraged parents to give their children the vaccine was to protect their child's health as reported by 1537 (55.5%) participants.

CONCLUSION

The Abu Dhabi community is highly accepting of the vaccine for their children. Future studies of how this vaccine acceptance can influence the pandemic are needed.

Efficacy and Safety of Complementary Therapy With Jing Si Herbal Tea in Patients With Mild-To-Moderate COVID-19: A Prospective Cohort Study

Background

Since late 2019, there has been a global COVID-19 pandemic. To preserve medical capacity and decrease adverse health effects, preventing the progression of COVID-19 to severe status is essential. Jing-Si Herbal Tea (JSHT), a novel traditional Chinese medicine formula was developed to treat COVID-19. This study examined the clinical efficacy and safety of JSHT in patients with mild-to-moderate COVID-19.

Methods

In this prospective cohort study, we enrolled 260 patients with mild-to-moderate COVID-19. The enrolled patients were divided into the JSHT (n = 117) and control (n = 143) groups. Both groups received standard management. The JSHT group was treated with JSHT as a complementary therapy.

Results

Compared with standard management alone, JSHT combined with standard management more effectively improved the reverse transcription–polymerase chain reaction cycle threshold value, C-reactive protein level, and Brixia score in the adult patients with mild-to-moderate COVID-19, especially in the male and older patients (those aged ≥60 years). The results revealed that the patients treated with JSHT combined with standard management had 51, 70, and 100% lower risks of intubation, Medisave Care Unit admission, and mortality compared with those receiving standard management only.

Conclusions

JSHT combined with standard management more effectively reduced the SARS-CoV-2 viral load and systemic inflammation and alleviated lung infiltrates in the patients with mild-to-moderate COVID-19, especially in the male and older patients (those aged ≥60 years). JSHT combined with standard management may prevent critical status and mortality in patients with mild-to-moderate COVID-19. JSHT is a promising complementary therapy for patients with mild-to-moderate COVID-19.

Parental coronavirus disease vaccine hesitancy for children in Bangladesh: a cross-sectional study

Background: Coronavirus disease 2019 (COVID-19) requires mass immunization to control the severity of symptoms and global spread. Data from developed countries have shown a high prevalence of parental COVID-19 vaccine hesitancy. However, parental vaccine hesitancy data in low- and middle-income countries are scarce. This study aimed to assess the prevalence of parental vaccine hesitancy and identify subgroups with higher odds of vaccine hesitancy in parents in Bangladesh.

Methods: A cross-sectional study was conducted on the parents of children aged <18 years from October 10, 2021 to October 31, 2021. Parents participated in face-to-face interviews in randomly selected locations in Bangladesh using a vaccine hesitancy questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified using binary logistic regression analysis.

Results: Data from 2,633 eligible parents were analyzed. Overall, 42.8% reported COVID-19 vaccine hesitancy for their youngest child. The final model suggested the following factors were associated with hesitancy: children's age; parent's age, religion, occupation, monthly household income, permanent address, living location, status of tobacco use, adherence with regular government vaccination programs (other than COVID-19), perceptions of COVID-19 vaccine efficacy among Bangladeshi children, self-vaccination intentions, reported family members' illness or death from COVID-19, and perceived threat of COVID-19 were the independent predictors of parental COVID-19 vaccine hesitancy. Conversely, participants who were not tobacco users, parents who were very likely to believe that their children or family members could be infected with COVID-19 in the following year and who were very concerned about their children or a family member contracting COVID-19 in the next year had significantly lower odds of COVID-19 vaccine hesitancy.

Conclusions: Our study suggested that vaccine hesitation varied based on sociodemographic characteristics, religion, behavior, and perceived COVID-19 threat. Therefore, interventions focused on addressing vaccine hesitancy among specific subgroups are warranted.

Unresolved COVID Controversies: 'Normal science' and potential non-scientific influences

ABSTRACTThe COVID-19 health crisis has so far involved enormous consequences in human pain, suffering and death. While biomedical science responded early, its response has been marked by several controversies between what appeared to be mainstream perspectives, and diverse alternative views; far from leading to productive debate, controversies often preceded polarisation and, allegedly, exclusion and even censorship of alternative views, followed by the pretense of scientific consensus. This paper describes and discusses the main controversies in the production of COVID biomedical knowledge and derived control measures, to establish if alternative positions are also legitimate from a 'normal science' perspective (rather than comparing them for superiority); explores potential non-scientific explanations of the alleged exclusion of certain views; and analyzes ethical issues implied. The operation of non-scientific factors in scientific and regulatory processes (e.g. various forms of subtle corruption) has been documented in the past; the intervention of such influences in the mishandling of controversies (i.e. on early management, non-pharmacological prevention and vaccination) cannot be ruled out and deserves further investigation. Some of these controversies, increasingly visible in the public domain, also involve ethical challenges that need urgent attention. Polarisation, censorship and dogma are foreign to true science and must be left behind.

Parental coronavirus disease vaccine hesitancy for children in Bangladesh: a cross-sectional study

Background: Coronavirus disease 2019 (COVID-19) requires mass immunization to control the severity of symptoms and global spread. Data from developed countries have shown a high prevalence of parental COVID-19 vaccine hesitancy. However, parental vaccine hesitancy data in low- and middle-income countries are scarce. This study aimed to assess the prevalence of parental vaccine hesitancy and identify subgroups with higher odds of vaccine hesitancy in parents in Bangladesh. Methods: A cross-sectional study was conducted on the parents of children aged <18 years from October 10, 2021 to October 31, 2021. Parents participated in face-to-face interviews in randomly selected locations in Bangladesh using a vaccine hesitancy questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified using binary logistic regression analysis. Results: Data from 2,633 eligible parents were analyzed. Overall, 42.8% reported COVID-19 vaccine hesitancy for their youngest child. The final model suggested the following factors were associated with hesitancy: children's age; parent's age, religion, occupation, monthly household income, permanent address, living location, status of tobacco use, adherence with regular government vaccination programs (other than COVID-19), perceptions of COVID-19 vaccine efficacy among Bangladeshi children, self-vaccination intentions, reported family members' illness or death from COVID-19, and perceived threat of COVID-19 were the independent predictors of parental COVID-19 vaccine hesitancy. Conversely, participants who were not tobacco users, parents who were very likely to believe that their children or family members could be infected with COVID-19 in the following year and who were very concerned about their children or a family member contracting COVID-19 in the next year had significantly lower odds of COVID-19 vaccine hesitancy. Conclusions: Our study suggested that vaccine hesitation varied based on sociodemographic characteristics, religion, behavior, and perceived COVID-19 threat. Therefore, interventions focused on addressing vaccine hesitancy among specific subgroups are warranted.

Suicidality and COVID-19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID-19 pandemic (Review)

Since the outbreak of the coronavirus 2019 (COVID-19) pandemic, there has been widespread concern that social isolation, financial stress, depression, limited or variable access to health care services and other pandemic-related stressors may contribute to an increase in suicidal behaviors. In patients who have recovered from COVID-19, an increased risk of developing suicidal behaviors may be noted, while post-COVID syndrome comprises another potential risk factor contributing to increased suicidal behaviors. Despite the initial alarming predictions for an increase in suicide rates due to the COVID-19 pandemic, the majority of published studies to date suggest that experienced difficulties and distress do not inevitably translate into an increased number of suicide-related deaths, at least not in the short-term. Nevertheless, the long-term mental health effects of the COVID-19 pandemic have yet to be unfolded and are likely to remain for a long period of time. Suicide prevention and measures aiming at promoting well-being and mitigating the effects of COVID-19 on mental health, particularly among vulnerable groups, should thus be a priority for healthcare professionals and policymakers amidst the evolving COVID-19 pandemic.