Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada

A Pilot Study on the Knowledge, Attitude, and Practice of Mothers About Their Children's Vaccination in a Medical Institute in Jharkhand, India

Introduction Immunisation is one of the key public health instruments to combat childhood morbidity and mortality. However, the lack of mothers' knowledge and motivation to vaccinate their children has affected vaccination programs and vaccination coverage rate in the state of Jharkhand. Therefore, addressing this knowledge gap, our study aims to evaluate the extent of mothers' understanding of the effects and aspects of vaccination for their children. Materials and method This is a cross-sectional study conducted at the paediatric vaccination clinic of Rajendra Institute of Medical Sciences (RIMS), Ranchi between October 2022 and September 2023. The sample population included 200 mothers as participants (18 years and above). The survey was done with a self-administered questionnaire of questions about socio-demographic factors, mothers' knowledge, and mothers' practices, and answers were consolidated in the form of a table. Results The majority of participants in this study were below 25 years of age and were literate. The missed vaccination percentage was also significantly higher among illiterates, mothers below 30 years of age, and unemployed ones. Among the respondents, 73.3% of illiterate mothers, 56% of those below 30 years of age, and 64% of unemployed mothers missed their children's vaccination schedule. Among the mothers, 75% did not know the names of vaccine-preventable diseases. Of the respondents, 50% believed intercurrent illnesses like fever and the common cold to be side effects and contraindications of vaccines. Among the mothers, 65% never posed any questions to the paediatrician. Of the mothers, 97% safely kept the vaccination card and 82% relied on government or public health centres for vaccination purposes. Conclusion The majority of our population was in favour of vaccinating their children but there existed a huge lacuna in their knowledge about vaccination. This study concludes that firmer measures have to be exercised to bridge this knowledge gap. Only this can improve the vaccination coverage rate.

Adaptation and application of the Parent Attitudes About Childhood Vaccines survey tool in the Vietnamese language: a cross-sectional study

BACKGROUND

Parental vaccine hesitancy could lead to outbreaks of vaccine-preventable diseases. Although parental vaccine hesitancy exists in the Vietnamese community, no research has directly investigated this social phenomenon in Vietnam. Among the validated measures, the 15-item Parent Attitudes About Childhood Vaccines survey tool (PACV) was reliable for predicting vaccine-hesitant parents. However, the PACV was not available in Vietnamese. This study aimed to develop a Vietnamese version of the PACV and examine factors associated with parental vaccine hesitancy in Hue city, Vietnam.

METHODS

This study was a cross-sectional study. The English PACV was translated into Vietnamese with content and face validation. Self-administered questionnaires were distributed to 400 parents at ten commune health centres in Hue city, Vietnam. The parents were asked to answer the questionnaire again after two weeks for the test-retest reliability. The Vietnamese PACV reliability was assessed using Cronbach's alpha and McDonald's omega, and the intra-class correlation (ICC) coefficients were used for the test-retest reliability. The construct validity was tested by the hypothesis that parental vaccine hesitancy would be related to the intention of getting the children vaccinated. Exploratory factor analysis was also undertaken to determine the construct validity. Bivariate and multivariable logistic regression were used to identify the factors associated with parental vaccine hesitancy.

RESULTS

The Vietnamese PACV final version (PACV-Viet) contained 14 items. Three hundred and fifteen parents returned completed questionnaires, giving a response rate of 78.8%. The Cronbach's alpha and McDonald's omega were 0.72 and 0.70, respectively. Out of 315 parents, 84 responses were returned for test-retest reliability. All ICCs were good to excellent, ranging from 0.81 to 0.99. The PACV-Viet was confirmed to have construct validity. Using the PACV-Viet, 8.9% of the parents were found hesitant to childhood vaccination. Being unemployed and having seen the news about adverse events following immunisation were associated with parental vaccine hesitancy, with AOR = 3.2 (95% CI 1.3-8.0) and AOR = 4.5 (95% CI 1.2-16.7), respectively.

CONCLUSIONS

The PACV-Viet is a valid and reliable tool. Community outreach is necessary to alleviate parents' concerns about childhood vaccination.

Risk perception and trust in the relationship between knowledge and HPV vaccine hesitancy among female university students in China: a cross-sectional study

BACKGROUND

Cervical cancer poses a heavy health burden in China, with the second highest incidence and mortality rate among female tumors, yet human papillomavirus (HPV) vaccination rate among female university students remain remains low. This study conducted a cross-sectional survey to assess the degree of HPV vaccine hesitancy among female university students and to explore the potential association between knowledge, risk perception, trust, and HPV vaccine hesitancy.

METHODS

A total of 1,438 female university students from four Chinese cities were recruited through stratified, multistage, cluster sampling method. The mediation model was constructed using the Bootstrap method, introducing trust and risk perception as mediating variables to examine the effect of knowledge on HPV vaccine hesitancy.

RESULTS

The study found that 8.9% (95%CI:7.4%∼10.4%) of the female university students exhibited HPV vaccine hesitancy. Pearson's correlation analysis revealed a negative association between vaccine hesitancy and knowledge, risk perception, and trust. The mediation model showed that knowledge had significant indirect effects on HPV vaccine hesitancy through trust (indirect effect: -0.224, 95% CI: -0.293 ∼ -0.167) and risk perception (indirect effect: -0.013, 95% CI: -0.033 ∼ -0.002).

CONCLUSION

HPV vaccine hesitancy among female university students has mitigated, but still needs to be addressed. In addition, trust and risk perception are mediators mediating the relationship between knowledge with HPV vaccine hesitancy. Therefore, there is a need to strengthen public health education to improve knowledge, with a particular focus on providing information about trust and risk perception to reduce HPV vaccine hesitancy.

Attitudes towards vaccination among parents of children aged 0-5 years: A scale development study

BACKGROUND

Vaccination is the most important public health practice for preventing infectious diseases and maintaining health. However, some parents are hesitant to vaccinate their children.

DESIGN

This study was designed as an instrument development study.

METHODS

This study aimed to develop a scale to measure the attitudes of parents with children aged 0-5 years towards vaccination and to evaluate the validity and reliability of this scale. The data were collected from 691 participants between November 2020 and January 2021. During the development of the scale, experts provided feedback on its technical, content and language dimensions. The data were analysed using exploratory and confirmatory factor analyses for conceptual validity and Cronbach's α and item-level test-retest analyses for reliability.

RESULTS

The developed scale is a reliable and valid tool for measuring attitudes towards vaccination among parents (Cronbach's α = 0.97, variance explained by these 28-item two factors = 62.47%).

CONCLUSION

This scale can be used as a guide in measuring the attitudes of parents towards vaccination and determining the direction of primary health-care services based on the results of the measurement.

Vaccine hesitancy for the COVID-19 vaccine booster dose among nursing home staff fully vaccinated with the primary vaccination course in Belgium

In Belgium, nursing home (NH) staff (NHS) and residents were prioritised for the initial COVID-19 vaccination and successive booster doses. The vaccination campaign for the first booster started in September 2021 in Belgian NH. Our first study about vaccine hesitancy towards the COVID-19 vaccine in Belgian NHS already showed a degree of fear for the primary vaccination course (T1). This new study aims to evaluate vaccine hesitancy to get the first booster (T2) in a population of fully vaccinated (with two doses) NHS. A random stratified sample of NHS who received the primary vaccination course (N = 954) completed an online questionnaire on COVID-19 booster hesitancy (between 25/11/2021 and 22/01/2022). NHS who hesitated or refused the booster were asked for the main reason for their hesitation/refusal. Overall, 21.0 % of our population hesitated before, were still hesitating or refused the booster, NHS that were not hesitant at T1 being 5.7 times less likely to hesitate to get the first booster dose (Adjusted OR 0.179, 95 % CI: 0.120, 0.267). Although there was a slight reduction (23.5 % to 20.1 %) in the proportion of NHS who hesitated/refused vaccination at T1 compared to T2 (p = 0.034), the fear of unknown effects was the principal reason for hesitation/refusal, already mentioned in our first study. NHS were not reassured concerning their initial fears. Given the likelihood that booster vaccinations will be necessary over the coming years, a communication strategy specific to NHS should be implemented.

Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy

OBJECTIVES

Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries.

STUDY DESIGN

A cross-sectional study was conducted from November 1 to December 15, 2022.

METHODS

Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed.

RESULTS

Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168).

CONCLUSIONS

Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.

What drives the vaccination intention against COVID-19? Application of EPPM, TAM, and theories of risk assessment

Vaccines are widely used to fight against COVID-19. However, COVID-19 vaccine hesitancy appears as some individuals are concerned with COVID-19 vaccines. This study investigates the vaccination intention against COVID-19 in China with the Extended Parallel Process Model (EPPM), Technology Acceptance Model (TAM), and theories of risk information assessment. Results showed that the formation mechanism of vaccination intention could be considered a psychological process, as subjective knowledge was a primary influence on correspondents' weighting of both the potentially positive (usefulness) and negative effects (threat) of vaccination. This unequal consideration then resulted in different levels of fear arousal between subjects. Driven by usefulness/threat perception and fear, people conducted different decision strategies, so-called analytical assessment, and experiential assessment to make vaccination decision. In addition to the direct effects of experiential assessment on vaccination intention, two decision strategies and fear arousal also affected people's vaccination intention through the mediation role of vaccination attitude. For policymakers and stakeholders, this study provides a knowledge base for confidence-building, and emotional guidance concerning against COVID-19 vaccination.

Worldwide Child Routine Vaccination Hesitancy Rate among Parents of Children Aged 0-6 Years: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Routine vaccine hesitancy is a major global health challenge observed in over 190 countries worldwide. This meta-analysis aims to determine the worldwide prevalence of routine vaccination hesitancy among parents of children aged 0-6. An extensive search was conducted in four scientific databases: PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were included if they reported hesitancy related to WHO-recommended routine immunizations for children under 7 years of age. A single-arm meta-analysis was performed using the OpenMeta[Analyst] software. An initial search retrieved 5121 articles, of which only 23 publications, involving 29,131 parents, guardians, and caregivers from over 30 countries met the inclusion criteria and quality assessment. The cumulative prevalence of parental vaccine hesitancy was found to be 21.1% (95% CI = 17.5-24.7%, I2 = 98.86%, p < 0.001). When stratifying the prevalence of vaccine hesitancy per WHO region, significant variations were observed, ranging from 13.3% (95% CI = 6.7-19.9%, I2 = 97.72%, p < 0.001) in the Region of the Americas to 27.9% (95% CI = 24.3-31.4%) in the Eastern Mediterranean region. The study findings highlight the need for healthcare providers and governments to develop and improve comprehensive programs with communication strategies to reduce parental vaccine hesitancy.

Knowledge, Attitudes, Intentions and Vaccine Hesitancy among Postpartum Mothers in a Region from the Northwest of Romania

This study aims to identify the presence of vaccine hesitancy and the factors that could have determined it in a group of mothers in the postpartum period, with an evaluation of both the level of knowledge and information, as well as the attitudes, perceptions, intentions and sources of information about vaccination. The study was based on a survey-Vaccine Hesitancy Identification Survey-applied in two maternity wards from Bihor County and structured into six subscales (34 items). Based on the answers to the key questions ("Which of the following statements best describes your plans for vaccinating your child?"-item 1 of subscale 4; "Overall, how hesitant do you consider yourself to be about vaccinating your child?"-item 4 of subscale 4), we identified two groups: the group of mothers without hesitant behavior (non-hesitant), called the group pro vaccine (GPV), and the group of mothers with hesitant behavior, called the group non vaccine (GNV). Vaccine hesitancy was identified in our study in 47.28% of the participants (191 of the 404 mothers included). Most of them come from an urban environment (57.59%), have university and post-secondary education (58.64%) and are prim parous (58.64%). The behavior of participants from GNV is influenced by a low level of knowledge and information regarding vaccination and by concerns related to adverse reactions, new vaccines and the number of vaccines administered. Also, this group is characterized by an increased perception of the risks related to vaccination, while the perception of the risks associated with the disease is low. For all subscales, important differences were registered between the two groups in favor of GPV, a group characterized by positive attitudes and perceptions and a better level of knowledge compared to GNV. This study aims to represent a starting point for the organization and running of information campaigns regarding vaccination at the level of Bihor County, especially in areas with low vaccination coverage, where this behavior is identified.

Psychological Impact of COVID-19 and Its Influence on Parental Willingness to Vaccinate Children: A Cross-Sectional Study at a Tertiary Care Hospital in Kolkata

Background COVID-19 has affected the physical and mental health of people globally, and vaccination is seen as a crucial tool in controlling the pandemic. However, the readiness to vaccinate children remains a concern, particularly in India. Aim The study aimed to investigate the association between the psychological impact of COVID-19 and willingness to vaccinate their children among attendees of the COVID-19 vaccination clinic at Nil Ratan Sircar Medical College, Kolkata. Method The study used an observational, cross-sectional design and collected data from 356 participants between August and September 2022. The COVID-19 Perceived Stress Scale-10 was used to assess participants' psychological impact, and willingness to vaccinate was determined using a survey. Results Approximately 64% (n=227) and 71% (n=253) of the participants exhibited a high level of perceived stress and willingness to vaccinate their children. The vaccine acceptance was significantly associated with perceived stress level and other factors such as family type, presence of chronic illness, and history of acquaintances suffering from COVID-19. Conclusion The study highlights the importance of addressing parental stress and anxiety to enhance vaccination rates among children. To achieve this, population-level awareness of vaccine safety measures and benefits should be raised to alleviate stress and increase vaccine uptake.

A survey on Malaysian's acceptance and perceptions towards COVID-19 booster dose

Progressive reopening of the economy and declaration of COVID-19 as endemic has relaxed social distancing and mask-wearing necessities in Malaysia. The Ministry of Health of Malaysia reported vaccination rate had reached 86.1% for the first dose and 84.3% for the second dose as of April 2023. However, the uptake of booster doses (third dose or fourth dose) is relatively lower at 68.6% and 1.5%, respectively. A cross-sectional survey was undertaken to study the acceptance and perception of Malaysians towards booster doses in Peninsular Malaysia with participants 18 years old and above by distributing questionnaires at public areas such as government offices, major city train stations, and airports. The study included elderly participants who were not technology savvy. Of 395 survey respondents, 69.4% accepted the COVID-19 booster dose. The results showed that smartphone usage (p = 0.019), living area (p = 0.049), and education level (p = 0.006) significantly influenced the perception of booster dose acceptance among socio-demographic characteristics. Despite experiencing side effects from previous vaccination, 65.9% of respondents still opted to receive booster doses (p = 0.019). The highest deciding factor in accepting booster dose was the need for more clinical studies on COVID-19 booster dose (58.2%) (p = 0.045). In conclusion, the survey demonstrates that greater emphasis on updating and providing more clinical studies regarding the need for booster doses will increase the public's acceptance of the COVID-19 booster dose.

Netnography: A novel methodology for nursing research

AIM

The aim of this paper is to critically reflect on our team's experience of using netnography to explore vaccine-hesitant parents and pregnant women, a group who have traditionally been difficult to recruit to research studies and a methodology that is underutilized in nursing research.

DESIGN

This paper takes the form of a discussion paper that will utilize data obtained from a qualitative netnographic study. Relevant literature was searched including 2015-2023.

METHOD

This paper utilized data obtained from a qualitative study that used netnography as methodology and an online minable data source. Netnography is a relatively new methodology that uses the online environment to explore digital cultures and study networked society. It pays particular attention to cultural insights and conditions that impact the human experience. This methodology is particularly relevant to nursing research which is often humanistic and always conducted to ensure optimal patient outcomes.

RESULTS

Using netnography for the first time has resulted in four main insights. These include the adaptability of the process; the creativity involved in designing the site; the ready acceptance of the site by participants and the co-creation knowledge that resulted.

CONCLUSIONS

Netnography is a creative methodology that was successful in accessing and engaging the vaccine-hesitant community, a group who are often marginalized. Netnography has the advantage of using a platform that is familiar and safe for many people and provides access to an extensive minable data source.

Expression of Toll-like Receptors on the Immune Cells in Patients with Common Variable Immune Deficiency after Different Schemes of Influenza Vaccination

BACKGROUND

for the first time, the effect of one and two doses of adjuvanted influenza vaccines on toll-like receptors (TLRs) in patients with common variable immunodeficiency (CVID) was studied and compared (primary vaccination with one vs. two doses, primary vs. repeated vaccination).

MATERIALS AND METHODS

Six patients received one dose of quadrivalent adjuvanted influenza vaccine during the 2018-2019 and 2019-2020 influenza seasons, and nine patients with CVID received two doses of trivalent inactivated influenza vaccine during 2019-2020. Expression of TLRs was measured by flow cytometry.

RESULTS

The expression of toll-like receptors in patients with CVID was noted both with repeated (annual) administration of the influenza vaccine and in most cases was accompanied by an increase in the proportion of granulocytes (TLR3 and TLR9), lymphocytes (TLR3 and TLR8), and monocytes (TLR3 and TLR9). When carried out for the first time as a simultaneous vaccination with two doses it was accompanied by an increase in the proportion of granulocytes, lymphocytes expressing TLR9, and on monocytes-TLR3 and TLR9.

CONCLUSION

in CVID patients, the use of adjuvanted vaccines is promising, and research on the influence of the innate immunity and more effective regimens should be continued.

Understanding Attitudes Toward Influenza Vaccination: Insights from a Romanian Family Medicine Patient Population

INTRODUCTION

Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial mortality rates. Vaccine hesitancy, characterized by delays or refusals despite vaccine availability, presents a growing challenge in achieving adequate vaccination rates globally.

AIM

This study aimed to assess the attitudes of Romanian general practitioners' patients toward influenza vaccination during the recommended immunization period.

MATERIALS AND METHODS

A prospective multi-centered study involving 319 patients across five Family Medicine Offices in Romania was conducted. Participants completed a 12-item Vaccination Attitudes Examination (VAX) scale, assessing factors influencing vaccine acceptance. Statistical analyses were performed to evaluate the impact of demographic variables and attitudes toward vaccination.

RESULTS

The study revealed significant variations in attitudes influencing influenza vaccine acceptance. Trust in vaccine benefits and confidence in natural immunity emerged as primary motivators for vaccine acceptance/denial, whereas concerns about commercial profiteering held lesser importance. Gender and residential environment impacted specific attitudes toward vaccination, while factors such as education and employment status did not significantly influence vaccine acceptance.

DISCUSSION

The study underscores the critical role of trust in vaccine benefits as a primary driver for vaccine acceptance, diverging from prevalent conspiracy theories. While gender and residential environment influenced attitudes toward vaccination, education and employment status did not exhibit significant correlations with vaccine acceptance.

CONCLUSIONS

Understanding public attitudes toward vaccination is crucial in designing effective public health strategies. This study emphasizes the importance of trust in vaccine benefits in driving vaccine acceptance, offering insights to enhance vaccination initiatives regionally.

A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial

BackgroundDespite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents' VH for childhood immunisations.AimTo determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities.MethodsWe conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers' VH (13 items, 0-100 score) and VI (1 item, 1-10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level.ResultsMotivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels.ConclusionsOur results show positive effects of MI intervention, and means of its implementation should be investigated in France.

Motivational interview-based health mediator interventions increase intent to vaccinate among disadvantaged individuals

Coverage for recommended COVID-19 and diphtheria-tetanus-poliomyelitis (DTP) booster shots is often inadequate, especially among disadvantaged populations. To help health mediators (HMs) involved in outreach programs deal with the problems of vaccine hesitancy (VH) in these groups, we trained them in motivational interviewing (MI). We evaluated the effectiveness of this training among HMs on their MI knowledge and skills (objective 1) and among the interviewees on their vaccination readiness (VR) and intention to get vaccinated or accept a booster against COVID-19 and/or DTP (objective 2). Two MI specialists trained 16 HMs in a two-day workshop in May 2022. The validated MISI questionnaire evaluated HMs' acquisition of MI knowledge and skills (objective 1). Trained HMs offered an MI-based intervention on vaccination to people in disadvantaged neighborhoods of Marseille (France). Those who consented completed a questionnaire before and after the interview to measure VR with the 7C scale and intentions regarding vaccination/booster against COVID-19 and DTP (objective 2). The training resulted in HMs acquiring good MI skills (knowledge, application, self-confidence in using it). HMs enrolled 324 interviewees, 96% of whom completed both questionnaires. VR increased by 6%, and intentions to get vaccinated or update COVID-19 and DTP vaccination increased by 74% and 52% respectively. Nearly all interviewees were very satisfied with the interview, although 21% still had questions about vaccination. HMs assimilated MI principles well. MI use in outreach programs appears to show promise in improving vaccine confidence and intentions among disadvantaged people.

Factors influencing parents' hesitancy to vaccinate their children aged 5-11 years old against COVID-19: results from a cross-sectional study in Malaysia

Introduction

Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia.

Method

A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents.

Results

Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education.

Conclusion

Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.

Attitudes, hesitancy, concerns, and inconsistencies regarding vaccines reported by parents of preschool children

OBJECTIVE

This study aimed to assess attitudes, concerns, information and knowledge about vaccines among parents of preschool children attending kindergartens in a city in the interior of São Paulo, Brazil, using a self-administered questionnaire.

METHODS

Cross-sectional, questionnaire-based study of knowledge and attitudes regarding vaccination among parents of children aged up to 72 months from public and private schools, between 2018 and 2019.

RESULTS

Among the 2,528 questionnaires, 1,261 were answered and grouped by respondents' educational level. According to information, 96.6% of the children were up to date with vaccines. The prevalence of vaccine hesitancy was 5.0%. The lower the educational level, the lower was the income, the larger the number of household members, and the greater the lack of knowledge about vaccines. The higher the educational level, the lower was the vaccine hesitancy, and the greater the dissatisfaction with the information received.

CONCLUSIONS

Generally, parents consider vaccines to be important for preventing diseases and to be safe, with their benefits outweighing the risks. Positive comments were accompanied by doubts, concerns, hesitancy, and inconsistencies. The level of educational attainment makes a difference in the access to information, medical care provided by pediatricians, and the feeling of obligation to vaccinate. Parents have vaccinated and still intend to vaccinate their children, but ensuring adequate levels of vaccination coverage will be a post-pandemic challenge.

A favorable impression of vaccination leads to a better vaccination rate for the human papillomavirus vaccine: A Japanese questionnaire survey investigation

Background

The Japanese vaccination rate for infants and children is seemingly excellent, except for the human papillomavirus (HPV) vaccine. Regardless of its efficacy, the inoculation rate in Japan has dropped to approximately 1 % since 2013 because of negative information about vaccine side effects. We aimed to demonstrate the factors that lead to low vaccine acceptance rates (e.g., caregiver attitudes, popular misconceptions) to inform the relevant target demographic of a stronger intention to immunize and to facilitate recovery of HPV vaccine coverage.

Methods

We conducted this study using data from two questionnaire surveys. Statistical analyses of factors affecting vaccine impressions and mediation effects of HPV vaccine impressions were performed. The difference in the knowledge about each vaccine was evaluated.

Results

Of the respondents, 95.9 % reported their intent to vaccinate their infants, whereas 58.2-78.3 % felt that they sufficiently understood the aims, efficacy, and risks of vaccination and 66.6 % had a positive impression of vaccines. Overall, 21.3 % of parents responded that they planned to have their child vaccinated against HPV, and 25.8 % had a favorable impression of this vaccine. Among factors affecting vaccine impressions, we found that parents had anxiety about vaccines when they felt that their knowledge of vaccines was insufficient. Additionally, impressions of the HPV vaccine had a mediating effect on the association between the impressions of infant vaccines and parents' intent to provide the vaccine to their children.

Conclusion

These findings show that as a society, we need to improve impressions and knowledge regarding vaccines, including but not exclusively the HPV vaccine. Moreover, although the recovery of HPV vaccine coverage is strongly desired for improving public health, simply improving impressions about the HPV vaccine or educating parents with substantive knowledge is insufficient. Instead, improving impressions and understanding of the vaccination itself is necessary.

A systematic literature review to clarify the concept of vaccine hesitancy

Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.

HPV Vaccination Coverage Rate in a Rural Area: An Observational, Retrospective, and Cohort Study

In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organization (WHO) declared the Global Strategy Goal for 2030, advocating for reaching a vaccination coverage rate of >90% against human papillomavirus for girls by the age of 15 years. The main objectives of this study were (1) to determine the papillomavirus vaccination coverage among women 15−40 years old and (2) to identify the at-risk subgroups and possible barriers to achieving WHO’s 2030 goal. Multicentre, observational, retrospective, and community-based cohort studies were conducted on women from a rural area in southern Catalonia until 31 December 2021. A total of 23,136 women were included, with a mean age of 26.6 (SD = 5.6) years. The average dose number was 1.7 (SD = 0.7). The results showed overall vaccination coverage of 17.4% among the target women. This coverage was unequal across regions (16.6−24.5%, p < 0.001), primary healthcare teams (15.5−24.3%, p < 0.001), and age groups (56.7% (15−19-year-olds) vs. 3.8% (35−40-year-olds), p < 0.001), related to accessibility to vaccination and economic−geographical indicators. Clinical practice guidelines on screening individuals at risk in terms of vaccination access and public vaccination protocols should be implemented in order to improve the vaccination coverage rate.

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

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

Assessment of factors affecting attitudes and knowledge of pregnant women about COVID-19 vaccination

The aim of this study was to analyse knowledge and attitudes of pregnant women about Coronavirus disease (COVID-19) and its vaccine. Pregnant women who attended outpatient maternal care between October 2020 and March 2021 were invited to participate in this cross-sectional survey study. To identify the effect of baseline characteristics of participants on their vaccination decision, the pregnant women were divided into two groups as accepting or rejecting the COVID-19 vaccine. The Multiparity rate was significantly higher in the rejection group (73.8 vs. 42.3, p = .001). Education level and rate of employment in the professional health sector were significantly higher in the acceptance group (p = .001 and p = .008). A total of 103 (26.4%) pregnant women from the acceptance group, and 23 (10.9%) from the rejection group had a history of the death of relatives and acquaintances from COVID-19 (p = .001). The present study demonstrated that nulliparous status, higher education level, working as a professional healthcare provider and incidence of death in relatives due to COVID-19 significantly rise pregnant women's acceptance of the COVID-19 vaccine. Considering the overall acceptance rate of 65%, improved vaccination programmes using all types of information sources need to be the main task to block the COVID-19 pandemic. IMPACT STATEMENTWhat is already known on this subject? There are previous studies that evaluated the attitudes and beliefs about several vaccine types among pregnant women. An important part of tackling the COVID-19 pandemic is the success of the COVID-19 vaccination program in pregnant women. In this respect, it is important to know the attitudes of pregnant women regarding COVID-19 vaccination.What do the results of this study add? The baseline characteristics of pregnant women with or without acceptance of COVID-19 vaccination were similar regarding COVID-19 infection. The rates of being not multiparous and a health worker were higher in women with acceptance of COVID-19 vaccination. The rate of loss of relatives was also higher in women with acceptance of COVID-19 vaccination. In women without acceptance of COVID-19 vaccination, the major drawback was related to the possibility of harm to their baby's and own health.What are the implications of these findings for clinical practice and/or further research? In pregnant women, the attitude to COVID-19 vaccination may be modifiable by the design of focussed information media with respect to their education, occupation, and parity. Longitudinal studies are needed to determine whether this approach can effectively increase the rate of COVID-19 vaccination in pregnant women.

Attitudes and Beliefs of the Italian Population towards COVID-19 Vaccinations

Background: Despite the numerous campaigns to encourage vaccination against COVID-19, the public debate and often conflicting information have left many individuals uncertain about the decision to make on whether or not to vaccinate. Methods: This research aims to analyze the attitudes and beliefs of the Italian population towards COVID-19 and other vaccinations through a quantitative methodology. In all, 500 adults (Age M = 39.52) participated in this exploratory study with an online questionnaire conducted in April 2021. Results: most participants believe vaccination is necessary to defeat COVID-19; there is an age-related difference in getting vaccinations, and women were more afraid of unexpected future effects than men; older participants have expressed a greater willingness to pay to be vaccinated against COVID-19 (4). Conclusion: In light of these results, it is necessary to pay greater attention to the perplexity and fears expressed by the population, especially women and youth, in relation to vaccinations; in fact, it would help to achieve a wider adherence to the tools designed to contain the spread of viruses at the base of severe health crises.

Vaccine Hesitancy Under the Magnifying Glass: A Systematic Review of the Uses and Misuses of an Increasingly Popular Construct

Resistance to vaccines has hindered attempts to contain and prevent outbreaks of infectious diseases for centuries. More recently, however, the term "vaccine hesitancy" has been used to describe not necessarily outright resistance but also a delay in acceptance or uncertainty regarding vaccines. Given concerns about hesitancy and its impact on vaccine uptake rates, researchers increasingly shifted the focus from resistance to vaccines toward vaccine hesitancy. Acknowledging the urgency to accurately assess the phenomenon, it is critical to understand the state of the literature, focusing on issues of conceptualization and operationalization. To carry out this systematic review, we collected and analyzed all published empirical articles from 2000 to 2021 that explicitly included quantitative self-report measures of vaccine hesitancy (k = 86). Using a mixed-method approach, the review demonstrates and quantifies crucial inconsistencies in the measurement of the construct, lack of clarity in regard to the determination of who should or should not be defined as hesitant, and overreliance on unrepresentative samples. Crucially, our analysis points to a potential systematic bias toward exaggerating the level of hesitancy in the population. Modeling a vaccine hesitancy co-citation network, the analysis also points to the existence of insular academic silos that make it harder to achieve a unified measurement tool. Theoretical and practical implications for academics, practitioners, and policymakers are discussed.

COVID-19 Vaccine Acceptance among Low- and Lower-Middle-Income Countries: A Rapid Systematic Review and Meta-Analysis

Widespread vaccination against COVID-19 is critical for controlling the pandemic. Despite the development of safe and efficacious vaccinations, low-and lower-middle income countries (LMICs) continue to encounter barriers to care owing to inequitable access and vaccine apprehension. This study aimed to summarize the available data on COVID-19 vaccine acceptance rates and factors associated with acceptance in LMICs. A comprehensive search was performed in PubMed, Scopus, and Web of Science from inception through August 2021. Quality assessments of the included studies were carried out using the eight-item Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies. We performed a meta-analysis to estimate pooled acceptance rates with 95% confidence intervals (CI). A total of 36 studies met the inclusion criteria and were included in the review. A total of 83,867 respondents from 33 countries were studied. Most of the studies were conducted in India (n = 9), Egypt (n = 6), Bangladesh (n = 4), or Nigeria (n = 4). The pooled-effect size of the COVID-19 vaccine acceptance rate was 58.5% (95% CI: 46.9, 69.7, I2 = 100%, 33 studies) and the pooled vaccine hesitancy rate was 38.2% (95% CI: 27.2-49.7, I2 = 100%, 32 studies). In country-specific sub-group analyses, India showed the highest rates of vaccine acceptancy (76.7%, 95% CI: 65.8-84.9%, I2= 98%), while Egypt showed the lowest rates of vaccine acceptancy (42.6%, 95% CI: 16.6-73.5%, I2= 98%). Being male and perceiving risk of COVID-19 infection were predictors for willingness to accept the vaccine. Increasing vaccine acceptance rates in the global south should be prioritized to advance global vaccination coverage.

COVID-19 Vaccine Hesitancy: The Role of Information Sources and Beliefs in Dutch Adults

COVID-19 vaccine hesitancy may be regarded as a new pandemic hindering the elimination of or coping with COVID-19. This study assessed reasons for COVID-19 vaccine hesitancy using the I-Change Model (ICM) by considering the role of informational and psychosocial factors. A cross-sectional online survey using a convenience sample was conducted among Dutch adults (n = 240). The questionnaire assessed information factors, predisposing factors, awareness factors, motivational factors, preparatory actions, and vaccination intention. Vaccine hesitant participants (n = 58, 24%) had lower levels of education, more often paid work, and tended to have a religion other than Catholicism. They used written media less often and tended to visit websites of public health organizations less often, but used messaging services like WhatsApp more frequently. All participants had neutral intentions towards checking information credibility. Vaccine hesitant respondents had less knowledge about vaccination, lower perceived severity of getting sick and dying of COVID-19, and reported fewer exposures to cues about the advantages of COVID-19 vaccination. They were less convinced of the emotional and rational advantages of COVID-19 vaccination and expressed more negative feelings about it. They also reported more negative social norms concerning COVID-19 vaccination, and lower self-efficacy to get vaccinated and to cope with potential side-effects. The regression model explained 58% of the variance in vaccination intention. The results suggest that strategies are needed to: 1. Reduce fake news and stimulate information checking to foster well-informed decision-making; 2. Target both rational and emotional consequences of COVID-19, in addition to strategies for optimizing levels of knowledge. Campaigns should acknowledge the perceptions of the emotional disadvantages and increase perceptions of emotional advantages of COVID-19 vaccinations, such as reducing feelings of regret, and increasing feelings of freedom and reassurance.

Women Empowerment Facilitates Complete Immunization in Indonesian Children: Cross-sectional Study

Objectives

The primary objective of this study was to examine the effect of women’s empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association.

Methods

We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12–23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women’s empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women’s empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group.

Results

The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women’s empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles.

Conclusions

To our knowledge, this study is the first to explore women’s empowerment as a determinant of child immunization in Indonesia. The results indicate that women’s empowerment must be considered in Indonesia’s child immunization program. Women’s empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women’s empowerment on health outcomes.

Knowledge, attitudes, and perceptions associated with HPV vaccination among female Korean and Chinese university students

Background

Human papillomavirus (HPV) vaccination is a form of primary prevention for cervical cancer. The HPV vaccination rate of female university students is not high in Korea and China. Therefore, the purpose of this study was to identify and compare the factors associated with intention to receive HPV vaccination between Korean and Chinese female university students.

Methods

The participants were 273 Korean and 317 Chinese female university students who had not been vaccinated for HPV, and data were collected using a self-reported questionnaire about attitudes toward HPV vaccination, HPV knowledge, perceptions of HPV infection, and intention to receive HPV vaccine.

Results

There were no significant differences between the Korean and Chinese female university students in HPV knowledge, attitudes, perceptions, and vaccination intention. The factors influencing the intention of HPV vaccination in Korean students were a positive attitude toward the HPV vaccine and a high HPV knowledge score. For Chinese students, sexual experience, awareness of genital warts, a positive attitude toward the HPV vaccine, a high HPV knowledge scores, a perception of the seriousness of HPV infection, and negative emotions regarding HPV infection were significant factors.

Conclusions

It is important to improve attitudes and knowledge about HPV and the HPV vaccine in order to enhance HPV vaccination both in Korea and China. Perceived seriousness and negative emotions regarding HPV infection should be used as a framework to develop subject-tailored interventions in China.

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

Aim:

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

Background:

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

Methods:

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

Findings:

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

Did this pandemic trigger a spike in mothers' hesitancy over their children's routine immunizations? -A cross sectional study

Back ground

The COVID-19 pandemic has created a lot of disruptions for delivery of health care services like routine immunization. Delayed immunization can lead to outbreak of many vaccine preventable diseases. The current pandemic created confusions and fear among mothers to vaccinate their children. This study was an initiative to understand the struggles faced by them during the pandemic.

Objective

To estimate the prevalence of hesitancy for routine immunization among urban mothers during COVID-19 pandemic and to determine the factors responsible for their hesitancy.

Methodology

It was a community based cross-sectional study which was done for three months, data were collected from 246 mothers (sample size calculated by assuming 20% as prevalence based on pilot study) having children whose age was less than 6 years by administering a pre-tested semi structured questionnaire.

Result

It was found that 38% of mothers were having vaccine hesitancy during the pandemic mainly due to the factors like fear of exposure to COVID-19 and due to lockdown.Out of 6 variables 5 variables(except religion) was found to be statistically significant.On the multivariate analysis only prior to pandemic hesitancy retained statistical significance.

Conclusion

From our study we infer that the pandemic has increased hesitancy among mothers, hampering routine immunization. Thus, this domain deserves more consideration by health care officials and policy makers, to prevent disruption of the immunization programme.

Parents' intention for their children to receive COVID-19 vaccine: Implications for vaccination program in Macao

INTRODUCTION

The decision about vaccinating children is subject to their parents' decision. To inform strategies that support full vaccination coverage, it is important to understand the parents' vaccination attitude and tendency to act. This study aims to investigate the intention and the factors affecting parents' decision-making about vaccinating their children.

METHODS

A cross-sectional, self-administered online questionnaire was completed by parents of children aged 3-12 yeas in Macao between 7 March and 17 April 2022. The survey tool was informed by the Theory of Planned Behavior (TPB) which composes of the variable "intention" and three TPB constructs (Attitude, Subjective Norm, and Perceived Behavioral Control). Respondents rated their level of agreement on the construct statements using a 5-point Likert scale. Multiple linear regression analysis was used to determine if the TPB constructs were predictors of parents' intention.

RESULTS

A total of 1,217 parents completed the questionnaire. The majority of participants were mothers (83.2%), aged 31-40 years (62.7%), having two or more children (74.1%), had at least one dose of COVID-19 vaccine (84.4%) and considered themselves knowledgeable about the vaccine (62.1%), all of which were significantly associated with the intention to vaccinate their children (all p < 0.05). Their intention varied from negative (19.1%), neutral (38.4%) to positive (42.5%). Respondents were mostly concerned about the serious side effects that the COVID-19 vaccine (mean = 3.96 ± 1.23), highly acknowledged the expectation by the school (mean = 3.94 ± 1.15) and the community (mean = 3.90 ± 1.19) of children vaccination, and rated highly the ease of making necessary arrangement (mean = 3.93 ± 1.25). In the multiple linear regression model which explained 63.5% of the variance in the intention-to-vaccinate their children, only Attitude (B = 0.52, p < 0.001) and Subjective Norm (B = 0.39, p < 0.001) were identified as strong predictors. The major reasons for not having intention were safety concerns (n = 646/699, 92.4%). Participants' most trusted local information sources were doctors (n = 682), government (n = 426) and healthcare professional organizations (n = 416).

CONCLUSIONS

Vaccinating children with COVID-19 vaccine is a complex decision-making for parents. A key to a successful COVID-19 vaccination program is effective communication about the safety profile and the usage experiences warranting the integration of reliable information sources across different healthcare sectors.

Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases

BACKGROUND

Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake.

METHODS

During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine.

RESULTS

Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%).

CONCLUSION

Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.

Knowledge, attitudes and behaviors of Inonu University faculty members regarding childhood vaccine refusal

INTRODUCTION

Although there is a lot of scientific evidence that the benefits of vaccines outweigh their risks, hesitancy about the safety of vaccines can occur in every segment of the community. In this study, we aimed to determine the knowledge, attitudes, and associated factors of vaccine hesitancy among Inonu University faculty members regarding childhood vaccinations.

METHOD

This is a cross-sectional study, and 258 faculty members were included in the study. The questionnaire used in the study explored the sociodemographic characteristics of the faculty members and their knowledge, attitudes and behaviors regarding childhood vaccination. A chi-square test and a fisher exact test were used for statistical analysis.

RESULTS

Of the faculty members, 31.8% were hesitant about childhood vaccines, 51.9% stated that there were studies reporting the side effects of vaccines, 48.1% did not agree with giving booster doses of vaccines, 35.7% stated that vaccines could cause autism due to the chemicals contained in the vaccines. The most important information sources of university faculty regarding childhood vaccines members are scientific publications and health professionals.

CONCLUSIONS

Faculty members level of hesitancy about vaccines was high and since health professionals and scientific articles are the most important information sources of faculty members, misinformation here may affect their knowledge, attitudes and behaviors about vaccination.

Beliefs about HPV vaccination and awareness of vaccination status: Gender differences among Northern Italy adolescents

Human papillomavirus (HPV) is one of the most frequent sexually transmitted infectious agents worldwide, and it is responsible for a significant burden of cancers. The aim of this study was to evaluate HPV knowledge and awareness in a sample of Northeastern Italian adolescents and parental support available to them, in order to highlight potential room for improvement towards optimal HPV vaccination adherence. Between April and May 2018 an observational questionnaire-based study was conducted in 1st year students of secondary upper schools in Udine (Italy). We quantitatively evaluated HPV knowledge, awareness and parental support level of male and female adolescents. The contribution of sociodemographic characteristics to HPV vaccination knowledge and uptake were explored using Chi-Square or Fisher test and multivariate logistic. Knowledge about HPV vaccine resulted to be mostly insufficient among enrolled adolescents, with a worrying proportion of them believing that HPV vaccine was expected to prevent HIV/AIDS. Awareness about their vaccination status was poor, and more than half of them were not involved in HPV vaccine uptake deliberation. Girls performed better than boys in relation to knowledge, awareness and engagement. Our results support the hypothesis that HPV vaccine knowledge and uptake can be affected by some gender bias. Improvements in adolescent health education and vaccination strategies are needed to engage and finally protect both genders from HPV.

Delays in routine childhood vaccinations and their relationship with parental vaccine hesitancy: a cross-sectional study in Wuxi, China

OBJECTIVES

This study aimed to examine childhood vaccination delay, explore the association between vaccination delay and parental vaccine hesitancy, and assess childhood vaccination delays during the coronavirus disease (COVID)-19 pandemic in China.

METHODS

This cross-sectional survey was conducted in Wuxi City. Participants were recruited from local vaccination clinics. Questionnaires were used to collect information about socio-demographics, vaccine hesitancy, and immunization clinic evaluations. Vaccination records were obtained from the Jiangsu Information Management System of Vaccination Cases.

RESULTS

Overall, 2728 participants were included. The coverage for seven category A vaccines (Expanded Program on Immunization (EPI)) was more than 95% at 24 months. The proportion of children vaccinated in a timely manner was the highest for the first dose of the hepatitis B vaccine (91.6%) and the lowest for the Bacillus-Calmette-Guerin vaccine (44.6%). More than 50% of the planned vaccinations were delayed in February and March 2020. The Vaccine Hesitancy Scale scores were not associated with vaccination delay (P = 0.842). Children's vaccination delays were negatively associated with parents who reported convenient access to clinics and satisfaction with immunization services (P = 0.020, P = 0.045).

CONCLUSIONS

EPI is highly successful in China. Despite vaccination delays due to the COVID-19 pandemic, coverage was recovered after lockdown restrictions were eased.

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.

COVID-19 Vaccination Attitudes, Perceptions, and Side Effect Experiences in Malaysia: Do Age, Gender, and Vaccine Type Matter?

This study aimed to investigate the attitudes, perceptions, and experiences of side effects with the COVID-19 vaccines in Malaysia among participants in the National Vaccination Program. A cross-sectional survey was conducted among a sample of vaccine-eligible and vaccinated individuals in Malaysia between May and July 2021. A total of 428 respondents completed the survey. A vast majority (98.6%) of the respondents had registered to be vaccinated. Twenty participants (4.7%) expressed concerns about either registering or receiving the COVID-19 vaccination, mainly due to their uncertainty of vaccine safety. Approximately 77.5% received their vaccinations. Of them, 76.8% had experienced vaccine-related side effects. About 40% of the side effects occurred more with the second dose, particularly those who received the Pfizer-BioNTech vaccine (p < 0.001). Pain at the injection site (61.1%) and tiredness (48.8%) were the most reported side effects. Compared to those aged ≥60 years, all age groups were more likely to exhibit vaccine-related side effects; meanwhile, males (OR: 0.51, 95% CI: 0.27-0.93) were less likely to experience side effects than females. Those who received the Sinovac vaccine were at lower risk of experiencing side effects (OR: 0.08, 95% CI: 0.03-0.22) and were more likely to report fewer side effects than Pfizer-BioNTech (p = 0.012) and Oxford-AstraZeneca groups (p= 0.001). The overall attitudes toward the COVID-19 vaccination program were positive. Several differences in the experiences of vaccine-related side effects, in terms of prevalence and numbers, were attributed to age, gender, and received vaccine type.

The Impact of COVID-19 Vaccination on Anxiety Levels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study

Background: The current study aimed to assess the anxiety and fear levels and the attitude towards clinical care, such as the use of personal protective equipment and number of patients examined, before and after COVID-19 vaccination among Turkish dental professionals. Methods: A questionnaire including socio-demographical characteristics and clinical data regarding the number of patients, the use of personal protective equipment, vaccine confidence interval, positive or negative COVID-19 diagnosis, and fear and anxiety levels were examined. Results: A total of 475 dentists (196 men and 279 women) participated. Overall, the vaccination had a positive effect on the decrease of fear and anxiety levels of dental professionals. It was observed that the number of interventional procedures significantly increased after vaccination. Besides that, the amount of personal protective equipment used in patients, especially after the vaccination, has decreased. Conclusion: Despite the positive effects of vaccination on the anxiety levels of dental professionals, protective measurements should further be the main concern, regardless of the vaccination status of both the dental professional and the patient.

Knowledge and behaviors of nurses working at Inonu University Turgut Ozal Medical Center on childhood vaccine refusal

Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working at Inonu University Turgut Ozal Medical Center on childhood vaccine refusal.This study, conducted between June and July 2019, is a descriptive cross-sectional study. It was conducted in a hospital located in Malatya in eastern Turkey. At the time of the study, 850 nurses work in this hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. Chi-square test and Fisher's exact test were used in statistical analyses.In the present study, 31.7% of the participating nurses stated that they had concerns about childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines was from their education. The level of hesitance in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p < .05).One-third of nurses was proven to have hesitance on childhood vaccines, and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary training and practices in order to ease their hesitance on vaccination.

Vaccine hesitancy and reported non-vaccination in an Irish pediatric outpatient population

Vaccine hesitancy is defined as a delay in acceptance, or refusal, of vaccines, despite availability. It is a complex and context specific phenomenon and identified as a global health priority. The "Parent Attitudes about Childhood Vaccines" (PACV) questionnaire is a validated tool for identifying vaccine hesitancy. Our aim was to use the PACV to assess vaccine hesitancy and its relationship with reported non-vaccination in an Irish population, for the first time. Our participants were parents or caregivers of children attending general pediatric clinics in a tertiary pediatric hospital in Dublin, Ireland, between September and December 2018. In total, 436 participants completed the questionnaire. 5.5% of our population reported non-vaccination. Human papilloma virus and measles, mumps, rubella vaccines were the most commonly cited vaccines of concern (11.5% and 6.7%, respectively), and autism spectrum disorder was the most commonly side effect of concern (4.3%). Mean PACV score was 26.9 (SD 19.1), with a significant difference between non-vaccinators and vaccinators (53.2 vs 25.3, p<0.001). Safety and efficacy concerns were the major contributor to non-vaccination. 14.4% of our population were vaccine-hesitant using the conventional cut-off score, which increased to 22% when using an optimal cut-off which maximized sensitivity and specificity. The accuracy of the PACV score to identify non-vaccination was good (area under the ROC curve = 0.827), and the optimal cut-off had a high negative predictive value (98.5%).Conclusion: PACV identified reported non-vaccination with high accuracy in our population. It may be useful to screen vaccine-hesitant parents who could benefit from interventions to improve uptake. What is Known: • Vaccine hesitancy is a leading threat to global health, with falls in vaccine uptake associated with disease outbreaks worldwide. • The Parent Attitudes about Childhood Vaccines (PACV) questionnaire is a validated measure of vaccine hesitancy and correlates with non-vaccination in many populations. What is New: • This large study in a pediatric outpatient clinic setting represents the first use of the PACV in a Western European population to assess vaccination hesitancy. • The PACV may be an effective way of screening a pediatric clinic population to identify vaccine-hesitant parents or caregivers for targeted vaccine promotion.

COVID-19 Vaccine Hesitancy among the Public in Kuwait: A Cross-Sectional Survey

Vaccine hesitancy (uncertainty or unwillingness to receive vaccinations) is a major barrier to manage the COVID-19 pandemic in the long term. This study aimed to explore the prevalence of COVID-19 vaccine hesitancy among the public in Kuwait, to understand their attitudes towards vaccines in general, and to identify predictors of COVID-19 vaccine hesitancy. A cross-sectional study was conducted among 4147 adults aged ≥ 18 years. The snowball sampling strategy was used for data collection through social media and e-mails. A total of 3061 (73.8%) respondents indicated that they were vaccinated or intending to be vaccinated against the COVID-19 infection, while 1086 (26.2%) expressed their vaccine hesitancy. The most common reasons for vaccine hesitancy were the concerns about the vaccine’s possible side effects, its rushed development, and its efficacy in preventing the infection. Over half (57.2%) of respondents expressed intermediate to high levels of negative attitude towards vaccines in general. On the multivariable logistic regression analysis, the findings revealed that vaccine hesitancy was significantly more prevalent among respondents aged 30–64 years; females; married or divorced; residents of Hawalli, Al-Farwaniyah, Al-Jahra, and Mubarak Al-Kabeer; had intermediate monthly average income; non-smokers; not feeling worried about catching the infection; do not know whether any of their family members have been infected or died because of COVID-19 infection; do not have a large extent of confidence in the Kuwait health system’s ability to handle the pandemic; did not receive influenza vaccine during the last year; refused or elected to forego a doctor-recommended vaccine; did not receive adequate information from the public health authorities/healthcare providers about the COVID-19 vaccines; none of their first-degree family members received or were intending to receive the vaccine; and expressed intermediate to high levels of negative attitudes towards vaccines in general. The present findings provide a steer as to the groups that most need to be reached to increase the rates of vaccine uptake.

The associations of geographic location and perceived risk of infection with the intentions to get vaccinated against COVID-19 in China

BACKGROUND

Vaccines are a critical tool against coronavirus disease 2019 (COVID-19) pandemic, yet little is known regarding the associations of geographic location and perceived risk with the intentions to get vaccinated against COVID-19 in China.

METHODS

An on-site survey of adults aged 18 or older (n = 7261) was conducted from November to December, 2020 in China, and this survey selected six provinces based on the geographic location.

RESULTS

In the total sample, 82.5% reported that they would intend to get vaccinated against COVID-19. Compared with Hubei province, respondents' intentions to get vaccinated decreased by 70% in Zhejiang, 61% in Guangdong, 87% in Gansu, and 71% in Jilin, respectively. However, within Hubei province, compared with Wuhan city, respondents' intentions to get vaccinated in other cities were not significantly different. Respondents with higher perceived risk of infection were associated with increased odds of intentions to get vaccinated against COVID-19.

CONCLUSION

Our study identified priority geographic regions that need to pay attention on the vaccination campaign and help design effective immunization strategies to increase the vaccine uptake against COVID-19. More attention should be paid to adults residing farther from the epicenter of the outbreak and having lower perceived risk of infection.

Understanding COVID-19 vaccine acceptance in Pakistan: an echo of previous immunizations or prospect of change?

BACKGROUND

As countries ramp up their COVID-19 vaccination programs, attitudes of the population remain a determining player in the success of these plans. This study analyses the factors associated with intent to vaccinate against COVID-19 in the Pakistani population.

METHODOLOGY

This cross-sectional, anonymous, online survey was carried out in April 2021. Participants' demographic details, experiences relating to COVID-19 and its vaccination, and their health beliefs were inquired and divided across Health Belief Model constructs. Multivariable regression was used to determine factors associated with a No/Not sure vs Yes response for vaccination intention.

RESULTS

Of the 655 respondents, 62.0% were willing to get vaccinated. Significant predictors of a less likelihood of resisting vaccination included advanced age (AOR 0.25; 95% CI 0.07-0.88), fear of contracting COVID-19 (AOR 0.47; 95% CI 0.27-0.82), hope of preventing its spread (AOR 0.30; 95% CI 0.19-0.49), and community pressure (AOR 0.22; 95% CI 0.13-0.37). Concerns about vaccine reliability (AOR 2.75; 95% CI 1.67-4.53) and religious inhibitions (AOR 2.45; 95% CI 1.34-4.48) swayed people away from vaccination.

CONCLUSION

Despite a reasonably good response of Pakistanis to vaccination, factors negatively influencing their intention need to be timely addressed to control this pandemic.

A critical review of measures of childhood vaccine confidence

The World Health Organization and global partners sought to identify existing measures of confidence in childhood vaccines, as part of a broader effort to measure the range of behavioural and social drivers of vaccination. We identified 14 confidence measures applicable to childhood vaccination in general, all published between 2010 and 2019. The measures examined 1-5 constructs and included a mean of 12 items. Validation studies commonly examined factor structure, internal consistency reliability, and criterion-related validity. Fewer studies examined convergent and discriminant validity, test-retest reliability, or used cognitive interviewing. Most measures were developed and validated only in high-income countries. These findings highlight the need for a childhood vaccine confidence measure validated for use in diverse global contexts.

Acceptability of Healthcare Professionals to Get Vaccinated against COVID-19 Two Weeks before Initiation of National Vaccination

Background and Objectives The greatest challenge vaccines face is that of acceptance from the general population. Healthcare professionals’ (HCPs) recommendations have significant influence on general public vaccination behavior. The aim of this study was to assess the willingness of HCPs to get vaccinated against COVID-19, two weeks before initiation of vaccinations. Materials and Methods: We conducted an anonymous online survey from 11–15 December 2020 among HCPs by emails delivered from the local medical and nursing stuff associations. Results: The 71.1% of 656 HCPs intended to accept vaccination, 5.9% did not and 23% were still undecided. The acceptance rate was higher in physicians (76.5%) and significantly lower in nurses (48.3%). Most of the responders who intended to accept vaccination were males (p = 0.01), physicians (p = 0.001), older (p = 0.02), married (p = 0.054) with children (p = 0.001), and had treated patients with COVID-19 (p < 0.001). In the multivariate logistic regression, the predictors of HCPs willingness to get vaccinated were parenthood (OR = 4.19, p = 0.003), being a physician (OR = 2.79, p = 0.04), and treating confirmed/suspected COVID-19 patients (OR = 2.87, p = 0.036). Conclusions: Low vaccination acceptance rate was found especially in nurses, and as this may have a negative impact in the vaccination compliance of the general public, interventional educational programs to enhance vaccination are crucial.

Parents' knowledge, attitude and practice towards children's vaccination in Lebanon: role of the parent-physician communication

Background

One of the most effective public health interventions in the world is immunization. However, some parents doubt its usefulness and safety. Many factors influence their decision to vaccinate, including their sociodemographic characteristics, their trust in the public health system, the parent-physician relationship, their level of knowledge and their attitudes towards vaccination. Our objective was to determine the factors, especially the parent-physician communication, associated with parental knowledge, attitudes and practices of their children’s vaccination.

Methods

Three thousand five hundred parents (father, mother or both) of children aged between 1 month and 15 years were approached by a trained personnel who performed the data collection through personal interviews (February–April 2019).

Results

The response rate was 79.5%. The results of the multivariable analysis showed that a better patient-physician communication was significantly associated with higher knowledge, better attitude and practice. Better knowledge was significantly associated with better attitude, whereas better knowledge and attitude were significantly associated with better practice.

Conclusion

Our study shows the importance of good physician-patient communication in improving knowledge, attitude and practice of parents towards their children’s vaccination.