Which older Brazilians will accept a COVID-19 vaccine? Cross-sectional evidence from the Brazilian Longitudinal Study of Aging (ELSI-Brazil)

Parity of esteem: A global COVID-19 vaccination approach for people with mental illnesses, based on facts from 34 countries; recommendations and solutions

Background

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre-existing conditions, and those exposed to SARS-CoV-2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID-19.

Methods

A questionnaire was developed to record details regarding COVID-19 vaccination and prioritizations for groups of persons with non-communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes.

Results

Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions.

Conclusion

The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.

COVID-19 vaccine hesitancy in Latin America and Africa: a scoping review

Vaccination has played an important role in the containment of COVID-19 pandemic advances. However, SARS-CoV-2 vaccine hesitancy has caused a global concern. This scoping review aims to map the scientific literature on COVID-19 vaccine hesitancy in Latin America and Africa from a Global Health perspective, observing the particularities of the Global South and using parameters validated by the World Health Organization (WHO). The review reporting observes the recommendations of the PRISMA for Scoping Reviews (PRISMA-ScR) model. Search was conducted in PubMed, Scopus, Web of Science, and Virtual Health Library (VHL) databases, selecting studies published from January 1, 2020 to January 22, 2022. Selected studies indicate that COVID-19 vaccine hesitancy involves factors such as political scenario, spread of misinformation, regional differences in each territory regarding Internet access, lack of access to information, history of vaccination resistance, lack of information about the disease and the vaccine, concern about adverse events, and vaccine efficacy and safety. Regarding the use of conceptual and methodology references from the WHO for vaccine hesitancy, few studies (6/94) use research instruments based on these references. Then, the replication in Global South of conceptual and methodological parameters developed by experts from the Global North contexts has been criticized from the perspective of Global Health because of it may not consider political and sociocultural particularities, the different nuances of vaccine hesitancy, and issues of access to vaccines.

Willingness of Older Adults with Chronic Diseases to Receive a Booster Dose of Inactivated Coronavirus Disease 2019 Vaccine: A Cross-Sectional Study in Taizhou, China

Vaccination is an important measure to control the spread of COVID-19 among elderly high-risk groups; however, the propensity to receive COVID-19 vaccine boosters has not been evaluated in these populations. Here, we aimed to investigate the willingness to receive a COVID-19 vaccine booster among the elderly chronic disease population in Taizhou, China. A cross-sectional, hospital-based survey was conducted in the outpatient department of a tertiary care hospital between 6 July and 11 August 2021 in Taizhou, China, and the data were uploaded to Wen-Juan-Xing, one of the largest online platforms used to collect survey data in China. The targeted population was non-oncology chronic disease patients aged 60 years and above. The minimum sample size was 229, determined by the G*Power software (v3.1.9.2, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). A total of 254 patients with valid data were enrolled in this study, with a response rate of 82.5% (254/308). Chi-square tests and one-way binary regression were used to compare the proportions and the degree of influence of categorical factors. The magnitude of the effect for the comparisons was measured by Gramer’s V. A multivariate binary logistic regression model was used to correct for confounders and to identify factors. All data were analyzed using SPSS v24.0 (IBM Corporation, Armonk, NY, USA). A total of 198 respondents (77.9%) were willing to receive a COVID-19 vaccine booster dose, and 77.6% of respondents were willing to receive the primary dose. Age < 70 years (OR 2.82), stable disease control (OR 2.79), confidence in the effectiveness of the COVID-19 vaccine (OR 3.11), and vaccine recipient (OR 5.02) were significantly associated with the willingness to receive a COVID-19 vaccine booster dose. Promoting primary dose vaccination is essential for advancing booster vaccination, and it is important to focus on elderly patients’ confidence in the vaccine, in addition to strengthening health management and promoting disease stability. Follow-up studies should focus on elderly patients who belong to specific disease groups.

The Association between Risk Perception and Hesitancy toward the Booster Dose of COVID-19 Vaccine among People Aged 60 Years and Older in China

Background: Given the prevalence of the omicron variant and decreased immunity provided by vaccines, it is imperative to enhance resistance to COVID-19 in the old population. We planned to explore the hesitancy rate toward the booster dose of the COVID-19 vaccine and the association between risk perception and the abovementioned rate among people aged 60 and older. Methods: This national cross-sectional study was conducted in mainland China from 25 May to 8 June 2022, targeting people who were 60 years old or above. Four dimensions were extracted from the Health Belief Model (HBM) to assess participants’ perceived risk levels, including perceived susceptibility, perceived severity, perceived barriers, and perceived benefit. An independent Chi-square test was used to compare the vaccine hesitancy rates among different groups stratified by characteristics. Univariable and multivariable logistic regression models were performed to explore the associations between risk perception and hesitancy rate. Results: Of 3321 participants, 17.2% (95% CI: 15.9–18.5%) were hesitant about booster shots of COVID-19 vaccines. Believing that they were ineligible for vaccination due to certain illnesses (38.3%), concern about vaccine safety (32.0%), believing the booster shots were unnecessary (33.1%), and their limitation on movements (28.0%) were the main reasons for vaccine hesitation. Adjusted by all the selected covariates, people with low perception level of susceptibility (aOR = 1.39, 95% CI: 1.00–1.92) and benefit (low: aOR = 3.31, 95% CI: 2.01–5.45; moderate: aOR = 2.23, 95% CI: 1.75–2.85) were less likely to receiving the booster dose, and the same results were found in people with higher perceived barriers (moderate: aOR = 2.67, 95% CI: 2.13–3.35; high: aOR = 2.04, 95% CI: 1.14–3.67). Our estimates were stable in all four models. Conclusions: In total, 17.2% of the people aged 60 years and older in China were hesitant about booster dose of COVID-19 vaccines, and it was closely associated with a lower level of perceived susceptibility and benefit, as well as a higher level of perceived barriers. Concerns about contraindications, vaccine safety, and limited movements were the main reasons for vaccine hesitancy. Targeted public health measure is a priority to improve the understanding of the elderly on their own susceptibility and vulnerability and clear the obstacles to vaccination.

Facilitators and Barriers to Take up a COVID-19 Vaccine Booster Dose among Community-Dwelling Older Adults in Hong Kong: A Population-Based Random Telephone Survey

A COVID-19 vaccine booster dose is effective and safe for older adults. This study investigated facilitators and barriers to take up a COVID-19 vaccine booster dose among older adults in Hong Kong. Participants were Chinese-speaking community-dwelling adults aged ≥65 years. Telephone numbers were randomly selected from up-to-date telephone directories. A total of 395 participants completed the telephone interview. Logistic regression models were fitted. Among the participants, 31.6% received a COVID-19 vaccine booster dose. After adjustment for significant background characteristics, positive attitudes toward the booster dose, perceiving significant others would support them to receive the booster dose, and less uncertainty regarding the choice of the booster dose was associated with higher uptake of a COVID-19 vaccine booster dose. Concerns about poorer responses to the booster dose due to older age and the presence of chronic conditions were negatively associated with the dependent variable. In addition, the belief that governmental promotional materials could address their concern and were helpful for them to make decisions was associated with a higher COVID-19 vaccine booster dose uptake. Improving booster dose health promotion materials, modifying perceptions, involving significant others and reducing uncertainty are potentially useful strategies to improve COVID-19 vaccine booster dose uptake among older adults.

Governmental Incentives, Satisfaction with Health Promotional Materials, and COVID-19 Vaccination Uptake among Community-Dwelling Older Adults in Hong Kong: A Random Telephone Survey

COVID-19 vaccination is proven to be effective and safe for older adults. This study investigated the impacts of incentives and health promotional materials provided by the government on the completion of the primary COVID-19 vaccination series among older adults in Hong Kong. Participants were Chinese-speaking community-dwelling adults aged ≥65 years. Telephone numbers were randomly selected from up-to-date Hong Kong telephone directories. A total of 440 participants completed the telephone interview. Logistic regression models were fitted. Among the participants, 58.4% had completed the primary COVID-19 vaccination series. Most participants believed that incentives provided by the government had almost no impact on increasing their motivation to receive COVID-19 vaccination, and less than half thought that vaccination promotional materials produced by the government could address their concerns and help them make decisions. After adjustment for significant background characteristics, we found perceived higher impacts of the incentives and belief that vaccination promotional materials produced by the government could address their concern and were helpful for them to make decisions to be associated with a higher rate of completion of primary COVID-19 vaccination series. Perceptions supporting COVID-19 vaccination and less decisional conflict regarding the choice of vaccine were also positively associated with the dependent variable. Government should develop incentives and health promotional materials tailored to the needs of older adults.

Preventable risk factors of dementia: Population attributable fractions in a Brazilian population-based study

Background

Knowledge regarding the modifiable risk factors of dementia is fundamental to guide public health policy. We aimed to estimate the population attributable fraction of modifiable risk factors of dementia among adults from a nationwide epidemiological study.

Methods

We used the public database of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to calculate the Population Attributable Fraction (PAF) for ten risk factors, including education level, hearing loss, hypertension, alcohol consumption, obesity, active smoking, depression, social isolation, physical inactivity, and diabetes. PAF was estimated for this sample after accounting for the communality of each risk factor.

Findings

The ten preventable risk factors for dementia accounted for 50·5% of the Population Attributable Fraction in Brazil. Hearing loss (14·2%), physical inactivity (11·2%), and hypertension (10·4%) accounted for the highest PAF among all the risk factors. Considerable variation in the relative contribution of the different risk factors was found in different regions.

Interpretation

This study might provide an opportunity to change the impact of dementia in Brazil. By targeting modifiable risk factors of dementia, the health of individuals in Brazil might be considerably improved.

Funding

This study did not receive any funding.

Hesitação vacinal contra a COVID-19 em amostra nacional de idosos brasileiros: iniciativa ELSI-COVID, março de 2021

Resumo Objetivo: Determinar a prevalência e fatores associados à intenção de se vacinar contra a COVID-19 entre idosos brasileiros. Métodos: Estudo seccional, baseado em entrevistas telefônicas de participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (60 anos ou mais), conduzidas em 70 municípios, em março de 2021. As análises foram realizadas mediante regressão logística multinomial. Resultados: Entre 4.364 participantes (idade média = 70,1 anos), 91,8% pretendiam se vacinar ou já haviam sido vacinados, 2,5% não tinham essa intenção e 5,7% estavam indecisos. Residentes do Norte e Sudeste brasileiros apresentaram maiores propensões para se vacinar, assim como aqueles com duas ou mais doenças crônicas. Os que se informam sobre a COVID-19 com amigos/familiares/mídia social foram mais propensos a estarem indecisos acerca da vacinação (odds ratio = 3,15; IC95% 1,28;7,77). Conclusão: Identificou-se uma das mais altas prevalências da intenção de se vacinar contra a COVID-19 descritas até a presente data.