Perceptions of measles, pneumonia, and meningitis vaccines among caregivers in Shanghai, China, and the health belief model: a cross-sectional study

The use of Health Belief Model (HBM) to explain factors underlying people to take the COVID-19 vaccine in Indonesia

BACKGROUND

SARS-COV-2 (COVID-19) has severely impacted people's health worldwide. Vaccines are one of the health measures taken to reduce the impact of COVID-19, but recent reports have revealed that some people are reluctant to be vaccinated against COVID-19. Understanding the factors underlying an individual's decision to take the COVID-19 vaccine is critical to designing an immunisation programme. This study examines factors that influence the intention to take a COVID-19 vaccine using the modified Health Belief Model (HBM) framework and analysing demographic factors.

METHOD

A cross-sectional online survey was conducted from 10 January to 20 January 2021. Five hundred thirty-seven respondents above 17 years old and residing in Indonesia voluntarily completed an online survey. Survey questions addressed sociodemographic factors; perception of susceptibility, severity, benefits and barriers; cues to action; and intention to take the COVID-19 vaccine. A Structural Equation Modelling (SEM) approach with SmartPLS software was used to analyse the measurements and model construct.

FINDINGS

The results showed that the perception of susceptibility, severity, benefits and barriers, as well as cues to action, predicted people's intention to take a COVID-19 vaccine. Model structure explained a large proportion of variance in people's intention to be vaccinated against COVID-19 (R2 = 66.8 %). Some demographic factors affected the key variables of the HBM. People with low and middle income negatively influence feeling severity, beneficial and barrier in intending to take vaccine. Other demographic factors such as sex, age, marriage and living areas did not affect the components of the HBM, except for females influencing severity and people living in urban areas associated with benefits variable. These findings imply that COVID-19 vaccination programmes should focus on providing accurate information about the severity of COVID-19 and the benefits of taking the vaccine. Building people's confidence in their ability to eliminate barriers to taking the vaccine and involving family members and community and religious leaders will increase COVID-19 vaccine uptake.

CONCLUSION

Despite limitations to the study, such as respondent demographics that are unrepresentative of the wider Indonesian population, inadequate survey timing and an exclusive focus on vaccine intention as the outcome variable, the present study contributes to explaining individuals' intentions to take a COVID-19 vaccine in a Eastern country context. This study is valuable to providing public health policy recommendations that focus on effectively designing immunisation programme interventions.

Psychological Distance, Construal Level, and Parental Vaccine Hesitancy for COVID-19, HPV, and Monkey Pox Vaccines

Building on the construal-level theory and the multi-dimensional model of behavioral barriers, this study examined whether psychological distance and construal level explain the association between behavioral intention and behavioral barriers that may lead to parental vaccine hesitancy. Results of multilevel structural equation models show that low vaccination intention, far distance perception, and abstract construal of vaccines led to more global concerns, such as vaccine safety and relevance. Such effects emerged when people considered specific vaccines, such as coronavirus disease 2019 (COVID-19), human papillomavirus (HPV), and monkeypox vaccines, and when they considered multiple vaccines in general.

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

COVID-19 Vaccine Acceptance Among Healthcare Students in Vietnam, Based on Health Belief Model

Introduction

Healthcare students have a high risk of acquiring COVID-19 while practicing in medical facilities, and their health-related decisions might considerably impact the people around them. In the circumstance of many people refusing vaccination, the delay in accepting the COVID-19 vaccine by this group could be a barrier to providing effective immunity to the entire population against the COVID-19 pandemic.

Objective

The study aimed to assess the prevalence of vaccination acceptance and the factors influencing COVID-19 vaccine acceptance among Vietnamese healthcare students.

Methods

A web-based cross-sectional study was conducted among 384 respondents. The chi-square, Fisher's exact, and Mann-Whitney tests were used to assess the association between independent and dependent variables. Binary logistic regression analysis was used to identify the potential determinants of COVID-19 vaccine acceptance. Variables with p values of less than .05 at the 95% confidence interval were considered significant variables.

Results

Out of 384 participants, 91.7% accepted COVID-19 vaccination. Nurse and midwife (odds ratio [OR] = 6.81, confidence interval [CI] = 2.02-22.94, p < .01), perceived normal health status (OR = 15.22, CI = 2.74-84.66, p < .001), perceived good health status (OR = 149.00, CI = 11.08-2003.42, p < .01), COVID-19 infection among relatives or friends (OR = 4.19, CI = 1.77-9.95, p < .01) were predictors for the COVID-19 vaccine acceptance. Participants were less likely to accept COVID-19 vaccination if they reported greater perceived barriers (OR = 0.80, CI = 0.69-0.93, p < .01).

Conclusion

The current study offers helpful information on the factors influencing vaccine acceptance based on the Health Belief Model. The findings could benefit policymakers in establishing effective campaigns to improve the acceptance rate of the COVID-19 vaccine among healthcare students and shorten the time required to achieve herd immunity.

Adopting social health insurance in Nepal: A mixed study

Objective

The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.

Methods

A cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.

Results and prospects

Of a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30-290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3-393.9) and accessibility (OR = 74.4; 95% CI, 42.5-130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.

Conclusion

Although enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.

Vaccine Uptake to Prevent Meningitis and Encephalitis in Shanghai, China

Multiple vaccines may prevent meningitis and encephalitis (M/E). In China, the meningococcal vaccine and Japanese encephalitis vaccine (JEV) have been included in the expanded program of immunization (EPI). The pneumococcal vaccine, Haemophilus influenzae type b (Hib) vaccine, rotavirus vaccine, and enterovirus 71 (EV-71) vaccine are non-EPI vaccines and are self-paid. We aim to investigate the uptake of these M/E vaccines in children and the related knowledge and health beliefs among family caregivers. A total of 1011 family caregivers with children aged 1-6 years in Shanghai, China were included in the study. The uptake of the pneumococcal vaccine, Hib-containing vaccine, rotavirus vaccine, and EV-71 vaccine remained at 44.0-48.1% in children, compared with the higher uptake of the meningococcal vaccine (88.8%) and JEV (87.1%). Moreover, family caregivers had limited knowledge on the M/E pathogens and possible vaccines. Their health beliefs were moderate to high. Then, a health belief model (HBM) and a structural equation model were established. The uptake of four non-EPI vaccines was significantly influenced by family income (β = 0.159), knowledge (β = 0.354), self-efficacy (β = 0.584), and perceived susceptibility (β = 0.212) within an HBM. Therefore, it warrants further improving the uptake rate for these non-EPI vaccines to prevent potential M/E in children. A specific health promotion may empower the caregivers' decision-making on childhood vaccination.

Vaccine hesitancy and receipt of mandatory and optional pediatric vaccines in Shanghai, China

Given increased global concern about vaccine hesitancy, this study estimates coverage of mandatory vs non-mandatory vaccines in children, and assesses whether vaccine hesitancy among young parents relates to their child's eventual vaccination status in Shanghai, China. In a cohort study within Shanghai, China, we ascertained vaccine hesitancy among parents of young infants, and later abstracted their child's electronic immunization records. We measure full coverage of vaccines on the mandatory, and publicly funded Expanded Program on Immunization (EPI). Non-EPI vaccines included pneumococcal conjugate vaccine, Haemophilus influenzae type b vaccine, and rotavirus vaccine. Vaccine hesitancy was linked to vaccine uptake through mixed effects logistic regression models. Among 972 children, full coverage of all EPI vaccines by 15 months was 95%, compared to dose 1 coverage of pneumococcal conjugate vaccine at 13%, Haemophilus influenzae type b vaccine at 68%, and rotavirus vaccine at 52%. Vaccine hesitancy was not significantly linked with full coverage of all EPI vaccines (OR: 1.55, 95% CI: .89, 2.72), but coverage in the vaccine hesitant was lower for pneumococcal conjugate vaccine dose 1 (OR: .70, 95% CI: .53, .91), and rotavirus vaccine dose 1 (OR: .69, 95% CI: .56, .86). Disparities by education level were not significant for EPI vaccines, but were for dose 1 of pneumococcal conjugate vaccine rotavirus vaccine. Overall, vaccine hesitancy was related to lower uptake of non-EPI, but not EPI vaccines. Shanghai has a robust system for insurance equitable access to EPI vaccines, but if vaccine hesitancy grows, it could reduce coverage of non-EPI vaccines.

Factors affecting childhood immunization: Thematic analysis of parents and healthcare workers' perceptions

Immunization against common childhood diseases is an important strategy as it is critical for reducing the global child morbidity and mortality. This review explores the perceptions of parents and HCWs toward childhood immunization. The PRISMA guideline was used to search and include the studies. Relevant electronic databases were systemically searched for the years ranging from 2000 to 2021 to identify studies reported in English. Themes were then identified using thematic analysis. A total of 44 studies met the review criteria and were summarized and categorized into 4 themes: barriers to immunization, parental knowledge, attitude and behavior (KAB), health system factors and HCWs' KAB. This review found that immunization decision-making is a complex process. Parental KAB leads to immunization decisions. HCWs were also noted to be the trusted sources of immunization information. Further research can be conducted on how to improve parents' perceptions of immunization and immunization practices.

COVID-19 Vaccination Status and Hesitancy among Breast Cancer Patients after Two Years of Pandemic: A Cross-Sectional Survey

Background: Patients with cancer show greater susceptibility and vulnerability to severe acute respiratory syndrome coronavirus 2 infection. However, data on the vaccination status among patients with breast cancer and any structured analysis of the factors influencing patients’ decisions regarding vaccines are lacking. Methods: This cross-sectional study on patients with breast cancer in China was conducted from 1 June 2022, to 17 June 2022. Every participant completed an online questionnaire about their vaccination status and any adverse reactions, and a scale based on the Health Belief Model (HBM) to assess the vaccination status of respondents and their willingness to receive following doses or boosters. Results: Among the 1132 participants, 55.2% had received a COVID-19 vaccine. The incidence of adverse events per dose was around 40%. Vaccine hesitancy of 61.9% was observed among patients who had not fully received three doses of vaccine or boosters. The only variable found to be associated with vaccine hesitancy was time since diagnosis (p < 0.05). In the HBM scale, vaccine hesitancy was closely related to a low level of perceived susceptibility, a low level of perceived benefit, a high level of perceived barriers and a low level of agreement with doctors’ advice. Conclusions: For patients with breast cancer, perceived susceptibility, benefits and barriers should be prioritized, and the advice from authoritative doctors is a vital cue to action.

Variations in COVID-19 Vaccine Attitudes and Acceptance among Refugees and Lebanese Nationals Pre- and Post-Vaccine Rollout in Lebanon

Vaccine hesitancy among displaced populations is associated with inequitable access to services and mistrust of authorities, among other factors. This study evaluated variations in attitudes toward COVID-19 vaccines and factors associated with vaccine acceptance among refugees and Lebanese nationals accessing 60 International Medical Corps-supported health facilities through two cross-sectional surveys pre- (n = 3927; Survey 1) and post- (n = 4174; Survey 2) vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health beliefs model. Refugees comprised 52.9% (Survey 1) and 54.2% (Survey 2) of respondents. Vaccine acceptance was low among both groups in Survey 1 (25.9% refugees vs. 23.1% Lebanese nationals), but higher in Survey 2 in Lebanese (57.6%) versus refugees (32.9%). Participants reported greater perceived benefits of vaccination, higher perceived COVID-19 susceptibility, and lower perceived vaccination barriers in Survey 2 versus Survey 1. Post-vaccine rollout, refugees had lower odds of vaccine acceptance compared to Lebanese (OR 0.50, 95%CI 0.41–0.60), while older age (OR 1.37, 95%CI 1.06–1.78, ≥51 years vs. 18–30 years) was associated with greater vaccine acceptance. Health beliefs model variables were associated with vaccine acceptance in both surveys. Tailored strategies to respond dynamically to changes in vaccine attitudes among vulnerable groups in Lebanon are essential for equitable vaccine uptake.

Factors influencing the acceptability of COVID-19 vaccination: A cross-sectional study from Malaysia

Background

With the surge of COVID-19 cases worldwide, vaccines against COVID-19 are also developing across the countries. However, the acceptability of COVID-19 vaccination among general people is questionable. The availability of several vaccines’ options against COVID-19 has perplexed people regarding individual vaccines’ efficacy and safety. Therefore, we aim to determine the acceptance, preferences, impact factors of future COVID-19 vaccines in Malaysia and the factors influencing the COVID-19 vaccination acceptance among vaccine demand and vaccine delay groups.

Material and methods

An online-based cross-sectional survey was conducted among Malaysian residents 18 years and above of either gender using the snowball sampling technique. A self-administered questionnaire was made available to participants through various social media networks, email, and telegram. The data obtained from the survey were analyzed using SPSS version 25.0. Association between background characteristics and respondents were analyzed using the Chi-square test in the vaccine delay group and vaccine acceptance group.

Results

Total of 1282 responses were considered for the study, mainly from male respondents (71%). Among the respondents, 95.9% thought that vaccination would be an effective way to prevent and control COVID-19, and 96% would accept vaccination if the COVID-19 vaccine were successfully developed and approved for listing in the future. Essential factors influencing vaccination decisions were vaccine convenience (95.7%) and doctor's recommendation (97.3%). Bivariate analysis revealed that age less than 24 years, Malay race, living in urban areas, tertiary education, students, single marital status, family income (Malaysian ringgits) RM 4,850 to RM 10,959 and >RM 10,960 were significantly associated with vaccine acceptance of COVID19 vaccination.

Conclusion

All the factors influencing COVID-19 vaccine acceptance rates throughout the country should be studied on a larger scale, and appropriate steps to ensure vaccine acceptance among the public should be meticulously devised by the government and related authorities.

Acceptance and willingness to pay under the different COVID-19 vaccines: A contingent valuation method

Background

The COVID-19 vaccine is recognized as a novel tool in the battle against COVID-19. Recently, there were several types of vaccines that have a different effectiveness and safety profile. Understanding the vaccine acceptance and willingness to pay (WTP) are essential to develop a strategic plan to increase the rate of COVID-19 vaccination uptake.

Objectives

To assess the acceptance and WTP for a COVID-19 Vaccine in Thailand using the contingent valuation method (CVM). Additionally, to identify the factors that affect the acceptance and the amount of WTP for a COVID-19 Vaccine.

Methods

We conducted a cross-sectional survey using a payment card approach with open-ended questions during September 2021. Three hypothetical COVID-19 vaccines (Vaccines A, B, and C) in two scenarios were employed. Data were collected from 752 people. Multivariate logistic regression was performed to assess the predictors of vaccine acceptance. Multiple linear regression was used to analyze factors associated with the maximum amount WTP for a vaccine.

Results

Of 742 respondents, the highest acceptance was vaccine C (70.71%), followed by B (17.72%) and A (11.57%). Similarly, 53.87%, 41.44%, and 36.21% of the respondents expressed WTP for vaccine C, B and A, respectively. The maximum amount WTP for vaccine C was US$46, followed by B (US$35) and A (US$32). Factors affecting acceptance included monthly salary, region of residence, education, perceived risk of COVID-19 infection, knowledge and attitude about the COVID-19 vaccine. In addition, monthly salary, region of residence, education and knowledge on COVID-19 vaccine were related to maximum amount WTP.

Conclusion

Acceptance and WTP depends on vaccine characteristics. Educational campaigns should be implemented to improve people's awareness, knowledge, and attitude towards COVID-19 vaccines to increase the vaccines' acceptance. To increase the rate of vaccination, the Thai government needs to allow freedom of choice on vaccines, while considering effectiveness and safety issues.

Seroprevalence Surgery of Anti-SARS-CoV-2 Antibodies Based on COVID-19 Vaccine Type in Academy Community, East Kalimantan, Indonesia

BACKGROUND OF THE STUDY: The implementation of the vaccine on a large scale has almost reached all provinces in Indonesia. East Kalimantan, one of the provinces affected by COVID-19, has also implemented a vaccine program. Seroprevalence surveys are essential to describe the success of vaccine program based on antibody titre test. AIM OF THE STUDY: This study aims to determine the anti-SARS-CoV-2 antibody titre value based on the type of vaccine received by the academic community in Samarinda, one of the cities most affected by COVID-19 in East Kalimantan. METHODOLOGY: The study was population-based. The study sampled 100 people from the community. Participants must be in good health, aged 16-60, with a positive COVID-19 test, no comorbid illnesses or other chronic problems, no blood transfusions, and most importantly, have received the least initial dosage of immunization. The data will be analyzed using SPSS 26 and STATA 16. A normality test and Tobit regression test to determine the antibody distribution in each vaccine type.  RESULTS: The results showed that Moderna COVID-19 Vaccine provided a significant (p=0.001) increase in antibody prediction of 1090 U/ml (95% CI: 764-1416), while Pfizer provided a significant (p=0.000) rise of 766 U/ml (95% CI: 307-1226). CONCLUSION: According to the results of a seroprevalence survey conducted among the academic community in East Kalimantan, receivers of inactivated vaccinations outnumbered those of mRNA and vector-based vaccines. It can be determined that booster immunizations for students and academic staff are required to guard against COVID-19 infection. As boosters, both Moderna's COVID-19 Vaccine and Pfizer's COVID-19 Vaccine are strongly recommended.

Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis

INTRODUCTION

The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue.

METHODS

We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible.

RESULTS

Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0-17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83-1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20-3.50). The most recent studies proposed the mandatory vaccination of HCWs.

DISCUSSION

According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.

Willingness of Caregivers to Have Their Children Vaccinated with Pneumococcal Vaccines in the Context of an Innovative Immunization Strategy - Weifang City, Shandong Province, 2021

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?

Pneumococcal diseases (PDs) pose a serious health threat to children. Vaccination is the most cost-effective intervention to prevent PDs, but pneumococcal vaccines coverage among children is low in China.

WHAT IS ADDED BY THIS REPORT?

This study investigated the willingness of children's caregivers to have their children vaccinated with pneumococcal vaccines under an innovative policy to offer 1-dose of the 13-valent pneumococcal conjugate vaccines at no charge to families. The research found that 70.51% of caregivers were willing to have their infants receive pneumococcal vaccines and that reducing the cost of vaccines may increase caregivers' willingness.

WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?

This is the first evaluation in China of acceptance of pneumococcal vaccines among children under a 1-dose, cost-free policy. The results provide scientific evidence for updating local and national pneumococcal immunization strategies to promote the use of the pneumococcal vaccine.

Health-care Workers’ Willingness to Pay for COVID-19 Vaccines in Eastern Ethiopia: Using Contingent Valuation Method

Background

Health-care workers (HCWs) are among the highest risk groups for COVID-19 infection. The vaccine is found to be vital for HCWs, their household contacts, and their patients to protect against COVID-19 infection and maintain the safety of health systems. The actual willingness to pay for COVID-19 vaccination and associated factors remain uncertain among health-care workers in Ethiopia. Therefore, studying health-care workers’ willingness to pay (WTP) for COVID-19 vaccination helps to have an insight on valuation of the vaccine.

Methods

Institution-based cross-sectional study was conducted among 403 randomly selected health-care workers working in health facilities in eastern Ethiopia from February 3 to March 20, 2021. Pretested structured questionnaire was used to collect data. Binary logistic regression analysis was fitted to test the associations between outcome and explanatory variables. A p-value of <0.05 with 95% confidence interval was used to declare statistical significance.

Results

The magnitude of willingness to pay for a COVID-19 vaccine was 42.8%. The median amounts of money respondents willing to pay was 400 ETB (US$ 10.04). Sex (male, AOR = 2.33; 95% CI: 1.39, 3.93), monthly income (>7000 ETB, AOR = 1.22; 95% CI: 1.11, 2.51), affordability (AOR = 1.99; 95% CI: 1.18, 3.35), fear of side effects (AOR = 3.75; 95% CI: 2.13, 6.60), support vaccinations (AOR = 2.97; 95% CI: 1.65, 5.35), the likelihood of getting COVID-19 infection (AOR = 2.11; 95% CI: 1.26, 3.52) were independent determinants of WTP for a COVID-19 vaccine.

Conclusion

Health-care workers’ willingness to pay for COVID-19 vaccination was found to be low. Detailed health education and training about COVID-19 vaccines are required regarding their side effects, and efficacy to make an informed decision to enhance the willingness to pay for the vaccine. Moreover, the government should consider providing COVID vaccines free of charge for low-income groups and at an affordable price for those who could pay.

Clinical characteristics, antimicrobial resistance, and risk factors for mortality in paediatric invasive pneumococcal disease in Beijing, 2012-2017

Background

To analyse clinical characteristics, antibiotic susceptibility, and risk factors for mortality in paediatric invasive pneumococcal disease (IPD) in Beijing.

Methods

Paediatric IPD patients in our hospital were retrospectively collected from 2012 to 2017. Clinical manifestations, laboratory tests, antimicrobial susceptibility and serotype of isolates, and risk factors for mortality of IPD were analysed.

Results

Overall, 186 IPD cases were enrolled. The major manifestations were meningitis (76), pneumonia with bacteraemia (60), bacteraemia without focus (21), and pneumonia with empyaema (22). Of 72 cases with underlying diseases, leukaemia (18.0%), congenital heart disease (15.3%), primary immunodeficiency disease (12.5%), nephrotic syndrome (12.5%), and cerebrospinal fluid leakage (12.5%) were most common. In total 96.9% of isolates would have been covered by the pneumococcal conjugate vaccine (PCV13), including 19F (32.8%), 19A (23.4%), 4 (17.2%), and 23F (9.4%). Nonsusceptibility rates of penicillin, cefotaxime, and cefepime among nonmeningitis patients increased between 2012 and 2017; The mortality rate was 21.5%. Meningitis, respiratory failure, multiple organ failure, and white blood cell count < 4000 cells/μL were independent risk factors for mortality.

Conclusion

Meningitis was the most common clinical manifestation of IPD, and was frequently associated with death. Strains in the PCV13 vaccine would cover most of the cases, and so wider use of PCV13 should be considered.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review

BACKGROUND AND AIMS

Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count.

METHODS

A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review.

RESULTS

In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States.

CONCLUSIONS

The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.

Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology

BACKGROUND

Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs.

OBJECTIVE

In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community.

METHODS

We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables.

RESULTS

We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people's decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition.

CONCLUSIONS

Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations.

Acceptance of a COVID-19 Vaccine Before it is Available in China During the Pandemic

Objectives: China was believed to be the country with the world’s highest acceptance rate of the COVID-19 vaccine following several investigations. This study aims to explore the Chinese acceptance of a COVID-19 vaccine before it is made available, including its determinants.

Methods: A cross-national online survey was conducted covering all 31 provinces of mainland China. The survey consists of the demographic variables, acceptance of a self-paid COVID-19 vaccine as the dependent variable, and the 3Cs factors (i.e., confidence, convenience, and complacency) as the independent variables.

Results: Among the 1,532 participants, 57.9% accepted to get a self-paid COVID-19 vaccine. COVID-19 vaccine acceptors were more likely to be concerned about the effectiveness of the vaccines, believe that they were at risk of COVID-19 infection, have a high perceived susceptibility of COVID-19, and trust in the health care system.

Conclusion: Findings indicate that the critical task in the early stage of the COVID-19 vaccine development in China is to increase the tolerance to some intuitive concerns about the vaccines, put more emphasis on the communication of the saliency of the disease threats, and effectively translate people’s trust in the government into vaccine acceptance.

Does Seeing What Others Do Through Social Media Influence Vaccine Uptake and Help in the Herd Immunity Through Vaccination? A Cross-Sectional Analysis

Widespread acceptance of COVID-19 vaccination is the next major step in fighting the pandemic. However, significant variations are observed in the willingness to take the vaccination by citizens across different countries. Arguably, differences in vaccination intentions will be influenced by beliefs around vaccines to influence health. Often perceptions of what others are doing and the information available guide individuals' behaviors for vaccination. This is more so in the digital age with the influence of the internet and media. This study aims to determine the factors that impact willingness to vaccinate for COVID-19. We examined factors associated with acceptance of vaccine based on (1) constructs of the Health Belief Model (HBM), (2) sources of information, (3) social media usage, (4) knowledge of COVID-19 treatment, and (5) perception of government's efforts for mitigation. Randomly sampled online survey data was collected by a global firm between December 2020 and January 2021 from 372 citizens (with a response rate of 96.6%) from multiple regions, including North America, the Middle East, Europe, and Asia. Ordered probit regression suggests that the health belief model constructs hold. Perceived severity of COVID-19 (P < 0.001) and action cues of others taking the vaccine positively influences a subject's vaccine intent (P < 0.001), perceived benefits and perceived efficacy of the vaccine positively influences a subject's vaccine intent (P < 0.001). Perceived barriers negatively influence vaccine intent (P < 0.001). Interestingly as for media usage, mainstream media (e.g., TV, newspaper) (P = 0.006) and social media (P = 0.013) both negatively influence a subject's vaccine intent. Social media platforms that are more entertainment and social-based, such as Whatsapp, Instagram, and YouTube, have a negative and significant influence on vaccine intent (P = 0.061), compared to other more information-based social media platforms (e.g., Twitter, LinkedIn). Knowledge of COVID-19 treatment positively influences vaccine intent (P = 0.023). Lastly, governmental efforts' perceived reliability in mitigation strategy (P = 0.028) and response efforts (P = 0.004) negatively influence vaccine intent. The study highlights the "wait-and-see" action cue from others and leaders in the community. It also informs the importance of shaping media information for vaccination through informative media and social media outlets to counteract any misinformation.

Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study

Background

The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19.

Objective

This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination.

Methods

A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled.

Results

The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=−0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=−0.45, P<.001) via vaccine hesitancy (SSC=−0.32, P<.001).

Conclusions

It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function.

Factors influencing the acceptability of COVID-19 vaccination: A cross-sectional study from Malaysia

Background

With the surge of COVID-19 cases worldwide, vaccines against COVID-19 are also developing across the countries. However, the acceptability of COVID-19 vaccination among general people is questionable. The availability of several vaccines’ options against COVID-19 has perplexed people regarding individual vaccines’ efficacy and safety. Therefore, we aim to determine the acceptance, preferences, impact factors of future COVID-19 vaccines in Malaysia and the factors influencing the COVID-19 vaccination acceptance among vaccine demand and vaccine delay groups.

Material and methods

An online-based cross-sectional survey was conducted among Malaysian residents 18 years and above of either gender using the snowball sampling technique. A self-administered questionnaire was made available to participants through various social media networks, email, and telegram. The data obtained from the survey were analyzed using SPSS version 25.0. Association between background characteristics and respondents were analyzed using the Chi-square test in the vaccine delay group and vaccine acceptance group.

Results

Total of 1282 responses were considered for the study, mainly from male respondents (71%). Among the respondents, 95.9% thought that vaccination would be an effective way to prevent and control COVID-19, and 96% would accept vaccination if the COVID-19 vaccine were successfully developed and approved for listing in the future. Essential factors influencing vaccination decisions were vaccine convenience (95.7%) and doctor's recommendation (97.3%). Bivariate analysis revealed that age less than 24 years, Malay race, living in urban areas, tertiary education, students, single marital status, family income (Malaysian ringgits) RM 4,850 to RM 10,959 and >RM 10,960 were significantly associated with vaccine acceptance of COVID19 vaccination.

Conclusion

All the factors influencing COVID-19 vaccine acceptance rates throughout the country should be studied on a larger scale, and appropriate steps to ensure vaccine acceptance among the public should be meticulously devised by the government and related authorities.

University students' perspectives, planned uptake, and hesitancy regarding the COVID-19 vaccine: A multi-methods study

PURPOSE

To investigate university students' willingness to receive a COVID-19 vaccine when it becomes available to them.

METHOD

A multi-methods approach was used-online convenience sample surveys and semi-structured interviews-of young adults attending a large Canadian public university. Two survey samples were collected (June 20-July 28, 2020 and September 22-October 17, 2020). Semi-structured interviews were conducted following each survey, interviewing 20 students in each round.

RESULTS

In June 77.8% of surveyed students (n = 483) were willing to get the COVID-19 vaccine; in September 79.6% were willing (n = 1269). Multinomial and binary logistic regression analyses found that increasing perception of the severity of COVID-19 predicted the likelihood that a respondent was willing to get the COVID-19 vaccine in both surveys. In the latter survey students who indicated they would be encouraged to get the COVID-19 vaccine if their doctor/pharmacist recommended it were 76 times more likely to be willing to get the vaccine than those who would not be encouraged by medical advice. Interviews revealed concerns about the speed of the vaccine roll out, safety, and efficacy.

CONCLUSIONS

The majority of university students intend to get the COVID-19 vaccine, but there are nuanced concerns about efficacy and safety that must be taken into account by public health authorities as the vaccine becomes available to this group. Ensuring that family doctors, pharmacists, and other front-line healthcare workers have consistent and clear information regarding the benefits of vaccination will be critical to encouraging uptake among young adults.

Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018-2019

To control the rise in Neisseria meningitidis strain W infections, during 2018–2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13–18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease, the MenACWY vaccination, vaccinations in general, and their MenACWY vaccination intentions. Using random forest analysis, we studied predictions of vaccination intentions by knowledge and beliefs. Survey response rate was 52.8% among teenagers and 59.4% among parents. MenACWY vaccination intentions were best predicted by knowledge and beliefs about vaccinations in general, surpassing knowledge and beliefs about meningococcal disease and the MenACWY vaccination. For teenagers, their parents’ intention that the teenager be vaccinated was a strong predictor of the teenagers’ own vaccination intention. To optimize vaccination uptake during future outbreaks, we recommend that communications emphasize the effectiveness and safety of vaccines and continue to focus on parents.

Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States

The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults.

Vaccine Hesitancy and Concerns About Vaccine Safety and Effectiveness in Shanghai, China

INTRODUCTION

Rapidly urbanizing communities in middle-income countries could be sources of vaccine hesitancy, and may create hot spots of low vaccination coverage. This study characterizes vaccine hesitancy in Shanghai and identifies disparities in vaccine safety and efficacy concerns by residency status-a marker for recent migration into the city.

METHODS

Parents of children aged ≤18 years from immunization clinics in Shanghai were enrolled in summer 2019, with the data analyzed during winter 2019-2020. The paper questionnaire used the Parental Attitudes towards Childhood Vaccines scale, which included questions about vaccine safety and efficacy concerns. The primary independent variable was residency-whether an individual was a Shanghai local or a recent migrant (i.e., non-local). Linear regression models assessed the relationship between residency and vaccine safety and efficacy concerns.

RESULTS

Among 1,021 participants, 65.4% had local residency, and the remainder were urban non-locals (13.1%) or rural non-locals (21.5%). A majority of parents expressed concerns about vaccine side effects (73.8%), vaccine safety (63.9%), and vaccine effectiveness (52.4%). Compared with locals, rural non-locals were more concerned about vaccine side effects (β=0.26, 95% CI=0.07, 0.46), vaccine safety (β=0.42, 95% CI=0.19, 0.65), and vaccine effectiveness (β=0.37, 95% CI=0.16, 0.58).

CONCLUSIONS

Differences in vaccine hesitancy by residency could lead to geographical and sociodemographic disparities in vaccination coverage and outbreaks of vaccine-preventable disease.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Factors impacting self-pay pediatric vaccine utilization in China: a large-scale maternal survey

OBJECTIVES

Utilization of self-pay vaccines worldwide is very low, especially in China; the reasons for this are unclear. We aimed to identify factors that impact the decision among Chinese mothers to utilize self-pay vaccines for their children.

METHODS

Mothers who were hospitalized at two hospitals in Zhanjiang City and who agreed to participate by completing the required questionnaire were eligible for this study.

RESULTS

In total, 7518 respondents (n = 7592) completed the questionnaire and were included in this survey. The self-pay option was largely elected by mothers with one child, compared with those who had two or more children. Similarly, utilization by workers at government agencies and organizations was higher than that among factory workers or unemployed respondents. Mothers with a college degree or above had higher utilization than those with a high school level education or lower. The main issues affecting maternal decisions to utilize self-pay pediatric vaccines were safety, the protective effect, and the high cost.

CONCLUSION

Mothers with higher socioeconomic status were more inclined to self-pay for pediatric vaccines. Steps taken to enhance public awareness about the safety and protective benefits of self-pay vaccines, as well as lowering their cost will likely encourage broader utilization of these vaccines.

A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination

Background

Acceptance of vaccines is an important predictor of vaccine uptake. This has public health implications as those who are not vaccinated are at a higher risk of infection from vaccine preventable diseases. We aimed to examine how parental attitudes and beliefs towards childhood vaccination were measured in questionnaires through a systematic review of the literature.

Methods

We systematically reviewed the literature to identify primary research studies using tools to measure vaccine attitudes and beliefs, published between January 2012 and May 2018. Studies were included if they involved a quantitative survey of the attitudes and beliefs of parents about vaccinations recommended for children. We undertook a synthesis of the results with a focus on evaluating the tools used to measure hesitancy.

Results

A total of 116 studies met the inclusion criteria, 99 used a cross sectional study design, 5 used a case control study design, 4 used a pre-post study design and 8 used mixed methods study designs. Sample sizes of included studies ranged from 49 to 12,259. The most commonly used tool was the Parent Attitudes about Childhood Vaccines (PACV) Survey (n = 7). The most common theoretical framework used was the Health Belief Model (n = 25). Questions eliciting vaccination attitudes and beliefs varied widely.

Conclusions

There was heterogeneity in the types of questionnaires used in studies investigating attitudes and beliefs about vaccination in parents. Methods to measure parental attitudes and beliefs about vaccination could be improved with validated and standardised yet flexible instruments. The use of a standard set of questions should be encouraged in this area of study.

Acceptance of a COVID-19 Vaccine in Southeast Asia: A Cross-Sectional Study in Indonesia

Introduction: Several vaccine candidates are being clinically tested in response to the 2019 coronavirus disease (COVID-19) pandemic. This study was conducted to assess the acceptance of a 50 or 95% effective COVID-19 vaccine, when it becomes available in southeast Asia, among the general population in Indonesia. Methods: A cross-sectional online survey was conducted between March 25 and April 6, 2020. Participants were asked if they would accept a free vaccine which was 95 or 50% effective. Using a logistic regression model, we assessed the associations between sociodemographic characteristics, exposure to COVID-19 information, or perceived risk of infection with acceptance of a hypothetical COVID-19 vaccine. Results: Among 1,359 respondents, 93.3% of respondents (1,268/1,359) would like to be vaccinated for a 95% effective vaccine, but this acceptance decreased to 67.0% (911/1,359) for a vaccine with 50% effectiveness. For a 95% effective vaccine, being a healthcare worker and having a higher perceived risk of COVID-19 infection were associated with higher acceptance, adjusted odds ratio (aOR): 2.01; 95%CI: 1.01, 4.00 and aOR: 2.21; 95%CI: 1.07, 4.59, respectively; compared to civil servants, being retired was associated with less acceptance (aOR: 0.15; 95%CI: 0.04, 0.63). For a 50% effective vaccine, being a healthcare worker was also associated with greater acceptance, aOR: 1.57; 95%CI: 1.12, 2.20. Conclusion: Acceptance of a COVID-19 vaccine was highly influenced by the baseline effectiveness of the vaccine. Preparing the general population to accept a vaccine with relatively low effectiveness may be difficult.

Acceptance of a COVID-19 Vaccine in Southeast Asia: A Cross-Sectional Study in Indonesia

Introduction: Several vaccine candidates are being clinically tested in response to the 2019 coronavirus disease (COVID-19) pandemic. This study was conducted to assess the acceptance of a 50 or 95% effective COVID-19 vaccine, when it becomes available in southeast Asia, among the general population in Indonesia. Methods: A cross-sectional online survey was conducted between March 25 and April 6, 2020. Participants were asked if they would accept a free vaccine which was 95 or 50% effective. Using a logistic regression model, we assessed the associations between sociodemographic characteristics, exposure to COVID-19 information, or perceived risk of infection with acceptance of a hypothetical COVID-19 vaccine. Results: Among 1,359 respondents, 93.3% of respondents (1,268/1,359) would like to be vaccinated for a 95% effective vaccine, but this acceptance decreased to 67.0% (911/1,359) for a vaccine with 50% effectiveness. For a 95% effective vaccine, being a healthcare worker and having a higher perceived risk of COVID-19 infection were associated with higher acceptance, adjusted odds ratio (aOR): 2.01; 95%CI: 1.01, 4.00 and aOR: 2.21; 95%CI: 1.07, 4.59, respectively; compared to civil servants, being retired was associated with less acceptance (aOR: 0.15; 95%CI: 0.04, 0.63). For a 50% effective vaccine, being a healthcare worker was also associated with greater acceptance, aOR: 1.57; 95%CI: 1.12, 2.20. Conclusion: Acceptance of a COVID-19 vaccine was highly influenced by the baseline effectiveness of the vaccine. Preparing the general population to accept a vaccine with relatively low effectiveness may be difficult.

Preferences for vaccination program attributes among parents of young infants in Shanghai, China

Compared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents' preferences for shot-limiting. The aim of this study was to assess Chinese parents' preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child's first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents' strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.

Inappropriate antibiotic prescriptions among pediatric inpatients in different type hospitals

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.

How Do Experts and Nonexperts Want to Promote Vaccines? Hepatitis E Vaccine as Example

Low- and middle-income countries receive limited guidance from external entities about how to introduce vaccines. This is especially true for the Hepatitis E (HepE) vaccine, which is currently only commercially available in China. The aims of this qualitative study are to identify which attributes of the HepE disease and vaccine are considered important, and to compare desired promotion methods between different stakeholders. Stakeholders included experts (Centers for Disease Control and Prevention staff, health care providers, and researchers), and nonexperts included members of high-risk populations, HepE cases, and vaccinees. Participants’ thoughts were coded and broadly summarized. We contacted 63 persons—35 experts and 28 nonexperts. Safety and effectiveness (but not price) of the vaccine, along with severity of disease and transmission route of infection, were all listed as important attributes. Emphasizing the importance of sharing stories from cases, relying on personal experiences, staying away from statistical explanations, and using the government as a source of promotion were other points repeatedly raised by the participants. Qualitative interviews with experts and nonexperts has revealed that focusing on attributes of disease severity and susceptibility to infection, as well as vaccine safety and effectiveness within stories of cases, are preferred ways to promote the vaccine.

Addressing Vaccine Hesitancy in China: A Scoping Review of Chinese Scholarship

Despite the well-developed Chinese National Immunization Program, vaccine hesitancy in China is rising. As part of the response, Chinese scholars have studied determinants and proposed solutions to vaccination hesitancy. We performed a scoping review of Chinese literature (2007-2019), drawn from four Chinese databases. We mapped relevant information and presented a systemic account of the proposed determinants and responses to vaccine hesitancy in China. We identified 77 relevant studies that reveal four approaches to vaccine hesitancy. Most Chinese studies define vaccine hesitancy as a problem of vaccine safety and vaccine incident response and place accountability on the level of governance, such as regulation deficits and inappropriate crisis management. A first minority of studies tied vaccination hesitancy to unprofessional medical conduct and called for additional resources and enhanced physician qualifications. A second minority of studies positioned vaccination hesitancy as a problem of parental belief and pointed to the role of media, proposing enhanced communication and education. Chinese literature ties vaccine hesitancy primarily to vaccine safety and medical conduct. Compared to international research, parental concerns are underrepresented. The Chinese context of vaccination scandals notably frames the discussion of vaccination hesitancy and potential solutions, which stresses the importance of considering vaccination hesitancy in specific social and political contexts.

"It depends how one understands it:" a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

Background

The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region.

Methods

We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location.

Results

No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including ‘wind’) and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as ‘western’ malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera.

Conclusions

Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds.

The demographics of vaccine hesitancy in Shanghai, China

BACKGROUND

Vaccine hesitancy has been little studied in low- and middle-income countries but is a potential concern because vaccine refusal may increase the burden of infectious diseases and impede control efforts. The aim of this study was to compare vaccine hesitancy between locals, long-time city residents, and non-locals, who have more recently moved to the city from either other urban or rural areas, in Shanghai, China.

METHODS

Parents of infants ≤3 months of age were surveyed at immunization clinics in Shanghai, China. Participants completed a paper questionnaire utilizing the 10-item Vaccine Hesitancy Scale, which was developed by the World Health Organization Strategic Advisory Group of Experts on Immunization. Items were grouped based on internal consistency, and regressed onto demographic variables using a negative binomial model.

RESULTS

In total, 1,188 (92.5%) individuals participated. For most items on the scale, parents expressed positive beliefs about vaccines. However, about half of parents somewhat or strongly agreed that new vaccines carried more risks than older vaccines, and 71.6% somewhat or strongly agreed that they were concerned about serious adverse effects. Seven items from the Vaccine Hesitancy Scale were highly correlated and mapped onto "lack of confidence"; the other three items were analysed separately. Compared to mothers, fathers had less lack of confidence (β: -0.06, 95% CI: -0.12, -0.01), and individuals living in the outer suburbs (β: 0.13, 95% CI: 0.01, 0.25) and rural non-locals (β: 0.10, 95% CI: 0.02, 0.18) had greater lack of confidence in vaccines compared to their urban or local counterparts, respectively.

DISCUSSION

Shanghai parents professed confidence in certain vaccine benefits, but vaccine messaging could focus on addressing misconceptions about vaccines for diseases no longer common, newer vaccines, and adverse effects associated with vaccination. These messages may need to be separately tailored to locals and non-locals, who have differing concerns.

The role of severity perceptions and beliefs in natural infections in Shanghai parents' vaccine decision-making: a qualitative study

Background

China has reduced incidence of vaccine-preventable diseases through its Expanded Program on Immunization (EPI). Vaccines outside of the EPI are not provided for free by the government, however. This study explored how the stated importance of different disease and vaccine-related attributes interacted with beliefs about the immune system of a child to affect Chinese parents’ decision to obtain a non-EPI vaccine.

Methods

Mothers and fathers of young children at immunization clinics in Shanghai, China, were interviewed about vaccine decision-making and what attributes of a disease were important when making this decision. An inductive thematic analysis explored their beliefs about disease attributes and how these related to vaccination decisions.

Results

Among the 34 interviews, severity of the disease—particularly in causing long-term disability—was the most commonly cited factor influencing a parent’s decision to get a vaccine for their child. Many parents believed that natural infection was preferable to vaccination, as long as disease was not severe, and many were concerned that imported vaccines were inadequate for Chinese children’s physical constitutions. All these beliefs could influence the decision to vaccinate.

Conclusions

Many parents do not appear to understand how and why vaccines can support development of a healthy immune system. Because severity emerged as parents’ overriding concern when making decisions about vaccines, marketing for a childhood vaccine could focus on the severe condition that a vaccine can protect against.

Parent and caregiver perceptions about the safety and effectiveness of foreign and domestic vaccines in Shanghai, China

Background

Chinese parents have access to domestic and foreign vaccines for their children. Their vaccine preferences are unclear, especially given recent pharmaceutical quality scandals and widely held beliefs deriving from Traditional Chinese Medicine (TCM). This study characterized parental beliefs about the safety and effectiveness of Chinese and foreign vaccines.

Methods

In May 2014, caregivers of young children at public immunization clinics in Shanghai, China, responded to a survey on vaccine perceptions. The two outcomes (differential belief in the effectiveness and safety of foreign vs domestic vaccines) were separately regressed onto demographic predictors in multinomial logistic regression models.

Results

Among 618 caregivers, 56% thought the effectiveness of domestic and foreign vaccines were comparable; 33% thought domestic were more effective and 11% foreign. Two-thirds thought foreign and domestic vaccines had similar safety; 11% thought domestic were safer and 21% thought foreign were safer. Compared to college graduates, those with a high school education or less had greater odds of believing domestic vaccines were more effective, and also had greater odds of believing imported vaccines were safer. Greater trust in TCM was not associated with differential beliefs in the effectiveness or safety of domestic vs foreign vaccines.

Conclusions

Although there is no evidence that foreign and domestic vaccines differ in either effectiveness or safety, less educated caregivers in China (but not those with greater trust in TCM) appear to believe such differences exist. Further exploration of the causes of these beliefs may be necessary in order to optimize vaccine communications in China.

Parents' concerns about vaccine scheduling in Shanghai, China

BACKGROUND

Several new vaccines have been introduced into China in recent years, but some parents in China have shown concerns about the scheduling of vaccinations for young infants. This study explores caregiver concerns about children receiving multiple vaccines during a single visit and about vaccine administration in infants <6months, and assesses the degree to which these concerns are associated with ratings of the importance of different sources of vaccine information in Shanghai.

METHODS

Caregivers of children 8months to 7years presenting at immunization clinics in Shanghai completed a survey about vaccine co-administration and vaccine administration <6months of age. Respondents provided ratings of information from different sources (Internet, family/friends, other parents) and trust in doctors. We analyzed vaccine concerns using linear regression analyses that included these information sources after adjusting for socioeconomic variables.

RESULTS

Among 618 caregivers, 64% were concerned about vaccine co-administration and 31% were concerned about vaccine administration to infants <6months of age. Higher ratings of Internet as an important source of information were associated with greater concern about co-administration (β=0.11, 95% CI: 0.00, 0.22) and concern about administration at <6months of age (β=0.17, 95% CI: 0.05, 0.28). Higher ratings given to information from other parents corresponded to 0.24 points greater concern about vaccine co-administration (95% CI: 0.04, 0.44). More trust in doctors and ratings of information from friends and family were not associated with vaccine concerns.

CONCLUSIONS

Caregiver concerns about vaccine scheduling may limit China's flexibility to add vaccines to its official immunization schedule. Reporting information about vaccine safety on the Internet and bringing groups of parents together to discuss vaccines might help to ameliorate concerns about vaccine scheduling.