Vaccinations against respiratory infections in Arabian Gulf countries: Barriers and motivators

A Cross-Sectional Study of Vaccination-Related Education in Pharmacy Programs in the Middle East

OBJECTIVE

Pharmacists play pivotal roles in improving vaccination rates. However, absence of vaccination-related undergraduate education impedes their ability for these roles. The study aims were to scope vaccination-related education in pharmacy colleges in the Middle East (ME) and to describe potential facilitators and barriers to vaccination administration education using Consolidated Framework for Implementation Research.

METHODS

A multinational survey of pharmacy faculty across 14 Arabic-speaking ME countries, involving 132 colleges, examined vaccination education. Data collection involved contacting deans for faculty nominations. Data was analyzed using Statistical Package for the Social Sciences.

RESULTS

The questionnaire response rate was 64.7% (89/132), with 89.9% of colleges including vaccination in their curricula. The topics commonly covered included vaccine development (n = 44, 97.8%), vaccine routes of administration (n = 43, 97.7%), and vaccine indications (n = 38, 95%). Planning and marketing vaccination programs (n = 35, 77.8%), documentation and record-keeping of vaccinations (n = 33, 75.0%), and legal and regulatory issues related to vaccinations (n = 32, 69.6%) were the least adequately covered topics. Most common methods used in teaching were didactic lectures (n = 74, 92.5%). Overall, 53 of 87 respondents (60.9%) responded that their college does not currently teach "vaccination administration". Lack of resources, attitudes of other health professionals and not prioritizing vaccination were considered as barriers for implementing vaccination administration.

CONCLUSION

Most pharmacy colleges in the ME cover vaccination-related topics in undergraduate curricula, yet they underemphasize vaccination administration and lack experiential learning methods. Implementing vaccination administration education requires addressing barriers related to the outer and inner settings, and planning, with stakeholder engagement.

Attitudes, motivators, and barriers toward influenza vaccination for children: a study from a conflict-ridden country

BACKGROUND

Despite the increased recommendations for influenza vaccination, particularly among high-risk groups such as young children, Yemen lacks an influenza vaccination program, and the influenza vaccine is not included in the national immunization regime. This is exacerbated by the country's fragile infrastructure, as well as the devastating consequences of the ongoing conflict, which include child undernutrition and strained healthcare resources. Thus, the objective of the current study is to assess the public attitudes and perceptions toward vaccinating children against influenza in Yemen.

METHODS

A cross-sectional study was conducted by distributing a validated survey questionnaire to potential participants using convenience sampling. Descriptive statistics were used to summarize sociodemographic data, knowledge of influenza vaccines, and attitudes and perceptions regarding vaccinating children against influenza. Logistic regression analysis was employed to identify associations between independent variables and the acceptance of vaccines for children.

RESULTS

A total of 853 eligible individuals, parents and non-parents, successfully completed the survey. The uptake of the influenza vaccine among the participants was notably low as the majority (69.2%) had not previously received the vaccine, although the majority expressed a willingness to get vaccinated in the future (59.4%). The majority (68.5%) were willing to vaccinate children. The largest percentage of the participants who expressed hesitancy toward children's vaccination cited multiple reasons to reject the vaccine (39.7%), with concerns regarding the safety of the vaccine being the predominant barrier to its acceptance for children (29.6%). On the other hand, motivating factors for vaccinating children included the validation of the vaccine's safety and efficacy, endorsement of the vaccine by the government and physicians, integration of the vaccine into the national immunization program, and the provision of the vaccine free of charge and through schools. Significant predictors for vaccine acceptance in children included male gender, knowledge of the protective effect of the influenza vaccine, previous receipt of the vaccine, and a willingness to receive the vaccine in the future.

CONCLUSIONS

The study highlights the need for educational health campaigns to raise awareness and remove misconceptions regarding influenza and the role, benefits, and availability of its vaccine. These findings can serve as a robust foundation for the future design and implementation of an influenza vaccination program for children in Yemen.

Motivators for the public to receive the seasonal influenza vaccination and the effect of coronavirus disease 2019 pandemic on the uptake of the seasonal influenza vaccination

BACKGROUND

The coverage of the seasonal influenza vaccine has always been sub-par. Understanding the motivators of receiving vaccines, especially during pandemics, could enhance and increase the coverage rates. The Saudi Ministry of Health launched its annual influenza vaccination campaign during the 2021 influenza season and provided vaccinations in primary healthcare settings. This study aims to explore public motivators to receive influenza vaccination, particularly during the coronavirus disease 2019 global pandemic.

MATERIALS AND METHODS

This cross-sectional study enrolled 783 participants who attended the influenza vaccination campaign. All persons who received the influenza vaccine in the influenza vaccination campaign held in Dammam, Saudi Arabia, from October to November 2021, were interviewed and completed a self-administered questionnaire. Odds ratio with a 95% confidence interval were estimated using the full model fit. The significance level was set as α = 0.05.

RESULTS

The majority of the participants had more than high school education (81%), were males (66.2%), and married (59.6%), and 50.6% were below 35 years of age. Participants with higher education, health-care workers, and those who had been previously counseled on influenza vaccination were less likely to have started taking the influenza vaccination, whereas smokers and persons who do not have routine checkups were more likely to start influenza vaccination. The main motivator to take the influenza vaccine was the establishment of a vaccination campaign near the participant's workplace (62.2%), followed by advice from their physician (30.3%), and fear of having influenza disease (29.6%).

CONCLUSION

Accessibility to the vaccination campaigns was the main motivator for receiving the vaccine followed by the advice from physician. Advice from physician and increasing mobile vaccination campaigns and mobile clinics would substantially increase influenza vaccine uptake.

Identifying gaps in vaccination perception after mandating the COVID-19 vaccine in Saudi Arabia

OBJECTIVE

The burden of COVID-19 pandemic affected the globe, and it is unclear how it has impacted the general perception of other vaccines. We aimed to investigate the public awareness, knowledge, and attitude towards other complementary vaccines after the mandate of the COVID-19 vaccine.

METHODS

A cross-sectional study was conducted in Saudi Arabia using a survey distributed via several social media platforms in June 2022. The questionnaire had three main sections; awareness; attitudes; and demographic information. Descriptive analysis was mainly used and supplemented with Chi-square test for correlation. All individuals over the age of 18 were eligible to participate in the study.

RESULTS

A total of 1,045 participants from Saudi Arabia completed the survey. Of the respondents, 55.9% were female, and 95% were Saudi citizens. Public awareness towards vaccines after the mandate of COVID-19 vaccine was the highest with the influenza vaccine (98.2%), followed by human papillomavirus (HPV) (40.7%), tetanus, diphtheria, and pertussis (Tdap) (37.2%), and lastly, pneumococcal vaccine (17%). More than 50% of the participants expressed their willingness to receive any of the four vaccines if they knew about the benefits related to these vaccines.

CONCLUSION

The study showed that participants were willing to receive the vaccination if they were aware of the general benefits of vaccinations. Therefore, health education and campaigns toward recommended vaccines for high-risk group are essential and needed.

Community pharmacists' participation in adult vaccination: A cross-sectional survey based on the theoretical domains framework

OBJECTIVES

This study aims to assess Qatar community pharmacists' practices in advocating and promoting adult vaccination and to characterize and quantify potential determinants of participation in adult vaccination as vaccine administrators, based on the theoretical domains framework (TDF).

METHODS

A cross-sectional survey of a randomly selected sample of community pharmacists in Qatar was conducted using a self-administered validated questionnaire. Items in the questionnaire on potential determinants of participation in adult vaccination were based on TDF. TDF items were subjected to principal components analysis.

RESULTS

In total, 271 respondents completed the questionnaire (67.7%). Most respondents (83.5%) did not have any previous training in vaccination administration and were not involved in any vaccine-related advocacy activities (78.9%). Principal components analysis of TDF items gave eight components: pharmacists' perceived knowledge and skills (median score of 22, interquartile range [IQR] 17-26, possible range: 7-35); perceived confidence (16; IQR 12-20, possible range: 5-25); perceived external support (9; IQR 7-11, possible range: 3-15); professional role identity (38; IQR 33-42, possible range: 11-55); emotions (10; IQR 9-12, possible range: 3-15); perceived consequences (22; IQR 18-24, possible range: 6-30); perceived usefulness (16; IQR 14-18, possible range: 4-20); and behaviour control (6; IQR 4-8, possible range: 2-10).

CONCLUSION

Pharmacists' perceived knowledge, skills, confidence and behavioural control are potentially important factors to address to facilitate participation in vaccination administration in Qatar. Along with providing vaccination training to community pharmacists, there is a need to change the current pharmacy practice structure to improve managerial and government support for and to equip pharmacies with resources for this role.

Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia

Objectives

This study aimed to assess the awareness of the general population regarding vaccines to determine the prevalence of vaccine hesitancy in Aseer Region in the southern part of Saudi Arabia.

Methods

A descriptive cross-sectional approach was used, targeting all parents in Aseer Region. The study was carried out from January to April 2020. The data for this study were collected using a structured questionnaire, which was developed by the researchers after an intensive literature review and consultation with experts. The questionnaire covered aspects such as parents’ sociodemographic data, their awareness regarding vaccine safety and efficacy for children and their attitude and adherence to children’s vaccination, including their hesitancy towards vaccines.

Results

The survey included 796 participants (response rate: 100%) whose ages ranged from 18 to 55 years. Two-thirds (63.4%) of the participants were female. Regarding vaccination adherence and hesitancy among participants, more than three-quarters completely adhered to the vaccination schedule for their children, and only 3.9% were non-adherent. With regards to participants’ awareness regarding vaccine safety and efficacy for children, 89.3% agreed that vaccination keeps children healthy, 84.2% reported that vaccines are safe and effective for children and 83.4% reported that all scheduled vaccines in Saudi Arabia are effective.

Conclusion

Vaccine hesitancy among participants was not low, and this should be taken into account notwithstanding their high awareness levels. The recorded antivaccine action was mostly related to vaccine safety and not its efficacy.

A comprehensive review of drivers influencing flu vaccine acceptance in the Middle East over the last six years: using Health Belief Model

OBJECTIVES

The objectives of this study were to review the literature covering the perceptions about influenza vaccines in the Middle East and to determine factors influencing the acceptance of vaccination using Health Belief Model (HBM).

METHODS

A comprehensive literature search was performed utilizing PubMed and Google Scholar databases. Three keywords were used: Influenza vaccine, perceptions and Middle East. Empirical studies that dealt with people/healthcare worker (HCW) perceptions of influenza vaccine in the Middle East and written in English were included. The search covered articles published between January 2015 and November 2020.

KEY FINDINGS

A total of 34 cross-sectional studies covering a total of 35 518 participants from 22 countries were included in this review. The overall influenza vaccination rates were generally low (<50%) among general population, particularly among pregnant women and children. HCWs had relatively higher vaccination rates compared with general population. Old age, health comorbidities or working in high-risk environments were noted as major motivators to receive the vaccine. Concerns about adverse reactions and the lack of vaccine efficacy were the most predominant reported barriers to receiving the vaccines. Lastly, cues to actions included receiving advice from HCWs, influence of institutional requirement, awareness/educational pamphlets and influence from the media.

SUMMARY

The HBM can be helpful in identifying and analysing motivators and barriers to vaccination. Additionally, by looking at the root causation, this model can help plan campaigns to increase vaccination rates in the region. Finally, we recommend empowering HCWs to proactively advocate for vaccination as part of preventive care.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths

This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette-Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.

Public Knowledge, Attitudes, and Practices toward Seasonal Influenza Vaccine in Saudi Arabia: A Cross-Sectional Study

Objectives: Increasing national influenza vaccination rates continues to be a challenge for Saudi Arabia. Therefore, the purpose of this study was to explore the Saudi public perceptions toward seasonal influenza vaccination and their association with the rate of vaccination. Methods: Individuals aged 15 years and older were surveyed about their knowledge, attitudes, and practices toward the seasonal influenza vaccine using a previously developed and validated 19-item online questionnaire. The impact of the participants’ perceptions toward the seasonal influenza vaccine on their past influenza vaccination history was assessed using multiple linear regressions. Results: The rate of regular vaccination among the 790 surveyed participants was 12.65%, and those who were aged <24 years had the highest rate (57%). The vast majority of the participants with chronic diseases (>90%) reported irregular vaccination histories against seasonal influenza. Participants who believed that the influenza vaccine is safe (β = 3.27; 95% CI: 2.067 to 5.171; p <0.001), efficacious (β = 2.87; 95% CI: 1.834 to 4.498; p <0.001), should be given during a specific time in the year (β = 1.821; 95% CI: 1.188 to 2.789; p = 0.0059), and were aware of their need to get vaccinated against the seasonal influenza (β = 2.781; 95% CI: 1.254 to 6.188; p = 0.0119) were more likely to have received the vaccine. Conclusion: The findings of this study suggest that the rate of seasonal influenza vaccination is low among the Saudi population, which necessitates the launching of public awareness campaigns about the importance of the seasonal influenza vaccine.

Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers

Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017–2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3–3.8, p < 0.01; and OR = 1.7, CI = 1–2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9–5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy–practice gap among domestic pilgrims.

Influenza vaccine effectiveness among Hajj pilgrims: a test-negative case-control analysis of data from different Hajj years

Background: Influenza is a common respiratory infection at Hajj. Thus, influenza vaccine is recommended for Hajj pilgrims but data on its effectiveness from a large sample are unavailable. This analysis aims to assess the effectiveness of the trivalent seasonal influenza vaccine (TIV) among Hajj pilgrims.Patients and methods: A 'test-negative' case-control analysis using data from individual studies was conducted. Included studies involved participants from Saudi Arabia, India, Australia and the United Kingdom who attended Hajj in Makkah, Saudi Arabia in different years between 2005 and 2015. Pilgrims who developed symptoms of respiratory infection during Hajj were included in these studies. Participants' vaccination histories were recorded and respiratory samples were collected to test for influenza by PCR. Vaccine effectiveness (VE) was calculated after adjusting for potential confounders.Results: A total of 1,569 pilgrims were included in this analysis. Influenza vaccine uptake was 52.2% and the attack rate of influenza was 8.2%. The estimated overall VE was 43.4% (95% CI 11.4% to 63.9%, P = 0.01). VE against a specific subtype of influenza was not significant.Conclusion: The current analysis has shown that TIV is moderately effective among Hajj pilgrims, but the vaccine uptake has been suboptimal. Power was much reduced when testing for influenza subtypes.

Influenza vaccine coverage, awareness, and beliefs regarding seasonal influenza vaccination among people aged 65 years and older in Central Saudi Arabia

OBJECTIVES

To investigate the level of awareness, sources of knowledge, and beliefs about the influenza vaccine in people ≥65 years in central Saudi Arabia.

METHODS

A cross-sectional study that used self-administered questionnaires conducted in 3 primary healthcare centers in Riyadh, Saudi Arabia between May 2018 and August 2018.

RESULTS

There were 496 Saudis participants (70.2% male) were included, of whom, 47.8% had been vaccinated against influenza at least once. Of unvaccinated individuals, 46% believed that the vaccine was unnecessary. The majority of participants (70.2%) preferred to receive medical information on vaccination from doctors and health workers. Participants with higher levels of education were significantly more likely to have been vaccinated (p less than 0.05). Compared to the vaccinated participants, unvaccinated individuals were significantly less likely to be aware of the Ministry of Health campaign against influenza, believe that influenza vaccine does not weaken the immune system, know that elderly people and people with long-standing health problems should be regularly vaccinated against influenza, and believe that the influenza vaccine was the best way of prevention. Approximately 40% of the participants considered the influenza vaccine to be very effective and safe.

CONCLUSIONS

There is a need for further programs in order to increase the awareness level of influenza vaccination. Also, health workers need to make more effort to educate patients because they are the preferred source of information.

Vaccination coverage in Qatar: Benchmarking with global figures

Introduction: Vaccination is considered one of the most successful and cost-effective public health interventions of the 20^th century. In 2017, Qatar's Expanded Program of Immunization (EPI) provided vaccination services against a comprehensive list of 15 vaccine-preventable diseases. Objectives: To assess the performance of Qatar's national immunization system, identify possible gaps by determining the national vaccination coverage rates, and benchmark these rates against regional and global figures. Methods: The data utilized herein were retrieved from the vaccination coverage estimates generated by the World Health Organization and United Nations International Children's Emergency Fund. Relevant local, regional, and global vaccination coverage figures were manually extracted and then analyzed for six vaccines (DTP3, Pol3, MCV2, HepB, PCV3, and RotaC) in 2017. Percentages and proportions were compared using the Chi-squared test. Results: Vaccination coverage levels in Qatar have surpassed the optimal level of 90% for all vaccines. Compared with international figures, the national coverage exceeds the relevant benchmarks. For DTP3 and Pol3, Qatar achieved 97% coverage compared with 99% coverage in Jordan and 85% coverage globally. For MCV2, Qatar achieved 93% coverage compared with 99% coverage in Jordan and 67% coverage globally. For RotaC, Qatar achieved 97% coverage compared with 96% coverage in Jordan and 28% coverage globally. For HepB, Qatar achieved 97% coverage compared with 43% coverage globally. Conclusions: Compared with the international benchmarks of major vaccines, the vaccination coverage rates in Qatar are high. However, challenges for maintaining high coverage, such as cultural and language barriers, should be addressed.

Prevalence of influenza and pneumococcal vaccine uptake in Saudi type 2 diabetic individuals

INTRODUCTION

Individuals with diabetes are at particularly at high risk for many of the negative health consequences associated with influenza and pneumococcal infections. This study aimed to determine the prevalence of influenza and pneumococcal vaccination among a population of type 2 diabetic patients in Saudi Arabia and to determine the factors associated with vaccine uptake.

METHODS

A cross-sectional survey was conducted among patients with type 2 diabetes at Security Forces Hospital, Riyadh in Saudi Arabia. The survey asked basic demographic questions as well as questions about awareness, vaccination status, and beliefs about the influenza and pneumococcal vaccines.

RESULTS

From a total number of 422 responses, 360 participants were ultimately included in the final sample. The overall prevalence of influenza and pneumococcal vaccination in this population were 47.8% and 2.8%, respectively. In general, there was a very low awareness of the pneumococcal vaccine. Older individuals, unmarried individuals, those with less education, and those living with certain chronic conditions were less likely to have gotten the influenza vaccine. Beliefs in the importance of vaccination for people with diabetes, the efficacy of the influenza vaccine, and not being worried about the side effect of the vaccine were strongly associated with having received the vaccine.

CONCLUSIONS

Attention should be given to increasing awareness of the pneumococcal vaccine among people living with diabetes. Particular consideration should also be paid to increasing access and awareness to both vaccines among those groups that have the lowest prevalence of vaccination and may be at the highest risk for the negative consequences associated with these infections. Finally, education interventions should be used to increase the understanding of the safety and efficacy of the influenza vaccine.

Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers

Background

Hajj is the world’s largest annual mass gathering that attracts two to three million Muslims from around the globe to a religious assemblage in Makkah, Saudi Arabia. The risk of acquisition and transmission of influenza among Hajj pilgrims is high. Therefore, influenza vaccination is recommended, and was monitored frequently among pilgrims from different countries. However, the vaccination uptake among Saudi pilgrims has not been assessed in recent years.

Objective

This analysis aims to evaluate influenza vaccine uptake among Saudi Hajj pilgrims, and identify the key barriers to vaccination.

Method

Data on influenza vaccination were obtained from Saudi pilgrims who took part in a large trial during the Hajj of 2013, 2014 and 2015. Pilgrims were met and recruited in Mina, Makkah during the peak period of Hajj and were asked to complete a baseline questionnaire that recorded their influenza vaccination history, including reason(s) for non-receipt of vaccine.

Results

A total of 6974 Saudi pilgrims aged between 18 and 95 (median 34) years were recruited; male to female ratio was 1:1.2. Of the total, 90.8% declared their influenza vaccination history, 51.3% of them reported receiving influenza vaccine before travel to Hajj. The vaccination rates for the years 2013, 2014 and 2015 were 21.4%, 48.2% and 58.1%, respectively (P < 0.001). Of 1,269 pilgrims who were at higher risk of severe disease, 54.5% received the vaccine. Lack of awareness (47.5%), reliance on natural immunity (15.8%) and being busy (15.5%) were the main reasons for non-receipt.

Conclusion

These data from a convenience sample indicate that influenza vaccine uptake among Saudi Hajj pilgrims is increasing over years but still needs further improvement. Lack of awareness and misperceptions are the main barriers. Education of Saudi pilgrims and health professionals is required to raise awareness about influenza vaccination. Further studies are needed to understand pilgrims’ misperceptions.