Pandemic influenza A/H1N1 vaccination coverage, adverse reactions, and reasons for vaccine refusal among medical students in Brazil

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

Understanding the Barriers and Attitudes toward Influenza Vaccine Uptake in the Adult General Population: A Rapid Review

Influenza is a common respiratory infection associated with a substantial clinical, humanistic, and economic burden globally. Vaccines are essential to prevent and control influenza and are recommended by public-health agencies, such as the WHO and US CDC; however, vaccination rates vary considerably across the globe. This review aimed to investigate the perceived barriers and attitudes to influenza vaccination in the global population, in order to identify strategies that may improve influenza vaccination coverage. A structured literature search was undertaken to identify studies that reported on patient-reported attitudes towards influenza vaccination, focused on the adult general population in 16 prespecified countries. Eighty studies were included in this review. Negative attitude towards healthcare were found to be the most agreed upon barrier to vaccine uptake (31.1% agreement). The most agreed promoter of influenza vaccination was trust in healthcare services (62.0% agreement). Approximately 50% of participants intended to receive the influenza vaccine in the following season. To improve influenza vaccination coverage, healthcare workers must strengthen the foundation of substantial trust in healthcare services and provide educational materials that improve influenza vaccination knowledge among the adult general population.

Health worker recommended vaccination rates among medical students in Brazil

•

Medical students are a risk population for many infectious diseases, which leads to their being included in health-staff vaccination recommendations.

•

There is an increasing noncompliance with vaccination programs, especially in the last decade, which can have also affected medical students’ immunization status and personal beliefs about this theme. Few studies have gauged student awareness of these programs and their effect in vaccination status along the medical course.

•

After being submitted to an electronic questionnaire, 74,7% Brazilian students were found to have incomplete vaccination in some way, with Pertussis, Varicella, and Influenza as the highest noncompliance rates. There was an increase in vaccination status toward the end of the course, though still far from optimal.

•

Main reasons given not to vaccinate were vaccination hesitancy (for influenza and varicella), and lack of awareness of the need to vaccinate (for pertussis).

Health workers are a risk population for many infectious diseases, which leads to a number of vaccines being routinely recommended for health care staff. Medical students are also prone to such hazards. This study accesses undergraduate medicine students’ compliance to recommended health-staff vaccination, and their reasons for noncompliance.

Method

An online questionnaire was sent to all undergraduates in a major public medical school in Brazil, asking about vaccination status to Hepatitis B, Measle-mumps-rubella, Varicella, Pertussis and Influenza, and reasons in case of noncompliance

Results

146 students answered the questionnaire, (response rate 14,6%). Overall vaccination status showed 74,7% of students with incomplete vaccination in some way, with an increase in vaccination status toward the end of the course. The highest noncompliance rates were Pertussis (49,3%), Varicella (47,3%) and Influenza (30,1%) vaccines. The vaccine with the lowest noncompliance rate was measles (9,6%). During the course, the greatest increases in adequate vaccination status were Hepatitis B, from 53,2% in first-years to 93,2% by the end sixth year (chi-sq 21, p < 0,0001), and Influenza, from 48,9% to 91,5% (chi-sq 22,5, p < 0,00009). Main reasons given not to vaccinate were vaccination hesitancy for influenza and varicella (respectively 61% and 46%), and lack of awareness of the need to vaccinate for pertussis (53%).

Conclusions

Overall vaccine coverage in medical students in Brazil is still far from optimal. There is a markedly high level of vaccine hesitancy and unawareness of need to vaccinate for some diseases, particularly pertussis and influenza.

Clinical trial registry (Brazilian regulation boards): 24159119.3.0000.0065.

ADHERENCE TO INFLUENZA VACCINATION AMONG MEDICAL STUDENTS DURING AND AFTER INFLUENZA A (H1N1) PANDEMIC

This study evaluated the adherence to influenza vaccination among medical students in 2010 and 2011. From August to December 2011, a questionnaire was used to record the influenza vaccination in 2010 and 2011, reasons for acceptance of the influenza vaccine and knowledge of healthcare workers about the influenza vaccine recommendation. One hundred and forty-four students from the 2ndto the 6th years of the medical school were interviewed. A great adherence to pandemic influenza vaccine was noted in 2010, (91% of the students), with "self-protection" being the most common reason cited for vaccination. Other determinants for the vaccination during pandemic were "convenient access to vaccine" and "encouragement by peers and teachers in workplaces and at the university". However, there was a great decay in the acceptance to vaccine in the next influenza season (2011). Only 42% of the students received the vaccine. They claimed "lack of time" and "have forgotten to take the vaccine" as the main reasons. The "knowledge on the recommendation of influenza vaccine to healthcare workers" increased when the students come to attend the last year of the medical school, but that was an insufficient motivator for vaccination. Strategies to increase vaccination should be based on the abovementioned aspects for the adoption of effective measures in both, pandemic and seasonal periods.

Proteção individual versus proteção coletiva: análise bioética do programa nacional de vacinação infantil em massa

A vacinação é considerada como uma das políticas de saúde pública mais efetivas e de menor custo-benefício, utilizada no controle e na prevenção de doenças. Mas é também considerada uma das técnicas biomédicas mais polêmicas e controversas, o que torna difícil evitar uma abordagem ética, principalmente quando a vacinação é utilizada de forma compulsória em toda a população. Com efeito, visto que as vacinas não são totalmente seguras e eficazes, há um conflito ético entre o interesse individual e o coletivo, pois as crianças carregam de fato o ônus da vacinação em benefício da saúde pública quando são acometidas com reações adversas graves e que ficam alheias aos cuidados que deveriam ser oferecidos pelo Poder Público. O objetivo deste artigo foi demonstrar que as ferramentas da bioética são relevantes nesta discussão para analisar e compreender criticamente estes conflitos, fornecendo argumentos cogentes para orientar a elaboração de biopolíticas que considerem não apenas, com rigor, a prevenção, mas, também, a responsabilidade solidária de todos como fundamento para uma proteção que seja tanto individual como coletiva.

Attitudes of the medical students from two Czech universities to pandemic flu A (H1N1) 2009 and to influenza vaccination

OBJECTIVES

The aim of the study was to find out the approach of students to vaccination against seasonal influenza, how they perceived risk associated with influenza pandemic, and whether the pandemic influenced their approach to vaccination against seasonal flu.

METHODS

Data collection was conducted through an anonymous questionnaire survey. Distribution and collection of questionnaires took place from November to December 2010 at the medical faculties of two universities. Out of the total 360 distributed questionnaires, 343 were filled. The qualitative data were analysed using chi2 test and Fisher's exact test. The analysis of variance (ANOVA) and two-sample t-test were used for the evaluation of quantitative data. Statistical tests were performed at a significance level of 5% in STATA 10.

RESULTS

The proportion of students regularly vaccinated against seasonal flu was low (4%). Students rated the risk of pandemic influenza A (H1N1) in 2009 as relatively low and an interest in vaccination did not increase even during the pandemic and consequently only 5% expressed their interest to get vaccinated during the pandemic. However, only 3% of respondents were vaccinated at the time of vaccine availability. In the following year, only 5% of respondents planned to get vaccinated against seasonal influenza.

CONCLUSION

The results of the questionnaire study indicate that young people have not perceived vaccination against influenza as an important anti-epidemic measure and their opinion have not changed even during the outbreak of pandemic influenza A (H1N1) in 2009.

The Swedish A(H1N1) vaccination campaign--why did not all Swedes take the vaccination?

BACKGROUND

In Sweden, a mass vaccination campaign against the influenza A(H1N1) 2009 resulted in 60% vaccination coverage. However, many countries had difficulty in motivating citizens to be vaccinated. To be prepared for future vaccination campaigns, it is important to understand people's reasons for not taking the vaccination.

OBJECTIVE

The aim of this qualitative study was to explore motives, beliefs and reactions of individuals with varying backgrounds who did not get vaccinated.

DATA AND METHODS

The total 28 individuals participating in the interviews were permitted to speak freely about their experiences and ideas about the vaccination. Interviews were analysed using a Grounded Theory approach. The strength of participants' decisions not to be vaccinated was also estimated.

FINDINGS

Patterns of motives were identified and described in five main categories: (A) distinguishing between unnecessary and necessary vaccination, (B) distrust, (C) the idea of the natural, (D) resisting an exaggerated safety culture, and (E) injection fear. The core category, upholding autonomy and own health, constitutes the base on which the decisions were grounded.

CONCLUSION

A prerequisite for taking the vaccine would be that people feel involved in the vaccination enterprise to make a sensible decision regarding whether their health will be best protected by vaccination.