Socio-Demographic Factors Associated With COVID-19 Vaccine Hesitancy Among Middle-Aged Adults During the Quebec's Vaccination Campaign

The majority of Canadians likely behaved as myopic rationalists rather than success-based learners when deciding on their first dose of COVID-19 vaccine

Introduction

Successful vaccine promotion communication strategies require knowing how eligible recipients will respond to the opportunity to get vaccinated. Two main classes of recipients are myopic rationalists, those who receive a dose of vaccine only if it maximizes their own instant benefit and if so, do it as soon as possible, and success-based learners, those who learn from others that they perceive to be most successful.

Methods

A recent study models these two decision-making types, and estimates the population proportion of myopic rationalists in each U.S. state. In this report, we fit a similar model to data on COVID-19 vaccine uptake across the Canadian provinces and territories.

Results

We estimated that 64% of Canadians behaved as myopic rationalists in taking the first dose of a COVID-19 vaccine, compared to an estimated 47% in the United States. Among the provinces, the lowest proportion of myopic rationalists was 0.51 in Saskatchewan, while the highest was 0.74 in Prince Edward Island. The correlation analysis suggested a positive correlation between the proportion of myopic rationalists and the average age across the Canadian provinces (Pearson-r = 0.71).

Discussion

Canadian health management may benefit from these results in tailoring the vaccine promotion communication strategies.

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources.

How socio-institutional contexts and cultural worldviews relate to COVID-19 acceptance rates: A representative study in Italy

RATIONALE

Despite its importance to counter the COVID-19 pandemic, vaccination has raised hesitation in large segments of the population. This hesitation makes it important to understand the mechanisms underlying vaccine acceptance. To this end, the study adopts the Semiotic Cultural Psychology Theory, holding that social behaviors - and therefore, vaccination acceptance - depend on the cultural meanings in terms of which people interpret the social world.

OBJECTIVE

The study aims at estimating the impact a) of the way people interpret the socio-institutional context of the pandemic and b) of the underlying cultural worldviews on vaccine acceptance. More particularly, the study tested the three following hypotheses. a) The meanings grounding the interpretation of the socio-institutional framework - that is, trust in institutions and political values - are an antecedent of vaccination acceptance. b) The impact of these meanings is moderated by the cultural worldviews (operationalized as symbolic universes). And c), the magnitude of the symbolic universes' moderator effect depends on the uncertainty to which the respondent is exposed. The exposure to uncertainty was estimated in terms of socioeconomic status - the lower the status, the high the exposure to uncertainty.

METHODS

An Italian representative sample (N = 3020) completed a questionnaire, measuring vaccination acceptance, the meanings attributed to the socio-institutional context - that is, political values and trust in institutions - and symbolic universes.

RESULTS

The findings were consistent with the hypotheses. a) Structural equation modelling proved that vaccine acceptance was predicted by trust in institutions. b) Multigroup analysis revealed that symbolic universes moderated the correlation between trust in institutions and vaccine acceptance. And c), the moderation effect of symbolic universes proved to occur only in the segment of lower socio-economic status (i.e., the group exposed to higher uncertainty).

CONCLUSIONS

Vaccination acceptance is not only a medical issue; it is also dependent upon the rationalization of the socio-institutional context. Implications for the promotion of vaccination acceptance are discussed.

Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey

BACKGROUND

Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death.

OBJECTIVE

This study aimed to explore the drivers of vaccine hesitancy among older adults based on the "3Cs" (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators.

METHODS

A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway's coefficients.

RESULTS

A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=-0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=-0.071; P=.02) and lower vaccine hesitancy.

CONCLUSIONS

Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.

Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience

INTRODUCTION

There are limited data on the effects of COVID-19 on peritoneal dialysis (PD) patients. This study aimed to describe the impact of COVID-19 on the PD population.

METHODS

A monocentric retrospective observational study was conducted on 146 consecutive PD patients followed from January 2020 to March 2022 at the University Hospital of Modena, Italy.

RESULTS

Twenty-seven (18.4%) PD patients experienced 29 episodes of SARS-CoV-2 infection, corresponding to an incidence rate of 0.16 episodes/patient-year. Median age of COVID-19 patients was 60.4 (interquartile range [IQR] 50.2-66.5) years. In unvaccinated patients (n. 9), COVID-19 was always symptomatic and manifested with fever (100%) and cough (77.7%). COVID-19 caused hospital admission of three (33.3%) patients and two (22.2%) died of septic shock. COVID-19 was symptomatic in 83.3% of vaccinated subjects (n.18) and manifested with fever (61.1%) and cough (55.6%). Hospital admission occurred in 27.8% of the subjects but all were discharged home. Median SARS-CoV-2 shedding was 32 and 26 days in the unvaccinated and vaccinated groups, respectively. At the end of the follow-up, COVID-19 triggered the shift from PD to HD in two subjects without affecting the residual renal function of the remaining patients. Overall, COVID-19 caused an excess death of 22.2%. COVID-19 vaccination refusal accounted for only 1.6% in this cohort of patients.

CONCLUSION

COVID-19 incident rate was 0.16 episodes/patient-year in the PD population. About one-third of the patients were hospitalized for severe infection. Fatal outcome occurred in two (7.4%) unvaccinated patients. A low vaccination refusal rate was observed in this population.

Safety and Immunogenicity of MVC-COV1901 Vaccine in Older Adults: Phase 2 Randomized Dose-Comparison Trial

Introduction

Older adults are subject to higher COVID-19 infection and mortality rates. Safety and immunogenicity of MVC-COV1901, a protein subunit vaccine have been demonstrated in phase 2 clinical trial for the general population, and negative correlations have been observed between immune responses and age, however, older adults were under-represented.

Methods

A double-blind, randomized, multi-center study compared safety and immunogenicity of high-dose (25 mcg) to mid-dose (15 mcg) of MVC-COV1901 administered 2 times 28 days apart in 420 participants of 65 years and older. The results have been stratified by the comorbidity status.

Results

Both high and mid-dose regimens elicited mostly mild adverse events and robust immune responses when measured as neutralizing and binding antibodies titers. High doses elicited better immune responses in the group without comorbidities.

Conclusion

Given the general population-associated safety and immunogenicity of MVC-COV1901, we recommend high dose for immunization of elder adults with MVC-COV1901. The clinical trial was registered at https://clinicaltrials.gov/ (NCT04822025).

In-hospital outcomes of SARS-CoV-2-infected health care workers in the COVID-19 pandemic first wave, Quebec, Canada

Background

Health care workers (HCW), particularly immigrants and ethnic minorities are at increased risk for SARS-CoV-2 infection. Outcomes during a COVID-19 associated hospitalization are not well described among HCW. We aimed to describe the characteristics of HCW admitted with COVID-19 including immigrant status and ethnicity and the associated risk factors for Intensive Care unit (ICU) admission and death.

Methods

Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Canada were included. Demographics, comorbidities, occupation, immigration status, country of birth, ethnicity, workplace exposures, and hospital outcomes (ICU admission and death) were obtained through a chart review and phone survey. A Fine and Gray competing risk proportional hazards model was used to estimate the risk of ICU admission among HCW stratified by immigrant status and region of birth.

Results

Among 1104 included persons, 150 (14%) were HCW, with a phone survey participation rate of 68%. HCWs were younger (50 vs 64 years; p<0.001), more likely to be female (61% vs 41%; p<0.001), migrants (68% vs 55%; p<0.01), non-White (65% vs 41%; p<0.001) and healthier (mean Charlson Comorbidity Index of 0.3 vs 1.2; p<0.001) compared to non-HCW. They were as likely to be admitted to the ICU (28% vs 31%; p = 0.40) but were less likely to die (4% vs. 17%; p<0.001). Immigrant HCW accounted for 68% of all HCW cases and, compared to Canadian HCW, were more likely to be personal support workers (PSW) (54% vs. 33%, p<0.01), to be Black (58% vs 4%) and to work in a Residential Care Facility (RCF) (59% vs 33%; p = 0.05). Most HCW believed that they were exposed at work, 55% did not always have access to personal protective equipment (PPE) and 40% did not receive COVID-19-specific Infection Control (IPAC) training.

Conclusion

Immigrant HCW were particularly exposed to COVID-19 infection in the first wave of the pandemic in Quebec. Despite being young and healthy, one third of all HCW required ICU admission, highlighting the importance of preventing workplace transmission through strong infection prevention and control measures, including high COVID-19 vaccination coverage.

The perspective of Iranian patients with multiple sclerosis on the third dose of COVID-19 vaccine

Background: Now that the majority of the population has been immunized with two-dose vaccines, debates over the third booster dose have been raised. We studied the viewpoint of cases with multiple sclerosis (MS) on this matter. Methods: In a cross-sectional study, a google form containing questions about participants' characteristics, the history of coronavirus disease 2019 (COVID-19) infection and vaccination, and opinions on the third dose was designed. Results: Of 1067 responders, only 16 (1.5%) were not vaccinated at all. The most used vaccine type was Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) (n = 1002, 93.9%). Generally, 58 (5.4%) cases were hospitalized due to COVID-19. Of those with full vaccination, 134 (13.3%) got COVID-19 infection after the second dose. Only 13 participants (1%) did not agree with the third dose, while 564 (53.0%) believed that a booster dose was needed. Of all, 488 (45.7%) declared that they did not have a final idea and would follow the instructions by the experts. A significant association was found between not receiving the first two doses and not believing in the third dose (P = 0.001). 692 patients declared their reasoning for the importance of the third dose. All the cases who thought the administered vaccine was not efficient enough had received Sinopharm BBIBP-CorV. Those who got infected after full vaccination were more uncertain about the efficacy of the vaccine [odds ratio (OR): 2.6, 95% confidence interval (CI): 1.6-4.2]. Conclusion: It seems that the majority of the Iranian patients with MS expect the authorities to administer a third booster dose, especially if scientifically validated.