From Isolation to Containment: Perceived Fear of Infectivity and Protective Behavioral Changes during the COVID-19 Vaccination Campaign

Cessation of Face Mask Use after COVID-19 Vaccination in Patients with Diabetes: Prevalence and Determinants

Studies on the cessation of face mask use after a COVID-19 vaccine in patients with diabetes are not available, despite their greater predisposition to complications. We estimated the prevalence of cessation of face mask use after receiving the COVID-19 vaccine in patients with diabetes and identified which factor was most strongly associated with non-use. This was a cross-sectional study in patients with diabetes 18-70 years with at least one dose of vaccine against COVID-19 (n = 288). Participants were asked to respond face-to-face to a questionnaire in a primary care center. Descriptive statistics, chi-square tests, and multivariate binary logistic regression were used for analyzing the association between vulnerability, benefits, barriers, self-efficacy, vaccine expectations (independent variables), and cessation of use (dependent variable), controlling for sociodemographic, smoking, medical, vaccine, and COVID-19 history. The prevalence of cessation of face masks was 25.3% (95% CI 20.2, 30.5). Not feeling vulnerable to hospitalization increased the odds of non-use (adjusted OR = 3.3, 95% CI 1.2, 8.6), while perceiving benefits did the opposite (adjusted OR = 0.4, 95% CI 0.2, 0.9). The prevalence was low, and only two factors were associated with the cessation of face mask use after COVID-19 vaccination in patients with type 2 diabetes.

An examination and extension of the Peltzman effect during the Covid-19 pandemic

Since the first COVID-19 case was confirmed in Germany, the German government has introduced various measures to counteract the pandemic. The implementation of safety measures can have counterproductive effects: people engage in risk compensatory behavior (fewer safety behaviors) after regulations are introduced and obligated by the government, which is known as the Peltzman effect (Peltzman, 1975). Based on the Peltzman effect, the researchers of this study hypothesized that people complied less with safety behaviors and took more health risks (e.g. keep less distance) after the implementation of more stringent COVID-19-related regulations (quarantine obligation and face mask duty) between the two measurement periods of this study. They also extended the Peltzman model by hypothesizing moderating roles of age, gender, and perceived COVID-19 threat. Results of the longitudinal survey study (N = 989, T1: 26 March - 31 March 2020 and T2: 27 April - 4 May 2020) confirm that people indeed complied less with safety recommendations over time associated with strengthened COVID-19-related regulations. Perceived COVID-19 threat to those in a person's surroundings (e.g. family, neighbors) had a positive impact on compliance, but age and gender had no effect. This extends the literature on the Peltzman effect by adding perceived COVID-19 threat as a new relevant construct, enabling the development of more effective safety preventions in the future.

COVID-19 Risk Compensation? Examining Vaccination Uptake among Recovered and Classification of Breakthrough Cases

The study has two primary aims: the first is to examine the uptake of COVID-19 vaccination patterns among those previously infected, and the second is an evaluation of the period elapsed between the patient’s latest dose of the vaccine and the infection itself by demographic group. A retrospective study was conducted from 1 March 2020, to 31 May 2022, in Israel. The study found that among Israelis, vaccination uptake following infection is relatively low. When examining gender, one sees that the immunization rate among recovering females is higher than among men. Similarly, differences in uptake exist between age groups. When examining the interval between vaccine dose and infection according to age groups, the most significant breakthrough infection rate is among the ages of 20−59 (1−6 days—0.3%; 7−13 days—0.48%; two to three weeks—0.3%, p < 0.001). This study reveals potential reservoir groups of virus spread. Among previously infected, low vaccination uptake levels are observed (first dose—30−40%, second dose—16−27%, third dose—9% and fourth dose—2%, p < 0.001), despite findings that indicate surging reinfection rates. Among vaccinated, two critical groups (0−19; 20−59) exhibit highest levels of breakthrough cases varying per vaccine doses, with statistically significant findings (p < 0.001). These population groups may be subject to a false sense of security as a result of perceived acquired long-term immunity prompting low perceived risk of the virus and non-vigilance with protective behavior. The findings point to the possibility that individuals engage in more risky health behavior, per the Peltzman effect.

Associations between Public Fear of COVID-19 and Number of COVID-19 Vaccinations: A County-Level Longitudinal Analysis

Background and Purpose: A large number of COVID-19 infections and deaths and the ensuing socioeconomic problems created widespread public fear around COVID-19. Fear around COVID-19 greatly influences people’s attitudes towards receiving the COVID-19 vaccines. The purpose of this study is examining (a) the impact of the public fear of COVID-19 (PFC) on the number of COVID-19 vaccinations at the county level; (b) the interaction effect between the PFC and per capita income, unemployment rates, and COVID-19 vaccines incentive policies, on the number of COVID-19 vaccinations at the county level. Method: This is a longitudinal analysis across states in the U.S. by using county-level data of 2856 counties from 1 February to 1 July. Random-effects models were adopted to analyze the associations between the PFC and the number of COVID-19 vaccinations. Result: the PFC was positively associated with the number of COVID-19 vaccinations at county-level, as PFC increases from 0 to 300, the predicted vaccination number increases from 10,000 to 230,000. However, the associations were divergent when the PFC interacts with county-level per capita income, unemployment rates, and incentive policies. Conclusion: public fear is an important indicator for the county-level vaccination numbers of COVID-19. However, it is critical to consider public fear and socioeconomic factors when making policies that aim to increase COVID-19 vaccination rates.

Are we suffering from the Peltzman effect? Risk perception among recovered and vaccinated people during the COVID-19 pandemic in Israel

OBJECTIVES

The challenge of waning immunity and reinfection has been an acknowledged concern since the beginning of the COVID-19 pandemic. In the ongoing outbreak, reinfection rates are increasing alongside breakthrough cases among vaccinated individuals. The objective of this study was to examine the demographic characteristics associated with vaccination uptake among individuals previously infected with COVID-19 and to evaluate the period elapsed between the last vaccine dose and infection.

STUDY DESIGN

A retrospective-archive study was conducted.

METHODS

Data were extracted from the Israeli Ministry of Health's open COVID-19 database.

RESULTS

The study found that uptake of vaccination in previously infected individuals is relatively low. When examining gender, previously infected females were more likely to receive vaccination than previously infected males. Similarly, differences in vaccination uptake exist between age groups. When examining the interval between the last vaccine dose and infection, the most significant breakthrough infection rate was observed among individuals aged 20-59 years.

CONCLUSIONS

This study shows that there are specific populations subgroups that may serve as reservoirs of viral spread. Individuals in these groups may experience a false sense of security from a perceived sense of acquired long-term immunity, resulting in low levels of vaccine uptake and non-compliance with protective behaviours. Targeted messaging should be used to reemphasise the need for continued protective behaviours.

COVID-19 Vaccination, Morbidity, and Mortality During a 12-Month Period in Israel: Can We Maintain a "Herd Immunity" State?

Despite widespread vaccination, the COVID-19 pandemic continues to cause global disruption. Authors describe the pace of COVID-19 vaccination in Israel and examine differences in morbidity and mortality rates over time between vaccinated and unvaccinated populations. Retrospective data were obtained between December 2020 and December 2021 on daily vaccine uptake by age group (20-39, 40-59, 60+ years): rate of hospitalized severely ill cases, vaccination status and age group, and death rate per 100,000 by date and vaccination status. Uptake of first and second doses was slower in 20-59-year olds, whereas in 60+-year olds, it occurred without delay. Once most adults were vaccinated, a gap appeared with much higher severe cases and deaths in unvaccinated versus vaccinated populations; this gap attenuated by late May with very low rates in both vaccinated and unvaccinated populations until mid-July, when rates began to rise again. A herd-immunity-like period occurred in Spring 2021, with unvaccinated benefitting from a highly vaccinated population. Staggered vaccine uptake led to unsynchronized high immunity, which contributed to the fourth pandemic wave. Population vaccination within a shorter timeframe or shorter intervals between boosters may be important to reduce viral transmission.

Lockdown Efficacy in Controlling the Spread of COVID-19 May Be Waning Due to Decline in Public Compliance, Especially among Unvaccinated Individuals: A Cross-Sectional Study in Israel

Public compliance is paramount for the success of public health measures and decision making, such as lockdowns, in controlling the spread of diseases. The aim of this population-based cross-sectional study was to investigate the level of reported compliance with home isolation among the adult Israeli population (n = 940) during the first three national lockdowns, compliance with a potential fourth national lockdown if enacted, risk perception of COVID-19, vaccination uptake status, perceived effectiveness of the vaccine, and compliance with additional protective health behaviors (e.g., mask wearing and social distancing). Following widespread compliance with initial lockdowns (90.7% reported "high" or "very high" compliance), as few as 60.1% of participants indicated that they would comply with a fourth lockdown if the government decides to enact it. Non-vaccinated individuals reported the lowest levels of compliance with previous lockdowns, compared to participants who received one or two vaccines and participants vaccinated with three doses. Adjusted for gender and age, the results suggest that fearing being infected with COVID-19, perceiving the vaccine to be effective, and reporting being compliant with other health behaviors-such as mask wearing and maintaining social distance from others-are predictors of lockdown compliance. Considering the effect of pandemic lockdown fatigue, there is little support for additional lockdowns among the Israeli public, unless dramatic changes occur in the characteristics of the COVID-19 pandemic. Compliance with lockdowns is reduced among individuals who are at higher risk of contracting COVID-19, therefore rendering this non-pharmaceutical intervention even less effective in reducing the spread of the disease.

Molecular and Serological Characterization of the SARS-CoV-2 Delta Variant in Bangladesh in 2021

Novel SARS-CoV-2 variants are emerging at an alarming rate. The delta variant and other variants of concern (VoC) carry spike (S)-protein mutations, which have the potential to evade protective immunity, to trigger break-through infections after COVID-19 vaccination, and to propagate future waves of COVID-19 pandemic. To identify SARS CoV-2 variants in Bangladesh, patients who are RT-PCR-positive for COVID-19 infections in Dhaka were screened by a RT-PCR melting curve analysis for spike protein mutations. To assess the anti-SARS CoV-2 antibody responses, the levels of the anti-S -proteins IgA and IgG and the anti-N-protein IgG were measured by ELISA. Of a total of 36 RT-PCR positive samples (75%), 27 were identified as delta variants, with one carrying an additional Q677H mutation and two with single nucleotide substitutions at position 23029 (compared to Wuhan-Hu-1 reference NC 045512) in the genome sequence. Three (8.3%) were identified as beta variants, two (5.5%) were identified as alpha variants, three (8.3%) were identified as having a B.1.1.318 lineage, and one sample was identified as an eta variant (B.1.525) carrying an additional V687L mutation. The trend of higher viral load (lower Cp values) among delta variants than in the alpha and beta variants was of borderline statistical significance (p = 0.045). Prospective studies with larger Bangladeshi cohorts are warranted to confirm the emergence of S-protein mutations and their association with antibody response in natural infection and potential breakthrough in vaccinated subjects.

Changes in Behaviors and Attitudes in Response to COVID-19 Pandemic and Vaccination in Healthcare Workers and University Students in Italy

The objectives of the cross-sectional study were to measure how behaviors and attitudes about preventive measures toward COVID-19 changed over time among Italian vaccinated healthcare workers and university students, and the associated characteristics. The study was carried out between February and March 2021 in the city of Naples, Campania region, Southern Italy. The perceived personal risk of being infected by SARS-CoV-2 after the vaccination was significantly higher among males, in those having a higher perceived personal risk of being infected by SARS-CoV-2 before the vaccination, and in those who were more concerned about the efficacy of the vaccination. The fear of getting the disease as reason to have the COVID-19 vaccination was reported more frequently in younger participants, in those with at least one chronic medical condition, in those with a higher concern about the severity of COVID-19, in those with a higher level of trust in the information received, and in those who acquired information from scientific journals. Overall, 21.3% were willing to engage the three main public health measures (wearing a mask, careful hand washing, physical distancing) after receiving the second dose of the vaccination compared to the behavior before the pandemic began. This willingness was predicted by a higher level of trust in the information received and by a lower self-rated health status. Only 0.1% of participants were willing to engage all three measures after receiving the second dose of the vaccination compared to the behavior before receiving the first dose. These findings are useful in order to develop information strategies regarding vaccine safety and efficacy and the importance of public health measures against COVID-19.