Willingness to Receive a COVID-19 Vaccine and Associated Factors among Older Adults: A Cross-Sectional Survey in Shanghai, China

Factors Related to the Compliance of Arab Parents in Israel to the Vaccination of Children and Adolescents against COVID-19

The Arab minority consists of 20% of the Israeli population. Most of the Arab minority live in rural villages, mostly in closed communities, with specific psycho-social and sociodemographic characteristics. Previous studies showed different attitudes to COVID-19 vaccination among Arab adults.

OBJECTIVES

To examine the influence of factors on the willingness of parents to vaccinate their young and adolescent children and if there is a difference between parents' attitudes to both groups.

METHODS AND MATERIALS

The survey examined correlations between variables and attitudes toward the vaccine and the pandemic and was disseminated anonymously to parents of children between the ages of 5 and 18 in the Arab population of Israel through social media networks, using the snowball method. Statistical analyses included the Pearson correlation, MANCOVA, and logistic regression tests.

RESULTS

In total, 361 Arab Israeli parents participated. As mentioned above, 130 parents had both children and adolescents. Overall, 48 parents (36.9%) chose not to vaccinate both their children and adolescents, 52 parents (40.0%) chose to vaccinate only their adolescents, only 1 parent (0.8%) chose to vaccinate only the child, and 29 parents (22.3%) vaccinated both their children and adolescents. Significant correlations were found among a higher age of parents and socioeconomic status, attitudes toward COVID vaccination, subjective norms, perceived severity of the disease, perceived benefits of vaccination, and trust in formal sources.

DISCUSSION

There is a difference between parents' decision to be vaccinated and their willingness to vaccinate their children. There is a difference between their decision to vaccinate their adolescents and their young children. Different factors positively or negatively influenced parents' decisions. Addressing these factors by authorities may increase compliance of Arab minorities with instructions in the future.

Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis

Objectives

Understanding COVID-19 vaccine hesitancy among migrant and refugee groups is critical for achieving vaccine equity. Therefore, we aimed to estimate the prevalence of COVID-19 vaccine acceptance among migrant and refugee populations.

Methods

A systematic review (PROSPERO: CRD42022333337) was conducted (December 2019-July 2022) using PubMed, Scopus, Web of Science, ProQuest and Google Scholar.

Results

Nineteen studies from 12 countries were included. The pooled estimated prevalence of COVID-19 vaccine willingness among migrant and refugee groups was 70% (19 studies, 95% CI: 62.3-77.4%, I2: 99.19%, τ2: 0.03). Female and male participants did not differ significantly with each other (p = 0.64). Although no individual variable contributed statistically significantly in multivariable meta-regression analysis, the multivariable model that considered methodological quality, mean age of participants, participant group and country of origin explained 67% of variance.

Discussion

Proportions of migrant/refugee groups receiving COVID-19 vaccinations approximated those observed among general populations. Additional studies are needed to examine factors relating to vaccine willingness to identify the most significant factors that may be targeted in interventions.

The SARS-CoV-2 vaccination rate and hesitation in Shanghai older adults with dementia

Background

Older adults, particularly those with dementia, are at the greatest risk for being affected by SARS-CoV-2. Despite the Chinese government's efforts to encourage older adults to receive SARS-CoV-2 vaccines, the vaccination rate, especially among older adults with dementia, remains low.

Objective

This study aimed to examine the willingness and attitudes towards vaccination among guardians of older adults with dementia and to uncover the factors that may have influenced attitudes towards vaccination during the 2022 Omicron Variant of SARS-CoV-2 outbreak in Shanghai, China.

Methods

We conducted a cross-sectional study using self-administered anonymous questionnaires to guardians of dementia patients in three settings: psychogeriatric inpatient wards, long-term care facilities, and home settings from April to May 2022. The primary outcome was participants' willingness to allow dementia patients to receive SARS-CoV-2 vaccines. Logistic regression analyses were used to identify factors associated with vaccination willingness.

Results

A total of 327 valid questionnaires were collected. The vaccination rate among participants from long-term care facilities (12.9%) was lower than those in the psychiatric ward (19.3%) or community-dwelling settings (27.1%) (p < 0.05). The guardians' primary concern was that vaccination would aggravate the health conditions of dementia patients [adjusted odds ratio (OR) = 5.11; 95% confidence interval (CI): 1.86-14.05]. Additionally, negative reports about the vaccination [OR = 3.94; 95% CI: 1.68-9.24], and adverse reactions [OR = 2.50; 95% CI: 1.13-5.52] were related to higher odds of vaccine hesitancy.

Conclusion

Our results showed that low vaccination rates in older adults with dementia were mainly due to their guardians' concerns about vaccine safety. Our findings first uncovered the actual SARS-CoV-2 vaccination rates among older adults with dementia and may provide potential interventions to reduce unjustified worries towards vaccination.

COVID-19 vaccine uptake, reasons, and associated factors among older adults in Shenzhen, China

Evidence is limited on the actual uptake of the coronavirus disease 2019 (COVID-19) vaccine among older adults, especially those with chronic diseases, during the pandemic. To examine COVID-19 vaccine uptake, reasons, and associated factor among older adults, a cross-sectional survey was conducted between September 24 and October 20, 2021 among older adults aged 60 and above in Shenzhen, China. Logistic regression analysis was used to examine associations of COVID-19 vaccine uptake with sociodemographic characteristics, pneumonia vaccination history, and participation in health education activities among older adults and among those with chronic diseases. Of the 951 participants, 82.8% reported being vaccinated against COVID-19 during the study period, but this proportion was relatively lower among adults aged 80 and above (62.7%) and those with chronic diseases (77.9%). The top-rated reasons for not being vaccinated included doctors not recommending it due to underlying diseases (34.1%), not being ready for it (18.3%), and failure to make an appointment (9.1%). General older adults who were aged below 70, had a high school and above education, were permanent residents of Shenzhen, were with good health and had pneumonia vaccination history were more likely to take the COVID-19 vaccination. Yet, among older adults with chronic diseases, other than age and permanent residency status, health status was the only significant indicator of COVID-19 vaccine uptake. Our study added to evidence that health condition is the critical barrier to the actual uptake of the COVID-19 vaccine among Chinese older adults, especially those aged 80 and above and those with chronic diseases.

Analysis of Socio-demographic, Economic and Individual Reasons for COVID-19 Vaccination Hesitancy in Ecuador: A Nationwide Longitudinal Study

The current outbreak of SARS-Cov-2, a virus responsible for COVID-19, has infected millions and caused a soaring death toll worldwide. Vaccination represents a powerful tool in our fight against the transmission of SARS-CoV-2. Ecuador is one of the Latin American countries most impacted by COVID-19. Despite free COVID-19 vaccines, Ecuadorians still hesitate to get vaccinated. A multivariate binary logistic regression was used to analyze data from the Ecuadorian National Institute of Statistics and Censuses. This study investigated socio-demographics, economic, and individual reasons associated with a person having "no intention" to receive COVID-19 vaccine across the study period of October 2021 to March 2022. The survey revealed an increase of unvaccinated people having no intention of COVID-19 vaccination from 57.4% (October-December 2021) to 72.9% (January-March 2022). COVID-19 vaccine hesitancy was dependent on factors like sex, age and ethnicity. Socio-economic characteristics and education level were not found to be statistically significant in lack of vaccine intention, but most vaccination hesitancy was due to distrust in the COVID-19 vaccine. People who believed that the vaccine could be unsafe because of possible side effects represented half of the surveyed participants, a proportion that barely diminished during the progress of the vaccination campaign across October-December 2021 (57.04%) and January-March 2022 (49.59%) periods. People who did not believe that the vaccine was effective enough increased from 11.47 to 18.46%. Misbeliefs about effectiveness and safety of vaccines should be considered in the implementation of public health initiatives of communication, education and intervention to improve vaccination campaigns.

Quantitative evaluation of the role of Fangcang shelter hospitals in the control of Omicron transmission: A case study of the outbreak in Shanghai, China in 2022

Since Omicron began to spread in China, Shanghai has become one of the cities with more severe outbreaks. Under the comprehensive consideration of the vaccine coverage rate, the number of Fangcang shelter hospital beds and the number of designated hospital beds in Shanghai, this paper established a deterministic compartmental model and used the Nelder-Mead Simplex Direct Search Algorithm and chi-square values to estimate the model parameters. we calculate ℛ₀ = 3.6429 when the number of beds in the Fangcang shelter hospital is relatively tight in the second stage and ℛ₀ = 0.4974 in the fifth stage when there are enough beds in both Fangcang shelter hospital and designated hospital. Then we perform a sensitivity analysis on ℛ₀ by using perturbation of fixed point estimation of model parameters in the fifth stage, and obtain three parameters that are more sensitive to ℛ₀, which are transmission rate (β _1d ), proportion of the infectious (η) and the hospitalization rate of asymptomatic infected cases (δ ₁). Through simulation, we obtain that if the hospitalization rate of asymptomatic infections δ ₂ > 0.9373 or the transmission rate β _1b  < 0.0467, the second stage of Omicron transmission in Shanghai can be well controlled. Finally, we find the measure that converting the National Convention and Exhibition Center (NECC) into a Fangcang shelter hospital has played an important role in curbing the epidemic. Whether this temporary Fangcang shelter hospital is not built or delayed, the cumulative number of confirmed cases will both exceed 100,000, and the cumulative asymptomatic infections will both exceed 1 million. In addition, for a city of 10 million people, we obtain that if a permanent Fangcang shelter hospital with 17,784 beds is built ahead of epidemic, there will be no shortage of beds during the outbreak of Omicron. Our findings enrich the content of the impact of Fangcang shelter hospital beds on the spread of Omicron and confirm the correct policy adopted by the Chinese government.

Knowledge and vaccination acceptance toward the human monkeypox among men who have sex with men in China

Background

MSM individuals are at high risk of monkeypox infection, and judicious use of vaccines can control the outbreak. Therefore, we conducted a national cross-sectional survey to assess the vaccination willingness, associated factors, and related knowledges of monkeypox among MSM individuals in China.

Methods

This anonymous cross-sectional study was conducted in China from July 1 to July 3, 2022, and electronic questionnaires were sent online to MSM individuals of specific institutions. Men, aged 18 or older, who had anal sex in the past year were recruited. Multivariable logistic regression models and univariable logistic regression models were performed in different groups of participants, including all eligible respondents, people with or without self-reported HIV infection, and people who had sex with at least one male sexual partner in last month.

Results

A total of 2,618 male respondents, including 2,134 homosexuals and 484 bisexuals, were enrolled in our final analysis. Most of the respondents had a certain understanding of the source of infection, transmission route, and preventive measures, but lacked knowledge of the susceptible population, clinical manifestations, vaccination, and treatment. In total, 90.2% of all respondents were willing to receive the vaccines against monkeypox. Among people with self-reported HIV infection, the vaccination acceptance rate was 91.7%, while it was 89.7% in the rest. The main influencing factors were knowledge about monkeypox (moderate: aOR = 1.47, 95% CI: 1.04-2.08; high: aOR = 2.03, 95% CI: 1.23-3.34), knowledge about prevention measures (moderate: aOR = 3.52, 95% CI: 2.51-4.94; high: aOR = 5.32, 95% CI: 2.98-9.47), concerns about their susceptibility to monkeypox infection (aOR = 4.37, 95% CI: 3.29-5.80), and possible contact with people and animals in epidemic areas (aOR = 0.42, 95% CI: 0.25-0.70). For self-reported HIV-infected individuals, education (bachelor degree: aOR = 0.40, 95% CI: 0.18-0.89) and poor condom use (sometimes: aOR = 2.18, 95% CI: 1.06-4.47) may also affect the vaccination.

Conclusions

There was still a lack of knowledge about the human monkeypox among MSM individuals in China. The vaccination acceptance rate of this high-risk population was high, and it was closely related to the knowledge factors, fear of infection, and possible contact with people or animals in affected areas. Targeted publicity and education of the high-risk groups, vaccination pre-arranged planning should be formulated to cope with the further development of this infectious disease.

Willingness of Older Adults with Chronic Diseases to Receive a Booster Dose of Inactivated Coronavirus Disease 2019 Vaccine: A Cross-Sectional Study in Taizhou, China

Vaccination is an important measure to control the spread of COVID-19 among elderly high-risk groups; however, the propensity to receive COVID-19 vaccine boosters has not been evaluated in these populations. Here, we aimed to investigate the willingness to receive a COVID-19 vaccine booster among the elderly chronic disease population in Taizhou, China. A cross-sectional, hospital-based survey was conducted in the outpatient department of a tertiary care hospital between 6 July and 11 August 2021 in Taizhou, China, and the data were uploaded to Wen-Juan-Xing, one of the largest online platforms used to collect survey data in China. The targeted population was non-oncology chronic disease patients aged 60 years and above. The minimum sample size was 229, determined by the G*Power software (v3.1.9.2, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). A total of 254 patients with valid data were enrolled in this study, with a response rate of 82.5% (254/308). Chi-square tests and one-way binary regression were used to compare the proportions and the degree of influence of categorical factors. The magnitude of the effect for the comparisons was measured by Gramer’s V. A multivariate binary logistic regression model was used to correct for confounders and to identify factors. All data were analyzed using SPSS v24.0 (IBM Corporation, Armonk, NY, USA). A total of 198 respondents (77.9%) were willing to receive a COVID-19 vaccine booster dose, and 77.6% of respondents were willing to receive the primary dose. Age < 70 years (OR 2.82), stable disease control (OR 2.79), confidence in the effectiveness of the COVID-19 vaccine (OR 3.11), and vaccine recipient (OR 5.02) were significantly associated with the willingness to receive a COVID-19 vaccine booster dose. Promoting primary dose vaccination is essential for advancing booster vaccination, and it is important to focus on elderly patients’ confidence in the vaccine, in addition to strengthening health management and promoting disease stability. Follow-up studies should focus on elderly patients who belong to specific disease groups.

Vaccine Resistance and Hesitancy among Older Adults Who Live Alone or Only with an Older Partner in Community in the Early Stage of the Fifth Wave of COVID-19 in Hong Kong

Vaccination is an effective way in providing protection against COVID-19 infection and severe outcomes. However, vaccine resistance and hesitancy are a great concern among vulnerable populations including older adults who live alone or only with an older partner. This study examined their vaccination status and reasons and associated factors of vaccine resistance and hesitancy. A cross-sectional study was conducted among older adults living alone or only with an older partner in communities in Hong Kong. Participants were interviewed between October 2021 and February 2022. Logistic regression analyses were employed to examine factors associated with vaccine resistance and hesitancy. Of the 2109 included participants, the mean age was 79.3 years (SD 7.6), 1460 (69.2%) were female, 1334 (63.3%) lived alone, and 1621 (76.9%) were receiving social security support. The vaccine uptake, non-uptake (i.e., resistance), and hesitancy rates were 50.1%, 34.4%, and 15.5%, respectively. The top four reasons for vaccine resistance and hesitancy were “Not feeling in good health” (27%), “Worry about vaccine side effects” (18%), “Feeling no need” (10%), and “Lack of recommendation from doctors” (9%). Vaccine resistance and hesitancy was significantly associated with older age, living alone, more chronic conditions, fewer types of social media use, and lower self-rated health status. Similar associations can be observed in their separate analysis for vaccine resistance and vaccine hesitancy, and ever hospital admission over the past 6 months was additionally related to vaccine hesitancy. Older people who live alone or only with an older partner had a low vaccination rate. Poor health or worry about vaccine side effects were the most common reasons for their vaccine resistance and hesitancy. Actions are greatly needed to improve the uptake rate among this vulnerable population, especially those who were older, have poorer health, and use less social media.

The Association between Risk Perception and Hesitancy toward the Booster Dose of COVID-19 Vaccine among People Aged 60 Years and Older in China

Background: Given the prevalence of the omicron variant and decreased immunity provided by vaccines, it is imperative to enhance resistance to COVID-19 in the old population. We planned to explore the hesitancy rate toward the booster dose of the COVID-19 vaccine and the association between risk perception and the abovementioned rate among people aged 60 and older. Methods: This national cross-sectional study was conducted in mainland China from 25 May to 8 June 2022, targeting people who were 60 years old or above. Four dimensions were extracted from the Health Belief Model (HBM) to assess participants’ perceived risk levels, including perceived susceptibility, perceived severity, perceived barriers, and perceived benefit. An independent Chi-square test was used to compare the vaccine hesitancy rates among different groups stratified by characteristics. Univariable and multivariable logistic regression models were performed to explore the associations between risk perception and hesitancy rate. Results: Of 3321 participants, 17.2% (95% CI: 15.9–18.5%) were hesitant about booster shots of COVID-19 vaccines. Believing that they were ineligible for vaccination due to certain illnesses (38.3%), concern about vaccine safety (32.0%), believing the booster shots were unnecessary (33.1%), and their limitation on movements (28.0%) were the main reasons for vaccine hesitation. Adjusted by all the selected covariates, people with low perception level of susceptibility (aOR = 1.39, 95% CI: 1.00–1.92) and benefit (low: aOR = 3.31, 95% CI: 2.01–5.45; moderate: aOR = 2.23, 95% CI: 1.75–2.85) were less likely to receiving the booster dose, and the same results were found in people with higher perceived barriers (moderate: aOR = 2.67, 95% CI: 2.13–3.35; high: aOR = 2.04, 95% CI: 1.14–3.67). Our estimates were stable in all four models. Conclusions: In total, 17.2% of the people aged 60 years and older in China were hesitant about booster dose of COVID-19 vaccines, and it was closely associated with a lower level of perceived susceptibility and benefit, as well as a higher level of perceived barriers. Concerns about contraindications, vaccine safety, and limited movements were the main reasons for vaccine hesitancy. Targeted public health measure is a priority to improve the understanding of the elderly on their own susceptibility and vulnerability and clear the obstacles to vaccination.