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Roy DN, Ferdiousi N, Mohabbot Hossen M, Islam E, Shah Azam M. Global disparities in COVID-19 vaccine booster dose (VBD) acceptance and hesitancy: An updated narrative review. Vaccine X 2024; 18:100480. [PMID: 38585380 PMCID: PMC10997838 DOI: 10.1016/j.jvacx.2024.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
The global deployment of COVID-19 vaccine booster dose (VBD) has been recognized as a promising therapeutic alliance to provide repeated immunity against the arrival of new variants. Despite scientific evidence supports the effectiveness of periodic doses, COVID-19 vaccine booster reluctance continues to thrive. This narrative review aimed to examine global COVID-19 vaccine booster dose (VBD) acceptance and summarize an up-to-date assessment of potential antecedents associated with VBD acceptance. A comprehensive search was performed in several reputable databases such as Medline (via PubMed), Scopus, Google scholar, and Web of Science from June 10th, 2023, to August 1st, 2023. All relevant descriptive and observational studies on COVID-19 VBD acceptance and hesitancy were included in this review. A total of fifty-eight (58) studies were included, with Asia representing the highest count with thirty-one (53%) studies, Europe with eleven (19 %), the United States with nine (16 %), and other regions (Africa and multi-ethnic) with seven (12 %). Worldwide, the pooled COVID-19 VBD acceptance rate was 77.09 % (95 % CI: 76.28-78.18), VBD willingness (n) = 164189, and the total sample (N) = 212,990. The highest and the lowest VBD acceptance rate was reported in Europe and American regions, respectively, 85.38 % (95 % CI: 85.02-85.73, (n) = 32,047, (N = 37,533) vs. 66.92 % (95 % CI: 66.56-67.4), (n) = 29335, (N) = 43,832. However, Asia and multi-ethnic areas reported moderately high VBD acceptance rate 79.13 % (95 % CI: 78.77-79.23, (n) = 93,994, (N) = 11,8779) and 72.16 % (95 % CI: 71.13-72.93, (n) = 9276, (N) = 12,853), respectively. The most common and key antecedents of COVID-19 VBD acceptance and hesitancy across the countries were "equal safety", "efficacy", "effectiveness", "post-vaccination side effects", "community protection" "family protection", "risk-benefit ratio", "booster necessity", "trust", and "variants control". Disparities in the uptake of COVID-19 VBD were observed globally, with the highest rates found in Europe, and the lowest rates in American regions. Multiple potential antecedents including safety, efficacy, and post-vaccination side effects were associated with VBD acceptance and hesitancy.
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Affiliation(s)
- Debendra Nath Roy
- Department of Pharmacy, Jashore University of Science and Technology, Jashore 7408, Bangladesh
- Institute of Education and Research, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Nowrin Ferdiousi
- Department of Pharmacy, Mawlana Bhasani Science and Technology University, Tangail 1902, Bangladesh
| | | | - Ekramul Islam
- Department of Pharmacy, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md. Shah Azam
- Department of Marketing, University of Rajshahi, Rajshahi 6205, Bangladesh
- Office of the Viec-Chancellor, Rabindra University, Bangladesh
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Lièvre G, Sicsic J, Galmiche S, Charmet T, Fontanet A, Mueller JE. Are the 7C psychological antecedents associated with COVID-19 vaccine behaviours beyond intentions? A cross-sectional study on at-least-one-dose and up-to-date vaccination status, and uptake speed among adults in France. Vaccine 2024; 42:3288-3299. [PMID: 38643038 DOI: 10.1016/j.vaccine.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Widely documented psychological antecedents of vaccination are confidence in vaccines, complacency, convenience, calculation, collective responsibility (5C model) with the recent addition of confidence in the wider system and social conformism. While the capacity of these seven antecedents (7C) to explain variance in COVID-19 vaccine intentions has been previously documented, we study whether these factors also are associated with vaccine behaviours, beyond intentions. METHODS From February to June 2022, we recruited a sample of adults in France, including persons with notified recent SARS-CoV-2 infection, along with relatives and randomly selected non-infected persons. Participants completed self-administered questionnaires assessing COVID-19 vaccination history and the 7C antecedents. We defined vaccination behaviours as three outcomes: at-least-one-dose vaccine status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). We conducted multivariable logistic regressions and Cox models. RESULTS Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes, although effects were weaker for up-to-date vaccination status and uptake speed. The strongest effects (most vs. least vaccine-favourable attitude level, at-least-one-dose vaccination status) were observed for collective responsibility (OR: 14.44; 95%CI: 10.72-19.45), calculation (OR: 10.29; 95%CI: 7.53-14.05), and confidence in the wider system (OR: 8.94; 95%CI: 6.51-12.27). CONCLUSION This study demonstrates that the 7C not only explain vaccine intention, but also vaccine behaviours, and underpins the importance of developing vaccine promotion strategies considering the 7C antecedents.
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Affiliation(s)
- Gaëlle Lièvre
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | | | - Simon Galmiche
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | - Tiffany Charmet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309 - F-35000 Rennes, France.
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Kobayashi T, Tokiya M, Matsumoto A, Nakano T, Hirota Y, Hara M. Predictive factors of coronavirus disease (COVID-19) vaccination series completion: a one-year longitudinal web-based observational study in Japan. Front Public Health 2024; 12:1348170. [PMID: 38487189 PMCID: PMC10937344 DOI: 10.3389/fpubh.2024.1348170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Addresing vaccine hesitancy is considered an important goal in management of the COVID-19 pandemic. We sought to understand what factors influenced people, especially those initially hesitant, to receive two or more vaccine doses within a year of the vaccine's release. Methods We conducted longitudinal Web-based observational studies of 3,870 individuals. The surveys were conducted at four different time points: January 2021, June 2021, September 2021, and December 2021. In the baseline survey (January 2021), we assessed vaccination intention (i.e., "strongly agree" or "agree" [acceptance], "neutral" [not sure], and "disagree" or "strongly disagree" [hesitance]), and assumptions about coronavirus disease (COVID-19), COVID-19 vaccine, COVID-19-related health preventive behavior, and COVID-19 vaccine reliability. In subsequent surveys (December 2021), we assessed vaccination completion (i.e., ≥2 vaccinations). To investigate the relationship between predictors of COVID-19 vaccination completion, a multivariable logistic regression model was applied. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated while adjusting for gender, age, marital status, presence of children, household income category, and presence of diseases under treatment. In a stratified analysis, predictors were determined based on vaccination intention. Results Approximately 96, 87, and 72% of those who demonstrated acceptance, were not sure, or hesitated had been vaccinated after 1 year, respectively. Overall, significant factors associated with COVID-19 vaccine compliance included the influence of others close to the index participant (social norms) (AOR, 1.80; 95% CI, 1.56-2.08; p < 0.001), vaccine confidence (AOR, 1.39; 95% CI, 1.18-1.64; p < 0.001) and structural constraints (no time, inconvenient location of medical institutions, and other related factors) (AOR, 0.80; 95% CI, 0.70-0.91; p = 0.001). In the group of individuals classified as hesitant, significant factors associated with COVID-19 vaccine compliance included social norms (AOR, 2.43; 95% CI, 1.83-3.22; p < 0.001), confidence (AOR, 1.44; 95% CI, 1.10-1.88; p = 0.008), and knowledge (AOR, 0.69; 95% CI, 0.53-0.88; p = 0.003). Discussion We found that dissemination of accurate information about vaccines and a reduction in structural barriers to the extent possible enhanced vaccination rates. Once the need for vaccination becomes widespread, it becomes a social norm, and further improvements in these rates can then be anticipated. Our findings may help enhance vaccine uptake in the future.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Mikiko Tokiya
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Akiko Matsumoto
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), Fukuoka, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
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Machida M, Inoue S, Tabuchi T. General Vaccination Readiness in Japan: Results from the JASTIS 2023 Study. Jpn J Infect Dis 2024; 77:34-39. [PMID: 37914292 DOI: 10.7883/yoken.jjid.2023.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
General vaccine hesitancy is a global concern. Clarifying general vaccination readiness and the psychological factors comprising it is important. Previous studies reported that Japan has one of the lowest vaccine confidence levels worldwide. However, the status of other psychological factors comprising general vaccination readiness in Japan remains unclear. Therefore, we aimed to clarify the status of seven psychological factors comprising general vaccination readiness and their patterns in Japan. This descriptive study utilized data from a large-scale nationwide internet survey (Japan Society and New Tobacco Internet Survey 2023 study, N = 31,037). Seven psychological factors were assessed using the 7C of vaccination readiness scale. Cluster analysis was performed using k-means++ clustering to clarify patterns. Of the seven factors, support for social monitoring of people refusing vaccination (e.g., vaccine passports) was very low among the participants. Cluster analysis showed that the participants' vaccination readiness could be classified into six patterns, of which the very low vaccination readiness cluster, with the lowest scores for most psychological factors, accounted for 11.1% and was more common among those aged 30-49 years (13.1-16.4%). Individuals in this cluster may refuse to receive recommended vaccines.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Japan
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Japan
- The Tokyo Foundation for Policy Research, Japan
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Machida M, Takamiya T, Odagiri Y, Fukushima N, Kikuchi H, Inoue S. Estimation of cutoff score for the 7C of vaccination readiness scale. Vaccine X 2023; 15:100394. [PMID: 37808267 PMCID: PMC10550591 DOI: 10.1016/j.jvacx.2023.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/17/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
The 7C of the vaccination readiness scale provides a score to evaluate the willingness and readiness to get vaccinated (vaccination readiness). This cross-sectional study clarifies the cutoff vaccination readiness score to determine whether an individual is willing to be vaccinated. We conducted an online survey of 774 participants. The vaccination readiness scores for the full and short survey versions were calculated. The coronavirus disease 2019 vaccination status was used to determine whether the participant was willing to be vaccinated. Receiver operating characteristic curve analysis was performed using the Youden index. The Youden Index was at its maximum when the cutoff score was 4.02 for the full version (area under the curve [AUC]:0.94) and 4.07 for the short version (AUC:0.90). Vaccination readiness scores greater than 4 on both the full and short version may indicate a willingness to be vaccinated. This cutoff value facilitates the interpretation of the 7C scale results.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Tomoko Takamiya
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Yuko Odagiri
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Noritoshi Fukushima
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
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Roy DN, Ali S, Sarker AK, Islam E, Azam MS. Acceptance of COVID-19 vaccine booster dose among the people of Bangladesh: A cross-sectional study. Heliyon 2023; 9:e22215. [PMID: 38053887 PMCID: PMC10694156 DOI: 10.1016/j.heliyon.2023.e22215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Vaccine booster dose (VBD) provides a potential therapeutic alliance in preventing breakthrough infection and new variant's arrival while preserving long-lasting host immunity. This study aimed to analyze COVID-19 VBD willingness and identified the key determinants of VBD acceptance among the general people of Bangladesh. This survey-based study applied a quantitative research paradigm. A validated, anonymous, and multi-item questionnaire was adopted through a theoretical review of pertinent literature on the topic. Data were collected between August 2022─October 2022, and sampling was done randomly. A total of 704 individuals were invited via face-to-face interview approach; however, 13.8 % of them declined to give consent, which resulted in the participation of 607 potential respondents. The main outcome measure was COVID-19 VBD acceptance willingness. Binary logistic regression analysis was conducted to rationalize the study's objectives. The pooled COVID-19 booster vaccine acceptance rate was 70.0 % (95 % confidence Interval [CI]: 67─73) among Bangladeshi people. An analysis of binary logistic regression revealed that, out of 14 potential factors, "efficacy", "repeated immunity", "communication", and "trust" showed highly significant positive association (adjusted odds ratio [aOR ] = 2.151 95 % CI: 1.391─ 3.508, aOR = 2.033 95 % CI: 1.299─ 3.181, and aOR = 2.552 95 % CI: 1.557─4.183 respectively, p<0.01), and "equal safety", "risk-benefit ratio" and "community protection" had significant positive association (aOR = 1.739 95 % CI: 1.070─2.825, aOR = 1.712 95 % CI: 1.116─2.627, and aOR = 1.628 95 % CI: 1.395─0.998, p<0.05) with VBD acceptance. However, post-vaccination "side effects" showed significant negative (aOR = 0.393 95 % CI: 0.237─0.674, p<0.01) associations with VBD acceptance. The odds of accepting the COVID-19 vaccine booster was found 1.26, and it was found insignificant (p>0.05) in the Chi-squared test. Bangladeshi people expressed a moderately high level response to COVID-19 VBD acceptance. A positive attitude towards the COVID-19 VBD is an outcome of this study, regardless of the circumstances, as far as safety, efficacy, perceived health benefits, communication, trust, and community resistance are concerned. Post-vaccination side effects fear was the primary reason for booster dose skepticism as well as a barrier to administering booster shots. The confidence in COVID-19 VBD will be boosted when mass people are effectively communicated and vaccine's data become more available publicly.
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Affiliation(s)
- Debendra Nath Roy
- Department of Pharmacy, Jashore University of Science and Technology, Jashore-7408, Bangladesh
- Institute of Education and Research, University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Shaheb Ali
- Department of Pharmacy, Jashore University of Science and Technology, Jashore-7408, Bangladesh
| | - Ashish Kumar Sarker
- Department of Pharmacy, Pabna University of Science and Technology, Pabna, Bangladesh
- School of Science, Western Sydney University, NSW-2560, Australia
| | - Ekramul Islam
- Department of Pharmacy, University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Md. Shah Azam
- Department of Marketing, University of Rajshahi, Rajshahi-6205, Bangladesh
- Office of the Vice Chancellor, Rabindra University, Bangladesh
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Askarian M, Kazerooni AR, Shayan Z, Karimzadeh P, Movahedi M, Hatam N. Investigating the tendency to use COVID-19 vaccine booster dose in Iran. BMC Health Serv Res 2023; 23:1051. [PMID: 37784095 PMCID: PMC10544311 DOI: 10.1186/s12913-023-09788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/05/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Vaccine hesitancy is recognized as a significant public health threats, characterized by delays, refusals, or reluctance to accept vaccinations despite their availability. This study, aimed to investigate the willingness of Iranians to receive booster shots, refusal rate, and their preferred type of COVID-19 vaccine. MATERIALS AND METHODS This cross-sectional study was conducted over a month from August 23 to September 22, 2022 using an online questionnaire distributed through WhatsApp and Telegram online communities. The questionnaire assessed participants' intent to accept COVID-19 booster vaccination and had no exclusion criteria. Data analysis involved using SPSS version 16.0, with t-tests and chi-square tests used to assess the bivariate association of continuous and categorical variables. A multivariate logistic regression model was built to examine the association between Health Belief Model (HBM) tenets and COVID-19 vaccination intent. The Hosmer Lemeshow Goodness of Fit statistic was used to assess the model's fit, with a p-value > 0.05 indicating a good fit. RESULTS The survey was disseminated to 1041 adults and the findings revealed that 82.5% of participants expressed a desire to receive the booster dose. Participants who intended to be vaccinated were generally older (46.4 ± 10.9), mostly female (53.3%), single (78.9%), had received a flu vaccine (45.8%). The findings indicated that the HBM items, including perception of COVID-19 disease, perceived benefits of COVID-19 vaccines, COVID-19 safety/cost concerns, preference of COVID-19 vaccine alternatives, and prosocial norms for COVID-19 vaccination, received higher scores among individuals intending to be vaccinated compared to vaccine-hesitant individuals, with statistical significance (p < 0.05). However, the "COVID-19 risk-reduction habits" item had a higher score but did not reach statistical significance (p = 0.167). CONCLUSION Factors such as lack of trust in the effectiveness of the vaccine, trust in specific vaccine manufacturers, and concerns about side effects of COVID-19 vaccine are among the most important factors. These findings have implications for national vaccination policies, emphasizing the need for policymakers in the health sector to address these factors as vital considerations to ensure the continuity of vaccination as one of the most important strategies for controlling the pandemic.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, School of Medicine, Health Behavior Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - zahra Shayan
- Department of Biostatistics, school of medicine, shiraz university of medical sciences, shiraz, Iran
| | | | - Mohammad Movahedi
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Nahid Hatam
- Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Berríos H, López-Cepero A, Pérez CM, Cameron S, Pons Calvo AD, Colón-López V. COVID-19 Vaccine Booster Hesitancy among Hispanic Adults: A Cross-Sectional Study from the Puerto Rico Community Engagement Alliance against COVID-19 Disparities (PR-CEAL). Vaccines (Basel) 2023; 11:1426. [PMID: 37766103 PMCID: PMC10537643 DOI: 10.3390/vaccines11091426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Hispanic/Latino communities have suffered a disproportionate burden of the COVID-19 pandemic. Although Puerto Rico has one of the highest COVID-19 primary series vaccination rates nationwide, this estimate contrasts with the reported booster doses' low uptake. This study aimed to assess health belief correlates of COVID-19 vaccine booster uptake. Using a convenience sampling approach, the Puerto Rico-Community Engagement Alliance (PR-CEAL) conducted a cross-sectional study where 787 participants were recruited using online and in-person strategies between December 2021 and February 2022. Participants were adults 18 years or older, Spanish-speaking, and residents of Puerto Rico. The Health Belief Model was used to evaluate attitudes and beliefs. A total of 784 participants were used in this analysis. Adjusted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of booster refusal. Overall, 22% of participants refused the vaccine booster or had not gotten it yet. Adjusted models showed that (i) participants who disagreed that getting the booster dose either made them feel less worried about COVID-19 or (ii) felt that the vaccine decreased their chances of getting COVID-19 presented higher booster-refusal prevalence ratios (PR = 4.20, 95% CI: 3.00, 5.90; PR = 3.70, 95% CI: 2.64, 5.18). Moreover, participants that (iii) reported having concerns for booster side effects [PR = 2.47; 95% CI = 1.73, 3.51], (iv) booster efficacy [PR = 2.50; 95% CI = 1.75, 3.58], and (v) booster safety [PR = 2.80; 95% CI = 1.96, 3.99] were significantly more likely to refuse the booster. In conclusion, booster vaccination refusal was associated with lower perceived vaccine benefits and greater barriers among adults in Puerto Rico. These results informed the development of PR-CEAL's targeted community outreach strategies and public health campaigns to increase booster vaccine uptake.
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Affiliation(s)
- Hérmilis Berríos
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00927, Puerto Rico; (H.B.); (S.C.); (A.D.P.C.)
| | - Andrea López-Cepero
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Cynthia M. Pérez
- Department of Biostatistics and Epidemiology, University of Puerto Rico Medical Sciences Campus, San Juan 00935, Puerto Rico;
| | - Stephanie Cameron
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00927, Puerto Rico; (H.B.); (S.C.); (A.D.P.C.)
| | - Adriana D. Pons Calvo
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00927, Puerto Rico; (H.B.); (S.C.); (A.D.P.C.)
| | - Vivian Colón-López
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan 00927, Puerto Rico; (H.B.); (S.C.); (A.D.P.C.)
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Khan M, Jabeen S, Khizer Ali S, Tofique MH, Shabbir MS, Baig R, Khalili MN, Kumar S, Khatri M, Varrassi G, Sapna F, Dass A, Kumar N. Public Knowledge About COVID-19 Booster Vaccines in Pakistan: A Study Conducted in a Tertiary Care Hospital in Karachi. Cureus 2023; 15:e40284. [PMID: 37448436 PMCID: PMC10336743 DOI: 10.7759/cureus.40284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has deteriorated the healthcare system and economy worldwide. Globally, by making the primary vaccination against the coronavirus necessary, the surge in cases waned, but as the effects of this vaccination decreased after some time, to prevent another pandemic, vaccination was still necessary. As a result, receiving a COVID-19 booster shot can boost immunity against the coronavirus. This study aimed to assess knowledge of COVID-19 booster vaccines in Pakistan among the general public and understand the factors affecting the vaccination process in the state. In this cross-sectional study, non-probability convenience sampling was done. Its physical data collection was conducted in September 2022 in a tertiary care hospital in Karachi, Pakistan. Data were collected from 384 individuals who visited the hospital with consent before filling out the questionnaire. The mean age of respondents was 35.81 (standard deviation (SD) = ±13.006), and 98.7% of individuals were primarily vaccinated for COVID-19, but out of these, only 60.1% received the booster jab. The most commonly reported side effects of primary doses of COVID-19 and its booster were pain at the injection site, fatigue, and fever, but these effects did not appear to have as much of an impact on the vaccination process as education did. The results are evident that out of primarily vaccinated individuals against COVID-19, 40.16% are reluctant to receive its booster. Therefore, it is essential to create awareness among the masses about vaccination and its importance.
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Affiliation(s)
- Misha Khan
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Sidra Jabeen
- Neurosurgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Syed Khizer Ali
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Rooha Baig
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Fnu Sapna
- Internal Medicine, Detroit Medical Center, Detroit, USA
| | - Arjan Dass
- Medicine and Surgery, Willis-Knighton Health System, Shreveport, USA
| | - Nomesh Kumar
- Internal Medicine, Detroit Medical Center/Wayne State University Sinai-Grace, Detroit, USA
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Tharwat S, Eleraky ES, Adel T, Nassar MK, Saleh M. Attitudes and concerns regarding booster dose of COVID-19 vaccine among Egyptian patients with autoimmune and rheumatic diseases: a cross-sectional survey study. J Pharm Policy Pract 2023; 16:54. [PMID: 37020249 PMCID: PMC10075500 DOI: 10.1186/s40545-023-00558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND COVID-19 booster dose vaccination acceptance and actual vaccination behavior is not known among Egyptian individuals with autoimmune and rheumatic diseases (ARDs). The aim of this study was to investigate the acceptability of booster dose of the COVID-19 vaccine, as well as the factors that drive and inhibit that acceptance among Egyptian patients diagnosed with ARDs. METHODS This interview-based, cross-sectional analytical study was carried out on ARD patients from 20 July to 20 November 2022. A questionnaire was created to assess sociodemographic and clinical data, as well as COVID-19 vaccination status and the intention to receive a COVID-19 vaccine booster dose, perception of health benefits of it in addition to the perceived barriers and/or concerns. RESULTS A total of 248 ARD patients were included, with a mean age of 39.8 years (SD = 13.2), and 92.3% were females. Among them, 53.6% were resistant to the COVID-19 booster dose, whereas 31.9% were acceptant and 14.5% were hesitant. Those who were administering corticosteroids and hydroxychloroquine shown significantly greater booster hesitancy and resistance (p = 0.010 and 0.004, respectively). The primary motivation for taking a booster dose among the acceptant group was own volition (92%). Most acceptants believed that booster dose can prevent serious infection (98.7%) and community spread (96.2%). Among the hesitant and resistant groups, the main concerns for booster dose were fear about its major adverse effects (57.4%) and long-term impact (45.6%). CONCLUSIONS There is a low acceptability rate of booster dose of COVID-19 vaccine among Egyptian patients with ARD diseases. Public health workers and policymakers need to make sure that all ARD patients get clear messages about accepting the COVID-19 booster dose.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, El Gomhouria St., Mansoura, 35511, Dakahlia Governorate, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
| | - Elshimaa Saad Eleraky
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt
| | - Toqa Adel
- Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
| | - Mohammed Kamal Nassar
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt
- Mansoura Nephrology and Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Marwa Saleh
- Mansoura Nephrology and Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Machida M, Inoue S. Patterns of HPV vaccine hesitancy among catch-up generations in Japan: A descriptive study. Vaccine 2023; 41:2956-2960. [PMID: 37024410 DOI: 10.1016/j.vaccine.2023.03.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Cervical cancer is a preventable disease caused by human papillomavirus (HPV). The HPV vaccine uptake in Japan has been slow since the Ministry of Health, Labour and Welfare suspended the recommendation for proactive HPV vaccination in 2013. In April 2022, Japan initiated catch-up vaccinations for women who missed the opportunity to receive the HPV vaccine. However, as of September 2022, very few women had received catch-up vaccination, raising concerns about vaccine hesitancy in the target population. It is necessary to understand the thinking and motivation of the target population to develop effective strategies to improve vaccination rates. Therefore, using cluster analysis, this study aimed to clarify the pattern of HPV vaccine hesitancy among the catch-up generations in Japan. METHODS This descriptive study was based on an Internet survey completed by 3,790 women in Japan aged over 18 years who were eligible for catch-up vaccination and had not yet received an HPV vaccine. Participants were asked about their intention and thinking about the HPV vaccine and descriptive norms on vaccination intention. Cluster analysis using k-means clustering was performed to clarify these patterns. RESULTS Cluster analysis revealed three hesitancy patterns: acceptance, neutral and refusal. The acceptance group, with high intention, comprised 28.2% of the participants, and students and a high-income level mainly dominated this group. The refusal group, with negative thinking and low intention, accounted for 20.1% and was more prevalent among workers and the unemployed. The neutral group, with neutral thinking and intention, accounted for 51.6%. The perceived effect of descriptive norms on vaccination intention was large in the acceptance group but small in the refusal group. CONCLUSION HPV vaccine awareness promotion strategies must be based on the characteristics of each group and the different distributions of sociodemographic factors.
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Affiliation(s)
- Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan; Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
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Deng X, Zhao Y, Wang S, He H, Chen Z, Zhou Y, Yan R, Tang X, Zhu Y, Xu X. Assessing COVID-19 Vaccine Booster Hesitancy Using the Modified 5C Scale in Zhejiang Province, China: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11030706. [PMID: 36992290 DOI: 10.3390/vaccines11030706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Following the rollout of a booster campaign to promote immunity against COVID-19 in China, this study aimed to assess booster hesitancy among adults who were fully vaccinated with primary doses across Zhejiang Province. Firstly, the modified 5C scale developed by a German research team was assessed for reliability and validity via a pre-survey in Zhejiang Province. Then, a 30-item questionnaire was established to conduct online and offline surveys during 10 November to 15 December 2021. Demographic characteristics and information on previous vaccination experience, vaccine type of primary doses, attitudes towards booster doses and awareness of SARS-CoV-2 infection were collected. Chi-square tests, pairwise comparison and multivariate logistic regression were performed in data analysis. In total, 4039 valid questionnaires were analyzed, with booster hesitancy of 14.81%. Dissatisfaction with previous vaccination experience of primary doses (ORs = 1.771~8.025), less confidence in COVID-19 vaccines (OR = 3.511, 95%CI: 2.874~4.310), younger age compared to the elderly aged 51-60 years old (2.382, 1.274~4.545), lower education level (ORs = 1.707~2.100), weaker awareness of social responsibility of prevention and control of COVID-19 (1.587, 1.353~1.859), inconvenience of booster vaccination (1.539, 1.302~1.821), complacency regarding vaccine efficacy as well as self-health status (1.224, 1.056~1.415) and excessive trade-offs before vaccination (1.184, 1.005~1.398) were positively associated with booster hesitancy. Therefore, intelligent means should be strengthened to optimize vaccination services. More influential experts and other significant figures should be supported to promote timely evidence-based information via various media platforms to reduce public hesitancy and increase booster uptake.
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Affiliation(s)
- Xuan Deng
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Yuchen Zhao
- Department of Preventive Medicine and Health Education, Fudan University, Shanghai 200032, China
| | - Shenyu Wang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Department of Epidemiology, Nanjing Medical University, Nanjing 211166, China
| | - Hanqing He
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Zhiping Chen
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Yang Zhou
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Rui Yan
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Xuewen Tang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Yao Zhu
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Xiaoping Xu
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
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Psychological determinants of COVID-19 vaccine acceptance: A comparison between immigrants and the host population in Japan. Vaccine 2023; 41:1426-1430. [PMID: 36702692 PMCID: PMC9868366 DOI: 10.1016/j.vaccine.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/24/2023]
Abstract
This study explored the differences in COVID-19 vaccination readiness based on the 7C model and its association with vaccine acceptance among foreign-born immigrants, Japan-born immigrants, and locals in Japan. A cross-sectional survey was conducted in October 2021 (n = 3,690). Our results show that COVID-19 vaccination readiness, acceptance, and their relationship differ according to migratory status and nativity. Immigrant participants reported higher general vaccination readiness and acceptability for vaccination against COVID-19 than the Japanese participants, but had lower vaccination coverage, particularly among those born in Japan. The psychological determinants of Japan-born immigrants were more similar to those of Japanese participants than those of foreign-born immigrants. The effects of confidence, complacency, and constraints on COVID-19 vaccine acceptance were strong among all three groups. However, the role of collective responsibility and conspiracy varied by migratory status. This study highlighted the importance of culturally tailored interventions in vaccine delivery to immigrants.
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The Relationship between Daily Behavior Changes and Vaccine Attitudes at the Early Stage of the COVID-19 Pandemic among Japanese People from Different Demographics: A Retrospective and Exploratory Examination Using a Free-Response Survey. Vaccines (Basel) 2023; 11:vaccines11010192. [PMID: 36680036 PMCID: PMC9862657 DOI: 10.3390/vaccines11010192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
This study investigated how daily behaviors of Japanese people changed during the early stages of the COVID-19 pandemic and whether the change was mediated by demographics. It also examined whether the magnitude of behavior change in a demographic group is related to their attitudes towards the COVID-19 vaccine. 301 Japanese responded to an online survey in February 2021, in which they first wrote some activities they frequently performed before the virus outbreak and then wrote about activities in their current life. The number of gathered answers were 1858 for 'before' and 1668 for 'after', and they were grouped into 19 behavior categories. Overall, behaviors such as traveling, eating out, and shopping were much less frequently described in the 'after' condition; while housework, food delivery, and pandemic prevention were mentioned more. However, the change pattern was significantly influenced by demographics of age, gender, having children or not, and household income. Especially women, younger generations, and people without children showed the greatest extent of behavior change compared with the other demographic cohorts. These groups were reported to be vaccine-hesitant in the literature. This study suggests that individuals with hesitant attitudes towards vaccines are more willing to change their behaviors to control viral transmission.
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Harapan H, Fathima R, Kusuma HI, Anwar S, Nalapraya WY, Wibowo A, Wati KDK, Medina A, Defrita AH, Astri Y, Prasetyowati A, Nurfarahin N, Khusna A, Oktariana S, Anwar S, Yussar MO, Khotimah S, Nainggolan BWM, Badri PRA, Argarini R, Winardi W, Indah R, Sallam M, Rajamoorthy Y, Wagner AL, Mudatsir M. Drivers of and Barriers to COVID-19 Vaccine Booster Dose Acceptance in Indonesia. Vaccines (Basel) 2022; 10:vaccines10121981. [PMID: 36560390 PMCID: PMC9783536 DOI: 10.3390/vaccines10121981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Obtaining a booster dose of coronavirus disease 2019 (COVID-19) vaccine is required to maintain the protective level of neutralizing antibodies and therefore herd immunity in the community, and the success of booster dose programs depends on public acceptance. The aim of this study was to determine the acceptance of a booster dose of COVID-19 vaccine and its drivers and barriers in Indonesia. A cross-sectional survey was conducted in the provinces of Indonesia between 1 and 15 August 2022. Individuals who completed the primary series of the COVID-19 vaccine were asked about their acceptance of a booster dose. Those who refused the booster dose were questioned about their reasons. A logistic regression was used to determine the determinants associated with rejection of a booster dose of COVID-19 vaccine. A total of 2935 respondents were included in the final analysis. With no information on the efficacy and safety of the COVID-19 vaccine, 95% of respondents agreed to receive a booster dose if it were provided for free by the government. This acceptance was reduced to only 50.3% if the vaccine had a 75% efficacy with a 20% chance of side effects. The adjusted logistic regression analysis indicated that there were eight factors associated with the rejection of the booster dose: age, marital status, religion, occupation, type of the first two vaccines received, knowledge regarding the importance of the booster dose, belief that natural immunity is sufficient to prevent COVID-19 and disbelief in the effectiveness of the booster dose. In conclusion, the hesitancy toward booster doses in Indonesia is influenced by some intrinsic factors such as lack of knowledge on the benefits of the booster dose, worries regarding the unexpected side effects and concerns about the halal status of the provided vaccines and extrinsic determinants such as the effectiveness and safety of the vaccine. These findings suggest the need for more campaigns and promotions regarding the booster dose benefits to increase its acceptance.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Tsunami and Disaster Mitigation Research Center (TDMRC), Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Correspondence:
| | - Raisha Fathima
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Hendrix Indra Kusuma
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Biology Education Department, Faculty of Tarbiyah and Teacher Training, Universitas Islam Negeri Ar-Raniry, Banda Aceh 23111, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Widhy Yudistira Nalapraya
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Islam Bandung, Bandung 40116, Indonesia
| | - Adityo Wibowo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Lampung, Bandar Lampung 35145, Indonesia
| | - Ketut Dewi Kumara Wati
- Department of Child Health, Faculty of Medicine, Universitas Udayana, Denpasar 80234, Indonesia
| | - Ayunda Medina
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | | | - Yesi Astri
- Neurology Department, Faculty of Medicine, Universitas Muhammadiyah Palembang, Palembang 30263, Indonesia
| | | | - Nurfarahin Nurfarahin
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Afriyani Khusna
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Setya Oktariana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Sarifuddin Anwar
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Tadulako University, Palu 94148, Indonesia
| | - Milza Oka Yussar
- Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh 23245, Indonesia
| | - Siti Khotimah
- Biochemistry Laboratory, Medical Faculty of Mulawarman University, Samarinda 75119, Indonesia
| | | | - Putri Rizki Amalia Badri
- Public Health Department, Faculty of Medicine, Universitas Muhammadiyah Palembang, Palembang 30263, Indonesia
| | - Raden Argarini
- Department of Medical Physiology and Biochemistry, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Wira Winardi
- Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Rosaria Indah
- Medical Education Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
| | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Kuala Lumpur 43200, Malaysia
| | - Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
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