Investigating the Reasons for Receiving the Second Booster Dose of the COVID-19 Vaccine in Adults and in People with Chronic Medical Conditions in Southern Italy

Acceptance of COVID-19 Vaccination and Vaccine Hesitancy Among People with Chronic Diseases in Thailand: Role of Attitudes and Vaccine Literacy Towards Future Implications

Introduction

Vaccination is an important strategy to prevent or reduce hospitalizations and mortality caused by COVID-19 infection. However, some people with chronic diseases are hesitant to get the COVID-19 vaccination.

Objective

This study aimed to assess the acceptance of COVID-19 vaccination and associated factors among people with chronic diseases.

Methods

A cross-sectional online survey was conducted between May and August 2021. A sample of 457 Thai adults living with one or more chronic diseases was drawn from a larger online survey.

Results

Participants were 19 to 89 years old. The three most commonly reported chronic diseases were hypertension, diabetes, and obesity. The acceptance rate of COVID-19 vaccination was 89.1%. Forty-six percent of respondents had received the COVID-19 vaccination, and 43.1% intended to get the vaccine. Reasons for vaccine hesitancy/refusal included concerns about adverse side effects from the vaccines including long-term effects that might complicate their disease condition. Multiple logistic regression analyses revealed that having a bachelor's degree or higher [aOR 4.40; 95% CI: 2.12-9.14], being employed [aOR 2.11; 95% CI: 1.03-4.39], and having positive attitudes [aOR 2.36; 95% CI: 1.69-3.29] and negative attitudes [aOR 0.38; 95% CI: 0.27-0.55] predicted acceptance of the COVID-19 vaccination. Vaccine literacy was significantly associated with acceptance of COVID-19 vaccination in binary logistic regression analyses, but it was not retained in the multiple logistic regression model.

Conclusion

Vaccine literacy and attitudes influence acceptance of COVID-19 vaccination in people with chronic diseases.

Simultaneous vaccination against seasonal influenza and COVID-19 among the target population in Italy

Introduction

Annual influenza and COVID-19 vaccinations are effective tools for reducing the disease burden. The goals of the present cross-sectional survey were to investigate attitudes and behaviors toward the simultaneous vaccination against seasonal influenza and COVID-19 and the factors associated.

Methods

Questionnaires were self-administered or researcher-administered between October 2023 and February 2024 in an immunization center in the southern part of Italy.

Results

All 151 subjects eligible for influenza and COVID-19 vaccinations who attended the center agreed to participate. A total of 59.9% of respondents received concurrent seasonal influenza and COVID-19 vaccinations. Those who perceived that the simultaneous vaccination was safer and those who have been infected by SARS-CoV-2 fewer times were more likely to have simultaneously received both vaccinations. Regarding the reasons reported, half of the sample stated that the simultaneous vaccination was safe and that they were adequately informed. This was more likely indicated by the respondents who had received at least four doses of the COVID-19 vaccination. Among those who had not received the simultaneous vaccination, 70.7% and 29.3% had received only seasonal influenza and COVID-19.

Conclusion

Educational health communication campaigns are necessary to improve compliance with simultaneous administration of seasonal influenza and COVID-19 vaccinations and to increase the unsatisfactory coverage.

Understanding the Reasons for Receiving HPV Vaccination among Eligible Adults in Italy

BACKGROUND

This cross-sectional survey aimed to explore the reasons for receiving the HPV vaccination among eligible adults in Italy.

METHODS

The survey was conducted from July 2023 to April 2024 in Naples, Southern Italy.

RESULTS

A total of 282 questionnaires were collected. The majority of the respondents (73.2%) was aware that HPV vaccination was recommended and this was more likely among women, healthcare workers (HCWs) or students in health sciences, and those who had acquired information from physicians. The most frequently cited reasons for vaccinating were self-protection from the infection (77.6%) and from cervical/oral/penile/anal cancer (68.9%), knowing that the vaccination was free of charge (46.2%), awareness of the severity of the HPV disease (43%), to protect their partner (42.6%), and perception of being at risk (24.2%). Being HCWs or students in health sciences, believing that HPV infection could cause a serious disease, and having a higher number of oral intercourse experiences in the last year were significant predictors of the perception of being at risk. Female and Italian respondents were more likely to receive the HPV vaccination because it was effective in preventing cancer.

CONCLUSIONS

Targeted educational programs and health interventions should be developed to ensure enhancing knowledge and fostering positive attitudes toward the HPV vaccination.

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic

BACKGROUND

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic.

AIM

Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments.

OBJECTIVES

To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital.

METHODS

Mixed-methods study using quantitative and qualitative methods.

RESULTS

Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters.

CONCLUSIONS

This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

Factors associated with intention to be vaccinated with the COVID-19 booster dose: a cross-sectional study in Peru

Introduction

The pandemic of COVID-19 continues to impact people worldwide, with more than 755 million confirmed cases and more than 6.8 million reported deaths. Although two types of treatment, antiviral and immunomodulatory therapy, have been approved to date, vaccination has been the best method to control the spread of the disease.

Objective

To explore factors associated with the intention to be vaccinated with the COVID-19 booster dose in Peru.

Material and Methods

Cross-sectional study, using virtual and physical surveys of adults with two or more doses of COVID-19 vaccine, where the dependent variable was the intention to be vaccinated (IBV) with the booster dose. We calculated prevalence ratios with 95% confidence intervals, using generalized linear models of the Poisson family with robust varying, determining associations between sociodemographic, clinical, and booster dose perception variables.

Results

Data from 924 adults were analyzed. The IBV of the booster doses was 88.1%. A higher prevalence was associated with being male (aPR = 1.05; 95% CI [1.01-1.10]), having a good perception of efficacy and protective effect (PR = 3.69; 95% CI [2.57-5.30]) and belonging to the health sector (PR = 1.10; 95% CI [1.04-1.16]). There was greater acceptance of the recommendation of physicians and other health professionals (aPR = 1.40; 95% CI [1.27-1.55]).

Conclusions

Factors associated with higher IBV with booster dose include male gender, health sciences, physician recommendation, and good perception of efficacy.

Vaccine hesitancy for the COVID-19 vaccine booster dose among nursing home staff fully vaccinated with the primary vaccination course in Belgium

In Belgium, nursing home (NH) staff (NHS) and residents were prioritised for the initial COVID-19 vaccination and successive booster doses. The vaccination campaign for the first booster started in September 2021 in Belgian NH. Our first study about vaccine hesitancy towards the COVID-19 vaccine in Belgian NHS already showed a degree of fear for the primary vaccination course (T1). This new study aims to evaluate vaccine hesitancy to get the first booster (T2) in a population of fully vaccinated (with two doses) NHS. A random stratified sample of NHS who received the primary vaccination course (N = 954) completed an online questionnaire on COVID-19 booster hesitancy (between 25/11/2021 and 22/01/2022). NHS who hesitated or refused the booster were asked for the main reason for their hesitation/refusal. Overall, 21.0 % of our population hesitated before, were still hesitating or refused the booster, NHS that were not hesitant at T1 being 5.7 times less likely to hesitate to get the first booster dose (Adjusted OR 0.179, 95 % CI: 0.120, 0.267). Although there was a slight reduction (23.5 % to 20.1 %) in the proportion of NHS who hesitated/refused vaccination at T1 compared to T2 (p = 0.034), the fear of unknown effects was the principal reason for hesitation/refusal, already mentioned in our first study. NHS were not reassured concerning their initial fears. Given the likelihood that booster vaccinations will be necessary over the coming years, a communication strategy specific to NHS should be implemented.

Factors Influencing the Healthcare Workers' Willingness to Receive the COVID-19 Booster Dose in Tuscany (Italy)

BACKGROUND

The World Health Organization has defined vaccine hesitancy as behavior influenced by several factors, including trust in the vaccine itself or its provider or the perceived need for vaccination. The aim of this study was to investigate the factors influencing the willingness to receive the COVID-19 vaccine among the employees and healthcare professionals of the Central Tuscany Local Health Authority (CT-LHA) in Italy.

METHODS

From July to October 2022, a cross-sectional study was conducted. An online questionnaire was administered to 7000 employees of the CT-LHA. The questionnaire analyzed the factors that influenced receiving the booster dose of the COVID-19 vaccine. The sample was stratified by gender, age, type of occupation (healthcare or non-healthcare workers), and seniority. Incomplete questionnaires were excluded. A chi-squared test was performed through STATA. The significance level was set at 95%.

RESULTS

Of the questionnaires administered, 1885 (26.9%) questionnaires were eligible for the study. In the previous vaccination campaign, the healthcare workers (HCWs) considered the vaccine used by CT-LHA as safe, in contrast to non-healthcare workers (N-HCWs), who considered it less secure (p < 0.05). The HCWs showed a higher propensity for vaccine safety to receive the booster dose than N-HCWs. N-HCWs appeared to be less affected by an updated booster dose than HCWs (p < 0.05).

CONCLUSIONS

The factors studied appear to influence HCWs differently from N-HCWs. Both HCWs and N-HCWs would choose an upgraded mRNA vaccine for the booster dose.

A survey on Malaysian's acceptance and perceptions towards COVID-19 booster dose

Progressive reopening of the economy and declaration of COVID-19 as endemic has relaxed social distancing and mask-wearing necessities in Malaysia. The Ministry of Health of Malaysia reported vaccination rate had reached 86.1% for the first dose and 84.3% for the second dose as of April 2023. However, the uptake of booster doses (third dose or fourth dose) is relatively lower at 68.6% and 1.5%, respectively. A cross-sectional survey was undertaken to study the acceptance and perception of Malaysians towards booster doses in Peninsular Malaysia with participants 18 years old and above by distributing questionnaires at public areas such as government offices, major city train stations, and airports. The study included elderly participants who were not technology savvy. Of 395 survey respondents, 69.4% accepted the COVID-19 booster dose. The results showed that smartphone usage (p = 0.019), living area (p = 0.049), and education level (p = 0.006) significantly influenced the perception of booster dose acceptance among socio-demographic characteristics. Despite experiencing side effects from previous vaccination, 65.9% of respondents still opted to receive booster doses (p = 0.019). The highest deciding factor in accepting booster dose was the need for more clinical studies on COVID-19 booster dose (58.2%) (p = 0.045). In conclusion, the survey demonstrates that greater emphasis on updating and providing more clinical studies regarding the need for booster doses will increase the public's acceptance of the COVID-19 booster dose.

Navigating Vaccine Uncertainty: Anxiety and Fourth Dose Hesitancy Among Saudi Adults

Background The continuous evolution of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and early evidence of declining effectiveness of the third dose over time have generated anxiety and hesitancy regarding vaccinations. The current study aimed to assess anxiety levels and the willingness to receive a fourth dose of the SARS-CoV-2 vaccine. Potential factors leading to this reluctance were also assessed. Methodology This was a cross-sectional cohort study conducted among the adult Saudi population. A questionnaire including demographic data, questions regarding Generalized Anxiety Disorder (GAD-7) assessment, and questions related to accepting the vaccine and reasons for hesitancy was employed. Results Of the 1,924 participants who responded, 1,033 were males, and 891 were females. Among the respondents, a significant level of anxiety toward receiving the fourth dose of the SARS-CoV-2 vaccine was reported in 1,097 cases, representing 57% of the total, with varying degrees of anxiety. Both gender and age were identified as co-factors contributing to this anxiety. A substantial portion of the participants, 1,369 individuals, accounting for 71.2%, exhibited vaccine hesitancy and reluctance to receive the fourth dose. Conclusions Our findings underscore the pressing need for targeted interventions to combat vaccine hesitancy and alleviate associated anxieties, particularly among the adult Saudi population. As we persist in confronting the ongoing challenges brought about by the evolving pandemic, it is crucial that we customize our vaccination campaigns and communication strategies to tackle the apprehensions and hesitations of the Saudi population directly.

Vaccination against COVID-19 and potential protective effects on seizure recurrence in children with epilepsy: A cross-sectional survey

OBJECTIVE

Despite strong evidence on the safety and tolerability of the COVID-19 vaccine, data on vaccination in children with epilepsy, particular younger children with specific epilepsy syndromes, are limited. The protective effects of vaccination against seizure increase upon COVID-19 infection also remain to be elucidated.

METHODS

Questionnaire surveys were distributed online via an established WeChat group for patient management as well as in our outpatient clinic. The data collected included demographics and clinical information related to COVID-19 vaccination and infection. Detailed information related to epilepsy diagnosis and treatment was also collected from our patient database. Logistic regression analysis was performed to determine the factors associated with non-vaccination. The characteristics of seizures following COVID-19 infection were described.

RESULTS

In total, 354 suitable questionnaires were included in the study. The median age at survey was 6 years (interquartile range 4, 9). The most common epilepsy syndrome was self-limited epilepsy (n = 153, 43.2%), followed by developmental and/or epileptic encephalopathy (D/EE, n = 81, 22.9%) and genetic generalized epilepsy (n = 59, 16.7%). The vaccine uptake rate was 43.8% (n = 155), and all related side-effects (n = 11, 7.1%) remitted spontaneously. Younger age (odds ratio [OR] = 0.877, P = 0.001), D/EE (OR = 5.096, P = 0.008), and less than six months seizure-freedom before vaccination (OR = 3.026, P = 0.005) were associated with unwillingness to be vaccinated. There were no significant differences in the rate of COVID-19 infection (33.7% vs 32.7%, P = 0.879) and resultant increased seizure activity following infection between the vaccinated and unvaccinated groups after propensity score matching (9.1% vs 15.6%, P = 0.428).Three unvaccinated cases of Dravet syndrome developed status epilepticus following COVID-19 infection.

SIGNIFICANCE

Vaccination against COVID-19 is safe and well tolerated in children, even in younger patients with D/EE. Although the risk of worsening seizures following COVID-19 infection may not be reduced by immunization, education focused on increased vaccination in pediatric epilepsy is still warranted.

Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy

Background

In Italy, on December 2022, COVID-19 vaccination was recommended for children aged 6 months-4 years with frail conditions and for those healthy. The purposes of the survey were to understand parental willingness and hesitancy toward COVID-19 vaccination of children with frail conditions in Italy and related influencing factors.

Methods

A cross-sectional survey was performed among 445 parents with a child aged 6 months-4 years with frail conditions who attended a teaching hospital and a public hospital randomly selected in the city of Naples, Italy.

Results

Almost one third (29.9%) were willing to vaccinate their frail children against COVID-19, whereas 21.3% were uncertain, and 48.8% did not intend to vaccinate. Parents with a higher level of perception that the vaccine is useful and safe and those who had received information by pediatrician were more likely to be willing to vaccinate their child. The mean Parent Attitudes About Childhood Vaccines (PACV-5) score was 3.4, with 13.5% of parents high-hesitant for the COVID-19 vaccination for their child. Parents with a higher COVID-19 vaccine-related safety concerns, those who have delayed at least one shot of a recommended vaccine for their child, and those who did not have received at least three doses of the vaccine against SARS-CoV-2 were more likely to be high-hesitant.

Conclusion

The survey findings have important implications for designing interventions to increase willingness and to reduce hesitancy for COVID-19 vaccine among parents of frail children aged 6 months-4 years in Italy.