Acceptance of a COVID-19 Vaccine in Japan during the COVID-19 Pandemic

Participation Questionnaire for Preschoolers With Autism Spectrum Disorder: Item Development

Occupational therapists need to comprehensively assess the participation of children with autism spectrum disorder (ASD) in daily activities and evaluate the effectiveness of relevant interventions. Several participation measurement tools have been developed for children with ASD, but these tools require expert involvement, which is a barrier to large-scale surveys. To address these concerns, a caregiver-administered questionnaire-the Participation Questionnaire for Preschoolers (PQP)-was developed. However, this tool could be improved due to its narrow age range of 48-72 months and because the item development process does not reflect the perspectives of children and caregivers. Therefore, we expanded the PQP's target age range to 36-83 months and developed new items that reflect the perspectives of professionals and caregivers. Interviews were conducted with eight experts in supporting children with ASD and 11 caregivers of children with ASD. The interviews were transcribed, and a content analysis was performed. The number of questions was reduced from 51 to 36, and the order of items was changed for clarity. Two of the eight subdomains were removed to clarify the conceptual difference between activity and participation. The updated version of the PQP has two unique features: (1) it can be administered without expert involvement, and (2) it includes items specific to the challenges faced by children with ASD. Future development of the scale and validation of its measurement properties are needed.

Coronavirus disease 2019 vaccination acceptance and associated factors among residents of Dire Dawa Administration, Eastern Ethiopia: a community-based cross-sectional study

BACKGROUND

Corona virus disease 2019 (COVID-19) is an extremely contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2. Understanding the willingness of the community to receive the COVID-19 vaccine will help in the development and implementation of effective COVID-19 vaccination promotion programs. Therefore, we aimed to assess the level of COVID-19 vaccine acceptance and associated factors among residents of Dire Dawa Administration, Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 840 residents in Dire Dawa Administration from May 18th to June 18th, 2021. Multistage cluster sampling followed by systematic random sampling was used to select respondents. A pretested interviewer-administered structured questionnaire was used to collect the data from respondents. Bivariable and multivariable logistic regression were used to identify predictors of COVID-19 vaccine acceptance. The odds ratio (OR), along with a 95% confidence interval (CI), was used to estimate the strength of the association.

RESULTS

Out of 840 respondents recruited, the proportion of COVID-19 vaccine acceptance was found to be 54.4% (457/840); (95% CI: 51.0%, 57.7%) Being male [AOR = 1.85, 95% CI: (1.35, 2.54), P < 0.001], not having a current habit of substance use [AOR = 2.38, 95% CI: (1.73, 3.26), P < 0.001], having a monthly income of less than 51.31 USD [AOR = 0.19, 95% CI: (0.04, 0.88), P = 0.001]; and not having a prior history of vaccination experience [AOR = 0.40, 95% CI: (0.29, 0.54), P < 0.001] were significantly associated with COVID-19 vaccine acceptance.

CONCLUSION

This study reveals that the proportion of COVID-19 vaccine acceptance among residents of Dire Dawa Administration, Eastern Ethiopia, was 54.4%. Factors like being male and not having a current habit of substance use were positively associated, whereas having a monthly income of less than 51.31 USD and not having a prior history of vaccination experience were negatively associated with COVID-19 vaccine acceptance. Health information dissemination and economic empowerment are crucial to improving COVID-19 vaccine acceptance among the community. This study provides valuable data for policymakers to plan early vaccination programs and tackle the challenges identified in the study.

The Japanese adaptation and validation of the COVID-19 Phobia Scale (C19P-S)

There exists a significant need of screening, measuring, and assessing phobic reactions to the negative effects and consequences of coronavirus disease 2019 (COVID-19) across the world. For this purpose, the C19P-S has b een developed and adapted to several languages and cultures including Turkish, Russian, Arabic, English, Korean, and soforth. This study aimed to adapt the scale into Japanese. Convenience sampling was used in the recruitment of the participants. The sample involved 310 Japanese-speaking natives from different prefectures of the country (MeanAGE = 49.97; SD = 13.07). The scale is a self-report instrument, which includes 20, 5-point Likert-type items. The scale assesses the levels of COVID-19 phobia in four areas: Psychological, Somatic, Economic, and Social. The validity (content, construct, convergent, and discriminant) and reliability (internal consistency) analyses were conducted. Multivariate analysis of variance (MANOVA) was used for group comparisons. MANOVA results show that women scored statistically higher in the psychological area. Furthermore, the participants with a lower educational level scored higher than those with a higher level in the somatic area. Among other scales measuring fear and anxiety, the C19P-S Japanese (C19P-SJ) is the first measurement tool specifically designed and adapted for evaluating coronaphobia. It is suggested that the individuals with psychiatric diagnoses be included to measure and support the construct validity of the scale.

Moral characteristics predicting COVID-19 vaccination

OBJECTIVE

The current study aims to assess, for the first time, whether vaccination is predicted by different behavioral and cognitive aspects of moral decision-making.

BACKGROUND

Studies linking moral factors to vaccination have largely examined whether vaccination decisions can be explained by individual differences in the endorsement of various principles and norms central to deontology-based arguments in vaccination ethics. However, these studies have overlooked whether individuals prioritize norms over other considerations when making decisions, such as maximizing consequences (utilitarianism).

METHOD

In a sample of 1492 participants, the current study assessed whether vaccination is explained by individual differences in three aspects of moral decision-making (consequence sensitivity, norm sensitivity, and action tendency), while also considering ethics position (idealism, relativism) and moral identity.

RESULTS

Supportive vaccination (vaccine uptake accompanied by a positive attitude toward vaccines) was associated with utilitarianism (increased consequence sensitivity) and increased tolerance to risks and harm toward others. Meanwhile, although those in the non-vaccinated group was associated with higher harm sensitivities, they neither supported nor received the COVID vaccines (when vaccines prevent harm from infection).

CONCLUSION

Pro-vaccination messages may be made more effective by addressing perceptions of harms associated with vaccines and infections, respectively.

Investigating the Spatial Accessibility and Coverage of the Pediatric COVID-19 Vaccine: An Ecologic Study of Regional Health Data

The COVID-19 pandemic presented the unique challenge of having to deliver novel vaccines during a public health crisis. For pediatric patients, it was further complicated by the delayed timeline for authorizing the vaccine and the differences in dosing/products depending on the patient's age. This paper investigates the relationship between the spatial accessibility and uptake of the COVID-19 vaccine in King County, WA, USA. Public data for COVID-19 vaccine sites were used to calculate spatial accessibility using an enhanced two-step floating catchment area (E2SFCA) technique. Spatial regression analyses were performed to look at the relationship between spatial accessibility and ZIP-code-level vaccination rates. The relationships of these data with other socioeconomic and demographic variables were calculated as well. Higher rates of vaccine accessibility and vaccine coverage were found in adolescent (12- to 17-year-old) individuals relative to school-age (5- to 11-year-old) individuals. Vaccine accessibility was positively associated with coverage in both age groups in the univariable analysis. This relationship was affected by neighborhood educational attainment. This paper demonstrates how measures such as E2SFCA can be used to calculate the accessibility of the COVID-19 vaccine in a region and provides insight into some of the ecological factors that affect COVID-19 vaccination rates.

Factors associated with willingness to receive coronavirus disease vaccination during the pandemic: A nationwide survey in Taiwan

BACKGROUND/PURPOSE

Vaccination is the most important preventive measure to protect people from coronavirus disease 2019 (COVID-19). Governments worldwide have prioritized their vaccination policy against COVID-19. However, there is a lack of relevant research on Taiwanese attitudes and considerations toward COVID-19 vaccination. This study aimed to investigate the cognition, preventive behaviors, and attitudes toward COVID-19 vaccines that influence people's willingness to get vaccinated in Taiwan.

METHODS

From October 1 to 31, 2021, a computer-assisted telephone interview system was used to randomly select Taiwanese people to investigate their COVID-19 preventive behaviors, knowledge, and willingness to be vaccinated.

RESULTS

We included 2000 participants of whom 96.45% showed vaccination willingness. The overall mean age and knowledge scores were 48.6 years and 5.78, respectively. All of the participants chose to wear masks, and 80% chose to be vaccinated to prevent COVID-19. Compared with the non-willing vaccination participants, those with younger ages, higher incomes, and higher knowledge scores regarding masks and vaccination were more likely to be vaccinated. Furthermore, apprehensions about vaccine side effects and negative news about COVID-19 vaccines were the major reasons for vaccination hesitancy.

CONCLUSION

To improve people's willingness to get vaccinated, the government should strive to deliver correct knowledge and refute inappropriate negative information about COVID-19 vaccination. Moreover, recommendation by physicians was an important factor for older individuals to decide on receiving the COVID-19 vaccine, and policies could be implemented from this aspect.

Traditional and Social Media Usage Associated With COVID-19 Vaccine Uptake in Sapporo, Japan

This study aimed to determine the relationship between specific information source usage and uptake of the coronavirus disease 2019 (COVID-19) vaccine. We analyzed 3348 participants aged 20 to 65 years who were not diagnosed with COVID-19 in a case-control study in Sapporo, Japan. The most prevalent information source on COVID-19 was television (TV; 87.8%), followed by online news sites (74.3%), newspapers (38.7%), websites of public institutions (30.9%), and families (29.7%). Multivariate logistic regression showed that the adjusted odds ratios of incompletion of second vaccinations for users of TV and newspaper to gather COVID-19 information were 0.31 and 0.32, respectively, whereas those for users of books, commercial video sites, Facebook, and "personal blog or bulletin board system" were 3.34, 2.22, 2.36, and 4.81, respectively. Social media use among older or male participants was associated with lower vaccine uptake.

COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review

OBJECTIVE

To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries.

DESIGN

A realist review.

DATA SOURCES

Embase, PubMed, Dimensions ai and Google Scholar.

SETTING

High-income countries.

DEFINITIONS

We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021.

RESULTS

We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited.

CONCLUSION

Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.

Factors affecting motivation for receiving a booster dose of the COVID-19 vaccine among Japanese university students and staff: a cross-sectional questionnaire survey

Understanding the factors that influence people's decisions regarding vaccination is essential to promote vaccination. We aimed to clarify the motivations for receiving booster vaccines. We conducted a paper-based questionnaire distributed during January-February 2022 involving students and faculty staff who received the first COVID-19 vaccination at the mass vaccination program during June-September 2021 at Keio University. A total of 1725 participants were enrolled, and all completed the survey. Among these, 64.9% reported a significant adverse event (AEs) affecting daily life after the second vaccine. "Fear of severe COVID-19 illness" (72.6%) was the most common reason for getting vaccinated, followed by "concern of infecting others" (68.4%) and "fear of COVID-19 infection itself" (68.3%). Television emerged as the most influential source of information (80%), followed by university information (50.2%) and social networking sites (42.8%). Multivariate analysis revealed "fear of severe COVID-19 illness", "fear of COVID-19 infection itself", and "trust in the efficacy and safety of the vaccines in general" were significantly correlated with willingness to receive paid vaccinations. The severity of AEs and source of information were not related to participants' willingness to receive booster vaccinations. Participants with positive reasons for vaccination were more likely to accept a third dose.

Factors associated with Covid-19 vaccine acceptance among persons with disabilities: A cross-sectional study in Ghana

BACKGROUND

While COVID-19 has had a wide-ranging impact on individuals and societies, persons with disabilities are uniquely affected largely due to secondary health conditions and challenges in adhering to protective measures. However, research on COVID-19 and vaccine acceptance has primarily focused on the general population and healthcare workers but has specifically not targeted PwDs, who are more vulnerable within societies. Hence, this study assessed PwDs knowledge of COVID-19 and factors associated with COVID-19 vaccine acceptance.

METHODS

A cross-sectional survey was conducted among PwDs in the Atwima Mponua District in the Ashanti Region of Ghana. Respondents were sampled systematically and data was collected using a structured questionnaire. The data were analyzed with STATA version 16.0. Descriptive analysis was done using means and proportions. The chi-square test and Logistic regression were used to assess Covid-19 vaccine acceptance among the respondents.

RESULTS

250 PwDs were recruited for the study. A higher proportion of the respondents were females, physically impaired, and between 30-50 years. The majority (74%) of the PwDs had average knowledge about Covid-19. Factors such as age, educational level and type of disability were significantly associated with PwDs' knowledge of COVID-19. The acceptance rate for COVID-19 among PwDs was 71.2%. Age, religion, knowledge of COVID-19, and educational level were significantly associated with Covid-19 vaccine acceptance. Persons with disabilities with low and average knowledge of COVID-19 were 95% and 65%, respectively, less likely to accept the vaccine compared to those with high knowledge of COVID-19 (AOR = 0.05, 95%CI: 0.01, 0.21; AOR = 0.35, 95%CI: 0.12, 1.03). Older people and those with higher education were more likely to accept the vaccine compared to younger people and those with no or less education.

CONCLUSION

Persons with disabilities have average knowledge of COVID-19 and a greater percentage of them were willing to accept the vaccine. The study identified age, religion, knowledge of COVID-19, and educational level as contributing factors to their willingness to accept the COVID-19 vaccine. This suggest that PwDs will lean positive toward COVID-19 vaccine programs and as such, vaccination programs should target them.

Psychological variables linked to hesitation toward vaccination against COVID-19 among late adolescents and young adults: The role of magical thinking and right-wing authoritarianism

INTRODUCTION

Several studies on the predisposition to be subjected to vaccination have shown that vaccine hesitation is a global phenomenon influenced by a lack of knowledge and awareness, as well as perceived risks and benefits. The purpose of this study was to investigate the mediating role of right-wing authoritarianism in the relationship between magical thinking and positive attitudes toward COVID-19 vaccines (i.e. trust of vaccine benefits, worries over unforeseen future effects, concerns about commercial profits, preference for natural immunity).

METHOD

The sample consisted of 201 Italian young adults, 49 males (24.4%), and 152 females (75.6%), aged between 18 and 25. Data were collected during 2022.

RESULTS

The results confirmed the role of right-wing authoritarianism as a mediator for magical thinking on positive vaccine attitudes. Findings indicated a positive association between right-wing authoritarianism and magical thinking and a negative relationship of both the aforementioned variables on positive vaccine attitudes. SEM analyses showed a direct positive association from magical thinking to right-wing authoritarianism and a direct negative association from right-wing authoritarianism to trust of vaccine benefits, to low worries over unforeseen future effects, to lack of concerns about commercial profits and to low preference for natural immunity.

CONCLUSIONS

The findings highlight that common contribution of odd or magical beliefs and right-wing authoritarianism may slow the spread of vaccines among late adolescents and young adults. Our findings provide insight on what effective communication with vaccine-resistant individuals should look like in order to increase the chances of reaching vaccine-hesitant individuals.

Predictors of COVID-19 vaccine uptake among persons aged 18 years and above in Ga North Municipality, Ghana using the Health Belief Model: A community-based cross-sectional study

BACKGROUND

Although the coronavirus disease 2019 (COVID-19) vaccination rollout has been accepted by the population of the Ga North Municipality, a substantial proportion has developed hesitancy to COVID-19 vaccination uptake. This study determined the predictors of COVID-19 vaccine uptake among persons aged 18 years and above in the Ga North Municipality using the Health Belief Model.

METHODS

The study used a cross-sectional study design. Structured questionnaires were used to collect data from a multistage sample of 388 respondents. Multivariable binary logistic regression was used to determine the predictors of COVID-19 vaccination uptake at the level of 0.05 and 95% confidence interval.

RESULTS

Vaccination uptake was 72.2%. The odds of COVID-19 vaccination uptake were higher among men than women [AOR = 2.02, 95% Cl: 1.13-3.20] and among singles than the married [AOR = 1.90, 95% Cl: 1.07-3.36], but lower among Muslims than Christians [AOR = 0.33, 95%Cl: 0.18-0.60]. Perceived susceptibility [AOR = 2.43, 95% Cl: 1.36-4.35], perceived barriers [AOR = 0.54, 95%Cl: 0.31-0.95], cues to action [AOR = 2.23, 95% Cl: 1.19-4.21] and self-efficacy [AOR = 3.23 95% Cl: 1.82-5.71] were the significant predictors of COVID-19 vaccination uptake.

CONCLUSION

The uptake of the COVID-19 vaccine in GA North Municipality is high. Health promotion interventions should focus on increasing perceived susceptibility to COVID-19, minimising barriers to COVID-19 vaccine uptake, and promoting cues and self-confidence for COVID-19 vaccine uptake. It should also target women, the married, and Muslims.

Analysis of ethical considerations of COVID‑19 vaccination: lessons for future

BACKGROUND

Since the beginning of the COVID-19 pandemic, different countries sought to manufacture and supply effective vaccines to control the disease and prevent and protect public health in society. The implementation of vaccination has created many ethical dilemmas for humans, which must be recognized and resolved. Therefore, the present study was conducted to analyze the ethical considerations in vaccination against COVID-19 from the perspective of service providers.

METHODS

The present qualitative research was conducted in 2022 in the north of Iran. The participants included 23 health workers with at least five years of work experience and members of the COVID-19 vaccination team. The data were initially collected through systematic semi-structured interviews, then snowball sampling and finally continued until data saturation. The next steps were transcription of interviews, identification of meaning units, coding, categorization based on similarity and symmetry, extraction of themes and the analysis of themes through content analysis.

RESULTS

The analysis of participants' experiences led to the extraction of five main categories of themes and fifteen sub-categories of the ethical considerations of COVID-19 vaccination. Safe and standard vaccine production, vaccine supply, fairness, respect for autonomy, and accountability were the main categories. The subcategories included compliance with scientific and ethical procedures, effectiveness and profitability of vaccine, absence of severe adverse effects, allocation of resources for vaccine supply, vaccine availability, diversity and comprehensiveness of alternative vaccines, vaccination prioritization, prioritization of the vulnerable populations of society, autonomy of patient (equal rights), autonomy of community, autonomy of service providers, reporting correct information, reporting vaccine side effects, public trust and acceptance.

CONCLUSION

The health system managers should be adequately prepared to solve the ethical problems posed by COVID-19 vaccination. Therefore, it is recommended to avoid haste in vaccination and pay more attention to vaccination safety standards, provide sufficient resources for a comprehensive vaccine supply, pay close attention to collective interests versus individual interests, and meet community needs.

Risk aversion and COVID-19 vaccine hesitancy

We here investigate the role of risk aversion in COVID-19 vaccine hesitancy. The theoretical effect is ambiguous, as both COVID-19 infection and vaccination side-effects involve probabilistic elements. In large-scale data covering five European countries, we find that vaccine hesitancy falls with risk aversion, so that COVID-19 infection is perceived as involving greater risk than is vaccination.

Understanding the role of personal experiences and contextual variables in shaping risk reduction preferences

This article explores how preferences for risk reduction during the COVID-19 pandemic are influenced by personal experiences and contextual variables such as having a close friend or relative who has been infected by the virus (closeness), the severity of the illness (severity), people's own perceptions of being in a risky group (risk group), change in employment status due to the pandemic (employment situation), and vaccination status (vaccination status and altruistic vaccination). We conducted a choice experiment (CE) in Chile, Colombia, and Costa Rica. The attributes of the experiment were risk reduction, latency, and cost. Then, we estimated a mixed logit model to capture preference heterogeneity across the countries. The attributes presented in the CE were statistically significant, with the expected sign in each country. The variables closeness and employment situation presented homogeneous behavior in each country; however, severity, risk group, and vaccination status showed mixed results. We found that preferences were more heterogeneous for the attributes of the CE than for the personal experiences and contextual variables. Understanding the impact of these variables is essential for generating more effective risk reduction policies. For instance, methodologies such as the value of statistical life base their calculations on society's valuation of risk reduction. We provide evidence that the preferences for risk reduction vary due to the everyday situations that individuals face in the context of the pandemic. The latter may cause distortions in the values used to evaluate policies aimed at mitigating the outbreak.

Attitudes towards COVID-19 vaccination and intention to get vaccinated in Western Balkans: cross-sectional survey

BACKGROUND

Introduction of vaccines against COVID-19 has not encountered expected acceptance. The uptake of COVID-19 vaccines in Western Balkans countries is lagging behind the European Union average. The aim of our study was to assess the intention to get vaccinated against COVID-19 in the population of unvaccinated adult citizens of five Western Balkans countries, and to explore factors that influence the vaccination intention.

METHODS

Cross-sectional study was conducted in the period from July to October 2021. The questionnaire was shared through online social media. Intention to get vaccinated against COVID-19 was measured by a single item assessing the likelihood of getting vaccinated on a 5-points Likert scale. Linear regressions were conducted with socio-demographic characteristics, presence of chronic diseases and attitudes towards COVID-19 vaccination as independent factors.

RESULTS

The largest proportion of unvaccinated respondents willing to get vaccinated in the future was observed in Montenegro and Albania (40.4% in each country), while in the Serbian sample, the willingness to get vaccinated was the lowest (22.6%). Socio-demographic characteristics were not significantly associated with the intention to get vaccinated against COVID-19 in most of the countries. In Albania, Bosnia and Herzegovina, North Macedonia and Serbia the strongest determinant of COVID-19 vaccination intention was the higher sense of social responsibility.

CONCLUSIONS

Vaccination interventions and campaigns aiming to improve the COVID-19 vaccine uptake should be focussed on specific set of factors in each country, appealing to social responsibility as most prevalent determinant of vaccination intention in Western Balkans.

Does the Integration of Migrants in the Host Society Raise COVID-19 Vaccine Acceptance? Evidence From a Nationwide Survey in Japan

Research indicates that integration contributes to maintaining health among migrants, yet little is known about the association between integration and vaccination acceptance. This study aimed to explore COVID-19 vaccine intention and acceptance, and the association between integration and vaccine hesitancy among migrants in Japan. We conducted an internet survey among migrants in Japan from October 5 to October 14, 2021. Among 1,455 participants, 11.6% reported hesitancy toward COVID-19 vaccination. We found that the overall integration and social integration were associated with the vaccination intention. Some commonly identified barriers (e.g., financial difficulties, language) were not related to COVID-19 vaccination acceptance among migrants in Japan. Highly integrated migrants were less likely to report vaccine hesitancy against COVID-19. To promote COVID-19 acceptance among migrants, customized intervention policies should focus on the migrants with a lower level of integration, especially those with little social connection with the locals.

Determinants of COVID-19 vaccine acceptance in Mozambique: The role of institutional trust

Background

Vaccination plays an imperative role in protecting public health and preventing avoidable mortality. Yet, the reasons for vaccine hesitancy in African countries are not well understood. This study investigates the factors associated with the acceptance of COVID-19 vaccine in Mozambique, with a focus on the role of institutional trust.

Methods

The data came from the three waves of the COVID-19 Knowledge, Attitudes and Practices (KAP) survey which followed a cohort of 1,371 adults in Mozambique over six months (N=3,809). We examined vaccine acceptance based on three measurements: willingness to take vaccine, perceived vaccine efficacy, and perceived vaccine safety. We conducted multilevel regression analysis to investigate the trajectories of, and the association between institutional trust and vaccine acceptance.

Results

One third of the survey participants (37%) would definitely take the vaccine. Meanwhile, 31% believed the vaccine would prevent the COVID-19 infection, and 27% believed the vaccine would be safe. There was a significant decrease in COVID-19 vaccine acceptance between waves 1 and 3 of the survey. Institutional trust was consistently and strongly correlated with different measures of vaccine acceptance. There was a greater decline in vaccine acceptance in people with lower institutional trust. The positive correlation between institutional trust and vaccine acceptance was stronger in younger than older adults. Vaccine acceptance also varied by gender and marital status.

Conclusions

Vaccine acceptance can be volatile even over short periods of time. Institutional trust is a central driver of vaccine acceptance and contributes to the resilience of the health system. Our study highlights the importance of health communication and building a trustful relationship between the general public and the institutions in the context of a global pandemic.

Knowledge, attitudes and practices of university students toward COVID-19 in Southern region, Afghanistan: a cross-sectional study

BACKGROUND

Successful implementation of preventive measures and level of awareness in particular among university students in Afghanistan could play a crucial role in spreading the information for better control of the ongoing pandemic. Therefore, the aim of this study was to determine the level of knowledge, attitudes and practices (KAP) regarding COVID-19 among Kandahar university students.

METHODS

A cross-sectional study conducted among undergraduate students to investigate their KAP regarding COVID-19 from January to March, 2021. The data were collected using a structured questionnaire (socio-demographic characteristics, KAP questionnaire) by phone call interviews.

RESULTS

From 359 participants, 88.9% were males, 81.3% were single, 65.1% lived in urban areas, and more than 64% of the students were less than 23 years old. Overall, 86.6% of the study participants had adequate level of knowledge and 87.5% had positive attitudes toward COVID-19. Almost one-third of the participants had good practices regarding COVID-19. All KAP scores were higher in male students. Significant difference of good practice (p < 0.001) was observed among students who were in high socioeconomic status (SES) group. In univariate analysis, female sex (β: -0.75, p = 0.007) was negatively and watching television (β: 0.44; p = 0.014) was positively associated with knowledge score. However, in multivariate linear regression analysis, the knowledge score was significantly associated with age (β: -0.115; p = 0.004); attitude score was significantly associated with female sex (β: -2.776; p < 0.001) and radio use (β: -0.974; p = 0.031); and practice score was significantly associated with female sex (β: -3.704; p = 0.002) and urban area (β: 1.702; p = 0.016).

CONCLUSIONS

The overall knowledge and attitudes regarding COVID-19 among university students were desirable. Higher university year, young age, male sex and living in urban areas were significantly associated with good KAP regarding COVID-19. Good practices towards COVID-19 should be increased through awareness programs.

Politics of COVID-19 vaccination in Japan: how governing incumbents' representation affected regional rollout variation

BACKGROUND

Despite initial delay, Japan's COVID-19 vaccination accelerated remarkably from May to September 2021 under the leadership of Prime Minister Yoshihide Suga. His "campaign" for vaccination, however, did not yield uniform results nationwide.

METHODS

To highlight political determinants for the regional variation, we employ ordinary least squares regression analyses to investigate how the share/presence of incumbent politicians belonging to the governing parties, the Liberal Democratic Party and Komei Party, influenced the varying progress of rollouts across prefectures as well as across cities/towns/villages. The data on the vaccination rate for all 47 prefectures was obtained from Government Chief Information Officer (CIO)'s Portal, Japan (GCPJ) approximately one month prior to the anticipated general election, the national election for the more important House of Representatives of Japan's bicameral parliament (Diet). The data for lower administrative units, though its availability was limited to only three prefectures, was obtained from the respective governments of Kagawa and Ehime and from a local newspaper in Gifu.

RESULTS

The findings reveal that at both prefectural and sub-prefectural administrative levels, the share/presence of the governing parties' representation in the national parliament had a positive and statistically significant effect on the region's vaccination progress, after controlling for the local proliferation of COVID-19 and demographic characteristics.

CONCLUSION

Our findings contribute insights into the understudied area of the contemporary COVID-19 health environment, namely how the political dynamics of democracy affect the pattern of vaccine dissemination in Japan.

TRIAL REGISTRATION

Not applicable.

Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan

BACKGROUND

Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic.

METHODS

Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence.

RESULTS

In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (β, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (β, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (β, -0.045; 95% CI, -0.078 to -0.012; p = 0.015).

CONCLUSIONS

A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

Introduction

The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine.

Methods

A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder.

Results

The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001).

Discussion

The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

COVID-19 vaccine acceptance and associated factors among health workers in West Guji zone, Southern Ethiopia: Cross-sectional study

Background

Currently, different COVID-19 vaccines are being developed and distributed worldwide to increase the proportion of the vaccinated people and as a result to halt the pandemic. However, the vaccination progress is different from place to place even among health care workers due to variation in vaccine acceptance. Therefore, this study aimed to assess the acceptance of COVID-19 vaccine and determinant factors among healthcare workers in west Guji zone, southern Ethiopia.

Method and materials

An institutional-based cross-sectional study design was employed to assess COVID-19 vaccine acceptance and associated factors among health care workers from July to August 2021. A simple random sampling technique was used to choose 421 representative healthcare workers from three hospitals in the west Guji Zone. The self-administrated questionnaire was used to collect data. Bivariate and multivariable logistic regression analyses were computed to identify factors associated with the acceptance of the COVID-19 vaccine. P < 0.05 was considered for significantly associated factors.

Result

From the representative health workers, 57, 47.02, and 57.9% of healthcare workers had good practice of COVID-19 prevention, adequate knowledge, and a positive attitude toward the COVID-19 vaccine consecutively. 38.1% of healthcare workers said they had a willingness to accept the COVI-19 vaccine. Profession (AOR-6, CI: 2.92-8.22), previous history of vaccine side effects (AOR: 3.67, CI: 2.75-11.41), positive attitude toward vaccine acceptance (AOR: 1.38, CI: 1.18-3.29), adequate knowledge toward COVID-19 vaccine (AOR: 3.33, CI: 1.36-8.12), and adequate practice of COVID-19 prevention measure (AOR: 3.45, CI: 1.39-8.61) were significant associated with COVID-19 vaccine acceptance.

Conclusion

The proportion of COVID-19 vaccine acceptance among health workers was found to be low. From the study variables, profession, previous history of vaccine side effects, positive attitude toward vaccine acceptance, adequate knowledge to ward off COVID-19 vaccine, and adequate practice of COVID-19 prevention measures were significantly associated with COVID-19 vaccine acceptance.

Factors associated with acceptance of a digital contact tracing application for COVID-19 in the Japanese working-age population

The working-age population is at the epicenter of coronavirus disease 2019 (COVID-19) infections. Therefore, it is important to increase the acceptance of digital contact tracing apps in this population. Contact-Confirming Application (COCOA) is the only digital contact tracing app in Japan. This study aimed to determine factors associated with acceptance of the COCOA for COVID-19 in the Japanese working-age population. A cross-sectional study was performed for 27,036 full-time workers registered with an internet survey company during December 2020 in Japan. Factors associated with COCOA adoption were evaluated by multivariate logistic regression analysis. The rate of downloading the COCOA was 25.1%. The COCOA was more likely to be accepted by people with married status, university graduation or above, higher income, and occupations involving desk work. Fear of COVID-19 transmission, wearing a mask, using hand disinfection, willingness to be vaccinated against COVID-19, and presence of an acquaintance infected with COVID-19 were also associated with a greater likelihood of adopting the app. The rate of downloading the COCOA in Japan was not very high. The present findings have important implications for widespread adoption of digital contact tracing apps in working-age populations in Japan and elsewhere.

Attitudes towards receiving COVID-19 vaccine and its associated factors among Southwest Ethiopian adults, 2021

INTRODUCTION

Many countries around the world are still affected by the global pandemic of coronavirus disease. The vaccine is the most effective method of controlling Coronavirus Disease 2019 (COVID-19). However, attitudes toward vaccination are heavily affected by different factors besides vaccine availability.

OBJECTIVES

This study aimed to determine community attitudes toward the COVID-19 vaccine in Gurage Zone, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from November 15th to December 15th, 2021. A simple random sampling technique was used to select 364 participants in the study area. An interview-administered structured questionnaire was used to collect the data; the data was entered into Epidata 3.1 version, and then exported to SPSS version 23 for further analysis. Descriptive statistics were used to determine the characteristics of study participants. Binary and multivariable logistic regression analyses with a p-value of less than 0.05 were used as a measure of significance.

RESULTS

In this study, 44.7% of study participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm [AOR: 1.85; 95% CI (1.15-2.96)], Having ever had a chronic disease [AOR: 3.22; 95% CI (2.02-5.14)], community belief on the effectiveness of the vaccine [AOR: 2.02; 95% CI (1.27-3.22)], and average monthly income 3001-5000 ETB [AOR: 0.54; 95% CI (0.30-0.97)], average monthly income 5001-10000 ETB [AOR: 0.48; 95% CI(0.27-0.86)] were statistically significantly towards COVID-19 vaccination.

CONCLUSIONS

Overall, less than half of the participants had a favorable attitude toward the COVID-19 vaccine. Perceived potential vaccine harm, having ever had a chronic disease, community belief in the effectiveness of the vaccine, and average monthly income were determinant factors of the community's attitude toward COVID-19 vaccination. As a result, information conversation with the community's awareness of the COVID-19 vaccination in reducing vaccine-related suspicion.

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

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.

Association between COVID-19 vaccines and the menstrual cycle in young Japanese women

INTRODUCTION

Although several studies have investigated the association between coronavirus disease 2019 (COVID-19) vaccines and the menstrual cycle, available data are limited. Therefore, this study investigated the effect of COVID-19 vaccines on the menstrual cycle and the effect of the menstrual cycle phase on the vaccine side effects during vaccine administration in Japan.

METHODS

A self-administered questionnaire was used to collect data on the date of vaccination; type of vaccine; type, grade, and duration of the side effects; regularity of menstruation; normal length of the menstrual cycle; and the day one date of menstruation around vaccination. The survey was conducted from October 2021 to March 2022.

RESULTS

The difference between the predicted and actual menstrual cycle length was 1.9 ± 3.0, 1.6 ± 2.8 (p = 0.557), and 2.5 ± 3.8 (p = 0.219) days before vaccination and after the first and second dose of the vaccine, respectively. In participants who received vaccinations twice within a single menstrual cycle, this difference was 1.3 ± 3.5 and 3.9 ± 3.3 (p = 0.045) days before and after vaccination, respectively. The grade and proportion of the side effects after the second dose of the vaccine was highest during the menstrual period and lowest during the ovulation period, with a significant effect on headache and chills.

CONCLUSION

COVID-19 vaccines tended to prolong the menstrual cycle. The side effects of the COVID-19 vaccine tended to be at a maximum when vaccination occurred during the menstrual period and minimal during the ovulation period.

Comparison of vaccine hesitancy during the low and high points of COVID-19 in a population under international sanctions: A longitudinal mixed-methods study in Iran

Introduction

Along with the challenges of COVID-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the affecting vaccine acceptance in the high and low points of the epidemic in Iran.

Methods

In the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1,200 and 1,872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine.

Results

Disbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3-85.9) and 65.8% (95% CI: 65.8-71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p = 0.001), being a student (Odds Ratio: 0.41, p = 0.011), housewives (Odds Ratio: 0.63, p = 0.033), illiteracy (Odds Ratio: 4.44, p = 0.001), and having an underlying disease (Odds Ratio: 4.44, p = 0.001) were factors affecting on vaccine acceptance.

Discussion

Counter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended.

Assessment of multiple domains of pain following BNT162b2 mRNA COVID-19 vaccination

Pain at the injection site is the most frequent reaction among COVID-19 vaccine recipients, but its characteristics were not fully described yet. The purpose of this study was to investigate multiple domains of pain following BNT162b2 mRNA vaccination. We included 107 subjects undergoing primary shot of the vaccination twice into deltoid muscle with a 3-week interval. They completed 6 sessions of pain assessments, one before the first and second dose (1-0, 2-0), and 1st/7th day after the first and second dose (1-1/1-7, 2-1/2-7). Pain visual analog scale (VAS), pain distribution, and pressure pain threshold (PPT) on deltoid muscle were evaluated in each session. The mean VAS (at rest/shoulder motion) was 6.0/27.6 mm at 1-1, and 12.8/34.0 mm at 2-1. Approximately, 90% of recipients showed localized pain within the upper arm. Percentage change of PPTs at 1-1 and 2-1 was bilaterally (ipsilateral/contralateral) decreased to 87.4/89.4% and 80.6/91.0%, which was recovered to the baseline level at 1-7 and 2-7. Temporary, mild-to-moderate intensity, localized distribution, concomitant with bilateral mechanical hyperalgesia on the deltoid muscle, were typical pain characteristics following this vaccination. These findings provide a rationale that will be informative for future recipients. J. Med. Invest. 70 : 355-360, August, 2023.

Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey

BACKGROUND

The COVID-19 pandemic is an additional burden on Lebanon's fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic.

OBJECTIVE

Our study's aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals' motivations for vaccinating as well as concerns and obstacles to vaccination.

METHODS

We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience "snowball" sampling to assess the perceptions of adults residing in Lebanon.

RESULTS

Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one's family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites.

CONCLUSIONS

Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination.

Cueing quality: Unpacking country-of-origin effects on intentions to vaccinate against COVID-19 in Taiwan

While existing studies have reported and recognized country-of-origin effects on the intentions to vaccinate against COVID-19 among individual citizens in some countries, the causal mechanism behind such effects to inform public health policymakers remain unexplored. Adding up a quality cue explanation for such effects to the existing literature, the authors argue that individual consumers are less willing to get a vaccine designed and manufactured by a country with a significantly lower quality perception than other countries. A survey experiment that recruited a nationally representative sample of Taiwanese adults (n = 1951) between December 13, 2020 and January 11, 2021 was designed and conducted to test the argument. We find that all else equal, Taiwanese respondents were on average less likely to express stronger willingness to take a vaccine from China than from the US, Germany, and Taiwan. Furthermore, even when the intrinsic quality of the vaccine was held constant by the experimental design, respondents still had a significantly lower quality perception of the vaccine from China, both in terms of perceived protection and severe side effects. Further evidence from casual mediation analyses shows that about 33% and 11% of the total average causal effects of the "China" country-of-origin label on vaccine uptake intention were respectively mediated through the perceived efficacy of protection and perceived risk of experiencing severe side effects. We conclude that quality cue constitutes one of many casual mechanisms behind widely reported country-of-origin effects on intention to vaccinate against COVID-19.

Altruistic Vaccination: Insights from Two Focus Group Studies

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people's vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people's vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally.

The vaccine hesitancy continuum among hesitant adopters of the COVID-19 vaccine

Vaccination is a strategy for mitigating the impact of coronavirus disease 2019 (COVID-19) at both the individual and population levels. Vaccine hesitancy is identified as a significant threat to global health by the World Health Organization (WHO). Vaccine hesitancy has been theorized as a continuum encompassing a range of attitudes, beliefs, emotional orientations, ideologies, and health-seeking behaviors. Individuals who received the COVID-19 vaccine but also indicated some level of hesitancy about vaccination, or "hesitant adopters," remain an understudied group. This study uses a qualitative descriptive design to understand motivations to receive the COVID-19 vaccine among hesitant adopters at various self-reported levels of hesitancy. We conducted interviews with hesitant adopters (n = 49) to analyze the elements of vaccine hesitancy corresponding to reported levels of COVID-19 vaccine hesitancy (i.e., "little hesitant," "somewhat hesitant," and "very hesitant"). Concerns about side effects are shared across the continuum but are articulated differently at each level of hesitancy. The "little hesitant" relate fears of side effects to their health and a lack of clear information to inform their health decision making, whereas the "very hesitant" articulate the risks of side effects within the frame of conspiracies related to the development, approval, and economics of the COVID-19 vaccine. Additionally, conspiracy theories generally increase in salience across the continuum, with the "very hesitant" reporting conspiracy theories as the most salient element of vaccine hesitancy. This research presents opportunities for developing targeted interventions for different levels of vaccine hesitancy.

High rates of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic in Japan

This study aimed to 1) determine the prevalence and contents of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic and 2) evaluate its association with maternal sociodemographic factors. A cross-sectional survey was conducted between August and December 2020 among pregnant women between 28 and 32 weeks of gestation who received antenatal care at four clinics and hospitals in Niigata City, Japan. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey, and associations between vaccine hesitancy and sociodemographic factors were analyzed. In total, 113/200 (56.5%) subjects responded to the survey. Overall, 46/113 (40.7%) pregnant women were resistant or hesitant to receive the vaccine. Women with vaccine hesitancy were more likely to fear adverse reactions (concern 79.6%, not concerned 15.9%, and not sure 4.4%), safety (concerned 69.0%, not concerned 23.9%, and not sure 7.1%), and efficacy (concerned 47.8%, not concerned 35.4%, and not sure 16.8%) compared to those without vaccine hesitancy (P < .01, < .01, and <.01, respectively). In the multivariate logistic regression analyses, primipara women had higher rates of vaccine hesitancy than multipara pregnant women (odds ratio: 2.38, P = .04). In conclusion, the prevalence of vaccine hesitancy among pregnant Japanese women, especially primipara women, was higher than that in other countries during the COVID-19 pandemic. Their major concerns were adverse reactions, safety, and the efficacy of childhood vaccines. Further strategies are needed to provide appropriate vaccine information to prevent vaccine-preventable diseases in both infants and children.

Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature"

Vaccination has proven to be the most effective tool in controlling the COVID-19 pandemic. While pregnant individuals are considered to be a high-risk population and are more likely to experience adverse effects from COVID-19, vaccination rates among pregnant individuals are significantly lower than in the general population. The Health Belief Model (HBM), Theory of Planned Behavior (TPB), 3C model, 5C model, and 5A model have been used to assess vaccination hesitancy behaviors. In this paper, we review the use of each of these models to address vaccine hesitancy, with a focus on the pregnant population and the COVID-19 vaccine. The HBM, TPB, 3C model, and 5C model have demonstrated great versatility in their ability to evaluate, explain, and modify vaccine hesitancy and behavior. Up to date, the HBM and 3C models appear to be the most effective models to study and address vaccination hesitancy within the pregnant persons.

Knowledge, attitude, acceptance, and practice of COVID-19 vaccination and associated factors complemented with constructs of health belief model among the general public in South Gondar, Ethiopia: A community-based study

Introduction

Understanding the epidemiological dynamics of disease control, as well as the effectiveness, compliance, and success of the vaccination program requires an understanding of the local population's knowledge, attitude, and practice regarding the Corona Virus Disease of 2019 (COVID-19) vaccine. Thus, the objective of this study was to assess knowledge, attitude, and practice toward COVID-19 vaccination and associated factors among the general public.

Methods

A cross-sectional study was conducted in the South Gondar Zone, among residents above the age of 18 years. The study used objective measures and the constructs of the Health Belief Model. Binary logistic regression was used and the result of the final model was presented in terms of adjusted odds ratio (AOR) and 95% confidence intervals (CI), and statistical significance was taken and considered at a P-value < 0.05.

Results

The study was conducted on 1,111 study participants. The mean age is 30.83 ± 7.106. About 575 (51.8%) of the respondents have good knowledge about the COVID-19 vaccination and 43.4% have a positive attitude toward COVID-19 vaccination. About 361 (32.5%) of the respondents were willing to take the vaccine if it is available and 113 (10.2%) of them were vaccinated. Participants with a positive attitude and good knowledge, those with a secondary level of education AOR = 5.70, 95% CI (2.60-12.60), those with a monthly income of >2,000 birr AOR = 6.30, 95% CI (2.50-15.60), those having a television (TV), and those who use Facebook AOR = 17.70, 95% CI (10.10-30.90) had a higher level of acceptance of COVID-19 vaccination. The Health Belief Model's constructs of perceived susceptibility AOR = 1.53, 95% CI (1.26-1.85), perceived benefit AOR = 1.49, 95% CI (1.28-1.75), and cues to action AOR = 0.54, 95% CI (0.45-0.65) were all linked to COVID-19 vaccine acceptability.

Conclusion

The level of acceptance of COVID-19 vaccination is much lower. Having a positive attitude score and good knowledge score, level of education, monthly income, presence of TV, the use of Facebook, and knowing the means of transmission of COVID-19 increase the level of acceptance of COVID-19 vaccination.

Public acceptance of COVID-19 vaccination among residents of Saudi Arabia: a cross-sectional online study

OBJECTIVES

The acceptance of the COVID-19 vaccine is essential for protecting the world population and stopping the COVID-19 pandemic. This paper aimed to measure public acceptance of the COVID-19 vaccination and the factors that may play an important role in increasing the acceptance of vaccinations in future pandemics.

DESIGN

A cross-sectional, observational study was conducted through a survey designed using the Google Forms platform. In this study, a logistic regression analysis was used to study and detect the variables linked to the acceptance of COVID-19 vaccination. To meet inclusion criteria, participants had to be 18 years or older at the time of collecting the data, reside in Saudi Arabia at the time of the survey, agree to the consent form and be able to complete the survey in Arabic.

SETTING

Randomly selected residents of Saudi Arabia.

NUMBER OF PARTICIPANTS

1658.

RESULTS

In general, the population of Saudi Arabia is supportive of the COVID-19 vaccine (72.0%) and has one of the highest acceptance rates, according to global studies. We found that men (OR 0.73; 95% CI: 0.55 to 0.97) were less likely to hesitate with regard to taking the vaccine, whereas previously infected individuals were more likely to hesitate (OR 1.77; 95% CI: 1.25 to 2.50). Those with a lower monthly income (<3000 Saudi riyal) were more likely to refuse the vaccine (OR 3.54; 95% CI: 1.81 to 6.91), while those living in cities (OR 0.62; 95% CI: 0.39 to 0.99) and the unemployed (OR 0.52; 95% CI: 0.33 to 0.83) were less likely to refuse it. Participants' history of viral infection and trust in the healthcare system were found to be important factors in the public's acceptance of the vaccine.

CONCLUSION

In general, acceptance of the COVID-19 vaccination is high in Saudi Arabia. Several factors have shown a method for predicting those who might reject the vaccine or hesitate to take it; thus, the healthcare system should target those residents throughout the campaign. Based on the conclusions of the current research, the acceptance of vaccinations could be increased.

COVID-19 Vaccine Acceptance and Associated Factors among Women in Saudi Arabia: A Cross-Sectional Study

Although women have been substantially affected by the pandemic, they tend to have a lower likelihood of COVID-19 vaccine acceptance. Research on factors associated with COVID-19 vaccine acceptance among this key population is imperative. Thus, this study aimed to assess COVID-19 vaccine acceptance and associated factors among women in Saudi Arabia. This study was part of a larger study conducted on the acceptance of the COVID-19 vaccine in Saudi Arabia, carried out between the 8th and 14th of December 2020. The study sample included 910 women aged 18 years and older. Bivariate and multivariable regression analyses was utilized to analyze the data. Overall, 41% of the participants were willing to receive the vaccine. Participants were more willing to accept vaccination if they were 40–49 years old (OR = 2.209, 95% CI: 1.49–2.02), if they had a moderate (OR = 2.570, 95% CI 1.562–4.228) or high to very high (OR = 1.925, 95% CI 1.093–3.390) perceived likelihood of being infected with COVID-19, or if they were in favor of mandatory COVID-19 vaccination for people in Saudi Arabia (OR = 64.916, 95% CI 35.911–117.351). However, participants with a high educational level (OR = 0.431, 95% CI 0.220–0.847) or who refused physician-recommended vaccines in the past (OR = 0.152, 95% CI 0.083–0.275) were less likely to accept COVID-19 vaccination. Given the low level of vaccine acceptance among women, relevant stakeholders should consider the needs and dynamics of this key population to increase vaccination uptake and to improve current and future outreach activities.

The Association between Socio-Demographics and Mental Distress Following COVID-19 Vaccination—Mediation of Vaccine Hesitancy

The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health following vaccination and to analyze the mediation effect of vaccine hesitancy. This study recruited 2112 individuals who took two doses of the COVID-19 vaccine in Shanghai. Structural equation modeling was performed to assess factors associated with anxiety and depression of the vaccinated individuals and the underlying mechanism. The results yielded that vaccine hesitancy partially mediated/suppressed the effect from gender and employment status to anxiety/depression and fully mediated the effects from education to anxiety/depression. This study advanced the understanding of mental health disparity among different socio-demographic groups after vaccination and the impact of vaccine hesitancy on the vaccinated population’s mental health. The finding offered insights into the possible mental vulnerability of people holding a hesitant attitude before vaccination and suggested that vaccine hesitancy played a crucial role in people’s mental health after vaccination. Health promotion programs can target vaccine hesitancy to prevent unfavorable mental health consequences among specific populations.

The Chaotic Behavior of the Spread of Infection during the COVID-19 Pandemic in Japan

In December 2019, China reported a new virus identified as SARS-CoV-2, causing COVID-19, which soon spread to other countries and led to a global pandemic. Although many countries imposed strict actions to control the spread of the virus, the COVID-19 pandemic resulted in unprecedented economic and social consequences in 2020 and early 2021. To understand the dynamics of the spread of the virus, we evaluated its chaotic behavior in Japan. A 0-1 test was applied to the time-series data of daily COVID-19 cases from January 26, 2020 to August 5, 2021 (3 days before the end of the Tokyo Olympic Games). Additionally, the influence of hosting the Olympic Games in Tokyo was assessed in data including the post-Olympic period until October 8, 2021. Even with these extended time period data, although the time-series data for the daily infections across Japan were not found to be chaotic, more than 76.6% and 55.3% of the prefectures in Japan showed chaotic behavior in the pre- and post-Olympic Games periods, respectively. Notably, Tokyo and Kanagawa, the two most populous cities in Japan, did not show chaotic behavior in their time-series data of daily COVID-19 confirmed cases. Overall, the prefectures with the largest population centers showed non-chaotic behavior, whereas the prefectures with smaller populations showed chaotic behavior. This phenomenon was observed in both of the analyzed time periods (pre- and post-Olympic Games); therefore, more attention should be paid to prefectures with smaller populations, in which controlling and preventing the current pandemic is more difficult.

A social ecological approach to identify the barriers and facilitators to COVID-19 vaccination acceptance: A scoping review

BACKGROUND

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that has caused substantial impact on population health, healthcare, and social and economic systems around the world. Several vaccines have been developed to control the pandemic with varying effectiveness and safety profiles. One of the biggest obstacles to implementing successful vaccination programmes is vaccine hesitancy stemming from concerns about effectiveness and safety. This review aims to identify the factors influencing COVID-19 vaccine hesitancy and acceptance and to organize the factors using the social ecological framework.

METHODS

We adopted the five-stage methodological framework developed by Arksey and O'Malley to guide this scoping review. Selection criteria was based on the PICo (Population, Phenomenon of interest and Context) framework. Factors associated with acceptance and hesitancy were grouped into the following: intrapersonal, interpersonal, institutional, community, and public policy factors using the social ecological framework.

RESULTS

Fifty-one studies fulfilled this review's inclusion criteria. Most studies were conducted in Europe and North America, followed by Asia and the Middle East. COVID-19 vaccine acceptance and hesitancy rates varied across countries. Some common demographic factors associated with hesitancy were younger age, being female, having lower than college education, and having a lower income level. Most of the barriers and facilitators to acceptance of the COVID-19 vaccines were intrapersonal factors, such as personal characteristics and preferences, concerns with COVID-19 vaccines, history/perception of general vaccination, and knowledge of COVID-19 and health. The remaining interpersonal, institution, community, and public policy factors were grouped into factors identified as barriers and facilitators.

CONCLUSION

Our review identified barriers and facilitators of vaccine acceptance and hesitancy and organised them using the social ecological framework. While some barriers and facilitators such as vaccine safety are universal, differentiated barriers might exist for different target groups, which need to be understood if they are to be addressed to maximize vaccine acceptance.

Towards novel nano-based vaccine platforms for SARS-CoV-2 and its variants of concern: Advances, challenges and limitations

Vaccination is the most effective tool available for fighting the spread of COVID-19. Recently, emerging variants of SARS-CoV-2 have led to growing concerns about increased transmissibility and decreased vaccine effectiveness. Currently, many vaccines are approved for emergency use and more are under development. This review highlights the ongoing advances in the design and development of different nano-based vaccine platforms. The challenges, limitations, and ethical consideration imposed by these nanocarriers are also discussed. Further, the effectiveness of the leading vaccine candidates against all SARS-CoV-2 variants of concern are highlighted. The review also focuses on the possibility of using an alternative non-invasive routes of vaccine administration using micro and nanotechnologies to enhance vaccination compliance and coverage.

The psychometric properties and the factorial structure of COVID-19 Vaccines Acceptance scale (VAC-COVID-19) within the Arabic language in a Palestinian contex

Background

The COVID-19 Vaccines Acceptance scale (VAC-COVID-19) is an international measure designed to evaluate vaccination acceptance against the COVID-19 virus. The current scale was translated from English to Arabic and validated within the Palestinian context.

Aims

Our study aimed to test the factorial structure and the psychotic properties of the VAC-COVID-19 within the Palestinian context using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) through 484 participants selected using online method techniques.

Findings

The VAC-COVID-19 was a reliable and valid method in assessing COVID-19 vaccine acceptance among Palestinians. Results of CFA indicated a stable construct of a two-factor solution in assessing COVID-19 vaccination acceptance in a Palestinian context. (1) Reasons for not receiving the vaccination, and (2) for receiving the vaccination.

Conclusion

The VAC-COVID-19 was a valid method to assess vaccination acceptance in the Arabic language within the Palestinian context. Therefore, it is recommended to conduct similar studies with diverse samples in Palestinian society; it would be prudent to target at-risk populations needed to develop the scale and its factorial structure. The VAC-COVID-19 can be a useful measure to assess vaccination acceptance among Palestinians, enabling health providers to implement interventions to modify negative attitudes toward not receiving vaccinations.

Global COVID-19 vaccine acceptance rate: a systematic review and meta-analysis

Aim

Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates.

Subject and methods

International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to pool estimate vaccine acceptance rates.

Results

The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1-70.1; P < 0.001, I2 = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5-74.5; P < 0.001, I2 = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8-64.1; P < 0.001, I2 = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1-57.0)), and the highest coverage rate was (85% (71-99.1)) in South America.

Conclusion

COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate.

Determinants of COVID-19 vaccine hesitancy and resistance in Russia

Vaccination is the main tool available to handle the COVID-19 pandemic globally. Though no vaccine is proven to be 100% effective, vaccination secures against getting seriously ill and dying from the disease. Russia announced the development of its first domestic vaccine back in August 2020 and launched the nationwide immunization campaign at the beginning of 2021. Despite these achievements, as of mid-October 2021, only 36% of the population got at least one shot of the vaccine. Massive vaccination hesitancy and refusal pose a great threat to public health and postpone social and economic recovery. Using nationally representative data from the general adult population of Russia, this study explores the scope of vaccination hesitancy and refusal as well as the determinants of vaccination attitudes. The results suggest that only 45% of the Russian population demonstrated positive attitudes towards the COVID-19 vaccination prior to the launch of a nationwide vaccination program. We analyze a wide array of demographic, socio-economic, and health-related factors in relation to vaccination intentions and explore the deep-rooted causes of vaccination reluctance by looking at personality traits, religiosity, and trust. The obtained results are vital for designing policy measures to promote vaccination.

Vaccinating Front-Line Healthcare Workers: Results of a Pre-Pandemic Cross-Sectional Study from North-Eastern Italy on First Responders

First responders are front-line healthcare workers who are potentially exposed to different infectious agents. Characterizing their knowledge, attitudes, and practices (KAP) towards immunization, therefore, has the potential to significantly improve occupational health and safety. A cross-sectional study was performed in October 2018 using a sample of 161 first responders from the Parma Province (mean age 45.1 ± 14.1 years; seniority 10.8 ± 8.6 years). The participants were questioned on three recommended vaccinations (i.e., the seasonal influenza, measles, and pertussis vaccines) and on meningococcal vaccines (not officially recommended for first responders). The participant’s knowledge status and risk perception were assessed as percentage values through a specifically designed questionnaire. Adjusted odds ratios (aOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis. The internal consistency result, calculated using a general knowledge test, was good (Cronbach’s alpha = 0.894), but the corresponding score was unsatisfying (46.5% ± 32.4), evidencing uncertainties surrounding the recommendations for measles and meningococcal vaccines (39.1% and 34.2% incorrect answers, respectively). While the large majority of respondents were favorable towards the meningococcal (89.4%), measles (87.5%), and pertussis vaccines (83.0%), 55.3% exhibited a favorable attitude toward the seasonal influenza vaccine, the uptake of which in 2018, was reported by 28.0% of respondents, compared to the self-reported lifetime status for meningitis (26.1%), measles (42.2%), and pertussis (34.8%). Not coincidentally, all assessed infections were associated with a low-risk perception score, particularly influenza (33.9% ± 18.4). Interestingly enough, neither knowledge status nor risk perception were associated with vaccination rates. More precisely, the main predictor for being vaccinated against seasonal influenza in 2018 was a seniority of ≥10 years (aOR 3.26, 95% confidence interval [95% CI] 1.35–7.91), while both pertussis and measles were positively associated with higher educational achievement (aOR 3.27, 95%CI 1.29–8.30; and aOR 2.69, 95%CI 1.09–6.65, respectively). The reasons for vaccination gaps among the sampled first responders, apparently, did not find their roots in inappropriate knowledge status and risk perception alone. However, the very low rates of sampled immunization lead us to recommend stronger and more appropriate information campaigns.

Mapping the Prevalence of COVID-19 Vaccine Acceptance at the Global and Regional Level: A Systematic Review and Meta-Analysis

Despite the availability of effective and safe vaccines, the acceptance of COVID-19 vaccination is suboptimal. In this meta-analysis we quantified the prevalence estimates of COVID-19 vaccine acceptance with a specific focus on worldwide geographical differences. We searched PubMed, Scopus, Web of Science and PsycInfo up to April 2021 (PROSPERO ID: CRD42021235328). Generalized random-effects linear models with a logit link were used to calculate the pooled estimated rate of vaccine acceptance at both the global and regional level. A meta-regression analysis was performed to assess the association between COVID-19 vaccine acceptance and various characteristics of the studies. Overall, 71 articles yielding 128 prevalence estimates were included. The pooled prevalence of COVID-19 vaccination acceptance rate was 66% (95% CI: 61-71%). This varied by geographic area, ranging from 36% (95% CI: 18-60%) in Africa to 83% (95% CI: 82-84%) in Oceania, and there was high variability between countries (15.4% Cameroon-100% Bhutan). Meta-regression analysis showed that studies that investigated COVID-19 vaccination intentions using multiple choice/scoring gave a vaccine acceptance prevalence lower than studies with only two possible answers (yes/no) (ß: -1.02 95% CI: -1.41 to -0.63). Despite some variation in the estimates, the results showed that one in three people may refuse/delay COVID-19 vaccination.

The acceptance of COVID-19 vaccine at early stage of development and approval: A global systematic review and meta-analysis

Background

Vaccination seems to be the most effective way to prevent and control the spread of COVID-19, a disease that has adversely impacted the lives of over 7 billion people across the globe. Vaccine hesitancy represents an important threat to combat infectious diseases worldwide. This study aims to inspect the COVID-19 vaccine acceptance rate worldwide and the regional variation of the acceptance rates among the general population and healthcare workers across different territories of the world. In addition, it compares the vaccine acceptance rates between the pre- and post-vaccine approval periods.

Method

A comprehensive systematic review was conducted using PRISMA statements. After quality evaluation, the data from eligible studies were analyzed using the random effect model. Q-test andI 2 statistics were used to search for heterogeneity. The publication bias was assessed by using Egger's test and funnel plot.

Results

The combined COVID-19 vaccine acceptance rate among the general population and healthcare workers (n = 1,581,562) was estimated at 62.79% (95% CI: 58.98-66.60). The acceptance rate substantially decreased from 66.29% (95% CI: 61.24-71.35) to 56.69% (95% CI: 48.68-64.71) among the general population from the pre-to post-vaccine approval periods but remained almost constant at 58.25% (95% CI: 46.52-69.97) among healthcare workers. The acceptance rates also varied in different regions of the world. The highest acceptance rate was found in the South-East Asia region at 70.18% (95% CI: 58.12-82.25) and the lowest was found in African Region at 39.51% (95% CI: 23.42-55.59).

Conclusion

Low COVID-19 vaccine acceptance rate might be a massive barrier to controlling the pandemic. More research is needed to address the responsible factors influencing the low global rate of COVID-19 vaccine acceptance. Integrated global efforts are required to remove the barriers.