The Role of Medication Beliefs in COVID-19 Vaccine and Booster Uptake in Healthcare Workers: An Exploratory Study

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire-measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake-was targeted to HCWs via social media platforms between May-July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity-Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity-Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers.

Evaluation of strategies against vaccine hesitancy in the COVID-19 and Indian context-A systematic review

The world has been severely affected by the COVID-19 pandemic in terms of loss of lives, health, and its socioeconomic consequences; however, the true magnitude and extent of the damage from COVID-19 is still elusive till date. With the advent of many efficacious vaccines, one of the most effective ways to get to grips with the pandemic is mass vaccination. However, due to vaccine hesitancy (VH), it remains a colossal challenge globally thereby causing serious threat to the pandemic response efforts. This review intends to identify evaluated interventions and evidence to support recommendation of specific strategies to address VH from an Indian context. A systematic review was conducted to synthesize relevant literature around the evaluation of strategies to tackle VH for effectiveness or impact in India. Electronic databases were searched using specific keywords and predefined inclusion-exclusion criteria. A total of 133 articles were screened, 15 were assessed for eligibility, and two were included in the final review. There is a paucity of research on evaluation of vaccine hesitancy interventions in India. Evidence is not strong enough to recommend one specific strategy or intervention. Together, a permutation of multicomponent and tailored interventions has been found most effective in repressingVH in India.

Prevalence and predictors of vaccine hesitancy among mothers of under-five children: A hospital-based cross-sectional study

BACKGROUND

The World Health Organization (WHO) states that vaccine hesitancy is one of the top 10 threats to global public health. Evidence shows that vaccine hesitancy studies in India are limited and targeted toward individual vaccines. The study aimed to fill this gap by exploring the relationship between demographics and SAGE factors toward vaccine hesitancy.

MATERIALS AND METHODS

A hospital-based, cross-sectional, analytical study was conducted in a non-governmental organization (NGO) hospital with 330 beds, located in Bathalapalli, Andhra Pradesh, India. Mothers of under-five children who attended outpatient departments of pediatrics or obstetrics and gynecology were included. A total of 574 mothers were enrolled and vaccine hesitancy was determined by reviewing the mother-child protection card for the presence of delay or refusal of the recommended vaccine. A face-to-face interview was conducted to obtain demographics and WHO-SAGE variables from the participants. Binary logistic regression analysis was performed to associate independent variables (demographics and SAGE variables) with the dependent variable (vaccine hesitancy).

RESULTS

Out of 574 respondents, 161 mother's children were noted as vaccine-hesitant (refusal = 7; delay = 154); and the prevalence of vaccine hesitancy was 28.05%. The delay was observed in all recommended vaccines, but the refusal or reluctance was seen in only four vaccines (hepatitis B birth dose = 1; IPV 1 and 2 = 2; Measles 1 and 2 = 3; and Rota 1, 2, and 3 = 1). The respondents' demographics like no or lower parent education (OR = 3.17; 95%CI = 1.50-6.72) and fewer antenatal visits (OR = 2.30; 95%CI = 1.45-3.36) showed higher odds, whereas the upper socioeconomic status showed lower odds (OR = 0.09; 95%CI = 0.02-0.36) toward vaccine hesitancy. The WHO-SAGE dimensions like awareness (OR = 0.14; 95%CI = 0.03-0.53), poor access (OR = 7.76; 95%CI = 3.65-16.51), and low acceptability of the individual (OR = 07.15; 95%CI = 1.87-27.29), community (OR = 6.21; 95%CI = 1.58-24.33) were significantly associated with vaccine hesitancy.

CONCLUSION

The study concludes that the prevalence of vaccine hesitancy was high. Vaccine safety and children's health are primary concerns for parents' refusal/reluctance. To achieve 100% immunization coverage, policymakers need to reduce vaccine hesitancy by developing strategies based on demographic and WHO-SAGE working group predictors.

Factors Associated with Delayed or Missed Second-Dose mRNA COVID-19 Vaccination among Persons >12 Years of Age, United States

To identify demographic factors associated with delaying or not receiving a second dose of the 2-dose primary mRNA COVID-19 vaccine series, we matched 323 million single Pfizer-BioNTech (https://www.pfizer.com) and Moderna (https://www.modernatx.com) COVID-19 vaccine administration records from 2021 and determined whether second doses were delayed or missed. We used 2 sets of logistic regression models to examine associated factors. Overall, 87.3% of recipients received a timely second dose (≤42 days between first and second dose), 3.4% received a delayed second dose (>42 days between first and second dose), and 9.4% missed the second dose. Persons more likely to have delayed or missed the second dose belonged to several racial/ethnic minority groups, were 18–39 years of age, lived in more socially vulnerable areas, and lived in regions other than the northeastern United States. Logistic regression models identified specific subgroups for providing outreach and encouragement to receive subsequent doses on time.

Parents' and caregivers' role toward childhood vaccination in Albania: assessment of predictors of vaccine hesitancy

Background

Vaccination has saved millions of lives through the protection of individuals and populations from communicable diseases. Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccines despite the availability of vaccination services, has become a growing global concern. The objective of this study was to investigate parents'/caregivers' hesitancy toward childhood vaccination and its predictors in Albania.

Study design

A cross-sectional survey was conducted.

Methods

The data comes from a survey conducted on a sample of parents/caregivers (89.6% mothers) of children aged 6 months to 8 years at health care vaccination centers in seven Albanian cities from December 2020 to February 2021. Parents/caregivers (one per child) were interviewed by trained healthcare staff using a standardized questionnaire on six main content domains, including immunization behavior, beliefs about vaccine safety and efficacy, attitudes about vaccines, vaccination confidence, estimation of vaccine delay, and the intention to immunize children against SARS-CoV-2, and a self-reported hesitancy. The Albanian Ministry of Health approved the questionnaire, after it was translated, validated and adapted to the local setting. Statistical analyses included independent sample t-tests (p<0.05) and a logistic regression (OR; 95% C.I.).

Results

A total of 475 parents/caregivers of children aged from 6 months to 8 years, attending childhood vaccination in public health services, were interviewed. To the question "how hesitant you are about childhood vaccination", a high number of parents/caregivers (46%) responded that they do not feel hesitant at all, and 32% were not hesitant, a small number of parents/caregivers said they are very hesitant (5%) or somewhat hesitant (12%). A binary logistic model was fitted to the data to test the hypothesis regarding the relationship between parental vaccine hesitancy and possible predictors. A lower parental attitude toward childhood vaccines (OR = 3.7; 95% C.I. 1.102-12.421), a health center with a high vaccine delay (OR = 2.878; C.I. 95% 1.735-4.773), and low confidence in health staff information (OR = 2.042; 95% C.I. 1.156-3.605) were all independent predictors of parental vaccine hesitancy. Regarding intention to vaccinate children against COVID-19, when available, nearly 75% of parents/caregivers showed hesitancy.

Conclusions

Our results highlighted the role of positive parents'/caregivers' attitudes toward childhood vaccines followed by high staff confidence and good health center organization in order to deal with vaccine hesitancy, particularly for traditional and well-known childhood vaccines. Nevertheless, the hesitancy can be a critical barrier for childhood vaccination when we have to introduce a new vaccine, as is demonstrated in the recent vaccination campaign against the ongoing pandemic of SARS-CoV2.

Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada

Response measures to mitigate the coronavirus disease 2019 pandemic impacted access to routine vaccination services. We evaluate the impact of the pandemic on routine infant vaccination uptake by comparing vaccination coverage, vaccine delays and doses administered in 2019 and 2020, in Quebec, Canada. Using a population-based vaccination registry, we compared vaccination coverage at 3, 5, 13 and 19 months of age between 2019 and 2020 cohorts each month from January to November. For vaccine delays, we measured the cumulative proportion vaccinated in each targeted cohort monthly. We also compared the measles-containing vaccines administered before 24 months of age between the same period in 2019 and 2020. A decline in vaccination coverage and children vaccinated on time was observed in all cohorts during the first months of the pandemic. The greatest impact was observed for the 18-month vaccination visit with a difference in vaccination coverage between both cohorts of 30.9% in May. Measles-containing doses administered during the first months of the pandemic were lower in 2020 compared with 2019: −21.1% in March (95%CI-21.6;-20.4), and −39.2% in April (95%CI-40.0;-38.2). After May, the coverage increased for all cohorts to reach pre-pandemic levels after a few months for most target ages. Routine childhood vaccinations were affected during the first months of the pandemic, but catch-up occurred thereafter and vaccination coverage in affected cohorts were very close to levels of 2019 after a few months of follow-up. Real-time monitoring of childhood vaccination is essential but also for other vaccination programs, severely affected by the pandemic.

Vaccine coverage, timeliness and delay estimated from regional and national cross-sectional surveys in Ethiopia, 2016

Introduction

measures of vaccine timing require data on vaccination dates, which may be unavailable. This study compares estimates of vaccine coverage and timing; and compares regression techniques that model these measures in the presence of incomplete data.

Methods

this cross-sectional study used the 2016 Ethiopian Demographic and Health Survey (DHS), and a 2016 survey from Worabe, Ethiopia. Three measures of vaccine uptake were calculated: coverage (regardless of timing), timeliness (within 1 week of recommended administration), and delay (the number of days between the recommended and actual date of vaccination). Vaccine coverage and timeliness were modeled with logistic regressions. After excluding those without dates, vaccine delay was estimated using linear regression or survival analysis. Vaccine delay was also estimated using accelerated failure time (AFT) models.

Results

the DHS survey included 3819 children aged 12-60 months and the Worabe survey included 484 children aged 12-23 months. In the Worabe survey, vaccine coverage for pentavalent vaccine dose 3 was 87.4%, with 8.6% receiving it within 1 week, and 71.7% within 4 weeks; the median delay was 19 days. Predictors of outcomes were similar in both the Worabe survey and Ethiopian DHS, with the largest numbers of significant associations seen in models with vaccine coverage or delays (with AFT models) as the outcomes.

Conclusion

estimates of coverage may miss a substantial proportion of infants who have delayed vaccination. Accelerated failure time (AFT) models are useful to estimate vaccine delay because they include information from all respondents (those with full and partial data on vaccination dates) and are agnostic about an age limit for timely vaccination.

The impact of the COVID-19 pandemic on parents' behavior toward scheduled pediatric vaccinations in Saudi Arabia

INTRODUCTION

Coronavirus disease (COVID-19) is caused by a newly discovered coronavirus and has resulted in a global pandemic. The World Health Organization recommended avoiding any delay or disruption of immunization services, as this could result in increases in outbreak-prone vaccine-preventable diseases. This study aimed to determine the impact of the COVID-19 pandemic on parents' behaviour towards their children's scheduled vaccinations.

METHODOLOGY

This web-based cross-sectional study recruited 1,143 parents/guardians of children below six years of age living in Saudi Arabia between May 1 and May 30, 2020 via social media platforms. A self-developed online questionnaire consisting of eight items was used. Simple and multiple binary logistic regression was used to determine the factors associated with vaccine delay during the COVID-19 pandemic.

RESULTS

The parents/guardians were aged 20-60 years; 82% were aged between 20 and 39 years. It was found that 26% of parents did not vaccinate their children on time according to the national immunization schedule in regular situations, and 38% of parents reported delaying vaccination due to the COVID-19 pandemic. The multiple logistic regression analysis found that having two or more children, living in Riyadh or the Western region or not vaccinating children during regular situations were associated with an increased risk of vaccine delay during the COVID-19 pandemic.

CONCLUSIONS

Delaying children's vaccinations during the COVID-19 pandemic was influenced most by living in regions with high COVID-19 prevalence and having two or more children.

COVID-19 vaccine delay: An examination of United States residents' intention to delay vaccine uptake

The current study examines differences between COVID-19 vaccine intention and delay. A survey was administered to 585 US respondents in late November 2020 as part of an online longitudinal study. Respondents provided information on whether they would obtain a COVID-19 vaccine, once available, and how long they intended to wait before obtaining it. In the negative intention group, 3.4% reported waiting a few weeks, 34.0% waiting a few months, and 62.6% never getting vaccinated. In multivariable models, social norms were a significant and independent predictor of all vaccine delay and intention models. Vaccine delay was associated with low levels of worry about becoming infected with COVID-19, political conservatism, concerns about vaccine side effects, and low levels of believing a vaccine would be effective. Negative vaccine intentions were associated with worries about becoming infected with COVID-19, concerns about vaccine side effects, beliefs that the vaccines were developed too quickly, and low endorsement of the altruistic belief that older people should have vaccination priority. The study results highlight the importance of a multifactorial approach to assessing vaccine attitudes. The findings suggest that uptake programs should focus on enhancing pro-vaccine norms.

The Social Basis of Vaccine Questioning and Refusal: A Qualitative Study Employing Bourdieu's Concepts of 'Capitals' and 'Habitus'

This article is an in-depth analysis of the social nature of vaccine decision-making. It employs the sociological theory of Bourdieu and Ingram to consider how parents experience non-vaccination as a valued form of capital in specific communities, and how this can affect their decision-making. Drawing on research conducted in two Australian cities, our qualitative analysis of new interview data shows that parents experience disjuncture and tugs towards 'appropriate' forms of vaccination behavior in their social networks, as these link to broader behaviors around food, school choices and birth practices. We show how differences emerge between the two cities based on study designs, such that we are able to see some parents at the center of groups valorizing their decisions, whilst others feel marginalized within their communities for their decisions to vaccinate. We draw on the work of philosopher Mark Navin to consider how all parents join epistemic communities that reward compliance and conformity with the status quo and consider what this means for interventions that seek to influence the flow of pro-vaccine information through vaccine-critical social groups.

Timely versus delayed early childhood vaccination and seizures

BACKGROUND

Little is known regarding the timing of childhood vaccination and postvaccination seizures.

METHODS

In a cohort of 323 247 US children from the Vaccine Safety Datalink born from 2004 to 2008, we analyzed the association between the timing of childhood vaccination and the first occurrence of seizure with a self-controlled case series analysis of the first doses of individual vaccines received in the first 2 years of life.

RESULTS

In infants, there was no association between the timing of infant vaccination and postvaccination seizures. In the second year of life, the incident rate ratio (IRR) for seizures after receipt of the first measles-mumps-rubella vaccine (MMR) dose at 12 to 15 months was 2.65 (95% confidence interval [CI] 1.99-3.55); the IRR after an MMR dose at 16 to 23 months was 6.53 (95% CI 3.15-13.53). The IRR for seizures after receipt of the first measles-mumps-rubella-varicella vaccine (MMRV) dose at 12 to 15 months was 4.95 (95% CI 3.68-6.66); the IRR after an MMRV dose at 16 to 23 months was 9.80 (95% CI 4.35 -22.06).

CONCLUSIONS

There is no increased risk of postvaccination seizure in infants regardless of timing of vaccination. In year 2, delaying MMR vaccine past 15 months of age results in a higher risk of seizures. The strength of the association is doubled with MMRV vaccine. These findings suggest that on-time vaccination is as safe with regard to seizures as delayed vaccination in the first year of life, and that delayed vaccination in the second year of life is associated with more postvaccination seizures than on-time vaccination.