The influence of social network on COVID-19 vaccine hesitancy among healthcare workers: a cross-sectional survey in Chongqing, China

2022 ◽  
pp. 1-15
Author(s):  
Binyue Xu ◽  
Yi Zhang ◽  
Lei Chen ◽  
Linling Yu ◽  
Lanxin Li ◽  
...  
Keyword(s):  
Social Network ◽  
Healthcare Workers ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional

scholarly journals Correlates of COVID-19 vaccine acceptance, hesitancy and refusal among employees of a safety net California county health system with an early and aggressive vaccination program: Results from a cross-sectional survey

2021 ◽  
Author(s):  
Nicole M. Gatto ◽  
Jerusha E Lee ◽  
Donatella Massai ◽  
Susanna Zamarripa ◽  
Bijan Sasaninia ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Workers ◽  
Model Building ◽  
Safety Net ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Job Classification

Information on vaccine acceptance among healthcare workers is needed as health professionals provide front line care to COVID-19 patients. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbachs alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. Appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates in healthcare workers.

scholarly journals Knowledge, Attitude, and Practice Regarding COVID-19 Among Healthcare Workers in Primary Healthcare Centers in Dubai: A Cross-Sectional Survey, 2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Abdulaziz Hussain Albahri ◽  
Shatha Ahmed Alnaqbi ◽  
Shahad Ahmed Alnaqbi ◽  
Asma Obaid Alshaali ◽  
Shaikha Mohammad Shahdoor
Keyword(s):  
Healthcare Workers ◽  
Primary Source ◽  
Healthcare Services ◽  
Health Centers ◽  
Vaccine Hesitancy ◽  
Attitude Score ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Primary Health

Introduction: The coronavirus disease 2019 (COVID-19) pandemic continues to challenge healthcare services worldwide. Healthcare workers (HCWs) are key to the continued effort to overcome the pandemic. This study aims to evaluate the knowledge, attitude, and practices of HCWs toward COVID-19 in primary health centers in Dubai.Methods: This cross-sectional study was conducted at four primary health centers in Dubai, including two fever clinics, from July 5th to July 11th, 2020. A self-administered online questionnaire was distributed to nurses and physicians working in these centers, which evaluated their knowledge, attitude, and practices regarding COVID-19 and their associations with the participants' demographic factors. A total score of 80% and above constituted a level of sufficiency in each section. Additionally, Mann-Whitney U test and multivariable logistic regression were used to analyze the variables.Results: A total of 176 HCWs completed the questionnaire, with a 91.2% (176/193) response rate. They were predominantly female (158/176, 90.0%), nurses (128/176, 72.7%), and non-Emiratis (150/176, 85.2%). While official health organizations were the primary source of information for 91.5% (161/176) of participants, only 38.1% (67/176) reported using scientific journals as one of their sources. Overall, 57.4% (101/176) of participants had a sufficient overall level of knowledge. Moreover, knowledge regarding signs, symptoms, and at-risk groups was generally satisfactory. However, knowledge about the virus, testing, transmission, and the isolation of contacts with positive cases was identified correctly by less than two-thirds of the participants. Half of the participants (89/176, 50.6%) expressed their concern about personally acquiring the infection, 112/176 (63.6%) worried about their relatives acquiring it, and 72/176 (40.9%) expressed some hesitancy to take the COVID-19 vaccine once available. Overall, only 58/176 (33.0%) HCWs had a sufficient overall positive attitude score. Nurses, compared to physicians, and non-Emiratis compared to Emiratis' HCWs, had statistically higher mean scores for attitude (U = 2,212, p < 0.01; and U = 1164.5, p < 0.01, respectively). The majority of participants (156/176, 88.6%) reported acceptable infection control practices.Conclusion: Given the gaps identified in the knowledge and attitude, we recommend further training to improve the skills of primary HCWs, with encouragement to practice evidence-based medicine. Additionally, further exploration regarding vaccine hesitancy is warranted.

scholarly journals Qatar Healthcare Workers' COVID-19 Vaccine Hesitancy and Attitudes: A National Cross-Sectional Survey

2021 ◽  
Vol 9 ◽  
Author(s):  
Rajeev Kumar ◽  
Majid Alabdulla ◽  
Nahid M. Elhassan ◽  
Shuja Mohd Reagu
Keyword(s):  
Healthcare Workers ◽  
Vaccine Safety ◽  
Vaccine Hesitancy ◽  
Measurement Tool ◽  
Safety Education ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Safety And Efficacy ◽  
Attitudinal Factors ◽  
Study Participants

Introduction: Healthcare workers are the critical frontline workforce of the COVD-19 pandemic and are considered a target group for vaccination. Hesitancy to vaccinate is a major concern that can jeopardize the vaccination programme. The hesitancy rates in the general population and healthcare workers (HCWs) vary globally, and more importantly, hesitancy in HCWs is of particular concern, as it can influence the wider population.Materials and Methods: The present study evaluated the vaccine hesitancy rate and its sociodemographic and attitudinal factors among the HCWs in the state of Qatar. We conducted a national cross-sectional survey using a validated hesitancy measurement tool between October 15 and November 15, 2020. A total of 7,821 adults above the age of 18 years out of the 2.3 million adult Qatari residents completed the survey. While majority of the participants were from the general public, 1,546 participants were HCWs. Sociodemographic data, along with attitudes and beliefs around COVID-19 vaccination, were collected from the respondents.Results: We found that 12.9% of the study participants showed vaccine hesitancy, defined as definitely or probably will not take the vaccine if offered, and 25.31% reported that they were unsure about the uptake of the COVID-19 vaccine. Female respondents were more hesitant toward the vaccine. Safety and efficacy concerns of vaccine were the significant predictors of vaccine hesitancy. The primary predictor for vaccine acceptance was a better understanding of the disease and vaccine.Discussion: Overall, 1 in 8 HCWs were reluctant to get vaccinated against COVID-19, mainly due to concerns about the vaccine's efficacy and safety. Education about the vaccine's safety and efficacy can potentially improve acceptance among healthcare workers.

scholarly journals Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1179
Author(s):  
Dimos D. Mitsikostas ◽  
Konstantina Aravantinou-Fatorou ◽  
Christina Deligianni ◽  
Evrydiki Kravvariti ◽  
Eleni Korompoki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Healthcare Workers ◽  
Logistic Regression Model ◽  
Vaccine Hesitancy ◽  
Multivariate Logistic Regression Model ◽  
Multivariate Logistic Regression ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Independent Variables

Among healthcare workers (HCWs), SARS-CoV-2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed with a self-completed questionnaire that included a tool (Q-No) for the identification of nocebo-prone individuals. A total of 1309 HCWs (67.2%women; 43.4% physicians; 28.4% nurses; 11·5% administrative staff; 16·6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q-No scores were ≥15 in 325 participants (24.8%) suggesting nocebo-prone behavior. In a multivariate logistic regression model with Q-No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p < 0.001) in participants with Q-No score ≥15 vs. Q-No score < 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p < 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu-like symptoms. In a multivariate logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated ORs of AE reporting were 2.0 in females vs. males (p < 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q-No score, which were not significantly associated with OR of AE. These findings suggest that nocebo-prone behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.

scholarly journals Factors Associated with the Acceptance and Willingness of COVID-19 Vaccination among Chinese Healthcare Workers

2021 ◽  
Author(s):  
Xinxin Ye ◽  
Wan Ye ◽  
Jinyue Yu ◽  
Yuzhen Gao ◽  
Ziyang Ren ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Vaccine Coverage ◽  
Personal Characteristics ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
Factors Associated ◽  
Wide Range ◽  
The Government

Background: Vaccination is a crucial measure in preventing the spread of epidemic. Vaccines targeting coronavirus disease 2019 (COVID-19) have been developed in a wide range of countries. Objective: This study aims to examine factors influencing vaccination rate and willingness to vaccinate against COVID-19 among Chinese healthcare workers (HCWs). Methods: From 3rd February to 18th February, 2021, an online cross-sectional survey was conducted among HCWs to investigate factors associated with the acceptance and willingness of COVID-19 vaccination. Respondents were classified into two categories, vaccinated and unvaccinated, and, the willingness of vaccination was assessed in the unvaccinated group. Information on socio-demographics and the psychological process of the participants for accepting the vaccine were evaluated. Results: A total of 2156 HCWs from 21 provinces in China responded to this survey (response rate: 98.99%)), among whom 1433 (66.5%) were vaccinated at least one dose. Higher vaccination rates were associated with older age (40-50 years vs. less than 30 years, OR=1.63, 95%CI: 1.02-2.58; >50 years vs. 30 years, OR=1.90, 95%CI: 1.02-3.52), working as a clinician (OR=1.54, 95% CI: 1.05-2.27), having no personal religion (OR=1.35, 95%CI: 1.06-1.71), working in a fever clinic (OR=4.50 , 95%CI:1.54-13.17) or higher hospital level(Municipal vs. County, OR=2.01, 95%CI: 1.28-3.16; Provincial vs. County, OR=2.01, 95%CI: 1.25-3.22) and having knowledge training of vaccine (OR=1.67, 95%CI:1.27-2.22), family history for influenza vaccination (OR=1.887, 95%CI:1.49-2.35) and strong familiarity with the vaccine (OR=1.43, 95%CI:1.05-1.95) (All P<0.05). Strong willingness for vaccination was related to having a working in midwestern China (OR=1.89, 95%CI:1.24-2.89), considerable knowledge of the vaccine (familiar vs. not familiar, OR=1.67, 95%CI: 1.17-2.39; strongly familiar vs. not familiar, OR=2.47, 95%CI: 1.36-4.49), knowledge training of vaccine(OR=1.61, 95%CI: 1.05-2.48) and strong confidence in the vaccine (OR=3.84 , 95%CI: 2.09-7.07). Conclusion: Personal characteristics, working environments, familiarity and confidence in the vaccine were related to vaccination rates and willingness to get vaccinated among healthcare workers. Results of this study could provide evidence for the government to improve vaccine coverage by addressing vaccine hesitancy in the COVID-19 pandemic and future public health emergencies.

scholarly journals Acceptability of COVID-19 Vaccination among Healthcare Workers in Sudan: A Cross Sectional Survey

2021 ◽  
Author(s):  
Amna Khairy ◽  
Esra Mahgoob ◽  
Mohammad Nimir ◽  
Mohammed Ahmed ◽  
Mawahib Jubara ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Cross Sectional Study ◽  
Nursing Profession ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Web Based ◽  
Perceived Harm ◽  
Structured Questionnaire

Abstract Introduction: Following emergency approval of COVID-19 vaccines, several studies have investigated COVID-19 vaccine acceptance and hesitancy especially among healthcare workers (HCWs). Nevertheless, the acceptability of the COVID-19 vaccine by HCWs in Sudan remains unclear. This study aims to investigate the acceptability of the COVID-19 vaccine and it’s determinants among the HCWs. Methods: A web-based cross sectional study design was used to study COVID-19 vaccine hesitancy and its associated determinants. The semi-structured questionnaire was distributed electronically, data collection took place from March-April 2021. Results: A total of 576 HCWs have responded to the survey with mean age of 35 years. The majority were females (53.3%), Medical Doctors (55.4%), and located in the capital state; Khartoum (76.0%). The absolute refusal of COVID-19 vaccine was expressed by 16% of the respondents while 57% were willing to get vaccinated. Males were twice to four times more likely to accept the vaccine. Lower acceptability of COVID-19 vaccine was significantly associated with the nursing profession (OR= 0.35, 95% CI:0.15-0.82, P<0.00), increased perceived harm from the vaccine (OR= 0.11, 95% CI: 0.05-0.23, P <0.00), lack of confidence in the source of vaccine (OR= 0.16, 95% CI:0.08-0.31, P=0.00), organizations and government supervising COVID-19 vaccination process ( OR=0.31, 95% CI:0.17-0.58 P=0.00). Conclusion: This study highlights a moderate level of COVID-19 vaccine acceptability by the HCWs in Sudan. Effective communication of correct, regular, up-to-date evidence on the safety and effectiveness of vaccines is crucial to building trust in vaccines. Special consideration should be in place to address vaccine hesitancy among female HCWs and the nursing profession.

scholarly journals COVID-19 Vaccine Acceptance and Hesitancy among Singaporean Primary Healthcare Workers

2021 ◽  
Author(s):  
Sky Wei Chee Koh ◽  
Yiyang Liow ◽  
Victor Weng Keong Loh ◽  
Seaw Jia Liew ◽  
Yiong-Huak Chan ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Primary Healthcare ◽  
Perceived Risk ◽  
Healthcare Workers ◽  
Collective Responsibility ◽  
Acceptance Rate ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccine Acceptance

Abstract BackgroundFactors affecting COVID-19 vaccine acceptance and hesitancy among primary healthcare workers (HCW) remain poorly understood. This study aims to identify factors associated with vaccine acceptance and hesitancy among HCW.MethodsA multi-centre online cross-sectional survey was performed across 6 primary care clinics from May to June 2021, after completion of vaccination exercise. Demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19 and previous influenza vaccination were collected. HCW who accepted vaccine were then asked to rank their top 5 reasons for vaccine acceptance; HCW who were vaccine hesitant had to complete the 5C scale on psychological antecedents of vaccination.Results557 out of 1182 eligible HCW responded (47.1%). 29 were excluded due to existing contraindications. Among 557 respondents, vaccine acceptance rate was 94.9% (n=501) and 5.1% were hesitant (n=27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk or previous influenza vaccination. The top 3 reasons for COVID-19 vaccine acceptance ranked by 501 HCW were to protect their family and friends, protect themselves from COVID-19 and due to high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCW. The mean scores for the components of the 5Cs were: ‘Confidence’ (3.96), ‘Complacency’ (3.23), ‘Constraint’ (2.85), ‘Calculation’ (5.79) and ‘Collective responsibility’ (4.12).ConclusionCOVID-19 vaccine hesitancy is a minute issue among Singapore primary HCW, having achieved close to 95% acceptance rate with 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates, and acceptance of booster vaccinations with the emergence of the delta COVID-19 variant.Trial RegistrationThis study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on 26th April 2021 (Reg No. 2021/00213).

scholarly journals COVID-19 vaccine hesitancy among Ethiopian healthcare workers

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261125
Author(s):  
Rihanna Mohammed ◽  
Teklehaimanot Mezgebe Nguse ◽  
Bruck Messele Habte ◽  
Atalay Mulu Fentie ◽  
Gebremedhin Beedemariam Gebretekle
Keyword(s):  
Healthcare Workers ◽  
Addis Ababa ◽  
Vaccine Safety ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
International Firms ◽  
The Government ◽  
Regional Health Authorities

Introduction COVID-19 poses significant health and economic threat prompting international firms to rapidly develop vaccines and secure quick regulatory approval. Although COVID-19 vaccination priority is given for high-risk individuals including healthcare workers (HCWs), the success of the immunization efforts hinges on peoples’ willingness to embrace these vaccines. Objective This study aimed to assess HCWs intention to be vaccinated against COVID-19 and the reasons underlying vaccine hesitancy. Methods A cross-sectional survey was conducted among HCWs in Addis Ababa, Ethiopia from March to July 2021. Data were collected from eligible participants from 18 health facilities using a pre-tested semi-structured questionnaire. Data were summarized using descriptive statistics and multivariable logistic regression was performed to explore factors associated with COVID-19 vaccine hesitancy. A p<0.05 was considered statistically significant. Results A total of 614 HCWs participated in the study, with a mean age of 30.57±6.87 years. Nearly two-thirds (60.3%) of HCWs were hesitant to use the COVID-19 vaccine. Participants under the age of 30 years were approximately five times more likely to be hesitant to be vaccinated compared to those over the age of 40 years. HCWs other than medical doctors and/or nurses (AOR = 2.1; 95%CI; 1.1, 3.8) were more likely to be hesitant for COVID-19 vaccine. Lack of believe in COVID-19 vaccine benefits (AOR = 2.5; 95%CI; 1.3, 4.6), lack of trust in the government (AOR = 1.9; 95%CI; 1.3, 3.1), lack of trust science to produce safe and effective vaccines (AOR = 2.6; 95%CI; 1.6, 4.2); and concern about vaccine safety (AOR = 3.2; 95%CI; 1.9, 5.4) were also found to be predictors of COVID-19 vaccine hesitancy. Conclusion COVID-19 vaccine hesitancy showed to be high among HCWs. All concerned bodies including the ministry, regional health authorities, health institutions, and HCWs themselves should work together to increase COVID-19 vaccine uptake and overcome the pandemic.

scholarly journals Differences in COVID-19 Vaccine Acceptance, Hesitancy, and Confidence between Healthcare Workers and the General Population in Japan

Vaccines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1389
Author(s):  
Megumi Hara ◽  
Motoki Ishibashi ◽  
Atsushi Nakane ◽  
Takashi Nakano ◽  
Yoshio Hirota
Keyword(s):  
General Population ◽  
Healthcare Workers ◽  
Multinomial Logistic Regression ◽  
Vaccine Hesitancy ◽  
Odds Ratios ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Multinomial Logistic Regression Analysis ◽  
Basic Characteristics

Little is known about the differences in coronavirus disease (COVID-19) vaccine acceptance and hesitancy between the general population and healthcare workers in Japan. To compare these differences, a nationwide web-based cross-sectional survey was conducted on 19 January 2021, shortly before the initiation of COVID-19 vaccinations in Japan. A total of 6180 men and women aged 20–69 years and 1030 healthcare workers aged 20–69 years were enrolled. Data on COVID-19 vaccine acceptance, basic characteristics, including socioeconomic factors, and confidence in immunization in general were collected. COVID-19 vaccine acceptance was also evaluated under hypothetical vaccine effectiveness and adverse event frequencies. Factors associated with vaccine hesitancy were examined using multinomial logistic regression analysis. The COVID-19 vaccine acceptance rate was 48.6% among the general population and was lower among nurses (45.5%) and medical clerks (40.7%). Women and young adults had significantly higher COVID-19 vaccine hesitancy odds ratios, and current smokers had significantly lower odds ratios. The frequency of adverse events was a COVID-19 vaccine hesitancy factor. Even if these factors were adjusted, COVID-19 vaccine hesitancy among nurses was 1.4 times higher than that among the general population. Thus, interventions to improve health literacy and vaccine hesitancy among the general population and healthcare workers, especially nurses, are needed.

scholarly journals Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1152
Author(s):  
Nicole M. Gatto ◽  
Jerusha E. Lee ◽  
Donatella Massai ◽  
Susanna Zamarripa ◽  
Bijan Sasaninia ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Workers ◽  
Model Building ◽  
Safety Net ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Job Classification

Since health professionals provide frontline care to COVID-19 patients, information on vaccine acceptance among healthcare workers is needed. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbach’s alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy, and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. The appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates amongst healthcare workers.

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