Abstract 396: Combating Inpatient Vaccine Hesitancy: I Raised The Rates In My Cardiac Patients

Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Influenza infections in patients with underlying CVD are associated with an increased risk of cardiovascular (CV) events. Influenza immunization is a global prevention strategy; however, more hospital-based policies are needed to combat the alarming rise of vaccine hesitancy across all age groups in the States. Our objective was to increase immunization rates in patients with CVD. Methods: Qualitative improvement project using FADE model to design and implement an in-hospital intervention for adults with CV comorbidities between November 2019-February 2020. A 5-question survey was administered to CV stepdown unit nurses to identify vaccination barriers. An immunization promotion intervention using the motivational interview model was performed by residents upon receipt of daily immunization updates in patients with unknown influenza vaccine status. The primary objective was to provide bedside education to vaccine-hesitant patients during their hospital course or upon discharge in the outpatient setting. Amongst unvaccinated patients, we tracked potential CV complications using the HCA database for patients admitted during the current flu season. Results: We identified 5,680 patients that met inclusion criteria for the 2018-2019 and current flu season admitted to CV stepdown unit for comparison. At the end of our pilot study, 91 patients were willing to receive the vaccine in the outpatient setting, and 73 patients opted to receive their influenza vaccination on the floors during their stay. Notable barriers found during the study (1) data collection for CV complications for the current flu season is ongoing, (2) physicians were not able to place orders for the patients that received the intervention, and (3) insufficient nursing immunization documentation for continued management. After overcoming institutional barriers, and in light of CDC’s findings during the 2018-19 influenza season; where it was found that 57% of adults ≥ 65 required hospitalization and accounted for 75% of all influenza-associated deaths. Our executive leadership will implement new policies to support nursing leadership in joining our crusade and implement our approach for a hospital-wide intervention next flu season as Florida is currently the third least vaccinated state as of 2019. Conclusions: Inpatient vaccine promotion via hospital-based vaccine programs should be utilized to combat vaccine hesitancy as misinformation continues to permeate the public sphere. The new threat of SARS-CoV-2 is a sobering reminder that we must not falter in our resolve to reach the masses. Further studies are needed to understand the role of influenza immunization campaigns to improve hospital policy and increase influenza vaccine rates to decrease CV events in patients with preexisting CVD.

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Determinants of influenza vaccine hesitancy among pregnant women in Europe: a systematic review

European Journal of Medical Research ◽

10.1186/s40001-021-00584-w ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Gbadebo Collins Adeyanju ◽

Elena Engel ◽

Laura Koch ◽

Tabea Ranzinger ◽

Imtiaz Bin Mohammed Shahid ◽

...

Keyword(s):

Systematic Review ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Pregnant Women ◽

Healthcare Providers ◽

Primary Objective ◽

World Health ◽

Vaccine Hesitancy ◽

Cochrane Central Register ◽

Adequate Knowledge

Abstract Background Pregnant women are at high risk for severe influenza. However, maternal influenza vaccination uptake in most World Health Organization (WHO) European Region countries remains low, despite the presence of widespread national recommendations. An influenza vaccination reduces influenza-associated morbidity and mortality in pregnancy, as well as providing newborns with protection in their first months. Potential determinants of vaccine hesitancy need to be identified to develop strategies that can increase vaccine acceptance and uptake among pregnant women. The primary objective of the systematic review is to identify the individual determinants of influenza vaccine hesitancy among pregnant women in Europe, and how to overcome the hesitancy. Methods Databases were searched for peer-reviewed qualitative and quantitative studies published between 2009 and 2019 inclusive. Databases included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor and Francis and Springer nature. These covered themes including psychology, medicine, and public health. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, 11 studies were eligible and analyzed for significant determinants of influenza vaccine hesitancy among pregnant women in Europe. Results The most commonly reported factors were psychological aspects, for example concerns about safety and risks to mother and child, or general low risk perception of becoming ill from influenza. Doubts about the effectiveness of the vaccine and a lack of knowledge about this topic were further factors. There was also influence of contextual factors, such as healthcare workers not providing adequate knowledge about the influenza vaccine or the pregnant lady stating their antivaccine sentiment. Conclusion Health promotion that specifically increases knowledge among pregnant women about influenza and vaccination is important, supporting a valid risk judgment by the pregnant lady. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.

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Prevalence of influenza vaccination among adults with high-risk conditions, United States, 2019

10.1101/2020.12.21.20248635 ◽

2020 ◽

Author(s):

Saji Saraswathy Gopalan ◽

Devi Kalyan Mishra ◽

Ashis Kumar Das

Keyword(s):

High Risk ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Family Income ◽

Influenza Infection ◽

Insurance Coverage ◽

Age Groups ◽

National Sample ◽

Medical Conditions ◽

To Receive

AbstractBackgroundInfluenza could be associated with illnesses, severe complications, hospitalizations, and deaths among adults with high-risk medical conditions. Influenza vaccination reduces the risks and complications associated with influenza infection in high-risk conditions. We assessed the prevalence and predictors of influenza vaccination in a national sample of adults with high-risk medical conditions.MethodsUsing the nationally representative National Health Interview Survey of 2019, we estimated the prevalence of influenza vaccination among adults with high-risk conditions. We tested the associations between receipt of vaccination and sociodemographic predictors with adjusted multivariable logistic regression.ResultsOut of 15,258 adults with high-risk conditions, 56% reported receiving an influenza vaccine over the previous 12 months. Multivariable regressions show that respondents from older age groups, females, other race/ethnic group, married, higher annual family income, having a health insurance and those with more than two high-risk conditions are more likely to receive the influenza vaccine. However, adults from non-Hispanic Black race/ethnicity and living in the Southern census region are less likely to receive the vaccination. Education levels and living in a metro show no associations with vaccination status.ConclusionState authorities, primary physicians, specialists, and pharmacists have important roles in sensitizing and reminding individuals with high-risk conditions to receive timely vaccination. Similarly, affordability needs to be enhanced for influenza vaccination including better insurance coverage and reduced co-payment.

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Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.410 ◽

2021 ◽

pp. 1-9

Author(s):

Safa K. Browne ◽

Kristen A. Feemster ◽

Angela K. Shen ◽

Judith Green-McKenzie ◽

Florence M. Momplaisir ◽

...

Keyword(s):

Nurse Practitioners ◽

Critical Role ◽

Physician Assistants ◽

Medical Doctor ◽

Vaccine Hesitancy ◽

Healthcare Personnel ◽

Clinical Exposure ◽

Academic Hospitals ◽

Increased Risk ◽

To Receive

Abstract Objective: To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania. Design, setting, and participants: HCP were surveyed in November–December 2020 about their intention to receive the COVID-19 vaccine. Methods: The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines. Results: Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2). Conclusions: Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.

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Evaluation of Direct Oral Anticoagulant Dosing and Monitoring in Two Geriatric Outpatient Clinics

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.192 ◽

2019 ◽

Vol 34 (3) ◽

pp. 192-205

Author(s):

Michelle A. Howerton ◽

Erin M. Suhrie ◽

Amelia S. Gennari ◽

Nancy Jones ◽

Christine M. Ruby

Keyword(s):

Medical Center ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Retrospective Chart Review ◽

Office Visit ◽

Outpatient Setting ◽

Primary Objective ◽

Improvement Project ◽

Care Institute ◽

Geriatric Center

OBJECTIVE: This study was conducted to evaluate direct oral anticoagulants (DOACs) prescribed to elderly patients in an outpatient setting, specifically evaluating if Food and Drug Administration (FDA) -approved dosing recommendations are followed. DESIGN: This study was a retrospective quality improvement project. SETTING: This study was conducted at geriatric hospital-based primary care clinics at the University of Pittsburgh Medical Center (UPMC), UPMC Senior Care Institute and UPMC Benedum Geriatric Center. PATIENTS: Subjects included were 65 years of age or older; had an office visit at UPMC Senior Care Institute or UPMC Benedum Geriatric Center from September 1, 2015, to August 31, 2017; and had a DOAC on their home medications. INTERVENTIONS: Data were obtained through retrospective chart review. MAIN OUTCOME MEASURE: The primary objective of the study was to evaluate the appropriateness of dosing of DOACs based on FDA-labeled recommendations. RESULTS: Of 232 patients included in analysis, 42.7% were found to have dosing inconsistent with FDAlabeled recommendations (47.3% apixaban, 35.8% rivaroxaban, and 31.6% dabigatran). No patients were prescribed edoxaban. The majority (72.7%) were dosed lower than FDA-recommended doses. Of all patients, the most frequent parameter (54.5%) for inappropriate dosing was patients meeting only 1 of 3 dose-reduction criteria when prescribed reduced-dose apixaban. Geriatrician and nongeriatrician prescribers had similar rates of prescribing DOACs with doses inconsistent with FDA-labeled recommendations (44.0% vs. 40.8%; P = 0.62). CONCLUSION: Results suggest that DOACs used in outpatient geriatric patients are frequently dosed inconsistent with FDA-approved dosing recommendations. Further research is needed regarding clinical outcomes in older patients receiving DOACs and in those with dose adjustments inconsistent with FDA-labeled recommendations.

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Influenza Immunization in Children with Cystic Fibrosis

Journal of International Medical Research ◽

10.1177/030006058701500603 ◽

1987 ◽

Vol 15 (6) ◽

pp. 344-351 ◽

Cited By ~ 14

Author(s):

P. Adlard ◽

K. Bryett

Keyword(s):

Cystic Fibrosis ◽

Side Effects ◽

Influenza Vaccine ◽

Haemagglutination Inhibition ◽

Serological Response ◽

Influenza Immunization ◽

Significant Difference ◽

To Receive ◽

Local Side

Nineteen children with cystic fibrosis and aged between 5 and 13 years were randomized to receive two doses at monthly intervals of either a split-virion influenza vaccine (MFV-Ject, Institut Merieux) or a sub-unit vaccine (Fluvirin, Evans). In those completing the study, there was a satisfactory serological response. There was no statistically significant difference between the immunogenicity of the two vaccines as evaluated by haemagglutination inhibition or single radial haemolysis tests. The incidence of local side-effects was similar in the two groups.

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Prevalence and Risk Factors of CoronaVac Side Effects: An Independent Cross-Sectional Study among Healthcare Workers in Turkey

Journal of Clinical Medicine ◽

10.3390/jcm10122629 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2629

Author(s):

Abanoub Riad ◽

Derya Sağıroğlu ◽

Batuhan Üstün ◽

Andrea Pokorná ◽

Jitka Klugarová ◽

...

Keyword(s):

Risk Factors ◽

Side Effects ◽

Healthcare Workers ◽

Age Groups ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Public Confidence ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

Background: COVID-19 vaccine hesitancy is a serious threat to mass vaccination strategies that need to be accelerated currently in order to achieve a substantial level of community immunity. Independent (non-sponsored) studies have a great potential to enhance public confidence in vaccines and accelerate their uptake process. Methods: A nationwide cross-sectional study for the side effects (SE) of CoronaVac was carried out in February 2021 among Turkish healthcare workers who were recently vaccinated. The questionnaire inquired about local and systemic SEs that occurred in the short-term, within four weeks, following vaccination. Results: A total of 780 healthcare workers were included in this study; 62.5% of them experienced at least one SE. Injection site pain (41.5%) was the most common local SE, while fatigue (23.6%), headache (18.7%), muscle pain (11.2%) and joint pain (5.9%) were the common systemic SEs. Female healthcare workers (67.9%) were significantly more affected by local and systemic SEs than male colleagues (51.4%). Younger age, previous infection, and compromised health status (chronic illnesses and regular medicines uptake) can be associated with an increased risk of CoronaVac SEs; Conclusions: The independent research shows a higher prevalence of CoronaVac SEs than what is reported by phase I–III clinical trials. In general, the results of this study confirm the overall safety of CoronaVac and suggest potential risk factors for its SEs. Gender-based differences and SEs distribution among age groups are worth further investigation.

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A Comparison of the Level of Acceptance and Hesitancy towards the Influenza Vaccine and the Forthcoming COVID-19 Vaccine in the Medical Community

Vaccines ◽

10.3390/vaccines9050475 ◽

2021 ◽

Vol 9 (5) ◽

pp. 475

Author(s):

Magdalena Grochowska ◽

Aleksandra Ratajczak ◽

Gabriela Zdunek ◽

Aleksander Adamiec ◽

Paweł Waszkiewicz ◽

...

Keyword(s):

Influenza Vaccine ◽

Healthcare Workers ◽

Medical Community ◽

Vaccine Hesitancy ◽

Allied Health Professionals ◽

Public Opinion Surveys ◽

Influenza Vaccinations ◽

To Receive ◽

Global Population ◽

Preliminary Description

Despite research conducted worldwide, there is no treatment specifically targeting SARS-CoV-2 infection with efficacy proven by randomized controlled trials. A chance for a breakthrough is vaccinating most of the global population. Public opinion surveys on vaccine hesitancy prompted our team to investigate Polish healthcare workers’ (HCWs) attitudes towards the SARS-CoV-2 and influenza vaccinations. In-person and online surveys of HCWs: doctors, nurses, medical students, and other allied health professionals (n = 419) were conducted between 14 September 2020 and 5 November 2020. In our study, 68.7% of respondents would like to be vaccinated against COVID-19. The safety and efficacy of COVID-19 vaccinations would persuade 86.3% of hesitant and those who would refuse to be vaccinated. 3.1% of all respondents claimed that no argument would convince them to get vaccinated. 61.6% of respondents declared a willingness to receive an influenza vaccination, of which 83.3% were also inclined to receive COVID-19 vaccinations. Although most respondents—62.5% (262/419) indicated they trusted in the influenza vaccine more, more respondents intended to get vaccinated against COVID-19 in the 2020/2021 season. The study is limited by its nonrandom sample of HCWs but provides a preliminary description of attitudes towards SARS-CoV-2 vaccination.

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Impact of age on excess risk of coronary heart disease in patients with familial hypercholesterolaemia

Heart ◽

10.1136/heartjnl-2017-312706 ◽

2018 ◽

Vol 104 (19) ◽

pp. 1600-1607 ◽

Cited By ~ 26

Author(s):

Liv J Mundal ◽

Jannicke Igland ◽

Marit B Veierød ◽

Kirsten Bjørklund Holven ◽

Leiv Ose ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

General Population ◽

Familial Hypercholesterolaemia ◽

Age Groups ◽

Primary Objective ◽

Excess Risk ◽

Hospital Death ◽

Increased Risk ◽

Incident Cases

ObjectiveThe primary objective was to study the risk of acute myocardial infarction (AMI) and coronary heart disease (CHD) in patients with familial hypercholesterolaemia (FH) and compare with the risk in the general population.MethodsPatients with an FH mutation but without prior AMI (n=3071) and without prior CHD (n=2795) were included in the study sample during 2001–2009. We obtained data on all AMI and CHD hospitalisations in Norway. We defined incident cases as first time hospitalisation or out-of-hospital death due to AMI or CHD. We estimated standardised incidence ratios (SIRs) with 95% CIs with indirect standardisation using incidence rates for the total Norwegian population stratified by sex, calendar year and 1 year age groups as reference rates.ResultsSIRs for AMI (95% CIs) were highest in the age group 25–39 years; 7.5 (3.7 to 14.9) in men and 13.6 (5.1 to 36.2) in women and decreased with age to 0.9 (0.4 to 2.1) in men and 1.8 (0.9 to 3.7) in women aged 70–79 years. Similarly, SIRs for CHD were highest among patients 25–39 years old; 11.1 (7.1–17.5) in men and 17.3 (9.6–31.2) in women and decreased 2.4 (1.4–4.2) in men and 3.2 (1.5–7.2) in women at age 70–79. For all age groups, combined SIRs for CHD were 4.2 (3.6–5.0) in men and 4.7 (3.9–5.7) in women.ConclusionPatients with FH are at severely increased risk of AMI and CHD compared with the general population. The highest excess risk was in the youngest group aged 25–39 years, in both sexes.

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Older adults’ vaccine hesitancy: psychosocial predictors of influenza, pneumococcal, & shingles vaccine uptake

Innovation in Aging ◽

10.1093/geroni/igaa057.3358 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 913-914

Author(s):

Louise Brown Nicholls ◽

Allyson Gallant ◽

Nicola Cogan ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Older Adults ◽

Influenza Vaccine ◽

Demographic Data ◽

Collective Responsibility ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Natural Immunity ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Abstract Influenza, pneumococcal disease, and shingles are more prevalent in older people, with this group having an increased risk of developing severe illnesses and complications. These illnesses are preventable via vaccination, but uptake of these vaccines is low and decreasing year-on-year. However, little research has focused on understanding the reasons behind vaccine hesitancy in older adults. We implemented a cross-sectional survey to determine the self-reported vaccination behaviours of 372 UK-based adults aged 65-92 years. We assessed previous uptake and future intention to receive the influenza, pneumococcal, and shingles vaccines. Participants also self-reported their health and socio-demographic data, and completed two scales measuring the psychological factors associated with vaccination behaviour (5C and VAX scales). Self-reported daily functioning, cognitive ability, and social support were also assessed. Considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines in this population. Greater calculation of the disease/vaccination risk and preference for natural immunity also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering predicted lack of uptake. Therefore, more understanding of vaccine benefits and disease risks may be required for these vaccines. Additional qualitative data generally supported these findings, which can contribute to future intervention development and research targeted at more diverse groups (e.g. older adults with cognitive impairments).

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COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases

Journal of Personalized Medicine ◽

10.3390/jpm11121283 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1283

Author(s):

Larisa Pinte ◽

Florentina Negoi ◽

Georgeta Daniela Ionescu ◽

Simona Caraiola ◽

Daniel Vasile Balaban ◽

...

Keyword(s):

Vaccine Hesitancy ◽

Control Group ◽

Disease Flare ◽

The Past ◽

Immune Mediated ◽

Increased Risk ◽

Risk Of Disease ◽

To Receive ◽

Autoimmune Phenomena

Background: Reports describing post-vaccine autoimmune phenomena, in previously healthy individuals, increased the concerns regarding the risk of disease flare-ups in patients with immune diseases. We aimed to assess the potential risk of disease flare-up, after receiving the COVID-19 (Coronavirus disease 2019) vaccine, during a follow-up period of 6 months. Methods: We performed a prospective cohort study, enrolling the patients with autoimmune- and immune-mediated diseases who voluntarily completed our questionnaire, both online and during hospital evaluations. Based on their decision to receive the vaccine, the patients were divided into two groups (vaccinated and non-vaccinated). Participants who chose not to receive the vaccine served as a control group in terms of flare-ups. Results: A total of 623 patients, 416 vaccinated and 207 non-vaccinated, were included in the study during hospital evaluations (222/623) and after online (401/623) enrolment. There was no difference concerning the risk of flare-up between vaccinated and non-vaccinated patients (1.16, versus 1.72 flare-ups/100 patients-months, p = 0.245). The flare-ups were associated with having more than one immune disease, and with a previous flare-up during the past year. Conclusions: We did not find an increased risk of flare-up following COVID-19 vaccination in patients with autoimmune-/immune-mediated diseases, after a median follow-up of 5.9 months. According to our results, there should not be an obvious reason for vaccine hesitancy among this category of patients.

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