Healthcare Workers Attitudes, Practices and Sources of Information for COVID-19 Vaccination: An Italian National Survey

Vaccination of healthcare workers (HCWs) is a crucial element to overcome the COVID-19 pandemic. The aim of this survey was to assess attitudes, sources of information and practices among Italian Healthcare workers (HCWs) in relation to COVID-19 vaccination. Methods: From 19 February to 23 April 2021, an anonymous voluntary questionnaire was sent to the mailing list of the main National Health Service structures. Data were collected through the SurveyMonkey platform. Results: A total of 2137 HCWs answered. Hesitancy towards COVID-19 vaccination was more frequent in females, in those with lower concern about COVID-19, and in nurses, auxiliary nurses (AN) and healthcare assistants. Hesitant professionals were more likely to not recommend vaccination to their patients or relatives, while a high concern about COVID-19 was related to an increased rate of recommendation to family members. HCWs were mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns were predictors influencing the aversion to mandatory vaccination. All categories of HCWs referred mainly to institutional sources of information, while scientific literature was more used by professionals working in the northern regions of Italy and in infection control, infectious diseases, emergencies and critical areas. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level were more likely to rely on internet, television, newspapers, and the opinions of family and friends. Conclusions: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories in order to efficiently reach all professionals, including the most hesitant ones.

Acceptance and use of communication technology by the elderly (Preprint)

BACKGROUND Population aging is a global phenomenon, with the proportion of the population over the age of 60 increasingly rapidly. However ownership and use of technology by people in this age group remains low, which impacts on introduction of and the assumptions made for, technology-based activities such as telehealth and telemedicine. It is essential to gain accurate information on the level of technology ownership in target groups. However, many studies on levels of technology ownership and use report using electronic methods for their survey, which introduces bias and may result in a higher value. OBJECTIVE To determine the level of ownership of technology in the elderly population using an unbiased data collection methodology. METHODS Our study collects data from patients invited to attend a clinic for their annual flu vaccination, and thereby captures a cross section of the population that is unbiased by the collection method. 309 patients completed a questionnaire, and were considered in three (3) age groups; young adults (25 to 45) (n=72), working-age (46 to 59) (n=80) and older adults (60 and above) (n=157). RESULTS In the older adult group (60+), 50 people (32%) out of 157 respondents had a mobile or smart phone and 107 (68%) did not; 38 people (24%) out of 157 respondents owned and used a computer and 119 (76%) had never used or owned a computer or tablet CONCLUSIONS Our results show a significantly lower ownership of technology in the elderly than found in other similar studies, which we attribute to the method of collection of the data, and consider to be a true reflection of the ownership in the general population.

Influenza A H1N1 mediated pre-existing immunity to SARS-CoV-2 predicts COVID-19 outbreak dynamics

Susceptibility to SARSCoV2 infections is highly variable, ranging from asymptomatic and mild infections in most, to deadly outcome in few. Here, we present evidence that antibodies induced by currently circulating influenza A H1N1 (flu) strains cross react with the most critical receptor binding motif of the SARSCoV2 spike protein that interacts with the ACE2 receptor. About 58 to 68% of blood donors in Stockholm had detectable antibodies to this cross-reactive peptide, NGVEGF, and seasonal flu vaccination trended to enhance binding of inhibitory antibodies to SARSCoV2. This peptide also activated CD8 T cells in 20% of healthy subjects. Eleven additional CD8 T cell peptides that cross react with flu and SARSCoV2 were identified that potentially protect against SARSCoV2 in 40 to 71% of individuals, depending on their HLA type.

Covid Vaccines for Children with Developmental Disabilities: Parent Survey of Willingness and Concerns

Objective While 1-in-6 US children has a developmental disability (DD), and such children are disproportionately affected by COVID-19, little is known about their vaccination status. We surveyed US parents of children with DDs to ascertain willingness and concerns regarding COVID-19 vaccines. Methods An online survey was distributed to national, statewide, and regional DD networks from June-September 2021. (Vaccines were authorized for adolescents in May 2021.) We report associations between vaccine willingness and concerns and: race/ethnicity, child age, in-person schooling, routine/flu vaccinations, and DD diagnoses. Willingness was categorized as Got /Will Get ASAP (high), Wait and See/Only if Required, or Definitely Not. Results 393 parents (51.2% white) responded. Willingness differed by age (p<.001). High willingness was reported for 75.3%, 48.9%, and 38.1% of children aged 12-17, 6-11 and 0-5 years-old, respectively. Willingness differed by Autism diagnosis (p<.001) and routine and flu vaccination status (p<.01). Predominant concerns included side effects (89%) and children with disabilities not being in trials (79%). Less common concerns were: COVID not serious enough in children to warrant vaccine (22%) and misinformation (e.g., microchips, 5G, DNA changes) (24%). Concerns about vaccine safety differed by age (p<.05) and were highest for young children. In age-stratified adjusted models, Autism was positively associated with high willingness for 6-11year-olds (OR= 2.66, 95% CI= 1.12-6.35). Conclusion Parents of children with DD are more willing for them to receive COVID-19 vaccines, compared to the general population. While few factors predicted willingness to vaccinate, addressing safety and developmental concerns regarding young children is warranted.

Nonadherence in diabetes care among US adults with diabetes by stroke status

Objective Effects of stroke (i.e., memory loss, paralysis) may make effective diabetes care difficult which can in turn contribute to additional diabetes related complications and hospitalization. However, little is known about US post-stroke diabetes care levels. This study sought to examine diabetes care levels among US adults with diabetes by stroke status. Methods Using 2015–2018 Behavioral Risk Factor Surveillance System surveys, the prevalence of nonadherence with the American Diabetes Association’s diabetes care measures (<1 eye exam annually, <1 foot exam annually, <1 blood glucose check daily, <2 A1C tests annually, no receipt of annual flu vaccination) was ascertained in people with diabetes by stroke status. A separate logistic regression model was run for each diabetes care measure to determine if nonadherence patterns differed by stroke status after adjustment for stroke and diabetes associated factors. Results Our study included 72,630 individuals, with 9.8% having had a stroke. Nonadherence levels varied for each diabetes care measure ranging from 20.4–42.2% for stroke survivors and 22.8–44.0% for those who had never had stroke. By stroke status, nonadherence with diabetes management measures was comparable except for stroke survivors having both a lower prevalence (30.2% versus 40.1%) and odds of nonadherence (OR: 0.73, 95% CI: 0.65, 0.82) with daily blood glucose check than those who had never had stroke. Conclusion While nonadherence with diabetes management does not vary by stroke status, considerable nonadherence still exists among stroke survivors with diabetes. Additional interventions to improve diabetes care may help to reduce risk of further diabetes complications in this population.

The role of non–COVID-specific and COVID-specific factors in predicting a shift in willingness to vaccinate: A panel study

Although declines in intent to vaccinate had been identified in international surveys conducted between June and October 2020, including in the United States, some individuals in the United States who previously expressed reluctance said, in spring 2021, that they were willing to vaccinate. That change raised the following questions: What factors predicted an increased willingness to inoculate against COVID-19? And, to what extent was the change driven by COVID-specific factors, such as personal worry about the disease and COVID-specific misinformation, and to what extent by background (non–COVID-specific) factors, such as trust in medical authorities, accurate/inaccurate information about vaccination, vaccination history, and patterns of media reliance? This panel study of more than 8,000 individuals found that trust in health authorities anchored acceptance of vaccination and that knowledge about vaccination, flu vaccination history, and patterns of media reliance played a more prominent role in shifting individuals from vaccination hesitance to acceptance than COVID-specific factors. COVID-specific conspiracy beliefs did play a role, although a lesser one. These findings underscore the need to reinforce trust in health experts, facilitate community engagement with them, and preemptively communicate the benefits and safety record of authorized vaccines. The findings suggest, as well, the need to identify and deploy messaging able to undercut health-related conspiracy beliefs when they begin circulating.

Adherence, Perception of, and Attitude toward Influenza and Flu Vaccination: A Cross-Sectional Study among a Population of Future Healthcare Workers

Healthcare students (HCSs) represent a target category for seasonal flu vaccination. This study aimed to examine adherence to flu vaccination campaigns from 2016 to 2019 among HCSs and to investigate knowledge and perception of and attitude toward influenza and flu vaccination. This cross-sectional study was conducted among the HCSs of a northern Italian university. Data on adherence, knowledge, perception, and attitude were investigated through an anonymous online self-administered questionnaire. The questionnaire was filled out by 352 out of 392 third-year HCSs (response rate = 90%). The main reason for refusal was the perception of influenza as non-threatening (24.4%), while self-protection was the main reason for adherence (87.5%). A univariate logistic regression analysis revealed some statistically significant associations with the adherence to the 2018–2019 campaign: being a nursing/midwifery student (OR: 4.14; 95% CI: 1.77–9.71) and agreeing with (OR: 19.28; 95% CI: 2.47–146.85) or being undecided (OR: 10.81; 95% CI: 1.33–88.27) about the obligation of vaccination in health facilities. The associations were also evaluated with a multiple logistic regression model. Despite the low vaccine uptake, good knowledge of the risks for HCSs and patients related to flu has emerged. Improving promotion strategies will be necessary to increase the adhesion of future healthcare workers.

Vaccine hesitancy for COVID-19 explored in a phenomic study of 259 socio-cognitive-behavioural measures in the UK-REACH study of 12,431 UK healthcare workers

Background Vaccination is key to successful prevention of COVID-19 particularly nosocomial acquired infection in health care workers (HCWs). 'Vaccine hesitancy' is common in the population and in HCWs, and like COVID-19 itself, hesitancy is more frequent in ethnic minority groups. UK-REACH (United Kingdom Research study into Ethnicity and COVID-19 outcomes) is a large-scale study of COVID-19 in UK HCWs from diverse ethnic backgrounds, which includes measures of vaccine hesitancy. The present study explores predictors of vaccine hesitancy using a 'phenomic approach', considering several hundred questionnaire-based measures. Methods UK-REACH includes a questionnaire study encompassing 12,431 HCWs who were recruited from December 2020 to March 2021 and completed a lengthy online questionnaire (785 raw items; 392 derived measures; 260 final measures). Ethnicity was classified using the Office for National Statistics' five (ONS5) and eighteen (ONS18) categories. Missing data were handled by multiple imputation. Variable selection used the islasso package in R, which provides standard errors so that results from imputations could be combined using Rubin's rules. The data were modelled using path analysis, so that predictors, and predictors of predictors could be assessed. Significance testing used the Bayesian approach of Kass and Raftery, a 'very strong' Bayes Factor of 150, N=12,431, and a Bonferroni correction giving a criterion of p<4.02 x 10-8 for the main regression, and p<3.11 x 10-10 for variables in the path analysis. Results At the first step of the phenomic analysis, six variables were direct predictors of greater vaccine hesitancy: Lower pro-vaccination attitudes; no flu vaccination in 2019-20; pregnancy; higher COVID-19 conspiracy beliefs; younger age; and lower optimism the roll-out of population vaccination. Overall 44 lower variables in total were direct or indirect predictors of hesitancy, with the remaining 215 variables in the phenomic analysis not independently predicting vaccine hesitancy. Key variables for predicting hesitancy were belief in conspiracy theories of COVID-19 infection, and a low belief in vaccines in general. Conspiracy beliefs had two main sets of influences: i) Higher Fatalism, which was influenced a) by high external and chance locus of control and higher need for closure, which in turn were associated with neuroticism, conscientiousness, extraversion and agreeableness; and b) by religion being important in everyday life, and being Muslim. ii) receiving information via social media, not having higher education, and perceiving greater risks to self, the latter being influenced by higher concerns about spreading COVID, greater exposure to COVID-19, and financial concerns. There were indirect effects of ethnicity, mediated by religion. Religion was more important for Pakistani and African HCWs, and less important for White and Chinese groups. Lower age had a direct effect on hesitancy, and age and female sex also had several indirect effects on hesitancy. Conclusions The phenomic approach, coupled with a path analysis revealed a complex network of social, cognitive, and behavioural influences on SARS-Cov-2 vaccine hesitancy from 44 measures, 6 direct and 38 indirect, with the remaining 215 measures not having direct or indirect effects on hesitancy. It is likely that issues of trust underpin many associations with hesitancy. Understanding such a network of influences may help in tailoring interventions to address vaccine concerns and facilitate uptake in more hesistant groups.

COVID-19 Impact and Vaccination Willingness among Romanian Patients with Autoimmune/Immune-Mediated Diseases

Background: During the COVID-19 pandemic, patients with immune diseases are a vulnerable population. We aimed to evaluate their access to medical care, as well as their awareness and willingness to obtain the vaccine after a year of the SARS-CoV-2 pandemic. Methods: A cross-sectional, multicenter study was conducted on a questionnaire basis, handled both online as well as in person. Results: 651 patients with autoimmune or immune mediated diseases were enrolled. More than half (339/641 [53%]) reported difficulties in obtaining medical care throughout the pandemic and 135/651 ([21%]) of them were confirmed with COVID-19; 442/651, ([68%]) expressed their willingness to be vaccinated against SARS-CoV-2. The factors associated with an increased probability of vaccination were the male gender (OR = 2.01, CI95% 1.2–3.7, p = 0.001), the patient’s opinion that she/he was well informed (OR = 3.2, CI 95% 2.1–6.01, p < 0.001), physician’s advice (OR = 2.1, CI 95% 1.3–3.5, p < 0.001), and flu vaccination in the past (OR = 1.5, CI 95% 1.1–2.3, p < 0.001), while those associated with a decreased probability of vaccination were COVID-19 disease in the past medical history (OR = 0.7, CI 95% 0.3-0.95, p = 0.02), and the opinion that patients with autoimmune diseases are at increased risk for adverse reactions (OR = 0.7, CI95% 0.53–0.89, p = 0.001). Conclusions: Given the fact that considering themselves informed regarding vaccination is the most important factor in order to be immunized against SARS-CoV-2, effective information campaigns would substantially increase willingness.

Influenza virus vaccination in pediatric nephrotic syndrome significantly reduces rate of relapse and influenza virus infection as assessed in a nationwide survey

Although vaccination may precipitate relapses of nephrotic syndrome (NS) in children with idiopathic NS, no data are available regarding NS activity regarding influenza (flu) virus infections and NS relapses after receiving inactivated flu vaccines. We conducted a nationwide study of children aged 6 months to 15 years with idiopathic NS to assess the relationship between NS relapse, flu vaccination, and flu infections. We used a multivariate Poisson regression model (MPRM) to calculate the risk ratio (RR) for flu infection and for NS relapse in children with and without flu vaccination. Data of 306 children were assessed. The MPRM in all 306 children showed a significantly lower RR for flu infection (RR: 0.21, 95% confidence interval CI 0.11–0.38) and for NS relapse (RR: 0.22, 95% CI 0.14–0.35) in children receiving flu vaccination compared with unvaccinated children. In an additional MPRM only among 102 children receiving flu vaccination, they had a significantly lower risk for NS relapse during the post-vaccination period (RR: 0.31. 95% CI 017–0.56) compared with the pre-vaccination period. Although our study was observational, based on the favorable results of flu vaccinations regarding flu infections and NS relapse, the vaccine may be recommended for children with NS.