Global COVID-19 Vaccine Acceptance: A Systematic Review of Associated Social and Behavioral Factors

COVID-19 vaccines have met varying levels of acceptance and hesitancy in different parts of the world, which has implications for eliminating the COVID-19 pandemic. The aim of this systematic review is to examine how and why the rates of COVID-19 vaccine acceptance and hesitancy differ across countries and continents. PubMed, Web of Science, IEEE Xplore and Science Direct were searched between 1 January 2020 and 31 July 2021 using keywords such as “COVID-19 vaccine acceptance”. 81 peer-reviewed publications were found to be eligible for review. The analysis shows that there are global variations in vaccine acceptance among different populations. The vaccine-acceptance rates were the highest amongst adults in Ecuador (97%), Malaysia (94.3%) and Indonesia (93.3%) and the lowest amongst adults in Lebanon (21.0%). The general healthcare workers (HCWs) in China (86.20%) and nurses in Italy (91.50%) had the highest acceptance rates, whereas HCWs in the Democratic Republic of Congo had the lowest acceptance (27.70%). A nonparametric one-way ANOVA showed that the differences in vaccine-acceptance rates were statistically significant (H (49) = 75.302, p = 0.009*) between the analyzed countries. However, the reasons behind vaccine hesitancy and acceptance were similar across the board. Low vaccine acceptance was associated with low levels of education and awareness, and inefficient government efforts and initiatives. Furthermore, poor influenza-vaccination history, as well as conspiracy theories relating to infertility and misinformation about the COVID-19 vaccine on social media also resulted in vaccine hesitancy. Strategies to address these concerns may increase global COVID-19 vaccine acceptance and accelerate our efforts to eliminate this pandemic.

Prevalence, characteristics, and predictors of Long COVID among diagnosed cases of COVID-19

Background: Long COVID or long-term complication after COVID-19 has the ability to affect health and quality of life. Knowledge about the burden and predictors could aid in their prevention and management. Most of the studies are from high-income countries and focus on severe cases. We did this study to estimate the prevalence and identify the characteristics and predictors of Long COVID among our patients. Methodology: We recruited adult (≥18 years) patients who were diagnosed as Reverse Transcription Polymerase Chain Reaction (RTPCR) confirmed SARS-COV-2 infection and were either hospitalized or tested on outpatient basis. Eligible participants were followed up telephonically after four weeks of diagnosis of SARS-COV-2 infection to collect data on sociodemographic, clinical history, vaccination history, Cycle threshold (Ct) values during diagnosis and other variables. Characteristic of Long COVID were elicited, and multivariable logistic regression was done to find the predictors of Long COVID. Results: We have analyzed 487 individual data with a median follow-up of 44 days (Inter quartile range (IQR): 39,47). Overall, Long COVID was reported by 29.2% (95% Confidence interval (CI): 25.3%,33.4%) participants. Prevalence of Long COVID among patients with mild/moderate disease (n = 415) was 23.4% (95% CI: 19.5%,27.7%) as compared to 62.5% (95% CI: 50.7%,73%) in severe/critical cases(n=72). The most common Long COVID symptom was fatigue (64.8%) followed by cough (32.4%). Statistically significant predictors of Long COVID were - Pre-existing medical conditions (Adjusted Odds ratio (aOR)=2.00, 95% CI: 1.16,3.44), having a more significant number of symptoms during acute phase of COVID-19 disease (aOR=11.24, 95% CI: 4.00,31.51), two doses of COVID-19 vaccination (aOR=2.32, 95% CI: 1.17,4.58), the severity of illness (aOR=5.71, 95% CI: 3.00,10.89) and being admitted to hospital (Odds ratio (OR)=3.89, 95% CI: 2.49,6.08). Conclusion: A considerable proportion of COVID-19 cases reported Long COVID symptoms. More research is needed in Long COVID to objectively assess the symptoms and find the biological and radiological markers.

The Willingness of Malaysian Parents To Vaccinate Their Children Below 12 Years Old Against COVID-19 – A Large Cross-Sectional Study

Background:The administration of a new drug such as the COVID-19 vaccine in children could be a major concern for their parents. This study aims to assess the willingness of Malaysian parents to vaccinate their children < 12 years old against COVID-19. Methods:An online cross-sectional study was conducted nationwide in Malaysia from 29th August 2021 to 17th October 2021. Parents with children < 12 years old were recruited by the snowball sampling method. Results:Of the 4,438 survey responses received, 3,528 (79.5%) parents were included in the analysis. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still undecided to vaccinate their children against COVID-19. Those who were single parent [odds ratio (OR): 2.0, 95% confidence internal (CI): 1.32 – 3.04, p = 0.001], had secondary or lower education (OR: 1.5, 95% CI: 1.21 – 1.96, p < 0.001), worked as healthcare worker (OR: 1.7, 95% CI: 1.34 – 2.26, p < 0.001), had significant contact with COVID-19 (OR: 1.3, 95% CI: 1.09 – 1.63, p = 0.006), and already received COVID-19 vaccine (OR: 15.4, 95% CI: 9.76 – 24.33, p < 0.001) were significantly more willing to vaccinate their children against COVID-19. The common reasons given by parents who were willing to vaccinate their children against COVID-19 include vaccination could protect their children (99.4%), the vaccination could protect other family members (99.3%), and the vaccine was effective (98.2%). The common reasons given by parents who were not willing to vaccinate their children against COVID-19 include the uncertainty towards the new vaccine (96.1%), worry about the vaccine contents (93.2%), limited information about the vaccine from the doctors (82.3%), and believed the vaccine was unsafe (79.8%)Conclusions:Nearly three-quarters of Malaysian parents were willing to vaccinate their children < 12 years old against COVID-19. The COVID-19 vaccination history of the parents was the strongest independent predictor for their willingness to vaccinate their children. Future health education should target parents at risk of vaccine refusal or hesitation, focus to address the common reasons for refusing the COVID-19 vaccine, and highlight the benefits of the COVID-19 vaccine.

CODCA – COVID-19 ONTOLOGY FOR DATA COLLECTION AND ANALYSIS IN E-HEALTH

Coronavirus (Covid-19) pandemic is one of the most deadly diseases that cause the death of millions around the world. Automatic collection and analysis of Covid-19 patient data will help medical practitioners in containing the virus. For this purpose, Semantic Web technologies can be utilized, which allows machine-processable data and enables data sharing, and reuse across machines. In this paper, we propose a Covid-19 ontology (named CODCA) that helps in collecting, analysing, and sharing medical information about people in the e-health domain. In particular, the proposed ontology uses information about medical history, drug history, vaccination history, and symptoms in order to analyse Covid-19 risk factors of people and their treatment plans. In this way, information about Covid-19 patients can be automatically processed and can be re-usable by other applications. We also demonstrate extensive semantic queries (i.e. SPARQL queries) to search the created metadata. Furthermore, we illustrate the usage of semantic rules (i.e. SWRL) so that treatment plans for individual patients can be inferred from the available knowledge.

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.

Comparative Cohort Epidemiological Study of Collective Immunity against New Coronavirus Infection among Different Groups of Military Personnel

Background. The need to study the population immunity to the SARS-CoV-2 virus is due to the intensive spread of COVID-19 and the implementation of immunoprophylaxis of this infection. The identification of the features of the formation of immunoresistance in organized military collectives will allow us to predict the development of the epidemic situation, including among comparable population groups. Aims the study of population immunity to the SARS-CoV-2 virus in the context of the COVID-19 pandemic against the background of specific immunoprophylaxis in organized military collectives. Methods. According to epidemiological indications, an epidemiological study of collective immunity to the SARS-CoV-2 virus was conducted against the background of vaccination among cadets of military educational organizations. The study involved 497 people, divided into groups by epidemiological and vaccination history for COVID-19, blood groups and Rh factor. The assessment of the immunity intensity was carried out by the levels of class G immunoglobulins (IgG) to SARS-CoV-2 in the blood serum by the method of solid-phase enzyme immunoassay. Results. Seroprevalence in the total sample was 92.6%. The highest rates were observed among vaccinated patients: those who were not ill and vaccinated 99.0 0.7%, those who were ill and vaccinated-100% (mean geometric antibody titers 1:2234 and 1:4399). Among the ill, unvaccinated individuals, the seroprevalence index was 84.5 3.2% (1:220). Among those who were not ill, not vaccinated 8.2 3.1% (1:113), which may indicate a hidden course of the epidemic process in the team. A negative immune response was more common (tSt = 2.01; p 0.05) in individuals A(II)Rh+ blood group. The highest proportion of maximum antibody titers (1:32001:6400) was determined in AB(IV) individuals. Rh-blood groups (tSt=2.21; p 0.05). Conclusions. For the first time, the formation of combined immunity with the highest concentrations of specific antibodies was revealed in patients who have been ill and vaccinated has been revealed, which allows us to recommend vaccination to those who have suffered from COVID-19. The emergence of post-infectious immunity in organized groups with a latent epidemic process has been established. The relationship between the intensity of immunity with blood groups and the Rh factor was found.

Influence of Prior Influenza Vaccination on Current Influenza Vaccine Effectiveness in Children Aged 1 to 5 Years

Background: Although annual influenza vaccination is an important strategy used to prevent influenza-related morbidity and mortality, some studies have reported the negative influence of prior vaccination on vaccine effectiveness (VE) for current seasons. Currently, the influence of prior vaccination is not conclusive, especially in children. Methods: We evaluated the association between current-season VE and prior season vaccination using a test-negative design in children aged 1–5 years presenting at nine outpatient clinics in Japan during the 2016/17 and 2017/18 influenza seasons. Children with influenza-like illness were enrolled prospectively and tested for influenza using real-time RT-PCR. Their recent vaccination history was categorized into six groups according to current vaccination doses (0/1/2) and prior vaccination status (unvaccinated = 0 doses/vaccinated = 1 dose or 2 doses): (1) 0 doses in the current season and unvaccinated in prior seasons (reference group); (2) 0 doses in the current season and vaccinated in a prior season; (3) 1 dose in the current season and unvaccinated in a prior season; (4) 1 dose in the current season and vaccinated in a prior season; (5) 2 doses in the current season and unvaccinated in a prior season, and (6) 2 doses in the current season and vaccinated in a prior season. Results: A total of 799 cases and 1196 controls were analyzed. The median age of the subjects was 3 years, and the proportion of males was 54%. Overall, the vaccination rates (any vaccination in the current season) in the cases and controls were 36% and 53%, respectively. The VEs of the groups were: (2) 29% (95% confidence interval: −25% to 59%); (3) 53% (6% to 76%); (4) 70% (45% to 83%); (5) 56% (32% to 72%), and (6) 61% (42% to 73%). The one- and two-dose VEs of the current season were significant regardless of prior vaccination status. The results did not differ when stratified by influenza subtype/lineage. Conclusion: Prior vaccination did not attenuate the current-season VE in children aged 1 to 5 years, supporting the annual vaccination strategy.

Functional and Binding H1N1pdm09-Specific Antibody Responses in Occasionally and Repeatedly Vaccinated Healthcare Workers: A Five-Year Study (2009-2014)

BackgroundIn 2009, a novel influenza A/H1N1pdm09 emerged and caused a pandemic. This strain continued to circulate and was therefore included in the seasonal vaccines up to the 2016/2017-season. This provided a unique opportunity to study the long-term antibody responses to H1N1pdm09 in healthcare workers (HCW) with a different vaccination history.MethodsHCW at Haukeland University Hospital, Bergen, Norway were immunized with the AS03-adjuvanted H1N1pdm09 vaccine in 2009 (N=55) and divided into groups according to their vaccination history; one vaccination (N=10), two vaccinations (N=15), three vaccinations (N=5), four vaccinations (N=15) and five vaccinations (N=10). HCW are recommended for influenza vaccination to protect both themselves and their patients, but it is voluntary in Norway. Blood samples were collected pre- and at 21 days, 3, 6, and 12 months after each vaccination, or annually from 2010 HCW without vaccination. ELISA, haemagglutination inhibition (HI) and microneutralization (MN) assays were used to determine the antibody response.ResultsPandemic vaccination induced a significant increase in the H1N1-specific antibodies measured by ELISA, HI and MN. Seasonal vaccination boosted the antibody response, both in HCW with only the current vaccination and those with prior and current vaccination during 2010/11-2013/14. We observed a trend of increased antibody responses in HCW with only the current vaccination in 2013/14. A two- and three-year gap before vaccination in 2013/14 provided a more potent antibody response compared to annually vaccinated HCW.ConclusionsOur long term follow up study elucidates the antibody response in HCW with different vaccination histories. Our findings contribute to our understanding of the impact of repeated vaccination upon antibody responses.

ImmunoStart: preparing patients for immunosuppression

Objectives Patients with immune-mediated inflammatory disease (IMID) present an increased risk of infection. Here, we present the concept of a preventive consultation called ImmunoStart and the first results of its implementation in the care pathway of patients with IMID. Methods Relevant information about vaccination history, TB exposition and other infectious risks are collected through blood sampling, complete anamnesis, chest X-Ray and Mantoux test. During ImmunoStart consultation, vaccination schedules, specific treatments and risk considerations are discussed. Results Between October 2016 and February 2020, 437 patients were seen at the ImmunoStart consultation, mainly referred by rheumatologists (56%), dermatologists (25%), and gastroenterologists (18%). A total of 421 (96%) patients needed at least one vaccine (a mean of 3.3 vaccines per patient). Live attenuated vaccine was indicated for 45 patients (10%), requiring them to reduce or interrupt their immunosuppressive drug(s). Ninety-two patients (21%) were treated for latent TB infection. Conclusion This preventive consultation provides a centralized and systematic setting for the direct management of patients with IMID in need of vaccination, treatment of latent disease and specific advice regarding their immunomodulating treatments.