Supporting Tourism by Assessing the Predictors of COVID-19 Vaccination for Travel Reasons

The persistence of the SARS-CoV-2 virus imposed vaccination passports for traveling in most countries. We investigated psychological factors that predict the intention to vaccinate for travel. In a cross-sectional study, we examined how demographic variables, vaccination status, perceived risk of infection and severity of disease contracted at travel destination, safety and effectiveness of vaccines against contracting COVID-19 during travel, and conspiracy beliefs are related to intention to vaccinate for travel. Further analyses involved differences between vaccinated and unvaccinated individuals in a Romanian sample regarding conspiracy beliefs, attitudes about vaccines, and self-efficacy of controlling COVID-19 infection. Results showed that the intention to vaccinate for travel reasons is best predicted by vaccination status and perceptions of safety and efficacy of vaccines against COVID-19. Thus, vaccinated individuals believing that vaccines are safe and effective most probably will take another vaccine booster if it will allow them to travel. Positive relationships of the intention to vaccinate for travel reasons were found with age, vaccination status, conspiracy beliefs, perceptions of safety and effectiveness of vaccines, intention to travel, and a more cautious approach to travel. No significant relationships were found between perceptions of risk for self or for transmitting the disease to others, severity of disease, and the intention to vaccinate for travel. We also found significant differences between vaccinated and unvaccinated participants, as unvaccinated participants showed higher levels of conspiracy beliefs and less trust in the safety and efficacy of vaccines. We conclude that campaigns focused on promoting information on the safety and efficacy of vaccines is the most important direction for promoting vaccination in young travelers.

Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States

Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection.

Diphtheria resurgence in Sada'a-Yemen, 2017–2020

Background Diphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children. Methods A study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors. Results 747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05). Conclusions The findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.

COVID-19 vaccination status should not be used in triage tie-breaking

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.

Effect of Vaccination on Household Transmission of SARS-CoV-2 Delta VOC

The SARS-CoV-2 Delta variant of concern (VOC), which has shown increased transmission compared with previous variants, emerged rapidly globally during the first half of 2021, and became one of the most widespread SARS-CoV-2 variants worldwide. We utilized total population data from 24,693 Danish households with 53,584 potential secondary cases to estimate household transmission of the Delta VOC in relation to vaccination status. We found that the vaccine effectiveness against susceptibility (VES) was 61\% (95\%-CI: 59-63) and that the vaccine effectiveness against transmissibility (VET) was 42\% (95\%-CI: 39-45). We also found that unvaccinated individuals with an infection exhibited a higher viral load (one third of a standard deviation) compared to fully vaccinated individuals with a breakthrough infection. Our results imply that vaccinations reduce susceptibility as well as transmissibility. The results are important for policy makers to select strategies for reducing transmission of SARS-CoV-2.

COVID-19 vaccination status is associated with physical activity in German-speaking countries: the COR-PHYS-Q cohort study

BackgroundTo examine the association between COVID-19 vaccination status and physical activity (PA), sporting behavior, as well as barriers to PA in adults in Switzerland, Germany, and Austria.MethodsA total of 1516 adults provided complete responses to our online questionnaire sent out in August 2021. Information about self-reported PA categories, sporting behavior, barriers to PA, and COVID-19 vaccination status were gathered. Main analyses were done using multiple linear regression adjusted for relevant parameters.ResultsWe found a significant association of vaccination status with total PA (p = .011), vigorous PA (p = .015), and moderate PA (p = .001) but not transport-related PA or sedentary time. Unvaccinated adults tended to have more total and vigorous PA than those vaccinated once (ratios of geometric means: 1.34 and 1.60, respectively) or twice (1.22 and 1.09, respectively). Yet, not sufficient evidence was available to confirm this. There was no between-group difference in the contribution of leisure time, work-related, or transport-related PA to total PA. Vaccination status was not associated with sporting behavior except for jogging as the primary intensive type of sports. Finally, there were no significant differences in any of the COVID-19 specific barriers to PA between groups.ConclusionOur data showed that vaccination status is associated with PA even in summer, where the number of COVID-19 cases was low and the severity of safety measures was mild. These findings may enhance future research and improve/extend COVID-19-specific PA guidelines.

Why do people consent to receiving SARS-CoV2 vaccinations? A Representative Survey in Germany

Objective: to answer the question: Why do people consent to being vaccinated with novel vaccines against SARS-CoV2? Design: Representative survey Setting: Online panel Participants: 1032 respondents of the general German population Method: a representative survey among German citizens in November/December 2021 which resulted in 1032 complete responses on vaccination status, socio-demographic parameters and opinions about the COVID-19 situation. Results: Almost 83% of the respondents were vaccinated. The major motivation was fear of medical consequences of an infection and the wish to lead a normal life again. The major motivation to be not vaccinated was the fear of side effects and skepticism about long-term effectiveness and safety. Sixteen percent of vaccinated respondents reported some serious side effect, while more than 30% reported health improvements, mostly due to the relief of psychological stress and social reintegration. We also validated a “Corona Orthodoxy Score – COS” consisting of 7 items reflecting opinions on Covid-19. The scale is reliable (alpha = 0.76) and unidimensional. The COS was a highly significant predictor of vaccination status and readiness to be vaccinated in a multivariable logistic regression model. Those who were vaccinated were more likely to live in smaller households (OR = 0.82, p=0.024), had a higher income (OR = 1.27, p<0.001), a higher COS score (OR 1.4, p<0.0001) and utilized less alternative media (OR = 0.44, p=0.0024) and scientific publications (OR=0.42, p=0.011) as information sources. Conclusions: The major motives for being vaccinated are fear of medical symptoms and the wish to lead a normal life. Those not wanting to be vaccinated cite a lack of knowledge regarding long-term safety and side effects as reasons. This can likely only be overcome by careful and active long-term efficacy and safety monitoring.

The Global Impact of COVID-19 on Craniomaxillofacial Surgeons: A Follow-Up Survey After One Year

Study Design Comparative cross-sectional. The Objective To measure the impact that COrona VIrus Disease-19 (COVID-19) has had on craniomaxillofacial (CMF) surgeons after 1 year and compare it with 2020 data by ( 1) measuring access to adequate personal protective equipment (PPE), ( 2) performance of elective surgery, and ( 3) the vaccination status. This should be investigated because most CMF surgeons felt that hospitals did not provide them with adequate PPE. Methods The investigators surveyed the international AO CMF membership using a 30-item online questionnaire and compared it to a previous study. The primary predictor variable was year of survey administration. Primary outcome variables were availability of adequate personal protective equipment (adequate/inadequate), performance of elective surgery (yes/no), and vaccination status (fully vaccinated/partly vaccinated/not vaccinated). Descriptive and analytic statistics were computed. Binary logistic regression models were created to measure the association between year and PPE availability. Statistical significance level was set at P < .05. Results The sample was composed of 523 surgeons (2% response rate). Most surgeons reported access to adequate PPE (74.6%). The most adequate PPE was offered in Europe (87.8%) with the least offered in Africa (45.5%). Surgeons in 2021 were more likely to report adequate PPE compared to 2020 (OR 3.74, 95% CI [2.59–4.39]). Most of the respondents resumed elective surgery (79.5% vs 13.3% in 2020) and were fully vaccinated (59.1%). Conclusion Most CMF surgeons now have access to adequate PPE, resumed elective surgery, and are either fully or partly vaccinated. Future studies should investigate the long-term impact of the fast-evolving COVID-19 pandemic on CMF surgeons.

Defining Antibody Seroprevalence and Duration of Humoral Responses to SARS-CoV-2 Infection and/or Vaccination in a Greek Community

Background: In this work we aimed to evaluate antibody-response longevity to SARS-CoV-2 infection and/or vaccination in one of the Greek communities that was worst hit by the pandemic, Deskati, five months after a previous serosurveillance and nine months after the pandemic wave initiation (October 2020). Methods: The SARS-CoV-2 IgG II Quant method (Architect, Abbott, IL, USA) was used for antibody testing. Results: A total of 69 subjects, who previously tested positive or negative for COVID-19 antibodies, participated in the study. We found that 48% of participants turned positive due to vaccination and 27% of participants were both previously infected and vaccinated. All previously infected participants retained antibodies to the virus, irrespective of their vaccination status. The antibody titers were significantly higher in previously infected participants that had been vaccinated than those who were unvaccinated and in those that had been previously hospitalized for COVID-19 than those with mild disease. Conclusions: Antibody responses to SARS-CoV-2 infection were maintained nine months after the pandemic. Vaccination alone had generated an immune response in almost half of the population. Higher antibody titers were found in the case of vaccination in previously infected subjects and especially in those with severe disease leading to hospitalization

I trust my immunity more than your vaccines: “Appeal to nature” bias strongly predicts questionable health behaviors in the pandemic

Health care policies often rely on public cooperation, especially during a health crisis. However, a crisis is also a period of uncertainty and proliferation of health related advice: while some people adhere to the official recommendations, others tend to avoid them and resort to non-evidence based, pseudoscientific practices. People prone to the latter are often the ones endorsing a set of epistemically suspect beliefs, with two being particularly relevant: conspiratorial pandemic-related beliefs, and the appeal to nature bias (i.e. trusting natural immunity to fight the pandemic). These in turn are rooted in trust in different epistemic authorities, seen as mutually exclusive: trust in science and trust in the “wisdom of the common man”. Drawing from two nationally representative probability samples, we tested a model in which trust in science/wisdom of the common man predicted COVID-19 vaccination status (Study 1, N = 1001) or vaccination status alongside use of pseudoscientific health practices (Study 2, N = 1010), through COVID-19 conspiratorial beliefs and the appeal to nature bias. As expected, epistemically suspect beliefs were interrelated, related to vaccination status, and to both types of trust. Moreover, trust in science had both a direct and indirect effect on vaccination status through both types of epistemically suspect beliefs. Trust in the wisdom of the common man had only an indirect effect on vaccination status. Contrary to the way they are typically portrayed, the two types of trust were unrelated. These results were largely replicated in the second study, in which we added pseudoscientific practices as an outcome; trust in science and the wisdom of the common man contributed to their prediction only indirectly, through epistemically suspect beliefs. We offer recommendations on how to make use of different types of epistemic authorities and how to tackle unfounded beliefs in communication during a health crisis.