COVID-19 and influenza vaccine hesitancy among college students

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

Data on US caregiver perceptions on coronavirus disease 2019 (COVID-19) and COVID-19 vaccination are limited. We identified trends in and associations with COVID-19 vaccine hesitancy in caregivers of hospitalized children. Cross-sectional surveys on pediatric COVID-19 disease and vaccine attitudes, behaviors, and beliefs were administered across study years (December 8, 2020-April 5, 2021, November 30, 2021-March 15, 2022, and October 26, 2022-March 15, 2023). English and Spanish-speaking caregivers of hospitalized children ages 6 months to 11 years were included. General vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey. Of 1268 caregivers from diverse backgrounds, one-third vaccinated or intended to vaccinate their child. Half endorsed fear of their child receiving the COVID-19 vaccine and were concerned the vaccine was new. Over time, more believed "the COVID-19 vaccine does not work" and fewer agreed "children who are otherwise healthy can die from COVID-19." Study season (2022-2023), older child age, higher income, child receipt of influenza vaccine, caregiver receipt of COVID-19 vaccine, and not being worried about vaccine novelty were positively associated with child vaccination. Intent to vaccinate was negatively associated with study season (2022-2023), Parent Attitudes about Childhood Vaccines score ≥50, lack of child influenza and caregiver COVID-19 vaccination, lack of fear of their child "getting COVID-19" and being "worried that the COVID-19 vaccine is new." The majority who intended to vaccinate were willing to immunize before discharge. Vaccine novelty and perceived lack of need were associated with refusal. Caregiver COVID-19 and child influenza vaccine acceptance were positively associated with COVID-19 vaccine acceptance. The inpatient setting offers the opportunity to improve vaccine uptake.

Healthcare workers (HCWs) are a priority group for coronavirus disease 2019 (COVID-19) and influenza vaccination. We evaluated sociodemographic and occupational factors, attitudes, and knowledge associated with the uptake of primary and booster doses of COVID-19 and seasonal influenza vaccines among HCWs. Between February 2022 and February 2023, we administered a structured questionnaire to HCWs in 3 Albanian hospitals who were enrolled in a multiyear cohort study. The questionnaire assessed participants' knowledge, confidence, and attitudes toward COVID-19 and seasonal influenza vaccines, and included questions on COVID-19 and influenza vaccination history, perceptions of vaccine safety and effectiveness, and factors influencing vaccine decision-making. We included 1456 HCWs. Their median age was 44 (interquartile range: 33-53) and 77.3% were female. Overall, 20.7% were physicians, 47.0% nurses or midwives, and 21.5% support staff. In all, 93.6% received a COVID-19 primary vaccine series, 20% a COVID-19 booster, and 23.7% received an influenza vaccine in the 2022-2023 season. In the multivariable analysis, male HCWs were more likely to receive COVID-19 boosters (adjusted odds ratio [aOR] 2.08; 95% confidence interval [CI]: 1.55-2.80). However, they were less likely to receive influenza vaccines (aOR 0.69; 95% CI: .51-.95). Medical doctors were more likely to receive COVID-19 vaccine doses, while nurses had higher uptake of the influenza vaccine (aOR 1.87; 95% CI: 1.30-2.68). Confidence in the safety and effectivity of both vaccines was positively associated with vaccine uptake. Among HCWs, primary series COVID-19 vaccine coverage was high, but COVID-19 booster doses and seasonal influenza vaccines were low. Findings related to age and sex differences among HCW groups with low vaccine uptake, as well as their knowledge and attitudes toward vaccines, should inform targeted strategies to improve COVID-19 and influenza vaccine uptake, particularly among younger HCWs, female HCWs, and nonphysicians.

Updated International Society of Geriatric Oncology COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Vaccination

This In Brief was accepted July, 2021. Due to the Pediatrics in Review process from authorship to publication and the rapidly evolving nature of the COVID-19 pandemic, this In Brief may not reflect the most recent events.Severe acute respiratory syndrome coronavirus 2 has infected hundreds of millions of individuals globally, and millions have died as a result of the associated coronavirus disease 2019 (COVID-19). Although severe COVID-19 disease has predominantly affected older adults, children have also been affected. As of early May 2021, nearly 4 million total cases of COVID-19 were reported in children, representing 14% of all cases. With wider availability and uptake of vaccination by adults, increased rates of infection are being reported in the unvaccinated pediatric population. New COVID-19 variants, loosening of public health measures, and lifting of restrictions on school activities are also driving increased infections in children. Serious illness and death are lower in children; however, after symptomatic or asymptomatic infection, they are vulnerable to multisystem inflammatory syndrome in children (MIS-C). This postinfectious, immune-mediated syndrome can lead to serious, life-threatening illness in otherwise healthy children. Children can also experience post–COVID-19 syndrome or long COVID-19 and suffer from persistent symptoms at the postviral stage of the disease. The COVID-19 pandemic has disrupted children’s education and recreational activities and has had a substantial effect on children’s physical, mental, and emotional health.Data suggest that vaccines are highly effective in preventing severe COVID-19, act against many new variants, and are incredibly safe. The Pfizer-BioNTech (mRNA) COVID-19 vaccine was initially authorized for those 16 years and older and the Moderna (mRNA) and Johnson and Johnson (adenovirus-vectored) vaccinations for those 18 years and older. Recently the Food and Drug Administration (FDA) provided Emergency Use Authorization for adolescents 12 to 15 years old to receive the Pfizer-BioNTech vaccination after promising clinical trial results. The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices has also recommended its use in adolescents. The Pfizer-BioNTech trial enrolled 2,260 participants, and the vaccine was 100% effective in preventing symptomatic infection in those 12 to 15 years old. The vaccine also exhibited appropriate immunogenicity and mostly mild to moderate reactogenicity symptoms. All the children were from the United States, and most identified as white (85.9%) and non-Hispanic/Latino (88.2%). The dose of the Pfizer-BioNTech vaccination in 12- to 17-years-olds is the same as that in adults. Moderna completed a clinical trial (TeenCOVE) of 12- to younger than 18-year-olds with encouraging results. TeenCOVE enrolled more than 3,700 participants in the United States with zero infections in fully vaccinated adolescents. In addition, the vaccine was highly effective (93%) 14 days after the first dose, and the safety and tolerability profile was similar in adolescents and adults. Emergency Use Authorization for the Moderna vaccine for adolescents is expected in early summer 2021.Pfizer-BioNTech and Moderna are currently conducting phase I clinical trials in children aged 6 months to younger than 12 years. Once age-specific doses are selected, larger clinical trials will be conducted this summer. Determining appropriate dosing is an important consideration as vaccination expands to younger children. Both the Moderna and Pfizer-BioNTech clinical trials in children are being performed as age de-escalation/dose escalation studies. It is probable that a smaller dose will produce adequate immune response, and the recommended doses may be different by age group. The results from these studies are anticipated in the second half of 2021, and if safety and immunogenicity are confirmed, authorization for vaccination of younger children could occur in late 2021 or early 2022.Although allergic reactions to vaccine ingredients are rare, children who have a history of severe allergic reaction to any ingredient in the vaccination should not get a COVID-19 vaccine. Children who have severe allergies to other entities should plan for a slightly longer observation after vaccination. The CDC allows vaccination of children with a history of MIS-C, although currently there are no data on the safety or efficacy in this population. The mechanism of the hyperinflammatory immune response in MIS-C is unclear, and the risk of recurrence after vaccination is unknown.Adolescents and older children had similar local reactogenicity as adults in the Pfizer-BioNTech clinical trial. Adolescents reported pain at the injection site more commonly after the second dose. Systemic responses were also similar, with fatigue (60% after dose 1, 66% after dose 2) and headache (55% after dose 1, 64.5% after dose 2) occurring most often. Chills, muscle pain, joint pain, and fever also occurred. Fever was slightly more common in 12- to 15-year-olds compared with adults, with 0.9% of children experiencing temperatures of 102°F to 104°F (38.9°C–40.0°C) and 0.1% of children with temperatures higher than 104°F (>40.0°C). Adverse effects typically lasted 1 to 3 days. Children and adolescents are more likely to have a more robust immune response and thus might experience more adverse effects than their parents or guardians.Survey data from the CDC and the University of Iowa suggest that children and parents feel most comfortable receiving COVID-19 vaccinations at their primary care physicians’ offices. This underscores the importance of ensuring that pediatricians are able to store and administer the vaccines. Recently after a review of data, the FDA authorized that undiluted, thawed Pfizer-BioNTech vaccine vials can be refrigerated for 1 month. Out of an abundance of caution, COVID-19 vaccines were previously recommended to be administered alone and spaced 2 weeks from other vaccinations. The CDC now allows for COVID-19 vaccines and other vaccinations to be given concurrently after evaluation of safety data for COVID-19 vaccines currently authorized by the FDA. It is not known whether the reactogenicity of the COVID-19 vaccine increases with co-administration, particularly with vaccines known to illicit robust immune responses. This is an important issue to consider for childhood vaccination because health supervision visits for routine care and vaccinations are important opportunities for COVID-19 vaccine administration. In addition, many children have had delayed vaccinations during the COVID-19 pandemic and will need catch-up vaccination schedules in addition to receipt of a COVID-19 vaccine.COVID-19 vaccinations are a crucial and promising step to containment of the pandemic. However, many parents are reluctant to vaccinate their children against COVID-19. A recent national survey found that 27% of mothers and 11% of fathers are extremely unlikely to vaccinate their children against COVID-19. Thoughts on vaccination differed based on parents’ education, income, and political party. A Kaiser Family Foundation survey found that parents’ intentions for children’s COVID-19 vaccination largely align with their own vaccination intentions. Pediatricians remain trusted resources for families and essential advocates who can listen to parents’ questions and provide more information regarding COVID-19 vaccination. Many resources are available for providers, including information from the CDC, the American Academy of Pediatrics, and the Children’s Hospital of Philadelphia Vaccine Education Center.Children younger than 15 years account for nearly one-fourth of the global population, remain at risk for both COVID-19 and sequelae of infection, and can spread disease among themselves and to older individuals. Adolescent vaccinations have thus far been highly effective and safe, with further clinical trials underway to expand use to younger children. Ensuring that children are vaccinated against COVID-19 has implications for return to school and activities, quarantine after exposure, and helping children and parents regain a sense of normalcy.Immunization of children and adolescents is an essential strategy in further containing the COVID-19 pandemic. Continued expansion of vaccination includes benefits to the individual who is being vaccinated, his or her family members, the community, and the public health benefits in striving to reach herd immunity. I find it a remarkable accomplishment of science that a safe vaccine has been developed in such a timely manner. Yet, vaccine hesitancy must be addressed in addition to strategies to enhance access of COVID vaccines to all who need them. We, as pediatricians, need to meet with parents and their children/adolescents, listen carefully to their concerns, provide accurate information that is easy to understand in respectful and nonjudgmental ways, answer questions, and promote the trusting relationship we all strive for in our relationships with patients and families. In addition, practices and communities need to continue to find creative strategies to ensure vaccine access to all patients. Although vaccination in the primary care provider’s office is optimal in maintaining the medical home and ensuring that all health-care issues are addressed, the pandemic has allowed us to think creatively in offering vaccine clinics in the community, through churches, sports centers and events, schools, pharmacies, and other locations to maximize the ease in obtaining the vaccine. These strategies, while helping our country and public health system now, will also be resources for future vaccine rollouts and minimizing health disparities.

<h3>Context:</h3> Mass vaccination serves as a potential solution to combat the Coronavirus disease 2019 (COVID-19) pandemic, with vaccine hesitancy being a recognized impediment. Collection of data defining the characteristics of healthcare worker (HCW) attitudes towards the vaccine can provide insight into vaccine hesitancy. <h3>Objective:</h3> To determine HCWs’ attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy. <h3>Study Design and Analysis:</h3> This cross-sectional study surveyed the attitudes of HCWs in Michigan using three-point agree/disagree scale questions. t-test and analysis of variance were used to measure HCWs’ attitudes towards the COVID-19 virus and vaccines. <h3>Population studied:</h3> 120 HCWs from Isabella, Saginaw, Sanilac, and Wayne counties in Michigan. <h3>Results:</h3> Most HCWs received (95.9%) and recommended (98.3%) the COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine to a patient are: 1) Efficacy of the vaccine, 2) Current exposure to patients with active COVID-19 infection and risk of virus spread, and 3) Safety of vaccine and long-term follow-up. Being a female HCW (P=0.01) or being a HCW outside of the 55–64 years age range (P=0.036) was associated with increased concern of contracting COVID-19. Regarding the COVID-19 vaccines, our data demonstrated that: 1) HCWs who specialized in family medicine (P=0.028) were more likely to agree that there was adequate testing compared to those who did not specialize in family medicine; 2) White HCWs (P=0.024) were less concerned with the speed of development compared to non-white HCWs; 3) Of all age groups, HCWs aged 55-64 years (P=0.02) were the least concerned about side effects 4) Of all provider types, physicians (P=0.017) were the least concerned about long-term effects. <h3>Conclusion:</h3> Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among attitudes towards the COVID-19 virus and vaccines. Vaccine hesitancy among HCWs can have negative effects on their patients. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

Objective In this study, we aimed to assess the rates of pneumococcal and seasonal influenza vaccinations among elderly and nonelderly diabetes patients andexamine their perceptions and attitudes toward the coronavirus disease 2019 (COVID-19) vaccine. Methods A single-center study was conducted among patients with diabetes, employing a structured survey encompassing sociodemographic data, vaccination records, and the COVID-19 vaccine perception and attitude scale. Results Among the 280 diabetes patients in our study, the vaccination rates for COVID-19, seasonal influenza, and pneumococcal vaccines were 96.1%, 16.8%, and 17.5%, respectively. A higher cumulative dosage of the COVID-19 vaccine was associated with older age (r = 0.463; p<0.001), increased safety score (r = 0.479; p<0.001), and lower conspiracy theory score (r = -0.336; p<0.001). Participants who had received COVID-19 and influenza vaccines were observed to have significantly higher safety scores related to COVID-19 vaccines (p<0.001; d = 2.381and p = 0.008; d = 0.525, respectively).Notably, vaccination rates for influenza and pneumococcus were significantly different between nonelderly and elderly patients (8.7% vs. 29.6%; p<0.001 and 13.4% vs. 24.1%; p = 0.022). Elderly patients with diabetes were 3.3 times more likely to receive the influenza vaccine than nonelderly participants [odds ratio (OR) = 3.319; 95% confidence interval (CI) = 1.592 - 6.920; p = 0.001] and had a higher safety score related to COVID-19 vaccines (OR= 1.076; 95% CI = 1.011 - 1.146; p = 0.021). Conclusions Both influenza and pneumococcal vaccination rates were below the desired targets in this study. The vaccination rates among the nonelderly diabetes population suggest that this group may be more likely to neglect to receive vaccination compared to the elderly diabetes population. The association between vaccination rates and post-pandemic safety perceptions highlights the critical need to implement public health strategies specifically designed to address and improve safety-related information dissemination.

De Novo and Relapsing Glomerular Diseases After COVID-19 Vaccination: What Do We Know So Far?

Immunization Update 2021

The COVID-19 Pandemic in 2021: Avoiding Overdiagnosis of Anaphylaxis Risk While Safely Vaccinating the World

The global fight against the COVID-19 pandemic has underscored the critical importance of widespread vaccination to mitigate the impact of the virus on public health. The current study aimed to investigate which social influences might be most important for predicting attitudes towards COVID-19 vaccination and vaccine uptake among young students in the UK. We focused on the cultural evolution and social transmission aspects, i.e., parent-to-child versus peer-to-peer, of attitudes and vaccine uptake during the COVID-19 pandemic. A sample of 192 UK students (aged 18 to 35 years old) filled in an online survey including measures for attitudes towards COVID-19 vaccination and vaccine uptake and/or intention, age, and gender. Participants were also asked about their mother's, father's, and best friend's attitudes towards COVID-19 vaccination and vaccine uptake. Finally, they provided a subjective measure of the quality relationship with their parents. Overall, our results suggest that both parents and very close friends are important agents in understanding the students' attitudes towards COVID-19 vaccination and vaccine uptake. More specifically, our findings suggest the mother's vaccine uptake as the most salient predictor of students' attitudes towards COVID-19 vaccination and vaccine uptake, particularly when the students report having a positive relationship with their parents. In cases where students' experience negative relationship with their parents, the best friend's vaccine uptake may supersede the mother's influence. Despite these nuances, a general trend emerges from our data suggesting that vaccine uptake could be primarily guided by vertical transmission (i.e., parent to child). Our results have the potential to influence public health strategies, communication campaigns, and targeted interventions to enhance vaccination uptake. Identifying key social predictors can enable policymakers and health authorities to tailor vaccination promotion efforts towards mothers' and peers' vaccine uptake to increase overall positive attitudes and vaccine uptake among young people.

COVID-19 vaccine hesitancy and media channel use in Japan: could media campaigns be a possible solution?

Background Coronavirus disease 2019 (COVID-19) vaccine hesitancy or refusal has arisen as a major global public health concern. The aim of this study was to address the attitudes of patients with autoimmune and autoinflammatory rheumatological diseases (AIIRDs) about COVID-19 vaccination and investigate the factors that influence their decision. Methods This interview-based cross-sectional study was carried out on AIIRD patients at the period between 15 August and 15 September 2021. The questionnaire included socioeconomic data, intention to receive COVID-19 vaccine, AIIRD subtype, disease duration, associated comorbidities, history of COVID-19, beliefs and attitudes towards COVID-19, and conventional vaccination in general and COVID-19 vaccine in particular, in addition to COVID-19 vaccination status. Results A total of 206 AIIRD patients were included, with a mean age of 37.61 years (SD = 10.67), and 84% were females. The percentage of vaccine acceptance was 70.39%, while only 16.02% were hesitant and 13.59% were resistant to COVID-19 vaccination. About one-fourth of patients reported getting infected with COVID-19. Of them, 15.1% were hospitalized and 5.7% were admitted at the intensive care unit (ICU). Most of the AIIRD patients (77.2%) believed that they are at a higher risk of getting COVID-19. The main motivation for vaccine acceptance was the fear of being infected (41.4%). About 40% of vaccine nonacceptants fear about the serious side effects of COVID-19 vaccine. Conclusion There is a high acceptability rate of COVID-19 vaccination among AIIRD patients. Public health workers and policymakers must emphasize efficient COVID-19 vaccine acceptance messaging for all AIIRD patients.

COVID-19 perceptions and vaccine hesitancy: Acceptance, attitude, and barriers among Cameroonians