Knowledge, Attitudes, Practice, and Hesitancy of Patients and HCWs Towards COVID-19 Vaccination and Factors Associated with Vaccination in the Republic of Srpska, Bosnia and Herzegovina

PCR158 Hungarians' Attitudes Toward the COVID-19 Disease and Vaccination: An Online Survey

.Background:Considering the major effects of COVID-19 pandemic on health, social, economic, and political dimensions of all countries, positive attitudes toward COVID-19 pandemic are essential to control the pandemic. In our study, we investigated attitudes toward COVID-19 pandemic among fully COVID-19 vaccinated individuals two years after the pandemic and we identified predictors of attitudes.Materials and Methods:We conducted an on-line cross-sectional study with 815 fully COVID-19 vaccinated individuals in Greece during May 2022. A self-administered and valid questionnaire was disseminated through social media platforms. We measured socio-demographic variables and COVID-19-related variables as potential predictors of attitudes toward COVID-19 pandemic. The outcome variable was attitudes toward COVID-19 pandemic (compliance with hygiene measures, trust in COVID-19 vaccination, fear of COVID-19, and information regarding the COVID-19 pandemic and vaccination).Results:We found a very high level of compliance with hygiene measures, a high level of trust and information about the COVID-19 pandemic and vaccination, and a moderate level of fear of COVID-19. Also, we identified that females, participants with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis adhered more in hygiene measures. Trust in COVID-19 vaccination was higher among females, older participants, those with a higher educational level, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis. Moreover, females, older participants, those with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, those that received a flu vaccine in previous season, and those without a previous COVID-19 diagnosis experienced more fear of COVID-19. Finally, level of information regarding COVID-19 pandemic and vaccination was higher for participants with a higher educational level, those without a chronic disease, those with a better self-perceived physical health, and those that received a flu vaccine in previous season.Conclusions:Understanding predictors of attitudes toward COVID-19 pandemic among fully vaccinated individuals is crucial for developing appropriate public health campaigns in the future. Vaccination should be accompanied by positive attitudes in order to decrease the frequency of negative outcomes of COVID-19, such as hospitalization, complications and mortality.

Background & Aim: Hungary started to administer several COVID-19 vaccines; however, attitudes toward COVID-19 and vaccination are still poorly understood. This study aimed to explore how the attitudes toward COVID-19 disease are associated with the attitudes toward COVID-19 vaccination in Hungary and compare the attitudes of health and non-health workers toward COVID-19 disease and vaccination in Hungary. Methods & Materials: Using a descriptive, cross-sectional design, we recruited a sample of 1820 persons through an electronic survey. In addition to the sociodemographic questions, the attitudes towards COVID-19 disease and vaccination were assessed through self-developed, literature-based questionnaires. Principal component analysis, Spearman's correlation, linear regression, and the Mann-Whitney test were used in the data analysis. Results: The mean age for the study participants (n=1735) was 43.8 ± 6.2 years, and females were the majority (84.6%). Overall, participants showed good attitudes toward COVID-19 disease (mean score= 3.48, SD= 0.43) as compared to their attitudes toward COVID-19 vaccination (Mean score= 2.67, SD= 0.44). A positive correlation was found between the attitudes toward COVID-19 disease and attitudes toward vaccination in Hungary (r= 0.247, p< 0.01). Nurses and other health workers showed more positive attitudes toward COVID-19 vaccination than non-health workers. Conclusion: Hungarian decision-makers should intervene to improve the public's willingness to be vaccinated against COVID-19 or future pandemics. Health workers' knowledge and positive attitudes should be utilized in the media to encourage the general population to be vaccinated. The suggested questionnaires need to be validated for future pandemics' use.

COVID-19 vaccine hesitancy is widespread and may lead to refusal or delay of vaccination, eventually reducing the overall vaccination coverage rate and vaccine effectiveness. Willingness to receive COVID-19 vaccination among health care workers (HCWs) is diverse across different jurisdictions. To assess the COVID-19 vaccine willingness among HCWs in 3 Southeast Asian jurisdictions in the context of pandemic severity and vaccination policy. A cross-sectional online survey was conducted among frontline HCWs in Hong Kong, Nepal, and Vietnam from May to November 2021. Eligible participants were nurses and doctors aged 18 and older, working in public or private health care settings on a full-time or part-time basis. The COVID-19 pandemic and vaccination policy. COVID-19 vaccination willingness was defined as HCW willingness toward receiving the COVID-19 vaccine in full course or the first dose of the vaccine, and willingness to take the second dose. Information on sociodemographic characteristics, the history of seasonal influenza vaccination, attitudes toward vaccination, and opinions on strategies associated with vaccination uptake from the study participants. Among the 3396 eligible doctors and nurses who participated in the survey, 2834 (83.4%) were from Hong Kong, 328 (9.7%) were from Nepal, and 234 (6.9%) were from Vietnam. Most respondents were female (76.2% [2589 ]), aged 30 to 39 years (31.2% [1058]), and nurse HCWs (77.6% [2636]); the response rates were 11% (2834 of 25 000) in Hong Kong, 36% (328 of 900) in Nepal, and 13% (234 of 1800) in Vietnam. Overall, the prevalence rate of willingness to take the COVID-19 vaccine was highest in Nepal (95.4% [313 of 328]), followed by Vietnam (90.6% [212 of 234]), and lowest in Hong Kong (54.4% [1542 of 2834]), relating to their different attitudes and opinions toward the COVID-19 vaccination, and the pandemic severity and vaccination policy in the 3 jurisdictions. Doctors were more willing to take COVID-19 vaccination than nurses (odds ratio, 5.28; 95% CI, 3.96-7.04). Older age (odds ratios, 1.39-3.70), male gender (odds ratio, 1.41; 95% CI, 1.11-1.75), higher educational level (odds ratio, 1.48; 95% CI, 1.17-1.87), and having seasonal influenza vaccination uptake history (odds ratio, 2.15; 95% CI, 1.82-2.54) were found to be associated with increased willingness. Choice of vaccination brand with adequate information, immunity passport, time off from work for vaccination and subsidy for travel to inconvenient vaccination centers were considered as strategies to enhance vaccine willingness. In this survey study, vaccination unwillingness existed among HCWs in Southeast Asian regions, especially in Hong Kong. The findings of this study may have utility in the formulation of vaccination promotion strategies such as vaccination incentives. Attitudes toward vaccination in HCWs might be examples for the general population; however, changes over time should be further investigated.

The quest for more COVID-19 vaccinations in Africa

Considering medical and economic burden of coronavirus disease 2019 (COVID-19), a high COVID-19 vaccination coverage among healthcare workers (HCWs) is an urgent need. The aim of this systematic review and meta-analysis was to evaluate the intention of HCWs to accept COVID-19 vaccination and to identify related factors. We searched PubMed, MEDLINE, Scopus, Web of Science, ProQuest, CINAHL and medRxiv until July 14, 2021. The heterogeneity between results was very high; thus, we applied a random effects model to estimate pooled effects. We performed subgroup and meta-regression analysis to identify possible resources of heterogeneity. Twenty four studies, including 50 940 HCWs, met the inclusion criteria. The overall proportion of HCWs that intend to accept COVID-19 vaccination was 63.5% (95% confidence interval: 56.5%-70.2%) with a wide range among studies from 27.7% to 90.1%. The following factors were associated with increased HCWs' willingness to get vaccinated against COVID-19: male gender, older age, white HCWs, physician profession, higher education level, comorbidity among HCWs, vaccination against flu during previous season, stronger vaccine confidence, positive attitude towards a COVID-19 vaccine, fear about COVID-19, individual perceived risk about COVID-19, and contact with suspected or confirmed COVID-19 patients. The reluctance of HCWs to vaccinate against COVID-19 could diminish the trust of individuals and trigger a ripple effect in the general public. Since vaccination is a complex behavior, understanding the way that HCWs take the decision to accept or refuse COVID-19 vaccination will give us the opportunity to develop the appropriate interventions to increase COVID-19 vaccination uptake.

<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.

The coronavirus disease 2019 (COVID-19) pandemic has created a national and global crisis. The United States has invested tremendous effort and resources to fast track severe acute respiratory syndrome coronavirus 2 vaccines from conception to market in 1 year, an amazing scientific achievement. Public health experts are now leading the distribution of COVID-19 vaccines. The Centers for Disease Control and Prevention (CDC) recommends that health care personnel be offered COVID-19 vaccination during the early phases of distribution. Health care personnel are broadly defined and include emergency medical service personnel, nurses and nursing assistants, physicians, technicians, therapists, dentists, dental hygienists and assistants, phlebotomists, pharmacists, students and trainees, contractual staff, dietary and food services staff, environmental services staff, and administrative staff. We strongly recommend that parents and family caregivers (collectively referred to as parents in this article) of children with medical complexity (CMC) be included in the early phases of vaccine distribution because they serve as essential frontline health care personnel.CMC have significant chronic health conditions that involve multiple organ systems, substantial health service needs, major functional limitations, and high health resource use. They have high levels of medical fragility, technology dependencies (tracheostomies, ventilators, feeding tubes, intrathecal baclofen infusion systems, and others), and psychosocial complexities. We identify CMC as those who have ≥3 organ systems affected (≥3 Feudtner chronic complex conditions), technology dependencies, and complex developmental disabilities.1 With delicately intertwined services from health and community programs, many parents care for their CMC at home. Without these parents, CMC would reside in care centers, hospitals, and ICUs. Thus, parents of CMC are essential health care personnel.CDC guidelines ask that all persons who test positive for COVID-19 be quarantined. Home care nurses who have prolonged close contact with COVID-19–positive CMC and families without full personal protective equipment are excluded from work.2 Long-term care centers are reticent to offer respite care for CMC that have been exposed to COVID-19. Community-based respite providers are in short supply. Who will care for CMC if their parents are unable to do so? Parents of CMC work without reserve. When they test positive for COVID-19, parents have little recourse but to render uninterrupted care for their CMC. Parents risk their own well-being for that of their CMC. It is our duty to mitigate their risk through vaccination.Parents of CMC perform as licensed health care personnel. They function as nurses in managing life-sustaining technologies and administering medications and as certified nursing assistants in caring for their children with disabilities. State Medicaid plans vary in how they implement options of home and community-based services to support care for persons with disabilities in their own homes.3 Some states recognize parents of CMC as formally employed certified nursing assistants, yet other states do not. Thus, some but not all parents of CMC are eligible for phase 1a COVID-19 vaccination. This inequity demands correction. The COVID-19 vaccine should be offered during early phases of distribution to all parents of CMC.More than 2.9 million US children have been infected with COVID-19.4 By vaccinating parents of CMC against COVID-19, we add a layer of protection for CMC and their parents while proceeding with pediatric vaccine development and cocooning our most medically fragile and complex pediatric population. As a vaccination strategy, cocooning can protect susceptible persons from infection by administering vaccines to those around them. It is an applicable strategy in hospitals, ambulatory care settings, and communities.5 Immunizing parents of CMC tightens the cocoon of their own homes.The CDC, with input from an independent panel of medical and public health experts on the Advisory Committee on Immunization Practices, has offered national recommendations on the distribution of COVID-19 vaccinations.6 The recommendations target 3 key goals: (1) to decrease death and serious disease as much as possible; (2) to preserve functioning of society; and (3) to reduce the extra burden COVID-19 is having on people already facing disparities.6 Additionally, recommendations uphold 4 ethical principles of vaccine distribution during initial phases of limited supply, including maximal benefit with minimal harm, justice, health care equity, and transparency.7 Aligning with these 3 core goals and 4 ethical principles, the CDC recommends that initial supplies of COVID-19 vaccine be allocated to health care personnel. We strongly recommend that parents of CMC be included in the early phases of vaccine distribution for health care personnel, thereby reducing the extra burden that families of CMC are experiencing related to COVID-19 and upholding ethical principles of beneficence, nonmaleficence, justice, and autonomy.CMC represent <1% of all US children, yet account for an estimated 30% of total pediatric health care costs, 56% of hospitalized patients, 82% of hospital days, and 86% of hospital charges in US children’s hospitals.1 They have the highest levels of medical fragility and intensive health care needs that drive them in and out of inpatient settings, particularly ICUs. These cost estimates do not include the cost of parents as (unemployed) health care providers for CMC. Parents of CMC prioritize the needs of their children over their own health and personal needs and often describe financial and social hardships.1 These hardships are at risk for escalation during the COVID-19 pandemic as families balance the complex medical and functional needs of their CMC with competing family and personal needs. COVID-19 has great potential to be a breaking point, and COVID-19 vaccination a promising tipping point.We commend the CDC for its rapid dissemination of guidelines for the distribution of COVID-19 vaccines and the strong collaborations of national and state leaders in this massive effort. We call for federal and state partners to recognize parents of CMC as essential, frontline health care personnel. We must offer COVID-19 vaccine during early phases of distribution to these parents. Identifying CMC for this intervention could be modeled after established processes of identifying children for palivizumab therapy for the prevention of severe respiratory syncytial virus infections, with pediatric providers supplying documentation of medical necessity on the basis of established complexity criteria. To guide busy pediatric providers in quickly identifying the CMC and their families, practices might begin with those children who are eligible for state Medicaid complexity and disability or technology waivers and those with home nursing services. Medical Homes can collaborate with families of CMC, family advocacy groups (Family Voices), generalist and subspecialist health care providers, educators, home nursing agencies, and public health programs to put policies into practice. This small change would affect <1% of US children and their families, yet it promises to have great impact.The COVID-19 pandemic and vaccine distribution heighten our national awareness of inequities in our health care system. Parents of CMC are among the most essential and least recognized group of health care providers, easily taken for granted because they cannot and will not demand sick time, vacation days, salaries or benefits; resignation and retirement are not options. We are called to address state-by-state variations in respite care, financial supports and waivers, educational and vocational services, and community-based programs that support the participation and inclusion of all persons across the life span. COVID-19 vaccination for parents of CMC is a simple next step along this continuum of supporting and sustaining family caregivers on whom our health care system depends.

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.

Vaccination

Vaccine Equity for Healthcare Workers-Reaching All of the Frontline.

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.

Anaphylaxis after COVID-19 vaccination: A registry-based study

Introduction Since the emergence of the coronavirus disease 2019 (COVID-19) virus at the beginning of 2020, the world has gone through various waves of pandemics. The health care workers (HCWs) or the COVID warriors as they were termed were the first line of defense against the virus. They were armed with personal protective equipment and prophylactic doses of the COVID-19 vaccine. Despite these precautions, some of the HCWs still contracted the disease and a few others succumbed to it. The objective of this study was to estimate the prevalence of COVID-19 infections and vaccine breakthrough infections (BTIs) in HCWs after receiving the COVID-19 vaccine during the second wave of the pandemic. Methods This was a cross-sectional, hospital-based study conducted over a period of four months from September 2021 to December 2021 on HCWs aged 18 years and above working at the COVID-19-designated tertiary care government hospital in Sikkim. A structured coded questionnaire with no patient identifiers was used to gather details on demographics, vaccination history, breakthrough infection, and other social details. HCWs who had received at least one dose of the COVID-19 vaccine at the time of initiation of the study and were >18 years of agewere included in this study. Results A total of 678 HCWs were screened, out of which 229 (33%) participants tested positive for COVID-19 and the rest of the participants(455; 67%) tested negative. COVID-19 infections and vaccine BTIs (COVID-19 infection >14 days after the second vaccination) were recorded and 137 (20%) respondents had a post-vaccination COVID-19 infection out of which 115 (18.5%) were BTI. The majority of the participants were females and of the age group of 26-35 years. The correlation of COVID-19 infections with the dose gap between vaccination, gender, age, profession, department, area posted during COVID duty, cycles of duty performed, hospitalization due to infection, influenza vaccination, and comorbidity was analyzed. Conclusion COVID-19 vaccines are disease-modifying and they decreasethe severity ofBTIs in HCWs. Pandemics and outbreaks cannot be predicted; therefore, it becomes very important to have healthy frontline workers who are constantly exposed to infectious agents. Monitoring of health and surveillance of infectious diseases among the HCWs should be encouraged.

Background: The coronavirus disease 2019 (COVID-19) vaccine is a novel vaccine that was created during the midst of the COVID-19 pandemic in 2020 to combat the highly contagious COVID-19 infection. Since the initiation of vaccine administration campaigns globally, lots of research was simultaneously being done to study the vaccine’s side effects and possible complications, especially in vulnerable groups such as pregnant women and children. Saudi Arabia is one of the leading countries in administering the COVID-19 vaccine to its population. However, due to the exchange of a lot of incorrect information through social media platforms about the vaccine’s safety, people, particularly women expecting a child, breastfeeding, or having younger children, started to display some vaccine hesitancy. This study aims to assess the knowledge, attitude, and practice (KAP) of the COVID-19 vaccine among Saudi mothers and to recognize how certain individual characteristics affect it.Methods: This is an observational cross-sectional study that was carried out among 293 Saudi mothers attending primary healthcare clinics at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia from April 2022 to July 2022. The participants completed a pre-validated self-administered questionnaire that was composed of 39 closed-response questions divided into four sections: participant characteristics, knowledge, attitude, and practice towards the COVID-19 vaccine. The English questionnaire was translated to Arabic, retranslated back to English, and then compared to the first English version by a different translator to ensure translation accuracy. A pilot study was conducted on 20 participants before the survey was distributed for data collection. Statistical analysis was done using SPSS version 23.0 (IBM Corp., Armonk, NY). The association between the four sections of the questionnaire was assessed using Chi-square test of proportion. Results: The study found that 64% of the participants were below the age of 40. The majority (56%) have earned a bachelor’s or a higher degree. According to 41%, "Ministry of Health official channels" was the most important source of COVID-19 vaccine-related information. Almost half of the respondents (45%) showed to have an excellent knowledge of the COVID-19 vaccine and 62% showed to have a positive attitude towards it. Around 40% of the participants reported that they delayed taking the COVID-19 vaccine until it was mandatory. For those who have children aged between 12 and 18 years, 78% stated that their children took the COVID-19 vaccine. Mothers aged below 40 years showed to have significantly better vaccine knowledge compared to the older group. Mothers who received the influenza vaccine over the past three years were less likely to delay taking the COVID-19 vaccine until it became mandatory compared to those who did not receive it. Conclusion: Younger age, higher educational level, flu vaccine administration in the previous three years, and adherence to child immunization schedules were all factors that had a significant impact on the KAP towards the COVID-19 vaccine. Correcting misunderstandings about vaccine safety through educational campaigns and providing timely information through the Ministry of Health channels can all contribute to achieving better practice related to vaccine uptake in this group.