Low Vaccination Rates Research Articles

Disparities in Vaccination Amongst Socially Vulnerable Patients with Inflammatory Bowel Disease.

Social determinants of health (SDOH) have a known impact on disparities in vaccination. Despite an increased risk for infection in patients with inflammatory bowel disease (IBD), SDOH and vaccination in this population have not been studied. Using census tract-level data from the Centers for Disease Control's social vulnerability index (SVI), we aimed to understand the relationship between SDOH and adherence to guideline-recommended vaccinations in patients with IBD. A single-center retrospective cohort of patients with IBD was used to geocode patient addresses to their individual census tract and corresponding SVI and subthemes (Socioeconomic Status, Household Composition, Minority Status, and Housing/Transportation). We used separate multivariable logistic regressions to examine the relationship between SVI and vaccination against influenza, COVID-19, pneumococcal pneumonia, and herpes zoster. A total of 7,036 patients were included. Rates of vaccination varied across vaccine-types: influenza (57%), COVID-19 (65%), pneumococcal pneumonia (58%), and herpes zoster (11%). High social vulnerability was associated with lower odds of vaccination against influenza (OR 0.47, p < 0.001), COVID-19 (OR 0.54, p < 0.001), pneumonia (OR 0.73, p = 0.012), and herpes zoster (OR 0.39, p < 0.001). Within the SVI subthemes, Socioeconomic Status, Household Composition, and Minority Status were important factors associated with differences in vaccine uptake. Higher social vulnerability was associated with lower rates of vaccination across all vaccine types. Identifying these disparities in vaccination for socially vulnerable patients with IBD is the first step to reducing preventable infections and ensuring all patients receive high quality, equitable care.

Tężec w Polsce w latach 2020-2022

BackgroundTetanus is an infectious disease caused by the bacterium &lt;i&gt;Clostridium tetani,&lt;/i&gt; which produces a neurotoxin (tetanospasmin) that causes spastic paralysis. This disease can only be prevented by vaccination. Tetanus is very rare in EU countries, where it mainly affects people over 60 years of age. Tetanus is a serious health problem in countries with low vaccination rates and poor hygiene conditions, and neonatal tetanus is a particularly significant problem in these countries. In Poland, according to the Vaccination Program, mandatory vaccinations against tetanus should be given to children and adolescents up to the age of 19.ObjectiveThe aim of the study was to assess the epidemiological situation of tetanus in Poland in 2020-2022.Material and methodsThe assessment of the epidemiological situation of tetanus in Poland in 2020-2022 was made based on the interpretation of data from the annual bulletins "Infectious diseases and poisonings in Poland" for 2020-2022 and the bulletins "Vaccinations in Poland" for 2020-2022 as well as data from individual epidemiological reports on diseases registered in the "Epibaza" system.ResultsIn 2020, 2 cases of tetanus were registered in Poland, in 2021 – 5 cases, and in 2022 also 5 cases. The total incidence in 2020 was 0.005 per 100 000 people, in 2021 and 2022 – 0.013 per 100 000 and was lower compared to the median for 2015-2019 (0.031). In 2020-2021, all reports concerned hospitalized people, while in 2022 one person was treated as an outpatient. No cases were recorded in people under 30 years of age.ConclusionsIn Poland, a decrease in the number of reported tetanus cases was observed in 2020-2022 compared to previous years. Sporadic tetanus cases in Poland are recorded mainly in older age groups but also occur among adults under 60 years of age. The cases can be associated with the lack of booster vaccinations in adults.

High Rates of High-Risk HPV Anal Infection and Abnormal Cytology in a Cohort of Transgender People Assigned Male at Birth

Abstract Background Transgender people assigned male at birth (TG-AMAB) have higher rates of anal Human-Papillomaviruses (HPV) infection and anal cancer compared to cisgender populations. In a cohort of TG-AMAB in Washington DC, we determined prevalence and epidemiological factors associated with anal high-risk-HPV (HR-HPV) infection and cytological abnormalities. Methods In an urban academic-community clinic we recruited adults identifying as a gender different than their sex assigned at birth. Participants provided blood samples, anal swabs for HR-HPV and cytology, and completed surveys on sexual behaviors and use of gender-affirming hormones. Logistic regression was used to identify predictors of HR-HPV and abnormal cytology. Results Of 97 TG, 80 were AMAB, of whom 66% were living-with-HIV (LWH), 73% tested positive for any anal HR-HPV, and 48% had abnormal cytology. Only 24% recalled HPV immunization. While TG-AMAB LWH had increased risk of HPV16 infection (37% vs 8%, p=0.014), the prevalence of any HR-HPV (80% vs 62%, p=0.097) and abnormal cytology (56% vs 32%, p=0.085) was similarly elevated regardless of HIV status. Among TG-AMAB, estradiol use was not associated with increased odds of any HR-HPV or abnormal cytology (all p&amp;gt;0.05), however higher testosterone levels were associated with any HR-HPV (p=0.014). Age ≥35 years was associated with abnormal cytology in TG-AMAB (59% vs 34%, p=0.035). Conclusion TG-AMAB have high prevalence of any HR-HPV and abnormal cytology, regardless of age, HIV status, or hormone use. Given high risk for anal cancer and low rates of HPV vaccination, there is a pressing need for primary and secondary anal cancer prevention strategies targeting this population.

Laboratory-Confirmed Influenza Hospitalizations During Pregnancy or the Early Postpartum Period - Suzhou City, Jiangsu Province, China, 2018-2023.

Pregnancy is associated with increased risk for severe illness and complications associated with influenza infection. Insufficient knowledge about the risk for influenza among pregnant women and their health care providers in China is an important barrier to increasing influenza vaccination coverage and treating influenza and its complications among pregnant women. Improved influenza incidence estimates might promote wider vaccine acceptance and higher vaccination coverage. In Suzhou, active population-based surveillance during October 2018-September 2023 estimated that the annual rate of hospitalization for acute respiratory or febrile illness (ARFI) among women who were pregnant or <2 weeks postpartum was 11.1 per 1,000 live births; the annual rate of laboratory-confirmed influenza-associated ARFI (influenza ARFI) hospitalization in this group was 2.1 per 1,000 live births. A majority of hospitalized pregnant or early postpartum patients with ARFI (82.6%; 2,588 of 3,133) or influenza ARFI (85.5%; 423 of 495) were admitted to obstetrics wards rather than respiratory medicine wards. Only one (0.03%) pregnant or postpartum ARFI patient had received influenza vaccination, and 31.3% of pregnant or postpartum women hospitalized for influenza ARFI received antiviral treatment; the lowest percentage of hospitalized women with influenza ARFI who received antiviral treatment was among women admitted to obstetrics and gynecology wards (29.6% and 23.1%, respectively), compared with 54.1% of those admitted to a respiratory medicine ward. These findings highlight the risk for influenza and its associated complications among pregnant and postpartum women, the low rates of influenza vaccination among pregnant women, and of antiviral treatment of women with ARFI admitted to obstetrics and gynecology wards. Increasing awareness of the prevalence of influenza ARFI among pregnant women, the use of empiric antiviral treatment for ARFI, and the infection control in obstetrics wards during influenza seasons might help reduce influenza-associated morbidity among pregnant and postpartum women.

Leveraging Social Marketing to Increase Vaccination Rates: A Systematic Review

Abstract Introduction Vaccinations are crucial for protecting individuals from preventable diseases, serving as a cornerstone of public health, safeguarding entire populations. Low vaccination rates can have devastating consequences, leading to outbreaks of preventable diseases. Social marketing has had an increasing role to play in public health. This systematic review seeks to investigate social marketing effectiveness in boosting vaccination adherence. Methods A literature search was conducted in PubMed, Scopus and Cochrane Library, using keywords “social marketing”, ‘campaigns”, “vaccination”, “vaccination uptake”. The search was limited to English-language studies, including studies discussing social marketing campaigns and its impact on vaccination uptake. Prior to inclusion, the studies were evaluated for relevance and applicability to the research question. Included studies were analysed for methodology, sample size, data collection methods, and key findings. Results Of 198 articles identified, 26 studies met inclusion criteria. All studies reported demonstrable improvement in vaccination adherence and hence higher vaccination rates with the use of social marketing campaigns. Targeted messaging on social media allows communication to be tailored to specific demographics and address their unique concerns. Community engagement combats vaccine hesitancy by dismantling misinformation and rebuilding trust. Additionally, these campaigns leverage social influence and mobilise communities to cultivate pro-vaccine attitudes. By addressing personal choice, knowledge gaps, and hesitancy, social marketing paves the way for greater vaccination uptake. Conclusions Social marketing has been proven to be an effective tool in promoting vaccination adherence in public health. As vaccination remains a critical aspect of public health, the continued use of social marketing interventions is essential for improving vaccination rates and ultimately enhancing overall population health. Key messages • Social marketing campaigns lead to higher vaccination rates across various populations. • By addressing vaccine hesitancy, social marketing paves the way for increased vaccination uptake.

What does international evidence tell us about the health of people with childhood social care (CSC) experiences?

Abstract International research into the health of people with childhood social care (CSC) experiences has found evidence of worse mental health and emotional-behavioural wellbeing, higher rates of substance use, neurodevelopmental conditions, and avoidable mortality. Lower vaccination rates and worse dental health among those in care has also been reported in few countries. However, research results have been more mixed with regard to some physical health conditions, with higher prevalence of asthma and respiratory ill health among foster children reported in the US but no obvious differences found in the UK. Are there countries where these inequalities are less pronounced, and can we draw such conclusions based on available evidence? When making international comparisons or aiming to give policy advice, we also need to consider the quality of our evidence. Has this been based on small sample sizes or without comparison to other children and adjusting for relevant (socioeconomic) confounders? Most of our current knowledge is also cross-sectional and we do not know if some health conditions precede entry to care and may even be risk-factors for entering social care. Recent longitudinal and cross-sectoral data linkage programmes in many nations (Australia, UK, Canada) have a potential to change this and provide a foundation for evidence-based recommendations for policy and practice.

Tailoring intervention targeting HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background Marginalized Roma communities (MRCs) are among underserved groups facing limited access to vaccination services and presumably low HPV vaccination rates. The most significant health system barriers to HPV vaccination include financial costs, lack of appropriate information and restricted capacities of healthcare providers. Two interventions identified as promising for implementation in the context of MRCs were discussed with a variety of stakeholders and community members to tailor intervention that would be well accepted and effective to increase HPV vaccination rates in MRCs. Methods The first intervention uses health promoters - trusted and trained community members to address cultural and language barriers and serve as a vital link between healthcare providers and community members. The second multilevel intervention is providing education, navigation, and vaccine access. Initial discussions were conducted with 23 stakeholders, and follow-up discussions were held with 16 stakeholders, including representatives of healthcare professionals, schools, local authorities, and community members. Results An intervention to be implemented in Slovakia focuses on the use of Roma health mediators who will provide parents and vaccine-eligible children (12-14 years old) from MRCs with information on HPV and HPV vaccination, invite them to educational sessions organized in community centres and at schools and navigate them through the vaccination process. The intervention also combines components such as videos and discussions with healthcare professionals, aligning with the needs and wishes of the target group. Conclusions This intervention will help to deliver reliable and understandable information on vaccination and enable people from MRCs to make informed decisions about vaccination. Roma health mediators will take the burden of providing information from overloaded healthcare providers and navigate community members through the vaccination process.

Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study.

Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents' preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.

Rationale and Design of a Multi-National Study of Physicians' Opinions, Attitudes, and Practices Regarding Influenza Vaccination in Patients with Cardiovascular Diseases: A Mixed Methods Designs. The FLUence Project.

Infections, particularly those involving the respiratory tract, are associated with an increased incidence of cardiovascular events, both de novo and as exacerbations of pre-existing cardiovascular diseases. Influenza vaccination has consistently been shown to reduce the incidence of cardiovascular events. Nonetheless, vaccination rates among adults remain suboptimal, both in the general population and among high-risk individuals. Multiple barriers hinder achieving adequate vaccination rates, with physicians' beliefs and attitudes towards these interventions being crucial. The FLUence project was developed within the framework of the World Heart Federation's Emerging Leaders program, to address this issue. This project has two phases: a global quantitative survey to assess the perceptions, opinions, and attitudes and challenges of physicians worldwide regarding the safety and efficacy of the influenza vaccination use, and a qualitative survey to further investigate the barriers and facilitators of recommending and using this vaccination. The quantitative survey was created and disseminated in five languages (English, Spanish, French, Italian, and Portuguese) to physicians of all specialties who care for adults, with a particular focus on patients with cardiovascular disease. The survey included eight domains with a total of 36 questions with closed options; a Likert scale with five possible answers was used to gauge participants' opinions. To gain deeper insights into the complexities behind the low vaccination rates in adults, the second part of the project comprises a qualitative survey, conducted in the two lower-middle- and upper-middle-income countries: India and Argentina, respectively. These countries were selected because patients with cardiovascular diseases have access to free influenza vaccination in Argentina, whereas patients must pay for the vaccine out of pocket in India. Thus, the FLUence study will provide valuable information to better understand the perceptions and barriers to improving influenza vaccination rates from the perspective of physicians. It is imperative to actively engage all healthcare providers to improve influenza vaccination rates.

Communicating about COVID-19 Vaccines: A Qualitative Study on Preferences, attitudes, and Influences on Canadian Post-secondary Student Decisions to Get Vaccinated

Given the reasonably low COVID-19 vaccine rates (e.g., &lt;60% fully vaccinated) among Canadian young adults (18–29), we sought to understand the factors that motivated this demographic to get vaccinated. Fifteen post-secondary students and graduates participated in semi-structured interviews about the type of health information they received during the pandemic, and their communication preferences. Analysis of interview data revealed four themes: (1) Participants had high science and health literacy which equipped them to identify and dismiss misinformation; (2) Participants expressed high trust in official sources which positively impacted their confidence in the vaccines; (3) Participants exhibited a low perceived risk from COVID-19 infection and got vaccinated for reasons beyond personal protection; and, (4) Participants responded best to communication that was targeted and tailored towards them. These themes form a foundation for effective vaccine communication campaigns targeted and tailored toward young adults, which is essential for acceptance of future vaccine recommendations.

Reconsidering inequalities in COVID-19 vaccine uptake in Germany: a spatiotemporal analysis combining individual educational level and area-level socioeconomic deprivation

Combining the frameworks of fundamental causes theory and diffusion of innovation, scholars had anticipated a delayed COVID-19 vaccination uptake for people in lower socioeconomic position depending on the socioeconomic context. We qualify these propositions and analyze educational differences in COVID-19 vaccination status over the first ten months of Germany’s vaccination campaign in 2021. Data from the study “Corona Monitoring Nationwide” (RKI-SOEP-2), collected between November 2021 and February 2022, is linked with district-level data of the German Index of Socioeconomic Deprivation (GISD). We estimated the proportion of people with at least one vaccination dose stratified by educational groups and within different settings of regional socioeconomic deprivation at three time points. Logistic multilevel regression models were applied to adjust for multiple covariates and to test cross-level-interactions between educational levels and levels of area-level socioeconomic deprivation. Vaccination rates were lower among respondents with lower education. With increasing area-level socioeconomic deprivation, educational differences were larger due to particularly low vaccination rates in groups with low education levels. The analysis of vaccination timing reveals that educational gaps and gaps by area-level socioeconomic deprivation had appeared early in the vaccination campaign and did not close completely before the 4th wave of COVID-19 infections

SARS-CoV-2 Vaccination in Patients with Cancer and COVID-19 in Mexico

Objectives: Vaccination is the best preventive measure for SARS-CoV-2 infection; however, efficacy is lower in cancer patients. During the pandemic period, Mexico was characterized by the use of seven different COVID-19 vaccine platforms, and oncologic patients were not prioritized for vaccination. We report the outcomes of COVID-19 in cancer patients after the beginning of the national vaccine campaign in Mexico. Methods: All patients with cancer and COVID-19 diagnosed at Instituto Nacional de Cancerología from 14 February 2021 to 28 February 2022 were included. Primary outcomes were the proportion of individuals who required hospital admission and/or invasive mechanical ventilation, according to the vaccination status; 30-day mortality; the period of infection; and other cancer-related variables. Results: A total of 691 patients were included; 524 (76%) had solid tumors (STs), and 167 (24%) had hematologic malignancies (HMs). Patients infected in the first two periods, had lower rates of vaccination and higher rates of mortality and hospitalization compared to those infected in the Omicron period. In the multivariate analysis, vaccination status was independently associated with hospitalization in patients with STs (aOR 0.38, 95%CI 0.19–0.75, p = 0.005), but it was not associated with invasive mechanical ventilation and 30-day mortality. In those with HMs, vaccination status was not associated with any outcome; in this group, only recent chemotherapy and time of infection were associated with invasive ventilation. Conclusions: Vaccination significantly reduced hospital admissions in patients with STs. Infections occurring during the Omicron period were associated with improved outcomes in both ST and HM patients. Despite having a lesser impact in immunosuppressed patients, vaccination is an essential strategy, and access to vaccination campaigns in patients with cancer needs to be prioritized.

Characterization of meningitis-causing bacteria, with focus on genomic and pangenomic study of multi-drug resistant Streptococcus pneumoniae from cerebrospinal fluid.

Streptococcus pneumoniae is a major cause of meningitis in under developed countries with low vaccination rates and high antibiotic resistance. This study aimed to analyze 83 suspected meningitis patients in Karachi for the detection of S. pneumoniae followed by its whole genome sequencing and Pan Genome analysis. Out of the 83 samples collected, 33 samples with altered physical (turbidity), cytological (white blood cell count) and biochemical (total protein and total glucose concentrations) parameters indicated potential meningitis cases, while these parameters were within normal healthy ranges in remaining 50 samples. Latex particle agglutination (LPA) was performed on the 33 samples, revealing 20 positive cases of bacterial meningitis. The PCR and culturing methods revealed 5 S. pneumoniae isolates. Antibiotic susceptibility tests showed that one S. pneumoniae strain was resistant to erythromycin, levofloxacin, and tetracycline. Whole-genome sequencing of this resistant strain was performed and S. pneumoniae was confirmed with MLST analysis, while it had > 2.3Mb genome and a single repUS43 plasmid. In CARD analysis, the strain had tet(M), ermB, RlmA(II), patB, pmrA, and patA ARGs, which could provide resistance against tetracycline, macrolide, fluoroquinolone, and glycopeptide antibiotics. Phylogenetic analysis revealed that the isolate was closely related to strains from Hungary and the USA. Pan-genome analysis with 144 genome assemblies from NCBI database showed that 1101 non-redundant core genes were shared between all strains. This study gives valuable understanding into the prevalence and characterization of meningitis-causing bacteria in Karachi, Pakistanwith prime focus on multi-drug resistant S. pneumoniae.

Study of the driving factors of the abnormal influenza A (H3N2) epidemic in 2022 and early predictions in Xiamen, China

BackgroundInfluenza outbreaks have occurred frequently these years, especially in the summer of 2022 when the number of influenza cases in southern provinces of China increased abnormally. However, the exact evidence of the driving factors involved in the prodrome period is unclear, posing great difficulties for early and accurate prediction in practical work.MethodsIn order to avoid the serious interference of strict prevention and control measures on the analysis of influenza influencing factors during the COVID-19 epidemic period, only the impact of meteorological and air quality factors on influenza A (H3N2) in Xiamen during the non coronavirus disease 2019 (COVID-19) period (2013/01/01-202/01/24) was analyzed using the distribution lag non-linear model. Phylogenetic analysis of influenza A (H3N2) during 2013–2022 was also performed. Influenza A (H3N2) was predicted through a random forest and long short-term memory (RF-LSTM) model via actual and forecasted meteorological and influenza A (H3N2) values.ResultsTwenty nine thousand four hundred thirty five influenza cases were reported in 2022, accounting for 58.54% of the total cases during 2013–2022. A (H3N2) dominated the 2022 summer epidemic season, accounting for 95.60%. The influenza cases in the summer of 2022 accounted for 83.72% of the year and 49.02% of all influenza reported from 2013 to 2022. Among them, the A (H3N2) cases in the summer of 2022 accounted for 83.90% of all A (H3N2) reported from 2013 to 2022. Daily precipitation(20–50 mm), relative humidity (70–78%), low (≤ 3 h) and high (≥ 7 h) sunshine duration, air temperature (≤ 21 °C) and O3 concentration (≤ 30 µg/m3, > 85 µg/m3) had significant cumulative effects on influenza A (H3N2) during the non-COVID-19 period. The daily values of PRE, RHU, SSD, and TEM in the prodrome period of the abnormal influenza A (H3N2) epidemic (19–22 weeks) in the summer of 2022 were significantly different from the average values of the same period from 2013 to 2019 (P < 0.05). The minimum RHU value was 70.5%, the lowest TEM value was 16.0 °C, and there was no sunlight exposure for 9 consecutive days. The highest O3 concentration reached 164 µg/m3. The range of these factors were consistent with the risk factor range of A (H3N2). The common influenza A (H3N2) variant genotype in 2022 was 3 C.2a1b.2a.1a. It was more accurate to predict influenza A (H3N2) with meteorological forecast values than with actual values only.ConclusionThe extreme weather conditions of sustained low temperature and wet rain may have been important driving factors for the abnormal influenza A (H3N2) epidemic. A low vaccination rate, new mutated strains, and insufficient immune barriers formed by natural infections may have exacerbated this epidemic. Meteorological forecast values can aid in the early prediction of influenza outbreaks. This study can help relevant departments prepare for influenza outbreaks during extreme weather, provide a scientific basis for prevention strategies and risk warnings, better adapt to climate change, and improve public health.

Younger and rural children are more likely to be hospitalized for SARS-CoV-2 infections.

To identify characteristics of SARS-CoV-2 infection that are associated with hospitalization in children initially evaluated in a Pediatric Emergency Department (ED). We identified cases of SARS-CoV-2 positive patients seen in the Arkansas Children's Hospital (ACH) ED or hospitalized between May 27, 2020, and April 28, 2022, using ICD-10 codes within the Pediatric Hospital Information System (PHIS) Database. We compared infection waves for differences in patient characteristics and used logistic regressions to examine which features led to a higher chance of hospitalization. We included 681 pre-Delta cases, 673 Delta cases, and 970 Omicron cases. Almost 17% of patients were admitted to the hospital. Compared to Omicron-infected children, pre-Delta and Delta-infected children were twice as likely hospitalized (OR = 2.2 and 2.0, respectively; p<0.0001). Infants under one year were >3 times as likely to be hospitalized than children ages 5-14 years regardless of wave (OR = 3.42; 95%CI = 2.36-4.94). Rural children were almost three times as likely than urban children to be hospitalized across all waves (OR = 2.73; 95%CI = 1.97-3.78). Finally, those with a complex condition had nearly a 15-fold increase in odds of admission (OR = 14.6; 95%CI = 10.6-20.0). Children diagnosed during the pre-Delta or Delta waves were more likely to be hospitalized than those diagnosed during the Omicron wave. Younger and rural patients were more likely to be hospitalized regardless of the wave. We suspect lower vaccination rates and larger distances from medical care influenced higher hospitalization rates.

Factors Affecting the Intention to Receive Future COVID-19 Booster Vaccines in East Coast States in Malaysia

This conceptual paper is presented to study the factors affecting the intention to receive future COVID-19 booster vaccines in three East Coast states in Malaysia, which has become a concern to the government and health system in the country. It begins by reviewing the literature on associated factors and intentions against the booster vaccination. The Theory of Planned Behavior is used as the basis of the study. This study is driven by the low vaccination rates in Kelantan, Terengganu, and Pahang. Past studies have discussed the acceptance of COVID-19 vaccination in the country, but very few focus on these states. Due to the limited findings on the issues, this study, therefore, attempts to explore the factors influencing vaccination intention using a quantitative method. The survey distribution and data collection focus on the three states' residents. The findings are believed to be able to provide new insight and knowledge, especially to the healthcare providers and government to increase the vaccination rates in these states and prevent the severity of COVID-19 comeback.

Real-world effectiveness of inactivated vaccine on COVID-19 patients with comorbidities.

Patients with underlying diseases do not respond adequately to vaccines. Thus, continued research on the effects of vaccination in patients with comorbidities is crucial to evaluate the necessity of vaccination in this population. This study assessed the protective effects of inactivated vaccines on the severity and prognosis of COVID-19 in patients with comorbidities. A real-world retrospective cohort study was conducted from April 7, 2022, to June 6, 2022, at the Fudan University Pudong Medical Center. The collected data included demographic characteristics, symptoms, clinical severity, and outcomes of the COVID-19 patients. A total of 3,996 indigenous confirmed cases and asymptomatic infections with the Omicron variant were enrolled. Of these, 1322 (33.1%) patients had chronic comorbidities. Compared to others, COVID-19 patients with comorbidities were older, had lower vaccination rates, longer days of nucleic acid conversion and hospitalization, and a higher incidence of severe-critical illness and composite endpoint. Multivariable analyses suggested that in the comorbidity group, two-dose- (odds ratio [OR] 0.38, 95% CI 0.24-0.60; OR 0.20, 95% CI 0.08-0.51) and three-dose vaccinated patients (OR 0.26, 95% CI 0.14-0.47; OR 0.21, 95% CI 0.08-0.58) had a lower risk of aggravation and the composite endpoint; similar results were observed in the non-comorbidity group. Two or more doses of inactivated vaccines could prevent deterioration and poor prognosis in Omicron-infected patients, regardless of the presence of an underlying disease. Our findings support maximizing coverage with inactivated vaccines in highly vaccinated populations, such as those in China.

Influence of Depression and Subjective Health Status on COVID-19 Vaccine Acceptance: Based on the 2021 Community Health Survey

Background: Coronavirus Disease 2019 (COVID-19) is a novel coronavirus identified in 2019 that exhibited an exceptionally rapid spread. Although the development and administration of COVID-19 vaccines progressed quickly, concerns about side effects and safety persisted. This study utilized data from the 2021 Community Health Survey to analyze the relationship between COVID-19 vaccination and psychosocial factors, including depression and subjective health status.Methods: Analysis included 203,449 individuals, excluding those who had not received or were ineligible for the COVID-19 vaccine, based on the 2021 Community Health Survey. The chi-square tests assessed sociodemographic and health status differences related to vaccination status. Subjective health status was categorized based on survey responses as ‘good’ or ‘poor,’ and depression was assessed using the self-reported Patient Health Questionnaire-9. The association between depression, subjective health status, and vaccination status was examined using chi-square tests, followed by multiple logistic regression to determine independent effects.Results: Vaccination rates were higher among the elderly, those with lower education, higher income, healthcare workers, and individuals with lower depression, higher subjective health, and chronic conditions like hypertension or diabetes. Significantly lower vaccination rates were observed in those with lower subjective health and Patient Health Questionnaire-9 scores ≥5 or ≥10. Among individuals with chronic illnesses, those with good subjective health had the lowest odds for non-vaccination (odds ratio=0.42; 95% confidence interval, 0.39-0.45), while those without chronic illnesses and poor subjective health had the highest odds (odds ratio=1.89; 95% confidence interval, 1.76-2.02).Conclusions: This study found significantly higher odds ratios for vaccine non-receipt among individuals with lower levels of depression and subjective health status. Incorporating psychosocial factors such as depression and subjective health status may be crucial in developing strategies to enhance vaccination rates during future outbreaks of novel infectious diseases.

Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study.

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts. The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts. Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

Exploring vaccine hesitancy among citizens of the Métis Nation of Ontario: a population-based data linkage study

Objective and ApproachUnderstanding vaccine hesitancy among distinct communities is crucial to ensuring equitable uptake of vaccination. The objective was to examine the influence of psychological antecedents of vaccine uptake, known as the “5Cs”, on COVID-19 vaccination among Métis Nation of Ontario (MNO) citizens. The Métis people are one of three Indigenous peoples in Canada. A population-based online survey was implemented by the MNO, including the short version of the “5C” (confidence, complacency, constraint, calculation, collective responsibility) psychological antecedents of vaccination scale. Census sampling achieved a 39% response rate and respondents were linked to the COVID-19 vaccine database (COVAX) in Ontario (n=4,012). Analyses included logistic regression models (adjusted for sociodemographics) and exploratory latent class analyses. ResultsIn logistic regression models, MNO citizens who were less confident that COVID-19 vaccines were safe (OR=0.04; 95% CI=0.03-0.06) and did not agree vaccination was a collective action to prevent the spread of disease (OR=0.11, 95% CI: 0.07-0.17) had lower odds of being vaccinated. MNO citizens who disagreed the risk of COVID-19 was small (OR=14.87, 95% CI: 9.99-22.13) had a higher odds of being vaccinated. Vaccine hesitancy profiles with (i) lower confidence in availability/safety of COVID-19 vaccines, (ii) lower perceptions about severity of COVID-19 and (iii) higher everyday life constraints/stressors were associated with lower vaccination rates (males, OR: 4.69; CI: 3.18–6.92; females, OR: 4.77, CI: 3.03–7.51) in latent class analyses. Conclusions and ImplicationsMétis-specific analyses enabled a community-driven response, resulting in low vaccine hesitancy and high uptake.