Vaccine Refusal Research Articles

Socioeconomic determinants and reasons for non-acceptance to vaccination recommendations during the 3rd - 5th waves of the COVID-19 pandemic in Hungary

BackgroundIn Hungary, although six types of vaccines were widely available, the percentage of people receiving the primary series of COVID-19 vaccination remained below the EU average. This paper investigates the reasons for Hungary’s lower vaccination coverage by exploring changing attitudes towards vaccination, socio-demographic determinants, and individual reasons for non-acceptance during the 3rd - 5th pandemic waves of COVID-19.MethodsThe study’s empirical analysis is based on representative surveys conducted in Hungary between February 19, 2021, and June 30, 2022. The study used a total of 17 surveys, each with a sample size of at least 1000 respondents. Binomial logistic regression models were used to investigate which socio-demographic characteristics are most likely to influence vaccine hesitancy in Hungary. The study analysed 2506 open-ended responses to identify reasons for vaccine non-acceptance. The responses were categorised into four main categories and 13 sub-categories.ResultsBetween the third and fifth wave of the pandemic, attitudes towards COVID-19 vaccination have significantly changed. Although the proportion of vaccinated individuals has increased steadily, the percentage of individuals who reported not accepting the vaccine has remained almost unchanged. Socio-demographic characteristics were an important determinant of the observed vaccine hesitancy, although they remained relatively stable over time. Individuals in younger age groups and those with lower socioeconomic status were more likely to decline vaccination, while those living in the capital city were the least likely. A significant reason behind vaccine refusal can undoubtedly be identified as lack of trust (specifically distrust in science), facing an information barrier and the perception of low personal risk.ConclusionAlthough compulsory childhood vaccination coverage is particularly high in Hungary, voluntary adult vaccines, such as the influenza and COVID-19 vaccines, are less well accepted. Vaccine acceptance is heavily affected by the social-demographic characteristics of people. Mistrust and hesitancy about COVID-19 vaccines, if not well managed, can easily affect people’s opinion and acceptance of other vaccines as well. Identifying and understanding the complexity of how vaccine hesitancy evolved during the pandemic can help to understand and halt the decline in both COVID-19 and general vaccine confidence by developing targeted public health programs to address these issues.

Factors Associated With Vaccination Refusal Among a Sample of the Jordanian Population

Using a questionnaire, this study investigated the numerous factors affecting the Jordanian population’s rejection of COVID-19 vaccines. The data were collected in 2020 to 2021. Using the chi-square test, t-test, Cramer’s V-test, and analysis of variance, we found that most of the Sample (72.6%) obtained information on COVID-19 and its vaccines from social media, radio, and television. In comparison, 31.1% and 35.4% of the Sample obtained from government/official sources or health specialists, respectively, with a lesser share relying on colleagues (13.7%) and scientific lectures (17.5%). Furthermore, depending on the participants’ characteristics, there were significant differences in the information sources or abstinence factors. Several factors were associated with vaccine refusal and hesitancy, including contradictory/conflicting information, lack of trust in vaccines/manufacturers, doubt about the vaccines’ effectiveness, and the belief that the risks of COVID-19 are minimal. Based on these findings, we present several recommendations for policymakers.

Unmasking vaccine hesitancy and refusal: a deep dive into Anti-vaxxer perspectives on COVID-19 in Spain

BackgroundAt the time of the emergence of COVID-19, denialist and anti-vaccine groups have also emerged and are shaking public confidence in vaccination.MethodsA qualitative study was conducted using online focus groups. Participants had not received any doses of vaccination against the disease. A total of five focus group sessions were conducted with 28 participants. They were recruited by snowball sampling and by convenience sampling.ResultsThe two major topics mentioned by the participants were adverse effects and information. The adverse effects described were severe and included sudden death. In the case of information, participants reported: (1) consultation of websites on which scientists posted anti-vaccination content; and (2) distrust.ConclusionsAt a time when anti-vaccine groups pose a major challenge to public health in general, and to COVID-19 vaccination campaigns in particular, this study is a first step towards gaining deeper insight into the factors that lead to COVID-19 vaccine refusal.

Concerns about vaccines and vaccination behavior among Japanese budget travelers to India

BackgroundLow vaccination coverage among travelers poses a critical challenge to global health security. Indeed, public concerns regarding vaccines can lead to vaccine reluctance and refusal, but evidence about the impacts of concerns regarding vaccines on the uptake of travel vaccinations remains sparse. We examined the associations between concerns about vaccines and vaccination behavior among travelers. MethodsJapanese travelers aged 18 years or older, who stayed at a guesthouse in New Delhi, India, were targeted (n = 153). We conducted cross-sectional surveys from August 23 to September 2, 2019, and from February 19 to March 5, 2020. We examined the associations of three concerns regarding vaccines (5-point scale)—serious side effects from vaccines, vaccine safety, and vaccine effectiveness—with the uptake of travel vaccinations. ResultsIn total, 60 participants (39.2 %) had been vaccinated for this or a past trip. After adjusting for all potential confounding variables, concerns about serious side effects from vaccines and vaccine safety were negatively associated with the uptake of travel vaccinations. The ORs (95 % CIs) for 1-point increases in concerns about serious side effects from vaccines and vaccine safety were 0.72 (0.52, 0.99) and 0.71 (0.52, 0.96), respectively. Sensitivity analyses did not change the results substantially. ConclusionsConcerns about vaccine safety issues were negatively associated with the uptake of travel vaccinations among the participants, with no corresponding association observed for vaccine effectiveness. Addressing concerns about vaccine safety issues, rather than vaccine effectiveness may contribute to an increased uptake of travel vaccinations.

COVID-19 Vaccination Acceptance During Pregnancy in Europe.

Pregnant women have been shown to have a higher risk of SARS-CoV-2 infection. Vaccination against the infection is the most effective strategy for preventing both severe disease and related complications. Nevertheless, vaccination hesitancy among pregnant women is an important issue affecting vaccine uptake and a major challenge for Public Health, as high rates of hesitancy can lead to complete refusal of vaccination, with health implications not only for the mother but also for the fetus. Based on the above, this review aims to capture the rates of vaccination against COVID-19 in pregnancy among European countries, from August 2020 to May 2022, as well as to highlight the predictive factors of its acceptance among pregnant women in these countries. The review of the available literature found that in Europe the acceptance of vaccination against COVID-19 among pregnant women varies with rates ranging from 21.3% to 87% for at least one dose and from 29.5% to 82.7%, for two doses of vaccine. Higher maternal education level, older age at pregnancy, previous vaccination against influenza and pertussis, positive attitude towards vaccines, and acceptance of vaccines during pregnancy are the most frequently reported positive predictors that are associated with higher vaccination rates. The information obtained from this study can contribute in the future, during epidemics or pandemics that may occur, to the development of targeted medical and communication strategies for the effective promotion of vaccination programs and the greatest possible coverage of the population, especially those belonging to vulnerable groups such as pregnant women.

Exploring Vaccine Hesitancy Among Parents in a Rural Pediatric Clinic System: A Statistical Study.

Vaccine hesitancy has been a growing concern in the United States, particularly in rural areas where access to healthcare services may be limited. A rural pediatric clinic system in central Louisiana serves a population with historically low childhood immunization rates. This study explored the prevalence and determinants of vaccine hesitancy among parents of pediatric patients at the organization's clinics. A qualitative survey was conducted among parents who declined vaccines for their children at the organization's clinics. The survey collected information on parents' attitudes, beliefs, decision-making processes regarding childhood vaccinations, and demographic information about the parents, including income and education levels. Thematic analysis was used to identify key themes and patterns in the survey responses. Thirty out of 47 parents (response rate: 64%) completed the survey. Most respondents (n=24, 80%) expressed concerns about vaccine safety and potential side effects. Many parents (n=16, 60%) cited information from social media and alternative health sources as influencing their decision to decline vaccines. Religious and philosophical beliefs were also common reasons for vaccine refusal (n=13, 43%). Another significant theme was the lack of trust in healthcare providers and the pharmaceutical industry (n=17, 53%). No significant differences in responses were observed based on the parent's race or the child's sex. Ninety percent of participants (n=27) reported a household income of under $50,000, and 87% of participants (n=26) had a high school education or less. Vaccine hesitancy among parents in this rural pediatric population appears to be driven by concerns about vaccine safety, exposure to misinformation, religious and philosophical beliefs, and distrust in the healthcare system. Addressing these factors through targeted education, provider communication, and community engagement may be essential for improving childhood immunization rates in this vulnerable population. The findings highlight the need for culturally sensitive, evidence-based interventions to combat vaccine hesitancy in rural communities.

Attitudes toward COVID-19 Vaccination: Cross-sectional Study in Anbar Province, Iraq

Abstract Background: On March 2020, the World Health Organization announced that coronavirus disease 2019 (COVID-19) has become a pandemic. In Iraq, since the start of applying the national COVID-19 vaccine campaign, many people refused to take the COVID-19 vaccine for various reasons, which has led to the further spread of the disease and the pandemic. Objectives: To determine some factors for refusing COVID-19 vaccination and the beliefs about the COVID-19 vaccine among Iraqi people in Anbar Province, Iraq. Subjects and Methods: A household-based cross-sectional study and a face-to-face interview were done on 814 participants who were involved in the survey. A convenient sample approach was followed in this study to recruit participants from 11 different areas in the entral, southern, and northern of Anbar Province, Iraq, including urban and rural regions. A questionnaire form was applied to participants enrolled in the study, and the principal researcher carried out a written interview by face-to-face with the participant. An analysis of data carried out using cross-tabulated chi square test to identify variables associated with vaccine acceptance, in addition to descriptive statistics. Results: A majority (71.7%) of the population did not take any type of COVID-19 vaccine; among those who took the COVID-19 vaccine, 58.4% took only one dose of vaccination. Among people who did not take any type of vaccine, a high percentage of 72.1% said that they did not trust it. Others (14.3%) did not take it because their friends and relatives did not take it. A significant difference (P = 0.001) was found regarding the characteristics of those who took the vaccine and those who did not take it, including age, gender, occupation, place of residence, education level, and having had COVID-19. Conclusion: A high prevalence of COVID-19 vaccine refusal was found in places in Anbar Governorate based on rumors, media communication, and behavioral attitudes needs many efforts from health workers in primary health-care centers and other health staff in other health institutions to increase people’s knowledge about the vaccine to lessen COVID-19 vaccine hesitancy.

Vaccine Hesitancy in HIV Patients Following the COVID-19 Pandemics

Introduction: The prevalence of vaccine hesitancy has been on the rise for several years in the United States leading up to the Covid19 pandemic. During the pandemic, there was controversy and media attention surrounding the effectiveness and safety of the Covid19 vaccine, with many individuals, including patients with HIV, refusing vaccination, despite evidence of its benefit. There are further concerns that patients with HIV are reluctant to receive additional vaccines that existed prior to the Covid19 pandemic. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine. Methods: We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 patients with HIV during a pre-Covid (approximately 18 months before the release of the Pfizer vaccine to the public on August 23, 2021) and post-Covid period (approximately 18 months after the previously mentioned date). The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A/B, and influenza. The data was collected using hospital records from Athena and Cerner, as well as Michigan State Records. Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for the Covid19 vaccine statistics. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance. Results: Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except Hepatitis A. There was an overall statistically significant difference (p <0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the Pneumococcal (p=0.026), Hepatitis B (p=0.035), and Shingles vaccine (p <0.001) respectively. The Covid19 vaccine was more likely to be refused in female patients (p=0.005), non-white patients (p=0.02), and younger patients (p=0.04, r= -0.21). Discussion/Conclusion: This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine in patients with HIV at Ascension St. John Hospital. Given the small size of the study population and this study being an initial evaluation, more will need to be performed. This is to further test these findings in other regions of the United States.

Identifying Expert Opinions on the Challenges and Barriers Faced in Implementing Iraq's National Plan for Controlling Hepatitis B.

This study examined the difficulties and obstacles faced by healthcare professionals in implementing Iraq's national plan for hepatitis B virus (HBV) control. This research aims to offer valuable insights into the intricacies of HBV control efforts and identify key areas for improvement. In this qualitative study, semi-structured interviews were conducted with a purposive sample of 10 physicians, representing diverse medical specialties and healthcare settings, including experts in the fields of medical sciences. Data analysis was conducted using MAXQDA software, version 24 (VERBI Software GmbH, Berlin, Germany)to identify recurring themes and gain insights into the challenges encountered during the implementation of the national plan. Ten physicians participated in the study, providing insights into challenges and barriers hindering the effective implementation of Iraq's national plan for HBV control. Consensus among participants highlighted challenges such as resource constraints, inadequate infrastructure, population ignorance, and vaccine refusal. Documentation challenges, including inaccuracies in reporting HBV-associated mortality, were also noted. Barriers to successful implementation included poor public awareness, inadequate education for healthcare providers, and funding shortages. Unmet needs highlighted the necessity for unified protocols, surveillance systems, and international training programs. The improvement strategies proposed by participants emphasized raising awareness, supporting primary healthcare centers, and enhancing funding allocation. This study underscores significant challenges in implementing Iraq's national plan for HBV control, with barriers ranging from resource constraints to communication barriers. Healthcare professionals advocate for targeted interventions, collaborative efforts, and policy measures to address these challenges effectively. The findings contribute to the evidence base for enhancing HBV control efforts in Iraq and emphasize the importance of tailored approaches to public health interventions.

Knowledge Level and Beliefs of Mothers of Children Under 5 Years of Age About Childhood Vaccinations

Vaccination prevents infectious diseases and mother’s consent is key to increasing childhood vaccination rates. The aim of this study was to assess mothers' knowledge, and beliefs about childhood vaccinations, as well as the impact of these factors on their vaccination behaviors. A descriptive cross-sectional study of 320 mothers was conducted. The data were collected using a questionnaire form. Most of mothers (98.4%) have their children fully vaccinated through the Extended Immunization Program (EIP), 96.6% of cases support vaccines necessity. Vaccine hesitancy was 7.8%, vaccine refusal was 1.6%. The majority of mothers believe that the most common side effects of vaccines are fever (53.4%). Mothers were not adequately informed about EIP were 42.2%, and 57.5% of them had not received non-EIP vaccines, and 33.1% cited lack of knowledge as the reason. The majority of cases (73.7%) received information about EIP from a doctor. Parents' educational status, higher family income, and having more than three children significantly increased non-EIP vaccination rates but had no significant effect on EIP vaccination (p<0.05). Mothers still support EIP, but vaccine hesitancy is growing due to a lack of information. It is critical to assess mothers' knowledge and beliefs about vaccination, and social awareness is also required.

Coverage and determinants of COVID-19 child vaccination in Munich, Germany in October 2022-January 2023: Results of the COVIP-Virenwächter study.

COVID-19 vaccination reduces the risk of severe disease, in children as well as adults. We studied COVID-19 vaccination coverage among children, parental COVID-19 vaccination intent for their children and determinants of vaccination among children to inform communication strategies. We invited parents of children aged 6 months-11 years in Munich, Germany, to an anonymous online survey between 13.10.2022 and 15.01.2023. Parents reported COVID-19 vaccination status and, for unvaccinated children, vaccination intent per child. We determined vaccination coverage (≥ 1 dose) and parental intent, and subsequently used logistic regression to identify determinants of vaccination, including the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, collective responsibility). In total, 339 parents reported on 591 children. Vaccination coverage was 7% (6/86) amongst 6-months-4-year-olds and 59% (295/498) amongst 5-11-year-olds. For unvaccinated 6-months-4-year-olds, 31% of parents reported high, 13% medium, 56% low vaccination intent; for 5-11-year-olds 8% reported high, 20% medium, 71% low intent. Positive determinants of vaccination were older child age, child belonging to a clinically vulnerable group, as well as parental COVID-19 vaccination, higher education level, country of birth Germany, and high level of trust in official guidelines; a negative determinant was previous vaccination refusal. For 5-11-year-olds, additional positive determinants were higher confidence and lower complacency. Conclusion: While a substantial proportion of 5-11-year-olds were vaccinated against COVID-19, coverage was low among 6-months-4-year-olds. Parental vaccination intent for unvaccinated children was low. Vaccination communication should take into account parental socio-demographic characteristics and specifically address individual risks and benefits of child vaccination. What is Known: • COVID-19 vaccination lowers severe disease risk in all ages. • Germany recommends vaccination for 5-11-years-olds since December 2021 and for 6 months-4 year-olds since November 2022. What is New: • In Munich, vaccine uptake was high in 5-11-year-olds but parental intent for not yet vaccinated children was low; the opposite was the case for 6-months-4-year-olds;vaccination determinants were eligibility, parental education, birth country and general vaccination hesitancy; psychological antecedents were confidence and complacency. • Tailored interventions should address guidelines, health literacy, cultural sensitivity, and boost confidence in vaccines and institutions while raising awareness of COVID-19 risks for children.

Assessing the Vaccination Status and Barriers to Influenza, Pneumococcal, and COVID-19 Vaccination Among Moroccan Patients With Chronic Inflammatory Rheumatic Disease.

To evaluate the vaccination coverage of patients with chronic inflammatory rheumatic disease (CIRD) against influenza, pneumococcus, and COVID-19 and to determine, per the patients' point of view, the possible factors related to vaccination hesitation and/or refusal. A cross-sectional study carried out by the vaccination working group of the Moroccan Society of Rheumatology, including patients with CIRD in Morocco. Information about vaccination coverage and reasons for non-vaccination against influenza, pneumococcal infection, and COVID-19 was collected. This survey included 230 patients (mean age of 46.9 +/-13.89 years; 68.7% females) affected by CIRD (rheumatoid arthritis 53%, spondyloarthritis 39.6%, psoriatic arthritis 7%). The study shows a significant lack of influenza and pneumococcal vaccination in CIRD patients, with vaccination coverage against influenza, pneumococcal infection, and COVID-19 at 2.2%, 0.4%, and 80.9%, respectively. The main reason for non-vaccination against influenza and pneumococcus was related to the absence of recommendations by their doctors (77%, 87%, p = 0.04). Additionally, the primary reason for non-vaccination against COVID-19 was the fear of the vaccine's side effects (51%, p = 0.0001), mainly a flare-up of CIRD (44%, p = 0.001). This survey shows a lack of influenza, pneumococcal, and COVID-19 vaccination in CIRD patients. The principal actions to improve vaccination should aim to educate patients and encourage rheumatologists to vaccinate their patients.

Parental knowledge and attitudes to infant immunization in the context of RSV: All about confidence?

BackgroundRecently, the first RSV vaccines have been approved, but vaccine hesitancy still poses great challenges to immunization programs. ObjectiveTo investigate this phenomenon in the context of the new RSV vaccines and an increased virus activity in 2022/23, we assessed parental knowledge and attitudes towards general childhood and RSV vaccines. MethodsParents of infants from 0-36 months completed an online questionnaire on demographics, socio-economic status, mental well-being, knowledge on RSV and perceptions of disease, attitudes to general childhood and RSV vaccines. The survey was conducted from February-June 2023 in the region of Regensburg, Germany. We compared continuous or categorical data with two-sided t-tests or Chi-square tests, respectively. Linear and logistic regression models were used to adjust for confounders. ResultsFrom 191 survey participants, 84 % had never refused any recommended vaccination and 91 % trusted their paediatrician’s information. 11 % felt that children should have fewer vaccinations or rather get over the illness. Parents who were supportive or undecided about RSV vaccination were less likely to be vaccine hesitant in general (OR 0.03, p < 0.001; OR 0.13, p = 0.003). 58 % reported to have basic or good knowledge on RSV, correlating with a higher socioeconomic index (p = 0.049). 24 % were undecided about RSV immunization, while all parents rated its benefit high in the child’s first year of life. Parents who refused RSV vaccination were less concerned about the infection compared to vaccine supporters (OR 0.44, p < 0.001). Parents with previously hospitalized (OR 3.88, p = 0.017) or preterm born children (OR 5.12, p = 0.026) were generally more concerned. ConclusionMany factors influence parental decision-making leading to three main groups of attitudes: vaccine acceptors, refusers and hesitant but accessible parents. They (24%) represent the “target group” to increase vaccine uptake. Information on the vaccine-preventable disease reduces vaccine hesitancy, underlining the importance of healthcare professionals who remain an important source of trust.

Influences on COVID-19 Vaccine Adherence among Pregnant Women: The Role of Internet Access and Pre-Vaccination Emotions.

The onset of the COVID-19 pandemic brought about global uncertainties and fears, escalating the dissemination of fake news. This study aims to analyze the impact of fake news on COVID-19 vaccine adherence among pregnant women, providing crucial insights for effective communication strategies during the pandemic. A cross-sectional, exploratory study was conducted with 113 pregnant women under care at a Women's Health Reference Center. Data analysis included relative frequency and odds ratio to assess the relationship between sociodemographic and behavioral variables regarding vaccination. In the behavioral context of vaccination, internet access shows a significant association with decision-making, influencing vaccine refusal due to online information. Nuances in the odds ratios results highlight the complexity of vaccine hesitancy, emphasizing the importance of information quality. Pre-vaccination sentiments include stress (87.61%), fear (50.44%), and anxiety (40.7%), indicating the need for sensitive communication strategies. Results revealed that pregnant women with higher education tend to adhere more to vaccination. Exposure to news about vaccine inefficacy had a subtle association with hesitancy, while finding secure sources was negatively associated with hesitancy. The behavioral complexity in the relationship between online information access and vaccination decision underscores the need for effective communication strategies. In the face of this challenging scenario, proactive strategies, such as developing specific campaigns for pregnant women, are essential. These should provide clear information, debunk myths, and address doubts. A user-centered approach, understanding their needs, is crucial. Furthermore, ensuring information quality and promoting secure sources are fundamental measures to strengthen trust in vaccination and enhance long-term public health.

Nurses' attitudes towards COVID-19 vaccines: A qualitative study (PROACTIVE-study).

To explore the attitudes of healthcare workers towards COVID-19 vaccines. A qualitative descriptive design was used. Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts. Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat. Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies. Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal. Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns. The study is reported using the Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

Adolescents With Breakthrough COVID-19 Infections Requiring Hospitalization: A Multicenter Retrospective Study.

Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.

COVID-19 Vaccine Hesitancy in a Rural Community of Nigeria

Introduction: Vaccine hesitancy is a major challenge to public health, particularly in the context of the COVID-19 pandemic. This research was aimed at examining COVID-19 vaccine hesitancy in the Idumebo Community, Irrua, Edo State, Nigeria, to understand the factors influencing vaccine acceptance and refusal. Objective: The primary objective of this research was to determine the level of knowledge, uptake, and reasons for vaccine hesitancy among residents of Idumebo, Irrua Edo State. By exploring these factors, the study aimed to provide insights that can inform targeted interventions to improve vaccine acceptance rates in the community. Method: A descriptive cross-sectional study was done among residents of age 18-60 years in Idumebo, utilizing structured questionnaires to gather data on socio-demographic characteristics, knowledge of COVID-19, and attitudes towards vaccination. Ethical considerations were prioritized, with institutional and community consent obtained before data collection. Results: The findings showed a high degree of awareness of COVID-19 among participants, with a majority acknowledging the contagious nature of the disease. However, vaccine hesitancy was observed among a subset of respondents, with reasons ranging from concerns about safety and efficacy to misinformation and mistrust. These results underscore the need for targeted educational campaigns and community engagement to address vaccine hesitancy effectively. Conclusion: It was concluded that the study brought to light the complex dynamics of COVID-19 vaccine hesitancy in the Idumebo Community, revealing the necessity of tailored interventions to address barriers to vaccine acceptance. By fostering a better understanding of community attitudes and concerns, public health authorities can develop strategies to enhance vaccine uptake and combat the spread of COVID-19 in the region.

Vaccine refusal in pregnant women in Kahramanmaraş: a community-based study from Türkiye.

The global health landscape is increasingly challenged by the rejection of childhood vaccines. This study investigates vaccination reservations and refusal among pregnant women. A cross-sectional study was conducted in Kahramanmaraş, Türkiye, spanning January to March 2019, entailing face to face interviews with 938 pregnant women. The questionnaire collected sociodemographic data and probed vaccination attitudes. The decision to vaccinate the baby was treated as the dependent variable, analyzed alongside sociodemographic factors and other variables. Data underwent evaluation via descriptive analysis, the Chi-square test, and binary logistic regression. Participants had a mean age of 27.6 years. Among them 20 (2.1%) expressed intent to either abstain from or partially vaccinate their babies, with 70% citing apprehensions regarding potential vaccine-related harm. Statistical analysis unveiled that higher economic income, elevated parental education level, fewer than two children, reliance on the Internet for vaccination information, and a lack of trust in physicians significantly correlated with vaccine refusal among pregnant women (p < 0.05). The study concludes that dissemination of vaccination information by the healthcare professionals, complemented by the enactment of pro-vaccine internet policies holds promise in shaping vaccination behavior.

Utilitarian Policy of Criminalization for the COVID-19 Vaccine Refusal in Indonesia

This article aims to analyze several issues of the implementation of the regulation of vaccination in Indonesia, encompassing the issues of the imposition of criminalization following the vaccination refusal, discussion on its objective, and practical challenges that potentially emerge. As qualitative research, this article employed a normative legal approach and social contextualization to comprehend regulations, legal interpretations, and arguments. This article finds that the government has amended the Presidential Regulation No. 99 of 2020 on the Procurement and Implementation of Vaccination to the Presidential Regulation No. 14 of 2021 on the Change of the Presidential Regulation No. 99 of 2020 in dealing with the issue of punishment imposed on those refusing the vaccination. From the perspective of utilitarian humanism, the regulation aims to ensure the success of the vaccination and is expected to result in the herd immunity of society that determines the social welfare in the country. The implementation of the regulation is being criticized on the practical level because it is claimed to raise the likelihood of the violation of human rights and overlook the public trust on account of excessive criminalization. This article argues that support from society is vital in the implementation of the regulation, while a positive campaign over public vaccinations need to be massively urged.

Determinants of Non-Acceptance of the COVID-19 Vaccine During Pregnancy in Pregnant and Postpartum Women: A Descriptive Cross-Sectional Study.

The rate of COVID-19 vaccination hesitation among Iranian pregnant women is around 50%. The objective of the present study was to determine the reasons for the refusal of COVID-19 vaccination among pregnant and postpartum women. This descriptive cross-sectional study was performed on 304 pregnant and postpartum women in the comprehensive health centers of Yazd, Iran, between October 2022 and April 2023. Researchers collected the data of unvaccinated women through phone calls using a validated questionnaire. Data was collected using a questionnaire consisting of baseline characteristics and reasons for refusing vaccination. Descriptive statistics were used to analyze the data using SPSS version 22. The mean age of the pregnant and postpartum women participating in this study was 28.31 ± 6.47 years. The most common reasons for refusing the COVID-19 vaccine included fear of harming the fetus (32.2%), fear of side effects in the mother (25.7%), disbelief in COVID-19 disease and vaccine (13.8%), lack of information about the vaccine (12.8%), and negative opinions of the media and society (12.8%). Less common reasons included husband's disagreement (8.2%), history of COVID-19 infection (6.9%), gynecologists' disagreement (6.3%), history of infertility (5.9%), and underlying disease (3.3%). Astonishingly, among participants who did not inject a booster dose of the vaccine, 76% reported they didn't receive any training and recommendation on booster dose injection from health providers. Findings highlight that the most common reasons for refusing the COVID-19 vaccine were fear of harming the fetus and fear of side effects in the mother.