Vaccination Of Healthcare Workers Research Articles

COVID-19 Vaccination Uptake and Its Effect on Morbidity and Mortality among Frontline Healthcare Workers in Kaduna State, Nigeria

The COVID-19 pandemic has placed tremendous burdens on healthcare workers (HCWs), accounting for over 1.4 million HCW infections and 10% of global fatalities. HCWs faced elevated infection risk, psychological distress, long working hours, fatigue, stigma, and violence. While vaccines are pivotal in reducing severe illness, HCW vaccine hesitancy, given their role as advocates, jeopardizes vaccination coverage global goals and healthcare systems. Addressing this vaccine uptake is imperative through education, transparent communication, and support to safeguard HCWs’ safety and pandemic containment. This study assessed COVID-19 vaccination uptake among frontline HCWs in Kaduna State, Nigeria, and its impact on morbidity and mortality. Utilizing a descriptive cross-sectional approach, we analyzed secondary data from the Surveillance Outbreak Response Management and Analysis System (SORMAS). The study encompassed HCWs in Kaduna State, excluding pregnant and lactating individuals, following national guidelines. Among 8095 HCWs tested for COVID-19, most were aged 31-40 years (35%), female (60.2%), and urban residents (70.3%). COVID-19 vaccination uptake was low at 17.4%, with 82.6% unvaccinated. COVID-19 infection was significantly associated with vaccination (p = 0.039). Although unvaccinated participants exhibited a higher mortality rate (60%) than vaccinated ones (40%), this difference was not statistically significant (p = 0.209). In conclusion, this study unveiled insufficient vaccination uptake among HCWs, potentially impeding pandemic response. While vaccination seemed to positively impact disease outcomes, it didn’t significantly affect the infection risk. Addressing HCW vaccine hesitancy remains critical for achieving immunization goals and ensuring healthcare system safety. Keywords: Covid-19, Vaccines, Vaccination uptake, Healthcare workers (HCW), Infection.

Identifying reasons for non-acceptance of influenza vaccine in healthcare workers: an observational study using declination form data

BackgroundHealthcare workers are sometimes required to complete a declination form if they choose not to accept the influenza vaccine. We analysed the declination data with the goal of identifying barriers to vaccination uptake across seasons, staff groups, and pre- and post- arrival of COVID-19.MethodsReasons for declining the vaccine were gathered from N = 2230 declination forms, collected over four influenza seasons, 2017/2018, 2018/2019, 2019/2020 and 2020/2021, from a single health board in the UK. Reasons were classified according to ten categories and the resulting distribution analysed across year and staff groups. A further analysis considered the two most prevalent categories in more detail.ResultsFear of adverse reactions and Lack of perception of own risk were identified as primary reasons for not accepting the vaccine across time and across staff groups. However, there was no evidence that Lack of concern with influenza, or Doubts about vaccine efficacy was prevalent, contrary to previous findings. Overall, reasons fitted a pattern of underestimating risk associated with influenza and overestimating risk of minor adverse reactions. There were also differences across years, χ2(24) = 123, p < .001. In particular, there were relatively fewer Lack of perception of own risk responses post-COVID-19 arrival than before, χ2(8) = 28.93, p = .002.ConclusionThis study shows that data collected from declination forms yields sensible information concerning vaccine non-acceptance without the difficulties of retrospective or pre-emptive reasoning suffered by questionnaires. Our findings will aid messaging campaigns designed to encourage uptake of the influenza vaccine in healthcare workers. In particular, we argue for an approach focused on risk perception rather than correction of straightforward misconceptions.

SARS-CoV-2 Infections, Re-Infections and Clinical Characteristics: A Two-Year Retrospective Study in a Large University Hospital Cohort of Vaccinated Healthcare Workers.

At the University Hospital of Bari, during the first year after the start of the mandatory vaccination campaign with BNT162b2 mRNA COVID-19 vaccine, the preliminary results of an observational study showed a significant prevalence of SARS-CoV-2 breakthrough infections (BIs) among healthcare workers (HCWs), but no hospitalization or deaths. In the present study, we extended the observation period (January 2021-January 2023) with the aim of determining the incidence, characteristics and clinical course of SARS-CoV-2 BIs among 6213 HCWs. All HCWs were regularly monitored and screened. To allow return to work after BI, the protocol required one negative nasopharyngeal swab test followed by a medical examination certifying complete clinical recovery. We observed an overall incidence rate of SARS-CoV-2 BIs of 20.2%. Females were most affected, especially in the nurse group compared with doctors and other HCWs (p < 0.0001). Cardiovascular diseases were the most frequent comorbidity (n = 140; 11.4%). The source of infection was non-occupational in 52.4% of cases. Most cases (96.9%) showed minor symptoms and only two cases of hospitalization (one in intensive care unit), 13 cases of re-infection and no deaths were recorded. Our results confirm that SARS-CoV-2 infection can break vaccination protection but the clinical course is favorable.

25-Hydroxyvitamin D concentrations do not affect the humoral or cellular immune response following SARS-CoV-2 mRNA vaccinations

BackgroundTo improve effectiveness of vaccination against SARS-CoV-2, it is important to identify factors that influence the immune response induced by vaccination. Evidence for the role of vitamin D in immune response against SARS-CoV-2 is contradictory. It is therefore of interest whether 25-hydroxyvitamin D (25[OH]D) concentrations affect the humoral and/or cellular response following SARS-CoV-2 vaccination. MethodsIn this prospective cohort study, blood samples were collected from 98 SARS-CoV-2 naive health care workers (HCW) receiving the first two doses of either BNT162b2 or mRNA-1273 in 2021. Wild-type spike (S) protein binding and neutralizing antibodies were determined approximately three weeks after the first dose and four to five weeks after the second dose. Antigen specific T-cells and functionality (proliferative response and interferon gamma [IFN-γ] release) were determined in 18 participants four weeks after the second dose of BNT162b2. We studied the association between 25(OH)D concentrations, which were determined prior to vaccination, and humoral and cellular immune responses following vaccination. ResultsWe found no association between 25(OH)D concentrations (median 55.9 nmol/L [IQR 40.5–69.8]) and binding or neutralizing antibody titers after complete vaccination (fold change of antibody titers per 10 nmol/L 25(OH)D increase: 0.98 [95% CI 0.93–1.04] and 1.03 [95% CI: 0.96–1.11], respectively), adjusted for age, sex and type of mRNA vaccine. Subsequently, continuous 25(OH)D concentrations were divided into commonly used clinical categories (<25 nmol/L [n = 6, 6%], 25–49 nmol/L [n = 33, 34%], 50–75 nmol/L [n = 37, 38%] and ≥75 nmol/L [n = 22, 22%]), but no association with the humoral immune response following vaccination was found. Also, 25(OH)D concentrations were not associated with the SARS-CoV-2 specific T cell response. ConclusionNo association was found between 25(OH)D concentrations and the humoral or cellular immune response following mRNA vaccination against SARS-CoV-2. Based on our findings there is no rationale to advise vitamin D optimization preceding SARS-CoV-2 vaccination in HCW with moderate vitamin D status.

Intention, Motivation, and Empowerment: Factors Associated with Seasonal Influenza Vaccination among Healthcare Workers (HCWs).

Vaccination against seasonal influenza has proven effective in preventing nosocomial influenza outbreaks among hospital patients and healthcare workers (HCWs). This study aims to explore the intention, motivation, and empowerment toward vaccination and vaccination advocacy as contributing factors for seasonal influenza vaccination in HCWs. A cross-sectional study in eight secondary hospitals in Greece was conducted from March to May 2022. An anonymous questionnaire was enclosed in an envelope and distributed to all participants, including questions on vaccine behavior and the MoVac-flu and MoVad scales. A total of 296 participants completed the questionnaire. In multivariate logistic regression models adjusted for potential confounders, increased age, intention score, MoVac-flu scale score, and the presence of chronic diseases were significant predictors of influenza vaccination this year, while increased age, intention score, and presence of chronic diseases were predictors of vaccination every year. Vaccination uptake is simultaneously affected by logical cognitive processes (intention), together with factors related to motivation and empowerment in distinct self-regulatory domains such as value, impact, knowledge, and autonomy. Interventions focused on these identified predictors may be used as a guide to increase HCWs' vaccination rates.

Influenza and Pneumococcal Vaccination of Healthcare Workers during a Pandemic Reduces the Risk and Severity of COVID-19 in Vaccinated

Background. Individuals who were vaccinated against seasonal influenza or had a history of pneumococcal vaccination were found to be less likely to become infected and tolerate COVID-19 more easily. However, it has not been sufficiently studied how vaccination against these infections, carried out during the pandemic period, can affect the incidence of COVID-19.Aims. The purpose of the investigation: to study the effect of vaccination against influenza and pneumococcal infection carried out during the pandemic of a new coronavirus infection on the susceptibility and course of COVID-19 in healthcare workers.Materials and methods. In August- Setempber 2020, after the first rise in the incidence of COVID-19, out of 547 employees (aged 18 to 70 years) of a medical organization (MO), 266 (49%) were vaccinated against influenza (group II, n = 98), pneumococcal infection (group III, n = 60) and combined vaccination (group IV, n = 108), while 281 (51%) remained unvaccinated (group 1). Follow-up period: from September 2020 to March 2021 with the registration of the incidence of acute respiratory infections (ARI) according to primary medical records and the use of PCR methods for SARS-CoV-2, epidemiological and statistical analysis.Results. Two months after the start of the study, the proportion of cases of COVID-19 in the 1st group (unvaccinated) was 5% versus 1% in the 4th group (persons vaccinated with two vaccines), after 4 months – 15% and 5%, respectively, and at the end of observation (166 days) – 16% and 8%, respectively. That is, among unvaccinated individuals, the risk of getting COVID-19 was higher by HR = 2.1 [95% CI: 1.0÷4.7] times. The time between the start of observation and a positive test for COVID-19 in study participants was significantly higher in the 4th group compared to the group I: 106 [60–136] days versus 47 [17–75] days. The distribution of patients with COVID-19 according to the severity of viral pneumonia showed that in unvaccinated patients in most (64%) cases, pneumonia had a moderate to severe course, while in the 4th group of patients with combined vaccination in 100% of cases, mild (p = 0.04 for the entire sample).Conclusions. During the COVID-19 epidemic rises, vaccination against respiratory infections remains relevant, reducing the number of cases, the severity of the coronavirus infection and preventing the occurrence of co-infections.

Influenza epidemics in Europe, nursing homes and vaccination of healthcare workers

During the 2022-2023 season, influenza circulation levels in the European Union (EU) have increased substantially compared to the 2021-2022 season but were still generally somewhat lower compared to pre-pandemic influenza seasons. Studies have shown that influenza epidemics in the EU countries were associated with a heavy toll of mortality for different principal causes of death including respiratory, cardiac and other causes. Mortality data also suggest that residents of long-term care facilities represent a sizeable share of all cases of death in the EU, and an even higher share among deaths stemming from infections with respiratory viruses, including influenza. Influenza vaccination coverage for healthcare workers in nursing homes in many EU countries is moderate to low, whereas evidence in the literature suggests that higher influenza vaccination coverage levels for healthcare workers result in a significant reduction in all-cause mortality during influenza seasons, both in nursing home residents as well as in hospital patients, though the magnitude of that effect varies with influenza season. Here, we review the above evidence, and as well as the effect of different strategies for boosting influenza vaccination coverage in healthcare workers, such as mandatory vaccination, educational initiatives/outreach activities and availability of on-sight vaccination.

COVID‐19 booster dose vaccination of healthcare workers in Qatar: A web‐based cross‐sectional survey

AbstractBackgroundVaccines are an important public health measure and effective strategy to protect the population from COVID‐19. Front‐line healthcare personnel should receive priority in vaccination programs. However, the reported hesitancy among healthcare workers (HCWs) toward the COVID‐19 vaccines cannot be ignored. It widely influences the level of vaccine hesitancy in the general population. Hesitancy, fear, and anxiety were documented in first and second rounds of COVID‐19 vaccination. This study assessed the acceptance of COVID‐19 booster doses among the HCWs in Qatar.MethodsA web‐based cross‐sectional online survey was conducted using the 7C Vaccine Readiness Scale to evaluate the preparedness of the HCWs to receive COVID‐19 vaccines. Descriptive and inferential statistics were used to identify factors associated with preparedness for vaccination.ResultsA total of 382 participants completed the survey. Allied health professionals scored the least on the readiness score (−7.0 ± 9.9) compared to the physicians (3.1 ± 7.2) and nurses (3.0 ± 7.8). Physicians scored higher on confidence (58.8%), calculation (64.7%), and complacency (60.8%). Nurses scored higher on constraints (51.6%), collective responsibility (62.7%), and compliance (39.1%), and allied health professionals scored higher on (67.9%) conspiracy. There was a significant association between readiness score and not being infected with COVID‐19, post‐vaccine symptom experience, and hesitancy for the initial two doses.ConclusionThis study reports higher complacency and constraints with the perception of lower risks and the lack of interest in taking collective responsibility among the HCWs. Addressing vaccine hesitancy among them is critical to ensure successful vaccination campaigns and promote community safety during future pandemics.

Evaluation of Seroconversion Rate Following SARS COV 2 Vaccination in Health Care Workers at Shahid Beheshti University of Medical Sciences

Background: Vaccines are the most effective way to prevent Coronavirus 2 severe acute respiratory syndrome (SARS-CoV-2). This study examines and compares the efficiency of AstraZeneca, Sinopharm, and Sputnik vaccines and the correlation of antibody response with age, sex, and history of corona disease in employees of Shahid Beheshti University of Medical Sciences.&#x0D; Methods: 202 participants were included, of which 82 were administered the AstraZeneca, 59 were given the Sinopharm, and 61 were given the Sputnik vaccine. SARS-CoV-2 IgM and IgG antibody levels were checked four weeks after passing the second dose of all three vaccines using the enzyme-linked immunosorbent assay (ELISA) technique.Results: There was no significant difference between the amount of IgM and IgG antibodies among three vaccines (p=0.056). For all three vaccines, gender and age did not significantly affect the amount of IgM and IgG antibodies. The history of infection with COVID-19 increased the antibody response (p&gt;0.5).&#x0D; Conclusion: The titer of IgM and IgG antibodies were not statistically significantly different. The IgM and IgG antibodies produced by vector-based vaccines are higher than the Sinopharm vaccine. Gender did not affect the produced antibody titer. No significant linear relationship was found between age and antibody titer. In people from this study who received two doses of the AstraZeneca vaccine and had a corona history, the average amount of both IgM and IgG antibodies was measured more than the other participants.

Adverse Effects Associated with the First Dose of the Pfizer–BioNTech COVID-19 Vaccine in Healthcare Workers from Mexico: A Case Serie from Passive Surveillance

Almost a year after the declaration of the pandemic due to the SARS-CoV-2 virus which causes the COVID-19 disease and the need to contain the progression and treatment, the promising option was designing an effective and safe vaccine to reach a state of massive immunity. The first vaccine approved was the one produced by Pfizer–BioNTech, and its application started in December 2020. Within days of the first applications, 0.2% of adverse events were reported. Herein, a series of 26 cases with the manifestation of adverse events related to the application of the first dose of the BNT162b2 vaccine from Pfizer–BioNTech in healthcare workers from Mexico. Of these cases, only five patients were classified with a certainty of anaphylaxis; two of them presented seizures, and their management is described individually. After the examination of all the cases, the symptoms were resolved. In Mexico and around the globe, the vaccination process continues, and the report of possible AEFIs is still needed to contribute to the pharmacovigilance of this new vaccine and improve its safety profile.

Comparison of COVID-19 epidemic among Czech dentists and the Czech general population

Dentists are one of the professional groups most at risk for COVID-19 infection. Enhanced protective measures in dentistry have been adopted worldwide; however, it is unclear to what extent they were sufficient. To assess whether the protective measures outweighed the high infection risk, we compared COVID-19-related data between Czech dentists and the general Czech population. The data was obtained through a survey study attended by 15.8% of Czech Dental Chamber members. Data of the general population were acquired from the Czech Ministry of Health database. By the end of May 2022, COVID-19 full vaccination and 1st booster dose rates among study participants were 85.8% and 70.1%, respectively, which is significantly higher (p < 0.0001) compared to the Czech general population aged over 24 years (74.9% and 49.4%, respectively). To the same date, PCR/Antigen test verified COVID-19 prevalence among participants was 41.7%, and 49.9% among the general population (p < 0.0001). Prevalence and reinfection rates among individuals who received the 1st booster were significantly lower than among individuals without the booster or full vaccination (p < 0.0001). Persons who received the booster showed a faster return to work, shorter and different types of complications. Willingness to future vaccination was positive among 79.7% of respondents. Mandatory vaccination for healthcare workers and the general population was supported by 62.0% and 49.0%, respectively. The results showed that the high risk of COVID-19 infection associated with dentistry did not lead to higher COVID-19 prevalence among respondents compared to the general population.

Inability to work following COVID-19 vaccination–a relevant aspect for future booster vaccinations

ObjectivesCOVID-19 vaccination is a key prevention strategy to reduce the spread and severity of SARS-CoV-2 infections. However, vaccine-related inability to work among healthcare workers (HCWs) could overstrain healthcare systems. Study designThe study presented was conducted as part of the prospective CoVacSer cohort study. MethodsThis study examined sick leave and intake of pro re nata medication after the first, second, and third COVID-19 vaccination in HCWs. Data were collected by using an electronic questionnaire. ResultsAmong 1704 HCWs enrolled, 595 (34.9%) HCWs were on sick leave following at least one COVID-19 vaccination, leading to a total number of 1550 sick days. Both the absolute sick days and the rate of HCWs on sick leave significantly increased with each subsequent vaccination. Comparing BNT162b2mRNA and mRNA-1273, the difference in sick leave was not significant after the second dose, but mRNA-1273 induced a significantly longer and more frequent sick leave after the third. ConclusionIn the light of further COVID-19 infection waves and booster vaccinations, there is a risk of additional staff shortages due to postvaccination inability to work, which could negatively impact the already strained healthcare system and jeopardise patient care. These findings will aid further vaccination campaigns to minimise the impact of staff absences on the healthcare system.

Safety of BCG vaccination and revaccination in healthcare workers

ABSTRACT BCG vaccination and revaccination are increasingly being considered for the protection of adolescents and adults against tuberculosis and, more broadly, for the off-target protective immunological effects against other infectious and noninfectious diseases. Within an international randomized controlled trial of BCG vaccination in healthcare workers (the BRACE trial), we evaluated the incidence of local and serious adverse events, as well as the impact of previous BCG vaccination on local injection site reactions (BCG revaccination). Prospectively collected data from 99% (5351/5393) of participants in Australia, Brazil, Spain, The Netherlands and the UK was available for analysis. Most BCG recipients experienced the expected self-limiting local injection site reactions (pain, tenderness, erythema, swelling). BCG injection site itch was an additional common initial local symptom reported in 49% of BCG recipients. Compared to BCG vaccination in BCG-naïve individuals, BCG revaccination was associated with increased frequency of mild injection site reactions, as well as earlier onset and shorter duration of erythema and swelling, which were generally self-limiting. Injection site abscess and regional lymphadenopathy were the most common adverse events and had a benign course. Self-resolution occurred within a month in 80% of abscess cases and 100% of lymphadenopathy cases. At a time when BCG is being increasingly considered for its off-target effects, our findings indicate that BCG vaccination and revaccination have an acceptable safety profile in adults.

Long follow-up of BNT162b2 mRNA vaccine in healthcare workers (2020–2022): A retrospective longitudinal SARS-CoV-2 serological surveillance

ABSTRACT SARS-CoV-2 anti-spike IgG production and protection from severe respiratory illness should be explored in greater depth after COVID-19 booster vaccination. This longitudinal observational retrospective study investigated the anti-spike IgG response elicited by the first, second and booster doses of BNT162b2 mRNA vaccine in healthcare workers (HCW) at San Martino IRCCS Policlinico Hospital (Genoa) up to the 12th month. Sequential blood sampling was performed at T0 (prior to vaccination), T1 (21 days after the 1st dose of vaccine), T2, T3, T4, T5, T6 (7 days and 1, 3, 6 and 9 months after the 2nd dose, respectively), T7 and T8 (1 and 3 months after a booster dose). A SARS-CoV-2 IgG panel (Bio-Rad, Marnes-la-Coquette, France) was used to determine levels of receptor-binding domain (RBD), spike-1 (S1), spike-2 and nucleocapsid structural proteins of SARS-CoV-2. In the 51 HCWs evaluated, seroprevalence was 96% (49/51) at T1 and 100% (51/51) from T2 to T5 for RBD and S1. At T6, only one HCW was negative. T2 [RBD = 2945 (IQR:1693–5364); S1 = 1574 (IQR:833–3256) U/mL], and T7 [RBD = 8204 (IQR:4129–11,912); S1 = 4124 (IQR:2124–6326) U/mL] were characterized by the highest antibody values. Significant humoral increases in RBD and S1 were documented at T7 and T8 compared to T2 and T4, respectively (p-value < .001). Following vaccination with BNT162b2 and a booster dose in the 9th month, naïve and healthy subjects show high antibody titers up to 12 months and a protective humoral response against COVID-19 disease lasting up to 20 months after the last booster.

Protecting the healthcare workers in low- and lower-middle-income countries through vaccination: barriers, leverages, and next steps

ABSTRACT Healthcare workers play a critical role in providing medical care to individuals and communities. Due to the nature of their work, compared to the general public, healthcare workers are at a higher risk of exposure to infectious diseases, including vaccine-preventable ones. The routine vaccination of healthcare workers in low- and lower-middle-income countries is a critical issue. Vaccination not only protects healthcare workers from contracting infectious diseases but also prevents the spread of diseases to the patients, reduces healthcare costs, increases healthcare workers’ morale and productivity, and demonstrates a commitment to health and safety. However, the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries faces several challenges, including lack of funds, lack of evidence-based data, vaccination hesitancy through misguided beliefs, and low literacy among healthcare workers. In this article, we discuss the need for a policy for routine vaccination of healthcare workers in low- and lower-middle-income countries. We also analyse the barriers and recommendations for policy implementation and the role of partnerships. Additionally, we highlight the main points of the World Federation of Public Health Associations’ policy statement ‘Protecting the Healthcare Workforce in Low- and Middle-Income Countries through Vaccination’ which has the potential to drive policy-makers and healthcare organisations worldwide into prioritising routine vaccination of healthcare workers in low- and lower-middle-income countries.

Determinants of COVID-19 Vaccine Acceptability among Healthcare Workers in Kenya-A Mixed Methods Analysis.

Healthcare workers (HCWs) were a priority group for COVID-19 vaccination. Adopting the World Health Organization's 3C and the expanded 5C vaccine hesitancy models, we assessed the factors associated with COVID-19 vaccine acceptability among HCWs in Kenya. In a mixed methods study, respondents were from eight selected counties across the country. An online survey (n = 746), key informant interviews (n = 18) and focus group discussions (n = 3) were conducted. The data were analyzed concurrently. Quantitative data showed that all the 3C antecedents were strong predictors of vaccine acceptability. The association of vaccine acceptability was strongest with convenience (aOR 20.13, 95% CI 9.01-44.96), then complacency (aOR 10.15, 95% CI 4.63-22.21) and confidence (aOR 6.37, 95% CI 2.90-14.02). Marital status was a significant independent factor associated with vaccine acceptability (aOR 2.70, 95% CI 1.20-6.08). Qualitatively, convenience presented as the no-cost availability of vaccines at the health facilities, whereas non-complacency manifested from the first-hand observed experience of COVID cases, and the need to protect oneself and family members. Confidence was mainly attributed to increased knowledge, resulting from multiple training sessions and trust in regulatory authorities. Other social factors including workplace pressure, religion and misinformation had a role in influencing HCW vaccination decisions. In the background of a pandemic, the 3C model is a strong predictor of vaccine acceptability, and making the vaccines easily available and convenient to HCWs significantly impacts their uptake.

Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers

Mandatory COVID-19 vaccination requirements for healthcare workers in the United States, instituted at the height of the pandemic to protect vulnerable patients and preserve the infrastructure of healthcare, nonetheless met with resistance by some members of the work force. As unprecedented numbers of employees sought religious accommodations, chaplain leaders were recruited by institutional leadership to adjudicate these requests, either alone or as part of a committee.This study reports results of a survey conducted from 6/1/2022 to 7/15/2022 with U.S. healthcare chaplains (n = 76) who were involved in the evaluation of coworker requests for religious exemption to the COVID-19 vaccine anytime during the pandemic until they accessed the survey. Chaplains were recruited online through national chaplaincy and ethics organizations. A mixed methods design facilitates integration of statistically significant associations with chaplains’ in-depth reflections on their experience. Surveying the religious experts on the review committee affords a rare look into how the tension between the free exercise of religion in the workplace and the obligation to protect the public played out during the pandemic. The study further addresses a gap in research literature on the experience of chaplains during the pandemic and identifies unique features of moral injury experienced by a subset of healthcare providers.Chaplains largely perceived their involvement as promoting an ethical, informed process of review. Although all chaplains found this role stressful, high levels of meaning were protective against distress. Sources of distress identified included: ethical concern that granting exemptions would lead to the spread of the virus; inconsistencies in the review process; and, repeated exposure to coworkers’ misunderstanding and political use of religious teachings. Featuring prominently in comments from chaplains was the difficulty navigating requests in the context of anti-science, anti-vaccine, and politically charged public discourse.

Knowledge and attitude factors associated with the prevalence of Tdap (tetanus, diphtheria, and acellular pertussis) booster vaccination in healthcare workers in a large academic hospital in Southern Italy in 2022: a cross-sectional study.

In Europe, there is still suboptimal tetanus, diphtheria, and acellular pertussis (Tdap) booster coverage. This study aimed to assess coverage status, knowledge, and attitude on Tdap vaccination in healthcare workers (HcWs) of the University Hospital "Federico II" in Naples, Southern Italy, in 2022, to improve current vaccination strategies. A cross-sectional study was conducted using a validated anonymous questionnaire. Knowledge and attitude were measured as scores. Multivariable logistic and linear regression models were employed to identify correlates of Tdap booster and knowledge and attitude toward the vaccination, as appropriate. Models were controlled for age, sex, profession, department, and job seniority. A total of 206 questionnaires were administered among HcWs, and 143 (69.4%) were medical doctors. In total, 71 (34.47%) HcWs received the Tdap booster. Those who have worked 5-9 years at the hospital had a 78% lower likelihood of being vaccinated with the Tdap booster (5-9 years-OR: 0.22, CI: 0.06 | 0.85) as compared with newly hired HcWs. No differences in the average knowledge score were found. Other healthcare workers had a lower attitude as compared to medical doctors (Other-Coef. -2.15; CI: -4.14 | -0.15) and, as compared with those who worked in a clinical department, those who worked in a diagnostic-therapeutic department or medical management had 3.1 and 2.0 lower attitude scores, on average, respectively (diagnostic-therapeutic-Coef. -3.12, CI: -5.13 | -1.12; public health-Coef. -1.98, CI: -3.41 | -0.56). The study findings support the necessity to implement public health strategies and improve knowledge and attitude toward vaccinations and specifically highlight the importance of Tdap booster every 10 years as a prevention tool to protect high-risk populations.

Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study

BackgroundDuring the coronavirus disease (COVID-19) pandemic, vaccination of healthcare workers (HCWs) has a critical role because of their high-risk exposure and being a role model. Therefore, we aimed to investigate vaccine hesitancy and the role of mandatory polymerase chain reaction (PCR) testing and education for vaccine uptake. MethodsWe conducted an explanatory sequential designed observational mixed-methods study, including quantitative and qualitative sections consecutively in two different pandemic hospitals between 15 September 2021 and 1 April 2022. The characteristics of vaccinated and unvaccinated HCWs were compared. The vaccine hesitancy scales were applied, and the effect of nudging, such as mandatory PCR and education, were evaluated. In-depth interviews were performed to investigate the COVID-19 vaccine hesitancy among HCWs according to Health Belief Model. ResultsIn total, 3940 HCWs were included. Vaccine hesitancy was more common among males than females, the ancillary workers than other health professions, and nonmedical departments than other departments. After the mandatory weekly PCR request nudge, 83.33 % (130/156) vaccine-hesitant HCWs were vaccinated, and 8.3 % (13/156) after the small group seminars and mandatory PCR every two days. The rate of COVID-19 vaccination was raised from 95.5 % to 99.67 % (3927/3940). At the end of in-depth interviews (n = 13), the vaccine hesitancy determinants were distrust, fear of uncertainty, immune confidence and spirituality, the media effect, social pressure, and obstinacy. ConclusionsThe nudging interventions such as mandatory PCR testing and small group seminars helped raise the rate of COVID-19 vaccination; the most effective one is mandatory PCR.

Seroprevalence and prevention of hepatitis B, measles and rubella among healthcare workers in Dili, Timor-Leste.

The World Health Organisation recommends that healthcare workers (HCWs) are immune to measles and rubella, and those at risk of exposure are offered the hepatitis B vaccine. No formal programme for occupational assessment and provision of vaccinations to HCWs currently exists in Timor-Leste. A cross-sectional study was undertaken to determine the seroprevalence of hepatitis B, measles and rubella among HCWs in Dili, Timor-Leste. All patient-facing employees at three healthcare institutions during April-June 2021 were invited to participate. Epidemiological data were collected by interview-questionnaire and a serum sample was collected by phlebotomy and analysed at the National Health Laboratory. Participants were contacted to discuss their results. Relevant vaccines were offered to seronegative individuals and those with active hepatitis B infection were referred for further assessment and management in a hepatology clinic as per national guidelines. Three-hundred-and-twenty-four HCWs were included (representing 51.3% of all eligible HCWs working at the three participating institutions). Sixteen (4.9%; 95% CI: 2.8-7.9%) had active hepatitis B infection, 121 (37.3%; 95% CI: 32.1-42.9%) had evidence of previous (cleared) hepatitis B infection, 134 (41.4%; 95% CI: 35.9-46.9%) were hepatitis B seronegative, and 53 (16.4%; 95% CI: 12.5-20.8%) had been vaccinated. Two-hundred-and-sixty-seven (82.4%; 95% CI: 77.8-86.4%) and 306 (94.4%; 95% CI: 91.4-96.7%) individuals exhibited antibodies to measles and rubella, respectively. There are significant immunity gaps and a high prevalence of hepatitis B infection among HCWs in Dili Municipality, Timor-Leste. Routine occupational assessment and targeted vaccination of this group would be beneficial and should include all types of HCWs. This study provided an opportunity to develop a programme for the occupational assessment and vaccination of HCWs and forms the template for a national guideline. This work was supported by the Department of Foreign Affairs and Trade, Australian Government [Complex Grant Agreement Number 75889].