Vaccine Attitudes Research Articles

Evaluation of Vaccination Status and Attitudes towards Vaccinations of Healthcare Workers in a University Hospital

Enfeksiyon hastalıkları açısından çok fazla riske maruz kalan sağlık çalışanlarının etkin bir şekilde aşılanmasının önemi bilinmesine rağmen hala aşılanma oranlarının düşük seyretmesi dikkat çekicidir. Bu çalışmanın amacı da geniş bir bölgede pek çok hastaya hizmet veren bir üniversite hastanesinin çalışanlarının aşılanma durumlarını ve aşıya karşı tutumlarını belirleyerek uygun yol haritasının çizilmesine veri sağlamaktır. Kesitsel, tanımlayıcı araştırmada gönüllü sağlık çalışanları tabakalı örneklem yöntemi ile belirlenerek sosyodemografik özellikleri, aşılara karşı tutumları, aşılanma durumları kendi bildirimleri ile değerlendirildi. Örneklem grubundaki 436 sağlık çalışanının %58,7’si kadın, %53,7’si evli, %24,5’i hekimdi. Aşılanma hakkında 152’si (%34,9) eğitim almıştı. Hepatit B ve hepatit A’ya karşı bağışık olduğunu bilenler sırasıyla 292 (%67) ve 185 (%42,4) idi ve 210’u (%48,1) son on yılda tetanoz aşısı yaptırmıştı. Her yıl düzenli olarak influenza aşısı yaptıranların oranı %7,8 (n=34) iken, COVID-19 aşısı yaptırma oranı %70,0 (n=305) idi. Sağlık çalışanlarının aşılanmaya karşı ortalama tutum puanı 95,80±13,79 ile olumlu yöndeydi. Üniversite seviyesinde alanlarda (96,52±13,21), almayanlara (92,87±15,69) göre (p=0,028), hekimlerde (98,95±9,78) diğer meslek (94,77±14,73) gruplarına göre aşıya yönelik olumlu tutum artmaktadır (p=0,006). Hekimler arasında ise dahili bölümlerde çalışanlarda (100,52±8,05), cerrahi bölümlerde çalışanlara (92,52±13,50) göre tutum puanının yüksek olması dikkat çekiciydi (p=0,003). Bu çalışma influenza, tetanoz ve tam aşılama hedeflenen COVID-19 aşıları açısından sağlık çalışanlarının etkin şekilde aşılanmadığını göstermektedir. Aşılara karşı tutum puanlarının oldukça yüksek olmasına karşı aşılanma oranlarının düşük seyretmesi risklerin bilinmesine karşı korunma davranışının yeterince içselleştirilmediğini göstermektedir. Bu nedenle çalışmanın sonuçları daha etkin ve davranışa yönelik eğitim ve bilgilendirilmelerin kurumlarda sürekli, zorunlu ve takipli olması gerektiğini düşündürmektedir.

COVID-19 vaccination attitudes, values, intentions: US parents for their children, September 2021

ObjectivesTo compare vaccine-related attitudes and values of parents of children 2–17 years old to other adults, examine intentions to vaccinate their children, and identify factors associated with intending to vaccinate children. MethodsA nationally representative survey was conducted in September 2021 (just before the EUA for children 5–11 years old) using Ipsos KnowledgePanel, a probability-based web panel. The survey measured COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities among US adults. Scale response options to survey items were dichotomized, and cross-tabulations and logistic regressions were performed. ResultsParents had lower odds of reporting being vaccinated against COVID-19 than other adults even after adjusting for associated sociodemographic characteristics such as age (aOR: 0.66; 95 %CI: 0.50–0.87). The most prevalent parental concerns about COVID-19 vaccines included the speed of their development (88 %), potential side effects (78 %), suspicion of government (77 %), and suspicion of pharmaceutical companies (72 %). Fewer than half (42 %) of parents intended to vaccinate their children 5–11 years old, while 38 % were uncertain and 20 % were unlikely to ever vaccinate their children. Vaccinated parents had higher odds than unvaccinated parents of intending to vaccinate their children (OR: 675.51; 95 %CI: 106.46–4286.12). Discussions with healthcare providers who encouraged COVID-19 vaccination were positively associated with intent to vaccinate children (OR: 11.29; 95 %CI: 2.60–49.02). ConclusionsWe found parental vaccination and conversations with providers were positively associated with intent to vaccinate children. Decisions about childhood vaccination need to be supported by healthcare providers and a public health system that makes vaccine access and related information equitable and accessible. Vaccination-related decision making should be guided by healthcare providers and provide information about safety and risk to children.

COVID-19 Vaccine Accessibility, Perceptions, and Attitudes in the LGBTQ+ Community.

Lesbian, gay, bisexual, transgender, and queer populations have historically experienced challenges accessing, trusting, and receiving health care services, which can negatively impact successful uptake of the COVID-19 vaccine series among this population. This research aimed to examine the perceptions and attitudes regarding the acceptability, accessibility, and efficacy of the COVID-19 vaccine among persons who self-identify within this community. A multidisciplinary, community-focused mixed-methods study was conducted. The quantitative portion of the study was conducted via an online survey throughout the United States for 2 months. The quantitative portion of the study consisted of multiple online focus group sessions after the completion of the survey. The online survey had an sample of 3868 participants, with 31 participants in the focus groups. High levels of acceptability toward COVID-19 vaccines were found within this community. Concerns highlighted included the need for culturally competent care, side effects of the vaccine, and unknown effects of the vaccine with hormone replacement therapy. Racial and ethnic minority, transgender, and nonbinary participants reported higher levels of uncertainty about vaccination. Findings demonstrate that most lesbian, gay, bisexual, transgender, and queer individuals felt comfortable with the COVID-19 vaccine, had a positive experience with the vaccination process, and believe that the vaccine can protect them and others from COVID-19. When developing future COVID-19 vaccination strategies and rollouts, public health officials should consider prioritizing lesbian, gay, bisexual, transgender, and queer individuals and other marginalized populations by partnering with local organizations to identify trusted organizations.

COVID-19 vaccination acceptance, safety and side-effects in European patients with severe asthma.

Vaccination is vital for achieving population immunity to severe acute respiratory syndrome coronavirus 2, but vaccination hesitancy presents a threat to achieving widespread immunity. Vaccine acceptance in chronic potentially immunosuppressed patients is largely unclear, especially in patients with asthma. The aim of this study was to investigate the vaccination experience in people with severe asthma. Questionnaires about vaccination beliefs (including the Vaccination Attitudes Examination (VAX) scale, a measure of vaccination hesitancy-related beliefs), vaccination side-effects, asthma control and overall safety perceptions following coronavirus disease 2019 (COVID-19) vaccination were sent to patients with severe asthma in 12 European countries between May and June 2021. 660 participants returned completed questionnaires (87.4% response rate). Of these, 88% stated that they had been, or intended to be, vaccinated, 9.5% were undecided/hesitant and 3% had refused vaccination. Patients who hesitated or refused vaccination had more negative beliefs towards vaccination. Most patients reported mild (48.2%) or no side-effects (43.8%). Patients reporting severe side-effects (5.7%) had more negative beliefs. Most patients (88.8%) reported no change in asthma symptoms after vaccination, while 2.4% reported an improvement, 5.3% a slight deterioration and 1.2% a considerable deterioration. Almost all vaccinated (98%) patients would recommend vaccination to other severe asthma patients. Uptake of vaccination in patients with severe asthma in Europe was high, with a small minority refusing vaccination. Beliefs predicted vaccination behaviour and side-effects. Vaccination had little impact on asthma control. Our findings in people with severe asthma support the broad message that COVID-19 vaccination is safe and well tolerated.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

ABSTRACT The decline in children’s vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents’ vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach’s alpha test (α) and McDonald’s omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

Opinions, Attitudes and Factors Related to SARS-CoV-2 Vaccine Uptake in Eight South American Countries.

This article presents attitudes and practices regarding COVID-19 vaccination in the South American population. The study collected data from a self-administered survey distributed through social media platforms between February and April 2022 (N = 6555). The survey included questions related to participants' sociodemographic background, flu vaccination practices, sources of information about COVID-19, and opinions regarding pandemic management and vaccination against SARS-CoV-2. The respondents agreed with the statement that COVID-19 vaccines were necessary (86.4%), effective (79.8%), safe (79.1%), and should be mandatory (64%). Overall, 83.4% accepted vaccination and 12.3% refused it completely. Main rejection reasons were safety (65.8%) and efficacy (54.9%) issues, and rushed development and approvals (49.1%). Vaccine uptake was associated with being ≥60 years, being a healthcare worker, previous influenza vaccine uptake, adherence to preventive measures, the death of ≥1 close people from COVID-19, and being informed through mass media or health authorities' channels. Vaccine uptake inversely correlated with male gender, low educational level, and use of closed social networks for COVID-19 information purposes. This study provides valuable insights into COVID-19 vaccination attitudes and practices in South America that may be used to promote vaccine uptake in the region. Higher COVID-19 vaccination acceptance among people with previously acquired prevention habits reinforces the importance of routine health promotion strategies.

Understanding COVID-19 vaccine hesitancy in Canada

While Canada has had relatively high vaccination rates against COVID-19, specifically during earlier waves of the pandemic, vaccine hesitancy has continued to serve as a significant barrier to adequate protection against the virus and, more recently, booster vaccine uptake. This paper explores the processes underlying Canadians’ perceptions of COVID-19 vaccines and their decisions to take or refuse them, as well as how public policy and health messaging about vaccination has influenced vaccination attitudes and behaviors. Our focus group interviews with 18 vaccinated and unvaccinated adult Canadians conducted during October 2021 reveal that, in some respects, COVID-19 vaccine hesitancy conforms to prior knowledge about some of the factors that affect vaccine attitudes (e.g., the influence of known medical providers) but deviates from current theoretical frameworks regarding general vaccine hesitancy. Specifically, these frameworks emphasize a lack of scientific knowledge and literacy (“knowledge deficit” accounts) or individuals’ inability to incorporate rational risk perceptions into initial emotional responses to vaccines (“emotionality/irrationality” accounts). In contrast to the knowledge deficit account, we find that expressions of COVID-19 vaccine hesitancy were most frequently associated with an information surplus or inability to prioritize information from multiple and often contradictory sources. Furthermore, top-down pro-vaccination messaging often triggered significant pushback against what participants perceived as moral shaming of the unvaccinated. Our findings demonstrate the necessity for a new framework to understand and address vaccine hesitancy. A better theoretical account of vaccine hesitancy has important implications for future vaccination efforts, specifically within the context of new variants and low booster vaccination rates in Canada.

Literacy and Attitudes Towards COVID-19 Vaccine in Cancer Patients

Abstract Background Identifying motives of the patients’ decision to be vaccinated against COVID-19 and assessing their attitudes towards the vaccine will provide them acquire the most convenient health care. The aim of this study is to assess the cancer patients’ COVID-19 vaccine literacy and attitudes toward the vaccine. Methods This cross-sectional study included 198 participants who were submitted treatment from the oncology department of Pendik Training and Research Hospital in October 2022. The socio-demographic and clinical characteristics were examined, including the knowledge on COVID-19 infection and vaccination. COVID-19 Vaccine Literacy Scale and Attitudes Towards COVID-19 Vaccine Scale were evaluated. Mann Whitney U and Kruskal Wallis tests are used in SPSS 28. The statistical significance was set at 0.05 level. Results All of the patients had at least one malignancy history, and 88.4% (n = 175) of them had received at least one COVID-19 vaccine. Positive vaccination attitude was higher in those patients who are male (p < 0.05) or older than 60 years (p < 0.001). The vaccine literacy was higher in the male patients, those who had higher education, and those who had vaccination intention (p < 0.05, p < 0.05, p < 0.05). The ones who get influenza or pneumococcal vaccines were more likely to have the next COVID-19 vaccine (p < 0.05, p < 0.05). The male patients had higher scores in functional skills (p < 0.05). While functional skill scores were lowest in those aged 18 to 45 (p < 0.05), communication skill scores were highest (p < 0.05). Conclusions As with all infectious diseases, COVID-19 is an important public health concern. Identifying risk groups of the community based on the vaccine attitude would allow health practitioners and policymakers to be prepared for probable crisis situations such as pandemic. Key messages • Special groups such as cancer patients are needed to be specifically assessed about the possible outcomes of the vaccination. • It is essential to provide vaccination consultation during pandemics due to the limited availability and accessibility of healthcare services.

Link between COVID-19 Vaccination Attitudes and Support for Mandatory Childhood Vaccinations

Abstract Introduction Despite vaccines being a proven intervention over time to limit the spread of infectious diseases, in recent decades there has been fluctuation among parents regarding the mandatory immunization calendar in Bulgaria. Aim This study aimed to investigate the impact of the COVID-19 pandemic on parents’ decisions regarding mandatory immunizations for children in Bulgaria. Methods A total of 1200 Bulgarian citizens participated in the cross-sectional study, which included questions related to socio-demographic indicators, COVID vaccination status, attitudes towards mandatory immunization, beliefs in personal doctors, rumors about vaccines, and the desire to vaccinate their own children against COVID-19. Data was analyzed using Jamovi software, and a chi-square test for association was used to investigate the relationship between COVID-19 vaccination status and attitudes towards mandatory childhood vaccinations. Results The study found that 93% of the 1133 participants who expressed an opinion on mandatory childhood vaccinations had a positive attitude. Respondents who were vaccinated against COVID-19 and had a positive attitude towards mandatory COVID vaccination were more likely to support mandatory childhood vaccinations – 98.8% vs 1.2% (χ2=27.6; p < 0.001). Those who perceived moderate to high benefits of COVID vaccines were also more likely to support mandatory childhood vaccinations (χ2=43.4; p < 0.001). Participants who had not heard of or did not believe in rumors about COVID vaccines and those who had trust in primary care physicians were more likely to support mandatory childhood vaccinations. Conclusions The study indicates that attitudes towards COVID vaccination could influence parents’ decisions on mandatory vaccines for children in Bulgaria. If parents distrust the safety and effectiveness of COVID vaccines, they may also be hesitant towards mandatory vaccinations for children. Key messages • Implementation of a proper vaccination policy is necessary to protect public health and limit infectious diseases. • The COVID-19 pandemic has raised questions about the possibility of including mandatory vaccination against COVID-19 in Bulgaria's immunization calendar.

Knowledge and attitudes towards vaccination in the Croatian adolescent population

Abstract Background Adolescents are a large and vulnerable group for infectious and other diseases. A good insight into their specific needs and their understanding of disease and prevention is necessary to adapt vaccination strategies for this population subgroup characterized by constant change and evolution. This study aimed to explore knowledge and attitudes about vaccination among the Croatian adolescent population. Methods This online cross-sectional questionnaire study was conducted from January 2021 to April 2021 in a convenient sample of adolescents from the northwestern part of Croatia. The knowledge was assessed through a specially designed validated questionnaire. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes towards vaccination in the study population, where the higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study included 1012 adolescents (29.2% males and 70.8% females). The median age of all subjects was 17.0 (interquartile range 17.0 - 18.0) years. According to the knowledge, there were 29.5% of students with poor, 53.9% of students with average and 16.6% of students with good knowledge about vaccination. The median VAX scale score was 50.0 (interquartile range 43.0-59.0). Male adolescents more frequently had poor knowledge about vaccination (P = 0.028), while female adolescents had more negative attitudes towards vaccination (P = 0.001). The study revealed that there was a positive correlation between poor knowledge and more negative attitudes towards vaccination in the studied population (P < 0.001; rs = 0.260). Conclusions The study showed that a large proportion of Croatian adolescents have poor knowledge about vaccination and negative attitudes toward vaccination. Public health programs specially designed for this vulnerable population subgroup are needed to successfully tackle observed negative indicators. Key messages • Public health interventions directed towards the suppression of negative attitudes about vaccination must involve younger population subgroups, such as adolescents. • Positive attitudes as well as better knowledge about vaccination among adolescents are crucial preconditions for adequate vaccination coverage.

‘Why did nobody ask us?’, parents’ views on childhood vaccines: A co-production research study

Abstract Background Inequalities in childhood vaccine uptake exist in the United Kingdom but previous surveys of vaccine attitudes have underrepresented parents of children with low vaccine uptake. We aimed to explore parents’ views and experiences of vaccinating their child and how the COVID-19 pandemic had impacted childhood vaccine attitudes. Methods We worked with Mosaic Community Trust, an ethnically diverse women's community group using a participatory approach to co-develop a questionnaire for parents with children aged under 10 years old. We targeted recruitment at parents living in the North-west London area, where vaccine uptake has been historically low and continues to be lower compared to regionally and nationally. The questionnaire was promoted through local community networks alongside targeted social media promotion. We then held four parents’ focus groups in 2023, co-facilitated by Mosaic. Results Between Jun-Oct 2022, 518 parents completed the questionnaire (64% UK born and 30% from ethnic minorities). Most parents (92%) believed childhood vaccines were important and 16% had delayed or refused a childhood vaccine. In both the questionnaire and the focus groups (n = 22), parents reported that lack of reminders and difficulties booking or going to appointments impacted uptake. They also wanted easier access to trusted health professionals to answer vaccine questions. In both the questionnaire responses and focus groups some parents reported that COVID-19 had changed their childhood vaccine views either highlighting their importance, increasing parents’ questions, or increasing mistrust. Conclusions Parents report practical barriers impact vaccine uptake including difficulties booking or attending childhood vaccine appointments. Parents should be offered easy access to trusted healthcare professionals to answer their questions about vaccines particularly in the aftermath of the COVID-19 pandemic which has negatively affected some parents’ views on childhood vaccines. Key messages • Parents want easy access to trusted healthcare professionals to answer their questions about childhood vaccination particularly since the COVID-19 pandemic. • Parents report that difficulties booking & attending vaccine appointments are key reasons for late or missed childhood vaccination in the UK.

Medical students’ vaccine hesitancy, knowledge and attitudes: A cross-sectional study

Abstract Background Despite physicians being in a unique position to address concerns about vaccine hesitancy (VH), there are hesitant and concerned physicians about vaccination safety and utility. This study aimed to investigate medical students’ knowledge, VH and their association: besides students’ attitudes towards vaccines. Methods VH, knowledge, and attitudes towards vaccines were collected using an anonymous self-administered questionnaire. Cronbach's alpha of questionnaire domains was 0.70, 0.80 and 0.78 for VH, knowledge and attitudes, respectively. The opinion answers were added to calculate vaccine Hesitancy Index (HI < 18=low, 19-22=medium, >23=high). Results Although the frequency of hesitant students decreased from the first to the fifth year, unfortunately a percentage of future doctors with a non-negligible HI level persisted (medium HI level: 31.3%, high HI level 14.9%). We found a negative association between the percentage of students aware of recommended vaccines for healthcare professionals (chickenpox 74.5%vs 57.5%, p = 0.00; measles, mumps, and rubella 92.8%vs83.5%, p = 0.03; meningococcus 79.7%vs 67.7%, p = 0.00) and HI (low vs high). Furthermore, we found a positive association between the frequency of students who had not been vaccinated (varicella 2.3%vs3.9%, p = 0.00) or who did not know if they were (varicella 8.2%vs22.8%, p = 0.00; Hepatitis B 11.4%vs20.5%, p = 0.02; Tdap 4.6%vs15.0%, p = 0.00) and HI (low vs high). Overall, the reason for not getting vaccinated given by most students was ‘I didn't have time’ (flu: 60.8%vs66.9%) showing a positive association with HI. Conversely, a negative association was found with the reason ‘The vaccine is not free’ (flu 71.4%vs0.0%) that is higher HI corresponded to less vaccine knowledge. Conclusions Actions are needed in the future on the education of medical students as well as on the role they perceive themselves to have in responding to patient hesitation, and on their level of confidence in doing so. Key messages • Physicians are in the best position to understand hesitance patients, to respond to their worries and concern, and to find ways of explaining to them the benefit of vaccination. • Widespread and interdisciplinary training on vaccine hesitancy, risk communication, infodemiology and community engagement are needed.

Attitudes toward vaccination in the Croatian adult population

Abstract Background The COVID-19 pandemic emphasized vaccine hesitancy as one of the major threats to global health. Attitudes toward vaccination are important predictors of vaccination behaviour. This study aimed to investigate attitudes toward vaccination and factors which influence them in the Croatian adult population. Methods This cross-sectional questionnaire study was conducted from June 2020 to December 2020 in the convenience sample of adults from Split-Dalmatia County in the primary healthcare setting. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes toward vaccination. The higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study sample consisted of 632 subjects (52.7% males and 47.3% females). The median age of all subjects was 38.0 (interquartile range 29.0 - 48.0) years. The median VAX scale score was 42.0 (interquartile range 35.0-50.0). The more negative attitudes towards vaccination were found in females (p = 0.015), subjects aged 25-44 years (p = 0.026) and subjects living in suburban areas (p = 0.040). Conclusions The Croatian adult population displayed quite negative attitudes toward vaccination. The study showed that some sociodemographic characteristics such as gender, age group and place of living had influenced attitudes towards vaccination in the studied population. Bearing in mind that attitudes are closely connected with the practices the development of public health programs created to promote vaccination should take into consideration the sociodemographic characteristics of the population for which they are intended. Key messages • It is highly important to improve attitudes towards vaccination in the Croatian adult population. • Understanding the factors that influence attitudes towards vaccination is crucial to design an appropriate public health program that promotes vaccination in selected population groups.

Perceived and functional parental health literacy and vaccine hesitancy among Cypriot parents

Abstract Background Assessing the association of perceived health literacy (PHL) and functional health literacy (FHL) with childhood vaccination hesitancy (VH) among parents is important in the context of developing targeted responses given that VH is of increasing public health concern. Methods A cross-sectional study was conducted with a convenience sample of parents of children, aged 6 months to 15 years old, presenting in pediatric primary care centers across 3 Cypriot cities. Participants responded to the HLS-EU-Q47 and the NVS (Newest Vital Sign), a self-rated and performance-based tool of health literacy (HL), respectively. They also completed a questionnaire tapping on attitudes and practices regarding childhood vaccinations. Parents were classified according to the overall and domain-specific PHL and FHL, and associations with VH were explored. Results Amongst 207 parents (82.6% female, 86.0% tertiary education), higher PHL was associated with certain positive attitudes and practices related to childhood vaccination e.g. childhood vaccination according to health science, whereas higher FHL appeared to be associated with certain negative attitudes and practices e.g. more concerns about side effects of vaccines. Lack of accurate information was the only reported vaccination barrier associated with lower PHL (34.28, SD = 7.54 versus 36.51, SD = 7.20 p = 0.04), whereas no vaccination barrier was associated with FHL. No significant associations between PHL and VH were observed. In contrast, higher FHL was associated with VH (p = 0.01) with parents categorized as ‘refusers’ (3.67, SD = 2.64) or ‘hesitant acceptors’ (3.15, SD = 2.74) having higher FHL than parents categorized as ‘delayers’ (2.95, SD = 2.63) or ‘non-hesitant acceptors’ (2.99, SD = 2.42). Conclusions Assessing both PHL and FHL led to a more comprehensive understanding on the influence of parental HL towards childhood vaccination which can guide the design and implementation of interventions to address VH among parents. Key messages • While parental HL is associated with childhood VH, a mixed pattern emerged depending on whether HL was operationalized using a perceived or functional measure. • While health education at clinical and population level are needed to counteract parental VH, the association of parental HL with childhood vaccination attitudes and practices is not straightforward.

Multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients

Abstract Background Target populations eligible for vaccinations are not comprehensively reached by out-of-hospital health services, particularly frail people with immunization deficits. The aim of this study was to evaluate the effectiveness of a model of shared management between hospital - IRCCS Fondazione Policlinico Universitario A.Gemelli (FPG) - and out-of-hospital health services -ASL Roma1- of fragile patients with an indication for herpes zoster (HZ) vaccination, based on counseling carried out by a multidisciplinary team in the hospital setting. Methods From June 2022 to April 2023, patients with congenital and/or acquired immunodepression, who were treated at the IRCCS FPG in the Units of Hematology, Geriatrics, Infectious Diseases, Rheumatology were offered vaccination with the recombinant Zoster vaccine. At the time of enrollment, all patients completed the Vaccination Attitudes Examination (VAX-I) scale, for the purpose of assessing vaccine hesitancy. Patients received multidisciplinary counseling focusing on HZ and contrasting vaccine hesitancy. Multiple linear regression was used to analyze the impact of demographic and clinical characteristics on the VAX-I items. Results Sixty fragile patients were included. Mean vaccine hesitancy score was 2.1 ± 0.9. A significant correlation between vaccine hesitancy and the age group 45-64 years, female sex and patient with HIV was demonstrated. These patients had significantly higher score of “mistrust of vaccine benefits”, “worries about unforeseen future effects”, “concerns about commercial profiteering” and “preference for natural immunity”. After counseling, all patients adhered to the vaccination with two doses of a recombinant zoster vaccine. No serious adverse events or breakthrough HZ infections were observed during a median follow-up of 65.5 days. Conclusions Although vaccine hesitancy in some age groups is high, hospital-based multidisciplinary counseling achieved full HZ vaccination compliance. Key messages • herpes zoster vaccination coverage of frail patients is not fully achieved in the community health setting. • The adoption of a multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients based on a Hospital-Territory Vaccination Center may help overcome vaccine hesitancy.

Attitudes towards vaccination and HPV vaccine uptake among Croatian university students

Abstract Background The attitudes that underlie vaccine hesitancy are important for predicting individuals’ vaccination behaviour but also for developing effective public health interventions. This study aimed to investigate attitudes towards vaccination among Croatian university students and to evaluate its possible association with human papillomavirus (HPV) vaccine uptake in the same population. Methods This cross-sectional questionnaire study was conducted from February to May 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data about HPV vaccine uptake, as well as the Vaccination Attitudes Examination Scale (VAX scale) was self-administered to a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. The higher scores on the VAX scale reflect more negative attitudes toward vaccination. Results The study sample included 840 subjects with, a median age of 20 years (interquartile range 20-21), 45.8% males, and 54.2% females. The median VAX scale score was 39.0 (interquartile range 32.0-46.0). The prevalence of vaccination uptake in the studied population was 20.8%. The more negative attitudes towards vaccination were found in students who studied within the scientific area of the social sciences (p < 0.001), students who had a lower average grade of study (p < 0.001), and students who were not vaccinated against HPV (p < 0.001). Conclusions The Croatian university students had rather negative attitudes towards vaccination probably reflected by the observed HPV vaccine uptake in this population. Identifying factors that influence general attitudes towards vaccination in the studied population would enable the design of more adequate public health interventions intended to promote HPV vaccine uptake. Key messages • Croatian university students have shown strong general vaccine hesitancy as well as low HPV vaccine uptake. • Better understanding of the attitudes that underlie vaccine hesitancy is important for developing public health interventions created to increase HPV vaccine uptake among Croatian university students.

Attitudes towards the childhood immunisation programme among Polish immigrants in Norway

Abstract Background Norwegian-born children by Polish-born parents have lower coverage of some childhood vaccines than the general population in the nationwide Childhood Immunisation Programme. However, we know little about why this group have lower coverage. This study explored attitudes towards the Childhood Immunisation Programme among Polish immigrants in Norway. This knowledge can enhance vaccine information and further improve the prevention of infectious diseases in Norway. Methods We conducted semi-structured interviews with 15 Polish immigrants in Norway in the fall of 2022. The project explored vaccination in general, while the focus herein is on child vaccination. To better understand how the experiences and knowledge shape the participants’ attitudes towards vaccines and vaccination, the data was inductively analysed using a reflexive thematic analysis. The analysis is ongoing, and results are thus preliminary. Results Most of the participants had lived more than 10 years in Norway, while three had lived here for less than five years. All the participants had children. Based on the thematic analysis, we focused on three sub themes: 1) view of the child immunisation programme; 2) vaccine hesitancy; and 3) differences in childhood vaccination between Poland and Norway. Most of the participants’ children followed the immunisation programme. Some reported hesitancy towards the pneumococcal vaccine and the human papilloma virus vaccine. The majority of the participants expressed feeling less vaccine pressure in Norway than Poland and emphasized a high level of trust in the Norwegian health authorities. Conclusions The knowledge related to vaccine attitudes and differences between the Polish and the Norwegian programmes identified in the study, can help adapt better vaccine information and further improve the prevention of infectious diseases in Norway in general and for under-vaccinated groups in particular. Key messages • This knowledge can be used to adapt better vaccine information. • This knowledge can help to improve the prevention of infectious diseases in Norway and for under-vaccinated groups in particular.

Vaccination Attitudes Examination (VAX) Scale: a Bifactor-ESEM approach in a youth sample (15–24 years)

BackgroundThe Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX’s structural, convergent, and discriminant validity is still limited, especially in youth samples.MethodsThe present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (Mage = 18.23, SDage = 2.66, age range = 15–24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria.ResultsThe results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors’ contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry.ConclusionsThe present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes.

Childhood immunization delay during the first wave of COVID-19 in an urban area of Sangli district from Maharashtra, India: a cross-sectional study

BackgroundCOVID-19-related lockdowns had resulted in overburdening on health services. The lockdowns along with anxiety of the disease have resulted in delay in routine vaccination of many under-5 children. The current study was undertaken to understand the extent of the delay in under-5 vaccination during COVID-19-related lockdown in March-December 2020.MethodsIt was a cross-sectional study conducted during January-December 2021. Study population was under five children due for vaccination during the first COVID-19 lockdown at March-December 2020. Vaccination cards were used to confirm the status of vaccination, and questionnaire was used to study the attitude of parents towards vaccination and reasons for delay in vaccination, if any. The calculated sample size was 1434. But cluster random sampling method was applied; hence, 2274 subjects were included in the study. Statistical analysis was done using IBM SPSS-22™, using descriptive statistics and chi-squared test.ResultsPercentages of children with delayed vaccination ranged from lowest for “at birth dose” (12.47%) to highest for “9th month dose, i.e. MR vaccine” (54.29%). Majority of parents stated lockdown and risk of COVID-19 infection as to be reason of the delay in vaccination. There was no uniform association between vaccination delay and attitude of parents towards vaccination.ConclusionCOVID-19 pandemic and subsequent lockdown are the reasons stated by majority of parents with delayed vaccination in their children. This could be important lesson to plan for such contingencies for developing health services in future.

The COVID-19 Pandemic and Parental Attitudes Toward Routine Childhood Vaccines.

The coronavirus disease 2019 (COVID-19) pandemic may have impacted parental attitudes toward childhood vaccines. However, few data sources followed attitudes before and after onset of the pandemic. We used data from a parental survey to describe the effect of the pandemic on parental attitudes toward childhood vaccines. Data were analyzed from the Health eMoms survey which randomly sampled birthing parents in Colorado from 2018 to 2021 on several health topics including vaccine hesitancy. Population weighted multivariable regression was used to measure the association between overall vaccine hesitancy and 5 individual hesitancy questions and different COVID-19 pandemic periods: prepandemic (April 2018-February 2020); pandemic prevaccine (April 2020-December 2020); and pandemic postvaccine (January 2021-August 2021), adjusting for demographic factors. Overall, 20.4% (726/3553) of respondents were vaccine hesitant. Vaccine hesitancy during pandemic time periods was not different from the prepandemic period (prevaccine adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] = 0.65-1.04; postvaccine aOR = 1.07, 95% CI = 0.85-1.34). In analyses of individual hesitancy questions, parents were more likely to be unsure about trusting vaccine information in the pandemic postvaccine time period compared with the prepandemic period (aOR = 2.14; 95% CI = 1.55-2.96), and less likely to be unsure about their hesitancy toward childhood vaccines (aOR = 0.48; 95% CI = 0.27-0.84). The COVID-19 pandemic was not associated with changes in parental vaccine hesitancy overall, although there were changes in trust about vaccine information and a polarization of vaccination attitudes.