Highlights from the 24th workshop on vitamin D in Austin, September 2022.

The 24th Workshop on Vitamin D was held September 7-9, 2022 in Austin, Texas and covered a wide diversity of research in the vitamin D field from across the globe. Here, we summarize the meeting, individual sessions, awards and presentations given.

LGBTQ+ College Students' Relationship Satisfaction During the COVID-19 Pandemic

Research suggests that COVID-19-related restrictions affected individuals' ability to engage in relationship maintenance behaviors and have led to poorer romantic relationship quality. Poor relationship quality may be especially problematic for lesbian, gay, bisexual, transgender, queer or questioning, and otherwise non-heterosexual or-cisgender (LGBTQ+) college students, who often lack family support and are at greater risk for mental health issues. We used a social exchange theory lens to examine correlates of relationship satisfaction for LGBTQ+ college students during the early months of the pandemic. The analytic sample consists of 175 LGBTQ+ students (Mage = 20.5) who completed an online survey and reported being in a romantic relationship. Our findings demonstrate that LGBTQ+ students with more supportive partners were more satisfied with their relationships. These results can inform clinicians how to better support LGBTQ+ college couples when they experience relationship stress.

Breath analysis by ultra-sensitive broadband laser spectroscopy detects SARS-CoV-2 infection.

Rapid testing is essential to fighting pandemics such as coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Exhaled human breath contains multiple volatile molecules providing powerful potential for non-invasive diagnosis of diverse medical conditions. We investigated breath detection of SARS-CoV-2 infection using cavity-enhanced direct frequency comb spectroscopy (CE-DFCS), a state-of-the-art laser spectroscopic technique capable of a real-time massive collection of broadband molecular absorption features at ro-vibrational quantum state resolution and at parts-per-trillion volume detection sensitivity. Using a total of 170 individual breath samples (83 positive and 87 negative with SARS-CoV-2 based on reverse transcription polymerase chain reaction tests), we report excellent discrimination capability for SARS-CoV-2 infection with an area under the receiver-operating-characteristics curve of 0.849(4). Our results support the development of CE-DFCS as an alternative, rapid, non-invasive test for COVID-19 and highlight its remarkable potential for optical diagnoses of diverse biological conditions and disease states.

"It's like an elephant in the room with my family”: LGBTQ+ College Students' Identity Expression During the COVID-19 Pandemic

The COVID-19 pandemic led many college campuses to close and transition to remote learning. For lesbian, gay, bisexual, transgender, queer, questioning, or otherwise non-heterosexual or cisgender (LGBTQ+) college students, these disruptions may have affected their ability to express their sexual orientation and gender identity (SOGI). We used a developmental assets framework and minority stress theory with open-ended survey responses to examine LGBTQ+ students' (N = 411, Mage = 20.5;38.4% bisexual;48.7% women) perceptions of whether and how their SOGI expression changed due to the pandemic. We found the majority of LGBTQ+ students described their SOGI expression as restricted. However, some students perceived no change or improvements in their SOGI expression. We also examined whether perceived change in expression differed by gender identity (transgender and gender non-conforming [TGNC] compared to cisgender), and whether students lived with family. TGNC students and students who lived with family were more likely than their peers to report restricted expression and TGNC students were more likely than cisgender students to perceive improvements in their expression. Our findings highlight the internal and external assets that promote positive developmental outcomes for adolescents with minoritized identities and how universities might support LGBTQ+ students. [ FROM AUTHOR]

Estimating the size of hard-to-reach subpopulations and segregation with the network scale-up method: lessons from a Hungarian survey

In this paper, we provide an empirical, descriptive analysis of the social networks of Hungarian society and illustrate how the network scale-up method estimates the size of hard-to-reach subpopulations and segregation of social groups. Based on a representative survey of 7000 respondents from Hungary (HS2021), we first estimate the average size of the respondents' personal networks. Then, we examine the social fault lines along various social groups and how accurately the network scale-up method estimates the size of these groups (e.g., unemployed, protesters, the Roma, Covid-infected). These estimates are then compared with data from other sources (census data, administrative data, surveys). Our results show that the network scale-up method estimates the size of visible social groups (e.g., the Roma, homeless people) quite well. The visibility of other social groups appears to be much lower. Social fault lines are greatest in the case of homeless people, protesters, and members of NGOs. Finally, we describe recent methodological advancements and summarize our suggestions for future research using this method. © 2022, Hungarian Sociological Association. All rights reserved.

THE IMPACT OF COVID-19-PANDEMIC ON PHARMACY WORKERS' MENTAL HEALTH AND PHARMACIST COMMUNICATION

The present study examined the impact of the first three waves of the Covid-19 pandemic on the mental health of Hungarian pharmacists and the way of communication with each other, patients, and physicians. Our online survey was conducted during the spring of 2021, after the 3rd wave of the epidemic (N = 300). In addition to pharmacist communication, our research also measured perceived stress and burnout. The vast majority of respondents reported their workload to be increased compared to the pre-epidemic period. Patients became more open to counseling, their need for conversation increased, and their problems often exceeded their pharmacist competence. The number of aggressive patients increased in the pharmacies. The level of perceived stress was high in the sample, and an increased risk of burnout has been identified. Pharmacists working for a longer time in this profession tended to be less stressed by the challenges during the epidemic. The more common aggressive behavior among patients, and the higher level of perceived stress were strongly correlated. The COVID 19 epidemic has placed a significant mental burden and communication challenge on pharmacists. In addition to professional support, it would be especially necessary to provide psychological counseling for free. © 2022 Literatura Medica Publishing House. All rights reserved.

Comparison of the prevalence of SARS-CoV-2 nucleoprotein antibodies in healthcare workers and an unselected adult and paediatric all-comer patient population: insights from a longitudinal study of healthcare workers and concurrent serial cross-sectional studies of patients at an academic medical centre in Austria.

OBJECTIVES: This study aimed to estimate and compare the prevalence of the virus-specific antibodies against the SARS-CoV-2 nucleoprotein antigen (anti-SARS-CoV-2 N) in healthcare workers and an all-comer paediatric and adult patient population. DESIGN, SETTING AND PARTICIPANTS: A longitudinal study enrolling healthcare professionals and concurrent serial cross-sectional studies of unselected all-comer patients were conducted at an Austrian academic medical centre. Healthcare workers were tested at enrolment and after 1, 2, 3, 6 and 12 months. The cross-sectional studies in patients were conducted at three time periods, which roughly coincided with the times after the first, second and third wave of SARS-CoV-2 in Austria (ie, 24 August-7 September 2020; 8-22 February 2021 and 9-23 November 2021). Anti-SARS-CoV-2 N antibodies were measured using a sandwich electrochemiluminescence assay (Roche). RESULTS: In total, 2735 and 9275 samples were measured in 812 healthcare workers (median age: 40 years, 78% female) and 8451 patients (median age: 55 years, 52% female), respectively. Over the entire study period, anti-SARS-CoV-2 N antibodies were detected in 98 of 812 healthcare workers, resulting in a seroprevalence of 12.1% (95% CI 10.0% to 14.5%), which did not differ significantly (p=0.63) from that of the all-comer patient population at the end of the study period (407/3184; 12.8%, 95% CI 11.7% to 14.0%). The seroprevalence between healthcare workers and patients did not differ significantly at any time and was 1.5-fold to 2-fold higher than the number of confirmed cases in Austria throughout the pandemic. In particular, there was no significant difference in the seroprevalence between paediatric and adult patients at any of the tested time periods. CONCLUSION: Throughout the pandemic, healthcare staff and an adult and paediatric all-comer patient population had similar exposure to SARS-CoV-2. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT04407429.

Scoping review and meta-analysis of COVID-19 epidemiological parameters for modeling from early Asian studies (preprint)

Retrospective epidemiological models are powerful tools to understand its transmission dynamics and to assess the efficacy of different control measures. This study summarises key epidemiological parameters of COVID-19 for retrospective mathematical and clinical modeling. A review of scientific papers and preprints published in English between 1 January and 15 April 2020 in PubMed, MedRxiv and BioRxiv was performed to obtain epidemiological parameters of the initial stage of COVID-19 pandemic in Asia. After excluding articles with unacceptable risks of bias and those that remained as preprints as of 15 November 2021, meta-analyses were performed to derive summary effect estimates from the data collected using the statistical software R. Out of 4,893 articles identified, 88 provided data for 22 parameters for the overall population and 7 specifically for children. Meta-analyses were conducted considering time period as a categorical moderator when it was statistically significant. The results obtained are essential for building more reliable models to help clinicians and policymakers improve their knowledge on COVID-19 and apply it in future decisions.

Telehealth for Preoperative Evaluation of Patients With Breast Cancer During the COVID-19 Pandemic.

Introduction The COVID-19 pandemic drove rapid, widespread adoption of telehealth (TH). We evaluated surgical telehealth utilization and outcomes for newly diagnosed breast cancer patients during the initial pandemic period. Methods We identified patients with breast cancer diagnosed March 17, 2020 through May 17, 2020 who underwent surgery as the initial treatment. Clinicodemographic characteristics were collected. Initial consultation types (office, telephone, or video) were categorized. Outcomes included time to consultation, surgeon touchpoints, time to surgery, surgery types, and reexcision rates. Continuous variables were compared using Mann-Whitney tests or t-tests, and categorical variables were compared using χ2 or Fisher's exact tests. Results Of 158 patients, 56% had initial telehealth consultations (21% telephone, 35% video) and 42% did not have a preoperative physical examination. Age, race/ethnicity, and stage distributions were similar between initial visit types. Median time to consultation was lower in the initial telehealth group than the office group (6 days vs 9 days, p = 0.01). Other outcomes (surgeon touchpoints, time to surgery, surgery type, reconstruction) were similar between visit types. We observed higher reexcision rates in patients with initial telehealth visits (20% telehealth vs 4% office, p = 0.01), but evaluation was limited by small numbers. The reexcision rate was 13% for patients with telehealth visits and no preoperative physical exam. Discussion During the initial pandemic period, the majority of new breast cancer patients had an initial telehealth surgical consultation. Office and telehealth consultation visits had comparable numbers of postconsultation surgeon touchpoints and most outcomes. Our findings suggest that telehealth consultations may be feasible for preoperative breast cancer consultations.

Inaccurate recording of routinely collected data items influences identification of COVID-19 patients.

BACKGROUND: During the Coronavirus disease 2019 (COVID-19) pandemic it became apparent that it is difficult to extract standardized Electronic Health Record (EHR) data for secondary purposes like public health decision-making. Accurate recording of, for example, standardized diagnosis codes and test results is required to identify all COVID-19 patients. This study aimed to investigate if specific combinations of routinely collected data items for COVID-19 can be used to identify an accurate set of intensive care unit (ICU)-admitted COVID-19 patients. METHODS: The following routinely collected EHR data items to identify COVID-19 patients were evaluated: positive reverse transcription polymerase chain reaction (RT-PCR) test results; problem list codes for COVID-19 registered by healthcare professionals and COVID-19 infection labels. COVID-19 codes registered by clinical coders retrospectively after discharge were also evaluated. A gold standard dataset was created by evaluating two datasets of suspected and confirmed COVID-19-patients admitted to the ICU at a Dutch university hospital between February 2020 and December 2020, of which one set was manually maintained by intensivists and one set was extracted from the EHR by a research data management department. Patients were labeled 'COVID-19' if their EHR record showed diagnosing COVID-19 during or right before an ICU-admission. Patients were labeled 'non-COVID-19' if the record indicated no COVID-19, exclusion or only suspicion during or right before an ICU-admission or if COVID-19 was diagnosed and cured during non-ICU episodes of the hospitalization in which an ICU-admission took place. Performance was determined for 37 queries including real-time and retrospective data items. We used the F1 score, which is the harmonic mean between precision and recall. The gold standard dataset was split into one subset including admissions between February and April and one subset including admissions between May and December to determine accuracy differences. RESULTS: The total dataset consisted of 402 patients: 196 'COVID-19' and 206 'non-COVID-19' patients. F1 scores of search queries including EHR data items that can be extracted real-time ranged between 0.68 and 0.97 and for search queries including the data item that was retrospectively registered by clinical coders F1 scores ranged between 0.73 and 0.99. F1 scores showed no clear pattern in variability between the two time periods. CONCLUSIONS: Our study showed that one cannot rely on individual routinely collected data items such as coded COVID-19 on problem lists to identify all COVID-19 patients. If information is not required real-time, medical coding from clinical coders is most reliable. Researchers should be transparent about their methods used to extract data. To maximize the ability to completely identify all COVID-19 cases alerts for inconsistent data and policies for standardized data capture could enable reliable data reuse.

Identification of the first COVID-19 infections in the US using a retrospective analysis (REMEDID).

Accurate detection of early COVID-19 cases is crucial to reduce infections and deaths, however, it remains a challenge. Here, we used the results from a seroprevalence study in 50 US states to apply our Retrospective Methodology to Estimate Daily Infections from Deaths (REMEDID) with the aim of analyzing the initial spread of SARS-CoV-2 infections across the US. Our analysis revealed that the virus likely entered the country through California on December 28, 2019, which corresponds to 16 days prior to the officially recognized entry date established by the Centers of Disease Control and Prevention. Furthermore, the REMEDID algorithm provides evidence that SARS-CoV-2 entered, on average, a month earlier than previously reflected in official data for each US state. Collectively, our mathematical modeling provides more accurate estimates of the initial COVID-19 cases in the US, and has the ability to be extrapolated to other countries and used to retrospectively track the progress of the pandemic. The use of approaches such as REMEDID are highly recommended to better understand the early stages of an outbreak, which will enable health authorities to improve mitigation and preventive measures in the future.

Caveats on COVID-19 herd immunity threshold: the Spain case.

After a year of living with the COVID-19 pandemic and its associated consequences, hope looms on the horizon thanks to vaccines. The question is what percentage of the population needs to be immune to reach herd immunity, that is to avoid future outbreaks. The answer depends on the basic reproductive number, R0, a key epidemiological parameter measuring the transmission capacity of a disease. In addition to the virus itself, R0 also depends on the characteristics of the population and their environment. Additionally, the estimate of R0 depends on the methodology used, the accuracy of data and the generation time distribution. This study aims to reflect on the difficulties surrounding R0 estimation, and provides Spain with a threshold for herd immunity, for which we considered the different combinations of all the factors that affect the R0 of the Spanish population. Estimates of R0 range from 1.39 to 3.10 for the ancestral SARS-CoV-2 variant, with the largest differences produced by the method chosen to estimate R0. With these values, the herd immunity threshold (HIT) ranges from 28.1 to 67.7%, which would have made 70% a realistic upper bound for Spain. However, the imposition of the delta variant (B.1.617.2 lineage) in late summer 2021 may have expanded the range of R0 to 4.02-8.96 and pushed the upper bound of the HIT to 90%.

Willingness to receive an annual COVID-19 booster vaccine in the German-speaking D-A-CH region in Europe: A cross-sectional study.

Background: Emergence of new coronavirus variants and waning immunity may necessitate regular COVID-19 vaccine boosters, but empirical data on population willingness for regular vaccination are limited. Methods: In August 2021, we surveyed 3,067 quota-sampled German-speaking adults residing in the D-A-CH region (Germany, Austria, Switzerland). Using multivariable adjusted ordered logistic regression models we calculated odds ratios (OR) and 95% confidence intervals (95% CIs) to assess factors associated with willingness to vaccinate annually against COVID-19. Findings: Among 2,480 participants vaccinated or planning to get vaccinated, 82·4% indicated willingness to receive annual COVID-19 boosters. This willingness was higher in Austria (OR=1·47, 95% CI, 1·19-1·82; p < 0·001) and Germany (OR=1·98, 95% CI, 1·60-2·45; p < 0·001) versus Switzerland and increased with age. Having voted in the last national election (ORopposition party voters=1·51, 95% CI=1·18-1·92; p = 0·001 and ORgoverning party voters=1·57, 95% CI=1·28-1·93; p < 0·001, versus non-voters) and not regularly participating in religious meetings (OR=1·37, 95% CI=1·08-1·73; p = 0·009, versus participation at least monthly) were significantly associated with willingness to vaccinate, as was partial (OR=1·97, 95% CI=1·43-2·72; p < 0·001) or total (OR=5·20, 95% CI=3·76-7·19; p < 0·001) approval of COVID-19 mitigation measures (versus non-approval). By country, Austrians showed the strongest association of voting behavior and mitigation measure approval with willingness to vaccinate. Interpretation: Targeted promotion programs informed by political and religious engagement and mitigation measure approval are needed to increase willingness to receive regular COVID-19 boosters. Funding: Medical University of Vienna, Department of Epidemiology, Danube University Krems, Department for Knowledge and Communication Management; Austrian Society of Epidemiology.

Implementing "Online Communities" for pregnant women in times of COVID-19 for the promotion of maternal well-being and mother-to-infant bonding: a pretest-posttest study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic elevated the risk for mental health problems in pregnant women, thereby increasing the risk for long-term negative consequences for mother and child well-being. There was an immediate need for easily accessible interventions for pregnant women experiencing elevated levels of pandemic related stress. METHODS: A three-session intervention "Online Communities" (OC) was developed at the beginning of the Dutch lockdown, and implemented by a team of midwives and psychologists specialized in Infant Mental Health. Pretest (N = 34) and posttest (N = 17) measurements of depressive symptoms, worries about COVID-19 and worries in general, and mother-to-infant bonding were administered, as well as a posttest evaluation. RESULTS: At pretest, the OC group was compared to two reference groups of pregnant women from an ongoing pregnancy cohort study: a COVID-19 (N = 209) and pre-COVID-19 reference group (N = 297). OC participants had significantly more depressive symptoms than both reference groups, and less positive feelings of bonding than the COVID-19 but not the pre-COVID-19 reference group. Compared to pretest, significant decreases in depressive symptoms (with significantly less participants scoring above cut-off) and worries about COVID-19 (large effect sizes) and worries in general (moderate to large effect size) were found at posttest for the OC participants. No significant improvement was found in bonding. Participants rated the intervention positively. CONCLUSIONS: The current study provides initial evidence supporting the idea that OC is a promising and readily accessible intervention for pregnant women experiencing stress due to the COVID-19 pandemic, and possibly also applicable to other stressors. TRIAL REGISTRATION: This intervention was registered in the Netherlands Trial Registration (registration number Trial NL8842 , registration date 18/08/2020).

How social support and parent-child relationship quality relate to LGBTQ+ college students' well-being during COVID-19.

The coronavirus disease (COVID-19) pandemic has negatively impacted the well-being of many college students, particularly lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ +) students who are already at a disproportionate risk for negative mental health and well-being outcomes. To identify potential risk and protective factors we examined LGBTQ + college students' disclosure of sexual orientation, gender identity, or both (SOGI) to mothers and fathers, living arrangements (whether or not students lived with mothers and fathers), social support from family and friends, and parent-child relationship quality and their association with stress, depressive symptoms, anxiety symptoms, and problem drinking during the pandemic. LGBTQ + college students (N = 366; Mage = 20.4) completed an online survey. Students who reported more social support from family and friends and better quality relationships with mothers or fathers had better well-being and were less likely to perceive a substantial decrease in their well-being due to the pandemic. In contrast, SOGI disclosure and whether or not students lived with mothers or fathers were generally unrelated to well-being. Findings suggest that universities should consider offering mental health resources for students living on- and off-campus, and that clinical professionals should consider strategies to help these young adults identify and maintain support systems and highlight the value of positive parent-child relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Breath analysis by ultra-sensitive broadband laser spectroscopy detects SARS-CoV-2 infection (preprint)

Rapid testing is essential to fighting pandemics such as COVID-19, the disease caused by the SARS-CoV-2 virus. Exhaled human breath contains multiple volatile molecules providing powerful potential for non-invasive diagnosis of diverse medical conditions. We investigated breath detection of SARS-CoV-2 infection using cavity-enhanced direct frequency comb spectroscopy (CE-DFCS), a state-of-the-art laser spectroscopic technique capable of a real-time massive collection of broadband molecular absorption features at ro-vibrational quantum state resolution and at parts-per-trillion volume detection sensitivity. Using a total of 170 individual breath samples (83 positive and 87 negative with SARS-CoV-2 based on Reverse Transcription Polymerase Chain Reaction tests), we report excellent discrimination capability for SARS-CoV-2 infection with an area under the Receiver-Operating-Characteristics curve of 0.849(4). Our results support the development of CE-DFCS as an alternative, rapid, non-invasive test for COVID-19 and highlight its remarkable potential for optical diagnoses of diverse biological conditions and disease states.

Facemask Usage Among People With Primary Ciliary Dyskinesia During the COVID-19 Pandemic: A Participatory Project.

Objectives: Primary ciliary dyskinesia (PCD) is a rare genetic disease that causes recurrent respiratory infections. People with PCD may be at high risk of severe COVID-19 and protection against SARS-CoV-2 is therefore important. We studied facemask usage and problems reported in relation with their use among people with PCD. Methods: We used data from COVID-PCD, an international observational cohort study. A questionnaire was e-mailed to participants in October 2020 that asked about facemask usage. Results: In total, 282 participants from 27 countries were included (Median age 32 years; 63% female). In total, 252 (89%) wore facemasks everywhere in public, 13 (5%) wore facemasks in most places, and 17 (6%) did not wear facemasks in public. Half of the participants reported that it was uncomfortable to wear facemasks because of runny nose, cough, or difficulty breathing. Participants less often wore facemasks when there was no national requirement. Conclusion: Most people with PCD wore facemasks despite frequent respiratory problems related to their use. Facemask usage was most frequent in countries with a national requirement emphasizing the importance of nationwide policies mandating facemasks.

Care in the time of COVID-19: impact on the diagnosis and treatment of breast cancer in a large, integrated health care system.

PURPOSES: To delineate operational changes in Kaiser Permanente Northern California breast care and evaluate the impact of these changes during the initial COVID-19 Shelter-in-Place period (SiP, 3/17/20-5/17/20). METHODS: By extracting data from institutional databases and reviewing electronic medical charts, we compared clinical and treatment characteristics of breast cancer patients diagnosed 3/17/20-5/17/20 to those diagnosed 3/17/19-5/17/2019. Outcomes included time from biopsy to consultation and treatment. Comparisons were made using Chi-square or Wilcoxon rank-sum tests. RESULTS: Fewer new breast cancers were diagnosed in 2020 during the SiP period than during a similar period in 2019 (n = 247 vs n = 703). A higher percentage presented with symptomatic disease in 2020 than 2019 (78% vs 37%, p < 0.001). Higher percentages of 2020 patients presented with grade 3 (37% vs 25%, p = 0.004) and triple-negative tumors (16% vs 10%, p = 0.04). A smaller percentage underwent surgery first in 2020 (71% vs 83%, p < 0.001) and a larger percentage had neoadjuvant chemotherapy (16% vs 11%, p < 0.001). Telehealth utilization increased from 0.8% in 2019 to 70.0% in 2020. Times to surgery and neoadjuvant chemotherapy were shorter in 2020 than 2019 (19 vs 26 days, p < 0.001, and 23 vs 28 days, p = 0.03, respectively). CONCLUSIONS: During SiP, fewer breast cancers were diagnosed than during a similar period in 2019, and a higher proportion presented with symptomatic disease. Early-stage breast cancer diagnoses decreased, while metastatic cancer diagnoses remained similar. Telehealth increased significantly, and times to treatment were shorter in 2020 than 2019. Our system continued to provide timely breast cancer treatment despite significant pandemic-driven disruption.

COVID-19 Vaccinations: Perceptions and Behaviours in People with Primary Ciliary Dyskinesia.

Primary ciliary dyskinesia (PCD) is a rare genetic disease that causes recurrent respiratory infections. People with PCD may be at higher risk of severe coronavirus disease 2019 (COVID-19), and therefore vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important. We studied vaccination willingness, speed of vaccination uptake, side effects, and changes in social contact behaviour after vaccination in people with PCD. We used data from COVID-PCD, an international participatory cohort study. A COVID-19 vaccination questionnaire was emailed to participants in May 2021 and 423 participants from 31 countries replied (median age: 30 years, range 1-85 years; 261 (62%) female). Vaccination uptake and willingness were high, with 273 of 287 adults (96%) being vaccinated or willing to be in June 2021; only 4% were hesitant. The most common reason for hesitancy was fear of side effects, reported by 88%. Mild side effects were common, but no participant reported severe side effects. Half of the participants changed their social behaviour after vaccination by seeing friends and family more often. The high vaccination willingness in the study population might reflect the extraordinary effort taken by PCD support groups to inform people about COVID-19 vaccination. Clear and specific information and involvement of representatives is important for high vaccine uptake.