ABSTRACT
Adult vaccination is an accepted part of health care and diabetes care. In spite of evidence regarding the efficacy and utility of vaccination in preventing disease, we continue to encounter vaccine hesitancy and vaccine skepticism. As physicians, it is our duty to encourage the public to get vaccinated. In this article, we create a simple framework which helps assess the barriers to vaccine acceptance, and create bridges to overcome vaccine hesitancy and skepticism. We use an interesting mnemonic, NARCO, to remind ourselves, and our readers, of the appropriate hierarchy of interviewing related to vaccine acceptance.
Subject(s)
Physicians , Vaccination Hesitancy , Adult , Humans , Health Facilities , Memory , Vaccination , Primary Health CareABSTRACT
BACKGROUND: Vaccines are one of the most important weapons in protection against diseases, especially pandemics lacking available treatment. The objective of this study was to investigate the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines. METHOD(S): The cross-sectional descriptive study comprised healthy individuals who presented to family medicine polyclinics in Ankara Training and Research Hospital, Ankara, Turkiye between 10 December 2020 and 31 January 2021. Data on participants' knowledge and attitudes for COVID-19 and influenza vaccines were collected through questionnaire surveys. In total, 521 individuals aged older than 18 years were included in the study. RESULT(S): If a COVID-19 vaccine were available, 34.4% (N.=179) of respondents would be vaccinated, and 35.3% (N.=184) of respondents would not consider vaccination. Of those considering COVID-19 vaccination, 55.3% (N.=99) of respondents deemed the vaccine an effective way of providing protection against the virus. Increased willingness to have the COVID-19 vaccine was associated with the following factors: considering the influenza vaccine an effective protection method (P<0.001), a history of influenza vaccination (P=0.003), and concern about COVID-19 related death rates (P=0.008). CONCLUSION(S): The most common reasons for COVID-19 vaccine hesitancy and refusal were fear of vaccine-related side effects and a lack of perceived research evidence on the vaccine. Having a positive view of the influenza vaccine had a positive impact on attitudes toward the COVID-19 vaccine.Copyright © 2022 EDIZIONI MINERVA MEDICA.
ABSTRACT
Background: Older patients with cancer are at a higher risk of invasive infections. Vaccination is an effective approach to decrease the mortality and morbidity associated with infections. Objective(s): Our primary objective was to evaluate the proportion of older patients with cancer who had received routine vaccinations against pneumococcal, influenza, and coronavirus disease 2019 (COVID-19). Our secondary objective was to identify the factors associated with vaccine uptake such as age, sex, education, marital status, comorbidities, and place of residence. Material(s) and Method(s): This cross-sectional observational study was conducted in the geriatric oncology outpatient clinic of the Department of Medical Oncology at the Tata Memorial Hospital, a tertiary care cancer hospital in Mumbai, India, from February 2020 to January 2023. We included all patients aged >=60 years who were evaluated in the geriatric oncology clinic during the study period and for whom the immunization details were available. The uptake of COVID-19 vaccine was calculated from March 2021 onwards, which was when the COVID-19 vaccine became available to patients aged >=60 years in India. Result(s): We enrolled 1762 patients;1342 (76.2%) were male. The mean age was 68.4 (SD, 5.8) years;795 (45%) patients were from the west zone of India. Only 12 (0.68%) patients had received the pneumococcal vaccine, and 13 (0.7%) had received the influenza vaccine. At least one dose of the COVID-19 vaccine had been taken by 1302 of 1562 patients (83.3%). On univariate logistic regression, education, marital status, geographic zone of residence, and primary tumor site were correlated with the uptake of COVID-19 vaccine. Factors associated with a greater COVID-19 vaccine uptake included education (up to Std 10 and higher vs. less than Std 10: Odds Ratio [OR], 1.46;95% confidence interval [CI], 1.07-1.99;P = 0.018, and illiterate vs. less than Std 10: OR, 0.70;95% CI, 0.50-0.99;P = 0.041), marital status (unmarried vs. married: OR, 0.27;95% CI, 0.08-1.08;P = 0.046, and widow/widower vs. married: OR, 0.67;95% CI, 0.48-0.94;P = 0.017), lung and gastrointestinal vs. head-and-neck primary tumors (lung cancer vs. head-and-neck cancer: OR, 1.60;95% CI, 1.02-2.47;P = 0.038, and gastrointestinal vs.head-and-neck cancer: OR, 2.18;95% CI, 1.37-3.42;P < 0.001), and place of residence (west zone vs. central India: OR, 0.34;95% CI, 0.13-0.75;P = 0.015). Conclusion(s): Fewer than 1 in 100 older Indian patients with cancer receive routine immunization with influenza and pneumococcal vaccines. Hearteningly, the uptake of COVID-19 vaccination in older Indian patients with cancer is over 80%, possibly due to the global recognition of its importance during the pandemic. Similar measures as those used to increase the uptake of COVID-19 vaccines during the pandemic may be beneficial to increase the uptake of routine vaccinations.Copyright © 2023 Cancer Research, Statistics, and Treatment.
ABSTRACT
The Sickle Cell Society have issued standards for additional immunisations that adults with sickle cell disease (SCD) require. These include annual influenza, 5-yearly pneumococcal conjugate vaccine (PPV23) and Hepatitis B vaccination. Patients who have not received their primary vaccination as part of the national schedule in the UK should also receive further additional vaccines. We reviewed whether adults with SCD in South Wales currently receive these. 49 adult patients were identified as having SCD under the care of the Hereditary Anaemia Service based in the University Hospital of Wales, Cardiff. GP records were not available for 5 patients leaving a final cohort of 44 patients to analyse. Average age was 33 years (range 17-67). Median age was 27 with the cohort predominantly lying in the 17-29 year category (52%). Results showed good compliance with the annual influenza vaccine in those over 40 (>80%). However, compliance for the 17-29 category and 30-39 categories were 37.5% and 42.8%, respectively. The improved compliance in those >40 was not seen with the 5-yearly pneumococcal vaccine. Compliance was worse in all age groups compared to the annual flu vaccine with only 23% compliance overall. However, when looking at those who had received a single dose of PPV23, the numbers improved to nearly 60%. Compliance with the SARS-CoV2 vaccination was highest at 61.3%. However, rates were lower in the 17-29 and 30-39 age groups in keeping with previous trends. Only 34.1% of patients had full hepatitis B cover. Again, trends in compliance mirrored previous with poorer rates in those under 40. Assessing compliance for the remainder of the standards was more challenging given that we could not confirm retrospectively how many of our cohort had received their primary vaccinations in other parts of the UK, thought to be around half. However, most of the cohort had not received any additional vaccines suggesting high non-compliance regardless. This review looked at data from 2020 and likely reflects the impact of the SARS-CoV2, whether positive or negative. The reduced compliance in 5-yearly pneumococcal compared to flu suggest better health-professional education is needed;if patients are attending for their annual flu vaccine, there is ample opportunity to administer other vaccines. The vaccination rate for our patient group is comparable to national rates by ethnicity although lower than the national average for age. Vaccination rates for the SCD population of South Wales are not adequate. Better education and engagement is needed.
ABSTRACT
Objectives: Several attributes may be important in flu vaccine and since Covid-19, the role of health care professionals (HCPs) may have become more important in increasing flu vaccine uptake. We conducted a literature review to assess if previous preference research could inform future flu vaccination policies. Method(s): We conducted a literature review to assess the most common attributes used in stated-preference studies to determine seasonal flu vaccination preferences. PubMed with key terms such as "discrete choice", "stated preference" and "flu/vaccin*" was used to retrieve relevant research. Result(s): In total, twelve studies investigating consumer and HCP preferences for flu vaccines using a discrete-choice experiment were included. Six studies were conducted in vaccine-eligible populations, three were conducted with parents (specifically, two focused on older adults and one elicited preferences directly from HCPs in Hong Kong). Three studies were conducted in the Netherlands, two in Japan and four in China. Vaccine efficacy was most often framed in terms of percentage (n=7). Out of pocket cost and duration of immunity were common attributes. Source of recommendation for vaccination (i.e., regulatory or public health body) was assessed in 25% of the studies. In studies assessing parental preferences for their children influenza vaccination, risks of fewer side effects were, unsurprisingly, preferred. Finally, among HCPs, vaccine effectiveness and vaccination location (staff clinic/mobile vaccination center) were most important and could increase the probability of vaccination. Conclusion(s): Information incompleteness and asymmetry could play a role in vaccine hesitation and/or aversion. To increase vaccination rates, evidence on the attributes perceived to be important to both HCPs and the general population may help the design and delivery of vaccines that match consumers' preferences. Currently, there is a critical need for more stated-preference studies among HCPs to better understand the attributes likely to increase vaccination rates against seasonal influenza.Copyright © 2023
ABSTRACT
Introduction: Patients with chronic lymphocytic leukaemia (CLL) are at increased risk of infection. CLL is associated with a secondary immunodeficiency and impaired response to vaccination. Recent British Society of Haematology guidelines recommend that patients with CLL should receive vaccination against pneumococcal infection at diagnosis, an annual influenza vaccine and COVID-19 vaccination. Patients aged 70-79 years should also receive the Shingrix vaccine. Patients with CLL should not receive live vaccines. In response to this guideline, a letter detailing vaccination requirements was created for patients to give to their general practitioner (GP). The local process for vaccination referral has since changed. Previously, vaccination requirements were communicated to the GP via letter. There is now a dedicated Vaccination Hub to which clinicians can directly refer patients for appropriate vaccinations. Aim(s): The aim of this project was to assess vaccination referral and vaccination status in patients with newly diagnosed CLL. Method(s): All new diagnoses of CLL from 2021 to 2022 were identified by review of the Haematology Multi-Disciplinary Team meeting electronic registration forms. Electronic patient records were reviewed to determine vaccination referral completion and vaccination status. Result(s): A total of 29 patients were identified as new diagnoses of CLL. Seventeen patients were diagnosed in 2021 and 12 in 2022. Sixty-nine percent of the patients were male and the average age was 70.9 years. Vaccination was discussed with 11 patients (38%) and 10 patients (34%) were referred for vaccination. Eleven patients (38%) had never received a pneumococcal vaccine. Nine patients (31%) had previously received the vaccine but not within the past 5 years. Five patients (17%) patients had received one dose of Pneumovax 23 following referral. No patients had received the initial Prevenar 13 vaccine. Twelve patients (41%) had not received an influenza vaccine. Of those who had received the vaccine, the majority (70%) had received this routinely. Similarly, 71% of patients had received the COVID-19 vaccine routinely as opposed to three patients who received this postreferral. Of those who were eligible, 50% had received the Shingrix vaccine. Conclusion/Discussion: Local rates of vaccination in patients with CLL are low. Numbers were too small to allow for comparison between the methods of referral. Of those referred, not all received the appropriate vaccinations. Further work is therefore required to improve both the number and completion of the referrals. Future steps will include local teaching on vaccinations in CLL and the referral pathway.
ABSTRACT
Infectious diseases pose a major threat to elderly populations. Streptococcus pneumonia bacteria, influenza-causing viruses, and COVID-19 viruses cause three pathologies in the respiratory system with similar symptoms, transmission routes, and risk factors. Our study aimed to evaluate the effects of pneumococcal, influenza, and COVID-19 vaccinations on the status of COVID-19 hospitalization and progression in people over 65 years of age living in nursing homes. This study was performed in all nursing homes and elderly care centers in the Uskudar district of Istanbul.The diagnosis rate of COVID-19 was determined as 49%, the rate of hospitalization as 22.4%, the rate of hospitalization in the intensive care unit as 12.2%. The rate of intubation was determined as 10.4%, the rate of mechanical ventilation as 11.1% and the rate of COVID-19 related mortality rate as 9.7%. When the factors affecting the diagnosis of COVID-19 were examined, the presence and dose of COVID-19 vaccine was protective. When the factors affecting hospitalization status were examined, male sex and presence of chronic disease were risk factors; four doses of COVID-19 vaccine and influenza vaccine and pneumococcal vaccine together with COVID-19 vaccine were protective. When the factors affecting COVID-19-related death were examined, the male sex was a risk factor; the pneumococcal and influenza vaccine together with COVID-19 vaccine were protective. Our results revealed that the availability of influenza and pneumococcal vaccines positively impacted the progression of COVID-19 disease in the elderly population living in nursing homes.
ABSTRACT
BACKGROUND: Enhanced vaccines (e.g., containing adjuvants) have shown increased immunogenicity and effectiveness in older adults, who often respond sub-optimally to conventional influenza vaccines. In this study, we evaluated the cost-effectiveness of an inactivated, seasonal, MF59-adjuvanted quadrivalent influenza vaccine (aQIV) for use in adults ≥ 65 years in Ireland. METHODS: A published dynamic influenza model incorporating social contact, population immunity, and epidemiological data was used to assess the cost-effectiveness of aQIV in adults ≥ 65 years of age compared with a non-adjuvanted QIV. Sensitivity analysis was performed for influenza incidence, relative vaccine effectiveness, excess mortality, and the impact on bed occupancy from co-circulating influenza and COVID-19. RESULTS: The use of aQIV resulted in discounted incremental cost-effectiveness ratios (ICERs) of EUR 2420/quality-adjusted life years (QALYs) and EUR 12,970/QALY from societal and payer perspectives, respectively, both of which are below the cost-effectiveness threshold of EUR 45,000/QALY. Sensitivity analysis showed that aQIV was effective in most scenarios, except when relative vaccine effectiveness compared to QIV was below 3%, and resulted in a modest reduction in excess bed occupancy. CONCLUSION: The use of aQIV for adults ≥ 65 years old in Ireland was shown to be highly cost-effective from both payer and societal perspectives.
ABSTRACT
During the coronavirus disease 2019 (COVID-19) pandemic, global vaccination efforts declined due to the burden on health systems and community resistance to epidemic control measures. Influenza and pneumococcal vaccines have been recommended for vulnerable populations to prevent severe pneumonia. We investigated community response towards influenza and pneumococcal vaccines (pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine) after the COVID-19 outbreak in Taiwan. We retrospectively included adults who visited Chang Gung Memorial Hospital (CGMH) institutions for influenza or pneumococcal vaccination from January 2018 to December 2021. The first case of COVID-19 in Taiwan was detected in January 2020; therefore, in this study, hospitalized cases from January 2018 to December 2019 were defined as "before COVID-19 outbreak," and hospitalized cases from January 2020 to December 2021 were defined as "after COVID-19 outbreak". A total of 105,386 adults were enrolled in the study. An increase in influenza vaccination (n = 33,139 vs. n = 62,634) and pneumococcal vaccination (n = 3035 vs. n = 4260) were observed after the COVID-19 outbreak. In addition, there was an increased willingness to receive both influenza and pneumococcal vaccinations among women, adults without underlying disease and younger adults. The COVID-19 pandemic may have increased awareness of the importance of vaccination in Taiwan.
ABSTRACT
Introduction: Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination. Methods: Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot. Results: A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769). Conclusion: The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale.
Subject(s)
COVID-19 , Influenza, Human , Child , Adolescent , Humans , Influenza, Human/prevention & control , Vaccination , Parents , IntentionABSTRACT
Influenza infection is asymptomatic in up to 75% of cases, but outbreaks result in significant morbidity. Reports found that severe influenza complications tend to occur among the very young (<5 years) and very old (>65 years), especially those with underlying co-morbidities like diabetes mellitus and heart disease. Even with no co-morbidity, some older persons with severe influenza may require hospitalisation or intensive care, with increased risk of myocardial infarction and stroke. In South-East Asia, influenza was often seen as a mild problem and was not deemed notifiable until the appearance of the Influenza A(H1N1) pandemic in 2009. For decades the data made available were based on extrapolated estimates collected mainly from paediatric populations, resulting in inconsistent findings. Following expanded surveillance across the region using national surveillance systems for influenza-like illness (ILI) and severe acute respiratory illness (SARI), and better diagnostic methods, improved estimates of disease burden was achieved in South-East Asia. However, two studies conducted in 2008-2010 reported findings ranging from 2-3% to 11%. With regards to increased risk of complications, the estimated global annual attack rates for influenza were 5-10% in adults and 20-30% in children, resulting in 3-5 million cases of severe illness and 290,000-650,000 deaths. A study In Singapore reported that influenza is associated with annual excess mortality rates (EMR) of 11-14.8 per 100 000 person-years, especially affecting the elderly;these rates are comparable to that of the USA. As for hospitalisation rates of children under 5 years with seasonal influenza, the USA estimated a rate of 1.4 per 100,000. Comparable rates were reported in Singapore (0.7-0.9), Thailand (2.4), Viet Nam (3.9-4.7), and the Philippines (4.7). In 2018, an updated study reported a mean annual influenza-associated respiratory EMR of 4.0-8.8 per 100 000 individuals, with South-East Asia showing a high mortality rate of 3.5-9.2 per 100,000 individuals. It was already estimated in Thailand in 2004 that influenza resulted in USD23-63 million in economic costs, with the main contribution from lost productivity due to missed workdays. Thus, comparable to countries in temperate climate, the clinical and socioeconomic impact of influenza in South-East Asia appear to be just as substantial. With the emergence of the COVID-19 pandemic in 2020, global influenza incidence dropped dramatically. In South-East Asia, the trend in influenza detections was similar to the rest of the world, with numbers slightly higher than average in early 2020, followed by a quick drop-off by the end of April 2020. After April 2020, the detection rate remained low until late July 2020, when Influenza A(H3N2) predominated in Cambodia, Malaysia, the Philippines, Singapore, Thailand and Timor-Leste;influenza B in Lao People's Democratic Republic but with an upsurge in A(H3N2) activity. Following a two-year hiatus, influenza outbreaks began to re-emerge significantly since early 2022. From February through August 2022, influenza activity in the southern hemisphere remained lower than in pre-COVID-19 pandemic years, but was at the highest level compared to similar periods since the start of the COVID-19 pandemic. Reasons for the reduction during the COVID-19 pandemic include non-pharmaceutical interventions (NPIs), reduced population mixing and reduced travel, and possibly viral interference between SARS-CoV-2 and influenza virus in the same host. In general, the reduction in influenza detections however does not appear to be associated with lack of testing. The World Health Organisation (WHO) continues to recommend that vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Although influenza vaccine is not commonly used in most countries in South-East Asia, its burden is similar in other parts of the world where influenza vaccine is now routinely used. Currently, the countries in South-East Asia that are providing free influenza vacc na ion for those at high risk include Thailand, Singapore, the Philippines and Lao People's Democratic Republic.Copyright © 2023
ABSTRACT
Introduction: Preventive care guidelines for patients with Inflammatory Bowel Disease (IBD) emphasize the need for a patient-centered interdisciplinary approach, with assessment and management of the patient's physical and mental health as well as the IBD. There is no data about compliance with current IBD preventive care guidelines in Puerto Rico. This study aims to evaluate current IBD preventive care in the clinic, and knowledge among patients and gastroenterologists about the preventive care guidelines. The 3-phase study includes retrospective medical record review, an anonymous online survey of gastroenterologists, and an anonymous survey of patients. We report the results of the patient survey. Method(s): Adult patients with an established diagnosis of at least 6 months of ulcerative colitis (UC), Crohn's disease (CD) or indeterminate colitis (IC), were recruited from the IBD Clinics and through IBDrelated social media. Questionnaires were filled in the clinic and online using Google forms. Statistical analysis was performed using descriptive statistics. Comparisons of proportions and means between groups was based on Fisher's exact and chi square tests. The study was approved by the MSC IRB. Result(s): 83 patients completed the survey, 42 from the clinics and 41 through social media. 60% had CD, 47.4% were diagnosed more than 10 years ago, 57.9% were younger than 38 years old and 68% were on immunosuppressants/biologics. 83.13% and 60.24% of patients knew that COVID and Influenza vaccines were indicated, respectively. However only 42.17%, 36.14%, 32.53% and 31.33% of patients knew about indications for HPV, pneumococcal, varicella and zoster vaccines, respectively. There was a significant difference about knowledge regarding screening for latent TB (p=0.019), anxiety and depression (p= 0.03) and smoking status (p=0.033) between CD and UC/IC patients, as shown in Table. Conclusion(s): Our study showed a significant lack of knowledge about IBD preventive care in patients. Strategies to improve patient education are needed. The results of the review of records from the clinic as well as the knowledge of gastroenterologists will point out other deficiencies in the healthcare system and help design methods to improve patient care. Another aspect that needs to be explored is access to preventive measures such as vaccines. (Table Presented).
ABSTRACT
Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023
ABSTRACT
AIM: There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. METHODS: The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. RESULTS: Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", "understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies). CONCLUSIONS: Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.
ABSTRACT
Aim: There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine. Method(s): The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary. Result(s): Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies). Conclusion(s): Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.Copyright © 2023, Czech Medical Association J.E. Purkyne. All rights reserved.
ABSTRACT
Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.Copyright © 2022 Journal of Zhongshan University. All Rights Reserved.
ABSTRACT
Background: People living with HIV are at greater risk of complications associated with influenza, SARS-CoV-2 and pneumococcus than the general population and BHIVA guidelines recommend vaccinating all patients against these infections. The purpose of this audit was to determine the uptake of these vaccines, and factors associated with uptake, to inform vaccine delivery models. Method(s): All patients who received HIV care in our service at the end of November 2022 were included. Demographic data were collected from the service database, clinical data and pneumococcal vaccine (Prevenar-13) status were obtained from clinical records and COVID-19 and flu vaccine (2021) uptake was obtained from the Vaccine Management Tool (VMT). At the time of audit all patients were recommended to have received at least 3 doses of a SARS-CoV-2 vaccine. Caldicott approval was received for this work. Result(s): There were 364 patients known to the service of which one was excluded as clinical information was not available. Sixty-seven percent had received flu vaccine, 88% >= one dose of COVID-19 vaccination, 76% at least 3 doses of COVID-19 vaccination and 88% had received Prevenar-13. Three percent had received no vaccines and 60% had completed all vaccines. Uptake of both flu and COVID-19 vaccines were lower in the following groups: <50 years old (51% and 62% respectively), urban residence (65%, 71%), higher deprivation scores (51-65%, 64-75%) less time in HIV care (57%, 70%), those not on ART (13%, 25%), CD4 <200 cells/mm3 (40%, 50%), detectable viral load (33%, 42%), those out of care (23%, 23%) and those known to the harm reduction service (33%, 33%). There was higher uptake of Prevenar-13 in all groups. Uptake of all vaccines was high in those with comorbidities. Conclusion(s): The high uptake of Prevenar-13 in higher risk groups suggests that the model of vaccine delivery, opportunistic and pro-active recall for inhouse vaccination, is more effective for protecting those at highest risk for poor outcomes and for those for whom access is challenging compared to the centralised national recall system at designated Vaccine hubs. Vaccination resourcing, planning and delivery should consider the needs of specific risk groups to ensure best outcomes.
ABSTRACT
Aim - the discutability of existing scientific publications prompted a retrospective analysis of COVID-19 risk factors among the working population using the example of Russian Railways. Material and methods. Based on the archival documentation of medical institutions of Russian Railways, an analysis of the incidence of employees of the holding was carried out. Data from 2452 cases were analysed, for which full medical documentation was available. The comparison group randomly included 2911 workers who did not have COVID-19, comparable in sex, age, and area of residence. Results. Significant factors of difference between the groups of patients and those who were not ill were: sex, the presence of influenza vaccination, smoking and established diabetes mellitus. There was a trend towards an association of COVID-19 incidence and the presence of cardiovascular disease. In the comparison group, unlike the group of COVID-19 cases, there are 23% more persons who were vaccinated against influenza. In the group of patients with diabetes mellitus was found 3 times more often than in the group of non-patients. In both groups, the incidence rates of cardiovascular disease did not differ. However, as the severity of the disease increased, there was a tendency to increase the incidence of cardiovascular diseases. Meanwhile, the presence of other cardiovascular risk factors (male sex, smoking, diabetes mellitus, obesity) was significantly associated with a higher incidence in the disease group compared to non-patients. Multifactorial analysis also revealed other significant combinations of risk factors with COVID-19 risk: lack of influenza vaccination and the presence of diabetes mellitus;lack of vaccination, smoking and the presence of diabetes mellitus. Conclusion. For the working population, male sex and diabetes may be a significant risk factor for developing COVID-19. Influenza vaccination should be considered as a factor in anti- COVID-19 protection. Cardiovascular diseas e and smoking may serve as additional risk factors.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.
ABSTRACT
Introduction/Aim: A chronic obstructive pulmonary disease (COPD) criteria-led discharge (CLD) pathway created on evidence-based guidelines was introduced at Canterbury Hospital to reduce unwanted clinical variation detected during a previous Agency for Clinical Innovation (ACI) audit. This audit aims to review whether adherence to COPD evidence-based guidelines improved after the CLD introduction. Method(s): The electronic medical records of patients admitted to Canterbury Hospital between 14/02/2022 and 01/08/2022 with a diagnosis of COPD, defined as DRG codes E65A and E65B, were reviewed. Data including patient demographics, admission dates, vaccination status, smoking status and cessation counselling, oxygen targets, inhalers, antibiotics, steroids and referrals on discharge were recorded in REDCap. Deidentified data was extracted into excel, grouped based on admission date being pre or post the CLD implementation date of 09/05/2022. The chi square test was used to determine significance. Result(s): A total of 66 patients were included for analysis (n = 25 pre-intervention, n = 39 post-intervention). Appropriate steroid discharge plans and inhaler technique reviews improved post CLD implementation. Antibiotic usage was more consistent with community acquired pneumonia guidelines rather than infective exacerbation of COPD for both groups. Vaccination documentation was generally poor aside from for Coronavirus disease (COVID-19), though there was significant improvement in the discussion of influenza vaccine post CLD. Documentation of oxygen targets did not improve. Referrals to outpatient respiratory services were high in both groups. Conclusion(s): Introduction of a COPD CLD improved adherence to some aspects of COPD evidence-based management at Canterbury Hospital. Further initiatives should be considered targeting appropriate antibiotic usage, oxygen targets and discussion of preventative measures such as vaccination.