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Vaccine hesitancy is a common issue in many countries and is likely to hamper the fight against the COVID-19 pandemic. This reluctance is alarming in diabetic patients who are more prone to severe forms of the disease. The aim of this study was to determine the COVID-19 vaccination rate in a population of diabetics followed for their diabetes and to analyze the factors associated with vaccine hesitancy. This cross-sectional, multicenter study, was carried out over 3 months (January 1st-March 31, 2022) in five consultation centers in Abidjan, Ivory Coast. All 254 patients with diabetes who had a consultation were included. There were more women than men (56.3%) and more with under high school diploma (72.8%). Among them, 2% had COVID-19 once and 14% had relatives affected with COVID-19;63.8% knew the symptoms of COVID-19 and the media (TV and social networks) were the main source of information (81.9%). Among the patients included, 51.9% were not vaccinated against COVID-19;25.9% refused vaccination while 12.0% were hesitant due to their diabetes. The reasons for refusal were: fear of side effects, questionable effectiveness of the vaccine and fear of injections.Copyright © 2022 Elsevier Masson SAS
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Background: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with decline in lung function and nutritional status. Cystic Fibrosis Foundation (CFF) guidelines recommend annual CFRD screening in patients starting at age 10. A review of our adult program data showed a decline in screening during 2020. We identified barriers, in addition to the COVID pandemic, that contributed to a decline in adherence. In July 2020, our clinic moved to a new location and began offering morning visits. After a quality improvement review, we began offering annual oral glucose tolerance testing (OGTT) within a routine clinic visit along with annual routine labs. Our objective was to use this multidisciplinary approach to increase OGTT screening to 50% within the first year of moving to our new location. Method(s): The CFF Patient Registry was used to compile a list of our nondiabetic patients overdue for annual OGTT. The list was reviewed during our multidisciplinary preclinic conference to identify patients who needed testing. Each patient was re-educated during clinic, and barriers to testing identified through patient interview and questionnaires. Common barriers to testing adherencewere length of testing time, time missed from work, COVID concerns, and needle phobia. The nurse and nurse coordinators made follow-up appointments, incorporating OGTT into next clinic appointment to increase adherence. Patients received phone call reminders for these appointments and the fasting criteria for testing. Result(s): CFF Registry Report data showed a decline in OGTT screening from 26% in 2019 to 21% in 2020.We identified 76 eligible patients who needed OGTT in 2021. Patient interviews were conducted during clinic visits and barriers identified. We offered routine clinic appointments in conjunction with lab appointments to increase screening adherence. We were able to capture seven patients in the first 6 months and 14 in the second 6 months, increasing our OGTT screening rate to 28%. Conclusion(s): Using a multimodal approach in a multidisciplinary team,we increased our OGTT annual screening rate by 7 percentage points. The ability to incorporate recommended screening into routine clinic visits supported adherence and patient satisfaction. Limitations to OGTT screening include continued COVID concerns and transportation to clinic.We plan to continue this quality improvement approach to increase adherence to 50% within this next year by continued consolidation of lab work and OGTT with visits and assisting patients with scheduling lab appointments and transportation to the clinic Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background: Vaccination is one of the most signifcant public health achievements;however, the success has been marred with vaccine hesitancy. The reasons for vaccine hesitancy are neither singular nor straightforward and arise from a complex interplay between Scientific, religious and political beliefs. This study aims to understand the possible reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases and the effectiveness of Specialist counselling on vaccine-hesitant patients willingness to take the vaccine. Objectives: 1. To assess causes of Vaccine hesitancy against COVID-19 vaccines in patients with autoimmune rheumatic diseases. 2. To study the effect of specialist counselling on vaccine-hesitant patients willingness to take vaccine. Methods: Study design: We conducted an observational survey-based in person cross-sectional study. Patients attending a tertiary care hospital's outpatient department were asked about their vaccination status. Those unvaccinated were asked reasons for vaccine hesitancy The vaccine-hesitant patients were counselled by the treating rheumatologist and asked regarding their willingness to take the vaccine after the counselling. The patient responses were recorded. Sample: Convenience sampling was used, so the sample size was not calculated. Inclusion and exclusion criteria: All adults(>18yrs) with AIRD coming to the rheumatology OPD. Those vaccinated, recently infected(within 6 weeks), and non-AIRD patients were excluded. Data collection: The questionnaire included patients' demographic details, Diagnosis, medication details, and response to the reason for vaccine hesitancy. Statistical analysis: Descriptive statistics were performed by calculating measures of central tendency for quantitative variables and using counts and percentages for qualitative and nominal variables. Results: A total of 322 patients participated in the study with a mean age of 40 years(18-76), with 73%(234) females and 27%(88) males. Most patients had Rheumatoid Arthritis(40%) followed by SPA (27%), SLE(13%) and others and may were on immunosuppressive medications(95%). A signifcant proportion of patients(60%) had more than one reason for vaccine hesitancy. Almost 60% of the respondents feared their disease might fare post-vaccination, while almost half(44.4%) were hesitant to take the vaccine due to the fear of vaccine side effects and more than one third (35%) feared vaccine may not be effective on them as they were on immunosuppressive medications. Other major causes of vaccine hesitancy were the inability to get a chance to get vaccinated (18%), doubts about vaccine efficacy (15%), and fear of injections (10%).Most patients(91%) were willing to take the vaccine after specialist counselling and only 28 of the 322 (9%) were unwilling even after specialist counselling. Conclusion: Vaccine hesitancy can be multifactorial. Major reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases were fear of fare of disease post-vaccination, fear of vaccine side effects and doubts whether the vaccine would work in patients taking immunosuppressive medications. Most patients were willing to take vaccine after counselling by a rheumatologist.
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Introduction/ Background: Vaccination is fundamental to COVID-19 epidemic control, however, hesitancy and other barriers may undermine high vaccine uptake in Africa as elsewhere. We measured vaccine hesitancy and its correlates over a six-month period as national rollout took place, in a continuous surveillance programme in rural KwaZulu-Natal, South Africa. Methods: From April-September 2021 we conducted rolling COVID-19 surveys (telephonic and in-person) with adult members (age 18+) of households in the SAPRIN network demographic & health node in rural KwaZulu-Natal, South Africa. Proxy respondents were asked to report vaccine uptake by household members every four months (n=26,934), and their own vaccine willingness (n=8,359) and reasons to accept/decline a vaccine (n=10,936). We measured how vaccine uptake and willingness differed by age, sex and time. We conducted adjusted multivariable regressions to see how vaccine hesitancy was associated with COVID-related: knowledge;past experience;perceived risk;and government trust. Results: By September, vaccine update was 52.4% among over-60s (eligible 17 May), 35.6% in 50-59 year-olds (1 July), 16.8% in 35-59 year-olds (1 August) and 3.3% in 18-34 year-olds (1 September). Only 52.1% of unvaccinated individuals said they definitely would get a free vaccine today. Vaccine hesitancy was associated with less trust in government (aOR:0.79;95%CI:0.74-0.84), lower perceived risk of getting COVID-19 (aOR:1.58;95%CI:1.32-1.88) and not knowing someone who has had COVID-19 (aOR:0.70;95%CI:0.55-0.90), but not concern about COVID-19 outcomes or COVID-19 knowledge. Common hesitancy reasons included were generic concerns (fear of needles) and COVID-19-specific ones (vaccine does not work;side-effects). Impact: Published evidence on COVID-19 vaccine willingness in Africa is mostly limited to knowledge and intentions, often from convenience samples. We have presented this work, linking intentions, vaccine uptake and hesitancy reasons, to national government to help guide their COVID-19 policymaking and intervention to maximize vaccine coverage, thus protecting against COVID-19. Conclusion: Despite cost-free availability and high self-reported willingness, many rural South Africans remain unvaccinated. Reported barriers to uptake most often relate to concerns about vaccines, rather than practical issues, e.g., cost or transport. Addressing perceived negative aspects of vaccines may be central in maximizing COVID-19 vaccine uptake in Africa as elsewhere.
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Introduction Vedolizumab is an anti-integrin biologic therapy for moderate-severe inflammatory bowel disease (IBD). Traditionally this was delivered by intravenous (IV) infusion. The VISIBLE trial demonstrated that subcutaneous (SC) vedolizumab was effective and safe. This also reduced the need for a hospital visit, reducing risk in the COVID-19 pandemic, with a substantial cost saving. Vedolizumab was switched to SC administration in NHS Tayside in October 2020. This study aimed to demonstrate a real-world experience of the use of SC vedolizumab for IBD. Methods Patients were identified from the IBD biologic database. Caldicott approval was granted for a retrospective analysis of patient data via electronic patient records including patient gender, age, IBD diagnosis and dates for when Vedolizumab was commenced, switched to SC or stopped. Blood markers of inflammation (albumin, platelets, CRP and haemoglobin) 1 month before and 3-6 months after the switch to SC and stool calprotectin were recorded when available. Statistical analysis with Chi Square and Mann Whitney non-parametric tests revealed significance if p<0.05. Results Seventy-one patients on IV vedolizumab in October 2020 were invited to switch to SC, supported by a nurse led clinic consultation. One patient declined due to needle phobia and 70 (98%) accepted. SC administration was well tolerated with no patients reporting injection difficulties. Eight patients (11%) stopped SC vedolizumab within a 6-month period, 5 (62.6%) due to a flare in IBD and 3 (37.5%) due to side effects (skin reactions, paraesthesia). Thirty patients who remained on this treatment with no issues were compared to the 8 patients who stopped SC vedolizumab to explore whether there was patient or disease characteristics to identify those who failed this therapy. There was no statistically significant difference in patient age (42 years versus 44 years, p=0.5124) or disease phenotype (UC versus CD, p=0.155) between the two groups. of those that stopped SC administration, more were female (75% versus 57%, p=0.007). There was no difference in total duration of vedolizumab therapy between the groups;19.6 months for those that continued versus 13.6 months for those that stopped, p=0.841. There was no significant difference in albumin, platelets, and haemoglobin reported before or after the switch between the two groups. There was insufficient recording of CRP and calprotectin to allow analysis. Conclusions SC vedolizumab was accepted, well tolerated and effective in the majority of patients in our centre. There was no blood inflammatory biomarker or demographic signature to identify those who stopped SC therapy due to flare or side effects using standard monitoring.
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Background: Caregiver hesitancy for their children to receive the COVID-19 vaccine remains due to concerns regarding safety and efficacy, but also due to fear of vaccine administration-related pain and distress. Study objectives were to determine caregivers' perceptions regarding both their personal and child's COVID-19 vaccine administration-related stress and fear and relate this to their likelihood to allow their child to receive COVID-19 vaccinations. Methods: This study was a secondary data analysis of a multicentre, cross-sectional survey of caregivers presenting to four Canadian pediatric emergency departments. Caregivers were surveyed between December 2020 and March 2021 and completed a digital survey on their own smartphones. Results: 331 caregivers responded to the survey (mean age 39.9 years [SD 7.71]); 74.2% (245/331) were mothers. Children's mean age was 8.8 years [SD 5.4]; 49.8% (165/331) were female. 64.1% (209/326) of caregivers were willing to vaccinate their child against COVID-19, while 35.9% (117/326) were not. Greater perceived COVID-19 vaccine administration-related pain (0.88 [0.80; 0.95], p = .003) and stress (0.82 [0.76; 0.89], p = <.001) for their child as well as greater perceived personal stress with their own COVID-19 vaccine administration (0.81 [0.75; 0.88], p = <.001) were associated with caregivers being less likely to vaccinate their child. Conclusions: During the time period between COVID-19 pandemic waves 2 and 3, and after the vaccine had been federally approved for adults, one-third of Canadian caregivers surveyed reported being unwilling to vaccinate their child against COVID-19 in the future. Managing children's and caregivers' vaccine administration-related fear and stress may improve vaccine uptake for children.
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Vaccination has produced a great improvement to the global health by decreasing/eradicating many infectious diseases responsible for significant morbidity and mortality. Thanks to vaccines, many infections affecting childhood have been greatly decreased or even eradicated (smallpox, measles, and polio). That is why great efforts are made to achieve mass vaccination against COVID-19. However, developed vaccines face many challenges with regard to their safety and stability. Moreover, needle phobia could prevent a significant proportion of the population from receiving vaccines. In this context, microneedles (MNs) could potentially present a solution to address these challenges. MNs represent single dose administration systems that do not need reconstitution or cold-chain storage. Being self-administered, pain-free, and capable of producing superior immunogenicity makes them a more attractive alternative. This review explores microneedles' types, safety, and efficacy in vaccine delivery. Preclinical and clinical studies for microneedle-based vaccines are discussed and patent examples are included.
Subject(s)
COVID-19 , Vaccines , Administration, Cutaneous , Child , Drug Delivery Systems , Humans , Needles , Technology , VaccinationABSTRACT
Background: The onset of the COVID-19 pandemic facilitated a rapid acceleration of the Subcutaneous Immunoglobulin in the Community Program (SCIg Program) in the Northern Sydney Local Health District (NSLHD) due to clinical need. SCIg may be administered at home, whilst IVIg is an intravenous infusion of 6 hours' duration administered monthly in the Day Procedure Unit. Methods: Between 1 March and 30 June 2020, all patients receiving IVIg under the supervision of our immunologists were enrolled in the SCIg Program. An allergy/immunology Clinical Nurse Specialist or Registered Nurse Year 8 provided the first training session to all patients, encompassing instruction on product inspection, draw-up, needle insertion, administration via push and pump methods, standard infection control precautions, waste/sharps disposal, record-keeping, storage, adverse event recognition, product and consumable pick-up, product reconciliation, and contact portals. Subsequent training sessions were provided by CSL Behring in the community. All product, consumables and support were funded by the NSLHD. Health economic data was obtained for the cost of IVIg and SCIg delivery. Results: Sixty-two patients were enrolled. Seven refused SCIg training citing needle phobia (n = 4), and lifestyle reasons (n = 3). Fifty-five completed training in 1 to 3 weekly training sessions. The age range of patients was 18 to 90. Four patients reverted to IVIg in the 12-month follow-up period because of lifestyle (n = 3) or inadequate manual dexterity (n = 1). There was no change in the number of infections in the 12-month period before and after SCIG transition. The cost of IVIg in the preceding 12-month period was $179,982. The cost of SCIg for 12 months was $46,019, with a cost saving of $133,963. Discussion: Fifty-five patients completed training over a 3-month period. SCIg has been shown to be an effective alternative to IVIg in preventing bacterial infection in all patients, and is associated with significant improvement to health economics.
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As mass vaccination is underway to combat the COVID-19 pandemic and achieve herd immunity, healthcare professionals need to recognize the fear and phobia of needles among their patients. Approximately 11.5 to 66 million U.S. adults may suffer from this condition. This population often avoids seeking medical care including vaccinations. The exact number of people suffering from this phobia is unknown, and the potential years of life lost in the American health care system cannot be estimated accurately. The resistance to vaccinations among this population may delay achieving herd immunity to end this current pandemic. An overview of needle phobia, vaccinations, and current treatments are explored. The use of telemedicine could prove critical for reaching this population as well as those who are hesitant about vaccinations. Providing education to healthcare providers to identify and manage these patients during the pandemic is necessary.