The Psychological Antecedents to COVID-19 Vaccination among Community Pharmacists in Khartoum State, Sudan.

Background and Objectives: Little is known regarding the 5C psychological antecedents to COVID-19 vaccination among pharmacists in low- and middle-income countries. This study aimed to assess the acceptance of COVID-19 vaccination and its psychological antecedents among community pharmacists in Khartoum State, Sudan. Materials and Methods: A cross-sectional study was conducted from July to September 2022. A self-administered questionnaire was used to collect data about sociodemographic and health status characteristics, vaccine acceptance, and the 5C psychological antecedents to vaccination. Stepwise logistic regression analysis was conducted, and results were presented using odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A total of 382 community pharmacists participated in the current study, with a mean age of 30.4 ± 5.6 years. Nearly two-thirds of the participants (65.4%) were females, and the majority (74.9%) have received or intended to receive the COVID-19 vaccination. Vaccine acceptance was significantly associated with the following psychological antecedents to vaccination: confidence, complacency, constraints, and calculation (p < 0.001). Results of the logistic regression showed that confidence in vaccines [OR = 6.82 (95% CI = 3.14-14.80)], conspiracy beliefs [OR = 0.44 (95% CI = 0.23-0.85)], and constraints to vaccination [OR = 0.18 (95% CI = 0.06-0.56)] were the significant determinants of vaccine acceptance. Conclusion: The study revealed important predictors of COVID-19 vaccine acceptance that can be used to guide policymakers in designing target-oriented interventions that can improve the vaccine acceptance rate among community pharmacists in Sudan. These findings suggest that interventions to promote vaccine acceptance among pharmacists should focus on building confidence in vaccines and providing accurate information about the safety and efficacy of the COVID-19 vaccine, and reducing constraints to vaccination.

COVID-19 Vaccination and Clinical Outcomes at a Secondary Referral Hospital During the Delta Variant-dominant Period in West Sumatra, Indonesia.

OBJECTIVES: The second wave of coronavirus disease 2019 (COVID-19) cases in Indonesia, during which the Delta variant predominated, took place after a vaccination program had been initiated in the country. This study was conducted to assess the impact of COVID-19 vaccination on unfavorable clinical outcomes including hospitalization, severe COVID-19, intensive care unit (ICU) admission, and death using a real-world model. METHODS: This single-center retrospective cohort study involved patients with COVID-19 aged ≥18 years who presented to the COVID-19 emergency room at a secondary referral teaching hospital between June 1, 2021 and August 31, 2021. We used a binary logistic regression model to assess the effect of COVID-19 vaccination on unfavorable clinical outcomes, with age, sex, and comorbidities as confounding variables. RESULTS: A total of 716 patients were included, 32.1% of whom were vaccinated. The elderly participants (≥65 years) had the lowest vaccine coverage among age groups. Vaccination had an effectiveness of 50% (95% confidence interval [CI], 25 to 66) for preventing hospitalization, 97% (95% CI, 77 to 99) for preventing severe COVID-19, 95% (95% CI, 56 to 99) for preventing ICU admission, and 90% (95% CI, 22 to 99) for preventing death. Interestingly, patients with type 2 diabetes had a 2-fold to 4-fold elevated risk of unfavorable outcomes. CONCLUSIONS: Among adults, COVID-19 vaccination has a moderate preventive impact on hospitalization but a high preventive impact on severe COVID-19, ICU admission, and death. The authors suggest that relevant parties increase COVID-19 vaccination coverage, especially in the elderly population.

Vaccination is preventing development of placental pathologies in SARS-CoV-2 infected pregnant patients.

INTRODUCTION: The coronavirus disease (COVID-19) has created a serious health problem in pregnant people. We aimed to address whether vaccination can prevent development of placental disease in SARS-CoV-2 infected mothers. METHODS: We reported the pathology findings obtained from routine histopathological examination of placentas of overall 38 cases. RESULTS: We found low prevalence of placental pathology in vaccinated pregnant people with active SARS-CoV-2 infection in comparison to those unvaccinated cases. CONCLUSION: Based on our findings, SARS-CoV-2 vaccination can prevent development of placental pathological lesions and may lower the risk of serious illness in pregnant people.

Effects of Antibody Response after Booster Vaccination on SARS-CoV-2 Breakthrough Infections and Disease Outcomes in Advanced Cancer Patients: A Prospective Analysis of the Vax-on-Third Study.

(1) Background: The clinical implications of COVID-19 outbreaks following SARS-CoV-2 vaccination in immunocompromised recipients are a worldwide concern. Cancer patients on active treatment remain at an increased risk of developing breakthrough infections because of waning immunity and the emergence of SARS-CoV-2 variants. There is a paucity of data on the effects of COVID-19 outbreaks on long-term survival outcomes in this population. (2) Methods: We enrolled 230 cancer patients who were on active treatment for advanced disease and had received booster dosing of an mRNA-BNT162b2 vaccine as part of the Vax-On-Third trial between September 2021 and October 2021. Four weeks after the third immunization, IgG antibodies against the spike receptor domain of SARS-CoV-2 were tested in all patients. We prospectively evaluated the incidence of breakthrough infections and disease outcomes. The coprimary endpoints were the effects of antibody titers on the development of breakthrough infections and the impact of COVID-19 outbreaks on cancer treatment failure. (3) Results: At a median follow-up of 16.3 months (95% CI 14.5-17.0), 85 (37%) patients developed SARS-CoV-2 infection. Hospitalization was required in 11 patients (12.9%) and only 2 (2.3%) deaths related to COVID-19 outbreaks were observed. Median antibody titers were significantly lower in breakthrough cases than in non-cases (291 BAU/mL (95% CI 210-505) vs. 2798 BAU/mL (95% CI 2323-3613), p < 0.001). A serological titer cut-off below 803 BAU/mL was predictive of breakthrough infection. In multivariate testing, antibody titers and cytotoxic chemotherapy were independently associated with an increased risk of outbreaks. Time-to-treatment failure after booster dosing was significantly shorter in patients who contracted SARS-CoV-2 infection (3.1 months (95% CI 2.3-3.6) vs. 16.2 months (95% CI 14.3-17.0), p < 0.001) and had an antibody level below the cut-off (3.6 months (95% CI 3.0-4.5) vs. 14.6 months (95% CI 11.9-16.3), p < 0.001). A multivariate Cox regression model confirmed that both covariates independently had a worsening effect on time-to-treatment failure. (4) Conclusions: These data support the role of vaccine boosters in preventing the incidence and severity of COVID-19 outbreaks. Enhanced humoral immunity after the third vaccination significantly correlates with protection against breakthrough infections. Strategies aimed at restraining SARS-CoV-2 transmission in advanced cancer patients undergoing active treatment should be prioritized to mitigate the impact on disease outcomes.

A retrospective cohort study of incidence and risk factors for severe SARS-CoV-2 breakthrough infection among fully vaccinated people.

SARS-CoV-2 vaccination is currently the mainstay in combating the COVID-19 pandemic. However, there are still people among vaccinated individuals suffering from severe forms of the disease. We conducted a retrospective cohort study based on data from nationwide e-health databases. The study included 184,132 individuals who were SARS-CoV-2 infection-naive and had received at least a primary series of COVID-19 vaccination. The incidence of BTI (breakthrough infection) was 8.03 (95% CI [confidence interval] 7.95⎼8.13/10,000 person-days), and for severe COVID-19 it was 0.093 (95% CI 0.084⎼ 0.104/10,000 person-days). The protective effect of vaccination against severe COVID-19 remained constant for up to six months, and the booster dose offered an additional pronounced benefit (hospitalization aHR 0.32, 95% CI 0.19⎼0.54). The risk of severe COVID-19 was higher among those ≥ 50 years of age (aHR [adjusted hazard ratio] 2.06, 95% CI 1.25⎼3.42) and increased constantly with every decade of life. Male sex (aHR 1.32, 95% CI 1.16⎼1.45), CCI (The Charlson Comorbidity Index) score ≥ 1 (aHR 2.09, 95% CI 1.54⎼2.83), and a range of comorbidities were associated with an increased risk of COVID-19 hospitalization. There are identifiable subgroups of COVID-19-vaccinated individuals at high risk of hospitalization due to SARS-CoV-2 infection. This information is crucial to driving vaccination programs and planning treatment strategies.

Urgent Need for Next-Generation COVID-19 Vaccines.

This Viewpoint argues that the development of a distinctly improved generation of SARS-CoV-2 vaccines is paramount to offering a greater breadth and depth of protection for a longer duration against COVID-19 disease.

COVID-19 Vaccine Acceptance, Attitude, Hesitancy, and Its Associated Factors among Wolaita Sodo University Students: A Mixed-Method Study.

Background: Countries in the world have been experiencing the ongoing impact and spread of the coronavirus disease (COVID-19) virus pandemic. The health and financial burden of the pandemic has prompted the need for timely and effective vaccination to be considered as the best strategy for controlling disease transmission. However, vaccine acceptability remains an area of concern in developing countries like Ethiopia. Objective: To assess attitude, hesitancy in the COVID-19 vaccine acceptance, and associated factors among health science students at Wolaita Sodo University. Methods: A triangulated mixed-method study was conducted. Quantitative data were entered into SPSS Windows version 25 for analysis, and the qualitative data were transcribed using open code version 4.3. A binary logistic regression model was used to establish the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the strengths of the association. Thematic approach was used for qualitative data analysis. Results: A total of 352 students participated in this study. Having family members who were infected with COVID-19, information about COVID-19 vaccine, the need for a vaccine with the level of concern, intention to take COVID-19 vaccine, and academic year were strongly associated with vaccine acceptability. Graduating class and other senior students were about 4 and 2 times more likely to accept vaccination as compared to freshman-year students (AOR = 4.128; 95% CI: 1.351-12.610;P = 0.012) and (AOR = 2.195; 95% CI: 1.182-4.077; P value = 0.013), respectively. Even if 67% of students had a good attitude towards the vaccine, 56% of the students hesitated to take the vaccine. Conclusion: The majority of respondents had a constructive attitude towards the COVID-19 vaccine, and only a few of them were vaccinated against the COVID-19 virus. It is of utmost importance to design an evidence-based strategy to increase the uptake of vaccination for healthcare students and other nonhealth science students in universities.

Association between distance to community health care facilities and COVID-19-related mortality across U.S. counties in the COVID-19-vaccine era.

OBJECTIVE: COVID-19 has caused tremendous damage to U.S. public health, but COVID vaccines can effectively reduce the risk of COVID-19 infections and related mortality. Our study aimed to quantify the association between proximity to a community healthcare facility and COVID-19 related mortality after COVID vaccines became publicly available and explore how this association varied across racial and ethnic groups. RESULTS: Residents living farther from a facility had higher COVID-19-related mortality across U.S. counties. This increased mortality incidence associated with longer distances was particularly pronounced in counties with higher proportions of Black and Hispanic populations.

COVID-19 vaccinations and mental health among U.S. adults: Individual and spillover effects.

RATIONALE: The COVID-19 pandemic led to dramatic increases not only in physical illness, but also in mental health symptoms and disorders among U.S. adults. Although the introduction of COVID-19 vaccines dramatically lowered rates of physical illness and death, little is known about the effects of vaccines on mental health. OBJECTIVES: We assessed both individual and spillover effects of COVID-19 vaccination on mental health disorders, and whether effects of individual vaccination varied based on contextual risks indicated by state infection rates and state vaccination rates. METHODS: Using data from the Household Pulse Survey, we assessed 448,900 adults surveyed within approximately the first six months of the U.S. vaccine rollout (February 3 - August 2, 2021). Coarsened exact matching balanced vaccinated and non-vaccinated participants on demographic and economic characteristics. RESULTS: Logistic regression analyses found 7% lowered odds of depression among vaccinated individuals, but no significant difference in anxiety. Reflecting potential spillover effects, state vaccination rates predicted lowered odds of anxiety and depression (1% decrease in odds for each additional 1% of the state population vaccinated). Although state COVID-19 infection rates did not moderate effects of individual vaccination on mental health outcomes, significant interactions indicated that effects of individual vaccination on mental health were stronger in contexts of lower state vaccination rates, and links between state vaccination rates and mental health problems were stronger among unvaccinated individuals. CONCLUSIONS: Results suggest that COVID-19 vaccinations improved the mental health of adults in the U.S., with lower rates of self-reported mental health disorders both among vaccinated individuals themselves and among other individuals living in the same state, particularly when those individuals were not themselves vaccinated. These direct and spillover effects on mental health expand our understanding of the benefits of COVID-19 vaccination for the wellbeing of adults in the U.S.

How do psychobehavioural variables shed light on heterogeneity in COVID-19 vaccine acceptance? Evidence from United States general population surveys on a probability panel and social media.

OBJECTIVES: To (1) understand what behaviours, beliefs, demographics and structural factors predict US adults' intention to get a COVID-19 vaccination, (2) identify segments of the population ('personas') who share similar factors predicting vaccination intention, (3) create a 'typing tool' to predict which persona people belong to and (4) track changes in the distribution of personas over time and across the USA. DESIGN: Three surveys: two on a probability-based household panel (NORC's AmeriSpeak) and one on Facebook. SETTING: The first two surveys were conducted in January 2021 and March 2021 when the COVID-19 vaccine had just been made available in the USA. The Facebook survey ran from May 2021 to February 2022. PARTICIPANTS: All participants were aged 18+ and living in the USA. OUTCOME MEASURES: In our predictive model, the outcome variable was self-reported vaccination intention (0-10 scale). In our typing tool model, the outcome variable was the five personas identified by our clustering algorithm. RESULTS: Only 1% of variation in vaccination intention was explained by demographics, with about 70% explained by psychobehavioural factors. We identified five personas with distinct psychobehavioural profiles: COVID Sceptics (believe at least two COVID-19 conspiracy theories), System Distrusters (believe people of their race/ethnicity do not receive fair healthcare treatment), Cost Anxious (concerns about time and finances), Watchful (prefer to wait and see) and Enthusiasts (want to get vaccinated as soon as possible). The distribution of personas varies at the state level. Over time, we saw an increase in the proportion of personas who are less willing to get vaccinated. CONCLUSIONS: Psychobehavioural segmentation allows us to identify why people are unvaccinated, not just who is unvaccinated. It can help practitioners tailor the right intervention to the right person at the right time to optimally influence behaviour.

Facilitators and barriers for vaccination in patients with inflammatory rheumatic musculoskeletal diseases: a prospective cohort study.

INTRODUCTION: To identify facilitators and barriers towards vaccination in general and specifically against pneumococci, influenza and SARS-CoV-2 in patients with rheumatic musculoskeletal diseases (RMD). METHODS: Between February and April 2021, consecutive patients with RMD were asked to complete a structured questionnaire on general knowledge about vaccination, personal attitudes and perceived facilitators and barriers towards vaccination. General facilitators (n=12) and barriers (n=15) and more specific ones for vaccination against pneumococci, influenza and SARS-CoV-2 were assessed. Likert scales had four response options: from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination records and attitudes towards vaccination against SARS-CoV-2 were assessed. RESULTS: 441 patients responded to the questionnaire. Knowledge about vaccination was decent in ≥70% of patients, but <10% of patients doubted its effectiveness. Statements on facilitators were generally more favourable than on barriers. Facilitators for SARS-CoV-2 vaccination were not different from vaccination in general. Societal and organisational facilitators were more often named than interpersonal or intrapersonal facilitators. Most patients indicated that recommendations of their healthcare professional would encourage them to be vaccinated-without preference for general practitioner or rheumatologists. There were more barriers towards SARS-CoV-2 vaccination than to vaccination in general. Intrapersonal issues were most frequently reported as a barrier. Statistically significant differences in response patterns to nearly all barriers between patients classified as definitely willing, probably willing and unwilling to receive SARS-CoV-2 vaccines were noted. DISCUSSION: Facilitators towards vaccination were more important than barriers. Most barriers against vaccination were intrapersonal issues. Societal facilitators identified support strategies in that direction.

COVID-19 vaccination: a systematic review of vaccination strategies based on economic evaluation studies.

INTRODUCTION: Countries must employ the most efficient way to vaccinate their population with the COVID-19 vaccines, given the vaccines' low availability compared to its demand. This review aims to identify and compare the different COVID-19 vaccine delivery strategies employed internationally in the recent year based on the economic evaluation findings and subsequently to recommend the most cost-effective strategy among them. MATERIAL AND METHODS: A systematic review was conducted by examining online databases (Scopus, MEDLINE and Science Direct) to identify health economic evaluation studies of COVID-19 vaccines. Critical appraisal of studies was conducted using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS: A total of nine studies were selected for analysis. Results show two strategies that were cost-effective compared to its comparators: mass vaccination program compared to no vaccination and universal vaccination approach compared to a risk-stratified vaccination approach. Several other strategies were found to increase the cost-consequences in the COVID-19 vaccination program: higher vaccine effectiveness, higher vaccination pace, increased vaccination coverage, and vaccine prioritisation for an at-risk population. The study findings were restricted to analysis based on the current available data. CONCLUSION: COVID-19 vaccination policies should aim for increased vaccine production as well as a rapid and extensive vaccine delivery system to ensure the maximal value of vaccination strategies. These results can aid policymakers in opting for the most efficient approach to vaccinating the population during this COVID-19 pandemic and future pandemic.

"This is most likely not the correct vaccine": Analyzing COVID-19's viral spread and vaccine anxieties in Ghana, Cameroon, and Malawi.

Following the successful development of vaccines for COVID-19, attention turned to the problem of vaccine access. However, in contexts where vaccines are available, hesitancy remains a major problem. Informed theoretically by the scholarship on vaccine anxiety, this paper uses a qualitative research approach that included 144 semi-structured interviews to investigate how social and political dynamics shaped people's perspectives in particular environments in Ghana, Cameroon, and Malawi about COVID-19's viral spread and COVID-19 vaccines. Vaccines and the viral spread of COVID-19 are related to political tensions and class-related fractures in particular contexts, and how the public interprets COVID-19's viral spread and engages with vaccination is based on people's social and political environment and their experience. Subjectivities are also rooted in coloniality. Vaccine confidence goes beyond clinical and regulatory authority approvals, and encompasses forces that are economic, social, and political in nature. Thus, an exclusive focus on technical prescriptions for enhancing vaccine uptake will not achieve significant positive results.

Global acceptance of COVID-19 vaccine among persons with diabetes: A systematic review and meta-analysis.

AIM: This review aimed to estimate the level of acceptance of COVID-19 vaccine among persons with diabetes. METHODS: A systematic search was conducted on PubMed, MEDLINE, Embase, and CINAHL to identify relevant studies for this review. A random-effects meta-analysis was performed to generate an overall estimate of vaccine acceptance. The I2 statistic was used to quantify the degree of variation across studies, and subgroup analysis was conducted to identify the sources of heterogeneity. The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). RESULTS: This review included 18 studies involving 11,292 diabetes patients. The pooled prevalence of COVID-19 vaccine acceptance among persons with diabetes was 76.1% (95% CI: 66.7%-83.5%). The pooled prevalence across the continent ranged from 68.9% (95% CI: 47.8%-84.3%) in Asia to 82.1% (95% CI: 80.2%-83.8%) in Europe. Barriers to vaccine acceptance included misinformation, lack of information, mistrust, health concerns, and external influences. CONCLUSION: The barriers to vaccine acceptance identified in this review, could inform the formulation of health policies and public health interventions that are specifically tailored to address the needs of persons with diabetes.

The Influence of Mass Media on the COVID-19 Vaccination Decision-making Process: Prospective Survey-Based Study.

BACKGROUND: Vaccine hesitancy during the COVID-19 pandemic was exacerbated by an infodemic of conflating accurate and inaccurate information with divergent political messages, leading to varying adherence to health-related behaviors. In addition to the media, people received information about COVID-19 and the vaccine from their physicians and closest networks of family and friends. OBJECTIVE: This study explored individuals' decision-making processes in receiving the COVID-19 vaccine, focusing on the influence of specific media outlets, political orientation, personal networks, and the physician-patient relationship. We also evaluated the effect of other demographic data like age and employment status. METHODS: An internet survey was disseminated through the Western Michigan University Homer Stryker MD School of Medicine Facebook account. The survey included questions on media sources for COVID-19 information, political affiliation, presidential candidate choice, and multiple Likert-type agreement scale questions on conceptions of the vaccine. Each respondent was assigned a media source score, which represented the political leaning of their media consumption. This was calculated using a model based on data from the Pew Research Center that assigned an ideological profile to various news outlets. RESULTS: The sample consisted of 1757 respondents, with 89.58% (1574/1757) of them choosing to take the COVID-19 vaccine. Those employed part-time and the unemployed were at 1.94 (95% CI 1.15-3.27) and 2.48 (95% CI 1.43-4.39) greater odds of choosing the vaccine than those employed full-time. For every 1-year increase in age, there was a 1.04 (95% CI 1.02-1.06) multiplicative increase in odds of choosing to receive the vaccine. For every 1-point increase in media source score toward more Liberal or Democrat, there was a 1.06 (95% CI 1.04-1.07) multiplicative increase in odds of choosing to take the COVID-19 vaccine. The Likert-type agreement scale showed statistically significant differences (P<.001) between respondents; those who chose the vaccine agreed more strongly on their belief in the safety and efficacy of vaccines, the influence of their personal beliefs, and the encouragement and positive experiences of family and friends. Most respondents rated their personal relationship with their physician to be good, but this factor did not correlate with differences in vaccine decision. CONCLUSIONS: Although multiple factors are involved, the role of mass media in shaping attitudes toward vaccines cannot be ignored, especially its ability to spread misinformation and foster division. Surprisingly, the effect of one's personal physician may not weigh as heavily in one's decision-making process, potentially indicating the need for physicians to alter their communication style, including involvement in social media. In the era of information overload, effective communication is critical in ensuring the dissemination of accurate and reliable information to optimize the vaccination decision-making process.

Efficacy and safety of a fourth dose of the COVID-19 vaccine in kidney transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Kidney transplant recipients (KTRs) who become infected with SARS-CoV-2 are at greater risk of serious illness and death than the general population. To date, the efficacy and safety of the fourth dose of the COVID-19 vaccine in KTRs have not been systematically discussed. METHODS: This systematic review and meta-analysis included articles from PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang Med Online published before May 15, 2022. Studies evaluating the efficacy and safety of a fourth dose of the COVID-19 vaccine in kidney transplant recipients were selected. RESULTS: Nine studies were included in the meta-analysis, with a total of 727 KTRs. The overall pooled seropositivity rate after the fourth COVID-19 vaccine was 60% (95% CI, 49%-71%, I2 = 87.83%, p > 0.01). The pooled proportion of KTRs seronegative after the third dose that transitioned to seropositivity after the fourth dose was 30% (95% CI, 15%-48%, I2 = 94.98%, p < 0.01). CONCLUSIONS: The fourth dose of the COVID-19 vaccine was well tolerated in KTRs with no serious adverse effects. Some KTRs showed a reduced response even after receiving the fourth vaccine dose. Overall, the fourth vaccine dose effectively improved seropositivity in KTRs, as recommended by the World Health Organization for the general population.

Perceived Influence of Incentives on COVID-19 Vaccination Decision-making and Trust.

This survey study examines the prevalence of incentive receipt for COVID-19 vaccination and the association of various sociodemographic characteristics with perspectives on incentives' influence on trust in the COVID-19 vaccine.