Healthcare workers' attitudes toward and factors influencing their acceptance of an annual COVID-19 booster vaccine: a cross-sectional study in Palestine.

BACKGROUND: The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine if recommended and its association with their attitudes and burnout levels. METHODS: We used an online self-administered questionnaire to conduct a cross-sectional study of all HCWs in the West Bank and Gaza Strip of Palestine between August and September 2022. We used the Vaccination Attitudes Examination scale to assess HCWs' vaccination attitudes and the Maslach Burnout Inventory to assess work-related Burnout. In addition, we conducted logistic regression to identify factors independently associated with the acceptance of the booster vaccine. RESULTS: The study included 919 HCWs; 52.4% were male, 46.5% were physicians, 30.0% were nurses, and 63.1% worked in hospitals. One-third of HCWs (95% CI: 30.5%-36.7%) said they would accept an annual COVID-19 booster vaccine if recommended. HCWs who are suspicious of vaccine benefits [aOR = .70; 95%CI: .65-.75] and those concerned about unforeseeable future effects [aOR = .90; 95%CI: .84-.95] are less likely to accept the booster vaccine if recommended, whereas those who receive annual influenza vaccine are more likely to get it [aOR = 2.9; 95%CI: 1.7-5.0]. CONCLUSION: Only about a third of HCWs would agree to receive an annual COVID-19 booster vaccine if recommended. Mistrust of the vaccine's efficacy and concerns about side effects continue to drive COVID-19 vaccine reluctance. Health officials need to address HCWs' concerns to increase their acceptance of the annual vaccine if it is to be recommended.

Jordanians' willingness to receive heterologous prime-boost COVID-19 vaccination and vaccine boosters.

OBJECTIVE: Coronavirus-2019 (COVID-19) vaccination is the game-changing approach that tops all other strategies to contain the pandemic spread. A growing interest has been raised to heterologous prime-boost and booster COVID-19 vaccination to tackle vaccine shortage and to increase the vaccine's immunogenicity. This study aimed to evaluate the willingness and acceptance of Jordanians to receive heterologous prime-boost COVID-19 vaccination and vaccine boosters. MATERIALS AND METHODS: A web-based cross-sectional study was conducted using a validated online questionnaire. Adult Jordanian participants were recruited using several social media platforms. The questionnaire link was randomly posted by researchers on public groups in Jordan. Participant's demographics, medical history, knowledge of mixed and booster COVID-19 vaccination and their willingness to receive them were obtained and analyzed. RESULTS: Approximately 50.5% and 49.3% of the respondents stated former knowledge of the mixed and booster COVID-19 vaccination, respectively. Approximately 50% of respondents acknowledged that the side effects could preclude them from taking mixed and booster vaccines, and 45.3% responded that taking a third dose of the vaccine would increase the side effects. The respondents with previous history of COVID-19 and influenza vaccination were more likely to agree on mixed vaccines compared to those not vaccinated (29.5% vs. 6.5%, p <0.0001; 38.0% vs. 24.5%, p=0.0078, respectively). Moreover, both previous history of COVID-19 and seasonal influenza vaccine was an encouraging response for acceptance of mixed and booster vaccines when compared to those who did not receive the vaccines (54.5% vs. 11.3%; p<0.0001, 69.0% vs. 45.5%; p <0.0001, respectively). CONCLUSIONS: The current study showed that nearly half of the respondents were familiar with COVID-19 mixed and booster vaccine programs; however, a high percentage still expressed reticence to receive the mixed vaccines. We consider these results to emphasize the importance and need of awareness campaigns that accentuate the safety profile of such updated vaccination programs.

Yellow Fever Vaccine Safety Perception of Pregnant Women in Emergency Response Mass Vaccination in Uganda.

Yellow fever vaccine, a live attenuated vaccine, is primarily administered to pregnant women during outbreaks. A qualitative study was conducted in pregnant women on the perception of yellow fever mass vaccination. In total, interviews with 20 women-13 semi-structured interviews and one focus group discussion with seven participants-were analyzed. This study showed that conflicting information about vaccine safety led to concern about miscarriage. Furthermore, it was believed that vaccination during gestation would concurrently immunize the fetus by transplacental antibody transfer. Consultation of health workers at the vaccination site led to diverse recommendations. When vaccinating pregnant women, clear health communication is crucial. Vaccine recommendations should be obeyed, and health workers should be trained to address emerging vaccine concerns. Pregnant women should be informed that a booster dose is recommended to achieve lifelong immunity. After pregnancy, a booster should be offered to women in endemic areas.

Kyasanur Forest Disease vaccination coverage and its perceived barriers in Goa, India-A mixed methods operational research.

BACKGROUND: Kyasanur Forest Disease (KFD) is a highly infectious viral illness transmitted by infected ticks through contact with monkeys and other forest animals. Till date there is no definite treatment available for KFD. Hence, vaccination is considered to be an important public health intervention to control KFD. This study aimed at estimating the vaccination coverage for primary and booster doses of KFD vaccine and exploring the perceived barriers to vaccination in the affected villages of Goa, India during 2015-18. METHODOLOGY & PRINCIPAL FINDINGS: In this explanatory mixed methods study, vaccine coverage was estimated bydata obtained from the KFD vaccination registers maintained at the health centers catering to the KFD affected villages. To understand the barriers to vaccination,key informant interviews were conducted among implementing health officers, medical officers and nurses involved in vaccination. Perceptions of vaccinees and community members were studied through in-depth interviews and focus group discussions. Out of the 35,500 targeted population (6-65 years)for KFD vaccination, 32% received one dose and 13.2% received two doses. The coverage for first booster and annual booster was 4.9% and 0.5% respectively. The drop out from first to second and third doses was 57% and 85% respectively. 69% of doses were delivered during community outreach programmes and remaining at health facilities. Inadequate vaccine stock, inappropriate timing of vaccination campaign, lack of awareness and misconceptions related to indications of vaccines, travel distance for follow up doses given at community health centre and pain due to injection were perceived as reasons for poor vaccination coverage. CONCLUSIONS: KFD vaccination coverage was poor in the villages affected by KFD in Goa. Both left-out and drop-out phenomena were observed in KFD vaccination. Vaccine implementation plan has to consider suitable time for the local people, maintain adequate vaccine stock and encourage community-based vaccination campaigns instead of facility-based to achieve optimal vaccine coverage.

Vacuna contra el virus del papiloma humano en adolescentes: Análisis mediante grupos focales / Human papilloma virus vaccination in teenage girls: a focus group evaluation

Objetivo La obtención de niveles de cobertura bajos frente a la vacunación contra el virus del papiloma humano, ha planteado la necesidad de analizar las causas que están afectando a la toma de decisiones sobre la administración de la vacuna, a partir de las manifestaciones de aquellas directamente implicadas, las adolescentes. Métodos Por tanto, se ha planteado la realización de una evaluación mediante la utilización de la metodología de grupos focales. Se han realizado un grupo piloto y cuatro grupos focales en el Instituto Tirant lo Blanc de Gandía con adolescentes pertenecientes a distintas poblaciones del departamento, incluyendo en los mismos adolescentes vacunadas, no vacunadas y con vacunación incorrecta. Resultados Las su experiencia, conocimientos y opiniones respecto a la vacunación frente al VPH que pueden resumirse en la existencia de ideas erróneas y una carencia importante de conocimientos. Conclusión Es necesario un cambio de dirección basado en el desarrollo de campañas educativas, que sirvan para poder obrar con responsabilidad y poder al mismo tiempo tomar decisiones adecuadas.

Objective The low immunization coverage levels for the human papilloma virus vaccine has led to a need to analyze the causes that affect the decision to vaccinate, as expressed by those directly involved in making this decision -teenage girls. Methodology Therefore, we proposed an assessment with a focus group methodology. An evaluation with a pilot group and four focal groups was carried out in Tirant lo Blanc of Gandia secondary school. The girls that made up the groups belonged to different populations within the health department, including vaccinated, non-vaccinated, and incorrectly vaccinated teenage girls. Results The girls talked about their experiences, knowledge and opinions with respect to HPV vaccination, which could be summarized as showing a large knowledge gap and the existence of erroneous ideas. Conclusion A change in direction, involving the development of educational campaigns that empowers girls and their families to make suitable decisions, is necessary.

Experiences of social harm and changes in sexual practices among volunteers who had completed a phase I/II HIV vaccine trial employing HIV-1 DNA priming and HIV-1 MVA boosting in Dar es Salaam, Tanzania.

BACKGROUND: Volunteers in phase I/II HIV vaccine trials are assumed to be at low risk of acquiring HIV infection and are expected to have normal lives in the community. However, during participation in the trials, volunteers may encounter social harm and changes in their sexual behaviours. The current study aimed to study persistence of social harm and changes in sexual practices over time among phase I/II HIV vaccine immunogenicity (HIVIS03) trial volunteers in Dar es Salaam, Tanzania. METHODS AND RESULTS: A descriptive prospective cohort study was conducted among 33 out of 60 volunteers of HIVIS03 trial in Dar es Salaam, Tanzania, who had received three HIV-1 DNA injections boosted with two HIV-1 MVA doses. A structured interview was administered to collect data. Analysis was carried out using SPSS and McNemars' chi-square (χ2) was used to test the association within-subjects. Participants reported experiencing negative comments from their colleagues about the trial; but such comments were less severe during the second follow up visits (χ2 = 8.72; P<0.001). Most of the comments were associated with discrimination (χ2 = 26.72; P<0.001), stigma (χ2 = 6.06; P<0.05), and mistrust towards the HIV vaccine trial (χ2 = 4.9; P<0.05). Having a regular sexual partner other than spouse or cohabitant declined over the two follow-up periods (χ2 = 4.45; P<0.05). CONCLUSION: Participants in the phase I/II HIV vaccine trial were likely to face negative comments from relatives and colleagues after the end of the trial, but those comments decreased over time. In this study, the inherent sexual practice of having extra sexual partners other than spouse declined over time. Therefore, prolonged counselling and support appears important to minimize risky sexual behaviour among volunteers after participation in HIV Vaccine trials.

[Human papilloma virus vaccination in teenage girls: a focus group evaluation]. / Vacuna contra el virus del papiloma humano en adolescentes: Análisis mediante grupos focales.

OBJECTIVE: The low immunization coverage levels for the human papilloma virus vaccine has led to a need to analyze the causes that affect the decision to vaccinate, as expressed by those directly involved in making this decision -teenage girls. METHODOLOGY: Therefore, we proposed an assessment with a focus group methodology. An evaluation with a pilot group and four focal groups was carried out in Tirant lo Blanc of Gandia secondary school. The girls that made up the groups belonged to different populations within the health department, including vaccinated, non-vaccinated, and incorrectly vaccinated teenage girls. RESULTS: The girls talked about their experiences, knowledge and opinions with respect to HPV vaccination, which could be summarized as showing a large knowledge gap and the existence of erroneous ideas. CONCLUSION: A change in direction, involving the development of educational campaigns that empowers girls and their families to make suitable decisions, is necessary.

[Polio vaccination failure in Italy, years 2006-2010]. / Mancata vaccinazione antipolio in Italia, anni 2006-2010.

OBJECTIVE: The purpose of this paper is to describe the lack of antipolio vaccination and its reasons, in the period 2006-2010. STUDY DESIGN, SETTING AND PARTICIPANTS. Until 2014 the data on vaccination activities, aggregated at the regional level, were sent to the Ministry of Health using a paper form used to collect the data and then to calculate vaccine coverage (CV) at 24 months. This form contains a section for identifying the reasons for polio vaccination failure. RESULTS: During the reporting period the national CV was always above 95%. The highest rates of non-vaccination were always observed in the same Region. Polio vaccination failure is well explained in 82%of cases, but only three Regions have always provided an explanation, while two have extremely low percentages of explanation, less than 50%. The dominant mode is «noncompliant ¼ (45.5%), followed by «undetectable¼ (26.5%). CONCLUSIONS: The percentage of explanation of non-vaccination was lower than expected. At the moment we cannot clarify why, but only speculate that the lack of a computerized immunization registry has been a key element. Probably, the form used was not sufficiently detailed to monitor the phenomenon of non-vaccination and program interventions. Updating the form, in 2013, we took into account these and other critical issues.

Factors predicting completion of the human papillomavirus vaccine series.

PURPOSE: This study identified factors associated with completion of the three dose quadrivalent human papillomavirus vaccine (HPV4) series by female adolescents. METHODS: Between February and September 2008, we prospectively surveyed 11- to 26-year-old female members of an integrated managed care organization shortly after their first HPV4 dose to identify factors that predicted series completion. We used regression analyses to assess whether self-reported experiences at the index visit, knowledge/attitudes about HPV and HPV4, and medical record data on adverse events, demographic characteristics, care-utilization frequency, and visit characteristics, were associated with vaccine series completion within one year of the first HPV4 dose. RESULTS: Of 899 survey respondents (27% of 3347 survey recipients), 786 (87%) maintained continuous enrollment in the health plan in the year following the first HPV4 dose. Fifty percent (n = 393) completed the vaccine series within that year. In multivariate analyses of survey respondents, only respondents' ability to correctly identify the number of shots required for series completion was significantly associated with series completion. Reported bruising was associated with decreased likelihood of completion, and the clinician stating that future shots were required was associated with increased likelihood, but both were of borderline significance. Females ages 16-20 had the lowest series completion. CONCLUSIONS: Improving HPV4 completion will require targeted efforts. Our results suggest that providers may help by stressing the need for additional doses of vaccine, and confirming that patients understand this information. Special attention should be given to females ages 16-20. Future randomized trials should assess the effect on vaccine completion of these simple, low-cost interventions.

[Study on the compliance and economic cost of rabies vaccination].

OBJECTIVE: To learn the compliance status regarding completing full rabies vaccination schedule, and to analyse the economic cost. METHODS: Interviewing patients who visited doctor at Emergency Department, the People's Hospital, Beijing University from June 2007 to January 2009 on vaccination compliance of Essen regimens. The economic cost of Essen regimen and Zagreb regimen were estimated using average vaccination cost, average release amount by National Institue for Control of Pharmaceutical and Biological Products. RESULTS: In total, 3440 patients were interviewed. The proportion completing full vaccine schedule was 33.3%, 77.1% and 78.0% for exposure category I, II and III respectively. The compliance was high for first 3 doses, it reduced significantly after the third dose. The individual medical costs was 694 RMB for Essen regimen, and 482.2 RMB for Zagreb regimen. The estimated annual medical costs was 9.709 billion RMB for Essen regimen, and 6.746 billion RMB for Zagreb regimen nationaly. CONCLUSIONS: The Zagreb regimen should be recommended in order to simplify the vaccine administration, to increase compliance and to reduce rabies vaccination cost.

Beliefs underlying UK parents' views towards MMR promotion interventions: a qualitative study.

This study sought to extract underlying beliefs towards measles, mumps and rubella (MMR) vaccination from UK parents' views towards potential motivational and organisational interventions to boost MMR vaccination. Thematic analysis of transcripts of five focus groups identified five underlying psychological themes: parents' information needs, distrust of government sources, trust of other parents, attentional biases towards risk information and problems of achieving "balance" in MMR information provision. These are likely to represent important psychological barriers to or facilitators of the effectiveness of MMR promotion interventions.

Behavioral frequency moderates the effects of message framing on HPV vaccine acceptability.

BACKGROUND: Research suggests that gain-framed messages are generally more effective than loss-framed messages at promoting preventive health behaviors. Virtually all previous studies, however, have examined prevention behaviors that require regular and repeated action to be effective. Little is known about the utility of message framing for promoting low-frequency prevention behaviors such as vaccination. Moreover, few studies have identified mediators of framing effects. PURPOSE: We investigated whether behavioral frequency (operationalized as the number of shots required) moderated the effect of framed health messages on women's intentions to receive the human papillomavirus (HPV) vaccine. We also sought to identify mediators of framing effects. METHOD: Undergraduate women (N = 237) were randomly assigned to read an HPV vaccination booklet that varied by message frame (gain vs. loss) and behavioral frequency (one shot vs. six shots). RESULTS: We observed a frame-by-frequency interaction such that the loss-framed message led to greater vaccination intentions than did the gain-framed message but only among participants in the one-shot condition. Perceived susceptibility to HPV infection mediated the observed framing effects. CONCLUSIONS: This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors. Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination.

Have you had a tetanus booster in the last 10 years? Sensitivity and specificity of the question.

OBJECTIVE: To evaluate the accuracy of patients' recall of their last Tetanus/Diphtheria (Td) booster in the setting of employee health clinics known for high immunization rates and good documentation of vaccine status. METHODS: Five hundred and seventy-two patients of an employee health clinic answered a written questionnaire about whether they have had a Td booster in the last 10 years. Answers were compared with patients' charts as the gold standard. RESULTS: The sensitivity of the question is 92.4% (95% CI 89.0-95.0) and specificity is 26.5% (95% CI 12.9-44.4). Positive predictive value is 92.6% (95% CI 89.3-95.2) and negative predictive value is 25.7% (95% CI 12.5-43.3). Age and gender do not affect the accuracy of recall. CONCLUSION: A positive answer to this question is highly reliable whereas a negative answer is unreliable. PRACTICE IMPLICATIONS: In the setting of employee health clinics, when patients affirm the receipt of a Td booster within the previous 10 years, it is quite likely that they are up to date and do not require re-administration of the vaccine. Any other answer to this question (No, I do not know) is unreliable and a booster should be recommended if not contraindicated.

'It's just the normal thing to do': exploring parental decision-making about the 'five-in-one' vaccine.

This qualitative study explored parental decision-making about the DTaP/IPV/Hib 'five-in-one' vaccine. Semi-structured interviews were conducted with 22 parents of babies aged between 4 and 13 weeks old, recruited from four practices in southern England. A modified Grounded Theory approach identified that although parents had some concerns, most complied with the recommended programme rather than making an informed decision. Other themes related to perceived importance of immunisation; beliefs about how immunisation works; trust; perceptions of vulnerability; feelings of guilt and responsibility; and practicalities. It is important to explore how parents' attitudes change over the preschool years and to develop ways of addressing uncertainties about immunisation, including the safety of combining antigens and the need for boosters.

Recently occurring adult tetanus in Korea: emphasis on immunization and awareness of tetanus.

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diphtheria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.

Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia.

OBJECTIVES: To (i) assess under-reporting of measles-mumps-rubella (MMR) vaccinations to the Australian Childhood Immunisation Register (ACIR); (ii) estimate MMR coverage among five-year-old children and the proportion immune to measles infection; (iii) identify factors related to non-uptake of MMR vaccination. METHODS: We analysed ACIR data for a birth cohort of approximately 64,000 children aged five years. The parents of a sample of 506 children with no ACIR record for the second MMR vaccination (MMR2), due at four years of age, were interviewed by telephone to assess under-reporting to the ACIR and reasons for non-uptake of MMR vaccination. RESULTS: Parents reported that 22% (n = 111) of the surveyed 506 children had received MMR2 before their fifth birthday, and 42% (n = 214) by approximately 5.5 years of age. After correcting for this level of under-reporting to the ACIR, MMR2 coverage for the entire cohort at five years of age was 52.9% (95% CI 52.3-53.4), and increased to 84.1% (95% CI 83.4-84.8) by approximately 5.5 years of age. This was 4.3% and 8.2%, respectively, higher than ACIR coverage estimates at the two ages. Based on the corrected MMR coverage estimates, 93% of the cohort was immune to measles due to vaccination. The most common parent-reported reason for incomplete vaccination was lack of knowledge about the MMR vaccination schedule. CONCLUSIONS: Measles elimination in Australia will require continued effort in vaccination coverage and timeliness among pre-school children. School-entry requirements are important for MMR2 uptake. Strategies are needed to improve reporting to the ACIR for more accurate measurement of coverage.

Recently Occurring Adult Tetanus in Korea: Emphasis on Immunization and Awareness of Tetanus

Since a nationwide childhood vaccination with tetanus toxoid, tetanus has become a rare disease in Korea. However, we recently experienced 17 cases of adult tetanus in a university hospital during a 21-month period. Seventy percent of the patients were female, and the mean age was 63 yr (range, 29-87). The majority (88.2%) of the patients did not get primary vaccinations for tetanus and decennial tetanus-diph-theria toxoid booster. Most patients (88.2%), who sustained acute injury, did not seek medical care for their wounds or did not receive the prophylaxis for tetanus. Tetanus was found most frequently among farmers. Tetanus was diagnosed initially only in 53% of patients. The case-fatality ratio was 23.5%. These cases show that recently occurring tetanus in Korea is a disease, affecting the elderly and the female who may have a lower immunity against tetanus, and the farmers who are likely to be exposed to Clostridium tetani. In addition, diagnosis of tetanus is often delayed in area where cases are seen infrequently. Therefore, improved education among patients and physicians, emphasis of anti-tetanus immunization and awareness of tetanus respectively, may be essential for the prevention of disease and the reduction of its mortality.

A retrospective cohort study of risk factors for missing preschool booster immunisation.

AIM: To identify factors associated with non-uptake of preschool booster immunisation. DESIGN: Data from the computerised child health system was used to study all children born in 1990 and living in South Glamorgan, Wales, on their 5th birthday. Factors associated with preschool booster uptake were investigated using multiple logistic regression. RESULTS: Preschool booster coverage in the study cohort was 91.4%. After adjustment for other variables, uptake was associated most strongly with completed primary immunisation for diphtheria, tetanus, and polio vaccine or first dose measles, mumps, and rubella vaccine. Identifying children who miss either of these predicts 52.4% of those who miss the preschool booster. CONCLUSION: Effective targeting of children who have missed previous immunisations could improve preschool booster uptake and ensure maximum uptake of at least one dose of measles, mumps, and rubella vaccine. Achieving optimum measles vaccine coverage is vital to achieve the goal of measles elimination.

Hepatitis B vaccination rates among medical personnel at Ain Shams University Hospital and obstacles to vaccine uptake.

The current study included 1426 medical personnel working at Ain Shams University hospitals selected randomly; 354 staff members, 679 junior doctors (residents and internships) and 393 nurses. The overall vaccination coverage with at least one dose of HB vaccine was 40.6%. The overall coverage with 3 doses of HB vaccine was 29.1%. The mean number of working years was higher among the vaccinated group. More than 55% of personnel who had direct exposure or contact with blood were not vaccinated. HB vaccine uptake was conducted at the work place by 65.6% of vaccinated personnel and about 50% received the vaccine recently, i.e. less than one year. The side effects experienced by vaccinated subjects were local pain (5.4%) and headache (0.7%). About 38% of included personnel were not sure about the effectiveness of HB vaccine, and 47% do not know exactly the duration of vaccine validity. The current price of the vaccine was unaffordable as stated by 60.9% of subjects and 95.2% concluded that the vaccine should be funded. It was recommended that the work place is the best place for HB vaccine uptake by 80.9% of subjects and the vaccine should be obligatory for all medical personnel by 84.3% of subjects.