Identification of groups at high risk for under-coverage of seasonal influenza vaccination: A national study to inform vaccination priorities during the COVID-19 pandemic

Predictors affecting vaccine hesitancy towards annual COVID-19 booster shots among populations from different countries

BACKGROUND

Coronavirus Disease-19 (COVID-19) is reported to cause significant mortalities. Vaccination has the probability to reduce the burden of COVID-19. Annual vaccination is better to be established, but vaccine reluctance has been observed among different populations.

OBJECTIVES

To recognize the associated factors and the predictors affecting vaccine hesitancy towards annual COVID-19 vaccine shots among African and Asian populations.

METHOD

A cross-sectional study was conducted on a population from diverse nationalities using a structured, self-administered questionnaire. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using multiple logistic regression to identify predictors of vaccine hesitancy.

RESULTS

A total of 502 participants from four countries: 152 Jordanians (30.3%), 145 Egyptians (28.9%), 103 Ghanaians (20.5%), and 102 Sudanese (20.3%) were included in the study. The majority were females (307, 61.2%). Egyptians show the highest willingness to receive annual COVID-19 vaccine shots (99, 68.3%), while Jordanians (68, 44.7%), Ghanaians (42, 40.8%), and Sudanese (60, 58.8%) exhibit more hesitancy or refusal. Hesitancy is higher among the younger age group (56.5%, P = 0.003) and lower education levels (55.6%, P = 0.008). Higher knowledge (OR = 0.843, p = 0.002), and a positive attitude toward vaccine administration (OR = 0.878, P < 0.001) significantly predict lower hesitancy. The fear of severe side effects (42%) was the most common cause of COVID-19 vaccine hesitancy.

CONCLUSIONS

Young age and low education levels are linked with increased hesitancy toward annual COVID-19 vaccination shots. Higher knowledge, and positive attitude, and previous influenza vaccination predict annual vaccine hesitance. Public health actions in the form of awareness campaigns are needed to promote the importance of COVID-19 booster shots vaccination and address worries about safety, and side effects to efficiently reach the target young and low education group with heighten vaccine service quality on the way to build vaccine assurance and lessen hesitancy.

Childhood factors and their impact on COVID-19 vaccine acceptance in older adults across Europe

OBJECTIVES

This study investigates how childhood factors, including early vaccinations and socio-demographic variables, influence COVID-19 vaccine acceptance among older adults across Europe.

STUDY DESIGN

Longitudinal panel study using data from the SHARE survey across 27 European countries.

METHODS

We analyzed responses from 43,790 participants aged 50+ who took part in both the SHARELIFE (waves 3 or 7) and the second SHARE Corona Survey. Childhood factors examined included early vaccinations, socioeconomic status (SES), health, and cognition. Additional variables were region, sex, and birth cohort. Multivariate logistic regression models were used to assess associations between these factors and COVID-19 vaccine acceptance, adjusting for household wealth, chronic diseases, education, and household composition.

RESULTS

Overall, 84.9 % of participants reported accepting the COVID-19 vaccine. Childhood vaccinations were significantly associated with higher odds of vaccine acceptance (OR: 1.65, 95 % CI: 1.39-1.96). Females (OR: 0.92, 95 % CI: 0.86-0.99), younger cohorts (born after 1956: OR: 0.61, 95 % CI: 0.53-0.71), and individuals from disadvantaged childhood SES backgrounds (OR: 0.85, 95 % CI: 0.77-0.94), were less likely to accept the vaccine. Regional differences were evident, with Eastern Europe showing the lowest acceptance rates (OR: 0.34, 95 % CI: 0.31-0.38). Low childhood cognition was also associated with a lower vaccine acceptance (OR: 0.72, 95 % CI: 0.72-0.89).

CONCLUSIONS

Childhood factors, including early vaccinations and socio-demographic variables, significantly influence COVID-19 vaccine acceptance in older Europeans. Interventions should focus on reducing disparities, enhancing trust in healthcare systems, and promoting early vaccination and parental engagement to foster long-term positive attitudes toward immunization.

Sociodemographic and health-related determinants of influenza vaccine nonreceipt among US adults: A cross-sectional analysis of the 2022 National Health Interview Survey

The purpose of this study was to determine the prevalence and factors associated with influenza vaccine nonreceipt among adults in the United States. This nationally representative, cross-sectional study analyzed self-reported data on influenza vaccination status and sociodemographic, physical health, and health care access factors among 27,189 adults from the 2022 National Health Interview Survey. The primary outcome was influenza vaccination nonreceipt in the past 12 months. A multivariable logistic regression model evaluated associations between 19 sociodemographic, physical health, and health care access variables with influenza vaccine nonreceipt. Shapley Additive Explanations assessed the relative importance of covariates associated with nonreceipt in the regression model. The population-weighted analysis indicated 52.8% influenza vaccination nonreceipt among US adults. The logistic regression model identified 15 covariates as significantly associated with vaccine nonreceipt. When evaluating the relative importance of the variables, the key determinants of vaccine nonreceipt were younger age, lack of doctor visits in the past year, and lower educational attainment. Influenza vaccine nonreceipt was 92.4% among adults with all 3 characteristics compared to only 16.0% among those with none of the characteristics. In conclusion, influenza vaccine coverage in the overall US adult population remains well below public health goals. Significant disparities persist among subgroups like younger adults, those without recent health care visits, and individuals with lower educational attainment. There is an urgent need for expanded outreach efforts targeting vulnerable populations to address disparities in vaccine uptake.

Building and Sustaining Flu Vaccine Acceptance and Trust in the Black Community through Partnerships with Churches, Salons, and Barbershops

Despite the benefits of flu vaccines, Black adults continue to experience lower vaccination rates in the United States. Contributing factors include lack of access to health care and trusted information about vaccines. The National Minority Quality Forum's Center for Sustainable Health Care Quality and Equity collaborated with church pastors, barbers, and hair stylists to disseminate a survey to their communities to assess barriers/facilitators to flu vaccine uptake. The population (n = 262) was mostly Black (93%), female (77%), between the age of 50-64 (39%) and vaccinated (73%). The most common reasons cited by respondents for being vaccinated were personal health, a habit of getting the shot, and a desire not to spread it to others. Among the unvaccinated (27%), the most common reasons for not vaccinating were lack of perceived need, concern the shot would make them sick, and that they do not normally get vaccinated. Vaccine knowledge and trust in health care providers' recommendations was higher amongst vaccinated individuals. Amongst the unvaccinated, trust was lower and there was a stronger belief that the vaccine would not prevent illness. Age was also associated with the likelihood of being vaccinated and greater vaccine knowledge and trust in provider recommendations. Unvaccinated individuals, particularly those under 54 years of age, did not hold strong distrust, attitudes were more neutral, and concern for others was moderate, suggesting an opportunity to target younger age groups. This study highlights the importance of trusted community messengers in conveying targeted messages on the safety and effectiveness of the flu vaccine.

Changes in vaccine hesitancy among parents of children aged 6 months - 17 Years, National Immunization Surveys, 2019-2022

BACKGROUND

Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States.

METHODS

Data from the 2019-2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months -17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5-11 years, and 12-17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points- before and after the authorization of the COVID-19 vaccine for each age group.

RESULTS

Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: -3.9, -0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5-11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12-17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups.

DISCUSSION

About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5-11 years and declined for children aged 6 months-4 years.

Naturally Occurring Isorhamnetin Glycosides as Potential Agents Against Influenza Viruses: Antiviral and Molecular Docking Studies

Influenza remains one of the most widespread infections, causing an annual illness in adults and children. Therefore, the search for new antiviral drugs is one of the priorities of practical health care. Eight isorhamnetin glycosides were purified from Persicaria species, characterized by nuclear magnetic resonance spectroscopy and mass spectrometry and then evaluated as potential agents against influenza virus. A comprehensive in vitro and in vivo assessment of the compounds revealed that compound 5 displayed the most potent inhibitory activity with an EC50 value of 1.2-1.3 μM, better than standard drugs (isorhamnetin 28.0-56.0 μM and oseltamivir 1.3-9.1 μM). Molecular docking results also revealed that compound 5 has the lowest binding energy (-10.7 kcal/mol) among the tested compounds and isorhamnetin (-8.1 kcal/mol). The ability of the isorhamnetin glycosides to suppress the reproduction of the influenza virus was studied on a model of a cell culture and chicken embryos. The ability of active compounds to influence the structure of the virion, as well as the activity of hemagglutinin and neuraminidase, has been demonstrated. Compound 1, 5, and 6 demonstrated the most effective inhibition of virus replication for all tested viruses. Molecular dynamics simulation techniques were run for 100 ns for compound 5 with two protein receptors Hem (1RUY) and Neu (3BEQ). These results revealed that the Hem-complex system acquired a relatively more stable conformation and even better descriptors than the other Neu-complex studied systems, suggesting that it can be an effective inhibiting drug toward hemagglutinin than neuraminidase inhibition. Based on the reported results, compound 5 can be a good candidate to be evaluated for effectiveness in preclinical testing.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

Understanding dynamic complexity in context-Enriching contextual analysis in implementation science from a constructivist perspective

Context in implementation science includes not only characteristics of a setting in which an intervention will be delivered, but also social systems (e.g., interrelationships). Context is dynamic and interacts with both, the intervention and its implementation. Therefore, contextual analysis is recognized as an indispensable part of implementation science methodology: it provides the foundation for successful and sustainable implementation projects. Yet, driven by the prevailing post-positivist understanding of context, contextual analysis typically focuses on individual characteristics of context i.e., contextual dynamics and interactions go unnoticed. Conducting contextual analysis from a constructivist perspective promotes a multilayered approach, building a more comprehensive understanding of context, and thus facilitating successful implementation. In this article, we highlight the limitations of prevailing perspectives on context and approaches to contextual analysis. We then describe how contextual analysis can be enriched by working from a constructivist perspective. We finish with a discussion of the methodological and practical implications the proposed changes would entail. Emerging literature attempts to address both the concept of context and methods for contextual analysis. Various theories, models and frameworks consider context, however, many of these are reductionistic and do not acknowledge the dynamic nature of context or interactions within it. To complement recent conceptualizations of context, we suggest consider the following five constructivist concepts: 1) social space; 2) social place; 3) agency; 4) sensation; and 5) embodiment. We demonstrate the value of these concepts using COVID-19 vaccination uptake as an example and integrate the concepts in the Context and Implementation of Complex Interventions (CICI) framework-an implementation science framework that pays ample attention to context. To study context from a constructivist perspective, we also suggest additional considerations in view of methodologies for data collection and analysis, e.g., rapid ethnographic methods. A constructivist perspective contributes to a stronger conceptualization of contextual analysis. Considering the five constructivist concepts helps to overcome contextual analysis' current shortcomings, while revealing complex dynamics that usually go unnoticed. Thus, more comprehensive understanding of context can be developed to inform subsequent phases of an implementation project, thereby maximizing an intervention's uptake and sustainability.