Physicians' Experience with COVID-19 Vaccination: A Survey Study

Healthcare Workers' Vulnerability to SARS-CoV-2 in Western Romania: A Study on Incidence and Risk Factors for Non-Vaccination and Reinfection

Purpose

The COVID-19 pandemic has severely impacted healthcare workers, a professional category at risk of infection in both hospital and community settings. The aim of the study was to compare morbidity among hospital staff and that in general population, as well as the factors predicting non-vaccination and reinfection.

Patients and Methods

The present study is a retrospective, cross-sectional study. It was conducted by including all the confirmed COVID-19 infection cases in medical staff members during the period 01.01.2021-31.03.2022 that were reported to the Public Health Authority of Timis County, Timisoara, Western Romania.

Results

Direct, strong, statistically significant correlations were found between the incidence of COVID-19 recorded in all categories of medical personnel and the community pandemic trend, with maximum values for auxiliary and medium medical staff (rho = 0.852/0.821, p < 0.001). The high socio-economic level, as well as the advanced medical education level, were predictor factors for anti-SARS-COV-2 vaccination among the personnel. The non-vaccinated status as well as incomplete vaccination or even the 2-dose vaccination represented independent risk factors for reinfection in 2022. Conversely, receiving a higher number of vaccine doses emerged as the primary protective factor. Notably, reduced adherence to the administration of the following doses was observed particularly among medium and auxiliary staff, leading to additional risks of infection with the Omicron variant.

Conclusion

Despite over 70% vaccination coverage among all studied medical personnel categories, there was low adherence to repeat doses of vaccination, particularly among medium and auxiliary staff. The study highlighted a distinct necessity for enhanced training on preventive behaviours and targeted prevention/control strategies for all professional groups interacting with patients, including caretakers, ambulance workers, receptionists, physiotherapists, and psychologists.

Alterations in Patients' Clinical Outcomes and Respiratory Viral Pathogen Activity following the COVID-19 Pandemic

BACKGROUND

Before the COVID-19 pandemic, respiratory pathogens such as influenza, parainfluenza, and respiratory syncytial virus were the most commonly detected viruses among hospitalized patients with respiratory tract infections.

METHODS

This was a retrospective observational study of inpatients and outpatients who attended Jordan University Hospital and underwent Nasopharyngeal Aspiration (NPA) in the periods from December 2017 to December 2018 and from December 2021 to December 2022. The results of multiplex respiratory pathogen real-time PCR tests for nasopharyngeal swab specimens were extracted from the electronic-based molecular diagnostic laboratory record of JUH. We compared the prevalence of the detected viruses as well as the patients' characteristics and outcomes between the two periods.

RESULTS

The total number of included patients was 695. Our analysis showed that a higher percentage of patients with hypertension and diabetes presented before the pandemic compared to the same period after it (p-value < 0.001). The need for O2 devices, white blood cell counts, diastolic blood pressure, and the length of hospital stay were significantly higher among patients who presented before the pandemic (p-value < 0.050). Influenza H1N1 (8.70% vs. 4.03%), influenza B (1.67% vs. 0.25%), parainfluenza (1.00% vs. 0.00%), human metapneumovirus (5.35% vs. 0.76%), adenoviruses (6.35% vs. 3.02%), and coronaviruses (8.70% vs. 3.53%) were detected with higher frequency in the period before the pandemic (p-value = 0.011, 0.045, 0.045, 0.000, 0.035, 0.004). These results were similar in terms of changes in the detection rates of viruses after matching the number of tested patients between the periods before and after the pandemic.

CONCLUSIONS

We have demonstrated a reduction in the detection of several viruses, which might be due to the increase in public awareness toward infection protection measures after the COVID-19 pandemic.

Respiratory Viruses in Nosocomial Pneumonia: An Evolving Paradigm

Nosocomial pneumonia (NP) represents a leading cause of morbidity and mortality in hospitalized patients. Historically, clinicians have considered hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which comprise NP, to be essentially bacterial processes. As such, patients suspected of having either HAP or VAP are initially treated with broad-spectrum antibiotics, and few clinicians search for a possible culprit virus. Recent reports which build on earlier studies, however, indicate that viruses likely play an important role in NP. Studies employing viral diagnostics as part of the evaluation for NP indicate that common respiratory viruses can spread nosocomially and lead to HAP and VAP. Similarly, studies of the general epidemiology of respiratory viral infections, such as influenza, respiratory syncytial virus, adenovirus, and rhinovirus, confirm that these pathogens are important causes of NP, especially among immunosuppressed and pediatric patients. More importantly, these more contemporary analyses reveal that one cannot, based on clinical characteristics, distinguish a viral from a bacterial cause of NP. Additionally, viral HAP and VAP result in crude mortality rates that rival or exceed those reported in bacterial NP. Rigorous prospective, multicenter trials are needed to confirm the significance of respiratory viruses in NP, as are studies of novel therapeutics for these viral infections.

The Role of Medication Beliefs in COVID-19 Vaccine and Booster Uptake in Healthcare Workers: An Exploratory Study

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire-measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake-was targeted to HCWs via social media platforms between May-July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity-Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity-Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers.

Investigation and Modeling of the Variables of the Decision to Vaccinate as the Foundation of an Algorithm for Reducing Vaccination Reluctance

The purpose of this study is to examine the factors that influence vaccination options, including vaccination against COVID-19, in order to develop a management algorithm for decision-makers to reduce vaccination reluctance. This paper’s primary objective is to empirically determine the relationships between different variables that correlate to non-vaccination behavior of the target population, as well as the implications for public health and situational management strategies for future vaccination intentions. We created a questionnaire to investigate the personal approach to disease prevention measures in general and vaccination in particular. Using SmartPLS, load factors for developing an algorithm to manage vaccination reluctance were calculated. The results shows that the vaccination status of an individual is determined by their vaccine knowledge. The evaluation of the vaccine itself influences the choice not to vaccinate. There is a connection between external factors influencing the decision not to vaccinate and the clients’ motives. This plays a substantial part in the decision of individuals not to protect themselves by vaccination. External variables on the decision not to vaccinate correlate with agreement/disagreement on COVID-19 immunization, but there is no correlation between online activity and outside influences on vaccination refusal or on vaccine opinion in general.

Lung transplantation as a treatment for patients with end-stage respiratory failure due to Coronavirus disease of 2019 (COVID-19)

Background

COVID-19 may lead to development of irreversible acute respiratory distress syndrome. Some patients sustain severe respiratory failure after infection subsides. They may require lung transplant as a last resort treatment. The aim of the study is to assess the effect and feasibility of lung transplant as a treatment for patients with severe irreversible respiratory failure due to COVID-19.

Methods

This retrospective study pertains to analysis of 119 patients in critical condition who were referred to Lung Transplant Ward (Zabrze, Poland). between July 2020 and June 2021 after developing respiratory failure requiring extracorporeal membrane oxygenation, invasive ventilation, or both, as well as a few patients on high-flow oxygen therapy. Inclusion criteria for referral were confirmed lack of viral disease and exhaustion of other therapeutic options.

Results

Of the referred patients, 21.84% were disqualified from such treatment owing to existing contraindications. Among the suitable patients, 75.8% died without transplant. Among all patients who were qualified for lung transplant, only 9 patients became double lung transplant recipients. Intraoperative mortality for this procedure was 33%. Four patients were discharged after the procedure and are currently self-reliant with full respiratory capacity.

Conclusions

Patients with severe irreversible respiratory failure after COVID-19 present significantly high mortality without lung transplant. This procedure may present satisfactory results but must be performed in a timely fashion owing to critical condition and scarcity of lung donors, only aggravated around the time of peak infection waves.

Acceptance and Factors Influencing Acceptance of COVID-19 Vaccine in a Romanian Population

COVID-19 vaccination has been recognized as one of the most effective ways to overcome the current SARS-CoV-2 pandemic. However, the success of this effort relies on national vaccination programmes. In May 2021, we surveyed 1552 people from Romania to determine acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 39.2% of participants reported that they were vaccinated and 25.6% desired vaccination; nonetheless, 29.5% expressed opposition to vaccination. Concerning vaccination refusal, the top justification given by respondents is that the vaccine is insufficiently safe and there is a risk of serious side effects (84.4%). A higher rate of vaccination refusal was observed among female gender, younger age, and lower educational level. Refusal was also associated with unemployment, being in a relationship, and having a decrease in income during the pandemic. People who are constantly informed by specialized medical staff have a statistically significant higher vaccination rate, while people who choose to get information from friends, family, and co-workers have the strongest intention of avoiding the vaccine. Current levels of vaccine are insufficient to achieve herd immunity of 67%. It is mandatory to understand the aspects that define and establish confidence and to craft nationwide interventions appropriately.