COVID-19 vaccine hesitancy: A Systematic review of cognitive determinants

Social Determinants of Health Associated With SARS-CoV-2 Testing and Vaccine Attitudes in a Cross-Sectional Study of Latinx Individuals in Oregon

Introduction

Latinx communities have reported higher barriers to SARS-CoV-2 testing and vaccination and experienced disproportionate COVID-19 burden, especially compared with non-Latinx Whites. Social determinants of health models explain health inequities; however, it is unknown how each social determinant of health is associated with SARS-CoV-2 testing and vaccination attitudes among Latinx Americans. This study determined the relative importance of social determinants of health indicators on testing and vaccine attitudes among Latinxs and whether English proficiency and parental nativity moderate associations.

Methods

Cross-sectional survey data were collected between January and December 2022. Multilevel structural equation path modeling addressed the nonindependence of respondents nested within 52 SARS-CoV-2 testing sites across Oregon, U.S. Equality constraints were used to test for differences in the magnitudes of the associations.

Results

Latinx respondents (n=1,247) predominantly spoke Spanish at home (94%) and had no U.S.-born parents (92%). Pandemic vulnerability (β=0.95, p<0.001), economic insecurity (β=0.17, p<0.001), and discrimination (β=0.16, p<0.001) were associated with testing hesitancy; education was associated with vaccine hesitancy (β=0.15, p<0.001); and education (β=0.13, p<0.001) and discrimination (β=0.08, p<0.01) were associated with vaccine safety acceptance. Social determinants of health associations were statistically equal in magnitude. English proficiency moderated the associations from discrimination (β=0.07, p<0.01) and economic insecurity (β= -0.09, p<0.05) to vaccine hesitancy. Parental nativity moderated the associations from economic insecurity to testing hesitancy (β= -0.21, p<0.001) and lack of healthcare access to vaccine hesitancy (β=0.37, p<0.01).

Conclusions

Findings from this study identified distinct social determinants of health paths to testing and vaccine attitudes among Latinxs as well as by English proficiency and parental nativity. These results inform culturally responsive disease prevention for Latinx subgroups.

Optimization of the preparation method of inactivated intact virus particle vaccine for COVID-19

It has been recognized that it is difficult to maintain the virus particle structure of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may be associated with lower immunogenicity of inactivated vaccines against coronavirus disease 2019 (COVID-19). We have previously demonstrated that an intact structure of the virus particles is critical for influenza inactivated whole virus particle vaccine (WPV) to be immunogenically potent. Here, we tested 37, 35, 33, and 31 °C for the virus propagation temperatures and the timing of formaldehyde treatment of the virus before and after centrifugation-based purification to obtain virus particles with an intact structure. Virus particles cultured at 33 °C retained spike proteins on the surface the most abundantly. The pretreatment of the virus with formaldehyde prevented the dissociation of the spike proteins from the viral surface during the centrifugation-based purification. The immunogenicity of the prepared vaccines, intact WPV and non-intact WPV that had lost the spike proteins, was evaluated in a mouse model. A single dose of intact WPV effectively induced humoral immunity compared to non-intact WPV, as indicated by higher titers of neutralizing antibodies. After a virus challenge, the mice vaccinated with a single dose of inactivated intact WPV showed less severe weight loss and lower virus titers in the lungs compared to those vaccinated with non-intact WPV. These results demonstrate the importance of the structural integrity of WPV in inducing effective and protective immunity, and provide significant insight into the development of COVID-19 WPV for practical use.

Communication-based interventions to increase COVID-19 vaccine willingness and uptake: a systematic review with meta-analysis

OBJECTIVE

This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness.

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

DATA SOURCES

We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention.

METHODS

Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention.

CONCLUSION

Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.

PROSPERO REGISTRATION NUMBER

PROSPERO (CRD42021296618).

Factors influencing adolescents' decision-making about COVID-19 vaccination: a systematic review with qualitative synthesis

Introduction

Attitudes towards vaccination are influenced by a broad range of factors, yet little is known about the drivers shaping adolescents' vaccination beliefs. The aim of this study was to qualitatively explore the factors influencing adolescents' individual decision-making towards COVID-19 vaccination.

Methods

A systematic review was conducted using Medline, Web of Science, Sociological Abstracts, and Publicly Available Content Database. Studies on attitudes, beliefs, and perceptions of adolescents regarding COVID-19 vaccines were included. The JBI Critical Appraisal Checklist was used for quality assessment, followed by thematic synthesis of the included studies.

Results

In total, 13 studies were included, revealing 5 key themes: (1) Limited vaccine literacy influences adolescents' attitudes towards COVID-19 vaccines; (2) Family, peers, and community strongly influence adolescents' COVID-19 vaccine decision-making; (3) Different levels of trust in vaccine providers and governments influence adolescents' attitudes towards COVID-19 vaccines; (4) Desire to go back to normality influences adolescents' COVID-19 vaccine attitudes towards vaccine acceptancy; (5) Autonomy influences adolescents' COVID-19 vaccine decision-making.

Discussion

The review findings suggest that vaccine acceptance among adolescents could be improved through tailored and accessible vaccine literacy messaging, addressing structural mistrust, and empowering adolescents to make autonomous health decisions that take into account diverse contexts and populations.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512197, identifier CRD42024512197.

A Latent Class Analysis of COVID-19 Vaccine Attitudes and Beliefs: Results from a Community Survey Conducted Via the Chicagoland Community Engagement Alliance (CEAL) Program

BACKGROUND

In the U.S., responses to the rollout of COVID-19 vaccine varied widely, with contrasting perceptions of the vaccine. We aimed to characterize distinct groups of respondents regarding COVID-19 vaccine perceptions.

METHODS

Data came from the 2021-2023 Common Survey (n = 852), collected in Chicago using a community-based participatory approach focusing on communities with low COVID-19 vaccination. Participants answered eight questions about vaccine-related perceptions. We conducted a latent class analysis in R.

RESULTS

The sample included 623 female participants (73.1%), 482 Black participants (56.6%), 259 Hispanic/Latino(a) participants (30.4%), 26 Asian participants (3.1%), and 261 participants with a college degree (30.6%). In a four-class model, Class 1 (skeptic) included 153 participants (18.0%) with low confidence in vaccine safety, effectiveness, and potential to get life back to normal. Class 2 (uncertain) included 163 participants (19.1%) who mostly indicated uncertainty. Class 3 (support with concerns) included 266 participants (31.2%) who recognized many vaccine benefits but also had concerns about its rapid development and "not being studied in people like me." Class 4 (pro-vaccine) included 270 participants (31.7%) with high confidence in vaccine safety and effectiveness and social approval of vaccination. Interestingly, both the skeptic and pro-vaccine groups had somewhat similar agreement with the statement "not enough information on COVID vaccine interaction." Class assignments varied by sociodemographic characteristics. Socioeconomic hardships were associated with a lower likelihood of being in the "pro-vaccine" group.

CONCLUSIONS

Given the distinct classes of vaccine beliefs, tailored public health messaging is needed to enhance vaccine confidence and uptake.

Predictors of COVID-19 vaccine recommendation practices among healthcare providers in the US

OBJECTIVE

To understand relationships between COVID-19 vaccine perceptions, confidence, trust, sociodemographic/practice characteristics, and COVID-19 vaccine recommendation practices among US healthcare providers.

METHODS

In November 2021, an electronic survey was administered to nurses and physicians in the US via Qualtrics®. The survey included: (1) COVID-19 perceptions, (2) vaccine confidence, (3) trust, (4) uptake, (5) recommendation practices, and (6) sociodemographic/practice characteristics. Binary logistic regressions were used to obtain unadjusted/adjusted odds ratios in predicting recommendation practices of COVID-19 vaccine.

RESULTS

The survey included 304 participants. In adjusted analyses, not believing that COVID-19 was man-made, not living in southeastern US (as compared to living in southeast), having no concerns about COVID-19 vaccines, having more positive perceptions about the vaccines, and having more trust in healthcare, media, vaccine manufacturers, and public health authorities was significantly (p < 0.05) related to routinely recommending the vaccine for all patients 12 and older. Providers who did not think COVID-19 was man-made had 6.1 (95 % CI = 1.10 - 33.5) times the odds to recommend the vaccine. Providers not practicing in the southeast region had 5.2 (95 % CI = 1.39 - 19.8) times the odds to recommend the vaccine.

CONCLUSION

To increase provider recommendation of COVID-19 vaccines, beliefs about disease origin, concerns, and trust should be addressed.

PRACTICE IMPLICATIONS

Clear, accurate, and trusted information delivery about COVID-19 vaccines to healthcare providers is needed, and in turn this may reduce patient vaccine hesitancy.

Vaccine Hesitancy: Where Are We Now?

Vaccine hesitancy is the delay in acceptance or outright refusal of immunizations, which has evolved into a growing public health threat. In this article, we explore recent trends in vaccine hesitancy in the setting of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, vaccine-specific variations, social media influence, and sociodemographic factors. During the coronavirus disease 2019 pandemic, the antivaccine movement gained increasing support and generated widespread conspiracy theories and mistrust. This highlighted the importance of enhancing communication between the health care field and general public. While the impact of antivaccine social media is widespread, physicians have also begun to use technology to spread factual information and increase vaccination uptake. There is a growing body of evidence regarding sociodemographic data, including the pervasive impact of medical racism on vaccine hesitancy, with additional studies on age, education, income, and more. Providers must serve as communicators and focus on presumptive language, strong recommendations, and tailored conversations with families who are hesitant about vaccines. [Pediatr Ann. 2025;54(5):e154-e159.].

Beyond the Pandemic Era: Recent Advances and Efficacy of SARS-CoV-2 Vaccines Against Emerging Variants of Concern

Vaccination has been instrumental in curbing the transmission of SARS-CoV-2 and mitigating the severity of clinical manifestations associated with COVID-19. Numerous COVID-19 vaccines have been developed to this effect, including BioNTech-Pfizer and Moderna's mRNA vaccines, as well as adenovirus vector-based vaccines such as Oxford-AstraZeneca. However, the emergence of new variants and subvariants of SARS-CoV-2, characterized by enhanced transmissibility and immune evasion, poses significant challenges to the efficacy of current vaccination strategies. In this review, we aim to comprehensively outline the landscape of emerging SARS-CoV-2 variants of concern (VOCs) and sub-lineages that have recently surfaced in the post-pandemic years. We assess the effectiveness of existing vaccines, including their booster doses, against these emerging variants and subvariants, such as BA.2-derived sub-lineages, XBB sub-lineages, and BA.2.86 (Pirola). Furthermore, we discuss the latest advancements in vaccine technology, including multivalent and pan-coronavirus approaches, along with the development of several next-generation coronavirus vaccines, such as exosome-based, virus-like particle (VLP), mucosal, and nanomaterial-based vaccines. Finally, we highlight the key challenges and critical areas for future research to address the evolving threat of SARS-CoV-2 subvariants and to develop strategies for combating the emergence of new viral threats, thereby improving preparedness for future pandemics.

Perspectives of stakeholders on barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in southern Thailand: A qualitative study

Studies have been conducted on migrant health during the COVID-19 pandemic. However, in-depth information is scarce regarding the barriers to preventing COVID-19 in this vulnerable population. The objective of the study is to explore the barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in Thailand. We conducted an interview-based qualitative study among 7 migrants from Myanmar, 6 Thai employers, and 9 Thai healthcare providers in the cities of Hat Yai and Pattani in Southern Thailand. We recruited participants by purposive sampling. We conducted in-depth interviews in-person or via telephone in Thai or Burmese language, transcribed the interview, and conducted thematic analysis. Regarding adherence to COVID-19 protective behaviors, two themes emerged: lifestyle and habit-related barriers, and non-vaccine supply chain management barriers. Regarding COVID-19 vaccination, three common themes emerged: fear, barriers related to health education and health promotion, and vaccine supply chain management. Supply chain management was a common theme in both domains. However, each domain also had additional themes. Our study contributed empirical findings that could be of interest to stakeholders in migrant health. However, limitations regarding the generalizability of the findings and social desirability should be considered in the interpretation of the findings.

Trust in official information as a key predictor of COVID-19 vaccine acceptance: evidence from a Czech longitudinal survey study

BACKGROUND

COVID-19 vaccine hesitancy (CVH) has become a critical public health issue, with attitudes toward vaccines emerging as a broader social issue. Public debates surrounding vaccines have expanded beyond health considerations to include issues of trust, misinformation, and societal values, making CVH a complex challenge that requires multifaceted solutions. Analyzing the various determinants of CVH is crucial for developing targeted strategies to improve vaccine acceptance in specific countries and to better prepare for future public health crises. However, no study to date has evaluated the determinants of CVH in a representative sample of the Czech population.

METHODS

A multiple hierarchical logistic regression was used to analyze the associations between various sociodemographic, trust and attitudinal factors with COVID-19 vaccine acceptance (CVA). The analysis utilized survey data from a representative longitudinal sample of the Czech population (N = 1,407).

RESULTS

After controlling for all other factors, trust in official statements from the Ministry of Health was the strongest predictor of CVA, followed by prior positive attitudes toward COVID-19 vaccination (prior to vaccine availability) and older age. Lower trust in COVID-19 misinformation also predicted CVA, while lower interest in COVID-19 media content was associated with CVA. Higher income initially predicted CVA but lost statistical significance after controlling for other variables. Interestingly, education did not play a role in CVA.

CONCLUSION

CVH was primarily driven by distrust in government-provided information. Notably, vaccine refusers demonstrated a higher motivation to seek information on the topic, offering a promising opportunity for health policy interventions. Our findings suggest that strategies to reduce CVH should prioritize building trust in state institutions and effectively combating misinformation.

Inhaled Dry Powder of Antiviral Agents: A Promising Approach to Treating Respiratory Viral Pathogens

Inhaled dry powder formulations of antiviral agents represent a novel and potentially transformative approach to managing respiratory viral infections. Traditional antiviral therapies in the form of tablets or capsules often face limitations in terms of therapeutic activity, systemic side effects, and delayed onset of action. Dry powder inhalers (DPIs) provide a targeted delivery system, ensuring the direct administration of antivirals to the infection site, the respiratory tract, which potentially enhance therapeutic efficacy and minimize systemic exposure. This review explores the current state of inhaled dry powder antiviral agents, their advantages over traditional routes, and specific formulations under development. We discuss the benefits of targeted delivery, such as improved drug deposition in the lungs and reduced side effects, alongside considerations related to the formulation preparation. In addition, we summarize the developed (published and marketed) inhaled dry powders of antiviral agents.

Analysis of public opinion polls about COVID-19 vaccines: Theoretical and policy implications for vaccine communication and campaigns to address vaccine hesitancy

This study analyzed 1432 questions asked in 19 surveys (N = 43,014) on COVID-19 vaccines between January 2020 and August 2022 using dimensions including (1) information sources about COVID-19 vaccine, (2) information about the access, effectiveness, and side effects of COVID-19 vaccine, (3) COVID-19 vaccine hesitancy (i.e. false perception, skepticism, and vaccine refusal), (4) motivations to get the COVID-19 vaccine (i.e. to perform routine activities, convenience, incentives, influences, and travel requirement), (5) false perceptions caused vaccine refusal, and (6) intentions to get vaccinated. Our results show that vaccine refusal was rampant throughout the pandemic and mostly attributed to the rush in the vaccine development process and perceived safety risks. Additionally, our analysis indicates that people's motivation to get vaccinated came from varied sources such as doctors, family members, and politicians. Lastly, mandating vaccines during the pandemic did not significantly increase uptake among individuals who were initially skeptical, and concerns about the rapid development of the vaccine were a major cause of vaccine hesitancy. Findings were discussed and interpreted using the information deficit model, the two-step flow theory, and the reactance theory. This research provides valuable insights and practical implications, along with significant theoretical contributions and policy recommendations.

Association Between County-Level Social Vulnerability and Vaccine-Related Attitudes and Hesitancy Toward COVID-19 Vaccination in the United States

BACKGROUND/OBJECTIVES

Understanding attitudes and behaviors related to vaccination is critical for enhancing COVID-19 vaccination acceptance and reducing disparities in vaccination coverage. This study examines disparities in vaccine-related attitudes and COVID-19 vaccine hesitancy in the United States in relation to community-level social vulnerability.

METHODS

This study analyzed cross-sectional national surveys conducted repeatedly between July 2020 and August 2021 (n = 6716). We assessed the association between county-level social vulnerability and general vaccine-related attitudes, as well as COVID-19 vaccine hesitancy. We developed Poisson models with robust variance estimation. The analysis also included the association of county social vulnerability with parental COVID-19 vaccine hesitancy.

RESULTS

Living in counties with high Socioeconomic Status vulnerability was associated with less vaccine support (adjusted Prevalence Ratio (aPR) 1.10; 95% CI 1.05-1.14) and residing in counties with high Household Characteristics vulnerability was associated with higher likelihood of COVID-19 vaccine hesitancy (aPR 1.13; 95% CI 1.07-1.20). In contrast, high vulnerability in the Racial and Ethnic Minority was associated with more positive attitudes toward vaccines (aPR 0.91; 95% CI 0.88-0.94) and lower COVID-19 vaccine hesitancy for both themselves (aPR 0.81; 95% CI 0.76-0.87) and children (aPR 0.84; 95% CI 0.75-0.94), after adjusting for sociodemographic factors.

CONCLUSIONS

Our study highlights the importance of addressing vulnerabilities related to socioeconomic status and household characteristics to reduce disparities in vaccine perceptions and hesitancy in socially vulnerable populations. The findings provide evidence for targeted public health interventions at the community level. They also demonstrate that the relationship between social vulnerability and vaccine attitudes varies across different vulnerability components.

Children and adolescents' experiences of mandatory SARS-CoV-2 testing in schools: a cross-sectional survey

BACKGROUND

Public health measures during the COVID-19 pandemic had dramatic consequences for children and adolescents. However, policy-makers and healthcare researchers did not give sufficient weight to children's perspectives. One common public health measure was mandatory SARS-CoV-2 tests in schools. This study examines the evaluation of such mandatory testing.

METHODS

We investigated the effects of test type (pooled PCR tests vs antigen rapid tests) and demographic and psychological factors on evaluations of the experience of being tested. A total of 569 children (8-17 years) in two major German cities completed online questionnaires between October and December 2021. Participants answered questions addressing test evaluation, vaccination status, pandemic-related stress, mental health difficulties and health-related quality of life.

RESULTS

Our results showed that overall test ratings were better for pooled PCR tests (p<0.001). Vaccine-willing students evaluated SARS-CoV-2 tests more positively than vaccine-unwilling students, regardless of test type (p<0.001). Children with mental health difficulties (abnormal/borderline Strength and Difficulties Questionnaire (SDQ) scores) evaluated SARS-CoV-2 tests more negatively than children with normal SDQ scores (p<0.001). Additionally, children who reported better health-related quality of life and children with less pandemic-related stress rated the tests more positively.

CONCLUSIONS

Our results suggest that there are differences in the appraisal of the test types and that specific subgroups' experiences of regular testing vary. Our study provides insights for policy-makers in future pandemics and raises questions regarding parallels between testing and vaccination hesitancy. Moreover, our study demonstrates the feasibility and value of collecting data directly from a large cohort of children in order to understand their experiences.

Assessment of COVID-19 Vaccine Knowledge, Uptake, and Factors Influencing its Uptake Among Medical Students at the University of Jos

Background

COVID-19 vaccination is crucial to containing the pandemic. COVID-19 vaccine knowledge, attitudes, and uptake among medical students are vital, as they are future healthcare professionals expected to promote vaccination. This study assessed the knowledge of the COVID-19 vaccine, its uptake, and associated factors among medical students.

Methodology

A cross-sectional study was conducted among 245 medical students at the University of Jos, Nigeria. Participants were selected using stratified random sampling. Data was collected via a self-administered questionnaire and analysed using descriptive and inferential statistics.

Results

The median knowledge score was 8, with an interquartile range (IQR) of 3. Most participants had low knowledge of the COVID-19 vaccine (65.7%), while a minority had high knowledge (34.3%). The overall vaccine coverage was 20%. Gender and tribe were significantly associated with vaccine uptake. Males were more likely to receive the vaccine than females (24.3% vs. 12.9%, p = 0.039), and participants from the Igbo tribe were less likely to receive the vaccine than those from the Yoruba tribe (0% vs. 29.4%, p = 0.002). Additionally, being tested for COVID-19 was significantly associated with vaccine uptake (p < 0.001). Factors influencing COVID-19 vaccination decisions were access to accurate information (68.9%, p < 0.001), healthcare professionals' recommendations (31.1%, p < 0.001), concerns about safety and side effects (26.6%, p < 0.006), self-protection (19.5%, p = 0.011), government guidelines (39.6%, p < 0.001), vaccine availability (38.0%, p = 0.005), and the availability and convenience of vaccination centres (33.7%, p < 0.001).

Conclusions

There was low COVID-19 vaccine knowledge and uptake among medical students. Gender, tribe, access to information, healthcare guidance, and practical barriers influenced vaccination decisions. Targeted education and provider involvement are needed to address hesitancy in this critical population.

COVID-19 Vaccine Hesitancy among Adults in India: A Systematic Review and Meta-analysis

SUMMARY

The global health crisis triggered by the SARS-CoV-2 in 2019, known as the COVID-19 pandemic, prompted vaccination drives worldwide, including in India, to address the crisis. However, vaccine hesitancy remains a significant challenge to achieving vaccination goals. Hence, we conducted a systematic review and meta-analysis during 2021-2023 to estimate the prevalence of COVID-19 vaccine hesitancy among adults in India and identify associated factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality assessment was performed using the Joanna Briggs Institute checklist. Pooled prevalence estimates were calculated using a random-effects model. A total of 265 articles were identified, of which 21 full-text articles were included in the review. The pooled estimated prevalence of COVID-19 vaccine hesitancy among adults in India was found to be 28% (95% confidence interval: 27-29). Subgroup analysis revealed variations in hesitancy rates across different states, with higher rates observed in Jammu and Kashmir (44%), West Bengal (49%), and Maharashtra (39%). Gender-based analysis indicated higher hesitancy among males (36%) compared to females (26%). Among different study populations, medical students showed the lowest hesitancy rate (13%), whereas the general population exhibited the highest (34%). The findings suggest that vaccine hesitancy remains a significant concern in India, with one in four adults expressing hesitancy toward COVID-19 vaccination. Hesitancy rates vary across states, genders, and study populations. Addressing the factors contributing to hesitancy, such as safety concerns, lack of evidence, and misinformation, is crucial to enhance vaccine acceptance.

SARS-CoV-2 Vaccination Coverage in Italian Children with Celiac Disease

Background: Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods: We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0-19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients' eligibility for vaccination at different times. Results: Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions: Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.

The Impact of Motivational Interviewing and MOTIVE Tool Use by Pharmacists on Vaccine Acceptance

Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.

Dataset on a reliability generalization meta-analysis of the Oxford COVID-19 vaccine hesitancy scale

The Oxford COVID-19 Vaccine Hesitancy Scale is a 7-item psychometric scale developed by Freeman and colleagues a year after detecting the first case of the disease in 2019. The scale assesses people's thoughts, feelings, and behavior toward COVID-19 vaccines. A comprehensive search of major electronic databases, including Scopus, Clarivate Analytics, and PubMed, was conducted to extract eligible articles for inclusion in this meta-analysis. This paper reports information on data collected for a reliability generalization meta-analysis of the Oxford COVID-19 Vaccine Hesitancy Scale. The dataset incorporates information on the average reliability of the scale as measured with Cronbach's alpha in 20 studies included in the meta-analysis. Several benefits can be derived from the dataset. In particular, the research community would find this dataset beneficial as it can enhance their understanding of the health challenges of COVID-19, helping them come up with better solutions to eradicate the disease.

Influences on COVID-19 Vaccine Adherence among Pregnant Women: The Role of Internet Access and Pre-Vaccination Emotions

INTRODUCTION

The onset of the COVID-19 pandemic brought about global uncertainties and fears, escalating the dissemination of fake news. This study aims to analyze the impact of fake news on COVID-19 vaccine adherence among pregnant women, providing crucial insights for effective communication strategies during the pandemic.

METHODS

A cross-sectional, exploratory study was conducted with 113 pregnant women under care at a Women's Health Reference Center. Data analysis included relative frequency and odds ratio to assess the relationship between sociodemographic and behavioral variables regarding vaccination.

RESULTS

In the behavioral context of vaccination, internet access shows a significant association with decision-making, influencing vaccine refusal due to online information. Nuances in the odds ratios results highlight the complexity of vaccine hesitancy, emphasizing the importance of information quality. Pre-vaccination sentiments include stress (87.61%), fear (50.44%), and anxiety (40.7%), indicating the need for sensitive communication strategies.

DISCUSSION

Results revealed that pregnant women with higher education tend to adhere more to vaccination. Exposure to news about vaccine inefficacy had a subtle association with hesitancy, while finding secure sources was negatively associated with hesitancy. The behavioral complexity in the relationship between online information access and vaccination decision underscores the need for effective communication strategies.

CONCLUSIONS

In the face of this challenging scenario, proactive strategies, such as developing specific campaigns for pregnant women, are essential. These should provide clear information, debunk myths, and address doubts. A user-centered approach, understanding their needs, is crucial. Furthermore, ensuring information quality and promoting secure sources are fundamental measures to strengthen trust in vaccination and enhance long-term public health.

COVID-19 Vaccine Motivation and Hesitancy among a Sample of African American, Afro-Caribbean, and African Respondents in the United States

Understanding the motivations and decisions behind COVID-19 vaccine acceptance is crucial for designing targeted public health interventions to address vaccine hesitancy. We conducted a qualitative analysis to explore COVID-19 vaccine acceptance among diverse ethnic subgroups of Black Americans in the United States. This study investigates the 2021-2022 responses of 79 African American, Afro-Caribbean, and African respondents over the age of 18 in Washington State and Texas. Respondents were asked "Do you plan to get the COVID-19 vaccination?" Qualitative responses were analyzed by content category and ethnic subgroup. Of the 79 responses, 60 expressed favorable perceptions, 16 expressed unfavorable perceptions, and 3 expressed neutral perceptions. Dominant categories among participants in favor of the vaccine included personal health (26), concern for health of family/or community members (13), and desire to protect others (11). Among the 42 vaccinated African American respondents, the primary motivation was personal health (20). The 12 unvaccinated African American respondents cited fear of side effects as their dominate motivation. Caribbean respondents cited family or elders as motivation for their decision. African respondents were nearly unanimous in taking the vaccine (13/16), citing trust in health care, protecting friends and family, and personal health as reasons. Community and personal relationships were critical decision-making factors in accepting the COVID-19 vaccine, with African Americans having the strongest hesitancy.

"It's not that I don't trust vaccines, I just don't think I need them": Perspectives on COVID-19 vaccination

In Quebec (Canada), the roll-out of the vaccination started slowly in December 2020 due to limited vaccine supply. While the first and second doses were well-accepted among adults and vaccine uptake was above 90%, in late 2021 and 2022, vaccine acceptance decreased for children vaccination and receipt of a 3rd or a 4th dose. In the autumn of 2022, four focus groups were conducted with vaccine-hesitant parents of children aged 0-4 and adults who expressed little intention to receive a booster dose. The objective of this study was to gather participants' perspectives on vaccination in general, on the COVID-19 vaccination campaign and the information available, and to gain insights into the underlying reasons for their low intention of either having their child(ren) vaccinated, or receiving an additional dose of vaccine. A total of 35 participants took part in the focus groups. While participants expressed a certain level of trust and confidence in public health and government authorities regarding pandemic management and the vaccination campaign, they were also concerned that transparent information was lacking to support an informed decision on booster doses and children's vaccination. Many participants felt adequately protected against the infection during the focus groups, citing a lack of perceived benefits as the primary reason for refusing a booster dose. Parents who refused to administer the COVID-19 vaccine to their young children felt that the vaccine was not useful for children and were concerned about potential side effects. The majority reported that their opinions regarding other recommended vaccines had not changed since the beginning of the pandemic. While these results are reassuring, our findings highlight the importance of transparency in public health communications about vaccines to increase confidence and to develop strategies to address vaccine fatigue and complacency toward COVID-19 vaccines.

Determination of COVID-19 Late Disorders as Possible Long-COVID and/or Vaccination Consequences

In this era in which the vast majority of the global population have developed COVID-19 infection and/or got vaccinated against it, identification of the late disorders as the vaccines' side effect or long-COVID manifestation seems essential. This study included the vaccinated individuals of 4 different vaccine regimens including inactivated virus-based, subunit protein, and adenovirus-based vaccines in a follow-up schedule 6-month post the booster shot. All the documented vaccine adverse events were thoroughly assessed considering the cases' medical history by Adverse Events Committee of Pasteur Institute of Iran. Totally 329 individuals who got 3 doses of vaccination were followed 6 months after the booster shots among whom 41 (12.4%) cases with the mean age of 40.9 ± 10.48 years had a type of disorder. Gynecological and osteoarticular involvements were the most common recorded disorders of which 73.1% were possibly linked to vaccination outcomes and the rest were affected by both long-COVID-19 and vaccination. Notably, the average time of symptoms persistence was 155 ± 10.4 days. This study has the advantage of long-term follow-up which presents various forms of late events in each episode of COVID-19 infection and vaccination. About 26.8% of people with persistent complications suffered from both long-COVOD/ vaccination in whom the differentiation between the vaccine side effect and long-COVID manifestation was quite challenging. Long-term follow-up studies in large population seems essential to outline the role of long-COVID and vaccination regarding persistent complications.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy

Background

Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML.

Methods

A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs).

Results

The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine.

Conclusions

According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy

Introduction

Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy.

Methods

This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures.

Results

In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures.

Discussion

Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.