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Across nationwide rollout of COVID-19 vaccination, people in Belgium differed widely in their vaccination intention. In the present study, we examined (a) how people's vaccination intentions changed during the vaccination rollout and (b) whether changes in motivation (i.e., autonomous, controlled, and distrust-based (a)motivation) predicted changes in vaccination intention, thereby taking into account people's vaccination intention at baseline. Method: Using 4 subsamples of participants who were vaccinated at different time points (ntotal = 10,799) between December 2020 and June 2021; we used latent change modeling and latent growth curve modeling to examine the associations among initial levels and changes in vaccination motivation and vaccination intention. Results: Across subsamples, changes in vaccination intention were found to be qualified by changes in motivation. An increase in autonomous motivation was related to a positive shift in vaccination intention, while an increase in both controlled motivation and distrust-based amotivation was related to a negative shift in vaccination intention. Moreover, autonomous motivation predicted especially an increase in vaccination intention among those initially low in vaccination intention, whereas an increase in either controlled motivation or distrust-based amotivation especially predicted a decrease in vaccination intention among those initially high in vaccination intention. Conclusions: Findings suggest that a growing sense of ownership and a reduction in distrust is critical for individuals to develop a stronger intention to get vaccinated, particularly when people had initially low vaccination intentions. We discuss conceptual, methodological, and practical implications. [ABSTRACT FROM AUTHOR]

This study aims to investigated COVID‐19 vaccine acceptance among people with chronic diseases and the factors correlating with their vaccination hesitancy. The articles were searched in PubMed, Ovid, EMBASE, and web of science databases between December 2019 and October 2022. Cross‐sectional studies, including the acceptance of the COVID‐19 vaccine by patients with chronic diseases (≥18 years old), were included in this study. The outcomes included the proportion and 95% confidence interval (95% CI) of chronic disease patients willing to be vaccinated and the odds ratio (OR) and 95% CI of correlating factors. The source of heterogeneity was analyzed through meta‐regression and subgroup analysis. We included 31 studies involving 57 875 patients with chronic disease. The overall COVID‐19 vaccine acceptance among patients with chronic disease was 0.65 (95% CI, 0.59–0.72). The acceptance among the elderly patients was 0.53 (95% CI, 0.26–0.80). South America had the highest COVID‐19 vaccine acceptance rate and Asia the lowest, while on a country level, the United Kingdom had the highest acceptance rate among patients with chronic diseases. People with rheumatic immune diseases had the lowest rate of COVID‐19 vaccine acceptance. Concerns about vaccine safety had a statistically different effect on acceptance. Overall, the health systems ought to focus on educating specific groups of individuals on the benefits of COVID‐19 vaccination and addressing safety concerns. [ABSTRACT FROM AUTHOR]

Vaccination is the most cost-effective action in preventing infectious diseases. Despite Iran's success in high vaccination coverage, in some areas there is a delay in vaccination. The aim of this study was to determine and compare the effect of education on immunization via lecture and film upon parental delay in vaccination uptake for children under 12 months of age. A multicentre cluster-randomized clinical trial with comprehensive urban health centres (CUHCs) in Shooshtar city, Khuzestan province, Iran as the unit of randomization was conducted. Overall, 8 CUHCs were randomized to receive education either via film (n = 165) or lecture (n = 164). In order to assign CUHCs to two groups, a simple random sampling method of coin tossing was used. Parents with children under 12 months and with a history of delayed vaccination were included in the study. Consecutive sampling was performed until the number needed for the cluster was reached. Interventions were delivered in small groups of 5–8 participants. Demographical data and clinical histories were collected from parents directly via a personal characteristic's questionnaire. Clinical data was extracted from vaccination records, the child's vaccine card and the vaccine information registration system. Statistical analyses of intervention effects were performed as per-protocol analysis. In terms of individual characteristics and vaccine information significant differences between the two groups were only observed in relation to the parent of the participant, the child's gender, the number of children in the family, and timely injection of the vaccine in the previous child (p < 0.05). The chance of delay in vaccination after the intervention, without and considering the effect of intervening variables was 78 % and 74 % higher in the lecture group than in the film group, respectively (OR = 1.786, CI = 1.152–2.774 vs AOR = 1.743, CI = 1.011–3.007). Overall, 37.6 % of children in the film-based education group and 51.8 % of children in the lecture-based education group received their next vaccine with a delay of more than 7 days. Education delivered via film can reduce the delay in vaccination more effectively. These findings, along with those of other studies conducted around the world suggest that multimedia education should be considered more widely in the field of education in children's vaccination. [ABSTRACT FROM AUTHOR]

This study examined the impact of health anxiety and emotional reasoning on COVID-19 vaccine hesitancy and preventative behaviors, hypothesizing that high anxiety and emotional reasoning would predict lower vaccine hesitancy and higher COVID-19 preventative health behavior after controlling for demographic variables. A large international non-probability convenience sample of 532 individuals consented to an online survey in a cross-sectional period from March through August 2021 (one month following availability of vaccinations in the USA). Participants completed questionnaires online. Findings revealed that health anxiety and general anxiety were significantly correlated with COVID-19 preventative behaviors, including mask wearing and social distancing, and emotional reasoning. General anxiety and emotional reasoning significantly predicted vaccine hesitancy. Results suggest that addressing anxiety and emotional reasoning in public health campaigns may foster compliance with Centers for Disease Control and Prevention (CDC) vaccination recommendations. [ABSTRACT FROM AUTHOR]

Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020-2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people's trust in vaccines during the pandemic and mass vaccinations. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to describe and critically evaluate the COVID-19 vaccination program for high-risk children in Curacao and provide information about important factors such as parents' vaccination hesitancy and effective strategies for communicating and delivering information about vaccination. Methods. This was a cross-sectional study. It was important to identify children aged 12--17 years who were at high risk of severe COVID-19 infection because of the limited medical facilities on the island; children considered to be at high risk were those with diseases such as obesity, hypertension or diabetes mellitus type 2. These children or their caregivers were invited by their pediatricians to be vaccinated as part of a program run by the Public Health Department of Curacao. These high-risk patients were vaccinated between 30 May 2021 and 25 February 2022 in designated child-friendly spaces, with a pediatrician present for guidance and reassurance. Children received the Pfizer-BioNTech COVID-19 vaccine at the recommended dose for their age. The primary outcome was a description and evaluation of the attendance for vaccination. The secondary outcomes were side effects after vaccination for the age groups 12--15 years and 16--17 years. Reasons for refusal or nonadherence were also registered. Results. Altogether 51% (24/47) of those aged 16--17 years who were invited were vaccinated compared with 42% (26/69) of those aged 12--15 years who were invited. Altogether, 46% of these high-risk children were vaccinated compared with 48% of children aged 12--17 years without risk factors. In our population, most patients did not experience any side effects and if they did, the side effects were mild. No cases of myocarditis or pericarditis were observed. A lack of trust in the vaccine and a lack of prioritization of vaccination when scheduling daily activities were important factors in refusal and nonadherence. Conclusions. To organize a successful vaccination program in a small community with limited resources for treating high-risk children it is crucial for medical professionals to provide reliable information. Public health initiatives should focus on assuaging parents' fears about vaccines. In addition, ensuring there is good cooperation between doctors and the Public Health Department can help to make implementation successful. Finally, involving pediatricians and using dedicated areas for vaccinating children can help build trust with parents and caregivers. [ABSTRACT FROM AUTHOR]

Background: Despite the government's and development partners' unmatched efforts to ensure that every eligible person receives vaccinations, there have been concerns about vaccine fear, government mistrust, vaccine hesitancy and rejection expressed by the public, as well as various conspiracy theories involving the COVID-19 vaccines. This study assessed the public beliefs and willingness to accept COVID-19 vaccines and related factors among residents of Ondo State, Nigeria. Methods: Using a convenience sample technique, a cross-sectional survey of the adult population was carried out in the months of February and March of 2022. Factors influencing beliefs and willingness to accept COVID-19 vaccines were found by using univariate and multivariate statistical analysis. Results: 306 out of 323 respondents completed the survey and were included in the final analysis. The respondents mean age was 28.16 ± 16.2 years. Although n = 223, 72.9% of respondents reported to have received at least one dose of COVID-19 vaccines, (n = 205) 67.0% believed COVID-19 vaccines to be effective. Among the individuals who had not yet had any COVID-19 vaccinations, 2.6% (n = 8) of respondents were willing to accept the vaccines, whereas 14.1% (n = 43) were unwilling. Respondents' beliefs about the efficacy of COVID-19 vaccines were influenced by their gender, occupation, religion and educational attainment (p < 0.005). Conclusion: The study revealed a good level of positive beliefs about the vaccine, which was mirrored in vaccination history. However, those who had not yet received the vaccine were unwilling to do so, opening the door for more aggressive risk communication to be able to alter the course of events. In addition to addressing additional COVID-19 vaccination myths, we advise policy-makers to develop communication strategies that emphasise the safety of the COVID-19 vaccine. It is advised that all relevant stakeholders be included in government COVID-19 vaccination programmes by sharing timely, transparent information that fosters accountability. [ABSTRACT FROM AUTHOR]

The current study aimed to explore Palestinian university students' perceptions and concerns about COVID-19 vaccination hesitancy. Our sample comprised 50 university students selected using snowball sampling techniques from Palestinian universities in the West Bank, Palestine. Thematic content analysis was conducted to identify the main themes of semi-structured interviews with students. The results of the thematic content analysis yielded four main themes: Students' perceptions and concerns on COVID-19 vaccinations, perceived risks of vaccination, experiences related to vaccination, and causes of vaccination hesitancy. Participants expressed concerns and doubts about the vaccine's safety, showing high hesitancy and scepticism; they also reported different causes for COVID-19 vaccination hesitancy in the Palestinian context, such as the lack of confidence in vaccines, false beliefs about vaccines, and peculiar political instability and conflict of the Palestinian territories enduring a military occupation undermining the health system's capacity to respond to the COVID-19 outbreak appropriately. Health authorities and policymakers are urgently called to invest in and potentiate awareness campaigns to change the diffuse people's stereotypes related to the COVID-19 vaccine in the Palestinian territories. [ABSTRACT FROM AUTHOR]

The development of COVID-19 vaccines is a major scientific accomplishment that has armed communities worldwide with powerful epidemic control tools. Yet, COVID-19 vaccination efforts in the US have been marred by persistent vaccine hesitancy. We used survey methodology to explore the impact of different cognitive and cultural factors on the public's general vaccination attitudes, attitudes towards COVID-19 vaccines, and COVID-19 vaccination status. The factors include information literacy, science literacy, attitudes towards science, interpersonal trust, public health trust, political ideology, and religiosity. The analysis suggests that attitudes towards vaccination are influenced by a multitude of factors that operate in a complex manner. General vaccination attitude was most affected by attitudes towards science and public health trust and to a lesser degree by information literacy, science literacy, and religiosity. Attitudes towards COVID-19 vaccines were most affected by public health trust and to a lesser extent by general trust, ideology and attitudes towards science. Vaccination status was most influenced by public health trust. Possible mediating effects of correlated variables in the model need to be further explored. The study underscores the importance of understanding the relationship between public health trust, literacies, and sociocultural factors. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand barriers and enabling conditions for HPV vaccination in school-based vaccination programs in Canada. Semi-structured interviews were conducted by telephone or in person with parents, nurses, and school staff (n = 50) in three Canadian provinces. Interviews explored views on HPV and HPV vaccination, strengths and weaknesses of the school-based HPV vaccination programs and proposed interventions to increase uptake. Interview transcripts were coded and analyzed thematically using the socio-ecological model. Participants had positive views towards HPV vaccination and school-based offer. They identified barriers and enabling conditions at the individual and interpersonal level (e.g., knowledge, attitudes, behaviours of – and relationships between – parents, nurses, and school personnel), at the organizational level (e.g., allocated resources, information provision, process to ensure informed consent, vaccination setting and environment) and at the community and policy level (e.g., social group values and norms, media coverage around the HPV vaccine). Participants also suggested strategies to reduce identified barriers (e.g., communication interventions, simpler inform consent process). Different layers of barriers and enabling conditions of HPV vaccination in school settings were identified. Tailored interventions remain key to enhance vaccine acceptance and uptake. • Different barriers and facilitators of HPV vaccination in school settings were identified by using the socio-ecological model. • Strategies to improve HPV vaccination include communication interventions and simplification of the information and consent process. • Enhanced collaboration between public health nurses and school personnel are key in achieving greater vaccine acceptance and uptake. [ABSTRACT FROM AUTHOR]

A number of minority ethnic groups (MEGs) exhibited persistent reluctance to receive the COVID-19 vaccine. This paper attempts to empirically identify and validate some of the contentious behavioral determinants for vaccine hesitancy (VH) that remain unexplained including the role of risk perceptions, trust in government institutions, and prior experiences of racism and trauma. We draw on unique longitudinal data from a minority-boosted sample that was collected in the United Kingdon (UK). We document robust evidence of MEG disparities in VH, which declined between November 2020 and March 2021. While VH is associated to both historical and current distrust in government, risk beliefs, exposure to racism, and an individuals socio-economic background, these factors do not fully explain MEG disparities. Furthermore, similar patterns of inequality are observed when we examine MEG disparities in healthcare use, suggesting that disparities in VH reflect broader unobservable structural barriers to healthcare access. • COVID-19 vaccine hesitancy is higher among some minority ethnic groups (MEGs). • Factors like trust in government, inaccurate risk perceptions, and experiences of racism are examined. • Data was collected in the UK from a minority-boosted sample between November 2020 and March 2021. • Distrust, risk beliefs, racism, and socio-economic factors do not fully explain the disparities among MEGs. • Similar healthcare inequalities suggest that structural barriers limit access to healthcare for these groups. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is a concerning public health issue, further amplified during the COVID-19 pandemic. Social media is an important player in this context, promoting the dissemination of both information and misinformation. Qualitative studies analyzing the meaning of social media contents in correlation with epidemiological data are scarce, and could aid our understanding of social media's impact on vaccine hesitancy. In this study, we identified open-ended responses on reasons to refuse the COVID-19 vaccine collected in an epidemiologic study, and analyzed meaning relations with Twitter posts according to theme categories using a qualitative approach. Among responses to open-ended questions on motivations for refusing the COVID-19 vaccine, we identified and analyzed five theme categories: 1. individuality; 2. fear of adverse events/distrust in vaccine safety; 3. political ideologies/aversion to recommendations issued by the State; 4. skepticism about vaccine efficacy; and 5. refusal of non-natural products or interventions. We observed a close correspondence between open-ended responses in the epidemiological study and Twitter posts in all 5 theme categories. The highest outreach of Twitter posts was observed for those in the "individuality" and "fear of adverse the events/distrust in vaccine safety" theme categories. Our study suggests that social media interactions can perpetuate misinformation and hesitant attitudes about vaccines. Social media algorithms can intensify ideologic isolation, and strategies to promote the dissemination of tailored health information among social media users should be implemented to promote an overall understanding of health, particularly those concerning the collective wellbeing. [ABSTRACT FROM AUTHOR]

To analyze COVID-19 vaccine uptake in children and to investigate factors associated with two outcomes variables: (a) not even beginning; (b) not completing the COVID-19 vaccine series. We used data of children aged 6–7 years from the 2015 Pelotas c Birth Cohort Study. COVID-19 vaccination status was collected from immunization cards and National Immunization Program Information System. Adjusted analyses were performed using a hierarchical model to identify factors associated with the two study outcomes. Among 3867 children, 20.7 % (95 % CI, 19.5 %–22.0 %) did not even begin the 2-dose primary COVID-19 vaccine series, and 28.2 % (95 % CI, 26.6 %–29.8 %) did not complete the series with the second dose. Children not even beginning the COVID-19 vaccine series were more likely to have a White mother, not to have obesity, to have a history of COVID-19 infection, to have received non-recommended drugs for COVID-19, to be afraid of needles, and to have an incomplete diphtheria-tetanus-pertussis (DTP) and poliovirus immunization schedule. Not completing the 2-dose series was associated with lower maternal age and education, mother's self-identification as White or Brown, lower household income, lack of access to health services, not having completed the DTP and poliovirus immunization schedule and living with a person with a history of infection with COVID-19. The results highlight a vaccine-hesitant parents' group who chose not beginning the COVID-19 vaccine series of their children and, another group of parents who failure to complete the child's series due to difficulty accessing health services. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) poses a significant burden on public health, causing lower respiratory tract infections in infants, young children, older adults, and immunocompromised individuals. Recent development and licensure of effective RSV vaccines provide a promising approach to lessening the associated morbidity and mortality of severe infections. This narrative review aims to empower clinicians with the necessary knowledge to make informed decisions regarding RSV vaccination, focusing on the prevention and control of RSV infections, especially among vulnerable populations. The paper explores the available RSV vaccines and existing evidence regarding their efficacy and safety in diverse populations. Synthesizing this information for clinicians can help the latter understand the benefits and considerations associated with RSV vaccination, contributing to improved patient care and public health outcomes.

The present research aimed at understanding individuals’ vaccination intentions and protective behaviours against COVID-19 through two different studies. In Study 1 (N = 213, 73% women; mean age = 24.03) the Protection Motivation Theory model was tested considering the fear of COVID-19 as a possible mediator between threat appraisal (in terms of both health and social life) and intentions to get vaccinated when the vaccination was not yet available. Study 2 (N = 1111, 68.9% women; mean age = 38.33) was conducted when the vaccine became available for the entire population. Through this study, by adopting the 5C model of vaccine hesitancy as a theoretical framework, we aimed to understand how people who got vaccinated and the ones who did not differed, considering fear of vaccination, personality and vaccination hesitancy. In Study 1, social limitations, perceived severity and COVID-19 perceived vulnerability were significantly and positively related to fear of COVID-19. Contrary to what we expected, fear of COVID-19 was not a significant predictor of vaccination intention, which was predicted by both response efficacy and self-efficacy. In Study 2, in line with previous studies, vaccine hesitancy was negatively related to vaccination. More specifically, the social-oriented dimension of collective responsibility was the strongest predictor of effective behaviour. Our findings provide insights into the complexity of vaccine acceptance and emphasise the need for targeted interventions to promote vaccination and mitigate the spread of infectious diseases.

Many studies identified factors associated with vaccination intention and hesitancy, but factors associated with vaccination promptness and the effect of vaccination intention on vaccination promptness are unknown. This study identified factors associated with COVID-19 vaccination promptness and evaluated the role of vaccination intention on vaccination promptness in 1223 participants in a community-based longitudinal cohort study (June 2020 to December 2021). Participants answered questions regarding COVID-19 vaccination intention, vaccination status, and reasons for not receiving a vaccine. The association of baseline vaccine hesitancy with vaccination was assessed by the Kaplan–Meier survival analysis. Follow-up analyses tested the importance of other variables predicting vaccination using the Cox proportional hazards model. Older age was associated with shorter time to vaccination (HR = 1.76 [1.37–2.25] 85-year-old versus 65-year-old). Lower education levels (HR = 0.80 [0.69–0.92]), household incomes (HR = 0.84 [0.72–0.98]), and baseline vaccination intention of ‘No’ (HR = 0.16 [0.11–0.23]) were associated with longer times to vaccination. The most common reasons for not being vaccinated (N = 58) were vaccine safety concerns (n = 33), side effects (n = 28), and vaccine effectiveness (n = 25). Vaccination campaigns that target populations prone to hesitancy and address vaccine safety and effectiveness could be helpful in future vaccination rollouts.

Objectives: This study aims to assess the health care provider (HCP) perception and knowledge about vaccination and to determine the presence of hesitancy toward it. Methods: An observational study on HCPs was conducted in King Abdullah Specialized Children’s Hospital (KASCH), Saudi Arabia using a questionnaire. The HCPs were categorized as physicians, nurses, and allied health care specialists with total participants of 344. Results: 24% expressed disagreement with the vaccination schedule required by the Saudi Ministry of Health and 17% expressed reluctance in recommending or receiving vaccines in general. There was an apparent reluctance toward the influenza vaccination among allied health care specialists compared to nurses and physicians (42.5% vs 6% vs 11.8% respectively, p =

Background: The acceptance and availability of effective vaccines are crucial for the success of vaccination programs. Medical doctors and students are the epitome of shaping the public interest in vaccines. Aim: To evaluate the general public's attitudes, including dental students and health care professionals, at the national level towards COVID-19 vaccines and explore the potential drivers for students' acceptance levels. Methods: A national-level cross-sectional study was carried out in May-June 2021 using an online questionnaire. The sample was categorized based on age, gender, academic level, and location. The dependent variable was the willingness to take the COVID-19 vaccine. The independent variables included demographic characteristics, COVID-19-related experience, and the drivers of the COVID-19 vaccine-related attitude suggested by the WHO SAGE. Results: The number of people who answered the questionnaire was 1271. The males accounted for 38.9%, and females were 61.1%. The age group, 18-45 years with 14.7%, has the highest percentage of people who have not taken vaccination. In context to gender, 13.5% of males and 13.1% of females have not taken vaccination. The percentage of vaccination hesitancy is highest in rural areas with 19.5%. The health care professionals were vaccinated with the highest percentage of 89.8%. Conclusion: The vaccination acceptance level of the population for COVID-19 vaccines was good, approximately 63%, and their worrisome level of vaccine hesitancy 27% was governed by demographic, social, and economic factors. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were major hurdles to vaccination.

Background: The COVID-19 pandemic has burdened disastrous mortality and morbidity rates in society all over the world. While vaccination is one of the most effective immunization methods to control infectious diseases globally, some have avoided receiving the vaccine. We have aimed to investigate the reasons behind the hesitancy of vaccination among healthcare workers. Method: We performed ten semi-structured interviews with volunteered healthcare workers of Rasoul Akram hospital. Then each interview was anonymized, and Braun and Clarke's thematic analysis method was used to analyze the interviews. Results: Our data analysis revealed thirty-eight different codes as reasons for vaccination hesitancy among our interviewees.All these thirty-eight codes were grouped into ten sub-themes, and these sub-themes were further grouped into our four main themes:1. Fear of side effects, 2. Distrust, 3. Inefficiency, and 4. Non-necessity.Fear of side effects was the most frequent reason that interviewees mentioned. Also, Half of the interviewees mentioned distrust as a reason for COVID-19 vaccine hesitancy.At least once, all interviewees mentioned that they believed vaccination is inefficient.Some interviewees had beliefs and reasons that made them assume vaccination is simply not necessary. Conclusion: Fear of side effects, distrust, inefficiency, and non-necessity were the reasons that our participants refused to get vaccinated. Fear of side effects and distrust were the most common reasons that led to non-vaccination.

Resumen: Objetivo: Confeccionar y validar una encuesta dirigida a profesionales de epidemiología para medir factores asociados a la reticencia vacunal. Método: La reticencia a la vacunación se refiere al retraso en la aceptación o el rechazo de la vacunación a pesar de la disponibilidad de ella. La OMS la incluyó entre las diez amenazas a la salud global en 2019. En este marco conceptual propuesto por la OMS, un comité de seis expertos de la Sociedad Española de Epidemiología (SEE) diseñó un cuestionario autoadministrado para estudiar los factores asociados a la reticencia a la vacunación en epidemiólogos/as. Este cuestionario fue aprobado por la Junta de la SEE y se envió on line a todos/as los/las socios/as en 2019. A partir de las respuestas obtenidas se validaron las siguientes características: validez aparente, interna, de constructo y de criterio, fiabilidad, curvas características de cada ítem y función de información por ítem y conjunta. Resultados: El cuestionario mostró dos componentes bien definidos: la percepción sobre las vacunas y la confianza en la transparencia de los datos sobre vacunas con altos grados de ajuste en todos los aspectos de la validación. Ambos componentes han demostrado que cuanto mayor es la reticencia a la vacunación, mejor informa el cuestionario sobre estos aspectos. Conclusiones: El estudio ha permitido elaborar un instrumento validado en español para medir los factores asociados a la reticencia vacunal entre los/las epidemiólogos/as. Abstract: Objective: To develop and validate a survey aimed at epidemiologists to measure factors associated with vaccine reluctance. Method: Vaccination hesitancy refers to delayed acceptance or refusal of vaccination despite the availability of vaccination services. WHO included vaccination hesitancy among the 10 global health threats in 2019. Within this conceptual framework proposed by WHO, a committee of six experts from the Spanish Society of Epidemiology (SEE) designed a self-administered questionnaire to study factors associated with vaccination hesitancy in epidemiologists. This questionnaire was approved by the SEE Board, and was sent online to all members in 2019. Based on the responses obtained, the following characteristics were validated: face validity, internal validity, construct validity, criterion validity, reliability, as well as the characteristic curves of each item and the information function per item and overall. Results: The final questionnaire showed two well-defined components, perception of vaccines and confidence in the transparency of vaccine data with high degrees of fit in all aspects of validation. Both components have shown that the higher the reluctance to vaccinate the better the questionnaire reports on these aspects. Conclusions: The study has allowed the development of a validated instrument in Spanish to measure the factors associated with vaccine reluctance among epidemiologists.

IntroductionVaccine distrust and rejection are thought to contribute to disease outbreaks and increased mortality. The present study aimed to analyze the socio-cultural characteristics and attitudes of the Saudi population toward vaccines, using a cross-sectional survey-based approach.MethodsAn online questionnaire was used, following the snowball method. A total of 444 people responded, of whom 333 (75%) were female, and 111 (25%) were male.ResultsThe demographic characteristics associated with vaccine confidence were gender, job type, medical problems, and knowledge of coronavirus disease 2019 (COVID-19) symptoms. The hesitancy was highest (31.17%) among individuals aged 21–30 years old, and in more males (27.03%) expressed hesitancy than females (25.23%). However, if we focused on the percentage of the refusal to receive the vaccine, more females (15.23%) refused the vaccine than males (4.5%). More than one-third of the vaccine-hesitant respondents had limited knowledge of COVID-19 symptoms. Personal characteristics associated with vaccine confidence were described as the following: do not fully trust vaccines produced in a short time (42.1%), fear of the future results of the vaccine (30.4%), reluctance to allow a foreign material to enter the body (17.6%), no interaction with others, so no need for the vaccine (11.5%), low interaction with people (67.8%), and reluctance to make decisions (11.3%). The primary social motivation for getting the vaccine was to get back to normal life (67.6%).DiscussionThe results of the present study revealed that more than half of the respondents in Saudi Arabia were confident about the vaccine (61.7%), while only 25.7% were hesitant and 12.6% were unconvinced. Based on these results, in the early period of COVID-19 vaccine administration in the country (early 2021), before any governmental allowance and political intervention, we found that the socio-demographic and socio-cultural characteristics of the population were significant factors contributing to vaccination acceptance. Therefore, policymakers should support long-term safety studies of the vaccine, conduct educational programs giving high-priority to the populations' health, and tailor vaccination hesitancy reduction techniques to local communities.

IntroductionAlong with the challenges of COVID-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the affecting vaccine acceptance in the high and low points of the epidemic in Iran.MethodsIn the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1,200 and 1,872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine.ResultsDisbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3–85.9) and 65.8% (95% CI: 65.8–71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p = 0.001), being a student (Odds Ratio: 0.41, p = 0.011), housewives (Odds Ratio: 0.63, p = 0.033), illiteracy (Odds Ratio: 4.44, p = 0.001), and having an underlying disease (Odds Ratio: 4.44, p = 0.001) were factors affecting on vaccine acceptance.DiscussionCounter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended.

Limited data on vaccination during pregnancy and breastfeeding can be difficult to access for these women, which then turns to the Internet. The purpose was to determine and then answer these questions, to create referenced summary sheets which would facilitate access to information during a general practice consultation. A non-participant netnography allowed a thematic analysis of the comments, in public access of the main French internet health forums, to generate standardized and referenced summary sheets by narrative review of the literature. Out of 14,941 messages extracted, 543 messages were included between January 2009 and March 2022. The five main vaccine-preventable diseases mentioned are: influenza, Covid-19, whooping cough, yellow fever, and Measles-Mumps-Rubella. Topics covered are similar between vaccines, and correspond to vaccination in practice, health communication and perceptions as well as contextual influences. The main questions concern the benefit/risk balance, the adjuvants, the indications, the transplacental and human milk passage, as well as the conferred passive immunity. Personal conceptions (naturalness, alternative medicine) and contextual influences (pharmaceutical lobbying, politics, and media) generate doubts about vaccine safety and efficiency. The contribution of independent, reliable scientific data, adapted for the transmission of consensual information by health professionals is necessary, in a context where the improvement of childhood immunization requires pregnant and breastfeeding women's vaccination. [ABSTRACT FROM AUTHOR]

The rapidly evolving COVID-19 pandemic has resulted in an upsurge of scientific productivity to help address the global health crisis. One area of active research is the impact of COVID-19 on pregnancy. Here, we provide an epidemiological overview about what is known about the effects of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes, and identify gaps in knowledge. Pregnant people are at increased risk for severe COVID-19, and maternal SARS-CoV-2 infection increases the risk of negative maternal-fetal outcomes. Despite this elevated risk, there have been high rates of vaccine hesitancy, heightened by the initial lack of safety and efficacy data for COVID-19 vaccination in pregnancy. In response, retrospective cohort studies were performed to examine the impact of COVID-19 vaccination during pregnancy. Here, we report the vaccine's efficacy during pregnancy and its impact on maternal-fetal outcomes, as well as an overview of initial studies on booster shots in pregnancy. We found that pregnant people are at risk for more severe COVID-19 outcomes, maternal SARS-CoV-2 infection is associated with worse birth outcomes, COVID-19 vaccine hesitancy remains prevalent in the pregnant population, and COVID-19 vaccination and boosters promote better maternal-fetal outcomes. The results should help reduce vaccine hesitancy by alleviating concerns about the safety and efficacy of administering the COVID-19 vaccine during pregnancy. Overall, this review provides an introduction to COVID-19 during pregnancy. It is expected to help consolidate current knowledge, accelerate research of COVID-19 during pregnancy and inform clinical, policy, and research decisions regarding COVID-19 vaccination in pregnant people. • Pregnant people with COVID-19 are at increased risk for severe illness and death. • Maternal COVID-19 infection is associated with worse birth outcomes. • COVID-19 vaccination decreases risk of maternal infection. • COVID-19 vaccination has neutral to positive benefit on birth outcomes. • Boosters beyond 2 doses during pregnancy report neutral to positive benefit. [ABSTRACT FROM AUTHOR]

The ongoing monkeypox (MPX) outbreak has been declared a public health emergency of international concern. People in close contact with active MPX cases, including healthcare workers (HCWs), are at higher risk of virus acquisition since the MPX virus can be transmitted by skin contact or respiratory secretions. In this study, we aimed to assess the psychological antecedents of MPX vaccination among Nigerian HCWs using the 5C scale. We used an anonymous online cross-sectional survey to recruit potential participants using snowball sampling. The questionnaire aimed to assess the geo/socioeconomic features and the 5C psychological antecedents of vaccine acceptance (confidence, complacency, constraints, calculation, and collective responsibility). A total of 389 responses were included, with a median age of 37 years (IQR: 28–48), 55.5% males, and 60.7% married participants. Among the studied Nigerian HCWs, only 31.1% showed confidence in MPX vaccination, 58.4% expressed complacency towards vaccination, 63.8% perceived constraints towards MPX vaccination, 27.2% calculated the benefits and risks of vaccination, and 39.2% agreed to receive MPX vaccination to protect others. The determinants of MPX vaccine confidence were being single (OR = 5.07, 95% CI: 1.26–20.34, p = 0.022), a higher education level (with pre-college/high school as a reference, professional/technical: OR = 4.12, 95% CI: 1.57–10.73, p = 0.004, undergraduate: OR = 2.94, 95% CI: 1.32–6.55, p = 0.008, and postgraduate degree (OR = 3.48, 95% CI: 1.51–8.04, p = 0.003), and absence of chronic disease (OR = 2.57, 95% CI: 1.27–5.22, p = 0.009). The significant complacency predictors were having a middle-income (OR = 0.53, 95% CI: 0.33–0.89, p = 0.008), having a bachelor's degree (OR = 2.37, 95% CI: 1.10–5.11, p = 0.027), and knowledge of someone who died due to MPX (OR = 0.20, 95% CI: 0.05–0.93, p = 0.040). Income was associated with perceived vaccination constraints (OR = 0.62, 95% CI: 0.39–0.99, p = 0.046). Participants aged 46–60 years had decreased odds in the calculation domain (OR = 0.52, 95% CI: 0.27–0.98, p = 0.044). Middle-income and bachelor degree/postgraduate education significantly influenced the collective responsibility domain (OR = 2.10, 95% CI: 1.19–3.69, p = 0.010; OR = 4.17, 95% CI: 1.85–9.38, p < 0.001; and OR = 3.45, 95% CI: 1.50–7.90, p = 0.003, respectively). An investigation of the 5C pattern-based psychological antecedents of MPX vaccination in a sample of Nigerian HCWs revealed low levels of vaccine confidence and collective responsibility with high levels of constraints and complacency. These psychological factors are recommended to be considered in any efforts aiming to promote MPX vaccination needed in a country where MPX is endemic. [ABSTRACT FROM AUTHOR]

Background: The recent human monkeypox virus (HMPXV) outbreak in non-endemic countries that started in May 2022 has raised concerns among public health authorities worldwide. Healthcare workers (HCWs) play a decisive role during epidemics in transmitting accurate information to the public and motivating them to pursue protective behaviours, including immunisation. Methods: A cross-sectional survey-based study was conducted in the Czech Republic in September 2022 to evaluate HMPXV-related knowledge and vaccination perceptions among HCWs. The study utilised a digital self-administered questionnaire (SAQ) to collect data from the target population. The proposed SAQ inquired about participants' sociodemographic and anamnestic characteristics, perceived knowledge of HMPXV, factual knowledge, and vaccination perceptions according to the health belief model (HBM). Results: A total of 341 participants were included in this study; most of them were females (88.9%), allied HCWs (89.4%), heterosexuals (87.1%), married (61.9%), and vaccinated against COVID-19 (91.2%). Only 8.8% of the participants agreed to receive vaccination against HMPXV; 44.9% rejected it, while 46.3% were hesitant. While digital news portals (47.5%) and social media (25.8%) were among the most utilised sources of information about HMPXV, the scientific journals (5.6%), ECDC (5%), and the U.S. CDC (1.5%) were the least common sources. The participants demonstrated suboptimal levels of factual knowledge, especially regarding HMPXV vaccines (1.5 ± 1.2 (0–4)) and treatments (0.9 ± 0.9 (0–4)). Additionally, several misconceptions were detectable among the participants, regarding topics such as the availability of effective vaccines and antivirals against HMPXV, the risk of vertical transmission, and homosexual stigmatisation. The HBM indicated that the cues to action and perceived susceptibility were the most important constructs to predict HMPXV vaccine acceptance. Conclusions: the findings of this study call upon public health practitioners and health policymakers in the Czech Republic to act accordingly in order to determine the drivers of vaccine hesitancy among Czech HCWs. Dedicated educational campaigns should aim to counter the HCWs' misconceptions around HMPXV, and future studies should aim to explore the prevalence and drivers of HMPXV vaccine hesitancy among the general population. [ABSTRACT FROM AUTHOR]

Objectives: The current study aims to survey the willingness of parents to vaccinate their children, who are childhood acute lymphoblastic leukemia survivors (CALLS), and identify factors associated with vaccine acceptance. Methods: Parents of CALLS on/off treatment, with the general condition of being amendable to vaccination, were recruited for interviews with attending oncologists about COVID-19 vaccination acceptance from July to November 2021 in China. After controlling for socioeconomic factors, the Association of Oncologists' recommendations and parent–oncologist alliance with acceptance status were investigated. For validation, propensity score-matched (PSM) analysis was used. Results: A total of 424 families were included in the study, with CALLS mean remission age of 5.99 ± 3.40 years. Among them, 91 (21.4%) agreed, 168 (39.6%) hesitated, and 165 (38.9%) parents disagreed with the vaccination. The most common reason that kept parents from vaccinating their children was lack of recommendations from professional personnel (84/165, 50.9%), and massive amounts of internet information (78/175, 44.6%) was the main nonhealthcare resource against vaccination. Logistic regression analysis showed that only the recommendation from the oncologist was associated with parents' vaccine acceptance (OR = 3.17, 95% CI = 1.93–5.20), as demonstrated by PSM comparison (42 in recommendation group vs. 18 in nonrecommendation group among 114 pairs, p < 0.001). An exploratory analysis revealed that parents with a better patient–oncologist alliance had a significantly higher level of acceptance (65.6% in alliance group vs. 15.6% in nonalliance group among 32 pairs, p < 0.001). Conclusions: Due to a lack of professional recommendation resources and the potential for serious consequences, parents were generally reluctant to vaccinate their CALLS. The recommendation of oncologists, which was influenced by the parent–oncologist alliance, significantly increased acceptance. This study emphasizes the critical role of oncologists in vaccinating cancer survivors and can be used to promote COVID-19 vaccines among vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Vaccination against COVID-19 has had a major impact over the course of the pandemic, leading to a reduced number of hospitalizations and deaths. However, the mass vaccination process has been accompanied by skepticism and hesitancy since its beginning. As health professionals and teachers are important public health actors who can strongly intervene to reduce vaccination hesitancy among their patients and students, respectively, this study aimed to assess their main perceptions towards COVID-19 vaccination. Methods: Two focus group sessions, one with health professionals and the other with teachers, were conducted according to the COREQ checklist. Qualitative data were analyzed through theoretical thematic analysis. Results: In general, none of the groups showed vaccine hesitancy, although both groups had concerns regarding the safety and efficacy of the vaccines. The main concerns of health professionals were mostly related to the long-term impact of the COVID-19 pandemic, while teachers were more worried about the lack of access to reliable information about the COVID-19 vaccination. Conclusions: It is plausible to conclude that it is imperative to provide clear and accurate information for the population in order to avoid vaccination hesitancy. [ABSTRACT FROM AUTHOR]

Attitudes toward vaccination are doubtless an important determinant of public health, and this became evident after the first year of the last COVID-19 pandemic. The issue, long-debated within European societies, especially with respect to occasional surges of diseases in given years, has become a crucial determinant of the wellbeing of a country since 2021. In this study, using microdata from a 2019 Eurobarometer survey, we frame and deepen our knowledge about the main determinants of vaccination attitudes as observed by the related literature. We argue that a positive attitude toward vaccination may be due to individualistic or altruistic reasons, or various incentives; our analysis aims to improve our knowledge about the determinants of such a complex decision. Our findings, obtained by means of a quantitative analysis that employs Ordered Probit, Ordered Logit and Generalized Ordered Logit estimations, provide complete support for some of the theories that have been debated in the literature, limited support for others because of mixed evidence, and no support for some. [ABSTRACT FROM AUTHOR]

In the European Union, SARS-CoV-2 vaccines became available in December 2020. The vaccination campaign in Germany was initially implemented through mass vaccination centers and later joined by general practitioners (GPs) in spring 2021. This study compared population characteristics, perceived access barriers, and satisfaction with the vaccination procedure between vaccination centers and GP practices. A paper-based survey was distributed (07/2021–10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Participants in vaccine centers were younger compared to participants in GP practices. GP preference was higher in older participants and those with pre-existing illnesses. Wait time at vaccination site was longer in GP practices, whereas travel distance to site was longer for participants in vaccine centers. However, satisfaction with patient education and recommendation of site were more likely with increasing comprehensibility of the vaccination procedure and physicians' information as well as perceived sufficiency of patient education duration, factors that can be easily modified by all vaccination sites. Our results demonstrate that both types of vaccination sites complement each other in terms of accessibility and target population and that satisfaction with the vaccination procedure can be promoted at all sites by an easy-to-understand process. [ABSTRACT FROM AUTHOR]

• Misbeliefs about the safety of vaccination predict adult hesitancy to COVID vaccines. • The same beliefs predict hesitancy for vaccinating children ages 5–11 against COVID. • Misbeliefs about COVID vaccines correlate highly with general concerns about vaccination. • Misinformation about vaccination in general is a barrier to uptake of COVID vaccines. Despite increasing rates of vaccination for COVID-19 in the US, hesitancy continues to be a barrier to the full immunization of the eligible population. Hesitancy appears to be particularly pronounced among adults deciding whether to recommend that children be vaccinated against COVID-19. In this research, we tested whether embrace of misinformation about the safety of vaccination is associated with hesitancy to vaccinate oneself and to recommend vaccination of a 5–11-year-old child for COVID-19. In a national probability panel created in April 2021, we assessed belief in both general vaccination misinformation and misinformation about COVID-19 vaccines, in particular. As hypothesized, belief in general vaccination misinformation predicted the uptake in reported vaccination among adults through September 2021, and likelihood to recommend COVID-19 vaccination of children aged 5–11 in January 2022, three months after the approval of that vaccine. In addition, misinformation about COVID-19 vaccines that arose over time correlated highly with more general vaccination misinformation. For both outcomes, general vaccine misinformation predicted vaccination hesitancy beyond concerns about the health risks of contracting COVID-19 for one's family and children ages 5–11. The findings indicate that continued efforts are needed to bolster beliefs about the safety of authorized and approved vaccines of many types and not just those for COVID-19. Some strategies to achieve this objective are suggested. [ABSTRACT FROM AUTHOR]

Background: To promote an acceptance rate of COVID-19 immunization among Thai children, concerns about parental vaccination hesitancy should be urgently studied. This study aimed to examine the parental COVID-19 vaccination hesitancy (PVh) level and influencing factors among Thai parents of children 5–18 years of age. Methods: This cross-sectional survey was conducted in Thailand during May and June of 2022. The Google forms for data collection were distributed to parents (a father, a mother, or one who nurtures and raises a child) via various online social media. Data regarding PVh level, relevant attitudes, experiences of COVID-19 and COVID-19 vaccination (EC&V), and family contexts (FC) were collected and analyzed using descriptive statistics. Mann–Whitney U test was used to compare the differences among groups of parents based on EC&V and FC. The factors influencing PVh were assessed by multiple regression analysis. Results: Four hundred and eighty-eight parents completed the online questionnaire. Their median (IQR) age was 41 (35–47) years. They lived in different provinces from all regions across Thailand. Ninety percent of them were authorized persons to make decision about children vaccination. Fifty-eight percent of the respondents had vaccine hesitancy, defined as PVh level at moderate or above. Parents who had ever refused COVID-19 vaccination for themselves or refused to vaccinate their children against any other diseases had statistically significant higher levels of PVh (p value < 0.001). Conversely, the parents who had finished the initial COVID-19 vaccine had lower PVh levels with statistical significance (p value = 0.001). Attitude towards COVID-19 (AC), attitude towards COVID-19 vaccine (AV), and perceived behavioral control (PC) of the parents negatively influenced PVh with statistical significance, according to the results of the multiple regression analysis (Betas = − 0.307, − 0.123, and − 0.232, respectively). Conclusions: COVID-19 vaccination hesitancy was commonly found among Thai parents. The factors of the hesitancy were multifaceted. Different experiences regarding COVID-19 vaccination for themselves and any vaccinations for their children were associated with different PVhs. The attitudes especially AC, AV, and PC statistically influenced PVh. These findings should be exploited for national and local policy planning as well as public campaigns. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are at increased risk for severe COVID‐19 and are a priority group for vaccination. The discrepancy in vaccination rates between pregnant and non‐pregnant cohorts is concerning. Aims: This study aimed to assess the perceptions and intentions of pregnant women toward COVID‐19 vaccination and explored vaccine uptake and reasons for vaccine hesitancy. Materials and method: A cross‐sectional exploratory design was performed evaluating pregnant women receiving care in two metropolitan maternity units in Western Australia. The main measurable outcomes included vaccination status, intention to be vaccinated, and reasons for delaying or declining vaccination. Results: In total, 218 women participated. Of these, 122 (56%) had not received either dose of the COVID‐19 vaccine. Sixty (28%) claimed that vaccination was not discussed with them and 33 (15%) reported being dissuaded from vaccination by a healthcare practitioner. Compared to vaccinated women, those who had not accepted vaccination were less likely to have had vaccination discussed by maternity staff, less aware that pregnant women are a priority group, and less aware that pregnancy increased the risk of severe illness. Unvaccinated women were concerned about the side effects of the vaccine for their newborn and their own health, felt there was inadequate information on safety during pregnancy, and felt that a lack of community transmission in Western Australia reduced the necessity to be vaccinated. Conclusion: Vaccine delay and hesitancy is common among pregnant women in Western Australia. Education of healthcare professionals and pregnant women on the recommendation for COVID‐19 vaccination in pregnancy is required. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to conduct a national survey of individuals with spina bifida (SB) and their care partners to assess COVID-19 vaccination behaviors and vaccine uptake. METHODS: A survey instrument was designed to assess current vaccination status, general perceptions towards vaccinations, and barriers to vaccination within the SB community. Surveys were administered to individuals with SB or their representing care partner. Chi-squared and independent-samples t-tests were used to analyze the relationship between vaccine uptake and demographics. Multivariable logistic regression modeling was used to test which predictors impacted the odds that a participant received a COVID vaccine. RESULTS: A total of 1,412 participants completed the questionnaire, and 1,145 participants reported their COVID-19 vaccine status. The most common reason for not getting vaccinated was a concern about vaccine safety and efficacy. Overall, healthcare professional recommendations played a significant (OR 2.77 p < 0.001) role in whether to get vaccinated. CONCLUSION: About one in five individuals with SB have not received any COVID-19 vaccine. Actionable and modifiable factors were identified which may help increase vaccine uptake. Importantly, health providers play a critical role in COVID-19 vaccination messaging and should emphasize vaccine safety and efficacy. [ABSTRACT FROM AUTHOR]

The initial case of coronavirus disease 2019 (COVID-19) in India was reported on January 30, 2020, and subsequently, the number of COVID-19-infected patients surged during the first wave of April 2020 and the second wave in the same month of 2021. The government of India imposed a strict nationwide lockdown in April 2020 and extended it until May 2020. The second wave of COVID-19 in India overwhelmed the country's health facilities and exhausted its medical and paramedical workforce. This narrative review was conducted with the aim of summarizing the evidence drawn from policy documents of governmental and nongovernmental organizations, as well as capturing India's COVID-19 vaccination efforts. The findings from this review cover the Indian government's vaccination initiatives, which ranged from steps taken to combat vaccine hesitancy to vaccination roadmaps, deployment plans, the use of digital health technology, vaccination monitoring, adverse effects, and innovative strategies such as Har Ghar Dastak and Jan Bhagidari Andolan (people's participation). These efforts collectively culminated in the successful administration of more than 1.8 billion doses of COVID-19 vaccines in India. This review also provides insights into other countries' responses to COVID-19 and guidance for future pandemics. [ABSTRACT FROM AUTHOR]

Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach's coefficients α > 0.70; McDonald's ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study's conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions. [ABSTRACT FROM AUTHOR]

The active immunization of health care workers (HCWs) is a crucial measure to avoid nosocomial infection; nevertheless, vaccine coverage (VC) among health personnel in Italy is unsatisfactory. To improve VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Policlinico General University Hospital applied a specific program. The operative procedure demands that in the context of the occupational medical examination, all workers are evaluated for susceptibility to vaccine-preventable diseases (VDPs), with immunization prophylaxis offered to those determined to be susceptible. This study analyzed data from workers who attended the biological risk assessment protocol from December 2017 to October 2021 (n = 1477), who were evaluated for the immune status for measles, mumps, rubella, and varicella. Among the enrolled subjects, non-protective antibody titers were higher for measles and mumps (13%), followed by rubella (11%) and varicella (8%). Appropriate vaccinations were offered to all susceptible HCWs, and HCWs were re-tested one month after immunization. The seroconversion rate after the administration of one or more booster dose(s) was over 80%. Overall, 2.5% of the subjects refused the offered vaccine(s); the main determinant of immunization compliance was younger age (aOR = 0.86; 95%CI = 0.80–0.92). Especially during the COVID-19 pandemic, VPDs may still present a hazard in nosocomial environment. Our experience suggests that, despite hospital procedures and dedicated human assets, satisfactory VC cannot be reached without the provision of federal regulations. Nevertheless, public health policymakers have to improve the promotion of vaccine prophylaxis and education to reach higher VC. [ABSTRACT FROM AUTHOR]

Despite the availability of safe and effective COVID-19 vaccines, vaccine acceptance has been low, particularly among parents. More information is needed on parental decision-making. We conducted a prospective cohort study from October 2021 to March 2022 among 334 parents in a large urban/suburban pediatric primary care network and linked longitudinal survey responses about attitudes and beliefs on vaccination, social norms, and access to vaccination services for COVID-19 to electronic health-record-derived vaccination outcomes for their eldest age-eligible children in June 2022. The odds of accepting two doses of COVID-19 vaccine for their child was higher in respondents who indicated the COVID-19 vaccine would be very safe (aOR [CI]: 2.69 [1.47–4.99], p = 0.001), as well as those who previously vaccinated their child against influenza (aOR [CI]: 4.07 [2.08–8.12], p < 0.001). The odds of vaccinating their child were lower for respondents who attended suburban vs. urban practices (aOR [CI]: 0.38 [0.21–0.67], p = 0.001). Parents in the cohort were active users of social media; the majority (78%) used their phone to check social media platforms at least once per day. Our findings suggest that healthcare providers and policymakers can focus on improving vaccination coverage among children living in suburban neighborhoods through targeted mobile-based messaging emphasizing safety to their parents. [ABSTRACT FROM AUTHOR]

Maternal immunization (MI) is an emerging strategy to combat infant mortality in low-income (LIC) and lower-middle income countries (LMIC). We conducted a systematic review to identify the facilitators and barriers to MI and strategies that improve uptake in LICs and LMICs. We searched PubMed, Cochrane Library, and Scopus for quantitative, qualitative, and mixed-methods studies published in English from January 1, 2011, to October 31, 2021, from all LICs and LMICs. Data was appraised using the Mixed Methods Appraisal Tool. 55 studies were included. The major barriers were low knowledge and concern of vaccine safety among pregnant women and healthcare providers (HCP). HCP's recommendation, maternal knowledge, vaccine confidence and ≥4 antenatal care (ANC) visits facilitated uptake. The key strategies encompassed health financing, reminders, intersectoral coordination, integration, community engagement, capacity building, and education. Community-based delivery models were effective. Tailored programs are needed to improve ANC access, and educate pregnant women and HCPs.

The exchange of knowledge and best practices in adult immunization are essential to improve vaccination strategies across the European region. Italy has made groundbreaking progress in the field, being one of the first countries to propose a life-course vaccination schedule, broadening the traditional focus on childhood immunization to include adults. All vaccines included in Italy's vaccination schedule are free of charge. Moreover, the country's National Immunization Plan sets clear coverage targets, immunization priorities, and actions to reduce disparities. However, the fragmentation of its National Health System following the constitutional reform of 2001 has led to an increased complexity and regional inequalities regarding immunization. Other challenges the country faces include growing vaccine hesitancy, data gaps and underserved populations. This review describes Italy's adult immunization system, from policy to implementation. The successes, challenges and lessons learned were shared during the first Adult Immunization Board country meeting in Italy, where local experts, healthcare providers, public health representatives, and policymakers engaged in collaborative discussions and shared insights through case studies and presentations (December 2023). These insights are reviewed and discussed in this manuscript.

This study aimed to assess the level of knowledge regarding influenza viruses and vaccines among different professional groups to investigate the reasons for vaccine hesitancy. We collected 2190 questionnaires regarding influenza vaccines in China in 2022. The respondents were categorized into the general population (GP), foreign affairs workforce population (FAWP), and veterinary workforce population (VWP) according to their job positions. Linear regression was used to assess the association between multiple factors and influenza vaccination rates. The association between work and influenza vaccination rates was also assessed by grouping different workforce populations. The vaccination rate of the GP was higher than that of the VWP (odds ratio: 1.342, 95% confidence interval: 1.025-1.853), surpassing the rates reported in previous studies. This may be attributed to heightened concerns about infectious diseases influenced by the ongoing coronavirus disease 2019 pandemic. Despite the VWP's more in-depth knowledge of the VWP on zoonotic diseases and their recognition of their importance, there was no significant difference in influenza knowledge among the three populations. This discrepancy contrasts with the observed differences in vaccination rates. Further investigation revealed that, compared with FAWP, the price of vaccines emerged as a primary influencing factor for vaccination rates (odds ratio:0.398, 95%CI; 0.280-0.564). General concerns regarding the protective effects and side effects of vaccines were also noted.

The role of immunization in public health is crucial, offering widespread protection against infectious diseases and underpinning societal well-being. However, achieving optimal vaccination coverage is impeded by vaccine hesitancy, a significant challenge that necessitates comprehensive strategies to understand and mitigate its effects. We propose the integration of Population Health Management principles with Immunization Information Systems (IISs) to address vaccine hesitancy more effectively. Our approach leverages systematic health determinants analysis to identify at-risk populations and tailor interventions, thereby promoting vaccination coverage and public health responses. We call for the development of an enhanced version of the Italian National Vaccination Registry, which aims to facilitate real-time tracking of individuals' vaccination status while improving data accuracy and interoperability among healthcare systems. This registry is designed to overcome current barriers by ensuring robust data protection, addressing cultural and organizational challenges, and integrating behavioral insights to foster informed public health campaigns. Our proposal aligns with the Italian National Vaccination Prevention Plan 2023-2025 and emphasizes proactive, evidence-based strategies to increase vaccination uptake and contrast the spread of vaccine-preventable diseases. The ultimate goal is to establish a data-driven, ethically sound framework that enhances public health outcomes and addresses the complexities of vaccine hesitancy within the Italian context and beyond.

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1 st , 2022 (Phase I: univalent booster dose availability), and between November 21 st , 2022 and January 11 th , 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman ( n  = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time ( n  = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

During the COVID-19 pandemic, the vaccine hesitancy has significantly affected the vaccination. To evaluate the booster vaccine hesitancy and its influencing factors among urban and rural residents, as well as to estimate the net difference of booster vaccine hesitancy between urban and rural residents. We conducted a nationwide, cross-sectional Internet survey on 1-8 February 2023, and employed stratified random sampling technique to select participants (≥18 years old) from urban and rural areas. Multivariate logistic regression was used to determine the factors impacting booster vaccine hesitancy. Propensity Score Matching was used to estimate the net difference of COVID-19 booster vaccine hesitancy between urban and rural residents. The overall COVID-19 booster vaccine hesitancy rate of residents was 28.43%. The COVID-19 booster vaccine hesitancy rate among urban residents was found to be 34.70%, among rural residents was 20.25%. Chronic diseases, infection status, vaccination benefits, and trust in vaccine developers were associated with booster vaccine hesitancy among urban residents. Barriers of vaccination were associated with booster vaccine hesitancy among rural residents. PSM analysis showed that the urban residents have a higher booster vaccine hesitancy rate than rural residents, with a net difference of 6.20%. The vaccine hesitancy rate increased significantly, and the urban residents have a higher COVID-19 booster vaccine hesitancy than rural residents. It becomes crucial to enhance the dissemination of information regarding the advantages of vaccination and foster greater trust among urban residents toward the healthcare system.

Immunization programs worldwide have been facing challenges in keeping vaccination coverage high. Even though universally known for its robust National Immunization Program, Brazil has also faced significant challenges regarding vaccination coverage. One of the reasons for this is vaccine hesitancy, a complex, multi-causal, and context-specific phenomenon. This qualitative study aims to understand the factors associated with decision-making and the drivers of vaccine hesitancy in Florianopolis, Santa Catarina state capital, regarding caregivers' perceptions of routine childhood vaccination. In-depth interviews were conducted in the Capital city of Santa Catarina State. Families with children up to 6 years old were included. Data were analyzed based on thematic content analysis. Twenty-nine caregivers in 18 families were interviewed. These caregivers were mainly mothers and fathers. Three themes emerged: 1. Access to information and the decision-making process, where we discuss the role of social circles, healthcare workers, and the internet; 2. Individual-institutions power relationships: Perceptions about the State's role and the Health institutions: 3. Reasons and motivations: The senses and meanings behind non-vaccination, where we discuss the drivers of vaccine hesitancy related to risk perception, caregivers' opinions on the medical-pharmaceutical industry, vaccines' composition and their side effects, families' lifestyles and worldviews, and the childhood routine vaccination schedule. The results of this study reaffirm the complexity of the decision-making process in childhood vaccination and further enable a better contextual understanding of the complex and challenging phenomenon of vaccine hesitancy.

Despite the high effectiveness of HPV vaccines in preventing infection, vaccine hesitancy remains a concern, particularly in China. This study aimed to explore college students' attitudes toward HPV vaccination and identify associated factors. Data was collected through a cross-sectional survey using self-administered questionnaires in four cities from May to June 2022. Chi-square tests and logistic regression analyses were conducted to identify factors. Additionally, an integrated structural equation model (SEM) based on the 3Cs (confidence, convenience, complacency) was developed to understand underlying factors contributing to hesitancy. The results from 2261 valid questionnaires were enlightening. A significant 89.47% (59.4% for females) considered HPV vaccination necessary, with 9.82% remaining neutral and only 0.71% deeming it unnecessary. Factors like higher education, being a medical student, residing in urban areas, having medical insurance, more extraordinary living expenses, a family history of tumors, and a solid understanding of HPV played a role in perceiving the vaccine as necessary. Among the 1438 female respondents, 84.36% had no hesitancy toward HPV vaccination, 13.53% expressed hesitancy, and 2.11% refused vaccination. Factors like age, understanding of HPV, medical staff recommendations, living expenses, and family history influenced hesitancy levels. SEM revealed that the 3Cs significantly affected vaccine hesitancy. Factors like price, booking process, vaccination times, trust in vaccines, medical staff recommendations, efficiency, and risk perception collectively influenced hesitancy. In conclusion, this study found high acceptance of HPV vaccination but acknowledged the complexity of hesitancy factors. It recommends medical staff disseminate scientific knowledge, offer recommendations, simplify booking procedures, and expand vaccination sites to address vaccine hesitancy effectively.

There is evidence that advice from Healthcare Professionals (HCPs) plays an important role in patients' decision to get vaccinated, but the extent to which patients perceive this impact is unclear. The aim of this study was to assess the perceived impact of a discussion with a HCP on participants' decision to be vaccinated against COVID-19. A cross-sectional survey was conducted among adults who consulted a general practitioner (GP) or a pharmacist in Ile-de-France, France, after COVID-19 vaccines became available (October-November 2021 period). A total of 344 participants were included, 65.2% of whom reported having had a discussion about COVID-19 vaccines with a HCP. Overall, 55% of participants were advised to be vaccinated by their HCP. Most of the discussions took place with a GP ( n  = 203, 48.9%). According to 52.5% of participants, the discussion had a positive impact, i.e. it was perceived as encouraging vaccination. The latter reported that, among HCPs, GPs had the greatest number of discussions with a positive impact on the decision to be vaccinated against COVID-19 (93.1%). In the study population, the COVID-19 vaccine hesitancy rate, according to the WHO definition, was high (38.1%), although the COVID-19 vaccine coverage rate was 87.1%. Vaccine hesitant participants were more likely to report a discussion that had a perceived negative impact on their decision to get vaccinated (20.0%) than non-hesitant participants (5.8%, p  = .004).