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Human Papillomavirus (HPV) vaccination is a recognised preventive measure against HPV-related cancers. Despite the availability of vaccines, challenges persist, including limited awareness and gender disparities in vaccination. Addressing the challenges necessitates a comprehensive approach involving knowledge advancements, understanding societal needs and cultural beliefs, and improving vaccine communication. This study aimed to determine young people's information needs, facilitators and barriers, influential messages, and thoughts on improving vaccine communication between youth & healthcare professionals (HCPs) and parents regarding HPV vaccination. Qualitative SWOT analysis. This report is part of Work Package 2.1 within the EU4Health project PROTECT-EUROPE. A multi-methodological approach involved data collection through open-ended questionnaires disseminated to European youth organisations. The data underwent content and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. The SWOT analysis of HPV vaccination communication efforts highlighted strengths, such as using educational institutions to disseminate information and vaccination. Primary obstacles to HPV vaccination include a lack of awareness among key demographics and logistical challenges for youth accessing vaccination services. Weaknesses included barriers created by the use of technical jargon. Opportunities were seen in HCPs engaging directly with students in educational settings and open dialogue, ensuring confidentiality to the target population. Threats encompassed cultural sensitivities to HPV. These insights underscore the importance of developing communication strategies that are effective and sensitive to cultural contexts and of creating accessible and adaptable vaccination programs. The findings suggest that targeted education and active engagement strategies can mitigate these issues. Moreover, prioritising open communication between HCPs and young individuals is critical for increasing vaccination uptake. [ABSTRACT FROM AUTHOR]

Federal regulators recently authorised two vaccines designed to prevent infection with respiratory syncytial virus (RSV) for adults aged 60 or older. While some efforts have been made to study vaccine uptake thus far, few have studied this group's intentions to vaccinate, as well as potential barriers to vaccination. This omission is noteworthy as adults aged 60 or older may be at an increased risk of experiencing severe complications from RSV infection. We fielded a nationally representative survey of 1200 US adults (n = 362 aged 60+). Respondents aged 60 or older were asked a series of questions about their willingness to receive an RSV vaccine, vaccine safety, and efficacy attitudes, and their knowledge about vaccination eligibility. We find that a majority of seniors (53%) intend to refuse an RSV vaccine. As of late fall 2023, just 14% of those eligible had already received an RSV vaccine. Multivariate regression models suggest that belief in the safety and efficacy of the RSV vaccine, as well as previous flu and COVID-19 vaccine uptake, are associated with increased RSV vaccination intentions. We document high levels of RSV vaccine hesitancy among adults aged 60 or older and show that negative vaccine attitudes and non-vaccination behaviors motivate RSV vaccine refusal. Our work thereby raises the possibility that efforts to communicate the safety and efficacy of RSV vaccination may have beneficial effects on RSV vaccine uptake. [ABSTRACT FROM AUTHOR]

This study introduces a SIR (Susceptible-Infectious-Recovered) model using fractional derivatives to assess the population's hesitancy to the COVID-19 vaccination campaign in Portugal. Leveraging the framework developed by Angstmann [1] , our approach incorporates fractional derivatives to best describe the nuanced dynamics of the vaccination process. We begin by examining the qualitative properties of the proposed model. To substantiate the inclusion of fractional derivatives, empirical data along with statistical criteria are applied. Numerical simulations are performed to compare both integer and fractional order models. An epidemiological interpretation for the fractional order of the model is provided, in the context of a vaccination campaign. • Fractional order models are suited to describe epidemics in the presence of population hesitancy towards a vaccine. • The fractional order measures the degree to which the time elapsed without vaccination influences future vaccine uptake. • Fractional order was estimated to be 0.7398 for COVID-19 vaccination in Portugal during 2021. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines are supplied at no-cost to residents as a measure to prevent comorbidities, fatalities, and the increased risk of community transmission, thus protecting public health systems. However, vaccine acceptance among cancer patients remained uncertain. This study aimed to elucidate the vaccination rates among oral cancer patients at a medical center in Taiwan. We included Individuals who attended for routine follow-ups from January 2021 to December 2022, with a total of 1448 patients subjected to comprehensive analysis. Medical records were reviewed to identify factors influencing vaccine acceptance. Our findings indicate that 1,264 patients received vaccinations, while 184 remained unvaccinated. The vaccination rates among patients in advanced disease stages and those with neck lymph node metastasis (N+) were significantly lower (both P < 0.001). Furthermore, a notable lower vaccination rate was evident among patients receiving active treatment modalities (P < 0.01). Conversely, age, and comorbidities (evaluated using the New Charlson Comorbidity Index), didn't show a significant correlation with vaccination rates. The risk of death caused by oral cancer among vaccinated patients was significantly lower compared to non-vaccinated group (P < 0.001). Logistic regression showed the risk of COVID infection was significant lower in vaccinated group than non-vaccinated group (OR = 0.31, P = 0.034). The risk of COVID-19 infection in oral cancer patients was lower among vaccinated group, and the vaccination was not associated with more mortality. Identifying the characteristics of non-vaccinated individuals and understanding factors influencing vaccine hesitancy in oral cancer patients is vital for developing targeted strategies to improve vaccine uptake. [ABSTRACT FROM AUTHOR]

To identify the range of factors that impact health behaviours pertaining to the uptake of pneumococcal vaccination (PV) among older persons. Scoping review. This review followed Arksey and O'Malley's framework. Five databases: PubMed, CINAHL, PsycINFO, Scopus and Embase were searched for relevant studies on PV uptake among outpatient older adults ≥65 years published between January 2013 and October 2023. Data were extracted and verified using a standardised template, and synthesised using inductive content analysis. Findings were classified according to Andersen's behavioural model of health services use (BMHSU). Twenty-seven papers were included in the final analysis. Reception of PV was influenced by predisposing factors such as (i) awareness and risk perception, (ii) demographic characteristics, and (iii) cultural beliefs towards preventive medicine; enabling factors including (i) disease and vaccine literacy, (ii) past experience with preventive health services, and (iii) access to relevant resources; as well as reinforcing factors namely, (i) vaccine efficacy and safety, (ii) social influence, (iii) support from healthcare professionals, and (iv) vaccine administration environment. Older adults' health behaviours, particularly their attitudes towards vaccination are often complex and this attests to the need for multidimensional, cross-sector barrier-specific strategies to raise PV coverage. Key issues identified in this review highlight the focus areas that healthcare providers, policy makers and other stakeholders should collaborate on to resolve underutilisation of preventive medicine and promote health among this population. [ABSTRACT FROM AUTHOR]

To understand how the perinatal care experiences among adolescents were impacted during the early years of the COVID-19 pandemic. Integrative review. We performed a search in the literature focusing on qualitative studies regarding the perceptions of pregnant adolescents during the pandemic (2020–2023). We described the most frequent thematic axes observed in the included studies, and we synthesized the results. The selection involved 69 articles, resulting in 9 studies from 7 countries (Indonesia, Kenya, the United Kingdom, South Africa, the United States, Malawi, and India). The studies highlight six main thematic axes: 1. Economic impact: the pandemic adversely influenced personal and family conditions, leading to early marriages and violence and exacerbating pre-existing economic inequalities. 2. Mental health: increased anxiety, depression, isolation, and fear among pregnant adolescents, with a focus on concerns related to contamination and perinatal uncertainties. 3. Compromised perinatal care: restrictions during prenatal and delivery care and lack of emotional and professional support lead to negative impacts on care for pregnant adolescents. 4. Breakdown of family Support network: school closures, family losses, and increased domestic violence affected family dynamics, influencing the occurrence of early pregnancies. 5. Impact on sexual education: school closures hindered access to contraceptives, contributing to unplanned pregnancies. 6. Vaccine hesitancy: misinformation led to hesitancy among pregnant women, highlighting the need for better communication to increase confidence in vaccination. The review emphasizes the wide geographic variety of the studies and highlights the interconnection between economic, social, and mental health factors. The pandemic intensified preexisting challenges, underscoring the importance of comprehensive support for pregnant adolescents, including emotional and psychological support. The COVID-19 pandemic exacerbated social and economic inequalities, negatively impacting the perinatal experiences of pregnant adolescents. The emphasis is on the need for comprehensive support, considering psychosocial factors, highlights the importance of more inclusive and sensitive health policies addressing the specific needs of this group during public health crises. The identified thematic axes, spanning economic, mental health, perinatal care, family support networks, sexual education, and vaccine hesitancy, illuminate the intricate challenges faced by adolescents during the pandemic. The identification of these axes provided a comprehensive analysis of the diverse consequences experienced by adolescents during the COVID-19 pandemic. It also allows the proposition of tailored interventions to mitigate the adverse effects on adolescent well-being and inform public health strategies for future pandemics or crises. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy has gained heightened relevance amid the COVID-19 pandemic, underscoring the urgency of understanding its determinants. This study explores the association between Covid-19 vaccine hesitancy, mental health variables and inflexible thinking. A convenience sample of 252 UK adults was assessed online between June 2021–July 2022 (when Covid-19 lockdown restrictions had finally eased). We assessed participants using the Oxford Covid Vaccine Hesitancy Scale (OCVHS), various aspects of mental health, using: the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress scale (DASS-21), and finally, performance on a computerized version of the Wisconsin Card Sort Task (WCST). This study was preregistered at the Open Science Framework (https://osf.io/xd5wz). Multiple regression analyses showed that only cognitive inflexibility, and specifically the WCST item of perseverative errors, significantly predicted vaccine hesitancy. Our exploratory analysis provides the first evidence that cognitive inflexibility, measured using an objective task, is an independent risk-factor for vaccine hesitancy. Public health strategies should consider the impact of an inflexible thinking style on the decision-making of those most at risk of vaccine hesitancy and adapt interventions accordingly. [ABSTRACT FROM AUTHOR]

This study aims to examine the attitudes of healthcare professionals toward vaccines and identify factors influencing these attitudes. The study, which employed a descriptive and cross-sectional methodology, included doctors, nurses, and midwives employed at a public hospital between March 2022 and February 2023. Data were collected through face-to-face interviews using structured questionnaires, including the "Attitudes Towards Vaccination Scale." Healthcare workers generally had positive attitudes toward vaccination, with nearly all receiving the COVID-19 vaccine. Participants with children reported high childhood vaccination rates, and factors such as gender and occupation significantly influenced vaccination attitudes (p < 0.001). While 87.1 % of the participants expressed concerns about the potential adverse effects of vaccines, those who believed vaccines had no side effects exhibited more favorable attitudes toward vaccination. Furthermore, the study revealed a considerable degree of endorsement for mandatory childhood vaccinations, with 75.1 % of participants expressing support for implementing legal obligations. The findings of this study show healthcare workers' generally positive attitudes and confidence toward vaccines. However, more research should be conducted on the reasons for hesitancy toward COVID-19 vaccination. Increasing education and information activities is essential to overcome hesitations against new vaccines. Since the attitudes of healthcare workers toward vaccines can affect society's general vaccine acceptance and vaccination rates, studies in this field are of great importance. The study underscores the crucial role of healthcare professionals as advocates for vaccination, emphasizing the need for tailored communication strategies to effectively address vaccine hesitancy, particularly regarding safety concerns. • It found that health workers generally had positive attitudes toward vaccination. • A positive attitude toward childhood vaccines is observed among healthcare professionals. • Healthcare professionals who have received the newly developed vaccine do not plan to administer the same vaccine to their children. [ABSTRACT FROM AUTHOR]

Immunosuppressive medications play a crucial role in inflammatory bowel disease (IBD) but increase susceptibility to infections, underlining the importance of vaccination. Nevertheless, vaccination rates are often low. This study assessed the perspective of gastroenterologists (GEs) on vaccination of IBD patients. An online survey was applied to GEs worldwide, from 10/2022 to 06/2023. The 271 respondents considered vaccination important, however, 26 % never/rarely prescribed vaccines and 60 % admitted having limited or no confidence on managing their side effects - GEs practicing in Europe, male and older more often felt capable of this. Female and younger participants were more aware of the need to alter the current workflow in vaccination. Some respondents proposed to delegate the responsibility of vaccination to general practitioners, nurses in gastroenterology units, or infectious diseases specialists, but 19 % considered that no change was needed. Overall, the importance of addressing vaccine hesitancy, providing flyers to patients, and implementing vaccine guidelines were consensually recognized. The data indicated that the vaccination process needs reformulation and that different opinions/attitudes toward vaccines are influenced by demographic factors, workplace characteristics, affiliation, and teaching activities. Delegating the responsibility of vaccination and adopting a multidisciplinary approach seem like effective strategies to increase vaccination coverage among IBD patients. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is considered 1 of the top 10 threats to global health. This study aims to assess the impact of an education program on parents' attitudes toward the measles-rubella vaccine. A study was conducted with 250 parents using a randomized controlled trial design. The intervention group (125 parents) received training, education programs, and video, while the control group (125 parents) only received video. The Parent Attitudes about Childhood Vaccines (PACV) scale, including its behavior, safety and efficacy, and trust subscales, was used for pre-post assessment. This allowed for comparison between the groups and measurement of score differences. The PACV scale (range 0-42) identified vaccine hesitancy, with a score below 21 indicating "non-hesitant" and 21 or higher indicating "hesitant." The intervention group had a significant decrease in PACV scores after the program (17.54 ± 4.7, P =.001), mainly in behavior, safety, efficacy, and trust (6.4 ± 3.6, 9.8 ± 4.7, 3.9 ± 2; P =.001,.011,.002). The control group showed no changes (23.6 ± 3.5; P =.402). Postintervention PACV score differences were significant (t = 11.562, P =.001). Findings indicate that the education program had a positive effect on changing vaccine hesitancy. The education programs promoted vaccine acceptance among parents. • Vaccine hesitancy is a significant issue regarding the measles-rubella vaccine in Jordan. • An educational program could help increase vaccination uptake and combat public vaccine hesitancy. • Health care providers are key to boosting vaccine use and preventing diseases. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine vaccine hesitancy for COVID-19 vaccinations, comparing immigrant and non-immigrant older adults (aged ≥60 years), after accounting for group-level and individual-level characteristics, and the interaction between immigrant and socio-economic status. This study used a retrospective cohort design. Analyses were conducted using R version 4.3.2. Logistic regression models had the dependent variables of obtained any COVID-19 vaccinations vs not and obtained all four required COVID-19 vaccinations vs not. The linear regression model's dependent variable was the interval in days between the COVID-19 vaccination availability and the date of obtaining the first COVID-19 vaccination. In the cohort of older adults (n = 35,109), immigrants were less likely than non-immigrants to obtain a single COVID-19 vaccination (P < 0.001) or the full series of required COVID-19 vaccinations (P < 0.001); however, immigrants vs non-immigrants delayed only in obtaining the first vaccination (P < 0.001) but not the remaining required COVID-19 vaccinations. In the linear regression model, a longer interval before obtaining the first COVID-19 vaccination was associated with immigrant status (P < 0.001), lower socio-economic status (SES; P < 0.001), and the interaction between immigrant status and low SES (P < 0.001), while a shorter interval was associated with preventive behaviours of obtaining seasonal influenza (P < 0.001) or pneumococcal (P < 0.001) vaccinations previously. Immigrant status in general, and especially when combined with low SES, is a major risk factor for vaccination hesitancy. Reorienting immigrants to embrace preventive healthcare behaviours is key. Culturally appropriate communication campaigns may improve the dissemination of effective vaccination-related information to immigrant communities. [ABSTRACT FROM AUTHOR]

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Health care workers play an essential role in maintaining the public trust in vaccination programmes globally, and more specifically, in low- and middle-income countries. This role is particularly important in building trust in the human papillomavirus (HPV) vaccine. While there are many factors that affect HPV vaccine acceptance, health care workers are one of the most critical influences in the decision-making process among parents as well as adolescent girls. In this paper, we sought to better understand how health care workers in a diverse set of countries communicate and promote HPV vaccines. We summarize communication approaches and lessons learned by health care workers in Kenya, India, and Nigeria through a case study approach. In Kenya, the utilization of a multisectoral approach proved to be very important. In India, intense social mobilization with targeted messaging by target audience laid the groundwork for community acceptance. An evolving communication strategy was essential in Nigeria, where there is no national HPV vaccination programme. Given the increase in vaccine hesitancy globally, the lessons learned through these three country examples highlight the importance of communication efforts in increasing vaccine acceptance. [ABSTRACT FROM AUTHOR]

This article presents an overview of the main challenges and lessons learned that were presented during the symposia organized by the Coalition to Strengthen the HPV Immunization Community (CHIC) in Africa and South Asia in 2022. Discussions at these meetings revolved around introduction, planning, implementation, and sustainability of HPV prevention and control programmes, with a particular focus in HPV immunisation, as well as cervical cancer screening in South Asian countries. This article also discusses the recently endorsed off-label single-dose HPV vaccination schedule and its potential impact on programme delivery and access. Furthermore, it highlights the importance of intersectional collaboration, effective communication and advocacy strategies, and the need for robust health information systems. Some of the critical factors identified for reducing the burden of cervical cancer in low- and middle-income countries (LMICs) included strategies for increasing access and coverage, addressing vaccine hesitancy, and building capacity among health care providers. The symposia emphasized the importance of face-to-face interactions for collaboration and decision making, with live translation services enabling full participation by stakeholders from diverse backgrounds. The paper concludes with a call for continued collaboration to make progress in reducing the burden of cervical cancer in LMICs. [ABSTRACT FROM AUTHOR]

Although COVID-19 vaccine safety in 5–11-year-old children has been documented, half of Ontarian children this age remain unvaccinated. This study aimed to assess caregivers' vaccine acceptance for 5–11-year-old children and identify factors associated with vaccine non-acceptance. A multi-language self-administered survey was sent to caregivers of 5–11-year-old children through schools and community health centers within the Greater Toronto Area from April–July 2022. Sociodemographic characteristics and immunization behaviours were collected for caregivers, their 5–11-year-old children, and any older siblings. The primary outcome, COVID-19 vaccine acceptance, was previous uptake of COVID-19 vaccine or caregiver intent to vaccinate for their 5–11-year-old child. Data were analyzed using descriptive statistics and multivariable logistic regression. In total, 807 caregivers were included in analysis. Although 93 % of caregivers had received two doses of COVID-19 vaccine, 77 % had a 5–11-year-old child who received at least one dose of vaccine. Caregivers age was associated with vaccine acceptance (vs. < 40 years; adjusted odds ratio [aOR] 2.1, 95 % confidence interval [CI] 1.4–3.1 for ages 40–49; aOR 2.8, 95 % CI 1.1–7.1 for ages ≥50 years). Immunization factors associated with vaccine acceptance included caregiver COVID-19 vaccination (aOR 38.1 vs. unvaccinated caregivers; 95 % CI 15.8–92.3), older siblings COVID-19 vaccination (aOR 49.2 vs. unvaccinated siblings; 95 % CI 18.3–132.3), and recent influenza vaccination for the child (aOR 6.9 vs. no influenza vaccine; 95 % CI 4.6–10.5). Among 189 caregivers with unvaccinated 5–11-year-old children, the most common reasons for non-acceptance were concerns about long-term side effects (59 %), lack of experience vaccinating children (41 %), and concerns that vaccines were developed too quickly (39 %). Acceptance of COVID-19 vaccination for 5–11-year-old children were associated with caregiver vaccine behaviors and sociodemographic factors. These findings highlight groups of caregivers that can be targeted for educational interventions and concerns that may be addressed to increase vaccine confidence. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the safety and immunogenicity of a dose-sparing fractional intradermal (ID) booster strategy with the mRNA-1273 COVID-19 vaccine. COVID-19 naive adults aged 18–30 years were recruited from a previous study on primary vaccination regimens that compared 20 μg ID vaccinations with 100 μg intramuscular (IM) vaccinations with mRNA-1273 as the primary vaccination series. Participants previously immunized with ID regimens were randomly assigned (1:1) to receive a fractional ID booster dose (20 μg) or the standard-of-care intramuscular (IM) booster dose (50 μg) of the mRNA-1273 vaccine, 6 months after completing their primary series (ID-ID and ID-IM group, respectively). Participants that had received a full dose IM regimen as the primary series, received the IM standard-of-care booster dose (IM-IM group). In addition, COVID-19 naive individuals aged 18–40 years who had received an IM mRNA vaccine as the primary series were recruited from the general population to receive a fractional ID booster dose (IM-ID group). Immunogenicity was assessed using IgG anti-spike antibody responses and neutralizing capacity against SARS-CoV-2. Cellular immune responses were measured in a sub-group. Safety and tolerability were monitored. In January 2022, 129 participants were included in the study. Fractional ID boosting was safe and well tolerated, with fewer systemic adverse events compared with IM boosting. At day 28 post-booster, anti-spike S1 IgG geometric mean concentrations were 9106 (95% CI, 7150–11 597) binding antibody units (BAU)/mL in the IM-IM group and 4357 (3003–6322) BAU/mL; 6629 (4913–8946) BAU/mL; and 5264 (4032–6873) BAU/mL in the ID-IM, ID-ID, and IM-ID groups, respectively. Intradermal boosting provides robust immune responses and is a viable dose-sparing strategy for mRNA COVID-19 vaccines. The favourable side-effect profile supports its potential to reduce vaccine hesitancy. Fractional dosing strategies should be considered early in the clinical development of future mRNA vaccines to enhance vaccine availability and pandemic preparedness. [ABSTRACT FROM AUTHOR]

The delivery of vaccines plays a pivotal role in influencing the strength and longevity of the immune response and controlling reactogenicity. Mucosal immunization, as compared to parenteral vaccination, could offer greater protection against respiratory infections while being less invasive. While oral vaccination has been presumed less effective and believed to target mainly the gastrointestinal tract, trans-buccal delivery using mucoadhesive films (MAF) may allow targeted delivery to the mucosa. Here we present an effective strategy for mucosal delivery of several vaccine platforms incorporated in MAF, including DNA plasmids, viral vectors, and lipid nanoparticles incorporating mRNA (mRNA/LNP). The mRNA/LNP vaccine formulation targeting SARS-CoV-2 as a proof of concept remained stable within MAF consisting of slowly releasing water-soluble polymers and an impermeable backing layer, facilitating enhanced penetration into the oral mucosa. This formulation elicited antibody and cellular responses comparable to the intramuscular injection, but also induced the production of mucosal IgAs, highlighting its efficacy, particularly for use as a booster vaccine and the potential advantage for protection against respiratory infections. The MAF vaccine preparation demonstrates significant advantages, such as efficient delivery, stability, and simple noninvasive administration with the potential to alleviate vaccine hesitancy. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients listed for solid organ transplants (LSOTP) are at high risk for severe COVID-19 outcomes. Despite national guidelines recommending COVID-19 vaccination for LSOTP, vaccine hesitancy and underuse are reported in this population; however, reasons for this finding have not been examined thoroughly. This single-center retrospective survey analysis aimed to characterize reasons for COVID-19 vaccine hesitancy among 110 heart, liver, and kidney patients LSOTP who had not received all the recommended vaccine doses at the time of the study. Survey questions also investigated experiences with influenza vaccination. Fifty-four patients (49.1%) responded to the telephone survey. The most common reasons for vaccine hesitancy were perceived lack of research in vaccine development (31%), fear of vaccine-related side effects (22%), and belief that the vaccine was unnecessary (20%). Of the respondents, 35% reported changing their vaccine perception after being listed for a transplant, most commonly attributing this to a perception that the COVID-19 vaccine is not safe for transplant recipients (32%). Gender differences in hesitancy reasons were observed, with males more likely to delay vaccination until after transplantation, although this difference was not significant (P =.07). Despite these findings, 54% of all respondents reported receiving annual influenza vaccines consistently. Despite their risk, patients LSOTP show significant hesitancy toward COVID-19 vaccines owing to perceived safety and necessity issues. The results of this study can inform targeted educational efforts to address and rectify misconceptions and concerns about COVID-19 vaccination among patients LSOTP. Future studies focused on larger, more diverse cohorts are needed to expand our understanding of and address vaccination hesitancy among this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) may be a viable method to observe and describe signals of implicit bias. Using the context of the human papillomavirus vaccine counseling, we sought to describe physicians' communication practices exploring differences when counseling parents with different skin colors. Physicians (N = 90) at an academic primary care center were recruited for a VR study in which they counseled dark or light-skinned parent avatars who expressed hesitation about human papillomavirus vaccination for their adolescent child. Investigators coded previously recorded simulations. Associations between communication and parent skin color were examined using t-tests and Chi-square tests. Both direct (e.g., addressing the concern immediately) and circuitous (e.g., providing alternative information) communication patterns were observed. Physicians used passive voice less commonly when counseling dark-skinned versus light-skinned avatars (p <.05). VR demonstrated feasibility in capturing clinicians' communication behaviors including measuring eight distinct indicators of implicit bias. [ABSTRACT FROM AUTHOR]

One out of four parents reported HPV vaccine hesitancy; however, little is known about HPV vaccine-hesitant parents who vaccinate their children (e.g., hesitant adopters). We use individual interviews (n = 8) to explore hesitancy and facilitators for overcoming hesitancy among hesitant adopter parents. We drew a priori codes from the Increasing Vaccination Model domains and identified seven emergent secondary themes. Understandable information about safety, side effects, and effectiveness could address HPV vaccine hesitancy. Health care professionals, family, friends, and coworkers were trusted vaccine and vaccination information sources. The study documents the lack of access to HPV vaccines with established health care providers as a barrier to vaccination. This is the first study of hesitant adopter parents that expands our understanding of factors driving HPV vaccination among them. Study insights can inform future efforts to increase HPV vaccine uptake among the hesitant. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is a major public health problem that emerged post-COVID-19 pandemic, especially for children. Different factors influence parents' perspectives about vaccinating their children and can vary across different populations and contexts. This study aimed to explore the vaccine hesitancy among parents in Jordan to vaccinate their children between the ages of 5 and 18. A descriptive cross-sectional design was used. A convenient sample was used to recruit Jordanian parents. Data was collected via an online questionnaire including demographic data, the Vaccine Hesitancy Questionnaire, the Questionnaire of Vaccine Hesitancy Reasons, and the Vaccine Conspiracy Beliefs Scale. Over 177 parents, the mean age was 37.74 years (SD = 8.39); the majority of them were females (74%). 51.4% of the participants refused to give the COVID-19 vaccine to their children. Concerns about the safety and efficacy of the vaccine and lack of information about disease and vaccine were the common reasons for the parents' hesitancy. In addition, 54.2% of participants agreement was with the conspiracy theory that pharmaceutical companies cover up the dangers of vaccines. Parents' younger age and fewer children were associated with hesitancy to vaccinate their children with COVID-19. Many parents are hesitant to vaccinate their children against COVID-19. Concerns about the vaccine's efficacy and safety as well as potential long-term negative effects were the main reasons for vaccine hesitancy. Nurses play a critical role in determining parental hesitancy. Providing detailed, accurate, evidence-based vaccine information is essential to reduce this hesitancy. • Parent vaccine choice for children related to COVID-19 and the vaccine information, attitudes, and beliefs. • Concerns about vaccine efficacy, safety, and long-term effects are the primary reasons for vaccine hesitation. • Addressing vaccination hesitancy necessitates the dissemination of clear, factual, and evidence-based vaccine information. [ABSTRACT FROM AUTHOR]

Trust in governments and public institutions as a determinant of public health outcomes has gained increased attention since the COVID-19 pandemic. Provided historically low confidence in vaccines in Japan, investigating the role of trust in information sources and actual COVID-19 vaccination uptake behavior will be invaluable for future vaccine promotion policymaking. Therefore, the objective of this study was to elucidate the determinants of COVID-19 vaccination uptake and evaluate the relationship between trust in different information sources and COVID-19 vaccination behavior in Japan. For this study, we leveraged a longitudinal series of web-based surveys of 19,174 individuals in Japan conducted between 2021 and 2022 which asked questions regarding a wide range of sociodemographic and psychographic characteristics related to the COVID-19 pandemic. Determinant analysis for vaccination (at least one dose of a COVID-19 vaccine) was conducted via multiple logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were estimated. After adjustment for sociodemographic determinants of vaccine uptake, aggregate trust in the systems and institutions of vaccine approval (OR: 1.42, 95% CI: 1.30–1.56), and trust in information about the COVID-19 pandemic coming from government sources (OR: 1.27, 95% CI: 1.12–1.44) were found to be consistently powerful predictors of COVID-19 vaccination. Trust in media sources including traditional media (OR: 1.21, 95% CI: 1.07–1.36), and the internet (OR: 0.77, 95% CI: 0.66–0.89) had significant and opposing effects. Our findings support the broader hypothesis that trust in governments and public health institutions remains a powerful determinant for COVID-19 vaccine uptake in Japan. We also found that vaccination decision-making is a multifactorial process that includes the synthesis of trust in public institutions and media, and its interaction with psychosocial determinants such as prosociality and health literacy. We hope to apply this study's findings towards future vaccine programs for contagious diseases. [ABSTRACT FROM AUTHOR]

Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region. A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records. A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41–58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3–81.8 %), 62.7 % for hepatitis A (57.3–67.9 %), 61.2 % for pneumococcal vaccines (55.8–66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0–61.9 %), 44.7 % for seasonal influenza (39.3–50.1 %), 31.4 % for measles/mumps/rubella (26.4–36.6 %) and 38.5 % for meningococcal vaccine (13.9–68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9–75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed. The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed. [ABSTRACT FROM AUTHOR]

Variation in COVID-19 vaccination coverage and increasing vaccine hesitancy are well documented, especially amongst ethnic minority populations and current channels of vaccine and communication have been found to be inadequate. It has been suggested that more be done to utilise community-led pathways to improve vaccine readiness in ethnic minority communities in Australia. The study aimed to explore receptiveness towards the role of different actors and methods of communication about immunisation. A cross-sectional survey of 1,227 adults in Australia was conducted to examine the roles of various actors in promoting vaccine uptake. Chi-square analyses and independent samples t-tests were used to identify significant associations between sociodemographic characteristics, vaccine practices, and vaccine information-seeking behaviours and (1) COVID-19 vaccine uptake (at least one dose) and (2) speaking a language other than English. At the time of the survey, 93% of respondents had received at least one dose of the COVID-19 vaccine. There were significant associations between COVID-19 vaccine uptake and: perceived capacity to locate accurate and timely vaccine information; receiving the COVID-19 vaccination information from a Nurse or Pharmacist; and receiving a vaccine recommendation by a GP. Additionally, respondents who spoke a language other than English reported were significantly more likely to have received information from family, friends, workplaces, local councils, religious centres, community leaders, and religious leaders than those who only spoke English. Significant variations in vaccine practices and vaccine information-seeking behaviours were found, especially in those who speak a language other than English. To enhance vaccine uptake and to address vaccine hesitancy in Australia, vaccine promotion strategies and health communication efforts require significant consideration of information accessibility and communication source preferences. [ABSTRACT FROM AUTHOR]

• Prevalence of any new menstrual disturbance after Covishield vaccine was 20%. • The cycles were mostly affected by less than 7 days, reversing within 1–3 cycles. • Previous SARS-CoV-2 infection was not associated with menstrual disturbance. • Emotional disturbance and previous dysmenorrhea are associated with menstrual disturbance. The association between covid-19 vaccine and menstrual disturbance is unclear. An in-person cross-sectional survey among female members ≥ 18 years enrolled in an ongoing Zero TB prospective cohort in Northern India who had received one or two doses of covid-19 vaccine was conducted to study the characteristics and association of menstrual disturbance within six months of receiving Covishield. Between June 29 and September 5, 2021, 339 females ≥ 18 years of age were administered the survey. Median age was 30 (IQR: 22–39) years; 84 % were between 18 and 49 and 16 % were ≥ 50 years old. There were 152 college students, 27 healthcare workers, and 160 nuns. Forty-two women (12 %) had received one dose and 297 (88 %) had received two doses of Covishield. Overall, 66 (20 %) women reported experiencing menstrual disturbance after receiving Covishield vaccine. The problems included early menstruation: 6 % (n = 19/339); late menstruation: 4 % (n = 14/339); and heavier bleeding: 5 % (n = 17/339). Disturbances lasted for less than seven days and cycles normalized in 1–3 months. There was no post-menopausal bleeding. There was no significant difference in menstrual disturbance based on receiving one vs. two doses of Covishield (OR: 1.58; 95 % CI: 0.55–4.57; p = 0.381). History of SARS-CoV-2 infection was not associated with the development of menstrual disturbance among the vaccinees (OR: 0.63; 95 % CI: 0.24–1.73; p = 0.379). Presence of emotional disturbance at baseline (OR: 31; 95 % CI: 3.52–267; p = 0.002) or previous history of dysmenorrhea (OR: 41; 95 % CI: 8.7–196; p < 0.001) was associated with menstrual disturbance in the vaccinees, indicating their potential to confound or bias study results. Menstrual problems were reported by Covishield vaccinees, but they were minor and reversible within three months and do not constitute a ground for vaccine hesitancy. Studies designed to assess causal link taking care to avoid selection bias or confounding are needed. [ABSTRACT FROM AUTHOR]

• Autonomy satisfaction is linked both directly and indirectly to vaccine acceptance. • Institutional trust mediates the effect of autonomy on vaccine acceptance. • Competence satisfaction is linked both directly and indirectly to vaccine hesitancy. • Science mistrust mediates the effect of competence on vaccine hesitancy. • We did not find any effect of relatedness satisfaction. Autonomous motivation is considered a powerful driver of health behaviour, but less is known about the specific roles played by basic needs. Drawing on the context of the COVID-19 pandemic, this research examined basic needs as a motivational determinant of vaccination. We hypothesized that satisfaction of basic needs (autonomy, competence, relatedness) has both a direct and an indirect effect (through trust in science and government) on vaccine hesitancy. Two studies (Study 1: N = 968 French and British; Study 2, pre-registered: N = 716 Americans) tested our hypotheses and compared vaccinated and non-vaccinated individuals using multigroup structural equation models. We found positive direct (in both studies) and indirect (in Study 1) effects of autonomy satisfaction on vaccine acceptance. In contrast, competence satisfaction was directly and indirectly, via science mistrust, related to vaccine hesitancy, particularly among non-vaccinated people. Competence satisfaction also indirectly reduced the intention to vaccinate in both studies. We found no impact of relatedness. Complementing previous work on self-determination theory, our research demonstrates the importance of considering the distinct roles of basic needs. Moreover, we highlight that increasing autonomy and science trust may be an efficient strategy to improve vaccine acceptance and vaccination, even among reluctant individuals. [ABSTRACT FROM AUTHOR]

This study sought to identify the behavioural and social drivers of vaccination in 16,745 older Australians. We analysed and compared influences on COVID-19 vaccination intention and uptake using prospectively collected survey data from the Sax Institute's 45 and Up Study. Vaccination intention increased with older age (adjusted odds ratio [aOR]:1.03; 95 % confidence interval [CI]: 1.01–1.04; p =.002), a belief that the vaccine is important for the person's own health (aOR: 5.17; 95 % CI: 4.23–6.24; p <.001), is safe (aOR:2.64; 95 % CI: 2.19–3.2; p <.001), and trusted by the person (aOR:6.79; 95 % CI: 5.59–8.26 p <.001); concern about contracting COVID-19 (aOR:1.78; 95 % CI: 1.47–2.17; p <.001); having enough information about COVID-19 vaccines (aOR:1.99; 95 % CI: 1.65–2.29; p <.001); a belief that most adults will receive a COVID-19 vaccine (aOR:2.31; 95 % CI: 1.93–2.77; p <.001); and a belief that family and friends wanted the person to receive a COVID-19 vaccine (aOR:6.07; 95 % CI: 5.06–7.27; p <.001). The same factors contributed to increased vaccine uptake, with the exception of age and the belief that the person had enough information about the vaccine. Concern that the vaccine will cause a serious reaction was associated with both lower intention (aOR:0.35; 95 % CI: 0.29–0.43; p <.001) and lower uptake (aOR:0.61; 95 % CI: 0.46–0.81; p <.001) while lower intention was also associated with low decisional autonomy (aOR:0.37; 95 % CI: 0.22–0.62; p <.001). Intentions changed over time and a change towards vaccination was associated with perceptions of vaccine safety. Access barriers played a role in the non-vaccination of otherwise intending older Australians. Messaging that is adaptive to safety concerns, emphasises vaccine benefits, leverages social norms, and targets people who make decisions for older Australians may be helpful for influencing vaccination intentions and increasing vaccine uptake. [ABSTRACT FROM AUTHOR]

Health care workers (HCWs) are at increased risk of exposure to hepatitis B virus (HBV). The most effective prevention measure is vaccination, with a serum hepatitis B surface antibody (HBsAb) titre > 10 mIU/ml considered protective. To date, the sociodemographic and occupational characteristics related to HBV serosusceptibility and factors associated with booster hesitancy remain unclear. Therefore, this study aimed to identify factors associated with maintaining a protective HBsAb titre in a large sample of HCWs and to evaluate factors potentially associated with hesitancy towards vaccine boosters. A cross-sectional study was conducted among HCWs who underwent a health surveillance visit between 2017 and 2022. If the serum HBsAb titre was < 10 MIU/ml, a vaccine booster dose was offered. Based on their willingness to be vaccinated, employees were classified into three groups: acceptance, hesitation, and refusal. Uni- and multivariable analyses were performed to assess the association of demographic and occupational characteristics with serosusceptibility and attitudes towards vaccination. A total of 1632 (27%) employees were shown to be nonimmune. A lower median age and being a physician were significantly associated with a protective HBsAb titre. A total of 706 nonimmune employees (43.3%) accepted the vaccination, 865 (53%) hesitated, and 61 (3.7%) refused. The median age of those who refused vaccination was significantly higher than that of those who hesitated and those who were vaccinated. Acceptance of vaccination was significantly higher among nurses, while nurse aides hesitated more; among nonmedical graduate staff both hesitation and refusal were higher than expected. In the multivariable analysis, higher age, female sex, and employment as an allied health care professional were shown to be significantly associated with hesitation/refusal, while being born abroad turned out to be protective. Our study showed that approximately a quarter of HCWs were not immune to HBV infection, and of these, more than half were hesitant towards or refused the booster dose. The risk of hesitation/refusal was higher with age in women and among allied health care staff. Based on these findings, further studies are needed to prospectively evaluate HBV seroprevalence, vaccination adherence, factors associated with hesitancy, and the effectiveness of health surveillance strategies in a high-risk population susceptible to infection. [ABSTRACT FROM AUTHOR]

The persistence of varicella outbreaks in Brazil has underscored the high concern with the low vaccine coverage in the last 4 years. Using publicly available data from the Brazilian Health System (SUS), this study analyzed varicella vaccine coverage and incidence trends from 2019 to 2022 in Brazilian States. Vaccine coverage decreased nationally in 2020, possibly influenced by the COVID-19 pandemic's initial phase. In Bahia State, we have the persistence of varicella with an incidence rate of 3.0 cases per 100,000 inhabitants (higher incidence compared to other States) in 2023. Under 15 months children and young children (4–6 Years old) faced the highest risk, urging the importance of vaccination. Despite a monovalent varicella vaccine being available through Brazil's National Immunization Program (NIP), Bahia fell short of achieving the ≥95 % disease control target for coverage. The study highlight the importance of vaccines to prevent some infectious diseases, as varicella, in poor tropical regions. Addressing vaccine hesitancy and misinformation, and augmenting awareness campaigns, are important to achieve and sustain high vaccine coverage over 80% as WHO guidelines to obtain a safe rate of protection for Brazilian population (Brazil's national immunization program has a target of 95% coverage). [ABSTRACT FROM AUTHOR]

• Vaccine Pass policy was associated with reduced COVID-19 vaccine hesitancy and associated with increased vaccine uptake. • Various significant psychosocial factors were identified to influence COVID-19 vaccine uptake. • Vaccine uptake in older adults was increased by a greater extent after introduction of the Vaccine Pass policy. Recognising the importance of attaining high vaccine coverage to mitigate the COVID-19 impact, a Vaccine Pass scheme was implemented during and after the first large Omicron wave with high mortality in older ages in Hong Kong in early 2022 requiring three doses by June 2022. We did not identify any studies evaluating the policy impact of vaccination mandates with vaccine uptake over whole policy period of time in a Chinese population. We aim to evaluate the impact of the Vaccine Pass policy on COVID-19 vaccine uptake in adults in a Chinese population in Hong Kong. We analysed patterns in vaccine uptake and hesitancy using local data from population vaccine registry and 32 cross-sectional telephone surveys conducted from October 2021 to December 2022. The association of Vaccine Pass phases with vaccine uptake was examined using logistic regression analyses, taking into account covariates including self-risk perception, perceived self-efficacy in preventing COVID-19 and trust in government in pandemic control as well as physical distancing measures and demographics. The uptake of primary series and third doses was positively significantly associated with the successive stages of Vaccine Pass implementation (adjusted odds ratios ranged from 2.41 to 7.81). Other statistically significant drivers of uptake included age group, chronic condition, higher perceived personal susceptibility to COVID-19, higher trust in government, and higher educational attainment. Vaccine uptake in older adults was observed to have increased by a greater extent after the policy annoucement and implementation, under the contextual changes during and after a large Omicron wave with high mortality in Hong Kong in early 2022. Since the policy withdrawal the uptake of further booster doses has been very low in all ages. We suggest that improving voluntary booster uptake in older adults should be prioritized. [ABSTRACT FROM AUTHOR]

Examining the spectrum of vaccine attitudes within the general public, spanning from hesitancy to confidence, is pivotal in addressing the challenges posed by the COVID-19 pandemic. Despite widespread campaigns advocating for vaccine uptake, a proportion of the population harbour reservations about the safety and efficacy of vaccines. This study seeks to explore the determinants of vaccine attitudes in Canada, leveraging key concepts from the well-established Self-Determination Theory (SDT), including basic psychological needs and the quality of an individual's motivation. During a crucial juncture in the COVID-19 pandemic (December 2021), 292 participants were recruited and completed an online survey assessing levels of satisfaction/frustration of basic psychological needs (sense of autonomy, relatedness, and competence), vaccine attitudes (confidence and hesitancy), and motivation towards vaccination (controlled and autonomous). Two mediation models were employed to examine whether autonomous-controlled motivation mediated the relationship between need satisfaction-frustration and vaccine attitudes. Model 1 revealed a full mediating effect, indicating that need satisfaction influenced vaccine confidence only through autonomous motivation (ab 1 = 0.09, SE = 0.04, z = 2.19, 95 % CI [0.01, 0.18]). Meanwhile, Model 2 demonstrated that need frustration was associated with vaccine hesitancy partially through controlled motivation (ab 2 = 0.05, SE = 0.02, z = 2.54, 95 % CI [0.02, 0.10]). These findings underscore the applicability of SDT in investigating the motivational mechanisms that shape vaccine attitudes. Recognizing psychosocial factors, including the balance of basic needs and quality of motivations, may be integral to informing effective public health strategies. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination is critical for reducing serious illness and hospitalizations, yet many remain hesitant. We conducted a survey of frontline physicians to identify patient concerns and physician strategies to address COVID-19 vaccine-hesitancy. A national random sample of physicians in frontline specialties selected from a comprehensive list of practicing physicians in the U.S. were emailed a survey in August 2021. Multiple choice and open-ended questions inquired about patient concerns related to the COVID-19 vaccines and strategies used by physicians to counter vaccine misinformation and encourage vaccine-hesitant patients. Weighting was applied to achieve representativeness and reduce non-response bias. Network analysis examined co-occurring patient concerns. Open-ended responses on communication strategies were coded via thematic analysis. Multi-variable logistic regression examined associations between physician and pandemic characteristics with patient concerns and use of communication strategies. 531 physicians responded: primary care (2 4 1); emergency medicine (1 4 2); critical care (84); hospitalists (34); and infectious disease (30). Weighted response balance statistics showed excellent balance between respondents and nonrespondents. On average, physicians reported four patient vaccine concerns. Safety, side effects, vaccine misinformation, and mistrust in government were most common, and often co-occurring. 297 physicians described communication strategies: 180 (61 %) provided vaccine education and 94 (32 %) created a safe space for vaccine discussion. Narrative responses from physicians provided compelling examples of both successes and communication challenges arising from misinformation. Compared with emergency medicine, critical care (OR 2.45, 95 % CI 1.14, 5.24), infectious disease (OR 2.45, 95 % CI 1.00, 6.02), and primary care physicians (OR 1.66, 95 % CI 1.02, 2.70) were more likely to provide communication strategies. Many physicians engage with vaccine hesitant patients using a variety of strategies. Dissemination of effective system and physician-level communication interventions could enhance physician success. [ABSTRACT FROM AUTHOR]

• Religion significantly related to COVID-19 vaccine uptake. • Church of England affiliation linked to higher rates of vaccination. • Lower uptake among Pentecostals, Muslims and Roman Catholics. • Religion needs to be considered in public health strategy. • Approaches need to be tailored for diverse religious groups. While many countries have successfully deployed COVID-19 vaccination programmes, there are disparities in their uptake. One factor influencing vaccine coverage is religion. Existing research has found a link between religious beliefs and vaccine hesitancy. This study looks at religion in England to examine its relationship with public health. This analysis used data from a survey of over 12,000 respondents in England, conducted through the YouGov Online Panel. Respondents were asked whether they identified with a religion, and if so which, and the number of COVID-19 vaccinations they had received. We employed logistic regressions to analyse the data, accounting for age, gender, education, generalised trust, trust in government, and political ideology. We find that respondents who identify as part of the Church of England have had significantly more COVID-19 vaccinations. Conversely, adherents to the Pentecostal Evangelical and Islamic faiths have had significantly fewer COVID-19 vaccinations. These relationships hold even when adjusting for age, education, level of trust, and political affiliation. This research indicates a potential influence of religious affiliation on vaccine uptake, highlighting the need for more carefully-tailored public health programmes. Recognizing the diverse associations of different religious affiliations on health behaviour is important for shaping future vaccination campaigns and policy interventions. Engaging with religious communities and leaders may be one method through which to deal with vaccine hesitancy and improve public health. [ABSTRACT FROM AUTHOR]

• The perception that COVID-19 vaccine is safe is positively affected by age group and negatively by religion; • The older the person, the greater the probability of considering the vaccine safe and, consequently, of getting vaccinated; • The religion variable showed great importance in the causal model. • The religion variable has a simultaneous causal effect on political preferences and the perception of vaccine safety; • The probability of a person accepting the vaccination against COVID-19 is reduced given the fact that they believe fake news related to the vaccine. This article presents a causal inference analysis of vaccine hesitancy for Coronavirus disease 2019 (COVID-19) vaccines based on socio-demographic data obtained via questionnaires applied to a sample of the Brazilian population. This data includes the respondents' political preferences, age group, education, salary range, country region, sex, believing fake news, vaccine confidence, and intention to get the COVID-19 vaccine. The research created a causal graph using these variables, seeking to answer questions about the probability of people getting vaccinated. The results of this research corroborate findings observed in the literature, also presenting unique findings: (i) The perception that the vaccine is safe is positively affected by age group and negatively by religion; (ii) The older the person, the greater the probability of considering the vaccine safe and, consequently, of getting vaccinated; (iii) The religion variable showed great importance in the model since it has a simultaneous causal effect on political preferences and the perception of vaccine safety; (iv) The data reveal that the probability of a person accepting the vaccination against COVID-19 is reduced given the fact that they believe fake news related to the vaccine. The methodology applied in this research can be replicated for populations from other countries so that it is possible to generate customized models. General causal models can be helpful for agencies dealing with vaccine hesitancy to decide which variables should be addressed to reduce this phenomenon. [ABSTRACT FROM AUTHOR]

To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. The study used a population-based cross-sectional design. Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak in China exposed health care workers (HCWs) to an increased risk of infection. The acquired immunity rapidly diminishes after the previous COVID-19 vaccination and the second booster vaccination has been recommended in several countries. HCWs are a priority group for vaccination because they are at increased risk of being infected, however, a certain amount of HCWs were hesitant. The survey was conducted among 5805 HCWs in China from January 5 to February 9, 2023. Questionnaire included sociodemographic information, COVID-19-related variables, psychological factors, and the COVID-19 vaccine hesitancy scale. Multiple logistic regression analysis was used to assess the influencing factors of the second dose of COVID-19 vaccine booster hesitancy. 42.2% of HCWs self-reported having the second dose of COVID-19 vaccine booster hesitancy. Occupations, years of working, COVID-19 infection status were associated with less vaccine hesitancy. HCWs who had received 3 doses of COVID-19 vaccine were less likely to be hesitant compared to those had not received. HCWs with PTSD symptoms and anxiety symptoms were more likely to be hesitant. No relation was observed between COVID-19 vaccine booster hesitancy and age, marriage, salary, and perceived an increased risk of COVID-19 infection due to work (all P > 0.05). A considerable proportion of HCWs were hesitant to accept the second dose of the COVID-19 booster vaccine. Incorporating vaccine knowledge and new evidence into routine health educations and procedures to raise confidence and reduce complacency may be effective and feasible in promoting the vaccination and implementing future vaccination programs. • 42.2% of HCWs have vaccine hesitancy, higher than the 10% to 30% in previous studies. • Frontline HCWs are less hesitant than those who have less contact with patients. • Intervention on alleviating anxiety and PTSD symptoms might reduce vaccine hesitancy. • Enhancing confidence in vaccine efficacy and safety might promote vaccination. [ABSTRACT FROM AUTHOR]

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Older adults are more vulnerable to the negative impacts of infectious diseases than younger individuals. However, regardless of the importance and effectiveness of vaccines to reduce morbidity and mortality, issues remain with vaccine hesitancy among this population. Older adults' sources of immunization information and their level of trust in those sources may play a role in their vaccination behaviors. This research aimed to better understand the role of information sources and related issues of trust as related to vaccine uptake among older adults. A community-based, cross-sectional survey was conducted with 901 older adults in North Dakota in May-July 2022. Measures included extent of reliance on specific sources of immunization information, levels of trust, and uptake for influenza, pneumonia, shingles, and COVID-19 vaccinations. Immunization information sources were grouped into medical experts, informal, and public outlets. Results indicated older adults were more likely to rely on medical experts than informal sources or public outlets for immunization information. Greater reliance on medical experts was associated with a greater likelihood of vaccine uptake for all vaccines, while reliance on public outlets was associated with a greater likelihood of vaccine uptake only for COVID primary series and boosters. Reliance on informal sources for immunization information was associated with a reduced likelihood of vaccine uptake for all vaccines except shingles. Nearly half of respondents were uncertain who to trust for vaccine information. Uncertainty who to trust for immunization information significantly mediated the associations between reliance on medical experts and uptake for most vaccines indicating that trust in medical experts fosters vaccine uptake. Increasing reliance on medical experts as sources of immunization information is vital to increasing vaccine uptake among older adults. Additionally, this population must be assisted in increasing their ability to successfully assess the trustworthiness of immunization information sources. [ABSTRACT FROM AUTHOR]

• Among 4,165 healthcare personnel, 17% were hesitant towards COVID-19 vaccine. • One-third (33%) of health care personnel were hesitant to vaccinate their children for COVID-19. • Vaccine hesitancy remains for COVID-19 booster despite mandated COVID-19 primary series for health care personnel. Healthcare personnel (HCP) are important messengers for promoting vaccines, for both adults and children. Our investigation describes perceptions of fully vaccinated HCP about COVID-19 vaccine for themselves and primary series for their children. To determine associations between sociodemographic, employment characteristics and perceptions of COVID-19 vaccines among HCP overall and the subset of HCP with children, who were all mandated to receive a COVID-19 vaccine, in a large US metropolitan region. Cross-sectional survey of fully vaccinated HCP from a large integrated health system. Participants were electronically enrolled within a multi-site NYS healthcare system from December 21, 2021, to January 21, 2022. Of 78,000 employees, approximately one-third accessed promotional emails; 6,537 employees started surveys and 4165 completed them. Immunocompromised HCP (self-reported) were excluded. We conducted a survey with measures including demographic variables, employment history, booster status, child vaccination status; vaccine recommendation, confidence, and knowledge. The primary outcome was COVID-19 vaccine hesitancy for all dose types − primary series or booster doses − among HCP. Findings from 4,165 completed surveys indicated that almost 17.2 % of all HCP, including administrative and clinical staff, were hesitant or unsure about receiving a COVID-19 vaccine booster, despite the NYS recommendation to do so. Depending on age group, between 20 % and 40 % of HCP were hesitant about having their children vaccinated for COVID-19, regardless of clinical versus non-clinical duties. In multivariable regression analyses, lack of booster dose, unvaccinated children, females, income less than $50,000, and residence in Manhattan remained significantly associated with vaccine hesitancy. Despite mandated COVID-19 vaccination, a substantial proportion of HCP remained vaccine hesitant towards adult booster doses and pediatric COVID-19 vaccination. While provider recommendation has been the mainstay of combatting COVID-19 vaccine hesitancy, a gap exists between HCP—despite clinical or administrative status—and the ability to communicate the need for vaccination in a healthcare setting. While previous studies describe the HCP vaccine mandate as a positive force to overcome vaccine hesitancy, we have found that despite a mandate, there is still substantial COVID-19 vaccine hesitancy, misinformation, and reluctance to vaccinate children. [ABSTRACT FROM AUTHOR]

Patients with autoimmune disease (AD) are at increased risk for complications from COVID-19 infection, so, optimizing vaccine utilization in this population is of particular importance. We compared COVID-19 vaccination perspectives among persons with and without AD. 471 patients in the MetroHealth System and Cleveland Veteran Affairs Medical Center completed a 38-item questionnaire between August 2021 and February 2022. This survey containing questions regarding COVID-19 vaccine perceptions and demographics was administered both to unvaccinated individuals and individuals who delayed vaccination for at least 2 months. Multivariable ordinary least squares regression models were created to assess factors associated with vaccination likelihood. The number of reasons given for (p < 0.001) and against receiving COVID-19 vaccination (p < 0.001) were highly associated with increased and decreased vaccination likelihood respectively. Factors most closely associated with obtaining vaccine were: protecting family (p = 0.045) personal safety (p < 0.001) and preventing serious infection (p < 0.001). Reasons associated with decreased vaccination likelihood were: lack of concern of COVID-19 infection (p < 0.001), vaccine safety (p < 0.001) and beliefs that the vaccine was made too quickly (p = 0.024). AD patients were more likely to cite having a chronic condition (29.1 % vs 17.1 %, p = 0.003) and physician recommendation(s) (18.4 % vs 9.1 %, p = 0.005) as reasons for vaccination and were more concerned about potential medication interaction than non-AD respondents (22.4 % vs 3.3 %, p < 0.001). The number of benefits of vaccination identified strongly related to vaccination likelihood. Affirmative provider recommendations correlated with increased vaccination likelihood in AD patients. Clinical conversations centered on the benefits of COVID-19 vaccination may help increase vaccine acceptance. [ABSTRACT FROM AUTHOR]

Incarcerated populations experienced high rates of SARS-CoV-2 infection and death during early phases of the COVID-19 pandemic. To evaluate vaccine effectiveness in the carceral context, we investigated the first outbreak of COVID-19 in a California state prison following widespread rollout of vaccines to residents in early 2021. We identified a cohort of 733 state prison residents presumed to be exposed between May 14 and June 22, 2021. 46.9 % (n = 344) were vaccinated, primarily with two doses of mRNA-1273 (n = 332, 93.6 %). In total, 92 PCR-positive cases were identified, of which 14 (14.5 %) occurred among mRNA-1273 vaccinated residents. No cases required hospitalization. All nine isolates collected belonged to the Alpha (B.1.1.7) variant. We used Cox proportional hazard regression to estimate vaccine effectiveness for at least one dose of any vaccine at the start of the outbreak. Vaccine effectiveness was 86 % (95 % CI: 75 %–97 %) against PCR-confirmed infection, with similar results for symptomatic infection. Higher rates of building-level vaccine uptake were associated with a lower overall rate of PCR-confirmed infection and symptomatic infection among unvaccinated residents. Among unvaccinated residents who lived in shared cells at the time of presumed exposure, exposure to a vaccinated cellmate was associated with a 38% (95% CI: 0.37, 1.04) lower hazard rate of PCR-confirmed infection over the study period. In this outbreak involving the Alpha SARS-CoV-2 variant, vaccination conferred direct and possibly indirect protection against SARS-CoV-2 infection and symptomatic COVID-19. Our results support the importance of vaccine uptake in mitigating outbreaks and severe disease in the prison setting and the consideration of community vaccination levels in policy and infection response. [ABSTRACT FROM AUTHOR]

• Prior research has reported high COVID-19 vaccine hesitancy among people who inject drugs. • COVID-19 vaccine uptake among this sample (84%) was high. • However, it is lower than Australian population coverage estimates at the same time. • Unstable housing was associated with lower odds of receiving vaccination. • Those in COVID-19 risk groups had higher odds of receiving a booster dose. Previous studies have reported high COVID-19 vaccine hesitancy among people who inject drugs. We aimed to examine COVID-19 vaccine coverage, motivations and barriers to vaccination, and factors associated with uptake among this population in Australia, 1.5 years after vaccine rollout commenced. In June-July 2022, 868 people (66.0 % male, mean age 45.6 years) who regularly inject drugs and reside in an Australian capital city reported the number of COVID-19 vaccine doses they had received and their primary motivation (if vaccinated) or barrier (if unvaccinated) to receive the vaccine. We compared vaccine uptake to Australian population estimates and used logistic regression to identify factors associated with ≥ 2 dose and ≥ 3 dose uptake. Overall, 84.1 % (n = 730) had received at least one COVID-19 vaccine dose, 79.6 % (n = 691) had received ≥ 2 doses, and 46.1 % (n = 400) had received ≥ 3 doses. Participants were less likely to be vaccinated than the Australian general population (prevalence ratio: 0.82, 95 % confidence interval [CI]: 0.76–0.88). Key motivations to receive the vaccine were to protect oneself or others from COVID-19, while barriers pertained to vaccine or government distrust. Opioid agonist treatment (adjusted odds ratio [aOR]: 2.49, 95 % CI: 1.44–4.42), current seasonal influenza vaccine uptake (aOR: 6.76, 95 % CI: 3.18–16.75), and stable housing (aOR: 1.58, 95 % CI: 1.02–2.80) were associated with receipt of at least two vaccine doses. Participants aged ≥ 40 years (versus < 40 years; aOR: 1.66, 95 % CI: 1.10–2.53) or who reported a chronic health condition (aOR: 1.71, 95 % CI: 1.18–2.47) had higher odds of receiving at least three vaccine doses. We observed higher COVID-19 vaccine uptake than expected given previous studies of vaccine acceptability among people who inject drugs. However, it was lower than the general population. People who inject drugs and reside in unstable housing are a subpopulation that require support to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

• Using longitudinal vaccination hesitancy and uptake data in the ALSPAC population. • Lower agreeableness was associated with vaccine hesitancy and uptake refusal. • Lower openness was associated with vaccine hesitancy and uptake refusal. • Lower cognitive ability was associated with vaccine hesitancy and uptake refusal. • Provides evidence of attitude/behaviour link in vaccination. Vaccines reduce the severity of symptoms, and risk of hospitalisation and death from infectious diseases. Yet, vaccination hesitancy persists. Research identifying psychological risk factors for vaccination hesitancy is limited and reports conflicting results. This study sought to address these inconsistencies and explore the role of personality and cognitive ability in COVID-19 vaccination hesitancy and uptake in a prospective cohort study. Data came from young adults (Generation-1; G1) and their mothers (Generation-0; G0) in the Avon Longitudinal Study of Parents and Children (ALSPAC). Multinomial logistic regressions, adjusting for several sociodemographic confounders, were used to explore whether personality and cognitive ability were associated with COVID-19 vaccination hesitancy and uptake. 4,960 G1 and 4,853 G0 mothers were included in the study population. Among G1, 38.4% exhibited vaccination hesitancy, yet 91.9% of the cohort received the vaccine. In adjusted models, higher levels of openness, agreeableness, conscientiousness, and cognitive ability were associated with an increased probability of wanting the vaccine. Similarly, higher levels of agreeableness, openness and cognitive ability were associated with an increased probability of vaccination uptake. However, the evidence of associations with vaccine uptake were generally weaker than with vaccination hesitancy. 56.7% of the offspring who did not want the vaccine either received the vaccine or intended to, whilst 43.3% still had no intention. Among G0 mothers, 25.6% were vaccination hesitant, yet 99.0% of the cohort received the vaccine. 3.1% said they did not want the vaccine; approximately 80% of these either received the vaccine or intended to. We found inconclusive evidence for an association between cognitive ability and vaccination hesitancy among G0 mothers. This study identified psychological factors associated with vaccination hesitancy and uptake. If these associations are causal, these findings may help design more effective vaccination hesitancy interventions. [ABSTRACT FROM AUTHOR]

• Past vaccination experiences influenced participants' vaccine uptake decisions. • Settlement support services promote vaccine uptake and trust in health care providers (HCPs). • Participants called for clear, dialogic vaccination information from HCPs. • Without HCP information, participants relied on community members for information. • At times community members contributed to vaccine hesitancy and distrust in HCPs. Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy. [ABSTRACT FROM AUTHOR]

Low rates of COVID-19 vaccination remain a substantial public health challenge. Despite early successes, vaccinations of Alaskans trail the US average, drawing attention to the need for better-designed and targeted vaccine confidence interventions. Our objective was to assess levels of community trust and theory-driven predictors of vaccination status to inform the design of future programs. We conducted a cross-sectional, telephone-based survey of 940 Alaskan adults between May and June 2022. Data were collected on vaccination status (including initial vaccination and receipt of booster shots), trust in local community members, demographic characteristics, and thematic questions designed using the Capability, Opportunity, Motivation - Behavior (COM-B) model to examine possible predictors (barriers/facilitators) of vaccination status. Among those who are not fully vaccinated and boosted, we observe significantly lower trust placed in many immediate community members, especially health workers (e.g., doctors, nurses, specialty care physicians, health administrators). Firefighters and emergency medical technicians enjoy the most community trust, followed by medical professionals. Among those who received only a primary vaccine series, we find that perceptions of whether close friends are vaccinated , a sense of professional responsibility , and age were the strongest predictors vaccination status. Among the unvaccinated, we find significant predictive power from the same variables, as well as perceptions of whether family members are vaccinated , perceived risks from non-vaccination and whether vaccination is a healthy choice. These findings will help inform the design and targeting of future vaccine promotion interventions to adult populations in Alaska. Interventions that leverage reflective motivation and social opportunity domains of the COM-B framework may be most effective. Local community members including firefighters and emergency medical technicians, as well as medical professionals may be perceived as the most trustworthy and influential messengers among those who are not fully vaccinated and boosted. [ABSTRACT FROM AUTHOR]

Varicella (chickenpox) is a highly contagious disease caused by the varicella-zoster virus. Although typically mild, varicella can cause complications leading to severe illness and even death. Safe and effective varicella vaccines are available. The Joint Committee on Vaccination and Immunisation has reviewed the evidence and recommended the introduction of varicella vaccine into the UK's routine childhood immunisation schedule. To explore UK healthcare professionals' (HCPs) knowledge and attitudes towards varicella vaccination, its introduction to the UK routine childhood immunisation schedule, and their preferences for how it should be delivered. We conducted an online cross-sectional survey exploring HCPs' attitudes towards varicella, varicella vaccine, and their preferences for delivery of the vaccine between August and September 2022 prior to the recommendation that varicella vaccine should be introduced. 91 HCPs working in the UK (81 % nurses/health visitors, 9 % doctors, 10 % researcher/other, mean age 48.7 years). All respondents agreed or strongly agreed that vaccines are important for a child's health. However, only 58% agreed or strongly agreed that chicken pox was a disease serious enough to warrant vaccination. Gaps in knowledge about varicella were revealed: 21.0% of respondents disagreed or were unsure that chickenpox can cause serious complications, while 41.8% were unsure or did not believe chickenpox was serious enough to vaccinate against. After receiving some basic information about chickenpox and the vaccine, almost half of the HCPs (47.3%) in our survey would prefer to administer the varicella vaccine combined with MMR. Given the positive influence of HCPs on parents' decisions to vaccinate their children, it is important to understand HCPs' views regarding the introduction of varicella vaccine into the routine schedule. Our findings highlighted areas for training and HCPs' preferences which will have implications for policy and practice when the vaccine is introduced. [ABSTRACT FROM AUTHOR]

• We present VaxConcerns, a new taxonomy for vaccine concerns and misinformation. • There is high agreement among annotators using VaxConcerns. • Data annotated using VaxConcerns can be used for machine learning. • Proof-of-concept study shows ability to track changes in vaccine concerns. We present VaxConcerns, a taxonomy for vaccine concerns and misinformation. VaxConcerns is an easy-to-teach taxonomy of concerns and misinformation commonly found among online anti-vaccination media and is evaluated to produce high-quality data annotations among crowdsource workers, opening the potential adoption of the framework far beyond just academic or medical communities. The taxonomy shows high agreement among experts and outperforms existing taxonomies for vaccine concerns and misinformation when presented to non-expert users. Our proof-of-concept study on the changes in anti-vaccination content during the COVID-19 pandemic indicate impactful future use cases, such as longitudinal studies of the shift in vaccine concerns over time. [ABSTRACT FROM AUTHOR]

• Vaccination was positively associated with Twitter use among adults. • Vaccination was positively associated with Instagram use among adults. • Among hesitant adults, vaccination was positively associated with TikTok use. • Among hesitant adults, vaccination was positively associated with Twitter use. • Among hesitant adults, vaccination was positively associated with Instagram use. The near-ubiquitous use of social media in the United States (U.S.) highlights the utility of social media for encouraging vaccination. Vaccination campaigns have used social media to reach audiences, yet research linking the use of specific social media platforms and vaccination uptake is nascent. This descriptive study assesses differences in social media use by COVID-19 vaccination status among adults overall and those who reported baseline vaccine hesitancy. We used data from a nationally representative longitudinal survey of U.S. adults administered between January 2021–August 2022 (n = 2,908). Results indicated a positive association between frequent Instagram and/or Twitter use and vaccination status (p <.05). Among baseline vaccine hesitant adults, results indicated a positive association between frequent TikTok, Instagram, and/or Twitter use and vaccination status (p <.05). Findings have implications for research that examines the content of social media platforms and their environment on vaccine attitudes and uptake. [ABSTRACT FROM AUTHOR]