Zika virus knowledge,attitudes, and vaccine interest among university students

BackgroundZika virus vaccine development is underway. We examined interest in receiving a Zika virus vaccine (after one becomes commercially available) among students at a large public university in Northern Virginia.MethodsAn online survey of Zika virus-related knowledge, attitudes, and interest in receiving a Zika vaccine was completed by 619 undergraduate students in April, 2016. Stepwise logistic regression with backward elimination was used to identify the variables most strongly associated with interest in being vaccinated against Zika virus.ResultsMore than half of participants (52.8%) reported that they would be likely or very likely to be vaccinated against Zika virus. Vaccination interest was significantly higher among participants who received an influenza vaccine in the past year (p = 0.002), had higher levels of knowledge about Zika virus (p = 0.046), reported knowing where to access information about Zika virus (p = 0.041), had higher perceived susceptibility to Zika virus (p < 0.001), and believed that the U.S. Government should prioritize actions to control Zika virus (p = 0.001).ConclusionsCommunication and intervention strategies encouraging vaccine uptake may benefit from increasing knowledge of Zika virus, addressing perceived susceptibility, and reaching students, travelers, and others who may be seeking information about prevention of Zika virus and other emerging infectious diseases.     

University Students’ Knowledge,Attitudes, and Sources of Information About Zika Virus

Colleges and universities are valuable partners for community health education outreach targeted to young adults. After the outbreak of Zika virus infection in the Americas was declared to be a Public Health Emergency of International Concern on February 1, 2016, postsecondary institutions played an important role in educating at-risk communities about health promotion and disease prevention strategies. In April 2016, we recruited 613 undergraduate students from a large public university to complete a survey about their Zika-related knowledge, attitudes, and information seeking behaviors. We standardized the results so that the participants’ reports would be representative of the age, sex, major (course of study), and other characteristics of the university’s student population. Most students knew that Zika virus is spread by mosquitoes (88.1%), but only about half knew that the virus could be transmitted through sexual intercourse (56.8%). Students perceived Zika to be a health risk for pregnant women in Zika-affected countries (83.0%), but did not personally feel at risk (12.1%). Many students (43.8%) reported not knowing where to get accurate information about Zika. Identifying gaps in scientific knowledge, misperceptions about personal susceptibility, and opportunities for behavioral risk reduction is an important foundation for designing community-based health interventions when future emerging infectious disease events occur.     

U.S. pregnant women’s knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition

IntroductionZika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women’s attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae.MethodsPregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination.ResultsMost women (91%) were married/living with the baby’s father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated.ConclusionsPregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.     

Risk society online: Zika virus,social media and distrust in the Centers for Disease Control and Prevention

While social construction of illness research has examined the redefinition of medically defined illness as non‐illness by laypersons, nothing has considered this process alongside emerging infectious diseases (EIDs). Using Gidden's notion of modern risk society and distrust in expert authority, this paper examines how social media posts construct Zika virus as nonhazardous while displaying a distrust in research and prevention. Using qualitative content analysis, we examine 801 posts on the Centers for Disease Control and Prevention's (CDC) Facebook page to highlight the interplay between risk, the social construction of Zika and trust in experts. Three themes are discussed, including Zika: (i) as legitimate public health threat; (ii) as product of CDC corruption and (iii) used to question medical expertise. We find the latter two themes supportive of Gidden's focus on risk and distrust in expert authority and discuss the danger of constructing EIDs as products of corrupt expert authority on public health social media platforms.     

Social norms and vaccine uptake: College students’ COVID vaccination intentions,attitudes, and estimated peer norms and comparisons with influenza vaccine

BackgroundVaccination may be critical to curtailing the spread of the SARS-CoV-2 virus responsible for the COVID-19 pandemic, but herd immunity can only be realized with high vaccination coverage. There is a need to identify empirically supported strategies to increase uptake, especially among young adults as this subpopulation has shown relatively poor adherence to physical distancing guidelines. Social norms – estimates of peers’ behavior and attitudes – are robust predictors of health behaviors and norms-based intervention strategies may increase COVID vaccine uptake, once available. This study examined the extent that vaccination intentions and attitudes were associated with estimated social norms as an initial proof-of-concept test.MethodIn November of 2020, 647 undergraduate students (46.21% response rate) completed online surveys in which they reported intentions to get COVID and influenza vaccines, perceived importance of these vaccines for young adults, and estimated social norms regarding peers’ vaccination behaviors and attitudes.ResultsStudents reported significantly greater intentions to get a COVID vaccine (91.64%) than an influenza vaccine (76.04%), and perceived COVID vaccination as significantly more important than influenza vaccination. The sample generally held strong intentions to receive a COVID vaccine and thought that doing so was of high importance, but participants, on average, perceived that other young adults would be less likely to be vaccinated and would not think vaccination was as important. Multiple regression models indicated that estimated social norms were positively associated with participants’ own intentions and perceived importance of getting a COVID vaccine.ConclusionsThese significant associations highlight the potential value in developing and testing norms-based intervention strategies, such as personalized normative feedback, to improve uptake of forthcoming COVID vaccines among young adults.     

Pregnant women’s attitudes toward Zika virus vaccine trial participation

IntroductionAs Zika virus infection during pregnancy can cause a range of congenital anomalies, pregnant women may be a target population for vaccination in future outbreaks. Their inclusion in vaccine trials is critical to ensure safe and effective vaccines in pregnancy. Though many vaccine candidates are in development, pregnant women’s willingness to participate in Zika virus vaccine research is unknown. This study aims to describe pregnant women’s attitudes toward Zika virus vaccine research participation, as well as perceived barriers to and facilitators of enrollment.MethodsPregnant and recently postpartum women (n = 128) attending prenatal care at Massachusetts General Hospital completed surveys querying their willingness to participate in four hypothetical Zika virus vaccine trials and their motivations for participation. Demographics, information on prior Zika virus exposure, and vaccine acceptance were collected.ResultsMost women (77%) accepted participation in at least one hypothetical Zika virus vaccine trial, and women were significantly more likely to accept prospective enrollment in an inactivated vaccine trial compared to a live-attenuated vaccine trial (p-value <0.0001) or a nucleic acid-based vaccine trial (p-value <0.0444). Important motivators for participation included evidence from research with pregnant and non-pregnant people, a desire to protect the baby from Zika, perceptions of vaccine safety, and provider recommendation.ConclusionsA majority of women in this cohort were willing to participate in a Zika virus vaccine trial while pregnant, however, differences in acceptance exist between vaccine platforms. The high value placed on evidence by participants highlights the importance of gathering and communicating pregnancy-specific data to potential research participants and their providers. Women’s motivations for accepting research participation during pregnancy are important to inform the Zika virus vaccine research agenda, candidate prioritization, and trial design.     

Social and behavioral determinants of attitudes towards and practices of hepatitis B vaccine birth dose in Vietnam

BackgroundHepatitis B virus (HBV) infection is a significant public health issue in Vietnam. Our goal was to understand the determinants of attitudes towards and practices of hepatitis B vaccine birth dose (HepB-BD) in certain regions of Vietnam.MethodA rapid qualitative assessment was conducted in three geographically diverse provinces that reported low coverage (<50%) of HepB-BD. Using purposive sampling of participants, 29 focus group discussions and 20 in-depth interviews were held with caregivers (n = 96), healthcare providers (n = 75), and healthcare administrators (n = 16). Summary notes from these were translated, and inductive coding was used to derive themes. The SAGE Vaccine Hesitancy Determinants Matrix was used as a theoretical framework to organize barriers and facilitators associated with the themes into three levels of influence.ResultsAt the individual and group level, caregivers who had higher levels of knowledge about HepB-BD sought the vaccine proactively, while others with lower knowledge faced barriers to the vaccine. Some caregivers reported a negative attitude toward health services because of a language barrier or had generalized concerns about HepB-BD due to media reporting of the past adverse events. Distress arising from potential adverse events was equally common among healthcare providers. At the contextual level, the physical environment made it difficult for caregivers to access healthcare facilities and for providers to conduct outreach. Home births posed a challenge for timely administration of HepB-BD, while health facility births facilitated it. Vaccination-specific barriers included misinterpretation of pre-vaccination screening criteria and asking for the consent of caregivers. Inadequate resources for service delivery negatively influenced HepB-BD attitudes and practices.ConclusionGiven the diversity of barriers associated with attitudes towards and practices of HepB-BD in the three provinces, tailored interventions will be necessary for both demand- and supply-side factors. Rural areas, often with more home births and geographic barriers, may require focused attention.     

The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study

BackgroundThe ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers.ObjectiveThis study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported.MethodsA total of 340,783 vaccine-related posts were captured with the poster’s information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine.ResultsThe positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7% to 77.0% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region.ConclusionsIn China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance.     

The Effects of News Coverage of Epidemics on Public Support for and Compliance with the CDC– An Experimental Study

Content analysis identified three dominant themes used by the news media to cover epidemics: the scientific, the pandemic, and the social. This study uses a randomized experimental design to test the effects of common news coverage patterns of epidemics on perceptions of efficacy, certainty, and trust in the CDC, and subsequently on intentions to comply with and support for the CDC during public health crises. The experiment also compares the effects of real-world coverage to that of hypothetical coverage that more closely follows the CDC’s recommendations for crisis communication. The results of the experiment (n = 321) demonstrate that exposure to articles from different themes affects perceptions of certainty and self-efficacy, that in turn affect intentions to comply with the CDC. Although organizational-efficacy and trust in the CDC are both correlated with intentions to support, and trust is also correlated with intentions to comply, exposure to different conditions did not affect these perceptions and there was no indirect effect from exposure to intentions. The results reveal the potential effects of real-world coverage on perceptions and intentions, and demonstrate the advantage of the hypothetical coverage that follows the CDC’s crisis communication guidelines. Implications for public health organizations and communicators are discussed.     

Performing purity: reproductive decision-making and implications for a community under threat of zika in iquitos,Peru

The long-term management and prevention of Zika virus requires understanding of reproductive and sexual health behaviours, including mechanisms of partnered decision-making. In this article, we report on a qualitative study conducted before the arrival of Zika in Iquitos, Peru. We assessed existing patterns of reproductive decision-making among partnered men and women in a community under threat of Zika and discuss how these may impact Zika prevention in the long-term. We used a rapid qualitative assessment methodology, including in-depth semi-structured interviews with partnered women (28) and men (21). Deeply unequal gender role expectations limit discussion of reproductive decisions until after a first child is born. Women needed to perform a domestic ‘of-the-house’ role to be considered suitable partners, leading them to hide their knowledge of sexual and reproductive health. Condoms symbolise risk and are unused with partners in committed relationships. A shared perception that men must take care of female partner’s sexual health, translates into male sexual and reproductive preferences overcoming female desires. Existing decision-making patterns lead to an increased risk of Zika exposure. Long-term response should expand Zika virus information and preventive messages to men and young people, in addition to engaging with broader societal challenges to gender inequity.     

Zika Virus and Zika Virus Disease

During recent months, there has been growing international public concern about the Zika virus. As scientific understanding of the Zika virus unfolds, there are still many unanswered questions. Public health officials, clinicians, and consumers alike have questions about the Zika virus and the Zika virus disease. There is a need to know where to turn for the most up-to-date and reliable online information sources. Although aspects of Zika virus disease and associated medical conditions can be frightening, information seekers may find reassurance in the following online sources to guide their understanding of risk, prevention, transmission, affected geographical areas, symptoms, and disease management.     

Prevention of Zika virus infection: Knowledge,attitudes, and practices of pregnant women in Korea

Abstract

This study was performed to investigate the association of knowledge, attitudes, and preventive practices for the prevention of Zika virus infection. The study sample consisted of 185 pregnant women in Korea. The Zika virus-related knowledge and attitude of pregnant women significantly affected preventive practices. The younger pregnant women and pregnant women who had not taken the influenza vaccine had lesser preventive practices of the Zika virus, thereby necessitating educating them and emphasizing good preventive practices. Our results suggest that systematic education and effective prevention programs for Zika virus will contribute to the prevention of infection.     

COVID-19 vaccination attitudes,values and intentions among United States adults prior to emergency use authorization

IntroductionSafe and effective vaccines against Coronavirus Disease 2019 (COVID-19) provide the best opportunity to control the pandemic. Having safe and efficacious vaccines available is only half the equation; people must also take them. We describe a study to identify COVID-19 vaccine attitudes, values and intentions immediately preceding authorization of COVID-19 vaccines in the US.MethodsA national panel survey was conducted to measure intent to receive COVID-19 vaccines as well as disease and vaccine attitudes, values and trust in local, state and federal public health authorities.ResultsGreater than 80% of respondents reported confidence they could adhere to COVID recommendations such as mask wearing, social distancing and hand washing. The majority of respondents (70%) reported believing that current drugs were somewhat or very good at treating COVID-19 infection.Vaccine intent fell into three groups: Intenders (50%), Wait and Learn (40%), and Unlikelys (10%). Intent to get vaccinated was substantially lower among African American (32%), and higher among men (56%), those over 60 years of age (61%), those with a Bachelor’s degree or higher (63%), and Democrats (63%). The Wait and Learn group, compared to the Intenders, were less likely to report being diagnosed with a high risk condition for COVID-19, receiving an influenza vaccine in the past 12 months, discussing COVID-19 vaccine with their healthcare provider, perceiving COVID-19 as severe, considering a COVID-19 vaccine important to stop the spread of infection, and wering a mask usually or almost always.ConclusionOnly half of US adults intend to accept COVID-19 vaccines; most others (40%) are uncertain. Levels of immunity associated with community protection will not be achieved without reaching those who are currently uncertain. Characterizing COVID-19 vaccine attitudes and intentions and ascertaining values and trust in local, state, and federal public health authorities that impact vaccine decision-making are essential.     

Zika: the origin and spread of a mosquito-borne virus

ObjectiveTo describe the temporal and geographical distribution of Zika virus infection and associated neurological disorders, from 1947 to 1 February 2016, when Zika became a Public Health Emergency of International Concern (PHEIC).MethodsWe did a literature search using the terms “Zika” and “ZIKV” in PubMed, cross-checked the findings for completeness against other published reviews and added formal notifications to WHO submitted under the International Health Regulations.FindingsFrom the discovery of Zika virus in Uganda in 1947 to the declaration of a PHEIC by the World Health Organization (WHO) on 1 February 2016, a total of 74 countries and territories had reported human Zika virus infections. The timeline in this paper charts the discovery of the virus (1947), its isolation from mosquitos (1948), the first human infection (1952), the initial spread of infection from Asia to a Pacific island (2007), the first known instance of sexual transmission (2008), reports of Guillain-Barré syndrome (2014) and microcephaly (2015) linked to Zika infections and the first appearance of Zika in the Americas (from 2015).ConclusionZika virus infection in humans appears to have changed in character as its geographical range has expanded from equatorial Africa and Asia. The change is from an endemic, mosquito-borne infection causing mild illness to one that can cause large outbreaks linked with neurological sequelae and congenital abnormalities.     

中国大陆首例输入性寨卡病毒病病例调查分析

目的 分析2016年2月9日中国大陆首例确诊寨卡病毒病病例的流行病学特征,为防控寨卡病毒病提供参考依据。方法 对中国大陆首例确诊寨卡病毒病病例进行流行病学调查并临床观察病例同行者与接触者。采集病例血清、尿液等标本,应用荧光定量RT-PCR进行核酸检测。结果 该病例确诊为寨卡病毒病,于第18病日解除隔离、痊愈出院。病例第10病日血清标本和第11~13病日尿液标本检测均为寨卡病毒核酸阳性。该病例系江西省赣县籍外派工作回国人员,发病前在寨卡病毒流行地区有蚊虫叮咬史,同行者与接触者医学观察期内均未出现寨卡病毒病症状。结论 该病例为中国大陆首例寨卡病毒感染确诊病例,系境外输入性病例,感染来源与在寨卡疫源地委内瑞拉蚊虫叮咬有关。     

Evaluación del riesgo de transmisión autóctona del virus Zika y otras enfermedades virales emergentes transmitidas por mosquitos en Cataluña

The recent Zika virus epidemic has highlighted the potential risk of introducing the arbovirosis to Europe, especially within the Mediterranean region where the vector, Aedes albopictus, has become established as an invasive species. In this context, a comprehensive evaluation of the risk of introducing the Zika virus and other mosquito-borne viruses of public health importance in Catalonia (Spain) was carried out. This article summarises the results of the preliminary assessment and the recommendations for the public health preparedness and response plan against the threat posed by these emerging diseases.     

Twitter vs. Zika—The role of social media in epidemic outbreaks surveillance

ObjectiveThe risk of global epidemic outbreaks led to the development of epidemic tracking services dedicated to track and warn against them. Despite the usefulness of these services, they suffer from shortcomings that impact their efficiency. This study examines the efficacy of social media in epidemic outbreak surveillance by studying Twitter users’ behavior related to the Zika virus outbreak in 2015–2016 and how this behavior can be used to track and predict Zika virus.MethodsWe collected 67,000 tweets in English and Spanish under the hashtag #Zikavirus and #Zika in the period from October 1st^, 2015 to February 25th, 2016. We examined the tweets using text analytics techniques and extracted the important concepts. We analyzed the differences in using these concepts from one month to another.ResultsThere are significant differences between the numbers of tweets during the Zika outbreak as well as between the concepts used in English and Spanish tweets.DiscussionThe differences in Zika epidemic related tweets evolved with the epidemic outbreak and reflected the different stages of the epidemic. However, those differences also reflected a digital divide between developed and developing communities. The number of tweets was related to the threatened community rather than the severity of the threat.ConclusionWhile Twitter can be used to augment current epidemic tracking systems, it cannot replace them. We identified digital divide and threat of misleading information as two factors that limit the dependence on Twitter as an epidemic tracking system.     

Attitudes towards mandatory vaccination and sanctions for vaccination refusal

AimsInvestigating attitudes towards mandatory vaccination and sanctions for vaccination refusal in an area with insufficient vaccination coverage may help health authorities to assess which strategies for increasing vaccination coverage are appropriate. This study examines attitudes to vaccine mandates and asks questions regarding what kinds of sanctions could legitimately result from vaccination refusal. It seeks to find out if people’s attitudes towards mandates and towards sanctions for vaccination refusal are related to their attitudes to vaccines and the degree of trust they feel towards health care professionals and health care authorities. The study also discusses how the observed attitudes towards mandates may be related to perceptions of autonomy, responsibility, and equitability.MethodsData collection was carried out in Finland through an online survey in a region with suboptimal vaccine uptake. Statistical analysis was conducted on a sample of 1101 respondents, using confirmatory factor analysis and structural regression analysis.ResultsPersons hold different views on mandates and sanctions. Importantly, the persons who support vaccination mandates and sanctions for vaccination refusal are to a great degree the same people who have positive attitudes to vaccines and high trust in health care professionals and health authorities.ConclusionTrust is a key factor which has a bearing on people’s attitudes towards mandates and sanctions for noncompliance. A focus on the reasons for lack of trust, and on how to enhance trust, is a more feasible long-term way (than mandates) to promote large- scale compliance with childhood vaccine programmes in the studied country context.     

A Literature Review of Zika Virus

Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus’s vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.