COVID-19 vaccine hesitancy among Israeli adults before and after vaccines’ availability: A cross-sectional national survey

Vaccine hesitancy (VH) is a major health threat to the efforts to tackle COVID-19 morbidity and mortality. This study’s objectives were to assess COVID-19 VH before and after vaccines' availability and to analyze the associations between COVID-19 VH and participants’ characteristics.A national cross-sectional telephone interview survey among Israeli adults aged 21 and older was conducted from September 2020 through May 2021. Attitudes towards COVID-19 vaccines were assessed pre/post vaccines' availability. Multivariate logistic regression analyses were used to identify associations between demographic and health-related characteristics and COVID-19 VH.Most study participants (72.0 % of 2,998) were willing to be vaccinated against COVID-19 across the survey period. The COVID-19 VH declined significantly from 45.6 % pre-vaccine availability to 16.3 % post-vaccine availability (P < 0.001). The multivariable analysis demonstrated that post-vaccine availability, COVID-19 VH was associated with younger age, Arab ethnicity, higher level of religiosity, lower education, past diagnosis of COVID-19, and influenza VH. The main reasons for VH after the vaccine availability included insufficient data on the vaccine (37.4 %) and fear of the vaccine's side effects (33.8 %).Despite the significant decrease in COVID-19 VH following vaccine availability, 16.3% of the population still refuses to get vaccinated. As Israel may face additional waves of the COVID-19 pandemic and booster vaccinations, multimedia vaccine promotions targeting the above-mentioned hesitant populations and their reasons for VH are urgently needed.     

Dengue severity in the elderly in Puerto Rico.

OBJECTIVE: Severe dengue affects all age groups in the Americas, but little detailed information is available about this disease in the elderly. The objective of this article is to describe the disease in this age group. METHODS: We reviewed suspected dengue-case investigation forms submitted with diagnostic samples as well as clinical reports from infection control nurses in Puerto Rico, for the period of 1994 through 1999. RESULTS: We assigned the laboratory-positive case-patients to four age groups: infants (1 year: 554), youth (2 to 18 years: 6 857), adults (19 to 64 years: 9 433), and elderly (>/= 65 years: 822). Regardless of infecting serotype, the elderly were more likely to have been hospitalized (48% vs. 33%) (P < 0.01) and were less likely to show hemorrhage (26% vs. 33%) (P < 0.01). On multivariate analysis, controlling for gender and the presence of hemorrhage, the elderly had a higher risk for hospitalization and death than did the youths and the adults. CONCLUSIONS: The elderly appear to be more likely than youth and younger adults to develop severe illness when infected with the dengue virus, in a pattern similar to that of infants. The clinical evaluation of elderly patients with dengue must include a careful assessment of increased capillary permeability and occult hemorrhage in order to avoid complications from delayed identification and treatment of severe dengue infection. These findings are of increasing importance for dengue epidemiology and medical care in view of the expanding nature of dengue and dengue hemorrhagic fever in a world that also has a growing number and proportion of elderly persons.     

Estimating and Characterizing COVID-19 Deaths,Puerto Rico,March–July 2020

ObjectivesUsing the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)–associated confirmed and probable deaths in Puerto Rico during March–July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.MethodsWe described data on COVID-19–associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention’s National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.ResultsDuring March–July 2020, 225 COVID-19–associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19–associated deaths could have occurred during the study period, up to 413 more COVID-19–associated deaths than originally reported.ConclusionsIncluding probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19–associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.     

Variations in microbicide gel acceptability among young women in the USA and Puerto Rico

In a multi-site study of vaginal microbicide acceptability conducted with sexually active young women, quantitative assessments revealed significant differences in acceptability by site. Participants in Puerto Rico rated the gel more favourably than mainland US participants in terms of liking the gel and likelihood of future use. To explain these differences, we examined responses to qualitative behavioural assessments. Young women in mainland USA associated gel leakage with uncomfortable sensations experienced during menstruation, while young women in Puerto Rico had positive associations of gel use with douching. These negative or positive associations affected assessments of the gel's physical qualities. In addition, young women's perceptions of primary partners' support for microbicide use influenced sexual satisfaction with the gel and, ultimately, product acceptability. Finally, geographic HIV-risk context contributed to heightened HIV-risk perception, which influenced likelihood of future microbicide use, even for women in stated monogamous relationships. Future microbicide acceptability studies should take into account potential differences in acceptability by site such as HIV-risk perception based on local HIV prevalence, popularity of vaginal hygiene products in a specific area and male attitudes in different cultures concerning women's use of HIV protection strategies.     

NIH funding for vaccine readiness before the COVID-19 pandemic

Rapid development of vaccines for COVID-19 has relied on the application of existing vaccine technologies. This work examines the maturity of ten technologies employed in candidate vaccines (as of July 2020) and NIH funding for published research on these technologies from 2000–2019. These technologies vary from established platforms, which have been used successfully in approved products, to emerging technologies with no prior clinical validation. A robust body of published research on vaccine technologies was supported by 16,358 fiscal years of NIH funding totaling $17.2 billion from 2000–2019. During this period, NIH funding for published vaccine research against specific pandemic threats such as coronavirus, Zika, Ebola, and dengue was not sustained. NIH funding contributed substantially to the advance of technologies available for rapid development of COVID-19 vaccines, suggesting the importance of sustained public sector funding for foundational technologies in the rapid response to emerging public health threats.     

Analysis on the availability of programs and services for elderly people in Puerto Rico

This research was conducted with the purpose of analyzing the programs and services available to the aged population in the municipalities of Puerto Rico during 1999 and 2000. The analysis was performed using an evaluation instrument which collected data of the programs and services directed exclusively to the aged population, such as: senior centers, foster homes, institutions, independent living, employed and/or volunteer people, geriatric services, adult education (literacy), recreation, discounts, corporations and/or associations that benefit the aged population, aging offices, support groups, social services, home meal services, and financial aid. Data was also collected from programs and services that benefit diverse aged populations in areas such as: health, housing, employment and social welfare. The sources for the collection of data were directories available to government and private agencies, telephone directories, telephone interviews, and personal visits. The municipalities were divided into two zones, the Northern zone, constituted by 40 municipalities and the Southern zone, constituted by 38 municipalities, for a total of 78 evaluated municipalities. In the Northern region, which accounted to approximately 295,938 aged persons, 18 types of programs or services were found to serve the aged population directly and 50 types were aged-related programs or services. In the Southern region, which accounted for approximately 169,798 aged persons, 13 types of programs or services served the aged exclusively and 43 were aged-related services. The following were among the principal programs or services available: senior centers, foster homes and/or institutions, employment programs, home care services and hospices, independent living, and agricultural extension services. Among the least available programs or services were private home meal services, literacy and retraining, arts and travel services, corporations or associations for the benefit of the aged, geriatric evaluation programs, home repair services, home-assistance programs, support and respite programs, adequate or specialized transportation services, diverse housing models, different types of senior centers, and programs for psychological or psychiatric assistance. In conclusion, the availability of the programs and services in this study and the evaluation of the services needed for a community of aged persons indicate the need for increasing and developing services considered essential in accordance to the population demands.     

Immunogenicity of a third dose viral-vectored COVID-19 vaccine after receiving two-dose inactivated vaccines in healthy adults

In June 2021, Thailand was hit by the delta variant of SARS-CoV-2 resulting in the biggest wave of COVID-19. Due to the widespread delta variant, more than 600 healthcare workers had COVID-19 despite completion of two-dose CoronaVac. The Ministry of Public Health recommended that healthcare workers received a third dose of AZD1222 to increase level of protection against SARS-CoV-2. However, immune response after the AZD1222 booster in individuals who completed the two-dose CoronaVac vaccine are limited. In this study, sera from those who received a booster of AZD1222 in June-July 2021 were tested for SARS-CoV-2 spike receptor-binding-domain (RBD) IgG, anti-RBD total immunoglobulins and anti-spike protein 1 (S1) IgA. The neutralizing activities in a subset of serum samples were tested against the wild type and variants of concern (B.1.1.7, B.1.617.2, and B.1.351) using an enzyme-linked immunosorbent assay-based surrogate virus neutralization test. Participants who received the booster of AZD1222 possessed higher levels of spike RBD-specific IgG, total immunoglobulins, and anti-S1 IgA than the two-dose vaccinees (p < 0.001). They also elicited higher neutralizing activity against the wild type and all variants of concern than the recipients of the two-dose vaccines. This study demonstrated a high immunogenicity of the AZD1222 booster in individuals who completed the two-dose inactivated vaccines.     

新型冠状病毒肺炎疫苗上市前疫苗犹豫情况及相关影响因素研究

目的 了解新型冠状病毒肺炎(简称新冠肺炎)疫苗上市前的疫苗犹豫发生情况及相关影响因素,为在疫苗上市早期采取针对性的干预措施提供科学依据.方法 自行设计调查问卷并通过网络发放,比较疫苗犹豫者和接受者在社会人口学信息、对新冠肺炎的认知情况、对疫苗的一般性认知情况,以及信心、自满和便利性等维度的差异.采用单因素和多因素log...     

WHO guidance on COVID-19 vaccine trial designs in the context of authorized COVID-19 vaccines and expanding global access: Ethical considerations

While the degree of COVID-19 vaccine accessibility and uptake varies at both national and global levels, increasing vaccination coverage raises questions regarding the standard of prevention that ought to apply to different settings where COVID-19 vaccine trials are hosted. A WHO Expert Group has developed guidance on the ethical implications of conducting placebo-controlled trials in the context of expanding global COVID-19 vaccine coverage. The guidance also considers alternative trial designs to placebo controlled trials in the context of prototype vaccines, modified vaccines, and next generation vaccines.     

Educational status and coronary heart disease in Puerto Rico: the Puerto Rico Heart Health Program

The Puerto Rico Heart Health Program is an observational epidemiological study of coronary heart disease (CHD) among 9824 Puerto Rican men conducted from 1965 to 1980. Increased level of education was associated with decreased total mortality and increased CHD incidence among the urban participants. Urban men with more education, age 45-64, also showed higher levels of blood pressure and serum cholesterol, more obesity, less physical activity and more atherogenic diets. The increased level of risk factors among those with high education could statistically account for the elevations in CHD incidence. Among rural participants there was an increase in total mortality among those at the highest and lowest levels of education.     

COVID-19 vaccine hesitancy scale and its association with actual COVID-19 vaccine uptake in Israel

BackgroundThe public's willingness to get vaccinated continues to be a source of concern. In this study we assessed the psychometric properties of the COVID-19 vaccine hesitancy scale (C19-VHS) as well as the association between the scale and self-reported past COVID-19 vaccination, approximately two weeks after the national vaccine distribution plan was launched in Israel.MethodsParticipants were recruited via an online survey distributed through social media platforms and mailing lists. A total of 650 individuals completed the C19-VHS, the general vaccine hesitancy scale, and the fear of COVID-19 scale, and reported on demographic and pandemic-related characteristics. Principal component and Cronbach’s alpha analyses were performed to assess the factor structure and reliability of the scale. Logistic regressions were employed to assess the scale’s convergent and discriminative validity.ResultsTwo factors pertaining to “lack of confidence” (Factor 1) and “risk perception” (Factor 2) emerged. Cronbach’s alpha indicated good reliability of Factor 1 (0.93), with lower reliability of Factor 2 (0.72). Younger age was associated with higher risk perception, with women showing less confidence and perceiving greater risks. Lower hesitancy significantly predicted actual COVID-19 vaccine uptake after adjusting for demographic and pandemic-related factors (OR = 1.16, 95%CI 1.11–1.21, p <.001). Older age, being a woman, and receiving the flu vaccine in the past year were also predictive of COVID-19 vaccine uptake.DiscussionThe C19-VHS measure shows robust psychometric properties and is associated with actual vaccine uptake. Future studies assessing COVID-19 vaccination attitudes may utilize this scale to assess current COVID-19 vaccine hesitancy in different contexts and cultures.     

Fertility and contraception in Puerto Rico

A contraceptive service was established in Puerto Rico in 1937. Detailed study of the reproductive history of low income families admitted to the service provides information for the basis of the present high fertility of the population and the likelihood of its continuance. The experience of these families following admission to the contraceptive service shows the impact of the service upon their fertility, testing the view that Puerto Rico might respond to an organized birth control effort. The sample consisted of 1962 families selected not randomly but on the basis of indigence and interest in contraceptive advice. 1/3 of the couples reported some previous effort at contraception, with most of the contraceptive practice depending on withdrawal. Residence, education, occupation, and income are all associated with the marked variation in the proportions who reported contraceptive experience. The percentages are 26 and 52 for rural and urban residence; 21, 27, 44, and 59 for the educational groupings with less than 5 to 7 and 8 or more completed grades. For the low, medium, and high occupational groups, the percentages are 20, 45, and 69, and for the corresponding income classes they are 22, 42, and 66. Women aged 25 to 29 and 30 to 34 report contraceptive practice with much greater relative frequency than younger women. Clearly marked differences are found in the rates for contraceptors of different social and economic classes. Although the reason for high fertility in Puerto Rico is due to lack of cultural and economic pressure to limit families, there is evidence to suggest that use of birth control has begun. It appears that fertility reduction would be implemented if the population possessed better knowledge of birth control measures and readier access to contraceptive materials, particularly condoms. A clinical program to encourage the use of contraception might also prove effective.     

新冠疫情前后南通市流感流行态势分析

目的分析新型冠状病毒病(COVID-19)疫情暴发前后，流感病原学监测结果的差异，为COVID-19下的流感防控提供科学依据。 方法收集南通市第一人民医院COVID-19暴发前(2018、2019年)及暴发后(2020、2021年)的流感样患者咽拭子进行核酸检测，采用RT-PCR法，运用描述流行病学方法比较COVID-19暴发前后流感病原体流行特征。 结果COVID-19暴发前后共采集标本4 181例，流感病毒核酸检测阳性405例，阳性率9.69%，前后阳性检出率差异有统计学意义(χ²＝91.65，P<0.001)；COVID-19前后流感均以冬春季流行为主，COVID-19后各季节阳性率均有下降；COVID-19后不同性别阳性检出率差异有统计学意义(χ²＝6.60，P<0.05)；COVID-19前后各年龄组除5~14岁组差异无统计学意义(χ²＝2.21，P>0.05)，其他组差异均有统计学意义(P<0.001)；COVID-19前以各型别流感交替传播，COVID-19后以BV型为主。 结论COVID-19严格管控措施有效遏制了流感病毒的传播，流感病毒阳性率和型别检出率明显下降，COVID-19流行期间要重点关注BV型别的流感及在校学生的流感传播。     

Misinformation and COVID-19 vaccine hesitancy

BackgroundCOVID-19 vaccine hesitancy has emerged as a major public health challenge. Although medical and scientific misinformation has been known to fuel vaccine hesitancy in the past, misinformation surrounding COVID-19 seems to be rampant, and increasing evidence suggests that it is contributing to COVID-19 vaccine hesitancy today. The relationship between misinformation and COVID-19 vaccine hesitancy is complex, however, and it is relatively understudied.MethodsIn this article, we report qualitative data from two related but distinct studies from a larger project. Study 1 included semi-structured, open-ended interviews conducted in October–November 2020 via phone with 30 participants to investigate the relationship between misinformation and COVID-19 vaccine hesitancy. Study 1′s results then informed the design of open-ended questions for Study 2, an online survey conducted in May–June 2021 to consider the relationship between misinformation and vaccine hesitancy further. The data were examined with thematic analysis.ResultsStudy 1 led to the identification of positive and negative themes related to attitudes toward COVID-19 vaccines. In Study 2, responses from vaccine-hesitant participants included six categories of misinformation: medical, scientific, political, media, religious, and technological. Across both Study 1 and Study 2, six vaccine hesitancy themes were identified from the data: concerns about the vaccines’ future effects, doubts about the vaccines’ effectiveness, commercial profiteering, preference for natural immunity, personal freedom, and COVID-19 denial.ConclusionsThe relationship between misinformation and vaccine hesitancy is complicated. Various types of misinformation exist, with each related to a specific type of vaccine hesitancy-related attitude. Personal freedom and COVID-19 denial are vaccine attitudes of particular interest, representing important yet understudied phenomena. Medical and scientific approaches may not be sufficient to combat misinformation based in religion, media, or politics; and public health officials may benefit from partnering with experts from those fields to address harmful misinformation that is driving COVID-19 vaccine hesitancy.     

COVID-19 vaccine preferences in India

India’s mass vaccination efforts have been slow due to high levels of vaccine hesitancy. This study uses data from an online discrete choice experiment with 1371 respondents to rigorously examine the factors shaping vaccine preference in the country. We find that vaccine efficacy, presence of side effects, protection duration, distance to vaccination centre and vaccination rates within social network play a critical role in determining vaccine demand. We apply a non-parametric model to uncover heterogeneity in the effects of these factors. We derive two novel insights from this analysis. First, even though, on average, domestically developed vaccines are preferred, around 30% of the sample favours foreign-developed vaccines. Second, vaccine preference of around 15% of the sample is highly sensitive to the presence of side effects and vaccination uptake among their peer group. These results provide insights for the ongoing policy debate around vaccine adoption in India.