Effectiveness of the BNT162b2 mRNA Covid-19 vaccine in Spanish healthcare workers

IntroductionFrontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine.Material and methodsProspective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital.ResultsTwo weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine.ConclusionsBNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.     

COVID-19 vaccination hesitancy among health care workers,communication, and policy-making

BackgroundCoronavirus disease 2019 (COVID-19) vaccine hesitancy in health care workers (HCWs) contributes to personal and patient risk in contracting COVID-19. Reasons behind hesitancy and how best to improve vaccination rates in HCWs are not clear.MethodsWe adapted a survey using the Health Belief Model framework to evaluate HCW vaccine hesitancy and reasons for choosing for or against COVID-19 vaccination. The survey was sent to 3 large academic medical centers in the Chicagoland area between March and May 2021.ResultsWe received 1974 completed responses with 85% of HCWs receiving or anticipating receiving COVID-19 vaccination. Multivariable logistic regression found HCWs were less likely to receive COVID-19 vaccination if they were Black (OR 0.34, 95% CI 0.15-0.80), Republican (OR 0.54, 95% CI 0.31-0.91), or allergic to any vaccine component (OR 0.27, 95% CI 0.10-0.70) and more likely to receive if they believed people close to them thought it was important for them to receive the vaccine (OR 5.2, 95% CI 3-8).ConclusionsA sizable number of HCWs remain vaccine hesitant 1 year into the COVID-19 pandemic. As HCWs are positively influenced by colleagues who believe in COVID-19 vaccination, development of improved communication across HCW departments and roles may improve vaccination rates.     

Covid-19 vaccine acceptance,hesitancy, and refusal among Canadian healthcare workers: A multicenter survey

BackgroundDeterminants of COVID-19 vaccine acceptance among healthcare workers (HCW) remains poorly understood. We assessed HCWs’ willingness to be vaccinated and reasons underlying hesitancy.MethodsCross-sectional survey across 17 healthcare institutions. HCWs eligible for vaccination (Pfizer-BioNTech mRNA) in December 2020 were invited to receive immunization. Multivariate logistic regression was performed to identify predictors of acceptance. Reasons for refusal among those who never intended to be vaccinated (ie, firm refusers) and those who preferred delaying vaccination (ie, vaccine hesitants) were assessed.ResultsAmong 2,761 respondents (72% female, average age, 44), 2,233 (80.9%) accepted the vaccine. Physicians, environmental services workers and healthcare managers were more likely to accept vaccination compared to nurses. Male sex, age over 50, rehabilitation center workers, and occupational COVID-19 exposure were independently associated with vaccine acceptance by multivariate analysis. Factors for refusal included vaccine novelty, wanting others to receive it first, and insufficient time for decision-making. Among those who declined, 74% reported they may accept future vaccination. Vaccine firm refusers were more likely than vaccine hesitants to distrust pharmaceutical companies and to prefer developing a natural immunity by getting COVID-19.ConclusionsVaccine hesitancy exists among HCWs. Our findings provide useful information to plan future interventions and improve acceptance.     

The Association of Social Factors and Health Insurance Coverage with COVID-19 Vaccinations and Hesitancy,July 2021

BackgroundThere are racial differences in COVID-19 vaccination rates, but social factors, such as lack of health insurance or food insecurity, may explain some of the racial disparities.ObjectiveTo assess social factors, including insurance coverage, that may affect COVID-19 vaccination as of June–July 2021 and vaccine hesitancy among those not yet vaccinated, and how these may affect racial equity in vaccinations.DesignCross-sectional analysis of nationally representative survey data.ParticipantsAdults 18 to 64 participating in the Census Bureau’s Household Pulse Survey for June 23 to July 5, 2021.Main MeasuresVaccination: receipt of at least one dose of a COVID-19 vaccine. Vaccine hesitancy: among those not yet vaccinated, intent to definitely or probably not get vaccinated.Key ResultsIn unadjusted analyses, black adults were less likely to be vaccinated than other respondents, but, after social factors were included, including health insurance status, food sufficiency, income and education, and state-level political preferences, differences between black and white adults were no longer significant and Hispanics were more likely to be vaccinated (OR = 1.87, p < .001). Among those not yet vaccinated, black and Hispanic adults were vaccine hesitant than white adults (ORs = .37 and .45, respectively, both p < .001) and insurance status and food insufficiency were not significantly associated with vaccine hesitancy. The percent of state voters for former President Trump in 2020 was significantly associated with lower vaccination rates and with increased vaccine hesitancy.DiscussionThe results indicate that much of the gap in COVID vaccination rates for minority adults are due to social barriers, rather than differences in racial attitudes. Unvaccinated minority adults expressed less vaccine hesitancy than white adults. Social barriers like food insecurity and insurance coverage could have deterred prompt COVID-19 vaccinations. Reducing these problems might help increase vaccination rates.     

COVID-19 vaccine uptake and hesitancy opinions from frontline health care and social care workers: Survey data from 37 countries

Background and aimsVaccine hesitancy is an ongoing major challenge. We aimed to assess the uptake and hesitancy of the COVID-19 vaccination.MethodsA short online survey was posted between April 12 to July 31, 2021 targeted at health and social care workers (HCWs) across the globe.Results275 from 37 countries responded. Most were hospital or primary care physicians or nurses, 59% women, aged 18–60 years, and 21% had chronic conditions with most prevalent being diabetes, hypertension, and asthma. We found that most HCWs (93%) had taken or willing to receive the COVID-19 vaccine. While 7% were vaccine hesitant (mainly women aged 30–39 years), respondents main concerns was the safety or potential side effects. Vaccine willing respondents raised concerns of unequal access to the COVID-19 vaccination in some countries, and highlighted that the only solution to overcoming COVID-19 infections was the vaccine booster doses given annually and free mass vaccination.ConclusionsThis study found that the majority of the frontline HCWs are willing to receive the COVID-19 vaccine. Further promotion of the COVID-19 vaccine would reassure and persuade HCWs to become vaccinated.     

Factors and reasons associated with low COVID-19 vaccine uptake among highly hesitant communities in the US

BackgroundThe inability to achieve high COVID-19 vaccination rates can continue to have serious harm to our communities. Vaccine hesitancy is a major barrier towards high vaccination rates. We evaluated the relationship between COVID-19 vaccine uptake and vaccine hesitancy, and then examined whether community factors were associated with COVID-19 vaccine uptake and hesitancy.MethodsWe constructed and evaluated a cross-sectional, county-level dataset that included the levels of vaccination uptake and vaccine hesitancy, and population characteristics based on those included in the CDC's Social Vulnerability Index.ResultsAcross 3142 US counties, vaccine hesitancy was significantly and negatively correlated with vaccine uptake rates (r = -0.06, P value <.01). The 2 predictors associated with a low vaccination level within highly hesitant communities were: no high school education (OR:0.70, P value <.001), and concern on vaccine availability and distribution (CVAC) (OR:0.00, P value <.001). The most common reason driving vaccine hesitancy was lack of trust in COVID-19 vaccines (55%), followed by concerns around side effects of the vaccine (48%), and lack of trust in government (46%).ConclusionsCOVID-19 vaccine hesitancy is a public health threat. Our findings suggest that low education levels are a major contributor to vaccine hesitancy and ultimately vaccination levels. Since education levels are not easily modifiable, our results suggest that policymakers would be best served by closing knowledge gaps to overcome negative perceptions of the vaccine through tailored interventions.     

Factors associated with risk of COVID-19 contagion for endoscopy healthcare workers: A survey from the Italian society of digestive endoscopy

Background and aimsThe present study was aimed to assess the risk of SARS-CoV-2 infection and associated factors among HCWs in endoscopy centers in Italy.MethodsAll members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey during the first months of the COVID-19 outbreak in Italy.Results314/1306 (24%) SIED members accounting for 201/502 (40%) endoscopic centers completed the survey. Personal Protection Equipment (PPE) were available in most centers, but filtering face-piece masks (FFP2 or FFP3) and negative pressure room were not in 10.9 and 75.1%. Training courses on PPE use were provided in 57.2% of centers only; there was at least one positive HCW in 17.4% of centers globally, 107/3308 (3.2%) HCWs were diagnosed with COVID-19 with similar rates of physicians (2.9%), nurses (3.5%) and other health operators (3.5%). Involvement in a COVID-19 care team (OR: 4.96) and the lack of training courses for PPE, (OR: 2.65) were associated with increased risk.ConclusionsThe risk of COVID-19 among endoscopy HCWs was not negligible and was associated with work in a COVID-19 care team and lack of education on proper PPE use. These data deserve attention during the subsequent waves.     

Knowledge,attitude, perceptions,and concerns of pregnant and lactating women regarding COVID-19 vaccination: A cross-sectional survey of 313 participants from a tertiary care centre of North India

AimThe study aimed to assess the knowledge, attitude, perceptions, and concerns of pregnant and lactating women regarding COVID-19 vaccination.MethodsA cross-sectional survey was conducted using a pre-validated questionnaire to assess the knowledge, attitude, perceptions, and concerns about COVID 19 vaccination among pregnant and lactating women.ResultsMost (90%) of the study participants(n =313) agreed that it was essential to get vaccinated for COVID-19 and were aware that pregnant (72.2%) or lactating women (65.2%) are eligible for vaccination. There was a significant positive association between willingness to pay for the vaccine and the socio-economic status (p<0.01). Women residing in rural areas wanted to wait to see the effect of the vaccine on other pregnant and lactating women (p<0.001). The major factors associated with vaccine hesitancy were unforeseen future effects of vaccines on the foetus (58.6%) and rapid development and approval of vaccine without including pregnant and lactating women in vaccine trials (53.6%). These factors were positively associated with socioeconomic status (p<0.05) and residence (p<0.01)ConclusionThe safety concerns regarding the COVID-19 vaccine is a major reason for vaccine hesitancy. The policymakers should advocate, investigate, and publicize relevant data on vaccine efficacy and safety among these women.     

The Impact of the COVID-19 Pandemic on Mental Health,Occupational Functioning,and Professional Retention Among Health Care Workers and First Responders

BackgroundThe COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.ObjectivesExamine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.DesignObservational, self-report, single time-point online assessment.ParticipantsA total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic.Main Outcomes and MeasuresCROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.ResultsCROS total scores correlated significantly with all four psychiatric symptom domains (R’s = .42–.53), likelihood of leaving one’s current occupation (R = .18), and trouble doing usual work (R = .28), all p’s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.Conclusions and RelevanceThese results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07252-z.KEY WORDS: COVID-19, PTSD, Occupational trauma, Insomnia, Professional retention     

Differences in Inflammation,Treatment, and Outcomes Between Black and Non-Black Patients Hospitalized for COVID-19: A Prospective Cohort Study

PurposeRacial disparities in coronavirus disease 2019 (COVID-19) outcomes have been described. We sought to determine whether differences in inflammatory markers, use of COVID-19 therapies, enrollment in clinical trials, and in-hospital outcomes contribute to racial disparities between Black and non-Black patients hospitalized for COVID-19.MethodsWe leveraged a prospective cohort study that enrolled 1325 consecutive patients hospitalized for COVID-19, of whom 341 (25.7%) were Black. We measured biomarkers of inflammation and collected data on the use COVID-19-directed therapies, enrollment in COVID-19 clinical trials, mortality, need for renal replacement therapy, and need for mechanical ventilation.ResultsCompared to non-Black patients, Black patients had a higher prevalence of COVID-19 risk factors including obesity, hypertension, and diabetes mellitus and were more likely to require renal replacement therapy (15.8% vs 7.1%, P < .001) and mechanical ventilation (37.2% vs 26.6%, P < .001) during their hospitalization. Mortality was similar between both groups (15.5% for Blacks vs 14.0% for non-Blacks, P = .49). Black patients were less likely to receive corticosteroids (44.9% vs 63.8%, P< .001) or remdesivir (23.8% vs 57.8%, P < .001) and were less likely to be enrolled in COVID-19 clinical trials (15.3% vs 28.2%, P < .001). In adjusted analyses, Black race was associated with lower levels of C-reactive protein and soluble urokinase receptor and higher odds of death, mechanical ventilation, and renal replacement therapy. Differences in outcomes were not significant after adjusting for use of remdesivir and corticosteroids.ConclusionsRacial differences in outcomes of patients with COVID-19 may be related to differences in inflammatory response and differential use of therapies.     

Evaluating the Impact of New York’s Executive Order on Face Mask Use on COVID-19 Cases and Mortality: a Comparative Interrupted Times Series Study

BackgroundOn April 17, 2020, the State of New York (NY) implemented an Executive Order that requires all people in NY to wear a face mask or covering in public settings where social distancing cannot be maintained. Although the Centers for Disease Control and Prevention recommended face mask use by the general public, there is a lack of evidence on the effect of face mask policies on the spread of COVID-19 at the state level.ObjectiveTo assess the impact of the Executive Order on face mask use on COVID-19 cases and mortality in NY.DesignA comparative interrupted time series analysis was used to assess the impact of the Executive Order in NY with Massachusetts (MA) as a comparison state.ParticipantsWe analyzed data on COVID-19 in NY and MA from March 25 to May 6, 2020.InterventionThe Executive Order on face mask use in NY.Main MeasuresDaily numbers of COVID-19 confirmed cases and deaths.Key ResultsThe average daily number of confirmed cases in NY decreased from 8549 to 5085 after the Executive Order took effect, with a trend change of 341 (95% CI, 187–496) cases per day. The average daily number of deaths decreased from 521 to 384 during the same two time periods, with a trend change of 52 (95% CI, 44–60) deaths per day. Compared to MA, the decreasing trend in NY was significantly greater for both daily numbers of confirmed cases (P = 0.003) and deaths (P < 0.001).ConclusionsThe Executive Order on face mask use in NY led to a significant decrease in both daily numbers of COVID-19 confirmed cases and deaths. Findings from this study provide important evidence to support state-level policies that require face mask use by the general public.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06476-9.KEY WORDS: COVID-19, public health intervention, epidemic, face mask     

Association between self-reported masking behavior and SARS-CoV-2 infection wanes from Pre-Delta to Omicron-predominant periods — North Carolina COVID-19 Community Research Partnership (NC-CCRP)

BackgroundWearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission.MethodsWe performed a nested case-control analysis within the North Carolina COVID-19 Community Research Partnership (NC-CCRP) of adults who completed daily surveillance surveys, April 2020 - February 2022. We assessed the association between self-reported mask wearing behavior during nonhousehold interactions and COVID-19 infection during 3 pandemic periods using conditional logistic regression models of risk of infection that were adjusted for demographics, vaccination status, and recent known exposure to COVID-19.ResultsAmong 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (P < .001). Prior to July 2021, the odds of a reported infection were 66% higher (aOR = 1.66, 95% CI = 1.43-1.91) among participants reporting ≥1 day not wearing a mask compared to those who reported no days (1,592 cases, 11,717 controls). During the Delta-predominant period, the results were similar (aOR = 1.53, 95% CI = 1.23-1.89; 659 cases, 4,649 controls). This association was attenuated during the Omicron-predominant period, where odds of an infection was 16% higher (aOR = 1.16, 95% CI = 1.03-1.32; 1,563 cases, 10,960 controls).ConclusionsWhile the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection.     

Psychosocial health in people with diabetes during the first three months of the COVID-19 pandemic in Denmark

AimsTo analyze trajectories of psychosocial health among people with diabetes during the first three months of lockdowns and reopenings of the COVID-19 pandemic in Denmark.MethodsAn online longitudinal survey of 2430 people with diabetes consisting of six questionnaire waves (Q1-Q6) was conducted between March 19 and June 25, 2020. Psychosocial outcomes assessed were COVID-19 worries, quality of life, feelings of social isolation, psychological distress, diabetes distress, anxiety, and general and diabetes-specific loneliness. Trajectories in psychosocial health were analyzed with linear multilevel mixed-effects models. Subgroup analyses were conducted.ResultsIn total, 1366 (56%) people with diabetes responded to the first questionnaire. COVID-19 worries, feelings of social isolation, psychological distress, anxiety and general loneliness had all improved at Q6 compared to Q1 (p < 0.001). In general, improvements in psychosocial health started after the first reopening phase (April 15); however, general loneliness increased up to the first reopening phase (p ≤ 0.001) before decreasing, and quality of life decreased up to the first reopening phase (p = 0.002), with no improvements to follow. Subgroup analyses revealed that women had larger decreases in feelings of social isolation (p < 0.001) and in psychological distress (p = 0.035) and increases in quality of life (p < 0.001), between Q1 and Q6, compared to men.ConclusionsPsychosocial health in people with diabetes improved following reopening of society. However, increases in loneliness and decreases in quality of life during lockdown indicates a potential need to mitigate the acute effects of such policies.     

Systems on Top of Nasal Cannula Improve Oxygen Delivery in Patients with COVID-19: a Randomized Controlled Trial

BackgroundTreating hypoxemia while meeting the soaring demands of oxygen can be a challenge during the COVID-19 pandemic.ObjectiveTo determine the efficacy of the surgical facemask and the double-trunk mask on top of the low-flow oxygen nasal cannula on arterial partial pressure of oxygen (PaO₂) in hypoxemic COVID-19 patients.DesignRandomized controlled trial.ParticipantsHospitalized adults with COVID-19 and hypoxemia treated with the low-flow nasal cannula were enrolled between November 13, 2020, and March 05, 2021.InterventionsPatients were randomized in a 1:1:1 ratio to receive either the nasal cannula alone (control) or the nasal cannula covered by the surgical facemask or the double-trunk mask. Arterial blood gases were collected at baseline and 30 min after the use of each system. The oxygen output was adapted afterwards to retrieve the baseline pulse oxygen saturation. The final oxygen output value was recorded after another 30-min period.Main MeasuresThe primary outcome was the absolute change in PaO₂. Secondary outcomes included changes in oxygen output, arterial partial pressure of carbon dioxide (PaCO₂), vital parameters, and breathlessness.Key ResultsArterial blood samples were successfully collected in 24/27 (8 per group) randomized patients. Compared to the nasal cannula alone, PaO₂ increased with the surgical facemask (mean change: 20 mmHg, 95% CI: 0.7–38.8; P = .04) and with the double-trunk mask (mean change: 40 mmHg; 95% CI: 21–59; P < .001). Oxygen output was reduced when adding the surgical facemask (median reduction: 1.5 L/min [95% CI: 0.5–4.5], P < .001) or the double-trunk mask (median reduction: 3.3 L/min [95% CI: 2–5], P < .001). The double-trunk mask was associated with a PaCO₂ increase of 2.4 mmHg ([95% CI: 0–4.7], P = .049). Neither mask influenced vital parameters or breathlessness.ConclusionsThe addition of the surgical facemask or the double-trunk mask above the nasal cannula improves arterial oxygenation and reduces oxygen consumption.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07419-2.KEY WORDS: coronavirus disease 2019, hypoxemia, oxygen therapy, double-trunk mask, surgical mask     

Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital

IntroductionHospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital.MethodsCross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure.ResultsAmong 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p = 0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p > 0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61–3.49), nurses (OR 1.67, CI95% 1.14–2.46), nurse assistants (OR 1.84, CI95% 1.24–2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22–2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30–2.73), and at the Emergency Room (OR 1.51, CI95% 1.01–2.27).ConclusionsSeroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission.     

COVID-19 vaccination in patients with diabetes mellitus: Current concepts,uncertainties and challenges

Background and aimsTo summarize the available evidence on the use COVID-19 vaccines in patients with diabetes mellitus.MethodsWe performed a thorough literature search with regard to COVID-19 vaccines in patients with type 1 and type 2 diabetes mellitus.ResultsThe novel coronavirus disease (COVID-19) tends to portend a poor prognosis in patients with diabetes mellitus (DM). Primary prevention remains the mainstay for mitigating the risks associated with COVID-19 in patients with DM. A significant step in primary prevention is timely vaccination. Routine vaccination against pneumococcal pneumonia, influenza, and hepatitis B is recommended in patients with DM with good efficacy and reasonable safety profile. With clinical data supporting a robust neutralizing antibody response in COVID-19 patients with DM, vaccination in individuals with DM is justified. In fact, as the burden of the disease is borne by people with DM, COVID-19 vaccination should be prioritized in individuals with DM. Multiple unresolved issues with regard to preferred vaccine type, vaccine efficacy and durability, frequency of administration, vaccination in children (<18 years) and pregnant/lactating women however remain, and need to be addressed through future research.ConclusionsPatients with type 1 and type 2 diabetes mellitus are at a high risk of poor prognosis with COVID-19 and vaccination should be prioritized in them. However, many unresolved issues with regard to COVID-19 vaccination need to be addressed through future research.     

Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy

Coronavirus disease 2019 (COVID-19) has afflicted tens of millions of people, fostering and unprecedent effort in vaccine development and distribution. Healthcare workers (HCW) play a key role in vaccine promotion and patient guidance, and it is likely that hesitancy among this population will have a major impact on the adoption of a successful immunization policy. To investigate HCW attitudes towards anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccination, we developed an anonymous online cross-sectional survey. 1723 Italian HCW responded. Overall, 1155 (67%) intended to be vaccinated, while 443 (26%) were not sure and 125 (7%) declared refusal. In multivariate analysis, factors associated with hesitancy were using Facebook as the main information source and being a non-physician HCW, while predictors of acceptance included younger age, being in close contact with high-risk groups and having received flu vaccination during the 2019–2020 season. Reasons for hesitancy included lack of trust in vaccine safety (85%) and receiving little (78%) or conflicting (69%) information about vaccines. According to our results, adequate investment in vaccine education for healthcare personnel appears to be urgently needed, prioritizing non-physicians and information quality spread through social media. We hope that our data could help governments and policy-makers to target communication in the ongoing COVID-19 vaccination campaign.     

Social Media Responses to COVID-19: Among sheeples and antivaxxers: Social media responses to COVID-19 vaccine news posted by Canadian news organizations,and recommendations to counter vaccine hesitancy

BackgroundTo create a successful public health initiative that counters vaccine hesitancy and promotes vaccine acceptance, it is essential to gain a strong understanding of the beliefs, attitudes and subjective risk perceptions of the population.MethodsA qualitative analysis of coronavirus disease 2019 (COVID-19) vaccine discourse from 3,731 social media posts on the Twitter and Facebook accounts of six Canadian news organizations was used to identify the perceptions, attitudes, beliefs and intentions of Canadian news organizations’ social media commenters toward taking a COVID-19 vaccine.ResultsFour main themes were identified: 1) COVID-19 vaccine safety and efficacy concerns; 2) conspiracy theories stemming from mistrust in government and other organizations; 3) a COVID-19 vaccine is unnecessary because the virus is not dangerous; and 4) trust in COVID-19 vaccines as a safe solution. Based on themes and subthemes, several key communication recommendations were developed for promotion of COVID-19 vaccine acceptance, including infographics championed by Public Health that highlight the benefits of the vaccine for those who have received it, public education about the contents and safety of the vaccine and eliciting an emotional connection through personal stories of those impacted by COVID-19.ConclusionSpecific considerations, such as leveraging the public’s trust in healthcare professionals to act as a liaison between Public Health and the Canadian public to communicate the benefits of the vaccine against COVID-19 and its variants, may help reduce COVID-19 vaccine hesitancy.     

Primary Source of Information About COVID-19 as a Determinant of Perception of COVID-19 Severity and Vaccine Uptake: Source of Information and COVID-19

BackgroundIdentifying the key determinants of vaccine uptake in the context of coronavirus disease 2019 (COVID-19) is critical to increasing vaccination rates, especially for Medicare beneficiaries.ObjectiveWe examined how the source of COVID-19 information shapes perceptions of COVID-19 severity and the likelihood of COVID-19 vaccine uptake among Medicare beneficiaries.Design, Setting, and ParticipantsWe included 6478 Medicare beneficiaries from the Fall 2020 Medicare Current Beneficiary Survey COVID-19 Supplement.Main MeasuresOur dependent variables were perception of COVID-19 severity and the likelihood of getting a COVID-19 vaccine. Our key independent variable was the beneficiaries’ primary source of information about COVID-19 and included six mutually exclusive categories: traditional news sources, guidance from government officials, social media, other webpages/Internet, friends or family members, or health care providers.Key ResultsCompared to those relying on traditional news sources or guidance from governmental officials, those relying on other sources had lower perceptions of COVID-19 severity and lower likelihood of getting a COVID-19 vaccine. Those relying on social media had the lowest levels in all measures (65.5% for those who agreed that COVID-19 is more contagious than the flu, 62.1% for those who agreed that COVID-19 is more deadly than the flu, 87.8% for those who agreed that all should take COVID-19 precautions, and 43.3% for those who answered that they would get a COVID-19 vaccine). The likelihood of COVID-19 vaccine uptake was also low among those relying on health care providers (55.5%). These findings remained similar even after adjusting for perceptions of COVID-19 severity in the relationship between the source of COVID-19 information and the likelihood of COVID-19 vaccine uptake.ConclusionsThe primary source of information that Medicare beneficiaries used to learn about COVID-19 may play a critical role in shaping perceptions of COVID-19 severity and attitudes toward getting a COVID-19 vaccine.KEY WORDS: COVID-19, vaccine uptake, risk perception, source of information, Medicare

A vaccine for coronavirus disease 2019 (COVID-19) has been developed and distributed at an unprecedented rate, but there are concerns about vaccine hesitancy and its impact on vaccine uptake. According to a survey of US adults conducted in November 2020, about 63% said they would get a COVID-19 vaccine if one were available today.¹ This rate is close to an actual uptake rate of COVID-19 vaccines. As of June 2021, a majority of the total US adult population have been fully vaccinated and two-thirds have received at least one dose of a vaccine.² However, evidence suggests that COVID-19 vaccination rates have started to level off. The 7-day average of newly administered doses of COVID-19 vaccines peaked in early April at more than three million COVID-19 doses per day, but has fallen below one million per day for the first time since January 2021.³Identifying the key determinants of vaccine uptake in the context of COVID-19 is critical to increasing vaccination rates. Prior research has investigated predictors of COVID-19 vaccine uptake among US adults and found that several demographic and socioeconomic factors were associated with the likelihood of COVID-19 vaccine uptake.^4–7 In addition, where people get their information from has been shown to be a key determinant of vaccine attitudes and uptake more broadly.⁸ This suggests that access to credible information sources may play a role in influencing risk perceptions, which may in turn shape attitudes toward COVID-19 vaccination. Recent research from an Internet survey panel found that the likelihood of COVID-19 vaccine uptake was lower among those who relied on social media for virus information compared to those who did not, as well as among those who watched Fox News for virus information compared to those who watched CNN/MSNBC.⁴However, existing evidence is limited in a number of ways. First, prior studies have examined the association of the source of information and vaccine uptake—there is a limited understanding of the underlying mechanism and the interplay between the source of information, risk perceptions, and vaccine uptake. Second, few population-based samples in recent studies limit the generalizability of findings. Third, when population-based samples were examined, the focus was on the entire US adult population. Our study adds to this research by focusing on Medicare beneficiaries those who are of high policy relevance as many of them are the most susceptive to COVID-19 mortality. Indeed, evidence suggests that the risk and severity of COVID-19 illness increases with age and/or baseline health status, leading to high case-fatality rates.⁹Using newly released nationally representative data from Medicare beneficiaries, we examined the role of the source of COVID-19 information in shaping perceptions of COVID-19 severity and the likelihood of COVID-19 vaccine uptake. Specifically, we investigated whether the primary source of information about COVID-19 was associated with perception of COVID-19 severity and the likelihood of COVID-19 vaccine uptake (if available). Furthermore, we examined whether the primary source of COVID-19 information was associated with the likelihood of COVID-19 vaccine uptake, independent of perception of COVID-19 severity. We also examined whether perceived COVID-19 severity was associated with the likelihood of getting a COVID-19 vaccine.