COVID-19 vaccines have met varying levels of acceptance and hesitancy in different parts of the world, which has implications for eliminating the COVID-19 pandemic. The aim of this systematic review is to examine how and why the rates of COVID-19 vaccine acceptance and hesitancy differ across countries and continents. PubMed, Web of Science, IEEE Xplore and Science Direct were searched between 1 January 2020 and 31 July 2021 using keywords such as “COVID-19 vaccine acceptance”. 81 peer-reviewed publications were found to be eligible for review. The analysis shows that there are global variations in vaccine acceptance among different populations. The vaccine-acceptance rates were the highest amongst adults in Ecuador (97%), Malaysia (94.3%) and Indonesia (93.3%) and the lowest amongst adults in Lebanon (21.0%). The general healthcare workers (HCWs) in China (86.20%) and nurses in Italy (91.50%) had the highest acceptance rates, whereas HCWs in the Democratic Republic of Congo had the lowest acceptance (27.70%). A nonparametric one-way ANOVA showed that the differences in vaccine-acceptance rates were statistically significant (H (49) = 75.302, p = 0.009*) between the analyzed countries. However, the reasons behind vaccine hesitancy and acceptance were similar across the board. Low vaccine acceptance was associated with low levels of education and awareness, and inefficient government efforts and initiatives. Furthermore, poor influenza-vaccination history, as well as conspiracy theories relating to infertility and misinformation about the COVID-19 vaccine on social media also resulted in vaccine hesitancy. Strategies to address these concerns may increase global COVID-19 vaccine acceptance and accelerate our efforts to eliminate this pandemic.

/pdf/global-covid-19-vaccine-acceptance-a-systematic-review-of-2u9tifnp.pdf

Global COVID-19 Vaccine Acceptance: A Systematic Review of Associated Social and Behavioral Factors

Introduction Vaccination is an essential intervention to curb the coronavirus disease 2019 (COVID-19) pandemic. This review aimed to estimate the pooled proportion of COVID-19 vaccine acceptance worldwide. Methods A systematic search of the MEDLINE (PubMed) database using “COVID-19,” “vaccine” and “acceptance” to obtain original research articles published between 2020 and July 2021. Only studies with full text and that were published in English were included. The Joanna Briggs Institute meta-analysis was used to assess the data quality. The meta-analysis was performed using generic inverse variance with a random-effects model using the Review Manager software. Results A total of 172 studies across 50 countries worldwide were included. Subgroup analyses were performed with regard to vaccine acceptance, regions, population, gender, vaccine effectiveness, and survey time. The pooled proportion of COVID-19 vaccine acceptance was 61% (95% CI: 59, 64). It was higher in Southeast Asia, among healthcare workers, in males, for vaccines with 95% effectiveness, and during the first survey. Conclusion COVID-19 vaccine acceptance needs to be increased to achieve herd immunity to protect the population from the disease. It is crucial to enhance public awareness of COVID-19 vaccination and improve access to vaccines. Systematic Review Registration PROSPERO 2021, identifier CRD42021268645.

Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance

Background Considering medical and economic burden of the coronavirus disease 2019 (COVID-19), a high COVID-19 vaccination coverage among health care workers (HCWs) is an urgent need. Objective To estimate the intention of HCWs to accept COVID-19 vaccination and to find out related factors. Design We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this study. Data sources We searched PubMed, Medline, Scopus, Web of Science, ProQuest, CINAHL and medRxiv from January 1, 2020 to December 02, 2020. Methods The heterogeneity between results was very high and thus we applied a random effect model to estimate pooled effects. We performed subgroup and meta-regression analysis to identify possible resources of heterogeneity. Results Eleven studies, including 8847 HCWs met the inclusion criteria. The overall proportion of HCWs that intent to accept COVID-19 vaccination was 55.9% (95% CI: 43.6-67.9%) with a wide range among studies from 27.7% to 81.5%. Intention of HCWs to accept COVID-19 vaccination was higher in studies with moderate quality and in studies that were conducted in Europe. The following factors were associated with increased HCWs’ willingness to get vaccinated against COVID-19: male gender, older age, physician profession, fewer work experience, comorbidity among HCWs, seasonal influenza vaccination, stronger vaccine confidence, positive attitude towards a COVID-19 vaccine, fear about COVID-19, individual perceived risk about COVID-19, and contact with suspected or confirmed COVID-19 patients. Conclusions HCWs represent a high-risk group for SARS-CoV-2 infection. The reluctance or refusal of HCWs to vaccinate against COVID-19 could diminish the trust of individuals and trigger a ripple effect in the general public. Since vaccination is a complex behavior, understanding the way that HCWs take the decision to accept or not COVID-19 vaccination will give us the opportunity to develop the appropriate interventions to increase COVID-19 vaccination uptake. Knowledge of the factors that affect intention of HWCs to accept COVID-19 vaccination is limited and there is an urgent need for further and more valid studies.

/pdf/intention-of-health-care-workers-to-accept-covid-19-1qzkckye6a.pdf

Intention of health care workers to accept COVID-19 vaccination and related factors: a systematic review and meta-analysis

COVID-19 vaccine has been available in China since the beginning of the 2021, however, certain numbers of people are reluctant for some reasons to vaccinate. The high vaccine coverage is crucial for controlling disease transmission, however, the vaccine hesitancy might be a barrier to the establishment of sufficient herd immunization. This study aims to investigate the prevalence of the COVID-19 vaccine hesitancy among different population groups, and explore common barriers and facilitators to vaccination decisions.The current survey was performed among Chinese students, public health professionals, medical workers and general population from January to March 2021 from seven cities in China. The questionnaire contained sociodemographic information, concerns about infection with COVID-19, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale and other potential factors. Univariate analysis was conducted by chi-squared test, and variables significant at P < 0.10 were then included in a multivariable regression model.The prevalence of COVID-19 vaccine hesitancy was 15.6% in our study, and 23.9% of students, 21.2% of the general population, 13.1% of medical workers, and 10.4% of public health professionals had vaccine hesitancy. The results of multivariate analysis indicated that participants who had received negative information of COVID-19 vaccine (OR: 1.563, 95% CI: 1.229-1.986) and who had doubts about the information source (OR: 2.157, 95% CI: 1.697-2.742) were more likely to have vaccine hesitancy. While those who needed transparent information about COVID-19 vaccine (OR: 0.722, 95% CI: 0.535-0.973) and who would get COVID-19 vaccine if doctors recommended (OR: 0.176, 95% CI: 0.132-0.234) were less likely to have COVID-19 vaccine hesitancy.Given recommendations from medical workers about vaccination can motivate people to accept COVID-19 vaccination, appropriate training in knowledge about vaccines and communication skills are necessary for them to increase public's willingness of vaccination. Reducing the spread of misinformation and disseminating facts in a timely and accurate way will likely reduce vaccine hesitancy. Moreover, to establish suitable communication strategies and information exchange platforms between the government and the public and a warning system on infodemic would be helpful to improve public's confidence in vaccination. 

/pdf/covid-19-vaccine-hesitancy-among-different-population-groups-vrjqs4ee.pdf

COVID-19 vaccine hesitancy among different population groups in China: a national multicenter online survey

People with weakened immune systems may not develop adequate protection after taking two doses of the mRNA-combined COVID-19 vaccine. The additional dose may improve the level of protection against Covid-19.Current study aimed to evaluate the knowledge, attitude and determents of third COVID-19 vaccine booster dose acceptance among population in the UAE.This is online descriptive cross-sectional community-based study conducted among the students and faculty of Ajman University from 25 August to 20 October 2021. The questionnaire, which was in the English language, encompassed two sections containing 22 items. Section one gathered the demographic details of the respondents, while Section two used 13 questions to evaluate the respondents' knowledge of and attitude to the third COVID-19 vaccine booster dose.614 respondents participated in this study. The average knowledge score was 44.6% with a 95% confidence interval (CI) of [41%, 49%]. Better knowledge scores were observed in postgraduates (OR 4.29; 95% CI 2.28-8.11), employees in the healthcare sector (OR 1.62; 95% CI 1.05-2.51), participants who had relatives infected with the Covid-19 (OR 1.46; 95% CI 1.05-2.02), participants who had infected with Covid-19 (OR 2.21; 95% CI 1.43-3.43) and participants who had received first two doses of the COVID-19 vaccine (OR 2.08; 95% CI 1.40-3.11). The average attitude score was 70.2% with a 95% confidence interval (CI) of [69.2%, 71.2%].Necessary steps should be taken by the government and public health authorities, in line with the local culture, to increase vaccination acceptance and foster positive attitudes towards the vaccine. A suitable approach to this would be to develop an educational framework that could demonstrate the risks of vaccine avoidance or delay to the general population. Moreover, health authorities should pay more attention to the false information being disseminated across the internet, especially social media. Also, healthcare workers should be trained in vaccinology and virology to make sure that they are able to understand important developments in these fields and convey the findings to their patients. 

/pdf/assessing-public-knowledge-attitudes-and-determinants-of-bl9s7kvu.pdf

Assessing public knowledge, attitudes and determinants of third COVID-19 vaccine booster dose acceptance: current scenario and future perspectives

Objective: The Coronavirus disease 2019 (COVID-19) vaccine is currently available. This timely survey was conducted to provide insight into on the willingness of healthcare workers (HCWs)to receive the vaccine and determine the influencing factors. Methods: This was a cross-sectional online survey. An online questionnaire was provided to all participants and they were asked if they would accept a free vaccine. The questionnaire gathered general demographic information, and included the General Health Questionnaire (GHQ-12); Myers-Briggs Type Indicator questionnaire (MBTI); Depression, Anxiety, and Stress Scales (DASS-21); and the 12-item Short Form Health Survey (SF-12). The data were collected automatically and electronically. Univariate analysis was done between all the variables and our dependent variable. Multivariable logistic regression models were employed to examine and identify the associations between the acceptance of the COVID-19 vaccine with the associated variables. Results: We collected 505 complete answers. The participants included 269 nurses (53.27%), 206 clinicians (40.79%), 15 administrative staff (2.97%), and 15 other staff (2.97%). Of these, 76.63% declared they would accept the vaccine. The major barriers were concerns about safety, effectiveness, and the rapid mutation in the virus. Moreover, four factors were significantly associated with the willingness to receive the vaccine: (a) "understanding of the vaccine" (odds ratio (OR):2.322; 95% confidence interval [CI]: 1.355 to 3.979); (b) "worried about experiencing COVID-19" (OR 1.987; 95% CI: 1.197-3.298); (c) "flu vaccination in 2020" (OR 4.730; 95% CI: 2.285 to 9.794); and (d) "living with elderly individuals" (OR 1.928; 95% CI: 1.074-3.462). Conclusions: During the vaccination period, there was still hesitation in receiving the vaccine. The results will provide a rationale for the design of future vaccination campaigns and education efforts concerning the vaccine.

/pdf/will-healthcare-workers-accept-a-covid-19-vaccine-when-it-2amyilgdjv.pdf

Will Healthcare Workers Accept a COVID-19 Vaccine When It Becomes Available? A Cross-Sectional Study in China.

Objective The coronavirus disease 2019 (COVID-19) vaccines are considered to be an effective way to prevent the spread of the infection. Our previous study has shown that about 75% of healthcare workers (HCWs) in China were willing to receive the vaccine when it became available. Here, we examined the acceptance of a third booster dose among Chinese people and identified the influencing factors. Methods A cross-sectional online survey was conducted and the snowball sampling method was utilized. An online questionnaire was provided to all the participants in the form of a quick response (QR) code. The questionnaire included general demographic information, views on vaccines, the General Health Questionnaire-12 (GHQ-12), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The univariate analysis was done between all the variables and our dependent variable. Then, we used the multivariate logistic regression model to examine the influencing factors of the third booster dose acceptance. Results We collected 1,062 complete answers. Of these, 90.39% (n = 960) declared that they would accept the booster dose. Knowing more about the vaccine and recognizing the efficacy of vaccines were significantly associated with greater acceptance of the booster dose. People willing to take the booster dose had better psychological health. A belief that the booster dose could prevent severe infection caused by COVID-19 and enhance the effectiveness of the first two doses were the main contributing factors to vaccine acceptance. Vaccine hesitancy was mainly due to a low perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and rapid mutation of SARS-CoV-2. Conclusion This study revealed that Chinese people were very receptive to the third booster dose, which is an inspiring result. More positive attitudes regarding COVID-19 vaccination were supported by its efficacy and few side effects.

/pdf/will-people-accept-a-third-booster-dose-of-the-covid-19-1txjrwvc.pdf

Will People Accept a Third Booster Dose of the COVID-19 Vaccine? A Cross-Sectional Study in China

Objective To compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED). Methods This was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes). Results The rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively). Conclusion Early mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.

https://journals.sagepub.com/doi/pdf/10.1177/03000605211025368

Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department.

Review question / Objective: The inclusion criteria for this study are based on the PICOS acronym: Participants (P): COVID-19 patients based on positive Coronavirus RT-PCR (reverse transcription-polymerase chain reaction) of nasopharyngeal and oropharyngeal swabs or a history of COVID-19 infection. Following previous research, the COVID-19 patients in this study will include the period of COVID-19 infection, symptom onset, recovery, and the onset of post-acute COVID-19 symptoms. Interventions (I): not applicable; Comparisons (C): healthy controls in comparative studies, or not applicable to epidemiological surveys; Outcome (O): the prevalence of poor sleep quality (PSQ) or available data could yield the prevalence of PSQ in COVID-19 patients. Sleep quality in COVID-19 patients will be assessed using standardized scales such as the Pittsburgh Sleep Quality Index (PSQI); Study design (S): epidemiological and comparative studies (only the baseline data of cohort study will be extracted).

/pdf/prevalence-of-poor-sleep-quality-in-covid-19-patients-a-29urhop7.pdf

Prevalence of poor sleep quality in COVID-19 patients: a systematic review and meta-analysis

Purpose Type 1 diabetes mellitus (T1DM) is associated with different types of infections; however, studies on the causal relationship between T1DM and infectious diseases are lacking. Therefore, our study aimed to explore the causalities between T1DM and six high-frequency infections using a Mendelian randomization (MR) approach. Methods Two-sample MR studies were conducted to explore the causalities between T1DM and six high-frequency infections: sepsis, acute lower respiratory infections (ALRIs), intestinal infections (IIs), infections of the genitourinary tract (GUTIs) in pregnancy, infections of the skin and subcutaneous tissues (SSTIs), and urinary tract infections (UTIs). Data on summary statistics for T1DM and infections were obtained from the European Bioinformatics Institute database, the United Kingdom Biobank, FinnGen biobank, and Medical Research Council Integrative Epidemiology Unit. All data obtained for summary statistics were from European countries. The inverse-variance weighted (IVW) method was employed as the main analysis. Considering the multiple comparisons, statistical significance was set at p< 0.008. If univariate MR analyses found a significant causal association, multivariable MR (MVMR) analyses were performed to adjust body mass index (BMI) and glycated hemoglobin (HbA1c). MVMR-IVW was performed as the primary analysis, and the least absolute shrinkage and selection operator (LASSO) regression and MVMR-Robust were performed as complementary analyses. Results MR analysis showed that susceptibility to IIs increased in patients with T1DM by 6.09% using the IVW-fixed method [odds ratio (OR)=1.0609; 95% confidence interval (CI): 1.0281–1.0947, p=0.0002]. Results were still significant after multiple testing. Sensitivity analyses did not show any significant horizontal pleiotropy or heterogeneity. After adjusting for BMI and HbA1c, MVMR-IVW (OR=1.0942; 95% CI: 1.0666–1.1224, p<0.0001) showed significant outcomes that were consistent with those of LASSO regression and MVMR-Robust. However, no significant causal relationship was found between T1DM and sepsis susceptibility, ALRI susceptibility, GUTI susceptibility in pregnancy, SSTI susceptibility, and UTI susceptibility. Conclusions Our MR analysis genetically predicted increased susceptibility to IIs in T1DM. However, no causality between T1DM and sepsis, ALRIs, GUTIs in pregnancy, SSTIs, or UTIs was found. Larger epidemiological and metagenomic studies are required to further investigate the observed associations between the susceptibility of certain infectious diseases with T1DM.

/pdf/causal-relationship-between-type-1-diabetes-mellitus-and-six-10vonczu.pdf

Tao Xiang

Papers

Will Healthcare Workers Accept a COVID-19 Vaccine When It Becomes Available? A Cross-Sectional Study in China.

Will People Accept a Third Booster Dose of the COVID-19 Vaccine? A Cross-Sectional Study in China

Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department.

Prevalence of poor sleep quality in COVID-19 patients: a systematic review and meta-analysis

Causal relationship between type 1 diabetes mellitus and six high-frequency infectious diseases: A two-sample mendelian randomization study