Association Between the Hepatic Steatosis Index and Risk of Incident Type 2 Diabetes Mellitus in the Normoglycemic Population:A Longitudinal Prospective Study in Japan.

Purpose: The Hepatic Steatosis Index (HSI) is a reliable predictor of non-alcoholic fatty liver disease (NAFLD), which can increase the risk of type 2 diabetes mellitus (T2DM). However, limited research has directly predicted HSI's association with T2DM occurrence at normal blood glucose levels. Hence, this study aimed to assess the link between baseline HSI and T2DM development under euglycemic conditions while also exploring potential sex differences. Methods: Using data from the NAGALA cohort study, a Cox regression model analyzed the relationship between HSI and T2DM risk, calculating hazard ratios (HR) and 95% confidence intervals (CI). Subgroup analyses were conducted to investigate factors influencing HSI's prediction of incident T2DM. Results: During a mean 6.1-year follow-up, 238 individuals (1.65% of participants) developed T2DM. After adjusting for age, ethanol consumption, smoking status, SBP, DBP, TG, and TC, HSI showed a significant association with incident T2DM in individuals with normal glucose levels, consistent across sexes. Compared to the lowest quartile group (Q1), the HR and 95% CI for Q2, Q3, and Q4 were 1.09 (0.61, 1.93), 1.16 (0.68, 1.98), and 3.30 (2.04, 5.33), respectively (P for trend < 0.001). Subgroup analysis indicated that elevated HSI significantly increased the risk of incident T2DM in individuals with normal TG levels (P for interaction = 0.0170). Conclusion: This study highlights the significant association between elevated HSI levels and the likelihood of developing incident T2DM in individuals with normal glucose levels. Furthermore, it offers a simple and valuable screening tool for predicting T2DM.

Dahuang Zhechong Pill Alleviates Liver Fibrosis Progression by Regulating p38 MAPK/NF-κ B/TGF-ß1 Pathway.

OBJECTIVE: To explore the effect and mechanism of Dahuang Zhechong Pill (DHZCP) on liver fibrosis. METHODS: Liver fibrosis cell model was induced by transforming growth factor-ß (TGF-ß) in hepatic stellate cells (HSC-T6). DHZCP medicated serum (DMS) was prepared in rats. HSC-T6 cells were divided into the control (15% normal blank serum culture), TGF-ß (15% normal blank serum + 5 ng/mL TGF-ß), DHZCP (15% DMS + 5 ng/mL TGF-ß), DHZCP+PDTC [15% DMS + 4 mmol/L ammonium pyrrolidine dithiocarbamate (PDTC)+ 5 ng/mL TGF-ß], and PDTC groups (4 mmol/L PDTC + 5 ng/mL TGF-ß). Cell activity was detected by cell counting kit 8 and levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the cell supernatant were determined by enzyme-linked immunosorbnent assay. Western blot was used to measure the expressions of p38 mitogen-activated protein kinase/nuclear factor kappa B/transforming growth factor-ß1 (p38 MAPK/NF-κ B/TGF-ß1) pathway related proteins, and the localization and expressions of these proteins were observed by immunofluorescence staining. RESULTS: DHZCP improves the viability of cells damaged by TGF-ß and reduces inflammatory cytokines and ALT and AST levels in the supernatant of HSC-T6 cells induced with TGF-ß (P<0.05 or P<0.01). Compared with the TGF-ß group, NF-κ B p65 levels in the DHZCP group were decreased (P<0.05). p38 MAPK and NF-κ B p65 levels in the DHZCP+PDTC were also reduced (P<0.01). Compared with the TGF-ß group, the protein expression of Smad2 showed a downward trend in the DHZCP, DHZCP+PDTC, and PDTC groups (all P<0.01), and the decreasing trend of Samd3 was statistically significant only in DHZCP+PDTC group (P<0.01), whereas Smad7 was increased (P<0.05 or P<0.01). CONCLUSION: DHZCP can inhibit the process of HSC-T6 cell fibrosis by down-regulating the expression of p38 MAPK/NF-κ B/TGF-ß1 pathway.

Impact of health education on promoting influenza vaccination health literacy in primary school students: a cluster randomised controlled trial protocol.

INTRODUCTION: Influenza is a major public health threat, and vaccination is the most effective prevention method. However, vaccination coverage remains suboptimal. Low health literacy regarding influenza vaccination may contribute to vaccine hesitancy. This study aims to evaluate the effect of health education interventions on influenza vaccination rates and health literacy. METHODS AND ANALYSIS: This cluster randomised controlled trial will enrol 3036 students in grades 4-5 from 20 primary schools in Dongguan City, China. Schools will be randomised to an intervention group receiving influenza vaccination health education or a control group receiving routine health education. The primary outcome is the influenza vaccination rate. Secondary outcomes include health literacy levels, influenza diagnosis rate, influenza-like illness incidence and vaccine protection rate. Data will be collected through questionnaires, influenza surveillance and self-reports at baseline and study conclusion. ETHICS AND DISSEMINATION: Ethical approval has been sought from the Ethics Committee of the School of Public Health, Sun Yat-sen University. Findings from the study will be made accessible to both peer-reviewed journals and key stakeholders. TRIAL REGISTRATION NUMBER: NCT06048406.

Assessment of the impact of the vaccine pass policy on COVID-19 vaccine hesitancy and uptake among Chinese adults in Hong Kong.

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

Monitoring the dynamic changes in aroma during the whole processing of Qingzhuan tea at an industrial scale: From fresh leaves to finished tea.

Aroma is one of the most outstanding quality characteristics of Qingzhuan tea (QZT), but its formation is still unclear. Thus, the volatile organic compounds (VOCs) during the whole processing of QZT were investigated by headspace solid-phase microextraction/gas chromatography-mass spectrometry. Based on 144 identified VOCs, the results showed that de-enzyming, sun-drying, and piling fermentation were the key processes of QZT aroma formation. Furtherly, 42 differential VOCs (VIP > 1.0 and p < 0.05) and 16 key VOCs (rOAV > 1.0 and/or ROAV > 1.0) were screened. Especially, sulcatone and ß-ionone (rOAV > 100 and ROAV > 10) were considered the most important contributors to the aroma of QZT. The metabolisms of key VOCs were mainly involved in oxidative degradation of fatty acids, degradation of carotenoids, and methylation of gallic acid. This study could help to more comprehensively understand the aroma formation in QZT processing at an industrial scale.

Comparison of control and transmission of COVID-19 across epidemic waves in Hong Kong: an observational study.

Background: Hong Kong contained COVID-19 for two years but experienced a large epidemic of Omicron BA.2 in early 2022 and endemic transmission of Omicron subvariants thereafter. We reflected on pandemic preparedness and responses by assessing COVID-19 transmission and associated disease burden in the context of implementation of various public health and social measures (PHSMs). Methods: We examined the use and impact of pandemic controls in Hong Kong by analysing data on more than 1.7 million confirmed COVID-19 cases and characterizing the temporal changes non-pharmaceutical and pharmaceutical interventions implemented from January 2020 through to 30 December 2022. We estimated the daily effective reproductive number (Rt) to track changes in transmissibility and effectiveness of community-based measures against infection over time. We examined the temporal changes of pharmaceutical interventions, mortality rate and case-fatality risks (CFRs), particularly among older adults. Findings: Hong Kong experienced four local epidemic waves predominated by the ancestral strain in 2020 and early 2021 and prevented multiple SARS-CoV-2 variants from spreading in the community before 2022. Strict travel-related, case-based, and community-based measures were increasingly tightened in Hong Kong over the first two years of the pandemic. However, even very stringent measures were unable to contain the spread of Omicron BA.2 in Hong Kong. Despite high overall vaccination uptake (>70% with at least two doses), high mortality was observed during the Omicron BA.2 wave due to lower vaccine coverage (42%) among adults ≥65 years of age. Increases in antiviral usage and vaccination uptake over time through 2022 was associated with decreased case fatality risks. Interpretation: Integrated strict measures were able to reduce importation risks and interrupt local transmission to contain COVID-19 transmission and disease burden while awaiting vaccine development and rollout. Increasing coverage of pharmaceutical interventions among high-risk groups reduced infection-related mortality and mitigated the adverse health impact of the pandemic. Funding: Health and Medical Research Fund.

Structural Characterization of Boron Sheets beyond the Monolayer and Implication for Experimental Synthesis and Identification.

The successful synthesis of quasi-freestanding bilayer borophene has aroused much attention for its superior physical properties and holds great promise for future electronic devices. Herein, we comprehensively explore six boron sheets beyond the monolayer and structurally characterize them via various methods using first-principles calculations for experimental references. On the basis of atomic models of borophenes, simulated scanning tunneling microscope (STM) images show different morphologies at different bias voltages and are explained by the partial densities of states and the height differences in the vertical direction. Simulated transmission electron microscope images further probe the internal atomic arrangement of boron sheets and compensate for the shortcomings of STM images to better distinguish different phases of boron sheets. The interlayer coupling strength is stronger in bilayer borophenes than in the three-layer system via the electron localization function and Mulliken bond population. In addition, simulated X-ray diffraction and infrared spectra show different characteristic peaks and corresponding vibrational modes to further characterize these boron sheets. These theoretical results can decrease the prime cost and provide vital guidance for the experimental synthesis and identification of boron sheets beyond the monolayer.

An HA/PEEK scaffold with modified crystallinity via 3D-bioprinting for multiple applications in hard tissue engineering.

Hard tissues, especially teeth and bones, are highly mineralized and the large-scale defect or total loss of them is irreversible. There is still no ideal strategy for the reconstruction of various hard tissue defects that can achieve the balance between biological and mechanical properties. Polyether ether ketone (PEEK) has the potential to substitute for natural hard tissue in defect areas but is limited by its biological inertness. The addition of hydroxyapatite (HA) can significantly improve the osteogenic properties and osteointegration of PEEK materials. But the mechanical properties of HA/PEEK scaffolds are far from satisfaction making scaffolds easy to fracture. We put forward a strategy to balance the mechanical and biological properties of HA/PEEK scaffolds via the regulation of the inner crystallinity and HA mixing ratio and we systematically evaluated the modified HA/PEEK scaffolds through material characterization,in vitroandin vivoexperiments. And we found that the 20%HA/PEEK scaffolds with low crystallinity achieved the required strength and elasticity, and exhibited the characteristics of promoting the proliferation, migration and osteogenic differentiation of bone marrow mesenchymal stem cells. The results of the implantation of beagles' teeth, mandible and rib showed that the 20%HA/PEEK scaffold with low crystallinity could well withstand the local complex force in the defect area and combine well with natural bone tissue, which made it a candidate for a practical versatile hard tissue engineering scaffold.

Density Functional Theory Study of Bilayer Borophene-Based Anode Material for Rechargeable Lithium Ion Batteries.

The bilayer borophene has been successfully fabricated in experiments recently and possesses superior antioxidation and robust metallic properties, which holds great promise for the future anode materials of Li-ion batteries. Herein, using first-principles calculations, two bilayer borophenes including P6/mmm or P6̅m2 symmetry groups with or without vacancy defects are comprehensively explored and acted as electrode materials with high performance in Li-ion batteries. The charge density difference, adsorption energies, and Bader charge analysis are calculated and discussed for single lithium adsorbed on bilayer borophene. The results shown that with the increase of lithium concentration, the adsorption energies are rapidly decreased due to the repulsion of boron atoms except for the P6̅m2 systems with double side adsorption and corresponding energies remain the narrow range. Meanwhile, the partial density of states shows metallic character after lithium adsorption and indicates good conductivity for the charge-discharge process. Furthermore, small diffusion barriers, low average open-circuit voltage, can be achieved, and large storage capacity is up to 930.2 mA h/g at the lower lithium content of 0.375. These results propose that bilayer borophene might be a good choice for anode material applications in future Li-ion batteries with fast ion diffusion and high power density.

Unravelling disparity in age-specific acceptance of COVID-19 vaccination: the contextual and psychosocial influences.

BACKGROUND: High COVID-19 vaccination uptake rates across all age groups are important for achieving herd immunity. However, age disparity in vaccination acceptance was consistently identified. OBJECTIVE: Taking cues from tenets of socioemotional selectivity theory, this study examined how the contextual and psychosocial factors contributed to age-specific COVID-19 vaccination acceptance. METHOD: Four rounds of population-based cross-sectional surveys were conducted before and after the COVID-19 vaccination programme started in Hong Kong (n = 3527). Participants' vaccination acceptance, trust in government, social norms, vaccine confidence and risk perception of COVID-19 were obtained. Vaccine-related news headlines were collected in the same timeframe. RESULT: Sentiment analysis found that the impact of negative news sentiment on vaccine hesitancy was greater among older people. The path analyses found that older people had greater trust in government, perceived greater influence of social norms, and had greater vaccine confidence which all in turn were associated with greater vaccination acceptance. However, older people were found to have less worry about contracting COVID-19, which somewhat lowered their vaccination acceptance. CONCLUSION: Communication to promote older people's vaccination uptake should focus on promoting the government's timely response to the negative news reports about vaccines and increasing the positive influences of social norms on their vaccination acceptance.

Full waveform inversion guided wave tomography with a recurrent neural network.

Corrosion quantitative detection of plate or plate-like structure materials is crucial in industrial Non-Destructive Testing (NDT) for determining their remaining life. For doing that, a novel ultrasonic guided wave tomography method, incorporating recurrent neural network (RNN) into full waveform inversion (FWI) called as RNN-FWI, is proposed in this paper. When the wave equation of an acoustic model is solved by a forward model with the cyclic calculation units of an RNN, it is shown that the inversion of the forward model can be obtained iteratively by minimizing a waveform misfit function of quadratic Wasserstein distance between the modeled and measured data. It is also demonstrated that the gradient of the objective function can be obtained by automatic differentiation while the parameters of the waveform velocity model are updated by the adaptive momentum estimation algorithm (Adam). The U-Net deep image prior (DIP) is used as the velocity model regularization in each iteration. The final thickness maps of the plate or plate-like structure materials shown can be archived by the dispersion characteristics of guided waves. Both the numerical simulation and experimental results show that the proposed RNN-FWI tomography method performs better than the conventional time-domain FWI in terms of convergence rate, initial model requirement, and robustness.

Drinking water disinfection byproduct iodoacetic acid affects thyroid hormone synthesis in Nthy-ori 3-1 cells.

Iodoacetic acid (IAA) is an emerging and the most genotoxic iodinated disinfection byproduct to date. IAA can disrupt the thyroid endocrine function in vivo and in vitro, but the underlying mechanisms remain unclear. In this work, transcriptome sequencing was used to investigate the effect of IAA on the cellular pathways of human thyroid follicular epithelial cell line Nthy-ori 3-1 and determine the mechanism of IAA on the synthesis and secretion of thyroid hormone (TH) in Nthy-ori 3-1 cells. Results of transcriptome sequencing indicated that IAA affected the TH synthesis pathway in Nthy-ori 3-1 cells. IAA reduced the mRNA expression of thyroid stimulating hormone receptor, sodium iodide symporter, thyroid peroxidase, thyroglobulin, paired box 8 and thyroid transcription factor-2, inhibited the cAMP/PKA pathway and Na+-K+-ATPase, and decreased the iodine intake. The results were confirmed by our previous findings in vivo. Additionally, IAA downregulated glutathione and the mRNA expression of glutathione peroxidase 1, leading to increased reactive oxygen species production. This study is the first to elucidate the mechanisms of IAA on TH synthesis in vitro. The mechanisms are associated with down-regulating the expression of genes related to TH synthesis, inhibiting iodine uptake, and inducing oxidative stress. These findings may improve future health risk assessment of IAA on thyroid in human.

Characterizing Human Collective Behaviors During COVID-19 - Hong Kong SAR, China, 2020.

What is already known about this topic?: People are likely to engage in collective behaviors online during extreme events, such as the coronavirus disease 2019 (COVID-19) crisis, to express awareness, take action, and work through concerns. What is added by this report?: This study offers a framework for evaluating interactions among individuals' emotions, perceptions, and online behaviors in Hong Kong Special Administrative Region (SAR) during the first two waves of COVID-19 (February to June 2020). Its results indicate a strong correlation between online behaviors, such as Google searches, and the real-time reproduction numbers. To validate the model's output of risk perception, this investigation conducted 10 rounds of cross-sectional telephone surveys on 8,593 local adult residents from February 1 through June 20 in 2020 to quantify risk perception levels over time. What are the implications for public health practice?: Compared to the survey results, the estimates of the risk perception of individuals using our network-based mechanistic model capture 80% of the trend of people's risk perception (individuals who are worried about being infected) during the studied period. We may need to reinvigorate the public by involving people as part of the solution that reduced the risk to their lives.

GC-MS and LC-MS/MS metabolomics revealed dynamic changes of volatile and non-volatile compounds during withering process of black tea.

High-performance liquid chromatography (HPLC), headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) and ultra-high performance liquid chromatography-Q-Exactive HF-X mass spectrometer (UHPLC-Q-Exactive HF/MS) were carried out to reveal dynamic changes of volatile and non-volatile compounds during the withering process of black tea. A total of 118 volatile organic compounds (VOCs) and 648 metabolites were identified in fresh and withered tea-leaves, respectively. Among them, 47 VOCs (OAV > 1.0) for the aroma formation, and 46 characteristic metabolites (VIP > 1.50, p < 0.01) selected through orthonormal partial least squares-discriminant analysis, indicated the withering contribution during black tea processing. Overall, the withering promoted alcohols, aldehydes, phenols, heterocyclic oxygen, hydrocarbons and halogenated hydrocarbons through relevant hydrolyzation, decomposition, terpene synthesis, and O-methylation. The hydrolyzation, O-methylation, condensation and N-acylation of kaempferol glycosides, quercetin glycosides, ester catechins, and gallic acid generated the accumulation of methoxyl flavonoids and flavonoid glucosides, dihydrokaempferol, syringic acid, theaflavins, and N-acylated amino acids, respectively.

Why Do Chinese Older Adults in Hong Kong Delay or Refuse COVID-19 Vaccination? A Qualitative Study Based on Grounded Theory.

OBJECTIVES: Older adults have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. While COVID-19 vaccines are effective for reducing mortality and severe complications, vaccine hesitancy remains a substantial concern particularly among older adults. This was a qualitative study to explore how Chinese older adults reached a decision to delay or refuse the COVID-19 vaccines in Hong Kong. METHODS: Semi-structured in-depth interviews were conducted with 27 older adults aged ≥60 years who had never received COVID-19 vaccines. The grounded theory approach guided the selection of informants, data collection, data analysis, and report writing. RESULTS: Older adults' vaccine hesitancy and resistance weaved into the context of lacking sufficient decisional support and attitude roots of negative perception of aging, fatalistic risk attitudes, present-oriented time perspectives, and negative values on western biomedicine. Attitude roots were used as the decisional anchors to further shape older adults' peripheral processing of vaccine-related information, resulting into a spectrum of vaccine-resistant and vaccine-hesitant attitudes. While participants refused or delayed COVID-19 vaccination, they engaged in alternative coping strategies to regain self-control and justify their vaccination disengagement in the pandemic. DISCUSSION: Interventions to address vaccine hesitancy in older adults should focus on addressing attitude roots and strengthening the connectivity of older adults with family, doctors, and government to engage older adults in the vaccination decision making. Risk communication should shift to provide more personal relevant information in a caring style, meet older adults' preference for peripheral information processing, and address their existing misperceptions about COVID-19 vaccines.

Pandemic fatigue impedes mitigation of COVID-19 in Hong Kong.

Hong Kong has implemented stringent public health and social measures (PHSMs) to curb each of the four COVID-19 epidemic waves since January 2020. The third wave between July and September 2020 was brought under control within 2 m, while the fourth wave starting from the end of October 2020 has taken longer to bring under control and lasted at least 5 mo. Here, we report the pandemic fatigue as one of the potential reasons for the reduced impact of PHSMs on transmission in the fourth wave. We contacted either 500 or 1,000 local residents through weekly random-digit dialing of landlines and mobile telephones from May 2020 to February 2021. We analyze the epidemiological impact of pandemic fatigue by using the large and detailed cross-sectional telephone surveys to quantify risk perception and self-reported protective behaviors and mathematical models to incorporate population protective behaviors. Our retrospective prediction suggests that an increase of 100 daily new reported cases would lead to 6.60% (95% CI: 4.03, 9.17) more people worrying about being infected, increase 3.77% (95% CI: 2.46, 5.09) more people to avoid social gatherings, and reduce the weekly mean reproduction number by 0.32 (95% CI: 0.20, 0.44). Accordingly, the fourth wave would have been 14% (95% CI%: -53%, 81%) smaller if not for pandemic fatigue. This indicates the important role of mitigating pandemic fatigue in maintaining population protective behaviors for controlling COVID-19.

Microbial community succession in the fermentation of Qingzhuan tea at various temperatures and their correlations with the quality formation.

With the aim to reveal the microbial community succession at various temperatures in the fermentation of Qingzhuan tea (QZT), the Illumina NovaSeq sequencing was carried out to analyze bacterial and fungal community structure in tea samples collected from the fermentation set at various temperatures, i.e., 25 °C, 30 °C, 37 °C, 45 °C, 55 °C, and room temperature. The results showed that fermentation temperature profoundly affected the microbial community succession in the QZT fermentation. Microbial richness and community diversity decreased along with the increase of fermentation temperature. Despite the differences between microorganisms and their metabolic types among various temperatures, most bacteria and fungi showed positive correlations at the genera level. Klebsiella, Paenibacillus, Cohnella, and Pantoea were confirmed as the main bacterial genera, and Aspergillus and Cyberlindnera were the main fungal genera in QZT fermentation. The microbial genera (i.e. Aspergillus, Rhizomucor, Thermomyces, Ralstonia, Castellaniella, and Vibrio) were positively correlated with fermentation temperature (P < 0.05), while Klebsiella, Paenibacillus, and Aspergillus had good adaptability at different temperatures. Conversely, Pantoea and Cyberlindnera were only suitable for low temperature (≤37 °C) growth, and Thermomyces was only suitable for high temperature (>37 °C) growth. Aspergillus had a significant positive correlation with tea aroma quality (r = 0.64, p < 0.05). This study would help to understand the formation mechanism of QZT from microflora perspective.

Effectiveness of CoronaVac and BNT162b2 Vaccines Against Severe Acute Respiratory Syndrome Coronavirus 2 Omicron BA.2 Infections in Hong Kong.

There is limited evidence on vaccine effectiveness against asymptomatic or mild Omicron infections. We estimated that recent third doses of messenger RNA or inactivated vaccines reduced the risk of self-reported infection by 52% (95% confidence interval, 17%-73%) among randomly sampled adults during the Omicron BA.2-dominated surge in Hong Kong.

Temporal changes in factors associated with COVID-19 vaccine hesitancy and uptake among adults in Hong Kong: Serial cross-sectional surveys.

Background: COVID-19 vaccine hesitancy can lead to reduced vaccine uptake and hinder the safe relaxation of other public health measures. This study aims to explore the factors associated with vaccine hesitancy and uptake among adults before and after the implementation of the COVID-19 vaccination program in Hong Kong. Methods: Cross-sectional telephone surveys were conducted every four weeks over a nine-month period from November 2020 through July 2021. Target respondents were Hong Kong resident aged 18 or above and recruited by random-digit dialling. In each survey, responses on COVID-19 vaccine hesitancy and COVID-19 vaccine uptake were collected as primary and secondary outcomes, respectively. Data of potentially associated factors, including socio-demographics, chronic medical conditions, perceived risk of COVID-19, perceived personal efficacy in self-protection, confidence in the government's ability to control the pandemic, compliance with social distancing measures, and confidence in COVID-19 vaccines, were also collected. Multivariable logistic regression models were used to examine the factors associated with COVID-19 vaccine hesitancy at different time points. Findings: Ten cross-sectional surveys were conducted, including 7411 respondents. The levels of vaccine hesitancy fluctuated over time. From December 2020 to May 2021, the age group with the highest vaccine hesitancy was young adults 18-34y, while the vaccine hesitancy was highest among adults ≥ 65y in June-July 2021 (Fig. 2C). Our regression analyses (Fig. 3) showed that before and at the beginning of the rollout of the mass vaccination program, there was no statistically significant association between chronic medical conditions and vaccine hesitancy. However, two-five months after the program implementation respondents with chronic medical conditions were more likely to be hesitant. From January to June 2021, higher confidence in the government was associated with lower vaccine hesitancy (Fig. 3). Confidence in COVID-19 vaccines was consistently associated with lower vaccine hesitancy at different stages of the program. Interpretation: The factors associated with COVID-19 vaccine hesitancy changed over time. This study highlighted the importance to monitor temporal changes in COVID-19 vaccine hesitancy and associated factors, and adjust promotion strategies correspondingly to boost vaccination uptake. Funding: Health and Medical Research Fund, Hong Kong.

Public acceptability of COVID-19 control measures in Singapore, Hong Kong, and Malaysia: A cross-sectional survey.

BACKGROUND: Several countries have implemented control measures to limit SARS-CoV-2 spread, including digital contact tracing, digital monitoring of quarantined individuals, and testing of travelers. These raise ethical issues around privacy, personal freedoms, and equity. However, little is known regarding public acceptability of these measures. METHODS: In December 2020, we conducted a survey among 3635 respondents in Singapore, Hong Kong, and Malaysia to understand public perceptions on the acceptability of COVID-19 control measures. FINDINGS: Hong Kong respondents were much less supportive of digital contact tracing and monitoring devices than those in Malaysia and Singapore. Around three-quarters of Hong Kong respondents perceived digital contact tracing as an unreasonable restriction of individual freedom; <20% trusted that there were adequate local provisions preventing these data being used for other purposes. This was the opposite in Singapore, where nearly 3/4 of respondents agreed that there were adequate data protection rules locally. In contrast, only a minority of Hong Kong respondents viewed mandatory testing and vaccination for travelers as unreasonable infringements of privacy or freedom. Less than 2/3 of respondents in all territories were willing to be vaccinated against COVID-19, with a quarter of respondents undecided. However, support for differential travel restrictions for vaccinated and unvaccinated individuals was high in all settings. INTERPRETATION: Our findings highlight the importance of sociopolitical context in public perception of public health measures and emphasize the need to continually monitor public attitudes toward such measures to inform implementation and communication strategies.