[Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women]. / Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas.

OBJECTIVE: To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DESIGN: Quasi-experimental study of community intervention. SITE: Two basic health zones belonging to the Elche-Crevillente health department, Spain. PARTICIPANTS: Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. INTERVENTIONS: Training session for the IG prior to the 2019/20 flu campaign. MAIN MEASUREMENTS: Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. RESULTS: The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). CONCLUSIONS: Joint training strategies for professionals and community assets improve the results of vaccination coverage.

Acceptability of the Vaccine against COVID-19 in Spanish Health Sciences Students: A Cross-Sectional Study.

Healthcare professionals must play an exemplary role in the field of vaccinology. It is convenient that they are trained during their time at university. The objective of this study was to determine the acceptability of the vaccines against COVID-19 in health sciences students in Spanish universities. A cross-sectional study was performed regarding the acceptance of the vaccines against COVID-19 in students in the Health Sciences Degrees in Spanish universities was performed on a sample of students of nursing, medicine, and pharmacy during the spring of 2021, via an online questionnaire with 36 questions designed ad hoc, self-administered, anonymized, and standardized. There were 1222 students participating, of Spanish nationality (97.4%), women (80.5%) and with an average age of 22.0 ± 4.8 years old. Of those, 12.3% had had the disease, 44.0% had to quarantine, 70.8% had undergone diagnostic tests, out of which 14.1% were positive. In total, 97.5% of those surveyed indicated their desire of being vaccinated, if possible, with Comirnaty® (74.9%). At the time of the study, 49.6% were already vaccinated. The reasons for vaccination differed according to the degree and the doubts about vaccine safety was the largest reason for reluctance. Some 37.7% suspected that there are unknown adverse effects and 85.6% of those vaccinated experienced some mild effects after injection. Vaccine acceptance and confidence in the recommendations given by health authorities is high in health sciences students.

Impact of the COVID-19 Pandemic on the Work Activity of Spanish Physical Therapists and Their Response to Vaccination.

Due to the COVID-19 pandemic, physical therapists have had to adopt a set of specific protection measures, which have had an impact on their clinical activity and economy. The objective was to evaluate the impact of the COVID-19 pandemic on the work of Spanish physical therapists, as well as their attitudes and predisposition to vaccination. An online questionnaire was divided into five sections: (1) demographic and professional data; (2) labor impact; (3) precautions and infection-control measures; (4) economic impact; and (5) vaccine acceptance and adverse effects. Of the 666 participants, 62.1% showed a reduction in their working hours motivated by: fear of infection (p = 0.007), financial issues (p = 0.002) and being in quarantine or isolation (p < 0.001). Of these, 36.4% were forced to close the clinic, 62.7% requested help from the government, but only 12.04% mentioned that it was adequate. The main prevention measures adopted were the use of gels and masks and, in the private sector, disinfection with ozone or ultraviolet light (p < 0.05). The acceptance of the vaccine was high, 87.5%, being lower among the group over 40 years of age, self-employed, widowed or separated. More adverse effects were mentioned after receiving the AstraZeneca-Oxford vaccine, compared to Pfizer-BioNTech or Moderna. In conclusion, this study assessed for the first time that the COVID-19 pandemic in Spain had a negative impact on work and finances of physical therapists. The vaccine was widely accepted, in part by the economic impact that an infection in the work setting could signify.

Obstetric-Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study.

This study analyses the obstetric−neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric−neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother−infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother−infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.

Willingness to Be Vaccinated against COVID-19 in Spain before the Start of Vaccination: A Cross-Sectional Study.

Vaccine hesitancy has increased in the past few years, influenced by the socio-cultural differences, political populism, or concerns related to the effectiveness and safety of some vaccines, resulting a feeling of distrust. This feeling can become a barrier against the achievement of the immunity necessary to stop the expansion of COVID-19. The aim of this study was to evaluate the acceptance of the vaccine against COVID-19 in Spain, as well as to identify the factors that have an influence on the concerns and attitudes of people against accepting the vaccine in the months prior to the start of vaccination on December 2020. An online questionnaire was created to obtain information about (1) sociodemographic characteristics; (2) concerns and sources of information about vaccines; and (3) attitudes about vaccination and state of health. A multivariate logistic regression was performed to identify the influencing factors. Of the 2501 participants, 1207 (48.3%) would accept the COVID-19 vaccine, 623 (24.9%) were hesitant, and 671 (26.8%) would reject it. The logistic regression showed that being male, older than 60, married, retired, with a high level of education, or with a leftist political inclination, could increase the probability of accepting the COVID-19 vaccine. Disinformation and the lack of political consensus were the main sources of distrust. The patients with hypertension, immunodepression, hypercholesterolemia, or respiratory disease, or were overweight, showed a greater acceptance to the vaccine, while those with cancer took the longest to accept it. A low acceptance of the vaccine against COVID-19 was observed among the Spanish population in the phase prior to its availability, and the main fears of the population were identified. It is necessary to offer correct and transparent information about these vaccines to reduce the concerns and increase the trust of the population, to thereby guarantee the success of the vaccination campaigns.

Knowledge, Attitudes, and Sources of Information on Vaccines in Spanish Nursing Students: A Cross-Sectional Study.

Health professionals are the most influential and main sources of information about vaccines for the general population, as they are regarded as role models by patients and society. The objective of the present study was to determine the knowledge and attitudes of a group of university Nursing students about vaccines, as well as their sources of information and their education needs. A cross-sectional study was performed through a questionnaire (55 items) provided to Nursing students at two Spanish universities. A total of 1122 students participated in the study. The mean score obtained for knowledge about vaccines was 44.6 ± 4.3, and for attitudes towards vaccines, it was 37.2 ± 3.9. Hepatitis B (94.7%) and the Flu (89%) are the two main vaccines they should receive as health workers. The main source of information was the family environment (65.6%). Most of them considered that post-graduate education about vaccines should be provided by academic entities (universities, 62.7%). Among the health professionals, Nurses (85.5%) must be better educated and trained on the subject of vaccines. It is therefore necessary to delve into and complete the nurses' training on vaccines, to educate them about the risks at the individual level, and their decisive role as promoters of the vaccination strategy for the general population. Universities must become the leaders in vaccine education and training.

[Immunological Status against Hepatitis B among Healthcare Workers in Two Public Health Departments of the Valencian Community (Spain)]. / Estado inmunológico frente a la Hepatitis B del personal sanitario en dos departamentos de salud de la Comunidad Valenciana (España).

OBJECTIVE: To estimate the prevalence of immunity against Hepatitis B virus among all healthcare workers linked to the Departments of Public Health in Torrevieja and Elx-Crevillent,two municipalities in the Valencian Community, Spain. METHODS: Cross-sectional descriptive study of healthcare workers in two different public health departments. Once the sample was obtained, the anti-hepatitis B surface antibody (anti-HBsAb) levels were abstracted based on serological test results recorded in the workers' medical records. Titers of anti-HBsAB ≥10mlU / ml were considered as evience of immunity. The variables analyzed were classified by department, gender, age (18-34; 35-49;≥50 years); professional category (physicians / nursing / other health personnel / nonhealth personnel); service at risk of contagion (Yes / No); immunity (≥10mlU/ml, 〈10mlU/ml,missing) and systematic anti-HBs vaccination by date of birth (Yes / No). RESULTS: The study population consisted of 2674 workers. The highest proportions of workers were female(68.8%), between 35 and 49 years of age (52.8%), and employed in nursing,(32.2%). Overall, 74.9% of employees had evidence of hepatitis B immunity, 11.3% had no inmunity, and 13.8% was missing information on serology. Among those employees with serological information (n=2306), lack of immunity was highest among males (17.8%).Protective titers were inversely proportional to age, with the lowest titers being found in the oldest age groups. Non-healthcare personnel and physicians also had lower levels of protection (36.9% and 11.1%, respectively). CONCLUSIONS: Despite identifying high levels of immunity among healthcare workers, the percentages of non-immunized employees and those lacking immunological information underscores the need to implement new communication strategies aimed at these at-risk groups.

OBJETIVO: Estimar la prevalencia de inmunización frente al virus de la Hepatitis B del personal sanitario, vinculado a los Departamentos de Salud de Torrevieja y Elche-Crevillente, de la Comunidad Valenciana. MÉTODOS: Estudio descriptivo transversal en todos los trabajadores sanitarios de dos departamentos de Salud. Obtenida la muestra se identificó los niveles de anticuerpos de superficie del virus de la Hepatitis B a través de los resultados serológicos ubicados en las historias clínicas. Se consideró inmunizado a títulos de anti-HBs ≥10mlU/ml. Las variablesanalizadas fueron categorizadas según: Departamento; Género; Edad (18-34; 35-49; >50años); categoría profesional (facultativos/Enfermería/Otro personal sanitario/Personal no sanitario); Servicio riesgo contagio (Si/No); Inmunidad (≥10mlU/ml / 〈10mlU/ml / No Dato) y Vacunacion sistemática anti-HBs según fecha nacimiento (Si/No). RESULTADOS: El personal estudiado ascendió a 2674. Predominó el género femenino 68,8%, el grupo de edad 35-49 años, 52,8%, y la categoría profesional de Enfermería, 32,2%. Un 74,9% de los resultados serológicos identificaron niveles de protección anti-HBs, frente al 11,3% no inmune, y un 13,8% que no disponían de información. Del personal con información serológica (2306), obtuvieron porcentajes de no protección más elevadas la categoría masculina, 17,8%. Los niveles de protección fueron inversamente proporcionales según la variable edad, menor inmunidad a mayor edad. El personal no sanitario y los facultativosarrojaron niveles de protección más bajos, 36,9% y 11,1% respectivamente. CONCLUSIONES: A pesar de identificarse una inmunidad elevada, el porcentaje de no inmunizadosy de ausencia de información inmunológica plantea la necesidad de implementar nuevas estrategias de comunicación dirigidas a este colectivo.

Influenza Vaccination Experiences of Pregnant Women as a Predictor of the Intention to Become Vaccinated in Future Pregnancies in Spain.

A good perception of the vaccines administered during pregnancy favors immunization coverage, which is still not optimal for the influenza vaccine. To understand the predisposition towards vaccination in future pregnancies, a study was performed that evaluated the experiences of women with the vaccine or influenza. A cross-sectional study was conducted through telephone interviews given to a total of 683 postpartum women in two health departments from the Valencia Community (Spain). This interview asked about their intention of becoming vaccinated in future pregnancies and whether they were favor or against vaccination. Most of them, 98.5% (n = 673 [95% CI: 97.6-99.4]) (p < 0.001) declared having received the systematic vaccines throughout their lives. The ones who were vaccinated against influenza, 91.9% (n = 387 [95% CI: 89.2-94.6]) (p < 0.001) manifested they would do so in future pregnancies. The probability of future non-vaccination was modeled, which was related to an unfavorable opinion towards vaccines (OR = 4.07 [95% CI: 2.01-8.24]) (p < 0.001), having suffered from influenza during pregnancy (OR = 3.84 [95% CI: 1.41-10.42]) (p < 0.05), and not having been vaccinated during previous pregnancies (OR = 38.47 [95% CI: 23.58-62.76]) (p < 0.001). Vaccination during pregnancy increases the intent of vaccination in the future.

Knowledge and Attitudes about the Flu Vaccine among Pregnant Women in the Valencian Community (Spain).

Background and Objectives: To describe the knowledge and attitudes related to the acceptance of the flu vaccine during pregnancy in women, from two Health Departments of the Valencian Community (VC), during the 2015-2016 season, after receiving prenatal care. Materials and Methods: A prospective observational study was conducted during the annual vaccine season of women ascribed to prenatal care. A midwife offered flu vaccine advice and afterwards conducted a telephone poll of a representative sample, in order to find out the reason for accepting or rejecting the vaccine. Results: Of the 1017 expectant women who received advice about the vaccine, 77.4% (95% CI: 74.8-79.9%) declared their intention to vaccinate. After the recommendation, the vaccine coverage was 61.6%, with a percentage of accordance of 98.8% (95% CI: 98.0-99.6%) between the coverage declared and the Nominal Vaccination Registry (NVR) of the VC. Additionally, 67.2% of the expectant women were interviewed (n = 683). Most were aware of the recommendation and identified the health center and the midwife as the main sources of information. The internet was a consistent source in favor of vaccination 80.8% (n = 42). The obstetric variables (risk during the pregnancy, end of pregnancy, and feeding the newborn) did not have a statistically significant relationship with the vaccination. The women declared a high adherence to the vaccinations present in the child vaccination calendar, but rejected (31.3%) the flu vaccine, as they had not received it previously and did not want it because of their expectant state. Conclusions: The women positively evaluated the effectiveness and safety of the vaccines. However, with the flu vaccine, "not being previously vaccinated" and the "doubts about its safety" represented more than half of the reasons put forth for its rejection. Ensuring that the flu vaccine is perceived as more effective and acceptable through the messages directed towards the expectant mothers, directly through the midwives or through the communication media and social networks, will result in an increase of vaccine coverage.

Adherence and Concordance of Influenza and Pertussis Vaccination Coverage in Pregnant Women in Spain.

Background: Pregnant women should receive two vaccines during pregnancy due to maternal-foetal complications and risks as well as the influenza and pertussis vaccinations. The goal was to evaluate vaccination coverage against influenza and pertussis in pregnant women, following midwife professional advice during the pregnancy follow-up; Methods: Prospective cohort study of 1017 pregnancies during the vaccination campaign in 2015⁻2016. To estimate the degree of consistency between the coverage declared by mothers and that registered in the Nominal Vaccination Registry (NVR), we used the Cohen's kappa index (k); Results: 95.4% were registered in the NVR. Vaccination coverage recorded against influenza was 64.2% (95% CI: 61.2⁻67.2), and 89.8% (95% CI: 87.9⁻91.7) against pertussis. The coverage of the pregnant women interviewed was 61.7% (95% CI: 58.1⁻67.3)) for influenza and 92.3% (95% CI: 91.4⁻95.3) for pertussis. Subsequent interviews of 67.2% of the women produced a kappa agreement index between the data obtained from interviews and those recorded in the NVR of 0.974 (IC95%: 98.0⁻99.6) for influenza, and 0.921 (IC95%: 98.1⁻99.7) for pertussis. The women identified midwives as the main source of vaccination information and advice 88.4% (IC95%: 85.8⁻90.9); Conclusions: The NVR is an effective platform for estimating immunisation coverage in pregnant women. The degree of agreement between declared vaccinations and registered vaccinations was high for both vaccines.