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Front Immunol ; 13: 864718, 2022.
Article in English | MEDLINE | ID: covidwho-20244339


mRNA based vaccines against COVID-19 have proven most successful at keeping SARS-CoV-2 pandemic at bay in many countries. Recently, there is an increased interest in heterologous prime-boost vaccination strategies for COVID-19 to maintain antibody responses for the control of continuously emerging SARS-CoV-2 variants of concern (VoCs) and to overcome other obstacles such as supply shortage, costs and reduced safety issues or inadequatly induced immune-responses. In this study, we investigated the antibody responses induced by heterologous prime-boost with vaccines based on mRNA and virus-like particles (VLPs). The VLP-based mCuMVTT-RBM vaccine candidate and the approved mRNA-1273 vaccine were used for this purpose. We find that homologous prime boost regimens with either mRNA or VLP induced high levels of high avidity antibodies. Optimal antibody responses were, however, induced by heterologous regimens both for priming with mRNA and boosting with VLP and vice versa, priming with VLP and boosting with mRNA. Thus, heterologous prime boost strategies may be able to optimize efficacy and economics of novel vaccine strategies.

COVID-19 , SARS-CoV-2 , 2019-nCoV Vaccine mRNA-1273 , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Immunoglobulin G , RNA, Messenger/genetics , SARS-CoV-2/genetics
Rheumatology (Oxford) ; 61(10): 3912-3918, 2022 10 06.
Article in English | MEDLINE | ID: covidwho-20242590


OBJECTIVES: Patients with inflammatory rheumatic diseases (IRDs) treated with the anti-CD20 mAb rituximab (RTX) have been identified as high-risk for severe COVID-19 outcomes. Additionally, there is increased risk due to reduced humoral immune response, induced by therapeutic B cell depletion. This study sought to quantify humoral response after vaccination against SARS-CoV-2 in patients with IRD treated with RTX. It also sought to elucidate the influence of the time frame between the last RTX dose and the first vaccination, or the status of B cell depletion on antibody titre. METHODS: In this case-control study, patients with IRDs previously treated with RTX were examined for humoral immune response after completing the first series of vaccinations with approved vaccines [BNT162b2 (Biontech/Pfizer), RNA-1273 (Moderna), AZD1222 (AstraZeneca/Oxford), Ad26.COV2.S (Janssen/Johnson & Johnson)]. Antibody levels were quantified using the Euroimmun Anti-SARS-CoV-2 QuantiVac ELISA (EI-S1-IgG-quant). Blood samples were taken just before the next infusion with RTX after the vaccination. The interval between the last RTX infusion and the first vaccination against SARS-CoV-2 and other possible factors influencing the antibody levels were evaluated. RESULTS: A total of 102 patients were included. Of these, 65 (64%) showed a negative antibody level (<24 IU (international unit)/ml) after the vaccination. The comparative univariate analysis of the antibody levels achieved a significant result (P = 0.0008) for the time between the last RTX infusion and first vaccination against SARS-CoV-2. No CD19+ peripheral B-cells could be detected in 73 of the patients (72%). CONCLUSION: The study confirms the negative impact of RTX on antibody level after vaccination against SARS-CoV-2. A clear relationship exists between the antibody titre and the interval between the last RTX infusion and the first vaccination, the number of peripheral B-cells, and immunoglobulin quantity. Improved understanding of the effect of these parameters can help guide synchronization of vaccination in relation to the RTX therapy regimen.

COVID-19 , Rheumatic Diseases , Ad26COVS1 , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Case-Control Studies , ChAdOx1 nCoV-19 , Humans , Immunoglobulin G , RNA , Rheumatic Diseases/chemically induced , Rheumatic Diseases/drug therapy , Rituximab/therapeutic use , SARS-CoV-2 , Vaccination
Chemosphere ; 302: 134805, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-20242488


The tremendous use of plastic products to averse the infection rate during Covid-19 pandemic has developed great pressure on the management and disposal systems of plastic waste. The compulsory use of face masks to curb the infection and prevent transmission of the virus has led to addition of millions of face masks into the terrestrial and marine environment. The current study attempts to assess and quantify the rate of infection in coherence with the annual usage of face masks in various nations across the globe. The ecological footprint of the plastic waste generated from used and discarded face masks along with their potential impacts have also been discussed. The current study has quantified the total annual face masks across thirty-six nations to be more than 1.5 million ton. The total estimated figure for annual plastic waste and microplastics in all these nations was ∼4.2 million tonnes and 9774 thousand tonnes, which emerges as a great threat to the global efforts towards reduction of plastic usage. The emergence of Covid-19 pandemic has modified the living habits with new enterprises being set up for Covid essential products, but the associated hazard of these products has been significantly ignored. Hence this study attempts to present a quantitative baseline database towards interpretation and understanding of the hazards associated with microplastics and increased dependence on plastic products.

COVID-19 , Microplastics , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Masks , Pandemics/prevention & control , Plastics
Urol J ; 17(6): 560-561, 2021 Jan 09.
Article in English | MEDLINE | ID: covidwho-20242698


In this correspondence the authors try to show that guidelines and recommendations including what was published by EAU rapid reaction group must be further updated and tailored according to different epidemiologic data in different countries. The authors assign the countries worldwide in three categories. First category comprises countries that experience the secondary surges smoother than the first one. The second category include countries with stronger or -merging and rising-secondary surges and the third category encompasses countries with successful initial response and secondary stronger but still more controllable surges. Authors proclaim that after passing the first baffling impact we find out that postponement strategies preached in many of these scout treatises are no more suitable at least for the countries delineated in the second category and can culminate in performance of procedures in worse. The authors proffer Iranian Urology Association COVID-19 Taskforce Pamphlet(IUA-CTP) as a paragonic document mentioning it's the time we must recognise the wide variability of the situation in different regions and any advisory position must consider this huge variance in epidemiologic profile.

COVID-19/epidemiology , COVID-19/prevention & control , Urologic Surgical Procedures/standards , Appointments and Schedules , Elective Surgical Procedures/standards , Humans , Iran/epidemiology , Practice Guidelines as Topic , SARS-CoV-2
Eur J Gastroenterol Hepatol ; 33(3): 319-324, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-20235516


Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus (SARS-CoV-2) originated in China in December 2020 and declared pandemic by WHO. This coronavirus mainly spreads through the respiratory tract and enters cells through angiotensin-converting enzyme 2 (ACE2). The clinical symptoms of COVID-19 patients include fever, cough, and fatigue. Gastrointestinal symptoms (diarrhea, anorexia, and vomiting) may be present in 50% of patients and may be associated with worst prognosis. Other risk factors are older age, male gender, and underlying chronic diseases. Mitigation measures are essential to reduce the number of people infected. Hospitals are a place of increased SARS-CoV-2 exposure. This has implications in the organization of healthcare services and specifically endoscopy departments. Patients and healthcare workers safety must be optimized in this new reality. Comprehension of COVID-19 gastrointestinal manifestations and implications of SARS-CoV-2 in the management of patients with gastrointestinal diseases, under or not immunosuppressant therapies, is essential. In this review, we summarized the latest research progress and major societies recommendations regarding the implications of COVID-19 in gastroenterology, namely the adaptations that gastroenterology/endoscopy departments and professionals must do in order to optimize the provided assistance, as well as the implications that this infection will have, in particularly vulnerable patients such as those with chronic liver disease and inflammatory bowel disease under or not immunosuppressant therapies.

COVID-19/prevention & control , Endoscopy, Gastrointestinal , Gastroenterologists , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Liver Diseases/therapy , Practice Patterns, Physicians' , COVID-19/immunology , COVID-19/transmission , Clinical Decision-Making , Decision Support Techniques , Endoscopy, Gastrointestinal/adverse effects , Humans , Immunocompromised Host , Liver Diseases/diagnosis , Liver Diseases/immunology , Occupational Health , Patient Safety , Risk Assessment , Risk Factors
Postgrad Med J ; 96(1137): 399-402, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-20234171


A novel coronavirus (severe acute respiratory syndrome-CoV-2) that initially originated from Wuhan, China, in December 2019 has already caused a pandemic. While this novel coronavirus disease (COVID-19) frequently induces mild diseases, it has also generated severe diseases among certain populations, including older-aged individuals with underlying diseases, such as cardiovascular disease and diabetes. As of 31 March 2020, a total of 9786 confirmed cases with COVID-19 have been reported in South Korea. South Korea has the highest diagnostic rate for COVID-19, which has been the major contributor in overcoming this outbreak. We are trying to reduce the reproduction number of COVID-19 to less than one and eventually succeed in controlling this outbreak using methods such as contact tracing, quarantine, testing, isolation, social distancing and school closure. This report aimed to describe the current situation of COVID-19 in South Korea and our response to this outbreak.

Betacoronavirus/pathogenicity , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Quarantine/organization & administration , Basic Reproduction Number , COVID-19/prevention & control , Coronavirus Infections/prevention & control , Epidemiological Monitoring , Evidence-Based Medicine , Human Activities , Humans , Physical Distancing , Pneumonia, Viral/prevention & control , Republic of Korea/epidemiology , SARS-CoV-2 , Travel
Cien Saude Colet ; 27(3): 951-956, 2022 Mar.
Article in Portuguese, English | MEDLINE | ID: covidwho-20239042


This paper reflects on the vaccination campaign against COVID-19 in Brazil in light of the consideration of scientific evidence in the decision-making process. Brazil has one of the largest and most complete vaccination programs in the world, the National Immunization Program (Programa Nacional de Imunizações or PNI). Unfortunately, in the current context, with the political interference of the federal government, the PNI lost its role in conducting the vaccination campaign against COVID-19. Despite being a vaccination campaign with a lot of potential and one of the most accepted by the population among countries in the world, it presented many problems and left several gaps in the Brazilian scenario. In this sense, it is essential that the quality scientific evidence produced during this period can guide a constant remodeling of the vaccination strategy. Four points deserve to be highlighted: 1) the interval between doses; 2) the interchangeability between vaccines; 3) vaccination in children and adolescentes; and 4) the need for better evidence to define the vaccination strategy in certain groups and age groups.

O presente texto trata de refletir sobre a campanha de vacinação contra COVID-19 no Brasil à luz da consideração das evidências científicas no processo de tomada de decisão. O Brasil possui um dos maiores e mais completos programas de vacinação do mundo, o Programa Nacional de Imunizações (PNI). Infelizmente, no contexto atual, com as interferências políticas do governo federal, o PNI perdeu seu protagonismo na condução da campanha de vacinação contra a COVID-19. Apesar de ser uma campanha de vacinação com muito potencial e uma das mais aceitas pela população entre os países no mundo, apresentou muitos problemas e deixou diversas lacunas no cenário brasileiro. Nesse sentido, é fundamental que as evidências científicas de qualidade produzidas nesse período possam guiar uma remodelagem constante da estratégia de vacinação. Quatro pontos merecem ser destacados: 1) o intervalo entre as doses; 2) a intercambialidade entre vacinas; 3) a vacinação em adolescentes; e 4) a necessidade de melhores evidências para definir a estratégia de vacinação em certos grupos e faixas etárias.

COVID-19 , SARS-CoV-2 , Brazil/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Child , Humans , Immunization Programs
Infect Dis Now ; 52(8S): S7-S8, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-20238432


Heterologous prime boost vaccination is a primary vaccination with different vaccines, most often from different vaccine platforms. It combines the immunological properties of the different vaccines and thereby induces humoral, cellular and, in some cases, mucosal response. For Covid prevention, it has been used in primary vaccination, due to safety issues and in boosters. We have evaluated some articles reporting on the results of this type of vaccine, and demonstrating its usefulness.

COVID-19 Vaccines , COVID-19 , Humans , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Immunization, Secondary/methods , Vaccination/methods
West J Emerg Med ; 23(4): 570-578, 2022 Jul 11.
Article in English | MEDLINE | ID: covidwho-20237020


INTRODUCTION: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake. METHODS: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression. RESULTS: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024). CONCLUSION: In this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.

COVID-19 Vaccines , COVID-19 , Emergency Medical Services , Health Personnel , Vaccination , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/supply & distribution , Cross-Sectional Studies , Decision Making , Health Personnel/psychology , Health Personnel/statistics & numerical data , Health Surveys , Humans , Influenza Vaccines/administration & dosage , North Carolina , Occupational Health , Patient Safety , Vaccination/legislation & jurisprudence , Vaccination/psychology , Vaccination/statistics & numerical data
Cien Saude Colet ; 27(3): 969-978, 2022 Mar.
Article in Portuguese, English | MEDLINE | ID: covidwho-20236329


This study aimed to evaluate the impact of the COVID-19 pandemic on the vaccination numbers for immunization geared toward individuals under 12 months of age in Brazil. This study analyzed the numbers of the nationwide vaccination coverage of ten vaccines present in the calendar from the National Immunization Program (NIP) over the past eight years (2013-2020). This is an ecological study, and all data were taken from the NIP. In comparison to the previous years, 2020 recorded the lowest figures of vaccination coverage (VC) of the average of the group of studied vaccines - 79.07% - while in 2019, this same index was 84.44%, resulting in a drop of 11.10% between these two periods. Moreover, during the year of the pandemic, of the ten analyzed vaccines, nine recorded their lowest historical VC figures, all of which were at least 14 percentage points below the goals set by the Brazilian Ministry of Health (MS, in Portuguese). Although there had already been a tendency toward a decline in VC, for various reasons, the present study illustrates that the numbers recorded in 2020 were significantly lower, a phenomenon also reported in other countries. Therefore, although it is impossible to affirm that the COVID-19 pandemic and its distancing measures are the causes for the drop in the immunization numbers, it can be inferred that there is indeed an association.

O objetivo do estudo foi avaliar o impacto da pandemia de COVID-19 nos valores de vacinação para as imunizações voltadas a indivíduos com menos de um ano de vida no Brasil. Analisou-se os valores de cobertura vacinal, em território nacional, de dez vacinas presentes no calendário do Programa Nacional de Imunizações (PNI) durante os últimos oito anos (2013-2020). Esse é um estudo ecológico e todos os dados foram extraídos do PNI. Comparativamente aos anos prévios, em 2020 registrou-se o menor valor de cobertura vacinal da média do conjunto das vacinas estudadas, 75,07%, enquanto em 2019 esse mesmo índice ficou em 84,44%, resultando em uma queda de 11,10% entre esses dois períodos. Além disso, no ano da pandemia, das dez vacinas analisadas, nove registraram o seu menor valor histórico de cobertura, todas estando a no mínimo 14 pontos percentuais abaixo da meta do Ministério da Saúde. Embora já houvesse uma tendência de queda na cobertura vacinal, por diversos motivos, o presente estudo demonstra que os valores registrados em 2020 foram significativamente menores, fenômeno também registrado em outros países. Portanto, mesmo não conseguindo afirmar que a pandemia de COVID-19 e as medidas de distanciamento sejam as causas da queda dos valores de imunização, podemos inferir que há uma associação.

COVID-19 , Pandemics , COVID-19/epidemiology , COVID-19/prevention & control , Child , Humans , Immunization Programs , Pandemics/prevention & control , Vaccination , Vaccination Coverage
Cien Saude Colet ; 27(12): 4435-4450, 2022 Dec.
Article in Portuguese, English | MEDLINE | ID: covidwho-20235216


This is a scoping review of the literature on actions taken by countries during 2020 regarding the care for people living in the prison environment during the COVID-19 pandemic. We selected 54 publications for data mining and found data from 45 countries, which were organized into categories. Most of the literature addressed strategies adopted by countries with advanced economies. All of them mentioned some strategies to reduce viral transmission - the major ones were restricted/suspended family visits and desincarceration - and interventions to improve infrastructures in prisons, the provision of a telephone or other devices for calls or video calls being the most mentioned. Policies to mitigate the effects of the epidemic and interventions were found in publications referencing 33 countries, with the main focus on keeping family contact and reviewing the public safety policy. Concerning governance policies, measures from 11 countries were reported, and the most cited was national authority reinforcement. This study highlights the need for research on the success of each strategy and the differences among those countries.

Trata-se de uma revisão de escopo da literatura sobre as ações adotadas pelos países, durante o ano de 2020, para o cuidado das pessoas que vivenciam o ambiente prisional durante a pandemia de COVID-19. Selecionamos 54 publicações para extração de dados, encontrando dados de 45 países, que foram organizados em categorias. A maior parte das publicações abordava as estratégias adotadas pelos países de economia avançada. Todas as publicações citavam alguma estratégia destinada a reduzir a transmissão viral - as principais foram a restrição/suspensão da visitação de familiares e o desencarceramento - e intervenções relativas à melhoria da infraestrutura nas prisões, sendo mais citada a disponibilização de telefone e/ou outro dispositivo para chamadas ou videochamadas. As políticas destinadas à mitigação das consequências da epidemia e das intervenções foram encontradas em publicações referentes a 33 países, sendo mais abordada a manutenção do contato familiar e a revisão da política de segurança pública. Em relação às políticas de governança, foram relatadas ações de 11 países, sendo a mais citada o fortalecimento da autoridade nacional. Este estudo aponta para a necessidade de pesquisas a respeito do sucesso de cada estratégia e das diferenças entre os países.

COVID-19 , Prisons , Humans , COVID-19/prevention & control , Pandemics/prevention & control , Government , Public Policy
Cien Saude Colet ; 27(5): 1849-1858, 2022 May.
Article in Portuguese, English | MEDLINE | ID: covidwho-20234276


This paper presents the evolution of fake news disseminated about vaccines and the SARS-CoV-2 virus and its adverse impacts on the current Brazilian health crisis. This quantitative, empirical study is based on the notifications received by the Eu Fiscalizo app, through which the Instagram, Facebook, Twitter, and WhatsApp platforms were identified as the principal means for disseminating and sharing rumors and misinformation about COVID-19. We observed large-scale circulation of fake news about vaccines directly related to the Brazilian political polarization, which became prevalent four months after the first COVID-19 case was recorded in the country. We can conclude that this phenomenon was crucial in discouraging the adherence of segments of the Brazilian population to social distancing and vaccination campaigns.

Este artigo apresenta a evolução das notícias falsas disseminadas a respeito das vacinas e do vírus Sars-CoV-2 e os impactos negativos desse fenômeno sobre a crise sanitária que o Brasil atravessa. Trata-se de um estudo empírico quantitativo, realizado a partir das notificações recebidas pelo aplicativo Eu Fiscalizo, por meio do qual foi identificado o predomínio das plataformas Instagram, Facebook, Twitter e WhatsApp como os principais meios de difusão e compartilhamento de boatos e desinformações acerca da COVID-19. Foi observada a circulação em escala de fake news sobre vacinas, diretamente relacionadas à polarização política brasileira, tornando-se prevalente quatro meses depois de ser registrado o primeiro caso de COVID-19 no Brasil. Conclui-se que o fenômeno colaborou para desestimular a adesão de parcelas da população brasileira às campanhas de isolamento social e de vacinação.

COVID-19 , Social Media , Brazil/epidemiology , COVID-19/prevention & control , Disinformation , Humans , Pandemics/prevention & control , SARS-CoV-2 , Vaccination Hesitancy
Eur Heart J ; 44(24): 2234-2243, 2023 06 25.
Article in English | MEDLINE | ID: covidwho-20234164


AIMS: A comprehensive nationwide study on the incidence and outcomes of COVID-19 vaccination-related myocarditis (VRM) is in need. METHODS AND RESULTS: Among 44 276 704 individuals with at least 1 dose of COVID-19 vaccination, the incidence and clinical courses of VRM cases confirmed by the Expert Adjudication Committee of the Korea Disease Control and Prevention Agency were analyzed. COVID-19 VRM was confirmed in 480 cases (1.08 cases per 100 000 persons). Vaccination-related myocarditis incidence was significantly higher in men than in women (1.35 vs. 0.82 per 100 000 persons, P < 0.001) and in mRNA vaccines than in other vaccines (1.46 vs. 0.14 per 100 000 persons, P < 0.001). Vaccination-related myocarditis incidence was highest in males between the ages of 12 and 17 years (5.29 cases per 100 000 persons) and lowest in females over 70 years (0.16 cases per 100 000 persons). Severe VRM was identified in 95 cases (19.8% of total VRM, 0.22 per 100 000 vaccinated persons), 85 intensive care unit admission (17.7%), 36 fulminant myocarditis (7.5%), 21 extracorporeal membrane oxygenation therapy (4.4%), 21 deaths (4.4%), and 1 heart transplantation (0.2%). Eight out of 21 deaths were sudden cardiac death (SCD) attributable to VRM proved by an autopsy, and all cases of SCD attributable to VRM were aged under 45 years and received mRNA vaccines. CONCLUSION: Although COVID-19 VRM was rare and showed relatively favorable clinical courses, severe VRM was found in 19.8% of all VRM cases. Moreover, SCD should be closely monitored as a potentially fatal complication of COVID-19 vaccination.

COVID-19 Vaccines , COVID-19 , Myocarditis , Adolescent , Aged , Child , Female , Humans , Male , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Death, Sudden, Cardiac , mRNA Vaccines , Myocarditis/epidemiology , Myocarditis/etiology , Republic of Korea/epidemiology , Vaccination/adverse effects
S Afr Med J ; 113(4): e16554, 2023 03 08.
Article in English | MEDLINE | ID: covidwho-20234141


BACKGROUND: In Malawi, only 1 072 229 people out of a national target population of 13 546 324 had received at least one dose of the AstraZeneca COVID­19 vaccine by 26 December 2021, and only 672 819 people were classified as fully vaccinated. Phalombe District in Malawi had particularly low COVID­19 vaccine uptake, with only 4% (n=8 538) of 225 219 people being fully vaccinated by 26 December. OBJECTIVES: To explore reasons for vaccine hesitancy and refusal among people living in Phalombe District. METHODS: This cross-sectional qualitative study employed six focus group discussions (FGDs) and 19 in-depth interviews (IDIs) to collect data. We purposefully selected two traditional authorities (TAs), Nazombe and Nkhumba, as study areas, and conducted FGDs and IDIs in 6 randomly selected villages in these two TAs. Participants were religious leaders, traditional leaders, youths, traditional healers and ordinary community members. We explored reasons for vaccine refusal and hesitancy, how contextual cultural beliefs influenced people's decision to receive the COVID­19 vaccine, and which sources of information were trusted in the community. Data were analysed using thematic content analysis. RESULTS: We conducted 19 IDIs and six FGDs. Themes that emerged from the data were reasons for vaccine refusal and hesitancy, contextual cultural beliefs affecting the decision whether to be vaccinated, ways to improve COVID­19 vaccine uptake, and means of communicating information about COVID­19 vaccines. Participants mentioned that myths contributing to vaccine refusal and hesitancy circulated in the community through social media. With regard to contextual cultural beliefs, most participants believed that COVID­19 was a disease of rich people, while others believed that it signalled the end of the world and that it could not be cured. CONCLUSION: Health systems should recognise and acknowledge the reasons leading to vaccine hesitancy and refusal and address these appropriately to improve vaccine uptake. Effective community sensitisation and engagement should be enhanced to clarify myths and address misinformation about the COVID­19 vaccine.

COVID-19 , Vaccines , Adolescent , Humans , COVID-19 Vaccines , Malawi/epidemiology , Cross-Sectional Studies , Patient Acceptance of Health Care , COVID-19/epidemiology , COVID-19/prevention & control , South Africa , Vaccination