Exploring the Relation Between Health Literacy, Infodemic, and Acceptance of COVID-19 Vaccination in Iran: A Cross-Sectional Study.

BACKGROUND: Health literacy (HL) plays a crucial role in navigating the coronavirus disease 2019 (COVID-19) pandemic, especially with the abundance of conflicting information from unauthorized sources. OBJECTIVE: This study aims to measure COVID-19 vaccine acceptability, COVID-19 HL, and COVID-19 infodemic and their predictors in Iranians. METHODS: A cross-sectional study was conducted on the general population in Iran between August 20, 2021 to October 29, 2021. Data were collected using a valid questionnaire with four parts. Univariable and multivariable logistic regression models, generalized linear models, and ordinal regression with the Polytomous Universal Model were performed using SPSS version 26. KEY RESULTS: The study revealed that 68.6% of the participants were willing to accept the COVID-19 vaccine, 45% had sufficient knowledge about COVID-19, and 52.2% were confused by false information during the pandemic. The results showed that having sufficient COVID-19 HL was significantly associated with higher acceptance of the vaccine (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.02, 2.12). Additionally, higher COVID-19 HL scores were associated with a higher adjusted odds of confusion by false information with an odds ratio of 1.12 (95% CI: 1 .11, 1 .13). CONCLUSION: This study exhibits low levels of COVID-19 HL in Iran, and the fact that higher COVID-19 HL is associated with higher vaccine acceptance. Because vaccination is an essential preventive measure to stop the COVID-19 pandemic, factors associated with low vaccine acceptance need to be addressed by public health strategies. [HLRP: Health Literacy Research and Practice. 2024;8(4):e184-e193.].

Plain Language Summary We investigated the relationship between health literacy, infodemic and acceptance of COVID-19 vaccination on the general population in Iran. Of the participants, 68.6% were willing to accept the COVID-19 vaccine, 45% had sufficient knowledge about COVID-19, and 52.2% were confused by false information during the pandemic. The results of the study showed a positive association between COVID-19 HL and acceptance of the vaccine, also, a negative relationship with confusion by false information.

Time to COVID-19 Vaccination by Language and Country of Origin.

Importance: Disparities in COVID-19 vaccination rates by race and ethnicity are well documented. Less is known about primary language and COVID-19 vaccine uptake. Objective: To describe the time to COVID-19 primary series vaccination and booster doses by primary language and country of origin. Design, Setting, and Participants: This retrospective cohort study included patients aged 6 months or older with at least 1 health encounter from July 1, 2019, to June 30, 2023, at a single health care system serving patients across Minnesota and western Wisconsin. Exposure: Primary language and country of origin documented in the electronic health record. Main Outcomes and Measures: Three COVID-19 vaccine coverage outcomes were evaluated: (1) primary series (1 Ad26.COV.S vaccine or 2 mRNA COVID-19 vaccines), (2) first-generation booster (primary series Ad26.COV.S vaccine plus 1 Ad26.COV.S or mRNA COVID-19 vaccine at least 2 months after the second dose or primary series mRNA vaccine plus 1 mRNA vaccine at least 5 months after the second dose), and (3) bivalent booster. Vaccine coverage was described by patient characteristics. Associations of primary language, race and ethnicity, and other patient characteristics with COVID-19 vaccine uptake were evaluated using time-to-event analysis in multivariable Cox proportional hazards regression models, and adjusted hazard ratios (AHRs) with 95% CIs were reported. Results: There were 1 001 235 patients included (53.7% female). Most patients reported English as a primary language (94.1%) and were born in the US (91.8%). Primary series coverage was 63.7%; first-generation booster coverage, 64.4%; and bivalent booster coverage, 39.5%. Coverage for all outcomes was lower among those with a non-English primary language compared with English as the primary language (56.9% vs 64.1% for primary series; 47.5% vs 65.3% for first-generation booster; 26.2% vs 40.3% for bivalent booster). Those with a non-English primary language had lower COVID-19 vaccine uptake for the primary series (AHR, 0.85; 95% CI, 0.84-0.86), first-generation booster (AHR, 0.74; 95% CI, 0.73-0.75), and bivalent booster (AHR, 0.65; 95% CI, 0.64-0.67) compared with patients with English as their primary language. Non-US-born patients had higher primary series uptake compared with US-born patients (AHR, 1.19; 95% CI, 1.18-1.20) but similar first-generation booster (AHR, 1.01; 95% CI, 0.99-1.02) and bivalent booster (AHR, 1.00; 95% CI, 0.98-1.02) uptake. Conclusions and Relevance: In this retrospective cohort study, patients with a non-English primary language had both lower coverage and delays in receiving COVID-19 vaccines compared with those with English as their primary language. Reporting on language may identify health disparities that can be addressed with language-specific interventions.

Management of COVID-19 in Ophthalmology.

From its outbreak in early 2020, the new SARS-CoV-2 infection has deeply affected the entire eye care system for several reasons. Since the beginning of the COVID-19 pandemic, ophthalmologists were among the "high-risk category" for contracting the SARS-CoV-2 infection based on the notion that the eye was suspected to be a site of inoculation, infection, and transmission. Clinical ophthalmologists have been required to learn and promptly recognize the ocular manifestations associated with the COVID-19 disease, with its treatments and vaccinations. Restriction measures, lockdown periods, guidelines to prevent SARS-CoV-2 infection transmission, and the use of telemedicine and artificial intelligence modalities have induced profound modifications. These changes, which are most likely to be irreversible, influence routine clinical practice, education, and research, thus giving rise to a "new ophthalmology in the COVID era". This book chapter aims to provide several notions regarding COVID-19 in ophthalmology, including the SARS-CoV-2 virus infection and transmission modalities; the ocular manifestation associated with the COVID-19 disease; the drugs and vaccines used for COVID-19; the precautions adopted in the ophthalmic practice to limit the spread of the virus; the consequences of the pandemic on the ophthalmic patients, clinicians, and the entire eye care system; and, the future of ophthalmology in the era of "COVID new normal".

Quantifying indirect and direct vaccination effects arising in the SIR model.

Vaccination campaigns have both direct and indirect effects that act to control an infectious disease as it spreads through a population. Indirect effects arise when vaccinated individuals block disease transmission in any infection chain they are part of, and this in turn can benefit both vaccinated and unvaccinated individuals. Indirect effects are difficult to quantify in practice but, in this article, working with the susceptible-infected-recovered (SIR) model, they are analytically calculated in important cases, through pivoting on the final size formula for epidemics. Their relationship to herd immunity is also clarified. The analysis allows us to identify the important distinction between quantifying the indirect effects of vaccination at the 'population level' versus the 'per capita' level, which often results in radically different conclusions. As an example, our analysis unpacks why the population-level indirect effect can appear significantly larger than its per capita analogue. In addition, we consider a recently proposed epidemiological non-pharmaceutical intervention (by the means of recovered individuals) used over the COVID-19 pandemic, referred to as 'shielding', and study its impact on our mathematical analysis. The shielding scheme is extended to take advantage of vaccination including imperfect vaccination.

Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military Parents in Lambayeque, Peru.

There is evidence that vaccine acceptability is strongly associated with mental health. However, no studies assessing intention to vaccinate (ITV) intention toward children of military parents have been documented. The current research aimed to establish the prevalence and factors of ITV children against COVID-19 in military parents in Lambayeque-Peru, 2021. Analysis was conducted with the dependent variable ITV children reported by military parents. The independent variables were history of mental health, searching for mental health support, food insecurity, resilience, anxiety, depression, burnout, posttraumatic stress, and suicidal risk. Prevalence ratios and 95% confidence intervals were estimated. Of 201 military personnel evaluated, 92.5% were male, 82.5% were of the Catholic faith, and the median age was 40.9% of respondents reported seeking mental health help during the COVID-19 pandemic. It was reported anxiety (20.3%), depression (6.5%), and posttraumatic stress disorder (6.5%). Most reported ITV in children against COVID-19 (93%). In the multiple models, we found that Catholics had a 23% higher prevalence of ITV in the children where PR = prevalence ratios and CI = confidence intervals (PR = 1.23; 95% CI: 1.01-1.50). Likewise, seeking mental health support increased the prevalence of ITV by 8% (PR = 1.08; 95% CI: 1.00-1.15). Seeking mental health support and belonging to the Catholic faith had a higher ITV of children of Peruvian military personnel. Finding mental health support, experiencing burnout syndrome, having a relative who suffers from mental health problems, and being part of the Catholic religion were associated with a higher willingness to immunize the children of Peruvian military members.

Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study.

IMPORTANCE: In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners. OBJECTIVES: The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting. DESIGN: We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients. SETTING AND PARTICIPANTS: Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada). ANALYSIS: Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data. RESULTS: Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care. CONCLUSIONS: Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.

COVID 19: Prevention and treatment through the Indian perspective.

The most destructive period the world has experienced seems to be behind us. Not a single nation was spared by this disease, and many continue to struggle today. Even after recovering from COVID, patient may continue to experience some post-COVID effects, such as heart irregularities or a decline in lung vitality. In the past three years (2019-2022), the world has witnessed the power of a small entity, a single peculiar virus. Science initially appeared to be helpless in this regard, but due to the emergence of disease, pharmaceutics (the development of anti-covid drugs), immunology (the rapid antigen test), microbiology (the isolation of viruses from infected people), biotechnology (the development of recombinant vaccines), biochemistry (the blood profile, the D-dimer test), and biochemistry (blood profile, D-dimer test), biophysics (PCR, RT-PCR, CT Scan, MRI) had worked together to fight the disease. The results of these efforts are the development of new diagnostic techniques, possible treatment and finally the availability of vaccines against COVID-19. However, it is not proven that the treatment through the traditional medical system is directly active on SARS-CoV-2 but is instead indirectly acting on SARS-CoV-2 effects by improving symptoms derived from the viral disease. In India, the traditional system of medicine and tradition knowledge together worked in the pandemic and proved effective strategies in prevention and treatment of SARS-CoV-2. The use of effective masks, PPE kits, plasma therapy, yoga, lockdowns and social seclusion, use of modern antiviral drugs, monoclonal antibodies, herbal remedies, homoeopathy, hygienic practice, as well as the willpower of people, are all contributing to the fight against COVID. Which methods or practices will be effective against COVID nobody is aware since medical professionals who wear PPE kits do not live longer, and some people in India who remained unprotected and roamed freely were not susceptible to infection. The focus of this review is on the mode of transmission, diagnosis, preventive measures, vaccines currently under development, modern medicine developed against SARS-CoV-2, ayurvedic medicine used during pandemic, homoeopathic medicine used during pandemic, and specific yoga poses that can be used to lessen COVID-related symptoms.

Computational Drug Design Strategies for Fighting the COVID-19 Pandemic.

The advent of COVID-19 has brought the use of computer tools to the fore in health research. In recent years, computational methods have proven to be highly effective in a variety of areas, including genomic surveillance, host range prediction, drug target identification, and vaccine development. They were also instrumental in identifying new antiviral compounds and repurposing existing therapeutics to treat COVID-19. Using computational approaches, researchers have made significant advances in understanding the molecular mechanisms of COVID-19 and have developed several promising drug candidates and vaccines. This chapter highlights the critical importance of computational drug design strategies in elucidating various aspects of COVID-19 and their contribution to advancing global drug design efforts during the pandemic. Ultimately, the use of computing tools will continue to play an essential role in health research, enabling researchers to develop innovative solutions to combat new and emerging diseases.

Upstream factors impacting COVID-19 vaccination rates across Africa: A systematic review protocol.

BACKGROUND: Upstream factors have been found to affect COVID-19 vaccination rates and coverage globally. However, there are inadequate details within the African context. This systematic review aims to close this research gap by investigating upstream factors influencing COVID-19 vaccination rates in Africa. METHODS: A literature search will be systematically conducted utilizing various databases including: MEDLINE, EMBASE, SCOPUS, CINAHL, Web of Science, and PsycINFO. Eligible studies will include peer-reviewed articles published in the English language from 2020-2023, conducted in Africa, focused on upstream factors, and include one barrier or facilitator to COVID-19 vaccination rates. Two reviewers will use a two-step screening process to examine every article's title, abstract, and full text. A third-party reviewer will resolve disagreements between both individual reviewers. This review will focus on extracting data from published studies to explain the upstream factors included and their impact on COVID-19 vaccination rates across Africa. Data and records will be managed using Covidence. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] framework will be used as the basis for reporting. To reduce bias, the researchers will use the Mixed Methods Appraisal Tool to assess the studies chosen for review. Results will be compiled utilizing four tables to summarize articles and group determinants based on the Consolidated Framework for Implementation Research (CFIR). DISCUSSION: Upstream factors have been cited as affecting population health, vaccination programs, and COVID-19, yet a large-scale systematic review has not been conducted to investigate these factors in relation to COVID-19 vaccination disparities faced in Africa. This review aims to analyze the root causes of African vaccination disparities by focusing on upstream factors. Understanding these factors is vital to help explain why these disparities occur and for designing effective interventions for future vaccinations. The results are expected to provide insights for researchers, policymakers, health systems, and individuals by identifying how resources and efforts can be better utilized to improve vaccination uptake and access. TRIAL REGISTRATION: Systematic review registration: CRD42024501293.

The impact of the COVID-19 pandemic on UK parents' attitudes towards routine childhood vaccines: A mixed-methods study.

BACKGROUND: COVID-19 vaccines were key to controlling the pandemic and vaccination has been discussed extensively by the media and the public since 2020. We aimed to explore parents' attitudes towards routine childhood vaccination since COVID-19 and how the pandemic impacted their experiences of getting their child vaccinated. METHODS: We used a mixed-methods approach-involving a questionnaire survey followed by focus groups. We partnered with The Mosaic Community Trust, an ethnic minority women's group based in a deprived area of North-West London, United Kingdom (UK) with historically low childhood vaccine uptake. Descriptive findings from the questionnaires were reported and chi-square analyses performed to examine differences by ethnicity. Thematic analysis of the free-text questionnaire responses and focus groups was undertaken, guided by the COM-B model of Capability, Opportunity, and Motivation. RESULTS: Between Jun-Oct 2022, 518 parents completed the questionnaire (25% from ethnic minorities). Between March-May 2023 we held four focus groups with 22 parents (45% from ethnic minorities). Most parents (>90%) thought routine childhood vaccines for children were important. Over a third (38%) of all parents reported having more questions about childhood vaccines since COVID-19, though among parents belonging to an ethnicity group other than white, 59% said they had more questions compared to those of any white ethnicity group (30%, (p = <0.0001)). Difficulties accessing vaccine appointments were commoner reasons for children's vaccinations being delayed than parents increased concerns about vaccines. Since COVID-19 some parents felt vaccinations were even more important, and a very small minority felt the pandemic had made them mistrust vaccinations. CONCLUSION: Following COVID-19, we found parents remain confident in childhood vaccines. However, some parents, particularly from ethnic minority groups may have more questions about childhood vaccines than pre-pandemic. Post COVID-19, to address declining vaccine uptake, parents need easy access to healthcare professionals to answer questions about childhood vaccinations.

Improving Pathways to Care for Ethnic Minority Communities.

It is well established that the COVID-19 pandemic has had a substantial impact on ethnic minority communities and has worsened existing health inequalities experienced by these populations globally. Individuals from ethnic minority backgrounds have not only been more likely to become infected with COVID-19 throughout the pandemic, but they have also higher risk of adverse symptoms and death following infection. Factors responsible for these discrepancies are wide reaching and encompass all aspects of the social determinants of health (SDoH). Although always an area of concern among healthcare professionals, barriers to health care experienced by ethnic minority populations became a more pertinent issue during the COVID-19 pandemic when all individuals required sufficient and sustained access to a healthcare system (whether this be for COVID-19 testing, vaccination or treatment). These healthcare barriers exacerbated the increased COVID-19 burden experienced by minority populations and will continue to detrimentally impact the health of these populations during future COVID-19 waves or indeed, future novel pandemics. This chapter aims to summarise the major healthcare barriers experienced by minority populations throughout the COVID-19 pandemic, including COVID-19 prevention, vaccine rollout, care during hospitalisation and post-COVID care for long COVID patients. To end, this chapter will summarise lessons learned and future directions that need to be taken to improve health disparities and healthcare access for minority populations in relation to the COVID pandemic and beyond.

Resilience throughout COVID-19: Unmasking the realities of COVID-19 and vaccination facilitators, barriers, and attitudes among Black Canadians.

Black communities have suffered disproportionately higher numbers of COVID-19 cases and deaths in Canada. Recognizing the significance of supporting targeted strategies with vulnerable populations extends beyond the COVID-19 pandemic, as it addresses longstanding health disparities and promotes equitable access to healthcare. The present study investigated 1) experiences with COVID-19, 2) COVID-19's impact, and 3) factors that have influenced COVID-19 vaccine acceptance and uptake among stakeholders and partners from the Federation of Black Canadians' (FBC). We conducted semi-structured interviews with 130 individuals and four focus groups with FBC, including stakeholders and partners, between November 2021 and June 2022. The semi-structured interviews and focus group discussions were conducted virtually over Zoom and lasted about 45 minutes each. Conversations from interviews and focus groups were transcribed and coded professionally using team-based methods. Themes were developed using an inductive-deductive approach and defined through consensus. The deductive approach was based on Consolidated Framework for Implementation Research (CFIR) domains and constructs. First, regarding experiences with COVID-19, 36 codes were identified and mapped onto 13 themes. Prominent themes included 39 participants who experienced highly severe COVID-19 infections, 25 who experienced stigma, and 18 who reported long recovery times. Second, COVID-19 elicited lifestyle changes, with 23 themes emerging from 62 codes. As many as 97 participants expressed feelings of isolation, while 63 reported restricted mobility. Finally, participants discussed determinants that influenced their vaccination decisions, in which 46 barriers and four facilitators were identified and mapped onto nine overarching themes. Themes around the CFIR domains Individuals, Inner Setting, and Outer Setting were most prominent concerning vaccine adoption. As for barriers associated with the constructs limited available resources and low motivation, 55 (41%) and 46 (34%) of participants, respectively, mentioned them most frequently. Other frequently mentioned barriers to COVID-19 vaccines fell under the construct policies & laws, e.g., vaccine mandates as a condition of employment. Overall, these findings provide a comprehensive and contextually rich understanding of pandemic experiences and impact, along with determinants that have influenced participants' vaccination decisions. Furthermore, the data revealed diverse experiences within Black communities, including severe infections, stigma, and vaccine-related challenges, highlighting the importance of targeted interventions, support, and consideration of social determinants of health in addressing these effects.

Efficacy and prognostic factors of COVID-19 vaccine in patients with hepatocellular carcinoma: Analysis of data from a prospective cohort study.

BACKGROUND: The efficacy of coronavirus disease 2019 (COVID-19) vaccines in preventing SARS-CoV-2 infection in patients with hepatocellular carcinoma (HCC) is not clear. METHODS: From January 2022 to October 2022, patients diagnosed with HCC in a prospective, multicenter, observational cohort were analyzed. RESULTS: One hundred and forty-one patients with (n = 107) or without COVID-19 vaccination (n = 34) were included. The number of patients with severe or very severe infection was relatively lower in the vaccinated group (3.7% vs. 11.8%, p = 0.096). Median infection-free survival in the vaccinated group (14.0 vs. 8.3 months, p = 0.010) was significantly longer than that in the unvaccinated group. COVID-19 vaccination (hazard ratio (HR) HR = 0.47), European Cooperative Oncology Group performance score = 0 (HR = 2.06), and extrahepatic spread (HR = 0.28) were found to be the independent predictive factors for infection-free survival. CONCLUSION: COVID-19 vaccines could effectively reduce the SARS-Cov-2 infection in patients with HCC.

Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment.

OBJECTIVES: The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance. METHODS: A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL. RESULTS: A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19. CONCLUSIONS: Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines. PATIENT OR PUBLIC CONTRIBUTION: A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.

COVID-19 vaccination attitudes and uptake: A sociocultural perspective focusing on parents and peers.

The global fight against the COVID-19 pandemic has underscored the critical importance of widespread vaccination to mitigate the impact of the virus on public health. The current study aimed to investigate which social influences might be most important for predicting attitudes towards COVID-19 vaccination and vaccine uptake among young students in the UK. We focused on the cultural evolution and social transmission aspects, i.e., parent-to-child versus peer-to-peer, of attitudes and vaccine uptake during the COVID-19 pandemic. A sample of 192 UK students (aged 18 to 35 years old) filled in an online survey including measures for attitudes towards COVID-19 vaccination and vaccine uptake and/or intention, age, and gender. Participants were also asked about their mother's, father's, and best friend's attitudes towards COVID-19 vaccination and vaccine uptake. Finally, they provided a subjective measure of the quality relationship with their parents. Overall, our results suggest that both parents and very close friends are important agents in understanding the students' attitudes towards COVID-19 vaccination and vaccine uptake. More specifically, our findings suggest the mother's vaccine uptake as the most salient predictor of students' attitudes towards COVID-19 vaccination and vaccine uptake, particularly when the students report having a positive relationship with their parents. In cases where students' experience negative relationship with their parents, the best friend's vaccine uptake may supersede the mother's influence. Despite these nuances, a general trend emerges from our data suggesting that vaccine uptake could be primarily guided by vertical transmission (i.e., parent to child). Our results have the potential to influence public health strategies, communication campaigns, and targeted interventions to enhance vaccination uptake. Identifying key social predictors can enable policymakers and health authorities to tailor vaccination promotion efforts towards mothers' and peers' vaccine uptake to increase overall positive attitudes and vaccine uptake among young people.

Reflections on the Advisory Committee on Immunization Practices During the COVID-19 Pandemic.

Pediatricians and primary care providers serve an important role in building trust with families and communities. To support the critical role of front-line providers, this perspective seeks to reflect on the work of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices to support COVID-19 pandemic response efforts. Although Advisory Committee on Immunization Practice (ACIP) recommends vaccines for all age groups, this perspective focuses on the pediatric lens and is tailored to Academic Pediatrics. ACIP adapted from in-person meetings 3 times yearly to virtual meetings on an emergency basis to ensure a thorough review and presentation of all the components of the evidence to recommendation framework, including explicit consideration of equity in the decision-making process. The need for diverse enrollment in clinical trials was highlighted as critical for supporting recommendations and enhancing trust. Near real-time vaccine safety surveillance was implemented at scale and emphasized the importance of collaboration between federal partners engaged in vaccine safety in the United States and extended to other countries with similar safety surveillance systems to enable early recognition and response to safety concerns. A key equity opportunity for future pandemics is to shorten the time between vaccines being available for adults and young children.

COVID-19 Vaccine Effectiveness in Autumn and Winter 2022 to 2023 Among Older Europeans.

Importance: In the context of emerging SARS-CoV-2 variants or lineages and new vaccines, it is key to accurately monitor COVID-19 vaccine effectiveness (CVE) to inform vaccination campaigns. Objective: To estimate the effectiveness of COVID-19 vaccines administered in autumn and winter 2022 to 2023 against symptomatic SARS-CoV-2 infection (with all circulating viruses and XBB lineage in particular) among people aged 60 years or older in Europe, and to compare different CVE approaches across the exposed and reference groups used. Design, Setting, and Participants: This case-control study obtained data from VEBIS (Vaccine Effectiveness, Burden and Impact Studies), a multicenter study that collects COVID-19 and influenza data from 11 European sites: Croatia; France; Germany; Hungary; Ireland; Portugal; the Netherlands; Romania; Spain, national; Spain, Navarre region; and Sweden. Participants were primary care patients aged 60 years or older with acute respiratory infection symptoms who were recruited at the 11 sites after the start of the COVID-19 vaccination campaign from September 2022 to August 2023. Cases and controls were defined as patients with positive and negative, respectively, reverse transcription-polymerase chain reaction (RT-PCR) test results. Exposures: The exposure was COVID-19 vaccination. The exposure group consisted of patients who received a COVID-19 vaccine during the autumn and winter 2022 to 2023 vaccination campaign and 14 days or more before symptom onset. Reference group included patients who were not vaccinated during or in the 6 months before the 2022 to 2023 campaign (seasonal CVE), those who were never vaccinated (absolute CVE), and those who were vaccinated with at least the primary series 6 months or more before the campaign (relative CVE). For relative CVE of second boosters, patients receiving their second booster during the campaign were compared with those receiving 1 booster 6 months or more before the campaign. Main Outcomes and Measures: The outcome was RT-PCR-confirmed, medically attended, symptomatic SARS-CoV-2 infection. Four CVE estimates were generated: seasonal, absolute, relative, and relative of second boosters. CVE was estimated using logistic regression, adjusting for study site, symptom onset date, age, chronic condition, and sex. Results: A total of 9308 primary care patients were included, with 1687 cases (1035 females; median [IQR] age, 71 [65-79] years) and 7621 controls (4619 females [61%]; median [IQR] age, 71 [65-78] years). Within 14 to 89 days after vaccination, seasonal CVE was 29% (95% CI, 14%-42%), absolute CVE was 39% (95% CI, 6%-60%), relative CVE was 31% (95% CI, 15% to 44%), and relative CVE of second boosters was 34% (95% CI, 18%-47%) against all SARS-CoV-2 variants. In the same interval, seasonal CVE was 44% (95% CI, -10% to 75%), absolute CVE was 52% (95% CI, -23% to 82%), relative CVE was 47% (95% CI, -8% to 77%), and relative CVE of second boosters was 46% (95% CI, -13% to 77%) during a period of high XBB circulation. Estimates decreased with time since vaccination, with no protection from 180 days after vaccination. Conclusions and Relevance: In this case-control study among older Europeans, all CVE approaches suggested that COVID-19 vaccines administered in autumn and winter 2022 to 2023 offered at least 3 months of protection against symptomatic, medically attended, laboratory-confirmed SARS-CoV-2 infection. The effectiveness of new COVID-19 vaccines against emerging SARS-CoV-2 variants should be continually monitored using CVE seasonal approaches.

Safety and efficacy of COVID-19 vaccination in the Chinese population with pulmonary lymphangioleiomyomatosis: a single-center retrospective study.

BACKGROUND: The safety and efficacy of vaccination against coronavirus disease 2019 (COVID-19) in patients with lymphangioleiomyomatosis (LAM) is still unclear. This study investigates COVID-19 vaccine hesitancy, vaccine safety and efficacy, and COVID-19 symptoms in LAM patients. RESULTS: In total, 181 LAM patients and 143 healthy individuals responded to the questionnaire. The vaccination rate of LAM patients was 77.34%, and 15.7% of vaccinated LAM patients experienced adverse events. Vaccination decreased the risk of LAM patients developing anorexia [OR: 0.17, 95% CI: (0.07, 0.43)], myalgia [OR: 0.34, 95% CI: (0.13, 0.84)], and ageusia [OR: 0.34, 95% CI: (0.14, 0.84)]. In LAM patients, a use of mTOR inhibitors reduced the risk of developing symptoms during COVID-19, including fatigue [OR: 0.18, 95% CI: (0.03, 0.95)], anorexia [OR: 0.30, 95% CI: (0.09, 0.96)], and ageusia [OR: 0.20, 95% CI: (0.06, 0.67)]. CONCLUSIONS: Vaccination rates in the LAM population were lower than those in the general population, as 22.7% (41/181) of LAM patients had hesitations regarding the COVID-19 vaccine. However, the safety of COVID-19 vaccination in the LAM cohort was comparable to the healthy population, and COVID-19 vaccination decreased the incidence of COVID-19 symptoms in LAM patients. In addition, mTOR inhibitors seem not to determine a greater risk of complications in patients with LAM during COVID-19.

Uptake of COVID-19 vaccination among community-dwelling individuals receiving healthcare for substance use disorder and major mental illness: a matched retrospective cohort study.

Introduction: Patients with major mental illness (MMI) and substance use disorders (SUD) face barriers in accessing healthcare. In this population-based retrospective cohort study, we investigated the uptake of COVID-19 vaccination in Ontario, Canada among community-dwelling individuals receiving healthcare for major mental illness (MMI) and/or substance use disorders (SUD), comparing them to matched general population controls. Methods: Using linked health administrative data, we identified 337,290 individuals receiving healthcare for MMI and/or SUD as of 14 December 2020, matched by age, sex, and residential geography to controls without such healthcare. Follow-up extended until 31 December 2022 to document vaccination events. Results: Overall, individuals receiving healthcare for MMI and/or SUD (N = 337,290) had a slightly lower uptake of first (cumulative incidence 82.45% vs. 86.44%; hazard ratio [HR] 0.83 [95% CI 0.82-0.83]) and second dose (78.82% vs. 84.93%; HR 0.77 [95% CI 0.77-0.78]) compared to matched controls. Individuals receiving healthcare for MMI only (n = 146,399) had a similar uptake of first (87.96% vs. 87.59%; HR 0.97 [95% CI 0.96-0.98]) and second dose (86.09% vs. 86.05%, HR 0.94 [95% CI 0.93-0.95]). By contrast, individuals receiving healthcare for SUD only (n = 156,785) or MMI and SUD (n = 34,106) had significantly lower uptake of the first (SUD 78.14% vs. 85.74%; HR 0.73 [95% CI 0.72-0.73]; MMI & SUD 78.43% vs. 84.74%; HR 0.76 [95% CI 0.75-0.77]) and second doses (SUD 73.12% vs. 84.17%; HR 0.66 [95% CI 0.65-0.66]; MMI & SUD 73.48% vs. 82.93%; HR 0.68 [95% CI 0.67-0.69]). Discussion: These findings suggest that effective strategies to increase vaccination uptake for future COVID-19 and other emerging infectious diseases among community-dwelling people with SUD are needed.

Epidemiology of Mpox Cases, and Tecovirimat and JYNNEOS Utilization, Alameda County, California, June-October 2022.

CONTEXT: The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men. PROGRAM: We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022. IMPLEMENTATION: Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox. EVALUATION: During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively. DISCUSSION: Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities.