To understand relationships between COVID-19 vaccine perceptions, confidence, trust, sociodemographic/practice characteristics, and COVID-19 vaccine recommendation practices among US healthcare providers.

In November 2021, an electronic survey was administered to nurses and physicians in the US via Qualtrics®. The survey included: (1) COVID-19 perceptions, (2) vaccine confidence, (3) trust, (4) uptake, (5) recommendation practices, and (6) sociodemographic/practice characteristics. Binary logistic regressions were used to obtain unadjusted/adjusted odds ratios in predicting recommendation practices of COVID-19 vaccine.

The survey included 304 participants. In adjusted analyses, not believing that COVID-19 was man-made, not living in southeastern US (as compared to living in southeast), having no concerns about COVID-19 vaccines, having more positive perceptions about the vaccines, and having more trust in healthcare, media, vaccine manufacturers, and public health authorities was significantly (p < 0.05) related to routinely recommending the vaccine for all patients 12 and older. Providers who did not think COVID-19 was man-made had 6.1 (95 % CI = 1.10 - 33.5) times the odds to recommend the vaccine. Providers not practicing in the southeast region had 5.2 (95 % CI = 1.39 - 19.8) times the odds to recommend the vaccine.

To increase provider recommendation of COVID-19 vaccines, beliefs about disease origin, concerns, and trust should be addressed.

Clear, accurate, and trusted information delivery about COVID-19 vaccines to healthcare providers is needed, and in turn this may reduce patient vaccine hesitancy.

This study introduces conditional adherence (CA) as the patients' inclination toward additional information sources instead of unconditionally adhering to treatment. The study examined how medical decision-making practices are associated with CA and the intention to turn to various information sources.

Scenario survey data (N = 1935) were used to analyse the association between decision-making practices and patients' intentions to seek additional information from either formal or informal sources.

Additional information was preferably acquired from the attending physician without the intention to seek additional information elsewhere. Shared decision-making (SDM) decreased the likelihood of CA and especially the need to consult other formal sources. Other kind of decision-making practices were associated with a higher likelihood of CA. Decisional conflicts from previous medical appointments associated with seeking information from informal sources.

Turning to additional formal information sources associates with appointments lacking the element of SDM. However, turning to informal information sources is more significantly associated with prior experiences of contradictory treatment recommendations.

SDM and open communication between the physician and the patient are underscored in the objective of treatment adherence. CA may be prevented by participating patients to decision-making and identifying possible trust issues concerning also prior medical decisions.

Lower respiratory tract infections caused by SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) cause a significant disease burden globally, despite the availability of effective vaccines. Certain populations, such as older adults (≥ 60 years) and individuals of all ages with particular comorbidities, are at increased risk for severe outcomes, including hospitalization and death. National administration schedules for available vaccines against respiratory viruses are not unified, and not all current guidelines are clear and directive, concerning the optimal timing of vaccination. Herein, we formulate an evidence-based position regarding the optimal timing of COVID-19, influenza, and RSV vaccination for older adults and individuals with chronic comorbidities, based on a synthesis of the literature and current guidelines. Vaccination impact and timing were found to be influenced by vaccinee risk factors, including age and comorbidities, and waning vaccine effectiveness and seasonal pathogen burden. Because COVID-19, influenza, and RSV display unique seasonal patterns within and between regions, local epidemiological surveillance of each virus is crucial for determining optimal vaccination timing and guidelines. To maximize the benefits of these respiratory virus vaccines, the timing of peak vaccine effectiveness and period of greatest risk for severe outcomes should be aligned. Thus, COVID-19, influenza, and other recommended vaccines given ahead of the start of the respiratory virus season (or other regionally appropriate time) and co-administered at a single, routine visit represent the optimal approach to protecting at-risk populations. More data will be required to establish the clinical benefit of additional RSV vaccine doses and whether these may be integrated within a seasonal schedule. Coordinated policy decisions that align with strain selection for new and annually reformulated vaccines would enable the timely raising of public health awareness, ultimately leading to enhanced vaccine uptake. Implementation strategies will require engagement of healthcare providers and strong, evidence-based public health recommendations for integrated vaccine schedules.

Adult vaccination rates in the United States (US) remain low, despite the availability of safe and effective vaccines. The objective of this study was to describe characteristics of US adults recently vaccinated in a pharmacy or healthcare provider (HCP) office, vaccination logistics, associated productivity losses, and preferences, barriers, and satisfaction related to vaccination visits in these settings.

This was a non-interventional, cross-sectional study using a web-based survey administered during September-November 2023. Respondents were adults recently vaccinated in a pharmacy or HCP office in the US recruited from an online panel. The study targeted a sample of 900 adults, divided approximately equally among those aged 18-49, 50-64, and ≥65 years. Responses were analyzed descriptively and reported overall, by vaccination location, and by age group.

A total of 938 adults completed the survey, including 618 pharmacy-vaccinated and 320 HCP office-vaccinated respondents. Influenza (74.2%) and COVID-19 (44.6%) vaccines were most commonly administered, and coadministration of 2-3 vaccines occurred in 35.7% of vaccination visits. Vaccination visits often involved other activities (e.g., 40.5% of pharmacy-vaccinated respondents also picked up a prescription and/or shopped during their vaccination visit). Productivity losses due to vaccination visits were minimal; only 8.1% of all respondents took paid or unpaid time off work to get vaccinated (mean [standard deviation; SD]: 15.6 [69.9] minutes). Most respondents encountered no barriers to vaccination (76.1%) and reported high satisfaction (mean [SD]: 9.3 [1.4] on a 1-10 scale) with their visit.

Findings indicate that pharmacies and HCP offices are convenient locations for adult vaccinations in the US, including coadministration of multiple vaccines in the same visit. Adult vaccinations in these locations were associated with low productivity losses, limited difficulties, and high satisfaction. Enhancing access to vaccinations in these settings could help to increase vaccination uptake.

Best practices for improving access to assessment of hereditary cancer risk in primary care are lacking.

To compare 2 population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offering eligible individuals genetic testing for cancer susceptibility.

The EDGE (Early Detection of Genetic Risk) clinical trial cluster-randomized 12 clinics from 2 health care systems in Montana, Wyoming, and Washington state to 1 of 2 engagement approaches for assessment of hereditary cancer risk in primary care. The study population included 95 623 English-speaking patients at least 25 years old with a primary care visit during the recruitment window between April 1, 2021, and March 31, 2022.

The intervention comprised 2 risk assessment engagement approaches: (1) point of care (POC), conducted by staff immediately preceding clinical appointments, and (2) direct patient engagement (DPE), where letter and email outreach facilitated at-home completion. Patients who completed risk assessment and met prespecified criteria were offered genetic testing via a home-delivered saliva testing kit at no cost.

Primary outcomes were the proportion of patients with a visit who (1) completed the risk assessment and (2) completed genetic testing. Logistic regression models were used to compare the POC and DPE approaches, allowing for overdispersion and including clinic as a design factor. An intention-to-treat analysis was used to evaluate primary outcomes.

Over a 12-month window, 95 623 patients had a primary care visit across the 12 clinics. Those who completed the risk assessment (n = 13 705) were predominately female (64.7%) and aged between 65 and 84 years (39.6%). The POC approach resulted in a higher proportion of patients completing risk assessment than the DPE approach (19.1% vs 8.7%; adjusted odds ratio [AOR], 2.68; 95% CI, 1.72-4.17; P < .001) but a similar proportion completing testing (1.5% vs 1.6%; AOR, 0.96; 95% CI, 0.64-1.46; P = .86). Among those eligible for testing, POC test completion was approximately half of that for the DPE approach (24.7% vs 44.7%; AOR, 0.49; 95% CI, 0.37-0.64; P < .001). The proportion of tested patients identified with an actionable pathogenic variant was significantly lower for the POC approach than the DPE approach (3.8% vs 6.6%; AOR, 0.61; 95% CI, 0.44-0.85; P = .003).

In this cluster randomized clinical trial of risk assessment delivery, POC engagement resulted in a higher rate of assessment of hereditary cancer risk than the DPE approach but a similar rate of genetic testing completion. Using a combination of engagement strategies may be the optimal approach for greater reach and impact.

ClinicalTrials.gov Identifier: NCT04746794.

We assessed healthcare provider recommendations for COVID-19 vaccination, disparities across sociodemographic factors, and associations with health care coverage, social norms, COVID-19 vaccine hesitancy, and Fox News preference.

We utilized random sample survey data of Arkansas residents (N = 2201) collected in October 2022 to identify adults with a personal provider who make up the analytical sample of this study (n = 1804).

Over a third (37.2 %; n = 607) of the weighted sample did not receive a recommendation. Adjusted odds of receiving a recommendation were positively associated with health care coverage (aOR=1.66; 95 % CI [1.05, 2.64]) and negatively associated with perceiving "very few" (aOR=0.48; 95 % CI [0.33, 0.72]) or "some but not many" (aOR=0.57; 95 % CI [0.41, 0.80]) rather than "nearly all" people close to them to be vaccinated. Adjusted odds of receiving a recommendation were negatively associated with being very hesitant (vs. not at all hesitant) (aOR=0.65; 95 % CI [0.47, 0.88]).

Provider recommendations for COVID-19 vaccination were not provided for a large portion of Arkansas adults, were inconsistently provided across sociodemographic groups, and were associated with health care coverage, social norms, and vaccine hesitancy.

Intervening on disparities in COVID-19 vaccination may require addressing disparities in provider recommendations.

Vaccines (a medical product) and vaccination recommendations (expert advice on who should receive, when, and how often) have grown in importance and prominence in the past 15 years, including because of a recent COVID-19 pandemic. This essay highlights contributions from vaccine and vaccination-related health communication research since 2010. This research has had significant impacts - that is, visible and discernible positive effects - on the ways health communication is undertaken broadly (e.g. at the campaign level) and at the health care provider-patient level (e.g. conversations with parents and patients regarding vaccine benefits, risks, and safety). As this essay illustrates, health communication research has resulted in greater use of formative research to guide vaccination campaign and education efforts, better identification and understanding of the factors behind vaccination delay and declination, and greater recognition that communication efforts can fail to achieve desired outcomes or generate unintended consequences. Health communication research has also documented the powerful influence of healthcare provider communication on parent and patient understanding and compliance with immunization recommendations. Importantly, this research has also shown the characteristics of provider-patient communication matter much. Healthcare providers must have or establish a high degree of trust, be well-versed in vaccine efficacy and safety, and be adept at using their personal experiences, information tailoring/personalization, and evidence-based communication strategies to increase the likelihood of success.

The emergence of multiple Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) variants presented an escalated risk to public health globally and prompted epidemiologic monitoring and classification. Health professionals are vital for patient education regarding Coronavirus Disease 2019 (COVID-19), discussing patient concerns, and providing guidance. Students enrolled in professional healthcare programs benefit from being adept with the evolution and spread of SARS-CoV-2 variants, and a team-based learning module can be helpful for applying foundational concepts to clinical problems.

This team-based learning (TBL) framework was developed in response to the COVID-19 pandemic and the emergence of viral variants. It was placed at the end of a hematology block within the first semester of year one of the medical school during the academic years 2021-2022. It consists of a 7-question readiness assurance process and a four-question application exercise.

The average score increased from 58.8% (iRAT) to 85.9% (tRAT) (n=104). The post-session survey data showed an increase in students' understanding of the classification of COVID-19 variants and the role of genetic mutations in viral pathogenesis. Qualitative data yielded positive feedback for the session, notably in students' ability to interpret phylogenetic trees and understand the role of variants.

This TBL framework cultivates higher-order thinking skills among medical students and effectively integrates virology, epidemiology, and pathology. Additionally, it provides a framework for developing a robust and up-to-date platform for the discussion of novel variants of COVID-19 or other infectious diseases.

To describe primary care providers' (PCPs) perspectives on discussing COVID-19 vaccination with their patients.

All PCPs from 11 primary care clinics at 3 health systems were invited to participate. Focus groups were conducted between December 2021-January 2022, and were recorded and transcribed. Participants were asked about their experience communicating about the COVID-19 vaccine. Themes and subthemes were inductively identified using thematic analysis.

40 PCPs participated. All PCPs viewed discussing COVID-19 vaccination as high priority. Strategies for promoting COVID-19 vaccination included influencing what people think and feel, building trust and leveraging their relationship with patients, and practical strategies such as on-site vaccination. Most strategies aimed at influencing what people think and feel and leveraging relationships were viewed as generally ineffective. On-site vaccine availability was identified as the most influential factor. PCPs expressed frustration by their interactions with vaccine hesitant patients, leading them to truncate their communication with these patients.

Despite using a broad range of strategies, most PCPs were unable to change the strongly held beliefs among the most vaccine hesitant patients that were often informed by misinformation and mistrust.

Promising strategies for promoting vaccination include social/relational (expressing empathy) and practical (on-site COVID-19 vaccine availability).

Following the World Health Organization's declaration that the COVID-19 pandemic is no longer a public health emergency of international concern (PHEIC), COVID-19 remains an ongoing threat to human health and healthcare systems. Vaccination plays a crucial role in reducing the disease's incidence, mitigating its severity, and limiting transmission, contributing to long-term public health resilience. However, incomplete vaccination coverage and vaccine hesitancy exist. This narrative review investigates strategies at the system and physician levels aimed at sustaining awareness and uptake of COVID-19 vaccination in a post-PHEIC era. Through an examination of the existing literature, this review explores the effectiveness of diverse approaches utilized by healthcare systems and individual providers. These approaches address every component of the 5C model of vaccine hesitancy: confidence, complacency, constraints/convenience, calculation, and collective responsibility. Physician-level approaches include appropriate message framing, persuasive communication containing safety and personal/social benefit information, sharing of personal stories, creating a safe space for discussion, harnessing co-administration with annual influenza vaccines, and use of decision aids and visual messages. System-level approaches include messaging, mass media for health communication, on-site vaccine availability, pharmacist delivery, healthcare protocol integration, incentives, and chatbot use.

In the United States, vaccination rates for many routinely recommended vaccines have recovered to pre-pandemic levels, yet human papillomavirus (HPV) vaccination rates still lag pre-pandemic levels. This study sought to uncover the potential effects of the pandemic on attitudes about the HPV vaccine, and factors associated with changes in attitudes. We conducted a national survey (n = 3968) of U.S. mothers with children aged 9-17 years. Outcome variables measured changes in attitude toward the HPV vaccine following the pandemic. Two logistic regression models identified predictors of (1) those who did not have attitude changes (always negative vs. always positive), and (2) those who reported attitude changes (change to negative vs. change to positive). Attitudes toward the HPV vaccine remained unchanged in 78.9% of participants (58.1% positive, 20.8% negative). Of the 21.1% reporting changed attitudes, 9.6% changed to positive and 11.5% to negative. Those reporting changing to a negative attitude had a greater odds of reporting conservative political views, and being unsure/undecided about vaccinating their child against HPV compared to those who reported changing to a positive attitude. Targeted strategies are needed to address erosion in confidence in the HPV vaccine and other vaccines resulting from mis- and disinformation associated with the COVID-19 pandemic and future pandemics.

The WHO SAGE vaccine hesitancy working group defined vaccine hesitancy as the delay or refusal of vaccination. Questions about individuals who become vaccinated while hesitant, or remain unvaccinated even though they are not hesitant, are unimaginable when starting from this behaviorally related definition of vaccine hesitancy. More critically, behaviorally related definitions limit the possibilities for vaccine hesitancy research to be translatable into clinical and public health practices that can increase vaccination.

Emerging research on hesitant adopters provides several lessons for the conceptualization of vaccine hesitancy and how practitioners might increase vaccination. Conceptualizations of vaccine hesitancy must account for some of the big lessons we have learned from hesitant adopters: (1) vaccine hesitancy and vaccination co-occur for many; (2) vaccine hesitancy may not always be characterized by a punctuated point-in-time or moment; and (3) following from the second lesson, vaccine hesitancy may not be temporally bound to the moments preceding a vaccination decision.

We recommend conceptualizing vaccine-hesitant attitudes as distinctive from behaviors, and not temporally bound to moments preceding vaccination decisions. Sharpening the use of vaccine hesitancy and its temporal characteristics could benefit from engagement with the Life Course Paradigm. We recommend healthcare professionals provide a recommendation even when individuals express hesitancy. Finally, we recommend public health officials consider ways to improve the frequency and consistency of provider recommendations even among patients who are hesitant.

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.

Care managers (CM) for low-income disabled clients may address COVID-19 vaccine hesitancy with specific training.

To assess the Partners in Vaccination (PIV) that trained CMs of a homecare program for disabled adults to promote COVID-19 vaccination.

We randomized 78 CMs to PIV intervention (N = 38) or control (N = 40). PIV featured motivational interviewing (MI) skills and educational materials for unvaccinated clients. The primary outcome was first COVID-19 vaccination between December 1, 2021 and June 30, 2022 for clients of intervention CMs versus control CMs. Mixed method analysis included key informant interviews conducted from 5/24/22 to 7/25/22 with CMs, administrators, and clients about the PIV intervention.

Among 1939 clients of 78 study CMs, 528 (26.8 %) were unvaccinated by December 1, 2021 (274 clients of intervention CMs; 254 clients of control CMs). These clients' mean age was 62.3 years old (SD = 22.4) and 54 % were Black or Hispanic/Latino. First vaccination rate did not differ for intervention and control groups (6.2 % vs. 5.9 %, p = .89) by 6/30/2022. Barriers to addressing COVID-19 vaccination from interviews with 7 CMs and administrators were competing responsibilities and potentially antagonizing clients. Seven interviewed clients (five vaccinated and two unvaccinated) cited concerns about vaccination they heard from their family/friends and belief that risks of COVID-19 infection may be less than vaccination. Yet, some clients were receptive to physician recommendations.

Training CMs to promote COVID-19 vaccination for disabled clients did not increase first vaccination rates. CMs preferred their usual role of coordinating care and, even after the training, expressed discomfort with this potentially polarizing topic.

Variation in COVID-19 vaccination coverage and increasing vaccine hesitancy are well documented, especially amongst ethnic minority populations and current channels of vaccine and communication have been found to be inadequate. It has been suggested that more be done to utilise community-led pathways to improve vaccine readiness in ethnic minority communities in Australia. The study aimed to explore receptiveness towards the role of different actors and methods of communication about immunisation.

A cross-sectional survey of 1,227 adults in Australia was conducted to examine the roles of various actors in promoting vaccine uptake. Chi-square analyses and independent samples t-tests were used to identify significant associations between sociodemographic characteristics, vaccine practices, and vaccine information-seeking behaviours and (1) COVID-19 vaccine uptake (at least one dose) and (2) speaking a language other than English.

At the time of the survey, 93% of respondents had received at least one dose of the COVID-19 vaccine. There were significant associations between COVID-19 vaccine uptake and: perceived capacity to locate accurate and timely vaccine information; receiving the COVID-19 vaccination information from a Nurse or Pharmacist; and receiving a vaccine recommendation by a GP. Additionally, respondents who spoke a language other than English reported were significantly more likely to have received information from family, friends, workplaces, local councils, religious centres, community leaders, and religious leaders than those who only spoke English.

Significant variations in vaccine practices and vaccine information-seeking behaviours were found, especially in those who speak a language other than English. To enhance vaccine uptake and to address vaccine hesitancy in Australia, vaccine promotion strategies and health communication efforts require significant consideration of information accessibility and communication source preferences.

Identify characteristics of healthcare personnel (HCP) who did not have timely initiation of the COVID-19 primary series, as well as HCP who did not receive a booster vaccine.

Characteristics of HCP enrolled in a COVID-19 vaccine effectiveness study between 12/28/2020-12/01/2022 were compared by timing of receipt of 1st mRNA dose, and by receipt of a booster dose. Data for this retrospective cohort analysis came from HCP working at a large healthcare system in Monroe County, New York, and included standardized questionnaires and verified vaccination status. HCP were categorized by whether they received their 1stmRNA COVID-19 vaccine between 12/14/2020-03/30/2021 (earlier) or 04/01/2021-09/28/2021 (later) based on timing of local vaccine eligibility and mandates, and by whether they received a 3rdmRNA booster dose by 12/01/22. Logistic regression models were run to identify characteristics of HCP who had later 1stdose receipt or did not receive a booster.

3,375 HCP were enrolled. Of these, 86.8 % had early initiation of their 1stCOVID-19 vaccine, and 85.0 % received a booster dose. Low education, low household income, younger age (<50), non-White race and public health insurance were all significant predictors of later receipt of 1stdose and lack of uptake of a booster. However, advanced professional role was only found to be a significant predictor of early 1stdose receipt.

Continual monitoring of COVID-19 vaccine uptake among HCP to identify those less likely to receive new booster doses will be crucial to support targeted vaccine campaigns in this important population.

Irrespective of the availability of a safe and effective COVID-19 vaccine and its success rate in adults, administering vaccines to children remains a challenge for healthcare workers. Children's vaccine hesitancy among parents remains substantial and is exacerbated due to misleading information. In the present study, we aimed to investigate the hesitancy of parents and their concern about the vaccination and clinical characteristics of COVID-19 in their children.

A cross-sectional web-based and offline survey comprised of questions about the demographic of children, the status of COVID-19 infection, its severity, vaccination status, sources of information, willingness, concerns and attitude of parents to vaccinate their children against the COVID-19 virus, was conducted. Overall, 846 responses from parents fulfilling the inclusion criteria were analysed by GraphPad Prism 5.

Out of the 846 responses, 51.2% (n = 433) of children were vaccinated against COVID-19. Out of vaccinated children (51.2%), 60.3% (n = 261) had experienced adverse events. Around 21% (n = 98) of children had a history of exposure to the SARS-CoV-2 virus. Among the infected children, 14.3% were asymptomatic and 85.7% had symptoms. Approximately 8% of children had comorbidities, with chronic lung diseases and asthma being the most common. Among the 846 participating parents, 59.5% were mothers and the remaining 40.5% were fathers. A total of 2.7% and 22.2% of parents were found hesitant to administer the COVID-19 vaccine to their children aged 15-18 years and below 15 years, respectively. Among hesitant parents, mothers were found slightly more hesitant as compared to fathers. Also, 35.5% of parents were found hesitant about their own COVID-19 vaccination. Furthermore, the concern for COVID-19 vaccine unwillingness among parents is that a child has already achieved natural immunity after COVID-19 infections (76.8%) followed by vaccine safety and its side effects. The motivating factors to convince parents for their children's COVID-19 vaccination were if their doctors recommend it, followed by detailed information on vaccine side effects and efficacy in children. The most trusted source of information for the parents was found to be the healthcare workers.

These results suggest that data and reviews regarding the safety and efficacy of the COVID-19 vaccine readily available in the public domain could serve as a highly effective strategy for promoting and implementing widespread vaccination among children. By providing easily accessible and comprehensive information, public health authorities can address parental concerns, dispel misconceptions and foster a greater sense of trust in the vaccination process.

The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection.

Using data from the Household Pulse Survey (n = 25,173) collected from December 9-19, 2022, January 4-16, 2023, and February 1-13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5-11 and adolescents 12-17 by educational setting.

Among children 5-11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12-17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4-51.6%), lack of trust in COVID-19 vaccines (45.0-50.9%), and lack of trust in the government (32.7-39.2%).

Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children.

Patients with diabetes mellitus (DM) are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications. The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) issued immunization re-commendations to protect this patient population.

To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.

An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.

Among participants, 10.01% (n = 71) had never received any vaccine, while 85.89% (n = 609) received at least one dose of the coronavirus disease 2019 (COVID-19) vaccine, and 34.83% (n = 247) had received the annual influenza vaccine. Only 2.96% (n = 21), 2.11% (n = 15), and 1.12% (n = 8) received herpes zoster, tetanus, diphtheria, and pertussis (Tdap), and human papillomavirus (HPV) vaccines, respectively. For patients with DM in Saudi Arabia, the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, site of care, income level, DM-related hospitalization history, residency site, hemoglobin A1c (HbA1c) level, and health sector type can significantly influence the vaccination rate in patients with DM. Among non-vaccinated patients with DM, the most reported barriers were lack of knowledge and fear of side effects. This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.

In Saudi Arabia, patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster, Tdap, pneumococcal, and HPV. Factors such as vaccine recommendations provided by family physicians or specialists, the site of care, income level, DM-related hospitalization history, residency site, HbA1c level, and health sector type can significantly influence the vaccination rate in patients with DM.

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South.

Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews.

Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions.

In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician.

The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

Rises in parental vaccine hesitancy, observed during the COVID-19 pandemic, threaten public health. This is especially concerning for vaccines not typically required for school-entry, such as the vaccines for COVID-19 and human papillomavirus (HPV), both of which also have much lower rates of completion compared to other adolescent vaccines. Pediatricians are well-positioned to address vaccine hesitancy and can offer insights into parents' perspectives in this area. There is evidence that pediatricians' sharing their own vaccine stories may help to address parents' concerns; yet we have little information on pediatricians' or their children's COVID-19 vaccine uptake. To address these gaps, we conducted a cross-sectional survey about Massachusetts pediatricians' behaviors and perspectives on vaccines that face significant resistance: HPV and COVID-19 vaccines. A total of 144 people initiated the survey, and 109 participants were eligible and completed the survey. Participants reported high levels of COVID-19 vaccine uptake for themselves (97%) and their children (98%). Similarities in parents' resistance toward both vaccines were identified: fear of side effects; general vaccine resistance. Pediatricians reported a rise in vaccine hesitancy since the beginning of the COVID-19 pandemic. Future research should focus on identifying strategies to build overall vaccine confidence and streamline these efforts for pediatricians.

Vaccination against seasonal flu is crucial to prevention of illness in modern societies. The level of influenza vaccination in Poland is low and, for many years, has hovered around a few percent of the general population. For this reason, it is crucial to understand the reasons for such a low level of vaccination and to assess the influence of medical and social authorities on the decision to vaccinate against influenza from the perspective of social vaccinology. For this purpose, a representative survey was conducted in 2022 among adult Poles (N = 805), orchestrated with the CAWI technique based on the author's questionnaire. The most significant authority in the context of influenza vaccination is held by physicians, especially among the oldest part of the population, over 65 years of age-in this group, 50.4% of respondents declare a very high level of respect for physicians on the issue of recommended influenza vaccination (p < 0.001), and the second-highest authority group for which seniors have respect in the aspect of influenza vaccination is pharmacists (p = 0.011). It was also shown that pharmacists have more authority on the issue of influenza vaccination than nurses, especially in the group that declared themselves opponents of vaccination (p < 0.001). The survey indicates the need to strengthen the authority of physicians and pharmacists regarding influenza vaccination, and, in the case of pharmacists, the need for changing the law to allow them to qualify for influenza vaccination.

Antimicrobial resistance is a current and pressing issue in Canada. Population-level antibiotic consumption is a key driver. The Public Health Agency of Canada undertook a comprehensive assessment of the Canadian public's knowledge, attitudes and practices in relation to antimicrobial resistance and antibiotic use, to help inform the implementation of public awareness and knowledge mobilization.

Data were collected in three phases: 1) six in-person focus groups (53 participants) to help frame the survey; 2) nationwide survey administration to 1,515 Canadians 18 years and older via cell phone and landline; and 3) 12 online focus groups to analyze survey responses. Survey data is descriptive.

A third (33.9%) of survey respondents reported using antibiotics at least once in the previous 12 months, 15.8% more than twice and 4.6% more than five times. Antibiotic use was reported more among 1) those with a household income below $60,000, 2) those with a medical condition, 3) those without a university education and 4) among the youngest adults (18-24 years of age) and (25-34 years of age). Misinformation about antibiotics was common: 32.5% said antibiotics "can kill viruses"; 27.9% said they are "effective against colds and flu"; and 45.8% said they are "effective in treating fungal infections". Inaccurate information was reported more often by those 1) aged 18-24 years, 2) with a high school degree or less and 3) with a household income below $60,000. In focus groups, the time/money trade-offs involved in accessing medical care were reported to contribute to pushing for a prescription or using unprescribed antibiotics, particularly in more remote contexts, while the cost of a prescription contributed to sharing and using old antibiotics. A large majority, across all demographic groups, followed the advice of medical professionals in making health decisions.

High trust in medical professionals presents an important opportunity for knowledge mobilization. Delayed prescriptions may alleviate concerns about the time/money constraints of accessing future care. Consideration should be given to prioritizing access to appropriate diagnostic and other technology for northern and/or remote communities and/or medical settings serving many young children to alleviate concerns of needing a prescription or of needing to return later.