@Article{info:doi/10.2196/73062, author="Flaherty, Thomas Gerard and Mangan, Michael Ryan", title="Impact of Social Media Influencers on Amplifying Positive Public Health Messages", journal="J Med Internet Res", year="2025", month="Mar", day="21", volume="27", pages="e73062", keywords="social media", keywords="COVID-19", keywords="vaccination", keywords="personal brands", keywords="public health", keywords="wellness", keywords="global health", keywords="pandemic", keywords="Twitter", keywords="tweets", keywords="vaccine", keywords="longitudinal design", keywords="wellness influencers", keywords="hand annotation", keywords="antivaccination", keywords="infodemiology", doi="10.2196/73062", url="https://www.jmir.org/2025/1/e73062" } @Article{info:doi/10.2196/64653, author="Atanasova, Sara and Kamin, Tanja and Perger, Nina", title="Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="21", volume="11", pages="e64653", keywords="vaccine uptake", keywords="young people", keywords="COVID-19 vaccine", keywords="health belief model", keywords="theory of planned behavior", abstract="Background: Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people. Objective: This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination. Methods: An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior. Results: Among respondents, 45.8\% (232/507) were vaccinated, 30.0\% (152/507) refused vaccination, 12.4\% (63/507) were hesitant, and 11.8\% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19--related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95\% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95\% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95\% CI 0.2-0.7) and refusers (aOR 0.3, 95\% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95\% CI 0.3-0.9) than among vaccinated individuals. Conclusions: This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake. ", doi="10.2196/64653", url="https://publichealth.jmir.org/2025/1/e64653", url="http://www.ncbi.nlm.nih.gov/pubmed/39983109" } @Article{info:doi/10.2196/62802, author="Zhang, Kehe and Hunyadi, V. Jocelyn and de Oliveira Otto, C. Marcia and Lee, Miryoung and Zhang, Zitong and Ramphul, Ryan and Yamal, Jose-Miguel and Yaseen, Ashraf and Morrison, C. Alanna and Sharma, Shreela and Rahbar, Hossein Mohammad and Zhang, Xu and Linder, Stephen and Marko, Dritana and Roy, White Rachel and Banerjee, Deborah and Guajardo, Esmeralda and Crum, Michelle and Reininger, Belinda and Fernandez, E. Maria and Bauer, Cici", title="Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e62802", keywords="COVID-19 testing", keywords="COVID-19 vaccination", keywords="study design", keywords="community-based interventions", keywords="geospatial analysis", keywords="public health", keywords="social determinants of health", keywords="data dashboard", abstract="Background: Geospatial data science can be a powerful tool to aid the design, reach, efficiency, and impact of community-based intervention trials. The project titled Take Care Texas aims to develop and test an adaptive, multilevel, community-based intervention to increase COVID-19 testing and vaccination uptake among vulnerable populations in 3 Texas regions: Harris County, Cameron County, and Northeast Texas. Objective: We aimed to develop a novel procedure for adaptive selections of census block groups (CBGs) to include in the community-based randomized trial for the Take Care Texas project. Methods: CBG selection was conducted across 3 Texas regions over a 17-month period (May 2021 to October 2022). We developed persistent and recent COVID-19 burden metrics, using real-time SARS-CoV-2 monitoring data to capture dynamic infection patterns. To identify vulnerable populations, we also developed a CBG-level community disparity index, using 12 contextual social determinants of health (SDOH) measures from US census data. In each adaptive round, we determined the priority CBGs based on their COVID-19 burden and disparity index, ensuring geographic separation to minimize intervention ``spillover.'' Community input and feedback from local partners and health workers further refined the selection. The selected CBGs were then randomized into 2 intervention arms---multilevel intervention and just-in-time adaptive intervention---and 1 control arm, using covariate adaptive randomization, at a 1:1:1 ratio. We developed interactive data dashboards, which included maps displaying the locations of selected CBGs and community-level information, to inform the selection process and guide intervention delivery. Selection and randomization occurred across 10 adaptive rounds. Results: A total of 120 CBGs were selected and followed the stepped planning and interventions, with 60 in Harris County, 30 in Cameron County, and 30 in Northeast Texas counties. COVID-19 burden presented substantial temporal changes and local variations across CBGs. COVID-19 burden and community disparity exhibited some common geographical patterns but also displayed distinct variations, particularly at different time points throughout this study. This underscores the importance of incorporating both real-time monitoring data and contextual SDOH in the selection process. Conclusions: The novel procedure integrated real-time monitoring data and geospatial data science to enhance the design and adaptive delivery of a community-based randomized trial. Adaptive selection effectively prioritized the most in-need communities and allowed for a rigorous evaluation of community-based interventions in a multilevel trial. This methodology has broad applicability and can be adapted to other public health intervention and prevention programs, providing a powerful tool for improving population health and addressing health disparities. ", doi="10.2196/62802", url="https://formative.jmir.org/2025/1/e62802" } @Article{info:doi/10.2196/58981, author="Rowley, AK Elizabeth and Mitchell, K. Patrick and Yang, Duck-Hye and Lewis, Ned and Dixon, E. Brian and Vazquez-Benitez, Gabriela and Fadel, F. William and Essien, J. Inih and Naleway, L. Allison and Stenehjem, Edward and Ong, C. Toan and Gaglani, Manjusha and Natarajan, Karthik and Embi, Peter and Wiegand, E. Ryan and Link-Gelles, Ruth and Tenforde, W. Mark and Fireman, Bruce", title="Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e58981", keywords="disease risk score", keywords="propensity score", keywords="vaccine effectiveness", keywords="COVID-19", keywords="simulation study", keywords="usefulness", keywords="comorbidity", keywords="assessment", abstract="Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from --5.3\% to 6.1\% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95\% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7\% (95\% CI 92.2\%-95.2\%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3\% (95\% CI 94.0\%-96.6\%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from --2.2\% to 4.2\%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95\% level. The lowest coverage in the DRS scenarios was 87.8\% (95\% CI 85.8\%-89.8\%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8\% (95\% CI 93.4\%-96.2\%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. ", doi="10.2196/58981", url="https://formative.jmir.org/2025/1/e58981" } @Article{info:doi/10.2196/58656, author="Kahlawi, Adham and Masri, Firas and Ahmed, Wasim and Vidal-Alaball, Josep", title="Cross-Cultural Sense-Making of Global Health Crises: A Text Mining Study of Public Opinions on Social Media Related to the COVID-19 Pandemic in Developed and Developing Economies", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e58656", keywords="COVID-19", keywords="SARS-CoV-2", keywords="pandemic", keywords="citizen opinion", keywords="text mining", keywords="LDA", keywords="health crisis", keywords="developing economies", keywords="Italy", keywords="Egypt", keywords="UK", keywords="dataset", keywords="content analysis", keywords="social media", keywords="twitter", keywords="tweet", keywords="sentiment", keywords="attitude", keywords="perception", keywords="perspective", keywords="machine learning", keywords="latent Dirichlet allocation", keywords="vaccine", keywords="vaccination", keywords="public health", keywords="infectious", abstract="Background: The COVID-19 pandemic reshaped social dynamics, fostering reliance on social media for information, connection, and collective sense-making. Understanding how citizens navigate a global health crisis in varying cultural and economic contexts is crucial for effective crisis communication. Objective: This study examines the evolution of citizen collective sense-making during the COVID-19 pandemic by analyzing social media discourse across Italy, the United Kingdom, and Egypt, representing diverse economic and cultural contexts. Methods: A total of 755,215 social media posts from X (formerly Twitter) were collected across 3 time periods: the virus' emergence (February 15 to March 31, 2020), strict lockdown (April 1 to May 30, 2020), and the vaccine rollout (December 1, 2020 to January 15, 2021). In total, 284,512 posts from Italy, 261,978 posts from the United Kingdom, and 209,725 posts from Egypt were analyzed using the latent Dirichlet allocation algorithm to identify key thematic topics and track shifts in discourse across time and regions. Results: The analysis revealed significant regional and temporal differences in collective sense-making during the pandemic. In Italy and the United Kingdom, public discourse prominently addressed pragmatic health care measures and government interventions, reflecting higher institutional trust. By contrast, discussions in Egypt were more focused on religious and political themes, highlighting skepticism toward governmental capacity and reliance on alternative frameworks for understanding the crisis. Over time, all 3 countries displayed a shift in discourse toward vaccine-related topics during the later phase of the pandemic, highlighting its global significance. Misinformation emerged as a recurrent theme across regions, demonstrating the need for proactive measures to ensure accurate information dissemination. These findings emphasize the role of cultural, economic, and institutional factors in shaping public responses during health crises. Conclusions: Crisis communication is influenced by cultural, economic, and institutional contexts, as evidenced by regional variations in citizen engagement. Transparent and culturally adaptive communication strategies are essential to combat misinformation and build public trust. This study highlights the importance of tailoring crisis responses to local contexts to improve compliance and collective resilience. ", doi="10.2196/58656", url="https://www.jmir.org/2025/1/e58656" } @Article{info:doi/10.2196/59352, author="Taira, Kazuya and Shiomi, Misa and Nakabe, Takayo and Imanaka, Yuichi", title="The Association Between COVID-19 Vaccination Uptake and Information-Seeking Behaviors Using the Internet: Nationwide Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e59352", keywords="COVID-19 vaccines", keywords="internet use", keywords="information seeking behavior", keywords="Japan", keywords="vaccine", keywords="COVID-19", keywords="behavior", keywords="panel study", keywords="longitudinal", keywords="survey", keywords="regression analysis", keywords="chi-square test", keywords="adult", keywords="epidemiology", keywords="health informatics", abstract="Background: The COVID-19 pandemic, declared in March 2020, profoundly affected global health, societal, and economic frameworks. Vaccination became a crucial tactic in combating the virus. Simultaneously, the pandemic likely underscored the internet's role as a vital resource for seeking health information. The proliferation of misinformation on social media was observed, potentially influencing vaccination decisions and timing. Objective: This study aimed to explore the relationship between COVID-19 vaccination rates, including the timing of vaccination, and reliance on internet-based information sources in Japan. Methods: Using a cross-sectional study design using a subset of panel data, this nationwide survey was conducted in 7 waves. A total of 10,000 participants were randomly selected through an internet survey firm, narrowing down to 8724 after applying inclusion and exclusion criteria. The primary outcome was the COVID-19 vaccination date, divided into vaccinated versus unvaccinated and early versus late vaccination groups. The main exposure variable was the use of internet-based information sources. Control variables included gender, family structure, education level, employment status, household income, eligibility for priority COVID-19 vaccination due to pre-existing medical conditions, and a health literacy scale score. Two regression analyses using generalized estimating equations accounted for prefecture-specific correlations, focusing on vaccination status and timing. In addition, chi-square tests assessed the relationship between each information source and vaccination rates. Results: Representing a cross-section of the Japanese population, the regression analysis found a significant association between internet information seeking and higher vaccination rates (adjusted odds ratio [aOR] 1.42 for those younger than 65 years; aOR 1.66 for those aged 65 years and older). However, no significant link was found regarding vaccination timing. Chi-square tests showed positive associations with vaccination for television, government web pages, and web news, whereas blogs and some social networking sites were negatively correlated. Conclusions: Internet-based information seeking is positively linked to COVID-19 vaccination rates in Japan, underscoring the significant influence of online information on public health decisions. Nonetheless, certain online information sources, including blogs and some social networks, negatively affected vaccination rates, warranting caution in their use and recognition. The study highlights the critical role of credible online sources in public health communication and the challenge of combating misinformation on less regulated platforms. This research sheds light on how the digital information landscape influences health behaviors, stressing the importance of accurate and trustworthy health information amidst global health emergencies. ", doi="10.2196/59352", url="https://www.jmir.org/2025/1/e59352", url="http://www.ncbi.nlm.nih.gov/pubmed/39808493" } @Article{info:doi/10.2196/53424, author="Daluwatte, Chathuri and Khromava, Alena and Chen, Yuning and Serradell, Laurence and Chabanon, Anne-Laure and Chan-Ou-Teung, Anthony and Molony, Cliona and Juhaeri, Juhaeri", title="Application of a Language Model Tool for COVID-19 Vaccine Adverse Event Monitoring Using Web and Social Media Content: Algorithm Development and Validation Study", journal="JMIR Infodemiology", year="2024", month="Dec", day="20", volume="4", pages="e53424", keywords="adverse event", keywords="COVID-19", keywords="detection", keywords="large language model", keywords="mass vaccination", keywords="natural language processing", keywords="pharmacovigilance", keywords="safety", keywords="social media", keywords="vaccine", abstract="Background: Spontaneous pharmacovigilance reporting systems are the main data source for signal detection for vaccines. However, there is a large time lag between the occurrence of an adverse event (AE) and the availability for analysis. With global mass COVID-19 vaccination campaigns, social media, and web content, there is an opportunity for real-time, faster monitoring of AEs potentially related to COVID-19 vaccine use. Our work aims to detect AEs from social media to augment those from spontaneous reporting systems. Objective: This study aims to monitor AEs shared in social media and online support groups using medical context-aware natural language processing language models. Methods: We developed a language model--based web app to analyze social media, patient blogs, and forums (from 190 countries in 61 languages) around COVID-19 vaccine--related keywords. Following machine translation to English, lay language safety terms (ie, AEs) were observed using the PubmedBERT-based named-entity recognition model (precision=0.76 and recall=0.82) and mapped to Medical Dictionary for Regulatory Activities (MedDRA) terms using knowledge graphs (MedDRA terminology is an internationally used set of terms relating to medical conditions, medicines, and medical devices that are developed and registered under the auspices of the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use). Weekly and cumulative aggregated AE counts, proportions, and ratios were displayed via visual analytics, such as word clouds. Results: Most AEs were identified in 2021, with fewer in 2022. AEs observed using the web app were consistent with AEs communicated by health authorities shortly before or within the same period. Conclusions: Monitoring the web and social media provides opportunities to observe AEs that may be related to the use of COVID-19 vaccines. The presented analysis demonstrates the ability to use web content and social media as a data source that could contribute to the early observation of AEs and enhance postmarketing surveillance. It could help to adjust signal detection strategies and communication with external stakeholders, contributing to increased confidence in vaccine safety monitoring. ", doi="10.2196/53424", url="https://infodemiology.jmir.org/2024/1/e53424", url="http://www.ncbi.nlm.nih.gov/pubmed/39705077" } @Article{info:doi/10.2196/63146, author="Nie, Jia and Huang, Tian and Sun, Yuhong and Peng, Zutong and Dong, Wenlong and Chen, Jiancheng and Zheng, Di and Guo, Fuyin and Shi, Wenhui and Ling, Yuewei and Zhao, Weijia and Yang, Haijun and Shui, Tiejun and Yan, Xiangyu", title="Influence of the Enterovirus 71 Vaccine and the COVID-19 Pandemic on Hand, Foot, and Mouth Disease in China Based on Counterfactual Models: Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="17", volume="10", pages="e63146", keywords="hand, foot, and mouth disease", keywords="vaccination", keywords="enterovirus 71", keywords="COVID-19", keywords="epidemical trend", keywords="HFMD", keywords="EV71", abstract="Background: Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness. Understanding the long-term trends of HFMD incidence and its epidemic characteristics under the circumstances of the enterovirus 71 (EV71) vaccination program and the outbreak of COVID-19 is crucial for effective disease surveillance and control. Objective: We aim to give an overview of the trends of HFMD over the past decades and evaluate the impact of the EV71 vaccination program and the COVID-19 pandemic on the epidemic trends of HFMD. Methods: Using official surveillance data from the Yunnan Province, China, we described long-term incidence trends and severity rates of HFMD as well as the variation of enterovirus proportions among cases. We conducted the autoregressive integrated moving average (ARIMA) of time series analyses to predict monthly incidences based on given subsets. The difference between the actual incidences and their counterfactual predictions was compared using absolute percentage errors (APEs) for periods after the EV71 vaccination program and the COVID-19 pandemic, respectively. Results: The annual incidence of HFMD fluctuated between 25.62 cases per 100,000 people in 2008 and 221.52 cases per 100,000 people in 2018. The incidence for men ranged from 30 to 250 cases per 100,000 people from 2008 to 2021, which was constantly higher than that for women. The annual incidence for children aged 1 to 2 years old ranged from 54.54 to 630.06 cases per 100,000 people, which was persistently higher than that for other age groups. For monthly incidences, semiannual peaks were observed for each year. All actual monthly incidences of 2014 to 2015 fell within the predicted 95\% CI by the ARIMA(1,0,1)(1,1,0)[12] model. The average APE was 19\% for a 2-year prediction. After the EV71 vaccination program, the actual monthly incidence of HFMD was consistently lower than the counterfactual predictions by ARIMA(1,0,1)(1,1,0)[12], with negative APEs ranging from ?11\% to ?229\% from January 2017 to April 2018. In the meantime, the proportion of EV71 among the enteroviruses causing HFMD decreased significantly, and the proportion was highly correlated (r=0.73, P=.004) with the severity rate. After the onset of the COVID-19 pandemic in 2020, the actual monthly incidence of HFMD consistently maintained a lower magnitude compared to the counterfactual predictions---ARIMA(1,0,1)(0,1,0)[12]---from February to September 2020, with considerable negative APEs (ranging from ?31\% to ?2248\%). Conclusions: EV71 vaccination alleviated severe HFMD cases and altered epidemiological trends. The HFMD may also benefit from nonpharmaceutical interventions during outbreaks such as the COVID-19 pandemic. Further development of a multivalent virus vaccine is crucial for effectively controlling HFMD outbreaks. Policymakers should implement nonpharmaceutical interventions and emphasize personal hygiene for routine prevention when appropriate. ", doi="10.2196/63146", url="https://publichealth.jmir.org/2024/1/e63146" } @Article{info:doi/10.2196/59425, author="AbuRaed, Tawfiq Ahmed Ghassan and Prikryl, Azuma Emil and Carenini, Giuseppe and Janjua, Zafar Naveed", title="Long COVID Discourse in Canada, the United States, and Europe: Topic Modeling and Sentiment Analysis of Twitter Data", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e59425", keywords="long COVID", keywords="topic modeling", keywords="sentiment analysis", keywords="Twitter", keywords="public perception", keywords="social media analysis", keywords="public health", abstract="Background: Social media serves as a vast repository of data, offering insights into public perceptions and emotions surrounding significant societal issues. Amid the COVID-19 pandemic, long COVID (formally known as post--COVID-19 condition) has emerged as a chronic health condition, profoundly impacting numerous lives and livelihoods. Given the dynamic nature of long COVID and our evolving understanding of it, effectively capturing people's sentiments and perceptions through social media becomes increasingly crucial. By harnessing the wealth of data available on social platforms, we can better track the evolving narrative surrounding long COVID and the collective efforts to address this pressing issue. Objective: This study aimed to investigate people's perceptions and sentiments around long COVID in Canada, the United States, and Europe, by analyzing English-language tweets from these regions using advanced topic modeling and sentiment analysis techniques. Understanding regional differences in public discourse can inform tailored public health strategies. Methods: We analyzed long COVID--related tweets from 2021. Contextualized topic modeling was used to capture word meanings in context, providing coherent and semantically meaningful topics. Sentiment analysis was conducted in a zero-shot manner using Llama 2, a large language model, to classify tweets into positive, negative, or neutral sentiments. The results were interpreted in collaboration with public health experts, comparing the timelines of topics discussed across the 3 regions. This dual approach enabled a comprehensive understanding of the public discourse surrounding long COVID. We used metrics such as normalized pointwise mutual information for coherence and topic diversity for diversity to ensure robust topic modeling results. Results: Topic modeling identified five main topics: (1) long COVID in people including children in the context of vaccination, (2) duration and suffering associated with long COVID, (3) persistent symptoms of long COVID, (4) the need for research on long COVID treatment, and (5) measuring long COVID symptoms. Significant concern was noted across all regions about the duration and suffering associated with long COVID, along with consistent discussions on persistent symptoms and calls for more research and better treatments. In particular, the topic of persistent symptoms was highly prevalent, reflecting ongoing challenges faced by individuals with long COVID. Sentiment analysis showed a mix of positive and negative sentiments, fluctuating with significant events and news related to long COVID. Conclusions: Our study combines natural language processing techniques, including contextualized topic modeling and sentiment analysis, along with domain expert input, to provide detailed insights into public health monitoring and intervention. These findings highlight the importance of tracking public discourse on long COVID to inform public health strategies, address misinformation, and provide support to affected individuals. The use of social media analysis in understanding public health issues is underscored, emphasizing the role of emerging technologies in enhancing public health responses. ", doi="10.2196/59425", url="https://www.jmir.org/2024/1/e59425" } @Article{info:doi/10.2196/54092, author="Na, Kilhoe and Zimdars, Melissa and Cullinan, E. Megan", title="Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey", journal="JMIR Form Res", year="2024", month="Dec", day="5", volume="8", pages="e54092", keywords="alternative health", keywords="social media", keywords="misinformation", keywords="vaccination", keywords="COVID-19", keywords="Coronavirus", abstract="Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination--related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon's Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95\% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95\% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95\% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=--1.09, SE=.17; P<.001; OR .33, 95\% CI 0.23-0.47) and attitudes toward vaccination (B=-- 2.33, SE=.09; P=.02; OR 0.79, 95\% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95\% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=--.84, SE=.17; P<.001; OR 48, 95\% CI 0.32-0.62), and influenza vaccination practice (B=--1.14, SE=.17; P<.001; OR .31, 95\% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. ", doi="10.2196/54092", url="https://formative.jmir.org/2024/1/e54092" } @Article{info:doi/10.2196/52871, author="B{\'e}chard, Beno{\^i}t and Gramaccia, A. Julie and Gagnon, Dominique and Laouan-Sidi, Anassour Elhadji and Dub{\'e}, {\`E}ve and Ouimet, Mathieu and de Hemptinne, Delphine and Tremblay, S{\'e}bastien", title="The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e52871", keywords="attitude toward vaccination", keywords="misinformation", keywords="reinformation", keywords="confidence", keywords="perceived tentativeness", keywords="vaccine hesitancy", keywords="COVID-19", abstract="Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article ($\chi$21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style ($\chi$21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23\% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 ", doi="10.2196/52871", url="https://formative.jmir.org/2024/1/e52871" } @Article{info:doi/10.2196/56651, author="O'Brien, Gabrielle and Ganjigunta, Ronith and Dhillon, S. Paramveer", title="Wellness Influencer Responses to COVID-19 Vaccines on Social Media: A Longitudinal Observational Study", journal="J Med Internet Res", year="2024", month="Nov", day="27", volume="26", pages="e56651", keywords="social media, COVID-19, vaccination", keywords="personal brands", keywords="public health", keywords="wellness", keywords="global health", keywords="pandemic", keywords="Twitter", keywords="tweets", keywords="vaccine", keywords="longitudinal design", keywords="wellness influencers", keywords="hand-annotation", keywords="anti-vaccination", keywords="infodemiology", abstract="Background: Online wellness influencers (individuals dispensing unregulated health and wellness advice over social media) may have incentives to oppose traditional medical authorities. Their messaging may decrease the overall effectiveness of public health campaigns during global health crises like the COVID-19 pandemic. Objective: This study aimed to probe how wellness influencers respond to a public health campaign; we examined how a sample of wellness influencers on Twitter (rebranded as X in 2023) identified before the COVID-19 pandemic on Twitter took stances on the COVID-19 vaccine during 2020-2022. We evaluated the prevalence of provaccination messaging among wellness influencers compared with a control group, as well as the rhetorical strategies these influencers used when supporting or opposing vaccination. Methods: Following a longitudinal design, wellness influencer accounts were identified on Twitter from a random sample of tweets posted in 2019. Accounts were identified using a combination of topic modeling and hand-annotation for adherence to influencer criteria. Their tweets from 2020-2022 containing vaccine keywords were collected and labeled as pro- or antivaccination stances using a language model. We compared their stances to a control group of noninfluencer accounts that discussed similar health topics before the pandemic using a generalized linear model with mixed effects and a nearest-neighbors classifier. We also used topic modeling to locate key themes in influencer's pro- and antivaccine messages. Results: Wellness influencers (n=161) had lower rates of provaccination stances in their on-topic tweets (20\%, 614/3045) compared with controls (n=242 accounts, with 42\% or 3201/7584 provaccination tweets). Using a generalized linear model of tweet stance with mixed effects to model tweets from the same account, the main effect of the group was significant ($\beta$1=--2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals ($\beta$=--0.9591, SE=0.2917; P=.001) but not social network position. A complementary modeling exercise of stance within user accounts showed a significant difference in the proportion of antivaccination users by group ($\chi$21[N=321]=36.1, P<.001). While nearly half of the influencer accounts were labeled by a K-nearest neighbor classifier as predominantly antivaccination (48\%, 58/120), only 16\% of control accounts were labeled this way (33/201). Topic modeling of influencer tweets showed that the most prevalent antivaccination themes were protecting children, guarding against government overreach, and the corruption of the pharmaceutical industry. Provaccination messaging tended to encourage followers to take action or emphasize the efficacy of the vaccine. Conclusions: Wellness influencers showed higher rates of vaccine opposition compared with other accounts that participated in health discourse before the pandemic. This pattern supports the theory that unregulated wellness influencers have incentives to resist messaging from establishment authorities such as public health agencies. ", doi="10.2196/56651", url="https://www.jmir.org/2024/1/e56651" } @Article{info:doi/10.2196/65740, author="Barbosa da Silva J{\'u}nior, Jarbas and Garcia-Saiso, Sebastian and Marti, Myrna and Salas, Daniel and Contreras, Marcela and Velandia-Gonzalez, Martha and Luna, Daniel and Nelson, Jennifer and Fitzgerald, James and Bascolo, Ernesto and Talavera Romero, Lorena Ivy and Chomali, May and Curioso, H. Walter and Plazzotta, Fernando and Otero, Carlos and Lopez Osornio, Alejandro and Lennemann, Tessa and Salinas, Karen and D'Agostino, Marcelo", title="Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="26", volume="10", pages="e65740", keywords="medical informatics", keywords="health systems", keywords="immunizations", keywords="public health", keywords="viewpoint", keywords="health challenges", keywords="digital vaccine certificates", keywords="outbreak management", keywords="outbreak", keywords="accuracy", keywords="healthcare", keywords="surveillance", keywords="health outcomes", keywords="global health", keywords="mobile phone", doi="10.2196/65740", url="https://publichealth.jmir.org/2024/1/e65740" } @Article{info:doi/10.2196/54597, author="Deady, Matthew and Duncan, Raymond and Sonesen, Matthew and Estiandan, Renier and Stimpert, Kelly and Cho, Sylvia and Beers, Jeffrey and Goodness, Brian and Jones, Daniel Lance and Forshee, Richard and Anderson, A. Steven and Ezzeldin, Hussein", title="A Computable Phenotype Algorithm for Postvaccination Myocarditis/Pericarditis Detection Using Real-World Data: Validation Study", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e54597", keywords="adverse event", keywords="vaccine safety", keywords="interoperability", keywords="computable phenotype", keywords="postmarket surveillance system", keywords="fast healthcare interoperability resources", keywords="FHIR", keywords="real-world data", keywords="validation study", keywords="Food and Drug Administration", keywords="electronic health records", keywords="COVID-19 vaccine", abstract="Background: Adverse events (AEs) associated with vaccination have traditionally been evaluated by epidemiological studies. More recently, they have gained attention due to the emergency use authorization of several COVID-19 vaccines. As part of its responsibility to conduct postmarket surveillance, the US Food and Drug Administration continues to monitor several AEs of interest to ensure the safety of vaccines, including those for COVID-19. Objective: This study is part of the Biologics Effectiveness and Safety Initiative, which aims to improve the US Food and Drug Administration's postmarket surveillance capabilities while minimizing the burden of collecting clinical data on suspected postvaccination AEs. The objective of this study was to enhance active surveillance efforts through a pilot platform that can receive automatically reported AE cases through a health care data exchange. Methods: We detected cases by sharing and applying computable phenotype algorithms to real-world data in health care providers' electronic health records databases. Using the fast healthcare interoperability resources standard for secure data transmission, we implemented a computable phenotype algorithm on a new health care system. The study focused on the algorithm's positive predictive value, validated through clinical records, assessing both the time required for implementation and the accuracy of AE detection. Results: The algorithm required 200-250 hours to implement and optimize. Of the 6,574,420 clinical encounters across 694,151 patients, 30 cases were identified as potential myocarditis/pericarditis. Of these, 26 cases were retrievable, and 24 underwent clinical validation. In total, 14 cases were confirmed as definite or probable myocarditis/pericarditis, yielding a positive predictive value of 58.3\% (95\% CI 37.3\%-76.9\%). These findings underscore the algorithm's capability for real-time detection of AEs, though they also highlight variability in performance across different health care systems. Conclusions: The study advocates for the ongoing refinement and application of distributed computable phenotype algorithms to enhance AE detection capabilities. These tools are crucial for comprehensive postmarket surveillance and improved vaccine safety monitoring. The outcomes suggest the need for further optimization to achieve more consistent results across diverse health care settings. ", doi="10.2196/54597", url="https://www.jmir.org/2024/1/e54597" } @Article{info:doi/10.2196/56926, author="Tor{\'a}n-Monserrat, Pere and Lamonja-Vicente, Noem{\'i} and Costa-Garrido, Anna and Carrasco-Ribelles, A. Luc{\'i}a and Quirant, Bibiana and Boigues, Marc and Molina, Xaviera and Chac{\'o}n, Carla and Dacosta-Aguayo, Rosalia and Arm{\'e}star, Fernando and Mart{\'i}nez C{\'a}ceres, Mar{\'i}a Eva and Prado, G. Julia and Viol{\'a}n, Concepci{\'o}n and ", title="SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="22", volume="10", pages="e56926", keywords="SARS-CoV-2", keywords="COVID-19", keywords="health care workers", keywords="cohort", keywords="extended Cox models", keywords="coronavirus", keywords="epidemiology", keywords="epidemiological", keywords="risks", keywords="infectious", keywords="respiratory", keywords="longitudinal", keywords="vaccines", keywords="vaccination", keywords="vaccinated", abstract="Background: As the vaccination campaign against COVID-19 progresses, it becomes crucial to comprehend the lasting effects of vaccination on safeguarding against new infections or reinfections. Objective: This study aimed to assess the risk of new SARS-CoV-2 infections based on the number of vaccine doses, prior infections, and other clinical characteristics. Methods: We defined a cohort of 800 health care workers in a 24-month study (March 2020 to December 2022) in northern Barcelona to determine new infections by SARS-CoV-2. We used extended Cox models, specifically Andersen-Gill (AG) and Prentice-Williams-Peterson, and we examined the risk of new infections. The AG model incorporated variables such as sex, age, job title, number of chronic conditions, vaccine doses, and prior infections. Additionally, 2 Prentice-Williams-Peterson models were adjusted, one for those individuals with no or 1 infection and another for those with 2 or 3 infections, both with the same covariates as the AG model. Results: The 800 participants (n=605, 75.6\% women) received 1, 2, 3, and 4 doses of the vaccine. Compared to those who were unvaccinated, the number of vaccine doses significantly reduced (P<.001) the risk of infection by 66\%, 81\%, 89\%, and 99\%, respectively. Unit increase in the number of prior infections reduced the risk of infection by 75\% (P<.001). When separating individuals by number of previous infections, risk was significantly reduced for those with no or 1 infection by 61\% (P=.02), and by 88\%, 93\%, and 99\% (P<.001) with 1, 2, 3, or 4 doses, respectively. In contrast, for those with 2 or 3 previous infections, the reduction was only significant with the fourth dose, at 98\% (P<.001). The number of chronic diseases only increased the risk by 28\%?31\% (P<.001) for individuals with 0?1 previous infections. Conclusions: The study suggests that both prior infections and vaccination status significantly contribute to SARS-CoV-2 immunity, supporting vaccine effectiveness in reducing risk of reinfection for up to 24 months after follow-up from the onset of the pandemic. These insights contribute to our understanding of long-term immunity dynamics and inform strategies for mitigating the impact of COVID-19. Trial Registration: ClinicalTrials.gov NCT04885478; http://clinicaltrials.gov/ct2/show/NCT04885478 ", doi="10.2196/56926", url="https://publichealth.jmir.org/2024/1/e56926" } @Article{info:doi/10.2196/54841, author="Calderon Ramirez, Lucrecia Claudia and Farmer, Yanick and Downar, James and Frolic, Andrea and Opatrny, Lucie and Poirier, Diane and Bravo, Gina and L'Esp{\'e}rance, Audrey and Gaucher, Nathalie and Payot, Antoine and Dahine, Joseph and Tanuseputro, Peter and Rousseau, Louis-Martin and Dumez, Vincent and Desc{\^o}teaux, Annie and Dallaire, Clara and Laporte, Karell and Bouthillier, Marie-Eve", title="Assessing the Quality of an Online Democratic Deliberation on COVID-19 Pandemic Triage Protocols for Access to Critical Care in an Extreme Pandemic Context: Mixed Methods Study", journal="J Particip Med", year="2024", month="Nov", day="11", volume="16", pages="e54841", keywords="quality assessment", keywords="online democratic deliberation", keywords="COVID-19 triage or prioritization", keywords="critical care", keywords="clinical ethics", abstract="Background: Online democratic deliberation (ODD) may foster public engagement in new health strategies by providing opportunities for knowledge exchange between experts, policy makers, and the public. It can favor decision-making by generating new points of view and solutions to existing problems. Deliberation experts recommend gathering feedback from participants to optimize future implementation. However, this online modality has not been frequently evaluated. Objective: This study aims to (1) assess the quality of an ODD held in Quebec and Ontario, Canada, on the topic of COVID-19 triage protocols for access to critical care in an extreme pandemic context and (2) determine its transformative aspect according to the perceptions of participants. Methods: We conducted a simultaneous ODD in Quebec and Ontario on May 28 and June 4, 2022, with a diversified target audience not working in the health care system. We used a thematic analysis for the transcripts of the deliberation and the written comments of the participants related to the quality of the process. Participants responded to a postdeliberation questionnaire to assess the quality of the ODD and identify changes in their perspectives on COVID-19 pandemic triage protocols after the deliberation exercise. Descriptive statistics were used. An index was calculated to determine equality of participation. Results: The ODD involved 47 diverse participants from the public (n=20, 43\% from Quebec and n=27, 57\% from Ontario). Five themes emerged: (1) process appreciation, (2) learning experience, (3) reflecting on the common good, (4) technological aspects, and (5) transformative aspects. A total of 46 participants responded to the questionnaire. Participants considered the quality of the ODD satisfactory in terms of process, information shared, reasoning, and videoconferencing. A total of 4 (80\%) of 5 participants reported at least 1 change of perspective on some of the criteria and values discussed. Most participants reported that the online modality was accessible and user-friendly. We found low polarization when calculating equal participation. Improvements identified were measures to replace participants when unable to connect and optimization of time during discussions. Conclusions: Overall, the participants perceived the quality of ODD as satisfactory. Some participants self-reported a change of opinion after deliberation. The online modality may be an acceptable alternative for democratic deliberation but with some organizational adaptations. ", doi="10.2196/54841", url="https://jopm.jmir.org/2024/1/e54841" } @Article{info:doi/10.2196/56989, author="Hong, Seohyun and Son, Yejun and Lee, Myeongcheol and Lee, Hyuk Jun and Park, Jaeyu and Lee, Hayeon and Dragioti, Elena and Fond, Guillaume and Boyer, Laurent and L{\'o}pez S{\'a}nchez, Felipe Guillermo and Smith, Lee and Tully, A. Mark and Rahmati, Masoud and Choi, Sung Yong and Lee, Joo Young and Yeo, Geun Seung and Woo, Selin and Yon, Keon Dong", title="Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="1", volume="10", pages="e56989", keywords="COVID-19", keywords="influenza", keywords="South Korea", keywords="vaccination", keywords="vaccinations", keywords="COVID-19 vaccine", keywords="COVID-19 vaccination", keywords="SARS-CoV-2", keywords="SARS-CoV-2 vaccine", keywords="pandemic", keywords="SARS-CoV-2 vaccination", keywords="vaccine", keywords="vaccine hesitancy", abstract="Background: The imperative arises to study the impact of socioeconomic factors on the acceptance of SARS-CoV-2 and influenza vaccines amid changes in immunization policies during the COVID-19 pandemic. Objective: To enhance targeted public health strategies and improve age-specific policies based on identified risk factors, this study investigated the associations between sociodemographic factors and vaccination behaviors during the COVID-19 pandemic, with emphasis on age-specific vaccine cost policies. Methods: This study analyzed data from the Korean Community Health Survey 2019?2022 with 507,964 participants to investigate the impact of age-specific policies on vaccination behaviors during the pandemic period. Cohorts aged 19?64 years and 65 years or older were stratified based on age (years), sociodemographic factors, and health indicators. The cohorts were investigated to assess the influence of relevant risk factors on vaccine acceptance under the pandemic by using weighted odds ratio and ratio of odds ratio (ROR). Results: Among 507,964 participants, the acceptance of the SARS-CoV-2 vaccine (COVID-19 vaccine) was higher among individuals with factors possibly indicating higher socioeconomic status, such as higher education level (age 19?64 years: ROR 1.34; 95\% CI 1.27?1.40 and age ?65 years: ROR 1.19; 95\% CI 1.01?1.41) and higher income (age 19?64 years: ROR 1.67; 95\% CI 1.58?1.76 and age ?65 years: ROR 1.21; 95\% CI 1.06?1.38) for both age cohorts compared to influenza vaccine acceptance before the pandemic. In the context of influenza vaccination during the pandemic, the older cohort exhibited vaccine hesitancy associated with health care mobility factors such as lower general health status (ROR 0.89; 95\% CI 0.81?0.97). Conclusions: SARS-CoV-2 vaccination strategies should focus on reducing hesitancy among individuals with lower social participation. To improve influenza vaccine acceptance during the pandemic, strategies for the younger cohort should focus on individuals with lower social participation, while efforts for the older cohort should prioritize individuals with limited access to health care services. ", doi="10.2196/56989", url="https://publichealth.jmir.org/2024/1/e56989" } @Article{info:doi/10.2196/57514, author="Gustafson Hedov, Emelie and Nyberg, Fredrik and Gustafsson, Stefan and Li, Huiqi and Gissl{\'e}n, Magnus and Sundstr{\"o}m, Johan", title="Person-Centered Web-Based Mobile Health System (Symptoms) for Reporting Symptoms in COVID-19 Vaccinated Individuals: Observational Study of System, Users, and Symptoms", journal="JMIR Form Res", year="2024", month="Oct", day="30", volume="8", pages="e57514", keywords="mHealth", keywords="mobile health", keywords="patient-reported outcomes", keywords="apps", keywords="COVID-19", keywords="vaccination side effects", keywords="web-based symptom reporting", abstract="Background: The full spectrum of side effects from COVID-19 vaccinations and infections, including milder symptoms or health effects that do not lead to health care visits, remains unknown. Person-centered self-reporting of symptoms may offer a solution. Monitoring patient-reported outcomes over time will vary in importance for different patients. Individuals have unique needs and preferences, in terms of both communication methods and how the collected information is used to support care. Objective: This study aims to describe how Symptoms, a system for person-centered self-reporting of symptoms and health-related quality of life, was utilized in investigating COVID-19 vaccine side effects. We illustrate this by presenting data from the Symptoms system in newly vaccinated individuals from the RECOVAC (Register-based large-scale national population study to monitor COVID-19 vaccination effectiveness and safety) study. Methods: During the COVID-19 pandemic, newly vaccinated individuals were identified as the ideal population to query for milder symptoms related to COVID-19 vaccinations and infections. To this end, we used posters in observation areas at 150 vaccination sites across the V{\"a}stra G{\"o}taland region of Sweden, inviting newly vaccinated individuals to use a novel digital system, Symptoms. In the Symptoms system, users can track their symptoms, functioning, and quality of life as often as they wish, using evidence-based patient-reported outcome measures and short numeric rating scales. These scales cover a prespecified list of symptoms based on common COVID-19 symptoms and previously reported vaccine side effects. Participants could also use numeric rating scales for self-defined symptoms if their symptom was not included on the prespecified list. Results: A total of 731 people created user accounts and consented to share data for research between July 21, 2021, and September 27, 2022. The majority of users were female (444/731, 60.7\%), with a median age of 38 (IQR 30-47) years. Most participants (498/702, 70.9\%) did not report any of the comorbidities included in the questionnaire. Of the 731 participants, 563 (77.0\%) reported experiencing 1 or more symptoms. The most common symptom was pain at the injection site (486/563, 86.3\%), followed by fatigue (181/563, 32.1\%) and headache (169/563, 30.0\%). In total, 143 unique symptoms were reported. Of these, 29 were from the prespecified list, while the remaining 114 (79.7\%) were self-defined entries in the symptom field. This suggests that the flexibility of the self-directed system---allowing individuals to decide which symptoms they consider worth tracking---may be an important feature. Conclusions: Self-reported symptoms in the Symptoms system appeared to align with previously observed post--COVID-19 vaccination symptoms. The system was relatively easy to use and successfully captured broad, longitudinal data. Its person-centered and self-directed design seemed crucial in capturing the full burden of symptoms experienced by users. ", doi="10.2196/57514", url="https://formative.jmir.org/2024/1/e57514" } @Article{info:doi/10.2196/56390, author="Preuhs, Katharina and Bussink-Voorend, Daphne and van Keulen, M. Hilde and Wildeman, Ilona and Hautvast, Jeannine and Hulscher, Marlies and van Empelen, Pepijn", title="An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use", journal="JMIR Form Res", year="2024", month="Oct", day="30", volume="8", pages="e56390", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="informed decision-making", keywords="user-centered design", keywords="low literacy", keywords="eHealth", keywords="tailored decision aid", abstract="Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one's attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. ", doi="10.2196/56390", url="https://formative.jmir.org/2024/1/e56390" } @Article{info:doi/10.2196/62657, author="Brooks, J. Donald and Kim, Inae Carolyn and Mboussou, Fortune Franck and Danovaro-Holliday, Carolina M.", title="Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="25", volume="10", pages="e62657", keywords="COVID-19", keywords="COVID-19 vaccine", keywords="immunization information system", keywords="vaccination monitoring", keywords="vaccine", keywords="monitoring and evaluation", abstract="Background: Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands---requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Objective: Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. Methods: We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. Results: In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85\% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, ``aggregate reporting system'' was the system most frequently reported as being in place (n=116, 98.3\%), while ``reminder system'' was the least (n=77, 89\%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6\%) of countries reported establishing at least one new system, ranging from 72\% (n=42) in high-income countries (HICs) to 62\% (n=16) in low-income countries. Concurrently, 55.3\% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62\% (n=36) of HICs reporting this compared to about 53\% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85\% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2\%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31\% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Conclusions: Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance. ", doi="10.2196/62657", url="https://publichealth.jmir.org/2024/1/e62657" } @Article{info:doi/10.2196/58257, author="Oan?, Iulian and H{\^a}ncean, Marian-Gabriel and Perc, Matja? and Lerner, J{\"u}rgen and Mih?il?, Bianca-Elena and Geant?, Marius and Molina, Luis Jos{\'e} and Tinc?, Isabela and Espina, Carolina", title="Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study", journal="J Med Internet Res", year="2024", month="Oct", day="25", volume="26", pages="e58257", keywords="vaccine hesitancy", keywords="online media", keywords="social media", keywords="assortative mixing", keywords="personal network analysis", keywords="social network analysis", keywords="Romania", keywords="vaccination", keywords="health information", keywords="COVID-19", abstract="Background: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. Objective: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. Methods: We conducted 83 face-to-face interviews with participants from a living lab in Lere?ti, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73\% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents' preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. Results: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95\% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95\% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95\% CI 1.79-7.85; P<.001). Conclusions: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes. ", doi="10.2196/58257", url="https://www.jmir.org/2024/1/e58257" } @Article{info:doi/10.2196/51909, author="Kolis, Jessica and Brookmeyer, Kathryn and Chuvileva, Yulia and Voegeli, Christopher and Juma, Sarina and Ishizumi, Atsuyoshi and Renfro, Katy and Wilhelm, Elisabeth and Tice, Hannah and Fogarty, Hannah and Kocer, Irma and Helms, Jordan and Verma, Anisha", title="Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="24", volume="10", pages="e51909", keywords="infodemic", keywords="infodemic management", keywords="vaccine confidence", keywords="vaccine demand", keywords="misinformation", keywords="disinformation", keywords="infodemiology", keywords="mixed methods", keywords="thematic analysis", keywords="COVID-19", abstract="Background: In the fall of 2020, the COVID-19 infodemic began to affect public confidence in and demand for COVID-19 vaccines in the United States. While polls indicated what consumers felt regarding COVID-19 vaccines, they did not provide an understanding of why they felt that way or the social and informational influences that factored into vaccine confidence and uptake. It was essential for us to better understand how information ecosystems were affecting the confidence in and demand for COVID-19 vaccines in the United States. Objective: The US Centers for Disease Control and Prevention (CDC) established an Insights Unit within the COVID-19 Response's Vaccine Task Force in January 2021 to assist the agency in acting more swiftly to address the questions, concerns, perceptions, and misinformation that appeared to be affecting uptake of COVID-19 vaccines. We established a novel methodology to rapidly detect and report on trends in vaccine confidence and demand to guide communication efforts and improve programmatic quality in near real time. Methods: We identified and assessed data sources for inclusion through an informal landscape analysis using a snowball method. Selected data sources provided an expansive look at the information ecosystem of the United States regarding COVID-19 vaccines. The CDC's Vaccinate with Confidence framework and the World Health Organization's behavioral and social drivers for vaccine decision-making framework were selected as guiding principles for interpreting generated insights and their impact. We used qualitative thematic analysis methods and a consensus-building approach to identify prevailing and emerging themes, assess their potential threat to vaccine confidence, and propose actions to increase confidence and demand. Results: As of August 2022, we have produced and distributed 34 reports to >950 recipients within the CDC and externally. State and local health departments, nonprofit organizations, professional associations, and congressional committees have referenced and used the reports for learning about COVID-19 vaccine confidence and demand, developing communication strategies, and demonstrating how the CDC monitored and responded to misinformation. A survey of the reports' end users found that nearly 75\% (40/53) of respondents found them ``very'' or ``extremely'' relevant and 52\% (32/61) used the reports to inform communication strategies. In addition, our methodology underwent continuous process improvement to increase the rigor of the research process, the validity of the findings, and the usability of the reports. Conclusions: This methodology can serve as a diagnostic technique for rapidly identifying opportunities for public health interventions and prevention. As the methodology itself is adaptable, it could be leveraged and scaled for use in a variety of public health settings. Furthermore, it could be considered beyond acute public health crises to support adherence to guidance and recommendations and could be considered within routine monitoring and surveillance systems. ", doi="10.2196/51909", url="https://publichealth.jmir.org/2024/1/e51909" } @Article{info:doi/10.2196/57242, author="Salisbury, David and Lazarus, V. Jeffrey and Waite, Nancy and Lehmann, Clara and Sri Bhashyam, Sumitra and de la Cruz, Marie and Hahn, Beth and Rousculp, D. Matthew and Bonanni, Paolo", title="COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="16", volume="10", pages="e57242", keywords="COVID-19", keywords="discrete choice experiment", keywords="vaccine hesitancy", keywords="vaccine side effects", keywords="SARS-CoV-2", keywords="COVID vaccination", keywords="immunization", keywords="preference elicitation", keywords="informed decision-making", keywords="antivaccine", abstract="Background: Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers. Objective: We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines. Methods: Participants in the 2019nCoV-408 study were aged ?18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants' backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an ``opt-out'' option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non--high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options. Results: The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25\% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8\% vs 30.6\%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7\% vs 8.2\%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non--high-risk subgroups were protection against severe COVID-19 (38.2\% vs 31.5\%; P<.000), avoiding common vaccine side effects (12\% vs 20.5\%; P<.000), and avoiding serious vaccine side effects (9.7\% vs 7.5\%; P=.002). Conclusions: This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor. ", doi="10.2196/57242", url="https://publichealth.jmir.org/2024/1/e57242", url="http://www.ncbi.nlm.nih.gov/pubmed/39412841" } @Article{info:doi/10.2196/56044, author="Luchman, Joseph and Bennett, Morgane and Kranzler, Elissa and Tuskeviciute, Rugile and Vega, Ronald and Denison, Benjamin and Trigger, Sarah and Nighbor, Tyler and Vines, Monica and Hoffman, Leah", title="Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="10", volume="10", pages="e56044", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="vaccine", keywords="United States", keywords="segmentation", keywords="latent class cluster analysis", keywords="vaccines", keywords="vaccination", keywords="segmentation analysis", keywords="estimation", keywords="validation", keywords="attitude", keywords="attitudes", keywords="belief", keywords="beliefs", keywords="behavior", keywords="behaviors", keywords="sociodemographic", keywords="nonintender", keywords="nonintenders", keywords="waiter", keywords="waiters", keywords="confident", keywords="confidents", keywords="social distancing", keywords="bivariate", keywords="regression analysis", keywords="survey", keywords="respondent", keywords="respondents", abstract="Background: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death. Objective: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors. Methods: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves. Results: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents. Conclusions: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases. ", doi="10.2196/56044", url="https://publichealth.jmir.org/2024/1/e56044", url="http://www.ncbi.nlm.nih.gov/pubmed/39255032" } @Article{info:doi/10.2196/49366, author="Kazi, Momin Abdul and Ahsan, Nazia and Jabeen, Rawshan and Allana, Raheel and Jamal, Saima and Mughal, Khan Muhammad Ayub and Hopkins, L. Kathryn and Malik, Aman Fauzia", title="Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study", journal="JMIR Infodemiology", year="2024", month="Sep", day="4", volume="4", pages="e49366", keywords="infodemics", keywords="mHealth", keywords="social media", keywords="electronic media", keywords="Pakistan", keywords="vaccination", keywords="misinformation", keywords="infodemiology", keywords="mobile phone", abstract="Background: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. Objective: We aimed to explore the effects of COVID-19--related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. Methods: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. Results: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media--driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. Conclusions: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale. ", doi="10.2196/49366", url="https://infodemiology.jmir.org/2024/1/e49366" } @Article{info:doi/10.2196/51054, author="Shea, Lindsay and Cooper, Dylan and Ventimiglia, Jonas and Frisbie, Shelby and Carlton, Conner and Song, Wei and Salzer, Mark and Lee, Brian and Hotez, Emily and Vanness, J. David", title="Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="28", volume="10", pages="e51054", keywords="autism", keywords="COVID-19", keywords="vaccination", keywords="public health", keywords="autism spectrum disorder", keywords="autistic", keywords="vaccine", keywords="vaccines", keywords="acceptance", keywords="hesitancy", keywords="immunize", keywords="immunization", keywords="immunizations", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="neurodevelopmental", keywords="infectious", keywords="respiratory", keywords="survey", keywords="surveys", abstract="Background: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population's perceptions and acceptance of COVID-19 boosters. Objective: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. Methods: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. Results: Most autistic adults (193/266, 72.6\%) intended to receive or received the vaccine and booster, 15\% (40/266) did not receive or intend to receive any vaccine, and 12.4\% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. Conclusions: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns. ", doi="10.2196/51054", url="https://publichealth.jmir.org/2024/1/e51054", url="http://www.ncbi.nlm.nih.gov/pubmed/39196609" } @Article{info:doi/10.2196/45513, author="Harrigan, P. Sean and Vel{\'a}squez Garc{\'i}a, A. H{\'e}ctor and Abdia, Younathan and Wilton, James and Prystajecky, Natalie and Tyson, John and Fjell, Chris and Hoang, Linda and Kwong, C. Jeffrey and Mishra, Sharmistha and Wang, Linwei and Sander, Beate and Janjua, Z. Naveed and Sbihi, Hind", title="The Clinical Severity of COVID-19 Variants of Concern: Retrospective Population-Based Analysis", journal="JMIR Public Health Surveill", year="2024", month="Aug", day="27", volume="10", pages="e45513", keywords="COVID-19", keywords="SARS-CoV-2", keywords="severity", keywords="whole genome sequencing", keywords="WGS", keywords="social determinants of health", keywords="SDOHs", keywords="vaccination", keywords="variants of concern", keywords="VOCs", keywords="Alpha", keywords="Gamma", keywords="Delta", keywords="Omicron", abstract="Background: SARS-CoV-2 variants of concern (VOCs) emerged and rapidly replaced the original strain worldwide. The increased transmissibility of these new variants led to increases in infections, hospitalizations, and mortality. However, there is a scarcity of retrospective investigations examining the severity of all the main VOCs in presence of key public health measures and within various social determinants of health (SDOHs). Objective: This study aims to provide a retrospective assessment of the clinical severity of COVID-19 VOCs in the context of heterogenous SDOHs and vaccination rollout. Methods: We used a population-based retrospective cohort design with data from the British Columbia COVID-19 Cohort, a linked provincial surveillance platform. To assess the relative severity (hospitalizations, intensive care unit [ICU] admissions, and deaths) of Gamma, Delta, and Omicron infections during 2021 relative to Alpha, we used inverse probability treatment weighted Cox proportional hazard modeling. We also conducted a subanalysis among unvaccinated individuals, as assessed severity differed across VOCs and SDOHs. Results: We included 91,964 individuals infected with a SARS-CoV-2 VOC (Alpha: n=20,487, 22.28\%; Gamma: n=15,223, 16.55\%; Delta: n=49,161, 53.46\%; and Omicron: n=7093, 7.71\%). Delta was associated with the most severe disease in terms of hospitalization, ICU admissions, and deaths (hospitalization: adjusted hazard ratio [aHR] 2.00, 95\% CI 1.92-2.08; ICU: aHR 2.05, 95\% CI 1.91-2.20; death: aHR 3.70, 95\% CI 3.23-4.25 relative to Alpha), followed generally by Gamma and then Omicron and Alpha. The relative severity by VOC remained similar in the unvaccinated individual subanalysis, although the proportion of individuals infected with Delta and Omicron who were hospitalized was 2 times higher in those unvaccinated than in those fully vaccinated. Regarding SDOHs, the proportion of hospitalized individuals was higher in areas with lower income across all VOCs, whereas among Alpha and Gamma infections, 2 VOCs that cocirculated, differential distributions of hospitalizations were found among racially minoritized groups. Conclusions: Our study provides robust severity estimates for all VOCs during the COVID-19 pandemic in British Columbia, Canada. Relative to Alpha, we found Delta to be the most severe, followed by Gamma and Omicron. This study highlights the importance of targeted testing and sequencing to ensure timely detection and accurate estimation of severity in emerging variants. It further sheds light on the importance of vaccination coverage and SDOHs in the context of pandemic preparedness to support the prioritization of allocation for resource-constrained or minoritized groups. ", doi="10.2196/45513", url="https://publichealth.jmir.org/2024/1/e45513", url="http://www.ncbi.nlm.nih.gov/pubmed/39190434" } @Article{info:doi/10.2196/52643, author="Williams, Paul and Herring, A. Timothy and Yokota, C. Renata T. and Maia, Tiago and Venkatesan, Sudhir and Marcus, C. James and Settergren, Gabriella and Arnetorp, Sofie and Lloyd, Andrew and Severens, L. Johan and Varni, W. James and Dixon, Sharon and Hamusankwa, Lweendo and Powell, A. Philip and Taylor, Sylvia and Ware Jr, E. John and Krol, Marieke", title="The Association Between Physical Distancing Behaviors to Avoid COVID-19 and Health-Related Quality of Life in Immunocompromised and Nonimmunocompromised Individuals: Patient-Informed Protocol for the Observational, Cross-Sectional EAGLE Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="13", volume="13", pages="e52643", keywords="SARS-CoV-2", keywords="social isolation", keywords="patient participation", keywords="patient-reported outcome measures", keywords="quality of life", keywords="immunosuppression", keywords="respiratory tract infection", keywords="cost of illness", keywords="surveys and questionnaires", keywords="protocol", abstract="Background: Immunocompromised individuals are known to respond inadequately to SARS-CoV-2 vaccines, placing them at high risk of severe or fatal COVID-19. Thus, immunocompromised individuals and their caregivers may still practice varying degrees of social or physical distancing to avoid COVID-19. However, the association between physical distancing to avoid COVID-19 and quality of life has not been comprehensively evaluated in any study. Objective: We aim to measure physical distancing behaviors among immunocompromised individuals and the association between those behaviors and person-centric outcomes, including health-related quality of life (HRQoL) measures, health state utilities, anxiety and depression, and work and school productivity impairment. Methods: A patient-informed protocol was developed to conduct the EAGLE Study, a large cross-sectional, observational study, and this paper describes that protocol. EAGLE is designed to measure distancing behaviors and outcomes in immunocompromised individuals, including children (aged ?6 mo) and their caregivers, and nonimmunocompromised adults in the United States and United Kingdom who report no receipt of passive immunization against COVID-19. We previously developed a novel self- and observer-reported instrument, the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19), to measure physical distancing behavior levels cross-sectionally and retrospectively. Using an interim or a randomly selected subset of the study population, the PDS-C19 psychometric properties will be assessed, including structural validity, internal consistency, known-group validity, and convergent validity. Associations (correlations) will be assessed between the PDS-C19 and validated HRQoL-related measures and utilities. Structural equation modeling and regression will be used to assess these associations, adjusting for potential confounders. Participant recruitment and data collection took place from December 2022 to June 2023 using direct-to-patient channels, including panels, clinician referral, patient advocacy groups, and social media, with immunocompromising diagnosis confirmation collected and assessed for a randomly selected 25\% of immunocompromised participants. The planned total sample size is 3718 participants and participant-caregiver pairs. Results will be reported by immunocompromised status, immunocompromising condition category, country, age group, and other subgroups. Results: All data analyses and reporting were planned to be completed by December 2023. Results are planned to be submitted for publication in peer-reviewed journals in 2024-2025. Conclusions: This study will quantify immunocompromised individuals' physical distancing behaviors to avoid COVID-19 and their association with HRQoL as well as health state utilities. International Registered Report Identifier (IRRID): RR1-10.2196/52643 ", doi="10.2196/52643", url="https://www.researchprotocols.org/2024/1/e52643", url="http://www.ncbi.nlm.nih.gov/pubmed/39137022" } @Article{info:doi/10.2196/55104, author="Yin, Dean-Chen Jason", title="Vaccine Hesitancy in Taiwan: Temporal, Multilayer Network Study of Echo Chambers Shaped by Influential Users", journal="Online J Public Health Inform", year="2024", month="Aug", day="9", volume="16", pages="e55104", keywords="network analysis", keywords="infodemiology", keywords="vaccine hesitancy", keywords="Taiwan", keywords="multiplex network", keywords="echo chambers", keywords="influential users", keywords="information dissemination", keywords="health communication", keywords="Taiwanese data set", keywords="multilayer network model", keywords="vaccine hesitant", keywords="antivaccination", keywords="infoveillance", keywords="disease surveillance", keywords="public health", abstract="Background: Vaccine hesitancy is a growing global health threat that is increasingly studied through the monitoring and analysis of social media platforms. One understudied area is the impact of echo chambers and influential users on disseminating vaccine information in social networks. Assessing the temporal development of echo chambers and the influence of key users on their growth provides valuable insights into effective communication strategies to prevent increases in vaccine hesitancy. This also aligns with the World Health Organization's (WHO) infodemiology research agenda, which aims to propose new methods for social listening. Objective: Using data from a Taiwanese forum, this study aims to examine how engagement patterns of influential users, both within and across different COVID-19 stances, contribute to the formation of echo chambers over time. Methods: Data for this study come from a Taiwanese forum called PTT. All vaccine-related posts on the ``Gossiping'' subforum were scraped from January 2021 to December 2022 using the keyword ``vaccine.'' A multilayer network model was constructed to assess the existence of echo chambers. Each layer represents either provaccination, vaccine hesitant, or antivaccination posts based on specific criteria. Layer-level metrics, such as average diversity and Spearman rank correlations, were used to measure chambering. To understand the behavior of influential users---or key nodes---in the network, the activity of high-diversity and hardliner nodes was analyzed. Results: Overall, the provaccination and antivaccination layers are strongly polarized. This trend is temporal and becomes more apparent after November 2021. Diverse nodes primarily participate in discussions related to provaccination topics, both receiving comments and contributing to them. Interactions with the antivaccination layer are comparatively minimal, likely due to its smaller size, suggesting that the forum is a ``healthy community.'' Overall, diverse nodes exhibit cross-cutting engagement. By contrast, hardliners in the vaccine hesitant and antivaccination layers are more active in commenting within their own communities. This trend is temporal, showing an increase during the Omicron outbreak. Hardliner activity potentially reinforces their stances over time. Thus, there are opposing forces of chambering and cross-cutting. Conclusions: Efforts should be made to moderate hardliner and influential nodes in the antivaccination layer and to support provaccination users engaged in cross-cutting exchanges. There are several limitations to this study. One is the bias of the platform used, and another is the lack of a comprehensive definition of ``influence.'' To address these issues, comparative studies across different platforms can be conducted, and various metrics of influence should be explored. Additionally, examining the impact of influential users on network structure and chambering through network simulations and regression analysis provides more robust insights. The study also lacks an explanation for the reasons behind chambering trends. Conducting content analysis can help to understand the nature of engagement and inform interventions to address echo chambers. These approaches align with and further the WHO infodemic research agenda. ", doi="10.2196/55104", url="https://ojphi.jmir.org/2024/1/e55104" } @Article{info:doi/10.2196/51120, author="Markovic, Andjela and Kovacevic, Vladimir and Brakenhoff, B. Timo and Veen, Duco and Klaver, Paul and Mitratza, Marianna and Downward, S. George and Grobbee, E. Diederick and Cronin, Maureen and Goodale, M. Brianna and ", title="Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial", journal="J Med Internet Res", year="2024", month="Jul", day="31", volume="26", pages="e51120", keywords="wearable technology", keywords="biosignals", keywords="digital health", keywords="SARS-CoV-2", keywords="vaccine reactogenicity", keywords="menstrual cycle", keywords="vaccine", keywords="wearables", keywords="sex", keywords="development", keywords="implementation", keywords="medical device", keywords="breathing rate", keywords="heart rate", keywords="biological mechanism", keywords="immune response", keywords="vaccination", abstract="Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine. Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases. Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination. Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8\% decrease in the duration of the menstrual phase following vaccination. Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05241-5 ", doi="10.2196/51120", url="https://www.jmir.org/2024/1/e51120" } @Article{info:doi/10.2196/47520, author="Basu, Saurav and Desai, Meghana and Karan, Anup and Bhardwaj, Surbhi and Negandhi, Himanshu and Jadhav, Nitin and Maske, Amar and Zodpey, Sanjay", title="COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="29", volume="10", pages="e47520", keywords="COVID-19", keywords="community intervention", keywords="COVID-19 vaccination", keywords="COVID-appropriate behavior", keywords="impact evaluation", keywords="rural health", keywords="community-based intervention", keywords="rural population", keywords="awareness", keywords="disease prevention", keywords="health literacy", keywords="public health", keywords="pandemic", keywords="digital health", keywords="community awareness", keywords="effectiveness", keywords="low- and middle-income countries", keywords="vaccination", keywords="infodemic", abstract="Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs. Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community--based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India. Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods. Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95\% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23\% (95\% CI 3\%-45\%) and masking was 17\% (0\%-38\%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22\% (95\% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95\% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95\% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95\% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19--related stigma or discrimination in Pune was 68\% (95\% CI 0.133-0.191) lower than that in Satara. Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings. ", doi="10.2196/47520", url="https://publichealth.jmir.org/2024/1/e47520", url="http://www.ncbi.nlm.nih.gov/pubmed/39073851" } @Article{info:doi/10.2196/56546, author="Huang, Yiting and Feng, Shuaixin and Zhao, Yuyan and Wang, Haode and Jiang, Hongbo", title="Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="29", volume="10", pages="e56546", keywords="systematic review", keywords="discrete choice experiment", keywords="preference", keywords="COVID-19", keywords="vaccine", abstract="Background: Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. Objective: We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. Methods: A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. Results: The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40\%) and safety (7/53, 13\%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10\%), a higher proportion of low- and middle-income countries (4/24, 17\%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8\%) during the pandemic wave and COVID-19 mortality risk (5/25, 20\%) after the pandemic wave emerged as 2 of the most important attributes. Conclusions: Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. Trial Registration: PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7 ", doi="10.2196/56546", url="https://publichealth.jmir.org/2024/1/e56546", url="http://www.ncbi.nlm.nih.gov/pubmed/39073875" } @Article{info:doi/10.2196/55422, author="Moffett, W. Kenneth and Marshall, C. Michael and Kim, C. Jae-Eun and Dahlen, Heather and Denison, Benjamin and Kranzler, C. Elissa and Meaney, Morgan and Hoffman, Blake and Pavisic, Ivica and Hoffman, Leah", title="Analyzing Google COVID-19 Vaccine Intent Search Trends and Vaccine Readiness in the United States: Panel Data Study", journal="Online J Public Health Inform", year="2024", month="Jul", day="29", volume="16", pages="e55422", keywords="information-seeking behavior", keywords="COVID-19", keywords="internet use", keywords="vaccination", keywords="vaccine hesitancy", abstract="Background: Factors such as anxiety, worry, and perceptions of insufficient knowledge about a topic motivate individuals to seek web-based health information to guide their health-related decision-making. These factors converged during the COVID-19 pandemic and were linked to COVID-19 vaccination decision-making. While research shows that web-based search relevant to COVID-19 was associated with subsequent vaccine uptake, less is known about COVID-19 vaccine intent search (which assesses vaccine availability, accessibility, and eligibility) as a signal of vaccine readiness. Objective: To increase knowledge about vaccine intent search as a signal of vaccine readiness, we investigated the relationship between COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume on Google. Methods: We compiled panel data from several data sources in all US counties between January 2021 and April 2023, a time during which those with primary COVID-19 vaccinations increased from <57,000 to >230 million adults. We estimated a random effects generalized least squares regression model with time-fixed effects to assess the relationship between county-level COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume. We controlled for health care capacity, per capita COVID-19 cases and vaccination doses administered, and sociodemographic indicators. Results: The county-level proportions of unvaccinated adults who reported that they would wait and see before getting a COVID-19 vaccine were positively associated with COVID-19 vaccine intent relative search volume ($\beta$=9.123; Z=3.59; P<.001). The county-level proportions of vaccine-enthusiast adults, adults who indicated they were either already vaccinated with a primary COVID-19 vaccine series or planned to complete the vaccine series soon, were negatively associated with COVID-19 vaccine intent relative search volume ($\beta$=--10.232; Z=--7.94; P<.001). However, vaccine intent search was higher in counties with high proportions of people who decided to wait and see and lower in counties with high proportions of vaccine enthusiasts. Conclusions: During this period of steep increase in COVID-19 vaccination, web-based search may have signaled differences in county-level COVID-19 vaccine readiness. More vaccine intent searches occurred in high wait-and-see counties, whereas fewer vaccine intent searches occurred in high vaccine-enthusiast counties. Considering previous research that identified a relationship between vaccine intent search and subsequent vaccine uptake, these findings suggest that vaccine intent search aligned with people's transition from the wait-and-see stage to the vaccine-enthusiast stage. The findings also suggest that web-based search trends may signal localized changes in information seeking and decision-making antecedent to vaccine uptake. Changes in web-based search trends illuminate opportunities for governments and other organizations to strategically allocate resources to increase vaccine uptake. Resource use is part of the larger public policy decisions that influence vaccine uptake, such as efforts to educate the public during evolving public health crises, including future pandemics. ", doi="10.2196/55422", url="https://ojphi.jmir.org/2024/1/e55422", url="http://www.ncbi.nlm.nih.gov/pubmed/39073868" } @Article{info:doi/10.2196/51007, author="Li, Yiming and Li, Jianfu and Dang, Yifang and Chen, Yong and Tao, Cui", title="Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="15", volume="10", pages="e51007", keywords="COVID-19", keywords="vaccine", keywords="COVID-19 vaccine", keywords="adverse drug event", keywords="ADE", keywords="Vaccine Adverse Event Reporting System", keywords="VAERS", keywords="adverse event following immunization", keywords="AEFI", abstract="Background: The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. Objective: This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. Methods: We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Results: Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68\%), pyrexia (n=122,120, 13.56\%), and fatigue (n=121,910, 13.54\%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32\%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. Conclusions: This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns. ", doi="10.2196/51007", url="https://publichealth.jmir.org/2024/1/e51007", url="http://www.ncbi.nlm.nih.gov/pubmed/39008362" } @Article{info:doi/10.2196/49812, author="Du, Zhanwei and Liu, Caifen and Bai, Yuan and Wang, Lin and Lim, Wen Wey and Lau, Y. Eric H. and Cowling, J. Benjamin", title="Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="12", volume="10", pages="e49812", keywords="COVID-19", keywords="SARS-CoV-2", keywords="dose fractionation", keywords="neutralizing antibody level", keywords="vaccination", keywords="review", keywords="vaccine", abstract="Background: With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. Objective: This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. Methods: In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. Results: In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8\% (95\% CI 1.4\%-16.1\%) to 71.8\% (95\% CI 63\%-80.7\%) and from 33.6\% (95\% CI 23.6\%-43.6\%) to 98.6\% (95\% CI 97.6\%-99.7\%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50\% and 100\% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Conclusions: Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration. ", doi="10.2196/49812", url="https://publichealth.jmir.org/2024/1/e49812" } @Article{info:doi/10.2196/53807, author="Xu, Stanley and Sy, S. Lina and Hong, Vennis and Holmquist, J. Kimberly and Qian, Lei and Farrington, Paddy and Bruxvoort, J. Katia and Klein, P. Nicola and Fireman, Bruce and Han, Bing and Lewin, J. Bruno", title="Ischemic Stroke After Bivalent COVID-19 Vaccination: Self-Controlled Case Series Study", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="25", volume="10", pages="e53807", keywords="ischemic stroke", keywords="bivalent COVID-19 vaccine", keywords="influenza vaccine", keywords="self-controlled case series", keywords="coadministration", keywords="ischemic", keywords="stroke", keywords="TIA", keywords="transient ischemic attack", keywords="ischemia", keywords="cardiovascular", keywords="COVID-19", keywords="SARS-CoV-2", keywords="vaccine", keywords="vaccines", keywords="vaccination", keywords="association", keywords="correlation", keywords="risk", keywords="risks", keywords="adverse", keywords="side effect", keywords="subgroup analyses", keywords="subgroup analysis", keywords="bivalent", keywords="influenza", keywords="infectious", keywords="respiratory", keywords="incidence", keywords="case series", abstract="Background: The potential association between bivalent COVID-19 vaccination and ischemic stroke remains uncertain, despite several studies conducted thus far. Objective: This study aimed to evaluate the risk of ischemic stroke following bivalent COVID-19 vaccination during the 2022-2023 season. Methods: A self-controlled case series study was conducted among members aged 12 years and older who experienced ischemic stroke between September 1, 2022, and March 31, 2023, in a large health care system. Ischemic strokes were identified using International Classification of Diseases, Tenth Revision codes in emergency departments and inpatient settings. Exposures were Pfizer-BioNTech or Moderna bivalent COVID-19 vaccination. Risk intervals were prespecified as 1-21 days and 1-42 days after bivalent vaccination; all non--risk-interval person-time served as the control interval. The incidence of ischemic stroke was compared in the risk interval and control interval using conditional Poisson regression. We conducted overall and subgroup analyses by age, history of SARS-CoV-2 infection, and coadministration of influenza vaccine. When an elevated risk was detected, we performed a chart review of ischemic strokes and analyzed the risk of chart-confirmed ischemic stroke. Results: With 4933 ischemic stroke events, we found no increased risk within the 21-day risk interval for the 2 vaccines and by subgroups. However, risk of ischemic stroke was elevated within the 42-day risk interval among individuals aged younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day; the relative incidence (RI) was 2.13 (95\% CI 1.01-4.46). Among those who also had a history of SARS-CoV-2 infection, the RI was 3.94 (95\% CI 1.10-14.16). After chart review, the RIs were 2.34 (95\% CI 0.97-5.65) and 4.27 (95\% CI 0.97-18.85), respectively. Among individuals aged younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the RI was 2.62 (95\% CI 1.13-6.03) before chart review and 2.24 (95\% CI 0.78-6.47) after chart review. Stratified analyses by sex did not show a significantly increased risk of ischemic stroke after bivalent vaccination. Conclusions: While the point estimate for the risk of chart-confirmed ischemic stroke was elevated in a risk interval of 1-42 days among individuals younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day and among individuals younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the risk was not statistically significant. The potential association between bivalent vaccination and ischemic stroke in the 1-42--day analysis warrants further investigation among individuals younger than 65 years with influenza vaccine coadministration and prior SARS-CoV-2 infection. Furthermore, the findings on ischemic stroke risk after bivalent COVID-19 vaccination underscore the need to evaluate monovalent COVID-19 vaccine safety during the 2023-2024 season. ", doi="10.2196/53807", url="https://publichealth.jmir.org/2024/1/e53807", url="http://www.ncbi.nlm.nih.gov/pubmed/38916940" } @Article{info:doi/10.2196/47070, author="Lang, Anna-Lena and Hohmuth, Nils and Vi{\vs}kovi{\'c}, Vuka{\vs}in and Konigorski, Stefan and Scholz, Stefan and Balzer, Felix and Remschmidt, Cornelius and Leistner, Rasmus", title="COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application--Based Prospective Observational Cohort Study", journal="J Med Internet Res", year="2024", month="Jun", day="4", volume="26", pages="e47070", keywords="COVID-19", keywords="SARS-CoV-2", keywords="COVID-19 vaccines", keywords="BNT162b2", keywords="vaccine effectiveness", keywords="participatory disease surveillance", keywords="web application", keywords="digital public health", keywords="vaccination", keywords="Germany", keywords="effectiveness", keywords="data collection", keywords="disease surveillance", keywords="tool", abstract="Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ?16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2\% (95\% CI 70.4\%-97.4\%) at week 4 to 37.2\% (95\% CI 23.5\%-48.5\%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6\% (95\% CI 50.3\%-78.8\%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. ", doi="10.2196/47070", url="https://www.jmir.org/2024/1/e47070", url="http://www.ncbi.nlm.nih.gov/pubmed/38833299" } @Article{info:doi/10.2196/54769, author="Rahbeni, Al Tahani and Satapathy, Prakasini and Itumalla, Ramaiah and Marzo, Rillera Roy and Mugheed, L. Khalid A. and Khatib, Nazli Mahalaqua and Gaidhane, Shilpa and Zahiruddin, Syed Quazi and Rabaan, A. Ali and Alrasheed, A. Hayam and Al-Subaie, F. Maha and Al Kaabil, A. Nawal and Alissa, Mohammed and Ibrahim, L. Amani Ahmed A. and Alsaif, Abdulkhaliq Hussain and Naser, Habeeb Israa and Rustagi, Sarvesh and Kukreti, Neelima and Dziedzic, Arkadiusz", title="COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="30", volume="10", pages="e54769", keywords="COVID-19", keywords="vaccine acceptance", keywords="vaccine hesitancy", keywords="umbrella review", keywords="systematic review", keywords="meta-analysis", keywords="vaccine", keywords="hesitancy", keywords="global perceptions", keywords="perception", keywords="random effect model", keywords="synthesis", keywords="healthcare workers", keywords="patients", keywords="patient", keywords="chronic disease", keywords="pregnant women", keywords="parents", keywords="child", keywords="children", abstract="Background: The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization. Objective: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions. Methods: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative. Results: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63\% (95\% CI 0.60\%-0.67\%) in the general population, with significant heterogeneity (I2 = 97.59\%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64\% (95\% CI 0.57\%-0.71\%) and 69\% (95\% CI 0.61\%-0.76\%), respectively. However, lower acceptance was noted among pregnant women, at 48\% (95\% CI 0.42\%-0.53\%), and parents consenting for their children, at 61.29\% (95\% CI 0.56\%-0.67\%). The pooled vaccine hesitancy rate was 32\% (95\% CI 0.25\%-0.39\%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses. Conclusions: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies. Trial Registration: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr ", doi="10.2196/54769", url="https://publichealth.jmir.org/2024/1/e54769", url="http://www.ncbi.nlm.nih.gov/pubmed/38687992" } @Article{info:doi/10.2196/50958, author="Liao, Qiuyan and Yuan, Jiehu and Wong, Ling Irene Oi and Ni, Yuxuan Michael and Cowling, John Benjamin and Lam, Tak Wendy Wing", title="Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="22", volume="10", pages="e50958", keywords="COVID-19", keywords="vaccination acceptance", keywords="vaccine hesitancy", keywords="motivators", keywords="co-occurrence network analysis", abstract="Background: Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy. Objective: This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys. Methods: We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group. Results: The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ?65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake. Conclusions: When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age. ", doi="10.2196/50958", url="https://publichealth.jmir.org/2024/1/e50958", url="http://www.ncbi.nlm.nih.gov/pubmed/38648099" } @Article{info:doi/10.2196/51449, author="Cheng, Wei and Xu, Yun and Jiang, Haibo and Li, Jun and Hou, Zhigang and Meng, Haibin and Wang, Wei and Chai, Chengliang and Jiang, Jianmin", title="SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="17", volume="10", pages="e51449", keywords="associated factors", keywords="COVID-19", keywords="hospitalization", keywords="infection", keywords="people living with HIV", keywords="SARS-CoV-2 Omicron variant", abstract="Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13\% (95\% CI 65.81\%-68.13\%), whereas the hospitalization rate was 0.71\% (95\% CI 0.46\%-0.97\%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95\% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95\% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95\% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. ", doi="10.2196/51449", url="https://publichealth.jmir.org/2024/1/e51449", url="http://www.ncbi.nlm.nih.gov/pubmed/38630534" } @Article{info:doi/10.2196/47241, author="Themistocleous, Sophia and Argyropoulos, D. Christos and Vogazianos, Paris and Shiamakkides, George and Noula, Evgenia and Nearchou, Andria and Yiallouris, Andreas and Filippou, Charalampos and Stewart, A. Fiona and Koniordou, Markela and Kopsidas, Ioannis and Askling, H. Helena and Vene, Sirkka and Gagneux-Brunon, Amandine and Prellezo, Baranda Jana and {\'A}lvarez-Barco, Elena and Salmanton-Garc{\'i}a, Jon and Leckler, Janina and Macken, J. Alan and Davis, Joanna Ruth and Azzini, Maria Anna and Armeftis, Charis and Hellemans, Margot and Di Marzo, Romina and Luis, Catarina and Olesen, F. Ole and Valdenmaiier, Olena and Jakobsen, Finne Stine and Naucl{\'e}r, Pontus and Launay, Odile and Mallon, Patrick and Ochando, Jordi and van Damme, Pierre and Tacconelli, Evelina and Zaoutis, Theoklis and Cornely, A. Oliver and Pana, Dorothea Zoi", title="Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="4", volume="10", pages="e47241", keywords="patient advocacy groups", keywords="clinical trials", keywords="volunteer registry", keywords="vaccines", keywords="public health", keywords="healthcare", keywords="COVID-19", keywords="vaccine trial", keywords="VACCELERATE", keywords="health promotion", keywords="health advocate", keywords="clinical trial", abstract="Background: The VACCELERATE Pan-European Scientific network aims to strengthen the foundation of vaccine trial research across Europe by following the principles of equity, inclusion, and diversity. The VACCELERATE Volunteer Registry network provides access to vaccine trial sites across the European region and supports a sustainable volunteer platform for identifying potential participants for forthcoming vaccine clinical research. Objective: The aim of this study was to approach members of patient advocacy groups (PAGs) across Europe to assess their willingness to register for the VACCELERATE Volunteer Registry and their perspectives related to participating in vaccine trials. Methods: In an effort to understand how to increase recruitment for the VACCELERATE Volunteer Registry, a standardized survey was developed in English and translated into 8 different languages (Dutch, English, French, German, Greek, Italian, Spanish, and Swedish) by the respective National Coordinator team. The online, anonymous survey was circulated, from March 2022 to May 2022, to PAGs across 10 European countries (Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Spain, and Sweden) to share with their members. The questionnaire constituted of multiple choice and open-ended questions evaluating information regarding participants' perceptions on participating in vaccine trials and their willingness to become involved in the VACCELERATE Volunteer Registry. Results: In total, 520 responses were collected and analyzed. The PAG members reported that the principal criteria influencing their decision to participate in clinical trials overall are (1) the risks involved, (2) the benefits that will be gained from their potential participation, and (3) the quality and quantity of information provided regarding the trial. The survey revealed that, out of the 520 respondents, 133 individuals across all age groups were ``positive'' toward registering in the VACCELERATE Volunteer Registry, with an additional 47 individuals reporting being ``very positive.'' Respondents from Northern European countries were 1.725 (95\% CI 1.206-2.468) times more likely to be willing to participate in the VACCELERATE Volunteer Registry than respondents from Southern European countries. Conclusions: Factors discouraging participants from joining vaccine trial registries or clinical trials primarily include concerns of the safety of novel vaccines and a lack of trust in those involved in vaccine development. These outcomes aid in identifying issues and setbacks in present registries, providing the VACCELERATE network with feedback on how to potentially increase participation and enrollment in trials across Europe. Development of European health communication strategies among diverse public communities, especially via PAGs, is the key for increasing patients' willingness to participate in clinical studies. ", doi="10.2196/47241", url="https://publichealth.jmir.org/2024/1/e47241", url="http://www.ncbi.nlm.nih.gov/pubmed/38573762" } @Article{info:doi/10.2196/53375, author="Zhang, M. Jueman and Wang, Yi and Mouton, Magali and Zhang, Jixuan and Shi, Molu", title="Public Discourse, User Reactions, and Conspiracy Theories on the X Platform About HIV Vaccines: Data Mining and Content Analysis", journal="J Med Internet Res", year="2024", month="Apr", day="3", volume="26", pages="e53375", keywords="HIV", keywords="vaccine", keywords="Twitter", keywords="X platform", keywords="infodemiology", keywords="machine learning", keywords="topic modeling", keywords="sentiment", keywords="conspiracy theory", keywords="COVID-19", abstract="Background: The initiation of clinical trials for messenger RNA (mRNA) HIV vaccines in early 2022 revived public discussion on HIV vaccines after 3 decades of unsuccessful research. These trials followed the success of mRNA technology in COVID-19 vaccines but unfolded amid intense vaccine debates during the COVID-19 pandemic. It is crucial to gain insights into public discourse and reactions about potential new vaccines, and social media platforms such as X (formerly known as Twitter) provide important channels. Objective: Drawing from infodemiology and infoveillance research, this study investigated the patterns of public discourse and message-level drivers of user reactions on X regarding HIV vaccines by analyzing posts using machine learning algorithms. We examined how users used different post types to contribute to topics and valence and how these topics and valence influenced like and repost counts. In addition, the study identified salient aspects of HIV vaccines related to COVID-19 and prominent anti--HIV vaccine conspiracy theories through manual coding. Methods: We collected 36,424 English-language original posts about HIV vaccines on the X platform from January 1, 2022, to December 31, 2022. We used topic modeling and sentiment analysis to uncover latent topics and valence, which were subsequently analyzed across post types in cross-tabulation analyses and integrated into linear regression models to predict user reactions, specifically likes and reposts. Furthermore, we manually coded the 1000 most engaged posts about HIV and COVID-19 to uncover salient aspects of HIV vaccines related to COVID-19 and the 1000 most engaged negative posts to identify prominent anti--HIV vaccine conspiracy theories. Results: Topic modeling revealed 3 topics: HIV and COVID-19, mRNA HIV vaccine trials, and HIV vaccine and immunity. HIV and COVID-19 underscored the connections between HIV vaccines and COVID-19 vaccines, as evidenced by subtopics about their reciprocal impact on development and various comparisons. The overall valence of the posts was marginally positive. Compared to self-composed posts initiating new conversations, there was a higher proportion of HIV and COVID-19--related and negative posts among quote posts and replies, which contribute to existing conversations. The topic of mRNA HIV vaccine trials, most evident in self-composed posts, increased repost counts. Positive valence increased like and repost counts. Prominent anti--HIV vaccine conspiracy theories often falsely linked HIV vaccines to concurrent COVID-19 and other HIV-related events. Conclusions: The results highlight COVID-19 as a significant context for public discourse and reactions regarding HIV vaccines from both positive and negative perspectives. The success of mRNA COVID-19 vaccines shed a positive light on HIV vaccines. However, COVID-19 also situated HIV vaccines in a negative context, as observed in some anti--HIV vaccine conspiracy theories misleadingly connecting HIV vaccines with COVID-19. These findings have implications for public health communication strategies concerning HIV vaccines. ", doi="10.2196/53375", url="https://www.jmir.org/2024/1/e53375", url="http://www.ncbi.nlm.nih.gov/pubmed/38568723" } @Article{info:doi/10.2196/50181, author="Blazek, Susanne E. and Bucher, Amy", title="Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study", journal="JMIR Form Res", year="2024", month="Mar", day="19", volume="8", pages="e50181", keywords="behavioral barriers", keywords="benefits", keywords="COVID-19", keywords="Marine Corps", keywords="military", keywords="vaccine reluctance", abstract="Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good ($\kappa$=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45\%), low estimates of risk (33/235, 14\%), and fear of physical discomfort (29/235, 12\%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. ", doi="10.2196/50181", url="https://formative.jmir.org/2024/1/e50181", url="http://www.ncbi.nlm.nih.gov/pubmed/38502179" } @Article{info:doi/10.2196/47979, author="Vike, L. Nicole and Bari, Sumra and Stefanopoulos, Leandros and Lalvani, Shamal and Kim, Woo Byoung and Maglaveras, Nicos and Block, Martin and Breiter, C. Hans and Katsaggelos, K. Aggelos", title="Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="18", volume="10", pages="e47979", keywords="reward", keywords="aversion", keywords="judgment", keywords="relative preference theory", keywords="cognitive science", keywords="behavioral economics", keywords="machine learning", keywords="balanced random forest", keywords="mediation", keywords="moderation", keywords="mobile phone", keywords="smartphone", abstract="Background: Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake. Objective: This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction. Methods: We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction. Results: Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30\% and 38\% (vs 74.2\% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8\%) and AUROC (79\%) with moderate to high accuracy (70.8\%) and balanced recall (69.6\%) and specificity (74.2\%). It should be noted that, for BRF, the negative predictive value was <50\% despite good specificity. For BRF and random forest, 63\% to 75\% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake. Conclusions: The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization). ", doi="10.2196/47979", url="https://publichealth.jmir.org/2024/1/e47979", url="http://www.ncbi.nlm.nih.gov/pubmed/38315620" } @Article{info:doi/10.2196/51331, author="Gonz{\'a}lez-Salinas, I. Anna and Andrade, L. Elizabeth and Abroms, C. Lorien and G{\'o}mez, Kaitlyn and Favetto, Carla and G{\'o}mez, M. Valeria and Collins, K. Karen", title="Latino Parents' Reactions to and Engagement With a Facebook Group--Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2024", month="Mar", day="14", volume="8", pages="e51331", keywords="COVID-19", keywords="misinformation", keywords="social media", keywords="Latino parents", keywords="Spanish", keywords="vaccines", keywords="digital intervention", abstract="Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants' reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ?18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants' exposure, reactions, and engagement, we used participants' responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40\%) or 4 to 6 (18/55, 33\%) times per week and viewing 1 to 2 (23/55, 42\%) or 3 to 4 (16/55, 29\%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89\%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93\%) and helpful (50/55, 91\%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82\%) and supportive (19/55, 35\%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53\%), understanding child risk levels (29/55, 53\%), and the science behind COVID-19 (24/55, 44\%). The preferred formats were educational posts that could be read (38/55, 69\%) and videos, including expert (28/55, 51\%) and instructional (26/55, 47\%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29\%) or 3 to 4 (15/55, 27\%) times per week and commenting on posts 1 to 2 (16/55, 29\%) or <1 (20/55, 36\%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine--related health promotion. ", doi="10.2196/51331", url="https://formative.jmir.org/2024/1/e51331", url="http://www.ncbi.nlm.nih.gov/pubmed/38483457" } @Article{info:doi/10.2196/48255, author="Kumwichar, Ponlagrit and Poonsiri, Chittawan and Botwright, Siobhan and Sirichumroonwit, Natchalaikorn and Loharjun, Bootsakorn and Thawillarp, Supharerk and Cheewaruangroj, Nontawit and Chokchaisiripakdee, Amorn and Teerawattananon, Yot and Chongsuvivatwong, Virasakdi", title="Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data", journal="JMIR Public Health Surveill", year="2024", month="Mar", day="5", volume="10", pages="e48255", keywords="COVID-19", keywords="heterologous vaccine", keywords="vaccine", keywords="vaccine effectiveness", keywords="durability", keywords="time", keywords="waning", keywords="real-world", keywords="public health", keywords="vaccination strategy", keywords="health outcome", keywords="vaccines", keywords="vaccination", keywords="unvaccinated", keywords="big data", keywords="registry", keywords="registries", keywords="health outcomes", keywords="effectiveness", keywords="SARS-CoV-2", keywords="cohort", keywords="database", keywords="databases", keywords="vaccinated", keywords="Cochran-Mantel-Haenszel", keywords="Mantel-Haenszel", keywords="regression", keywords="risk", keywords="risks", keywords="association", keywords="associations", keywords="odds ratio", keywords="odds ratios", abstract="Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50\%. Methods: We formed a dynamic cohort by linking records of Thai citizens aged ?18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50\% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50\% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80\% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82\% (95\% CI 80.3\%-84\%) and 86.3\% (95\% CI 83.6\%-84\%), respectively. Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50\% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50\% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. ", doi="10.2196/48255", url="https://publichealth.jmir.org/2024/1/e48255", url="http://www.ncbi.nlm.nih.gov/pubmed/38441923" } @Article{info:doi/10.2196/47257, author="Hakim, Hina and Driedger, Michelle S. and Gagnon, Dominique and Chevrier, Julien and Roch, Genevi{\`e}ve and Dub{\'e}, Eve and Witteman, O. Holly", title="Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review", journal="JMIR Serious Games", year="2024", month="Feb", day="29", volume="12", pages="e47257", keywords="digital gamified tools", keywords="digital game", keywords="vaccination", keywords="gamification", keywords="vaccine uptake", keywords="scoping review", keywords="review method", keywords="vaccine", keywords="gamified", keywords="COVID-19", keywords="COVID", keywords="SARS-CoV-2", keywords="health behaviour", keywords="health behavior", keywords="health promotion", keywords="behavior change", keywords="behaviour change", abstract="Background: Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. Objective: In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. Methods: We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. Results: Of 1402 records, we included 28 (2\%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25\%) explained the development of the tool, 16 (57\%) described evaluation, and 2 (7\%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44\%) were web-based tools, 8 (32\%) mobile (native mobile or mobile-enabled web) apps, and 6 (24\%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. Conclusions: Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts. ", doi="10.2196/47257", url="https://games.jmir.org/2024/1/e47257", url="http://www.ncbi.nlm.nih.gov/pubmed/38421688" } @Article{info:doi/10.2196/45536, author="Dreyer, A. Nancy and Knuth, B. Kendall and Xie, Yiqiong and Reynolds, W. Matthew and Mack, D. Christina", title="COVID-19 Vaccination Reactions and Risk of Breakthrough Infections Among People With Diabetes: Cohort Study Derived From Community Reporters", journal="JMIR Diabetes", year="2024", month="Feb", day="27", volume="9", pages="e45536", keywords="COVID-19", keywords="diabetes", keywords="vaccine", keywords="vaccine hesitancy", keywords="registry", keywords="person-generated health data", keywords="patient-reported outcomes", keywords="side effects", keywords="vaccination", keywords="infection", keywords="nondiabetic adult", keywords="clinical data", keywords="fatigue", keywords="headache", keywords="risk", keywords="patient data", keywords="medication", keywords="community health", abstract="Background: This exploratory study compares self-reported COVID-19 vaccine side effects and breakthrough infections in people who described themselves as having diabetes with those who did not identify as having diabetes. Objective: The study uses person-reported data to evaluate differences in the perception of COVID-19 vaccine side effects between adults with diabetes and those who did not report having diabetes. Methods: This is a retrospective cohort study conducted using data provided online by adults aged 18 years and older residing in the United States. The participants who voluntarily self-enrolled between March 19, 2021, and July 16, 2022, in the IQVIA COVID-19 Active Research Experience project reported clinical and demographic information, COVID-19 vaccination, whether they had experienced any side effects, test-confirmed infections, and consented to linkage with prescription claims. No distinction was made for this study to differentiate prediabetes or type 1 and type 2 diabetes nor to verify reports of positive COVID-19 tests. Person-reported medication use was validated using pharmacy claims and a subset of the linked data was used for a sensitivity analysis of medication effects. Multivariate logistic regression was used to estimate the adjusted odds ratios of vaccine side effects or breakthrough infections by diabetic status, adjusting for age, gender, education, race, ethnicity (Hispanic or Latino), BMI, smoker, receipt of an influenza vaccine, vaccine manufacturer, and all medical conditions. Evaluations of diabetes medication-specific vaccine side effects are illustrated graphically to support the examination of the magnitude of side effect differences for various medications and combinations of medications used to manage diabetes. Results: People with diabetes (n=724) reported experiencing fewer side effects within 2 weeks of vaccination for COVID-19 than those without diabetes (n=6417; mean 2.7, SD 2.0 vs mean 3.1, SD 2.0). The adjusted risk of having a specific side effect or any side effect was lower among those with diabetes, with significant reductions in fatigue and headache but no differences in breakthrough infections over participants' maximum follow-up time. Diabetes medication use did not consistently affect the risk of specific side effects, either using self-reported medication use or using only diabetes medications that were confirmed by pharmacy health insurance claims for people who also reported having diabetes. Conclusions: People with diabetes reported fewer vaccine side effects than participants not reporting having diabetes, with a similar risk of breakthrough infection. Trial Registration: ClinicalTrials.gov NCT04368065; https://clinicaltrials.gov/study/NCT04368065 ", doi="10.2196/45536", url="https://diabetes.jmir.org/2024/1/e45536", url="http://www.ncbi.nlm.nih.gov/pubmed/38412008" } @Article{info:doi/10.2196/44258, author="Kopila{\vs}, Vanja and Nasadiuk, Khrystyna and Martinelli, Lucia and Lhotska, Lenka and Todorovic, Zoran and Vidmar, Matjaz and Machado, Helena and Svalastog, Lydia Anna and Gajovi{\'c}, Sre{\'c}ko", title="Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework", journal="JMIR Hum Factors", year="2024", month="Feb", day="19", volume="11", pages="e44258", keywords="SARS-CoV-2 virus", keywords="COVID-19 vaccination", keywords="pandemic", keywords="hesitancy", keywords="safety", keywords="vaccination", keywords="COVID-19", keywords="tool", keywords="implementation", keywords="vaccine hesitancy", keywords="effectiveness", keywords="sociocultural", keywords="communication", keywords="disinformation", abstract="Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2{\texttimes}2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. ", doi="10.2196/44258", url="https://humanfactors.jmir.org/2024/1/e44258", url="http://www.ncbi.nlm.nih.gov/pubmed/38373020" } @Article{info:doi/10.2196/48466, author="Mahmood, Bushra and Adu, Prince and McKee, Geoffrey and Bharmal, Aamir and Wilton, James and Janjua, Zafar Naveed", title="Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey", journal="JMIR Public Health Surveill", year="2024", month="Feb", day="16", volume="10", pages="e48466", keywords="COVID-19", keywords="vaccine hesitancy", keywords="mistrust", keywords="trust", keywords="ethnic minorities", keywords="South Asian", keywords="vaccine", keywords="vaccination", keywords="hesitancy", keywords="ethnic", keywords="ethnicity", keywords="minority", keywords="cultural", keywords="racial", keywords="minorities", keywords="SARS-CoV-2", keywords="coronavirus", keywords="Asia", keywords="Asian", abstract="Background: Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination. Objective: This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada. Methods: We included adults ?18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups. Results: The analysis included 25,640 adults. Overall, 76.7\% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1\%, South Asian=79.6\%, White=75.5\%, and other ethnicity=73.2\%). Overall, 13.7\% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1\%, South Asian=8.2\%, White=15.4\%, and other ethnicity=15.2\%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93\% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95\% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81\%, 92\%, 94\%, and 95\% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70\% and 78\% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively. Conclusions: Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada. ", doi="10.2196/48466", url="https://publichealth.jmir.org/2024/1/e48466", url="http://www.ncbi.nlm.nih.gov/pubmed/38363596" } @Article{info:doi/10.2196/48511, author="Li, Guanjian and Zhang, Rongqiu and Song, Bing and Wang, Chao and Shen, Qunshan and He, Xiaojin and Cao, Yunxia", title="Effects of SARS-CoV-2 Vaccines on Sperm Quality: Systematic Review", journal="JMIR Public Health Surveill", year="2023", month="Dec", day="6", volume="9", pages="e48511", keywords="COVID-19 vaccine", keywords="SARS-CoV-2", keywords="reproductive system", keywords="fertility", keywords="sperm quality", abstract="Background: The COVID-19 pandemic, caused by SARS-CoV-2, has triggered a global public health crisis of unprecedented proportions. SARS-CoV-2 vaccination is a highly effective strategy for preventing infections and severe COVID-19 outcomes. Although several studies have concluded that COVID-19 vaccines are unlikely to affect fertility, concerns have arisen regarding adverse events, including the potential impact on fertility; these concerns are plagued by limited and inconsistent evidence. Objective: This review aims to provide a recent assessment of the literature on the impact of COVID-19 vaccines on male sperm quality. The possible impact of COVID-19 vaccines on fertility potential was also examined to draw a clearer picture and to evaluate the effects of COVID-19 on male reproductive health. Methods: PubMed, Scopus, Web of Science, Embase, and Cochrane databases were searched from their inception to October 2023. Eligible studies included articles reporting SARS-CoV-2 vaccination and human semen quality and fertility, as well as the impact of vaccination on assisted reproductive technology treatment outcomes. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale, and the quality of cross-sectional studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: The initial literature search yielded 4691 records by searching 5 peer-reviewed databases (PubMed, Scopus, Web of Science, Embase, and Cochrane). Finally, 24 relevant studies were selected for our study. There were evident research inequalities at the regional level, with the United States and Western European countries contributing 38\% (9/24) of the studies, Middle Eastern countries contributing 38\% (9/24), China accounting for 21\% (5/24), and Africa and South America accounting for none. Nonetheless, the overall quality of the included studies was generally good. Our results demonstrated that serious side effects of the COVID-19 vaccine are extremely rare, and men experience few problems with sperm parameters or reproductive potential after vaccination. Conclusions: On the basis of the studies published so far, the COVID-19 vaccine is safe for male reproductive health. Obviously, vaccination is a wise option rather than experience serious adverse symptoms of viral infections. These instances of evidence may help reduce vaccine hesitancy and increase vaccination coverage, particularly among reproductive-age couples. As new controlled trials and prospective cohort studies with larger sample sizes emerge, the possibility of a negative effect of the COVID-19 vaccine on sperm quality must be further clarified. ", doi="10.2196/48511", url="https://publichealth.jmir.org/2023/1/e48511", url="http://www.ncbi.nlm.nih.gov/pubmed/37976132" } @Article{info:doi/10.2196/44257, author="Zeng, Chengbo and Zhang, Jiajia and Li, Zhenlong and Sun, Xiaowen and Ning, Huan and Yang, Xueying and Weissman, Sharon and Olatosi, Bankole and Li, Xiaoming", title="Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study", journal="JMIR Public Health Surveill", year="2023", month="Dec", day="5", volume="9", pages="e44257", keywords="Deep South", keywords="COVID-19", keywords="vaccine", keywords="booster", keywords="residential segregation", abstract="Background: COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation. Objective: We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation. Methods: An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model. Results: As of October 19, 2022, among the 418 counties, the median of booster uptake was 40\% (IQR 37.8\%-43\%). Compared with older adults (ie, at least 65 years; median 63.1\%, IQR 59.5\%-66.5\%), youth (ie, 12 to 17 years; median 14.1\%, IQR 11.3\%-17.4\%) and adults (ie, 18 to 64 years; median 33.4\%, IQR 30.5\%-36.5\%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups. Conclusions: The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities. ", doi="10.2196/44257", url="https://publichealth.jmir.org/2023/1/e44257", url="http://www.ncbi.nlm.nih.gov/pubmed/38051568" } @Article{info:doi/10.2196/48641, author="Chau, Brian and Taba, Melody and Dodd, Rachael and McCaffery, Kirsten and Bonner, Carissa", title="Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People", journal="JMIR Res Protoc", year="2023", month="Oct", day="18", volume="12", pages="e48641", keywords="twitch", keywords="social media", keywords="COVID-19", keywords="vaccination communication", keywords="video gaming", keywords="gaming", keywords="health promotion", keywords="streaming", abstract="Background: Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research. Objective: This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research. Methods: The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology. Results: The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments. Conclusions: This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on. International Registered Report Identifier (IRRID): RR1-10.2196/48641 ", doi="10.2196/48641", url="https://www.researchprotocols.org/2023/1/e48641", url="http://www.ncbi.nlm.nih.gov/pubmed/37851494" } @Article{info:doi/10.2196/47272, author="Liu, Ming and Zhao, Tianshuo and Mu, Qiuyue and Zhang, Ruizhi and Liu, Chunting and Xu, Fei and Liang, Luxiang and Zhao, Linglu and Zhao, Suye and Cai, Xianming and Wang, Mingting and Huang, Ninghua and Feng, Tian and Lei, Shiguang and Yang, Guanghong and Cui, Fuqiang", title="Immune-Boosting Effect of the COVID-19 Vaccine: Real-World Bidirectional Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="11", volume="9", pages="e47272", keywords="bidirectional cohort study", keywords="booster administration", keywords="COVID-19 vaccine", keywords="real-world study", keywords="SARS-CoV-2", keywords="vaccine efficacy", keywords="COVID-19", abstract="Background: As the SARS-CoV-2 attenuates and antibodies from the COVID-19 vaccine decline, long-term attention should be paid to the durability of primary booster administration and the preventive effect of the second or multiple booster doses of the COVID-19 vaccine. Objective: This study aimed to explore the durability of primary booster administration and the preventive effect of second or multiple booster doses of the COVID-19 vaccine. Methods: We established a bidirectional cohort in Guizhou Province, China. Eligible participants who had received the primary booster dose were enrolled for blood sample collection and administration of the second booster dose. A retrospective cohort for the time of administration was constructed to evaluate antibody attenuation 6-12 months after the primary booster dose, while a prospective cohort on the vaccine effect of the second booster dose was constructed for 4 months after the second administration. Results: Between September 21, 2022, and January 30, 2023, a total of 327 participants were included in the final statistical analysis plan. The retrospective cohort revealed that approximately 6-12 months after receiving the primary booster, immunoglobulin G (IgG) slowly declined with time, while immunoglobulin A (IgA) remained almost constant. The prospective cohort showed that 28 days after receiving the second booster, the antibody levels were significantly improved. Higher levels of IgG and IgA were associated with better protection against COVID-19 infection for vaccine recipients. Regarding the protection of antibody levels against post--COVID-19 symptoms, the increase of the IgG had a protective effect on brain fog and sleep quality, while IgA had a protective effect on shortness of breath, brain fog, impaired coordination, and physical pain. Conclusions: The IgG and IgA produced by the second booster dose of COVID-19 vaccines can protect against SARS-CoV-2 infection and may alleviate some post--COVID-19 symptoms. Further data and studies on secondary booster administration are required to confirm these conclusions. ", doi="10.2196/47272", url="https://publichealth.jmir.org/2023/1/e47272", url="http://www.ncbi.nlm.nih.gov/pubmed/37819703" } @Article{info:doi/10.2196/39919, author="Bagasra, Anisah and Allen, T. Christopher and Doan, Sara", title="Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States", journal="JMIR Hum Factors", year="2023", month="Oct", day="10", volume="10", pages="e39919", keywords="health promotion", keywords="health communication", keywords="health risk behavior", keywords="behavioral intention", keywords="public health", keywords="COVID-19", keywords="vaccination", keywords="prevention", keywords="health education", abstract="Background: Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy. Objective: This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)--recommended individual health behaviors in the first year of the pandemic. Methods: In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel. Results: The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days. Conclusions: The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors. ", doi="10.2196/39919", url="https://humanfactors.jmir.org/2023/1/e39919", url="http://www.ncbi.nlm.nih.gov/pubmed/37815862" } @Article{info:doi/10.2196/46318, author="Xu, Stanley and Hong, Vennis and Sy, S. Lina and Bruxvoort, J. Katia and Lewin, Bruno and Han, Bing and Holmquist, J. Kimberly and Qian, Lei", title="Risk Factors for Not Completing a 2-Dose Primary Series of Messenger RNA COVID-19 Vaccination in a Large Health Care System in Southern California: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="4", volume="9", pages="e46318", keywords="mRNA COVID-19 vaccines", keywords="2-dose primary series", keywords="vaccines", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="communicable", keywords="immunization", keywords="immunize", keywords="noncompletion", keywords="risk factors", keywords="multiple Poisson regression model", keywords="COVID-19", keywords="vaccination", keywords="vaccine", keywords="dose", keywords="dosing", keywords="regression", keywords="risk", keywords="risks", keywords="health outcome", keywords="health outcomes", keywords="retrospective", keywords="cohort", keywords="dosage", keywords="United States", keywords="community", keywords="inoculation", abstract="Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series. Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination. Methods: We conducted a retrospective cohort study among members aged ?18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series. Results: Among 2.5 million recipients of ?1 dose of mRNA COVID-19 vaccines, 3.3\% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ?75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95\% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95\% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95\% CI 1.85-2.12; 1.99, 95\% CI 1.43-2.76; and 1.85, 95\% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose. Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses. ", doi="10.2196/46318", url="https://publichealth.jmir.org/2023/1/e46318", url="http://www.ncbi.nlm.nih.gov/pubmed/37792452" } @Article{info:doi/10.2196/44822, author="Wu, Jian and Ma, Mingze and Li, Quanman and Guo, Xinghong and Tarimo, Silver Clifford and Jia, Shiyu and Zhou, Xue and Wang, Meiyun and Gu, Jianqin and Miao, Yudong and Ye, Beizhu", title="Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="1", volume="9", pages="e44822", keywords="COVID-19 vaccine", keywords="vaccine hesitancy", keywords="COVID-19 booster vaccination", keywords="influencing factors", keywords="China", abstract="Background: COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. Objective: This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. Methods: The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (?18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95\% CI for the statistical associations were estimated using logistic regression models. Results: Overall, 6659 participants (females: n=3540, 53.2\%; males: n=3119, 46.8\%) responded. In total, 533 (8\%; 95\% CI 7.4\%-8.7\%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1\%; 95\% CI 10.3\%-11.8\%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. Conclusions: The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy. ", doi="10.2196/44822", url="https://publichealth.jmir.org/2023/1/e44822", url="http://www.ncbi.nlm.nih.gov/pubmed/37526963" } @Article{info:doi/10.2196/45263, author="Thai-Van, Hung and Valnet-Rabier, Marie-Blanche and Anciaux, Ma{\"e}va and Lambert, Aude and Maurier, Ana{\"i}s and Cottin, Judith and Pietri, Tessa and Dest{\`e}re, Alexandre and Damin-Pernik, Marl{\`e}ne and Perrouin, Fanny and Bagheri, Haleh", title="Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database", journal="JMIR Public Health Surveill", year="2023", month="Jul", day="14", volume="9", pages="e45263", keywords="mRNA COVID-19 vaccine", keywords="COVID-19", keywords="messenger RNA", keywords="tozinameran", keywords="elasomeran", keywords="sudden sensorineural hearing loss", keywords="audiogram", keywords="positive rechallenge", keywords="spontaneous reporting", keywords="postmarketing", keywords="surveillance", keywords="pharmacovigilance", abstract="Background: The World Health Organization recently described sudden sensorineural hearing loss (SSNHL) as a possible adverse effect of COVID-19 vaccines. Recent discordant pharmacoepidemiologic studies invite robust clinical investigations of SSNHL after COVID-19 messenger RNA (mRNA) vaccines. This postmarketing surveillance study, overseen by French public health authorities, is the first to clinically document postvaccination SSNHL and examine the role of potential risk factors. Objective: This nationwide study aimed to assess the relationship between SSNHL and exposure to mRNA COVID-19 vaccines and estimate the reporting rate (Rr) of SSNHL after mRNA vaccination per 1 million doses (primary outcome). Methods: We performed a retrospective review of all suspected cases of SSNHL after mRNA COVID-19 vaccination spontaneously reported in France between January 2021 and February 2022 based on a comprehensive medical evaluation, including the evaluation of patient medical history, side and range of hearing loss, and hearing recovery outcomes after a minimum period of 3 months. The quantification of hearing loss and assessment of hearing recovery outcomes were performed according to a grading system modified from the Siegel criteria. A cutoff of 21 days was used for the delay onset of SSNHL. The primary outcome was estimated using the total number of doses of each vaccine administered during the study period in France as the denominator. Results: From 400 extracted cases for tozinameran and elasomeran, 345 (86.3\%) spontaneous reports were selected. After reviewing complementary data, 49.6\% (171/345) of documented cases of SSNHL were identified. Of these, 83\% (142/171) of SSNHL cases occurred after tozinameran vaccination: Rr=1.45/1,000,000 injections; no difference for the rank of injections; complete recovery in 22.5\% (32/142) of cases; median delay onset before day 21=4 days (median age 51, IQR 13-83 years); and no effects of sex. A total of 16.9\% (29/171) of SSNHL cases occurred after elasomeran vaccination: Rr=1.67/1,000,000 injections; rank effect in favor of the first injection (P=.03); complete recovery in 24\% (7/29) of cases; median delay onset before day 21=8 days (median age 47, IQR 33-81 years); and no effects of sex. Autoimmune, cardiovascular, or audiovestibular risk factors were present in approximately 29.8\% (51/171) of the cases. SSNHL was more often unilateral than bilateral for both mRNA vaccines (P<.001 for tozinameran; P<.003 for elasomeran). There were 13.5\% (23/142) of cases of profound hearing loss, among which 74\% (17/23) did not recover a serviceable ear. A positive rechallenge was documented for 8 cases. Conclusions: SSNHL after COVID-19 mRNA vaccines are very rare adverse events that do not call into question the benefits of mRNA vaccines but deserve to be known given the potentially disabling impact of sudden deafness. Therefore, it is essential to properly characterize postinjection SSNHL, especially in the case of a positive rechallenge, to provide appropriate individualized recommendations. ", doi="10.2196/45263", url="https://publichealth.jmir.org/2023/1/e45263", url="http://www.ncbi.nlm.nih.gov/pubmed/37071555" } @Article{info:doi/10.2196/42143, author="Hori, Daisuke and Takahashi, Tsukasa and Ozaki, Akihiko and Tabuchi, Takahiro", title="The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Jul", day="10", volume="9", pages="e42143", keywords="cohort studies", keywords="SARS-CoV-2", keywords="COVID-19", keywords="Japan", keywords="vaccination", keywords="vaccination hesitancy", keywords="vaccines", abstract="Background: Distributing COVID-19 vaccines to the public was an important task for the governments of each country. Because of various limitations, priority settings for vaccination were determined at the time of mass vaccination. However, trends between vaccine intention and uptake, as well as reasons for getting vaccinated or not getting vaccinated, among these groups were understudied, undermining verification of the legitimacy of priority selection. Objective: This study aims to illustrate a trend from prior COVID-19 vaccine intention, when the vaccine was not available, to the actual uptake within 1 year when all residents had access to the vaccine, to illustrate a change of reason for getting vaccinated or not getting vaccinated and to examine whether priority settings predicted subsequent vaccination uptake. Methods: Prospective cohort, web-based, self-administered surveys were conducted in Japan at 3 time points: February 2021, September to October 2021, and February 2022. In total, 13,555 participants (age: mean 53.1, SD 15.9 years) provided valid responses, with a 52.1\% follow-up rate. On the basis of the information obtained in February 2021, we identified 3 types of priority groups: health care workers (n=831), people aged ?65 years (n=4048), and those aged 18 to 64 years with underlying medical conditions (n=1659). The remaining patients were treated as nonpriority (n=7017). Modified Poisson regression analysis with a robust error estimated the risk ratio for COVID-19 vaccine uptake after adjusting for socioeconomic background, health-seeking behavior, attitude toward vaccines, and COVID-19 infection history. Results: In February 2021, a total of 5182 out of 13,555 (38.23\%) respondents expressed their intention to get vaccinated. In February 2022, a total of 1570 out of 13,555 (11.6\%) respondents completed the third dose and 10,589 (78.1\%) respondents completed the second dose. Prior vaccine intention and subsequent vaccine coverage rates were higher in the priority groups. Protection of themselves and their families from potential infection was the most frequent reason for getting vaccinated, whereas concern about side effects was the most frequent reason for hesitation across the groups. Risk ratios for received, reserved, or intended for vaccination in February 2022 were 1.05 (95\% CI 1.03-1.07) for the health care worker group, 1.02 (95\% CI 1.005-1.03) for the older adult group, and 1.01 (95\% CI 0.999-1.03) for the preexisting conditions group compared with the nonpriority group. Prior vaccine intention and confidence in vaccines were strong predictors of vaccine uptake. Conclusions: The priority settings at the start of the COVID-19 vaccination program had a significant impact on vaccine coverage after 1 year. The priority group for vaccination achieved higher vaccination coverage in February 2022. There was room for improvement among the nonpriority group. The findings of this study are essential for policy makers in Japan and other countries to develop effective vaccination strategies for future pandemics. ", doi="10.2196/42143", url="https://publichealth.jmir.org/2023/1/e42143", url="http://www.ncbi.nlm.nih.gov/pubmed/37235691" } @Article{info:doi/10.2196/42958, author="Huang, Yiman and Zhang, Ling and Fu, Jiaqi and Wu, Yijin and Wang, Hao and Xiao, Weijun and Xin, You and Dai, Zhenwei and Si, Mingyu and Chen, Xu and Jia, Mengmeng and Leng, Zhiwei and Cui, Dan and Su, Xiaoyou", title="COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study", journal="JMIR Public Health Surveill", year="2023", month="Jul", day="3", volume="9", pages="e42958", keywords="COVID-19", keywords="COVID-19 survivors", keywords="vaccine hesitancy", keywords="complacency", keywords="confidence", keywords="convenience", keywords="cross-sectional questionnaire", keywords="health education", keywords="health promotion", keywords="public health", abstract="Background: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. Objective: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. Methods: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. Results: Among the 1422 participants, 538 (37.8\%) were not vaccinated against COVID-19. The COVID-19--recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95\% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95\% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95\% CI 1.09-1.19). ``Self-needs'' was the main reason for patients to receive the COVID-19 vaccine, whereas ``already have antibodies and do not need vaccination'' was the main reason for patients to not receive the COVID-19 vaccine. Conclusions: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19--recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19--recovered patients could foster trust and promote their uptake of vaccination. ", doi="10.2196/42958", url="https://publichealth.jmir.org/2023/1/e42958", url="http://www.ncbi.nlm.nih.gov/pubmed/37247615" } @Article{info:doi/10.2196/44465, author="Archambault, M. Patrick and Rosychuk, J. Rhonda and Audet, Martyne and Bola, Rajan and Vatanpour, Shabnam and Brooks, C. Steven and Daoust, Raoul and Clark, Gregory and Grant, Lars and Vaillancourt, Samuel and Welsford, Michelle and Morrison, J. Laurie and Hohl, M. Corinne and ", title="Accuracy of Self-Reported COVID-19 Vaccination Status Compared With a Public Health Vaccination Registry in Qu{\'e}bec: Observational Diagnostic Study", journal="JMIR Public Health Surveill", year="2023", month="Jun", day="16", volume="9", pages="e44465", keywords="electronic vaccination registry", keywords="self-reported vaccination status", keywords="COVID-19", keywords="accuracy", keywords="diagnostic study", keywords="interrater agreement", abstract="Background: The accuracy of self-reported vaccination status is important to guide real-world vaccine effectiveness studies and policy making in jurisdictions where access to electronic vaccine registries is restricted. Objective: This study aimed to determine the accuracy of self-reported vaccination status and reliability of the self-reported number of doses, brand, and time of vaccine administration. Methods: This diagnostic accuracy study was completed by the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive patients presenting to 4 emergency departments (EDs) in Qu{\'e}bec between March 24, 2020, and December 25, 2021. We included adult patients who were able to consent, could speak English or French, and had a proven COVID-19 infection. We compared the self-reported vaccination status of the patients with their vaccination status in the electronic Qu{\'e}bec Vaccination Registry. Our primary outcome was the accuracy of the self-reported vaccination status (index test) ascertained during telephone follow-up compared with the Qu{\'e}bec Vaccination Registry (reference standard). The accuracy was calculated by dividing all correctly self-reported vaccinated and unvaccinated participants by the sum of all correctly and incorrectly self-reported vaccinated and unvaccinated participants. We also reported interrater agreement with the reference standard as measured by unweighted Cohen $\kappa$ for self-reported vaccination status at telephone follow-up and at the time of their index ED visit, number of vaccine doses, and brand. Results: During the study period, we included 1361 participants. At the time of the follow-up interview, 932 participants reported at least 1 dose of a COVID-19 vaccine. The accuracy of the self-reported vaccination status was 96\% (95\% CI 95\%-97\%). Cohen $\kappa$ for self-reported vaccination status at phone follow-up was 0.91 (95\% CI 0.89-0.93) and 0.85 (95\% CI 0.77-0.92) at the time of their index ED visit. Cohen $\kappa$ was 0.89 (95\% CI 0.87-0.91) for the number of doses, 0.80 (95\% CI 0.75-0.84) for the brand of the first dose, 0.76 (95\% CI 0.70-0.83) for the brand of the second dose, and 0.59 (95\% CI 0.34-0.83) for the brand of the third dose. Conclusions: We reported a high accuracy of self-reported vaccination status for adult patients without cognitive disorders who can express themselves in English or French. Researchers can use self-reported COVID-19 vaccination data on the number of doses received, vaccine brand name, and timing of vaccination to guide future research with patients who are capable of self-reporting their vaccination data. However, access to official electronic vaccine registries is still needed to determine the vaccination status in certain susceptible populations where self-reported vaccination data remain missing or impossible to obtain. Trial Registration: Clinicaltrials.gov NCT04702945; https://clinicaltrials.gov/ct2/show/NCT04702945 ", doi="10.2196/44465", url="https://publichealth.jmir.org/2023/1/e44465", url="http://www.ncbi.nlm.nih.gov/pubmed/37327046" } @Article{info:doi/10.2196/34163, author="Matas, L. Jennifer and Landry, G. Latrice and Lee, LaTasha and Hansel, Shantoy and Coudray, S. Makella and Mata-McMurry, V. Lina and Chalasani, Nishanth and Xu, Liou and Stair, Taylor and Edwards, Christina and Puckrein, Gary and Meyer, William and Wiltz, Gary and Sampson, Marian and Gregerson, Paul and Barron, Charles and Marable, Jeffrey and Akinboboye, Olakunle and Il'yasova, Dora", title="Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2023", month="Apr", day="27", volume="9", pages="e34163", keywords="COVID-19 vaccine", keywords="vaccine hesitancy", keywords="underrepresented in research", keywords="minority populations", keywords="federally qualified health center (FQHC)", keywords="public health", keywords="COVID-19", abstract="Background: COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. Objective: This study aims to characterize COVID-19 vaccine hesitancy in underserved diverse populations. Methods: The Minority and Rural Coronavirus Insights Study (MRCIS) recruited a convenience sample of adults (age?18, N=3735) from federally qualified health centers (FQHCs) in California, the Midwest (Illinois/Ohio), Florida, and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as a response of ``no'' or ``undecided'' to the question ``Would you get a coronavirus vaccine if it was available?'' (``yes'' categorized as not hesitant). Cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed using the chi-square test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95\% CIs. Interactions between geography and each demographic characteristic were evaluated in separate models. Results: The strongest vaccine hesitancy variability was by geographic region: California, 27.8\% (range 25.0\%-30.6\%); the Midwest, 31.4\% (range 27.3\%-35.4\%); Louisiana, 59.1\% (range 56.1\%-62.1\%); and Florida, 67.3\% (range 64.3\%-70.2\%). The expected estimates for the general population were lower: 9.7\% (California), 15.3\% (Midwest), 18.2\% (Florida), and 27.0\% (Louisiana). The demographic patterns also varied by geography. An inverted U-shaped age pattern was found, with the highest prevalence among ages 25-34 years in Florida (n=88, 80.0\%,) and Louisiana (n=54, 79.4\%; P<.05). Females were more hesitant than males in the Midwest (n= 110, 36.4\% vs n= 48, 23.5\%), Florida (n=458, 71.6\% vs n=195, 59.3\%), and Louisiana (n= 425, 66.5\% vs. n=172, 46.5\%; P<.05). Racial/ethnic differences were found in California, with the highest prevalence among non-Hispanic Black participants (n=86, 45.5\%), and in Florida, with the highest among Hispanic (n=567, 69.3\%) participants (P<.05), but not in the Midwest and Louisiana. The main effect model confirmed the U-shaped association with age: strongest association with age 25-34 years (OR 2.29, 95\% CI 1.74-3.01). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. Compared to males in California, the associations with the female gender were strongest in Florida (OR=7.88, 95\% CI 5.96-10.41) and Louisiana (OR=6.09, 95\% CI 4.55-8.14). Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida (OR=11.18, 95\% CI 7.01-17.85) and Black in Louisiana (OR=8.94, 95\% CI 5.53-14.47). However, the strongest race/ethnicity variability was observed within California and Florida: the ORs varied 4.6- and 2-fold between racial/ethnic groups in these regions, respectively. Conclusions: These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns. ", doi="10.2196/34163", url="https://publichealth.jmir.org/2023/1/e34163", url="http://www.ncbi.nlm.nih.gov/pubmed/36811869" } @Article{info:doi/10.2196/45051, author="Wu, Xiaoqian and Li, Ziyu and Xu, Lin and Li, Pengfei and Liu, Ming and Huang, Cheng", title="COVID-19 Vaccine--Related Information on the WeChat Public Platform: Topic Modeling and Content Analysis", journal="J Med Internet Res", year="2023", month="Apr", day="14", volume="25", pages="e45051", keywords="health belief model", keywords="COVID-19 vaccines", keywords="WeChat", keywords="content analysis", keywords="topic modeling", keywords="public health", keywords="COVID-19", abstract="Background: The COVID-19 vaccine is an effective tool in the fight against the COVID-19 outbreak. As the main channel of information dissemination in the context of the epidemic, social media influences public trust and acceptance of the vaccine. The rational application of health behavior theory is a guarantee of effective public health information dissemination. However, little is known about the application of health behavior theory in web-based COVID-19 vaccine messages, especially from Chinese social media posts. Objective: This study aimed to understand the main topics and communication characteristics of hot papers related to COVID-19 vaccine on the WeChat platform and assess the health behavior theory application with the aid of health belief model (HBM). Methods: A systematic search was conducted on the Chinese social media platform WeChat to identify COVID-19 vaccine--related papers. A coding scheme was established based on the HBM, and the sample was managed and coded using NVivo 12 (QSR International) to assess the application of health behavior theory. The main topics of the papers were extracted through the Latent Dirichlet Allocation algorithm. Finally, temporal analysis was used to explore trends in the evolution of themes and health belief structures in the papers. Results: A total of 757 papers were analyzed. Almost all (671/757, 89\%) of the papers did not have an original logo. By topic modeling, 5 topics were identified, which were vaccine development and effectiveness (267/757, 35\%), disease infection and protection (197/757, 26\%), vaccine safety and adverse reactions (52/757, 7\%), vaccine access (136/757, 18\%), and vaccination science popularization (105/757, 14\%). All papers identified at least one structure in the extended HBM, but only 29 papers included all of the structures. Descriptions of solutions to obstacles (585/757, 77\%) and benefit (468/757, 62\%) were the most emphasized components in all samples. Relatively few elements of susceptibility (208/757, 27\%) and the least were descriptions of severity (135/757, 18\%). Heat map visualization revealed the change in health belief structure before and after vaccine entry into the market. Conclusions: To the best of our knowledge, this is the first study to assess the structural expression of health beliefs in information related to the COVID-19 vaccine on the WeChat public platform based on an HBM. The study also identified topics and communication characteristics before and after the market entry of vaccines. Our findings can inform customized education and communication strategies to promote vaccination not only in this pandemic but also in future pandemics. ", doi="10.2196/45051", url="https://www.jmir.org/2023/1/e45051", url="http://www.ncbi.nlm.nih.gov/pubmed/37058349" } @Article{info:doi/10.2196/40186, author="Remmel, Christopher and Tuli, Gaurav and Varrelman, J. Tanner and Han, R. Aimee and Angkab, Pakkanan and Kosiyaporn, Hathairat and Netrpukdee, Chanikarn and Sorndamrih, Supatnuj and Thamarangsi, Thaksaphon and Brownstein, S. John and Astley, M. Christina", title="COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey", journal="JMIR Public Health Surveill", year="2023", month="Apr", day="13", volume="9", pages="e40186", keywords="COVID-19 vaccines", keywords="Thailand", keywords="survey", keywords="vaccines", keywords="COVID-19", keywords="pandemic", keywords="public health", keywords="health policy", keywords="epidemiology", keywords="social media", keywords="vaccine hesitancy", abstract="Background: The third most severe COVID-19 wave in the middle of 2021 coincided with the dual challenges of limited vaccine supply and lagging acceptance in Bangkok, Thailand. Understanding of persistent vaccine hesitancy during the ``608'' campaign to vaccinate those aged over 60 years and 8 medical risk groups was needed. On-the-ground surveys place further demands on resources and are scale limited. We leveraged the University of Maryland COVID-19 Trends and Impact Survey (UMD-CTIS), a digital health survey conducted among daily Facebook user samples, to fill this need and inform regional vaccine rollout policy. Objective: The aims of this study were to characterize COVID-19 vaccine hesitancy, frequent reasons for hesitancy, mitigating risk behaviors, and the most trusted sources of COVID-19 information through which to combat vaccine hesitancy in Bangkok, Thailand during the 608 vaccine campaign. Methods: We analyzed 34,423 Bangkok UMD-CTIS responses between June and October 2021, coinciding with the third COVID-19 wave. Sampling consistency and representativeness of the UMD-CTIS respondents were evaluated by comparing distributions of demographics, 608 priority groups, and vaccine uptake over time with source population data. Estimates of vaccine hesitancy in Bangkok and 608 priority groups were tracked over time. Frequently cited hesitancy reasons and trusted information sources were identified according to the 608 group and degree of hesitancy. Kendall tau was used to test statistical associations between vaccine acceptance and vaccine hesitancy. Results: The Bangkok UMD-CTIS respondents had similar demographics over weekly samples and compared to the Bangkok source population. Respondents self-reported fewer pre-existing health conditions compared to census data overall but had a similar prevalence of the important COVID-19 risk factor diabetes. UMD-CTIS vaccine uptake rose in parallel with national vaccination statistics, while vaccine hesitancy and degree of hesitancy declined (?7\% hesitant per week). Concerns about vaccination side effects (2334/3883, 60.1\%) and wanting to wait and see (2410/3883, 62.1\%) were selected most frequently, while ``not liking vaccines'' (281/3883, 7.2\%) and ``religious objections'' (52/3883, 1.3\%) were selected least frequently. Greater vaccine acceptance was associated positively with wanting to ``wait and see'' and negatively with ``don't believe I need (the vaccine)'' (Kendall tau 0.21 and ?0.22, respectively; adjusted P<.001). Scientists and health experts were most frequently cited as trusted COVID-19 information sources (13,600/14,033, 96.9\%), even among vaccine hesitant respondents. Conclusions: Our findings provide policy and health experts with evidence that vaccine hesitancy was declining over the study timeframe. Hesitancy and trust analyses among the unvaccinated support Bangkok policy measures to address vaccine safety and efficacy concerns through health experts rather than government or religious officials. Large-scale surveys enabled by existing widespread digital networks offer an insightful minimal-infrastructure resource for informing region-specific health policy needs. ", doi="10.2196/40186", url="https://publichealth.jmir.org/2023/1/e40186", url="http://www.ncbi.nlm.nih.gov/pubmed/36811852" } @Article{info:doi/10.2196/40587, author="Asim, Saba and Wang, Kailu and Nichini, Elena and Yip, Fu Faustina and Zhu, Liling and Fung, Eddy Hin Chung and Zeng, Yan and Fang, Zhilan and Cheung, Wai-Ling Annie and Wong, Lai-yi Eliza and Dong, Dong and Yeoh, Eng-Kiong", title="COVID-19 Vaccination Preferences Among Non-Chinese Migrants in Hong Kong: Discrete Choice Experiment", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="27", volume="9", pages="e40587", keywords="COVID-19 vaccination", keywords="migrants", keywords="discrete choice experiment", keywords="ethnic minorities", keywords="vaccine attributes", keywords="Hong Kong", keywords="COVID-19", abstract="Background: Studies have shown increasing COVID-19 vaccination hesitancy among migrant populations in certain settings compared to the general population. Hong Kong has a growing migrant population with diverse ethnic backgrounds. Apart from individual-level factors, little is known about the migrants' preference related to COVID-19 vaccines. Objective: This study aims to investigate which COVID-19 vaccine--related attributes combined with individual factors may lead to vaccine acceptance or refusal among the migrant population in Hong Kong. Methods: An online discrete choice experiment (DCE) was conducted among adults, including Chinese people, non-Chinese Asian migrants (South, Southeast and Northeast Asians), and non-Asian migrants (Europeans, Americans, and Africans) in Hong Kong from February 26 to April 26, 2021. The participants were recruited using quota sampling and sent a link to a web survey. The vaccination attributes included in 8 choice sets in each of the 4 blocks were vaccine brand, safety and efficacy, vaccine uptake by people around, professionals' recommendation, vaccination venue, and quarantine exemption for vaccinated travelers. A nested logistic model (NLM) and a latent-class logit (LCL) model were used for statistical analysis. Results: A total of 208 (response rate 62.1\%) migrant participants were included. Among the migrants, those with longer local residential years (n=31, 27.7\%, for ?10 years, n=7, 20.6\%, for 7-9 years, n=2, 6.7\%, for 4-6 years, and n=3, 9.7\%, for ?3 years; P=.03), lower education level (n=28, 28.3\%, vs n=15, 13.9\%, P=.01), and lower income (n=33, 25.2\%, vs n=10, 13.2\%, P=.04) were more likely to refuse COVID-19 vaccination irrespective of vaccination attributes. The BioNTech vaccine compared with Sinovac (adjusted odds ratio [AOR]=1.75, 95\% CI 1.14-2.68), vaccine with 90\% (AOR=1.44, 95\% CI 1.09-1.91) and 70\% efficacy (AOR=1.21, 95\% CI 1.03-1.44) compared with 50\% efficacy, vaccine with fewer serious adverse events (1/100,000 compared with 1/10,000; AOR=1.12, 95\% CI 1.00-1.24), and quarantine exemption for cross-border travelers (AOR=1.14, 95\% CI 1.01-1.30) were the vaccine attributes that could increase the likelihood of vaccination among migrants. For individual-level factors, full-time homemakers (AOR=0.44, 95\% CI 0.29-0.66), those with chronic conditions (AOR=0.61, 95\% CI 0.41-0.91) and more children, and those who frequently received vaccine-related information from the workplace (AOR=0.42, 95\% CI 0.31-0.57) were found to be reluctant to accept the vaccine. Those with a higher income (AOR=1.79, 95\% CI 1.26-2.52), those knowing anyone infected with COVID-19 (AOR=1.73, 95\% CI 1.25-2.38), those having greater perceived susceptibility of COVID-19 infection (AOR=3.42, 95\% CI 2.52-4.64), those who received the influenza vaccine (AOR=2.15, 95\% CI 1.45-3.19), and those who frequently received information from social media (AOR=1.52, 95\% CI 1.12-2.05) were more likely to accept the vaccine. Conclusions: This study implies that migrants have COVID-19 vaccination preference heterogeneity and that more targeted and tailored approaches are needed to promote vaccine acceptance for different subgroups of the migrant population in Hong Kong. Vaccination promotion strategies are needed for low-education and low-income migrant groups, migrants with chronic diseases, the working migrant population, homemakers, and parents. ", doi="10.2196/40587", url="https://publichealth.jmir.org/2023/1/e40587", url="http://www.ncbi.nlm.nih.gov/pubmed/36848242" } @Article{info:doi/10.2196/43819, author="Clarkson, D. Melissa", title="Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study", journal="JMIR Hum Factors", year="2023", month="Mar", day="20", volume="10", pages="e43819", keywords="COVID-19", keywords="data visualization", keywords="data dashboard", keywords="public health reporting", keywords="human information interaction", keywords="transparency", keywords="trust", abstract="Background: The SARS-CoV-2 pandemic provided an opportunity to use public-facing web data visualization tools to help citizens understand the evolving status of the outbreak. Given the heterogeneity of data sources, developers, tools, and designs used in this effort, it raised questions about how visualizations were constructed during a time when daily batches of data were available, but issues of data quality and standardization were unresolved. Objective: This paper surveyed web-based COVID-19 dashboards and trackers that are likely to be used by the residents of the United States to monitor the spread of infection on a local, national, and global scale. This study is intended to provide insights that will help application developers increase the usefulness, transparency, and trustworthiness of dashboards and trackers for public health data in the future. Methods: Websites of coronavirus dashboards and trackers were identified in August 2020 using the Google search engine. They were examined to determine the data sources used, types of data presented, types of data visualizations, characteristics of the visualizations, and issues with messy data. The websites were surveyed 3 more times for changes in design and data sources with the final survey conducted in June 2022. Themes were developed to highlight the issues concerning challenges in presenting COVID-19 data and techniques of effective visualization. Results: In total, 111 websites were identified and examined (84 state focused, 11 nationwide, and 16 with global data), and this study found an additional 17 websites providing access to the state vaccination data. This study documents how data aggregators have played a central role in making data accessible to visualization developers. The designs of dashboards and tracker visualizations vary in type and quality, with some well-designed displays supporting the interpretation of the data and others obscuring the meaning of the data and potentially misleading the viewers. Five themes were identified to describe challenges in presenting COVID-19 data and techniques of effective visualization. Conclusions: This analysis reveals the extent to which dashboards and trackers informing the American public about the COVID-19 pandemic relied on an ad hoc pipeline of data sources and data aggregators. The dashboards and trackers identified in this survey offer an opportunity to compare different approaches for the display of similar data. ", doi="10.2196/43819", url="https://humanfactors.jmir.org/2023/1/e43819", url="http://www.ncbi.nlm.nih.gov/pubmed/36696270" } @Article{info:doi/10.2196/38072, author="Nguyen, Vincent and Liu, Yunzhe and Mumford, Richard and Flanagan, Benjamin and Patel, Parth and Braithwaite, Isobel and Shrotri, Madhumita and Byrne, Thomas and Beale, Sarah and Aryee, Anna and Fong, Erica Wing Lam and Fragaszy, Ellen and Geismar, Cyril and Navaratnam, D. Annalan M. and Hardelid, Pia and Kovar, Jana and Pope, Addy and Cheng, Tao and Hayward, Andrew and Aldridge, Robert and ", title="Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Mar", day="8", volume="9", pages="e38072", keywords="COVID-19", keywords="SARS-CoV-2", keywords="vaccination", keywords="global positioning system", keywords="GPS", keywords="movement tracking", keywords="geographical tracking", keywords="mobile app", keywords="health application", keywords="surveillance", keywords="public health", keywords="mHealth", keywords="mobile surveillance", keywords="tracking device", keywords="geolocation", abstract="Background: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. Objective: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. Methods: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. Results: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95\% CI --50.08 to --31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95\% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95\% CI --19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95\% CI 38.6-149.00; P=.69) in the 30 days after vaccination. Conclusions: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period. ", doi="10.2196/38072", url="https://publichealth.jmir.org/2023/1/e38072", url="http://www.ncbi.nlm.nih.gov/pubmed/36884272" } @Article{info:doi/10.2196/40161, author="Kipke, D. Michele and Karimipour, Nicki and Wolfe, Nicole and Orechwa, Allison and Stoddard, Laura and Rubio-Diaz, Mayra and North, Gemma and Dezfuli, Ghazal and Murphy, Sheila and Phelps, Ashley and Kagan, Jeremy and De La Haye, Kayla and Perry, Christina and Baezconde-Garbanati, Lourdes", title="Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles' Black and Latino Communities: Protocol for a Participatory Study", journal="JMIR Res Protoc", year="2023", month="Feb", day="20", volume="12", pages="e40161", keywords="community engagement", keywords="COVID-19", keywords="vaccine", keywords="vaccination", keywords="public health", keywords="population health", keywords="health equity", keywords="social media", keywords="vaccine hesitancy", abstract="Background: The COVID-19 pandemic has significantly affected Los Angeles County and disproportionately impacted Black and Latino populations who experienced disparities in rates of infection, hospitalizations, morbidity, and mortality. The University of Southern California (USC), USC Keck School of Medicine, Southern California Clinical and Translational Science Institute, USC Mann School of Pharmacy and Pharmaceutical Sciences, Annenberg School for Journalism and Communication, and Children's Hospital Los Angeles will launch a collaborative public health campaign called VaccinateLA. Objective: VaccinateLA will implement a community-based, community-partnered public health campaign that (1) delivers culturally tailored information about COVID-19 and available vaccines; and (2) addresses misinformation and disinformation, which serves as a barrier to vaccine uptake. The campaign will be targeted to communities in Los Angeles with the highest rates of COVID-19 infection and the lowest vaccination rates. Using these criteria, the campaign will be targeted to neighborhoods located in 34 zip codes in the Eastside and South Los Angeles. The primary aim of VaccinateLA will be to design and deliver an evidence-based multimedia public health campaign tailored for Black and Latino populations. A secondary aim will be to train and deploy community vaccine navigators to deliver COVID-19 education, help individuals overcome barriers to getting vaccinated (eg, transportation and challenges registering), and assist with delivering vaccinations in our targeted communities. Methods: We will use a community-based, participatory research approach to shape VaccinateLA's public health campaign to address community members' attitudes and concerns in developing campaign content. We will conduct focus groups, establish a community advisory board, and engage local leaders and stakeholders to develop and implement a broad array of educational, multimedia, and field-based activities. Results: As of February 2023, target communities have been identified. The activities will be initiated and evaluated over the course of this year-long initiative, and dissemination will occur following the completion of the project. Conclusions: Engaging the community is vital to developing culturally tailored public health messages that will resonate with intended audiences. VaccinateLA will serve as a model for how an academic institution can quickly mobilize to address a pressing public health crisis, particularly in underrepresented and underresourced communities. Our work has important implications for future public health campaigns. By leveraging community partnerships and deploying community health workers or promotores into the community, we hope to demonstrate that urban universities can successfully partner with local communities to develop and deliver a range of culturally tailored educational, multimedia, and field-based activities, which in turn may change the course of an urgent public health crisis, such as the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/40161 ", doi="10.2196/40161", url="https://www.researchprotocols.org/2023/1/e40161", url="http://www.ncbi.nlm.nih.gov/pubmed/36757953" } @Article{info:doi/10.2196/44234, author="Batzella, Erich and Cantarutti, Anna and Caranci, Nicola and Giaquinto, Carlo and Barbiellini Amidei, Claudio and Canova, Cristina", title="The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort", journal="JMIR Public Health Surveill", year="2023", month="Feb", day="1", volume="9", pages="e44234", keywords="SEP", keywords="socioeconomic position", keywords="quantile-g-computation", keywords="nested case-control study", keywords="COVID-19 vaccine", keywords="children", keywords="area deprivation index", abstract="Background: The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined. Objective: We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort. Methods: A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)---a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95\% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years). Results: The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36\% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95\% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11--year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17\% decrease in the probability of being vaccinated (95\% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families. Conclusions: This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity. ", doi="10.2196/44234", url="https://publichealth.jmir.org/2023/1/e44234", url="http://www.ncbi.nlm.nih.gov/pubmed/36645419" } @Article{info:doi/10.2196/43055, author="Tran, Xuan Bach and Do, Linh Anh and Boyer, Laurent and Auquier, Pascal and Le, Thi Huong and Le Vu, Ngoc Minh and Dang, Thi Trang Huyen and Cao, Minh Khuy and Le, Thi Linh Dieu and Cu, Ngoc Lam Tung and Ly, Viet Bang and Nguyen, Thi Duong Anh and Nguyen, Duc Manh and Latkin, A. Carl and Ho, M. Roger C. and Ho, H. Cyrus S. and Zhang, B. Melvyn W.", title="Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="31", volume="9", pages="e43055", keywords="COVID-19", keywords="epidemic", keywords="vaccine", keywords="booster", keywords="willingness to take", keywords="willingness to pay", keywords="Vietnam", keywords="policy", keywords="feasibility", keywords="acceptability", keywords="infection", keywords="vaccination", keywords="social media", keywords="intervention", abstract="Background: The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial. Objective: This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam's waning vaccine immunity period. Methods: A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined. Results: Among the participants, 761 (87.4\%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US \$8.02, and most participants indicated an unwillingness to pay (n=225, 25.8\%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4\%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95\% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95\% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95\% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95\% CI 0.86-1.00) were negative factors associated with the level of willingness to pay. Conclusions: A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities. ", doi="10.2196/43055", url="https://publichealth.jmir.org/2023/1/e43055", url="http://www.ncbi.nlm.nih.gov/pubmed/36599156" } @Article{info:doi/10.2196/39045, author="Perez-Ramos, G. Jose and Leon-Thomas, Mariela and Smith, L. Sabrina and Silverman, Laura and Perez-Torres, Claudia and Hall, C. Wyatte and Iadarola, Suzannah", title="COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots", journal="JMIR Form Res", year="2023", month="Jan", day="25", volume="7", pages="e39045", keywords="mHealth", keywords="ICT", keywords="Information and Communication Technology", keywords="community", keywords="chatbot", keywords="COVID-19", keywords="health equity", keywords="mobile health", keywords="health outcome", keywords="health disparity", keywords="minority population", keywords="health care gap", keywords="chatbot tool", keywords="user experience", keywords="chatbot development", keywords="health information", abstract="Background: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. Objective: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named ``Ana'' and (2) characterize and evaluate user experiences of these innovative technologies. Methods: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of {\ss} chatbots were tested, and a total of 22 {\ss} testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. Results: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87\% (n=221) of English users and 22.14\% (n=62) of Spanish users returned to use Ana at least once; 18.49\% (n=64) among the English version users and 18.57\% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the ``smiley'' and ``loved'' emojis, and negative ranking comprised the ``neutral,'' ``sad,'' and ``mad'' emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06\%; Spanish: n=41, 77.35\%) versus the former (English: n=23, 35.93\%; Spanish: n=12, 22.64\%). Conclusions: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19--related information. ", doi="10.2196/39045", url="https://formative.jmir.org/2023/1/e39045", url="http://www.ncbi.nlm.nih.gov/pubmed/36630649" } @Article{info:doi/10.2196/40201, author="Zhao, Sihong and Hu, Simeng and Zhou, Xiaoyu and Song, Suhang and Wang, Qian and Zheng, Hongqiu and Zhang, Ying and Hou, Zhiyuan", title="The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review", journal="JMIR Public Health Surveill", year="2023", month="Jan", day="11", volume="9", pages="e40201", keywords="COVID-19", keywords="COVID-19 vaccine", keywords="misinformation", keywords="anti-vaccine", keywords="review", keywords="social media", keywords="survey", abstract="Background: During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered pandemic exiting strategies. Misinformation around COVID-19 vaccines is a vital contributor to vaccine hesitancy. However, no evidence systematically summarized COVID-19 vaccine misinformation. Objective: This review aims to synthesize the global evidence on misinformation related to COVID-19 vaccines, including its prevalence, features, influencing factors, impacts, and solutions for combating misinformation. Methods: We performed a systematic review by searching 5 peer-reviewed databases (PubMed, Embase, Web of Science, Scopus, and EBSCO). We included original articles that investigated misinformation related to COVID-19 vaccines and were published in English from January 1, 2020, to August 18, 2022. We excluded publications that did not cover or focus on COVID-19 vaccine misinformation. The Appraisal tool for Cross-Sectional Studies, version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and Critical Appraisal Skills Programme Checklist were used to assess the study quality. The review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42021288929). Results: Of the 8864 studies identified, 91 observational studies and 11 interventional studies met the inclusion criteria. Misinformation around COVID-19 vaccines covered conspiracy, concerns on vaccine safety and efficacy, no need for vaccines, morality, liberty, and humor. Conspiracy and safety concerns were the most prevalent misinformation. There was a great variation in misinformation prevalence, noted among 2.5\%-55.4\% in the general population and 6.0\%-96.7\% in the antivaccine/vaccine hesitant groups from survey-based studies, and in 0.1\%-41.3\% on general online data and 0.5\%-56\% on antivaccine/vaccine hesitant data from internet-based studies. Younger age, lower education and economic status, right-wing and conservative ideology, and having psychological problems enhanced beliefs in misinformation. The content, format, and source of misinformation influenced its spread. A 5-step framework was proposed to address vaccine-related misinformation, including identifying misinformation, regulating producers and distributors, cutting production and distribution, supporting target audiences, and disseminating trustworthy information. The debunking messages/videos were found to be effective in several experimental studies. Conclusions: Our review provides comprehensive and up-to-date evidence on COVID-19 vaccine misinformation and helps responses to vaccine infodemic in future pandemics. Trial Registration: PROSPERO CRD42021288929; https://tinyurl.com/2prejtfa ", doi="10.2196/40201", url="https://publichealth.jmir.org/2023/1/e40201", url="http://www.ncbi.nlm.nih.gov/pubmed/36469911" } @Article{info:doi/10.2196/36827, author="Abou-Arraj, Elias Nadeem and Maddah, Diana and Buhamdan, Vanessa and Abbas, Roua and Jawad, Kamel Nadine and Karaki, Fatima and Alami, H. Nael and Geldsetzer, Pascal", title="Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey", journal="JMIR Form Res", year="2022", month="Dec", day="14", volume="6", number="12", pages="e36827", keywords="Lebanon", keywords="COVID-19", keywords="SARS-CoV-2", keywords="coronavirus", keywords="vaccination", keywords="vaccine hesitancy", keywords="vaccine acceptance", keywords="health care system", keywords="misinformation", keywords="public health", abstract="Background: The COVID-19 pandemic is an additional burden on Lebanon's fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study's aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals' motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience ``snowball'' sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1\% (95\% CI: 43.2\%-49.0\%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0\% (95\% CI 16.8\%-21.4\%) indicated they would not, and 34.0\% (95\% CI 31.3\%-36.8\%) were unsure (with an additional 0.9\% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one's family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. ", doi="10.2196/36827", url="https://formative.jmir.org/2022/12/e36827", url="http://www.ncbi.nlm.nih.gov/pubmed/36383635" } @Article{info:doi/10.2196/40701, author="Wang, Dandan and Zhou, Yadong and Ma, Feicheng", title="Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis", journal="J Med Internet Res", year="2022", month="Nov", day="18", volume="24", number="11", pages="e40701", keywords="COVID-19", keywords="COVID-19 vaccine", keywords="echo chamber", keywords="opinion leader", keywords="structural hole spanner", keywords="topic", keywords="sentiment", keywords="social media", keywords="vaccine hesitancy", keywords="public health", keywords="vaccination", keywords="health promotion", keywords="online campaign", keywords="social network analysis", abstract="Background: Social media provide an ideal medium for breeding and reinforcing vaccine hesitancy, especially during public health emergencies. Algorithmic recommendation--based technology along with users' selective exposure and group pressure lead to online echo chambers, causing inefficiency in vaccination promotion. Avoiding or breaking echo chambers largely relies on key users' behavior. Objective: With the ultimate goal of eliminating the impact of echo chambers related to vaccine hesitancy on social media during public health emergencies, the aim of this study was to develop a framework to quantify the echo chamber effect in users' topic selection and attitude contagion about COVID-19 vaccines or vaccinations; detect online opinion leaders and structural hole spanners based on network attributes; and explore the relationships of their behavior patterns and network locations, as well as the relationships of network locations and impact on topic-based and attitude-based echo chambers. Methods: We called the Sina Weibo application programming interface to crawl tweets related to the COVID-19 vaccine or vaccination and user information on Weibo, a Chinese social media platform. Adopting social network analysis, we examined the low echo chamber effect based on topics in representational networks of information, according to attitude in communication flow networks of users under different interactive mechanisms (retweeting, commenting). Statistical and visual analyses were used to characterize behavior patterns of key users (opinion leaders, structural hole spanners), and to explore their function in avoiding or breaking topic-based and attitude-based echo chambers. Results: Users showed a low echo chamber effect in vaccine-related topic selection and attitude interaction. For the former, the homophily was more obvious in retweeting than in commenting, whereas the opposite trend was found for the latter. Speakers, replicators, and monologists tended to be opinion leaders, whereas common users, retweeters, and networkers tended to be structural hole spanners. Both leaders and spanners tended to be ``bridgers'' to disseminate diverse topics and communicate with users holding cross-cutting attitudes toward COVID-19 vaccines. Moreover, users who tended to echo a single topic could bridge multiple attitudes, while users who focused on diverse topics also tended to serve as bridgers for different attitudes. Conclusions: This study not only revealed a low echo chamber effect in vaccine hesitancy, but further elucidated the underlying reasons from the perspective of users, offering insights for research about the form, degree, and formation of echo chambers, along with depolarization, social capital, stakeholder theory, user portraits, dissemination pattern of topic, and sentiment. Therefore, this work can help to provide strategies for public health and public opinion managers to cooperate toward avoiding or correcting echo chamber chaos and effectively promoting online vaccine campaigns. ", doi="10.2196/40701", url="https://www.jmir.org/2022/11/e40701", url="http://www.ncbi.nlm.nih.gov/pubmed/36367965" } @Article{info:doi/10.2196/37203, author="Kasting, L. Monica and Macy, T. Jonathan and Grannis, J. Shaun and Wiensch, J. Ashley and Lavista Ferres, M. Juan and Dixon, E. Brian", title="Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="14", volume="8", number="11", pages="e37203", keywords="SARS-CoV-2", keywords="COVID-19 vaccines", keywords="vaccination intention", keywords="vaccine hesitancy", keywords="Health Belief Model", keywords="reasoned action approach", keywords="COVID-19", keywords="vaccination", keywords="public health", keywords="online survey", keywords="health intervention", keywords="logistic regression", keywords="demographic", abstract="Background: The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy. Objective: The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none. Methods: This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone. Results: The majority of participants were male (n=974, 59.3\%), White (n=1347, 82.0\%), and non-Hispanic (n=1518, 92.4\%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5\%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95\% CI 1.04-1.06), other race (AOR 0.47, 95\% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95\% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95\% CI 2.42-5.73), self-efficacy (AOR 1.75, 95\% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95\% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs. Conclusions: Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted. ", doi="10.2196/37203", url="https://publichealth.jmir.org/2022/11/e37203", url="http://www.ncbi.nlm.nih.gov/pubmed/36219842" } @Article{info:doi/10.2196/36712, author="Giner-Soriano, Maria and de Dios, Vanessa and Ouchi, Dan and Vilaplana-Carnerero, Carles and Monteagudo, M{\`o}nica and Morros, Rosa", title="Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="11", volume="8", number="11", pages="e36712", keywords="SARS-CoV-2", keywords="COVID-19", keywords="influenza vaccines", keywords="pneumonia", keywords="electronic health records", keywords="primary health care", keywords="vaccination", keywords="public health", keywords="cohort study", keywords="epidemiology", keywords="eHeatlh", keywords="health outcome", keywords="mortality", abstract="Background: A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. Objective: This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. Methods: We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. Results: We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9\%) having been vaccinated at least once and 194,858 (63.1\%) having never been vaccinated. In total, 21,721 (19\%) vaccinated individuals and 11,000 (5.7\%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95\% CI 1.10-1.19), recently (OR 1.13, 95\% CI 1.10-1.18), or recurrently (OR 1.10, 95\% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. Conclusions: We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting. ", doi="10.2196/36712", url="https://publichealth.jmir.org/2022/11/e36712", url="http://www.ncbi.nlm.nih.gov/pubmed/36265160" } @Article{info:doi/10.2196/39670, author="Tennant, Ryan and Tetui, Moses and Grindrod, Kelly and Burns, M. Catherine", title="Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study", journal="JMIR Hum Factors", year="2022", month="Nov", day="10", volume="9", number="4", pages="e39670", keywords="cognitive work analysis", keywords="contextual design", keywords="COVID-19", keywords="decision making", keywords="health care system", keywords="pandemic", keywords="vaccination clinics", keywords="workplace stress", abstract="Background: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. Objective: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. Methods: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Results: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Conclusions: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making. ", doi="10.2196/39670", url="https://humanfactors.jmir.org/2022/4/e39670", url="http://www.ncbi.nlm.nih.gov/pubmed/36219839" } @Article{info:doi/10.2196/40175, author="Kwan, Ho Tsz and Wong, Sze Ngai and Chan, Pok Chin and Yeoh, Kiong Eng and Wong, Yeung-shan Samuel and Lee, Shan Shui", title="Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="9", volume="8", number="11", pages="e40175", keywords="COVID-19", keywords="SARS-CoV-2 antigen testing", keywords="COVID-19 vaccine", keywords="mass screening", keywords="antigen test", keywords="epidemiology", keywords="Omicron", keywords="Hong Kong", keywords="public health", keywords="outbreak", keywords="epidemic", keywords="screening", keywords="transmission", keywords="online", keywords="vaccination", keywords="vaccines", keywords="surveillance", abstract="Background: The COVID-19 Omicron BA.2 epidemic wave in Hong Kong peaked in the first quarter of 2022. Following the implementation of stringent public health measures, the daily number of reported cases fell from over 50,000 to below 2000. Although outbreaks steadily receded, the government rolled out a 3-day ``voluntary universal rapid testing'' campaign to invite all citizens to self-perform a rapid antigen test (RAT) daily to identify undetected prevalent infections. Objective: This study aimed to evaluate the uptake and results of RAT mass screening to estimate the population's residual epidemic burden and assess the risk of further transmission. Methods: A cross-sectional study comprising an open web-based population-based survey was conducted a week after the RAT campaign. Participants were asked to report their COVID-19 vaccination and infection history and the RAT performance and test result during the period. They were also invited to report their coliving individuals' test performance and results. Reasons for nonuptake were enquired. Testing and positive rates were age-adjusted. Determinants of undergoing RAT were identified using univariable and multivariable logistic regression models. Results: In total, particulars from 21,769 individuals were reported by 8338 participants. The overall age-adjusted testing rate was 74.94\% (95\% CI 73.71\%-76.18\%), with over 80\% of participants in the age groups between 45-84 years having self-performed RAT during the campaign period. After age-adjustment, 1.03\% (95\% CI 0.86\%-1.21\%) of participants tested positive. The positive rates in the age groups between 20-29 years and >84 years exceeded 2\%. Taking into account the positive rate and 5819 reported cases during the period, the cases identified in the campaign might account for 7.65\% (95\% CI 6.47\%-9.14\%) of all infections. Testers were more likely to be female, older, not previously diagnosed with COVID-19, and have received COVID-19 vaccination. Adjusting for the number of household members, those living with a child aged <12 years and whose household members were also tested were more likely to have self-performed an RAT. Main reasons for not performing an RAT included the absence of symptoms (598/1108, 53.97\%), disbelief of the appropriateness of the campaign as an antiepidemic measure (355/1108, 32.04\%), and a recent COVID-19 diagnosis (332/1108, 29.96\%). Conclusions: The residual population burden remained substantial in spite of the clear evidence of a receding epidemic wave. Despite caution in generalization to the Hong Kong population, the high participation rate in mass screening indicated that the voluntary RAT was well accepted, making it a feasible option for implementation as a complementary means of public health surveillance. ", doi="10.2196/40175", url="https://publichealth.jmir.org/2022/11/e40175", url="http://www.ncbi.nlm.nih.gov/pubmed/36240027" } @Article{info:doi/10.2196/38898, author="Kshirsagar, Meghana and Nasir, Md and Mukherjee, Sumit and Becker, Nicholas and Dodhia, Rahul and Weeks, B. William and Ferres, Lavista Juan and Richardson, Barbra", title="The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data", journal="JMIR Public Health Surveill", year="2022", month="Nov", day="8", volume="8", number="11", pages="e38898", keywords="breakthroughs", keywords="vaccines", keywords="Pfizer", keywords="Moderna", keywords="Janssen", keywords="SARS-CoV-2", keywords="COVID-19", keywords="coronavirus", keywords="infectious disease", keywords="viral infection", keywords="vaccination", keywords="breakthrough infection", keywords="public health", keywords="health policy", keywords="decision making", keywords="booster vaccine", keywords="mortality", keywords="hospitalization", keywords="healthcare system", abstract="Background: Several risk factors have been identified for severe COVID-19 disease by the scientific community. In this paper, we focus on understanding the risks for severe COVID-19 infections after vaccination (ie, in breakthrough SARS-CoV-2 infections). Studying these risks by vaccine type, age, sex, comorbidities, and any prior SARS-CoV-2 infection is important to policy makers planning further vaccination efforts. Objective: We performed a comparative study of the risks of hospitalization (n=1140) and mortality (n=159) in a SARS-CoV-2 positive cohort of 19,815 patients who were all fully vaccinated with the Pfizer, Moderna, or Janssen vaccines. Methods: We performed Cox regression analysis to calculate the risk factors for developing a severe breakthrough SARS-CoV-2 infection in the study cohort by controlling for vaccine type, age, sex, comorbidities, and a prior SARS-CoV-2 infection. Results: We found lower hazard ratios for those receiving the Moderna vaccine (P<.001) and Pfizer vaccine (P<.001), with the lowest hazard rates being for Moderna, as compared to those who received the Janssen vaccine, independent of age, sex, comorbidities, vaccine type, and prior SARS-CoV-2 infection. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection over and above the protection already provided by the vaccines, from hospitalization (P=.001) and death (P=.04), independent of age, sex, comorbidities, and vaccine type. We found that the top statistically significant risk factors for severe breakthrough SARS-CoV-2 infections were age of >50, male gender, moderate and severe renal failure, severe liver disease, leukemia, chronic lung disease, coagulopathy, and alcohol abuse. Conclusions: Among individuals who were fully vaccinated, the risk of severe breakthrough SARS-CoV-2 infection was lower for recipients of the Moderna or Pfizer vaccines and higher for recipients of the Janssen vaccine. These results from our analysis at a population level will be helpful to public health policy makers. Our result on the influence of a previous SARS-CoV-2 infection necessitates further research into the impact of multiple exposures on the risk of developing severe COVID-19. ", doi="10.2196/38898", url="https://publichealth.jmir.org/2022/11/e38898", url="http://www.ncbi.nlm.nih.gov/pubmed/36265135" } @Article{info:doi/10.2196/38153, author="Fuster-Casanovas, A{\"i}na and Das, Ronnie and Vidal-Alaball, Josep and Lopez Segui, Francesc and Ahmed, Wasim", title="The \#VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis", journal="JMIR Public Health Surveill", year="2022", month="Oct", day="28", volume="8", number="10", pages="e38153", keywords="Twitter", keywords="social media", keywords="COVID-19", keywords="misinformation", keywords="vaccination", keywords="public health", keywords="vaccine hesitancy", keywords="infodemiology", keywords="health campaign", keywords="content analysis", keywords="social network", keywords="layout algorithm", abstract="Background: Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children's Emergency Fund), alongside other organizations, were promoting the hashtag \#VaccinesWork. Objective: The aim of this paper is to analyze the \#VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved. Methods: The data set used in this study consists of 11,085 tweets containing the \#VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm. Results: The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario. Conclusions: This study investigated the discussions surrounding the \#VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter. ", doi="10.2196/38153", url="https://publichealth.jmir.org/2022/10/e38153", url="http://www.ncbi.nlm.nih.gov/pubmed/36219832" } @Article{info:doi/10.2196/36210, author="Buller, David and Walkosz, Barbara and Henry, Kimberly and Woodall, Gill W. and Pagoto, Sherry and Berteletti, Julia and Kinsey, Alishia and Divito, Joseph and Baker, Katie and Hillhouse, Joel", title="Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages", journal="JMIR Infodemiology", year="2022", month="Aug", day="23", volume="2", number="2", pages="e36210", keywords="social media", keywords="COVID-19", keywords="vaccination", keywords="nonpharmaceutical interventions", keywords="information source", keywords="misinformation", keywords="vaccine", keywords="public health", keywords="COVID-19 prevention", keywords="health promotion", abstract="Background: Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance. Objective: In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media. Methods: A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) {\texttimes} 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother--daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Results: Nearly all mothers (n=298, 98.3\%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1\%, completed the 3-week posttest; n=273, 90.1\%, completed the 6-week posttest; n=275, 90.8\%, completed the 9-week posttest; and n=244, 80.5\%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=--0.10, 95\% CI --0.12 to --0.08, P<.001) and daughters (b=--0.10, 95\% CI --0.18 to --0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95\% CI 0.19-0.49, P<.001; daughters: b=0.17, 95\% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=--0.04, 95\% CI --0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95\% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95\% CI 0.09-0.49, P<.01; daughters: b=0.31, 95\% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95\% CI 1.83-6.53, P<.001; daughters: b=3.36, 95\% CI 1.67-5.04, P<.001). Mothers' intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=--0.50, 95\% CI --0.99 to --0.01, P=.05). Conclusions: Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general. Trial Registration: ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 ", doi="10.2196/36210", url="https://infodemiology.jmir.org/2022/2/e36210", url="http://www.ncbi.nlm.nih.gov/pubmed/36039372" } @Article{info:doi/10.2196/37367, author="Skafle, Ingjerd and Nordahl-Hansen, Anders and Quintana, S. Daniel and Wynn, Rolf and Gabarron, Elia", title="Misinformation About COVID-19 Vaccines on Social Media: Rapid Review", journal="J Med Internet Res", year="2022", month="Aug", day="4", volume="24", number="8", pages="e37367", keywords="social media", keywords="misinformation", keywords="COVID-19 vaccines", keywords="vaccination hesitancy", keywords="autism spectrum disorder", abstract="Background: The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19. Objective: We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms. Methods: We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines. Conclusions: To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021277524 International Registered Report Identifier (IRRID): RR2-10.31219/osf.io/tyevj ", doi="10.2196/37367", url="https://www.jmir.org/2022/8/e37367", url="http://www.ncbi.nlm.nih.gov/pubmed/35816685" } @Article{info:doi/10.2196/38351, author="Mehta, N. Shivani and Burger, C. Zoe and Meyers-Pantele, A. Stephanie and Garfein, S. Richard and Ortiz, O. Dayanna and Mudhar, K. Pavan and Kothari, B. Smit and Kothari, Jigna and Meka, Meena and Rodwell, Timothy", title="Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey", journal="JMIR Form Res", year="2022", month="Aug", day="4", volume="6", number="8", pages="e38351", keywords="COVID-19", keywords="knowledge", keywords="attitude", keywords="practices", keywords="KAP survey", keywords="vaccine hesitancy", keywords="Latinx", keywords="Latinx cohort", keywords="minority population", keywords="primary care", keywords="sociodemographic characteristic", keywords="public health", keywords="vulnerable population", keywords="epidemiology", abstract="Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.? Methods: Participants aged ?18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1\% (n=191) were female, 77\% (n=204) had at most a high school degree, 34.7\% (n=92) had an annual income