TY - JOUR AU - Flaherty, Thomas Gerard AU - Mangan, Michael Ryan PY - 2025/3/21 TI - Impact of Social Media Influencers on Amplifying Positive Public Health Messages JO - J Med Internet Res SP - e73062 VL - 27 KW - social media KW - COVID-19 KW - vaccination KW - personal brands KW - public health KW - wellness KW - global health KW - pandemic KW - Twitter KW - tweets KW - vaccine KW - longitudinal design KW - wellness influencers KW - hand annotation KW - antivaccination KW - infodemiology UR - https://www.jmir.org/2025/1/e73062 UR - http://dx.doi.org/10.2196/73062 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/73062 ER - TY - JOUR AU - Atanasova, Sara AU - Kamin, Tanja AU - Perger, Nina PY - 2025/2/21 TI - 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 JO - JMIR Public Health Surveill SP - e64653 VL - 11 KW - vaccine uptake KW - young people KW - COVID-19 vaccine KW - health belief model KW - theory of planned behavior N2 - 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. UR - https://publichealth.jmir.org/2025/1/e64653 UR - http://dx.doi.org/10.2196/64653 UR - http://www.ncbi.nlm.nih.gov/pubmed/39983109 ID - info:doi/10.2196/64653 ER - TY - JOUR AU - Zhang, Kehe AU - Hunyadi, V. Jocelyn AU - de Oliveira Otto, C. Marcia AU - Lee, Miryoung AU - Zhang, Zitong AU - Ramphul, Ryan AU - Yamal, Jose-Miguel AU - Yaseen, Ashraf AU - Morrison, C. Alanna AU - Sharma, Shreela AU - Rahbar, Hossein Mohammad AU - Zhang, Xu AU - Linder, Stephen AU - Marko, Dritana AU - Roy, White Rachel AU - Banerjee, Deborah AU - Guajardo, Esmeralda AU - Crum, Michelle AU - Reininger, Belinda AU - Fernandez, E. Maria AU - Bauer, Cici PY - 2025/2/11 TI - Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis JO - JMIR Form Res SP - e62802 VL - 9 KW - COVID-19 testing KW - COVID-19 vaccination KW - study design KW - community-based interventions KW - geospatial analysis KW - public health KW - social determinants of health KW - data dashboard N2 - 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. UR - https://formative.jmir.org/2025/1/e62802 UR - http://dx.doi.org/10.2196/62802 ID - info:doi/10.2196/62802 ER - TY - JOUR AU - Rowley, AK Elizabeth AU - Mitchell, K. Patrick AU - Yang, Duck-Hye AU - Lewis, Ned AU - Dixon, E. Brian AU - Vazquez-Benitez, Gabriela AU - Fadel, F. William AU - Essien, J. Inih AU - Naleway, L. Allison AU - Stenehjem, Edward AU - Ong, C. Toan AU - Gaglani, Manjusha AU - Natarajan, Karthik AU - Embi, Peter AU - Wiegand, E. Ryan AU - Link-Gelles, Ruth AU - Tenforde, W. Mark AU - Fireman, Bruce PY - 2025/1/27 TI - Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study JO - JMIR Form Res SP - e58981 VL - 9 KW - disease risk score KW - propensity score KW - vaccine effectiveness KW - COVID-19 KW - simulation study KW - usefulness KW - comorbidity KW - assessment N2 - 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. UR - https://formative.jmir.org/2025/1/e58981 UR - http://dx.doi.org/10.2196/58981 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58981 ER - TY - JOUR AU - Kahlawi, Adham AU - Masri, Firas AU - Ahmed, Wasim AU - Vidal-Alaball, Josep PY - 2025/1/27 TI - 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 JO - J Med Internet Res SP - e58656 VL - 27 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - citizen opinion KW - text mining KW - LDA KW - health crisis KW - developing economies KW - Italy KW - Egypt KW - UK KW - dataset KW - content analysis KW - social media KW - twitter KW - tweet KW - sentiment KW - attitude KW - perception KW - perspective KW - machine learning KW - latent Dirichlet allocation KW - vaccine KW - vaccination KW - public health KW - infectious N2 - 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. UR - https://www.jmir.org/2025/1/e58656 UR - http://dx.doi.org/10.2196/58656 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58656 ER - TY - JOUR AU - Taira, Kazuya AU - Shiomi, Misa AU - Nakabe, Takayo AU - Imanaka, Yuichi PY - 2025/1/14 TI - The Association Between COVID-19 Vaccination Uptake and Information-Seeking Behaviors Using the Internet: Nationwide Cross-Sectional Study JO - J Med Internet Res SP - e59352 VL - 27 KW - COVID-19 vaccines KW - internet use KW - information seeking behavior KW - Japan KW - vaccine KW - COVID-19 KW - behavior KW - panel study KW - longitudinal KW - survey KW - regression analysis KW - chi-square test KW - adult KW - epidemiology KW - health informatics N2 - 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. UR - https://www.jmir.org/2025/1/e59352 UR - http://dx.doi.org/10.2196/59352 UR - http://www.ncbi.nlm.nih.gov/pubmed/39808493 ID - info:doi/10.2196/59352 ER - TY - JOUR AU - Daluwatte, Chathuri AU - Khromava, Alena AU - Chen, Yuning AU - Serradell, Laurence AU - Chabanon, Anne-Laure AU - Chan-Ou-Teung, Anthony AU - Molony, Cliona AU - Juhaeri, Juhaeri PY - 2024/12/20 TI - Application of a Language Model Tool for COVID-19 Vaccine Adverse Event Monitoring Using Web and Social Media Content: Algorithm Development and Validation Study JO - JMIR Infodemiology SP - e53424 VL - 4 KW - adverse event KW - COVID-19 KW - detection KW - large language model KW - mass vaccination KW - natural language processing KW - pharmacovigilance KW - safety KW - social media KW - vaccine N2 - 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. UR - https://infodemiology.jmir.org/2024/1/e53424 UR - http://dx.doi.org/10.2196/53424 UR - http://www.ncbi.nlm.nih.gov/pubmed/39705077 ID - info:doi/10.2196/53424 ER - TY - JOUR AU - Nie, Jia AU - Huang, Tian AU - Sun, Yuhong AU - Peng, Zutong AU - Dong, Wenlong AU - Chen, Jiancheng AU - Zheng, Di AU - Guo, Fuyin AU - Shi, Wenhui AU - Ling, Yuewei AU - Zhao, Weijia AU - Yang, Haijun AU - Shui, Tiejun AU - Yan, Xiangyu PY - 2024/12/17 TI - 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 JO - JMIR Public Health Surveill SP - e63146 VL - 10 KW - hand, foot, and mouth disease KW - vaccination KW - enterovirus 71 KW - COVID-19 KW - epidemical trend KW - HFMD KW - EV71 N2 - 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. UR - https://publichealth.jmir.org/2024/1/e63146 UR - http://dx.doi.org/10.2196/63146 ID - info:doi/10.2196/63146 ER - TY - JOUR AU - AbuRaed, Tawfiq Ahmed Ghassan AU - Prikryl, Azuma Emil AU - Carenini, Giuseppe AU - Janjua, Zafar Naveed PY - 2024/12/9 TI - Long COVID Discourse in Canada, the United States, and Europe: Topic Modeling and Sentiment Analysis of Twitter Data JO - J Med Internet Res SP - e59425 VL - 26 KW - long COVID KW - topic modeling KW - sentiment analysis KW - Twitter KW - public perception KW - social media analysis KW - public health N2 - 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. UR - https://www.jmir.org/2024/1/e59425 UR - http://dx.doi.org/10.2196/59425 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59425 ER - TY - JOUR AU - Na, Kilhoe AU - Zimdars, Melissa AU - Cullinan, E. Megan PY - 2024/12/5 TI - Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey JO - JMIR Form Res SP - e54092 VL - 8 KW - alternative health KW - social media KW - misinformation KW - vaccination KW - COVID-19 KW - Coronavirus N2 - 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. UR - https://formative.jmir.org/2024/1/e54092 UR - http://dx.doi.org/10.2196/54092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54092 ER - TY - JOUR AU - Béchard, Benoît AU - Gramaccia, A. Julie AU - Gagnon, Dominique AU - Laouan-Sidi, Anassour Elhadji AU - Dubé, Čve AU - Ouimet, Mathieu AU - de Hemptinne, Delphine AU - Tremblay, Sébastien PY - 2024/12/4 TI - The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation JO - JMIR Form Res SP - e52871 VL - 8 KW - attitude toward vaccination KW - misinformation KW - reinformation KW - confidence KW - perceived tentativeness KW - vaccine hesitancy KW - COVID-19 N2 - 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 (?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 (?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 UR - https://formative.jmir.org/2024/1/e52871 UR - http://dx.doi.org/10.2196/52871 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52871 ER - TY - JOUR AU - O'Brien, Gabrielle AU - Ganjigunta, Ronith AU - Dhillon, S. Paramveer PY - 2024/11/27 TI - Wellness Influencer Responses to COVID-19 Vaccines on Social Media: A Longitudinal Observational Study JO - J Med Internet Res SP - e56651 VL - 26 KW - social media, COVID-19, vaccination KW - personal brands KW - public health KW - wellness KW - global health KW - pandemic KW - Twitter KW - tweets KW - vaccine KW - longitudinal design KW - wellness influencers KW - hand-annotation KW - anti-vaccination KW - infodemiology N2 - 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 (?1=?2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals (?=?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 (?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. UR - https://www.jmir.org/2024/1/e56651 UR - http://dx.doi.org/10.2196/56651 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56651 ER - TY - JOUR AU - Barbosa da Silva Júnior, Jarbas AU - Garcia-Saiso, Sebastian AU - Marti, Myrna AU - Salas, Daniel AU - Contreras, Marcela AU - Velandia-Gonzalez, Martha AU - Luna, Daniel AU - Nelson, Jennifer AU - Fitzgerald, James AU - Bascolo, Ernesto AU - Talavera Romero, Lorena Ivy AU - Chomali, May AU - Curioso, H. Walter AU - Plazzotta, Fernando AU - Otero, Carlos AU - Lopez Osornio, Alejandro AU - Lennemann, Tessa AU - Salinas, Karen AU - D'Agostino, Marcelo PY - 2024/11/26 TI - Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes JO - JMIR Public Health Surveill SP - e65740 VL - 10 KW - medical informatics KW - health systems KW - immunizations KW - public health KW - viewpoint KW - health challenges KW - digital vaccine certificates KW - outbreak management KW - outbreak KW - accuracy KW - healthcare KW - surveillance KW - health outcomes KW - global health KW - mobile phone UR - https://publichealth.jmir.org/2024/1/e65740 UR - http://dx.doi.org/10.2196/65740 ID - info:doi/10.2196/65740 ER - TY - JOUR AU - Deady, Matthew AU - Duncan, Raymond AU - Sonesen, Matthew AU - Estiandan, Renier AU - Stimpert, Kelly AU - Cho, Sylvia AU - Beers, Jeffrey AU - Goodness, Brian AU - Jones, Daniel Lance AU - Forshee, Richard AU - Anderson, A. Steven AU - Ezzeldin, Hussein PY - 2024/11/25 TI - A Computable Phenotype Algorithm for Postvaccination Myocarditis/Pericarditis Detection Using Real-World Data: Validation Study JO - J Med Internet Res SP - e54597 VL - 26 KW - adverse event KW - vaccine safety KW - interoperability KW - computable phenotype KW - postmarket surveillance system KW - fast healthcare interoperability resources KW - FHIR KW - real-world data KW - validation study KW - Food and Drug Administration KW - electronic health records KW - COVID-19 vaccine N2 - 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. UR - https://www.jmir.org/2024/1/e54597 UR - http://dx.doi.org/10.2196/54597 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54597 ER - TY - JOUR AU - Torán-Monserrat, Pere AU - Lamonja-Vicente, Noemí AU - Costa-Garrido, Anna AU - Carrasco-Ribelles, A. Lucía AU - Quirant, Bibiana AU - Boigues, Marc AU - Molina, Xaviera AU - Chacón, Carla AU - Dacosta-Aguayo, Rosalia AU - Arméstar, Fernando AU - Martínez Cáceres, María Eva AU - Prado, G. Julia AU - Violán, Concepción AU - PY - 2024/11/22 TI - SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study JO - JMIR Public Health Surveill SP - e56926 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - health care workers KW - cohort KW - extended Cox models KW - coronavirus KW - epidemiology KW - epidemiological KW - risks KW - infectious KW - respiratory KW - longitudinal KW - vaccines KW - vaccination KW - vaccinated N2 - 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 UR - https://publichealth.jmir.org/2024/1/e56926 UR - http://dx.doi.org/10.2196/56926 ID - info:doi/10.2196/56926 ER - TY - JOUR AU - Calderon Ramirez, Lucrecia Claudia AU - Farmer, Yanick AU - Downar, James AU - Frolic, Andrea AU - Opatrny, Lucie AU - Poirier, Diane AU - Bravo, Gina AU - L'Espérance, Audrey AU - Gaucher, Nathalie AU - Payot, Antoine AU - Dahine, Joseph AU - Tanuseputro, Peter AU - Rousseau, Louis-Martin AU - Dumez, Vincent AU - Descôteaux, Annie AU - Dallaire, Clara AU - Laporte, Karell AU - Bouthillier, Marie-Eve PY - 2024/11/11 TI - 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 JO - J Particip Med SP - e54841 VL - 16 KW - quality assessment KW - online democratic deliberation KW - COVID-19 triage or prioritization KW - critical care KW - clinical ethics N2 - 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. UR - https://jopm.jmir.org/2024/1/e54841 UR - http://dx.doi.org/10.2196/54841 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54841 ER - TY - JOUR AU - Hong, Seohyun AU - Son, Yejun AU - Lee, Myeongcheol AU - Lee, Hyuk Jun AU - Park, Jaeyu AU - Lee, Hayeon AU - Dragioti, Elena AU - Fond, Guillaume AU - Boyer, Laurent AU - López Sánchez, Felipe Guillermo AU - Smith, Lee AU - Tully, A. Mark AU - Rahmati, Masoud AU - Choi, Sung Yong AU - Lee, Joo Young AU - Yeo, Geun Seung AU - Woo, Selin AU - Yon, Keon Dong PY - 2024/11/1 TI - Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e56989 VL - 10 KW - COVID-19 KW - influenza KW - South Korea KW - vaccination KW - vaccinations KW - COVID-19 vaccine KW - COVID-19 vaccination KW - SARS-CoV-2 KW - SARS-CoV-2 vaccine KW - pandemic KW - SARS-CoV-2 vaccination KW - vaccine KW - vaccine hesitancy N2 - 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. UR - https://publichealth.jmir.org/2024/1/e56989 UR - http://dx.doi.org/10.2196/56989 ID - info:doi/10.2196/56989 ER - TY - JOUR AU - Gustafson Hedov, Emelie AU - Nyberg, Fredrik AU - Gustafsson, Stefan AU - Li, Huiqi AU - Gisslén, Magnus AU - Sundström, Johan PY - 2024/10/30 TI - Person-Centered Web-Based Mobile Health System (Symptoms) for Reporting Symptoms in COVID-19 Vaccinated Individuals: Observational Study of System, Users, and Symptoms JO - JMIR Form Res SP - e57514 VL - 8 KW - mHealth KW - mobile health KW - patient-reported outcomes KW - apps KW - COVID-19 KW - vaccination side effects KW - web-based symptom reporting N2 - 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 Västra Götaland 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. UR - https://formative.jmir.org/2024/1/e57514 UR - http://dx.doi.org/10.2196/57514 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57514 ER - TY - JOUR AU - Preuhs, Katharina AU - Bussink-Voorend, Daphne AU - van Keulen, M. Hilde AU - Wildeman, Ilona AU - Hautvast, Jeannine AU - Hulscher, Marlies AU - van Empelen, Pepijn PY - 2024/10/30 TI - An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use JO - JMIR Form Res SP - e56390 VL - 8 KW - COVID-19 KW - COVID-19 vaccination KW - informed decision-making KW - user-centered design KW - low literacy KW - eHealth KW - tailored decision aid N2 - 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. UR - https://formative.jmir.org/2024/1/e56390 UR - http://dx.doi.org/10.2196/56390 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56390 ER - TY - JOUR AU - Brooks, J. Donald AU - Kim, Inae Carolyn AU - Mboussou, Fortune Franck AU - Danovaro-Holliday, Carolina M. PY - 2024/10/25 TI - Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study JO - JMIR Public Health Surveill SP - e62657 VL - 10 KW - COVID-19 KW - COVID-19 vaccine KW - immunization information system KW - vaccination monitoring KW - vaccine KW - monitoring and evaluation N2 - 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. UR - https://publichealth.jmir.org/2024/1/e62657 UR - http://dx.doi.org/10.2196/62657 ID - info:doi/10.2196/62657 ER - TY - JOUR AU - Oan?, Iulian AU - Hâncean, Marian-Gabriel AU - Perc, Matja? AU - Lerner, Jürgen AU - Mih?il?, Bianca-Elena AU - Geant?, Marius AU - Molina, Luis José AU - Tinc?, Isabela AU - Espina, Carolina PY - 2024/10/25 TI - Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study JO - J Med Internet Res SP - e58257 VL - 26 KW - vaccine hesitancy KW - online media KW - social media KW - assortative mixing KW - personal network analysis KW - social network analysis KW - Romania KW - vaccination KW - health information KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2024/1/e58257 UR - http://dx.doi.org/10.2196/58257 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58257 ER - TY - JOUR AU - Kolis, Jessica AU - Brookmeyer, Kathryn AU - Chuvileva, Yulia AU - Voegeli, Christopher AU - Juma, Sarina AU - Ishizumi, Atsuyoshi AU - Renfro, Katy AU - Wilhelm, Elisabeth AU - Tice, Hannah AU - Fogarty, Hannah AU - Kocer, Irma AU - Helms, Jordan AU - Verma, Anisha PY - 2024/10/24 TI - Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action JO - JMIR Public Health Surveill SP - e51909 VL - 10 KW - infodemic KW - infodemic management KW - vaccine confidence KW - vaccine demand KW - misinformation KW - disinformation KW - infodemiology KW - mixed methods KW - thematic analysis KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51909 UR - http://dx.doi.org/10.2196/51909 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51909 ER - TY - JOUR AU - Salisbury, David AU - Lazarus, V. Jeffrey AU - Waite, Nancy AU - Lehmann, Clara AU - Sri Bhashyam, Sumitra AU - de la Cruz, Marie AU - Hahn, Beth AU - Rousculp, D. Matthew AU - Bonanni, Paolo PY - 2024/10/16 TI - COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e57242 VL - 10 KW - COVID-19 KW - discrete choice experiment KW - vaccine hesitancy KW - vaccine side effects KW - SARS-CoV-2 KW - COVID vaccination KW - immunization KW - preference elicitation KW - informed decision-making KW - antivaccine N2 - 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. UR - https://publichealth.jmir.org/2024/1/e57242 UR - http://dx.doi.org/10.2196/57242 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412841 ID - info:doi/10.2196/57242 ER - TY - JOUR AU - Luchman, Joseph AU - Bennett, Morgane AU - Kranzler, Elissa AU - Tuskeviciute, Rugile AU - Vega, Ronald AU - Denison, Benjamin AU - Trigger, Sarah AU - Nighbor, Tyler AU - Vines, Monica AU - Hoffman, Leah PY - 2024/9/10 TI - 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 JO - JMIR Public Health Surveill SP - e56044 VL - 10 KW - COVID-19 KW - COVID-19 vaccination KW - vaccine KW - United States KW - segmentation KW - latent class cluster analysis KW - vaccines KW - vaccination KW - segmentation analysis KW - estimation KW - validation KW - attitude KW - attitudes KW - belief KW - beliefs KW - behavior KW - behaviors KW - sociodemographic KW - nonintender KW - nonintenders KW - waiter KW - waiters KW - confident KW - confidents KW - social distancing KW - bivariate KW - regression analysis KW - survey KW - respondent KW - respondents N2 - 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. UR - https://publichealth.jmir.org/2024/1/e56044 UR - http://dx.doi.org/10.2196/56044 UR - http://www.ncbi.nlm.nih.gov/pubmed/39255032 ID - info:doi/10.2196/56044 ER - TY - JOUR AU - Kazi, Momin Abdul AU - Ahsan, Nazia AU - Jabeen, Rawshan AU - Allana, Raheel AU - Jamal, Saima AU - Mughal, Khan Muhammad Ayub AU - Hopkins, L. Kathryn AU - Malik, Aman Fauzia PY - 2024/9/4 TI - 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 JO - JMIR Infodemiology SP - e49366 VL - 4 KW - infodemics KW - mHealth KW - social media KW - electronic media KW - Pakistan KW - vaccination KW - misinformation KW - infodemiology KW - mobile phone N2 - 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. UR - https://infodemiology.jmir.org/2024/1/e49366 UR - http://dx.doi.org/10.2196/49366 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49366 ER - TY - JOUR AU - Shea, Lindsay AU - Cooper, Dylan AU - Ventimiglia, Jonas AU - Frisbie, Shelby AU - Carlton, Conner AU - Song, Wei AU - Salzer, Mark AU - Lee, Brian AU - Hotez, Emily AU - Vanness, J. David PY - 2024/8/28 TI - Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data JO - JMIR Public Health Surveill SP - e51054 VL - 10 KW - autism KW - COVID-19 KW - vaccination KW - public health KW - autism spectrum disorder KW - autistic KW - vaccine KW - vaccines KW - acceptance KW - hesitancy KW - immunize KW - immunization KW - immunizations KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - neurodevelopmental KW - infectious KW - respiratory KW - survey KW - surveys N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51054 UR - http://dx.doi.org/10.2196/51054 UR - http://www.ncbi.nlm.nih.gov/pubmed/39196609 ID - info:doi/10.2196/51054 ER - TY - JOUR AU - Harrigan, P. Sean AU - Velásquez García, A. Héctor AU - Abdia, Younathan AU - Wilton, James AU - Prystajecky, Natalie AU - Tyson, John AU - Fjell, Chris AU - Hoang, Linda AU - Kwong, C. Jeffrey AU - Mishra, Sharmistha AU - Wang, Linwei AU - Sander, Beate AU - Janjua, Z. Naveed AU - Sbihi, Hind PY - 2024/8/27 TI - The Clinical Severity of COVID-19 Variants of Concern: Retrospective Population-Based Analysis JO - JMIR Public Health Surveill SP - e45513 VL - 10 KW - COVID-19 KW - SARS-CoV-2 KW - severity KW - whole genome sequencing KW - WGS KW - social determinants of health KW - SDOHs KW - vaccination KW - variants of concern KW - VOCs KW - Alpha KW - Gamma KW - Delta KW - Omicron N2 - 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. UR - https://publichealth.jmir.org/2024/1/e45513 UR - http://dx.doi.org/10.2196/45513 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190434 ID - info:doi/10.2196/45513 ER - TY - JOUR AU - Williams, Paul AU - Herring, A. Timothy AU - Yokota, C. Renata T. AU - Maia, Tiago AU - Venkatesan, Sudhir AU - Marcus, C. James AU - Settergren, Gabriella AU - Arnetorp, Sofie AU - Lloyd, Andrew AU - Severens, L. Johan AU - Varni, W. James AU - Dixon, Sharon AU - Hamusankwa, Lweendo AU - Powell, A. Philip AU - Taylor, Sylvia AU - Ware Jr, E. John AU - Krol, Marieke PY - 2024/8/13 TI - 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 JO - JMIR Res Protoc SP - e52643 VL - 13 KW - SARS-CoV-2 KW - social isolation KW - patient participation KW - patient-reported outcome measures KW - quality of life KW - immunosuppression KW - respiratory tract infection KW - cost of illness KW - surveys and questionnaires KW - protocol N2 - 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 UR - https://www.researchprotocols.org/2024/1/e52643 UR - http://dx.doi.org/10.2196/52643 UR - http://www.ncbi.nlm.nih.gov/pubmed/39137022 ID - info:doi/10.2196/52643 ER - TY - JOUR AU - Yin, Dean-Chen Jason PY - 2024/8/9 TI - Vaccine Hesitancy in Taiwan: Temporal, Multilayer Network Study of Echo Chambers Shaped by Influential Users JO - Online J Public Health Inform SP - e55104 VL - 16 KW - network analysis KW - infodemiology KW - vaccine hesitancy KW - Taiwan KW - multiplex network KW - echo chambers KW - influential users KW - information dissemination KW - health communication KW - Taiwanese data set KW - multilayer network model KW - vaccine hesitant KW - antivaccination KW - infoveillance KW - disease surveillance KW - public health N2 - 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. UR - https://ojphi.jmir.org/2024/1/e55104 UR - http://dx.doi.org/10.2196/55104 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55104 ER - TY - JOUR AU - Markovic, Andjela AU - Kovacevic, Vladimir AU - Brakenhoff, B. Timo AU - Veen, Duco AU - Klaver, Paul AU - Mitratza, Marianna AU - Downward, S. George AU - Grobbee, E. Diederick AU - Cronin, Maureen AU - Goodale, M. Brianna AU - PY - 2024/7/31 TI - Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial JO - J Med Internet Res SP - e51120 VL - 26 KW - wearable technology KW - biosignals KW - digital health KW - SARS-CoV-2 KW - vaccine reactogenicity KW - menstrual cycle KW - vaccine KW - wearables KW - sex KW - development KW - implementation KW - medical device KW - breathing rate KW - heart rate KW - biological mechanism KW - immune response KW - vaccination N2 - 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 UR - https://www.jmir.org/2024/1/e51120 UR - http://dx.doi.org/10.2196/51120 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51120 ER - TY - JOUR AU - Basu, Saurav AU - Desai, Meghana AU - Karan, Anup AU - Bhardwaj, Surbhi AU - Negandhi, Himanshu AU - Jadhav, Nitin AU - Maske, Amar AU - Zodpey, Sanjay PY - 2024/7/29 TI - COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation JO - JMIR Public Health Surveill SP - e47520 VL - 10 KW - COVID-19 KW - community intervention KW - COVID-19 vaccination KW - COVID-appropriate behavior KW - impact evaluation KW - rural health KW - community-based intervention KW - rural population KW - awareness KW - disease prevention KW - health literacy KW - public health KW - pandemic KW - digital health KW - community awareness KW - effectiveness KW - low- and middle-income countries KW - vaccination KW - infodemic N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47520 UR - http://dx.doi.org/10.2196/47520 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073851 ID - info:doi/10.2196/47520 ER - TY - JOUR AU - Huang, Yiting AU - Feng, Shuaixin AU - Zhao, Yuyan AU - Wang, Haode AU - Jiang, Hongbo PY - 2024/7/29 TI - Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments JO - JMIR Public Health Surveill SP - e56546 VL - 10 KW - systematic review KW - discrete choice experiment KW - preference KW - COVID-19 KW - vaccine N2 - 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 UR - https://publichealth.jmir.org/2024/1/e56546 UR - http://dx.doi.org/10.2196/56546 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073875 ID - info:doi/10.2196/56546 ER - TY - JOUR AU - Moffett, W. Kenneth AU - Marshall, C. Michael AU - Kim, C. Jae-Eun AU - Dahlen, Heather AU - Denison, Benjamin AU - Kranzler, C. Elissa AU - Meaney, Morgan AU - Hoffman, Blake AU - Pavisic, Ivica AU - Hoffman, Leah PY - 2024/7/29 TI - Analyzing Google COVID-19 Vaccine Intent Search Trends and Vaccine Readiness in the United States: Panel Data Study JO - Online J Public Health Inform SP - e55422 VL - 16 KW - information-seeking behavior KW - COVID-19 KW - internet use KW - vaccination KW - vaccine hesitancy N2 - 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 (?=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 (?=?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. UR - https://ojphi.jmir.org/2024/1/e55422 UR - http://dx.doi.org/10.2196/55422 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073868 ID - info:doi/10.2196/55422 ER - TY - JOUR AU - Li, Yiming AU - Li, Jianfu AU - Dang, Yifang AU - Chen, Yong AU - Tao, Cui PY - 2024/7/15 TI - Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis JO - JMIR Public Health Surveill SP - e51007 VL - 10 KW - COVID-19 KW - vaccine KW - COVID-19 vaccine KW - adverse drug event KW - ADE KW - Vaccine Adverse Event Reporting System KW - VAERS KW - adverse event following immunization KW - AEFI N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51007 UR - http://dx.doi.org/10.2196/51007 UR - http://www.ncbi.nlm.nih.gov/pubmed/39008362 ID - info:doi/10.2196/51007 ER - TY - JOUR AU - Du, Zhanwei AU - Liu, Caifen AU - Bai, Yuan AU - Wang, Lin AU - Lim, Wen Wey AU - Lau, Y. Eric H. AU - Cowling, J. Benjamin PY - 2024/7/12 TI - Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis JO - JMIR Public Health Surveill SP - e49812 VL - 10 KW - COVID-19 KW - SARS-CoV-2 KW - dose fractionation KW - neutralizing antibody level KW - vaccination KW - review KW - vaccine N2 - 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. UR - https://publichealth.jmir.org/2024/1/e49812 UR - http://dx.doi.org/10.2196/49812 ID - info:doi/10.2196/49812 ER - TY - JOUR AU - Xu, Stanley AU - Sy, S. Lina AU - Hong, Vennis AU - Holmquist, J. Kimberly AU - Qian, Lei AU - Farrington, Paddy AU - Bruxvoort, J. Katia AU - Klein, P. Nicola AU - Fireman, Bruce AU - Han, Bing AU - Lewin, J. Bruno PY - 2024/6/25 TI - Ischemic Stroke After Bivalent COVID-19 Vaccination: Self-Controlled Case Series Study JO - JMIR Public Health Surveill SP - e53807 VL - 10 KW - ischemic stroke KW - bivalent COVID-19 vaccine KW - influenza vaccine KW - self-controlled case series KW - coadministration KW - ischemic KW - stroke KW - TIA KW - transient ischemic attack KW - ischemia KW - cardiovascular KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - vaccines KW - vaccination KW - association KW - correlation KW - risk KW - risks KW - adverse KW - side effect KW - subgroup analyses KW - subgroup analysis KW - bivalent KW - influenza KW - infectious KW - respiratory KW - incidence KW - case series N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53807 UR - http://dx.doi.org/10.2196/53807 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916940 ID - info:doi/10.2196/53807 ER - TY - JOUR AU - Lang, Anna-Lena AU - Hohmuth, Nils AU - Vi?kovi?, Vuka?in AU - Konigorski, Stefan AU - Scholz, Stefan AU - Balzer, Felix AU - Remschmidt, Cornelius AU - Leistner, Rasmus PY - 2024/6/4 TI - COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application?Based Prospective Observational Cohort Study JO - J Med Internet Res SP - e47070 VL - 26 KW - COVID-19 KW - SARS-CoV-2 KW - COVID-19 vaccines KW - BNT162b2 KW - vaccine effectiveness KW - participatory disease surveillance KW - web application KW - digital public health KW - vaccination KW - Germany KW - effectiveness KW - data collection KW - disease surveillance KW - tool N2 - 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. UR - https://www.jmir.org/2024/1/e47070 UR - http://dx.doi.org/10.2196/47070 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833299 ID - info:doi/10.2196/47070 ER - TY - JOUR AU - Rahbeni, Al Tahani AU - Satapathy, Prakasini AU - Itumalla, Ramaiah AU - Marzo, Rillera Roy AU - Mugheed, L. Khalid A. AU - Khatib, Nazli Mahalaqua AU - Gaidhane, Shilpa AU - Zahiruddin, Syed Quazi AU - Rabaan, A. Ali AU - Alrasheed, A. Hayam AU - Al-Subaie, F. Maha AU - Al Kaabil, A. Nawal AU - Alissa, Mohammed AU - Ibrahim, L. Amani Ahmed A. AU - Alsaif, Abdulkhaliq Hussain AU - Naser, Habeeb Israa AU - Rustagi, Sarvesh AU - Kukreti, Neelima AU - Dziedzic, Arkadiusz PY - 2024/4/30 TI - COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis JO - JMIR Public Health Surveill SP - e54769 VL - 10 KW - COVID-19 KW - vaccine acceptance KW - vaccine hesitancy KW - umbrella review KW - systematic review KW - meta-analysis KW - vaccine KW - hesitancy KW - global perceptions KW - perception KW - random effect model KW - synthesis KW - healthcare workers KW - patients KW - patient KW - chronic disease KW - pregnant women KW - parents KW - child KW - children N2 - 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 UR - https://publichealth.jmir.org/2024/1/e54769 UR - http://dx.doi.org/10.2196/54769 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687992 ID - info:doi/10.2196/54769 ER - TY - JOUR AU - Liao, Qiuyan AU - Yuan, Jiehu AU - Wong, Ling Irene Oi AU - Ni, Yuxuan Michael AU - Cowling, John Benjamin AU - Lam, Tak Wendy Wing PY - 2024/4/22 TI - 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 JO - JMIR Public Health Surveill SP - e50958 VL - 10 KW - COVID-19 KW - vaccination acceptance KW - vaccine hesitancy KW - motivators KW - co-occurrence network analysis N2 - 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. UR - https://publichealth.jmir.org/2024/1/e50958 UR - http://dx.doi.org/10.2196/50958 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648099 ID - info:doi/10.2196/50958 ER - TY - JOUR AU - Cheng, Wei AU - Xu, Yun AU - Jiang, Haibo AU - Li, Jun AU - Hou, Zhigang AU - Meng, Haibin AU - Wang, Wei AU - Chai, Chengliang AU - Jiang, Jianmin PY - 2024/4/17 TI - 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 JO - JMIR Public Health Surveill SP - e51449 VL - 10 KW - associated factors KW - COVID-19 KW - hospitalization KW - infection KW - people living with HIV KW - SARS-CoV-2 Omicron variant N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51449 UR - http://dx.doi.org/10.2196/51449 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630534 ID - info:doi/10.2196/51449 ER - TY - JOUR AU - Themistocleous, Sophia AU - Argyropoulos, D. Christos AU - Vogazianos, Paris AU - Shiamakkides, George AU - Noula, Evgenia AU - Nearchou, Andria AU - Yiallouris, Andreas AU - Filippou, Charalampos AU - Stewart, A. Fiona AU - Koniordou, Markela AU - Kopsidas, Ioannis AU - Askling, H. Helena AU - Vene, Sirkka AU - Gagneux-Brunon, Amandine AU - Prellezo, Baranda Jana AU - Álvarez-Barco, Elena AU - Salmanton-García, Jon AU - Leckler, Janina AU - Macken, J. Alan AU - Davis, Joanna Ruth AU - Azzini, Maria Anna AU - Armeftis, Charis AU - Hellemans, Margot AU - Di Marzo, Romina AU - Luis, Catarina AU - Olesen, F. Ole AU - Valdenmaiier, Olena AU - Jakobsen, Finne Stine AU - Nauclér, Pontus AU - Launay, Odile AU - Mallon, Patrick AU - Ochando, Jordi AU - van Damme, Pierre AU - Tacconelli, Evelina AU - Zaoutis, Theoklis AU - Cornely, A. Oliver AU - Pana, Dorothea Zoi PY - 2024/4/4 TI - Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study JO - JMIR Public Health Surveill SP - e47241 VL - 10 KW - patient advocacy groups KW - clinical trials KW - volunteer registry KW - vaccines KW - public health KW - healthcare KW - COVID-19 KW - vaccine trial KW - VACCELERATE KW - health promotion KW - health advocate KW - clinical trial N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47241 UR - http://dx.doi.org/10.2196/47241 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573762 ID - info:doi/10.2196/47241 ER - TY - JOUR AU - Zhang, M. Jueman AU - Wang, Yi AU - Mouton, Magali AU - Zhang, Jixuan AU - Shi, Molu PY - 2024/4/3 TI - Public Discourse, User Reactions, and Conspiracy Theories on the X Platform About HIV Vaccines: Data Mining and Content Analysis JO - J Med Internet Res SP - e53375 VL - 26 KW - HIV KW - vaccine KW - Twitter KW - X platform KW - infodemiology KW - machine learning KW - topic modeling KW - sentiment KW - conspiracy theory KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2024/1/e53375 UR - http://dx.doi.org/10.2196/53375 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568723 ID - info:doi/10.2196/53375 ER - TY - JOUR AU - Blazek, Susanne E. AU - Bucher, Amy PY - 2024/3/19 TI - Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study JO - JMIR Form Res SP - e50181 VL - 8 KW - behavioral barriers KW - benefits KW - COVID-19 KW - Marine Corps KW - military KW - vaccine reluctance N2 - 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 (?=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. UR - https://formative.jmir.org/2024/1/e50181 UR - http://dx.doi.org/10.2196/50181 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502179 ID - info:doi/10.2196/50181 ER - TY - JOUR AU - Vike, L. Nicole AU - Bari, Sumra AU - Stefanopoulos, Leandros AU - Lalvani, Shamal AU - Kim, Woo Byoung AU - Maglaveras, Nicos AU - Block, Martin AU - Breiter, C. Hans AU - Katsaggelos, K. Aggelos PY - 2024/3/18 TI - Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study JO - JMIR Public Health Surveill SP - e47979 VL - 10 KW - reward KW - aversion KW - judgment KW - relative preference theory KW - cognitive science KW - behavioral economics KW - machine learning KW - balanced random forest KW - mediation KW - moderation KW - mobile phone KW - smartphone N2 - 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). UR - https://publichealth.jmir.org/2024/1/e47979 UR - http://dx.doi.org/10.2196/47979 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315620 ID - info:doi/10.2196/47979 ER - TY - JOUR AU - González-Salinas, I. Anna AU - Andrade, L. Elizabeth AU - Abroms, C. Lorien AU - Gómez, Kaitlyn AU - Favetto, Carla AU - Gómez, M. Valeria AU - Collins, K. Karen PY - 2024/3/14 TI - Latino Parents? Reactions to and Engagement With a Facebook Group?Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study JO - JMIR Form Res SP - e51331 VL - 8 KW - COVID-19 KW - misinformation KW - social media KW - Latino parents KW - Spanish KW - vaccines KW - digital intervention N2 - 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. UR - https://formative.jmir.org/2024/1/e51331 UR - http://dx.doi.org/10.2196/51331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483457 ID - info:doi/10.2196/51331 ER - TY - JOUR AU - Kumwichar, Ponlagrit AU - Poonsiri, Chittawan AU - Botwright, Siobhan AU - Sirichumroonwit, Natchalaikorn AU - Loharjun, Bootsakorn AU - Thawillarp, Supharerk AU - Cheewaruangroj, Nontawit AU - Chokchaisiripakdee, Amorn AU - Teerawattananon, Yot AU - Chongsuvivatwong, Virasakdi PY - 2024/3/5 TI - Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data JO - JMIR Public Health Surveill SP - e48255 VL - 10 KW - COVID-19 KW - heterologous vaccine KW - vaccine KW - vaccine effectiveness KW - durability KW - time KW - waning KW - real-world KW - public health KW - vaccination strategy KW - health outcome KW - vaccines KW - vaccination KW - unvaccinated KW - big data KW - registry KW - registries KW - health outcomes KW - effectiveness KW - SARS-CoV-2 KW - cohort KW - database KW - databases KW - vaccinated KW - Cochran-Mantel-Haenszel KW - Mantel-Haenszel KW - regression KW - risk KW - risks KW - association KW - associations KW - odds ratio KW - odds ratios N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48255 UR - http://dx.doi.org/10.2196/48255 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441923 ID - info:doi/10.2196/48255 ER - TY - JOUR AU - Hakim, Hina AU - Driedger, Michelle S. AU - Gagnon, Dominique AU - Chevrier, Julien AU - Roch, Genevičve AU - Dubé, Eve AU - Witteman, O. Holly PY - 2024/2/29 TI - Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review JO - JMIR Serious Games SP - e47257 VL - 12 KW - digital gamified tools KW - digital game KW - vaccination KW - gamification KW - vaccine uptake KW - scoping review KW - review method KW - vaccine KW - gamified KW - COVID-19 KW - COVID KW - SARS-CoV-2 KW - health behaviour KW - health behavior KW - health promotion KW - behavior change KW - behaviour change N2 - 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. UR - https://games.jmir.org/2024/1/e47257 UR - http://dx.doi.org/10.2196/47257 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421688 ID - info:doi/10.2196/47257 ER - TY - JOUR AU - Dreyer, A. Nancy AU - Knuth, B. Kendall AU - Xie, Yiqiong AU - Reynolds, W. Matthew AU - Mack, D. Christina PY - 2024/2/27 TI - COVID-19 Vaccination Reactions and Risk of Breakthrough Infections Among People With Diabetes: Cohort Study Derived From Community Reporters JO - JMIR Diabetes SP - e45536 VL - 9 KW - COVID-19 KW - diabetes KW - vaccine KW - vaccine hesitancy KW - registry KW - person-generated health data KW - patient-reported outcomes KW - side effects KW - vaccination KW - infection KW - nondiabetic adult KW - clinical data KW - fatigue KW - headache KW - risk KW - patient data KW - medication KW - community health N2 - 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 UR - https://diabetes.jmir.org/2024/1/e45536 UR - http://dx.doi.org/10.2196/45536 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412008 ID - info:doi/10.2196/45536 ER - TY - JOUR AU - Kopila?, Vanja AU - Nasadiuk, Khrystyna AU - Martinelli, Lucia AU - Lhotska, Lenka AU - Todorovic, Zoran AU - Vidmar, Matjaz AU - Machado, Helena AU - Svalastog, Lydia Anna AU - Gajovi?, Sre?ko PY - 2024/2/19 TI - 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 JO - JMIR Hum Factors SP - e44258 VL - 11 KW - SARS-CoV-2 virus KW - COVID-19 vaccination KW - pandemic KW - hesitancy KW - safety KW - vaccination KW - COVID-19 KW - tool KW - implementation KW - vaccine hesitancy KW - effectiveness KW - sociocultural KW - communication KW - disinformation N2 - 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 2×2 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. UR - https://humanfactors.jmir.org/2024/1/e44258 UR - http://dx.doi.org/10.2196/44258 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373020 ID - info:doi/10.2196/44258 ER - TY - JOUR AU - Mahmood, Bushra AU - Adu, Prince AU - McKee, Geoffrey AU - Bharmal, Aamir AU - Wilton, James AU - Janjua, Zafar Naveed PY - 2024/2/16 TI - Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey JO - JMIR Public Health Surveill SP - e48466 VL - 10 KW - COVID-19 KW - vaccine hesitancy KW - mistrust KW - trust KW - ethnic minorities KW - South Asian KW - vaccine KW - vaccination KW - hesitancy KW - ethnic KW - ethnicity KW - minority KW - cultural KW - racial KW - minorities KW - SARS-CoV-2 KW - coronavirus KW - Asia KW - Asian N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48466 UR - http://dx.doi.org/10.2196/48466 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363596 ID - info:doi/10.2196/48466 ER - TY - JOUR AU - Li, Guanjian AU - Zhang, Rongqiu AU - Song, Bing AU - Wang, Chao AU - Shen, Qunshan AU - He, Xiaojin AU - Cao, Yunxia PY - 2023/12/6 TI - Effects of SARS-CoV-2 Vaccines on Sperm Quality: Systematic Review JO - JMIR Public Health Surveill SP - e48511 VL - 9 KW - COVID-19 vaccine KW - SARS-CoV-2 KW - reproductive system KW - fertility KW - sperm quality N2 - 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. UR - https://publichealth.jmir.org/2023/1/e48511 UR - http://dx.doi.org/10.2196/48511 UR - http://www.ncbi.nlm.nih.gov/pubmed/37976132 ID - info:doi/10.2196/48511 ER - TY - JOUR AU - Zeng, Chengbo AU - Zhang, Jiajia AU - Li, Zhenlong AU - Sun, Xiaowen AU - Ning, Huan AU - Yang, Xueying AU - Weissman, Sharon AU - Olatosi, Bankole AU - Li, Xiaoming PY - 2023/12/5 TI - Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study JO - JMIR Public Health Surveill SP - e44257 VL - 9 KW - Deep South KW - COVID-19 KW - vaccine KW - booster KW - residential segregation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44257 UR - http://dx.doi.org/10.2196/44257 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051568 ID - info:doi/10.2196/44257 ER - TY - JOUR AU - Chau, Brian AU - Taba, Melody AU - Dodd, Rachael AU - McCaffery, Kirsten AU - Bonner, Carissa PY - 2023/10/18 TI - Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People JO - JMIR Res Protoc SP - e48641 VL - 12 KW - twitch KW - social media KW - COVID-19 KW - vaccination communication KW - video gaming KW - gaming KW - health promotion KW - streaming N2 - 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 UR - https://www.researchprotocols.org/2023/1/e48641 UR - http://dx.doi.org/10.2196/48641 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851494 ID - info:doi/10.2196/48641 ER - TY - JOUR AU - Liu, Ming AU - Zhao, Tianshuo AU - Mu, Qiuyue AU - Zhang, Ruizhi AU - Liu, Chunting AU - Xu, Fei AU - Liang, Luxiang AU - Zhao, Linglu AU - Zhao, Suye AU - Cai, Xianming AU - Wang, Mingting AU - Huang, Ninghua AU - Feng, Tian AU - Lei, Shiguang AU - Yang, Guanghong AU - Cui, Fuqiang PY - 2023/10/11 TI - Immune-Boosting Effect of the COVID-19 Vaccine: Real-World Bidirectional Cohort Study JO - JMIR Public Health Surveill SP - e47272 VL - 9 KW - bidirectional cohort study KW - booster administration KW - COVID-19 vaccine KW - real-world study KW - SARS-CoV-2 KW - vaccine efficacy KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e47272 UR - http://dx.doi.org/10.2196/47272 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819703 ID - info:doi/10.2196/47272 ER - TY - JOUR AU - Bagasra, Anisah AU - Allen, T. Christopher AU - Doan, Sara PY - 2023/10/10 TI - Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States JO - JMIR Hum Factors SP - e39919 VL - 10 KW - health promotion KW - health communication KW - health risk behavior KW - behavioral intention KW - public health KW - COVID-19 KW - vaccination KW - prevention KW - health education N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e39919 UR - http://dx.doi.org/10.2196/39919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37815862 ID - info:doi/10.2196/39919 ER - TY - JOUR AU - Xu, Stanley AU - Hong, Vennis AU - Sy, S. Lina AU - Bruxvoort, J. Katia AU - Lewin, Bruno AU - Han, Bing AU - Holmquist, J. Kimberly AU - Qian, Lei PY - 2023/10/4 TI - 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 JO - JMIR Public Health Surveill SP - e46318 VL - 9 KW - mRNA COVID-19 vaccines KW - 2-dose primary series KW - vaccines KW - SARS-CoV-2 KW - coronavirus KW - respiratory KW - infectious KW - communicable KW - immunization KW - immunize KW - noncompletion KW - risk factors KW - multiple Poisson regression model KW - COVID-19 KW - vaccination KW - vaccine KW - dose KW - dosing KW - regression KW - risk KW - risks KW - health outcome KW - health outcomes KW - retrospective KW - cohort KW - dosage KW - United States KW - community KW - inoculation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e46318 UR - http://dx.doi.org/10.2196/46318 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792452 ID - info:doi/10.2196/46318 ER - TY - JOUR AU - Wu, Jian AU - Ma, Mingze AU - Li, Quanman AU - Guo, Xinghong AU - Tarimo, Silver Clifford AU - Jia, Shiyu AU - Zhou, Xue AU - Wang, Meiyun AU - Gu, Jianqin AU - Miao, Yudong AU - Ye, Beizhu PY - 2023/8/1 TI - Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study JO - JMIR Public Health Surveill SP - e44822 VL - 9 KW - COVID-19 vaccine KW - vaccine hesitancy KW - COVID-19 booster vaccination KW - influencing factors KW - China N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44822 UR - http://dx.doi.org/10.2196/44822 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526963 ID - info:doi/10.2196/44822 ER - TY - JOUR AU - Thai-Van, Hung AU - Valnet-Rabier, Marie-Blanche AU - Anciaux, Maëva AU - Lambert, Aude AU - Maurier, Anaďs AU - Cottin, Judith AU - Pietri, Tessa AU - Destčre, Alexandre AU - Damin-Pernik, Marlčne AU - Perrouin, Fanny AU - Bagheri, Haleh PY - 2023/7/14 TI - Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database JO - JMIR Public Health Surveill SP - e45263 VL - 9 KW - mRNA COVID-19 vaccine KW - COVID-19 KW - messenger RNA KW - tozinameran KW - elasomeran KW - sudden sensorineural hearing loss KW - audiogram KW - positive rechallenge KW - spontaneous reporting KW - postmarketing KW - surveillance KW - pharmacovigilance N2 - 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. UR - https://publichealth.jmir.org/2023/1/e45263 UR - http://dx.doi.org/10.2196/45263 UR - http://www.ncbi.nlm.nih.gov/pubmed/37071555 ID - info:doi/10.2196/45263 ER - TY - JOUR AU - Hori, Daisuke AU - Takahashi, Tsukasa AU - Ozaki, Akihiko AU - Tabuchi, Takahiro PY - 2023/7/10 TI - The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study JO - JMIR Public Health Surveill SP - e42143 VL - 9 KW - cohort studies KW - SARS-CoV-2 KW - COVID-19 KW - Japan KW - vaccination KW - vaccination hesitancy KW - vaccines N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42143 UR - http://dx.doi.org/10.2196/42143 UR - http://www.ncbi.nlm.nih.gov/pubmed/37235691 ID - info:doi/10.2196/42143 ER - TY - JOUR AU - Huang, Yiman AU - Zhang, Ling AU - Fu, Jiaqi AU - Wu, Yijin AU - Wang, Hao AU - Xiao, Weijun AU - Xin, You AU - Dai, Zhenwei AU - Si, Mingyu AU - Chen, Xu AU - Jia, Mengmeng AU - Leng, Zhiwei AU - Cui, Dan AU - Su, Xiaoyou PY - 2023/7/3 TI - COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study JO - JMIR Public Health Surveill SP - e42958 VL - 9 KW - COVID-19 KW - COVID-19 survivors KW - vaccine hesitancy KW - complacency KW - confidence KW - convenience KW - cross-sectional questionnaire KW - health education KW - health promotion KW - public health N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42958 UR - http://dx.doi.org/10.2196/42958 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247615 ID - info:doi/10.2196/42958 ER - TY - JOUR AU - Archambault, M. Patrick AU - Rosychuk, J. Rhonda AU - Audet, Martyne AU - Bola, Rajan AU - Vatanpour, Shabnam AU - Brooks, C. Steven AU - Daoust, Raoul AU - Clark, Gregory AU - Grant, Lars AU - Vaillancourt, Samuel AU - Welsford, Michelle AU - Morrison, J. Laurie AU - Hohl, M. Corinne AU - PY - 2023/6/16 TI - Accuracy of Self-Reported COVID-19 Vaccination Status Compared With a Public Health Vaccination Registry in Québec: Observational Diagnostic Study JO - JMIR Public Health Surveill SP - e44465 VL - 9 KW - electronic vaccination registry KW - self-reported vaccination status KW - COVID-19 KW - accuracy KW - diagnostic study KW - interrater agreement N2 - 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 Québec 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 Québec Vaccination Registry. Our primary outcome was the accuracy of the self-reported vaccination status (index test) ascertained during telephone follow-up compared with the Québec 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 ? 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 ? 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 ? 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 UR - https://publichealth.jmir.org/2023/1/e44465 UR - http://dx.doi.org/10.2196/44465 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327046 ID - info:doi/10.2196/44465 ER - TY - JOUR AU - Matas, L. Jennifer AU - Landry, G. Latrice AU - Lee, LaTasha AU - Hansel, Shantoy AU - Coudray, S. Makella AU - Mata-McMurry, V. Lina AU - Chalasani, Nishanth AU - Xu, Liou AU - Stair, Taylor AU - Edwards, Christina AU - Puckrein, Gary AU - Meyer, William AU - Wiltz, Gary AU - Sampson, Marian AU - Gregerson, Paul AU - Barron, Charles AU - Marable, Jeffrey AU - Akinboboye, Olakunle AU - Il'yasova, Dora PY - 2023/4/27 TI - Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study JO - JMIR Public Health Surveill SP - e34163 VL - 9 KW - COVID-19 vaccine KW - vaccine hesitancy KW - underrepresented in research KW - minority populations KW - federally qualified health center (FQHC) KW - public health KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e34163 UR - http://dx.doi.org/10.2196/34163 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811869 ID - info:doi/10.2196/34163 ER - TY - JOUR AU - Wu, Xiaoqian AU - Li, Ziyu AU - Xu, Lin AU - Li, Pengfei AU - Liu, Ming AU - Huang, Cheng PY - 2023/4/14 TI - COVID-19 Vaccine?Related Information on the WeChat Public Platform: Topic Modeling and Content Analysis JO - J Med Internet Res SP - e45051 VL - 25 KW - health belief model KW - COVID-19 vaccines KW - WeChat KW - content analysis KW - topic modeling KW - public health KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2023/1/e45051 UR - http://dx.doi.org/10.2196/45051 UR - http://www.ncbi.nlm.nih.gov/pubmed/37058349 ID - info:doi/10.2196/45051 ER - TY - JOUR AU - Remmel, Christopher AU - Tuli, Gaurav AU - Varrelman, J. Tanner AU - Han, R. Aimee AU - Angkab, Pakkanan AU - Kosiyaporn, Hathairat AU - Netrpukdee, Chanikarn AU - Sorndamrih, Supatnuj AU - Thamarangsi, Thaksaphon AU - Brownstein, S. John AU - Astley, M. Christina PY - 2023/4/13 TI - COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey JO - JMIR Public Health Surveill SP - e40186 VL - 9 KW - COVID-19 vaccines KW - Thailand KW - survey KW - vaccines KW - COVID-19 KW - pandemic KW - public health KW - health policy KW - epidemiology KW - social media KW - vaccine hesitancy N2 - 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. UR - https://publichealth.jmir.org/2023/1/e40186 UR - http://dx.doi.org/10.2196/40186 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811852 ID - info:doi/10.2196/40186 ER - TY - JOUR AU - Asim, Saba AU - Wang, Kailu AU - Nichini, Elena AU - Yip, Fu Faustina AU - Zhu, Liling AU - Fung, Eddy Hin Chung AU - Zeng, Yan AU - Fang, Zhilan AU - Cheung, Wai-Ling Annie AU - Wong, Lai-yi Eliza AU - Dong, Dong AU - Yeoh, Eng-Kiong PY - 2023/3/27 TI - COVID-19 Vaccination Preferences Among Non-Chinese Migrants in Hong Kong: Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e40587 VL - 9 KW - COVID-19 vaccination KW - migrants KW - discrete choice experiment KW - ethnic minorities KW - vaccine attributes KW - Hong Kong KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e40587 UR - http://dx.doi.org/10.2196/40587 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848242 ID - info:doi/10.2196/40587 ER - TY - JOUR AU - Clarkson, D. Melissa PY - 2023/3/20 TI - Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study JO - JMIR Hum Factors SP - e43819 VL - 10 KW - COVID-19 KW - data visualization KW - data dashboard KW - public health reporting KW - human information interaction KW - transparency KW - trust N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43819 UR - http://dx.doi.org/10.2196/43819 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696270 ID - info:doi/10.2196/43819 ER - TY - JOUR AU - Nguyen, Vincent AU - Liu, Yunzhe AU - Mumford, Richard AU - Flanagan, Benjamin AU - Patel, Parth AU - Braithwaite, Isobel AU - Shrotri, Madhumita AU - Byrne, Thomas AU - Beale, Sarah AU - Aryee, Anna AU - Fong, Erica Wing Lam AU - Fragaszy, Ellen AU - Geismar, Cyril AU - Navaratnam, D. Annalan M. AU - Hardelid, Pia AU - Kovar, Jana AU - Pope, Addy AU - Cheng, Tao AU - Hayward, Andrew AU - Aldridge, Robert AU - PY - 2023/3/8 TI - 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 JO - JMIR Public Health Surveill SP - e38072 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - vaccination KW - global positioning system KW - GPS KW - movement tracking KW - geographical tracking KW - mobile app KW - health application KW - surveillance KW - public health KW - mHealth KW - mobile surveillance KW - tracking device KW - geolocation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e38072 UR - http://dx.doi.org/10.2196/38072 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884272 ID - info:doi/10.2196/38072 ER - TY - JOUR AU - Kipke, D. Michele AU - Karimipour, Nicki AU - Wolfe, Nicole AU - Orechwa, Allison AU - Stoddard, Laura AU - Rubio-Diaz, Mayra AU - North, Gemma AU - Dezfuli, Ghazal AU - Murphy, Sheila AU - Phelps, Ashley AU - Kagan, Jeremy AU - De La Haye, Kayla AU - Perry, Christina AU - Baezconde-Garbanati, Lourdes PY - 2023/2/20 TI - Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles? Black and Latino Communities: Protocol for a Participatory Study JO - JMIR Res Protoc SP - e40161 VL - 12 KW - community engagement KW - COVID-19 KW - vaccine KW - vaccination KW - public health KW - population health KW - health equity KW - social media KW - vaccine hesitancy N2 - 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 UR - https://www.researchprotocols.org/2023/1/e40161 UR - http://dx.doi.org/10.2196/40161 UR - http://www.ncbi.nlm.nih.gov/pubmed/36757953 ID - info:doi/10.2196/40161 ER - TY - JOUR AU - Batzella, Erich AU - Cantarutti, Anna AU - Caranci, Nicola AU - Giaquinto, Carlo AU - Barbiellini Amidei, Claudio AU - Canova, Cristina PY - 2023/2/1 TI - The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort JO - JMIR Public Health Surveill SP - e44234 VL - 9 KW - SEP KW - socioeconomic position KW - quantile-g-computation KW - nested case-control study KW - COVID-19 vaccine KW - children KW - area deprivation index N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44234 UR - http://dx.doi.org/10.2196/44234 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645419 ID - info:doi/10.2196/44234 ER - TY - JOUR AU - Tran, Xuan Bach AU - Do, Linh Anh AU - Boyer, Laurent AU - Auquier, Pascal AU - Le, Thi Huong AU - Le Vu, Ngoc Minh AU - Dang, Thi Trang Huyen AU - Cao, Minh Khuy AU - Le, Thi Linh Dieu AU - Cu, Ngoc Lam Tung AU - Ly, Viet Bang AU - Nguyen, Thi Duong Anh AU - Nguyen, Duc Manh AU - Latkin, A. Carl AU - Ho, M. Roger C. AU - Ho, H. Cyrus S. AU - Zhang, B. Melvyn W. PY - 2023/1/31 TI - Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e43055 VL - 9 KW - COVID-19 KW - epidemic KW - vaccine KW - booster KW - willingness to take KW - willingness to pay KW - Vietnam KW - policy KW - feasibility KW - acceptability KW - infection KW - vaccination KW - social media KW - intervention N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43055 UR - http://dx.doi.org/10.2196/43055 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599156 ID - info:doi/10.2196/43055 ER - TY - JOUR AU - Perez-Ramos, G. Jose AU - Leon-Thomas, Mariela AU - Smith, L. Sabrina AU - Silverman, Laura AU - Perez-Torres, Claudia AU - Hall, C. Wyatte AU - Iadarola, Suzannah PY - 2023/1/25 TI - COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots JO - JMIR Form Res SP - e39045 VL - 7 KW - mHealth KW - ICT KW - Information and Communication Technology KW - community KW - chatbot KW - COVID-19 KW - health equity KW - mobile health KW - health outcome KW - health disparity KW - minority population KW - health care gap KW - chatbot tool KW - user experience KW - chatbot development KW - health information N2 - 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. UR - https://formative.jmir.org/2023/1/e39045 UR - http://dx.doi.org/10.2196/39045 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630649 ID - info:doi/10.2196/39045 ER - TY - JOUR AU - Zhao, Sihong AU - Hu, Simeng AU - Zhou, Xiaoyu AU - Song, Suhang AU - Wang, Qian AU - Zheng, Hongqiu AU - Zhang, Ying AU - Hou, Zhiyuan PY - 2023/1/11 TI - The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review JO - JMIR Public Health Surveill SP - e40201 VL - 9 KW - COVID-19 KW - COVID-19 vaccine KW - misinformation KW - anti-vaccine KW - review KW - social media KW - survey N2 - 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 UR - https://publichealth.jmir.org/2023/1/e40201 UR - http://dx.doi.org/10.2196/40201 UR - http://www.ncbi.nlm.nih.gov/pubmed/36469911 ID - info:doi/10.2196/40201 ER - TY - JOUR AU - Abou-Arraj, Elias Nadeem AU - Maddah, Diana AU - Buhamdan, Vanessa AU - Abbas, Roua AU - Jawad, Kamel Nadine AU - Karaki, Fatima AU - Alami, H. Nael AU - Geldsetzer, Pascal PY - 2022/12/14 TI - Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey JO - JMIR Form Res SP - e36827 VL - 6 IS - 12 KW - Lebanon KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - vaccination KW - vaccine hesitancy KW - vaccine acceptance KW - health care system KW - misinformation KW - public health N2 - 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. UR - https://formative.jmir.org/2022/12/e36827 UR - http://dx.doi.org/10.2196/36827 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383635 ID - info:doi/10.2196/36827 ER - TY - JOUR AU - Wang, Dandan AU - Zhou, Yadong AU - Ma, Feicheng PY - 2022/11/18 TI - Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis JO - J Med Internet Res SP - e40701 VL - 24 IS - 11 KW - COVID-19 KW - COVID-19 vaccine KW - echo chamber KW - opinion leader KW - structural hole spanner KW - topic KW - sentiment KW - social media KW - vaccine hesitancy KW - public health KW - vaccination KW - health promotion KW - online campaign KW - social network analysis N2 - 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. UR - https://www.jmir.org/2022/11/e40701 UR - http://dx.doi.org/10.2196/40701 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367965 ID - info:doi/10.2196/40701 ER - TY - JOUR AU - Kasting, L. Monica AU - Macy, T. Jonathan AU - Grannis, J. Shaun AU - Wiensch, J. Ashley AU - Lavista Ferres, M. Juan AU - Dixon, E. Brian PY - 2022/11/14 TI - Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study JO - JMIR Public Health Surveill SP - e37203 VL - 8 IS - 11 KW - SARS-CoV-2 KW - COVID-19 vaccines KW - vaccination intention KW - vaccine hesitancy KW - Health Belief Model KW - reasoned action approach KW - COVID-19 KW - vaccination KW - public health KW - online survey KW - health intervention KW - logistic regression KW - demographic N2 - 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. UR - https://publichealth.jmir.org/2022/11/e37203 UR - http://dx.doi.org/10.2196/37203 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219842 ID - info:doi/10.2196/37203 ER - TY - JOUR AU - Giner-Soriano, Maria AU - de Dios, Vanessa AU - Ouchi, Dan AU - Vilaplana-Carnerero, Carles AU - Monteagudo, Mňnica AU - Morros, Rosa PY - 2022/11/11 TI - Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records JO - JMIR Public Health Surveill SP - e36712 VL - 8 IS - 11 KW - SARS-CoV-2 KW - COVID-19 KW - influenza vaccines KW - pneumonia KW - electronic health records KW - primary health care KW - vaccination KW - public health KW - cohort study KW - epidemiology KW - eHeatlh KW - health outcome KW - mortality N2 - 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. UR - https://publichealth.jmir.org/2022/11/e36712 UR - http://dx.doi.org/10.2196/36712 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265160 ID - info:doi/10.2196/36712 ER - TY - JOUR AU - Tennant, Ryan AU - Tetui, Moses AU - Grindrod, Kelly AU - Burns, M. Catherine PY - 2022/11/10 TI - Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study JO - JMIR Hum Factors SP - e39670 VL - 9 IS - 4 KW - cognitive work analysis KW - contextual design KW - COVID-19 KW - decision making KW - health care system KW - pandemic KW - vaccination clinics KW - workplace stress N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e39670 UR - http://dx.doi.org/10.2196/39670 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219839 ID - info:doi/10.2196/39670 ER - TY - JOUR AU - Kwan, Ho Tsz AU - Wong, Sze Ngai AU - Chan, Pok Chin AU - Yeoh, Kiong Eng AU - Wong, Yeung-shan Samuel AU - Lee, Shan Shui PY - 2022/11/9 TI - Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation JO - JMIR Public Health Surveill SP - e40175 VL - 8 IS - 11 KW - COVID-19 KW - SARS-CoV-2 antigen testing KW - COVID-19 vaccine KW - mass screening KW - antigen test KW - epidemiology KW - Omicron KW - Hong Kong KW - public health KW - outbreak KW - epidemic KW - screening KW - transmission KW - online KW - vaccination KW - vaccines KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2022/11/e40175 UR - http://dx.doi.org/10.2196/40175 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240027 ID - info:doi/10.2196/40175 ER - TY - JOUR AU - Kshirsagar, Meghana AU - Nasir, Md AU - Mukherjee, Sumit AU - Becker, Nicholas AU - Dodhia, Rahul AU - Weeks, B. William AU - Ferres, Lavista Juan AU - Richardson, Barbra PY - 2022/11/8 TI - The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data JO - JMIR Public Health Surveill SP - e38898 VL - 8 IS - 11 KW - breakthroughs KW - vaccines KW - Pfizer KW - Moderna KW - Janssen KW - SARS-CoV-2 KW - COVID-19 KW - coronavirus KW - infectious disease KW - viral infection KW - vaccination KW - breakthrough infection KW - public health KW - health policy KW - decision making KW - booster vaccine KW - mortality KW - hospitalization KW - healthcare system N2 - 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. UR - https://publichealth.jmir.org/2022/11/e38898 UR - http://dx.doi.org/10.2196/38898 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265135 ID - info:doi/10.2196/38898 ER - TY - JOUR AU - Fuster-Casanovas, Aďna AU - Das, Ronnie AU - Vidal-Alaball, Josep AU - Lopez Segui, Francesc AU - Ahmed, Wasim PY - 2022/10/28 TI - The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis JO - JMIR Public Health Surveill SP - e38153 VL - 8 IS - 10 KW - Twitter KW - social media KW - COVID-19 KW - misinformation KW - vaccination KW - public health KW - vaccine hesitancy KW - infodemiology KW - health campaign KW - content analysis KW - social network KW - layout algorithm N2 - 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. UR - https://publichealth.jmir.org/2022/10/e38153 UR - http://dx.doi.org/10.2196/38153 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219832 ID - info:doi/10.2196/38153 ER - TY - JOUR AU - Buller, David AU - Walkosz, Barbara AU - Henry, Kimberly AU - Woodall, Gill W. AU - Pagoto, Sherry AU - Berteletti, Julia AU - Kinsey, Alishia AU - Divito, Joseph AU - Baker, Katie AU - Hillhouse, Joel PY - 2022/8/23 TI - Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages JO - JMIR Infodemiology SP - e36210 VL - 2 IS - 2 KW - social media KW - COVID-19 KW - vaccination KW - nonpharmaceutical interventions KW - information source KW - misinformation KW - vaccine KW - public health KW - COVID-19 prevention KW - health promotion N2 - 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) × 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 UR - https://infodemiology.jmir.org/2022/2/e36210 UR - http://dx.doi.org/10.2196/36210 UR - http://www.ncbi.nlm.nih.gov/pubmed/36039372 ID - info:doi/10.2196/36210 ER - TY - JOUR AU - Skafle, Ingjerd AU - Nordahl-Hansen, Anders AU - Quintana, S. Daniel AU - Wynn, Rolf AU - Gabarron, Elia PY - 2022/8/4 TI - Misinformation About COVID-19 Vaccines on Social Media: Rapid Review JO - J Med Internet Res SP - e37367 VL - 24 IS - 8 KW - social media KW - misinformation KW - COVID-19 vaccines KW - vaccination hesitancy KW - autism spectrum disorder N2 - 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 UR - https://www.jmir.org/2022/8/e37367 UR - http://dx.doi.org/10.2196/37367 UR - http://www.ncbi.nlm.nih.gov/pubmed/35816685 ID - info:doi/10.2196/37367 ER - TY - JOUR AU - Mehta, N. Shivani AU - Burger, C. Zoe AU - Meyers-Pantele, A. Stephanie AU - Garfein, S. Richard AU - Ortiz, O. Dayanna AU - Mudhar, K. Pavan AU - Kothari, B. Smit AU - Kothari, Jigna AU - Meka, Meena AU - Rodwell, Timothy PY - 2022/8/4 TI - Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey JO - JMIR Form Res SP - e38351 VL - 6 IS - 8 KW - COVID-19 KW - knowledge KW - attitude KW - practices KW - KAP survey KW - vaccine hesitancy KW - Latinx KW - Latinx cohort KW - minority population KW - primary care KW - sociodemographic characteristic KW - public health KW - vulnerable population KW - epidemiology N2 - 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 55.8%; z>5.8; P*<.001). The regression model confirmed the greater significance of VRQ versus VRH (P*<.001 vs P=.03, P*=.29). Conclusions: This research provides preliminary evidence in favor of using Google Trends as a surveillance and prediction tool for vaccine adherence against COVID-19 in Italy. Further research is needed to establish the appropriate use and limits of Google Trends for vaccination tracking. However, these findings prove that the search for suitable keywords is a fundamental step to reduce confounding factors. Additionally, targeting hypotheses helps diminish the likelihood of spurious correlations. It is recommended that Google Trends be leveraged as a complementary infoveillance tool by government agencies to monitor and predict vaccine adherence in this and future crises by following the methods proposed in this paper. UR - https://med.jmirx.org/2022/2/e35356 UR - http://dx.doi.org/10.2196/35356 UR - http://www.ncbi.nlm.nih.gov/pubmed/35481982 ID - info:doi/10.2196/35356 ER - TY - JOUR AU - Nour, Radwa AU - Powell, Leigh AU - Alnakhi, K. Wafa AU - Mamdouh, Heba AU - Zidoun, Youness AU - Hussain, Y. Hamid AU - Al Suwaidi, Hanan AU - Zary, Nabil PY - 2022/4/12 TI - Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for Translation and Validation in the World Health Organization Eastern Mediterranean Region JO - JMIR Res Protoc SP - e36928 VL - 11 IS - 4 KW - scale KW - instrument KW - vaccine hesitancy KW - COVID-19 KW - validation KW - translation KW - Arabic KW - French KW - EMRO N2 - Background: The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French. Objective: The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region. Methods: The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants? responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected. Results: As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022. Conclusions: This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation. International Registered Report Identifier (IRRID): PRR1-10.2196/36928 UR - https://www.researchprotocols.org/2022/4/e36928 UR - http://dx.doi.org/10.2196/36928 UR - http://www.ncbi.nlm.nih.gov/pubmed/35247043 ID - info:doi/10.2196/36928 ER - TY - JOUR AU - Jang, Hyeju AU - Rempel, Emily AU - Roe, Ian AU - Adu, Prince AU - Carenini, Giuseppe AU - Janjua, Zafar Naveed PY - 2022/3/29 TI - Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis JO - J Med Internet Res SP - e35016 VL - 24 IS - 3 KW - COVID-19 KW - vaccination KW - Twitter KW - aspect-based sentiment analysis KW - Canada KW - social media KW - pandemic KW - content analysis KW - vaccine rollout KW - sentiment analysis KW - public sentiment KW - public health KW - health promotion KW - vaccination promotion N2 - Background: The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity. Objective: We aim to investigate Twitter users? attitudes toward COVID-19 vaccination in Canada after vaccine rollout. Methods: We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination?related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward ?vaccination? changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects. Results: After applying the ABSA system, we obtained 170 aspect terms (eg, ?immunity? and ?pfizer?) and 6775 opinion terms (eg, ?trustworthy? for the positive sentiment and ?jeopardize? for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to ?vaccine distribution,? ?side effects,? ?allergy,? ?reactions,? and ?anti-vaxxer,? and positive sentiments related to ?vaccine campaign,? ?vaccine candidates,? and ?immune response.? These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the ?anti-vaxxer? population that used negative sentiments as a means to discourage vaccination and the ?Covid Zero? population that used negative sentiments to encourage vaccinations while critiquing the public health response. Conclusions: Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination. UR - https://www.jmir.org/2022/3/e35016 UR - http://dx.doi.org/10.2196/35016 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275835 ID - info:doi/10.2196/35016 ER - TY - JOUR AU - Aronson, David Ian AU - Bennett, S. Alex AU - Ardouin-Guerrier, Mary-Andrée AU - Rivera-Castellar, German AU - Gibson, Brent AU - Santoscoy, Samantha AU - Vargas-Estrella, Brittney PY - 2022/3/23 TI - How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study JO - JMIR Form Res SP - e35066 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - people who inject drugs KW - vaccine KW - vaccine hesitancy KW - barrier KW - vaccination KW - drugs KW - hesitancy KW - qualitative KW - impact KW - interview KW - United States KW - communication KW - danger KW - community N2 - Background: People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. Objective: This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. Methods: We conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants? understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. Results: Participants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. Conclusions: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines? ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective. UR - https://formative.jmir.org/2022/3/e35066 UR - http://dx.doi.org/10.2196/35066 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191841 ID - info:doi/10.2196/35066 ER - TY - JOUR AU - Mungmunpuntipantip, Rujittika AU - Wiwanitkit, Viroj PY - 2022/3/21 TI - Ensuring Interrater Reliability When Evaluating Voice Assistants. Comment on ?Evaluating Voice Assistants? Responses to COVID-19 Vaccination in Portuguese: Quality Assessment? JO - JMIR Hum Factors SP - e36610 VL - 9 IS - 1 KW - voice assistant KW - natural user interface KW - Portuguese language KW - COVID-19 KW - vaccine UR - https://humanfactors.jmir.org/2022/1/e36610 UR - http://dx.doi.org/10.2196/36610 UR - http://www.ncbi.nlm.nih.gov/pubmed/35312626 ID - info:doi/10.2196/36610 ER - TY - JOUR AU - Seródio Figueiredo, Maurício Carlos AU - de Melo, Tiago AU - Goes, Raphaela PY - 2022/3/21 TI - Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment JO - JMIR Hum Factors SP - e34674 VL - 9 IS - 1 KW - voice assistant KW - natural user interface KW - Portuguese language KW - health information KW - COVID-19 KW - vaccine KW - immunization KW - health device KW - digital health N2 - Background: Voice assistants (VAs) are devices that respond to human voices and can be commanded to do a variety of tasks. Nowadays, VAs are being used to obtain health information, which has become a critical point of analysis for researchers in terms of question understanding and quality of response. Particularly, the COVID-19 pandemic has and still is severely affecting people worldwide, which demands studies on how VAs can be used as a tool to provide useful information. Objective: This work aimed to perform a quality analysis of different VAs? responses regarding the actual and important subject of COVID-19 vaccines. We focused on this important subject since vaccines are now available and society has urged for the population to be rapidly immunized. Methods: The proposed study was based on questions that were collected from the of?cial World Health Organization website. These questions were submitted to the 5 dominant VAs (Alexa, Bixby, Cortana, Google Assistant, and Siri), and responses were evaluated according to a rubric based on the literature. We focused this study on the Portuguese language as an additional contribution, since previous works are mainly focused on the English language, and we believe that VAs cannot be optimized to foreign languages. Results: Results showed that Google Assistant has a better overall performance, and only this VA and Samsung Bixby achieved high scores on question understanding in the Portuguese language. Regarding the obtained answers, the study also showed the best Google Assistant overall performance. Conclusions: Under the urgent context of COVID-19 vaccination, this work can help to understand how VAs must be improved to be more useful to the society and how careful people must be when considering VAs as a source of health information. VAs have been demonstrated to perform well regarding comprehension and user-friendliness. However, this work has found that they must be better integrated to their information sources to be useful as health information tools. UR - https://humanfactors.jmir.org/2022/1/e34674 UR - http://dx.doi.org/10.2196/34674 UR - http://www.ncbi.nlm.nih.gov/pubmed/35041617 ID - info:doi/10.2196/34674 ER - TY - JOUR AU - Calac, J. Alec AU - Haupt, R. Michael AU - Li, Zhuoran AU - Mackey, Tim PY - 2022/3/16 TI - Spread of COVID-19 Vaccine Misinformation in the Ninth Inning: Retrospective Observational Infodemic Study JO - JMIR Infodemiology SP - e33587 VL - 2 IS - 1 KW - infoveillance KW - infodemiology KW - COVID-19 KW - vaccine KW - Twitter KW - social listening KW - social media KW - misinformation KW - spread KW - observational KW - hesitancy KW - communication KW - discourse N2 - Background: Shortly after Pfizer and Moderna received emergency use authorizations from the Food and Drug Administration, there were increased reports of COVID-19 vaccine-related deaths in the Vaccine Adverse Event Reporting System (VAERS). In January 2021, Major League Baseball legend and Hall of Famer, Hank Aaron, passed away at the age of 86 years from natural causes, just 2 weeks after he received the COVID-19 vaccine. Antivaccination groups attempted to link his death to the Moderna vaccine, similar to other attempts misrepresenting data from the VAERS to spread COVID-19 misinformation. Objective: This study assessed the spread of misinformation linked to erroneous claims about Hank Aaron?s death on Twitter and then characterized different vaccine misinformation and hesitancy themes generated from users who interacted with this misinformation discourse. Methods: An initial sample of tweets from January 31, 2021, to February 6, 2021, was queried from the Twitter Search Application Programming Interface using the keywords ?Hank Aaron? and ?vaccine.? The sample was manually annotated for misinformation, reporting or news media, and public reaction. Nonmedia user accounts were also classified if they were verified by Twitter. A second sample of tweets, representing direct comments or retweets to misinformation-labeled content, was also collected. User sentiment toward misinformation, positive (agree) or negative (disagree), was recorded. The Strategic Advisory Group of Experts Vaccine Hesitancy Matrix from the World Health Organization was used to code the second sample of tweets for factors influencing vaccine confidence. Results: A total of 436 tweets were initially sampled from the Twitter Search Application Programming Interface. Misinformation was the most prominent content type (n=244, 56%) detected, followed by public reaction (n=122, 28%) and media reporting (n=69, 16%). No misinformation-related content reviewed was labeled as misleading by Twitter at the time of the study. An additional 1243 comments on misinformation-labeled tweets from 973 unique users were also collected, with 779 comments deemed relevant to study aims. Most of these comments expressed positive sentiment (n=612, 78.6%) to misinformation and did not refute it. Based on the World Health Organization Strategic Advisory Group of Experts framework, the most common vaccine hesitancy theme was individual or group influences (n=508, 65%), followed by vaccine or vaccination-specific influences (n=110, 14%) and contextual influences (n=93, 12%). Common misinformation themes observed included linking the death of Hank Aaron to ?suspicious? elderly deaths following vaccination, claims about vaccines being used for depopulation, death panels, federal officials targeting Black Americans, and misinterpretation of VAERS reports. Four users engaging with or posting misinformation were verified on Twitter at the time of data collection. Conclusions: Our study found that the death of a high-profile ethnic minority celebrity led to the spread of misinformation on Twitter. This misinformation directly challenged the safety and effectiveness of COVID-19 vaccines at a time when ensuring vaccine coverage among minority populations was paramount. Misinformation targeted at minority groups and echoed by other verified Twitter users has the potential to generate unwarranted vaccine hesitancy at the expense of people such as Hank Aaron who sought to promote public health and community immunity. UR - https://infodemiology.jmir.org/2022/1/e33587 UR - http://dx.doi.org/10.2196/33587 UR - http://www.ncbi.nlm.nih.gov/pubmed/35320982 ID - info:doi/10.2196/33587 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Wochele-Thoma, Thomas AU - Eibensteiner, Fabian AU - Klager, Elisabeth AU - Hribersek, Mojca AU - Parvanov, D. Emil AU - Hrg, Dalibor AU - Völkl-Kernstock, Sabine AU - Kletecka-Pulker, Maria AU - Schaden, Eva AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2022/3/15 TI - Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis JO - JMIR Public Health Surveill SP - e34003 VL - 8 IS - 3 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - vaccine KW - readability KW - content quality KW - online health information KW - side effect KW - public health KW - medicine KW - quality KW - perception N2 - Background: Online information on COVID-19 vaccination may influence people?s perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The ?frequently asked questions? or ?questions and answers? section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46% (23/50) of the websites stated that they do not know, and another 40% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78%), headache (36/50, 72%), fatigue (33/50, 66%), and muscle/joint pain (31/50, 62%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. UR - https://publichealth.jmir.org/2022/3/e34003 UR - http://dx.doi.org/10.2196/34003 UR - http://www.ncbi.nlm.nih.gov/pubmed/35073276 ID - info:doi/10.2196/34003 ER - TY - JOUR AU - Blane, T. Janice AU - Bellutta, Daniele AU - Carley, M. Kathleen PY - 2022/3/7 TI - Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets JO - J Med Internet Res SP - e34040 VL - 24 IS - 3 KW - social cybersecurity KW - social-cyber maneuvers KW - social network analysis KW - disinformation KW - BEND maneuvers KW - COVID-19 KW - coronavirus KW - social media KW - vaccine KW - anti-vaccine KW - pro-vaccine KW - ORA-PRO KW - cybersecurity KW - security KW - Twitter KW - community KW - communication KW - health information KW - manipulation KW - belief N2 - Background: During the time surrounding the approval and initial distribution of Pfizer-BioNTech?s COVID-19 vaccine, large numbers of social media users took to using their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups toward the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences. Objective: This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole. Methods: COVID-19 Twitter vaccine data were collected using the Twitter application programming interface (API) for 1-week periods before, during, and 6 weeks after the initial Pfizer-BioNTech rollout (December 2020 to January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. Organization Risk Analyzer (ORA)-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network. Results: Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages. Conclusions: Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online. UR - https://www.jmir.org/2022/3/e34040 UR - http://dx.doi.org/10.2196/34040 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044302 ID - info:doi/10.2196/34040 ER - TY - JOUR AU - Cummins, Alexander Jack PY - 2022/2/23 TI - Getting a Vaccine, Jab, or Vax Is More Than a Regular Expression. Comment on ?COVID-19 Vaccine-Related Discussion on Twitter: Topic Modeling and Sentiment Analysis? JO - J Med Internet Res SP - e31978 VL - 24 IS - 2 KW - COVID-19 KW - vaccine KW - vaccination KW - Twitter KW - infodemiology KW - infoveillance KW - topic KW - sentiment KW - opinion KW - discussion KW - communication KW - social media KW - perception KW - concern KW - emotion KW - natural language processing UR - https://www.jmir.org/2022/2/e31978 UR - http://dx.doi.org/10.2196/31978 UR - http://www.ncbi.nlm.nih.gov/pubmed/35195531 ID - info:doi/10.2196/31978 ER - TY - JOUR AU - Huangfu, Luwen AU - Mo, Yiwen AU - Zhang, Peijie AU - Zeng, Dajun Daniel AU - He, Saike PY - 2022/2/8 TI - COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment?Based Topic Modeling JO - J Med Internet Res SP - e31726 VL - 24 IS - 2 KW - COVID-19 KW - COVID-19 vaccine KW - sentiment evolution KW - topic modeling KW - social media KW - text mining N2 - Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public?s conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public?s vaccine awareness through sentiment?based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson & Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter?s application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment?based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51%) were positive, 204,084 (23.81%) were negative, 245,976 (28.70%) were neutral, 6899 (0.80%) were highly positive, and 1508 (0.18%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13%), getting vaccination (76,029/405,560, 18.75%), and vaccine information and knowledge (21,127/405,560, 5.21%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04%), extreme side effects of the vaccines (19,690/205,592, 9.58%), and vaccine supply and rollout (17,154/205,592, 8.34%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment?based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. UR - https://www.jmir.org/2022/2/e31726 UR - http://dx.doi.org/10.2196/31726 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783665 ID - info:doi/10.2196/31726 ER - TY - JOUR AU - Gisondi, A. Michael AU - Barber, Rachel AU - Faust, Samuel Jemery AU - Raja, Ali AU - Strehlow, C. Matthew AU - Westafer, M. Lauren AU - Gottlieb, Michael PY - 2022/2/1 TI - A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation JO - J Med Internet Res SP - e35552 VL - 24 IS - 2 KW - COVID-19 KW - social media KW - misinformation KW - disinformation KW - infodemic KW - ethics KW - vaccination KW - vaccine hesitancy KW - infoveillance KW - vaccine UR - https://www.jmir.org/2022/2/e35552 UR - http://dx.doi.org/10.2196/35552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35007204 ID - info:doi/10.2196/35552 ER - TY - JOUR AU - Ietto, Giuseppe AU - Mortara, Lorenzo AU - Dalla Gasperina, Daniela AU - Iovino, Domenico AU - Azzi, Lorenzo AU - Baj, Andreina AU - Ageno, Walter AU - Genoni, Paolo Angelo AU - Acquati, Francesco AU - Gallazzi, Matteo AU - Spina, Giorgia AU - Coco, Grace AU - Pierin, Federica AU - Noonan, Douglas AU - Vigezzi, Andrea AU - Monti, Elisa AU - Iori, Valentina AU - Masci, Federica AU - Franchi, Caterina AU - Di Saverio, Salomone AU - Carcano, Giulio PY - 2022/1/25 TI - Immune-Mediated Mechanisms in Patients Testing Positive for SARS-CoV-2: Protocol for a Multianalysis Study JO - JMIR Res Protoc SP - e29892 VL - 11 IS - 1 KW - SARS-CoV-2 KW - COVID-19 KW - immunomodulation KW - severe acute respiratory syndrome KW - mechanism KW - phenotype KW - immunology KW - white blood cell KW - immune system KW - monocyte KW - natural killer cell KW - blood KW - infectious disease KW - immune response KW - antigen KW - vaccine KW - immunity KW - protection KW - genetics KW - epidemiology N2 - Background: The novel coronavirus has a high mortality rate (over 1% for patients older than 50 years). This can only be partially ascribed to other comorbidities. A possible explanation is a factor that assures a prompt response to SARS-CoV-2 in younger people, independent from the novelty of the virus itself. A factor is believed to stimulate the immune system and provide immunity against more antigens. The only external stimulation received by healthy people is vaccination (eg, the diphtheria, tetanus, and pertussis [DTP] vaccine). One hypothesis is that vaccination helps develop specific immunity but generates sprouting immunity against antigens in transit. The underlying immunological phenomena are the ?bystander effect? and ?trained immunity.? The developed immunity gives protection for years until it naturally fades out. After the fifth decade of life, the immune system is almost incompetent when a viral infection occurs, and thus, at this stage, the novel coronavirus can enter the body and cause acute respiratory distress syndrome. Objective: The initial aim is to demonstrate that blood monocytes and natural killer cells show overpowering hyperactivity, while CD4+ and CD8+ T cells experience impediments to their defensive functions in patients with severe SARS-CoV-2 infection. The secondary objectives are to correlate clinical data and vaccination history with laboratory immune patterns in order to identify protective factors. Subsequently, we are also interested in characterizing the phenotypes and state of the degree of activation of peripheral blood mononuclear cells, including monocytes, natural killer cells, and CD4+ and CD8+ T cells, in healthy subjects vaccinated with the Pfizer vaccine. Methods: Data will be collected using the following 3 approaches: (1) an experimental analysis to study the innate immune response and to identify genetic profiles; (2) an epidemiological analysis to identify the patients? vaccination history; and (3) a clinical analysis to detect the immunological profile. Results: The protocol was approved by the Ethics Committee on April 16, 2020, and the study started on April 27, 2020. As of February 2021, enrollment has been completed. Immunological analysis is ongoing, and we expect to complete this analysis by December 2022. Conclusions: We will recognize different populations of patients, each one with a specific immunological pattern in terms of cytokines, soluble factor serum levels, and immune cell activity. Anamnestic data, such as preceding vaccinations and comorbidities, biochemical findings like lymphocyte immunophenotyping, and pre-existing persistent cytomegalovirus infection, allow depicting the risk profile of severe COVID-19. Proof of the roles of these immunological phenomena in the development of COVID-19 can be the basis for the implementation of therapeutic immunomodulatory treatments. Trial Registration: ClinicalTrials.gov NCT04375176; https://clinicaltrials.gov/ct2/show/NCT04375176 International Registered Report Identifier (IRRID): DERR1-10.2196/29892 UR - https://www.researchprotocols.org/2022/1/e29892 UR - http://dx.doi.org/10.2196/29892 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854818 ID - info:doi/10.2196/29892 ER - TY - JOUR AU - Zhang, Chunyan AU - Xu, Songhua AU - Li, Zongfang AU - Liu, Ge AU - Dai, Duwei AU - Dong, Caixia PY - 2022/1/21 TI - The Evolution and Disparities of Online Attitudes Toward COVID-19 Vaccines: Year-long Longitudinal and Cross-sectional Study JO - J Med Internet Res SP - e32394 VL - 24 IS - 1 KW - COVID-19 KW - vaccine KW - attitude KW - Twitter KW - data mining KW - pandemic KW - population group KW - evolution KW - disparity N2 - Background: Due to the urgency caused by the COVID-19 pandemic worldwide, vaccine manufacturers have to shorten and parallel the development steps to accelerate COVID-19 vaccine production. Although all usual safety and efficacy monitoring mechanisms remain in place, varied attitudes toward the new vaccines have arisen among different population groups. Objective: This study aimed to discern the evolution and disparities of attitudes toward COVID-19 vaccines among various population groups through the study of large-scale tweets spanning over a whole year. Methods: We collected over 1.4 billion tweets from June 2020 to July 2021, which cover some critical phases concerning the development and inoculation of COVID-19 vaccines worldwide. We first developed a data mining model that incorporates a series of deep learning algorithms for inferring a range of individual characteristics, both in reality and in cyberspace, as well as sentiments and emotions expressed in tweets. We further conducted an observational study, including an overall analysis, a longitudinal study, and a cross-sectional study, to collectively explore the attitudes of major population groups. Results: Our study derived 3 main findings. First, the whole population?s attentiveness toward vaccines was strongly correlated (Pearson r=0.9512) with official COVID-19 statistics, including confirmed cases and deaths. Such attentiveness was also noticeably influenced by major vaccine-related events. Second, after the beginning of large-scale vaccine inoculation, the sentiments of all population groups stabilized, followed by a considerably pessimistic trend after June 2021. Third, attitude disparities toward vaccines existed among population groups defined by 8 different demographic characteristics. By crossing the 2 dimensions of attitude, we found that among population groups carrying low sentiments, some had high attentiveness ratios, such as males and individuals aged ?40 years, while some had low attentiveness ratios, such as individuals aged ?18 years, those with occupations of the 3rd category, those with account age <5 years, and those with follower number <500. These findings can be used as a guide in deciding who should be given more attention and what kinds of help to give to alleviate the concerns about vaccines. Conclusions: This study tracked the year-long evolution of attitudes toward COVID-19 vaccines among various population groups defined by 8 demographic characteristics, through which significant disparities in attitudes along multiple dimensions were revealed. According to these findings, it is suggested that governments and public health organizations should provide targeted interventions to address different concerns, especially among males, older people, and other individuals with low levels of education, low awareness of news, low income, and light use of social media. Moreover, public health authorities may consider cooperating with Twitter users having high levels of social influence to promote the acceptance of COVID-19 vaccines among all population groups. UR - https://www.jmir.org/2022/1/e32394 UR - http://dx.doi.org/10.2196/32394 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878410 ID - info:doi/10.2196/32394 ER - TY - JOUR AU - Lee, Minjung AU - You, Myoungsoon PY - 2022/1/6 TI - Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey JO - J Med Internet Res SP - e32329 VL - 24 IS - 1 KW - COVID-19 KW - coronavirus KW - vaccination KW - vaccine hesitancy KW - media use KW - social media KW - public health KW - pandemic KW - epidemiology KW - online information KW - health information N2 - Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public?s vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one?s COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population?s vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. UR - https://www.jmir.org/2022/1/e32329 UR - http://dx.doi.org/10.2196/32329 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870605 ID - info:doi/10.2196/32329 ER - TY - JOUR AU - Klein, Z. Ari AU - O'Connor, Karen AU - Gonzalez-Hernandez, Graciela PY - 2022/1/6 TI - Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification JO - JMIR Form Res SP - e33792 VL - 6 IS - 1 KW - natural language processing KW - social media KW - COVID-19 KW - data mining KW - COVID-19 vaccine KW - pregnancy outcomes N2 - Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. UR - https://formative.jmir.org/2022/1/e33792 UR - http://dx.doi.org/10.2196/33792 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870607 ID - info:doi/10.2196/33792 ER - TY - JOUR AU - Tsai, Richard AU - Hervey, John AU - Hoffman, Kathleen AU - Wood, Jessica AU - Johnson, Jennifer AU - Deighton, Dana AU - Clermont, Donald AU - Loew, Brian AU - Goldberg, L. Stuart PY - 2022/1/5 TI - COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey JO - JMIR Public Health Surveill SP - e29872 VL - 8 IS - 1 KW - COVID-19 KW - vaccine KW - hesitancy KW - cancer KW - autoimmune diseases KW - vaccination KW - comorbidities KW - SARS-CoV-2 KW - survey KW - cross-sectional KW - incidence KW - safety KW - vulnerable KW - perception KW - attitude N2 - Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual?s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care?related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. UR - https://publichealth.jmir.org/2022/1/e29872 UR - http://dx.doi.org/10.2196/29872 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709184 ID - info:doi/10.2196/29872 ER - TY - JOUR AU - Benham, L. Jamie AU - Atabati, Omid AU - Oxoby, J. Robert AU - Mourali, Mehdi AU - Shaffer, Blake AU - Sheikh, Hasan AU - Boucher, Jean-Christophe AU - Constantinescu, Cora AU - Parsons Leigh, Jeanna AU - Ivers, M. Noah AU - Ratzan, C. Scott AU - Fullerton, M. Madison AU - Tang, Theresa AU - Manns, J. Braden AU - Marshall, A. Deborah AU - Hu, Jia AU - Lang, Raynell PY - 2021/12/23 TI - COVID-19 Vaccine?Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis JO - JMIR Public Health Surveill SP - e30424 VL - 7 IS - 12 KW - coronavirus KW - COVID-19 KW - public health KW - marketing KW - behavior KW - risk reduction KW - attitudes KW - compliance KW - vaccine KW - hesitancy KW - risk KW - belief KW - communication KW - cross-sectional KW - Canada KW - gender KW - education KW - income KW - race KW - ethnicity N2 - Background: There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective: We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods: A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question ?what would you do if a COVID-19 vaccine were available to you?? Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results: Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions: These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations. UR - https://publichealth.jmir.org/2021/12/e30424 UR - http://dx.doi.org/10.2196/30424 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779784 ID - info:doi/10.2196/30424 ER - TY - JOUR AU - Gurley, Stephen AU - Bennett, Brady AU - Sullivan, Sean Patrick AU - Kiley, Maryellen AU - Linde, Jamie AU - Szczerbacki, David AU - Guest, Jodie PY - 2021/12/15 TI - COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study JO - JMIR Public Health Surveill SP - e33739 VL - 7 IS - 12 KW - COVID-19 KW - vaccine KW - hesitancy KW - college KW - higher education KW - race KW - perception KW - intention KW - uptake KW - prospective KW - cohort KW - demographic KW - minority KW - young adult N2 - Background: Uptake of the COVID-19 vaccine among US young adults, particularly those that belong to racial and ethnic minorities, remains low compared to their older peers. Understanding vaccine perceptions and their influence on vaccination uptake among this population remains crucial to achieving population herd immunity. Objective: We sought to study perceptions of COVID-19 vaccines as well as intended and actual vaccine uptake among one population of college students, faculty, and staff. Methods: As part of a larger study aimed at investigating the dynamics of COVID-19 transmission, serology, and perception on a college campus, participants were asked about their views on the COVID-19 vaccine in February 2021. Vaccination status was assessed by self-report in April 2021. Logistic regression was used to calculate prevalence ratios with marginal standardization. Results: We found that non-White participants were 25% less likely to report COVID-19 vaccination compared to White participants. Among those who were unvaccinated, Black and other non-White participants were significantly more likely to indicate they were unwilling to receive a COVID-19 vaccine compared to White participants. The most common reason for unwillingness to receive the vaccine was belief that the vaccine approval process was rushed. Conclusions: There are racial differences in perceptions of the COVID-19 vaccine among young adults, and these differences might differentially impact vaccine uptake among young racial and ethnic minorities. Efforts to increase vaccine uptake among college populations might require campaigns specifically tailored to these minority groups. UR - https://publichealth.jmir.org/2021/12/e33739 UR - http://dx.doi.org/10.2196/33739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847054 ID - info:doi/10.2196/33739 ER - TY - JOUR AU - Brauer, Eden AU - Choi, Kristen AU - Chang, John AU - Luo, Yi AU - Lewin, Bruno AU - Munoz-Plaza, Corrine AU - Bronstein, David AU - Bruxvoort, Katia PY - 2021/12/8 TI - Health Care Providers? Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study JO - JMIR Infodemiology SP - e33330 VL - 1 IS - 1 KW - health information KW - trust KW - health care provider KW - COVID-19 KW - vaccine KW - mixed method KW - communication N2 - Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. Results: The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ?1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P<.001), and more physicians trusted their employer (n=1115, 84%) than advanced practice providers (n=95, 67%) and nurses (n=759, 64%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a ?war zone? during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19. Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources. UR - https://infodemiology.jmir.org/2021/1/e33330 UR - http://dx.doi.org/10.2196/33330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34926995 ID - info:doi/10.2196/33330 ER - TY - JOUR AU - Cruickshank, Iain AU - Ginossar, Tamar AU - Sulskis, Jason AU - Zheleva, Elena AU - Berger-Wolf, Tanya PY - 2021/12/3 TI - Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis JO - J Med Internet Res SP - e29127 VL - 23 IS - 12 KW - COVID-19 KW - agenda setting KW - antivaccination KW - cross-platform KW - data mining of social media KW - misinformation KW - social media KW - Twitter KW - vaccinations KW - vaccine hesitancy N2 - Background: The onset of the COVID-19 pandemic and the consequent ?infodemic? increased concerns about Twitter?s role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. Objective: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. Methods: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. Results: Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. Conclusions: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its ?bursty? pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation. UR - https://www.jmir.org/2021/12/e29127 UR - http://dx.doi.org/10.2196/29127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665760 ID - info:doi/10.2196/29127 ER - TY - JOUR AU - Goldin, Shoshanna AU - Kong, Joyce So Yeon AU - Tokar, Anna AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Bahl, Jhilmil AU - Appuhamy, Ranil AU - Moen, Ann PY - 2021/12/3 TI - Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study JO - JMIR Public Health Surveill SP - e33455 VL - 7 IS - 12 KW - COVID-19 KW - vaccination KW - training KW - massive open online course KW - pandemic KW - vaccine KW - education KW - online education KW - preparation KW - evaluation KW - user experience KW - challenge KW - impact KW - knowledge KW - interest N2 - Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform?s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. UR - https://publichealth.jmir.org/2021/12/e33455 UR - http://dx.doi.org/10.2196/33455 UR - http://www.ncbi.nlm.nih.gov/pubmed/34794116 ID - info:doi/10.2196/33455 ER - TY - JOUR AU - Edwards, J. Laura AU - Fowlkes, L. Ashley AU - Wesley, G. Meredith AU - Kuntz, L. Jennifer AU - Odean, J. Marilyn AU - Caban-Martinez, J. Alberto AU - Dunnigan, Kayan AU - Phillips, L. Andrew AU - Grant, Lauren AU - Herring, K. Meghan AU - Groom, C. Holly AU - Respet, Karley AU - Beitel, Shawn AU - Zunie, Tnelda AU - Hegmann, T. Kurt AU - Kumar, Archana AU - Joseph, Gregory AU - Poe, Brandon AU - Louzado-Feliciano, Paola AU - Smith, E. Michael AU - Thiese, S. Matthew AU - Schaefer-Solle, Natasha AU - Yoo, M. Young AU - Silvera, A. Carlos AU - Mayo Lamberte, Julie AU - Mak, Josephine AU - McDonald, Clifford L. AU - Stuckey, J. Matthew AU - Kutty, Preeta AU - Arvay, L. Melissa AU - Yoon, K. Sarang AU - Tyner, L. Harmony AU - Burgess, L. Jefferey AU - Hunt, Rentz Danielle AU - Meece, Jennifer AU - Gaglani, Manjusha AU - Naleway, L. Allison AU - Thompson, G. Mark PY - 2021/12/3 TI - Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study JO - JMIR Res Protoc SP - e31574 VL - 10 IS - 12 KW - COVID-19 KW - SARS-CoV-2 KW - incidence KW - vaccine effectiveness KW - cohort study KW - health care personnel KW - first responder KW - essential and frontline workers N2 - Background: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. Objective: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. Methods: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19?like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)?confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR?confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. Results: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. Conclusions: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/31574 UR - https://www.researchprotocols.org/2021/12/e31574 UR - http://dx.doi.org/10.2196/31574 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662287 ID - info:doi/10.2196/31574 ER - TY - JOUR AU - Jarynowski, Andrzej AU - Semenov, Alexander AU - Kami?ski, Miko?aj AU - Belik, Vitaly PY - 2021/11/29 TI - Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning JO - J Med Internet Res SP - e30529 VL - 23 IS - 11 KW - adverse events KW - Sputnik V KW - Gam-COVID-Vac KW - social media KW - Telegram KW - COVID-19 KW - Sars-CoV-2 KW - deep learning KW - vaccine safety N2 - Background: There is a limited amount of data on the safety profile of the COVID-19 vector vaccine Gam-COVID-Vac (Sputnik V). Previous infodemiology studies showed that social media discourse could be analyzed to assess the most concerning adverse events (AE) caused by drugs. Objective: We aimed to investigate mild AEs of Sputnik V based on a participatory trial conducted on Telegram in the Russian language. We compared AEs extracted from Telegram with other limited databases on Sputnik V and other COVID-19 vaccines. We explored symptom co-occurrence patterns and determined how counts of administered doses, age, gender, and sequence of shots could confound the reporting of AEs. Methods: We collected a unique dataset consisting of 11,515 self-reported Sputnik V vaccine AEs posted on the Telegram group, and we utilized natural language processing methods to extract AEs. Specifically, we performed multilabel classifications using the deep neural language model Bidirectional Encoder Representations from Transformers (BERT) ?DeepPavlov,? which was pretrained on a Russian language corpus and applied to the Telegram messages. The resulting area under the curve score was 0.991. We chose symptom classes that represented the following AEs: fever, pain, chills, fatigue, nausea/vomiting, headache, insomnia, lymph node enlargement, erythema, pruritus, swelling, and diarrhea. Results: Telegram users complained mostly about pain (5461/11,515, 47.43%), fever (5363/11,515, 46.57%), fatigue (3862/11,515, 33.54%), and headache (2855/11,515, 24.79%). Women reported more AEs than men (1.2-fold, P<.001). In addition, there were more AEs from the first dose than from the second dose (1.1-fold, P<.001), and the number of AEs decreased with age (?=.05 per year, P<.001). The results also showed that Sputnik V AEs were more similar to other vector vaccines (132 units) than with messenger RNA vaccines (241 units) according to the average Euclidean distance between the vectors of AE frequencies. Elderly Telegram users reported significantly more (5.6-fold on average) systemic AEs than their peers, according to the results of the phase 3 clinical trials published in The Lancet. However, the AEs reported in Telegram posts were consistent (Pearson correlation r=0.94, P=.02) with those reported in the Argentinian postmarketing AE registry. Conclusions: After the Sputnik V vaccination, Russian Telegram users reported mostly pain, fever, and fatigue. The Sputnik V AE profile was comparable with other vector COVID-19 vaccines. Discussion on social media could provide meaningful information about the AE profile of novel vaccines. UR - https://www.jmir.org/2021/11/e30529 UR - http://dx.doi.org/10.2196/30529 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662291 ID - info:doi/10.2196/30529 ER - TY - JOUR AU - Cheong, Queena AU - Au-yeung, Martin AU - Quon, Stephanie AU - Concepcion, Katsy AU - Kong, Dzevela Jude PY - 2021/11/25 TI - Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning?Based Approach JO - J Med Internet Res SP - e33231 VL - 23 IS - 11 KW - COVID-19 KW - vaccine KW - public health KW - machine learning KW - XGBoost KW - SARS-CoV-2 KW - sociodemographic factors KW - United States KW - sociodemographic KW - prediction KW - model KW - uptake N2 - Background: Although the COVID-19 pandemic has left an unprecedented impact worldwide, countries such as the United States have reported the most substantial incidence of COVID-19 cases worldwide. Within the United States, various sociodemographic factors have played a role in the creation of regional disparities. Regional disparities have resulted in the unequal spread of disease between US counties, underscoring the need for efficient and accurate predictive modeling strategies to inform public health officials and reduce the burden on health care systems. Furthermore, despite the widespread accessibility of COVID-19 vaccines across the United States, vaccination rates have become stagnant, necessitating predictive modeling to identify important factors impacting vaccination uptake. Objective: This study aims to determine the association between sociodemographic factors and vaccine uptake across counties in the United States. Methods: Sociodemographic data on fully vaccinated and unvaccinated individuals were sourced from several online databases such as the US Centers for Disease Control and Prevention and the US Census Bureau COVID-19 Site. Machine learning analysis was performed using XGBoost and sociodemographic data. Results: Our model predicted COVID-19 vaccination uptake across US counties with 62% accuracy. In addition, it identified location, education, ethnicity, income, and household access to the internet as the most critical sociodemographic features in predicting vaccination uptake in US counties. Lastly, the model produced a choropleth demonstrating areas of low and high vaccination rates, which can be used by health care authorities in future pandemics to visualize and prioritize areas of low vaccination and design targeted vaccination campaigns. Conclusions: Our study reveals that sociodemographic characteristics are predictors of vaccine uptake rates across counties in the United States and, if leveraged appropriately, can assist policy makers and public health officials to understand vaccine uptake rates and craft policies to improve them. UR - https://www.jmir.org/2021/11/e33231 UR - http://dx.doi.org/10.2196/33231 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751650 ID - info:doi/10.2196/33231 ER - TY - JOUR AU - Muric, Goran AU - Wu, Yusong AU - Ferrara, Emilio PY - 2021/11/17 TI - COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies JO - JMIR Public Health Surveill SP - e30642 VL - 7 IS - 11 KW - vaccine hesitancy KW - COVID-19 vaccines KW - dataset KW - COVID-19 KW - SARS-CoV-2 KW - social media KW - network analysis KW - hesitancy KW - vaccine KW - Twitter KW - misinformation KW - conspiracy KW - trust KW - public health KW - utilization N2 - Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword?centered data collection with more than 1.8 million tweets, and (2) a historical account?level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. UR - https://publichealth.jmir.org/2021/11/e30642 UR - http://dx.doi.org/10.2196/30642 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653016 ID - info:doi/10.2196/30642 ER - TY - JOUR AU - An, Lawrence AU - Russell, M. Daniel AU - Mihalcea, Rada AU - Bacon, Elizabeth AU - Huffman, Scott AU - Resnicow, Ken PY - 2021/11/12 TI - Online Search Behavior Related to COVID-19 Vaccines: Infodemiology Study JO - JMIR Infodemiology SP - e32127 VL - 1 IS - 1 KW - online health information KW - behavior KW - search KW - COVID-19 KW - vaccine KW - infodemiology KW - internet KW - trend KW - public health KW - awareness KW - concern KW - interest KW - public KW - misinformation KW - safety KW - side effect KW - availability N2 - Background: Vaccination against COVID-19 is an important public health strategy to address the ongoing pandemic. Examination of online search behavior related to COVID-19 vaccines can provide insights into the public's awareness, concerns, and interest regarding COVID-19 vaccination. Objective: The aim of this study is to describe online search behavior related to COVID-19 vaccines during the start of public vaccination efforts in the United States. Methods: We examined Google Trends data from January 1, 2021, through March 16, 2021, to determine the relative search volume for vaccine-related searches on the internet. We also examined search query log data for COVID-19 vaccine-related searches and identified 5 categories of searches: (1) general or other information, (2) vaccine availability, (3) vaccine manufacturer, (4) vaccine side-effects and safety, and (5) vaccine myths and conspiracy beliefs. In this paper, we report on the proportion and trends for these different categories of vaccine-related searches. Results: In the first quarter of 2021, the proportion of all web-based search queries related to COVID-19 vaccines increased from approximately 10% to nearly 50% of all COVID-19?related queries (P<.001). A majority of COVID-19 vaccine queries addressed vaccine availability, and there was a particularly notable increase in the proportion of queries that included the name of a specific pharmacy (from 6% to 27%; P=.01). Queries related to vaccine safety and side-effects (<5% of total queries) or specific vaccine-related myths (<1% of total queries) were uncommon, and the relative frequency of both types of searches decreased during the study period. Conclusions: This study demonstrates an increase in online search behavior related to COVID-19 vaccination in early 2021 along with an increase in the proportion of searches related to vaccine availability at pharmacies. These findings are consistent with an increase in public interest and intention to get vaccinated during the initial phase of public COVID-19 vaccination efforts. UR - https://infodemiology.jmir.org/2021/1/e32127 UR - http://dx.doi.org/10.2196/32127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34841200 ID - info:doi/10.2196/32127 ER - TY - JOUR AU - Lee, Bohee AU - Ibrahim, Aishah Siti AU - Zhang, Tiying PY - 2021/11/11 TI - Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e32093 VL - 9 IS - 11 KW - mobile apps KW - applications KW - eHealth KW - mHealth KW - mobile health KW - digital health KW - telemedicine KW - telehealth KW - COVID-19 KW - coronavirus KW - pandemic KW - public health KW - health policy N2 - Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19?related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app?s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. UR - https://mhealth.jmir.org/2021/11/e32093 UR - http://dx.doi.org/10.2196/32093 UR - http://www.ncbi.nlm.nih.gov/pubmed/34748515 ID - info:doi/10.2196/32093 ER - TY - JOUR AU - Singh, Akansha AU - Lai, Yan Angel Hor AU - Wang, Jingxuan AU - Asim, Saba AU - Chan, Shing-Fong Paul AU - Wang, Zixin AU - Yeoh, Kiong Eng PY - 2021/11/9 TI - Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e31707 VL - 7 IS - 11 KW - COVID-19 KW - South Asian ethnic minorities KW - COVID-19 vaccination KW - uptake KW - cultural and religious reasons for vaccine hesitancy KW - perceptions KW - information exposure on social media KW - influence of peers KW - socioecological model KW - Hong Kong N2 - Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. UR - https://publichealth.jmir.org/2021/11/e31707 UR - http://dx.doi.org/10.2196/31707 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653014 ID - info:doi/10.2196/31707 ER - TY - JOUR AU - Liew, Ming Tau AU - Lee, Sin Cia PY - 2021/11/3 TI - Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts JO - JMIR Public Health Surveill SP - e29789 VL - 7 IS - 11 KW - social media KW - COVID-19 KW - vaccine hesitancy KW - natural language processing KW - machine learning KW - infodemiology N2 - Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to ?COVID-19? and ?vaccine? over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model. Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133). Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3%), (2) public concerns related to COVID-19 vaccines (19.6%), (3) discussions about news items related to COVID-19 vaccines (13.3%), (4) public health communications about COVID-19 vaccines (10.3%), (5) discussions about approaches to COVID-19 vaccination drives (17.1%), and (6) discussions about the distribution of COVID-19 vaccines (20.3%). Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines. Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks. The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. UR - https://publichealth.jmir.org/2021/11/e29789 UR - http://dx.doi.org/10.2196/29789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34583316 ID - info:doi/10.2196/29789 ER - TY - JOUR AU - Monselise, Michal AU - Chang, Chia-Hsuan AU - Ferreira, Gustavo AU - Yang, Rita AU - Yang, C. Christopher PY - 2021/10/21 TI - Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis JO - J Med Internet Res SP - e30765 VL - 23 IS - 10 KW - health care informatics KW - topic detection KW - unsupervised sentiment analysis KW - COVID-19 KW - vaccine hesitancy KW - sentiment KW - concern KW - vaccine KW - social media KW - trend KW - trust KW - health information KW - Twitter KW - discussion KW - communication KW - hesitancy KW - emotion KW - fear N2 - Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. UR - https://www.jmir.org/2021/10/e30765 UR - http://dx.doi.org/10.2196/30765 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581682 ID - info:doi/10.2196/30765 ER - TY - JOUR AU - Huang, Xiaojie AU - Yu, Maohe AU - Fu, Gengfeng AU - Lan, Guanghua AU - Li, Linghua AU - Yang, Jianzhou AU - Qiao, Ying AU - Zhao, Jin AU - Qian, Han-Zhu AU - Zhang, Xiangjun AU - Liu, Xinchao AU - Jin, Xia AU - Chen, Guohong AU - Jiang, Hui AU - Tang, Weiming AU - Wang, Zixin AU - Xu, Junjie PY - 2021/10/21 TI - Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey JO - JMIR Public Health Surveill SP - e31125 VL - 7 IS - 10 KW - people living with HIV and AIDS KW - COVID-19 vaccination KW - willingness KW - perceptions KW - internet and social media influences KW - interpersonal communication N2 - Background: HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. Objective: The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China. Methods: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis. Results: Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (?=.43, 95% CI .37-.51; P<.001). Conclusions: As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA?s perceptions and willingness to receive COVID-19 vaccination. UR - https://publichealth.jmir.org/2021/10/e31125 UR - http://dx.doi.org/10.2196/31125 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543223 ID - info:doi/10.2196/31125 ER - TY - JOUR AU - Benis, Arriel AU - Chatsubi, Anat AU - Levner, Eugene AU - Ashkenazi, Shai PY - 2021/10/14 TI - Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence?Based Infodemiology Study JO - JMIR Infodemiology SP - e31983 VL - 1 IS - 1 KW - influenza KW - vaccines KW - vaccination KW - social media KW - social networks KW - health communication KW - artificial intelligence KW - machine learning KW - text mining KW - infodemiology KW - COVID-19 KW - SARS-CoV-2 N2 - Background: Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines. Objective: Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence?based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications. Methods: The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy. Results: We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: ?flu,? ?influenza,? ?vaccination,? ?vaccine,? and ?vaxx.? We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that ?flu? and ?covid? occurrences were inversely correlated as ?flu? disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: ?health and medicine (biological and clinical aspects),? ?protection and responsibility,? and ?politics.? By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events. Conclusions: This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations? engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process. UR - https://infodemiology.jmir.org/2021/1/e31983 UR - http://dx.doi.org/10.2196/31983 UR - http://www.ncbi.nlm.nih.gov/pubmed/34693212 ID - info:doi/10.2196/31983 ER - TY - JOUR AU - Yan, Cathy AU - Law, Melanie AU - Nguyen, Stephanie AU - Cheung, Janelle AU - Kong, Jude PY - 2021/9/24 TI - Comparing Public Sentiment Toward COVID-19 Vaccines Across Canadian Cities: Analysis of Comments on Reddit JO - J Med Internet Res SP - e32685 VL - 23 IS - 9 KW - COVID-19 KW - public sentiment KW - social media KW - Reddit KW - Canada KW - communication KW - sentiment KW - opinion KW - emotion KW - concern KW - pandemic KW - vaccine KW - hesitancy N2 - Background: Social media enables the rapid consumption of news related to COVID-19 and serves as a platform for discussions. Its richness in text-based data in the form of posts and comments allows researchers to identify popular topics and assess public sentiment. Nonetheless, the vast majority of topic extraction and sentiment analysis based on social media is performed on the platform or country level and does not account for local culture and policies. Objective: The aim of this study is to use location-based subreddits on Reddit to study city-level variations in sentiments toward vaccine-related topics. Methods: Comments on posts providing regular updates on COVID-19 statistics in the Vancouver (r/vancouver, n=49,291), Toronto (r/toronto, n=20,764), and Calgary (r/calgary, n=21,277) subreddits between July 13, 2020, and June 14, 2021, were extracted. Latent Dirichlet allocation was used to identify frequently discussed topics. Sentiment (joy, sadness, fear, and anger) scores were assigned to comments through random forest regression. Results: The number of comments on the 250 posts from the Vancouver subreddit positively correlated with the number of new daily COVID-19 cases in British Columbia (R=0.51, 95% CI for slope 0.18-0.29; P<.001). From the comments, 13 topics were identified. Two were related to vaccines, 1 regarding vaccine uptake and the other about vaccine supply. The levels of discussion for both topics were linked to the total number of vaccines administered (Granger test for causality, P<.001). Comments pertaining to either topic displayed higher scores for joy than for other topics (P<.001). Calgary and Toronto also discussed vaccine uptake. Sentiment scores for this topic differed across the 3 cities (P<.001). Conclusions: Our work demonstrates that data from city-specific subreddits can be used to better understand concerns and sentiments around COVID-19 vaccines at the local level. This can potentially lead to more targeted and publicly acceptable policies based on content on social media. UR - https://www.jmir.org/2021/9/e32685 UR - http://dx.doi.org/10.2196/32685 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519654 ID - info:doi/10.2196/32685 ER - TY - JOUR AU - Glampson, Ben AU - Brittain, James AU - Kaura, Amit AU - Mulla, Abdulrahim AU - Mercuri, Luca AU - Brett, J. Stephen AU - Aylin, Paul AU - Sandall, Tessa AU - Goodman, Ian AU - Redhead, Julian AU - Saravanakumar, Kavitha AU - Mayer, K. Erik PY - 2021/9/17 TI - Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e30010 VL - 7 IS - 9 KW - health informatics KW - real-word evidence KW - COVID-19 KW - medical informatics KW - vaccine KW - vaccination N2 - Background: On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. Objective: This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. Methods: A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. Results: In this study, 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=?0.94; P=.002) with 13.5% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74% (hazard ratio 0.26, 95% CI 0.19-0.35) and 78% (hazard ratio 0.22, 95% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. Conclusions: There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population. UR - https://publichealth.jmir.org/2021/9/e30010 UR - http://dx.doi.org/10.2196/30010 UR - http://www.ncbi.nlm.nih.gov/pubmed/34265740 ID - info:doi/10.2196/30010 ER - TY - JOUR AU - Jiang, Crystal Li AU - Chu, Hang Tsz AU - Sun, Mengru PY - 2021/9/14 TI - Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis JO - JMIR Infodemiology SP - e25636 VL - 1 IS - 1 KW - topic modeling KW - social media KW - infoveillance KW - vaccine KW - coronavirus KW - COVID-19 N2 - Background: During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions. Objective: This study aimed to uncover the emerging themes in Twitter users? perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak. Methods: This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, ?COVID? AND ?vaccine?) to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms. Results: In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level?the extent to which a tweet being retweeted, quoted, liked, or replied by other users?was similar among different themes, but tweets venting negative emotions yielded the lowest engagement. Conclusions: This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence. UR - https://infodemiology.jmir.org/2021/1/e25636 UR - http://dx.doi.org/10.2196/25636 UR - http://www.ncbi.nlm.nih.gov/pubmed/34604707 ID - info:doi/10.2196/25636 ER - TY - JOUR AU - Hu, Tao AU - Wang, Siqin AU - Luo, Wei AU - Zhang, Mengxi AU - Huang, Xiao AU - Yan, Yingwei AU - Liu, Regina AU - Ly, Kelly AU - Kacker, Viraj AU - She, Bing AU - Li, Zhenlong PY - 2021/9/10 TI - Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective JO - J Med Internet Res SP - e30854 VL - 23 IS - 9 KW - Twitter KW - public opinion KW - COVID-19 vaccines KW - sentiment analysis KW - emotion analysis KW - topic modeling KW - COVID-19 N2 - Background: The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance. Objective: The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter. Methods: We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes. Results: An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis. Conclusions: The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines. UR - https://www.jmir.org/2021/9/e30854 UR - http://dx.doi.org/10.2196/30854 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346888 ID - info:doi/10.2196/30854 ER - TY - JOUR AU - Lee, Hocheol AU - Noh, Bi Eun AU - Park, Jong Sung AU - Nam, Kweun Hae AU - Lee, Ho Tae AU - Lee, Ram Ga AU - Nam, Woo Eun PY - 2021/9/8 TI - COVID-19 Vaccine Perception in South Korea: Web Crawling Approach JO - JMIR Public Health Surveill SP - e31409 VL - 7 IS - 9 KW - COVID-19 vaccine KW - COVID-19 KW - instagram KW - social media KW - infodemiology KW - sentiment analysis KW - vaccine perception KW - South Korea KW - web crawling KW - AstraZeneca KW - Pfizer N2 - Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens? perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens? perception of COVID-19 vaccines. The keywords searched were ?vaccine,? ?AstraZeneca,? and ?Pfizer.? In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with ?vaccine,? ?good? ranked first, with a frequency of 13.43% (312/2323). Meanwhile, ?side effect? ranked highest, with a frequency of 29.2% (163/559) for ?AstraZeneca,? but 0.6% (4/673) for ?Pfizer.? With ?vaccine,? positive words were more frequently used, whereas with ?AstraZeneca? and ?Pfizer? negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. UR - https://publichealth.jmir.org/2021/9/e31409 UR - http://dx.doi.org/10.2196/31409 UR - http://www.ncbi.nlm.nih.gov/pubmed/34348890 ID - info:doi/10.2196/31409 ER - TY - JOUR AU - Chen, Hao AU - Li, Xiaomei AU - Gao, Junling AU - Liu, Xiaoxi AU - Mao, Yimeng AU - Wang, Ruru AU - Zheng, Pinpin AU - Xiao, Qianyi AU - Jia, Yingnan AU - Fu, Hua AU - Dai, Junming PY - 2021/9/6 TI - Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study JO - J Med Internet Res SP - e29329 VL - 23 IS - 9 KW - COVID-19 pandemic KW - vaccination behavior KW - vaccine hesitancy KW - health belief model N2 - Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=?0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=?0.45, P<.001) via vaccine hesitancy (SSC=?0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function. UR - https://www.jmir.org/2021/9/e29329 UR - http://dx.doi.org/10.2196/29329 UR - http://www.ncbi.nlm.nih.gov/pubmed/34280115 ID - info:doi/10.2196/29329 ER - TY - JOUR AU - Luo, Chen AU - Ji, Kaiyuan AU - Tang, Yulong AU - Du, Zhiyuan PY - 2021/8/27 TI - Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach JO - J Med Internet Res SP - e30715 VL - 23 IS - 8 KW - COVID-19 KW - vaccine KW - Zhihu KW - structural topic modeling KW - medical professional KW - laypeople KW - adverse reactions KW - vaccination KW - vaccine effectiveness KW - vaccine development N2 - Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine?related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the ?safety of Chinese-made vaccine? topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as ?qualitatively different? in perspective rather than ?quantitatively different? in scientific knowledge. Among those questions closely associated with medical expertise, the ?qualitatively different? characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. UR - https://www.jmir.org/2021/8/e30715 UR - http://dx.doi.org/10.2196/30715 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346885 ID - info:doi/10.2196/30715 ER - TY - JOUR AU - Roghani, Ali PY - 2021/8/12 TI - The Influence of COVID-19 Vaccination on Daily Cases, Hospitalization, and Death Rate in Tennessee, United States: Case Study JO - JMIRx Med SP - e29324 VL - 2 IS - 3 KW - COVID-19 KW - pandemic KW - vaccination KW - vaccine KW - strategy KW - vaccination strategy KW - hospitalization KW - mortality rates KW - older adults KW - mortality N2 - Background: The COVID-19 outbreak highlights our vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the immediate vaccination of the whole population. Therefore, policies have adopted a strategy to vaccinate older adults and vulnerable populations while delaying vaccination for others. Objective: This study aimed to understand how age-specific vaccination strategies reduce daily cases, hospitalizations, and death rates using official statistics for Tennessee, United States. Methods: This study used publicly available data on COVID-19, including vaccination rates, positive cases, hospitalizations, and deaths from the Tennessee Department of Health. Data from the first date of vaccination (December 17, 2020) to March 3, 2021, were retrieved. The rates were adjusted by 2019 data from the US Census Bureau, and age groups were stratified into 10-year intervals starting with 21 years of age. Results: The findings showed that vaccination strategy can reduce the numbers of patients with COVID-19 in all age groups, with lower hospitalization and death rates in older populations. Older adults had a 95% lower death rate from December to March; no change in the death rate of other age groups was observed. The hospitalization rate was reduced by 80% for people aged ?80 years, while people who were 50 to 70 years old had nearly the same hospitalization rate as prior to vaccination. Conclusions: This research indicates that targeting older age groups for vaccination is the optimal way to avoid higher transmissions and reduce hospitalization and death rates. UR - https://med.jmirx.org/2021/3/e29324 UR - http://dx.doi.org/10.2196/29324 UR - http://www.ncbi.nlm.nih.gov/pubmed/34424255 ID - info:doi/10.2196/29324 ER - TY - JOUR AU - Boucher, Jean-Christophe AU - Cornelson, Kirsten AU - Benham, L. Jamie AU - Fullerton, M. Madison AU - Tang, Theresa AU - Constantinescu, Cora AU - Mourali, Mehdi AU - Oxoby, J. Robert AU - Marshall, A. Deborah AU - Hemmati, Hadi AU - Badami, Abbas AU - Hu, Jia AU - Lang, Raynell PY - 2021/8/12 TI - Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study JO - JMIR Infodemiology SP - e28800 VL - 1 IS - 1 KW - coronavirus KW - COVID-19 KW - public health KW - social media KW - Twitter KW - behavior KW - risk reduction KW - attitudes KW - social network analysis KW - machine learning N2 - Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government?s handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. UR - https://infodemiology.jmir.org/2021/1/e28800 UR - http://dx.doi.org/10.2196/28800 UR - http://www.ncbi.nlm.nih.gov/pubmed/34447924 ID - info:doi/10.2196/28800 ER - TY - JOUR AU - Sajjadi, B. Nicholas AU - Shepard, Samuel AU - Ottwell, Ryan AU - Murray, Kelly AU - Chronister, Justin AU - Hartwell, Micah AU - Vassar, Matt PY - 2021/8/4 TI - Examining the Public?s Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study JO - JMIR Infodemiology SP - e28740 VL - 1 IS - 1 KW - content KW - COVID-19 KW - frequently asked questions KW - internet KW - machine learning KW - natural language processing KW - quality KW - question KW - SARS-CoV-2 KW - search analytics KW - search engine KW - transparency KW - vaccine hesitancy KW - vaccine KW - web-based health information N2 - Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19?related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective: Using Google?s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods: We searched COVID-19 vaccine terms on Google and used the ?People also ask? box to obtain FAQs generated by Google?s machine learning algorithms. FAQs are assigned an ?answer? source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association?s (JAMA?s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results: Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine?related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (?24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions: The most frequently asked COVID-19 vaccine?related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine?related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts. UR - https://infodemiology.jmir.org/2021/1/e28740 UR - http://dx.doi.org/10.2196/28740 UR - http://www.ncbi.nlm.nih.gov/pubmed/34458683 ID - info:doi/10.2196/28740 ER - TY - JOUR AU - Su, Zhaohui AU - McDonnell, Dean AU - Cheshmehzangi, Ali AU - Li, Xiaoshan AU - Maestro, Daniel AU - ?egalo, Sabina AU - Ahmad, Junaid AU - Hao, Xiaoning PY - 2021/8/4 TI - With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines JO - JMIR Public Health Surveill SP - e26111 VL - 7 IS - 8 KW - COVID-19 KW - coronavirus KW - COVID-19 vaccine KW - made in China KW - vaccine efficacy KW - vaccine safety KW - vaccine KW - China KW - expectation KW - safety KW - efficacy KW - infectious disease KW - public health KW - consequence KW - standard UR - https://publichealth.jmir.org/2021/8/e26111 UR - http://dx.doi.org/10.2196/26111 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560997 ID - info:doi/10.2196/26111 ER - TY - JOUR AU - Hajduczok, G. Alexander AU - DiJoseph, M. Kara AU - Bent, Brinnae AU - Thorp, K. Audrey AU - Mullholand, B. Jon AU - MacKay, A. Stuart AU - Barik, Sabrina AU - Coleman, J. Jamie AU - Paules, I. Catharine AU - Tinsley, Andrew PY - 2021/8/4 TI - Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study JO - JMIR Form Res SP - e28568 VL - 5 IS - 8 KW - COVID-19 KW - wearable devices KW - remote physiologic monitoring KW - heart rate KW - heart rate variability KW - respiratory rate KW - sleep KW - REM sleep KW - deep sleep KW - wearable KW - vaccine KW - monitoring KW - respiratory KW - physiological KW - cohort N2 - Background: The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective: We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods: In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results: In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean ?13.44%, SD 13.62%) and second vaccine dose (mean ?9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions: This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration: ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703 UR - https://formative.jmir.org/2021/8/e28568 UR - http://dx.doi.org/10.2196/28568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34236995 ID - info:doi/10.2196/28568 ER - TY - JOUR AU - Chan, Calvin AU - Sounderajah, Viknesh AU - Daniels, Elisabeth AU - Acharya, Amish AU - Clarke, Jonathan AU - Yalamanchili, Seema AU - Normahani, Pasha AU - Markar, Sheraz AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2021/7/8 TI - The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study JO - JMIR Public Health Surveill SP - e29942 VL - 7 IS - 7 KW - COVID-19 KW - infodemiology KW - public health KW - quality KW - reliability KW - social media KW - vaccination KW - vaccine KW - video KW - web-based health information KW - YouTube N2 - Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases ?coronavirus vaccine? and ?COVID-19 vaccine? were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. UR - https://publichealth.jmir.org/2021/7/e29942 UR - http://dx.doi.org/10.2196/29942 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081599 ID - info:doi/10.2196/29942 ER - TY - JOUR AU - Lyu, Chen Joanne AU - Han, Le Eileen AU - Luli, K. Garving PY - 2021/6/29 TI - COVID-19 Vaccine?Related Discussion on Twitter: Topic Modeling and Sentiment Analysis JO - J Med Internet Res SP - e24435 VL - 23 IS - 6 KW - COVID-19 KW - vaccine KW - vaccination KW - Twitter KW - infodemiology KW - infoveillance KW - topic KW - sentiment KW - opinion KW - discussion KW - communication KW - social media KW - perception KW - concern KW - emotion N2 - Background: Vaccination is a cornerstone of the prevention of communicable infectious diseases; however, vaccines have traditionally met with public fear and hesitancy, and COVID-19 vaccines are no exception. Social media use has been demonstrated to play a role in the low acceptance of vaccines. Objective: The aim of this study is to identify the topics and sentiments in the public COVID-19 vaccine?related discussion on social media and discern the salient changes in topics and sentiments over time to better understand the public perceptions, concerns, and emotions that may influence the achievement of herd immunity goals. Methods: Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, the day the World Health Organization declared COVID-19 a pandemic, to January 31, 2021. We used R software to clean the tweets and retain tweets that contained the keywords vaccination, vaccinations, vaccine, vaccines, immunization, vaccinate, and vaccinated. The final data set included in the analysis consisted of 1,499,421 unique tweets from 583,499 different users. We used R to perform latent Dirichlet allocation for topic modeling as well as sentiment and emotion analysis using the National Research Council of Canada Emotion Lexicon. Results: Topic modeling of tweets related to COVID-19 vaccines yielded 16 topics, which were grouped into 5 overarching themes. Opinions about vaccination (227,840/1,499,421 tweets, 15.2%) was the most tweeted topic and remained a highly discussed topic during the majority of the period of our examination. Vaccine progress around the world became the most discussed topic around August 11, 2020, when Russia approved the world?s first COVID-19 vaccine. With the advancement of vaccine administration, the topic of instruction on getting vaccines gradually became more salient and became the most discussed topic after the first week of January 2021. Weekly mean sentiment scores showed that despite fluctuations, the sentiment was increasingly positive in general. Emotion analysis further showed that trust was the most predominant emotion, followed by anticipation, fear, sadness, etc. The trust emotion reached its peak on November 9, 2020, when Pfizer announced that its vaccine is 90% effective. Conclusions: Public COVID-19 vaccine?related discussion on Twitter was largely driven by major events about COVID-19 vaccines and mirrored the active news topics in mainstream media. The discussion also demonstrated a global perspective. The increasingly positive sentiment around COVID-19 vaccines and the dominant emotion of trust shown in the social media discussion may imply higher acceptance of COVID-19 vaccines compared with previous vaccines. UR - https://www.jmir.org/2021/6/e24435 UR - http://dx.doi.org/10.2196/24435 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115608 ID - info:doi/10.2196/24435 ER - TY - JOUR AU - Surapaneni, Mohan Krishna AU - Kaur, Mahima AU - Kaur, Ritika AU - Grover, Ashoo AU - Joshi, Ashish PY - 2021/6/24 TI - The Impact of COVID-19 Vaccine Communication, Acceptance, and Practices (CO-VIN-CAP) on Vaccine Hesitancy in an Indian Setting: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e29733 VL - 10 IS - 6 KW - COVID-19 vaccine KW - vaccine hesitancy KW - vaccine acceptance KW - unintended consequences KW - vaccination KW - COVID-19 KW - pandemic KW - coronavirus KW - infectious disease KW - protocol KW - vaccine N2 - Background: COVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. Objective: This study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19?related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. Methods: A cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. Results: A pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. Conclusions: The proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID): DERR1-10.2196/29733 UR - https://www.researchprotocols.org/2021/6/e29733/ UR - http://dx.doi.org/10.2196/29733 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/29733 ER - TY - JOUR AU - Hou, Zhiyuan AU - Tong, Yixin AU - Du, Fanxing AU - Lu, Linyao AU - Zhao, Sihong AU - Yu, Kexin AU - Piatek, J. Simon AU - Larson, J. Heidi AU - Lin, Leesa PY - 2021/6/11 TI - Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study JO - J Med Internet Res SP - e27632 VL - 23 IS - 6 KW - COVID-19 vaccine KW - hesitancy KW - infoveillance KW - infodemiology KW - confidence KW - acceptance KW - engagement KW - social media KW - COVID-19 N2 - Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions. Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination. Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization?s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media. Results: Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online. Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts. UR - https://www.jmir.org/2021/6/e27632 UR - http://dx.doi.org/10.2196/27632 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061757 ID - info:doi/10.2196/27632 ER - TY - JOUR AU - Hou, Zhiyuan AU - Song, Suhang AU - Du, Fanxing AU - Shi, Lu AU - Zhang, Donglan AU - Lin, Leesa AU - Yu, Hongjie PY - 2021/5/26 TI - The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e26372 VL - 7 IS - 5 KW - COVID-19 KW - prevention KW - vaccination KW - behavior KW - children KW - China N2 - Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children?s and adolescents? prevention and vaccination behaviors amid China?s COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children?s and adolescents? prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents? characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2% (638/776) of children or adolescents always wore masks when going out compared with 31.5% (521/1655) before the epidemic; in addition, 25.0% (414/1655) and 79.8% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9% (776/1655) went out during the epidemic. Meanwhile, 56.1% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8% (468/626) delaying scheduled vaccinations and 80.9% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. UR - https://publichealth.jmir.org/2021/5/e26372 UR - http://dx.doi.org/10.2196/26372 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882450 ID - info:doi/10.2196/26372 ER - TY - JOUR AU - Liu, Siru AU - Liu, Jialin PY - 2021/5/12 TI - Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets JO - J Med Internet Res SP - e28118 VL - 23 IS - 5 KW - vaccine KW - COVID-19 KW - behavior KW - tweet KW - intention KW - content analysis KW - Twitter KW - social media KW - acceptance KW - threshold KW - willing KW - theory KW - model KW - infodemiology KW - infoveillance N2 - Background: Acceptance rates of COVID-19 vaccines have still not reached the required threshold to achieve herd immunity. Understanding why some people are willing to be vaccinated and others are not is a critical step to develop efficient implementation strategies to promote COVID-19 vaccines. Objective: We conducted a theory-based content analysis based on the capability, opportunity, motivation?behavior (COM-B) model to characterize the factors influencing behavioral intentions toward COVID-19 vaccines mentioned on the Twitter platform. Methods: We collected tweets posted in English from November 1-22, 2020, using a combination of relevant keywords and hashtags. After excluding retweets, we randomly selected 5000 tweets for manual coding and content analysis. We performed a content analysis informed by the adapted COM-B model. Results: Of the 5000 COVID-19 vaccine?related tweets that were coded, 4796 (95.9%) were posted by unique users. A total of 97 tweets carried positive behavioral intent, while 182 tweets contained negative behavioral intent. Of these, 28 tweets were mapped to capability factors, 155 tweets were related to motivation, 23 tweets were related to opportunities, and 74 tweets did not contain any useful information about the reasons for their behavioral intentions (?=0.73). Some tweets mentioned two or more constructs at the same time. Tweets that were mapped to capability (P<.001), motivation (P<.001), and opportunity (P=.03) factors were more likely to indicate negative behavioral intentions. Conclusions: Most behavioral intentions regarding COVID-19 vaccines were related to the motivation construct. The themes identified in this study could be used to inform theory-based and evidence-based interventions to improve acceptance of COVID-19 vaccines. UR - https://www.jmir.org/2021/5/e28118 UR - http://dx.doi.org/10.2196/28118 UR - http://www.ncbi.nlm.nih.gov/pubmed/33939625 ID - info:doi/10.2196/28118 ER - TY - JOUR AU - Basch, E. Charles AU - Basch, H. Corey AU - Hillyer, C. Grace AU - Meleo-Erwin, C. Zoe AU - Zagnit, A. Emily PY - 2021/5/6 TI - YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study JO - JMIR Public Health Surveill SP - e28352 VL - 7 IS - 5 KW - YouTube KW - vaccination KW - COVID-19 KW - social media KW - communication KW - misinformation KW - disinformation KW - adverse reactions N2 - Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords ?coronavirus vaccination,? we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. UR - https://publichealth.jmir.org/2021/5/e28352 UR - http://dx.doi.org/10.2196/28352 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886487 ID - info:doi/10.2196/28352 ER - TY - JOUR AU - Eibensteiner, Fabian AU - Ritschl, Valentin AU - Nawaz, A. Faisal AU - Fazel, S. Sajjad AU - Tsagkaris, Christos AU - Kulnik, Tino Stefan AU - Crutzen, Rik AU - Klager, Elisabeth AU - Völkl-Kernstock, Sabine AU - Schaden, Eva AU - Kletecka-Pulker, Maria AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2021/4/29 TI - People?s Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis JO - J Med Internet Res SP - e28973 VL - 23 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - vaccination KW - Twitter KW - survey KW - vaccination willingness KW - vaccination hesitancy KW - coronavirus KW - vaccine confidence KW - willingness KW - hesitancy KW - social media KW - safety KW - concern KW - public health KW - opinion KW - perception N2 - Background: On January 30, 2020, the World Health Organization?s Emergency Committee declared the rapid, worldwide spread of COVID-19 a global health emergency. Since then, tireless efforts have been made to mitigate the spread of the disease and its impact, and these efforts have mostly relied on nonpharmaceutical interventions. By December 2020, the safety and efficacy of the first COVID-19 vaccines were demonstrated. The large social media platform Twitter has been used by medical researchers for the analysis of important public health topics, such as the public?s perception on antibiotic use and misuse and human papillomavirus vaccination. The analysis of Twitter-generated data can be further facilitated by using Twitter?s built-in, anonymous polling tool to gain insight into public health issues and obtain rapid feedback on an international scale. During the fast-paced course of the COVID-19 pandemic, the Twitter polling system has provided a viable method for gaining rapid, large-scale, international public health insights on highly relevant and timely SARS-CoV-2?related topics. Objective: The purpose of this study was to understand the public?s perception on the safety and acceptance of COVID-19 vaccines in real time by using Twitter polls. Methods: We developed 2 Twitter polls to explore the public?s views on available COVID-19 vaccines. The surveys were pinned to the Digital Health and Patient Safety Platform Twitter timeline for 1 week in mid-February 2021, and Twitter users and influencers were asked to participate in and retweet the polls to reach the largest possible audience. Results: The adequacy of COVID-19 vaccine safety (ie, the safety of currently available vaccines; poll 1) was agreed upon by 1579 out of 3439 (45.9%) Twitter users. In contrast, almost as many Twitter users (1434/3439, 41.7%) were unsure about the safety of COVID-19 vaccines. Only 5.2% (179/3439) of Twitter users rated the available COVID-19 vaccines as generally unsafe. Poll 2, which addressed the question of whether users would undergo vaccination, was answered affirmatively by 82.8% (2862/3457) of Twitter users, and only 8% (277/3457) categorically rejected vaccination at the time of polling. Conclusions: In contrast to the perceived high level of uncertainty about the safety of the available COVID-19 vaccines, we observed an elevated willingness to undergo vaccination among our study sample. Since people's perceptions and views are strongly influenced by social media, the snapshots provided by these media platforms represent a static image of a moving target. Thus, the results of this study need to be followed up by long-term surveys to maintain their validity. This is especially relevant due to the circumstances of the fast-paced pandemic and the need to not miss sudden rises in the incidence of vaccine hesitancy, which may have detrimental effects on the pandemic?s course. UR - https://www.jmir.org/2021/4/e28973 UR - http://dx.doi.org/10.2196/28973 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872185 ID - info:doi/10.2196/28973 ER - TY - JOUR AU - Li, Junjiang AU - Giabbanelli, Philippe PY - 2021/4/29 TI - Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study JO - JMIR Med Inform SP - e27419 VL - 9 IS - 4 KW - agent-based model KW - cloud-based simulations KW - COVID-19 KW - large-scale simulations KW - vaccine KW - model KW - simulation KW - United States KW - agent-based KW - effective KW - willingness KW - capacity KW - plan KW - strategy KW - outcome KW - interaction KW - intervention KW - scenario KW - impact N2 - Background: In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. Objective: We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. Methods: We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. Results: For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. Conclusions: Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections. UR - https://medinform.jmir.org/2021/4/e27419 UR - http://dx.doi.org/10.2196/27419 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872188 ID - info:doi/10.2196/27419 ER - TY - JOUR AU - Griffith, Janessa AU - Marani, Husayn AU - Monkman, Helen PY - 2021/4/13 TI - COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework JO - J Med Internet Res SP - e26874 VL - 23 IS - 4 KW - vaccine hesitancy KW - vaccine KW - COVID-19 KW - immunization KW - Twitter KW - infodemiology KW - infoveillance KW - social media KW - behavioral science KW - behavior KW - Canada KW - content analysis KW - framework KW - hesitancy N2 - Background: With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. Objective: The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods: We screened 3915 tweets from public Twitter profiles in Canada by using the search words ?vaccine? and ?COVID.? The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results: Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions: With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines. UR - https://www.jmir.org/2021/4/e26874 UR - http://dx.doi.org/10.2196/26874 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769946 ID - info:doi/10.2196/26874 ER - TY - JOUR AU - Hussain, Amir AU - Tahir, Ahsen AU - Hussain, Zain AU - Sheikh, Zakariya AU - Gogate, Mandar AU - Dashtipour, Kia AU - Ali, Azhar AU - Sheikh, Aziz PY - 2021/4/5 TI - Artificial Intelligence?Enabled Analysis of Public Attitudes on Facebook and Twitter Toward COVID-19 Vaccines in the United Kingdom and the United States: Observational Study JO - J Med Internet Res SP - e26627 VL - 23 IS - 4 KW - artificial intelligence KW - COVID-19 KW - deep learning KW - Facebook KW - health informatics KW - natural language processing KW - public health KW - sentiment analysis KW - social media KW - Twitter KW - infodemiology KW - vaccination N2 - Background: Global efforts toward the development and deployment of a vaccine for COVID-19 are rapidly advancing. To achieve herd immunity, widespread administration of vaccines is required, which necessitates significant cooperation from the general public. As such, it is crucial that governments and public health agencies understand public sentiments toward vaccines, which can help guide educational campaigns and other targeted policy interventions. Objective: The aim of this study was to develop and apply an artificial intelligence?based approach to analyze public sentiments on social media in the United Kingdom and the United States toward COVID-19 vaccines to better understand the public attitude and concerns regarding COVID-19 vaccines. Methods: Over 300,000 social media posts related to COVID-19 vaccines were extracted, including 23,571 Facebook posts from the United Kingdom and 144,864 from the United States, along with 40,268 tweets from the United Kingdom and 98,385 from the United States from March 1 to November 22, 2020. We used natural language processing and deep learning?based techniques to predict average sentiments, sentiment trends, and topics of discussion. These factors were analyzed longitudinally and geospatially, and manual reading of randomly selected posts on points of interest helped identify underlying themes and validated insights from the analysis. Results: Overall averaged positive, negative, and neutral sentiments were at 58%, 22%, and 17% in the United Kingdom, compared to 56%, 24%, and 18% in the United States, respectively. Public optimism over vaccine development, effectiveness, and trials as well as concerns over their safety, economic viability, and corporation control were identified. We compared our findings to those of nationwide surveys in both countries and found them to correlate broadly. Conclusions: Artificial intelligence?enabled social media analysis should be considered for adoption by institutions and governments alongside surveys and other conventional methods of assessing public attitude. Such analyses could enable real-time assessment, at scale, of public confidence and trust in COVID-19 vaccines, help address the concerns of vaccine sceptics, and help develop more effective policies and communication strategies to maximize uptake. UR - https://www.jmir.org/2021/4/e26627 UR - http://dx.doi.org/10.2196/26627 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724919 ID - info:doi/10.2196/26627 ER - TY - JOUR AU - Bonner, Carissa AU - Cvejic, Erin AU - Ayre, Julie AU - Isautier, Jennifer AU - Semsarian, Christopher AU - Nickel, Brooke AU - Batcup, Carys AU - Pickles, Kristen AU - Dodd, Rachael AU - Cornell, Samuel AU - Copp, Tessa AU - McCaffery, J. Kirsten PY - 2021/3/30 TI - The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study JO - JMIRx Med SP - e25610 VL - 2 IS - 1 KW - public health KW - global health KW - COVID-19 KW - hypertension KW - risk KW - strategy KW - mental health KW - behavior KW - response KW - anxiety KW - vaccine KW - retrospective KW - perception KW - prevention KW - intention N2 - Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. UR - https://xmed.jmir.org/2021/1/e25610 UR - http://dx.doi.org/10.2196/25610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076628 ID - info:doi/10.2196/25610 ER - TY - JOUR AU - Benis, Arriel AU - Khodos, Anna AU - Ran, Sivan AU - Levner, Eugene AU - Ashkenazi, Shai PY - 2021/3/16 TI - Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study JO - J Med Internet Res SP - e25977 VL - 23 IS - 3 KW - influenza KW - vaccines KW - vaccination KW - social media KW - online social networking KW - health literacy KW - eHealth KW - information dissemination KW - access to information KW - COVID-19 N2 - Background: Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. Objective: The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. Methods: A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. Results: A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. Conclusions: Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well. UR - https://www.jmir.org/2021/3/e25977 UR - http://dx.doi.org/10.2196/25977 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651709 ID - info:doi/10.2196/25977 ER - TY - JOUR AU - Gbashi, Sefater AU - Adebo, Ayodeji Oluwafemi AU - Doorsamy, Wesley AU - Njobeh, Berka Patrick PY - 2021/3/16 TI - Systematic Delineation of Media Polarity on COVID-19 Vaccines in Africa: Computational Linguistic Modeling Study JO - JMIR Med Inform SP - e22916 VL - 9 IS - 3 KW - COVID-19 KW - coronavirus KW - vaccine KW - infodemiology KW - infoveillance KW - infodemic KW - sentiment analysis KW - natural language processing KW - media KW - computation KW - linguistic KW - model KW - communication N2 - Background: The global onset of COVID-19 has resulted in substantial public health and socioeconomic impacts. An immediate medical breakthrough is needed. However, parallel to the emergence of the COVID-19 pandemic is the proliferation of information regarding the pandemic, which, if uncontrolled, cannot only mislead the public but also hinder the concerted efforts of relevant stakeholders in mitigating the effect of this pandemic. It is known that media communications can affect public perception and attitude toward medical treatment, vaccination, or subject matter, particularly when the population has limited knowledge on the subject. Objective: This study attempts to systematically scrutinize media communications (Google News headlines or snippets and Twitter posts) to understand the prevailing sentiments regarding COVID-19 vaccines in Africa. Methods: A total of 637 Twitter posts and 569 Google News headlines or descriptions, retrieved between February 2 and May 5, 2020, were analyzed using three standard computational linguistics models (ie, TextBlob, Valence Aware Dictionary and Sentiment Reasoner, and Word2Vec combined with a bidirectional long short-term memory neural network). Results: Our findings revealed that, contrary to general perceptions, Google News headlines or snippets and Twitter posts within the stated period were generally passive or positive toward COVID-19 vaccines in Africa. It was possible to understand these patterns in light of increasingly sustained efforts by various media and health actors in ensuring the availability of factual information about the pandemic. Conclusions: This type of analysis could contribute to understanding predominant polarities and associated potential attitudinal inclinations. Such knowledge could be critical in informing relevant public health and media engagement policies. UR - https://medinform.jmir.org/2021/3/e22916 UR - http://dx.doi.org/10.2196/22916 UR - http://www.ncbi.nlm.nih.gov/pubmed/33667172 ID - info:doi/10.2196/22916 ER - TY - JOUR AU - Zhang, Chun Ke AU - Fang, Yuan AU - Cao, He AU - Chen, Hongbiao AU - Hu, Tian AU - Chen, Yaqi AU - Zhou, Xiaofeng AU - Wang, Zixin PY - 2021/3/9 TI - Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey JO - J Med Internet Res SP - e24673 VL - 23 IS - 3 KW - COVID-19 KW - vaccination KW - behavioral intention KW - perception KW - social media influence KW - personal preventive behaviors KW - factory workers KW - China KW - social media KW - vaccine KW - behavior KW - intention KW - risk N2 - Background: COVID-19 vaccines will become available in China soon. Understanding communities? responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective: This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods: Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results: The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). Conclusions: Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination. UR - https://www.jmir.org/2021/3/e24673 UR - http://dx.doi.org/10.2196/24673 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646966 ID - info:doi/10.2196/24673 ER - TY - JOUR AU - Cabral, Pereira Bernardo AU - Braga, Luiza AU - Mota, Fabio PY - 2021/2/26 TI - Expert Opinions on the Most Promising Treatments and Vaccine Candidates for COVID-19: Global Cross-sectional Survey of Virus Researchers in the Early Months of the Pandemic JO - JMIR Public Health Surveill SP - e22483 VL - 7 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - treatment KW - survey KW - public health KW - drug KW - clinical trial N2 - Background: The COVID-19 pandemic presents a great public health challenge worldwide, especially given the urgent need to identify effective drugs and develop a vaccine in a short period of time. Globally, several drugs and vaccine candidates are in clinical trials. However, because these drugs and vaccines are still being tested, there is still no definition of which ones will succeed. Objective: This study aimed to assess the opinions of over 1000 virus researchers with knowledge on the prevention and treatment of coronavirus-related human diseases to determine the most promising drug and vaccine candidates to address COVID-19. Methods: We mapped the clinical trials related to COVID-19 registered at ClinicalTrials.gov. These data were used to prepare a survey questionnaire about treatments and vaccine candidates for COVID-19. In May 2020, a global survey was conducted with authors of recent scientific publications indexed in the Web of Science Core Collection related to viruses, severe acute respiratory syndrome coronavirus, coronaviruses, and COVID-19. Results: Remdesivir, immunoglobulin from cured patients, and plasma were considered to be the most promising treatments in May 2020, while ChAdOx1 and mRNA-1273 were considered to be the most promising vaccine candidates. Almost two-thirds of the respondents (766/1219, 62.8%) believed that vaccines for COVID-19 were likely to be available in the next 18 months. Slightly fewer than 25% (289/1219, 23.7%) believed that a vaccine was feasible, but probably not within 18 months. Conclusions: The issues addressed in this study are constantly evolving; therefore, the current state of knowledge has changed since the survey was conducted. However, for several months after the survey, the respondents? expectations were in line with recent results related to treatments and vaccine candidates for COVID-19. UR - https://publichealth.jmir.org/2021/2/e22483 UR - http://dx.doi.org/10.2196/22483 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635275 ID - info:doi/10.2196/22483 ER - TY - JOUR AU - Yin, Fulian AU - Wu, Zhaoliang AU - Xia, Xinyu AU - Ji, Meiqi AU - Wang, Yanyan AU - Hu, Zhiwen PY - 2021/1/15 TI - Unfolding the Determinants of COVID-19 Vaccine Acceptance in China JO - J Med Internet Res SP - e26089 VL - 23 IS - 1 KW - COVID-19 vaccines KW - COVID-19 vaccination KW - affordability KW - efficacy KW - risk communication KW - evidence communication KW - social media KW - COVID-19 KW - vaccine KW - communication KW - risk KW - acceptance KW - China KW - opinion KW - strategy KW - promotion N2 - Background: China is at the forefront of global efforts to develop COVID-19 vaccines and has five fast-tracked candidates at the final-stage, large-scale human clinical trials testing phase. Vaccine-promoting policymaking for public engagement is a prerequisite for social mobilization. However, making an informed and judicious choice is a dilemma for the Chinese government in the vaccine promotion context. Objective: In this study, public opinions in China were analyzed via dialogues on Chinese social media, based on which Chinese netizens? views on COVID-19 vaccines and vaccination were investigated. We also aimed to develop strategies for promoting vaccination programs in China based on an in-depth understanding of the challenges in risk communication and social mobilization. Methods: We proposed a novel behavioral dynamics model, SRS/I (susceptible-reading-susceptible/immune), to analyze opinion transmission paradigms on Chinese social media. Coupled with a meta-analysis and natural language processing techniques, the emotion polarity of individual opinions was examined in their given context. Results: We collected more than 1.75 million Weibo messages about COVID-19 vaccines from January to October 2020. According to the public opinion reproduction ratio (R0), the dynamic propagation of those messages can be classified into three periods: the ferment period (R01=1.1360), the revolution period (R02=2.8278), and the transmission period (R03=3.0729). Topics on COVID-19 vaccine acceptance in China include price and side effects. From September to October, Weibo users claimed that the vaccine was overpriced, making up 18.3% (n=899) of messages; 38.1% (n=81,909) of relevant topics on Weibo received likes. On the contrary, the number of messages that considered the vaccine to be reasonably priced was twice as high but received fewer likes, accounting for 25.0% (n=53,693). In addition, we obtained 441 (47.7%) positive and 295 (31.9%) negative Weibo messages about side effects. Interestingly, inactivated vaccines instigated more heated discussions than any other vaccine type. The discussions, forwards, comments, and likes associated with topics related to inactivated vaccines accounted for 53% (n=588), 42% (n=3072), 56% (n=3671), and 49% (n=17,940), respectively, of the total activity associated with the five types of vaccines in China. Conclusions: Most Chinese netizens believe that the vaccine is less expensive than previously thought, while some claim they cannot afford it for their entire family. The findings demonstrate that Chinese individuals are inclined to be positive about side effects over time and are proud of China?s involvement with vaccine development. Nevertheless, they have a collective misunderstanding about inactivated vaccines, insisting that inactivated vaccines are safer than other vaccines. Reflecting on netizens? collective responses, the unfolding determinants of COVID-19 vaccine acceptance provide illuminating benchmarks for vaccine-promoting policies. UR - http://www.jmir.org/2021/1/e26089/ UR - http://dx.doi.org/10.2196/26089 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400682 ID - info:doi/10.2196/26089 ER - TY - JOUR AU - Zhang, Chun Ke AU - Fang, Yuan AU - Cao, He AU - Chen, Hongbiao AU - Hu, Tian AU - Chen, Qi Ya AU - Zhou, Xiaofeng AU - Wang, Zixin PY - 2020/12/30 TI - Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey JO - JMIR Pediatr Parent SP - e24827 VL - 3 IS - 2 KW - parental acceptability KW - COVID-19 vaccination KW - children under the age of 18 years KW - theory of planned behavior KW - social media influence KW - China N2 - Background: It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children?s vaccination. Objective: The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods: This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020. Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. Results: The prevalence of parents? acceptability of COVID-19 vaccination for their children was 72.6% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95% CI 0.74-0.99). Conclusions: Parents? acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner. UR - http://pediatrics.jmir.org/2020/2/e24827/ UR - http://dx.doi.org/10.2196/24827 UR - http://www.ncbi.nlm.nih.gov/pubmed/33326406 ID - info:doi/10.2196/24827 ER -