BACKGROUND: Pregnant women, fetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their fetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the fetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low- and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in LMICs.
METHODS: A Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy, and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2024. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy, and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute\'s (JBI) critical appraisal tools.
CONCLUSIONS: This protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs.

COVID-19 vaccination effectively reduces disease severity, hospitalization, and mortality, particularly among individuals with chronic conditions who bear a disproportionate burden of disease complications. Vaccine confidence - belief in its safety, effectiveness, and importance - boosts uptake. However, limited data on vaccine confidence in this population hinders the development of targeted interventions. This study examined COVID-19 vaccine confidence and its impact on uptake among individuals with hypertension or diabetes mellitus in the Kilimanjaro region, Tanzania. A community-based cross-sectional study was conducted in March 2023 among 646 randomly selected adults aged ≥18 years with hypertension or diabetes mellitus in three districts of Kilimanjaro region, northern Tanzania. An interviewer-administered electronic questionnaire assessed confidence and uptake of COVID-19 vaccines in addition to related knowledge and demographic characteristics. Data analysis was done for 646 individuals who consented to participate. Multivariable logistic regression models determined the factors associated with COVID-19 vaccine confidence and its effect on vaccine uptake. The proportion of COVID-19 vaccine confidence among all 646 participants was 70% and was highest for perceived vaccine importance (80%), followed by perceived vaccine effectiveness (77%) and perceived vaccine safety (74%). Good knowledge of COVID-19 vaccines and living in the Mwanga municipal council (MC), a semi-urban district, was independently associated with confidence in the vaccines\' importance, safety, effectiveness, and overall COVID-19 vaccine confidence. Confidence in COVID-19 vaccines increased the odds of vaccine uptake. Targeted interventions to boost vaccine confidence are therefore essential to enhance vaccine uptake in this high-risk population.

BACKGROUND: To inform vaccination policy and programmatic strategies to increase COVID-19 vaccine uptake, an understanding of the factors associated with the willingness to vaccinate is needed.
METHODS: We analyzed data collected from the sixth and tenth round of the Nigerian COVID-19 National Longitudinal Phone Survey conducted by the National Bureau of Statistics and the World Bank in 2020 and 2021, respectively. Exploratory data analysis and feature selection techniques were used to identify important variables. Multivariable logistic regression models were fitted to assess the association between socio-demographic and economic factors and the willingness to receive a free COVID-19 vaccine among Nigerian households at two different time points before vaccines became widely available.
RESULTS: Data from 1,733 and 1,651 Nigerian households who completed the sixth and tenth round of the survey, respectively, were included. Most respondents (>85% of households) were willing to receive a free COVID-19 vaccine from both survey rounds. The median household size was 6 (IQR: [4, 8]) with females heading about 18% of the households. Approximately 22% of the household heads had not received any formal education. Compared to households whose head had no education, households whose heads had completed tertiary education or higher had significantly lower odds of willingness to be vaccinated (ORround 6: 0.46, 95% CI: [0.31, 0.68], ORround 10: 0.49, 95% CI: [0.34, 0.71]). An increasing proportion of male household members was associated with greater willingness to receive a free COVID-19 vaccine (ORround 6: 1.84, 95% CI: [1.01, 3.33], ORround 10: 5.25, 95% CI: [2.86, 9.65]). Significant associations with vaccine willingness were also observed across geopolitical zones of residence with households in South-East Nigeria (ORround 6: 0.16, 95% CI: [0.10, 0.24]; ORround 10: 0.29, 95% CI: [0.19, 0.43]) and South-South Nigeria (ORround 6: 0.57, 95% CI: [0.36, 0.90], ORround 10: 0.32, 95% CI: [0.22, 0.48]) less likely to be willing to receive a free vaccine compared to households in North-Central Nigeria.
CONCLUSIONS: These findings from two different time points before vaccine roll-out suggest that the educational level of household head, proportion of male household members, and the geopolitical zone of residence are important baseline predictors of the willingness to receive a free COVID-19 vaccine in Nigeria. These factors should be carefully considered and specifically targeted when designing public health programs to inform early-stage strategies that address underlying vaccine hesitancy, improve vaccine uptake, promote ongoing COVID-19 vaccination efforts, and potentially enhance other immunization programs in Nigeria.

Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists\' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.

Influenza, COVID-19, tetanus, pertussis and hepatitis B pose increased risk for pregnant women and infants and could be mitigated by maternal immunization. In India Tetanus-diphtheria (Td) and COVID-19 vaccines are recommended during pregnancy, while influenza and tetanus-acellular pertussis-diphtheria (Tdap) vaccines are not. We conducted a multicenter study from November 2021 to June 2022 among pregnant women (n = 172) attending antenatal clinics in three public hospitals in West Bengal, to understand the factors that influence women\'s decisions to get vaccinated during pregnancy. Questions assessed vaccination coverage, knowledge, intention and willingness to pay for influenza vaccine, and factors influencing decisions to get Td, influenza, and COVID-19 vaccines. 152/172 (88.4%) women were vaccinated with Td, 159/172 (93%) with COVID-19, 1/172 (0.6%) with influenza, and none with Tdap. 10/168 (6%) had received hepatitis B vaccine (HBV). Community health workers advice was crucial for Td uptake and, the belief of protection from COVID for COVID-19 vaccines. Most women were unaware about Tdap (96%), influenza (75%), and influenza severity during pregnancy and infancy (85%). None were advised for influenza vaccination by healthcare providers (HCP), albeit, 93% expressed willingness to take, and pay INR 100-300 (95% CI: ≤100 to 300-500) [$ 1.3-4.0 (95% CI: ≤1.3, 4-6.7)] for it. Vaccination on flexible dates and time, HCP\'s recommendation, proximity to vaccination center, and husband\'s support were most important for their vaccination decisions. Women were generally vaccine acceptors and had high uptake of vaccines included in the Universal Immunization Program (UIP). Inclusion of influenza, Tdap, and HBV into UIP may improve maternal vaccine uptake.
Vaccinations during pregnancy protect mothers and babies from lethal infections from tetanus, influenza, COVID-19, pertussis, and hepatitis B. In India all pregnant women get tetanus (Td) vaccines, and during the pandemic, pregnant women got COVID-19 vaccines as part of the government program. We conducted a study among pregnant women attending three public hospitals in West Bengal, India, during the COVID-19 pandemic to understand the factors that influence women’s decisions to get vaccinated during pregnancy. We found that most pregnant women had gotten Td (88.4%) and COVID-19 (93%) vaccines; however, the uptake was low for influenza (0.6%), pertussis (0%), and hepatitis B vaccines (6%) which are all not available in government programs. Though the majority (92%) of women had not heard about influenza vaccines, once they learnt about them, 93% said they would get vaccinated and even pay for it. Vaccination at flexible times and their doctor’s advice were important in their decisions to get vaccinated. Our research builds the case to include influenza, pertussis, and hepatitis B vaccines in programs for pregnant women.

UNASSIGNED: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has taken a toll on humans, and the development of effective vaccines has been a promising tool to end the pandemic. However, for a vaccination program to be successful, a considerable proportion of the community must be vaccinated. Hence, public acceptance of coronavirus disease 2019 (COVID-19) vaccines has become the key to controlling the pandemic. Recent studies have shown vaccine hesitancy increasing over time. This systematic review aims to evaluate the COVID-19 vaccine hesitancy rate and related factors in different communities.
UNASSIGNED: A comprehensive search was performed in MEDLINE (via PubMed), Scopus, and Web of Science from January 1, 2019 to January 31, 2022. All relevant descriptive and observational studies (cross-sectional and longitudinal) on vaccine hesitancy and acceptance were included in this systematic review. In the meta-analysis, odds ratio (OR) was used to assess the effects of population characteristics on vaccine hesitancy, and event rate (acceptance rate) was the effect measure for overall acceptance. Publication bias was assessed using the funnel plot, Egger\'s test, and trim-and-fill methods.
UNASSIGNED: A total of 135 out of 6,417 studies were included after screening. A meta-analysis of 114 studies, including 849,911 participants, showed an overall acceptance rate of 63.1%. In addition, men, married individuals, educated people, those with a history of flu vaccination, those with higher income levels, those with comorbidities, and people living in urban areas were less hesitant.
UNASSIGNED: Increasing public awareness of the importance of COVID-19 vaccines in overcoming the pandemic is crucial. Being men, living in an urban region, being married or educated, having a history of influenza vaccination, having a higher level of income status, and having a history of comorbidities are associated with higher COVID-19 vaccine acceptance.

Vaccine hesitancy is one of the major roadblocks to ending the COVID-19 pandemic. However, little is known about individuals\' motivators and barriers to vaccination in Russia. We aimed to determine which factors were associated with COVID-19 vaccine acceptance in Russia. We conducted a cross-sectional, online survey across Russia at the end of 2021, during a time with increasing new cases of COVID-19. We used the Health Belief Model to test which of the constructs were associated with vaccine acceptance and controlled for demographic variables in the multivariate logistic regression analysis among our analytic sample of 550 respondents. About one-fifth (18.5%) of our study respondents reported vaccine hesitancy. Our multivariate analysis showed that perceived susceptibility, perceived benefits, perceived barriers, self-efficacy, and friends and family supporting vaccination (cue to action) all contributed to the likelihood of whether or not an individual was accepting of the COVID-19 vaccine. Analysis of our open-ended questions showed that individuals also considered the following factors in making decisions to vaccinate for COVID-19: policy restrictions, less worry, social responsibility, lack of trust, conspiracy theories, concerns about side effects and contraindications. Our results demonstrated the Health Belief Model to be a useful framework for understanding COVID-19 vaccine acceptance in Russia. Our study results highlight the need to focus on health beliefs in order to develop interventions to improve vaccine acceptance.

The COVID-19 pandemic has presented the importance of vaccination as a pivotal strategy for controlling its spread. However, vaccine hesitancy poses a significant barrier to achieving widespread immunization in the United States. This systematic review utilizes the 5C model to examine the factors contributing to hesitancy, which include confidence in vaccines, complacency about disease risk, calculations of individual benefit, convenience of vaccination, and collective responsibility for the protection of others.
METHODS: We conducted a comprehensive search across several relevant databases and the gray literature, identifying 544 studies that used quantitative and qualitative methods to explore COVID-19 vaccine hesitancy in the general U.S.
METHODS:
RESULTS: This review identifies a complex interplay of factors affecting hesitancy, such as concerns over vaccine safety and efficacy, misinformation and conspiracy theories, demographic variables, and socioeconomic conditions. Key strategies for increasing vaccine uptake include transparent and effective communication along with proactive community engagement.
CONCLUSIONS: To effectively mitigate vaccine hesitancy, it is crucial to understand its multifaceted causes. Tailored interventions that consider socioeconomic and cultural contexts and prioritize clear communication, community involvement, and specific strategies to address unique concerns can enhance vaccine acceptance.

BACKGROUND: Prior research suggests that belief in conspiracy theories can reduce the willingness of individuals to get vaccinated during the COVID-19 pandemic. Examining factors that may moderate this negative effect is an important area of research.
OBJECTIVE: The objective of this study was to examine the relationship between vaccine uptake and two types of conspiracy beliefs (COVID-19 and vaccine-related) and the moderating role of direct and indirect experiences with the coronavirus.
METHODS: We draw on nationally representative survey data collected in Hungary in January 2022 (N=1000, 47% male, 53% female; mean age 49.6 years). Structural equation models and multi-group analysis were performed.
RESULTS: Conspiracy beliefs were strongly associated with vaccine uptake, however, both direct and indirect experiences with the virus moderated the effect of conspiracy beliefs. Individuals who experienced a serious infection or reported a close person being infected by the virus developed severe symptoms or even died were less likely to take conspiracy theories seriously when deciding about their own vaccination. In two out of the four tested moderation effects, a negative experience with the virus reduced the negative effect of conspiracy beliefs.
CONCLUSIONS: Our findings demonstrate that personal or close real-life experience with severe COVID-19 infection can significantly mitigate the impact of conspiracy beliefs on vaccine hesitancy, highlighting the importance of real-life evidence in overcoming misinformation and increasing vaccine uptake. Nevertheless, it is important to mention that our results are preliminary, and future studies need to replicate the findings and test their robustness.

BACKGROUND: Assessing vaccine willingness and understanding sources of vaccine hesitancy in individuals with multiple sclerosis (MS) helps healthcare providers approach patients more effectively while respecting their autonomy to encourage coronavirus disease 2019 (COVID-19) vaccination.
METHODS: A descriptive-analytical cross-sectional study using a researcher-made checklist was conducted on MS patients referred to Neshat Clinic of Hamadan during the years 2020-2021. The checklist contained questions about demographic information, MS phenotype, duration of illness, expanded disability status scale (EDSS) score, and COVID-19 vaccination status. The expanded disability status scale (EDSS) is the most commonly used instrument for measuring disability in patients with multiple sclerosis (MS). The EDSS scale ranges from 0 to 10 in increments of 0.5 units, denoting advanced points of disability.
RESULTS: Based on the results, 20 individuals (10%) were in the vaccine non-acceptance group, while 181 individuals (90%) were in the vaccine acceptance group. A significant number of relapsing and remitting (RR) type MS patients (90.7%) and all primary progressive (PP) type MS patients (100%) accepted the vaccine. In comparison, vaccine non-acceptance in the secondary progressive (SP) group was relatively higher (20.7%) compared to other types of MS, and this difference was significant (P < 0.05). Additionally, there was a statistically significant relationship between the history of COVID-19 and vaccine acceptance (P < 0.05).
CONCLUSIONS: The study results demonstrated a high rate of COVID-19 vaccine acceptance among MS patients. MS phenotype, previous infection experiences, and other influences allow for COVID-19 vaccine acceptance among MS patients. This information can improve health programs and communication strategies for COVID-19 and future possible infectious disease vaccination in individuals with MS.