Postoje sester a studentů ošetřovatelství k očkování proti covid-19 – přehled

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Autoři: A. Chrdle ^1,2,3; S. Bártlová ¹; I. Chloubová ¹
Působiště autorů: University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and, Emergency Care, České Budějovice, Czechia ¹; Infectious Disease Department, České Budějovice Hospital, České Budějovice, Czechia ²; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK ³
Vyšlo v časopise: Epidemiol. Mikrobiol. Imunol. 72, 2023, č. 1, s. 25-39
Kategorie: Souhrnné sdělení

Souhrn

Cíl: Téma očkování zdravotníků proti covid-19 je předmětem diskusí především v případě zdravotních sester. Primární otázkou pro tento literární přehled bylo: “Jaké jsou postoje sester vůči očkování proti covid-19 ve srovnání s ostatními typy zdravotnických profesí?” Druhou otázkou bylo, jaký je podíl sester, které se chystají nechat se očkovat a dále co sestrám v očkování brání, a naopak co jim pomůže při rozhodování nechat se očkovat.

Metody: Pro přehledovou práci byl použit formát PRISMA-ScR pro přehledy typu scoping review s ohledem na novou oblast vakcín proti covid-19. V databázích (PubMed/MEDLINE, PROquest and EBSCO) byly vyhledány původní studie ze všech zemí světa, publikované v anglickém jazyce před 20. březnem 2022.

Ochota nechat se očkovat byla hodnocena v jedné kategorii společně pro zdravotní sestry a studenty ošetřovatelství, zatímco ve druhé kategorii byli ostatní zdravotničtí pracovníci. Vývoj postojů sester k očkování v čase ve vztahu k postoji ostatních zdravotníků byl vyhodnocen post hoc.

Faktory spojené s ochotou nechat se očkovat proti covid-19 byly rozděleny podle kategorií WHO (kontextuální vlivy, individuální/ skupinové vlivy a otázky specifické pro očkování/danou vakcínu) a jsou shrnuty v narativním přehledu.

Výsledky: Celkem bylo do přehledu zařazeno 58 studií, které všechny měly průřezové dotazníkové uspořádání, a kterých se zúčastnilo 95 418 zdravotníků (včetně 33 130 sester a 7 391 studentů ošetřovatelství) v 44 zemích Evropy, Ameriky, Afriky a Asie. Hlavní kontextuální faktory, které v hodnocených studiích zvyšovaly ochotu nechat se očkovat, byly důvěra ve vědu, důvěra v lékaře, v odborníky a ve vládní instituce, zatímco altruismus a kolektivní ochrana nebo ochrana ohrožených osob v domácnosti dotazovaných zdravotníků byly zmíněny pouze v malém počtu studií. V počátečních obdobích očkování, tedy před uvedením vakcín do praxe, uváděly sestry nižší ochotu nechat se očkovat než lékaři a ostatní zdravotníci a tento rozdíl mezi zdravotnickými profesemi v čase klesal (p = 0,022). Ochota nechat se očkovat se zvyšovala s rostoucím věkem (n = 25 studií), vyšším stupněm dosaženého vzdělání (n = 7), vyšším počtem let v klinické praxi (n = 4) a byla vyšší u mužů než u žen (n = 23). Pouze v malém poštu studií uváděli zdravotníci jako důvod pro očkování pociťované vysoké osobní riziko těžkého průběhu infekce covid-19 (n = 14) nebo práci na covidových jednotkách (n = 5). Mezi hlavní faktory spojené s vakcinací či vakcínou, které zvyšovaly ochotu nechat se očkovat, patřily důvěra ve vakcínu a v její účinnost a bezpečnost, celkový pozitivní vztah k očkování a především absolvované očkování proti chřipce v předchozích letech (n = 21 studií). Významným faktorem spojeným s vyšší ochotou nechat se očkovat patřila “vakcinační gramotnost”, “pochopení vakcinace”, “znalosti o vakcinaci” případně “pochopení výhod a nevýhod očkování” (n = 17 studií).

Závěry: Zdravotní sestry byly zpočátku méně ochotné nechat se očkovat proti covid-19 než ostatní zdravotníci, ale tento rozdíl postupem času vymizel. Podobně váhavý vyčkávací postoj sester k očkování se projevuje i v údajích realizovaného očkování zdravotníků proti covid-19, které registruje Ústav zdravotnických informací a statistiky ČR. Důvěra ve vědecké instituce a výrobce vakcín zvyšuje ochotu nechat se očkovat. Tato ochota také roste s rostoucím věkem, vyšším stupněm vzdělání, delší dobou klinické praxe a také je vyšší u mužů. Mezi nezávislé, zevní intervencí potenciálně ovlivnitelné faktory spojené s vyšší ochotou nechat se očkovat patří vakcinační gramotnost a účast v jiném očkovacím programu, především v případě očkování proti sezonní chřipce.

Klíčová slova:

zdravotníci – očkování – COVID-19 – postoje – ochota nechat se očkovat – váhavost k očkování – odmítání očkování – zdravotní sestry

Zdroje

1. UNICEF. Facilitator Guide Interpersonal Communication for Immunization: Training for Front Line Workers; UNICEF Europe and Central Asia Region: Geneva, Switzerland, 2019; Available at: https://www.unicef.org/eca/media/8566/file/interpersonal-communication-immunization.pdf.

2. Li T, Qi X, Li Q, et al. A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers. Vaccines, 2021; 9(10):1104. doi: 10.3390/vaccines9101104.

3. Dini G, Toletone A, Sticchi L, et al. Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Hum Vaccin Immunother, 2018;14(3):772–789. doi: 10.1080/21645515.2017.1348442.

4. Adli A, Rahimi M, Khodaie R, et al. Role of Genetic Variants and Host Polymorphisms on COVID-19: From Viral Entrance Mechanisms to Immunological Reactions. J Med Virol, 2022. doi: 10.1002/jmv.27615.

5. Mohammed I, Nauman A, Paul P, et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review. Hum Vaccin Immunother, 2022:1–20. doi: 10.1080/ 21645515.2022.2027160.

6. Boudreau HS, Singh N, Boyd CJ. Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on „Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study“. J Med Internet Res, 2022. doi: 10.2196/31415.

7. Garett R, Young SD. Online misinformation and vaccine hesitancy. Transl Behav Med, 2021;11(12):2194–2199. doi: 10.1093/tbm/ ibab128.

8. ECDC. Vaccine tracker. Available at: https://vaccinetracker.ecdc. europa.eu/public/extensions/COVID-19/vaccine-tracker.html#target-group-tab.

9. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med, 2018;169(7):467–473. doi: 10.7326/M18-0850.

10. World Health Organisation. Report of the SAGEWorking Group on Vaccine Hesitancy. 2014. Available at: https://cdn.who. int/media/docs/default-source/immunization/sage/2014/ october/2-sage-appendicies-background-final.pdf?sfvrsn=2259f1bf_4.

11. Wang K, Wong ELY, Ho KF, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: A cross-sectional survey. Vaccine, 2020;38(45):7049–7056. doi: 10.1016/j.vaccine.2020.09.021.

12. Gagneux-Brunon A, Detoc M, Bruel S, et al. Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect, 2021;108:168–173. doi: 10.1016/j.jhin.2020.11.020.

13. Rosental H, Shmueli L. Integrating Health Behavior Theories to Predict COVID-19 Vaccine Acceptance: Differences between Medical Students and Nursing Students. Vaccines (Basel), 2021;9(7):783. Published 2021 Jul 13. doi: 10.3390/vaccines9070783.

14. Wang J, Feng Y, Hou Z, et al. Willingness to receive SARS-CoV-2 vaccine among healthcare workers in public institutions of Zhejiang Province, China. Hum Vaccin Immunother, 2021;17(9):2926– 2933. doi: 10.1080/21645515.2021.1909328.

15. Manning ML, Gerolamo AM, Marino MA, et al. COVID-19 vaccination readiness among nurse faculty and student nurses. Nurs Outlook, 2021;69(4):565–573. doi: 10.1016/j.outlook.2021.01.019.

16. Cuschieri S, Grech V. A comparative assessment of attitudes and hesitancy for influenza vis-à-vis COVID-19 vaccination among healthcare students and professionals in Malta. Z Gesundh Wiss, 2021:1–8. doi: 10.1007/s10389-021-01585-z.

17. Grochowska M, Ratajczak A, Zdunek G, et al. A Comparison of the Level of Acceptance and Hesitancy towards the Influenza Vaccine and the Forthcoming COVID-19 Vaccine in the Medical Community. Vaccines (Basel), 2021;9(5):475. Published 2021 May 8. doi: 10.3390/vaccines9050475.

18. Di Gennaro F, Murri R, Segala FV, et al. Attitudes towards AntiSARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy. Viruses, 2021;13(3):371. Published 2021 Feb 26. doi: 10.3390/v13030371.

19. Dubov A, Distelberg BJ, Abdul-Mutakabbir JC, et al. Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just „Anti“ vs. „Pro“ Vaccine. Vaccines (Basel), 2021;9(12):1428. Published 2021 Dec 2. doi: 10.3390/vaccines9121428.

20. Fontenot HB, Mattheus DB, Lim E, et al. Undergraduate nursing students‘ COVID-19 vaccine intentions: A national survey. PLoS One, 2021;16(12):e0261669. Published 2021 Dec 22. doi: 10.1371/journal.pone.0261669.

21. Aldosary AH, Alayed GH. Willingness to vaccinate against Novel COVID-19 and contributing factors for the acceptance among nurses in Qassim, Saudi Arabia. Eur Rev Med Pharmacol Sci, 2021;25(20):6386–6396. doi: 10.26355/eurrev_202110_27012

22. Alshehry AS, Cruz JP, Alquwez N, et al. Predictors of nursing students‘ intention to receive COVID-19 vaccination: A multi-university study in Saudi Arabia. J Adv Nurs, 2022;78(2):446–457. doi: 10.1111/jan.15002.

23. Fakonti G, Kyprianidou M, Toumbis G, et al. Attitudes and Acceptance of COVID-19 Vaccination Among Nurses and Midwives in Cyprus: A Cross-Sectional Survey. Front Public Health, 2021;9:656138. Published 2021 Jun 16. doi: 10.3389/ fpubh.2021.656138.

24. Pataka A, Kotoulas S, Stefanidou E, et al. Acceptability of Healthcare Professionals to Get Vaccinated against COVID-19 Two Weeks before Initiation of National Vaccination. Medicina (Kaunas), 2021;57(6):611. Published 2021 Jun 12. doi: 10.3390/ medicina57060611.

25. Trabucco Aurilio M, Mennini FS, Gazzillo S, et al. Intention to Be Vaccinated for COVID-19 among Italian Nurses during the Pandemic. Vaccines (Basel), 2021;9(5):500. Published 2021 May 12. doi: 10.3390/vaccines9050500.

26. Yigit M, Ozkaya-Parlakay A, Senel E. Evaluation of COVID-19 vaccine acceptance of healthcare providers in a tertiary Pediatric hospital. Hum Vaccin Immunother, 2021;17(9):2946–2950. doi: 10.1080/21645515.2021.1918523.

27. Bauernfeind S, Hitzenbichler F, Huppertz G, et al. Brief report: attitudes towards Covid-19 vaccination among hospital employees in a tertiary care university hospital in Germany in December 2020. Infection, 2021;49(6):1307–1311. doi: 10.1007/ s15010-021-01622-9.

28. Dzieciolowska S, Hamel D, Gadio S, et al. Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: A multicenter survey. Am J Infect Control, 2021;49(9):1152– 1157. doi: 10.1016/j.ajic.2021.04.079.

29. Kaplan AK, Sahin MK, Parildar H, et al. The willingness to accept the COVID-19 vaccine and affecting factors among healthcare professionals: A cross-sectional study in Turkey. Int J Clin Pract, 2021;75(7):e14226. doi: 10.1111/ijcp.14226.

30. Shaw J, Stewart T, Anderson KB, et al. Assessment of US Healthcare Personnel Attitudes Towards Coronavirus Disease 2019 (COVID-19) Vaccination in a Large University Healthcare System. Clin Infect Dis, 2021;73(10):1776–1783. doi: 10.1093/ cid/ciab054.

31. Zürcher K, Mugglin C, Egger M, et al. Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton. Swiss Med Wkly, 2021;151:w30061. Published 2021 Sep 15. doi: 10.4414/smw.2021.w30061.

32. Browne SK, Feemster KA, Shen AK, et al. Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia [published online ahead of print, 2021 Sep 20]. Infect Control Hosp Epidemiol, 2021:1–9. doi: 10.1017/ ice.2021.410.

33. Adeniyi OV, Stead D, Singata-Madliki M, et al. Acceptance of COVID-19 Vaccine among the Healthcare Workers in the Eastern Cape, South Africa: A Cross Sectional Study. Vaccines (Basel), 2021;9(6):666. Published 2021 Jun 18. doi: 10.3390/vaccines9060666.

34. Mena G, Blanco B, Casas I, et al. Attitudes of Spanish hospital staff towards COVID-19 vaccination and vaccination rates. PLoS One, 2021;16(9):e0257002. Published 2021 Sep 10. doi: 10.1371/ journal.pone.0257002.

35. Patelarou E, Galanis P, Mechili EA, et al. Factors influencing nursing students‘ intention to accept COVID-19 vaccination: A pooled analysis of seven European countries. Nurse Educ Today, 2021;104:105010. doi: 10.1016/j.nedt.2021.105010.

36. Fontenot HB, Mattheus D, Lim E, et al. Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii. Hum Vaccin Immunother, 2021;17(11):3933–3940. doi: 10.1080/21645515.2021.1947097.

37. Ahmed G, Almoosa Z, Mohamed D, et al. Healthcare Provider Attitudes toward the Newly Developed COVID-19 Vaccine: Cross-Sectional Study. Nurs Rep, 2021;11(1):187–194. Published 2021 Mar 23. doi: 10.3390/nursrep11010018.

38. Zaitoon H, Sharkansky L, Ganaim L, et al. Evaluation of Israeli healthcare workers knowledge and attitudes toward the COVID-19 vaccine. Public Health Nurs, 2022;39(2):415–422. doi: 10.1111/phn.12987.

39. Zhou Y, Wang Y, Li Z. Intention to get vaccinated against COVID-19 among nursing students: A cross-sectional survey. Nurse Educ Today, 2021;107:105152. doi: 10.1016/j.nedt.2021.105152

40. Sun Y, Chen X, Cao M, et al. Will Healthcare Workers Accept a COVID-19 Vaccine When It Becomes Available? A Cross-Sectional Study in China. Front Public Health, 2021;9:664905. Published 2021 May 20. doi: 10.3389/fpubh.2021.664905.

41. Rabi R, Maraqa B, Nazzal Z, et al. Factors affecting nurses‘ intention to accept the COVID-19 vaccine: A cross-sectional study. Public Health Nurs, 2021;38(5):781–788. doi: 10.1111/phn.12907.

42. Nohl A, Ben Abdallah H, Weichert V, et al. A Local Survey of COVID-19: Vaccine Potential Acceptance Rate among Personnel in a Level 1 Trauma Center without Severe COVID-19 Cases. Healthcare (Basel), 2021;9(12):1616. Published 2021 Nov 23. doi: 10.3390/healthcare9121616.

43. Xu B, Zhang Y, Chen L, et al. The influence of social network on COVID-19 vaccine hesitancy among healthcare workers: a cross-sectional survey in Chongqing, China. Hum Vaccin Immunother, 2021;17(12):5048–5062. doi: 10.1080/21645515.2021.2004837.

44. Saddik B, Al-Bluwi N, Shukla A, et al. Determinants of healthcare workers perceptions, acceptance and choice of COVID-19 vaccines: a cross-sectional study from the United Arab Emirates. Hum Vaccin Immunother, 2022;18(1):1–9. doi: 10.1080/21645515.2021.1994300.

45. Patelarou A, Saliaj A, Galanis P, et al. Predictors of nurses‘ intention to accept COVID-19 vaccination: A cross-sectional study in five European countries. J Clin Nurs, 2022;31(9-10):1258–1266. doi: 10.1111/jocn.15980.

46. Oliver K, Raut A, Pierre S, et al. Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers. BMJ Open, 2022;12(1):e053641. Published 2022 Jan 6. doi: 10.1136/ bmjopen-2021-053641.

47. Khamis F, Badahdah A, Al Mahyijari N, et al. Attitudes Towards COVID-19 Vaccine: A Survey of Health Care Workers in Oman. J Epidemiol Glob Health, 2022;12(1):1–6. doi: 10.1007/s44197-021- 00018-0.

48. Luma AH, Haveen AH, Faiq BB, Stefania M, Leonardo EG. Hesitancy towards Covid-19 vaccination among the healthcare workers in Iraqi Kurdistan. Public Health Pract (Oxf), 2022;3:100222. doi: 10.1016/j.puhip.2021.100222.

49. Kumar R, Beniwal K, Bahurupi Y, et al. Determinants of COVID-19 Vaccination Willingness among Health Care Workers: A Quick Online Survey in India. Korean J Fam Med, 2021;42(6):445–452. doi: 10.4082/kjfm.21.0071.

50. Paris C, Bénézit F, Geslin M, et al. COVID-19 vaccine hesitancy among healthcare workers. Infect Dis Now, 2021;51(5):484–487. doi: 10.1016/j.idnow.2021.04.001.

51. Holzmann-Littig C, Braunisch MC, Kranke P, et al. COVID-19 Vaccination Acceptance and Hesitancy among Healthcare Workers in Germany. Vaccines (Basel), 2021;9(7):777. Published 2021 Jul 12. doi: 10.3390/vaccines9070777.

52. Li XH, Chen L, Pan QN, et al. Vaccination status, acceptance, and knowledge toward a COVID-19 vaccine among healthcare workers: a cross-sectional survey in China. Hum Vaccin Immunother. 2021;17(11):4065-4073. doi:10.1080/21645515.2021.1957415

53. Krishnamurthy K, Sobers N, Kumar A, et al. COVID-19 Vaccine Intent Among Health Care Professionals of Queen Elizabeth Hospital, Barbados. J Multidiscip Healthc, 2021;14:3309–3319. Published 2021 Nov 30. doi: 10.2147/JMDH.S336952.

54. Vignier N, Brureau K, Granier S, et al. Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin. Vaccines (Basel), 2021;9(6):682. Published 2021 Jun 21. doi: 10.3390/vaccines9060682.

55. Wiysonge CS, Alobwede SM, de Marie C Katoto P, et al. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines, 2022;21(4):549–559. doi: 10.1080/14760584.2022.2023355.

56. Amuzie CI, Odini F, Kalu KU, et al. COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study. Pan Afr Med J, 2021;40:10. Published 2021 Sep 3. doi: 10.11604/pamj.2021.40.10.29816

57. Nasir M, Zaman MA, Majumder TK, et al. Perception, Preventive Practice, and Attitude Towards Vaccine Against COVID-19 Among Health Care Professionals in Bangladesh. Infect Drug Resist, 2021;14:3531–3540. Published 2021 Aug 31. doi: 10.2147/ IDR.S326531.

58. Al-Sanafi M, Sallam M. Psychological Determinants of COVID-19 Vaccine Acceptance among Healthcare Workers in Kuwait: A Cross-Sectional Study Using the 5C and Vaccine Conspiracy Beliefs Scales. Vaccines (Basel), 2021;9(7):701. Published 2021 Jun 25. doi: 10.3390/vaccines9070701.

59. Angelo AT, Alemayehu DS, Dachew AM. Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021. PLoS One, 2021;16(9):e0257109. Published 2021 Sep 3. doi: 10.1371/journal.pone.0257109.

60. Pal S, Shekhar R, Kottewar S, et al. COVID-19 Vaccine Hesitancy and Attitude toward Booster Doses among US Healthcare Workers. Vaccines (Basel), 2021;9(11):1358. Published 2021 Nov 19. doi: 10.3390/vaccines9111358.

61. Green-McKenzie J, Shofer FS, Momplaisir F, et al. Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability [published correction appears in JAMA Netw Open. 2022 Jan 4;5(1):e2147879. JAMA Netw Open. 2021;4(12):e2136582. Published 2021 Dec 1. doi: 10.1001/jamanetworkopen.2021.36582.

62. Gotlib J, Sobierajski T, Jaworski M, et al. „Vaccinate, Do Not Hesitate!“. Vaccination Readiness against COVID-19 among Polish Nursing Undergraduate Students: A National Cross-Sectional Survey. Vaccines (Basel), 2021;9(9):1029. Published 2021 Sep 16. doi: 10.3390/vaccines9091029.

63. Fotiadis K, Dadouli K, Avakian I, et al. Factors Associated with Healthcare Workers‘ (HCWs) Acceptance of COVID-19 Vaccinations and Indications of a Role Model towards Population Vaccinations from a Cross-Sectional Survey in Greece, May 2021. Int J Environ Res Public Health, 2021;18(19):10558. Published 2021 Oct 8. doi: 10.3390/ijerph181910558.

64. Puertas EB, Velandia-Gonzalez M, Vulanovic L, et al. Concerns, attitudes, and intended practices of Caribbean healthcare workers concerning COVID-19 vaccination: A cross-sectional study. Lancet Reg Health Am, 2022;9:100193. doi: 10.1016/j. lana.2022.100193.

65. Mohammed R, Nguse TM, Habte BM, et al. COVID-19 vaccine hesitancy among Ethiopian healthcare workers. PLoS One, 2021;16(12):e0261125. Published 2021 Dec 17. doi: 10.1371/ journal.pone.0261125.

66. Arif SI, Aldukhail AM, Albaqami MD, et al. Predictors of healthcare workers‘ intention to vaccinate against COVID-19: A cross sectional study from Saudi Arabia. Saudi J Biol Sci, 2022;29(4):2314– 2322. doi: 10.1016/j.sjbs.2021.11.058.

67. Ulbrichtova R, Svihrova V, Tatarkova M, et al. Acceptance of COVID-19 Vaccination among Healthcare and Non-Healthcare Workers of Hospitals and Outpatient Clinics in the Northern Region of Slovakia. Int J Environ Res Public Health, 2021;18(23):12695. Published 2021 Dec 2. doi: 10.3390/ ijerph182312695.

68. Klugar M, Riad A, Mohanan L, et al. COVID-19 Vaccine Booster Hesitancy (VBH) of Healthcare Workers in Czechia: National Cross-Sectional Study. Vaccines (Basel), 2021;9(12):1437. Published 2021 Dec 6. doi: 10.3390/vaccines9121437.

69. World Health Organization Top Ten Threats to Global Health in 2019. 2019 Available at: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.

70. Quinn SC, Parmer J, Freimuth VS, et al. Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey. Biosecur Bioterror, 2013;11(2):96–106.

71. Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ, SAGE Working Group on Vaccine Hesitancy. Strategies for addressing vaccine hesitancy – A systematic review. Vaccine, 2015;33(34):4180–4190. doi: 10.1016/j.vaccine.2015.04.040.