key: cord-0905760-06uxl9te authors: Doran, Jason; Seyidov, Nabil; Mehdiyev, Samir; Gon, Giorgia; Kissling, Esther; Herdman, Trent; Suleymanova, Javahir; Rehse, Ana Paula Couthino; Pebody, Richard; Katz, Mark A.; Hagverdiyev, Gahraman title: Factors associated with early uptake of COVID‐19 vaccination among healthcare workers in Azerbaijan, 2021 date: 2022-03-22 journal: Influenza Other Respir Viruses DOI: 10.1111/irv.12978 sha: 36b22438103b03ae4bca8954f740631f90d53623 doc_id: 905760 cord_uid: 06uxl9te INTRODUCTION: We evaluated uptake and factors associated with COVID‐19 vaccination among health workers (HWs) in Azerbaijan. RESULTS: Among 1575 HWs, 73% had received at least one dose, and 67% received two doses; all received CoronaVac. Factors associated with vaccination uptake included no previous COVID‐19 infection, older age, belief in the vaccine's safety, previous vaccination for influenza, having patient‐facing roles and good or excellent health by self‐assessment. CONCLUSION: These findings could inform strategies to increase vaccination uptake as the campaign continues. Vaccination is the best approach to reduce COVID-19 morbidity and mortality and to preserve healthcare infrastructures. 1 Health workers (HWs) are a critical group for vaccination; they provide essential delivery of the COVID-19 pandemic response and are at elevated risk of infection and onward transmission to vulnerable patients. 2 However, vaccine hesitancy among HWs is widespread globally. 3 Low COVID-19 vaccine uptake in HWs has previously been associated with vaccine safety concerns and younger age. 4, 5 In Azerbaijan, an upper-middle income country with a population of approximately 10 million people, the voluntary COVID-19 vaccination campaign began on January 18th, 2020, for the population deemed most at risk, including HWs. CoronaVac, an inactivated vaccine developed by the Chinese firm Sinovac Biotech, was the main vaccine administered at the beginning of the campaign. We used enrollment data from an ongoing study of COVID-19 vaccine effectiveness (VE) among HWs in Azerbaijan (clinicaltrials.gov description) to identify factors associated with uptake of the vaccine early in the campaign. of whether they had been vaccinated or intended to get vaccinated. Participants completed an interviewer-led questionnaire, including questions about demographics, history of COVID-19 vaccine and infection, and knowledge and attitudes toward the vaccine. Vaccination and infection history for all participants was cross-checked with the national vaccination database and testing database, respectively. Data were entered into an electronic data management system (www. sorgular.az) and exported into Stata v16.1 (Texas, United States of America). We assessed factors associated with uptake of at least one dose of the COVID-19 vaccine, calculating odds ratios (with 95% confidence intervals). Stratified analyses were conducted to assess for potential effect modification. Factors associated with uptake of the COVID-19 vaccine at the univariable level (defined as p value < 0.1) were inserted into a stepwise forward multivariable regression model (with age included a priori), and retention was based on the model with the lowest Akaike information criterion. As the Azerbaijan Government advised (but did not enforce) that people previously infected with COVID-19 should wait at least 6 months before receiving the COVID-19 vaccine, we also conducted a sensitivity analysis excluding participants who reported COVID-19 infection in the 6 months prior to enrollment. In this model, we only retained variables that showed an association in the main analysis. infection in the 6 months prior to enrollment were demographically similar to those who did not report a previous COVID-19 infection (see Table S1 ). Most HWs (62%) agreed or strongly agreed that the COVID-19 vaccine was safe, whereas 28% were neutral. Nearly all participants (91%) believed that the COVID-19 vaccine was extremely, very, or somewhat effective in preventing illness. One-third of participants (36%) were not worried about becoming ill from COVID-19. Over a third of participants (34%) reported knowing a great deal about the vaccine, and 60% agreed or strongly agreed that they would regret if they were unvaccinated ( Figure 1 ). HWs > 60 years old were more likely to be vaccinated against COVID-19 compared with HWs < 35 years old (aOR: 1.8; 95% CI: 1.09-2.86). Participants who received the influenza vaccine in 2019-20 were twice as likely to have received the COVID-19 vaccine compared with those who did not (aOR: 2.3; 95% CI: 1.67-3.2). Participants with a patient-facing role were 41% more likely to have received the vaccine than those who did not (aOR: 1.41; 95% CI: 1.1-1.84). Participants who characterized their health as fair or poor were half as likely to have received the COVID-19 vaccine compared with those in excellent health (aOR: 0.49; 95% CI: 0.31-0.81). Participants who did not strongly agree or agree that the vaccine was safe were much less likely to have received the COVID-19 vaccine than those who did (aOR: 0.25; 95% CI: 0.13-0.49). Finally, those who said they would not regret not receiving the COVID-19 vaccine were significantly less likely to have received the vaccine compared with those who said they would regret it (aOR: 0.31; 95% CI: 0.2-0.47). Compared with participants previously infected with COVID-19, those who were not known to be previously infected were nine times more likely to have received the COVID-19 vaccine (aOR: 8.98; 95% CI: 6.7-11.9). However, associations with vaccination uptake remained in the sensitivity analysis that excluded HWs who reported a COVID-19 infection in the 6 months prior to enrollment (Table S2) those at higher risk for severe outcomes from infection. 8 Barriers to uptake of the influenza vaccine include negative attitudes toward the vaccine and lack of knowledge 9 -similar reasons to those we found to be associated with Covid-19 vaccine hesitancy in our study. Improved provision and promotion of the influenza vaccine to HWs and vulnerable adults in Azerbaijan may have a positive effect in promoting current and future COVID-19 vaccination campaigns. Our study also found that those with a nonexcellent self-assessed health status were less likely to be vaccinated. A Canadian study found that chronic conditions, income, and stress can all significantly influence self-perceived health status. 10 16, 17 Our study has limitations. As only a proportion of HWs from seven hospitals in Baku were included, and the study was voluntary, our results may suffer from selection bias and may not be generalizable to all HWs in Azerbaijan. We also did not collect information about socioeconomic status, education, ethnicity, and religion, which may influence vaccine uptake. Although Covid-19 vaccine uptake was high in this cohort of HWs in Azerbaijan, we identified a number of factors associated with lower vaccine uptake among HWs that could be targeted in order to increase uptake of the vaccine among HWs in Azerbaijan and help contain the pandemic. This study was funded by the WHO Regional Office for Europe. Supervision; validation. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. The peer review history for this article is available at https://publons. com/publon/10.1111/irv.12978. Anonymized data may be provided upon request. 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