key: cord-1025665-6yw4td6w authors: Jiang, Ning; Gu, Pengfei; Sun, Xian; Han, Hui; Liu, Wenwen; Song, Na; Jiang, Xiaolian title: Acceptance of COVID‐19 vaccines in patients with chronic diseases: A cross‐sectional study date: 2022-03-13 journal: J Clin Nurs DOI: 10.1111/jocn.16284 sha: 62638724a408f2b0752c99a22f226b3f10910a60 doc_id: 1025665 cord_uid: 6yw4td6w AIMS AND OBJECTIVES: This study aimed to clarify the attitudes, knowledge and vaccination willingness of patients with chronic diseases toward COVID‐19 vaccines and the influencing factors. BACKGROUND: Vaccination against COVID‐19 is an important way to protect patients with chronic diseases, but the vaccination acceptance varies across diseases and populations. A better understanding of this condition will lead to tailored intervention strategies and high vaccination rates. DESIGN: Cross‐sectional study. METHODS: Data were collected between March 2021 and May 2021 in China. A self‐compiled questionnaire was used in the survey. Two independent‐samples t‐tests/one‐way analysis of variance or U test/H test was used to measure the differences between groups. Multivariate regression analysis was used to identify the influencing factors. The study adhered to the EQUATOR checklist, STROBE. RESULTS: A total of 998 patients participated in the study. Score rates of attitudes, knowledge and vaccination willingness were 69.9%, 68.4% and 70.6% respectively. Age, vaccination status of family members, education levels, vaccine side effects and economic level were positive factors that could influence patients’ vaccination acceptances, while time of illness, type of disease and political affiliations were negative predictors. The top reasons for willingness toward vaccination were supporting national strategies, belief on the vaccines and fearing of contracting COVID‐19, while physical reasons, side effects and having a wait‐and‐see attitude were unwillingness factors. CONCLUSIONS: Patients’ attitudes, knowledge and vaccination willingness were medium. Nurses should pay attention to patients who are from lower socioeconomic backgrounds, under 30 or over 70 years old, have no political affiliations, have damage to vital organs, have a long course of illness, family members have not received COVID‐19 vaccines and had no side effects after receiving other vaccines. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses are recommended to take measures from patients’ duration of illness, damaged organs, demographic characteristics and families to improve patients’ vaccination acceptances. The COVID-19 pandemic has posed a great threat to global public health security. In this pandemic, people with chronic diseases have a much higher risk and mortality from COVID-19 than other populations (Boulle et al., 2021; Nikpouraghdam et al., 2020) . Prophylactic vaccination against COVID-19 can effectively control the spread of the virus; therefore, the population's willingness to be vaccinated is key to achieving a high coverage rate (Williams et al., 2020) . However, the influencing factors can also vary because of the particularity of the patients' physical conditions and the differences in different groups' willingness toward vaccination. This study investigated the attitudes, knowledge and willingness toward vaccination of patients with chronic diseases to clarify the current status of patients' acceptance of COVID-19 vaccines and the related influencing factors and to provide a basis for formulating strategies to increase the vaccination rate. Control (ECDC) (2021) recommended the use of risk-and age-based methods to determine the priority populations for COVID-19 vaccination. They identified medical personnel as the top-priority population, followed by individuals with high medical risks, such as the elderly and patients with chronic diseases. Vaccination against COVID-19 is an important way to protect patients with chronic diseases (Kelkar et al., 2021) . However, in recent years, the vaccination rate and the public's confidence in vaccines have continued to decline (Larson et al., 2016) . In patients with chronic diseases, who are regarded as a high-risk group, the influenza vaccination rate is lower than 50%, which is much lower than the 75% target set by the WHO (Finney Rutten et al., 2021; Jorgensen et al., 2018) . Williams et al. (2020) surveyed the elderly and patients with respiratory diseases in the United Kingdom and found that 86% of the respondents wanted to receive COVID-19 vaccines. This positively correlated with the severity of COVID-19 and negatively correlated with patients' perception that the media had excessively exaggerated the risk of the pandemic. The main influencing factors were personal health conditions, health consequences for others, concerns about vaccine safety and perceived severity of COVID-19 (Williams et al., 2020) . The acceptance rate of COVID-19 vaccines for HIV patients was 71.3%. Concerns about individual health, mandatory vaccination requirements and chronic diseases were positive influencing factors on the willingness toward vaccination; those who refused vaccination stated that they were worried about the side effects of the vaccine and assumed they already had immunity to COVID-19 (Vallée et al., 2021) . The willingness to be vaccinated was 37%-60% in patients with rheumatic disorders, and 50% of patients with tumours was unsure whether they were willing to be vaccinated (Campochiaro et al., 2021; Ehrenstein et al., 2021) . Kelkar et al. (2021) conducted a survey involving cancer patients and their caregivers and found that 71% was willing to receive a COVID-19 vaccine, 24% was unsure and 5% was unwilling (Kelkar et al., 2021) . The vaccine acceptance rate among epilepsy patients was 46.6% (Puteikis & Mameniškienė, 2021) . Olanipekun et al. (2021) conducted a survey on vaccine acceptance for patients of African descent with chronic diseases (hypertension, diabetes and heart failure) who had recovered from COVID-19. In the study, 30% of people expressed their willingness to receive a COVID-19 vaccine, 54% said they would not receive a COVID-19 vaccine and 16% was undecided. Other studies have shown that one-fifth of hemodialysis patients were unwilling to receive a COVID-19 vaccine (Garcia et al., 2021) , whereas 80.9% of patients with multiple sclerosis was clearly willing or may be willing to receive a COVID-19 vaccine (Salavisa & Correia, 2021) . The main reasons for patients' unwillingness to get vaccinated were fear of adverse reactions (Campochiaro et al., 2021; Garcia et al., 2021; Kelkar et al., 2021; Puteikis & Mameniškienė, 2021) , fear of disease deterioration (Campochiaro et al., 2021) , interference with treatment (Kelkar et al., 2021) , vaccine safety issues (Campochiaro et al., 2021; Garcia et al., 2021; Olanipekun et al., 2021) , lack of effective information (Kelkar et al., 2021) and rapid vaccination development (Campochiaro et al., 2021) . Higher education level (Campochiaro et al., 2021; Garcia et al., 2021) , past history of flu vaccination (Campochiaro et al., 2021; Garcia et al., 2021; Puteikis & Mameniškienė, 2021) , age over 45 years old (Garcia et al., 2021; Salavisa & Correia, 2021 ) and doctor's advice (Campochiaro et al., 2021; Kourlaba et al., 2021; Papa et al., 2021; Salavisa & Correia, 2021) were factors that promoted vaccination. On the basis of the above summary, we found that the willingness of patients with chronic diseases to be vaccinated varied and that the proportion of those patients who were unsure about being vaccinated (16%-50%) (Ehrenstein et al., 2021; Olanipekun et al., 2021) was significantly higher than that of the general population (Lin et al., 2020; Reiter et al., 2020) . The factors that affected willingness toward vaccination were also different among patients with different diseases. Therefore, it is necessary to investigate the acceptance of vaccines in more chronic disease patients to clarify the correlation between different diseases and the willingness toward vaccination and its influencing factors. attitudes, COVID-19 vaccines, knowledge, nursing, patients with chronic diseases, willingness The study methods were compliant with the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist for cross-sectional studies (File S1). (Lin et al., 2020; Qiao et al., 2020) . This questionnaire consisted of four parts. The first part includes the questionnaire introduction and questions on the demographic data of the patient, including gender, age, nationality, educational level, political affiliations, occupation, high-risk profession, marital status, major diseased systems, duration of illness, place of residence, family economic conditions, history of travel to high-risk areas, basic information about family members, relationship and vaccine status of family members and side effects after receiving other vaccines (18 items). The remaining three parts are as follows: (1) The attitude part included the influences of COVID-19, risk perception, vaccine acceptance and concerns about the vaccine (11 items); the attitude dimension was scored on a 5-point Likert scale, and the total score was between 11-55 points. A higher total score indicated a more positive attitude. (2) The knowledge part included priority groups for vaccination, recommended age group for vaccination, correct methods, contraindications, adverse reactions, matters needing attention, herd immunity and objective item sources of acquired knowledge (nine items). ① The knowledge dimension included single-and multiple-choice questions and was scored according to the correct rate. Each correct answer to the single-choice questions is given a score of five, and each correct answer to the multiple-choice questions is given a score of 1; the total score was between 1-46 points. ② The objective item sources of acquired knowledge included mobile phone, TV, radio, network, newspaper, school/enterprise, community, professionals, relatives/ friends and others. (3) The vaccination willingness part included vaccine selection, vaccination form, duration of protection, willingness, reasons and vaccine prices (eight items). Vaccination willingness was scored on a six-point Likert scale. Two of these items were scored to determine the level of vaccination willingness. A higher score means higher willingness. The remaining items were objective indicators and were expressed as percentages. Four experts were invited to review the questionnaire, including two professors in public health, a community-based nursing specialist in charge of vaccination, and a nursing education specialist. All of the experts have more than 15 years of professional experience and have senior professional titles. The content validity of the questionnaire was 0.98. Prior to the survey, 15 patients with chronic diseases were selected to test the acceptability of the scale. The patients indicated that the items of the AKW scale were clear and easy to understand. The Cronbach's alpha coefficient was 0.71 in patients. According to the purposive sampling method, patients with chronic diseases in three general hospitals in mainland China were selected as the research subjects. This questionnaire comprises three dimensions and 28 variables for statistical analysis; therefore, the required samples should be 10-20 times the number of variables (Wang, 1990 ). The minimum sample size for the current study was 280-560 patients. The inclusion criteria for patients were as follows: ① diagnosis of chronic disease, ② age ≥18 years old, ③ stable disease and ④ provision of informed consent and willingness to participate. The exclusion criteria were as follows: ① language and written communication disorders, ② cognitive or intellectual disorders and ③ prior vaccination against COVID-19. A total of 1132 patients were invited in this survey. The survey team comprised six people, all of whom were registered nurses/doctors with more than 10 years of work experience. By using the convenience sampling method, the research team members first contacted the doctors/nurses working in the chronic disease departments that they were familiar with. After getting to know the basic information of the patients, the patients who met the sampling criteria were investigated. By using the method of snowball sampling, the doctors/nurses recommended other chronic disease departments that they were familiar with for further investigation. A total of 28 medical wards, including the respiratory department, neurology department, nephrology department, cardiology department, gastroenterology department, endocrinology department, and oncology department participated in the survey. A paper AKW questionnaire was used to conduct onsite surveys of hospitalised patients who met the inclusion criteria. After entering the department, investigators first explained the purpose, significance and methods of the study to the patient and conducted the survey after obtaining the consent of the patient. The patients completed the questionnaire independently. For patients with reading difficulties, visual impairment or difficulty in writing, the investigators read the questions one by one in neutral, nonsuggestive language and assisted the patient in filling out the questionnaire. After the patient completed the questionnaire, the investigator checked whether the questionnaire was filled completely. If items were missing, the patient would fill them on the spot, and the questionnaire was returned after reverification. Similarly, questionable items were verified with the patient on the spot and then returned after verification. This study followed the biomedical ethics code and was approved by the ethics committee of a medical university. Before the survey, all participants signed a written informed consent form. During the survey, the privacy of the patients was protected, and their data were kept strictly confidential. SPSS software was used for statistical analysis. Attribute data were expressed by frequency distribution, and variable data were expressed as mean ± SD. This study used the P-P graph and histogram to analyse the normality of the data. When the data were normally distributed, two independent-samples t-tests or one-way analysis of variance was used. If the data showed a skewed distribution, the Mann-Whitney U test or Kruskal-Wallis H test was used to measure the differences between different sociodemographic characteristic groups. Demographic data were used as independent variables to perform multivariate regression analysis to further clarify the factors that affected AKW. A p < .05 indicated statistical significance (two tailed). A total of 1,132 questionnaires were distributed, and 998 valid questionnaires were returned with a validity rate of 88.2%. The ratio of men to women in this study was approximately 1:0.92. Among the subjects, 97.5% was Han Chinese, 71.3% was aged 40-69.9 years old and 44.9% had a high school degree or above. Most of the subjects were farmers (30.8%), followed by retired personnel (18.3%) and enterprise employees (15.6%). Furthermore, 90.2% was married/cohabiting. When divided by disease, 27.1% had diseases in the urinary system (including nephrology), 21.3% in the digestive system (including liver disease and gastrointestinal tract disease), 13.2% in the respiratory system, 10.7% in the circulatory system, 9.4% in the reproductive system, 7.6% in the endocrine system, 5.3% in the nervous system, 1.9% in the head and face, 1.4% in the bone joints and skin and 1.3% in the blood. Furthermore, 0.7% had rheumatic and immune disorders. Most patients had suffered from the disease for 1-9.9 years (74.5%), had a moderate economic level (66.6%), had never been to medium-and high-risk areas (98.2%) and had good family relations (75.3%). The majority of them had fewer than three family members over the age of 60 and under 18 years old (87%), and the ratio of urban/rural residents among them was 1:0.92. Among the subjects, 9.6% of them had family members who were engaged in medical professions, and 28.7% of them had family members who had been vaccinated against COVID-19. Table 1 shows the results. According to the normality analysis of the P-P graph and the histogram of the AKW score, the dimensions of knowledge and vaccination willingness showed a skewed distribution, and the attitudes and total scores were normally distributed. Therefore, the data on knowledge and willingness were described by the medians and other dimensions by mean ± SD. The average score of the attitude was 38.47 ± 5.8, and the score rate was 69.9%. Most patients believed that their potential infection with COVID-19 could have a significant effect not only on their own bodies (81%) but also on the people around them or the environment (85.2%). They believed that the epidemic in China will not be repeated and that the risk of contracting COVID-19 is low. The knowledge dimension score rate was 68.4%, and the top three items with the highest score rates were "priority populations for vaccination" (84.4%), "contraindications for vaccination" (82.5%) and "matters needing attention" (78.8%). The top three items with the lowest score rates were "correct vaccination methods" (49.7%), "herd immunity" (57%) and "familiarity with COVID-19 vaccine-related knowledge" (59.7%). The score rate of vaccination willingness was 70.6%, and 88. Figure 1 show the results. Demographic characteristics, diseases and family factors were used as grouping variables to analyse the differences between groups. Given that knowledge and willingness showed a skewed distribution, the U test or H test was used. Attitudes and total scales were normally distributed, and t-test or analysis of variance was used. As seen from the statistical results, there were statistically signifi- In terms of willingness to be vaccinated, the differences in scores between the groups were statistically significant when the following were used as grouping variables: type of illness, time of illness and economic level, whether they had been to medium-and highrisk areas in the past six months, whether family members had been vaccinated and whether there were vaccine side effects. The lowranked patients in terms of willingness toward vaccination were patients with diseases in the blood system (70.5%), circulatory system (68.5%) and urinary system (66%) and had rheumatic and immune disorders (64.3%). The top-ranked patients in terms of willingness to be vaccinated were patients with diseases of the head and face (76.8%), reproductive system (75.7%), bone and skin (74.4%) and respiratory system (73%). As the time of illness increased, the willingness toward vaccination of patients with different durations of illness fluctuated. The willingness toward vaccination of patients with medium and high economic levels was significantly higher than that of patients with low economic levels (medium and high vs. low: 71.2% and 73.1% vs. 65.9%), patients who had been to medium-and high-risk areas in the past six months were more willing to be vaccinated (yes vs. no: 74.5% vs. 70.5%). Like knowledge scores, patients whose family members had received the COVID-19 vaccine and had side effects after receiving other vaccines also scored higher in willingness. The results of the correlation analysis showed that age, type of disease, and duration of illness were significant factors that influ- and vaccine side effects. Table 1 shows the results. In this study, we developed an AKW questionnaire via literature review and expert consultation. The content validity of the scale was 0.98, and Cronbach's alpha coefficient was 0.71. This indicated that the questionnaire was reliable. In this study, male and female patients had significantly different attitudes toward vaccines. Women tend to have a more positive attitude toward COVID-19 vaccines. Their perception of individual diseases, health beliefs and vaccination willingness was significantly higher than that of men (Krawczyk et al., 2012) . However, an uncomfortable experience with a previous vaccination was an important factor that affected women's willingness toward vaccination (Jamal et al., 2020) . Xiao et al. (2005) indicated that vaccination willingness was consistent with 56% of the adverse reactions caused by influenza vaccinations. In this study, age was a significant influencing factor of vaccination knowledge, and this finding was consistent with the existing result (Yang et al., 2021) . Furthermore, the degree of knowledge mastery gradually decreased with age. Although patients aged 18-29.9 years old were the youngest group in this study, their degree of knowledge mastery was not high. This may be because patients in this age group had suffered from their disease for less than three years and had obvious feelings of illness anxiety, in addition to the fact that the illness itself had a significant effect on their daily lives. So, they paid little attention to vaccine information. Similarly, patients ≥70 years of age had the lowest attitudes and knowledge among the groups. Although other studies have shown that the elderly are more willing to be vaccinated (Kabamba Nzaji et al., 2020; Shaw et al., 2021; Unroe et al., 2021) , this study found that the willingness of elderly patients to be vaccinated was only moderate. Nurses should pay more attention to these two age groups to increase their vaccine acceptance. In this study, patients with formal occupations, such as medical personnel, civil servants, enterprise employees and public institution personnel, have higher knowledge and total scores, whereas patients with relatively unstable occupations have lower scores. This therefore, patients who work in the public sector have higher scores. In the same way, patients with formal occupations had relatively higher income levels and stability. This was similar to the statistical results for "family economic level." With increasing economic level, the vaccination knowledge, willingness, and total score of patients increased significantly. Patients with better economic conditions had a higher acceptance of the COVID-19 vaccine (Harapan et al., 2020) . However, Liu et al. (2021) showed that high-income groups were more willing to accept paid vaccines than free vaccines. Follow-up studies should include a larger sample size and further analyse this point of contradiction to find the exact cause. By using this survey, we identified that patients with chronic diseases had medium attitudes and knowledge mastery regarding COVID-19 vaccines, and their willingness to be vaccinated was relatively high. Only 4.5% of patients was unsure of COVID-19 vaccination, which showed that patients were very clear about their personal willingness toward vaccination and were willing to be vaccinated. This differed from other studies (Campochiaro et al., 2021; Ehrenstein et al., 2021; Kelkar et al., 2021; Vallée et al., 2021) . After analysing the acceptance of COVID-19 vaccines in patients with different diseases, we found that patients suffering from diseases in nonvital organs or having mild illnesses (e.g. the head and face, reproductive system, bone and skin and respiratory system) had good acceptances of vaccines. By contrast, patients with lower acceptances were those with diseases of vital organs. On one hand, for patients with diseases in nonvital organs, their acceptances of COVID-19 vaccines were less impacted by the disease. On the other hand, given that the circulatory system, nervous system and respiratory system are important systems of the human body and that some patients were seriously ill. Many patients were concerned about whether certain components of the vaccine would increase the burden on the already damaged organs during the metabolic process or whether certain components of the vaccine could not be excreted from the body, which might worsen their conditions (Garcia et al., 2021) . (Kourlaba et al., 2021; Shaw et al., 2021) . It is recommended that hospital administrators assess the level of knowledge mastery of nurses regarding COVID-19 vaccines and conduct targeted training to remedy any gaps in knowledge. The duration of illness was an important factor that influenced the attitude and willingness toward COVID-19 vaccination. Udell et al. (2013) found that early vaccination can help patients maintain stable health. However, in this study, we found that the acceptance of patients who had suffered from disease for more than one year exhibited a downward trend with increasing duration of illness. This is a question worthy of deep consideration. As the course of an illness progresses, disease recurrence and the emergence of complications could cause a patient to experience negative emotions toward medical practice, including fear, anger and anxiety (Vinaccia & Orozco, 2005) . Certain diseases, such as cancer, not only cause physical changes but also financial difficulties, thus changing people's self-perception and affecting their relations with family and friends (Kimmel, 2001 This study found that family was an important factor affecting the vaccine acceptance of patients. Elderly people who are over 60 years of age and children, who are in the growth period, are highly susceptible to COVID-19, and serious complications may occur if they are infected (Oliver & Wood, 2014) . Owing to the disease, patients need to go in and out of the hospital frequently even during a pandemic, thus increasing their risk of contracting COVID-19. Therefore, the proportion of people who were willing to be vaccinated to protect family members from being infected increased (46.7%), and this finding agrees with the results of existing research (Bell et al., 2020) . We found that the knowledge and attitude scores of patients were the highest when the number of family members over 60 and under 18 years old was 4-5, and the willingness to be vaccinated was strongest when this number was 2-3. We posit that when there were less than two disadvantaged members in the family, patients might not worry about the effects of COVID-19; when there were more than five such members, it would result in too much energy being spent trying to care for the disadvantaged members and might prevent patients from paying attention to vaccine news and information. In this study, patients having family members who were previously vaccinated with the COVID-19 vaccine and who showed side effects after receiving other vaccines were significant factors that influenced knowledge, willingness and total scales. The vaccination rate for family members in this study was 28.7%, which was higher than the current vaccination level in China (China NHC, 2021), and the side effect rate was lower than 6‰, which was at the low level of current adverse reaction rates (Baden et al., 2021; China CDC, 2021) . The positive effects driven by family members may be the reason for the improvements in patients' acceptance of COVID-19 vaccines. Owing to the pandemic, most studies on the acceptance of COVID-19 vaccines were online surveys. Given the limitations of internet access and the particularities of the patients' physical conditions, this survey method might limit the participation of some populations with low incomes, low education levels, elderly age and frail bodies. This study was an onsite survey conducted by clinical nurses. Face-to-face communication between nurses and patients can allow elderly patients with low literacy levels or advanced age to complete the questionnaire, allow for an assessment of the completeness of the questionnaire and allow the surveyors to provide timely feedback to patients regarding uncertainties in the questions, thus improving the effective response rate of the questionnaire. However, given that this study mainly collected patient data in large general hospitals, caution needs to be exercised when promoting the results, and future surveys should be conducted in primary hospitals and specialised hospitals. Vaccines are an important means to prevent the spread of COVID-19, but the vaccine acceptance for patients with chronic diseases may be affected by factors such as age, education level, disease, economy and family. This survey found that the patients' attitudes, knowledge and willingness to be vaccinated were medium Our thanks should go to all patients in this survey for their time and sharing their experiences. No conflict of interest has been declared by the authors. The data that support the findings of this study are available from the corresponding author upon reasonable request. Ning Jiang https://orcid.org/0000-0003-3620-1456 Xiaolian Jiang https://orcid.org/0000-0001-9129-0012 Determinants of COVID-19 vaccine acceptance in Saudi Arabia: A web-based national survey Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England Risk factors for coronavirus disease 2019 (COVID-19) death in a population cohort study from the Western Cape province, South Africa Potential acceptance of COVID-19 vaccine in rheumatological patients: A monocentric comparative survey Overview of surveillance information on adverse reactions of Novel Coronavirus vaccine in China Obesity and COVID-19: The two sides of the coin Factors associated with willingness to be vaccinated against COVID-19 in a large convenience sample Hygienemaßnahmen bezüglich COVID-19 in der ambulanten versorgung: Akzeptanz durch die patienten? Overview of the implementation of COVID-19 vaccination strategies and deployment plans in the EU/EEA Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy SARS-CoV-2 vaccine acceptability in patients on hemodialysis: A nationwide survey Willingnessto-pay for a COVID-19 vaccine and its associated determinants in Indonesia Chronic obstructive pulmonary disease: An update for the primary physician Low vaccination in rural Sindh, Pakistan: A case of refusal, ignorance or access? Vaccine How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes Acceptability of vaccination against COVID-19 among healthcare workers in the democratic republic of the Congo Vaccine enthusiasm and hesitancy in cancer patients and the impact of a webinar Psychosocial factors in dialysis patients Willingness of Greek general population to get a COVID-19 vaccine Human papillomavirus vaccination intentions and uptake in college women Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey The state of vaccine confidence 2016: Global insights through a 67-country survey Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China COVID-19 vaccination willingness among Chinese adults under the free vaccination policy. Vaccines Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine, 26, 100495 National Health Commission of the People's Republic of China (China NHC) (2021) Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in Iran: A single center study Attitudes and perceptions towards coronavirus disease 2019 (COVID-19) vaccine acceptance among recovered African American patients Medical conspiracy theories and health behaviors in the United States Winter is coming and COVID-19 vaccine is available! The role of gastroenterologist in increasing COVID-19 vaccine acceptability among IBD patients Factors associated with COVID-19 vaccine hesitancy among people with epilepsy in Lithuania Distribution of the Vaccine Risk exposures, risk perceptions, negative attitudes toward general vaccination, and COVID-19 vaccine acceptance among college students in South Carolina. medRxiv: the preprint server for health sciences Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine Willingness to be vaccinated against COVID-19: An exploratory online survey in a Portuguese cohort of multiple sclerosis patients. Multiple Sclerosis and Related Disorders Assessment of US healthcare personnel attitudes towards coronavirus disease 2019 (COVID-19) vaccination in a large university healthcare system Association between influenza vaccination and cardiovascular outcomes in high-risk patients: A metaanalysis Willingness of long-term care staff to receive a COVID-19 vaccine: A single state survey COVID-19 vaccine hesitancy among French people living with HIV. Vaccines Aspectos psicosociales asociados con la calidad de vida de personas con enfermedades crónicas Clinical epidemiology-Design, measurement and evaluation of clinical scientific research Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines: interim guidance R&D blueprint and COVID-19 Vaccine Explained' series features illustrated articles on vaccine development and distribution Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: Outlining evidence-based and theoretically informed future intervention content Analysis of adverse reaction assessment questionnaire for staff of medical institutions after influenza vaccination Knowledge, attitude and practice of residents in the prevention and control of COVID-19: An online questionnaire survey Willingness to receive COVID-19 vaccination in Japan. Vaccines