研究背景

疫苗犹豫是指延迟或者拒绝接受安全的疫苗接种服务。COVID-19大流行使各个地区新冠感染者激增，严重影响了公共卫生。由于病毒的不断变异且感染不能提供长期的保护性免疫，新冠再感染的风险较高，而免疫加强接种可以减少病毒传播，降低感染风险，特别是对于感染风险高的人群具有很好的保护作用。但在新冠流行期间，仍有很多已接种疫苗者对加强针犹豫。

研究目的

本研究旨在调查新冠流行期间医务工作者和普通公众对第二剂COVID-19加强针疫苗的疫苗犹豫情况，并探讨相关影响因素及其在不同人群中的差异，为今后可能发生的疫苗可预防X传染病的防控和疫苗推广提供参考依据。

研究方法

本研究为横断面研究，采用方便抽样的方法于2022年12月至2023年2月通过线上（微信朋友圈、社群等）和线下（社区中心、合作单位等）分别向医务人员和普通公众发放问卷链接，共收集问卷18002份，纳入分析16041份。其中医务工作者为在中国大陆医院工作的医务人员，普通公众为18周岁以上具有行为能力、自愿参加并签署知情同意者。问卷调查内容包括年龄、性别、职业等社会人口学信息，既往感染史、疫苗接种剂次等与COVID-19相关的信息以及焦虑症状、抑郁症状、社会支持等心理因素。单因素分析使用t检验和卡方检验，使用Logistic回归分析进行疫苗犹豫的多因素分析。

研究结果

本研究中，医务工作者的疫苗犹豫率为33.9%，普通公众的疫苗犹豫率为47.6%。医务工作者疫苗犹豫多因素Logistic回归分析结果显示，与行政人员等其他医务工作者相比，临床医生（OR=0.705，P=0.001）、护士（OR=0.800，P=0.040）、药剂师（OR=0.465，P=0.002）的疫苗犹豫风险更低；调查时COVID-19感染状态为阳性（OR=1.251，P=0.041）、感知因工作感染风险（OR=1.274，P=0.026）、存在创伤后应激障碍症状（OR=1.414，P<0.001）的医务工作者的疫苗犹豫风险更高；与无职业倦怠症状相比，存在轻度症状（OR=1.256，P=0.001）中度症状（OR=1.470，P=0.004）的医务工作者更容易发生疫苗犹豫；社会支持水平越高，发生疫苗犹豫的风险越低（OR=0.894，P<0.001）。普通公众疫苗犹豫多因素Logistic回归分析结果显示，女性发生风险高于男性（OR=1.302，P<0.001），职场群体发生风险高于大学生群体（OR=1.183，P=0.013），月均收入高于10000元的群体发生风险高于月均收入低于5000元的群体（OR=1.359，P<0.001），吸烟群体发生风险高于不吸烟群体（OR=1.201，P=0.016）；与从未接种过新冠疫苗的群体相比，已接种2剂次（OR=0.537，P=0.003）和3剂次（OR=0.372，P<0.001）的人群发生风险较低；担心感染后遗症（OR=1.979，P<0.001）、存在创伤后应激障碍症状（OR=1.180，P=0.001）的普通公众的疫苗犹豫风险更高；与无抑郁症状相比，存在轻度症状（OR=1.176，P=0.003）、中度症状（OR=1.383，P<0.001）和重度症状（OR=1.322，P=0.008）更容易发生疫苗犹豫；社会支持水平越高，发生疫苗犹豫的风险越低（OR=0.920，P<0.001）。

研究结论

医务工作者和普通公众均存在较高的疫苗犹豫率。针对不同人群制定针对性干预措施，缓解大流行期间发生的心理健康问题，增强心理韧性、社会支持等积极情绪，提高人们对疫苗的信心，对于未来可能发生的疫苗可预防X传染病的防控和促进疫苗接种可能是有效可行的。

Background:

Vaccine hesitancy refers to the delay or denial of safe vaccination services. The COVID-19 pandemic has caused a surge in COVID-19 infections in all regions, significantly affecting public health. Due to the constant virus mutation and the fact that infection does not provide long-term protective immunity, the risk of reinfection with COVID-19 is high. Immunization boosters can reduce the spread of the virus and the risk of infection and are particularly protective for people at high risk of infection. However, there are still many vaccinated individuals who are hesitant to receive booster shots during COVID-19 epidemics.

Objectives:

This study aimed to investigate the vaccine hesitancy of healthcare workers and public for the second dose of COVID-19 booster vaccine during COVID-19 epidemic, and to explore the related influencing factors and the differences between healthcare workers and public. It will provide scientific reference for the prevention and control of vaccine-preventable X infectious diseases and vaccine promotion that may occur in the future.

Methods:

This cross-sectional study was conducted online from December 2022 to February 2023 with a total of 18002 questionnaires collected through convenience sampling and 16041 were included in the analysis. Questionnaires were distributed to healthcare workers and general public through online (WeChat circle, community groups, etc.) and offline (community centers, partner organizations, etc.) respectively. Healthcare workers were those working in hospitals in mainland China, and the general public were those over 18 years of age who signed the informed consent. The questionnaire included sociodemographic information such as age, gender, and occupation, information related to COVID-19 such as previous infections and COVID-19 vaccination doses, as well as psychological factors such as anxiety, depressive, and social support. Univariate analyses were conducted using t-tests and chi-square tests, and multivariate analyses were conducted using Logistic regression analyses.

Results:

In this study, the vaccine hesitancy rate was 33.9% among healthcare workers and 47.6% among the public. According to the results of multivariate analysis, the influencing factors of vaccine hesitancy among healthcare workers were occupation type (Physician: OR=0.705, P=0.001; Nurse: OR=0.800, P=0.040; Pharmacist: OR=0.465, P=0.002), COVID-19 infection status (positive: OR=0.606, P=0.049), perceived COVID-19 risk due to work (OR=1.274, P=0.026), PTSD symptoms (OR=1.414, P<0.001), occupational burnout (Mild: OR=1.256, P=0.001; Moderate: OR=1.470, P=0.004), and social support (OR=0.922, P<0.001). Influencing factors of vaccine hesitancy in the public were gender (female: OR=1.302, P<0.001), social role (occupational groups: OR=1.183, P=0.013), monthly salary (>10,000 CNY: OR=1.359, P<0.001), smoking (OR=1.201, P=0.016), COVID-19 vaccination doses (2 doses: OR=0.537, P=0.003; 3 doses: OR=0.372, P<0.001), concern about long-COVID (OR=1.979, P<0.001), PTSD symptoms (OR=1.180, P=0.001), depressive symptoms (mild: OR=1.176, P=0.003; moderate: OR=1.383, P<0.001; severe: OR=1.322, P=0.008) and social support (OR=0.920, P<0.001).

Conclusions:

Both healthcare workers and the public have high vaccine hesitancy rates on the second dose of COVID-19 booster vaccine. Developing targeted interventions for different populations to increase willingness to vaccinate and confidence in vaccines, alleviating mental health problems that occur during pandemics, and enhancing positive emotions such as resilience and social support may be effective and feasible for the prevention and control of vaccine-preventable X infectious diseases and the promotion of vaccinations that may occur in the future.