McElvaney Oliver J, Cleary Brian, Fraughen Daniel D, Kelly Geraldine, Murphy Mark P, McElvaney Oisín F, Branagan Peter, Gunaratnam Cedric, Carroll Tomás P, McElvaney Noel G
Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Beaumont Hospital, Dublin, Ireland.
Chronic Obstr Pulm Dis. 2022 Apr 29;9(2):266-273. doi: 10.15326/jcopdf.2022.0288.
Patients with severe alpha-1 antitrypsin deficiency (AATD) are at increased risk for the development of chronic obstructive pulmonary disease (COPD), particularly if they smoke. This, coupled with their predilection for dysregulated inflammation and autoimmunity, makes affected individuals priority candidates for vaccination against coronavirus disease 2019 (COVID-19). To promote vaccine uptake effectively, an understanding of the factors motivating people to proceed with vaccination is essential. The attitudes of patients with AATD towards COVID-19 vaccination have yet to be described. We prospectively studied 170 PiZZ genotype AATD patients, 150 patients with nonhereditary (PiMM genotype) COPD and 140 PiMM genotype individuals without lung disease receiving first-dose vaccination with ChAdOx1 nCoV-19 (AstraZeneca). Patient attitudes towards vaccination and motivations for getting vaccinated were assessed at the time of the vaccine being offered. Following completion of the 2-dose vaccine series, PiZZ patients were then re-assessed regarding their attitudes towards booster vaccination. The most common primary motivation for accepting vaccination in PiZZ participants ≥50 years old was a fear of illness or death from COVID-19. In contrast, PiZZ patients <50 years most often cited a desire to socialize. The motivation pattern of younger PiZZ AATD patients was similar to that of non-deficient individuals of comparable age, whereas older PiZZ individuals were more closely aligned with PiMM COPD and differed from age-matched controls without lung disease. When considering booster vaccination, PiZZ patients were increasingly motivated by a desire to reacquire social freedoms. A desire to reduce the risk of transmission was not a prominent consideration in any of the groups studied. The most commonly cited reason for booster hesitancy was a lack of incentive, given that no additional social freedoms were available to triple-vaccinated individuals compared to those who were double-vaccinated at the time. Taken together, these data may inform policymakers attempting to promote vaccine uptake among patients with AATD.
严重α-1抗胰蛋白酶缺乏症（AATD）患者患慢性阻塞性肺疾病（COPD）的风险增加，尤其是在他们吸烟的情况下。再加上他们倾向于炎症失调和自身免疫，这使得受影响的个体成为2019冠状病毒病（COVID-19）疫苗接种的优先候选者。为了有效地促进疫苗接种，了解促使人们进行疫苗接种的因素至关重要。AATD患者对COVID-19疫苗接种的态度尚未得到描述。我们前瞻性地研究了170名PiZZ基因型AATD患者、150名非遗传性（PiMM基因型）COPD患者和140名无肺部疾病的PiMM基因型个体，他们接受了ChAdOx1 nCoV-19（阿斯利康）的首剂疫苗接种。在提供疫苗时评估了患者对疫苗接种的态度和接种疫苗的动机。在完成2剂疫苗接种系列后，对PiZZ患者关于加强疫苗接种的态度进行了重新评估。≥50岁的PiZZ参与者接受疫苗接种最常见的主要动机是害怕死于COVID-19疾病。相比之下，<50岁的PiZZ患者最常提到的动机是社交的愿望。年轻的PiZZ AATD患者的动机模式与年龄相仿的非缺陷个体相似，而年长的PiZZ个体与PiMM COPD患者更为相似，且与无肺部疾病的年龄匹配对照组不同。在考虑加强疫苗接种时，PiZZ患者越来越受到重新获得社会自由愿望的驱使。在任何研究组中，降低传播风险的愿望都不是一个突出的考虑因素。加强疫苗接种犹豫最常提到的原因是缺乏激励措施，因为与当时接种两剂疫苗的人相比，接种三剂疫苗的人没有获得额外的社会自由。综上所述，这些数据可能为试图促进AATD患者疫苗接种的政策制定者提供参考。
