Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia.
Department of Medicine, The University of Melbourne, Clinical Sciences Building 601, Royal Parade, Parkville, VIC 3050, Australia; MS Unit, Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, VIC 3050, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Level 5, 30 Royal Parade, Parkville, VIC 3010, Australia.
Mult Scler Relat Disord. 2022 Jul;63:103933. doi: 10.1016/j.msard.2022.103933. Epub 2022 Jun 1.
People with Multiple Sclerosis (PwMS) were first able to access COVID-19 vaccines in Australia from March 2021, when vaccine hesitancy in the general population was high (14-43%). High uptake of vaccination is important globally and critical to protect this vulnerable population. We conducted an on-line survey to examine factors influencing COVID-19 vaccination willingness among PwMS in Australia.
149 PwMS living in Australia completed the on-line survey (April-September 2021) examining demographic, environmental and clinical factors with respect to vaccine willingness, including attitudes towards COVID-19 illness and vaccines. Additional items explored the influence of different information sources on vaccination decisions. Continuous and ordinal data were compared using the Mann-Whitney U test. All tests were two-tailed, with alpha set at 0.5.
A majority of the respondents were female (87.2%) with relapsing-remitting MS (77.5%) treated by a neurologist (94.0%). A majority were on high efficacy disease-modifying therapies (DMTs) (64.9%), while 19.9% were on no DMTs. About one third of respondents (32.9%) had had two doses, 20.8% had received their first dose, and 22.1% were unvaccinated, while 24.2% of responses were missing. When asked about vaccine intentions, 60.6% of the unvaccinated indicated they were likely to extremely likely to get vaccinated, while 15.2% were very unlikely or extremely unlikely to do so and 24.2% were undecided. Unvaccinated people were significantly more concerned about vaccine side effects (mean 5.3 versus 3.1/10; p < .001). Only 53.3% of people on DMTs were vaccinated, compared to 75% of those who were not. People on ocrelizumab therapy (n = 35) had a lower vaccination rate (39%) than those on other medications (n = 86, 59%). Vaccine willingness in the unvaccinated was most highly correlated with knowledge regarding the vaccine (r=.709), agreement with the statement that COVID-19 vaccination is "too new for me to be confident about getting vaccinated" (r= -.709), anticipation of regret due to side effects of vaccination (r= -.642), and lack of knowledge regarding interactions between COVID-19 vaccines and DMTs (r= -.570). Almost two thirds had read MS-specific information about COVID-19 vaccinations and found it easy to understand (67.6%) and applicable to their situation (53.6%). However, less than half (47.8%) reported the information helped them make a personal vaccination decision. Over two-thirds (64.9%) had discussed vaccinations with their healthcare professional and 31.1% had not. Those who had not, were significantly more uninformed about the interactions of the vaccine with MS medications (mean 3.9 versus 2.9/10; p = .044) and significantly lower intention of vaccine uptake than those who had (mean 5.8 versus 7.9/10; p = .009).
Our study highlights that vaccination efforts should be delivered by healthcare professionals, focus on educating those who are managed with DMTs, and include individual recommendations related to specific DMTs, how the vaccines work, expectations regarding potential side-effects, potential exacerbation of MS symptoms, likelihood of recovery from any exacerbation, and the relative risks of side effects versus COVID-19 infection. Specific recommendations are provided.
多发性硬化症患者（PwMS）于 2021 年 3 月开始能够在澳大利亚接种 COVID-19 疫苗，当时普通人群的疫苗犹豫情绪很高（14-43%）。在全球范围内，高疫苗接种率非常重要，对于保护这一脆弱人群至关重要。我们进行了一项在线调查，以研究澳大利亚 PwMS 对 COVID-19 疫苗接种意愿的影响因素。
149 名居住在澳大利亚的 PwMS 完成了在线调查（2021 年 4 月至 9 月），调查了与疫苗接种意愿相关的人口统计学、环境和临床因素，包括对 COVID-19 疾病和疫苗的态度。其他项目探讨了不同信息来源对疫苗接种决策的影响。使用 Mann-Whitney U 检验比较连续和有序数据。所有检验均为双侧检验，α 值设定为 0.5。
大多数受访者为女性（87.2%），患有复发缓解型多发性硬化症（77.5%），由神经科医生治疗（94.0%）。大多数人正在接受高疗效的疾病修饰疗法（DMTs）（64.9%），而 19.9%的人未接受 DMTs。约三分之一的受访者（32.9%）已接种两剂疫苗，20.8%已接种第一剂疫苗，22.1%未接种疫苗，而 24.2%的回复缺失。在询问疫苗接种意向时，60.6%的未接种者表示他们极有可能接种疫苗，而 15.2%的人极不可能或非常不可能接种疫苗，24.2%的人尚未决定。未接种疫苗的人更担心疫苗的副作用（平均值为 5.3 比 3.1/10；p<0.001）。只有 53.3%的 DMT 使用者接种了疫苗，而未接种疫苗的比例为 75%。接受奥瑞珠单抗治疗的患者（n=35）的接种率（39%）低于接受其他药物治疗的患者（n=86，59%）。未接种疫苗者的疫苗接种意愿与疫苗相关知识高度相关（r=.709），与“COVID-19 疫苗对我来说太新了，我无法自信地接种疫苗”的说法一致（r= -.709），对因接种疫苗产生副作用而感到遗憾的预期（r= -.642），以及对 COVID-19 疫苗和 DMTs 之间相互作用的了解不足（r= -.570）。近三分之二的人阅读了多发性硬化症 COVID-19 疫苗接种的特定信息，认为这些信息容易理解（67.6%）且适用于他们的情况（53.6%）。然而，不到一半（47.8%）的人报告说这些信息帮助他们做出了个人接种决定。超过三分之二（64.9%）的人曾与他们的医疗保健专业人员讨论过疫苗接种，而 31.1%的人没有。那些没有讨论过的人，对疫苗与多发性硬化症药物相互作用的了解明显不足（平均值为 3.9 比 2.9/10；p=0.044），而且他们接种疫苗的意愿明显低于那些讨论过的人（平均值为 5.8 比 7.9/10；p=0.009）。
我们的研究强调，疫苗接种工作应由医疗保健专业人员提供，重点是教育接受 DMTs 治疗的患者，并包括与特定 DMTs 相关的个人建议，疫苗如何发挥作用，对潜在副作用的预期，多发性硬化症症状加重的可能性，任何加重症状从恢复的可能性，以及副作用与 COVID-19 感染的相对风险。提供了具体建议。
