Chrdle A, Bártlová S, Chloubová I
Epidemiol Mikrobiol Imunol. 2023 Winter;72(1):25-39.
There is a discussion about COVID-19 vaccination rates among healthcare workers (HCW), especially nurses. The primary question for this review was: "What are the attitudes of nurses, compared to other HCW, towards COVID-19 vaccination?" The secondary questions included the proportion of nurses with intention to get vaccinated, what prevents the nurses from accepting the vaccine and what enables them to accept the vaccine.
The PRISMA-ScR format for scoping reviews was chosen to respect the novelty of COVID-19 vaccines. Database search (PubMed/MEDLINE, PROquest and EBSCO) was performed for original studies in English language, from all geographies, with most recent search on March 20, 2022. Vaccination acceptance rates were charted for nurses and nursing students in one category, and HCW other than nurses in the other category. The evolution in time of the nurses attitude to vaccine acceptance relative to that of HCW other than nurses was charted post hoc. The factors associated with COVID-19 vaccination intention according to the WHO categories (contextual influences, individual/ group influences, and vaccine/vaccination specific issues) were reviewed as narrative summary.
Total 58 eligible studies were selected, all with cross-sectional study design, including 95418 healthcare workers of whom 33130 were nurses and 7391 were nursing students, from 44 countries in Europe, Americas, Africa and Asia. Trust in science, in doctors, in experts and in governments were the main contextual factors increasing vaccination acceptance mentioned in the studies, while altruism and collective protection, or protecting a person at risk at home was mentioned only few times. The nurses were less likely to accept vaccination compared to doctors and other HCWs at the onset, eg. before vaccine rollout, and this difference decreased with time (p = 0.022). Being older (n = 25 studies), being male (n = 23), having higher degree of education (n = 7), and having more years of clinical practice (n = 4) were associated with higher vaccination acceptance. Percieved individual risk of having severe COVID-19 (n = 14) or working in a COVID-19 dedicated units (n = 5) was mentioned in a minority of studies. The main vaccine-releated factors associated with higher vaccination intention were trust in the vaccine and its efficacy and safety, general vaccinatoin acceptance and specifically having had influenza vaccination in previous years (n = 21 studies). A significant factor associated with higher vaccine acceptance was high "vaccine knowledge", "vaccine literacy", "understanding the vaccine" or "understanding benefits and barriers of vaccination" (n = 17 studies).
Nurses have been more hesitant to accept COVID-19 vaccination than other healthcare professions at the beginning, but with time this difference disappeared. This general nurse attitude of wait-and-see reported in the studies corresponds with real-life data from practicing healthcare workers as reported by the Czech Institute of Health Information and Statistics on vaccination against COVID-19. Trust in scientific structures and vaccine makers increases the vaccine acceptance. The acceptance increases also with higher age, increasing level of education, longer clinical experience, and also with being a male. Vaccine literacy and having participated in previous vaccination programmes, especially influenza vaccine, were identified as independent modifiable factors increasing vaccination acceptance.
关于医护人员（HCW），尤其是护士的新冠疫苗接种率存在讨论。本综述的主要问题是：“与其他医护人员相比，护士对新冠疫苗接种的态度是怎样的？”次要问题包括有接种意愿的护士比例、阻碍护士接受疫苗的因素以及促使他们接受疫苗的因素。
选择PRISMA - ScR格式进行范围综述，以尊重新冠疫苗的新颖性。对来自所有地区、英文撰写的原始研究进行数据库检索（PubMed/MEDLINE、PROquest和EBSCO），最近一次检索时间为2022年3月20日。将护士和护生的疫苗接种接受率归为一类，将护士以外的医护人员归为另一类。事后绘制了护士相对于护士以外的医护人员对疫苗接受态度随时间的变化情况。按照世界卫生组织的类别（背景影响、个人/群体影响以及疫苗/接种特定问题）对与新冠疫苗接种意愿相关的因素进行了叙述性总结回顾。
共筛选出58项符合条件的研究，均为横断面研究设计，涉及来自欧洲、美洲、非洲和亚洲44个国家的95418名医护人员，其中33130名是护士，7391名是护生。研究中提到，对科学、医生、专家和政府的信任是提高疫苗接种接受度的主要背景因素，而利他主义和集体保护，或保护家中高危人员仅被提及几次。一开始，例如在疫苗推出之前，护士比医生和其他医护人员接受疫苗接种的可能性更小，且这种差异随时间减小（p = 0.022）。年龄较大（25项研究）、男性（23项研究）、教育程度较高（7项研究）以及临床实践年限较长（4项研究）与较高的疫苗接种接受度相关。少数研究提到了感知到的感染严重新冠的个人风险（14项研究）或在新冠专门病房工作（5项研究）。与较高疫苗接种意愿相关的主要疫苗相关因素是对疫苗及其有效性和安全性的信任、总体疫苗接种接受度，特别是既往接种过流感疫苗（21项研究）。与较高疫苗接受度相关的一个重要因素是高“疫苗知识”、“疫苗素养”、“理解疫苗”或“理解接种疫苗的益处和障碍”（17项研究）。
起初，护士比其他医疗职业更犹豫是否接受新冠疫苗接种，但随着时间推移这种差异消失了。研究中报告的护士这种普遍观望态度与捷克卫生信息和统计局报告的执业医护人员关于新冠疫苗接种的实际数据相符。对科学机构和疫苗制造商的信任会提高疫苗接受度。随着年龄增长、教育水平提高、临床经验增加以及男性身份，接受度也会提高。疫苗素养以及参与过既往接种项目，尤其是流感疫苗接种，被确定为提高疫苗接受度的独立可改变因素。
