ABSTRACT
Many countries have initiated a booster dose for COVID-19 vaccination. However, little is known about the association between adverse events to vaccination and individual psychological status and willingness to receive the booster dose. From December 1, 2021 to February 1, 2022, 474 participants answered a questionnaire in a university town in China, and information about previous adverse events, anxiety status, and vaccination intention were collected. Chi-square test and logistic regression models were used to analyze the factors associated with willingness to receive booster dose of vaccine. Previous adverse events, such as pain at the injection site, fatigue, muscle pain and headache were associated with anxiety of the participants. About 76.2% of the participants were willing to receive booster dose of vaccine. However, adverse event was not associated with their willingness to receive the booster dose. Participants with age ≤25 were less willing to receive the booster dose, although the association was not statistically significant in the multivariable model. In conclusion, the adverse events of COVID-19 vaccination were associated with psychology status of the vaccinated people. It is still necessary to strengthen the public education on COVID-19 vaccination to improve the vaccination willingness of people, especially among the young people.
Introduction
Corona Virus Disease 2019 (hereinafter referred to as COVID-19) is in the state of global pandemic from 2020, and vaccination for COVID-19 has become one of the most effective public health interventions to deal with the pandemic. With the popularization of COVID-19 vaccine, the booster dose of COVID-19 vaccine has been provided to improve the immune status of the population. The existing clinical research results of COVID-19 vaccines showed that the incidence of unexpected adverse events of the vaccine is low.Citation1 However, some of the adverse events caused by vaccination are psychogenic,Citation2 and these adverse events might still contribute to the willingness to receive the booster dose of vaccine.
To understand the association between adverse events of COVID-19 vaccination and personal psychological status and willingness to receive the booster dose, this study conducted a questionnaire survey among individuals in a university town in China. We further aimed to provide evidence to solve the vaccine hesitation problem in the COVID-19 pandemic era.
Materials and methods
Study population
Four communities were selected from the university town of Fuzhou City in southeast China, with one community inside the college campus. Altogether, 501 questionnaires were distributed, of which, 474 were received with valid data.
The questionnaire collected information including basic characteristics such as sex, age, student status, and education level. Adverse events for vaccination included pain at the injection site, fatigue, fever, muscle pain, cough, headache, allergy, diarrhea, nausea and vomiting. We further used the Generalized Anxiety Disorder scale (GAD-7) to measure the anxiety status.Citation3
Statistical analyses
Demographic characteristics of the participants were described by frequency and percentage. The chi square trend test and ordinal logistic regression models were used to analyze the association between adverse events after vaccination and anxiety. Chi square test and logistic regression models were further used to analyze the potential factors associated with the willingness to receive booster dose of COVID-19 vaccine. Excel 2019 software was used to sort out the questionnaire data, and SPSS 25.0 software was used for statistical analysis. p < .05 was considered as statistically significant.
Results
Among the 474 participants, 39.9% were males and 60.1% were females. The age group 16–25 covered 59.3% of the participants, and students accounted for 56.5%. Around 67.7% of the participants had received college level education ().
Table 1. Sociodemographic characteristics of the participants.
Adverse event and the association with anxiety
By assigning scores, the anxiety level of 474 participants were divided into 0, 1–4, 5 and above. Adverse event during the first dose and second dose of vaccine were significantly associated with increased anxiety level of the respondents (p < .05), while gender, whether or not was a student, and education were not (). In the multivariable adjusted model, adverse events during the first and second dose were associated with anxiety (OR for the first dose = 2.48, 95%CI = 1.39–4.43; OR for the second dose = 1.77, 95%CI = 0.98–3.17). When further investigating the adverse events after the first and second dose, the association of pain at the injection site and fatigue with the anxiety level were statistically significant (p < .001). At the second dose, headache and muscle pain were additionally associated with higher anxiety level. ().
Table 2. Factors associated with anxiety level of the participants.
Table 3. Specific adverse events and the association with anxiety level.
Factors associated with participants’ willingness to receive booster dose of vaccine
Of the 474 participants, 361 (76.2%) were willing to receive the booster dose. Participants with age>25 were more willing to receive the booster dose of vaccination (p = .048). However, the association was not statistically significant in the model mutually adjusted for other factors. Sex, student status, education and the adverse event did not contribute to the willingness ().
Table 4. Factors influencing willingness to receive booster dose of vaccine.
Discussion
This study showed that the association between adverse events from both the first and second dose of vaccination and anxiety was statistically significant. To prevent the anxiety related to adverse events, a well understanding of the normal and expected adverse events during vaccination might help the vaccinated people to get prepared for these events. In addition to increasing awareness of vaccination related adverse events, over-the-counter medicine could be used to release the symptoms of adverse events such as pain and fever. However, efforts to take care of the adverse events should follow the instructions from the pharmacists or primary health care providers.
Younger age was inversely associated with willingness to receive the booster dose in our study, which is consistent with previous results in other regions.Citation4 A survey of young people and medical students also found that young people and medical students lacked a preventive attitude when facing the COVID-19 epidemic.Citation5,Citation6 In addition, young people aged 16–25 often lack a strong demand for vaccines, and most take a wait-and-see attitude. This phenomenon may be exacerbated with the effective control of the COVID-19 epidemic in China. Considering our small sample size, further researches are needed to confirm this finding.
In our study, only 76.2% of the participants were willing to receive the booster dose of COVID-19 vaccine, which was relatively lower than other studies.Citation7,Citation8 This might be explained by the relatively young population that we included in our study, and younger age was associated with lower willingness to receive the booster dose.
Surprisingly, we found that adverse events in previous COVID-19 vaccination was not associated with the willingness to receive the booster dose, which is different from other studies,Citation9,Citation10 probably because of the identified adverse events such as pain at the injection site and fatigue were not that severe.
This study still has some limitations. The survey results were limited to a certain period during the COVID-19 pandemic, and people’s willingness and attitude to vaccination may change due to the severity of the pandemic and change of national policies. In addition, due to the pandemic situation and resource constraints, the survey was only conducted in Fuzhou, which might not represent the population in other regions, affecting the generalizability of the study.
Conclusions
In conclusion, the adverse events of COVID-19 vaccination were associated with anxiety, while age might be related to the willingness to receive the booster dose of vaccine. Increasing awareness of vaccination related adverse events and adherence to the recommendations from health care providers might help to prevent the anxiety related to these adverse events. Young adults, especially college students, should be the target group for intervention to increase coverage of booster dose of COVID-19 vaccination.
Authors’ contributions
HL and HY were responsible for the study concept and design. LL and WQ did the data and project management. WQ did the data cleaning and analysis. LC, LS and HY interpreted the data. LC and HL drafted the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Consent to publish
The authors confirm that this publication has been approved by all coauthors.
Ethics approval
This study used anonymous questionnaires and ethics approval is therefore not needed.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
References
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