Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01–1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79–6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21–2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137–3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19–0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population’s acceptance of booster vaccination.
Dengue has become endemic in Pakistan with annual recurrence. A sudden increase in the dengue cases was reported from Rawalpindi in 2016, while an outbreak occurred for the first time in Peshawar in 2017. Therefore, a multi-center study was carried out to determine the circulating dengue virus (DENV) serotypes and Chikungunya virus (CHIKV) co-infection in Lahore, Rawalpindi, and Peshawar cities in 2016–18. A hospital-based cross-sectional study was carried out in Lahore and Rawalpindi in 2016–18, while a community-based study was carried out in Peshawar in 2017. The study participants were tested for dengue NS1 antigen using an immunochromatographic device while anti-dengue IgM/IgG antibodies were detected by indirect ELISA. All NS1 positive samples were used for DENV serotyping using multiplex real-time PCR assay. Additionally, dengue samples were tested for CHIKV co-infection using IgM/IgG ELISA. A total of 6291 samples were collected among which 8.11% were NS1 positive while 2.5% were PCR positive. DENV-2 was the most common serotype (75.5%) detected, followed by DENV-1 in 16.1%, DENV-3 in 3.9% and DENV-4 in 0.7% while DENV-1 and DENV-4 concurrent infections were detected in 3.9% samples. DENV-1 was the predominant serotype (62.5%) detected from Lahore and Rawalpindi, while DENV-2 was the only serotype detected from Peshawar. Comorbidities resulted in a significant increase (p-value<0.001) in the duration of hospital stay of the patients. Type 2 diabetes mellitus substantially (p-value = 0.004) contributed to the severity of the disease. Among a total of 590 dengue positive samples, 11.8% were also positive for CHIKV co-infection. Co-circulation of multiple DENV serotypes and CHIKV infection in Pakistan is a worrisome situation demanding the urgent attention of the public health experts to strengthen vector surveillance.
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Background: Mycobacterium tuberculosis sometimes become resistant to the drugs that are used to treat it. Drug resistant TB (DR-TB) is spread in the same way as drug susceptible TB. DR-TB is a public health crisis. This study aims to find the pattern of drug resistance and correlations between drug resistance and comorbid/non-comorbid conditions in patients with a relapse of TB. Methodology: A cross-sectional study was conducted among 200 HIV-negative relapsed TB patients from 2016-2017 in Mayo Hospital Lahore. The patients’ sputum samples were tested by Ziehl-Neelsen staining to observe acid-fast bacilli. The demographics and medical history of patients was recorded, who were positive for AFB in their sputum samples. Molecular procedure of Gene-Xpert assay was conducted to detect the presence of MTB and rifampicin resistance in the samples. Whereas, the drug susceptibility test (DST) was conducted on the LJ culture medium containing drugs.Results: Out of 200 relapsed TB cases; 97 were comorbid, 99 were non-comorbid. The most prevalent comorbidities were hypertension (42 cases- 43.3%), diabetes (45 cases-46.4%) and hepatitis B (14 cases-14.4%). Among 97 comorbid patients; 37 worked as laborers, 43 earned less than 20,000 PKR and 23 were found to have a history of imprisonment. Whereas in non-comorbid patients; 20 worked as laborers, 28 earned less than 20,000 PKR and 12 had been in prison before. The Gene-Xpert test detected rifampicin resistance (RR) in 20 comorbid (20.6%) and 33 non-comorbid (33.3%) patients. Whereas, the drug susceptibility test (DST) showed that 22 comorbid (22.7%) and 33 non-comorbid (33.3%) patients were RR. A contrast was seen in the results of Gene-Xpert and DST; Gene-Xpert detected 3 cases of RR-negative whereas the same 3 cases were found to be RR-positive on DST. Only 1 case was RR-positive on Gene-Xpert but RR-negative on DST. 17 comorbid patients (17.5%) were diagnosed with MDR-TB and 5 (5.2%) with XDR-TB. Whereas, in non-comorbid patients, there were 26 cases of MDR-TB (26.3%) and 5 cases of XDR-TB (5.1%). There were 2 patients (2.1%) resistant to all drugs.Conclusion: There was a deviation in the results of molecular Gene-Xpert assay compared to the conventional culture methods. Drug resistance was relatively higher in non-comorbid patients than comorbid patients, however, the difference between the two is not very significant.
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