Introduction Vaccine hesitancy is a chronic public health threat. This study was carried out to ascertain Maltese healthcare workers' hesitancy to a novel COVID-19 vaccine and correlate this with influenza vaccine uptake. Methods A short, anonymous questionnaire was sent out to all of Malta's government sector healthcare workers via the service's standard email services (11–19/09/2020). A total of 9681 questionnaires were posted electronically, with 10.4% response. Results The proportion of Maltese healthcare workers who will take the influenza vaccine increased significantly. Doctors had the highest baseline uptake and highest likely influenza vaccine uptake next winter. The likely/undecided/unlikely to take a COVID-19 vaccine were 52/22/26% respectively. Males were likelier to take the vaccine. Doctors were the occupation with the highest projected vaccine uptake. Likelihood of taking COVID-19 vaccine was directly related to the likelihood of influenza vaccination. Concerns raised were related to insufficient knowledge about such a novel vaccine, especially unknown long term side effects. Discussion The increased uptake of influenza vaccine is probably due to increased awareness of respiratory viral illness. Doctors may have higher vaccine uptakes due to greater awareness and knowledge of vaccine safety. The proportions of who are likely/undecided/unlikely (half, quarter, quarter respectively) to take a COVID-19 are similar to rates reported in other countries. The higher male inclination to take the vaccine may be due the innate male propensity for perceived risk taking. Shared COVID-19 with influenza vaccine hesitancy implies an innate degree of vaccine reluctance/hesitancy and not merely reluctance based on novel vaccine knowledge gap.

Background The long‐term control of COVID‐19 depends on an effective global vaccination strategy. Protecting healthcare workers (HCWs) from serious infection is critical. Malta, a European country, initiated the vaccination roll‐out using Pfizer‐BioNTech COVID‐19 vaccine targeting HCWs. This study determined vaccination adverse effects (AEs) in this cohort. Method An online survey was disseminated to all HCWs via work email (29/3/21 to 9/4/21) to gather AEs regarding pain, redness and swelling at injection site, fever, chills, fatigue, muscle/joint pains, headache, vomiting and diarrhoea severity following each dose (Likert scale). Descriptive, comparative and multiple binary regression analyses were performed. Results A response of 30.30% (n = 1480) was achieved with the commonest AEs being pain at injection site (88.92% CI 95%: 87.21‐90.42), mostly mild (51%) and moderate (43%). Fatigue was reported by 72.97% (CI 95%: 70.65‐75.17), 42% were mild and 41% were moderate. Females reported significantly ( P ≤ .05, respectively) more pain (OR: 1.90), redness (OR: 2.49), swelling at injection site (OR: 1.33), fever (OR: 1.74), chills (OR: 2.32), fatigue (OR: 2.43), muscle (OR: 1.54) and joint pains (OR: 2.01), headache (OR: 2.07) and vomiting (OR: 3.43) when adjusted for age and HCW role. Localised AEs were reported following both vaccine doses unlike systemic AEs that were mostly reported after second doses. Conclusion Vaccination benefits outweigh the minor AEs experienced, with females exhibiting a higher susceptibility. The general low vaccination AEs observed within the HCW cohort is encouraging and should help in allaying vaccine hesitancy among the population.

Background COVID-19 vaccines reduce morbidity and mortality, but mass vaccination faces multiple challenges leading to different vaccination rates in different countries. Malta, a small European country, has achieved a very rapid vaccination rollout. This paper presents a narrative review of Malta's vaccination strategy and its impact on the country's COVID-19 situation. Methods Data was obtained through a literature review of Maltese newspapers and from Malta's COVID-19 government dashboard. A comprehensive summary of vaccination operations was provided by Malta's COVID-19 vaccination team. Results Malta comprised part of the European Commission joint procurement and obtained the maximum vaccines that were eligible from all manufacturers. Four tier priority population groups were set up, with both vaccine doses (where applicable) allocated and stored for each individual. Multiple hubs were set up to simultaneously administer first and eventually second doses accordingly. To date (August 9, 2021) 398,128 of the population are fully vaccinated and 405,073 received the first dose, with both morbidity and mortality declining progressively as vaccination coverage progressed. Conclusion Malta has successfully implemented a COVID-19 strategy that rapidly covered a substantial proportion of the population over a short period of time, with herd immunity reached by end of May 2021. Low population vaccination hesitancy and high vaccine doses availability were two major factors in this success.

We have reviewed all acute neurosurgical admissions between December 2007 and December 2009. Hundred and nine (46.6%) of our admissions were head injuries. A subdural haematoma(SDH) was found in 51.4%(56) of the head injuries. Of these, 50/56 presented with a Glasgow Coma Scale(GCS) of 14 to 15, 41.1% (23) of these SDH needed surgery. The commonest mode of injury was falls [67.9%(74) of head injuries]. Risk factors for falls are co-morbidities which are particular to an elderly population, these include osteoarthritis and audio/ visual impairment. Falls are more common in rural areas where elderly are more likely to feel comfortable to walk and sustain trivial falls resulting in chronic subdural heamatomas.

Background COVID-19 has severely impacted global healthcare services. Malta has only one acute state hospital, Mater Dei Hospital (MDH), and at the time of writing is the most vaccinated country in Europe. Malta thus provides an ideal setting to assess the impact of COVID-19 on healthcare services at population level, including the impact of vaccination on hospital admissions. Methods Hospital data was obtained as anonymised totals from MDH’s Clinical Performance Unit and the European Centre for Disease Prevention and Control. COVID-19-related data was obtained from the Ministry of Health dashboard. Comparative assessments were performed to explore associations between the COVID-19 situation, vaccination, and hospital activity. Poisson regression was used to model the counts of monthly accident and emergency (A&E), outpatient clinics attendances and hospital admissions. Results A&E, hospital admissions, and outpatient clinics attendances declined (31.88%; 23.89%; 29.57%; p < 0.01 respectively) with onset of COVID-19 till April 2021 when compared to pre-COVID years (2017–2019). Admissions due to COVID-19 initially increased in parallel to the population’s COVID positivity. Vaccination rollout led to a decline in COVID-19 admissions. Conclusions The drastic drop in admissions and outpatient attendees was expected but not for A&E attendees as acutely ill patients should still have attended. This is of public health concern since delayed or deferred medical management increases population morbidity, mortality and increases the eventual burden on the healthcare system. Mass vaccination saw the return to normality with an increase in A&E burden.