Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Clinical Immunology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 38489

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Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
Interests: viral infection; coagulation; intensive care; diabetes
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Guest Editor
Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
Interests: dengue virus; emerging infections; vaccination; travel medicine; hemostasis; infectious diseases; HIV

Special Issue Information

Dear Colleagues,

We are soliciting articles for a Special Issue of MDPI Vaccines, which is entitled “Vaccination coverage, efficacy and attitude in targeted risk groups”.
Vaccination, if available, has proven to be the most effective way of preventing and reducing the burden of many infectious diseases. However, two of the current biggest challenges in the field of vaccinology are the upcoming trend of vaccine hesitancy and the decreased efficacy in risk groups. In fact, if we are able to produce effective and safe vaccines but their uptake is low, the desired effect will not be achieved. Furthermore, vaccines effective in healthy adults could have a decreased effect in the immunocompromised and elderly.
An improved understanding of drivers of vaccine uptake and efficacy will enhance targeted interventions. In addition, due to the high heterogeneity of risk groups in general, one could learn a lot about the efficacy of interventions to increase vaccination uptake and efficacy.
For this Special Issue, risk populations are defined as groups of human individuals with an increased risk of acquiring a (severe) infection because of their behaviour, health, or occupation. These include travellers, immunocompromised patients, and healthcare workers.
We invite perspectives, review articles, and original research articles from specialists in infectious disease education, risk group analysis, vaccination efficacy, vaccination coverage in risk groups, vaccination hesitancy, and clinical and/or preclinical trials.

Dr. Marco Goeijenbier
Prof. Eric C.M. van Gorp
Guest Editors

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Keywords

  • vaccination
  • vaccine hesitancy
  • education
  • vaccination coverage
  • vaccination efficacy
  • travel medicine
  • occupational medicine
  • immune compromised
  • vaccine uptake
  • vaccine attitude

Published Papers (10 papers)

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Research

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14 pages, 929 KiB  
Article
Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis
by Michael Jahn, Johannes Korth, Oliver Dorsch, Olympia Evdoxia Anastasiou, Adalbert Krawczyk, Leonie Brochhagen, Lukas van de Sand, Burkhard Sorge-Hädicke, Bartosz Tyczynski, Oliver Witzke, Ulf Dittmer, Sebastian Dolff, Benjamin Wilde and Andreas Kribben
Vaccines 2022, 10(2), 327; https://doi.org/10.3390/vaccines10020327 - 18 Feb 2022
Cited by 9 | Viewed by 2081
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 [...] Read more.
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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13 pages, 1302 KiB  
Article
Antibody Titer Kinetics and SARS-CoV-2 Infections Six Months after Administration with the BNT162b2 Vaccine
by Davide Ferrari, Nicola Clementi, Elena Criscuolo, Alessandro Ambrosi, Francesca Corea, Chiara Di Resta, Rossella Tomaiuolo, Nicasio Mancini, Massimo Locatelli, Mario Plebani and Giuseppe Banfi
Vaccines 2021, 9(11), 1357; https://doi.org/10.3390/vaccines9111357 - 19 Nov 2021
Cited by 25 | Viewed by 4013
Abstract
Background: Studies reporting the long-term humoral response after receiving the BNT162b2 COVID-19 vaccine are important to drive future vaccination strategies. Yet, available literature is scarce. Covidiagnostix is a multicenter study designed to assess the antibody response in >1000 healthcare professionals (HCPs) who received [...] Read more.
Background: Studies reporting the long-term humoral response after receiving the BNT162b2 COVID-19 vaccine are important to drive future vaccination strategies. Yet, available literature is scarce. Covidiagnostix is a multicenter study designed to assess the antibody response in >1000 healthcare professionals (HCPs) who received the BNT162b2 vaccine. Methods: Serum was tested at time-0 (T0), before the first dose, T1, T2, and T3, respectively, 21, 42, and 180 days after T0. Antibodies against the SARS-CoV-2 nucleocapsid-protein were measured to assess SARS-CoV-2 infections, whereas antibodies against the receptor-binding domain of the spike protein were measured to assess the vaccine response. Neutralization activity against the D614G, B.1.1.7, and B.1.351 variants were also analyzed. Results: Six months post-vaccination HCPs showed an antibody titer decrease of approximately 70%, yet, the titer was still one order of magnitude higher than that of seropositive individuals before vaccination. We identified 12 post-vaccination infected HCPs. None showed severe symptoms. Interestingly, most of them showed titers at T2 above the neutralization thresholds obtained from the neutralization activity experiments. Conclusion: Vaccination induces a humoral response which is well detectable even six months post-vaccination. Vaccination prevents severe COVID-19 cases, yet post-vaccination infection is possible even in the presence of a high anti-S serum antibody titer. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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7 pages, 234 KiB  
Article
Evaluation of Immunity for Mumps among Vaccinated Medical Students
by Cristiana Ferrari, Marco Trabucco Aurilio, Andrea Mazza, Antonio Pietroiusti, Andrea Magrini, Ottavia Balbi, Matteo Bolcato and Luca Coppeta
Vaccines 2021, 9(6), 599; https://doi.org/10.3390/vaccines9060599 - 4 Jun 2021
Cited by 10 | Viewed by 2443
Abstract
Healthcare workers are considered at higher risk for mumps infection than the general population. Since 2017, the national immunization plan recommended the administration of a dose of measles–mumps–rubella (MMR) vaccine to the healthcare operators who are unable to demonstrate a complete vaccination history [...] Read more.
Healthcare workers are considered at higher risk for mumps infection than the general population. Since 2017, the national immunization plan recommended the administration of a dose of measles–mumps–rubella (MMR) vaccine to the healthcare operators who are unable to demonstrate a complete vaccination history or that are seronegative for at least one of the three agents. Regarding mumps infection, based on actual concerns regarding the loss of protection over the years after vaccination, the Advisory Committee on Immunization Practices (ACIP) recommended to administer a third dose of vaccine to operators previously vaccinated with two doses of MMR vaccine who belong to a group at increased risk of mumps infection in the event of an epidemic. This guideline, however, is not currently followed in Italy, resulting in a potential risk for vaccinated operators to become unprotected from mumps over the years. The aim of our study is to evaluate the persistence of a protective antibody level for mumps among medical students vaccinated during infancy or adolescence, at the start of their hospital internship. We retrospectively evaluated mumps-specific IgG levels in a group of medical students, in the period from 1 January to 31 December 2020. We evaluated the persistence of the detectable level of mumps-specific antibodies in relation to their vaccinal status, gender and time elapsed from vaccination. We found that 17.4% (65 subjects) of our sample were seronegative for mumps. The univariate analysis showed a significant difference in serological protection between male and female gender (77.0% vs. 86.2%; p < 0.05 with chi2 test) and between age classes (86.5% vs. 76.4%; p < 0.05 for subjects aged 18–23 years and over 23 years, respectively). Female gender was significantly related to higher serological protection even after adjusting for age classes and number of vaccine doses administered in a multivariate analysis model. Our study shows a substantial percentage of subjects lacking a protective mumps titer among medical students who were vaccinated in childhood. Given the higher risk of infection among those subjects, routine pre-employment screening should be performed among those operators regardless of their vaccination history and a third dose of MMR should be offered to unprotected students. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
10 pages, 1146 KiB  
Article
Influenza Vaccination and COVID-19 Mortality in the USA: An Ecological Study
by Claudio Zanettini, Mohamed Omar, Wikum Dinalankara, Eddie Luidy Imada, Elizabeth Colantuoni, Giovanni Parmigiani and Luigi Marchionni
Vaccines 2021, 9(5), 427; https://doi.org/10.3390/vaccines9050427 - 24 Apr 2021
Cited by 71 | Viewed by 5224
Abstract
The COVID-19 mortality rate is higher in the elderly and in those with pre-existing chronic medical conditions. The elderly also suffer from increased morbidity and mortality from seasonal influenza infections; thus, an annual influenza vaccination is recommended for them. In this study, we [...] Read more.
The COVID-19 mortality rate is higher in the elderly and in those with pre-existing chronic medical conditions. The elderly also suffer from increased morbidity and mortality from seasonal influenza infections; thus, an annual influenza vaccination is recommended for them. In this study, we explore a possible county-level association between influenza vaccination coverage in people aged 65 years and older and the number of deaths from COVID-19. To this end, we used COVID-19 data up to 14 December 2020 and US population health data at the county level. We fit quasi-Poisson regression models using influenza vaccination coverage in the elderly population as the independent variable and the COVID-19 mortality rate as the outcome variable. We adjusted for an array of potential confounders using different propensity score regression methods. Results show that, on the county level, influenza vaccination coverage in the elderly population is negatively associated with mortality from COVID-19, using different methodologies for confounding adjustment. These findings point to the need for studying the relationship between influenza vaccination and COVID-19 mortality at the individual level to investigate any underlying biological mechanisms. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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9 pages, 224 KiB  
Article
Intention to Get COVID-19 Vaccinations among Ophthalmology Residents in Poland: A Cross-Sectional Survey
by Joanna Konopińska, Iwona Obuchowska, Łukasz Lisowski, Natalia Dub, Milena Kozera and Marek Rękas
Vaccines 2021, 9(4), 371; https://doi.org/10.3390/vaccines9040371 - 11 Apr 2021
Cited by 20 | Viewed by 2707
Abstract
This study aimed to evaluate the acceptability of coronavirus disease of 2019 (COVID-19) vaccination among ophthalmology residents in Poland. An online, self-administered, anonymous survey was distributed among Polish ophthalmology residents in early 2021. Of 126 residents who completed the survey, 71.4% indicated that [...] Read more.
This study aimed to evaluate the acceptability of coronavirus disease of 2019 (COVID-19) vaccination among ophthalmology residents in Poland. An online, self-administered, anonymous survey was distributed among Polish ophthalmology residents in early 2021. Of 126 residents who completed the survey, 71.4% indicated that they would get vaccinated, 17.5% were unsure, and 11.1% would refuse vaccination. Married respondents with children (p = 0.036) and respondents living with their families (p = 0.310) were more likely to accept vaccination, believing that the vaccine is effective (p = 0.002 and p = 0.001, respectively), and fearing for themselves (p = 0.031 and p = 0.023, respectively) or their families (p = 0.032 and 0.055, respectively) getting infected. Respondents who contracted COVID-19 often reported the expected relief in sanitization (p = 0.011) as their reason for vaccination, and the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (p = 0.050) as their reason for not vaccinating. Unmarried residents and residents living alone often declared that they were waiting for the effectiveness and long-term complications of the vaccine to be assessed (p = 0.005, both). Residents living with their families were significantly less likely to report COVID-19 as the reason for refusing vaccination (p = 0.022). In conclusion, most ophthalmology residents expressed a willingness to get vaccinated. Marital status and cohabitants affect vaccination acceptance. People with COVID-19 have different reasons for accepting or refusing vaccination. Medical authorities should persuade citizens more to vaccinate. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
8 pages, 939 KiB  
Communication
Humoral Response to SARS-CoV-2-Vaccination with BNT162b2 (Pfizer-BioNTech) in Patients on Hemodialysis
by Michael Jahn, Johannes Korth, Oliver Dorsch, Olympia Evdoxia Anastasiou, Burkhard Sorge-Hädicke, Bartosz Tyczynski, Anja Gäckler, Oliver Witzke, Ulf Dittmer, Sebastian Dolff, Benjamin Wilde and Andreas Kribben
Vaccines 2021, 9(4), 360; https://doi.org/10.3390/vaccines9040360 - 8 Apr 2021
Cited by 79 | Viewed by 5976
Abstract
mRNA-based SARS-CoV-2 vaccines offer a preventive strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that is of interest in the care of patients on hemodialysis (HDP). We measured humoral immune responses in 72 HDP after standard vaccination with two doses of the [...] Read more.
mRNA-based SARS-CoV-2 vaccines offer a preventive strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that is of interest in the care of patients on hemodialysis (HDP). We measured humoral immune responses in 72 HDP after standard vaccination with two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Pfizer-BioNTech). Antibody responses were evaluated with an anti-SARS-CoV-2 IgG ChemiLuminescent ImmunoAssay (CLIA) two weeks after the second dose. In addition, SARS-CoV-2 IgG was determined in a control of 16 healthy healthcare workers (HCW). The control group of HCW has shown a strong antibody response with a median (MD (Q1; Q3)) antibody titer of 800.0 AU/mL (520.5; 800.0). In comparison to HCW, HDP under 60 years of age responded equally (597.0 AU/mL (410.5; 800.0), p = 0.051). However, the antibody responses of the HDP negatively correlated with age (r2 = 0.2954 p < 0.0001), leading to significantly lower antibody titers in HDP over 60 years (280.0 AU/mL (45.7; 477.0), p < 0.0001). To thoroughly understand the immunogenicity of the new mRNA-based vaccines in HDP, longitudinal data on the effectiveness and durability of antibody responses are needed. Modifications of immunization schedules should be considered in HDP with low or without antibody responsiveness after standard vaccination to boost immune reactivity and prolong protective effects in these vulnerable patients. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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8 pages, 656 KiB  
Article
Evaluation of the Hepatitis B Vaccination Programme in Medical Students in a Dutch University Hospital
by Leanne P. M. van Leeuwen, Laura Doornekamp, Simone Goeijenbier, Wesley de Jong, Herbert J. de Jager, Eric C. M. van Gorp and Marco Goeijenbier
Vaccines 2021, 9(2), 69; https://doi.org/10.3390/vaccines9020069 - 20 Jan 2021
Cited by 3 | Viewed by 2827
Abstract
Healthcare workers (HCW) are at increased risk of contracting hepatitis B virus (HBV) and are, therefore, vaccinated pre-exposure. In this study, the HBV vaccination programme for medical students in a university hospital in the Netherlands was evaluated. In the first part, the effectiveness [...] Read more.
Healthcare workers (HCW) are at increased risk of contracting hepatitis B virus (HBV) and are, therefore, vaccinated pre-exposure. In this study, the HBV vaccination programme for medical students in a university hospital in the Netherlands was evaluated. In the first part, the effectiveness of the programme, which consisted of a vaccination with Engerix-B® at 0, 1, and 6 months, was retrospectively evaluated over 7 years (2012–2019). In the second part of this study, we followed students (the 2019 cohort) who had previously been vaccinated against HBV vaccination (4–262 months prior to primary presentation) in order to investigate the most efficient strategy to obtain an adequate anti hepatitis B surface antigen titre. In the latter, titre determination was performed directly during primary presentation instead of giving previously vaccinated students a booster vaccination first. The vaccination programme, as evaluated in the retrospective first part of the study, was effective (surpassed the protection limit of 10 IU/L) in 98.8 percent of the students (95% CI (98.4–99.2)). In the second part of our study, we found that 80 percent (95% CI (70–87)) of the students who had previously been vaccinated against HBV were still sufficiently protected and did not require a booster vaccination. With this strategy, the previously vaccinated students needed an average of 1.4 appointments instead of the 2 appointments needed with the former strategy. This knowledge is important and can save time and resources in the process of occupational HBV vaccination of HCW. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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16 pages, 1162 KiB  
Article
High Immunogenicity to Influenza Vaccination in Crohn’s Disease Patients Treated with Ustekinumab
by Laura Doornekamp, Rogier L. Goetgebuer, Katharina S. Schmitz, Marco Goeijenbier, C. Janneke van der Woude, Ron Fouchier, Eric C.M. van Gorp and Annemarie C. de Vries
Vaccines 2020, 8(3), 455; https://doi.org/10.3390/vaccines8030455 - 14 Aug 2020
Cited by 37 | Viewed by 4043
Abstract
Influenza vaccination can be less effective in patients treated with immunosuppressive therapy. However, little is known about the effects of ustekinumab; an anti-IL-12/23 agent used to treat Crohn’s disease (CD), on vaccination response. In this prospective study, we assessed immune responses to seasonal [...] Read more.
Influenza vaccination can be less effective in patients treated with immunosuppressive therapy. However, little is known about the effects of ustekinumab; an anti-IL-12/23 agent used to treat Crohn’s disease (CD), on vaccination response. In this prospective study, we assessed immune responses to seasonal influenza vaccination in CD patients treated with ustekinumab compared to CD patients treated with anti-TNFα therapy (adalimumab) and healthy controls. Humoral responses were assessed with hemagglutinin inhibition (HI) assays. Influenza-specific total CD3+, CD3+CD4+, and CD3+CD8+ T-cell responses were measured with flow cytometry. Fifteen patients treated with ustekinumab; 12 with adalimumab and 20 healthy controls were vaccinated for seasonal influenza in September 2018. Seroprotection rates against all vaccine strains in the ustekinumab group were high and comparable to healthy controls. Seroconversion rates were comparable, and for A/H3N2 highest in the ustekinumab group. HI titers were significantly higher in the ustekinumab group and healthy controls than in the adalimumab group for the B/Victoria strain. Post-vaccination T-cell responses in the ustekinumab group were similar to healthy controls. One-month post-vaccination proliferation of CD3+CD8+ T-cells was highest in the ustekinumab group. In conclusion, ustekinumab does not impair immune responses to inactivated influenza vaccination. Therefore, CD patients treated with ustekinumab can be effectively vaccinated for seasonal influenza. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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Review

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34 pages, 2217 KiB  
Review
Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review
by Laura Doornekamp, Leanne van Leeuwen, Eric van Gorp, Helene Voeten and Marco Goeijenbier
Vaccines 2020, 8(3), 480; https://doi.org/10.3390/vaccines8030480 - 27 Aug 2020
Cited by 45 | Viewed by 5691
Abstract
Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination [...] Read more.
Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants—based on the integrated change model—predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician’s recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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Other

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8 pages, 233 KiB  
Perspective
How to Face the Advent of SARS-CoV-2 Vaccination in IBD Patients: Another Task for Gastroenterologists
by Alfredo Papa, Franco Scaldaferri, Lorenzo Maria Vetrone, Matteo Neri, Antonio Gasbarrini and Loris Riccardo Lopetuso
Vaccines 2021, 9(3), 248; https://doi.org/10.3390/vaccines9030248 - 12 Mar 2021
Cited by 1 | Viewed by 2024
Abstract
The severity of the COVID-19 pandemic has led to an unprecedented effort to develop vaccines against SARS-CoV-2 infection since this seems to be the most effective strategy to counter the pandemic. In the past weeks, the administration of vaccines has started in different [...] Read more.
The severity of the COVID-19 pandemic has led to an unprecedented effort to develop vaccines against SARS-CoV-2 infection since this seems to be the most effective strategy to counter the pandemic. In the past weeks, the administration of vaccines has started in different parts of the world sustaining the hype of significantly containing the impact of SARS-CoV-2 infection. However, the rapid time lapse from vaccine development to distribution has raised several concerns on its safety and efficacy. This topic is particularly felt by patients with chronic conditions and immumodulating therapies that could compromise their immune system such as inflammatory bowel disease (IBD). Here, we explore the potential future implications of the SARS-CoV-2 vaccines introduction in the IBD field, touching upon the clinical experience coming from available data on vaccinations against other infections. We also dissect the factors associated with the acceptability of SARS-CoV-2 vaccination, describing the possible strategies that gastroenterologist should adopt to reach the highest rate of vaccinations in IBD patients. Full article
(This article belongs to the Special Issue Vaccination Coverage, Efficacy and Attitude in Targeted Risk Groups)
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