Knowledge, Perception, Attitudes and Behavior on Influenza Immunization and the Determinants of Vaccination

BACKGROUND: We sought to determine the knowledge of, perception, attitudes, and behaviors toward influenza virus and immunization, and the determinants of vaccination among students, patients, and Healthcare Workers (HCWs) at the American University of Beirut and its affiliated Medical Center. METHODS: We conducted a cross-sectional study between October 2016 and January 2017 utilizing a self-administered questionnaire that was provided to 247 randomly selected adult participants. Data collected included socio-demographic characteristics, prior vaccination against influenza, knowledge, perception, attitudes, and behaviors toward influenza and influenza immunization. A multivariable regression model was used to evaluate for independent associations between the different variables and regular or yearly vaccination as a primary outcome. RESULTS: The overall survey response rate was 77%. A substantial proportion of respondents (47.4%) had never received the influenza vaccine. Only 10.2% of students, 19.1% of patients, and 35.6% of HCWs reported regular or yearly influenza vaccine uptake. HCWs had the lowest knowledge score about influenza and its vaccine despite high self-reported levels of knowledge. Barriers to vaccinations included lack of information (31%), fear of adverse effects (29%), and a perception of not being at risk (23%). Several factors were independently associated with regular or yearly vaccination uptake including having children (adjusted OR = 3.8; 95% CI 1.2-12.5), a "very good" self-reported level of knowledge (OR = 16.3; 95% CI 1.4-194.2) and being afraid of the consequences of influenza (OR = 0.2; 95% CI 0.1-0.6). CONCLUSION: Adherence rates with regular or yearly vaccination against influenza remain low across all study groups. We were able to identify predictors as well as barriers to vaccination. Future awareness and vaccination campaigns should specifically aim at correcting misconceptions about vaccination, particularly among HCWs, along with addressing the barriers to vaccination. Predictors of vaccination should be integrated in the design of future campaigns

Emergence of Mycobacterium simiae: A retrospective study from a tertiary care center in Lebanon.

The objective of this study is to describe the clinical significance of Mycobacterium simiae at a major tertiary care center in Lebanon.This is a retrospective study of patients with positive cultures for M. simiae isolated between 2004 and 2016 at the American University of Beirut Medical Center.This study included 103 M. simiae isolates recovered from 51 patients. Their mean age was 62.7 years. The majority were males and smokers. Specimens were mostly from respiratory sources (97%). Common comorbidities included chronic lung disease (such as chronic obstructive pulmonary disease), solid tumor, systemic disease, and diabetes mellitus. Productive cough and dyspnea were the most common symptoms. Frequent radiographic findings were infiltrates and nodules on chest X-ray and nodules, infiltrates, and bronchiectasis on chest computed tomography scan. Among 18 tested isolates, 5.8% were resistant to clarithromycin, 11.7% to amikacin, and 70-100% to other antimicrobials. Out of 13 patients receiving early treatment, 5 noted improvement, one had recurrence of symptoms, two received alternative diagnosis, and five died. Two of those deaths were related to M. simiae. Common treatment regimens included clarithromycin in different combinations with trimethoprim-sulfamethoxazole, moxifloxacin, and amikacin. Moreover, clofazimine was used in only two patients whose isolates were resistant to all but one agent. Duration of treatment ranged from 6-24 months.In Lebanon, M. simiae is increasingly encountered with true infection rates of at least 47%. Furthermore, the prevalence of multidrug resistance among the Lebanese M. simiae isolates is very high limiting the treatment options

CT chest showing patchy ground glass opacities with right apical consolidation.

<p>CT chest showing patchy ground glass opacities with right apical consolidation.</p

Demographics and clinical manifestations of patients with positive cultures for <i>M</i>. <i>simiae</i>.

<p>Demographics and clinical manifestations of patients with positive cultures for <i>M</i>. <i>simiae</i>.</p

CT chest showing tree-in-bud infiltrates and diffuse nodularity.

<p>CT chest showing tree-in-bud infiltrates and diffuse nodularity.</p

Radiographic findings in patients with positive cultures for <i>M</i>. <i>simiae</i>.

<p>Radiographic findings in patients with positive cultures for <i>M</i>. <i>simiae</i>.</p

<i>In vitro</i> resistance of the 17 <i>M</i>. <i>simiae</i> isolates to the tested antibiotics (MIC mcg/ml).

<p><i>In vitro</i> resistance of the 17 <i>M</i>. <i>simiae</i> isolates to the tested antibiotics (MIC mcg/ml).</p

CT chest showing cavitary nodules.

<p>CT chest showing cavitary nodules.</p

Outcome of patients with positive cultures for <i>M</i>. <i>simiae</i> isolates.

<p>Outcome of patients with positive cultures for <i>M</i>. <i>simiae</i> isolates.</p