key: cord-0916938-z2ybdhmd authors: Andrian, Titus; Koppe, Laetitia; Novel, Etienne; Massat, Maeva; Barba, Christophe; Ioriatti, Donatella; Barnel, Cecile; Villar, Emmanuel; Luce, Mathilde; Guerraoui, Abdallah; Mezaache, Sarah; Kalbacher, Emilie; Tournebize, Corentin; Fouque, Denis; Chalencon, Elodie title: COVID-19 VACCINE ACCEPTANCE AMONGST HEMODIALYSIS PATIENTS: a French survey date: 2021-04-28 journal: Clin Kidney J DOI: 10.1093/ckj/sfab084 sha: 250cba7afb42cc92b5e5642277e812939f13a406 doc_id: 916938 cord_uid: z2ybdhmd nan Compelling evidence has shown that chronic kidney disease (CKD) is not only the most prevalent comorbidity associated with severe COVID-19 but also a condition that conveys the highest risk of death amongst infected patients. 1 Urgent calls have been made by leading working groups in order to grant these patients with priority access to vaccination. 2, 3 French health authorities implemented a priority vaccine program for hemodialysis patients 4 , leaving only one major barrier for successful mass vaccination: vaccine hesitancy. Here we report COVID-19 vaccine acceptance from six maintenance hemodialysis centers located in Lyon, France. Our study consisted of a paper survey distributed to all patients during their hemodialysis session. Participants were asked whether they will be in favor of COVID-19 vaccine (including whether they were already vaccinated or willing to be) or against it. In case of refusal, further questions aimed to assess possible reasons. Further information was collected using scale type answers for patients to self-estimate their health status and risk of being infected. Vaccine hesitancy was evaluated according to the WHO definition 5,6 , defined by a positive answer to at least one of the following questions : 1/Have you ever refused a vaccine for yourself or a child because you considered it as useless or dangerous?; 2/Have you ever postponed a vaccine recommended by a physician because of doubts about it? and 3/Have you ever had a vaccine for a child or yourself despite doubts about its efficacy?. Patients were asked if they received influenza vaccination in the early winter 2020. One hundred fifty nine patients filled out the form, mostly men (66%) aged above 65 years. About 20% of the responders declared that they already had a positive test for the COVID-19 infection and half met the criteria for vaccine hesitancy. 79.9% of patients were in favor of COVID-19 vaccine: 30.2% were already vaccinated and 49.7% were willing to be as soon as possible. Vaccine refusal was expressed by 20.1% of patients and was supported by fears concerning quality (84%), side effects (84%) and inefficacy (90%) of the vaccine. Unexpectedly, having a personal or familial history of COVID-19 infection, a self-perception of poorer health or high risk to develop severe COVID-19 infection was not associated with vaccine acceptation. Amongst tested parameters, vaccine acceptance was significantly higher in older patients and was associated with flu vaccination the same year (p<0,001). (Table 1) This study shows for the first time in Europe an important adherence to COVID-19 vaccine among dialysis patients despite a manifested hesitancy towards vaccination. Many of the patients who underwent the survey reported their dialysis medical team as the most reliable source of information concerning COVID 19 vaccination. Medical guidance should be offered to support their decision on reliable grounds. In a study published in January 2021, in a single US hemodialysis center, only 49% of patients declared being in favor of COVID-19 vaccination. We hypothesized that the higher vaccine acceptance in Europe might be due to a better awareness of the population to the severe consequences of the pandemic in absence of an effective vaccination schedule. As in the present work, acceptance of COVID 19 vaccination was associated with prior influenza vaccination 7 . A difference between the percentage of patients in favor of vaccination and the percentage of patients actually vaccinated will be expected because of a reporting bias inherent to this type of study. Moreover, potential temporary medical contraindications might delay vaccine administration in some patients. One of the biggest stakes of limiting the spread of SARS-CoV-2 is achieving herd immunity. At least 50% of the population needs to become immune in order to diminish viral circulation 8 . Our data prove that "micro-environments" of acquired herd immunity are achievable in high-risk population of hemodialysis patients. Hemodialysis units that will reach the threshold of 80% vaccinated patients might in the future be considered as COVID-19 free units. In conclusion, an important percentage of our hemodialysis patients accept COVID-19 vaccination despite a high prevalence of vaccine hesitancy. The medical team should play a key role to properly guide and inform dialysis patients in this process. Comparisons between the two groups (vaccine acceptance and refusal) were assessed with a chi-squared test, p<0.05 was considered as significant. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA The urgent need to vaccinate dialysis patients against severe acute respiratory syndrome coronavirus 2: a call to action At least 156 reasons to prioritize COVID-19 vaccination in patients receiving in-centre haemodialysis de la Haute Autorité de santé portant adoption de recommandations complétant la recommandation vaccinale « Stratégie de vaccination contre le SARS-Cov-2 -Recommandations préliminaires sur la stratégie de priorisation des populations à vacciner Vaccine hesitancy: Definition, scope and determinants Measuring vaccine hesitancy: The development of a survey tool COVID-19 vaccine hesitancy among African American hemodialysis patients: A single-center experience COVID-19 herd immunity: where are we? The authors have no conflict of interest to declare.