{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:58:50Z","timestamp":1788307130435,"version":"build-2803163510"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Hesitancy and incomplete vaccination against coronavirus disease 2019 (COVID-19) remains an obstacle to achieving herd immunity. Because of fear of vaccine reactions, patients with medical and allergic co-morbidities express heightened hesitancy. Limited information is available to guide these patients. We sought to identify factors associated with mRNA-based COVID-19 vaccines hesitancy and reactogenicity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We surveyed employees of a multi-site health system in central Pennsylvania who were offered the COVID-19 vaccine (N = 18,740) inquiring about their experience with the Moderna and Pfizer-BioNTech mRNA-based vaccines. The survey was administered online using the REDCap platform. We used multivariable regression analysis to determine whether a particular factor(s) (e.g., demographics, selected co-morbid allergic and medical conditions, vaccine brand, and prior COVID-19) were associated with vaccine reactogenicity including the occurrence and severity of local and systemic reactions. We also explored factors and reasons associated with vaccine hesitancy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 5709 who completed the survey (response rate, 30.4%), 369 (6.5%) did not receive the vaccine. Black race and allergy to other vaccines were associated with vaccine hesitancy. Reaction intensity following the first vaccine dose and allergic co-morbidities were associated with incomplete vaccination. Older individuals (&gt;60 years) experienced less reactogenicity. Females had higher odds of local and systemic reactions and reported more severe reactions. Asians reported more severe reactions. As compared to Pfizer-BioNTech, the Moderna vaccine was associated with higher odds of vaccine reactions of higher severity. Prior COVID-19 resulted in more severe reactions following the first dose, but less severe reactions following the second dose.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Targeted campaigns to enhance vaccination acceptance should focus on Black individuals, females, and those with allergic co-morbidities. Prior COVID-19 caused more severe reactions after the first but not the second vaccine dose. Moderna vaccine caused more vaccine reactions. Lessons learned from the early rollout of COVID-19 vaccine may serve to inform future novel vaccine experiences.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0272691","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T17:38:35Z","timestamp":1659721115000},"page":"e0272691","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Hesitancy and reactogenicity to mRNA-based COVID-19 vaccines\u2013Early experience with vaccine rollout in a multi-site healthcare system"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1250-7779","authenticated-orcid":true,"given":"Sarah","family":"Al-Obaydi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Hennrikus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazar","family":"Mohammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B.","family":"Lehman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3978-1302","authenticated-orcid":true,"given":"Abhishek","family":"Thakur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Al-Shaikhly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"issue":"9","key":"pone.0272691.ref001","doi-asserted-by":"crossref","first-page":"e2016632118","DOI":"10.1073\/pnas.2016632118","article-title":"Lifestyle and mental health disruptions during COVID-19","volume":"118","author":"O Giuntella","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"3","key":"pone.0272691.ref002","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1001\/jama.2020.11132","article-title":"COVID-19 Pandemic, Unemployment, and Civil Unrest: Underlying Deep Racial and Socioeconomic Divides","volume":"324","author":"S Galea","year":"2020","journal-title":"Jama"},{"issue":"10","key":"pone.0272691.ref003","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41577-020-00451-5","article-title":"COVID-19 herd immunity: where are we?","volume":"20","author":"A Fontanet","year":"2020","journal-title":"Nat Rev Immunol"},{"issue":"27","key":"pone.0272691.ref004","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine","volume":"383","author":"FP Polack","year":"2020","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0272691.ref005","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"LR Baden","year":"2021","journal-title":"N Engl J Med"},{"issue":"10287","key":"pone.0272691.ref006","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/S0140-6736(21)00947-8","article-title":"Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data","volume":"397","author":"EJ Haas","year":"2021","journal-title":"Lancet"},{"issue":"1","key":"pone.0272691.ref007","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/JAC.0000000000000360","article-title":"COVID-19 and Vaccine Hesitancy: A Challenge the United States Must Overcome","volume":"44","author":"A Coustasse","year":"2021","journal-title":"J Ambul Care Manage"},{"key":"pone.0272691.ref008","doi-asserted-by":"crossref","first-page":"n1138","DOI":"10.1136\/bmj.n1138","article-title":"Covid-19 vaccination hesitancy","volume":"373","author":"MS Razai","year":"2021","journal-title":"BMJ"},{"issue":"12","key":"pone.0272691.ref009","doi-asserted-by":"crossref","first-page":"964","DOI":"10.7326\/M20-3569","article-title":"Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults","volume":"173","author":"KA Fisher","year":"2020","journal-title":"Ann Intern Med"},{"key":"pone.0272691.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/ice.2021.410","article-title":"Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia","author":"SK Browne","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"key":"pone.0272691.ref011","unstructured":"COVID Data Tracker: Center for Disease Control and Prevention, 2021. Available from: https:\/\/covid.cdc.gov\/covid-data-tracker\/#cases_casesper100klast7days."},{"issue":"3","key":"pone.0272691.ref012","first-page":"1663","article-title":"COVID-19 vaccines: comparison of biological, pharmacological characteristics and adverse effects of Pfizer\/BioNTech and Moderna Vaccines","volume":"25","author":"SA Meo","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"pone.0272691.ref013","article-title":"Incentives for Immunity\u2014Strategies for Increasing Covid-19 Vaccine Uptake","author":"KG Volpp","year":"2021","journal-title":"N Engl J Med"},{"key":"pone.0272691.ref014","first-page":"1","article-title":"The Limits of Medical Trust in Mitigating COVID-19 Vaccine Hesitancy among Black Americans","author":"J Stoler","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"1","key":"pone.0272691.ref015","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.52225\/narra.v2i1.74","article-title":"Willingness-to-pay for COVID-19 vaccine in ten low-middle-income countries in Asia, Africa and South America: A cross-sectional study","volume":"2","author":"M Sallam","year":"2022","journal-title":"Narra J"},{"issue":"15","key":"pone.0272691.ref016","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1001\/jama.2021.3976","article-title":"Acute Allergic Reactions to mRNA COVID-19 Vaccines","volume":"325","author":"KG Blumenthal","year":"2021","journal-title":"JAMA"},{"key":"pone.0272691.ref017","article-title":"COVID-19 vaccine safety update. 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