{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:19:46Z","timestamp":1760145586626,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibodies"],"abstract":"<jats:p>Background: Previous studies showed that the fourth SARS-CoV-2 vaccine dose has a protective effect against infection, as well as against severe disease and death. This study aimed to examine whether knowledge of a high-level antibody after the third dose may reduce compliance to the fourth booster dose among healthcare workers (HCWs). Methods: We conducted a prospective cohort study among HCWs vaccinated with the first three doses at Rambam Healthcare Campus, a tertiary hospital in northern Israel. Participants underwent a serological test before the fourth booster vaccine was offered to all of them, with results provided to participants. The population was divided into two groups, namely those with antibodies below 955 AU\/mL and those with 955 AU\/mL and higher, a cutoff found protective in a previous study. Multiple logistic regression was carried out to compare the compliance to the fourth booster between the two groups, adjusted for demographic and clinical variables. Results: After adjusting for the confounding variables, the compliance was higher in those with antibody levels below 955 AU\/mL (OR = 1.41, p = 0.05, 95% CI 1.10\u20131.96). In addition, male sex and age of 60 years and above were also associated with higher vaccination rates (OR = 2.28, p &lt; 0.001, 95% CI 1.64\u20133.17), (OR = 1.14, p = 0.043, 95% CI 1.06\u20131.75), respectively. Conclusions: Knowledge of the antibody status may affect compliance with the booster dose. Considering waning immunity over time, reduced compliance may affect the protection of HCWs who declined the fourth dose.<\/jats:p>","DOI":"10.3390\/antib13030063","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T08:14:46Z","timestamp":1722500086000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Knowledge of the Serological Response to the Third BNT162b2 Vaccination May Influence Compliance of Healthcare Workers to Booster Dose"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-1806","authenticated-orcid":false,"given":"Avi","family":"Magid","sequence":"first","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9754-7955","authenticated-orcid":false,"given":"Khetam","family":"Hussein","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Infection Control Unit, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halima","family":"Dabaja-Younis","sequence":"additional","affiliation":[{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Pediatric Infectious Disease Unit, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moran","family":"Szwarcwort-Cohen","sequence":"additional","affiliation":[{"name":"Virology Laboratory, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronit","family":"Almog","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Mekel","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avi","family":"Weissman","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gila","family":"Hyams","sequence":"additional","affiliation":[{"name":"Nursing Management, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vardit","family":"Gepstein","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Pediatrics B, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Netanel A.","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hagar","family":"Cohen Saban","sequence":"additional","affiliation":[{"name":"Nursing Management, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jalal","family":"Tarabeia","sequence":"additional","affiliation":[{"name":"Infection Control Unit, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Nursing Faculty, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-7619","authenticated-orcid":false,"given":"Michael","family":"Halberthal","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8353-0108","authenticated-orcid":false,"given":"Yael","family":"Shachor-Meyouhas","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1038\/s41591-022-02185-4","article-title":"A survey of COVID-19 vaccine acceptance across 23 countries in 2022","volume":"29","author":"Lazarus","year":"2022","journal-title":"Nat. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2200559","DOI":"10.2807\/1560-7917.ES.2022.27.30.2200559","article-title":"COVID-19 vaccination and BA.1 breakthrough infection induce neutralising antibodies which are less efficient against BA.4 and BA.5 Omicron variants, Israel, March to June 2022","volume":"27","author":"Kliker","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3203","DOI":"10.1038\/s41467-022-30884-6","article-title":"Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine","volume":"13","author":"Patalon","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1056\/NEJMoa2109072","article-title":"COVID-19 Breakthrough Infections in Vaccinated Health Care Workers","volume":"385","author":"Bergwerk","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e072141","DOI":"10.1136\/bmj-2022-072141","article-title":"Waning of vaccine effectiveness against moderate and severe COVID-19 among adults in the US from the VISION network: Test negative, case-control study","volume":"379","author":"Ferdinands","year":"2022","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1056\/NEJMoa2201688","article-title":"Fourth Dose of BNT162b2 mRNA COVID-19 Vaccine in a Nationwide Setting","volume":"386","author":"Magen","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1056\/NEJMoa2201570","article-title":"Protection by a Fourth Dose of BNT162b2 against Omicron in Israel","volume":"386","author":"Goldberg","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Shachor-Meyouhas, Y., Dabaja-Younis, H., Magid, A., Leiba, R., Szwarcwort-Cohen, M., Almog, R., Mekel, M., Weissman, A., Hyams, G., and Gepstein, V. (2023). Immunogenicity and SARS-CoV-2 Infection following the Fourth BNT162b2 Booster Dose among Health Care Workers. Vaccines, 11.","DOI":"10.3390\/vaccines11020283"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Portoghese, I., Siddi, M., Chessa, L., Costanzo, G., Garcia-Larsen, V., Perra, A., Littera, R., Sambugaro, G., Giacco, S.D., and Campagna, M. (2023). COVID-19 Vaccine Hesitancy among Italian Healthcare Workers: Latent Profiles and Their Relationships to Predictors and Outcome. Vaccines, 11.","DOI":"10.3390\/vaccines11020273"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.idnow.2021.04.001","article-title":"COVID-19 vaccine hesitancy among healthcare workers","volume":"51","author":"Paris","year":"2021","journal-title":"Infect. Dis. Now"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9.","DOI":"10.1101\/2020.12.28.20248950"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Peterson, C.J., Lee, B., and Nugent, K. (2022). COVID-19 vaccination hesitancy among healthcare workers\u2014A review. Vaccines, 10.","DOI":"10.3390\/vaccines10060948"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pal, S., Shekhar, R., Kottewar, S., Upadhyay, S., Singh, M., Pathak, D., Kapuria, D., Barrett, E., and Sheikh, A.B. (2021). COVID-19 vaccine hesitancy and attitude toward booster doses among US healthcare workers. Vaccines, 9.","DOI":"10.3390\/vaccines9111358"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1007\/s10900-021-00984-3","article-title":"The nature and extent of COVID-19 vaccination hesitancy in healthcare workers","volume":"46","author":"Biswas","year":"2021","journal-title":"J. Community Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1086\/676427","article-title":"Factors associated with healthcare worker acceptance of vaccination: A systematic review and meta-analysis","volume":"35","author":"Vasilevska","year":"2014","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1080\/21645515.2020.1801072","article-title":"Monitoring influenza vaccination coverage and acceptance among health-care workers in German hospitals\u2013results from three seasons","volume":"17","author":"Neufeind","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1093\/cid\/ciac886","article-title":"The association between prebooster vaccination antibody levels and the risk of severe acute respiratory syndrome coronavirus 2 infection","volume":"76","author":"Barda","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4423","DOI":"10.1016\/j.vaccine.2021.05.063","article-title":"Evidence for antibody as a protective correlate for COVID-19 vaccines","volume":"39","author":"Earle","year":"2021","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2314757","DOI":"10.1001\/jamanetworkopen.2023.14757","article-title":"Factors Associated with Protection from SARS-CoV-2 Omicron Variant Infection and Disease among Vaccinated Health Care Workers in Israel","volume":"6","author":"Gilboa","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3241","DOI":"10.1093\/cid\/ciaa660","article-title":"Lower Rate of Seropositivity to Measles Among Young Healthcare Personnel in New York City","volume":"71","author":"Lucca","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"114770","DOI":"10.1016\/j.jviromet.2023.114770","article-title":"Clinical performance of the MAGLUMI Anti-HCV (CLIA) Test for detection of hepatitis C virus antibodies","volume":"319","author":"Li","year":"2023","journal-title":"J. Virol. Methods"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1097\/INF.0000000000003574","article-title":"Serologic Tests for COVID-19 Infections and Vaccination","volume":"41","author":"Plotkin","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_23","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":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e0011","DOI":"10.5041\/RMMJ.10469","article-title":"COVID-19: Healthcare Workers May Be at Greater Risk Outside Their Work Environment\u2014A Retrospective Observational Study","volume":"13","author":"Hussein","year":"2022","journal-title":"Rambam Maimonides Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4180","DOI":"10.1016\/j.vaccine.2015.04.040","article-title":"Strategies for addressing vaccine hesitancy\u2013A systematic review","volume":"33","author":"Jarrett","year":"2015","journal-title":"Vaccine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yasmin, F., Najeeb, H., Moeed, A., Naeem, U., Asghar, M.S., Chughtai, N.U., Yousaf, Z., Seboka, B.T., Ullah, I., and Lin, C.-Y. (2021). COVID-19 vaccine hesitancy in the United States: A systematic review. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.770985"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1017\/ice.2021.421","article-title":"Coronavirus disease 2019 (COVID-19) vaccination uptake among healthcare workers","volume":"43","author":"Gilboa","year":"2022","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.ajic.2021.06.020","article-title":"Intention to COVID-19 vaccination and associated factors among health care workers: A systematic review and meta-analysis of cross-sectional studies","volume":"49","author":"Luo","year":"2021","journal-title":"Am. J. Infect. Control"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/S1473-3099(21)00566-1","article-title":"Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer\u2013BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: A retrospective surveillance study","volume":"22","author":"Haas","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"6902","DOI":"10.1016\/j.vaccine.2021.10.016","article-title":"Single BNT162b2 vaccine dose produces seroconversion in under 60 s cohort","volume":"39","author":"Hussein","year":"2021","journal-title":"Vaccine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1016\/j.vaccine.2022.03.045","article-title":"Disparities in COVID-19 vaccine uptake among health care workers","volume":"40","author":"Farah","year":"2022","journal-title":"Vaccine"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bashkin, O., Otok, R., Leighton, L., Czabanowska, K., Barach, P., Davidovitch, N., Dopelt, K., Duplaga, M., Emegwa, L.O., and MacLeod, F. (2022). Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.990353"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Boas, H., and Davidovitch, N. (2022). Into the \u201cNew Normal\u201d: The Ethical and Analytical Challenge Facing Public Health Post-COVID-19. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148385"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1605395","DOI":"10.3389\/phrs.2022.1605395","article-title":"ASPHER Statement: Facing the Fourth Winter of the COVID-19 Pandemic","volume":"43","author":"Hrzic","year":"2022","journal-title":"Public Health Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1056\/NEJMc2202542","article-title":"Efficacy of a fourth dose of Covid-19 mRNA vaccine against Omicron","volume":"386","author":"Gonen","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the Health Belief Model","volume":"15","author":"Rosenstock","year":"1988","journal-title":"Health Educ. Q."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Bord, S., Satran, C., and Schor, A. (2022). The mediating role of the perceived COVID-19 vaccine benefits: Examining Israeli parents\u2019 perceptions regarding their adolescents\u2019 vaccination. Vaccines, 10.","DOI":"10.3390\/vaccines10060917"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Limbu, Y.B., Gautam, R.K., and Pham, L. (2022). The health belief model applied to COVID-19 vaccine hesitancy: A systematic review. Vaccines, 10.","DOI":"10.3390\/vaccines10060973"}],"container-title":["Antibodies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4468\/13\/3\/63\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:27:54Z","timestamp":1760110074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4468\/13\/3\/63"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["antib13030063"],"URL":"https:\/\/doi.org\/10.3390\/antib13030063","relation":{},"ISSN":["2073-4468"],"issn-type":[{"type":"electronic","value":"2073-4468"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}