COVID-19 vaccination acceptance among dental students and dental practitioners: A systematic review and meta-analysis

PLOS ONE RESEARCH ARTICLE COVID-19 vaccination acceptance among dental students and dental practitioners: A systematic review and meta-analysis Galvin Sim Siang Lin ID1*, Hern Yue Lee2☯, Jia Zheng Leong3☯, Mohammad Majduddin Sulaiman4‡, Wan Feun Loo5‡, Wen Wu Tan6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Lin GSS, Lee HY, Leong JZ, Sulaiman MM, Loo WF, Tan WW (2022) COVID-19 vaccination acceptance among dental students and dental practitioners: A systematic review and metaanalysis. PLoS ONE 17(4): e0267354. https://doi. org/10.1371/journal.pone.0267354 Editor: Andrej M. Kielbassa, Danube Private University, AUSTRIA Received: January 3, 2022 Accepted: April 6, 2022 Published: April 19, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0267354 Copyright: © 2022 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. 1 Department of Dental Materials, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Bedong, Kedah, Malaysia, 2 Seberang Jaya Dental Clinic, Ministry of Health Malaysia, Perai, Pulau Pinang, Malaysia, 3 Petaling Dental Clinic, Ministry of Health Malaysia, Negeri Sembilan, Malaysia, 4 Prosthodontics Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia, 5 Bukit Panchor Dental Clinic, Ministry of Health Malaysia, Nibong Tebal, Pulau Pinang, Malaysia, 6 Department of Dental Public Health, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Bedong, Kedah, Malaysia ☯ These authors contributed equally to this work. ‡ MMS and WFL also contributed equally to this work. * Abstract Background Dental practitioners and dental students are classified as high-risk exposure to COVID-19 due to the nature of dental treatments, but evidence of their acceptance towards COVID-19 vaccination is still scarce. Hence, this systemic review aims to critically appraise and analyse the acceptability of COVID-19 vaccination among dental students and dental practitioners. Materials and methods This review was registered in the PROSPERO database (CRD42021286108) based on PRISMA guidelines. Cross-sectional articles on the dental students’ and dental practitioners’ acceptance towards COVID-19 vaccine published between March 2020 to October 2021 were searched in eight online databases. The Joanna Briggs Institute critical appraisal tool was employed to analyse the risk of bias (RoB) of each article, whereas the Oxford Centre for Evidence-Based Medicine recommendation tool was used to evaluate the level of evidence. Data were analysed using the DerSimonian-Laird random effect model based on a single-arm approach. Results Ten studies were included of which three studies focused on dental students and seven studies focused on dental practitioners. Four studies were deemed to exhibit moderate RoB and the remaining showed low RoB. All the studies demonstrated Level 3 evidence. Singlearm meta-analysis revealed that dental practitioners had a high level of vaccination PLOS ONE | https://doi.org/10.1371/journal.pone.0267354 April 19, 2022 1 / 14 PLOS ONE Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abbreviations: CI, Confidence Interval; COVID-19, Coronavirus Disease 2019; EBSCO, EBSCO Information Services; JBI, Joanna Briggs Institute; LILACS, Latin American and Caribbean Health Science Information Database; NIHR, National Institute for Health Research; OCEBM, Oxford Centre for Evidence-Based Medicine; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols; PROSPERO, Prospective Register of Systematic Reviews; RoB, Risk of Bias; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; WHO, World Health Organisation. Vaccine acceptance among dental students and dental practitioners acceptance (81.1%) than dental students (60.5%). A substantial data heterogeneity was observed with the overall I2 ranging from 73.65% and 96.86%. Furthermore, subgroup analysis indicated that dental practitioners from the Middle East and high-income countries showed greater (p < 0.05) acceptance levels, while meta-regression showed that the sample size of each study had no bearing on the degree of data heterogeneity. Conclusions Despite the high degree of acceptance of COVID-19 vaccination among dental practitioners, dental students still demonstrated poor acceptance. These findings highlighted that evidence-based planning with effective approaches is warranted to enhance the knowledge and eradicate vaccination hesitancy, particularly among dental students. Introduction A newly identified coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) or known as the coronavirus disease 2019 (COVID-19), has been wreaking havoc all over the world since its emergence in Wuhan, China in December 2019 [1]. The World Health Organisation (WHO) labelled the COVID-19 outbreak a "Public Health Emergency of International Concern" on January 30, and later, a global pandemic on March 11, 2020 [2]. Ever since, COVID-19 has inflicted millions of deaths globally, presented the government with an unprecedented challenge in the face of severe economic, fiscal, and social pressures, as well as exerted an incredible impact on every sphere of human life. Despite the implementation of several lockdowns around the world, the infection was not contained due to the reappearance of new COVID-19 variations that were more infective [3]. Several strains of SARS-CoV-2 have been discovered throughout the pandemic and are categorized into three groups: variants of interest, variants of concern, and variants of high consequence [4]. Delta and Omicron variants are among the mutated strains listed as variants of concern which appeared to spread more swiftly than the initial SARS-CoV-2 strain, leading to an increase in COVID-19 cases [4]. These variants have also been linked to increased hospitalisations, reduced neutralisation by antibodies from a previous infection, and diagnostic detection failures [5, 6]. It was soon realised and agreed that herd immunity was the only way to halt the pandemic as several studies have reported promising antibody responses to these variants after vaccine administration [5, 7]. Many countries have begun mass immunisation camp (...truncated)