Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : OC09 - OC13 Full Version

COVID-19 Vaccination Status among Patients with Chronic Respiratory Diseases: A Cross-sectional Study from a Tertiary Care Centre in Southern India

Published: August 1, 2022 | DOI:
Anil Kumar Kodavala, Surekha Tadisetti, MD Badusha, Prasannapurna Kuruganti

1. Associate Professor, Department of Respiratory Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, Tagore Medical College, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Respiratory Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India. 4. Professor, Department of Respiratory Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India.

Correspondence Address :
Dr. Anil Kumar Kodavala,
G-7, DSR Square Apartment, D.No.16-13-305, 5th Cross, Haranathapuram, Nellore, Andhra Pradesh, India.


Introduction: Pre-existing respiratory diseases were recognised as risk factors for COVID-19 associated morbidity and mortality. One year after the launch of vaccines against COVID-19, vaccination status in specific population was not clear. Vaccination of population at risk is crucial for COVID-19 control.

Aim: To estimate the COVID-19 vaccination status and to detect the reasons for vaccine hesitancy among people with chronic respiratory diseases.

Materials and Methods: This cross-sectional observational study was conducted in Respiratory Medicine Department at Narayana Medical College, Nellore, Andhra Pradesh, India, from January 2022 and February 2022. All the patients above 18 years of age, who presented with chronic respiratory diseases, were included in the study. After taking informed consent, their responses were noted using a validated questionnaire containing data like demographic data and details of vaccination against COVID-19 and reasons for refusal/hesitancy.

Results: Out of total 755 subjects, 44.50% were of Chronic Obstructive Pulmonary Disease (COPD), 42.38% were of asthma, 9.40% were of Post-tuberculosis lung disease, 2.52% were of bronchiectasis, and 1.72% were of Interstitial Lung Disease (ILD). Mean age of study population was 51.37±15.30 years, 58% were male and 42% were female. Overall, 75% subjects received atleast single dose of COVID-19 vaccine. Higher vaccine acceptance was noted among 31-42 years age group, males, residents of rural area, graduates, subjects with income more than one lac per month and smokers. Vaccine hesitancy was 25%. Intake of a native medicine (72.87%) was the most common cause for vaccine refusal among these subjects. Other reasons for vaccine hesitancy were, worries about side-effects (63.3%), associated multiple co-morbidities (44.15%), lack of confidence in vaccines (15.96%) and fear of injection (14.89%).

Conclusion: Vaccine acceptance against COVID-19 is nearly 75% among people with chronic respiratory diseases in India. Nonetheless, some people were still hesitant to receive vaccine. Continuous health education at every level is needed to achieve vaccination targets.


Adverse effects, Asthma, Coronavirus disease-2019, Co-morbidity, Mass vaccination, Risk factors, Vaccine hesitancy

Irrespective of health standards being followed, COVID-19 pandemic adversely affected the lives of millions of people around the world during last 2 years. India, being a Southeast Asian country with dense population, was one of the most affected countries on the globe (1). By 28th February 2022, there have been 434,154,739 confirmed cases of COVID-19 and 5,944,342 deaths across the globe of which 42,924,130 cases and 5,13,843 deaths were from India (2). Vaccination against COVID-19 became one of the rays of hope in this desperate situation inspite of many preventive measures (3). Though a number of vaccines were rolled out in various countries, India faced several challenges during mass vaccination program starting from availability to acceptability (4).

The COVID-19 vaccine acceptance was highly variable across countries ranging from 15.4% to 97% (5),(6). India being a diversified country, various regional and population wise differences were expected towards the mass vaccination (4). Available evidence suggests that patients with chronic respiratory disease were at increased risk of morbidity and mortality during COVID-19 (1),(7). Of the total global Disease Adjusted Life Years (DALYs) due to chronic respiratory diseases in 2016, 32.0% occurred in India (8). Chronic Obstructive Pulmonary Disease (COPD) is the most common disease among chronic respiratory diseases (9). Nearly 65 million moderate to severe COPD patients are there globally and COPDaccounts for 5% (41.9 per I lakh) of total deaths annually (9). Chronic respiratory diseases constitute 10.9% of total deaths and 6.4% of total DALYs in India in 2016 (8). In India, the crude prevalence of COPD was 4.2%, and asthma was 2.9% in 2016 (8). In India, COPD and asthma were responsible for 75.6% and 20.0% of the chronic respiratory disease DALYs, respectively, in 2016 (8). COPD is responsible for 8.7% of total deaths and 4.8% of total DALYs in India (8). Asthma is responsible for 1.9% of total deaths and 1.3% of total DALYs in India (8). In 2016, the DALYs per patient of COPD and asthma were 1.7 and 2.4 times higher in India than the global average, respectively. The crude case fatality rates of COPD and asthma are 1.53% and 0.48% in India.

Interstitial Lung Disease (ILD) constitute 0.28% of total deaths and 0.14% of total DALYs in India (8). Overall, 39% of mortality is from COPD among chronic respiratory diseases (9), 66% of COPD mortality is in India and China (9). Approximately 50% survivors of Pulmonary Tuberculosis (PT) develop Post-tuberculosis Lung Diseases (PTLD), like parenchymal cavitation, bronchitis, fibrotic alteration, and bronchiectasis. Adult PT survivors have a 2-4 fold increase in spirometry abnormalities and have a 3-fold increased risk of death. Worldwide 58 million PTLD were present (10). The prevalence of non cystic fibrosis bronchiectasis in high-income countries (566 per 1 lakh population). But data from low and middle-income countries is not consistent (10).

Prevalence of respiratory co-morbidities in COVID-19 was 1.5-17.7% (non asthmatics) and 14.5% asthmatics (11). In South Africa, 10% of COVID-19 had current or past tuberculosis (12). PTLD with persistent pulmonary impairment are more susceptible to COVID-19 and increased mortality with COVID-19 (12). COVID-19 mortality rate was 1.54% in India, as on 24th March 2021 (11). COVID-19, when associated with concurrent or past PT, hospital-based mortality increased by two times (12). Hence these people are a priority for earlier Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccination. Even among survivors of COVID-19 with underlying PTLD, increased chance of long COVID-19 or lung disease after COVID-19 (12). Vaccination against COVID-19 in this group of people is not only crucial for ending the pandemic but also essential for restoring tuberculosis services (12). Hence, this study was aimed to assess COVID-19 vaccine coverage and reasons for vaccine hesitancy among people with chronic respiratory diseases.

Material and Methods

This cross-sectional observational study was conducted in Respiratory Medicine Department at Narayana Medical College, Nellore, Andhra Pradesh, India, from January 2022 and February 2022. Institutional Ethics Committee approved the study protocol (IEC/NMC/02/02/

Sample size estimation: The estimated sample size was 539 with the prevalence of vaccine acceptance (66%) against COVID-19 in India (1), 95% of confidence and 4% of precision.

Inclusion criteria: All subjects above 18 years of age with chronic respiratory diseases, who visited the study institution during the study period, were included in the study.

Exclusion criteria: Patients who had acute respiratory symptoms, and patients who failed to show their vaccination certificates were excluded from the study. Incompletely filled questionnaires were also excluded.


A questionnaire was used to collect data. It was developed in English language by investigators of the study. It comprised of two sections:

First section: Socio-demographic details of patients like name, age, gender, education, occupation, marital status, place of residence, smoking status, presence or absence of chronic respiratory disease, name of disease, any co-morbid condition, type of co-morbidity and previous COVID-19 infection.
Second section: Details of vaccination against COVID-19 and reasons for refusal/hesitancy.

The questionnaire was validated through a pilot study among 20 patients. The data was excluded during the final analysis.

All participants were explained clearly about the confidentiality, purpose and procedure of the study. After taking informed consent, each participant was interviewed in person without affecting their privacy and the questions were explained in their local language. The self-reported responses to the questionnaire was collected.

Study subjects were stratified into Asthma, COPD, Bronchiectasis, ILD, and Pulmonary Tuberculosis (PT) sequelae based on their clinical history, physical examination, chest imaging and spirometry. Participants who claimed vaccinated status, but failed to show vaccination certificate, were excluded from the study. Those who did not receive single dose of a vaccine were inquired about reasons for doing so and their responses were noted.

Statistical Analysis

Data were analysed by Statistical Package for Social Sciences (SPSS) IBM, version 28.0. Continuous variables like age were expressed as mean and standard deviation. Categorical variables like socio-demographic parameters, smoking status, co-morbidities, chronic respiratory condition, and previous COVID-19 were expressed as 10numbers and percentages. Relation between categorical variables and the vaccination status was analysed using Chi-square test. A p-value <0.05 was considered as significant.


A total of 802 eligible subjects were identified. Of them, 47 participants were excluded for not showing vaccination certificates. Finally, 755 participants’ data were analysed. Mean age of study population was 51.37±15.30 years and males were 438 (58%). Demographic characteristics were displayed in (Table/Fig 1). They were stratified into COPD, asthma, PT sequelae, bronchiectasis and ILD. Further subgroup analysis of chronic respiratory diseases and vaccine acceptance were mentioned in (Table/Fig 2).

The overall prevalence of COVID-19 vaccine acceptance among study participants was 75%, significantly higher than vaccine hesitancy (25%) (Table/Fig 1). On subgroup analysis, higher COVID-19 vaccine acceptance among participants with chronic respiratory diseases were noted among men (76%), 31-42 years age group (79.6%), unmarried people (82.5%), rural dwellers (76.55%), graduates (78.26%), subjects with income more than one lakh per month (85%), smokers (76.5%).

The reasons for vaccine refusal includes reception of a native medicine, having multiple co-morbidities, concerns about unforeseen side-effects, lack of confidence, and afraid of injection. The association between descriptive parameters and vaccine status among the study participants was not statistically significant (p-value >0.05) (Table/Fig 3).


In India, vaccination against COVID-19 rolled out in a stepwise manner. Initially, healthcare workers/frontline workers followed by people above 60 years of age or above 45 years with multiple co-morbidities. COVID-19 has severely affected individuals with co-morbid conditions. When these people also have chronic respiratory diseases, risk of COVID-19 morbidity and mortality increases many folds (1). Vaccination of at-risk populations is a crucial step in achieving herd immunity. Hence, vaccine allocation policies have prioritised these people. Some previous studies assessed acceptance of vaccines against COVID-19 in countries like the United States of America (USA), Saudi Arabia, India, China, and Ethiopia. The following (Table/Fig 4) depicts the details of these studies.

These studies took place from April 2020 to May 2021. Some of them occurred even before the rollout of any vaccine (13),(14). And some other studies were conducted during the 2nd wave of COVID-19 in respective countries (15),(16),p17]. The majority of the studies included subjects with non specific chronic diseases (14),(16),(17),(18),(19). Few studies happened among people with a specific disease. For instance, a study from the USA was to assess the willingness to vaccination among African Americans who recently recovered from COVID-19, even before the actual vaccine was brought into usage (13). In a study from India by Gaur P et al., they investigated vaccination coverage against COVID-19 among patients with autoimmune rheumatic disease during the early phase of the mass vaccination (15).

Authors estimated the prevalence of COVID-19 vaccine acceptance among patients with chronic respiratory diseases, during the decline phase of the 3rd wave of COVID-19, one year after the beginning of the mass vaccination program against COVID-19. It was found that vaccine acceptance was higher than vaccine hesitancy in subjects with chronic respiratory diseases. However, some subjects were not yet convinced to take vaccine.

A multinational study in the USA, Canada, and other countries, assessed COVID-19 vaccination status among patients with different co-morbidities, including chronic respiratory diseases (18). The vaccine acceptance ranged from 30% to 81% across these studies (13),(14),(15),(16),(17),(18),(19). In studies that happened before actual vaccination, COVID-19 vaccine acceptance varied from 30% to 52% (13),(14),(19). However, in studies that occurred either during the 2nd wave of COVID-19 or after the beginning of the mass vaccination, it spanned from 54% to 81% (15),(16)(17),(18).

In the current study, 75% of the participants received at least one dose of a vaccine against COVID-19, whereas vaccine acceptance among patients with chronic respiratory diseases in a multinational study was 82% (18). This variability was due to multiple factors like country, type of study, population of interest, the time of the study following vaccine roll out, socio-demographic and cultural backgrounds.

Coming to the causes of vaccine hesitancy or refusal, most of the studies have reported concerns about vaccine safety and associated side-effects (1),(3),(4),(5),(6),(7),(8). In a multinational study, self-reported local and systemic reactions were a concern among subjects with chronic respiratory diseases (3). As COVID-19 is a new disease, some of the participants of these studies have expressed a lack of trust (1),(3),(7). As vaccines received emergency approval to control the spread of COVID-19, some of the patients wanted to be watchful about the impact of the vaccine (3),(5),(6). Some patients even opined that a vaccine might not be required as it could not boost immunity and prevent reinfection, and natural infection provides better immunity (4). Some of them had vaccine apathy, as they have not received any other vaccine till now (2),(7). Few patients with chronic diseases felt that following the prevention measures was sufficient to control the pandemic rather than taking vaccines (4),(5).

The present study found that intake of native medicine was the most common cause for vaccine refusal among the study population in this region. This was not mentioned in previous studies. Health authorities should address this issue, investigate further and take appropriate measures to drop vaccine hesitancy. Some of the study patients refused to take the vaccine as they had multiple co-morbidities, indicating the low level of knowledge they had about indications for vaccination against COVID-19. Some of the participants, who were afraid of injection, preferred to take vaccine through other routes.

Hypertension, diabetes mellitus, and coronary artery disease were the most common co-morbidities, similar to the present study (1),(14),(16),(17),(18). Patients with these co-morbidities have a doubled risk of severe COVID-19 (8). Among chronic respiratory diseases, patients with COPD are at six times greater risk of progressing to severe COVID-19 (8). COPD was the most common respiratory disease among the present study participants.

Patients with chronic diseases like cardiovascular disease, hypertension, diabetes, cancer, respiratory diseases, and kidney diseases are at enhanced risk of acquiring COVID-19, severe complications, and death due to COVID-19 (2). The risk of death depends on the number of co-morbidities patients have. It becomes twice in the presence of single co-morbidity and rises to 8 times with five or more diseases (3).

Policymakers need to design multifaceted interventions to reach the goals of vaccination outcomes in specific subgroups at risk (2). Since there is a lack of sufficient data about vaccine safety in patients with autoimmune diseases, people of this group are in a dilemma about vaccination against COVID-19 (3). This group of patients was skeptical about the effect of the vaccine on the immune system, like a flare-up of underlying immunological disease (5). Treating physicians should clarify their doubts about COVID-19 vaccines by providing accurate information. Vaccine hesitancy among subjects with a chronic disease ranged from every alternate patient to one in five, depending on study population (14),(15),(16),(17),(18),(19),(20). However, in the index study every fourth patient with a chronic respiratory disease had vaccine hesitancy. Many people had dilemma about vaccination following COVID-19. Patients who had previous COVID-19 were reluctant to vaccination (3).

The prevalence of vaccine acceptance was equal among the current study subjects with or without previous COVID-19. Uncertainty about vaccine composition with the background of a chronic disease may affect the acceptance of vaccines among these patients (6). Healthcare providers, like nurses, are expected to have correct information about the vaccines, and they should be ready to educate the patients regarding this. These can fill the gaps in the knowledge of these patients and improve the overall acceptance of vaccines (6). Patients having family members who developed side effects after receiving a COVID-19 vaccine were likely to refuse it (6).

Vaccination is the only option to control the COVID-19 pandemic lacking specific treatment (7). To achieve the goals of the vaccination, herd immunity is necessary that hinges on vaccine acceptance by the risk population, 60-75% of the population is to be vaccinated to achieve herd immunity (7). With increasing the knowledge of patients, improvement in attitudes toward COVID-19 vaccines, and the availability of a safe and effective vaccine at free or minimum cost, wider acceptance of vaccination is possible (7). Continuous promotion of awareness on the necessity of the COVID-19 vaccine, particularly among patients with chronic diseases, by committed healthcare workers, using different ways of disseminating information, is vital for improving the knowledge and attitude of patients who doubt COVID-19 vaccines (7).

The present study has specific strengths and limitations. It is one of the study that assessed vaccination status among chronic respiratory diseases subjects with higher mean age group. Both are risk factors for severe COVID-19 (7). Unlike previous studies in India, this study was conducted one year after the launch of mass vaccination and interviewed study participants face to face. Data represent actual numbers at ground level. The study also reports the use of a native medicine in vaccine rejecters.


Being a study in a specific population, results can not be generalised. The study did not assess the knowledge of the participants about guidelines of COVID-19 vaccination.


One year after starting the mass vaccination in India, vaccine acceptance was more than hesitancy against COVID-19 among subjects with chronic respiratory diseases in South India. Inspite of being a priority community, still some subjects with chronic respiratory diseases have been avoiding vaccine for various reasons. Intake of a native medicine was the most common cause for vaccine hesitancy. This needs further investigation at ground level. Not only framing of central health guidelines and but also providing continuous health education at every possible level to all sectors of the population, imperative to achieve rapid mass vaccination to halt COVID-19 pandemic.


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DOI and Others

DOI: 10.7860/JCDR/2022/56474.16701

Date of Submission: Mar 21, 2022
Date of Peer Review: Apr 18, 2022
Date of Acceptance: May 19, 2022
Date of Publishing: Aug 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 31, 2022
• Manual Googling: May 19, 2022
• iThenticate Software: Jul 29, 2022 (8%)

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