Cagayan State University College of Medicine

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LEVEL OF KNOWLEDGE AND ACCEPTANCE OF HPV VACCINE AMONG
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CHILDBEARING AGE WOMEN FROM SELECTED BARANGAYS OF

TUGUEGARAO CITY

A Research Proposal Presented to

The Faculty of College of Medicine

Cagayan State University

In Partial Fulfillment of the Requirements in

Health Research Methodology

By

Dela Cruz, Aaron C.

Lin, Lloyd Jay A.

Madduma, Justine Joshua Yshmael C.

January 2021
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CHAPTER I
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PROBLEM AND THE BACKGROUND

INTRODUCTION

HPV stands for human papillomavirus. It is not the same with

HIV and HSV (herpes). It is a very common sexually transmitted infection which does

not show any manifestation and because it is caused by a virus, it is self-limiting and

heals by itself. However, contacting HPV may lead to serious illnesses. In the

Philippines, cervical cancer is second among the leading type of cancer among women of

ages 15 to 44 years (DOH, 2020). It is stated in the 2015 Philippine Cancer Facts and

Estimates that there is an annual age standardized incidence of cervical cancer of

16/100,000 and mortality rate of 7.5 per 100,000. (Ref: Clinical Practice Guidelines by

SGOP, July 2019)

There were about 43 million HPV infections in 2018, many among people in their

late teens and early 20s (CDC, 2019). There are many different types of HPV. Some

types can cause health problems including genital warts and cancers. But there are

vaccines that can stop these health problems from happening.

Filipino women marry at the age of 22, and have their first birth at age 23, on

average. However, a signifi cant number of women start childbearing in their teens. In

2003, 24 percent of young women were pregnant or had had a child by age 19. Teenage

mothers and their babies have a higher risk of illness and death. More than 40 percent of
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poor young women already have a child by age 24, compared with only 11 percent of
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women from wealthier backgrounds.

HPV-related cancers such as cervical cancer can be prevented and treated if

detected at its early stages. The pre-cancerous stage provides ample window for detection

and treatment, and it could take as long as 30 years before it reaches malignancy.

However, it is one of the most common type of cancers and common cause of cancer-

related deaths worldwide, affecting mostly young, uneducated women from poor

countries.

Majority of the candidate vaccines target on the S protein due to its elicitation of

virus neutralizing antibodies as the immune correlates to vaccine protection. Different

past studies revealed several safety concerns associated with the use of coronavirus S‐

based vaccines, including inflammatory and immunopathological effects such as

pulmonary eosinophilic infiltration and antibody‐dependent disease enhancement (ADE)

following subsequent viral challenge of vaccinated animals. (Czub et. al 2017). Further

studies from animal models and human trials are important for developing a safe and

effective COVID‐19 vaccine.

According to the New York Times, as of October 7, 2020, researchers are testing

44 vaccines in clinical trials on humans, and at least 92 preclinical vaccines are under

active investigation in animals. Here in the Philippines, where there is 343,000 confirmed

cases with 6,300 confirmed deaths and still rising, the Philippine government is relying

on the possible vaccine trials that may be administered to its citizen. According to
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President Rodrigo Duterte on September 26, 2020, the government will prioritize buying
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COVID-19 vaccine to be made available by Russia or China.

Given the possible vaccination program that may conduct soon, it is highly

recommended to conduct a research to know the knowledge of Filipino citizens

especially in the young adults and adults since they will be the primary target of the

programs. Additionally, this research will investigate whether the subjects will be

interested to participate and their other possible responses. It will serve as a basis for

government offices, specially the DOH for their policy planning on immunization of

these possible vaccines.

The goal of this research is to determine the knowledge and possible responses of

CSU-Carig students on the possible COVID-19 vaccination programs since they are

probable candidates for the vaccination trials. Furthermore, the students are ideal to be

the subjects of this study since the research will opt to use an online survey.

RESEARCH PARADIGM

The paradigm will utilize the IV-DV model to illustrate the interrelation of the

different variables included in the study.

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STATEMENT OF THE PROBLEM

This study will determine the knowledge and possible responses CSU-Carig students on

the possible COVID-19 vaccination program.

Specifically, the study aspires to answer the following questions:

1. What is the profile of respondents in terms of;

a. Age

b. Sex

c. Course

d. Year level

e. Religion

f. Socio-economic status
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g. Number of seminars attended on COVID-19
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2. What is the level of knowledge of the respondents in COVID-19 vaccination in

terms of;

a. Benefits of COVID-19 vaccination

b. Risks of COVID-19 vaccination

c. Process on COVID-19 vaccination participation

d. Management of adverse reaction after vaccination

3. What are the probable responses of the respondents to the possibility that they

will be the subjects of a COVID-19 vaccination program?

4. Is there a significant difference in the level of knowledge of respondents on

COVID-19 vaccination and their possible responses when they are grouped

according to profile variants?

HYPOTHESES AND ASSUMPTIONS

1. There is no significant difference on the extent of knowledge of the respondents

on the possible COVID-19 vaccine clinical trial in terms of the benefits and risks

of the vaccines, the process of the vaccination programs and the possible adverse

reactions after its introduction to the subjects and its management.

2. There will be no significant differences among the possible response of

respondents to COVID-19 vaccination trial.

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3. There is no significant difference in the level of knowledge of respondents on
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COVID-19 vaccination and their possible responses when they are grouped

according to profile variants.

SCOPE AND DELIMITATION

Out of (#of students CSU-carig), at least 10 participants will be randomly chosen

in each college department as sample in conducting the survey.

The study limits its coverage to only the students of CSU-Carig campus to

identify their knowledge and common problems regarding the COVID-19 and its

upcoming vaccine trials, and vaccination in general.

The limitation is due to the fact that COVID-19 cases are still rising and social

distancing is being practiced as of the moment and the usual type of survey is highly

improbable.

SIGNIFICANCE OF THE STUDY

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This study will contribute to provide a general information of the knowledge of
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selected respondents towards the importance, benefits and risks of vaccination,

particularly, the current Covid 19 vaccines available to be used or administer to each of

the individuals in the community. The result of the study is expected to give valuable

information which could be beneficial to the following:

To the Community. This research will help and guide the community and the

people to have information and be aware on the current status of different programs

implemented by the Government such as vaccination programs , the effectivity and

benefits of vaccination and immunization for disease prevention, trends in the health care

and other information that will help maintain and improve the health status of the

community.

To the Department of Health. The result of the research study will help the

DOH to set an action plan and strategies to effectively promote the safety and benefits of

vaccination, set guidelines for its issuance and administration, and to encourage people to

get vaccinated and be reassured by providing supported and confirmed successful clinical

vaccination results.

To the Government. This research will help the government to promote health

awareness and improve health conditions; through the collection, monitoring, and
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dissemination of information about health status of Covid 19 occurrence in the country as
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well as to take into account the health concerns or issues of the people regarding their

beliefs about the effectivity and risk of vaccines, and to give reassurance to the people by

taking the best and wisest actions with the priority to seek the welfare of the community

amidst crisis.

To the City Health Office. To develop guidelines for best practices and

remarkable improvement in health care and public health to ensure high- quality patient

care and provide important information about disease and risk factors, outcomes of

treatment or public health interventions and patterns of care.

To future researchers. This research study will serve as base-line information

and guide to undertake future studies along this are of interest

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Definition of Terms
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COVID-19 (Coronavirus disease). An infectious disease caused by a newly discovered

coronavirus.

Vaccine. A substance used to stimulate the production of antibodies and provide

immunity against one or several diseases, prepared from the causative agent of a disease,

its products, or a synthetic substitute, treated to act as an antigen without inducing the

disease.

Vaccination. Procedure of administration of a vaccine to help the immune system

develop protection from a disease. Vaccines contain a microorganism or virus in a

weakened, live or killed state, or proteins or toxins from the organism.

Severe Acute Respiratory Syndrome. An infectious disease with symptoms including

fever and cough and, in some cases, progressing to pneumonia and respiratory failure.

Pneumonia. An infection that inflames the air sacs in one or both lungs. The air sacs may

fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills,

and difficulty breathing.

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Coronaviridae. A family of single-stranded RNA viruses that are surrounded by a
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lipoprotein envelope with large club-shaped projections and that infect birds and many

mammals including humans but with each species of virus usually having a restricted

range of hosts

Betacoronavirus. A family virus that are enveloped, positive-strand RNA viruses that

infect humans and mammals. The natural reservoir for betacoronaviruses are bats and

rodents. Rodents are the reservoir for the subgenus Embecovirus, while bats are the

reservoir for the other subgenera

DOH (Department of Health). The principal health agency in the Philippines. It is

responsible for ensuring access to basic public health services to all Filipinos through the

provision of quality health care and regulation of providers of health goods and services.
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CHAPTER II

REVIEW OF RELATED LITERATURE

COVID 19

Background

The China Health Authority alerted the World Health Organization (WHO) to

multiple cases of unexplained pneumonia in Wuhan City in Hubei Province in central

China on December 31, 2019 (Harapan H et al., 2020).

A novel coronavirus, initially abbreviated as 2019-nCoV by WHO, was identified

from a patient's throat swab sample on January 7, 2020. Because of its high homology

(~80%) to SARS-CoV, which caused acute respiratory distress syndrome (ARDS) and

high mortality during 2002-2003, the novel coronavirus was known as the extreme acute

respiratory syndrome coronavirus-2 (SARS-CoV-2, 2019-nCoV) (Ksiazek T.G et al.,

2003).

This pathogen was eventually renamed by the Coronavirus Research Group as the

extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was

named coronavirus disease 2019 or COVID-19 (WHO, 2020).

According to China's National Health Commission, as of February 4, the

mortality rate for confirmed cases in China was 2.1% and the mortality rate for cases
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outside China was 0.2 %. Among patients admitted to hospitals, the mortality rate ranged
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between 11% and 15% (WHO, 2020; Huang C; Chen N et al., 2020).

SARS-CoV-2 virus primarily affects the respiratory system, although other organ

systems are also involved. In the initial case series from Wuhan, China, lower respiratory

tract infection-related symptoms including fever, dry cough and dyspnea were recorded

( Wang Y et al., 2020).

Headaches, dizziness, generalized fatigue, vomiting and diarrhea were also

observed. Respiratory signs with COVID-19 are now generally accepted to be highly

heterogeneous, ranging from mild symptoms to severe hypoxia with ARDS. The time

between the onset of symptoms and the development of ARDS was as brief as 9 days in

the Wuhan study referred to above, indicating that respiratory symptoms could progress

rapidly ( Shi H, Li X., 2020).

COVID-19 infects people of all ages. However, epidemiological studies have

shown that mortalities are higher in elder population and the incidence is much lower in

children. There are two key groups at greater risk of contracting serious illnesses: the

elderly and those with underlying comorbidities, such as diabetes mellitus, asthma,

cardiorespiratory conditions, chronic liver diseases and renal failure. It is also suspected

that cancer patients and others taking immunosuppressive drugs, as well as pregnant

women, are at a greater risk of contracting serious illness when infected ( B. Wang, R. Li,

Z. Lu, Y. Huang., 2020).

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With no targeted therapy available, current medical management is largely
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supportive. Several drugs have been studied in clinical trials, including lopinavir-

ritonavir, remdesivir, hydroxychloroquine, and azithromycin, but none of them have been

proved to be a definite cure yet. In clinical trials, more drugs are being studied (Zhou F.,

Cao B., Gautret P., 2020).

Etiology of the virus

The China CDC found the virus called novel coronavirus 2019 (2019-nCoV) on 7

January 2020, which was colloquially referred to as the "Wuhan Coronavirus. The WHO

renamed it to SARS-CoV-2 to destigmatize the association of the virus with any

geographic location or nationality and relate it to the disease symptomatology. The

SARS-CoV-2 virus is genetically identical to the SARS Coronavirus of 2002 (SARS-

CoV-1) (Kakodkar, P., Kaka, N., & Baig, M. N., 2020).

SARS-CoV-2 belongs to the Coronaviridae family and to the order Nidovirales.

The family consists of two subfamilies, Coronavirinae and Torovirinae, and four genera

are subdivided into the subfamily Coronavirinae. (1) Alphacoronavirus contains the

human coronavirus (HCoV)-229E and HCoV-NL63; (2) Betacoronavirus includes

HCoV-OC43, Severe Acute Respiratory Syndrome human coronavirus (SARS-HCoV),

HCoV-HKU1, and Middle Eastern respiratory syndrome coronavirus (MERS-CoV); (3)

Gammacoronavirus includes viruses of whales and birds and; (4) Deltacoronavirus

includes viruses isolated from pigs and birds ((Burrell C., Howard C., Murphy F., 2016.)
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Along with two extremely pathogenic viruses, SARS-CoV and MERS-CoV, SARS-CoV-
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2 is part of the Betacoronavirus. SARS-CoV-2 is an enveloped and positive-sense single-

stranded RNA (+ssRNA) virus (Kramer A., Schwebke I., Kampf G., 2006).

The origin of the SARS-CoV-2 genome has been linked to bats akin to the SARS-

CoV-1 and MERS-CoV viruses (Li W., Smith C., Epstein JH., 2005). Interestingly, the

whole genome of SARS-CoV-2 matched with the virus genomes (Bat-CoV and Bat-CoV

RaTG13) in the Yunnan Province Rhinolophus affinis species with 96 percent similarity

(Zhou P. et al, 2020).

In the study of Liu P. et al. (2019) it was hypothesized that the natural reservoir of

SARS-CoV-2 was in pangolins. This was based on the analysis of the genome contig

alignment of SARS-CoV-2 like CoV harbored in the lung tissue of two dead Malayan

pangolins. This Pangolin-CoV’s whole genome had 91.02% similarity with SARS-CoV-2

and 90.55% similarity with Bat-CoV RaTG13. However, whether pangolin species are

good candidates for SARS-CoV-2 origin is still under debate. Considering the wide

spread of SARSr-CoVs in natural reservoirs, such as bats, camels, and pangolins.

Figure 1. Origin, Intermediate host and host of Covid 19

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138423/figure/FIG2/

Pathophysiology

A. Transmission

When the droplet particles are >5-10 μm in diameter they are referred to as

respiratory droplets, and when then are <5μm in diameter, they are referred to as droplet

nuclei.

Current evidence indicates that respiratory droplets among people who are in

close contact with each other are the main way in which the virus spreads. The virus can

spread from an infected person’s mouth or nose in small liquid particles when they

cough, sneeze, speak, sing or breathe heavily. When a person is in close contact (within 1

m) with someone who has respiratory symptoms, droplet transmission occurs. In the

immediate environment around the infected person, transmission of the COVID-19 virus

can also occur through fomites. Thus, transmission of the COVID-19 virus may occur

via direct contact with infected people and indirect contact with surfaces in the immediate

environment or with items used on the infected person (WHO, 2020.)

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In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not
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reported. There is some evidence that infection with COVID-19 may lead to intestinal

infection and may be present in feces. However, to date only one study has cultured the

COVID-19 virus from a single stool specimen. There have been no reports of faecal−oral

transmission of the COVID-19 virus to date. (WHO, 2020).

Some case reports indicate suspected transmission of asymptomatic careers, but

the exact mechanism is unknown. Cases related to transmission from asymptomatic

careers generally have a history of close contact with COVID-19 patients (Y. Han, H.

Yang, 2020).

B. Pathogenesis

The coronaviruses are made up of four structural proteins, namely, the spike (S),

membrane (M), envelop (E) and nucleocapsid (N) proteins. The virus is transmitted via

respiratory droplets and aerosols from person to person. Once inside the body, the virus

binds to host receptors and enters host cells through endocytosis or membrane fusion

(Cascella M., Bosch BJ. et al, 2020). Active replication and release of the virus in the

lung cells contribute to non-specific symptoms such as fever, myalgia, headache, and

respiratory symptoms (Cevik M., 2020)

Following viral transmission, SARS-CoV-2 binds to ACE 2, the host target cell

receptor. It is suspected that ACE 2 protein, which is highly expressed on multiple human

cells including type II alveolar cells (AT2), nasal, esophageal, ileal epithelial cells,
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myocardial cells, proximal kidney tubule cells and urothelial bladder cells, mediates the
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internalization of SARS-CoV2 (Zou X et. al, 2020).

Isolated from the bronchoalveolar lavage fluid (BALF) of a COVID-19 patient,

Zhou et al. have confirmed that the SARS-CoV-2 uses the same cellular entry receptor,

ACE2, as SARS-CoV1. ACE2, found in the lower respiratory tract of humans, regulates

both the cross-species and human-to-human transmission (Wan Y et al., 2020).

The virion S-glycoprotein on the surface of coronavirus can attach to the receptor,

ACE2 on the surface of human cells (Tortorici MA. et al, 2019). S glycoprotein includes

two subunits, S1 and S2 (Zhang N., 2014). With the primary role domain - RBD, S1

specifies the virus-host spectrum and cellular tropism, while S2 mediates virus-cell

membrane fusion through two tandem domains, heptad repeats 1 (HR1) and HR2 (Xia S,

Yu F., 2020)

The viral genome RNA is released into the cytoplasm after membrane fusion, and

the uncoated RNA translates into two polyproteins, pp1a and pp1ab (de Wilde AH, 2014)

which encode non-structural proteins and form a double-membrane vesicle replication-

transcription complex (RTC) (Sawicki SG., 2015)

A nested collection of subgenomic RNAs, encoding accessory proteins and

structural proteins, is continuously replicated and synthesized by RTC (Hussain S. et al.,

2005). Mediating endoplasmic reticulum (ER) and Golgi, newly formed genomic RNA,

nucleocapsid proteins and envelope glycoproteins assemble and form viral particle buds.
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Lastly, the virion-containing vesicles fuse with the plasma membrane to release the virus.
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(Perrier A. et al., 2019).

A cellular enzyme called furin at the S1/S2 site cleaves the spike (S) protein of

SARS-CoV2. For viral entry into the lung cells, this cleavage is necessary (Hoffmann M.

et al., 2020). TMPRSS2 primes the activated S protein and ultimately binds ACE 2

receptors to the host cells for entry. SARS-genetic CoV-2's sequence is homologous to

SARS-CoV, and the (S) protein structure of both viruses is highly similar. Both use the

same receptor to reach the host cell, but SARS-CoV-2 binds to ACE 2 receptors with 10

times greater affinity (Wrapp D, Wang N, Corbett KS et al., 2020).

Figure 2. Viral and host factors that contribute to pathogenesis of COVID 19

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Source: https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-00240-0/figures/1

C. Clinical manifestation and characteristics

People of all ages are vulnerable to the infection of COVID-19. Children and

adolescents under 18 years of age account for fewer than 2% of reported cases of

COVID-19 (Dong Y, Mo X, Hu Y et al., 2020). Several reports suggest that the majority

of infected children in the COVID-19 pandemic are asymptomatic or have mild

symptoms. Of the children who are infected, 11% need hospitalization (Bialek S, Gierke

R et al., 2020).
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Most children survive the disease and death related to COVID-19 is uncommon in
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cases aged under 18 years. In a cohort of 100 children admitted in the emergency in Italy

low-grade fever (54%), cough (44%) and anorexia (23%) were observed. Severe disease

was observed in 1–2% of the cases (Parri N. 2020)

Fever, dry cough, sore throat, headache, exhaustion, myalgia and breathlessness

are the typical clinical features of COVID-19 pneumonia in adults [39,40]. Disease

symptoms range from mild pneumonia (81%) to moderate pneumonia (hypoxia requiring

hospitalization, 14%) and serious illness in infected patients (leading to invasive

mechanical ventilation. n, multiorgan dysfunction and possibly death, 5 percent) (Wang

D, Chen N., 2020)

C. Complications

The risk of death depends on the age, underlying comorbidity and seriousness of

the condition, with critically ill patients increasing by up to 49%. Epidemiological results

from China show that, regardless of age, males are at higher risk of developing extreme

COVID-19 relative to females (Jin J-M, Bai P, He W et al., 2020)

Underlying comorbidities includes cardiovascular disease, chronic kidney disease,

chronic lung disease, diabetes and malignancy are associated with increased risk of

severity of COVID-19 (Wu Z, McGoogan JM. 2020). Obese patients as defined by BMI

of at least 30 Kg/m2 are at greater risk of deterioration of the disease and requirement of

intensive care unit (ICU) care (Caussy C, François P, Wallet F et al., 2020) The most
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affected organs are the lungs, followed by the heart, kidneys, liver, brain and
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gastrointestinal system ( Zhou F, Yu T, Du R et al., 2020)

Diagnosis

COVID-19 clinical diagnosis is primarily based on epidemiological history,

clinical symptoms and certain auxiliary tests, such as nucleic acid detection, CT scan,

IgM/IgG point-of-care (POCT) immune recognition technology, enzyme-linked

immunosorbent assay (ELISA) and blood culture. However, the clinical symptoms and

signs of patients infected with SARS-CoV-2 are highly atypical, including respiratory

symptoms, cough, fever, dyspnea, and viral pneumonia. Therefore, auxiliary

examinations are necessary for the diagnosis of COVID-19, just as the epidemiological

history (Xiaowei L. et al., 2020)

The China CDC shared the SARS-CoV-2 genetic sequence on 12 January 2020.

This required countries to develop primers against the SARS-CoV-2 genome and to

diagnose COVID-19 using reverse transcriptase polymerase chain reaction (RT-PCR)

assays. RT-PCR has thus become the gold standard for COVID-19 diagnosis, but it is

only 66-80% sensitive. Essentially, this means that despite being contaminated, 20-34

percent of patients with COVID-19 out of 100 will test negative. This sensitivity

variation can be attributed to patients being checked early in the course of the disease in

which the viral load is below the detection stage or due to a lack of automation in RT-

PCR sample preparation. (Ai T, Yang Z, Hou H, et al., 2020).

Treatment
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After the diagnosis of SARS-Cov2 infection, prevention and quarantine are
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considered to be the most effective way to avoid the rapid spread of the virus since there

is no effective vaccine, medication or antiviral to prevent and treat this disease, despite

the great efforts made by scientists and researchers around the world to develop

coronavirus vaccines and treatments. Furthermore, several strategies were carried out to

help patients with COVID-2019 as oxygen therapy (major treatment intervention),

antivirals Lopinavir, Ritonavir, Ribavirin, Favipiravir (T-705), remdesivir, oseltamivir,

Chloroquine, and Interferon (Y.-H. Jin et al. 2020; N. Chen et al., 2020; L. Zhang, 2020).

In October 2020, the FDA approved the antiviral drug remdesivir to treat COVID-19.

The drug may be used to treat adults and children ages 12 and older and weighing at least

88 pounds, who have been hospitalized for COVID-19. Clinical trials suggest that in

these patients, remdesivir may modestly speed up recovery time.

CHAPTER III
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RESEARCH DESIGN
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RESEARCH METHOD

In the middle of the COVID-19 pandemic, students of Cagayan State University –

Carig Campus will be investigated regarding their knowledge and possible response on

the vaccine trials in a descriptive type.

SAMPLES, SAMPLING DESIGN AND LOCALE OF THE STUDY

The study will be conducted on Cagayan State University – Carig Campus. This

study will use probability sampling procedure in selecting the respondents. The

researchers will select the suitable respondents based on their knowledge and opinion

about vaccination. Through these criteria, the researchers will be able to acquire the

adequate information.

RESEARCH INSTRUMENT

The instrument will be online surveys which comprise of several questions will be

utilized since face-to-face contact is improbable. The questionnaire will be composed of

the title of the research, brief introduction regarding the research, researchers, name of

the respondent (optional), age, course, as well as questions regarding the upcoming

vaccine trials, their knowledge about vaccines, the COVID-19, and issues regarding

dengvaxia vaccine which may affect vaccine administration.

DATA GATHERING PROCEDURE

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The researchers will first secure an ethics clearance from the CMVC Ethics
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Review Board. The data will be gathered using questionnaires which will be given

through online surveys.

The results of the online survey will be analyzed and interpreted by the

researchers for the questions posed in the study to be answered.

ANALYSIS FRAMEWORK

The researchers will analyze the data gathered by using Descriptive Statistics

(frequency and percentage) in interpreting the respondents’ profile, overall knowledge

and response of participants to the vaccination trial, and issues and concern of COVID-19

vaccine. Inferential-corretional statistics will be used in determining the association

between knowledge and response in vaccine trials and profile of respondents. From these

findings, the researchers will be able to understand the student’s knowledge and response

on COVID-19 vaccine trials.

REFERENCES
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1. Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al. Coronavirus disease 1

2019 (COVID-19): A literature review. J Infect Public Health. 2020;13(5):667–73.
   
2. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical
presentation, and management of the pandemic Coronavirus disease 2019 (COVID-
19). Cureus. 2020;12(4):e7560.
   
3. Parasher A. COVID-19: Current understanding of its Pathophysiology, Clinical
presentation and Treatment. Postgrad Med J. 2020;ostgradmedj-2020-138577.
   
4. Azer SA. COVID-19: pathophysiology, diagnosis, complications and investigational
therapeutics. New Microbes New Infect. 2020;37(100738):100738.
   
5. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin,
transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91–8.
   
6. Zhang T, Wu Q, Zhang Z. Probable pangolin origin of SARS-CoV-2 associated with
the COVID-19 outbreak. Curr Biol. 2020;30(7):1346-1351.e2.
   
7. Guidelines WHO. Infection prevention and control of epidemic- and pandemic-prone
acute respiratory infections in health care [Internet]. Who.int. [cited 2021 Jan 15].
Available from:
https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf?
sequence=1
   
8. Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin,
transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak
- an update on the status. Mil Med Res. 2020;7(1):11.
   
9. Office of the Commissioner. Coronavirus (COVID-19) Update: December 17, 2020
[Internet]. Fda.gov. 2020 [cited 2021 Jan 15]. Available from:
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-
december-17-2020
   
10 CDC. Different COVID-19 Vaccines [Internet]. Cdc.gov. 2020 [cited 2021 Jan 15].
. Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-
vaccines.html
   
Questionnaire
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Name: (Optional) Age:
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College/Course: Sex:

Religion:

1. Are you immunized with the available vaccines in your YES NO

Health Care Unit before?
2. Are you aware of the health benefits of vaccination? YES NO
3. What would you prefer for your vaccination?
___ Receive a vaccine at health center
___ Receive it from a private doctor
___ Receive it door-to-door
___ During mass immunizations
___ Through school-based programs
4. Did you ever refrain from having vaccinated? Why? YES NO

5. Does the timing of the vaccination program prevent you

YES NO
from getting immunized?
6. Do you believe that vaccines are safe? YES NO
7. Are you afraid of the possible effects of vaccine in
YES NO
general?
8. Do you believe that following a recommended shot
YES NO
schedule is a good idea for your child?
9. Are you afraid of the possible consequences of
YES NO
introducing a new vaccine to your system?
10. Covid-19 vaccines, being a new vaccine formulation, do
YES NO
you approve having it?
11. Among the following, which is more likely to give you an idea about
vaccination programs? Rate them from 1-6, 1 being the most influential.
___ Media (television, Radio, Newspapers)
___ Healthcare givers (Nurses, Midwives, etc.)
___ Community leaders (Mayor, Barangay Captain, etc.)
___ Religion and cultural beliefs
___ Family or other relatives
___ Friends or other individual aside from relatives
12. Do vaccinators provide you with sufficient information to
YES NO
address your concerns?
Cagayan State University College of Medicine
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13. Are you aware which vaccines should you get? YES NO
14. Are you aware of the Sinovac controversy? YES NO 1

15. If yes, do you approve having the vaccination? YES NO