Original article
Vol. 153 No. 12 (2023)
Use of complementary medicine and its association with SARS-CoV-2 vaccination during the COVID-19 pandemic: a longitudinal cohort study
- Mayssam Nehme
- Olivia Braillard
- Pierre-Yves Rodondi
- Idris Guessous
Summary
AIMS OF THE STUDY: Patients are increasingly using and requesting complementary medicine therapies, especially during the COVID-19 pandemic. However, it remains unclear whether they use them in conjunction with conventional medicine or to replace vaccination or other approaches and whether they discuss them with their physicians as part of shared decision-making. This study aimed to evaluate the use and initiation of complementary medicine during the COVID-19 pandemic, focusing on the association between complementary medicine use and COVID-19 vaccination status.
METHODS: This study is a part of the longitudinal cohort of the CoviCare program, which follows all outpatients tested for COVID-19 at the Geneva University Hospitals. Outpatients tested for COVID-19 were contacted 12 months after their positive or negative test between April and December 2021. Participants were asked about their vaccination status and if they had used complementary medicine in the past 12 months. Complementary medicine use was defined based on a specific list of therapies from which participants could choose the options they had used. Logistic regression models adjusting for age, sex, education, profession, severe acute respiratory system coronavirus 2 (SARS-CoV-2) infection, and pre-existing conditions were used to evaluate the association between being unvaccinated and complementary medicine use. SARS-CoV-2 infection status was evaluated for effect modification in the association between being unvaccinated and complementary medicine use.
RESULTS: This study enrolled 12,246 individuals (participation proportion = 17.7%). Their mean age was 42.8 years, 59.4% were women, and 63.7% used complementary medicine. Complementary medicine use was higher in women, the middle-aged, and those with a higher education level, a SARS-CoV-2 infection, or pre-existing comorbidities. A third of cases initiated complementary medicine therapies as prevention against COVID-19. Being unvaccinated was associated with complementary medicine use (adjusted odds ratio [aOR] 1.22 [1.09–1.37]), and more specifically when these therapies were used for COVID-19 prevention (aOR 1.61 [1.22–2.12]). Being unvaccinated was associated with the use of zinc (aOR 2.25 [1.98–2.55]), vitamin D (aOR 1.45 [1.30–1.62]), and vitamin C (aOR 1.59 [1.42–1.78]), and more specifically when these therapies were used for COVID-19 prevention. Only 4% of participants discussed using complementary medicine with their primary care physicians.
CONCLUSION: While complementary medicine is increasingly used, it is rarely discussed with primary care physicians. Complementary medicine use, especially for COVID-19 prevention, is associated with COVID-19 vaccination status. Communication between physicians, patients, and complementary medicine therapists is encouraged to facilitate a truly holistic approach to making a shared decision based on the best available information.
References
- National Center for Complementary and Integrative Health. NCCIH. Complementary, Alternative, or Integrative Health: What’s In a Name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name [Last updated April 2021].
- Carruzzo P, Graz B, Rodondi PY, Michaud PA. Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland. Swiss Med Wkly. 2013 Sep;143:w13756. 10.4414/smw.2013.13756
DOI: https://doi.org/10.4414/smw.2013.13756
- Shen J, Andersen R, Albert PS, Wenger N, Glaspy J, Cole M, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC Complement Altern Med. 2002 Aug;2(1):8. 10.1186/1472-6882-2-8
DOI: https://doi.org/10.1186/1472-6882-2-8
- Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol. 2000 Jul;18(13):2505–14. 10.1200/JCO.2000.18.13.2505
DOI: https://doi.org/10.1200/JCO.2000.18.13.2505
- Navo MA, Phan J, Vaughan C, Palmer JL, Michaud L, Jones KL, et al. An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies. J Clin Oncol. 2004 Feb;22(4):671–7. 10.1200/JCO.2004.04.162
DOI: https://doi.org/10.1200/JCO.2004.04.162
- Lee AH, Ingraham SE, Kopp M, Foraida MI, Jazieh AR. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital. Am J Clin Oncol. 2006 Apr;29(2):178–82. 10.1097/01.coc.0000209369.44100.25
DOI: https://doi.org/10.1097/01.coc.0000209369.44100.25
- Meier-Girard D, Lüthi E, Rodondi PY, Wolf U. Prevalence, specific and non-specific determinants of complementary medicine use in Switzerland: Data from the 2017 Swiss Health Survey. PLoS One. 2022 Sep;17(9):e0274334. 10.1371/journal.pone.0274334
DOI: https://doi.org/10.1371/journal.pone.0274334
- Kemppainen LM, Kemppainen TT, Reippainen JA, Salmenniemi ST, Vuolanto PH. Use of complementary and alternative medicine in Europe: health-related and sociodemographic determinants. Scand J Public Health. 2018 Jun;46(4):448–55. 10.1177/1403494817733869
DOI: https://doi.org/10.1177/1403494817733869
- Kim TH, Kang JW, Jeon SR, Ang L, Lee HW, Lee MS. Use of Traditional, Complementary and Integrative Medicine During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022 May;9:884573. 10.3389/fmed.2022.884573
DOI: https://doi.org/10.3389/fmed.2022.884573
- Jeon SR, Kang JW, Ang L, Lee HW, Lee MS, Kim TH. Complementary and alternative medicine (CAM) interventions for COVID-19: an overview of systematic reviews. Integr Med Res. 2022 Sep;11(3):100842. 10.1016/j.imr.2022.100842
DOI: https://doi.org/10.1016/j.imr.2022.100842
- Kretchy IA, Boadu JA, Kretchy JP, Agyabeng K, Passah AA, Koduah A, et al. Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana: A national cross-sectional online survey. Prev Med Rep. 2021 Dec;24:101633. 10.1016/j.pmedr.2021.101633
DOI: https://doi.org/10.1016/j.pmedr.2021.101633
- Seifert G, Jeitler M, Stange R, Michalsen A, Cramer H, Brinkhaus B, et al. The Relevance of Complementary and Integrative Medicine in the COVID-19 Pandemic: A Qualitative Review of the Literature. Front Med (Lausanne). 2020 Dec;7:587749. 10.3389/fmed.2020.587749
DOI: https://doi.org/10.3389/fmed.2020.587749
- Kim TH, Jeon SR, Kang JW, Kwon S. Complementary and Alternative Medicine for Long COVID: Scoping Review and Bibliometric Analysis. Evid Based Complement Alternat Med. 2022 Aug;2022:7303393. 10.1155/2022/7303393
DOI: https://doi.org/10.1155/2022/7303393
- Bourqui A, Rodondi PY, El May E, Dubois J. Practicing traditional Chinese medicine in the COVID-19 pandemic in Switzerland - an exploratory study. BMC Complement Med Ther. 2022 Sep;22(1):240. 10.1186/s12906-022-03715-w
DOI: https://doi.org/10.1186/s12906-022-03715-w
- Kristoffersen AE, Jong MC, Nordberg JH, van der Werf ET, Stub T. Safety and use of complementary and alternative medicine in Norway during the first wave of the COVID-19 pandemic using an adapted version of the I-CAM-Q; a cross-sectional survey. BMC Complement Med Ther. 2022 Sep;22(1):234. 10.1186/s12906-022-03656-4
DOI: https://doi.org/10.1186/s12906-022-03656-4
- O’Connor EA, Evans CV, Ivlev I, Rushkin MC, Thomas RG, Martin A, et al. Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022 Jun;327(23):2334–47. 10.1001/jama.2021.15650
DOI: https://doi.org/10.1001/jama.2021.15650
- An P, Wan S, Luo Y, Luo J, Zhang X, Zhou S, et al. Micronutrient Supplementation to Reduce Cardiovascular Risk. J Am Coll Cardiol. 2022 Dec;80(24):2269–85. 10.1016/j.jacc.2022.09.048
DOI: https://doi.org/10.1016/j.jacc.2022.09.048
- Parvizi MM, Forouhari S, Shahriarirad R, Shahriarirad S, Bradley RD, Roosta L. Prevalence and associated factors of complementary and integrative medicine use in patients afflicted with COVID-19. BMC Complement Med Ther. 2022 Sep;22(1):251. 10.1186/s12906-022-03722-x
DOI: https://doi.org/10.1186/s12906-022-03722-x
- Attwell K, Ward PR, Meyer SB, Rokkas PJ, Leask J. “Do-it-yourself”: vaccine rejection and complementary and alternative medicine (CAM). Soc Sci Med. 2018 Jan;196:106–14. 10.1016/j.socscimed.2017.11.022
DOI: https://doi.org/10.1016/j.socscimed.2017.11.022
- Kohl-Heckl WK, Schröter M, Dobos G, Cramer H. Complementary medicine use and flu vaccination - A nationally representative survey of US adults. Vaccine. 2021 Sep;39(39):5635–40. 10.1016/j.vaccine.2021.08.017
DOI: https://doi.org/10.1016/j.vaccine.2021.08.017
- Jones L, Sciamanna C, Lehman E. Are those who use specific complementary and alternative medicine therapies less likely to be immunized? Prev Med. 2010 Mar;50(3):148–54. 10.1016/j.ypmed.2009.12.001
DOI: https://doi.org/10.1016/j.ypmed.2009.12.001
- Neely SR, Eldredge C, Ersing R, Remington C. Vaccine Hesitancy and Exposure to Misinformation: a Survey Analysis. J Gen Intern Med. 2022 Jan;37(1):179–87. 10.1007/s11606-021-07171-z
DOI: https://doi.org/10.1007/s11606-021-07171-z
- Antonelli M, Penfold RS, Merino J, Sudre CH, Molteni E, Berry S, Canas LS, Graham MS, Klaser K, Modat M, Murray B, Kerfoot E, Chen L, Deng J, Österdahl MF, Cheetham NJ, Drew DA, Nguyen LH, Pujol JC, Hu C, Selvachandran S, Polidori L, May A, Wolf J, Chan AT, Hammers A, Duncan EL, Spector TD, Ourselin S, Steves CJ. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2021 Sep 1:S1473-3099(21)00460-6. doi: 10.1016/S1473-3099(21)00460-6. Epub ahead of print. PMID: 34480857; PMCID: PMC8409907.
DOI: https://doi.org/10.1016/S1473-3099(21)00460-6
- Lazarus JV, Wyka K, White TM, Picchio CA, Rabin K, Ratzan SC, et al. Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021. Nat Commun. 2022 Jul;13(1):3801. 10.1038/s41467-022-31441-x
DOI: https://doi.org/10.1038/s41467-022-31441-x
- Heiniger S, Schliek M, Moser A, von Wyl V, Höglinger M. Differences in COVID-19 vaccination uptake in the first 12 months of vaccine availability in Switzerland - a prospective cohort study. Swiss Med Wkly. 2022 Apr;152(1314):w30162. 10.4414/smw.2022.w30162 10.4414/SMW.2022.w30162
DOI: https://doi.org/10.4414/SMW.2022.w30162
- Nehme M, Baysson H, Pullen N, Wisniak A, Pennacchio F, Zaballa ME, et al.; Specchio-COVID19 study group. Perceptions of vaccination certificates among the general population in Geneva, Switzerland. Swiss Med Wkly. 2021 Nov;151(4748):w30079. 10.4414/smw.2021.w30079 10.4414/SMW.2021.w30079
DOI: https://doi.org/10.4414/SMW.2021.w30079
- Nehme M, Braillard O, Chappuis F, Courvoisier DS, Kaiser L, Soccal PM, et al.; CoviCare Study Team. One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals. J Intern Med. 2022 Jul;292(1):103–15. 10.1111/joim.13482; Epub ahead of print. 10.1111/joim.13482
DOI: https://doi.org/10.1111/joim.13482
- Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021 Feb;27(2):258–63. 10.1016/j.cmi.2020.09.052
DOI: https://doi.org/10.1016/j.cmi.2020.09.052
- Kristoffersen AE, Stub T, Salamonsen A, Musial F, Hamberg K. Gender differences in prevalence and associations for use of CAM in a large population study. BMC Complement Altern Med. 2014 Dec;14(1):463. 10.1186/1472-6882-14-463
DOI: https://doi.org/10.1186/1472-6882-14-463
- Shen HN, Lin CC, Hoffmann T, Tsai CY, Hou WH, Kuo KN. The relationship between health literacy and perceived shared decision making in patients with breast cancer. Patient Educ Couns. 2019 Feb;102(2):360–6. 10.1016/j.pec.2018.09.017
DOI: https://doi.org/10.1016/j.pec.2018.09.017
- Meyer SB, Ward PR, Jiwa M. Does prognosis and socioeconomic status impact on trust in physicians? Interviews with patients with coronary disease in South Australia. BMJ Open. 2012 Oct;2(5):e001389. 10.1136/bmjopen-2012-001389
DOI: https://doi.org/10.1136/bmjopen-2012-001389
- Fjær EL, Landet ER, McNamara CL, Eikemo TA. The use of complementary and alternative medicine (CAM) in Europe. BMC Complement Med Ther. 2020 Apr;20(1):108. 10.1186/s12906-020-02903-w
DOI: https://doi.org/10.1186/s12906-020-02903-w
- Thomas S, Patel D, Bittel B, Wolski K, Wang Q, Kumar A, et al. Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial. JAMA Netw Open. 2021 Feb;4(2):e210369. 10.1001/jamanetworkopen.2021.0369
DOI: https://doi.org/10.1001/jamanetworkopen.2021.0369
- National Institutes of Health. COVID-19 Treatment Guidelines, Zinc Supplementation and COVID-19. 2021. https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/zinc/ [Last accessed January, 15, 2023].
- National Institutes of Health. COVID-19 Treatment Guidelines, Vitamin D. 2021. https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/vitamin-d/ [Last accessed January 15, 2023].
- National Institutes of Health. COVID-19 Treatment Guidelines, Vitamin C. 2021. https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/vitamin-c/ [Last accessed January 15, 2023].
- Paudyal V, Sun S, Hussain R, Abutaleb MH, Hedima EW. Complementary and alternative medicines use in COVID-19: A global perspective on practice, policy and research. Res Social Adm Pharm. 2022 Mar;18(3):2524–8. 10.1016/j.sapharm.2021.05.004
DOI: https://doi.org/10.1016/j.sapharm.2021.05.004
- Dehghan M, Ghanbari A, Ghaedi Heidari F, Mangolian Shahrbabaki P, Zakeri MA. Use of complementary and alternative medicine in general population during COVID-19 outbreak: A survey in Iran. J Integr Med. 2022 Jan;20(1):45–51. 10.1016/j.joim.2021.11.004
DOI: https://doi.org/10.1016/j.joim.2021.11.004
- Département de la sécurité, de la population et de la santé (DSPS). COVID-19 : Chiffres et campagne de vaccination à Genève. https://www.ge.ch/document/covid-19-chiffres-campagne-vaccination-geneve. Last updated January 23, 2023.
- Overbeck S, Rink L, Haase H. Modulating the immune response by oral zinc supplementation: a single approach for multiple diseases. Arch Immunol Ther Exp (Warsz). 2008;56(1):15–30. 10.1007/s00005-008-0003-8
DOI: https://doi.org/10.1007/s00005-008-0003-8
- te Velthuis AJ, van den Worm SH, Sims AC, Baric RS, Snijder EJ, van Hemert MJ. Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathog. 2010 Nov;6(11):e1001176. 10.1371/journal.ppat.1001176
DOI: https://doi.org/10.1371/journal.ppat.1001176
- Read SA, Obeid S, Ahlenstiel C, Ahlenstiel G. The Role of Zinc in Antiviral Immunity. Adv Nutr. 2019 Jul;10(4):696–710. 10.1093/advances/nmz013
DOI: https://doi.org/10.1093/advances/nmz013
- Soveri A, Karlsson LC, Mäki O, Antfolk J, Waris O, Karlsson H, et al. Trait reactance and trust in doctors as predictors of vaccination behavior, vaccine attitudes, and use of complementary and alternative medicine in parents of young children. PLoS One. 2020 Jul;15(7):e0236527. 10.1371/journal.pone.0236527
DOI: https://doi.org/10.1371/journal.pone.0236527
- Hornsey MJ, Lobera J, Díaz-Catalán C. Vaccine hesitancy is strongly associated with distrust of conventional medicine, and only weakly associated with trust in alternative medicine. Soc Sci Med. 2020 Jun;255:113019. 10.1016/j.socscimed.2020.113019
DOI: https://doi.org/10.1016/j.socscimed.2020.113019
- Braillard O, Guessous I, Gaspoz JM. Dialoguer au sujet de la vaccination à l’ère de la post-vérité. Rev Med Suisse. 2017 Sep 27;13(576):1635. French. PMID: 28953331.
- Lucas Ramanathan P, Baldesberger N, Dietrich LG, Speranza C, Lüthy A, Buhl A, et al. Health Care Professionals’ Interest in Vaccination Training in Switzerland: A Quantitative Survey. Int J Public Health. 2022 Nov;67:1604495. 10.3389/ijph.2022.1604495
DOI: https://doi.org/10.3389/ijph.2022.1604495
- Frawley JE, McKenzie K, Forssman BL, Sullivan E, Wiley K. Exploring complementary medicine practitioners’ attitudes towards the use of an immunization decision aid, and its potential acceptability for use with clients to reduce vaccine related decisional conflict. Hum Vaccin Immunother. 2021 Feb;17(2):588–91. 10.1080/21645515.2020.1787069
DOI: https://doi.org/10.1080/21645515.2020.1787069