Effect of Covid19 Pandemic on Preventive Vaccinations Among Patients with The End Stage Kidney Disease At New York Harbor VA Medical Center

Abstract

Background: The COVID-19 pandemic revealed challenges and barriers in achieving high preventive vaccination rates. This study aimed to explore the effects of the pandemic on vaccination rates in patients with end stage kidney disease (kidney dialysis) patients in New York City. These patients compose a challenging cohort as their transplant optimization includes routine vaccinations including pneumococcal, flu, Hepatitis A and B, meningococcal, H flu, HPV, Tdap, RZV, and Covid. Materials and Methods: This study population consisted of 142 participants from two Veteran Affairs hospitals in New York City. Vaccination and demographic information were compiled via EMR and compared to long term US vaccination rates using exact binomial tests. Secondary analysis using generalized estimating equations was used to compare vaccination rates pre- and post-pandemic within the Brooklyn VA population controlling for demographic variables. Results: The combined vaccination rate for the post-pandemic period was found to be significantly lower than the pre-pandemic rate in the general US population for several vaccines, including Hepatitis A (CI: 0.088, 0.098; p<0.001), Influenza (CI: 0.68, 0.69, p<0.001), Meningococcal (CI: 0.34, 0.35; p<0.001), MMR (, CI: 0.51, 0.52; p=0.001), and TDAP (CI: 0.18, 0.20; p<0.001). Secondary analysis using generalized estimating equations controlling for age, race, and time on dialysis within the Brooklyn VA population revealed increases in post-pandemic vaccination rates for Shingles (subunit; B=1.03; 95% Wald CI: .178, 1.87; p=.018) and Hepatitis B (B=-.739; 95% Wald CI: .084, 1.39; p=.027), while a significant decrease was observed for Hep A (B=-2.65; 95% Wald CI: -4.4, -.90; p=.003). Conclusion: This data demonstrates that post-pandemic vaccination rates in VA dialysis patients is lower than the past 10-year US average for several vaccines including Hepatitis A, Influenza, Meningococcal, MMR, and TDAP. Mixed effects of pre- and post-pandemic vaccination rates within the Brooklyn VA were also found with a decreased vaccination rate for Hepatitis A, and increased rates for Shingles and Hepatitis B. Further study is needed to evaluate pandemic’s effect on these rates, disease prevention, and identify the reasons contributing to vaccine hesitancy vs. acceptance.