Disparities In Vaccination Coverage Research Articles

The clinical and economic costs associated with regional disparities in varicella vaccine coverage in Italy over 50 years (2020–2070)

Italy implemented two-dose universal varicella vaccination (UVV) regionally from 2003 to 2013 and nationally from 2017 onwards. Our objective was to analyze regional disparities in varicella outcomes resulting from disparities in vaccine coverage rates (VCRs) projected over a 50-year time-horizon (2020–2070). A previously published dynamic transmission model was updated to quantify the potential public health impact of the UVV program in Italy at the national and regional levels. Four 2-dose vaccine strategies utilizing monovalent (V) and quadrivalent (MMRV) vaccines were evaluated for each region: (A) MMRV-MSD/MMRV-MSD, (B) MMRV-GSK/MMRV-GSK, (C) V-MSD/MMRV-MSD, and (D) V-GSK/MMRV-GSK. Costs were reported in 2022 Euros. Costs and quality-adjusted life-years (QALYs) were discounted 3% annually. Under strategy A, the three regions with the lowest first-dose VCR reported increased varicella cases (+ 34.3%), hospitalizations (+ 20.0%), QALYs lost (+ 5.9%), payer costs (+ 22.2%), and societal costs (+ 14.6%) over the 50-year time-horizon compared to the three regions with highest first-dose VCR. Regions with low first-dose VCR were more sensitive to changes in VCR than high first-dose VCR regions. Results with respect to second-dose VCR were qualitatively similar, although smaller in magnitude. Results were similar across all vaccine strategies.

Disparities in Vaccination Coverage and Timeliness among Children Aged 12 to 23 Months within Calabar South, Cross River State, Nigeria

Immunization serves as a cost-effective shield against vaccine-preventable diseases, promoting population health and sustainable prosperity. This study aimed to determine vaccination coverage and assess the timeliness of vaccination (BCG, PENTA1, and measles vaccines) among children aged 12 to 23 months in the wards of Calabar South Local Government Area (LGA) in Cross River State. A community-based cross-sectional descriptive design was employed, with the number of children sampled being 460 to account for non-response and design. Information about children were obtained through interviews with proxy caregivers. Data analysis was performed using SPSS version 25.0. Ethical approval was obtained from the CRS Ministry of Health. There were 190 male children (41.3%) and 275 female children (58.7%) in the study. The age group of 12-15 months (55.2%) represents the largest category. The overall vaccination coverage was 88.3%, varying across wards (100% in ward 4, followed by 96.1% in ward 8, then 96% in ward 5, 91.6% in ward 12, and 80.8% in ward 11). The proportion of overall timely vaccination was 71.5%, with PENTA1 having the highest timeliness (88.3%). The proportions of timely vaccination for BCG and PENTA1 were highest in ward 4, followed by ward 5, but lowest in ward 11. Timeliness for all vaccines was also highest in ward 4, followed by ward 12, then ward 5, ward 8 and ward 11. Vaccination coverage and timeliness differed between locations, highlighting the need for Government interventions to be context-specific, addressing challenges within different ward locations rather than applying a one-size-fits-all approach.

The Association of Vaccination for Common Adult Infectious Diseases and Uptake of COVID-19 Vaccines among 5,006,851 Veterans, 20 December 2020-31 October 2021.

Disparities in vaccination coverage for coronavirus disease 2019 (COVID-19) in the United States (U.S.) are consistent barriers limiting our ability to control the spread of disease, particularly those by age and race/ethnicity. This study examines the association between previous vaccination for common adult infectious diseases and vaccination for SARS-CoV-2 among a cohort of veterans in the U.S. Sociodemographic and clinical data were utilized from three databases within the Veterans Health Administration included in the electronic health record. We examined the association of previous vaccination for common adult vaccinations through six separate multivariable logistic regression analyses, one for each previous vaccine exposure, adjusting for demographic and clinical variables. We also examined the association of receiving any one of the six common adult vaccinations and vaccination against SARS-CoV-2. Adjusted models indicate higher odds of vaccination for SARS-CoV-2 among those who received each of the previous vaccinations. Significant differences were also noted by race/ethnicity and age. Veterans who recorded receiving any one of the previous vaccinations for common adult infections had significantly greater odds of receiving any vaccination against SARS-CoV-2. Understanding veterans' previous vaccination status can assist researchers and clinicians in impacting the uptake of novel vaccines, such as vaccination against SARS-CoV-2.

Increasing equity in adult immunization through community-level action.

Inequities in availability and access to adult vaccinations represent significant gaps in the US public health infrastructure. Adults in racial and ethnic minority groups are less likely to receive routinely recommended vaccinations due to systemic barriers, distribution inequities, and lack of trust in vaccines; similar disparities were seen during early COVID-19 vaccination efforts. However, a deliberate focus on reducing disparities can yield progress. National data show narrowing of racial and ethnic adult COVID-19 vaccination coverage disparities over time, highlighting the value of the equity-focused, community-level interventions implemented during the pandemic. This paper describes the Centers for Disease Control and Prevention's efforts during the COVID-19 pandemic to address racial and ethnic disparities in adult immunization, and how lessons learned may be applied post-pandemic. Progress made is likely to be lost without sustained support for adult vaccination at national, state, and community levels.

1143. Meningococcal Vaccination Coverage Disparities in the United States: An Analysis with 2016-2021 National Immunization Survey-Teen Data

Abstract Background The US Advisory Committee on Immunization Practices recommends meningococcal vaccination against serogroups A, C, W, and Y (MenACWY) for 11–12 year-olds (y/o) with a booster at 16; and against serogroup B (MenB) for 16–23 y/o under shared clinical decision making (SCDM). We used a large US survey to assess vaccination coverage across vaccines, geography and race/ethnicity. Methods This was a cross-sectional analysis using 2016-2021 National Immunization Survey-Teen survey data on MenACWY (≥1 dose [d]) in 13 y/o, MenACWY (≥2 d) and MenB (≥1 d) in 17 y/o. Data were collected via phone interviews with provider confirmation. We assessed coverage throughout the calendar year for MenACWY (≥1 d) and MenB (≥1 d) after the interview date, and for MenACWY (≥2 d) at the interview date. Results MenACWY coverage (≥1 d) in 13 y/o evolved from 82.71% (2016) to 86.42% (2021). MenACWY coverage (≥1 d) in 13-17 y/o changed from 83.36% (2016) to 89.82% (2021). MenB coverage (≥1 d) in 17 y/o changed from 5.63% (2016) to 34.05% (2021). Geographic coverage was more variable moving from MenACWY (≥1 d) in 13 y/o (74.44% Pacific region 2016 to 91.00% New England region 2021) to MenACWY (≥2 d) in 17 y/o (21.05% East South Central region 2016 to 75.68% Mid-Atlantic region 2021) and MenB (≥1 d) in 17 y/o (2.34% Pacific region 2016 to 45.29% South Atlantic region 2021). MenACWY coverage (≥1 d) in 13 y/o was consistent across race/ethnicity, while 17 y/o Hispanic had lower MenACWY coverage (≥2 d) in 2021 (50.63%). For MenB (≥1 d) in 17 y/o, coverage varied by race/ethnicity; coverage in Hispanic and Non-Hispanic (NH) Black populations increased from 5.55% and 7.55% to 33.58% and 42.33% over 5 years, respectively. In NH White population, coverage yearly increased from 5.29% to 33.88%, while it only progressed from 5.34% to 27.17% in other NH + Multiple race population. Conclusion Meningococcal vaccination disparities persist across vaccines, ages, geography, and race/ethnicity (MenB only). Disparities increase with age, and with SCDM- versus routinely- recommended vaccines (MenB vs. MenACWY). Top performing states show that better coverage is possible (∼70% MenB coverage in North Dakota vs. 34% nationally in 2021), pointing at the need to reduce access barriers to vaccination, e.g., via simplified vaccine recommendations/schedules. Disclosures Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Sara Poston, PharmD, GSK: Stocks/Bonds

Mpox Vaccination and the Role of Social Vulnerability in Durham County, North Carolina, USA.

Disparities in vaccine coverage among groups in the USA is common, possibly due to higher vaccine hesitancy in certain populations, difficulty accessing vaccines, and underlying social vulnerability. The aim of this study was to investigate the association between mpox vaccine administration, social determinants of health, and social vulnerability index (SVI) in Durham County, North Carolina, USA. Random forest regression (RFE) and min-max scaling preprocessing were used to predict mpox vaccinations in Durham County at the census tract level. The top eleven most influential features and their correlations with mpox vaccination were calculated. Non-Hispanic white individuals, males, and those between the ages of 20 and 40 years were overrepresented in mpox vaccine reception in Durham County. Surprisingly, lacking a high school diploma, lacking health insurance, lacking a household vehicle, and living below the poverty line were all positively associated with receiving the mpox vaccine. Being a Black or African American and Hispanic or Latino individual was also positively associated with receiving the mpox vaccine. Vaccine outreach efforts in Durham County, North Carolina, had success in reaching at-risk individuals, including socially vulnerable individuals. Future research should focus more specifically on how social vulnerability relates to vaccine reception for vaccine-preventable diseases.

Disparities in COVID-19 Vaccination Status Among Long-Term Care Facility Residents - United States, October 31, 2022-May 7, 2023.

Residents of long-term care (LTC) facilities constitute a population that is vulnerable to SARS-CoV-2 infection; COVID-19 vaccination effectively reduces severe COVID-19 in these settings. To examine demographic differences in primary and up-to-date vaccination status against COVID-19 among LTC facility residents, a descriptive analysis of COVID-19 vaccination data from the National Healthcare Safety Network (NHSN) COVID-19 vaccination data from October 31, 2022, to May 7, 2023, were analyzed. Being up to date was defined as having received a bivalent COVID-19 vaccine dose or having completed a primary vaccination series <2 months earlier. Geographic disparities in vaccination coverage were identified, with substantially lower prevalences of up-to-date status among LTC facility residents in the South (Region 6) (37.7%) and Southeast (Region 4) (36.5%) than among those in the Pacific Northwest (Region 10) (53.3%) and Mountain West (Region 8) (59.6%) U.S. Department of Health and Human Services regions. Up-to-date status was lowest among Black or African American (39.9%) and multiracial (42.2%) LTC facility residents. Strategies to increase up-to-date COVID-19 vaccination among LTC facility residents could include and address these geographic and racial differences.

Epidemiology of confirmed measles virus cases, surveillance, incidence, and associated factors in Eritrea: 18-year retrospective analysis.

Despite the outstanding measles vaccine coverage (MVC) in Eritrea, sporadic outbreaks are not uncommon. Therefore, understanding the incidence of laboratory-confirmed measles virus cases, related factors, and spatial inequalities in testing and surveillance remains crucial. In this analysis, we evaluated the incidence and spatiotemporal distribution of measles in Eritrea. An evaluation of the factors associated with measles vaccination and IgM positive (+) febrile rash was also undertaken. A retrospective (period: 2002-2020) study was carried out by abstracting data from the integrated disease surveillance and response database (IDSR). Data was analyzed using descriptive statistics and binary logistic regression. Spatial variability and distribution of confirmed cases was evaluated using ArcGIS Pro version 3.0.1. In total, 9,111 suspected cases, 2,767 [1,431 (51.7%) females] were serologically tested. The median (IQR) age, minimum-maximum age were 7 years (IQR: 4-14 years) and 1 month-97 years, respectively. Among the 608(21.9%) laboratory-confirmed cases, 534 (87.8%) were unvaccinated and 53 (9.92%) were < 1 year old. The crude incidence rate for MV was 14/100,000 persons. The age-specific positivity rate per 100,000 suspected cases tested was 21.5 with individuals >30 years presenting with the highest rates (69.9/100,000). Higher odds (OR) of MV test positivity was associated with age at onset - higher in the following age-bands [10-14 years: OR = 1.6 (95%CI, 1.1-2.2, value of p = 0.005); 15-29 years: OR = 7.0 (95%CI, 5.3-9.2, value of p = 0.005); and > =30 years: OR = 16.7 (95%CI, 11.7-24) p < 0.001]. Other associations included: Address - higher in Anseba (OR = 2.3, 95%CI: 1.7-3.1, value of p<0.001); Debub (OR = 2.7, 95%CI: 1.9-3.9, value of p < 0.001); Gash-Barka (OR = 15.4, 95%CI: 10.9-21.7, value of p < 0.001); Northern Red Sea (OR = 11.8, 95%CI: 8.5-16.2, value of p < 0.001); and Southern Red Sea (OR = 14.4, 95%CI: 8.2-25.2, value of p < 0.001). Further, test positivity was higher in health centers (OR = 2.5, 95%CI: 1.9-3.4, value of p < 0.001) and hospitals (OR = 6.8, 95%CI: 5.1-9.1, value of p < 0.001). Additional factors included vaccination status - higher in the unvaccinated (OR = 14.7, 95%CI: 11.4-19.1, value of p < 0.001); and year of onset of rash - (higher >2015: OR = 1.4, 95%CI: 1.1-1.7, value of p<0.001). Uptake of measles vaccine associated with a similar complement of factors. In large part, efforts to eliminate measles in Eritrea are hindered by disparities in vaccine coverage, under-surveillance, and low vaccination rates in neighboring countries. Enhanced surveillance and regional micro planning targeting hard-to-reach areas can be an effective strategy to improve measles elimination efforts in Eritrea.

Beyond the numbers: An in-depth look at Cameroon's fifth national COVID-19 vaccination campaign through geographical and gender lenses

BackgroundCameroon has been struggling with low Covid-19 vaccination coverage, with only 4.5 % of the population receiving the primary series as of November 2022. The COVID-19 Vaccine Delivery Partnership (CoVDP) conducted a high-level mission to Cameroon to assess progress and advocate for actions to address bottlenecks. The objective of the mission was to administer at least 3,000,000 doses of vaccines during the 5th Mass vaccination campaign. This study examines the factors contributing to the success of the campaign and uses a geographical and gender lens to assess the results. MethodsThe study is a secondary analysis of data from the DHIS2 collected during the 5th mass vaccination campaign for Covid-19. Descriptive statistics were used to assess coverages per location and gender expressed in OR. sccess factors, and chi-squared tests were used to assess differences in vaccine distribution across regions and by gender. ResultsThis 5th vaccination campaign benefitted from a strong political commitment facilitated by CoVDP's mission, international support, collaboration, planning, supervision, and demand generation.The campaign recorded 2 019 118 administered vaccine doses, a staggering 46-fold increase in vaccinated individuals relative to the first round, with vaccination coverage reaching 10.1 % of the general population. However, the study reveals regional and gender disparities in vaccination coverage. Men had higher odds of being vaccinated than women in the three Sahel regions. Among individuals with comorbidities, the national coverage rate was only 14 %, and the Far North and East regions exhibited the lowest coverage rates. Janssen was the most used vaccine, and the total AEFI cases reported were 2 per 1000 vaccine doses. ConclusionThe 5th COVID-19 vaccination campaign in Cameroon saw a strong political commitment and was the most successful so far. Despite the gains, there was gender disparity in coverage in some regions. It is important to continue the established momentum, ensure equitable access in the Sahel regions, and reach high-priority groups with primary series and booster doses.

Vaccination coverage among laboratory personnel - health safety imperative for all

AimThe objective of the study was to evaluate disparities in vaccination coverage among laboratory personnel in health care facilities and to identify risk factors for nonvaccination. Materials and methodsA multicenter, quantitative, cross-sectional study was conducted between November 2020 and February 2021. The validated bilingual questionnaire was distributed online through professional association networks. Descriptive and inferential statistics were included in the analysis. ResultsOf the 640 respondents, approximately one-third (30.9%) had received an annual influenza vaccination. Significantly higher vaccination coverage rates were reported for measles, tuberculosis, and hepatitis B (82.8%, 78.3%, and 72.5%, respectively). Influenza vaccination coverage was higher among LPs with higher education (p < 0.001), in microbiology laboratories (p = 0.009), in the private sector (p = 0.012), and twice as high in EU countries (p < 0.001). Measles vaccination coverage was lower among LPs older than 45 years (p < 0.001), had a college degree (p = 0.015), and were EU citizens (p = 0.002). Better tuberculosis vaccination coverage was found among LPs older than 45 years (p < 0.001), with higher educational degrees (p = 0.003), employed in microbiology laboratories (p = 0.004), and working in the private sector (p = 0.025). Hepatitis B vaccination coverage was higher among LPs under 45 years (p = 0.020), with higher levels of education (p = 0.003), and with respect to territorial affiliation (p < 0.001). ConclusionThe present study showed that the vaccination coverage rate was satisfactory for most LPs against hepatitis B, tuberculosis, and measles, while the coverage rate against influenza was low.

Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020.

Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States. We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics. In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined. These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.

Recombinant zoster vaccine coverage in the United States: An analysis of claims-based data.

Recombinant zoster vaccine (RZV) is recommended for individuals ≥ 50 years of age for protection against herpes zoster (HZ). This study quantifies RZV coverage and assesses predictors for RZV vaccination using a U.S. claims database. Univariate linear regression provided annual prevalence of RZV vaccination and multivariable logistic regression provided ORs and 95% CIs for associations between predictors and RZV vaccination. A total of 4,124,315 individuals (19,080,914 person-years) were included in this study. Since receiving FDA approval for the prevention of HZ, RZV coverage (of at least one dose) has reached approximately 17% within the eligible U.S. population by January 2021, although significant disparities between demographic groups were noted. Our findings suggest that HZ vaccine coverage may be reduced below goal in the U.S. and highlights the importance of continuing to monitor RZV vaccination. Additionally, as our study found disparities in vaccine coverage, attention towards marginalized and medically underserved populations is needed.

Exclusive and dual influenza and COVID-19 vaccination among U.S. adults and adolescents in 2021

Introduction Despite recommendations for influenza and COVID-19 vaccines, studies have documented gaps and disparities in vaccination coverage for adults and adolescents. Understanding the proportion and demographics of those unvaccinated against influenza and/or COVID-19 is important for tailoring appropriate messaging and strategies to increase confidence and uptake. Methods Using the 2021 National Health Interview Survey (NHIS), we assessed the prevalence of four vaccination patterns (exclusive influenza vaccination, exclusive COVID-19 vaccination, dual influenza and COVID-19 vaccination, and neither vaccination) by sociodemographic and other characteristics among adults and adolescents 12–17 years. Adjusted multivariable regression analyses were conducted to examine factors associated with each of the four vaccination categories among adults and adolescents. Results In 2021, 42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine. Among adults and adolescents, 6.0% and 11.4% were exclusively vaccinated against influenza and 29.1% and 26.4% were exclusively vaccinated against COVID-19, respectively. Among adults, exclusive COVID-19 or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree compared to their respective counterparts. Exclusive influenza or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below the poverty level, and having a previous COVID-19 diagnosis. Conclusion During the COVID-19 pandemic, approximately two-thirds of adolescents and three-fourths of adults received exclusive influenza or COVID-19 vaccines or both vaccines in 2021. Vaccination patterns differed by sociodemographic and other characteristics. Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases. Key messages 42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines in 2021, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine; 6.0% of adults and 11.4% of adolescents were exclusively vaccinated against influenza and 29.1% of adults and 26.4% of adolescents were exclusively vaccinated against COVID-19. Among adults, exclusive COVID-19 vaccination or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree or higher compared to their respective counterparts; exclusive influenza vaccination or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below poverty level, and having a previous COVID-19 diagnosis compared to their respective counterparts. Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases, especially as new variants emerge.

Vaccination coverage among laboratory personnel - health safety imperative for all

AimThe objective of the study was to evaluate disparities in vaccination coverage among laboratory personnel in health care facilities and to identify risk factors for nonvaccination. Materials and methodsA multicenter, quantitative, cross-sectional study was conducted between November 2020 and February 2021. The validated bilingual questionnaire was distributed online through professional association networks. Descriptive and inferential statistics were included in the analysis. ResultsOf the 640 respondents, approximately one-third (30.9%) had received an annual influenza vaccination. Significantly higher vaccination coverage rates were reported for measles, tuberculosis, and hepatitis B (82.8%, 78.3%, and 72.5%, respectively). Influenza vaccination coverage was higher among LPs with higher education (p < 0.001), in microbiology laboratories (p = 0.009), in the private sector (p = 0.012), and twice as high in EU countries (p < 0.001). Measles vaccination coverage was lower among LPs older than 45 years (p < 0.001), had a college degree (p = 0.015), and were EU citizens (p = 0.002). Better tuberculosis vaccination coverage was found among LPs older than 45 years (p < 0.001), with higher educational degrees (p = 0.003), employed in microbiology laboratories (p = 0.004), and working in the private sector (p = 0.025). Hepatitis B vaccination coverage was higher among LPs under 45 years (p = 0.020), with higher levels of education (p = 0.003), and with respect to territorial affiliation (p < 0.001). ConclusionThe present study showed that the vaccination coverage rate was satisfactory for most LPs against hepatitis B, tuberculosis, and measles, while the coverage rate against influenza was low.

Associations between Influenza Vaccination and Health Care Access among Adults in the United States.

Few studies have investigated the relationship between influenza vaccination and health care access. Furthermore, despite the well-documented disparities in vaccine coverage for communities of color, few studies have examined how experiences of discrimination may influence vaccine uptake. To fill this gap in the literature, this study examined associations between 5-year influenza vaccination rates and sociodemographic characteristics, health care access, and racial discrimination. Age, race/ethnicity, education, health care coverage, primary care provider, no medical care due to cost, and routine doctor checkups were significant correlates of 5-year influenza vaccination. In contrast to previous studies, discrimination scores were not a significant correlate of regular influenza vaccination. Respondents who reported forgoing care due to cost were less likely to report vaccination every year out of the last 5 years compared to all of the less frequent categories combined, demonstrating a more complex association between sometimes not being able to afford medical care and influenza vaccination. Future research should examine the relationship between influenza vaccination uptake, racial discrimination, and forgone care due to cost to enhance resources and messaging for influenza vaccination uptake.

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study.

Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015-2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state's population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in "percent college educated" was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher "percent Black/Latino/Indigenous" and higher "percent essential workers" had lower vaccine coverage (-0.8, 95% CI -1.3 to -0.3, p < 0.01; -5.5, 95% CI -7.3 to -3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between "median household income" and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. Eighteen months into MA's general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

Factors Associated With Marshallese and Hispanic Adults' Willingness to Receive a COVID-19 Booster Dose.

New variants of the SARS-CoV-2 virus that causes COVID-19 will continue to develop and spread globally. The Omicron variant identified in November 2021 has many lineages. Variants spread quickly and can infect previously vaccinated individuals, prompting the Centers for Disease Control and Prevention to update vaccination recommendations. While ~230 million Americans received the initially-recommended vaccine sequence, booster uptake has been much lower; less than half of fully vaccinated individuals report receiving a booster. Racial disparities also mark patterns of COVID-19 vaccination booster uptake. This study explored willingness and motivations to get a COVID-19 booster among a diverse sample of participants. We used convenience sampling to recruit participants 18 years of age or older who attended a community vaccine event. We conducted informal interviews during the recommended 15-min post-vaccination wait time with 55 participants who attended vaccine events at Marshallese and Hispanic community locations and comprised the recruitment pool for individual interviews. Using a qualitative descriptive design, we conducted in-depth follow-up interviews with 9 participants (Marshallese n = 5, Hispanic n = 4) to explore willingness and motivations to get boosted. We used rapid thematic template analysis to review informal interview summaries and formal interviews. The research team resolved data discrepancies by consensus. Participants reported high willingness to get boosted, especially if boosters were recommended in the future to protect against serious illness and mitigate the spread of COVID-19. This finding underscores how essential including recommendations to get a COVID-19 booster from trusted sources in health messaging and educational campaigns may be for increasing booster uptake. Participants described their preference for receiving future COVID-19 boosters, reporting that they would attend similar vaccine events, especially those held at faith-based organizations and facilitated by the same community partners, community health workers, and research staff. This finding shows how community engagement can overcome barriers to vaccination (ie, transportation, language, and fear of discrimination) by providing services in preferred community locations with trusted community partners. Findings document high willingness to get a COVID-19 booster, emphasize the role of recommendations from trusted sources in motivating booster uptake, and highlight the importance of community engagement to address disparities in vaccination coverage and reach.

107. Identification of state-level variables associated with changes in vaccination coverage rates in adults aged 18 to 64 in the United States

Abstract Background Despite the recognized value of life-course vaccination, adult vaccine uptake remains low. State-level vaccination coverage disparities may be associate with state-level variables (e.g., policies, programs, practices, and population characteristics). The objective of this study was to identify state-level variables associated with increased adult vaccination coverage rates (VCR) in the US for influenza, tetanus, herpes zoster (HZ), and pneumococcal vaccines over time. Methods Retrospective, exploratory database analysis of 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) data was used to calculate state-level VCRs for adults 18-64 years old. Using publicly available data, state-level variables associated with increases in VCRs were identified via a systematic variable selection. The multivariable regression models included variables meeting the criteria: correlations &amp;gt; 0.4 or &amp;lt; -0.4 (continuous) or Kruskal-Wallis Test p-value &amp;lt; 0.2 (categorical). Results Final multivariable regression models included 5 variables: Medicaid expansion status, accountable care organizations in place, health homes program, percentage of adults who report not seeing a doctor in past 12 months because of cost, and percentage of adults who report participating in any physical activity. In the multivariable models, the following state-level variables were significantly associated with changes in VCR: Influenza: percentage of adults who report participating in any physical activity (p = .01)Pneumococcal: percentage of adults who report not seeing a doctor in the past 12 months because of cost (p = .02)HZ: health homes (p = .04); percentage of adults who report participating in any physical activity or exercise (p = .01); percentage of adults who report not seeing a doctor in past 12 months because of cost (marginally significant, p = .056)Tetanus: none Conclusion Few state-level variables demonstrated an association with changes in VCR but some significant findings were observed in final models. Associated variables may not have a direct relationship but may be associated with public health infrastructure supporting vaccination ecosystems. Further research is underway to better understand the factors affecting adult vaccination. Disclosures Amanda Eiden, PhD, MBA, MPH, Merck &amp; Co., Inc.: Stocks/Bonds Mark A. Price, MA, MEd, Merck: Advisor/Consultant|Merck: I am an employee of RTI Health Solutions. Merck has contracted with my company to conduct the study described in the abstract. Alexandra Bhatti, JD, MPH, Merck &amp; Co. Inc.: Grant/Research Support|Merck &amp; Co. Inc.: Stocks/Bonds.

Vital Signs: Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity-United States, 2009-10 Through 2021-22 Influenza Seasons.

CDC estimates that influenza resulted in 9-41 million illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths annually during 2010-2020. Persons from some racial and ethnic minority groups have historically experienced higher rates of severe influenza and had lower influenza vaccination coverage compared with non-Hispanic White (White) persons. This report examines influenza hospitalization and vaccination rates by race and ethnicity during a 12-13-year period (through the 2021-22 influenza season). Data from population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected states participating in the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET) from the 2009-10 through 2021-22 influenza seasons (excluding 2020-21) and influenza vaccination coverage data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2010-11 through 2021-22 influenza seasons were analyzed by race and ethnicity. From 2009-10 through 2021-22, age-adjusted influenza hospitalization rates (hospitalizations per 100,000 population) were higher among non-Hispanic Black (Black) (rate ratio [RR]=1.8), American Indian or Alaska Native (AI/AN; RR=1.3), and Hispanic (RR=1.2) adults, compared with the rate among White adults. During the 2021-22 season, influenza vaccination coverage was lower among Hispanic (37.9%), AI/AN (40.9%), Black (42.0%), and other/multiple race (42.6%) adults compared with that among White (53.9%) and non-Hispanic Asian (Asian) (54.2%) adults; coverage has been consistently higher among White and Asian adults compared with that among Black and Hispanic adults since the 2010-11 season. The disparity in vaccination coverage by race and ethnicity was present among those who reported having medical insurance, a personal health care provider, and a routine medical checkup in the past year. Racial and ethnic disparities in influenza disease severity and influenza vaccination coverage persist. Health care providers should assess patient vaccination status at all medical visits and offer (or provide a referral for) all recommended vaccines. Tailored programmatic efforts to provide influenza vaccination through nontraditional settings, along with national and community-level efforts to improve awareness of the importance of influenza vaccination in preventing illness, hospitalization, and death among racial and ethnic minority communities might help address health care access barriers and improve vaccine confidence, leading to decreases in disparities in influenza vaccination coverage and disease severity.

Birth Order and Up-To-Date Vaccination Status.

Birth Order and Up-To-Date Vaccination Status.