Future Infectious Disease Research Articles

Increase in febrile illness among children in mainland China, winter 2023 - 2024

In late 2023, mainland China reportedly saw a rise in respiratory illnesses, primarily among children. Officials from the Chinese Center for Disease Control attributed this increase to the circulation of known pathogens, including influenza viruses, respiratory syncytial virus, SARS-CoV-2, and mycoplasma pneumoniae, to which the population had only limited exposure while strict “zero Covid” measures were enforced in recent years. However, outside observers raised concerns that a novel infectious agent could be circulating, and the World Health Organisation took the unusual step of publicizing a request for further information from Beijing. While no novel pathogen has been identified at the time of writing, this apprehension among the international press, and among some public health experts, is an instructive reminder of how unresolved issues relating to the outbreak of SARS-CoV-2 in late 2019 continue to impact international public health. Such reactions suggest that the political control of epidemiological data in the early stages of the COVID-19 pandemic has had a lasting impact on international collaboration, institutional trust and global health security. Resolving these issues is essential if the world is to be prepared for future infectious disease outbreaks of potential international concern.

One Health Economics: why and how economics should take on the interdisciplinary challenges of a promising public health paradigm.

In this perspective paper, we argue that Economics could and should contribute to the development and implementation of the One Health approach currently emerging as a relevant interdisciplinary framework to address present and future infectious diseases. We show how proven tools from Health and Environmental Economics, such as burden evaluation, can be extended to fit the One Health multisectoral perspective. This global health framework could also benefit significantly from Economics to design efficient schemes for prevention and disease control. In return, adapting Economics to the challenges of One Health issues could pave the way for exciting developments in the Economics discipline itself, across many subfields.

Evaluation of willingness to obtain of Covid 19 vaccine in patients with multiple sclerosis.

Assessing vaccine willingness and understanding sources of vaccine hesitancy in individuals with multiple sclerosis (MS) helps healthcare providers approach patients more effectively while respecting their autonomy to encourage coronavirus disease 2019 (COVID-19) vaccination. A descriptive-analytical cross-sectional study using a researcher-made checklist was conducted on MS patients referred to Neshat Clinic of Hamadan during the years 2020-2021. The checklist contained questions about demographic information, MS phenotype, duration of illness, expanded disability status scale (EDSS) score, and COVID-19 vaccination status. The expanded disability status scale (EDSS) is the most commonly used instrument for measuring disability in patients with multiple sclerosis (MS). The EDSS scale ranges from 0 to 10 in increments of 0.5 units, denoting advanced points of disability. Based on the results, 20 individuals (10%) were in the vaccine non-acceptance group, while 181 individuals (90%) were in the vaccine acceptance group. A significant number of relapsing and remitting (RR) type MS patients (90.7%) and all primary progressive (PP) type MS patients (100%) accepted the vaccine. In comparison, vaccine non-acceptance in the secondary progressive (SP) group was relatively higher (20.7%) compared to other types of MS, and this difference was significant (P < 0.05). Additionally, there was a statistically significant relationship between the history of COVID-19 and vaccine acceptance (P < 0.05). The study results demonstrated a high rate of COVID-19 vaccine acceptance among MS patients. MS phenotype, previous infection experiences, and other influences allow for COVID-19 vaccine acceptance among MS patients. This information can improve health programs and communication strategies for COVID-19 and future possible infectious disease vaccination in individuals with MS.

Comparison of RT-ddPCR and RT-qPCR platforms for SARS-CoV-2 detection: Implications for future outbreaks of infectious diseases

The increased frequency of human infectious disease outbreaks caused by RNA viruses worldwide in recent years calls for enhanced public health surveillance for better future preparedness. Wastewater-based epidemiology (WBE) is emerging as a valuable epidemiological tool for providing timely population-wide surveillance for disease prevention and response complementary to the current clinical surveillance system. Here, we compared the analytical performance and practical applications between predominant molecular detection methods of RT-qPCR and RT-ddPCR on SARS-CoV-2 detection in wastewater surveillance. When pure viral RNA was tested, RT-ddPCR exhibited superior quantification accuracy at higher concentration levels and achieved more sensitive detection with reduced variation at low concentration levels. Furthermore, RT-ddPCR consistently demonstrated more robust and accurate measurement either in the background of the wastewater matrix or with the presence of mismatches in the target regions of the consensus assay. Additionally, by detecting mock variant RNA samples, we found that RT-ddPCR outperformed RT-qPCR in virus genotyping by targeting specific loci with signature mutations in allele-specific (AS) assays, especially at low levels of allele frequencies and concentrations, which increased the possibility for sensitive low-prevalence variant detection in the population. Our study provides insights for detection method selection in the WBE applications for future infectious disease outbreaks.

Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study.

This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.

Present and Future Infectious Diseases Challenges for the Greek State and Society

The current pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has redefined normality in many social parameters, and has imposed (and continues to) a significant additional burden on health settings, economy, and state resilience worldwide. On the other hand, the SARS-CoV-2 pandemic has highlighted the vulnerabilities that pre-existed in our planning for facing major health-related events. One wonders though whether these lessons are learned, and whether they can be implemented in real life, particularly in a country like Greece, that is still under the shadow of the financial distraught of the previous decade. Based on the Global Health Security Index,1 which measures individual countries’ capability and infrastructure adequacy to deal with epidemics and pandemics, Greece has not exhibited systematic progress in improving aspects of health security that lagged behind the global average. For example, the Greek score for immunization exhibited a significant decline between 2019 and 2021. Other aspects that improved, or remained steady, between the 2019 and 2021 evaluations have not yet reached the global average, as is for example the zoonotic disease, emergency preparedness and response planning, dual-use research and culture of responsible science, real-time surveillance and reporting, case-based investigation, risk communication, medical countermeasures and personnel deployment, healthcare access, communications with health-care workers during a public health emergency, specific funding for correcting gaps identified by Joint External Evaluation or Performance of Veterinary Sciences, financing health, commitment to sharing of genetic and biological data and specimens, infrastructure adequacy, and environmental risks. That’s a lot of work to be done, and it has to be performed in times with significant infectious disease risks, either circulating or anticipated.

Excess mortality in adults from Sao Paulo during the COVID-19 pandemic in 2020: analyses of all-cause and noncommunicable diseases mortality

In this study, we estimated the excess mortality from all-causes of death and noncommunicable diseases (NCDs) in adults living in the state of São Paulo during the COVID-19 pandemic in 2020. Number of deaths were retrieved from the Mortality Information System before (2017–2019) and during (2020) the COVID-19 pandemic, considering the following underlying causes of death: Neoplasms; Diabetes Mellitus; Circulatory System Diseases, and Respiratory System Diseases. Standardized Mortality Ratio (SMR) were calculated by dividing the mortality rates in 2020 by average mortality rates in 2017–2019, according to sex, age group, geographic location (state, capital, and Regional Health Departments). In 2020, occurred 341,704 deaths in the state of São Paulo vs 290,679 deaths in 2017–2019, representing an 18% increase in all-cause mortality (SMR 1.18) or 51,025 excess deaths during the first year of COVID-19 pandemic. The excess mortality was higher in men (186,741 deaths in 2020 vs 156,371 deaths in 2017–2019; SMR 1.18; 30,370 excess deaths) compared to women (154,963 deaths in 2020 vs 134,308 deaths in 2017–2019; SMR 1.15; 20,655 excess deaths). Regarding NCDs mortality, we observed a reduction in cancer mortality (SMR 0.98; −1,354 deaths), diseases of the circulatory system (SMR 0.95; −4,277 deaths), and respiratory system (SMR 0.88; −1,945). We found a 26% increase in Diabetes Mellitus mortality (SMR 1.26; 2885 deaths) during the pandemic year. Our findings corroborate the need to create and strengthen policies aimed at the prevention and control of NCDs, in order to mitigate the impact of future infectious disease pandemics.

Comparison of pediatric injury patterns before and during the COVID-19 pandemic in Korea: a retrospective study.

The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic. This study is based on the data of patients who presented with injuries at 23 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year. When comparing the COVID-19 pandemic period to the pre-COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (38.9% vs. 39.7%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%). During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.

EFFECTS OF ESSENTIAL CAREGIVER POLICIES ON COVID-19 AND NON-COVID-19 DEATHS IN NURSING HOMES

Abstract Balancing the safety of nursing home residents with their need for social interaction has emerged as a key challenge from the COVID-19 pandemic. Strict bans on nursing home visitation eventually led to growing concern that physical isolation may have unintended harms on nursing home residents. To address this concern, at staggered times between June 2020 and January 2021, 17 states implemented Essential Caregiver policies allowing nursing home visitation by designated family members or friends under controlled circumstances. Using the Nursing Home COVID-19 Public File and other relevant data, we analyze the effects of Essential Caregiver policies on COVID-19 and non-COVID-19 deaths for nursing home residents. To estimate plausibly causal effects, we employ recent innovations in difference-in-differences and event-study estimation. We find that on average, Essential Caregiver policies prevent 0.44 non-COVID-19 deaths, 0.42 COVID-19 deaths, and 0.86 total deaths per 1,000 residents in a two-week period, representing 8 percent, 17 percent, and 11 percent of the sample mean for the three outcomes, respectively. The effects are mainly driven by state policies that are mandatory or implemented without restrictions and are larger for high-quality facilities and highly staffed facilities. Our results suggest that nursing home residents derive substantial benefit from regular social interaction with family members and friends and from the additional care they provide. Our findings support the use and expansion of Essential Caregiver policies to balance resident safety and the need for social interaction for future infectious disease outbreaks.

A case for ongoing structural support to maximise infectious disease modelling efficiency for future public health emergencies: A modelling perspective

This short communication reflects upon the challenges and recommendations of multiple COVID-19 modelling and data analytic groups that provided quantitative evidence to support health policy discussions in Switzerland and Germany during the SARS-CoV-2 pandemic.Capacity strengthening outside infectious disease emergencies will be required to enable an environment for a timely, efficient, and data-driven response to support decisions during any future infectious disease emergency.This will require 1) a critical mass of trained experts who continuously advance state-of-the-art methodological tools, 2) the establishment of structural liaisons amongst scientists and decision-makers, and 3) the foundation and management of data-sharing frameworks.

Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey.

COVID-19 mitigation behaviors, such as wearing masks, maintaining social distancing, and practicing hand hygiene, have been and will remain vital to slowing the pandemic. This study aims to describe the period prevalence of consistent mask-wearing, social distancing, and hand hygiene practices during the peak of COVID-19 incidence (August-December 2020) and just before COVID-19 vaccine availability, overall and in demographic subgroups. We used baseline survey data from a nationwide household probability sample to generate weighted estimates of mitigation behaviors: wearing masks, maintaining social distancing, and practicing hand hygiene. Weighted logistic regression explored differences in mitigation behaviors by demographics. Latent class analysis (LCA) identified patterns in mitigation behaviors. Among 4654 participants, most (n=2727, 58.6%) were female, were non-Hispanic White (n=3063, 65.8%), were aged 55 years or older (n=2099, 45.1%), lived in the South (n=2275, 48.9%), lived in metropolitan areas (n=4186, 89.9%), had at least a bachelor's degree (n=2547, 54.7%), had an income of US $50,000-$99,000 (n=1445, 31%), and were privately insured (n=2734, 58.7%). The period prevalence of consistent mask wearing was 71.1% (sample-weighted 95% CI 68.8-73.3); consistent social distancing, 42.9% (95% CI 40.5-45.3); frequent handwashing, 55.0% (95% CI 52.3-57.7); and frequent hand sanitizing, 21.5% (95% CI 19.4-23.8). Mitigation behaviors were more prevalent among women, older persons, Black or Hispanic persons, those who were not college graduates, and service-oriented workers. LCA identified an optimal-mitigation class that consistently practiced all behaviors (n=2656, 67% of US adults), a low-mitigation class that inconsistently practiced all behaviors (n=771, 20.6%), and a class that had optimal masking and social distancing but a high frequency of hand hygiene (n=463, 12.4%). Despite a high prevalence of COVID-19 mitigation behaviors, there were likely millions who did not consistently practice these behaviors during the time of the highest COVID-19 incidence. In future infectious disease outbreak responses, public health authorities should also consider addressing disparities in mitigation practices through more targeted prevention messaging.

The bibliometric landscape of infectious disease research in Panama (1990-2019).

This work aims to analyze the landscape of scientific publications on subjects related to One Health and infectious diseases in Panama. The research questions are: How does the One Health research landscape look like in Panama? Are historical research efforts aligned with the One Health concept? What infectious diseases have received more attention from the local scientific community since 1990? Boolean searches on the Web of Science, SCOPUS and PubMed were undertaken to evaluate the main trends of publications related to One Health and infectious disease research in the country of Panama, between 1990 and 2019. 4546 publications were identified since 1990, including 3564 peer-reviewed articles interconnected with One Health related descriptors, and 211 articles focused particularly on infectious diseases. A pattern of exponential growth in the number of publications with various contributions from Panamanian institutions was observed. The rate of multidisciplinary research was moderate, whereas those of interinstitutional and intersectoral research ranged from low to very low. Research efforts have centered largely on protozoan, neglected and arthropod-borne diseases with a strong emphasis on malaria, Chagas and leishmaniasis. Panama has scientific capabilities on One Health to tackle future infectious disease threats, but the official collaboration schemes and strategic investment to develop further competencies need to be conciliated with modern times, aka the pandemics era. The main proposition here, addressed to the government of Panama, is to launch a One Health regional center to promote multidisciplinary, interinstitutional and intersectoral research activities in Panama and beyond.

Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development.

The COVID-19 pandemic revealed that with high infection rates, health services conducting contact tracing (CT) could become overburdened, leading to limited or incomplete CT. Digital CT support (DCTS) tools are designed to mimic traditional CT, by transferring a part of or all the tasks of CT into the hands of citizens. Besides saving time for health services, these tools may help to increase the number of contacts retrieved during the contact identification process, quantity and quality of contact details, and speed of the contact notification process. The added value of DCTS tools for CT is currently unknown. To help determine whether DCTS tools could improve the effectiveness of CT, this study aims to develop a framework for the comprehensive assessment of these tools. A framework containing evaluation topics, research questions, accompanying study designs, and methods was developed based on consultations with CT experts from municipal public health services and national public health authorities, complemented with scientific literature. These efforts resulted in a framework aiming to assist with the assessment of the following aspects of CT: speed; comprehensiveness; effectiveness with regard to contact notification; positive case detection; potential workload reduction of public health professionals; demographics related to adoption and reach; and user experiences of public health professionals, index cases, and contacts. This framework provides guidance for researchers and policy makers in designing their own evaluation studies, the findings of which can help determine how and the extent to which DCTS tools should be implemented as a CT strategy for future infectious disease outbreaks.

771. The impact of infectious diseases research involvement on future infectious disease fellowship application

Abstract Background Infectious diseases physicians invest significant time mentoring medical students and internal medicine residents developing research projects as well as writing case reports. The impact of research or case reports on future application to infectious diseases fellowship is unknown. Methods All research projects and case reports published or presented at conferences from Brooke Army Medical Center between 2014-2022 with an infectious diseases senior author and a medical student or internal medicine resident first author were evaluated. The presentations and publications that resulted from each project as well as whether the trainee applied to infectious diseases were recorded. Results During the study period, 12 faculty mentored 51 trainees in 35 research projects and 26 case reports. Research and case reports were primarily performed by residents (88% and 96% respectively) (Table 1). Most trainees presented or published their research in multiple venues. Compared to case reports, research projects were more likely to be presented at national meetings (77% vs 31%, p=0.0003). Individuals who completed research projects had greater rates of infectious diseases fellowship application as compared to those who completed case reports (42% vs. 5%, p=0.006) (Table 2). Summary of Research and Case Reports by Medical Students and Residents Mentored by Infectious Diseases Faculty at Brooke Army Medical Center, 2014-2022 Internal Medicine Resident and Medical Student Application to Infectious Diseases Fellowship Organized by Projects Mentored by an Infectious Diseases Faculty Member at Brooke Army Medical Center, 2014-2022 Conclusion Internal medicine resident and medical student involvement in research mentored by an infectious disease physician was associated with a higher infectious diseases fellowship application rate as compared to those who were mentored for case reports. Despite the significant time required to mentor trainees, investment in trainee research should be considered as an important component to the infectious diseases recruiting effort. Disclosures All Authors: No reported disclosures

767. Impact of Standardized Patient Simulation on Pharmacy Students' Confidence and Perceptions in Community-Acquired Bacterial Meningitis Management

Abstract Background Limited data describes the use of standardized patient simulation (SPS) for infectious disease (ID) education, particularly among pharmacy students. We sought to assess the impact of SPS on pharmacy students’ knowledge and confidence of community-acquired bacterial meningitis (CABM), and to evaluate students’ perceptions of SPS. Methods This single-center, cross-sectional, voluntary, anonymous survey was conducted among second-year Doctor of Pharmacy students (n=69). CABM education was initially delivered via didactic, large classroom instruction, which occurred 1.5 weeks prior to the SPS. The pre-SPS survey asked students to assess their confidence in CABM. The confidence questions focused on pathophysiology, microbiology, clinical presentation, diagnosis, and empiric/targeted management. The SPS included two group graded sections: a rounding experience focused on patient assessment, clinical presentation, and empiric management (Figure 1) followed by a microbiology lab simulation, targeted management, and duration/monitoring. A post-SPS survey was distributed, which included the same pre-survey questions and questions related to perceptions of SPS. All survey confidence and perception questions were evaluated using a Likert scale from strongly disagree (1) to strongly agree (5). Descriptive statistics and Student’s t-test were used. Standardized Patient Simulation Rounding Experience Student group engaged in the standardized patient simulation rounding experience (all individuals pictured gave permission for the use of this picture). Results Sixty-three students fully completed the pre- and post-SPS surveys (91.3% response rate), and pre-post responses were matched. Overall mean (+SD) confidence in CABM management was significantly higher following SPS (4.3+0.5 vs. 3.5+0.7; p&amp;lt; 0.001). A statistically significant mean increase was also observed for each individual confidence item following SPS. Mean (+SD) perceptions following SPS for feeling more comfortable with patient interaction skills, preferring SPS compared to written case-based instruction, and having interest in more ID SPS were 4.2+0.8, 4.2+0.9, and 4.3+0.9, respectively. Conclusion SPS was associated with increased confidence in CABM management among pharmacy students. Students appeared to have a positive impression of SPS and are interested in future ID SPS. SPS appears to be an effective educational modality for CABM and should be assessed among other student clinicians for ID. Disclosures Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck &amp; Co.: Grant/Research Support

The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals

Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The implementation of genetic testing to identify host genomic risk factors associated with infectious diseases raises several ethical, legal, and social implications (ELSIs). As an important stakeholder group, health professionals can provide key insights into these ELSI issues. In 2021, a cross-sectional online survey was fielded to US health professionals. The survey explored how they view the value and ethical acceptability of using COVID-19 host genomic information in three main decision-making settings: (1) clinical, (2) public health, and (3) workforce. The survey also assessed participants' personal and professional experience with genomics and infectious diseases and collected key demographic data. A total of 603 participants completed the survey. A majority (84%) of participants agreed that it is ethically acceptable to use host genomics to make decisions about clinical care and 73% agreed that genetic screening has an important role to play in the public health control of COVID-19. However, more than 90% disagreed that it is ethically acceptable to use host genomics to deny resources or admission to individuals when hospital resources are scarce. Understanding stakeholder perspectives and anticipating ELSI issues will help inform policies for hospitals and public health departments to evaluate and perhaps adopt host genomic technologies in an ethically and socially responsible manner during future infectious disease outbreaks.

Why presumptions are important in occupational health: The example of COVID-19 infection as an occupational disease.

Workers who become ill or injured on the job while undertaking extraordinary risks on behalf of the public are, at times, granted facilitated access to workers' compensation (WC) benefits through the application of presumptions in the compensation process. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, a broad range of occupational groups faced an elevated risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure at work to perform vital services to maintain our food supply, sustain needed transportation, provide health care, assure energy supply and others. Some states or jurisdictions in the United States recognized both the risk and the service of these workers by enacting COVID-19 presumption laws to streamline selected essential workers' eligibility for WC benefits. Other states did not. Results of these contrasting public approaches permit an examination of the impact of presumptions in compensation by examining the frequency and outcomes of COVID-19 claims in "COVID-19 presumption" and "nonpresumption" states. Despite state-level variations in economic response to the pandemic, industry mix, and presumption eligibility criteria, the use of COVID-19 presumptions appears to have substantially increased claim filing rates and improved access to benefits. Lastly, the additional costs of COVID-19 claims to employers and insurers were lower than initially predicted. In response to future airborne infectious disease outbreaks, workers' compensation presumption laws should be universally implemented to permit a broad range of high-risk workers to work on the public's behalf without fear of losing wages and incurring medical expenses associated with a work-related viral exposure.

County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.

County-level vaccination barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, history of low vaccination) may partially explain COVID-19 vaccination intentions among U.S. adults. This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S. and were associated with willingness to receive the COVID-19 vaccine. In addition, this study assessed whether these associations differed across racial/ethnic groups. This study used data from the REACH-US study, a large online survey of U.S. adults (N = 5,475) completed from January 2021-March 2021. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Ordinal logistic regression estimated associations between race/ethnicity and county-level vaccination barriers and between county-level vaccination barriers and willingness to receive the COVID-19 vaccine. Models adjusted for covariates (age, gender, income, education, political ideology, health insurance, high-risk chronic health condition). Multigroup analysis estimated whether associations between barriers and willingness to receive the COVID-19 vaccine differed across racial/ethnic groups. American Indian/Alaska Native, Black/African American, Hispanic/Latino ELP [English Language Preference (ELP); Spanish Language Preference (SLP)], and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers [Adjusted Odd Ratios (AORs):1.63-3.81]. Higher county-level vaccination barriers were generally associated with less willingness to receive the COVID-19 vaccine, yet associations were attenuated after adjusting for covariates. Trends differed across barriers and racial/ethnic groups. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine (AOR:0.78, 95% CI:0.64-0.94), whereas higher irregular care-seeking behavior was associated with greater willingness to receive the vaccine (AOR:1.20, 95% CI:1.04-1.39). Greater history of low vaccination was associated with less willingness to receive the COVID-19 vaccine among Black/African American adults (AOR:0.55, 95% CI:0.37-0.84), but greater willingness to receive the vaccine among American Indian/Alaska Native and Hispanic/Latino ELP adults (AOR:1.90, 95% CI:1.10-3.28; AOR:1.85, 95% CI:1.14-3.01). Future public health emergency vaccination programs should include planning and coverage efforts that account for structural barriers to preventive healthcare and their intersection with sociodemographic factors. Addressing structural barriers to COVID-19 treatment and preventive services is essential for reducing morbidity and mortality in future infectious disease outbreaks.

Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study

BackgroundVaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities.MethodsParticipants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section.ResultsThe rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups’ attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines’ production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination.ConclusionsWhile our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates.

Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.