Low Vaccination Rates Research Articles

Emergence and evolution of the Omicron SARS-CoV-2 variant in the island of Martinique

IntroductionWe aimed to describe the epidemiological situation during the Omicron variant circulation in light of genomic surveillance data in Martinique, a territory with low vaccination rates. Patients and methodsWe exploited COVID-19 national databases of virological tests, for the collection of hospital data and for the sequencing data from December 13, 2021 to July 11, 2022. ResultsThree prevailing sub-lineages of Omicron have been identified in Martinique (BA.1, BA.2, BA.5) during this period causing three distinct waves characterized by an increase in virological indicators compared to previous waves, with moderate severity in the first and last waves, caused by BA.1 and BA.5, respectively. ConclusionThe SARS-CoV-2 outbreak is still progressing in Martinique. Genomic surveillance system in this overseas territory must be continued for rapid detection of emerging variants/sub-lineages.

The impact of COVID-19 vaccination campaign in Hong Kong SAR China and Singapore.

Vaccination has been the most important measure to mitigate the COVID-19 pandemic. The vaccination coverage was relatively low in Hong Kong Special Administrative Region China, compared to Singapore, in early 2022. Hypothetically, if the two regions, Hong Kong (HK) and Singapore (SG), swap their vaccination coverage rate, what outcome would occur? We adopt the Susceptible - Vaccinated - Exposed - Infectious - Hospitalized - Death - Recovered model with a time-varying transmission rate and fit the model to weekly reported COVID-19 deaths (the data up to 2022 Nov 4) in HK and SG using R package POMP. After we obtain a reasonable fitting, we rerun our model with the estimated parameter values and swap the vaccination rates between HK and SG to explore what would happen. Our model fits the data well. The reconstructed transmission rate was higher in HK than in SG in 2022. With a higher vaccination rate as in SG, the death total reported in HK would decrease by 37.5% and the timing of the peak would delay by 3 weeks. With a lower vaccination rate as in HK, the death total reported in SG would increase to 5.5-fold high with a peak 6 weeks earlier than the actual during the Delta variant period. Vaccination rate changes in HK and SG may lead to very different outcomes. This is likely due that the estimated transmission rates were very different in HK and SG which reflect the different control policies and dominant variants. Because of strong control measures, HK avoided large-scale community transmission of the Delta variant. Given the high breakthrough infection rate and transmission rate of the Omicron variant, increasing the vaccination rate in HK will likely yield a mild (but significant) contribution in terms of lives saved. While in SG, lower vaccination coverage to the level of HK will be disastrous.

Evaluation of a team-based quality improvement initiative for influenza vaccination in an underserved population.

Influenza vaccine is the most effective way to prevent influenza. However, low vaccination rates continue especially in underserved populations. To increase influenza vaccinations in an underserved population and to evaluate the impact of influenza vaccinations compared to previous year influenza vaccinations. Federally-Qualified Health care Center for the Homeless, Richmond, Virginia PRACTICE INNOVATION: Team-based quality improvement initiative led by a pharmacist champion. Before and after evaluation of the quality improvement initiative was conducted by comparing the total number of vaccines administered to those administered the previous year. Influenza vaccinations increased by 42% over the prior influenza vaccination season (1269 vs. 895), respectively. From a population perspective, 31% of patients received an influenza vaccine in 2019-20 and 48% in 2020-21. During the 2019-20 influenza vaccine season, the majority of patients vaccinated were female 56% versus 50.9% in 2020-21. The average age increased from 2019-20 to 2020-21, 37.62 years of age versus 42.71 years of age, respectively. A team-based quality improvement initiative was successful in improving our influenza vaccination program for adults and has served as a foundation for the delivery of other vaccines. Lessons learned were used to implement a COVID-19 vaccine program.

Attitudes and experiences of asylum seekers and refugees to the COVID-19 vaccination: a qualitative study.

COVID-19 disproportionately affected asylum seeker and refugee (ASR) populations owing to language and cultural barriers, lower health literacy, polytraumas and mental health needs, and increased exposure. Despite this, there was vaccine hesitancy and low vaccination rates in ASR populations. To explore the attitudes to and experiences of the COVID-19 vaccination among ASRs. Qualitative study of 12 diverse purposively recruited ASRs in Bristol. Semi-structured interviews were conducted, transcribed verbatim, and analysed thematically to identify emergent themes. Eight refugees and four asylum seekers were recruited, five of whom were female and seven male, aged between 23 years and 48 years; together representing seven countries. Six were part of a UK Home Office (UKHO) resettlement programme, and six had arrived in the UK by independent means. Analysis showed delayed uptake rather than vaccine refusal owing to the following three main themes: systemic asylum issues (repeated relocation, uncertainty, and dependency on the charity sector); fear (secondary to social isolation, misinformation, and mental illness); and trust (surrounding access to care and community relationships). Fear, trauma, and isolation propagated by systemic issues are primary factors impacting healthcare decision making, and standard approaches to increasing vaccination uptake must be reconsidered in light of these issues. General practice must appreciate and invest in providing security in healthcare access for ASR populations. Barriers to practice registration must be overcome to enable ASRs to access care both around vaccination and afterwards. Communication must be clear and accessible to aid individuals in making informed decisions, balancing the benefits and potential risks of vaccinations.

Immunization status in patients with multiple sclerosis: Across-sectional, monocenter study in Austria.

Patients with multiple sclerosis (MS) under certain disease-modifying therapies (DMT) show a higher risk of infection and a lower immune response to vaccination. Hence, assessing immunization status prior to DMT start and, where necessary, performing vaccinations is recommended. We aimed to determine the immunization status in MS patients and to identify factors associated with low vaccination rates. Patients with MS who were seen at the MS clinic of the Medical University of Innsbruck throughout a period of 14 months in 2020 and 2021 were eligible for inclusion into this prospective, single-center study. Immunization status against 17 different pathogens was obtained from vaccination certificate and by patient questionnaire. Antibody detection against seven antigens was performed in peripheral blood. Of 424 patients with MS at a mean age of 43 ± 12 years, the vast majority had vaccinations against tetanus (94%), diphtheria (92%), and poliomyelitis (90%), whereas a lower proportion had vaccinations against tick-borne encephalitis (70%), pertussis (69%), hepatitis B (65%), rubella (55%), hepatitis A (50%), measles (49%), mumps (47%), and only a minority against influenza (10%), pneumococcal (6%) and meningococcal disease (4%), human papillomavirus (4%), yellow fever (2%), and varicella zoster virus (1%). A total of 87% received vaccination against SARS-CoV-2. Overall, higher vaccination rates were associated with younger age, relapsing disease course, and education level. Misinformation on infectious diseases and vaccines was associated with lower vaccination rates. The majority of MS patients did not fulfil vaccination recommendations. Efforts to increase vaccination rates, preferentially before DMT start, should be promoted.

One Year of COVID-19 Vaccine Misinformation on Twitter: Longitudinal Study.

Vaccinations play a critical role in mitigating the impact of COVID-19 and other diseases. Past research has linked misinformation to increased hesitancy and lower vaccination rates. Gaps remain in our knowledge about the main drivers of vaccine misinformation on social media and effective ways to intervene. Our longitudinal study had two primary objectives: (1) to investigate the patterns of prevalence and contagion of COVID-19 vaccine misinformation on Twitter in 2021, and (2) to identify the main spreaders of vaccine misinformation. Given our initial results, we further considered the likely drivers of misinformation and its spread, providing insights for potential interventions. We collected almost 300 million English-language tweets related to COVID-19 vaccines using a list of over 80 relevant keywords over a period of 12 months. We then extracted and labeled news articles at the source level based on third-party lists of low-credibility and mainstream news sources, and measured the prevalence of different kinds of information. We also considered suspicious YouTube videos shared on Twitter. We focused our analysis of vaccine misinformation spreaders on verified and automated Twitter accounts. Our findings showed a relatively low prevalence of low-credibility information compared to the entirety of mainstream news. However, the most popular low-credibility sources had reshare volumes comparable to those of many mainstream sources, and had larger volumes than those of authoritative sources such as the US Centers for Disease Control and Prevention and the World Health Organization. Throughout the year, we observed an increasing trend in the prevalence of low-credibility news about vaccines. We also observed a considerable amount of suspicious YouTube videos shared on Twitter. Tweets by a small group of approximately 800 "superspreaders" verified by Twitter accounted for approximately 35% of all reshares of misinformation on an average day, with the top superspreader (@RobertKennedyJr) responsible for over 13% of retweets. Finally, low-credibility news and suspicious YouTube videos were more likely to be shared by automated accounts. The wide spread of misinformation around COVID-19 vaccines on Twitter during 2021 shows that there was an audience for this type of content. Our findings are also consistent with the hypothesis that superspreaders are driven by financial incentives that allow them to profit from health misinformation. Despite high-profile cases of deplatformed misinformation superspreaders, our results show that in 2021, a few individuals still played an outsized role in the spread of low-credibility vaccine content. As a result, social media moderation efforts would be better served by focusing on reducing the online visibility of repeat spreaders of harmful content, especially during public health crises.

The effect of the third dose of the BNT162b2 vaccine on anti-SARS-CoV-2 spike antibody levels in healthcare workers with and without COVID-19 infection

Aim A third (booster) dose of the anti-SARS-CoV-2 vaccine became necessary due to the observed decrease in anti-SARS-CoV-2S antibody levels over time, new mutations, and low global vaccination rates. In this study, anti-SARS-CoV-2S antibody levels were measured (ECLIA assay) in 50 healthcare workers with and without a history of COVID-19 infection to determine the humoral immune response to the third dose of the BNT162b2 vaccine. Methods Antibody levels were determined in the blood serum, and blood was sampled for analysis 20–40 days after the administration of the booster dose. Results A greater increase in anti-SARS-CoV-2S antibody titers was noted in persons without a history of infection, but antibody levels continued to be higher in previously infected individuals when the results were adjusted for age, gender, BMI, type of work, and presence of comorbidities. Conclusion The results of this study can be used to improve the vaccination strategy for the general population. KEY MESSAGES Three doses of the vaccine BNT162b2 strongly stimulate the immune system to produce anti-SARS-CoV-2s antibodies, especially in people with a previous infection COVID-19. Age, gender, and BMI may be associated with different humoral immune response to the BNT162b2 vaccine.

Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles' Black and Latino Communities: Protocol for a Participatory Study.

The COVID-19 pandemic has significantly affected Los Angeles County and disproportionately impacted Black and Latino populations who experienced disparities in rates of infection, hospitalizations, morbidity, and mortality. The University of Southern California (USC), USC Keck School of Medicine, Southern California Clinical and Translational Science Institute, USC Mann School of Pharmacy and Pharmaceutical Sciences, Annenberg School for Journalism and Communication, and Children's Hospital Los Angeles will launch a collaborative public health campaign called VaccinateLA. VaccinateLA will implement a community-based, community-partnered public health campaign that (1) delivers culturally tailored information about COVID-19 and available vaccines; and (2) addresses misinformation and disinformation, which serves as a barrier to vaccine uptake. The campaign will be targeted to communities in Los Angeles with the highest rates of COVID-19 infection and the lowest vaccination rates. Using these criteria, the campaign will be targeted to neighborhoods located in 34 zip codes in the Eastside and South Los Angeles. The primary aim of VaccinateLA will be to design and deliver an evidence-based multimedia public health campaign tailored for Black and Latino populations. A secondary aim will be to train and deploy community vaccine navigators to deliver COVID-19 education, help individuals overcome barriers to getting vaccinated (eg, transportation and challenges registering), and assist with delivering vaccinations in our targeted communities. We will use a community-based, participatory research approach to shape VaccinateLA's public health campaign to address community members' attitudes and concerns in developing campaign content. We will conduct focus groups, establish a community advisory board, and engage local leaders and stakeholders to develop and implement a broad array of educational, multimedia, and field-based activities. As of February 2023, target communities have been identified. The activities will be initiated and evaluated over the course of this year-long initiative, and dissemination will occur following the completion of the project. Engaging the community is vital to developing culturally tailored public health messages that will resonate with intended audiences. VaccinateLA will serve as a model for how an academic institution can quickly mobilize to address a pressing public health crisis, particularly in underrepresented and underresourced communities. Our work has important implications for future public health campaigns. By leveraging community partnerships and deploying community health workers or promotores into the community, we hope to demonstrate that urban universities can successfully partner with local communities to develop and deliver a range of culturally tailored educational, multimedia, and field-based activities, which in turn may change the course of an urgent public health crisis, such as the COVID-19 pandemic. PRR1-10.2196/40161.

The importance of cultural tailoring of communicators and media outlets in an influenza vaccination awareness campaign: a digital randomized trial

The COVID-19 pandemic has exposed the vulnerability of ethnic minorities again. Health inequity within ethnic minorities has been explained by factors such as higher prevalence of underlying disease, restricted access to care, and lower vaccination rates. In this study, we investigated the effect of cultural tailoring of communicators and media outlets, respectively, on vaccine willingness in an influenza vaccination campaign in the Netherlands. A total of 1226 participants were recruited from two culturally non-tailored media outlets (Dutch newspaper and Facebook), and one media outlet tailored to a large community in the Netherlands with Indian ancestry. The participants from all three media outlets were randomly exposed to a vaccination awareness video delivered by a physician with an Indian or Dutch background, followed by an online survey. Cultural tailoring compared to cultural non-tailoring of communicators showed no difference in improvement of vaccine willingness (13.9% vs. 20.7% increment, respectively, p = 0.083). However, the media outlet tailored to the community with Indian ancestry, resulted in a higher improvement of vaccine willingness compared to non-tailored media outlets (46.7% vs. 14.7% increment, respectively, p < 0.001, unadjusted OR = 5.096). These results suggest that cultural tailoring of media outlets may be critical to effectively reach out to ethnic minorities to help optimize vaccination rates and improve general health.

Consumption and tax gains attributable to Covid-19 vaccinations in 12 EU countries with low vaccination rates.

The Covid-19 pandemic is an economic and a health crisis. Households reduced consumption expenditures as large-scale physical distancing measures, lower disposable incomes and fear of infection when engaging in many types of economic activity took hold. This, in turn, reduced domestic tax revenues at a time when governments were facing increased financial pressures to strengthen and sustain welfare states. We developed a simulation model, the Covid-19 Taxination Simulator, to estimate potential economic gains and tax revenues attributable to vaccine rollouts. We apply the model to 12 European Union countries which had low vaccination rates at the beginning of 2022. The highest growth in aggregate personal consumption expenditure attributable to Covid-19 vaccines administered as of January 2022 is in Greece (10.8%), Slovenia (8.6%) and Czechia (8.6%), while the lowest is in Bulgaria (2.2%) and Slovakia (2.1%). If countries had vaccinated 85% of their adult population, the largest gains in consumption tax revenues would be expected in Romania (830 million Euros) and Poland (738 million Euros). Consumption tax revenues generated by meeting the 85% of the adult population target would, on their own, be large enough to fully cover the costs of expanding the vaccine rollout itself in Estonia, Latvia, Slovenia, Croatia, Czechia, Hungary and Greece. Covid-19 vaccination rollouts not only save lives and relieve pressures on health systems, they also support economic growth and generate additional tax revenues. These revenues can partially offset the costs of vaccines programmes themselves.

Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database.

Subjects with diabetes are at higher risk of serious influenza-related complications. We aimed to investigate the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza in subjects with diabetes using a nationwide observational study performed within the recent decade. Among 105,732 subjects from the Korea National Health and Nutrition Examination Survey between 2007 and 2019, 8,632 with diabetes were included. We investigated the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza. During the study period, the prevalence of influenza vaccination in subjects with diabetes showed a tendency to increase every year, reaching almost 60% in 2019, which was higher than the rate in subjects without diabetes. Younger age (adjusted hazard ratio (aHR) [95% CI] 11.29 [8.63-14.75] for < 50 years; 6.16 [5.21-7.29] for 50-65 years), male (aHR 1.67 [1.52-1.87]), current smoker (aHR 1.31 [1.00-1.72], lower-income status (aHR 1.46 [1.17, 1.84]), and high education level (aHR 1.30 [1.01-1.67]) were associated with being unvaccinated. Also, a poorer glycemic control with HbA1c ≥ 9% was found to be correlated with unvaccinated status (aHR 1.48 [1.15-1.90]). The influenza vaccination rate is still unsatisfactory in subjects with diabetes. Young age, males, low-income level, high education level, and poor glycemic control were associated with unvaccinated status. Considering the risk-benefits of influenza vaccination in patients with diabetes, physicians should make an effort to increase vaccination rates, especially in low vaccination rate groups.

Urban-rural disparities in acceptance of human papillomavirus vaccination among women in Can Tho, Vietnam.

In Vietnam, cervical cancer is a significant public health concern for women. Unfortunately, despite the availability of the HPV vaccine, low vaccination rates persist. This study investigates the discrepancy between urban and rural areas in the willingness to receive HPV vaccination with or without fees. A cross-sectional study was conducted on a sample of 648 women aged between 15 and 49, living in two urban and two rural Vietnamese districts of Can Tho, between May and December 2021. The overall vaccination rate was 4%, with urban women having a higher rate of 4.9% compared to rural women at 3.1%. Among unvaccinated women, those from rural areas expressed a significantly higher desire to receive the free vaccine (91.4%) than urban women (84.4%). However, the intention to vaccinate declined when rural women and urban women were advised to pay the cost (63.4% and 57.1%, respectively). A strong correlation was found between a positive attitude and intention for vaccination, irrespective of its price or free availability. Education and access to information about the HPV vaccine were also identified as the most significant factors influencing the intention to vaccination among urban and rural women. The low HPV vaccination rates among women aged 15-49 living in both urban and rural regions of Vietnam are a notable public health concern. These outcomes emphasize the critical need for effective programs of vaccine laterization, as an introduction to the offer of affordable and accessible HPV vaccines for women in Can Tho, Vietnam.

Racial Discrimination, Social Disadvantage, and Racial–Ethnic Disparities in COVID-19 Vaccine Uptake

Racial-ethnic disparities in COVID-19 vaccination are well documented. The extent to which racism, manifested at the individual and ZIP code levels, explains disparities in early vaccination uptake remains unclear. Data from a statewide poll of California registered voters (N=10,256), conducted between April 29 and May 5, 2021, linked to area-level resource data, were analyzed. Weighted multivariable logistic regression models examined racial disparities in COVID-19 vaccination. Decomposition analyses quantified how much of the observed racial disparities in vaccination were explained by racial discrimination and social disadvantage (i.e., educational attainment, 2019 household income, and ZIP code social vulnerability). Latinx (64.6%) and Black (66.7%) adults were less likely to have at least 1 COVID-19 vaccine dose by April or May 2021 than White adults (74.7%). In adjusted analyses, Latinx (AOR=0.69, 95% CI=0.57, 0.84) and Black (AOR=0.51, 95% CI=0.37, 0.70) adults had a lower likelihood of being vaccinated than Whites. Social disadvantage accounted for 77.4% (p<0.05) and 35.8% (p<0.05) of the explainable variation in Latinx-White and Black-White disparities, respectively. Self-reported racial discrimination was not associated with COVID-19 vaccination in adjusted analyses. Social disadvantage but not self-reported racial discrimination explained racial-ethnic disparities in COVID-19 vaccination in California. Removing resource-related barriers may help to increase the relatively low COVID-19 vaccination rates among Black and Latinx populations.

Determinants of COVID-19 vaccination status and hesitancy among older adults in China.

Vaccination is the primary defense against severe acute respiratory syndrome coronavirus 2, especially among older adults and those with chronic conditions. Using a nationally representative sample of 12,900 participants from the fifth wave (2021-2022) of the China Health and Retirement Longitudinal Study (CHARLS), we examined the coronavirus disease 2019 (COVID-19) vaccination status and the determinants of vaccination hesitancy in Chinese adults aged 52 and older. By July/August 2022, 92.3% of the Chinese population aged 60 years and older had received at least one COVID-19 vaccination, 88.6% had completed the primary series and 72.4% had received a booster. Those aged 80 years and older had lower vaccination rates, with 71.9% and 46.7% completing the primary series and booster shots, respectively. These statistics represent the situation before China ended the Zero-COVID policy in November 2022 because vaccination stagnated between July/August and November 2022. Multivariate regression analysis revealed that belonging to the oldest age groups (individuals aged 70 years and older and especially those aged 80 years and older) as well as being female and unmarried, residing in urban areas, being functionally dependent and having chronic conditions meant that these individuals were less likely to receive COVID-19 vaccines. Our regression analysis results were corroborated by self-reported reasons for nonvaccination. Vaccination hesitancy probably contributed to excessive mortality among vulnerable populations after China ceased its Zero-COVID policy. Our study provides important lessons on how to balance containment efforts with vaccination and treatment measures, as well as highlighting the need to clarify the side effects and contraindications of vaccines early on.

Public Health Security

Public health security refers to the ability of a society to protect and promote the health of its population, particularly in the face of emerging health threats. Ensuring public health security is essential for the well-being of communities and is a key responsibility of government agencies and health care systems.&#x0D; One significant aspect of public health security is the ability to identify, track, and respond to emerging health threats. This includes diseases that are transmitted from person to person, such as infectious diseases like influenza, as well as diseases that are transmitted through the environment, such as waterborne illnesses. In order to effectively respond to these threats, it is important for public health agencies to have access to reliable data and surveillance systems, as well as the resources and capacity to implement effective interventions [1].&#x0D; Another important aspect of public health security is the ability to prepare for and respond to disasters and emergencies. This includes natural disasters, such as hurricanes and earthquakes, as well as man-made disasters, such as chemical spills or acts of terrorism. Ensuring that communities have the necessary resources and infrastructure in place to respond to these events can save lives and prevent further suffering.&#x0D; Finally, public health security also involves addressing social and environmental determinants of health, such as poverty, housing, and access to clean water and sanitation. These issues can have a significant impact on the health and well-being of communities and must be addressed in order to ensure the long-term health and security of the population [2].&#x0D; Public health security is a significant concern in Pakistan, as the country faces a range of health threats, including infectious diseases, environmental hazards, and natural disasters. One of the major public health challenges in Pakistan is the high burden of infectious diseases, such as malaria, tuberculosis, and HIV/AIDS. The country also faces outbreaks of vaccine-preventable diseases, such as measles and polio, due to low vaccination rates and inadequate vaccination coverage. Pakistan is also vulnerable to natural disasters, such as earthquakes, floods, and cyclones, which can have a significant impact on the health of the population. In addition to infectious diseases and natural disasters, Pakistan also faces environmental health hazards, such as air pollution and water contamination. Poor air quality has been linked to a range of health problems, including respiratory and cardiovascular diseases, while access to clean water is a major concern in many parts of the country.&#x0D; In conclusion, public health security is a critical issue that affects the well-being of communities around the world. Ensuring that we have the necessary systems and resources in place to identify, track, and respond to emerging health threats, as well as prepare for and respond to disasters and emergencies, is essential for the health and security of the population.

P725 Patients with Immune Mediated Inflammatory Diseases are insufficiently protected against vaccine-preventable influenza and pneumococcal infections due to low vaccination rates

Abstract Background Patients with Immune Mediated Inflammatory Diseases (IMIDs) treated with immunosuppressive drugs are at an increased risk of infections and a more complicated course of the infection, including vaccine-preventable infections. National and international guidelines have specified vaccination strategies in patients with IMIDs. However, the adherence to these guidelines in clinical practice is uncertain. Therefore, we evaluated the current vaccination status of patients with IMIDs at the outpatient clinic of the Erasmus MC Rotterdam. Methods Between August 2022 and October 2022, a survey was sent out to patients with various IMIDs at the rheumatology, dermatology and gastroenterology outpatient clinics. Only patients on immunosuppressive treatment were included. The survey contained questions on patient demographics, disease characteristics and current vaccination status. Results The survey was sent out to 3,345 patients with IMIDs, of whom 1,094 patients filled in the questionnaire (response rate 32.7%). Mean age was 51 ± 16 years and 40.8% were male (Table 1). Patients were treated by a dermatologist (n=306), gastroenterologist (n=414) and/or rheumatologist (n=527). Overall, 55.1% of patients received a yearly influenza vaccination and 9.2% occasionally (Table 2). Furthermore, 8.7% of patients received the pneumococcal vaccination five-yearly and 1.4% occasionally. Both the influenza and pneumococcal vaccination rates were highest in patients with rheumatoid arthritis (64.1%, and 14.7%, respectively). On the contrary, patients with hidradenitis suppurativa had the lowest rates for both the influenza vaccination (32.3%) and pneumococcal vaccination (n=0). Overall, 91.7% of patients (n=1,003) received one or more COVID-19 vaccinations. Conclusion Patients with Immune Mediated Inflammatory Diseases are insufficiently protected against vaccine-preventable infections due to low vaccination rates. Better implementation strategies of current guidelines on seasonal influenza vaccination and pneumococcal vaccination are required. A high rate of COVID-19 vaccination was observed, possibly indicating the willingness of patients to receive vaccinations. Further research into facilitators and barriers to vaccination in these specific patient populations is required.

Human Papillomavirus Vaccination Among Low-Income, Underserved Children in the Greater DC and Hackensack, NJ Metropolitan Areas

Human Papillomavirus (HPV) is the most common sexually transmitted infection. In 2018, 43 million cases of HPV were recorded in the United States, mostly afflicting young adults in their late teens and early twenties. Gardasil-9, the HPV vaccine currently distributed in the U.S., protects against nine HPV types that cause genital warts and cancers, such as cervical, penile, and oropharyngeal cancer. There is an urgent need for widespread pre-exposure vaccination against HPV among adolescents to prevent the spread of the disease and the future development of associated cancers. This study aims to identify barriers- including lack of knowledge or access, relationship with a provider, and sociocultural factors- to HPV vaccination, to understand the complex motivations behind HPV vaccination and hesitancy to improve vaccine uptake and the health of the community. By identifying these interpersonal and systemic barriers, we can begin to understand what contributes to the lower vaccination rates in low-income, medically underserved communities and what is needed to address them. Data for this analysis was drawn from a quantitative survey and qualitative narratives compiled from key informant interviews (KIIs). Data suggested that receipt of a provider recommendation is associated with vaccine uptake, and greater knowledge of HPV is significantly associated with vaccination. The KIIs revealed that COVID-19 strengthened existing beliefs about vaccination generally, indicating that individuals prone to vaccine hesitancy grew more hesitant while proponents of vaccination pre-pandemic became more supportive after COVID-19. In conclusion, data suggested that increasing the frequency of provider recommendations for HPV vaccination and awareness of HPV would positively impact uptake and result in higher vaccination rates nationwide. Further studies are needed to assess the impact of additional factors, such as medical mistrust, vaccine hesitancy, and stress stemming from COVID-19 on HPV vaccination.

SOCIALLY VULNERABLE PATIENTS WITH INFLAMMATORY BOWEL DISEASE ARE AT INCREASED RISK FOR VACCINE PREVENTABLE ILLNESS

Abstract INTRODUCTION Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds; however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHODS We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULTS 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p&amp;lt;0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p&amp;lt;0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p&amp;lt;0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p&amp;lt;0.001). On SVI sub-scales, high scores in Socioeconomic Status, Household Composition, and Housing/Transportation were important predictors of vaccine uptake while Minority Status/Language was non-significant (Table 1). CONCLUSION Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients.

Assessment of COVID-19 outbreaks in long-term care facilities

The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities.

Are short-term cultural shocks persistent? Taliban rule and long-run human capital accumulation

We analyze the impact of religious and culturally motived policy on long-term human-capital development. Exploiting the unexpected rise and fall of the Taliban in Afghanistan from 1996 to 2001 and geographic variation in exposure to Taliban rule, we find a large negative impact of its rule on education and literacy rates among both men and women who were early-school-age under their rule. We also find that when those girls later became mothers, they reduced health investment in their own children– e.g., lower vaccination rates and higher infant mortality. Yet, this reduced investment is not explained by family-planning differences or the Taliban's enforcement of highly patriarchal norms. Rather it appears to relate to the lack of knowledge in basic healthcare, which is likely associated with the Taliban's role in depressing education and literacy. In sum, even short-term cultural/religious-related policies can have persistent impacts on long-term human-capital formation and overall growth and development.