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Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.
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We examine how lower-income households in the United States acquire automobiles. Although car ownership plays a vital role in social and economic mobility in the US, transportation scholars know little about how low-income households obtain cars. Better understanding the pathways to car ownership can help policymakers and non-government actors design interventions to assist low-income households in acquiring and maintaining cars. Our research contributes to basic social science by illuminating the financial and quality of life effects of obtaining cars through various means. We use an online opt-in survey of adults from lower-income households to examine how and why they acquire cars and the effects of these different pathways to car ownership on finances and quality of life. We identify-five pathways to car ownership. The most common pathway is to acquire a used car from a dealer (38% of our sample), followed by buying a used car informally (24%), purchasing a new car (17%), receiving a car as a gift (15%), and via a move-in with someone who has a car (5%). Respondents most often acquired a car for financial reasons and to increase accessibility. In contrast, the COVID-19 pandemic, life events, and built environment factors played a smaller role. Respondents reported that acquiring a car had a positive effect on their lives. Almost 90% of respondents said that acquiring the car was worth it, despite nearly half of the survey respondents experiencing financial hardship related to car ownership, operation, and maintenance. © 2023 The Author(s)
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What is this summary about? This is a summary of an article about part of a clinical study for the BNT162b2 COVID-19 vaccine, also called the Pfizer-BioNTech vaccine. The article was published in the New England Journal of Medicine in May 2021. This summary describes how the vaccine worked in participants 12- to 15-years old. The part of the study described in the article is ongoing and expected to finish March 2023. This means that the final results may be different from the results included in this summary. What happened in this study? The part of the study described in this summary included participants 12- to 15-years old who had no serious health issues. The BNT162b2 vaccine had already been studied in participants 16 years of age or older. In this part of the study, the researchers wanted to find out: * How effective and safe the vaccine was in participants 12- to 15-years old. * What the immune response to the vaccine and the vaccine safety were like in 12- to 15-year-olds compared with 16- to 25-year-olds. * How well the vaccine prevented SARS-CoV-2 infections in participants who received the vaccine compared to those who did not. This is also called efficacy of the BNT162b2 vaccine Half of the participants in this study received 2 injections of the BNT162b2 vaccine and half received 2 injections of a placebo in a muscle of the upper arm. The placebo looked like the BNT162b2 vaccine but did not have any active vaccine in it. What were the results? * BNT162b2 had a favorable safety profile. The most common reactions were pain at the injection site, fatigue, and headache. None of the participants had serious reactions to the vaccine. * The 12- to 15-year-old participants' immune system responses to the BNT162b2 vaccine were as good as or stronger than the 16- to 25-year-old participants' immune responses. * The participants who received the BNT162b2 vaccine were less likely to get COVID-19 compared with the participants who got the placebo.Copyright © 2023 The Authors.
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Background. COVID-19 presents a serious health risk to pregnant people and pregnancy outcomes. However, pregnant people were not included in pivotal phase III COVID-19 vaccine efficacy trials. Methods. We used Cox regression models in a cohort study to determine hazard ratios (HR) of a PCR positive test ("infection") comparing vaccinated with unvaccinated pregnant persons in Kaiser Permanente Northern California. HRs were adjusted for age, race/ethnicity, type of insurance coverage, geographical area, BMI, preexisting diabetes, hypertension, parity, time since pregnancy onset and smoking status. Vaccine effectiveness (VE), calculated as 1 minus adjusted HR, was estimated for fully vaccinated < 150 and >= 150 days prior to infection. VE was estimated for before and during Delta, and Omicron. We also calculated incidence rates of COVID-pneumonia associated hospitalization by vaccination status. Results. Among 68836 pregnancies between 12/15/2020 and 3/31/2022, 21834 (31.7%) were fully vaccinated and 5980 (8.7%) were boosted by the end of pregnancy. Compared with unvaccinated persons, the HRs of infection for fully vaccinated < 150 days prior were 0.13 (95% CI: 0.07 - 0.23;VE=87% [77% - 93%]) before Delta;0.25 (CI: 0.20 - 0.30;VE=75% [70% - 80%]) during Delta and 0.76 (CI: 0.61 - 0.94;VE= 24% [16% - 39%]) during Omicron. The HRs for >= 150 days prior were 0.38 (CI: 0.31 - 0.46;VE=62 % [54% - 69%]) during Delta and 1.04 (CI: 0.89 - 1.22;VE= -0.04% [-0.22% - 0.11%]) during Omicron. The HRs for boosted persons were 0.10 (CI: 0.04 - 0.25;VE= 90% [75% - 96%]) during Delta and 0.42 (CI: 0.34 - 0.52;VE=58% [48% - 66%]) during Omicron periods. Incidence rates (IR) per 1000 person-years for hospitalization before delta were 0.75 among unvaccinated and zero among vaccinated. During Delta, the IR was 6.64 for unvaccinated and zero for fully vaccinated and boosted. During Omicron, the IR was 10.27 for unvaccinated, zero for fully vaccinated < 150 days prior, 2.48 for fully vaccinated >= 150 days prior and zero for those boosted. Conclusion. COVID-19 vaccines protect against infection and hospitalization among pregnant people. However, vaccine effectiveness against infection wanes over time and was lower during Omicron. Booster doses are necessary for continuous protection.
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Problem, research strategy, and findings New transportation options like ride-hail can expand accessibility without the costs of car ownership. Ride-hail's potential is particularly salient for lower-income and zero-car households. We used interviews and a national (U.S.) survey to examine how and why lower-income travelers in the United States use ride-hail. Survey and interview responses provided a temporal snapshot and thus reflect, in part, travel challenges specific to COVID-19. Findings suggest that lower-income travelers, particularly those without personal cars, use ride-hail in ways distinct from those typically reported in broader travel surveys. Individuals without cars are more likely to use ride-hail, and use it more often, compared with people with cars, particularly to fill spatial and temporal gaps in public transit service and to access medical care and groceries. Costs and price unpredictability remain significant barriers limiting travelers' use of ride-hail services. Takeaway for practice This research demonstrates a latent need for car access among lower-income travelers. Substantial gaps in alternative modes pose challenges for travelers seeking reliable and timely transportation. Planners should invest in transit, biking, and walking to provide robust alternatives to car ownership. Such investments, however, take time. In the meantime, cities and agencies should consider subsidizing ride-hail trips to bridge existing gaps in the transportation network.
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Background. We conducted a large real-world study of the long-term vaccine effectiveness (VE) of the live attenuated zoster vaccine (Zostavax;ZVL). Using an innovative approach with automated observational data we measured VE for incident herpes zoster (HZ) and severe HZ outcomes including post-herpetic neuralgia (PHN), herpes zoster ophthalmicus (HZO), and hospitalized HZ. This approach could be useful in long-term effectiveness studies of other vaccines. Methods. We assessed VE against HZ, PHN, HZO and hospitalized HZ for up to 10+ years after vaccination at Kaiser Permanente Northern California. We identified incident cases using diagnoses, laboratory tests and prescriptions, and validated a sample by chart review. For each outcome, we used a Cox regression model with a calendar timeline to estimate VE in relation to year since vaccination. The model for HZ included 11 time-varying vaccination status indicators to denote -- at each timepoint during follow-up -- either the number of years since ZVL vaccination (30 days to < 1 year, 1 to < 2 years, . . ., and 10+ years) or that the individual is unvaccinated (reference group). Analyses were adjusted for demographics and time-varying measures of immune compromise status, healthcare use and comorbidities. Results. From 2007-2018, 1.5 million people contributed to analyses;507,000 (34%) were vaccinated. During 9 million person-years of follow-up, we observed 75,135 HZ cases, including 4,982 (7%) with PHN, 4,418 (6%) with HZO, and 555 (< 1%) who were hospitalized. VE for HZ was 67% (95% Confidence Interval [CI]: 65-69%) in the first year after vaccination, waned to 50% (CI: 47-52%) in the second year after vaccination, and then waned more gradually to 15% (CI: 5-24%) by 10+ years after vaccination. Initial VE was higher against PHN (83%;CI: 78-87%) and hospitalized HZ (89%;CI: 67-97%) with less waning observed over time (42% by Year 8 for PHN and 53% in Years 5 to < 8 for hospitalized HZ). VE against HZO was 71% in Year 1 and waned to 29% in Years 5 to < 8. Conclusion. Our large population, long follow-up and innovative methods let us estimate VE against HZ, PHN, HZO and hospitalized HZ for 10+ years after vaccination. Our approach could help assess waning and need for boosters for vaccines against other agents including COVID-19.
Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/complications , Child , Humans , Systemic Inflammatory Response Syndrome/diagnosisABSTRACT
Social distancing is a necessary policy with an unfortunate name. Although maintaining geographical, or physical, distance from one another is important for slowing the spread of COVID-19, people should strive to maintain social connections even while physically apart. That is because the lack of connection and the attendant loneliness that can result from physical distancing are not benign: loneliness can impair well-being and harm health. In this article, we review evidence demonstrating the ill effects of loneliness and summarize actions that psychological science suggests can enhance social connection during the COVID-19 pandemic despite physical distancing. We also discuss ways that governments, nonprofit organizations, and for-profit organizations can help motivate people to adopt these actions. Efforts to mitigate the medical risks of COVID-19 should not have to exacerbate the public health problem of loneliness. © 2020, Brookings Institution Press. All rights reserved.
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COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19–associated morbidity and mortality (1);however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC’s Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020–May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson And Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020–May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18–24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19. VSD is a collaboration between CDC’s Immunization Safety Office and eight integrated health care organizations in six U.S. states.† VSD captures information on COVID-19 vaccine doses administered, regardless of where they are received, based on an automated search within the organizations’ facilities (outpatient and inpatient records) and external systems (e.g., health insurance claims and state or local immunization What is already known about this topic? Non-Hispanic Black and Hispanic persons experience higher COVID-19–associated morbidity and mortality, yet COVID-19 vaccination coverage is lower in these groups. What is added by this report? As of May 15, 2021, 48.3% of persons identified in CDC’s Vaccine Safety Datalink aged ≥16 years had received ≥1 COVID-19 vaccine dose and 38.3% were fully vaccinated. Coverage with ≥1 dose was lower among non-Hispanic Black (40.7%) and Hispanic persons (41.1%) than among non-Hispanic White persons (54.6%);coverage was highest (57.4%) among non-Hispanic Asian persons. What are the implications for public health practice? Continued monitoring of vaccination coverage and efforts to improve equity in vaccination coverage are critical, especially among populations disproportionately affected by COVID-19. © 2021 Department of Health and Human Services. All rights reserved.
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Cruise ships have contributed to the spread of COVID-19 around the world and State responses to the pandemic have needed to account for the presence of these ships in their ports and the medical treatment of both passengers and crew on board. This contribution outlines the key bodies of international law that must be brought to bear in deciding on State action in response to cruise ships and their COVID-19 cases: the law of the sea, international health law, shipping conventions and especially treaties protecting the rights of seafarers, international human rights law and laws relating to consular assistance. While these laws tend to reinforce each other, it is argued that the need for humanitarian considerations to feature strongly in State decision-making is challenged by systemic weaknesses.