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1.
JAMA ; 328(14): 1389-1390, 2022 10 11.
Article in English | MEDLINE | ID: covidwho-2084918
2.
Vaccine ; 40(48): 6908-6916, 2022 Nov 15.
Article in English | MEDLINE | ID: covidwho-2076797

ABSTRACT

Interactive stories are a relatively newer form of storytelling with great potential to correct misinformation while increasing self-efficacy, which is crucial to vaccine acceptance. To address COVID-19 vaccine hesitancy and medical mistrust in young Black adults (BYA), we sought to adapt a pre-existing application ("app"; Tough Talks) designed to address HIV disclosure decision-making through choose-your-own adventure (CYOA) narratives and other activities. The adapted app (Tough Talks - COVID) uses a similar approach to situate COVID-19 vaccination decision-making within social contexts and to encourage greater deliberation about decisions. To inform content for the CYOA narratives, we conducted an online survey that was used to elicit the behavioral, cognitive, and environmental determinants influencing COVID-19 vaccine hesitancy among 150 BYA (ages 18-29) in Georgia, Alabama, and North Carolina. The survey included scenario questions that were developed with input from a youth advisory board to understand responses to peer and family influences. In two scenarios that involved discussions with family and friends about vaccination status, most respondents chose to be honest about their vaccination status. However, vaccinated individuals perceived more social pressure and stigma about not being vaccinated than unvaccinated respondents who were not as motivated by social pressure. Personal choice/agency in the face of perceived vaccine risks was a more common theme for unvaccinated respondents. Results suggest that relying on changing social norms alone may not impact barriers to vaccination in unvaccinated young adults without also addressing other barriers to vaccination such as concerns about autonomy and vaccine safety. Based on these findings, CYOA narratives in the app were adapted to include discussions with family and friends but also to touch on themes of personal choice as well as other topics that influence behaviors besides norms such as safety, side effects, and risk of COVID-19 in an evolving pandemic.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adolescent , Young Adult , Humans , Adult , COVID-19/prevention & control , Alabama , Georgia , North Carolina , Trust , Vaccination/methods
3.
AAPS J ; 24(6): 104, 2022 Oct 04.
Article in English | MEDLINE | ID: covidwho-2054054

ABSTRACT

Mankind has recently had to deal a series of virus-mediated pandemics, resulting in extensive morbidity and mortality rates that have severely strained healthcare systems. While dealing with viral infections as a healthcare concern is not new, our exceptionally mobile society has added to the critical challenge of limiting pathogen spread of a highly transmissible virus prior to the generation, testing, and distribution of safe and effective vaccines. The tremendous global effort put forth to address the recent pandemic induced by SARS-CoV-2 infection has highlighted many of the strengths and weaknesses of how vaccines are identified, tested, and used to provide protection. These uncertainties are exacerbated by the lack of clear and consistent messaging that can occur when the processes of research, development, and clinical testing that normally requires years of study and consideration are compressed into a few months. In this commentary, I will provide some background on the intramuscular (IM), subcutaneous (SC), and intradermal (ID) administration routes used for injectable vaccines and some information on potential immunological outcomes. With this background, I will address the recent FDA decision to allow an approved vaccine against monkeypox virus to be administered by ID, as well as its initial approval route via SC, injection as a dose-sparing strategy to maximize immunization numbers using current stockpiles.


Subject(s)
COVID-19 , Monkeypox , COVID-19/prevention & control , Humans , Injections, Intramuscular , SARS-CoV-2 , Vaccination/methods
4.
Chaos ; 32(9): 093140, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2050656

ABSTRACT

An insufficient supply of an effective SARS-CoV-2 vaccine in most countries demands an effective vaccination strategy to minimize the damage caused by the disease. Currently, many countries vaccinate their population in descending order of age (i.e., descending order of fatality rate) to minimize the deaths caused by the disease; however, the effectiveness of this strategy needs to be quantitatively assessed. We employ the susceptible-infected-recovered-dead model to investigate various vaccination strategies. We constructed a metapopulation model with heterogeneous contact and fatality rates and investigated the effectiveness of vaccination strategies to reduce epidemic mortality. We found that the fatality-based strategy, which is currently employed in many countries, is more effective when the contagion rate is high and vaccine supply is low, but the contact-based method outperforms the fatality-based strategy when there is a sufficiently high supply of the vaccine. We identified a discontinuous transition of the optimal vaccination strategy and path-dependency analogous to hysteresis. This transition and path-dependency imply that combining the fatality-based and contact-based strategies is ineffective in reducing the number of deaths. Furthermore, we demonstrate that such phenomena occur in real-world epidemic diseases, such as tuberculosis and COVID-19. We also show that the conclusions of this research are valid even when the complex epidemic stages, efficacy of the vaccine, and reinfection are considered.


Subject(s)
COVID-19 , Epidemics , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Epidemics/prevention & control , Humans , SARS-CoV-2 , Vaccination/methods
5.
Vaccine ; 40(45): 6481-6488, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2042195

ABSTRACT

BACKGROUND: Active monitoring of safety outcomes following COVID-19 vaccination is critical to understand vaccine safety and can provide early detection of rare outcomes not identified in pre-licensure trials. We present findings from an early warning rapid surveillance system in three large commercial insurance databases including more than 16 million vaccinated individuals. METHODS: We evaluated 17 outcomes of interest following COVID-19 vaccination among individuals aged 12-64 years in Optum, HealthCore, and CVS Health databases from December 11, 2020, through January 22, 2022, January 7, 2022, and December 31, 2021, respectively. We conducted biweekly or monthly sequential testing and generated rate ratios (RR) of observed outcome rates compared to historical (or expected) rates prior to COVID-19 vaccination. FINDINGS: Among 17 outcomes evaluated, 15 did not meet the threshold for statistical signal in any of the three databases. Myocarditis/pericarditis met the statistical threshold for a signal following BNT162b2 in two of three databases (RRs: 1.83-2.47). Anaphylaxis met the statistical threshold for a signal in all three databases following BNT162b2 vaccination (RRs: 4.48-10.86) and mRNA-1273 vaccination (RRs: 7.64-12.40). DISCUSSION: Consistent with published literature, our near-real time monitoring of 17 adverse outcomes following COVID-19 vaccinations identified signals for myocarditis/pericarditis and anaphylaxis following mRNA COVID-19 vaccinations. The method is intended for early detection of safety signals, and results do not imply a causal effect. Results of this study should be interpreted in the context of the method's utility and limitations, and the validity of detected signals must be evaluated in fully adjusted epidemiologic studies.


Subject(s)
Anaphylaxis , COVID-19 , Myocarditis , Pericarditis , Humans , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Anaphylaxis/etiology , Myocarditis/etiology , BNT162 Vaccine , Vaccination/adverse effects , Vaccination/methods , Pericarditis/etiology , RNA, Messenger
6.
J Clin Pharmacol ; 62(11): 1335-1349, 2022 11.
Article in English | MEDLINE | ID: covidwho-2034816

ABSTRACT

The coronavirus disease 2019 (COVID-19), induced by the severe acute respiratory syndrome coronavirus 2, is responsible for a global pandemic following widespread transmission and death. Several vaccines have been developed to counter this public health crisis using both novel and conventional methods. Following approval based on promising efficacy and safety data, the AstraZeneca, Janssen, Moderna, Pfizer/BioNTech, and Sinovac vaccines have been administered globally among different populations with various reported side effects. Reports of life-threatening anaphylaxis following administration were of particular concern for both health care providers and the public. A systematic literature search using PubMed, Embase, Scopus, Web of Science, Science Direct, MedRxiv, and Lens.org databases identified relevant studies reporting anaphylaxis following vaccine administration. This systematic review includes 41 studies reporting anaphylaxis. A total of 7942 cases, including 43 deaths, were reported across 14 countries. Most cases occurred following the administration of the first dose. Importantly, the benefits of vaccination outweigh the risks of anaphylaxis. Subsequently, as populations continue to get vaccinated, it is important for health care providers to be able to recognize individuals at risk of developing anaphylaxis. Furthermore, they must be familiar with both the clinical hallmarks and treatment of anaphylactic reactions to minimize long-term sequalae and prevent death in vaccinated individuals.


Subject(s)
Anaphylaxis , COVID-19 , Vaccines , Anaphylaxis/chemically induced , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Vaccination/adverse effects , Vaccination/methods , Vaccines/therapeutic use
7.
Sci Rep ; 12(1): 15688, 2022 09 20.
Article in English | MEDLINE | ID: covidwho-2036895

ABSTRACT

An Adaptive Susceptible-Infected-Removed-Vaccinated (A-SIRV) epidemic model with time-dependent transmission and removal rates is constructed for investigating the dynamics of an epidemic disease such as the COVID-19 pandemic. Real data of COVID-19 spread is used for the simultaneous identification of the unknown time-dependent rates and functions participating in the A-SIRV system. The inverse problem is formulated and solved numerically using the Method of Variational Imbedding, which reduces the inverse problem to a problem for minimizing a properly constructed functional for obtaining the sought values. To illustrate and validate the proposed solution approach, the present study used available public data for several countries with diverse population and vaccination dynamics-the World, Israel, The United States of America, and Japan.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Disease Susceptibility/epidemiology , Epidemiological Models , Humans , Models, Biological , Pandemics/prevention & control , Vaccination/methods
8.
Front Immunol ; 13: 967226, 2022.
Article in English | MEDLINE | ID: covidwho-2022751

ABSTRACT

The global coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of vaccines against this disease. Despite the success of the international vaccination program, adverse events following vaccination, and the mechanisms behind them, remain poorly understood. Here we present four cases of death following receipt of a second dose of COVID-19 vaccine, with no obvious cause identified at autopsy. Using RNA sequencing, we identified genes that were differentially expressed between our post-vaccination cases and a control group that died of blood loss and strangulation. Three hundred and ninety genes were found to be upregulated and 115 genes were downregulated in post-vaccination cases compared with controls. Importantly, genes involved in neutrophil degranulation and cytokine signaling were upregulated. Our results suggest that immune dysregulation occurred following vaccination. Careful observation and care may be necessary if an abnormally high fever exceeding 40°C occurs after vaccination, even with antipyretic drugs.


Subject(s)
COVID-19 , COVID-19 Vaccines/adverse effects , Cytokine Release Syndrome , Humans , Pandemics/prevention & control , Vaccination/adverse effects , Vaccination/methods
9.
Allergy Asthma Proc ; 43(5): 431-434, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2022490

ABSTRACT

Background: Although severe allergic reactions to coronavirus disease 2019 (COVID-19) vaccines are rare, fear of allergic reactions remains a major source of vaccine hesitancy. For concerned patients and providers alike, allergist consultation is recommended for further guidance on the risk of vaccination. The electronic consultation (e-consult) medium has the potential to make this guidance more widely accessible, thereby supporting vaccination efforts. Objective: To determine the safety and efficacy of an e-consult program for COVID-19 vaccine allergy concerns. Methods: We performed a retrospective analysis of a single-center COVID-19 vaccine allergy e-consult program. Data on demographics, allergy history, and outcomes after recommendations were gathered via review of the electronic medical record (EMR). Patients without EMR data available following the e-consult were called to inquire about vaccination status. Results: Our study included 64 patients, most of whom (51.6% [33/64]) had e-consults placed for second-dose concerns. E-consults were completed within 2 days for all patients. The most common recommendation was that patients receive any COVID-19 vaccination available (62.5%, [40/64]). Forty-one patients (64.1%) were vaccinated after receiving recommendations from an allergist, 11 of whom (26.8%) reported a vaccine reaction. Most of these reactions were nonallergic (9/11 [81.2%]). No anaphylactic events were reported. Conclusion: Results of our study suggest that e-consults were a safe and effective method of providing guidance with regard to COVID-19 vaccine risk in patients with concerns about allergic reactions. The efficiency of this medium, highlighted by the 2-day turnaround time in our study, has the potential to expand access to vaccine risk evaluations by board-certified allergist/immunologists.


Subject(s)
COVID-19 , Hypersensitivity , Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Hypersensitivity/epidemiology , Hypersensitivity/etiology , Referral and Consultation , Retrospective Studies , Vaccination/adverse effects , Vaccination/methods , Vaccines/adverse effects
10.
Clin Drug Investig ; 42(10): 799-806, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2014598

ABSTRACT

BACKGROUND AND OBJECTIVE: A limited number of studies have addressed the protective duration of coronavirus disease 2019 (COVID-19) vaccines following primary and booster doses in Saudi Arabia. Therefore, this study aimed to evaluate the protective duration of primary and booster doses of BNT162b2 and ChAdOx1 COVID-19 vaccine batches in Saudi Arabia. METHODS: A cross-sectional study was conducted from 1 January to 31 December, 2021. The study included 53,354 people infected with severe acute respiratory syndrome coronavirus-2 2 weeks or more after receiving at least a primary vaccination of either the ChAdOx1 or BNT162b2 vaccine. RESULTS: The total median protective duration of both primary COVID-19 vaccinations was 134 days. Heterologous primary vaccination (ChAdOx1 followed by BNT162b2) showed a significantly higher median protective duration of 142 days. The results show that the total median protective duration of the first booster doses of COVID-19 vaccines was 57 days. ChAdOx1 batch code C1 was found to have the most extended protective duration of 173 days (range 163-192 days). CONCLUSIONS: The current study revealed that the median protective duration of ChAdOx1 and BNT162b2 COVID-19 primary vaccination regimens administered in Saudi Arabia in 2021 was 134 days and that heterologous primary vaccination (ChAdOx1→BNT162b2) exhibited a significantly higher protective duration than other vaccination regimens.


Subject(s)
COVID-19 , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , ChAdOx1 nCoV-19 , Cross-Sectional Studies , Humans , SARS-CoV-2 , Vaccination/methods
11.
Vaccine ; 40(45): 6528-6548, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2008169

ABSTRACT

OBJECTIVES: To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. METHODS: Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout. RESULTS: We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications. CONCLUSIONS: Both supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time. POLICY IMPLICATIONS: Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.


Subject(s)
COVID-19 , Vaccines , Aged , Humans , COVID-19 Vaccines , Health Expenditures , Vaccination Hesitancy , COVID-19/prevention & control , Vaccination/methods
12.
Transplant Cell Ther ; 28(11): 784.e1-784.e9, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2007886

ABSTRACT

Chronic graft-versus-host disease (cGVHD) and its management with immunosuppressive therapies increase the susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as progression to severe Coronavirus 19 disease (COVID-19). Vaccination against COVID-19 is strongly recommended, but efficacy data are limited in this patient population. In this study, responses to COVID-19 vaccination were measured at 3 time points-after the initial vaccine series, before the third dose, and after the third dose-in adults with cGVHD receiving immunosuppressive therapy. Humoral response was measured by quantitative anti-spike antibody and neutralizing antibody levels. Anti-nucleocapsid antibody levels were measured to detect natural infection. T cell response was evaluated by a novel immunosequencing technique combined with immune repertoire profiling from cryopreserved peripheral blood mononuclear cell samples. Present or absent T cell responses were determined by the relative proportion of unique SARS-CoV-2-associated T cell receptor sequences ("breadth") plus clonal expansion of the response ("depth") compared with those in a reference population. Based on both neutralizing antibody and T cell responses, patients were categorized as vaccine responders (both detected), nonresponders (neither detected), or mixed (one but not both detected). Thirty-two patients were enrolled for the initial series, including 17 (53%) positive responders, 7 (22%) mixed responders, and 8 (25%) nonresponders. All but one patient categorized as mixed responders had humoral responses while lacking T cell responses. No statistical differences were observed in patient characteristics among the 3 groups of patients categorized by immune response, although sample sizes were limited. Significant positive correlations were observed between the robustness of cellular and humoral responses after the initial series. Among the 20 patients with paired samples (pre- and post-third dose), a third vaccination resulted in increased neutralizing antibody titers. cGVHD worsened in 10 patients (26%; 6 after the initial series and 4 after the third dose), necessitating escalation of immunosuppressive doses in 5 patients, although 4 had been tapering immunosuppression and 5 had already worsening cGVHD at the time of vaccination, and a clear association between COVID-19 vaccination and cGVHD could not be drawn. Among the patients with cGVHD on immunosuppressive therapy, 72% demonstrated a neutralizing antibody response after a 2-dose primary COVID-19 vaccination, two-thirds of whom also developed a T cell response; 25% had neither a humoral nor a T cell response. A third dose further amplified the antibody response.


Subject(s)
COVID-19 , Graft vs Host Disease , Immunologic Deficiency Syndromes , Adult , Humans , COVID-19 Vaccines , SARS-CoV-2 , Antibodies, Viral , Leukocytes, Mononuclear , Vaccination/methods , Immunity, Cellular , Antibodies, Neutralizing , Immunosuppression Therapy
13.
STAR Protoc ; 3(3): 101652, 2022 09 16.
Article in English | MEDLINE | ID: covidwho-2004615

ABSTRACT

Vaccination route dictates the quality and localization of immune responses within tissues. Intranasal vaccination seeds tissue-resident adaptive immunity, alongside trained innate responses within the lung/airways, critical for superior protection against SARS-CoV-2. This protocol encompasses intranasal vaccination in mice, step-by-step bronchoalveolar lavage for both cellular and acellular airway components, lung mononuclear cell isolation, and detailed flow cytometric characterization of lung tissue-resident memory T cell responses, and airway macrophage-trained innate immunity. For complete details on the use and execution of this protocol, please refer to Afkhami et al. (2022).


Subject(s)
COVID-19 , Memory T Cells , Animals , COVID-19/prevention & control , Immunity, Innate , Lung , Mice , SARS-CoV-2 , Vaccination/methods
14.
Viruses ; 14(8)2022 08 19.
Article in English | MEDLINE | ID: covidwho-1997801

ABSTRACT

Solid organ transplant (SOT) recipients are at greater risk of coronavirus disease 2019 (COVID-19) and have attenuated response to vaccinations. In the present meta-analysis, we aimed to evaluate the serologic response to the COVID-19 vaccine in SOT recipients. A search of electronic databases was conducted to identify SOT studies that reported the serologic response to COVID-19 vaccination. We analyzed 44 observational studies including 6158 SOT recipients. Most studies were on mRNA vaccination (mRNA-1273 or BNT162b2). After a single and two doses of vaccine, serologic response rates were 8.6% (95% CI 6.8-11.0) and 34.2% (95% CI 30.1-38.7), respectively. Compared to controls, response rates were lower after a single and two doses of vaccine (OR 0.0049 [95% CI 0.0021-0.012] and 0.0057 [95% CI 0.0030-0.011], respectively). A third dose improved the rate to 65.6% (95% CI 60.4-70.2), but in a subset of patients who had not achieved a response after two doses, it remained low at 35.7% (95% CI 21.2-53.3). In summary, only a small proportion of SOT recipients achieved serologic response to the COVID-19 mRNA vaccine, and that even the third dose had an insufficient response. Alternative strategies for prophylaxis in SOT patients need to be developed. Key Contribution: In this meta-analysis that included 6158 solid organ transplant recipients, the serologic response to the COVID-19 vaccine was extremely low after one (8.6%) and two doses (34.2%). The third dose of the vaccine improved the rate only to 66%, and in the subset of patients who had not achieved a response after two doses, it remained low at 36%. The results of our study suggest that a significant proportion of solid organ transplant recipients are unable to achieve a sufficient serologic response after completing not only the two series of vaccination but also the third booster dose. There is an urgent need to develop strategies for prophylaxis including modified vaccine schedules or the use of monoclonal antibodies in this vulnerable patient population.


Subject(s)
COVID-19 Vaccines , COVID-19 , Organ Transplantation , Vaccines , Antibodies, Viral , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Testing , COVID-19 Vaccines/adverse effects , Humans , Organ Transplantation/adverse effects , Vaccination/methods , Vaccines, Synthetic , mRNA Vaccines
15.
Med (N Y) ; 3(8): 531-537, 2022 08 12.
Article in English | MEDLINE | ID: covidwho-1983656

ABSTRACT

The protection provided by natural versus hybrid immunity from COVID-19 is unclear. We reflect on the challenges from trying to conduct a randomized post-SARS-CoV-2 infection vaccination trial study with rapidly evolving scientific data, vaccination guidelines, varying international policies, difficulties with vaccine availability, vaccine hesitancy, and a constantly evolving virus.


Subject(s)
COVID-19 Vaccines , COVID-19 , Vaccination , COVID-19/prevention & control , COVID-19/therapy , Humans , Inpatients , Randomized Controlled Trials as Topic , Vaccination/methods
16.
Comput Biol Med ; 149: 105986, 2022 10.
Article in English | MEDLINE | ID: covidwho-1982868

ABSTRACT

Recently, a high number of daily positive COVID-19 cases have been reported in regions with relatively high vaccination rates; hence, booster vaccination has become necessary. In addition, infections caused by the different variants and correlated factors have not been discussed in depth. With large variabilities and different co-factors, it is difficult to use conventional mathematical models to forecast the incidence of COVID-19. Machine learning based on long short-term memory was applied to forecasting the time series of new daily positive cases (DPC), serious cases, hospitalized cases, and deaths. Data acquired from regions with high rates of vaccination, such as Israel, were blended with the current data of other regions in Japan such that the effect of vaccination was considered in efficient manner. The protection provided by symptomatic infection was also considered in terms of the population effectiveness of vaccination as well as the vaccination protection waning effect and ratio and infectivity of different viral variants. To represent changes in public behavior, public mobility and interactions through social media were also included in the analysis. Comparing the observed and estimated new DPC in Tel Aviv, Israel, the parameters characterizing vaccination effectiveness and the waning protection from infection were well estimated; the vaccination effectiveness of the second dose after 5 months and the third dose after two weeks from infection by the delta variant were 0.24 and 0.95, respectively. Using the extracted parameters regarding vaccination effectiveness, DPC in three major prefectures of Japan were replicated. The key factor influencing the prevention of COVID-19 transmission is the vaccination effectiveness at the population level, which considers the waning protection from vaccination rather than the percentage of fully vaccinated people. The threshold of the efficiency at the population level was estimated as 0.3 in Tel Aviv and 0.4 in Tokyo, Osaka, and Aichi. Moreover, a weighting scheme associated with infectivity results in more accurate forecasting by the infectivity model of viral variants. Results indicate that vaccination effectiveness and infectivity of viral variants are important factors in future forecasting of DPC. Moreover, this study demonstrate a feasible way to project the effect of vaccination using data obtained from other country.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Hospitalization , Humans , SARS-CoV-2 , Vaccination/methods
17.
Vaccine ; 40(37): 5471-5482, 2022 09 02.
Article in English | MEDLINE | ID: covidwho-1977886

ABSTRACT

Vaccine hesitancy has been identified as a major obstacle preventing comprehensive coverage against the COVID-19 pandemic. However, few studies have analyzed the association between ex-ante vaccine hesitancy and ex-post vaccination coverage. This study leveraged one-year county-level data across the contiguous United States to examine whether the prospective vaccine hesitancy eventually translates into differential vaccination rates, and whether vaccine hesitancy can explain socioeconomic, racial, and partisan disparities in vaccine uptake. A set of structural equation modeling was fitted with vaccine hesitancy and vaccination rate as endogenous variables, controlling for various potential confounders. The results demonstrated a significant negative link between vaccine hesitancy and vaccination rate, with the difference between the two continuously widening over time. Counties with higher socioeconomic statuses, more Asian and Hispanic populations, more elderly residents, greater health insurance coverage, and more Democrats presented lower vaccine hesitancy and higher vaccination rates. However, underlying determinants of vaccination coverage and vaccine hesitancy were divergent regarding their different associations with exogenous variables. Mediation analysis further demonstrated that indirect effects from exogenous variables to vaccination coverage via vaccine hesitancy only partially explained corresponding total effects, challenging the popular narrative that portrays vaccine hesitancy as a root cause of disparities in vaccination. Our study highlights the need of well-funded, targeted, and ongoing initiatives to reduce persisting vaccination inequities.


Subject(s)
COVID-19 , Vaccination Coverage , Aged , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Pandemics , United States , Vaccination/methods , Vaccination Hesitancy
18.
Euro Surveill ; 27(30)2022 07.
Article in English | MEDLINE | ID: covidwho-1974589

ABSTRACT

This work evaluated neutralising antibody titres against wild type (WT) SARS-CoV-2 and four Omicron variants (BA.1, BA.2, BA.4 and BA.5) in healthcare workers who had breakthrough BA.1 infection. Omicron breakthrough infection in individuals vaccinated three or four times before infection resulted in increased neutralising antibodies against the WT virus. The fourth vaccine dose did not further improve the neutralising efficiency over the third dose against all Omicron variants, especially BA.4 and BA.5. An Omicron-specific vaccine may be indicated.


Subject(s)
COVID-19 , Vaccines , Antibodies, Neutralizing , Antibodies, Viral , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Israel/epidemiology , SARS-CoV-2/genetics , Vaccination/methods
19.
BMC Public Health ; 22(1): 1288, 2022 07 04.
Article in English | MEDLINE | ID: covidwho-1974136

ABSTRACT

BACKGROUND: Vaccination is key to reducing the spread and impacts of COVID-19 and other infectious diseases. Migrants, compared to majority populations, tend to have lower vaccination rates, as well as higher infection disease burdens. Previous studies have tried to understand these disparities based on factors such as misinformation, vaccine hesitancy or medical mistrust. However, the necessary precondition of receiving, or recognizing receipt, of an offer to get a vaccine must also be considered. METHODS: We conducted a web-based survey in six parishes in Oslo that have a high proportion of migrant residents and were hard-hit during the COVID-19 pandemic. Logistic regression analyses were conducted to investigate differences in reporting being offered the COVID-19 vaccine based on migrant status. Different models controlling for vaccination prioritization variables (age, underlying health conditions, and health-related jobs), socioeconomic and demographic variables, and variables specific to migrant status (language spoken at home and years lived in Norway) were conducted. RESULTS: Responses from 5,442 participants (response rate of 9.1%) were included in analyses. The sample included 1,284 (23.6%) migrants. Fewer migrants than non-migrants reported receiving a vaccine offer (68.1% vs. 81.1%), and this difference was significant after controlling for prioritization variables (OR 0.65, 95% CI: 0.52-0.82). Subsequent models showed higher odds ratios for reporting having been offered the vaccine for females, and lower odds ratios for those with university education. There were few to no significant differences based on language spoken at home, or among birth countries compared to each other. Duration of residence emerged as an important explanatory variable, as migrants who had lived in Norway for fewer than 15 years were less likely to report offer of a vaccine. CONCLUSION: Results were consistent with studies that show disparities between non-migrants and migrants in actual vaccine uptake. While differences in receiving an offer cannot fully explain disparities in vaccination rates, our analyses suggest that receiving, or recognizing and understanding, an offer does play a role. Issues related to duration of residence, such as inclusion in population and health registries and health and digital literacy, should be addressed by policymakers and health services organizers.


Subject(s)
COVID-19 , Transients and Migrants , Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , Norway/epidemiology , Pandemics , Trust , Vaccination/methods
20.
Clin Res Cardiol ; 111(10): 1161-1173, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1971699

ABSTRACT

BACKGROUND: Coronavirus Disease-2019 (COVID-19) vaccination has been associated with the development of carditis, especially in children and adolescent males. However, the rates of these events in the global setting have not been explored in a systematic manner. The aim of this systematic review and meta-analysis is to investigate the rates of carditis in children and adolescents receiving COVID-19 vaccines. METHODS: PubMed, Embase and several Latin American databases were searched for studies. The number of events, and where available, at-risk populations were extracted. Rate ratios were calculated and expressed as a rate per million doses received. Subgroup analysis based on the dose administered was performed. Subjects ≤ 19 years old who developed pericarditis or myocarditis following COVID-19 vaccination were included. RESULTS: A total of 369 entries were retrieved. After screening, 39 articles were included. Our meta-analysis found that 343 patients developed carditis after the administration of 12,602,625 COVID-19 vaccination doses (pooled rate per million: 37.76; 95% confidence interval [CI] 23.57, 59.19). The rate of carditis was higher amongst male patients (pooled rate ratio: 5.04; 95% CI 1.40, 18.19) and after the second vaccination dose (pooled rate ratio: 5.60; 95% CI 1.97, 15.89). In 301 cases of carditis (281 male; mean age: 15.90 (standard deviation [SD] 1.52) years old) reported amongst the case series/reports, 261 patients were reported to have received treatment. 97.34% of the patients presented with chest pain. The common findings include ST elevation and T wave abnormalities on electrocardiography. Oedema and late gadolinium enhancement in the myocardium were frequently observed in cardiac magnetic resonance imaging (CMR). The mean length of hospital stay was 3.91 days (SD 1.75). In 298 out of 299 patients (99.67%) the carditis resolved with or without treatment. CONCLUSIONS: Carditis is a rare complication after COVID-19 vaccination across the globe, but the vast majority of episodes are self-limiting with rapid resolution of symptoms within days. Central illustration. Balancing the benefits of vaccines on COVID-19-caused carditis and post-vaccination carditis.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Vaccines , Adolescent , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Contrast Media , Gadolinium , Humans , Infant , Male , Myocarditis/epidemiology , Myocarditis/etiology , Vaccination/adverse effects , Vaccination/methods , Young Adult
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