Vaccinating Children Against COVID-19 is Essential Prior to the Removal of Non-Pharmaceutical Interventions

Objectives(s): To evaluate the joint impact of childhood vaccination rates and masking policies, in schools and workplaces, on community transmission and severe outcomes due to COVID-19. Study design: We utilized a stochastic, agent-based simulation of North Carolina, to evaluate the impact of 24 health policy decisions on overall incidence of disease, COVID-19 related hospitalization, and mortality from July 1, 2021-July 1, 2023. Results: Universal mask removal in schools in January 2022 could lead to a 38.1-47%, 27.6-36.2%, and 15.9-19.7% increase in cumulative infections for ages 5-9, 10-19, and the total population, respectively, depending on the rate of vaccination of children relative to the adult population. Additionally, without increased vaccination uptake in the adult population, a 25% increase in child vaccination uptake from 50% to 75% uptake and from 75% to 100% uptake relative to the adult population, leads to a 22% and 18% or 28% and 33% decrease in peak hospitalizations in 2022 across scenarios when masks are removed either January 1st or March 8th 2022, respectively. Increasing vaccination uptake for the entire eligible population can reduce peak hospitalizations in 2022 by an average of 89% and 92% across all masking scenarios compared to the scenarios where no children are vaccinated. Conclusion(s): High vaccination uptake among both children and adults is necessary to mitigate the increase in infections from mask removal in schools and workplaces.

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The Impact of COVID-19 Restrictions on Childhood Vaccination Uptake: A Rapid Review

10.1101/2021.06.25.21259371 ◽

2021 ◽

Author(s):

Carl Heneghan ◽

Jon Brassey ◽

Tom Jefferson

Keyword(s):

Original Data ◽

Vaccine Uptake ◽

Childhood Vaccination ◽

Rapid Review ◽

Older Children ◽

Vaccination Rates ◽

Vaccination Uptake ◽

International Agencies ◽

Retrospective Cohort Studies ◽

The Impact

Abstract: Background Vaccines are highly effective for preventing a range of childhood infections. However, there have been concerns about an alarming decline in vaccinations in 2020 due to the COVID-19 pandemic. Methods We performed a rapid review for studies that assessed childhood vaccination uptake during restrictive phases of the covid-19 pandemic. Results We found 35 published studies that compared changes in the pattern of childhood vaccinations before and during the pandemic. Thirteen were surveys; two mixed-methods surveys and interviews, three modelling studies and 17 retrospective cohort studies with historical controls. We also included ten reports by national or international agencies that had original data on vaccination uptake. Significant global disruptions to vaccine services were reported in Africa, Asia, America (including Latin America and the Caribbean) and Europe. We also found evidence of significant disruption to vaccine uptake for diphtheria tetanus pertussis, BCG, measles and polio. Countries, where vaccination rates were already suboptimal, had greater drops in uptake and there was evidence of smaller declines in younger children compared to older children. Children born to women who could not read and write were more likely to have an incompletely immunized child. Various initiatives were used to drive up vaccination rates post restrictions. Conclusions Obstacles to the delivery of vaccination services during the COVID-19 pandemic drove down immunisation rates, especially in disadvantaged people and poorer countries.

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Simulating the impact of vaccination rates on the initial stages of a COVID-19 outbreak in New Zealand (Aotearoa) with a stochastic model

10.1101/2021.11.22.21266721 ◽

2021 ◽

Author(s):

Leighton M Watson

Keyword(s):

New Zealand ◽

Stochastic Model ◽

Process Model ◽

Branching Process ◽

Total Population ◽

Median Number ◽

Vaccination Rate ◽

Vaccination Rates ◽

The Impact ◽

Different Levels

Aim: The August 2021 COVID-19 outbreak in Auckland has caused the New Zealand government to transition from an elimination strategy to suppression, which relies heavily on high vaccination rates in the population. As restrictions are eased and as COVID-19 leaks through the Auckland boundary, there is a need to understand how different levels of vaccination will impact the initial stages of COVID-19 outbreaks that are seeded around the country. Method: A stochastic branching process model is used to simulate the initial spread of a COVID-19 outbreak for different vaccination rates. Results: High vaccination rates are effective at minimizing the number of infections and hospitalizations. Increasing vaccination rates from 20% (approximate value at the start of the August 2021 outbreak) to 80% (approximate proposed target) of the total population can reduce the median number of infections that occur within the first four weeks of an outbreak from 1011 to 14 (25th and 75th quantiles of 545-1602 and 2-32 for V=20% and V=80%, respectively). As the vaccination rate increases, the number of breakthrough infections (infections in fully vaccinated individuals) and hospitalizations of vaccinated individuals increases. Unvaccinated individuals, however, are 3.3x more likely to be infected with COVID-19 and 25x more likely to be hospitalized. Conclusion: This work demonstrates the importance of vaccination in protecting individuals from COVID-19, preventing high caseloads, and minimizing the number of hospitalizations and hence limiting the pressure on the healthcare system.

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Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

eLife ◽

10.7554/elife.66448 ◽

2021 ◽

Vol 10 ◽

Author(s):

Louise H Moncla ◽

Allison Black ◽

Chase DeBolt ◽

Misty Lang ◽

Nicholas R Graff ◽

...

Keyword(s):

Virus Disease ◽

Mumps Virus ◽

Washington State ◽

Childhood Vaccination ◽

Data Set ◽

Vaccination Rates ◽

Epidemiologic Factors ◽

Increased Risk ◽

Community Transmission ◽

Virus Genomes

In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected in Washington and other US states, and traced mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Although age and vaccination status may have impacted transmission, our data set could not quantify their precise effects. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission and pinpoint contact networks as critical for mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.

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Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

10.1101/2020.10.19.20215442 ◽

2020 ◽

Author(s):

Louise H. Moncla ◽

Allison Black ◽

Chas DeBolt ◽

Misty Lang ◽

Nicholas R. Graff ◽

...

Keyword(s):

Genomic Data ◽

Mumps Virus ◽

Washington State ◽

Vaccination Status ◽

Childhood Vaccination ◽

Contact Networks ◽

Vaccination Rates ◽

Epidemiologic Factors ◽

School Aged Children ◽

Community Transmission

AbstractIn 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. Sequencing 166 mumps genomes revealed that mumps was introduced into Washington approximately 13 times, primarily from Arkansas, sparking multiple, co-circulating transmission chains. Neither vaccination status nor age were strong determinants of transmission. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission, and pinpoint contact networks as critical determinants of mumps transmission in Washington.

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1422. Burden of Pertussis in South Korea: Implications for adults

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1604 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S718-S718

Author(s):

Bruce Mungall ◽

Hyungwoo Kim ◽

Kyu-Bin Oh

Keyword(s):

Literature Review ◽

South Korea ◽

National Level ◽

Vaccine Uptake ◽

Childhood Vaccination ◽

Vaccine Preventable Diseases ◽

Vaccination Rates ◽

Antibody Levels ◽

The Impact ◽

Pertussis Epidemiology

Abstract Background There are a limited number of published studies on pertussis disease burden and epidemiology in South Korea, particularly those evaluating the impact in adults. Methods We conducted a systematic literature review on pertussis epidemiology and burden of disease in South Korea. The objective was to highlight evidence gaps which could help improve awareness about pertussis disease in adults in South Korea. Results Of 940 articles published between January 2000 to December 2019, 19 articles provided data for pertussis epidemiology and 9 provided data in adults. Laboratory confirmation rates in adults varied according to methodology, likely influenced by study/sampling variations. Three studies reported serological evidence of infection in adolescents and adults (33-57%). Among cases, the average cough duration was 16.5 days (range 7-30 days) and over 85% of cases presented with paroxysmal cough, while only 25% of cases or less presented with a characteristic whoop or post-tussive vomiting. Importantly, in 4 studies reporting vaccination status, almost all adult cases had no history of pertussis vaccination since childhood. Conclusion Primary childhood vaccination rates in South Korea are among the highest globally, while adult pertussis vaccine uptake appears to be quite low. Our literature review suggests that pertussis is underreported in adults, as evidenced by serology data demonstrating that tetanus antibody levels are low while pertussis toxin antibody levels are relatively high, suggesting continued circulation of community pertussis. These findings highlight the need for strategies such as maternal immunization and decennial revaccination of adults to address the changing epidemiology and waning immunity. Active pertussis testing/reporting and better utilization of adult vaccine registries is required to help provide robust data for vaccine decision-making at the national level. In the current COVID-19 environment, strategies that can reduce clinic or hospital visits will have substantial benefits to authorities managing rapid increases in health care resource utilization, and vaccine preventable diseases provide an easy and immediate target for achieving that goal. Disclosures Bruce Mungall, PhD, the GSK group of companies (Employee, Shareholder) Hyungwoo Kim, MD, MPH, the GSK group of companies (Employee) Kyu-Bin Oh, MD, the GSK group of companies (Employee, Shareholder)

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Use of Apps to Promote Childhood Vaccination: Systematic Review

JMIR mhealth and uhealth ◽

10.2196/17371 ◽

2020 ◽

Vol 8 (5) ◽

pp. e17371 ◽

Cited By ~ 2

Author(s):

Caroline de Cock ◽

Michelle van Velthoven ◽

Madison Milne-Ives ◽

Mary Mooney ◽

Edward Meinert

Keyword(s):

Systematic Review ◽

Decision Making ◽

Mobile Apps ◽

Information Provision ◽

Risk Of Bias ◽

Childhood Vaccination ◽

Cochrane Central Register ◽

Mobile Platforms ◽

Vaccination Rates ◽

Vaccination Uptake

Background Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. Objective This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. Methods PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. Results A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P≤.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. Conclusions There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. International Registered Report Identifier (IRRID) RR2-10.2196/16929

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Modelling the impact of shutdowns on resurging SARS-CoV-2 transmission in Canada

Royal Society Open Science ◽

10.1098/rsos.210233 ◽

2021 ◽

Vol 8 (5) ◽

Author(s):

Victoria Ng ◽

Aamir Fazil ◽

Lisa A. Waddell ◽

Patricia Turgeon ◽

Ainsley Otten ◽

...

Keyword(s):

Public Health ◽

Negative Relationship ◽

Local Context ◽

Socioeconomic Impact ◽

Baseline Scenario ◽

Agent Based ◽

Health Measures ◽

Trade Offs ◽

Community Transmission ◽

The Impact

Background: Shutdowns are enacted when alternative public health measures are insufficient to control the epidemic and the population is largely susceptible. An age-stratified agent-based model was developed to explore the impact of shutdowns to control SARS-CoV-2 transmission in Canada under the assumption that current efforts to control the epidemic remains insufficient and in the absence of a vaccine. Methods: We estimated the current levels of interventions in Canada to generate a baseline scenario from 7 February to 7 September 2020. Four aspects of shutdowns were explored in scenarios that ran from 8 September 2020 to 7 January 2022, these included the impact of how quickly shutdowns are implemented, the duration of shutdowns, the minimum break (delays) between shutdowns and the types of sectors to shutdown. Comparisons among scenarios were made using cases, hospitalizations, deaths and shutdown days during the 700-day model runs. Results: We found a negative relationship between reducing SARS-CoV-2 transmission and the number of shutdown days. However, we also found that for shutdowns to be optimally effective, they need to be implemented fast with minimal delay, initiated when community transmission is low, sustained for an adequate period and be stringent and target multiple sectors, particularly those driving transmission. By applying shutdowns in this manner, the total number of shutdown days could be reduced compared to delaying the shutdowns until further into the epidemic when transmission is higher and/or implementing short insufficient shutdowns that would require frequent re-implementation. This paper contrasts a range of shutdown strategies and trade-offs between health outcomes and economic metrics that need to be considered within the local context. Interpretation: Given the immense socioeconomic impact of shutdowns, they should be avoided where possible and used only when other public health measures are insufficient to control the epidemic. If used, the time it buys to delay the epidemic should be used to enhance other equally effective, but less disruptive, public health measures.

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Mask Interventions in K12 Schools Can Also Reduce Community Transmission in Fall 2021

10.1101/2021.09.11.21263433 ◽

2021 ◽

Author(s):

Jessica A. Mele ◽

Erik Rosenstrom ◽

Julie Ivy ◽

Maria Mayorga ◽

Mehul D Patel ◽

...

Keyword(s):

General Population ◽

Disease Burden ◽

Disease Spread ◽

High Quality ◽

System Planning ◽

Vaccination Rates ◽

School Settings ◽

Community Transmission ◽

The Impact

The dominance of the COVID-19 Delta variant has renewed questions about the impact of K12 school policies, including the role of masks, on disease burden. A recent study showed masks and testing could reduce infections in students, but failed to address the impact on the community, while another showed masking is critical to slow disease spread in communities, but did not consider school openings under Delta. We project the impact of school-masking on the community, which can inform policy decisions, and support healthcare system planning. Our findings indicate that the implementation of masking policies in school settings can reduce additional infections post-school opening by 23-36% for fully-open schools, with an additional 11-13% reduction for hybrid schooling, depending on mask quality and fit. Masking policies and hybrid schooling can also reduce peak hospitalization need by 71% and result in the fewest additional deaths post-school opening. We show that given the current vaccination rates within the community, the best option for children and the general population is to employ consistent high-quality masking, and use social distancing where possible.

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Improving older adults’ vaccination uptake: are existing measures of vaccine hesitancy valid and reliable for older people?

10.1101/2021.09.29.21263161 ◽

2021 ◽

Author(s):

Nicola Cogan ◽

Allyson J. Gallant ◽

Louise A. Brown Nicholls ◽

Susan Rasmussen ◽

David Young ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Discriminant Validity ◽

Adult Population ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Future Research ◽

Vaccination Uptake ◽

Older Adult Population ◽

The Impact

ABSTRACTOlder adults are particularly vulnerable to vaccine-preventable diseases (VDU), due to decreased immunity and increased comorbidity. Vaccination can support healthy ageing and help reduce morbidity, mortality, and loss of quality of life associated with VPDs. Despite the availability of effective vaccines, many countries, including the UK, fail to reach recommended coverage levels. Psychosocial factors are recognised as providing important insights into the determinants of vaccination uptake. Little research has sought to establish psychometrically sound scales of vaccine attitudes with older adults. In the present study, a total of 372 UK-based participants (65-92 years, M = 70.5 yrs, SD = 4.6) completed a cross-sectional, online survey measuring health and socio-demographic characteristics in relation to vaccination uptake for influenza, pneumococcal and shingles. Two recently developed vaccination attitude scales, the 5C scale and the Vaccination Attitudes Examination (VAX) scale, were also administered to test their reliability and validity for use with an older adult population. Additional scales used to examine convergent and discriminant validity, the Beliefs about Medicines Questionnaire, the Perceived Sensitivity to Medicines Scale, the Medical Mistrust Index, the Perceived Stress Scale, and the Interpersonal Support Evaluation List, were included. The factor structure of the 5C and VAX scales was confirmed. Both scales showed good internal reliability, convergent, discriminant and concurrent validity, supporting their use with older adult populations. The 5C and VAX scales were found to be reliable and valid psychosocial measures of vaccine hesitancy and acceptance within a UK-based, older adult population. Future research could use these scales to evaluate the impact of psychological antecedents of vaccine uptake, and how concerns about vaccination may be understood and addressed among older adults.Ethics approval & informed consentEthical approval (34/26/11/2019/Staff Williams) was granted by the School of Psychological Sciences and Health Ethics Committee, University of Strathclyde. (SEC19/20: Williams, Nicholls, Rasmussen, Young & Gallant). Approved on 8th January 2020.

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Rapid Impact Analysis of B 1.1.7 Variant on the Spread of SARS-CoV-2 in North Carolina

10.1101/2021.02.07.21251291 ◽

2021 ◽

Author(s):

Michael DeWitt

Keyword(s):

North Carolina ◽

Impact Analysis ◽

Reproduction Number ◽

Population Level ◽

Vaccination Rate ◽

Vaccination Rates ◽

Current Vaccine ◽

Spread Of Infection ◽

The Impact ◽

Pharmaceutical Interventions

AbstractBackgroundSeveral cases of the B1.1.7 variant of the SARS-CoV-2 virus were identified in North Carolina first on January 23, 2021 in Mecklenburg County and later in Guilford County on January 28, 2021.[1,2] This variant has been associated with higher levels of transmissibility.[3–6] This study examines the potential impact of increased transmissibility as the B1.1.7 variant becomes more predominant given current vaccine distribution plans and existing non-pharmaceutical interventions (NPIs).MethodWe explored the anticipated impact on the effective reproduction number for North Carolina and Guilford County given the date of import of B1.1.7. The approximate growth rate in proportion of B1.1.7 observed in the United Kingdom was fit and used to establish the estimate share of B1.1.7 circulating in North Carolina. Using the nowcasted reproduction numbers, a stochastic discrete compartmental model was fit with the current vaccination rates and B1.1.7 transmissibility to estimate the impact on the effective reproduction number.ResultsWe found that the effective reproduction number for North Carolina and Guilford County may exceed one, indicating a return to accelerating spread of infection in April as the proportion of B1.1.7 increases. The effective reproduction number will likely decrease into March, then increase as the proportion of B1.1.7 increases in circulation in the population.ConclusionsExisting non-pharmaceutical interventions will need to remain in effect through the spring. Given the current vaccination rate and these interventions, it is likely that there will be an increase in SARS-CoV-2 infections. The impact of the variant will likely be heterogeneous across North Carolina given the reproduction number and volume of susceptible persons in each county at the time of introduction of the variant. Age-based vaccinations will likely reduce the overall impact on hospitalizations. This analysis underlines the need for population level genetic surveillance to confirm the proportion of variants circulating.

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