Evaluating the Geographical Accessibility and Equity of COVID-19 Vaccination Sites in England

We assess the geographical accessibility of COVID-19 vaccination sites—including mass vaccination centers and community-level provision—in England utilizing open data from NHS England and detailed routing data from HERE Technologies. We aim to uncover inequity in vaccination site accessibility, highlighting small-area inequality hidden by coverage figures released by the NHS. Vaccination site accessibility measures are constructed at a neighborhood level using indicators of journey time by private and public transport. We identify inequity in vaccination-site accessibility at the neighborhood level, driven by region of residence, mode of transport (specifically availability of private transport), rural-urban geography and the availability of GP-led services. We find little evidence that accessibility to COVID-19 vaccination sites is related to underlying area-based deprivation. We highlight the importance of GP-led provision in maintaining access to vaccination services at a local level and reflect on this in the context of phase 3 of the COVID-19 vaccination programme (booster jabs) and other mass vaccination programmes.

VACCINATION INFODEMIC AMONG CITIZENS OF MAGALLANES, CAVITE, PHILIPPINES

Objective. This survey research intends to understand how people from a fourth-class municipality of Cavite made their decision to be vaccinated in spite of false information circulating within family, friends, and neighbors. Methods. The study employed survey research and gathered data using voluntary sampling from a pool of citizens with an appointment schedule in the vaccination site located in Magallanes, Cavite. Results. The pandemic saw a rise in the spread of information disorders. The proliferation of fake news and misinformation affect our lives as they disrupt relationships with family members and friends. Trust is being questioned as people believe in contrasting medical opinions. The overload of information sharing is a challenge for individuals to evaluate news sources coming from multiple platforms. As the status of inoculation in the Philippines is ongoing, citizens who want protection took time to get vaccinated. The impact of traditional and social media continues to be powerful influencers in information dissemination. As we deal with overabundance of information, librarians have an emerging role to play. Conclusions. Librarians are seen as partners of a local government unit in promoting citizens' well-being, providing credible sources of health information vital for an individual to help them arrive at an informed decision, and showcase advantages of vaccines as evidenced by scientific publications.

Data-Driven Real-Time Strategic Placement of Mobile Vaccine Distribution Sites

The deployment of vaccines across the US provides significant defense against serious illness and death from COVID-19. Over 70% of vaccine-eligible Americans are at least partially vaccinated, but there are pockets of the population that are under-vaccinated, such as in rural areas and some demographic groups (e.g. age, race, ethnicity). These unvaccinated pockets are extremely susceptible to the Delta variant, exacerbating the healthcare crisis and increasing the risk of new variants. In this paper, we describe a data-driven model that provides real-time support to Virginia public health officials by recommending mobile vaccination site placement in order to target under-vaccinated populations. Our strategy uses fine-grained mobility data, along with US Census and vaccination uptake data, to identify locations that are most likely to be visited by unvaccinated individuals. We further extend our model to choose locations that maximize vaccine uptake among hesitant groups. We show that the top recommended sites vary substantially across some demographics, demonstrating the value of developing customized recommendation models that integrate fine-grained, heterogeneous data sources. In addition, we used a statistically equivalent Synthetic Population to study the effect of combined demographics (eg, people of a particular race and age), which is not possible using US Census data alone. We validate our recommendations by analyzing the success rates of deployed vaccine sites, and show that sites placed closer to our recommended areas administered higher numbers of doses. Our model is the first of its kind to consider evolving mobility patterns in real-time for suggesting placement strategies customized for different targeted demographic groups. Our results will be presented at IAAI-22, but given the critical nature of the pandemic, we offer this extended version of that paper for more timely consideration of our approach and to cover additional findings.

Axillary Adenopathy Secondary to SARS-CoV-2 Vaccination: a Case Report

Introduction: SARS-CoV-2 mRNA vaccines are safe and effective for the prevention of COVID-19 infection, though local reactions are commonly reported. Axillary lymphadenopathy has also been reported, which has the potential of causing diagnostic confusion and unnecessary testing and procedures. Case Description: A 58 year-old female with untreated latent tuberculosis was noted to have a pulmonary nodule on chest radiograph. Evaluation for Mycobacterium tuberculosis was undertaken, and a FDG PET/CT was performed to rule out malignancy. While the nodule demonstrated low avidity, highly avid lymph nodes were noted in the left axillary region. Further questioning elicited a recent history of mRNA-1273 (Moderna) COVID-19 vaccination in her left deltoid muscle three weeks prior, and a sensation of axillary fullness. She was managed conservatively with spontaneous resolution of her lymphadenopathy. Conclusions: Axillary lymphadenopathy following mRNA vaccination has been reported, and appears to be more common with mRNA-1273 (Moderna) than BNT162b2 vaccine (Pfizer-BioNTech), in those aged 18 to 64 as compared to age ≥65, and following the second vaccine dose compared to the first dose. Vaccination should be considered in the differential diagnosis of axillary lymphadenopathy, particularly ipsilateral to the vaccination site, to avoid unnecessary testing, treatment, and patient anxiety.

14. Postmarketing Safety Experience With MenACWY-TT

Background MenACWY-TT (Nimenrix®), a quadrivalent meningococcal tetanus toxoid conjugate vaccine, was first licensed in 2012 and is available in 82 countries but not in the United States. MenACWY-TT is administered in infants as a 2 + 1 (6 weeks to < 6 months of age) or 1 + 1 (6 to < 12 months of age) schedule with the booster dose at 12 months of age, and from 12 months of age as a single dose. In addition to its widespread use to protect against meningococcal serogroups A, C, W, and Y, MenACWY-TT is a constituent of an investigational pentavalent meningococcal (MenABCWY) vaccine currently undergoing clinical development. Methods Using the MenACWY-TT Periodic Safety Update Report (PSUR) with format and content in accordance with Good Pharmacovigilance Practice Module VII and International Council for Harmonisation Guideline E2C, for data up to April 19, 2020, postmarketing safety experience with MenACWY-TT is considered. The PSUR data included herein are spontaneous adverse events (AEs) from the Pfizer safety database. AEs were coded by system organ class (SOC) and preferred term (PT) using MedDRA v.22.1J. Results The cumulative estimated exposure of MenACWY-TT was nearly 26 million doses, with the majority administered in 0- to 16-year-olds and in the Western European Union (Figure 1). Over the reporting period, 13,301 cumulative AEs occurred. The most common SOCs in the reporting period were general disorders and administration site conditions (n=5169; 39%); nervous system disorders (n=1986; 15%); injury, poisoning and procedural complications (n=1266; 10%); and gastrointestinal disorders (n=1031; 8%) (Figure 2). By PT, the most common AEs were pyrexia (n=1613; 12%), headache (n=738; 6%), and vaccination site pain (n=394; 3%) (Figure 3). Of the 3299 serious AEs reported, the most common were pyrexia (n=317; 10%) and headache (n=209; 6%). Conclusion Based on cumulative safety data in conjunction with existing efficacy and effectiveness data, the benefit-risk profile of MenACWY-TT remains favorable and is consistent with the safety profile of MenACWY-TT established in clinical studies. Disclosures Lidia Serra, MS, Pfizer Inc (Employee, Shareholder) Susan Mather, MD, Pfizer Inc (Employee, Shareholder) Cindy Burman, PharmD, Pfizer Inc (Employee, Shareholder) Chris Webber, MD, Pfizer (Employee, Shareholder)

475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities

Background In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic. Methods LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics. Results The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black. Conclusion The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups. COVID-19 Vaccination Comparisons Between Models This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics Disclosures All Authors: No reported disclosures

Mosque as a vaccination site for ethnic minority in Japan: leaving no one behind amid the COVID-19 pandemic

Ethnic minorities with different languages and religions are potentially vulnerable not only during natural hazard-induced disasters, but also during the COVID-19 pandemic. Their vaccination coverage may be lower, and vaccination strategies should prevent them from being left behind. This report presents the first case in Japan where a mosque, being the hub of foreign Muslims, was used as a vaccination site from the end of July 2021. The targeted mosque was Ebina Mosque in Kanagawa Prefecture, and most of the vaccine recipients were foreign Muslims. The mosque differed from other vaccination sites in that reservations could be made easily through the managers, and linguistic diversity (i.e., the mosque managers and mosque-related volunteers served as interpreters) and gender were considered. These efforts are likely to have removed some barriers to vaccination for ethnic minorities and contributed to “no one will be left behind.”

Herpes zoster following mRNA-1273 COVID-19 vaccination

Sir, Skin rashes have been associated with COVID-19 and studies suggest the inclusion of skin diseases in the list of COVID-19 symptoms. Skin eruptions are also associated with the mRNA-1273 COVID-19 vaccine. Findings by Baden et al. [1] describe immediate injection-site reactions observed in 84.2% of participants after the first dose, with delayed onset reactions—on or after day eight—occurring much more infrequently, 0.8% after the first dose and 0.2% after the second dose. Blumenthal et al. [2] discuss twelve cases of delayed vaccine reactions, with all patients experiencing reactions in the vaccination site. Herein, we describe two cases of herpes zoster within days of receiving their first mRNA-1273 vaccine. Both cases presented to the same dermatology clinic. A 77-year-old male presented with a bumpy, itchy, red rash on the upper right arm and axilla three days following an mRNA-1273 vaccine injection. The symptoms continued to worsen and the patient was clinically diagnosed with herpes zoster and treated with valacyclovir (Fig. 1). Another patient, also a 77-year-old male, complained of a rash located on the right upper arm and axilla. It was a red, itchy, bumpy rash that the patient developed two days after an mRNA-1273 vaccine injection (Fig. 2). Both rashes demonstrated a similar distribution pattern and both patients responded well to valacyclovir with the resolution of the erythema; however, one patient did have residual post-herpetic neuralgia.

Critical concepts for COVID-19 Mass Vaccination Site Operations

Mass vaccination campaigns have been used effectively to limit the impact of communicable disease on public health. However, the scale of the COVID19 vaccination campaign is unprecedented. Mass vaccination sites consolidate resources and experience into a single entity and are essential to achieving community (“herd”) immunity rapidly, efficiently, and equitably. Healthcare systems, local and regional public health entities, emergency medical services, and private organizations can rapidly come together to solve problems and achieve success. As medical directors at several mass vaccination site across the United States, we describe key mass vaccination site concepts including site selection, operational models, patient flow, inventory management, staffing, technology, reporting, medical oversight, communication, and equity. Lessons learned from experience operating a diverse group of mass vaccination sites will help to inform not only sites operating during the current pandemic but may serve as a blueprint for future outbreaks of highly infectious communicable disease.

On the question of mute infection in experimental syphilis of rabbits

A silent infection, according to Reitery, is one that does not show any clinical symptoms, just like Levinthals Symptomlose Infektion . As you know, about 10% of rabbits experimentally infected with syphilis do not detect, after inoculation by means of pieces of chancre containing millions of spirochetes, no clinical signs of syphilis: there are no primary affects, there are no sufficiently definite infiltrates at the vaccination site, there are no swelling of the glands and secondary phenomena.