Starts and Stops: Strategizing an Age-Friendly University Commitment During a Pandemic

The Global Network of Age-Friendly Universities seeks to enhance age-inclusivity and engagement in higher education, but delivering age-friendly programming became very challenging during the COVID-19 pandemic. We examine how two land-grant universities adapted to the pandemic and draw some lessons from those experiences that may be useful for other universities seeking to implement or resume the AFU programming. The two main responses were to either pause many of the age-friendly initiatives at the university or adapt to virtual or online delivery platforms. To ensure the health and safety of older adults, colleges and universities paused many age-friendly initiatives such as intergenerational service-learning, technological assistance to older adults, and influenza vaccinations. Other programs continued but in a modified delivery format. Examples include: converting a face-to-face balance-training program to telehealth delivery; transitioning visitation programs to pen pal communication; and replacing face-to-face workshops offered by Extension Services with webinar delivery. Despite these challenges, we conclude that moving to virtual platforms and other methods of delivery, including conventional mail, has in some cases increased access for many older adults and became a lifeline during a time of social isolation for many older adults. Taken together, these experiences highlight the need for age-friendly universities to have contingency plans to ensure continuation of age-friendly programming in the event of pandemics or disasters. Finally, the pause in programming creates opportunities to re-launch or re-organize those initiatives in accord with federal and state safety guidelines.

The Effects of the COVID-19 Pandemic and Vaccine Knowledge on Vaccine Hesitancy in Adolescents

This research study addresses the issue of vaccine hesitancy in adolescents. The research questions of this study include: To what extent does an adolescent’s experience with COVID-19 influence their vaccine hesitancy, if an adolescent routinely gets influenza vaccinations will they have a lower vaccine hesitancy, will an individual’s vaccine hesitancy impact their willingness to receive a vaccination for COVID-19, and to what extent does an individual's knowledge of vaccines impact their vaccine hesitancy? To obtain participants for this study a random sample of students enrolled in science classes at the researcher’s school were selected. The students completed a 4 part survey which included sample demographics, COVID-19 experience, and routine flu vaccinations questions; knowledge of vaccines questions; the Vaccine Hesitancy Scale; and questions regarding the refusal of vaccines. The study cannot conclude that individuals who know someone who has had COVID or know someone who has died of COVID will be less vaccine hesitant. However, the study is able to conclude with a 95% confidence that individuals who receive the flu vaccine routinely will be less vaccine hesitant. Moreover, it is concluded with greater than 99% confidence that an individual who is more knowledgeable about vaccines or willing to receive a vaccination for COVID-19 will be less vaccine hesitant. The issue of vaccine hesitancy is not only important to address because of the effectiveness of vaccinations, but it is also critical to reduce vaccine hesitancy during the current pandemic, where vaccinations could stop the spread of COVID-19 and ultimately save lives.

24. An analysis of the National Institutes of Health All of Us Research Database: Sociodemographic Disparities Among Patients Who Received Vaccinations

Background The National Institutes of Health All of Us (AoU) research program is building a diversified database of 1 million+ adult subjects. With this database, we seek to describe the sociodemographic characteristics of those with documented vaccinations. Methods The AoU recruited subjects ≥ 18 years beginning in 2018. Eligible subjects were subsequently divided into five vaccine cohorts based on their vaccine history [influenza, hepatitis B (HepB), pneumococcal (Pneu) < 65, Pneu ≥ 65, human papillomavirus (HPV)]. The vaccine cohorts were compared to the general AoU cohort. Subjects in the influenza cohort had documented influenza vaccinations from 09/2017-05/2018. Other vaccine cohorts comprised subjects with ≥ 1 lifetime record(s) of vaccination by 12/2018. The Pneu < 65 and ≥ 65 cohorts comprised those who received pneumococcal vaccination before or after (inclusive) 65 years old, respectively. Descriptive statistics for all cohorts were generated using survey and electronic health record (EHR) data. Results We analyzed 315297 subjects in the AoU dataset R2020Q4R2. The cohort sizes were: influenza (n=15346), HepB (n=6323), HPV (n=2125), and Pneu (< 65 n=15217; ≥65 n=15100). For all vaccine cohorts, comparing the 95% confidence intervals (CIs), the proportions of whites and non-Hispanics/Latinos were statistically higher than the general AoU cohort, the largest being from the Pneu ≥ 65 cohort (Table 1). For educational attainment, the Pneu < 65 (36.5%) had the smallest proportion of college or advanced degree graduates while the largest was observed in the Pneu ≥ 65 cohort (59.0%). The proportions of subjects with < &10k in annual household income (AHI) were largest among Pneu < 65 (17.1%) and smallest among Pneu ≥ 65 (3.8%). In contrast, the largest proportion of subjects with ≥ &100k AHI was among Pneu ≥ 65 (25.3%) and the smallest among Pneu < 65 (15.8%). Table 1. Sociodemographic characteristics of subjects in the All of Us research program based on vaccine receipt Conclusion Racial and ethnic disparities in vaccinations were apparent. Pneumococcal vaccination at age 65 years and above was more prevalent among white, non-Hispanic/Latino subjects who were also more educated and affluent. Conversely, those receiving pneumococcal vaccination before age 65 years were less educated and had lower AHI. Disclosures All Authors: No reported disclosures

Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

ABSTRACT Background: More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents. Methods: We analyzed 2014-2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three groups. We examined three NH-level outcomes: percentage of residents assessed and appropriately provided the influenza vaccine, receiving influenza vaccine, and refusing influenza vaccine. Results: There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n=4131 NHs), moderate (3.4% to 18.6%; n=4127 NHs) and high (>18.6%; n=4126 NHs). Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.7%, P<0.0001), or high (3.1%, P<0.0001) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (-3.1%, P<0.0001), or high (-4.6% P<0.0001) MA compared with NHs with the lowest prevalence of MA. Among 753,616 short-stay residents in 12,205 NHs, there was no association between MA concentration and influenza vaccination receipt but vaccine refusal was greater in NHs with higher MA prevalence (high or moderate vs. low MA: 5.2%, P<0.0001). Conclusion: The relationship between MA concentration and influenza vaccination measures varied among post-acute and long-term NH residents. As MA takes a larger role in the Medicare program, and more MA beneficiaries enter NHs, there is need to consider how managed care can be leveraged to improve the delivery of preventive services such as influenza vaccinations in NH settings.

A Systematic Review and Meta-Analysis of Seasonal Influenza Vaccination of Health Workers

A systematic review and meta-analysis was conducted to estimate the pooled effect of influenza vaccinations for health workers (HWs). Nine databases were screened to identify randomized clinical trials and comparative observational studies that reported the effect of influenza vaccination among HWs. The risk ratio (RR), standardized mean difference, and 95% confidence interval (CI) were employed to study the effect size using fixed/random-effect models. Subgroup analyses and sensitivity analyses were conducted accordingly. Publication bias was examined. Sixteen studies (involving 7971 HWs from nine countries) were included after a comprehensive literature search. The combined RR regarding the incidence of laboratory-confirmed influenza was 0.36 (95% CI: 0.25 to 0.54), the incidence of influenza-like illness (ILI) was 0.69 (95% CI: 0.45 to 1.06), the absenteeism rate was 0.63 (95% CI: 0.46 to 0.86), and the integrated standardized mean difference of workdays lost was −0.18 (95% CI: −0.28 to −0.07) days/person. The subgroup analysis indicated that vaccination significantly decreases the incidence of laboratory-confirmed influenza in different countries, study populations, and average-age vaccinated groups. Influenza vaccinations could effectively reduce the incidence of laboratory-confirmed influenza, absenteeism rates, and workdays lost among HWs. It is advisable, therefore, to improve the coverage and increase the influenza vaccination count among HWs, which may benefit both workers and medical institutions.

Influenza Vaccination Coverage among Older Adults with Hypertension in Shenzhen, China: A Cross-Sectional Survey during the COVID-19 Pandemic

Background: Older individuals with hypertension are at a high risk of being infected with influenza. However, there have been few studies investigating the influenza vaccination status among older people with hypertension. The present work aimed to estimate the vaccination coverage and determine the predictors of seasonal influenza vaccinations among hypertensive patients aged over 60 years in Shenzhen, China. Method: The study used data from an online cross-sectional survey that was conducted in Shenzhen City, China, in October 2020. Frequencies and proportions of all the variables including sociodemographic characteristics and health-related information were described and tabulated based on the influenza vaccination status. Bivariate and multivariable logistic regression analyses were used to identify independent predictors associated with the influenza vaccination. Results: A total of 5216 older people with hypertension aged above 60 years were recruited. Overall, only 4.7% had received an influenza vaccine in the latest influenza season. Using the action toward being vaccinated as the primary outcome, the multivariable regression analysis showed that participants aged over 80 years (aOR 2.957, 95% CI: 1.784–4.900), obtaining higher education levels (aOR 1.424, 95% CI: 1.060–1.914 for high school, aOR 1.681, 95% CI: 1.066–2.650 for college or above), living with a partner (aOR 1.432, 95% CI: 1.068–1.920), using a family doctor (aOR 2.275, 95% CI: 1.744–2.968), and taking a physical examination 1–2 and ≥3 times each year (aOR 2.107, 95% CI: 1.601–2.772 and aOR 2.118, 95% CI: 1.083–4.143, respectively) were more likely to be vaccinated. In contrast, smokers had less likelihood of having the influenza vaccination than non-smokers (aOR 1.829, 95% CI: 1.208–2.767). Conclusions: The coverage rate of influenza vaccinations is far away from optimistic among older adults with hypertension. Additional works should be undertaken immediately to improve the influenza vaccination status.

Influenza Vaccination in Massachusetts Jails: A Mixed-Methods Analysis

Objectives Influenza infects millions of people each year and contributes to tens of thousands of deaths annually despite the availability of vaccines. People most at risk of influenza complications are disproportionately represented in people incarcerated in US prisons and jails. The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. Methods In April 2020, we administered surveys to the health services administrators in Massachusetts’ 14 county jails to gather information about influenza vaccination policies and delivery practices. To calculate influenza vaccination rates for each facility, we obtained data on influenza vaccine orders from the Massachusetts Department of Public Health for each county in Massachusetts for influenza seasons 2013-2020. We calculated summary statistics for each reporting facility and each year, conducted a Kruskal–Wallis analysis to compare vaccination rates between years, and used a linear regression model to identify predictors of vaccination rates. Results Influenza vaccination rates in Massachusetts jails ranged from 1.9% to 11.8%. We found no significant differences in vaccination rates between years. Influenza vaccine ordering and delivery practices varied by jail, and respondents had high levels of confidence in influenza policies and vaccine delivery practices. Conclusions Influenza vaccination rates in Massachusetts jails are low, and delivery practices in jails vary. Lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. Further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.

Changes in Attitudes and Beliefs Concerning Vaccination and Influenza Vaccines between the First and Second COVID-19 Pandemic Waves: A Longitudinal Study

Perceptions of the risks of vaccine-preventable diseases and preventive behaviors change over time. The ongoing COVID-19 pandemic may have modified laypeople’s attitudes towards routine vaccinations. In this longitudinal study, we aimed to assess changes in attitudes and beliefs concerning (influenza) vaccines between the first and second COVID-19 pandemic waves. A total of 1979 participants completed both 2020 and 2021 surveys. After one year, more interviewees agreed that vaccines were fundamental and should be mandatory (77.3% vs. 75.0%). Analogously, willingness to undergo influenza vaccination increased (p < 0.001) from 44.1% to 48.6%. This increase was seen in subjects aged ≥35 years. Previous influenza vaccinations, receipt of a COVID-19 vaccine, positive attitudes towards (influenza) vaccination, male sex, and older age were the main correlates of willingness to receive the 2021/22 influenza vaccine. Totals of 12.6% and 11.8% had no intention to receive the next seasonal influenza and COVID-19 vaccines, respectively. Most respondents favored a hypothetical combined influenza/COVID-19 vaccine (73.7%) or influenza and COVID-19 vaccine co-administration (67.5%). In Italy, influenza and COVID-19 vaccination hesitancy and refusal are common. Effective public health strategies to pursue higher uptake of both vaccines are urgently needed.