Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States

Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection.

Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

Background Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. Methods We analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. Results Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. Conclusion Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

Robust Neutralizing Antibody Responses 6 Months Post Vaccination with BNT162b2: A Prospective Study in 308 Healthy Individuals

Elucidating long-term immunity following COVID-19 vaccination is essential for decision-making regarding booster shots. The aim of this study was to investigate the kinetics of neutralizing antibodies (Nabs) against SARS-CoV-2 up to six months after the second vaccination dose with the BNT162b2 mRNA vaccine. Nabs levels were measured on days 1 (before the first vaccine shot), 8, 22 (before the second shot), 36, 50, and 3 and 6 months after the second vaccination (NCT04743388). Three hundred and eight healthy individuals without malignant disease were included in this study. At six months, 2.59% of the participants had a Nabs value less than 30%, while 11.9% had Nabs values of less than 50%. Importantly, 58% of the subjects had Nabs values of more than 75%. Nabs were initially eliminated at a relatively slow rate, but after three months their elimination was 5.7 times higher. Older age was inversely associated with Nabs levels at all examined timepoints. Interestingly, a population modeling analysis estimated that half of the subjects will have Nabs values less than 73.8% and 64.6% at 9 and 12 months, respectively, post vaccination completion. In conclusion, we found a persistent but declining anti-SARS-CoV-2 humoral immunity at six months following full vaccination with BNT162b2 in healthy individuals, which was more pronounced among older persons. These data may inform the public health policies regarding the prioritization of booster vaccine shots.

Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria

Background: Reminders via mobile devices deployed as short message services (SMS) or calls have been identified to be a useful strategy in improving routine immunization uptake in several countries. Objective: To identify the timeliness of appointments with reminders (calls or SMS), SMS health education and the routine care, and the vaccination completion rates in Ilorin, Nigeria. Method: Mother-infant pairs presenting for the first vaccination appointment were randomized into four (three inter- ventions, one control) groups, each consisting of 140 participants. Intervention groups were reminders via calls (A), SMS reminders (B), immunization fact SMS messages (C) and controls on usual care (D). Reminders were made a day before the appointment while SMS immunization facts were sent at five weeks, nine weeks and eight months. Appropriate timing was defined as the scheduled visit ±3 days. Results: The immunization completion rates after the nine months’ visit were 99.2%, 99.3%, 97% and 90.4% for Groups A, B, C and D respectively. Compared with controls, Group A had the highest odds [AOR 8.78 (6.10, 12.63)] of presenting at an appropriate time, followed by Group B [AOR 2.56 (1.96, 3.35)], then Group C [AOR 2.44 (1.87, 3.18)]. Conclusion: Reminders/SMS immunization facts improve vaccination completion rates. Keywords: Call reminders; short message services (SMS) reminders; SMS immunization; vaccination timing; Nigeria.

Success of community approach to HPV vaccination in school-based and non-school-based settings in Haiti

Objectives To assess the success of a human papillomavirus (HPV) vaccination program among adolescent girls aged 9–14 years in Haiti and to understand predictors of completion of a two-dose HPV vaccination series. Methods Data collection was conducted during HPV vaccination campaigns in Port-au-Prince between August 2016 and April 2017. Descriptive statistics and logistic regression models were used to examine characteristics associated with vaccination series completion of school based and non-school based vaccination delivery modalities. Results Of the 2,445 adolescent girls who participated in the awareness program, 1,994 participants (1,307 in non-school program, 687 in school program) received the first dose of the vaccine; 1,199 (92%) in the non-school program and 673 (98%) in the school program also received the second dose. Menarche (OR: 1.87; 95% CI, 1.11–3.14), if the participant was a prior patient at the GHESKIO clinics (OR: 2.17; 95% CI, 1.32–3.58), and participating in the school-based program (OR: 4.17; 95% CI, 2.14–8.12) were significantly associated with vaccination completion. Conclusions Vaccination in school- and non-school-based settings was successful, suggesting that a nationwide HPV vaccination campaign using either approach would be successful using either approach.

Ensuring High and Equitable COVID-19 Vaccine Uptake Among Patients With IBD

The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients’ concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.

Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011–2019

Background Tetanus is a rare, vaccine-preventable but extremely serious disease. We investigated the recent trend of the clinical outcomes and medical costs for inpatients with tetanus in South Korea over 10 years. Methods We conducted a retrospective review to determine the clinical factors and medical costs associated with tetanus at two national university hospitals in South Korea between January 2011 and October 2019. Results Forty-nine patients were admitted for tetanus (mean age, 67.0 years [range, 53.0–80.0 years]; 32 women [57.1%]). All the patients had generalized tetanus, and 5 (10.2%) died during hospitalization. The median duration from symptom onset to hospital admission was 4 days. Trismus (85.7%) was the most common symptom, and the median hospital stay was 39 days. Thirty-two patients (65.3%) required mechanical ventilation, and 20 (40.8%) developed aspiration pneumonia. The median total healthcare cost per patient was US $18,011. After discharge, 35 patients (71.4%) recovered sufficiently to walk without disability. Conclusions Tetanus requires long hospital stays and high medical expenditures in South Korea; however, the vaccination completion rate is low. Medical staff should therefore promote medical advice and policies on the management of tetanus to the general South Korean population.

179. Individual and State-level Factors Associated with Receipt of Multiple Recommended Adolescent Vaccines in the United States

Background The Advisory Committee on Immunization Practices (ACIP) routinely recommends several adolescent vaccines, including human papillomavirus (HPV); quadrivalent meningococcal conjugate (MenACWY); and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. Limited data are available on the percentage of adolescents receiving this complement of ACIP-recommended vaccines and factors that may increase likelihood of completion. Methods This study used 2015–18 pooled National Immunization Survey-Teen (NIS-Teen) data to estimate national and state-level completion rates by age 17 of a two-dose MenACWY series, two- or three- dose HPV series (depending on age at first vaccination), and a Tdap vaccine, using multivariable logistic regression modeling to adjust for individual characteristics. NIS-Teen data were then combined with public state-level data to construct a multilevel model evaluating effects of both individual- and state-level factors on completion. Results After adjusting for individual-level factors, the national completion rate for these ACIP-recommended vaccines by age 17 was 30.6% (95% confidence interval [CI]: 30.1–31.0%). However, rates for individual states varied substantially, from 11.3% in Idaho (CI: 6.9–18.0%) to 56.4% in Rhode Island (CI: 49.8–62.8%) (Figure 1). In the multilevel model, individual characteristics associated with increased likelihood of receiving the recommended vaccines by age 17 included female gender, black or Hispanic race, Medicaid coverage (vs. private/other), last provider visit at age 16 or 17, generally having ≥1 provider visit in last year, and receiving a provider recommendation for HPV vaccination. Residing in a state with a MenACWY vaccination mandate for elementary and secondary schools was the only state-level variable that significantly increased the likelihood of completion (odds ratio: 1.6; CI: 1.2–2.3) (Figure 2). Figure 1: Model-Adjusted Completion Rates of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Note: Model-adjusted composite vaccination completion is adjusted for sex, race/ethnicity, mother’s educational attainment, health insurance status, continuity of health insurance coverage since age 11, whether the individual was 16 or 17 years old at their last checkup, number of physician or other healthcare professional visits in past 12 months, whether a doctor or other healthcare professional ever recommended that the individual receive HPV vaccination, and state. The model-adjusted estimate is generated by taking the average of the predicted probability of vaccination for each individual as if they were all from the same state (while retaining all other characteristics). Figure 2: Individual-Level and State-Level Characteristics Associated with an Individual’s Completion of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; CI, confidence interval; HCP, healthcare professional; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; ref, referent category; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Bold characters and darker circles indicate significant results. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Conclusion Recommended adolescent vaccine completion rates are suboptimal and highly variable across states. Provider recommendations, visits at 16–17 years of age, and state mandates for MenACWY are implementable strategies associated with completion of recommended adolescent vaccines. Funding GlaxoSmithKline Biologicals SA (study identifier: HO-19-19991) Disclosures Elizabeth M. La, PhD, RTI Health Solutions (Employee) Diana Garbinsky, MS, GSK (Other Financial or Material Support, The study was conducted by RTI Health Solutions, which received consultancy fees from GSK. I am a salaried employee at RTI Health Solutions and received no direct compensation from GSK for the conduct of this study..) Shannon Hunter, MS, GSK (Other Financial or Material Support, Ms. Hunter is an employee of RTI Health Solutions, who received consultancy fees from GSK for conduct of the study. Ms. Hunter received no direct compensation from the Sponsor.) Sara Poston, PharmD, The GlaxoSmithKline group of companies (Employee, Shareholder) Patricia Novy, PhD, GSK (Employee, Shareholder) Parinaz Ghaswalla, PhD, ORCID: 0000-0002-2883-5590, GlaxoSmithKline (Employee, Shareholder)