Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults - United States, Fall 2023
Black CL , Kriss JL , Razzaghi H , Patel SA , Santibanez TA , Meghani M , Tippins A , Stokley S , Chatham-Stephens K , Dowling NF , Peacock G , Singleton JA . MMWR Morb Mortal Wkly Rep 2023 72 (51) 1377-1382 During the 2023-24 respiratory virus season, the Advisory Committee on Immunization Practices recommends influenza and COVID-19 vaccines for all persons aged ≥6 months, and respiratory syncytial virus (RSV) vaccine is recommended for persons aged ≥60 years (using shared clinical decision-making), and for pregnant persons. Data from the National Immunization Survey-Adult COVID Module, a random-digit-dialed cellular telephone survey of U.S. adults aged ≥18 years, are used to monitor influenza, COVID-19, and RSV vaccination coverage. By December 9, 2023, an estimated 42.2% and 18.3% of adults aged ≥18 years reported receiving an influenza and updated 2023-2024 COVID-19 vaccine, respectively; 17.0% of adults aged ≥60 years had received RSV vaccine. Coverage varied by demographic characteristics. Overall, approximately 27% and 41% of adults aged ≥18 years and 53% of adults aged ≥60 years reported that they definitely or probably will be vaccinated or were unsure whether they would be vaccinated against influenza, COVID-19, and RSV, respectively. Strong provider recommendations for and offers of vaccination could increase influenza, COVID-19, and RSV vaccination coverage. Immunization programs and vaccination partners are encouraged to use these data to understand vaccination patterns and attitudes toward vaccination in their jurisdictions to guide planning, implementation, strengthening, and evaluation of vaccination activities. |
Comparison of adult hesitancy towards COVID-19 vaccines and vaccines in general in the USA
Nguyen KH , Coy KC , Black CL , Scanlon P , Singleton JA . Vaccine 2023 BACKGROUND: Adults who are hesitant toward routinely recommended vaccines for adults may also be hesitant toward COVID-19 vaccines. However, the distribution and differences in hesitancy between routinely recommended vaccines and COVID-19 vaccines, and the association of hesitancy regarding routinely recommended vaccines and hesitancy with COVID-19 vaccination status and intent, is unknown. METHODS: Using the Research and Development Survey (RANDS) during COVID-19, Round 3, a probability-sampled, nationally representative, web and phone survey fielded from May 17 - June 30, 2021 (n = 5,434), we examined the distribution and difference in prevalence of hesitancy towards COVID-19 and vaccines in general, beliefs associated with vaccine hesitancy, and factors impacting plans to be vaccinated against COVID-19. RESULTS: Reported hesitancy towards COVID-19 vaccines (42.2%) was 6-percentage points higher than hesitancy towards vaccines in general (35.7%). Populations who were most hesitant toward COVID-19 vaccines were younger adults, non-Hispanic Black adults, adults with lower education or income, and adults who were associated with a religion. Beliefs in the social benefit and the importance of vaccination, and the belief that COVID-19 vaccines lower risk for infection, were strongly associated with COVID-19 vaccination and intent to be vaccinated. CONCLUSIONS: Vaccine hesitancy for both COVID-19 vaccines and vaccines in general is common. Health providers and public health officials should utilize strategies to address vaccine hesitancy, including providing strong clear recommendations for needed vaccines, addressing safety and effectiveness concerns, and utilizing trusted messengers such as religious and community leaders to improve vaccine confidence. |
Influenza, tdap, and COVID-19 vaccination coverage and hesitancy among pregnant women - United States, April 2023
Razzaghi H , Kahn KE , Calhoun K , Garacci E , Skoff TH , Ellington SR , Jatlaoui TC , Black CL . MMWR Morb Mortal Wkly Rep 2023 72 (39) 1065-1071 Influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines can reduce the risk for influenza, pertussis, and COVID-19 among pregnant women and their infants. To assess influenza, Tdap, and COVID-19 vaccination coverage among women pregnant during the 2022-23 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 16, 2023. Among 1,814 survey respondents who were pregnant at any time during October 2022-January 2023, 47.2% reported receiving influenza vaccine before or during their pregnancy. Among 776 respondents with a live birth by their survey date, 55.4% reported receiving Tdap vaccine during pregnancy. Among 1,252 women pregnant at the time of the survey, 27.3% reported receipt of a COVID-19 bivalent booster dose before or during the current pregnancy. Data from the same questions included in surveys conducted during influenza seasons 2019-20 through 2022-23 show that the proportion of pregnant women who reported being very hesitant about influenza and Tdap vaccinations during pregnancy increased from 2019-20 to 2022-23. Pregnant women who received a provider recommendation for vaccination were less hesitant about influenza and Tdap vaccines. Promotion of efforts to improve vaccination coverage among pregnant women, such as provider recommendation for vaccination and informative conversations with patients to address vaccine hesitancy, might reduce vaccine hesitancy and increase coverage with these important vaccines to protect mothers and their infants against severe respiratory diseases. |
Factors Associated with Receipt and Parental Intent for COVID-19 Vaccination of Children Ages 5-11 years (preprint)
Santibanez TA , Lendon JP , Singleton JA , Black CL , Zhou T , Kriss JL , Jain A , Elam-Evans LD , Masters NB , Peacock G . medRxiv 2022 27 Background and Objectives COVID-19 vaccine was first recommended for children ages 5-11 years on November 2, 2021. This report describes COVID-19 vaccination coverage and parental intent to vaccinate their child ages 5-11 years, overall, by sociodemographic characteristics, and by social and behavioral drivers of vaccination, the fourth month after recommendation. Methods We analyzed data from 5,438 interviews conducted in February 2022 from the National Immunization Survey-Child COVID Module (NIS-CCM), a national random-digit-dial cellular telephone survey of households with children. Results 30.9% of children ages 5-11 were vaccinated with >=1 dose of COVID-19 vaccine, 35.2% were unvaccinated and the parent reported they probably or definitely would get the child vaccinated or were unsure, and 33.9% were unvaccinated and the parent probably or definitely would not get the child vaccinated. Vaccination coverage and parental intent differed by sociodemographic variables, including income, health insurance status, and rurality. Parental intent to vaccinate children also differed by ethnicity and race. Concern about the child getting COVID-19 and confidence in vaccine importance and safety were positively associated with vaccination receipt and intent to get the child vaccinated. Conclusions By the fourth month of the COVID-19 vaccination program for children ages 5-11 years, less than one-third were vaccinated, and coverage was lower for some sociodemographic subgroups. An additional one-third of children had a parent who was open to vaccinating the child. Efforts to address parental concerns regarding vaccine safety and to convey the importance of the vaccine might improve vaccination coverage. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Prevalence of influenza-specific vaccination hesitancy among adults in the United States, 2018
Srivastav A , Lu PJ , Amaya A , Dever JA , Stanley M , Franks JL , Scanlon PJ , Fisher AM , Greby SM , Nguyen KH , Black CL . Vaccine 2023 41 (15) 2572-2581 BACKGROUND: The role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination. METHODS: A four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs. RESULTS: Overall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18-49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy. CONCLUSIONS: Among the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance. |
Surveillance systems for monitoring vaccination coverage with vaccines recommended for pregnant women, United States
Meghani M , Razzaghi H , Kahn KE , Hung MC , Srivastav A , Lu PJ , Ellington S , Zhou F , Weintraub E , Black CL , Singleton JA . J Womens Health (Larchmt) 2023 32 (3) 260-270 Pregnant women* and their infants are at increased risk for serious influenza, pertussis, and COVID-19-related complications, including preterm birth, low-birth weight, and maternal and fetal death. The advisory committee on immunization practices recommends pregnant women receive tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, and influenza and COVID-19 vaccines before or during pregnancy. Vaccination coverage estimates and factors associated with maternal vaccination are measured by various surveillance systems. The objective of this report is to provide a detailed overview of the following surveillance systems that can be used to assess coverage of vaccines recommended for pregnant women: Internet panel survey, National Health Interview Survey, National Immunization Survey-Adult COVID Module, Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Vaccine Safety Datalink, and MarketScan. Influenza, Tdap, and COVID-19 vaccination coverage estimates vary by data source, and select estimates are presented. Each surveillance system differs in the population of pregnant women, time period, geographic area for which estimates can be obtained, how vaccination status is determined, and data collected regarding vaccine-related knowledge, attitudes, behaviors, and barriers. Thus, multiple systems are useful for a more complete understanding of maternal vaccination. Ongoing surveillance from the various systems to obtain vaccination coverage and information regarding disparities and barriers related to vaccination are needed to guide program and policy improvements. |
Paid sick leave among U.S. healthcare personnel, April 2022
de Perio MA , Srivastav A , Razzaghi H , Laney AS , Black CL . Am J Prev Med 2023 65 (3) 521-527 INTRODUCTION: Healthcare personnel (HCP) are at risk for acquiring and transmitting respiratory infections in the workplace. Paid sick leave benefits allow workers to stay home and visit a healthcare provider when ill. The objectives of this study were to quantify the percentage of HCP reporting paid sick leave, identify differences across occupations and settings, and determine factors associated with having paid sick leave. METHODS: In a national nonprobability Internet panel survey of HCP in April 2022, respondents were asked, "Does your employer offer paid sick leave?." Responses were weighted to the U.S. HCP population by age, sex, race/ethnicity, work setting, and census region. The weighted percentage of HCP who reported paid sick leave was calculated by occupation, work setting, and type of employment. Using multivariable logistic regression, factors associated with having paid sick leave were identified. RESULTS: In April 2022, 73.2% of 2,555 responding HCP reported having paid sick leave, similar to 2020 and 2021 estimates. The percentage of HCP reporting paid sick leave varied by occupation, ranging from 63.9% (assistants/aides) to 81.2% (non-clinical personnel). Female HCP and those working as licensed independent practitioners, in the Midwest, and in the South were less likely to report paid sick leave. CONCLUSIONS: The majority of HCP from all occupational groups and healthcare settings reported having paid sick leave. However, differences by sex, occupation, type of work arrangement, and Census region exist and highlight disparities. Increasing HCP access to paid sick leave may decrease presenteeism and subsequent transmission of infectious diseases in healthcare settings. |
COVID-19 bivalent booster vaccination coverage and intent to receive booster vaccination among adolescents and adults - United States, November-December 2022
Lu PJ , Zhou T , Santibanez TA , Jain A , Black CL , Srivastav A , Hung MC , Kriss JL , Schorpp S , Yankey D , Sterrett N , Fast HE , Razzaghi H , Elam-Evans LD , Singleton JA . MMWR Morb Mortal Wkly Rep 2023 72 (7) 190-198 COVID-19 vaccine booster doses are safe and maintain protection after receipt of a primary vaccination series and reduce the risk for serious COVID-19-related outcomes, including emergency department visits, hospitalization, and death (1,2). CDC recommended an updated (bivalent) booster for adolescents aged 12-17 years and adults aged ≥18 years on September 1, 2022 (3). The bivalent booster is formulated to protect against the Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 as well as the original (ancestral) strain (3). Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Child COVID Module (NIS-CCM) (4), among all adolescents aged 12-17 years who completed a primary series, 18.5% had received a bivalent booster dose, 52.0% had not yet received a bivalent booster but had parents open to booster vaccination for their child, 15.1% had not received a bivalent booster and had parents who were unsure about getting a booster vaccination for their child, and 14.4% had parents who were reluctant to seek booster vaccination for their child. Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Adult COVID Module (NIS-ACM) (4), 27.1% of adults who had completed a COVID-19 primary series had received a bivalent booster, 39.4% had not yet received a bivalent booster but were open to receiving booster vaccination, 12.4% had not yet received a bivalent booster and were unsure about getting a booster vaccination, and 21.1% were reluctant to receive a booster. Adolescents and adults in rural areas had a much lower primary series completion rate and up-to-date vaccination coverage. Bivalent booster coverage was lower among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) adolescents and adults compared with non-Hispanic White (White) adolescents and adults. Among adults who were open to receiving booster vaccination, 58.9% reported not having received a provider recommendation for booster vaccination, 16.9% had safety concerns, and 4.4% reported difficulty getting a booster vaccine. Among adolescents with parents who were open to getting a booster vaccination for their child, 32.4% had not received a provider recommendation for any COVID-19 vaccination, and 11.8% had parents who reported safety concerns. Although bivalent booster vaccination coverage among adults differed by factors such as income, health insurance status, and social vulnerability index (SVI), these factors were not associated with differences in reluctance to seek booster vaccination. Health care provider recommendations for COVID-19 vaccination; dissemination of information by trusted messengers about the continued risk for COVID-19-related illness and the benefits and safety of bivalent booster vaccination; and reducing barriers to vaccination could improve COVID-19 bivalent booster coverage among adolescents and adults. |
Vaccination coverage with selected vaccines and exemption rates among children in kindergarten - United States, 2021-22 school year
Seither R , Calhoun K , Yusuf OB , Dramann D , Mugerwa-Kasujja A , Knighton CL , Black CL . MMWR Morb Mortal Wkly Rep 2023 72 (2) 26-32 State and local school vaccination requirements protect students and communities against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage and exemptions to vaccination among children in kindergarten in 49 states(†) and the District of Columbia and provisional enrollment or grace period status for kindergartners in 27 states(§) for the 2021-22 school year. Nationwide, vaccination coverage with 2 doses of measles, mumps and rubella vaccine (MMR) was 93.5%(¶); with the state-required number of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) doses was 93.1%**; with poliovirus vaccine (polio) was 93.5%(††); and with the state-required number of varicella vaccine doses was 92.8%.(§§) Compared with the 2020-21 school year, vaccination coverage decreased 0.4-0.9 percentage points for all vaccines. Although 2.6% of kindergartners had an exemption for at least one vaccine,(¶¶) an additional 3.9% who did not have an exemption were not up to date with MMR. Although there has been a nearly complete return to in-person learning after COVID-19 pandemic-associated disruptions, immunization programs continued to report COVID-19-related impacts on vaccination assessment and coverage. Follow-up with undervaccinated students and catch-up campaigns remain important for increasing vaccination coverage to prepandemic levels to protect children and communities from vaccine-preventable diseases. |
Cluster analysis of adults unvaccinated for COVID-19 based on behavioral and social factors, National Immunization Survey-Adult COVID Module, United States.
Meng L , Masters NB , Lu PJ , Singleton JA , Kriss JL , Zhou T , Weiss D , Black CL . Prev Med 2022 107415 By the end of 2021, approximately 15% of U.S. adults remained unvaccinated against COVID-19, and vaccination initiation rates had stagnated. We used unsupervised machine learning (K-means clustering) to identify clusters of unvaccinated respondents based on Behavioral and Social Drivers (BeSD) of COVID-19 vaccination and compared these clusters to vaccinated participants to better understand social/behavioral factors of non-vaccination. The National Immunization Survey Adult COVID Module collects data on U.S. adults from September 26-December 31,2021 (=187,756). Among all participants, 51.6% were male, with a mean age of 61years, and the majority were non-Hispanic White (62.2%), followed by Hispanic (17.2%), Black (11.9%), and others (8.7%). K-means clustering procedure was used to classify unvaccinated participants into three clusters based on 9 survey BeSD items, including items assessing COVID-19 risk perception, social norms, vaccine confidence, and practical issues. Among unvaccinated adults (N=23,397), 3 clusters were identified: the "Reachable" (23%), "Less reachable" (27%), and the "Least reachable" (50%). The least reachable cluster reported the lowest concern about COVID-19, mask-wearing behavior, perceived vaccine confidence, and were more likely to be male, non-Hispanic White, with no health conditions, from rural counties, have previously had COVID-19, and have not received a COVID-19 vaccine recommendation from a healthcare provider. This study identified, described, and compared the characteristics of the three unvaccinated subgroups. Public health practitioners, healthcare providers and community leaders can use these characteristics to better tailor messaging for each sub-population. Our findings may also help inform decisionmakers exploring possible policy interventions. |
Sociodemographic Variation in Early Uptake of COVID-19 Vaccine and Parental Intent and Attitudes Toward Vaccination of Children Aged 6 Months-4 Years - United States, July 1-29, 2022.
Santibanez TA , Zhou T , Black CL , Vogt TM , Murthy BP , Pineau V , Singleton JA . MMWR Morb Mortal Wkly Rep 2022 71 (46) 1479-1484 COVID-19 vaccines are safe and effective for infants and young children, and on June 18, 2022, CDC recommended COVID-19 vaccination for infants and children (children) aged 6 months-4 years (1,2). As of November 9, 2022, based on administrative data reported to CDC,* 5.9% of children aged <2 years and 8.8% of children aged 2-4 years had received ≥1 dose. To better understand reasons for low coverage among children aged <5 years, CDC analyzed data from 4,496 National Immunization Survey-Child COVID Module (NIS-CCM) interviews conducted during July 1-29, 2022, to examine variation in receipt of ≥1 dose of COVID-19 vaccine and parental intent to vaccinate children aged 6 months-4 years by sociodemographic characteristics and by parental beliefs about COVID-19; type of vaccination place was also reported. Among children aged 6 months-4 years, 3.5% were vaccinated; 59.3% were unvaccinated, but the parent was open to vaccination; and 37.2% were unvaccinated, and the parent was reluctant to vaccinate their child. Openness to vaccination was higher among parents of Hispanic or Latino (Hispanic) (66.2%), non-Hispanic Black or African American (Black) (61.1%), and non-Hispanic Asian (Asian) (83.1%) children than among parents of non-Hispanic White (White) (52.9%) children and lower among parents of children in rural areas (45.8%) than among parents of children in urban areas (64.1%). Parental confidence in COVID-19 vaccine safety and receipt of a provider recommendation for COVID-19 vaccination were lower among unvaccinated than vaccinated children. COVID-19 vaccine recommendations from a health care provider, along with dissemination of information about the safety of COVID-19 vaccine by trusted persons, could increase vaccination coverage among young children. |
Vital Signs: Influenza hospitalizations and vaccination coverage by race and ethnicity-United States, 2009-10 through 2021-22 influenza seasons
Black CL , O'Halloran A , Hung MC , Srivastav A , Lu PJ , Garg S , Jhung M , Fry A , Jatlaoui TC , Davenport E , Burns E . MMWR Morb Mortal Wkly Rep 2022 71 (43) 1366-1373 INTRODUCTION: CDC estimates that influenza resulted in 9-41 million illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths annually during 2010-2020. Persons from some racial and ethnic minority groups have historically experienced higher rates of severe influenza and had lower influenza vaccination coverage compared with non-Hispanic White (White) persons. This report examines influenza hospitalization and vaccination rates by race and ethnicity during a 12-13-year period (through the 2021-22 influenza season). METHODS: Data from population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected states participating in the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET) from the 2009-10 through 2021-22 influenza seasons (excluding 2020-21) and influenza vaccination coverage data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2010-11 through 2021-22 influenza seasons were analyzed by race and ethnicity. RESULTS: From 2009-10 through 2021-22, age-adjusted influenza hospitalization rates (hospitalizations per 100,000 population) were higher among non-Hispanic Black (Black) (rate ratio [RR] = 1.8), American Indian or Alaska Native (AI/AN; RR = 1.3), and Hispanic (RR = 1.2) adults, compared with the rate among White adults. During the 2021-22 season, influenza vaccination coverage was lower among Hispanic (37.9%), AI/AN (40.9%), Black (42.0%), and other/multiple race (42.6%) adults compared with that among White (53.9%) and non-Hispanic Asian (Asian) (54.2%) adults; coverage has been consistently higher among White and Asian adults compared with that among Black and Hispanic adults since the 2010-11 season. The disparity in vaccination coverage by race and ethnicity was present among those who reported having medical insurance, a personal health care provider, and a routine medical checkup in the past year. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Racial and ethnic disparities in influenza disease severity and influenza vaccination coverage persist. Health care providers should assess patient vaccination status at all medical visits and offer (or provide a referral for) all recommended vaccines. Tailored programmatic efforts to provide influenza vaccination through nontraditional settings, along with national and community-level efforts to improve awareness of the importance of influenza vaccination in preventing illness, hospitalization, and death among racial and ethnic minority communities might help address health care access barriers and improve vaccine confidence, leading to decreases in disparities in influenza vaccination coverage and disease severity. |
Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel - United States, 2021-22.
Razzaghi H , Srivastav A , de Perio MA , Laney AS , Black CL . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1319-1326 The Advisory Committee on Immunization Practices (ACIP) and CDC recommend that all health care personnel (HCP) receive annual influenza vaccination to reduce influenza-related morbidity and mortality among these personnel and their patients (1). ACIP also recommends that all persons aged ≥6 months, including HCP, be vaccinated with COVID-19 vaccines and remain up to date (2,3). During March 29-April 19, 2022, CDC conducted an opt-in Internet panel survey of 3,618 U.S. HCP to estimate influenza vaccination coverage during the 2021-22 influenza season as well as receipt of the primary COVID-19 vaccination series and a booster dose. Influenza vaccination coverage was 79.9% during the 2021-22 season, and 87.3% of HCP reported having completed the primary COVID-19 vaccination series; among these HCP, 67.1% reported receiving a COVID-19 booster dose. Among HCP, influenza, COVID-19 primary series, and COVID-19 booster dose vaccination coverage were lowest among assistants and aides, those working in long-term care (LTC) or home health care settings, and those whose employer neither required nor recommended the vaccines. Overall, employer requirements for influenza and COVID-19 primary series vaccines were reported by 43.9% and 59.9% of HCP, respectively; among HCP who completed the primary series of COVID-19 vaccines, 23.5% reported employer requirements for COVID-19 booster vaccines. Vaccination coverage for all three vaccine measures was higher among HCP who reported employer vaccination requirements and ranged from 95.8% to 97.3% for influenza, 90.2% to 95.1% for COVID-19 primary series, and 76.4% to 87.8% for COVID-19 booster vaccinations among HCP who completed the primary series of COVID-19 vaccines, by work setting. Implementing workplace strategies demonstrated to improve vaccination coverage among HCP, including vaccination requirements or active promotion of vaccination, can increase influenza and COVID-19 vaccination coverage among HCP and reduce influenza and COVID-19-related morbidity and mortality among HCP and their patients (4). |
Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States.
Santibanez TA , Black CL , Vogt TM , Chatham-Stephens K , Zhou T , Lendon JP , Singleton JA . Vaccine 2022 40 (48) 6917-6923 BACKGROUND: Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. METHODS: Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. RESULTS: Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. CONCLUSION: Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years. |
COVID-19 Vaccination and Intent for Vaccination of Adults With Reported Medical Conditions.
Lu PJ , Hung MC , Jackson HL , Kriss JL , Srivastav A , Yankey D , Santibanez TA , Lee JT , Meng L , Razzaghi H , Black CL , Elam-Evans LD , Singleton JA . Am J Prev Med 2022 63 (5) 760-771 INTRODUCTION: Individuals with certain medical conditions are at substantially increased risk for severe illness from COVID-19. The purpose of this study is to assess COVID-19 vaccination among U.S. adults with reported medical conditions. METHODS: Data from the National Immunization Survey-Adult COVID Module collected during August 1-September 25, 2021 were analyzed in 2022 to assess COVID-19 vaccination status, intent, vaccine confidence, behavior, and experience among adults with reported medical conditions. Unadjusted and age-adjusted prevalence ratios (PRs and APRs) were generated using logistic regression and predictive marginals. RESULTS: Overall, COVID-19 vaccination coverage with 1 dose was 81.8% among adults with reported medical conditions, and coverage was significantly higher compared with those without such conditions (70.3%) Among adults aged 18 years with medical conditions, COVID-19 vaccination coverage was significantly higher among those with a provider recommendation (86.5%) than those without (76.5%). Among all respondents, 9.2% of unvaccinated adults with medical conditions reported they were willing or open to vaccination. Adults who reported high risk medical conditions were more likely to report receiving a provider recommendation, often or always wearing masks during the last 7 days, concerning about getting COVID-19, thinking the vaccine is safe, and believing a COVID-19 vaccine is important for protection from COVID-19 infection than those without such conditions. CONCLUSIONS: Approximately 18.0% of those with reported medical conditions were unvaccinated. Receiving a provider recommendation was significantly associated with vaccination, reinforcing that provider recommendation is an important approach to increase vaccination coverage. Ensuring access to vaccine, addressing vaccination barriers, and increasing vaccine confidence can improve vaccination coverage among unvaccinated adults. |
Factors Associated with Delayed or Missed Second-Dose mRNA COVID-19 Vaccination among Persons >12 Years of Age, United States.
Meng L , Murthy NC , Murthy BP , Zell E , Saelee R , Irving M , Fast HE , Roman PC , Schiller A , Shaw L , Black CL , Gibbs-Scharf L , Harris L , Chorba T . Emerg Infect Dis 2022 28 (8) 1633-1641 To identify demographic factors associated with delaying or not receiving a second dose of the 2-dose primary mRNA COVID-19 vaccine series, we matched 323 million single Pfizer-BioNTech (https://www.pfizer.com) and Moderna (https://www.modernatx.com) COVID-19 vaccine administration records from 2021 and determined whether second doses were delayed or missed. We used 2 sets of logistic regression models to examine associated factors. Overall, 87.3% of recipients received a timely second dose (≤42 days between first and second dose), 3.4% received a delayed second dose (>42 days between first and second dose), and 9.4% missed the second dose. Persons more likely to have delayed or missed the second dose belonged to several racial/ethnic minority groups, were 18-39 years of age, lived in more socially vulnerable areas, and lived in regions other than the northeastern United States. Logistic regression models identified specific subgroups for providing outreach and encouragement to receive subsequent doses on time. |
COVID-19 Vaccine Provider Availability and Vaccination Coverage Among Children Aged 5-11 Years - United States, November 1, 2021-April 25, 2022.
DeCuir J , Meng L , Pan Y , Vogt T , Chatham-Stevens K , Meador S , Shaw L , Black CL , Harris LQ . MMWR Morb Mortal Wkly Rep 2022 71 (26) 847-851 COVID-19 can lead to severe outcomes in children, including multisystem inflammatory syndrome, hospitalization, and death (1,2). On November 2, 2021, the Advisory Committee on Immunization Practices issued an interim recommendation for use of the BNT162b2 (Pfizer-BioNTech) vaccine in children aged 5-11 years for the prevention of COVID-19; however, vaccination coverage in this age group remains low (3). As of June 7, 2022, 36.0% of children aged 5-11 years in the United States had received 1 of COVID-19 vaccine (3). Among factors that might influence vaccination coverage is the availability of vaccine providers (4). To better understand how provider availability has affected COVID-19 vaccination coverage among children aged 5-11 years, CDC analyzed data on active COVID-19 vaccine providers and county-level vaccine administration data during November 1, 2021-April 25, 2022. Among 2,586 U.S. counties included in the analysis, 87.5% had at least one active COVID-19 vaccine provider serving children aged 5-11 years. Among the five assessed active provider types, most counties had at least one pharmacy (69.1%) or public health clinic (61.3%), whereas fewer counties had at least one pediatric clinic (29.7%), family medicine clinic (29.0%), or federally qualified health center (FQHC)* (22.8%). Median county-level vaccination coverage was 14.5% (IQR=8.9%-23.6%). After adjusting for social vulnerability index (SVI)() and urbanicity, the analysis found that vaccination coverage among children aged 5-11 years was higher in counties with at least one active COVID-19 vaccine provider than in counties with no active providers (adjusted rate ratio [aRR]=1.66). For each provider type, presence of at least one provider in the county was associated with higher coverage; the largest difference in vaccination coverage was observed between counties with and without pediatric clinics (aRR=1.37). Ensuring broad access to COVID-19 vaccines, in addition to other strategies to address vaccination barriers, could help increase vaccination coverage among children aged 5-11 years. |
COVID-19 vaccination coverage, intentions, attitudes and barriers by race/ethnicity, language of interview, and nativity, National Immunization Survey Adult COVID Module, April 22, 2021-January 29, 2022.
Ohlsen EC , Yankey D , Pezzi C , Kriss JL , Lu PJ , Hung MC , Bernabe MID , Kumar GS , Jentes E , Elam-Evans LD , Jackson H , Black CL , Singleton JA , Ladva CN , Abad N , Lainz AR . Clin Infect Dis 2022 75 S182-S192 The National Immunization Survey Adult COVID Module used a random-digit-dialed phone survey during April 22, 2021-January 29, 2022 to quantify COVID-19 vaccination, intent, attitudes, and barriers by detailed race/ethnicity, interview language, and nativity. Foreign-born respondents overall and within racial/ethnic categories had higher vaccination coverage (80.9%), higher intent to be vaccinated (4.2%), and lower hesitancy towards COVID-19 vaccination (6.0%) than US-born respondents (72.6%, 2.9%, and 15.8%, respectively). Vaccination coverage was significantly lower for certain subcategories of national origin or heritage (e.g., Jamaican (68.6%), Haitian (60.7%), Somali (49.0%) in weighted estimates). Respondents interviewed in Spanish had lower vaccination coverage than interviewees in English but higher intent to be vaccinated and lower reluctance. Collection and analysis of nativity, detailed race/ethnicity and language information allow identification of disparities among racial/ethnic subgroups. Vaccination programs could use such information to implement culturally and linguistically appropriate focused interventions among communities with lower vaccination coverage. |
COVID-19 Vaccination Coverage, by Race and Ethnicity - National Immunization Survey Adult COVID Module, United States, December 2020-November 2021.
Kriss JL , Hung MC , Srivastav A , Black CL , Lindley MC , Lee JT , Koppaka R , Tsai Y , Lu PJ , Yankey D , Elam-Evans LD , Singleton JA . MMWR Morb Mortal Wkly Rep 2022 71 (23) 757-763 Some racial and ethnic minority groups have experienced disproportionately higher rates of COVID-19-related illness and mortality (1,2). Vaccination is highly effective in preventing severe COVID-19 illness and death (3), and equitable vaccination can reduce COVID-19-related disparities. CDC analyzed data from the National Immunization Survey Adult COVID Module (NIS-ACM), a random-digit-dialed cellular telephone survey of adults aged 18 years, to assess disparities in COVID-19 vaccination coverage by race and ethnicity among U.S. adults during December 2020-November 2021. Asian and non-Hispanic White (White) adults had the highest 1-dose COVID-19 vaccination coverage by the end of April 2021 (69.6% and 59.0%, respectively); 1-dose coverage was lower among Hispanic (47.3%), non-Hispanic Black or African American (Black) (46.3%), Native Hawaiian or other Pacific Islander (NH/OPI) (45.9%), multiple or other race (42.6%), and American Indian or Alaska Native (AI/AN) (38.7%) adults. By the end of November 2021, national 1-dose COVID-19 vaccination coverage was similar for Black (78.2%), Hispanic (81.3%), NH/OPI (75.7%), and White adults (78.7%); however, coverage remained lower for AI/AN (61.8%) and multiple or other race (68.0%) adults. Booster doses of COVID-19 vaccine are now recommended for all adults (4), but disparities in booster dose coverage among the fully vaccinated have become apparent (5). Tailored efforts including community partnerships and trusted sources of information could be used to increase vaccination coverage among the groups with identified persistent disparities and can help achieve vaccination equity and prevent new disparities by race and ethnicity in booster dose coverage. |
COVID-19 Vaccination and Intent Among Pregnant Women, United States, April 2021.
Razzaghi H , Kahn KE , Masalovich S , Black CL , Nguyen KH , Barfield WD , Galang RR , Singleton JA . Public Health Rep 2022 137 (5) 333549221099244 OBJECTIVES: National data on COVID-19 vaccination coverage among pregnant women are limited. We assessed COVID-19 vaccination coverage and intent, factors associated with COVID-19 vaccination, reasons for nonvaccination, and knowledge, attitudes, and beliefs related to COVID-19 illness and vaccination among pregnant women in the United States. METHODS: Data from an opt-in internet panel survey of pregnant women conducted March 31-April 16, 2021, assessed receipt of 1 dose of any COVID-19 vaccine during pregnancy. The sample included 1516 women pregnant any time during December 1, 2020-April 16, 2021, who were not fully vaccinated before pregnancy. We used multivariable logistic regression to determine variables independently associated with receipt of COVID-19 vaccine. RESULTS: As of April 16, 2021, 21.7% of pregnant women had received 1 dose of COVID-19 vaccine during pregnancy, 24.0% intended to receive a vaccine, 17.2% were unsure, and 37.1% did not intend to receive a vaccine. Pregnant women with (vs without) a health care provider recommendation (adjusted prevalence ratio [aPR] = 4.86), those who lived (vs not) with someone with a condition that could increase risk for serious medical complications of COVID-19 (aPR = 2.11), and those who had received (vs not) an influenza vaccination (aPR = 2.35) were more likely to receive a COVID-19 vaccine. Common reasons for nonvaccination included concerns about safety risk to baby (37.2%) or self (34.6%) and about rapid vaccine development (29.7%) and approval (30.9%). CONCLUSIONS: Our findings indicate a continued need to emphasize the benefits of COVID-19 vaccination during pregnancy and to widely disseminate the recommendations of the Centers for Disease Control and Prevention and other clinical professional societies for all pregnant women to be vaccinated. |
Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2020-21 School Year.
Seither R , Laury J , Mugerwa-Kasujja A , Knighton CL , Black CL . MMWR Morb Mortal Wkly Rep 2022 71 (16) 561-568 State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected for the 2020-21 school year by state and local immunization programs* on vaccination coverage among children in kindergarten in 47 states and the District of Columbia (DC), exemptions for kindergartners in 48 states and DC, and provisional enrollment or grace period status for kindergartners in 28 states. Vaccination coverage(†) nationally was 93.9% for 2 doses of measles, mumps, and rubella vaccine (MMR); 93.6% for the state-required number of doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 93.6% for the state-required doses of varicella vaccine. Compared with the 2019-20 school year, vaccination coverage decreased by approximately one percentage point for all vaccines. Although 2.2% of kindergartners had an exemption from at least one vaccine,(§) an additional 3.9% who did not have a vaccine exemption were not up to date for MMR. The COVID-19 pandemic affected schools' vaccination requirement and provisional enrollment policies, documentation, and assessment activities. As schools continue to return to in-person learning, enforcement of vaccination policies and follow-up with undervaccinated students are important to improve vaccination coverage. |
COVID-19 Vaccination and Intent Among Healthcare Personnel, U.S.
Razzaghi H , Masalovich S , Srivastav A , Black CL , Nguyen KH , de Perio MA , Laney AS , Singleton JA . Am J Prev Med 2021 62 (5) 705-715 INTRODUCTION: Healthcare personnel are at increased risk for COVID-19 from workplace exposure. National estimates on COVID-19 vaccination coverage among healthcare personnel are limited. METHODS: Data from an opt-in Internet panel survey of 2,434 healthcare personnel, conducted on March 30, 2021-April 15, 2021, were analyzed to assess the receipt of ≥1 dose of a COVID-19 vaccine and vaccination intent. Multivariable logistic regression was used to assess the factors associated with COVID-19 vaccination and intent for vaccination. RESULTS: Overall, 68.2% of healthcare personnel reported a receipt of ≥1 dose of a COVID-19 vaccine, 9.8% would probably/definitely get vaccinated, 7.1% were unsure, and 14.9% would probably/definitely not get vaccinated. COVID-19 vaccination coverage was highest among physicians (89.0%), healthcare personnel working in hospitals (75.0%), and healthcare personnel of non-Hispanic White or other race (75.7%-77.4%). Healthcare personnel who received influenza vaccine in 2020-2021 (adjusted prevalence ratio=1.92) and those aged ≥60 years (adjusted prevalence ratio=1.37) were more likely to report a receipt of ≥1 dose of a COVID-19 vaccine. Non-Hispanic Black healthcare personnel (adjusted prevalence ratio=0.74), nurse practitioners/physician assistants (adjusted prevalence ratio=0.55), assistants/aides (adjusted prevalence ratio=0.73), and nonclinical healthcare personnel (adjusted prevalence ratio=0.79) were less likely to have received a COVID-19 vaccine. The common reasons for vaccination included protecting self (88.1%), family and friends (86.3%), and patients (69.2%) from COVID-19. The most common reason for nonvaccination was concern about side effects and safety of COVID-19 vaccine (59.7%). CONCLUSIONS: Understanding vaccination status and intent among healthcare personnel is important for addressing barriers to vaccination. Addressing concerns on side effects, safety, and effectiveness of COVID-19 vaccines as well as their fast development and approval may help improve vaccination coverage among healthcare personnel. |
Booster and Additional Primary Dose COVID-19 Vaccinations Among Adults Aged ≥65 Years - United States, August 13, 2021-November 19, 2021.
Fast HE , Zell E , Murthy BP , Murthy N , Meng L , Scharf LG , Black CL , Shaw L , Chorba T , Harris LQ . MMWR Morb Mortal Wkly Rep 2021 70 (50) 1735-1739 Vaccination against SARS-CoV-2 (the virus that causes COVID-19) is highly effective at preventing hospitalization due to SARS-CoV-2 infection and booster and additional primary dose COVID-19 vaccinations increase protection (1-3). During August-November 2021, a series of Emergency Use Authorizations and recommendations, including those for an additional primary dose for immunocompromised persons and a booster dose for persons aged ≥18 years, were approved because of reduced immunogenicity in immunocompromised persons, waning vaccine effectiveness over time, and the introduction of the highly transmissible B.1.617.2 (Delta) variant (4,5). Adults aged ≥65 years are at increased risk for COVID-19-associated hospitalization and death and were one of the populations first recommended a booster dose in the U.S. (5,6). Data on COVID-19 vaccinations reported to CDC from 50 states, the District of Columbia (DC), and eight territories and freely associated states were analyzed to ascertain coverage with booster or additional primary doses among adults aged ≥65 years. During August 13-November 19, 2021, 18.7 million persons aged ≥65 years received a booster or additional primary dose of COVID-19 vaccine, constituting 44.1% of 42.5 million eligible* persons in this age group who previously completed a primary vaccination series.(†) Coverage was similar by sex and age group, but varied by primary series vaccine product and race and ethnicity, ranging from 30.3% among non-Hispanic American Indian or Alaska Native persons to 50.5% among non-Hispanic multiple/other race persons. Strategic efforts are needed to encourage eligible persons aged ≥18 years, especially those aged ≥65 years and those who are immunocompromised, to receive a booster and/or additional primary dose to ensure maximal protection against COVID-19. |
COVID-19 Vaccination Coverage Among Adolescents Aged 12-17 Years - United States, December 14, 2020-July 31, 2021.
Murthy BP , Zell E , Saelee R , Murthy N , Meng L , Meador S , Reed K , Shaw L , Gibbs-Scharf L , McNaghten AD , Patel A , Stokley S , Flores S , Yoder JS , Black CL , Harris LQ . MMWR Morb Mortal Wkly Rep 2021 70 (35) 1206-1213 Although severe COVID-19 illness and hospitalization are more common among adults, these outcomes can occur in adolescents (1). Nearly one third of adolescents aged 12-17 years hospitalized with COVID-19 during March 2020-April 2021 required intensive care, and 5% of those hospitalized required endotracheal intubation and mechanical ventilation (2). On December 11, 2020, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 16-17 years; on May 10, 2021, the EUA was expanded to include adolescents aged 12-15 years; and on August 23, 2021, FDA granted approval of the vaccine for persons aged ≥16 years. To assess progress in adolescent COVID-19 vaccination in the United States, CDC assessed coverage with ≥1 dose* and completion of the 2-dose vaccination series(†) among adolescents aged 12-17 years using vaccine administration data for 49 U.S. states (all except Idaho) and the District of Columbia (DC) during December 14, 2020-July 31, 2021. As of July 31, 2021, COVID-19 vaccination coverage among U.S. adolescents aged 12-17 years was 42.4% for ≥1 dose and 31.9% for series completion. Vaccination coverage with ≥1 dose varied by state (range = 20.2% [Mississippi] to 70.1% [Vermont]) and for series completion (range = 10.7% [Mississippi] to 60.3% [Vermont]). By age group, 36.0%, 40.9%, and 50.6% of adolescents aged 12-13, 14-15, and 16-17 years, respectively, received ≥1 dose; 25.4%, 30.5%, and 40.3%, respectively, completed the vaccine series. Improving vaccination coverage and implementing COVID-19 prevention strategies are crucial to reduce COVID-19-associated morbidity and mortality among adolescents and to facilitate safer reopening of schools for in-person learning. |
COVID-19 Vaccination Coverage Among Adults - United States, December 14, 2020-May 22, 2021.
Diesel J , Sterrett N , Dasgupta S , Kriss JL , Barry V , Vanden Esschert K , Whiteman A , Cadwell BL , Weller D , Qualters JR , Harris L , Bhatt A , Williams C , Fox LM , Meaney Delman D , Black CL , Barbour KE . MMWR Morb Mortal Wkly Rep 2021 70 (25) 922-927 The U.S. COVID-19 vaccination program launched on December 14, 2020. The Advisory Committee on Immunization Practices recommended prioritizing COVID-19 vaccination for specific groups of the U.S. population who were at highest risk for COVID-19 hospitalization and death, including adults aged ≥75 years*; implementation varied by state, and eligibility was gradually expanded to persons aged ≥65 years beginning in January 2021. By April 19, 2021, eligibility was expanded to all adults aged ≥18 years nationwide.(†) To assess patterns of COVID-19 vaccination coverage among U.S. adults, CDC analyzed data submitted on vaccinations administered during December 14, 2020-May 22, 2021, by age, sex, and community-level characteristics. By May 22, 2021, 57.0% of persons aged ≥18 years had received ≥1 COVID-19 vaccine dose; coverage was highest among persons aged ≥65 years (80.0%) and lowest among persons aged 18-29 years (38.3%). During the week beginning February 7, 2021, vaccination initiation among adults aged ≥65 years peaked at 8.2%, whereas weekly initiation among other age groups peaked later and at lower levels. During April 19-May 22, 2021, the period following expanded eligibility to all adults, weekly initiation remained <4.0% and decreased for all age groups, including persons aged 18-29 years (3.6% to 1.9%) and 30-49 years (3.5% to 1.7%); based on the current rate of weekly initiation (as of May 22), younger persons will not reach the same levels of coverage as older persons by the end of August. Across all age groups, coverage (≥1 dose) was lower among men compared with women, except among adults aged ≥65 years, and lower among persons living in counties that were less urban, had higher social vulnerabilities, or had higher percentages of social determinants of poor health. Continued efforts to improve vaccination confidence and alleviate barriers to vaccination initiation, especially among adults aged 18-49 years, could improve vaccination coverage. |
Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity - United States, December 14, 2020-May 1, 2021.
Barry V , Dasgupta S , Weller DL , Kriss JL , Cadwell BL , Rose C , Pingali C , Musial T , Sharpe JD , Flores SA , Greenlund KJ , Patel A , Stewart A , Qualters JR , Harris L , Barbour KE , Black CL . MMWR Morb Mortal Wkly Rep 2021 70 (22) 818-824 Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category.(†) SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties.(§) During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. Vaccination coverage disparities were largest for two SVI themes: socioeconomic status (Q4 = 44.3% versus Q1 = 61.0%) and household composition and disability (Q4 = 42.0% versus Q1 = 60.1%). Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in high-SVI counties. |
COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons - United States, December 14, 2020-February 14, 2021.
Kriss JL , Reynolds LE , Wang A , Stokley S , Cole MM , Harris LQ , Shaw LK , Black CL , Singleton JA , Fitter DL , Rose DA , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (11) 389-395 In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.*(,)(†) Both vaccines require 2 doses for a completed series. The recommended interval between doses is 21 days for Pfizer-BioNTech and 28 days for Moderna; however, up to 42 days between doses is permissible when a delay is unavoidable.(§) Two analyses of COVID-19 vaccine administration data were conducted among persons who initiated the vaccination series during December 14, 2020-February 14, 2021, and whose doses were reported to CDC through February 20, 2021. The first analysis was conducted to determine whether persons who received a first dose and had sufficient time to receive the second dose (i.e., as of February 14, 2021, >25 days from receipt of Pfizer-BioNTech vaccine or >32 days from receipt of Moderna vaccine had elapsed) had received the second dose. A second analysis was conducted among persons who received a second COVID-19 dose by February 14, 2021, to determine whether the dose was received during the recommended dosing interval, which in this study was defined as 17-25 days (Pfizer-BioNTech) and 24-32 days (Moderna) after the first dose. Analyses were stratified by jurisdiction and by demographic characteristics. In the first analysis, among 12,496,258 persons who received the first vaccine dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series, 8.6% had not received the second dose but remained within the allowable interval (≤42 days since the first dose), and 3.4% had missed the second dose (outside the allowable interval, >42 days since the first dose). The percentage of persons who missed the second dose varied by jurisdiction (range = 0.0%-9.1%) and among demographic groups was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (5.1%) and persons aged 16-44 years (4.0%). In the second analysis, among 14,205,768 persons who received a second dose, 95.6% received the dose within the recommended interval, although percentages varied by jurisdiction (range = 79.0%-99.9%). Public health officials should identify and address possible barriers to completing the COVID-19 vaccination series to ensure equitable coverage across communities and maximum health benefits for recipients. Strategies to ensure series completion could include scheduling second-dose appointments at the first-dose administration and sending reminders for second-dose visits. |
Vaccination coverage with selected vaccines and exemption rates among children in kindergarten - United States, 2019-20 school year
Seither R , McGill MT , Kriss JL , Mellerson JL , Loretan C , Driver K , Knighton CL , Black CL . MMWR Morb Mortal Wkly Rep 2021 70 (3) 75-82 State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten (kindergartners) in 48 states, exemptions for kindergartners in 49 states, and provisional enrollment and grace period status for kindergartners in 28 states for the 2019-20 school year, which was more than halfway completed when most schools moved to virtual learning in the spring because of the coronavirus 2019 (COVID-19) pandemic. Nationally, vaccination coverage(†) was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 95.2% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required number of varicella vaccine doses. Although 2.5% of kindergartners had an exemption from at least one vaccine,(§) another 2.3% were not up to date for MMR and did not have a vaccine exemption. Schools and immunization programs can work together to ensure that undervaccinated students are caught up on vaccinations in preparation for returning to in-person learning. This follow-up is especially important in the current school year, in which undervaccination is likely higher because of disruptions in vaccination during the ongoing COVID-19 pandemic (2-4). |
Influenza and Tdap vaccination coverage among pregnant women - United States, April 2020
Razzaghi H , Kahn KE , Black CL , Lindley MC , Jatlaoui TC , Fiebelkorn AP , Havers FP , D'Angelo DV , Cheung A , Ruther NA , Williams WW . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1391-1397 Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage. |
Changing Age Distribution of the COVID-19 Pandemic - United States, May-August 2020.
Boehmer TK , DeVies J , Caruso E , van Santen KL , Tang S , Black CL , Hartnett KP , Kite-Powell A , Dietz S , Lozier M , Gundlapalli AV . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1404-1409 As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in more than 6,800,000 reported U.S. cases and more than 199,000 associated deaths.* Early in the pandemic, COVID-19 incidence was highest among older adults (1). CDC examined the changing age distribution of the COVID-19 pandemic in the United States during May-August by assessing three indicators: COVID-19-like illness-related emergency department (ED) visits, positive reverse transcription-polymerase chain reaction (RT-PCR) test results for SARS-CoV-2, the virus that causes COVID-19, and confirmed COVID-19 cases. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19-like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. Census regions. During June-August, COVID-19 incidence was highest in persons aged 20-29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20-39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range = 4-15 days), suggesting that younger adults likely contributed to community transmission of COVID-19. Given the role of asymptomatic and presymptomatic transmission (2), strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and subsequent transmission of SARS-CoV-2 to persons at higher risk for severe illness. |
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