A tree model identified adults age ≤34 years, Johnson & Johnson primary series recipients, people from racial/ethnic minority groups, residents of nonlarge metro areas, and those living in socially vulnerable communities in the South as less likely to be boosted. These findings can guide clinical/public health outreach toward specific subpopulations.

IMPORTANCE: Understanding risk factors for hospitalization in vaccinated persons and the association of COVID-19 vaccines with hospitalization rates is critical for public health efforts to control COVID-19. OBJECTIVE: To determine characteristics of COVID-19-associated hospitalizations among vaccinated persons and comparative hospitalization rates in unvaccinated and vaccinated persons. DESIGN, SETTING, AND PARTICIPANTS: From January 1, 2021, to April 30, 2022, patients 18 years or older with laboratory-confirmed SARS-CoV-2 infection were identified from more than 250 hospitals in the population-based COVID-19-Associated Hospitalization Surveillance Network. State immunization information system data were linked to cases, and the vaccination coverage data of the defined catchment population were used to compare hospitalization rates in unvaccinated and vaccinated individuals. Vaccinated and unvaccinated patient characteristics were compared in a representative sample with detailed medical record review; unweighted case counts and weighted percentages were calculated. EXPOSURES: Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test result within 14 days before or during hospitalization. MAIN OUTCOMES AND MEASURES: COVID-19-associated hospitalization rates among vaccinated vs unvaccinated persons and factors associated with COVID-19-associated hospitalization in vaccinated persons were assessed. RESULTS: Using representative data from 19509 hospitalizations (see Table 1 for demographic information), monthly COVID-19-associated hospitalization rates ranged from 3.5 times to 17.7 times higher in unvaccinated persons than vaccinated persons regardless of booster dose status. From January to April 2022, when the Omicron variant was predominant, hospitalization rates were 10.5 times higher in unvaccinated persons and 2.5 times higher in vaccinated persons with no booster dose, respectively, compared with those who had received a booster dose. Among sampled cases, vaccinated hospitalized patients with COVID-19 were older than those who were unvaccinated (median [IQR] age, 70 [58-80] years vs 58 [46-70] years, respectively; P<.001) and more likely to have 3 or more underlying medical conditions (1926 [77.8%] vs 4124 [51.6%], respectively; P<.001). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US adults hospitalized with COVID-19, unvaccinated adults were more likely to be hospitalized compared with vaccinated adults; hospitalization rates were lowest in those who had received a booster dose. Hospitalized vaccinated persons were older and more likely to have 3 or more underlying medical conditions and be long-term care facility residents compared with hospitalized unvaccinated persons. The study results suggest that clinicians and public health practitioners should continue to promote vaccination with all recommended doses for eligible persons.

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.

We analyzed first-dose coronavirus disease vaccination coverage among US children 5-11 years of age during November-December 2021. Pediatric vaccination coverage varied widely by jurisdiction, age group, and race/ethnicity, and lagged behind vaccination coverage for adolescents aged 12-15 years during the first 2 months of vaccine rollout.

CONTEXT: On February 3, 2019, Atlanta, Georgia, hosted Super Bowl LIII, which is classified as a National Special Security Event. The festivities comprising this major sporting event brought approximately half a million people to Atlanta, which posed significant challenges to the local public health community. As the lead local agency for public health planning, preparedness, and response efforts, Fulton County Board of Health (FCBOH) needed to address multiple specific tasks based on core functional areas outlined in the Emergency Support Function (ESF) 8 (eg, bioterrorism preparedness and epidemiological surveillance). PROGRAM: To prepare for the Super Bowl, FCBOH developed a systematic approach to ensure community-wide public health preparedness for mass gatherings. This approach came to be known as the 6 E framework, which consists of (1) engaging stakeholders, (2) examining current capabilities and identifying gaps, (3) establishing roles and responsibilities, (4) executing plans to fill gaps, (5) exercising plans, and (6) evaluating impact. IMPLEMENTATION: We define each step of the 6 E framework and present practical examples of how FCBOH implemented each step when preparing for the Super Bowl. Challenges that FCBOH faced and the lessons learned in the process are illustrated. The 6 E framework provides a systematic approach to community preparedness and allows local health departments to tailor the approach to serve local public health needs. EVALUATION: The successful implementation of the 6 E framework allowed for stakeholders at the federal, state, and local levels (including law enforcement) to effectively coordinate an epidemiological investigation and response when 4 staff members reported gastrointestinal symptoms after eating at a feeding station. DISCUSSION: Preparation for the Super Bowl required months of diligent cross-sectoral and cross-jurisdictional partnership building, and the 6 E framework can help other local public health jurisdictions prepare to host major mass gatherings.

Objectives: Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth. Methods: An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs. Results: Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy. Conclusions: Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.

The Centers for Disease Control and Prevention (CDC) coordinates the Public Health Emergency Preparedness (PHEP) program through cooperative agreements with 62 jurisdictions, including all 50 states, eight US territories and freely associated states, and four local jurisdictions.1 Jurisdictions are required to maintain plans to ensure that large volumes of medical countermeasures, both pharmaceutical and nonpharmaceutical, can be distributed and dispensed in a timely manner. Plans must consider both the characteristics of the emergency and the medical countermeasures being dispensed. For example, differences in skills, infrastructure, and equipment should be expected when dispensing antibiotics or antiviral medications compared with administering vaccines in mass vaccination settings. Jurisdictions that receive PHEP funding are required to conduct at least one full-scale exercise or functional exercise every five years to test the operational status of their distribution or dispensing plans.1