Factors associated with uptake of bivalent mRNA COVID-19 vaccines in a large US health care system

Bruxvoort, Katia J.; Sy, Lina S.; Hong, Vennis; Lewin, Bruno; Qian, Lei; Huang, Xuan; Holmquist, Kimberly J.; Han, Bing; Xu, Stanley

doi:10.1016/j.vaccine.2023.11.012

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…and uptake of the recent boosters in the general US population was poor. 16 As transplant centers relax pre-transplant vaccination require-ments, information gained from this work may be applicable to select future cases. Furthermore, our work adds important detail by highlighting the devastating effect that COVID-19 can have on some SOTR even after the initial admission or discharge.…”

Section: Discussionmentioning

confidence: 99%

“…While our findings are comparable to some previously reported data, the impact of COVID‐19 infection on SOTR today may be less severe due to the evolution of variants and vaccine availability. Still, a significant fraction of the US population remains unvaccinated; and uptake of the recent boosters in the general US population was poor 16 . As transplant centers relax pre‐transplant vaccination requirements, information gained from this work may be applicable to select future cases.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes after COVID‐19 infection in transplant recipients

Freels,

Saharia,

Baddley

et al. 2024

Clinical Transplantation

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BackgroundLong‐term outcomes after COVID‐19 infection unique to solid organ transplant recipients (SOTR) are not published. We describe outcomes including readmission, allograft rejection, allograft dysfunction, allograft failure, and death.MethodsWe conducted a retrospective cohort study of mostly unvaccinated SOTR with COVID‐19 from March 2020 to November 2021. Disease severity was assigned by NIH criteria. Data included demographics, clinical features, treatment, and outcomes and are presented as mean ± standard deviation or median (range).ResultsOne hundred and thirty‐eight SOTR were diagnosed with COVID‐19 at a median of 5 (IQR 3–8) years post‐transplant with a mean age of 57 ± 12 years at diagnosis. Forty‐one recovered at home; 97 were admitted. 12/32 (37.5%) SOTR with critical disease expired during initial admission. Among those who recovered, 48/126 (38.0%) had asymptomatic or mild infection, 31/126 (24.6%) had moderate, 27/126 (21.4%) severe, and 20/126 (15.9%) critical infection. 38/85 (44.7%) of SOTR who survived initial admission had 74 readmissions within 180 days (Figure 1). The 6‐month mortality rate among those who survived infection was 4/126 (3.2%). The mean time from initial infection to death was 32 ± 66 days in inpatient deaths and 95 ± 39 days in those who were discharged or never admitted. Six‐month graft dysfunction occurred in 18/125 (14.4%) and graft failure in 9/126 (7.2%); five failures were deaths with function.ConclusionReadmissions after COVID‐19 infection were frequent after the index admission. Rejection was relatively infrequent; graft dysfunction at 6 months post‐infection was more common than rejection. Six‐month mortality following COVID‐19 recovery in SOTR was significant; close follow‐up of patients is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes after COVID‐19 infection in transplant recipients

Freels,

Saharia,

Baddley

et al. 2024

Clinical Transplantation

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“…To determine the covariates included in this study, we considered factors found to be associated with vaccination uptake or completion in the literature as well as factors that could increase the risk for severe COVID-19 disease and thus influence vaccine uptake . Individual-level factors considered in this study included baseline sociodemographic characteristics (age, sex, and self-reported race and ethnicity recorded in the electronic health record, including Asian, Hispanic, non-Hispanic Black, non-Hispanic White, and other race and ethnicity [which included multiple races, Native American, and Pacific Islander], census tract level neighborhood, educational level, household income, and Medicaid status); history of SARS-CoV-2 infection; body mass index (BMI; calculated as weight in kilograms divided by height in meters squared: underweight, <18.5; normal, 18.5-24.9; overweight, 25.0-29.9; obese, ≥30.0); and Charlson Comorbidity Index (range with HIV excluded, 0-23, with higher values indicating greater comorbid disease burden) assessed during the 12 months prior to the index date.…”

Section: Methodsmentioning

confidence: 99%

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Hechter,

Qian,

Liu

et al. 2024

JAMA Netw Open

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ImportancePeople with HIV (PWH) may be at increased risk for severe outcomes with COVID-19 illness compared with people without HIV. Little is known about COVID-19 vaccination coverage and factors associated with primary series completion among PWH.ObjectivesTo evaluate COVID-19 vaccination coverage among PWH and examine sociodemographic, clinical, and community-level factors associated with completion of the primary series and an additional primary dose.Design, Setting, and ParticipantsThis retrospective cohort study used electronic health record data to assess COVID-19 vaccination information from December 14, 2020, through April 30, 2022, from 8 health care organizations of the Vaccine Safety Datalink project in the US. Participants were adults diagnosed with HIV on or before December 14, 2020, enrolled in a participating site.Main Outcomes and MeasuresThe percentage of PWH with at least 1 dose of COVID-19 vaccine and PWH who completed the COVID-19 vaccine primary series by December 31, 2021, and an additional primary dose by April 30, 2022. Rate ratios (RR) and 95% CIs were estimated using Poisson regression models for factors associated with completing the COVID-19 vaccine primary series and receiving an additional primary dose.ResultsAmong 22 058 adult PWH (mean [SD] age, 52.1 [13.3] years; 88.8% male), 90.5% completed the primary series by December 31, 2021. Among 18 374 eligible PWH who completed the primary series by August 12, 2021, 15 982 (87.0%) received an additional primary dose, and 4318 (23.5%) received a booster dose by April 30, 2022. Receipt of influenza vaccines in the last 2 years was associated with completion of the primary series (RR, 1.17; 95% CI, 1.15-1.20) and an additional primary dose (RR, 1.61; 95% CI, 1.54-1.69). PWH with uncontrolled viremia (HIV viral load ≥200 copies/mL) (eg, RR, 0.90 [95% CI, 0.85-0.95] for viral load 200-10 000 copies/mL vs undetected or &lt;200 copies/mL for completing the primary series) and Medicaid insurance (eg, RR, 0.89 [95% CI, 0.87-0.90] for completing the primary series) were less likely to be fully vaccinated. By contrast, greater outpatient utilization (eg, RR, 1.07 [95% CI, 1.05-1.09] for ≥7 vs 0 visits for primary series completion) and residence in counties with higher COVID-19 vaccine coverage (eg, RR, 1.06 [95% CI, 1.03-1.08] for fourth vs first quartiles for primary series completion) were associated with primary series and additional dose completion (RRs ranging from 1.01 to 1.21).Conclusions and RelevanceFindings from this cohort study suggest that, while COVID-19 vaccination coverage was high among PWH, outreach efforts should focus on those who did not complete vaccine series and those who have uncontrolled viremia.

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“…Despite continued high infection rates and 641,838 hospitalizations and 53,961 deaths from COVID-19 in the first 9 months of 2023, most of the US population has not received any COVID-19 vaccine in ≥1 year [1]. Since only 17% of US individuals received a bivalent vaccine dose, concerns exist that uptake of the updated monovalent XBB vaccine may also be low [10,11]. Hence, data on the durability of bivalent COVID-19 vaccine effectiveness against COVID-19 outcomes with currently circulating variants are needed to inform regulatory agencies, healthcare providers, and individuals, of the potential importance of receiving an updated monovalent XBB vaccine [12].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and durability of mRNA-1273 BA.4/BA.5 bivalent vaccine (mRNA-1273.222) against SARS-CoV-2 BA.4/BA.5 and XBB sublineages

Ackerson,

Bruxvoort,

Qian

et al. 2023

Preprint

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BackgroundEmerging SARS-CoV-2 sublineages continue to cause serious COVID-19 disease, but most individuals have not received COVID-19 vaccine for >1 year. Assessment of long-term effectiveness of bivalent COVID-19 vaccines against circulating sublineages is important to inform the potential need for vaccination with updated vaccines.MethodsIn this test-negative study at Kaiser Permanente Southern California, sequencing-confirmed BA.4/BA.5- or XBB-related SARS-CoV-2-positive cases during 9/1/2022-6/30/2023 were matched 1:3 to SARS-CoV-2-negative controls. We assessed mRNA-1273 bivalent relative (rVE) and absolute vaccine effectiveness (VE) compared to ≥2 or 0 doses of original monovalent vaccine, respectively. Outcomes were BA.4/BA.5- or XBB-related infection, emergency department/urgent care (ED/UC) encounters, and hospitalization.ResultsThe rVE analysis included 20,966 cases and 62,898 controls. rVE (95%CI) against BA.4/BA.5 at 14-60 days and 121-180 days was 52.7% (46.9-57.8%) and 35.5% (-2.8%-59.5%) for infection, and 59.3% (49.7-67.0%) and 33.2% (-28.2-68.0%) for ED/UC encounters. For BA.4/BA.5-related hospitalizations, rVE was 71.3% (44.9-85.1%) and 52.0% (-1.2-77.3%) at 14-60 days and 61-120 days, respectively. rVE against XBB at 14-60 days and 121-180 days, was 48.8% (33.4-60.7%) and -3.9% (-18.1-11.3%) for infection, 70.7% (52.4-82.0%) and 15.7% (-6.0-33.2%) for ED/UC encounters, and 87.9% (43.8-97.4%) and 57.1% (17.0-77.8%) for hospitalization. Results for VE and subgroup analyses (age, immunocompromise, and previous SARS-CoV-2 infection) were similar to rVE analyses.ConclusionsrVE of mRNA-1273 bivalent vaccine against BA.4/BA.5 and XBB infections, ED/UC encounters, and hospitalizations waned over time. Periodic adjustment of vaccines to target emerging variants and revaccination may be important in reducing COVID-19 morbidity and mortality.SummarymRNA-1273 BA.4/BA.5 bivalent vaccine effectiveness against infection and hospitalization with BA.4/BA.5-related and XBB-related sublineages waned over time. Periodic vaccination with vaccines reflecting circulating variants may reduce SARS-CoV-2 associated morbidity and mortality.

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Factors associated with uptake of bivalent mRNA COVID-19 vaccines in a large US health care system

Cited by 5 publications

References 30 publications

Long‐term outcomes after COVID‐19 infection in transplant recipients

Long‐term outcomes after COVID‐19 infection in transplant recipients

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Effectiveness and durability of mRNA-1273 BA.4/BA.5 bivalent vaccine (mRNA-1273.222) against SARS-CoV-2 BA.4/BA.5 and XBB sublineages

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