COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers

INTRODUCTION: In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time. METHODS: Initiated in July 2020, the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. Using two follow-up surveys approximately three months apart, COVID-19 vaccine KAP, intention, and receipt was collected; the first survey categorized participants as reluctant, reachable, or endorser. RESULTS: A total of 4,803 participants were included in the analysis. Most (70%) were vaccine endorsers, 16% were reachable, and 14% were reluctant. By May 2021, 77% had received at least one vaccine dose. KAP responses strongly predicted vaccine uptake, particularly positive attitudes about safety (aOR = 5.46, 95% CI: 1.4-20.8) and effectiveness (aOR = 5.0, 95% CI: 1.3-19.1). Participants' with prior SARS-CoV-2 infection were 22% less likely to believe the COVID-19 vaccine was effective compared with uninfected participants (aOR 0.78, 95% CI: 0.64-0.96). This was even more pronounced in first responders compared with other occupations, with first responders 42% less likely to believe in COVID-19 vaccine effectiveness (aOR = 0.58, 95% CI 0.40-0.84). Between administrations of the two surveys, 25% of reluctant, 56% reachable, and 83% of endorser groups received the COVID-19 vaccine. The reachable group had large increases in positive responses for questions about vaccine safety (10% of vaccinated, 34% of unvaccinated), and vaccine effectiveness (12% of vaccinated, 27% of unvaccinated). DISCUSSION: Our study demonstrates attitudes associated with COVID-19 vaccine uptake and a positive shift in attitudes over time. First responders, despite potential high exposure to SARS-CoV-2, and participants with a history of SARS-CoV-2 infection were more vaccine reluctant. CONCLUSIONS: Perceptions of the COVID-19 vaccine can shift over time. Targeting messages about the vaccine's safety and effectiveness in reducing SARS-CoV-2 virus infection and illness severity may increase vaccine uptake for reluctant and reachable participants

Severe Acute Respiratory Infection-Preparedness: Protocol for a Multicenter Prospective Cohort Study of Viral Respiratory Infections

OBJECTIVES: Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity. DESIGN: Prospective cohort study. SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States. PATIENTS: Patients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7-14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes. CONCLUSIONS: SARI-Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI

Examination of Latinx Bullying Victimization and Depressive Symptoms through a Social-Ecological Framework

BACKGROUND: Bullying victimization is correlated with depressive symptoms in adolescents. While the literature is extensive, there has been little focus on racial/ethnic minorities, specifically Latinx youth. In the United States, there is some evidence that Latinx adolescents experience bullying victimization and depressive symptoms at higher rates than their non-Hispanic white (NHW) peers. OBJECTIVES: This dissertation is composed of three studies that work together to identify factors of influence in the development of depressive symptoms within Latinx adolescents that experience peer violence: 1) a synthesis of the bullying/depression literature to evaluate Latinx representation and Latinx-specific factors; 2) identification of the interaction between racial/ethnic discrimination and bullying victimization on depressive symptoms; and 3) examination of the role of family and social support as a protective factor in the relationship between bullying victimization and depressive symptoms three years after victimization. METHODS: A systematic review was conducted for research aim one following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. For research aims two and three, secondary data analysis was conducted utilizing the Healthy Passages national and longitudinal dataset with permission from the publication committee. Hierarchal regression analyses were conducted for research aims two and three. RESULTS: For research aim one, of 957 studies identified, 17 included a Latinx population of 25% or more. They all identified a relationship between bullying and depression, with nine examining factors related to race/ethnicity or unique to the Latinx population. For aims two and three, a sample of 1,666 Latinx adolescents (grade 7) reported bullying victimization rates of 60% within the previous year. For aim two specifically, 15.7% reported racial/ethnic discrimination and 14.4% reported bullying and discrimination victimization in the previous year. All forms of victimization were found to be significantly related to depressive symptoms, including the interaction between bullying and discrimination victimization (p<.001 for immediate effect, p<.05 three years later). For research aim three, parent/child connectedness had a moderation effect (p<.001, b=-.061; p=.011, b=.006), reducing the likelihood of depressive symptoms three years after victimization. Social support reduced the relationship to depressive symptoms (p<.001, b=.025) but was not a moderator, and global parental monitoring had no significant effect. CONCLUSIONS: The Latinx community is the fastest growing racial/ethnic minority population in the United States, but they are underrepresented in the bullying literature. Studies that included variables unique to Latinx communities such as acculturation and unique family factors found a stronger relationship between bullying victimization and depression. In a Latinx sample, this dissertation identified an increased likelihood of depressive symptoms when bullying and racial/ethnic discrimination were experienced. Additionally, this work found that strong family relationships and strong social support reduced the likelihood of depressive symptoms of bullying victimization even three years after victimization occurred. These two findings identify potential future directions for bullying research and practice. At a minimum, they illustrate a need for an expanded social-ecological lens when measuring victimization as well as the inclusion of family and the development of strong family relationships in bullying interventions.Release after 01/10/202

Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study

Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness

Humoral Immune Response to mRNA COVID-19 Vaccination Among Children 5-11 in a Multisite Prospective Cohort study, September 2021-September 2022

Abstract Background The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for SARS-CoV-2 in four states: Arizona, Florida, Texas, and Utah. This study aims to examine the protective effect of vaccine-elicited antibody response against post-vaccination SARS-CoV-2 infections. Methods Participants, children aged 5-11, had serum collected 14-59 days after second dose of monovalent Pfizer-BioNTech COVID-19 mRNA vaccine. Vaccine-elicited antibodies were measured by area under the curve (AUC) and endpoint titer by ELISA (RBD and S2) and surrogate neutralization (SN) assays against ancestral (WA1) and Omicron (BA.2). Results Among 79 vaccinated participants, (33 [41.7%] female; median age 8.8 [SD 1.9] years), 48 (60.8%) were from Tucson, Arizona, 64 (81.0%) were non-Hispanic white, 63 (80.8%) attended school in person, 68 (86.1%) did not have any chronic conditions, 56 (72.7%) did not take daily medications; and 47 (59.5%) were infected after vaccination. Uninfected children had higher AUCs after vaccination against WA1 (p = 0.0093) and Omicron (p = 0.018). The geometric mean SN titer above the limit of detection was 346.0 for WA1 and 39.7 for Omicron, an 8.7-fold decrease (p = <0.0001). After adjustment of covariates in the WA1-specific model, we observed a 47% reduction in the odds of a post-vaccination infection for every standard deviation increase of RBD AUC (aOR: 0.53, 95% CI: 0.29, 0.97) and a 69% reduction in the odds of infection for every three-fold increase in RBD end titer, (aOR: 0.31, 95% CI: 0.06, 1.57). Conclusion Children with higher antibody levels experienced lower incidence of post-vaccination SARS-CoV-2 infection

Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers

In a cohort of frontline health care workers, a third dose of an mRNA vaccine provided 91% protection against SARS-CoV-2 infection with the delta variant and 60% against the omicron variant

2082. Effectiveness of Bivalent mRNA Vaccines in Preventing SARS-CoV-2 Infection Among Children Aged 5-17 years: an Evaluation of Multicenter Prospective Cohorts, United States, September 2022 - January 2023

Abstract Background The bivalent mRNA COVID-19 vaccine booster dose, composed of mRNA from ancestral and Omicron BA.4/BA.5 strains, was recommended for adolescents aged ≥12 years on September 1, 2022, and for children aged 5–11 years on October 12, 2022. However, data demonstrating the effectiveness of bivalent boosters among children and adolescents are limited. During Omicron variant sublineage predominance, September 4, 2022 – February 4, 2023, we conducted a multicenter prospective cohort study at 7 sites in the United States to assess vaccine effectiveness (VE) of bivalent COVID-19 vaccine boosters against laboratory-confirmed SARS-CoV-2 virus infection among children aged 5–17 years. Methods Participants collected weekly nasal swabs, irrespective of symptoms, and at onset of symptoms if present outside of their weekly swab cadence. Vaccination status was captured from periodic surveys (self-report), supplemented with queries from the state immunization information systems, and abstraction of electronic medical records system, when available. All respiratory swabs were tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction. Symptomatic infection was defined as ≥2 COVID-like illness symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios of infections comparing participants with receipt of a bivalent booster to participants without (either unvaccinated or received monovalent only), adjusting for age, sex, race/ethnicity, underlying health conditions, prior infection status, geographic site, and local virus prevalence. Results Among 3,331 participants aged 5-17 years, adjusted VE against infection was 51% (95% CI: 29–66%). When stratified by age, adjusted VE was 48% (95% CI: 15-68%) for 5-11 year old participants and 55% (95% CI: 17-76%) for 12-17 year old participants. Against symptomatic infection, adjusted VE among 5-17 year old participants was 51% (95% CI: 14-72%). Conclusion These results demonstrate that the COVID-19 bivalent booster reduces risk of SARS-CoV-2 infection and symptomatic illness among children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations. Disclosures Helen Y. Chu, MD, MPH, Abbvie: Advisor/Consultant|Ellume: Advisor/Consultant|Ellume: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Vir: Advisor/Consultant Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honorari

Hybrid immunity and SARS-CoV-2 antibodies: results of the HEROES-RECOVER prospective cohort study

There are limited data on whether hybrid immunity differs by count and order of immunity-conferring events (SARS-CoV-2 infection or COVID-19 vaccination). From a cohort of health care personnel, first responders, and other frontline workers in six US states, we examined heterogeneity of the effect of hybrid immunity on SARS-CoV-2 antibody levels. Exposures included event-count (sum of infections and vaccine doses) and event-order, categorized into seven permutations of vaccination and/or infection. Outcome was level of serum binding antibodies against receptor binding domain (RBD) of the ancestral SARS-CoV-2 spike protein (total RBD-binding Ig), measured by enzyme-linked immunosorbent assay. Mean antibody levels were examined up to 365 days after each of the 1st-7th events. Analysis included 5,793 participants measured from August 7, 2020 to April 15, 2023. Hybrid immunity from infection before one or two vaccine doses elicited modestly superior antibody responses after the 2nd and 3rd events (compared to infections or vaccine-doses alone). This superiority was not evident after the 4th and 5th events (additional doses). Among adults infected before vaccination, adjusted geometric mean ratios (95% CI) of anti-RBD early response (versus vaccinated-only) were 1.23 (1.14-1.33), 1.09 (1.03-1.14), 0.87 (0.81-0.94), and 0.99 (0.85-1.15) after the 2nd-5th events, respectively. Post-vaccination infections elicited superior responses: adjusted geometric mean ratios (95% CI) of anti-RBD early response (versus vaccinated-only) were: 0.93 (0.75-1.17), 1.11 (1.06-1.16), 1.17 (1.11-1.24), and 1.20 (1.07-1.34) after the 2nd-5th events, respectively. Findings reflecting heterogeneity in antibody levels by permutations of infection and vaccination history could inform COVID-19 vaccination policy

Neutralizing Antibody Response to Pseudotype SARS-CoV-2 Differs between mRNA-1273 and BNT162b2 COVID-19 Vaccines and by History of SARS-CoV-2 Infection

BackgroundData on the development of neutralizing antibodies against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with messenger RNA (mRNA) COVID-19 vaccines are limited. MethodsFrom a prospective cohort of 3,975 adult essential and frontline workers tested weekly from August, 2020 to March, 2021 for SARS-CoV-2 infection by Reverse Transcription- Polymerase Chain Reaction (RT-PCR) assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum- neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t-tests and linear mixed effects models. ResultsAmong 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed neutralizing antibodies (nAb) with a GMT of 1,003 (95% CI=766-1,315). Among 139 previously uninfected participants, 138 (99%) developed nAb after mRNA vaccine dose-2 with a GMT of 3,257 (95% CI = 2,596-4,052). GMT was higher among those receiving mRNA-1273 vaccine (GMT =4,698, 95%CI= 3,186-6,926) compared to BNT162b2 vaccine (GMT=2,309, 95%CI=1,825-2,919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21,655 (95%CI=14,766-31,756) after mRNA vaccine dose-1, without further increase after dose- 2. ConclusionsA single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAb to SARS-CoV-2 than after one dose of vaccine or SARS- CoV-2 infection alone. Neutralizing antibody response also differed by mRNA vaccine product. Main Point SummaryOne dose of mRNA COVID-19 vaccine after previous SARS-CoV-2 infection produced the highest neutralizing antibody titers; among those without history of infection, two doses of mRNA vaccine produced the most robust response