COVID-19 Vaccine Hesitancy among Physicians, Physician Assistants, Nurse Practitioners, and Nurses in Two Academic Hospitals in Philadelphia.

2021

1-24

2021 Sep 20

1559-6834

<p><strong>OBJECTIVE: </strong>To evaluate COVID-19 vaccine hesitancy among health care personnel (HCP) with significant clinical exposure to COVID-19 at two large, academic hospitals in Philadelphia.</p>

<p><strong>DESIGN, SETTING AND PARTICIPANTS: </strong>HCP were surveyed between November-December 2020 about their intention to receive the COVID-19 vaccine.</p>

<p><strong>METHODS: </strong>The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (MD, NP/PA, RN) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines.</p>

<p><strong>RESULTS: </strong>Among 5,929 HCP (2,253 MDs/DOs, 582 NPs, 158 PAs, and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs/NPs and 13.1% of MDs/DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (OR∼5) and females were more hesitant than males (OR∼2).</p>

<p><strong>CONCLUSION: </strong>Although a majority of clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race/ethnicity across all positions. These results underline the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.</p>

10.1017/ice.2021.410

Infect Control Hosp Epidemiol

34538290

Epidemiology and Risk Factors for Healthcare-Associated Viral Infections in Children.

2021

2021 Jul 27

2048-7207

<p><strong>BACKGROUND: </strong>Healthcare-associated viral infections (HA-VIs) are common in hospitalized children and are increasingly recognized as a cause of preventable harm; however, the epidemiology and modifiable risk factors for pediatric HA-VIs are poorly understood.</p>

<p><strong>METHODS: </strong>We performed a retrospective case-control study to identify risk factors and outcomes associated with pediatric HA-VIs at a quaternary care children's hospital. HA-VI surveillance was performed hospital-wide using Centers for Disease Control and Prevention (CDC) definitions. We abstracted data from the electronic medical record and conducted semi-structured interviews with patient caregivers to identify potential exposures 4 days before the HA-VI onset.</p>

<p><strong>RESULTS: </strong>During the 20-month study period, we identified 143 eligible patients with HA-VIs and enrolled 64 matched case-control pairs. In total, 79 viruses were identified among 64 case patients. During the exposure period, case, as compared with control, patients were more frequently exposed to a sick visitor (odds ratio = 5.19; P = .05). During the 7 days after the HA-VI onset, case, as compared with control, patients had a greater length of antibacterial therapy per patient-days (mean 411 vs 159) as well as greater days of antibacterial therapy per patient-days (mean 665 vs 247).</p>

<p><strong>CONCLUSIONS: </strong>The results of this study show that exposure to a sick visitor is a potentially modifiable risk factor for pediatric HA-VIs. Hospitalized children with HA-VIs also have increased exposure to antibacterial agents when compared with matched controls. Our findings suggest that hospital policies may need to be revised, with emphasis on visitor screening and partnership with families, to reduce the incidence of pediatric HA-VIs during hospitalization.</p>

10.1093/jpids/piab015

J Pediatric Infect Dis Soc

34313773

Vaccine exemption requirements and parental vaccine attitudes: an online experiment.

2020

2620-2625

2020 03 04

1873-2518

<p>Increases in vaccine hesitancy and vaccine-preventable disease outbreaks have focused attention on state laws governing school-entry vaccine mandates and the allowable exemptions (medical and nonmedical) from those mandates. There is substantial variation in the type of exemptions available in each state, and states with more rigorous or burdensome exemption requirements generally have lower exemption rates. States have little evidence, however, about how vaccine-hesitant parents respond to different requirements. Despite recent efforts to formulate "model legislation" templates for states to follow, policy evidence about optimal exemption regimes is limited to observational studies in states that have changed exemption laws. We conducted two online experiments to explore how parental attitudes and intentions responded to different school-entry vaccine mandate exemption requirements. We randomly assigned online participants to one of four hypothetical vaccine exemption application scenarios: parental signature only, a checklist of vaccines for which an exemption is requested, a lengthy (10-30+ min) video-based vaccine education module, and a requirement to write a statement justifying the exemption. Among parents with high vaccine hesitancy, a required vaccine education module led to significant decreases in vaccine hesitancy, while checklist and justification requirements increased vaccine hesitancy slightly. Among parents with low vaccine hesitancy, we observed a potential backfire effect when parents were required to write a justification statement. Our findings warrant replication in a larger, fully-powered trial to accelerate knowledge about how parents across the vaccine hesitancy spectrum respond to exemption regimes.</p>

10.1016/j.vaccine.2020.01.035

Vaccine

32057577

Effect of Haemophilus influenzae type b and 13-valent pneumococcal conjugate vaccines on childhood pneumonia hospitalizations and deaths in Botswana.

2020

2020 Jul 08

1537-6591

<p><strong>BACKGROUND: </strong>Globally, pneumonia is the leading cause of death among children. Few data exist regarding the effect of Haemophilus influenzae type b (Hib) vaccine and 13-valent pneumococcal conjugate vaccine (PCV-13) on the burden of childhood pneumonia in African settings.</p>

<p><strong>METHODS: </strong>We collected data on children 1 to 59 months of age at three hospitals in Botswana. Hib vaccine and PCV-13 were introduced in Botswana in November 2010 and July 2012, respectively. We compared pneumonia hospitalizations and deaths pre-vaccine (January 2009 to October 2010) to post-vaccine (January 2013 to December 2017) using seasonally-adjusted interrupted time-series analyses.</p>

<p><strong>FINDINGS: </strong>We identified 6943 pneumonia hospitalizations and 201 pneumonia deaths. In the pre-vaccine period, pneumonia hospitalizations and deaths increased by 24% (rate: 1.24; 95% CI: 0.94, 1.64) and 59% (rate: 1.59; 95% CI: 0.87, 2.90) per year, respectively. Vaccine introduction was associated with a 48% (95% CI: 29%, 62%) decrease in the number of pneumonia hospitalizations and a 50% (95% CI: 1%, 75%) decrease in the number of pneumonia deaths between the end of the pre-vaccine period (October 2010) and the beginning of the post-vaccine period (January 2013). During the post-vaccine period, pneumonia hospitalizations and deaths declined by 6% (rate 0.94; 95% CI: 0.89, 0.99) and 22% (rate: 0.78; 95% CI: 0.67, 0.92) per year, respectively.</p>

<p><strong>INTERPRETATION: </strong>Pneumonia hospitalizations and deaths among children declined sharply following introduction of Hib vaccine and PCV-13 in Botswana. This effect was sustained for more than five years after vaccine introduction, supporting the long-term effectiveness of these vaccines in preventing childhood pneumonia in Botswana.</p>

10.1093/cid/ciaa919

Clin. Infect. Dis.

32634831

Implementation of a rapid influenza A/B and RSV direct molecular assay improves emergency department oseltamivir use in paediatric patients.

2018

358-363

2018 Mar

1473-5644

<p><strong>PURPOSE: </strong>Influenza A virus (FluA), influenza B virus (FluB) and respiratory syncytial virus (RSV) illnesses increase hospitalizations during seasonal epidemics.</p>

<p><strong>METHODOLOGY: </strong>To determine the utility of the Simplexa FluA/B &amp; RSV Direct Assay (Direct Flu/RSV) and its impact on oseltamivir use, we offered this assay to emergency department (ED) patients with influenza-like illness.</p>

<p><strong>RESULTS: </strong>Utilization of the Direct Flu/RSV provided a turnaround time (TAT) of 2 hours. Compared to the flu season prior to implementation of the Direct Flu/RSV, clinicians were more likely to prescribe 5 days of oseltamivir therapy for Direct Flu/RSV-positive patients in comparison to those with a negative test.</p>

<p><strong>CONCLUSIONS: </strong>Use of Direct Flu/RSV provides results rapidly, which leads to more appropriate use of oseltamivir. The ease of use of this assay and quick TAT allows for prompt decision-making, which is essential for patient care and effective disease control during the influenza season.</p>

10.1099/jmm.0.000676

J. Med. Microbiol.

29458688

Incidence of Healthcare-Associated Influenza-Like Illness After a Primary Care Encounter Among Young Children.

2018

2018 Mar 22

2048-7207

<p><strong>Background: </strong>Despite potential respiratory virus transmission in pediatric clinics, little is known about the risk of healthcare-associated viral infections attributable to outpatient encounters. We evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI).</p>

<p><strong>Methods: </strong>Using electronic health record data, we conducted a retrospective cohort study of all children aged &lt;6 years who presented to a provider in a 29-clinic pediatric primary care network for a non-ILI-related encounter over 2 respiratory virus seasons (September 1, 2012, to April 30, 2014). We defined a risk period for potential healthcare-associated (HA) ILI of 1 to 8 days after a non-ILI clinic visit and identified all cases of ILI to compare the incidences of ILI visits 1 to 8 days after a non-ILI encounter and those of visits &gt;8 days after a non-ILI encounter.</p>

<p><strong>Results: </strong>Among 149987 children &lt;6 years of age (mean age, 2.5 years) with ≥1 non-ILI visit during the study period, 531928 total encounters and 13951 (2.9%) ILI encounters were identified; 1941 (13.9%) occurred within the HA-ILI risk window. The incidence rate ratios (IRRs) for ILI 1 to 8 days after compared with ILI &gt;8 days after a non-ILI visit during season 1 were 1.36 (95% confidence interval, 1.22-1.52) among children ≥2 years of age and 1.01 (95% confidence interval, 0.93-1.09) among children &lt;2 years of age. Estimates remained consistent during season 2 and with a risk window of 3, 4, or 9 days.</p>

<p><strong>Conclusions: </strong>Pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged &lt;2 years. These findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in HA ILI in young children.</p>

10.1093/jpids/piy023

J Pediatric Infect Dis Soc

29579251