Occupation, Worker Vulnerability, and COVID-19 Vaccination Uptake: Analysis of the Virus Watch prospective cohort study

Community Vulnerability: Measuring the Health Situation of a Population After COVID-19 Through Electronic Health Record Indicators

Background: The COVID-19 pandemic made people face the fact that we are all vulnerable. This vulnerability can be measured through the Basic Variables of Care (BVC) using the Care Vulnerability Index (CVI). Health systems work with indicators that nurses can consult to understand the care and health situation of their population. These indicators provide valuable information on the vulnerability of the population. Objective: to determine the level of community vulnerability of a population group using health indicators from the computerized clinical records of Primary Care. Methods: observational, retrospective study from March 2023 to January 2024, with a sample of 2106 people assigned to a nurse at the Meco Health Centre (Madrid, Spain). Phases: selection of dashboard indicators, linkage to BVC, score assignment, population adjustment and calculation of the CVI. Results: The sample of indicators selects 18 out of 376 included in the Specific Dashboard; each indicator is related to 6 to 10 BCVs, with different rank values. Each score is adjusted by a Vulnerability Correction Factor according to the number of people included in the indicator. Finally, the population-adjusted CVI scores 1.95 points (percentile 37.90). Conclusions: community vulnerability is an essential tool in community health diagnostics and can be measured through health indicators that reflect the care situation of a population group at a given time, including changes in the situation in the face of health crises such as the COVID-19 pandemic.

COVID-19 risk by work-related factors: pooled analysis of individual linked data from 14 cohorts

BACKGROUND

SARS-CoV-2 infection rates vary by occupation, but the association with work-related characteristics (such as home working, keyworker or furlough) are not fully understood and may depend on ascertainment approach. We assessed infection risks across work-related characteristics and compared findings using different ascertainment approaches.

METHODS

Participants of 14 UK-based longitudinal cohort studies completed surveys before and during the COVID-19 pandemic about their health, work and behaviour. These data were linked to the National Health Service digital health records, including COVID-19 diagnostic testing, within the UK Longitudinal Linkage Collaboration (UK LLC) research environment. Poisson regression modelled self-reported infection and diagnostic test confirmed infection within each cohort for work-related characteristics. Relative Risk (RR) were then combined using random effects meta-analysis.

RESULTS

Between March 2020 and March 2021, 74 757 individuals completed 167 302 surveys. Overall, 15 174 survey responses self-reported an infection, whereas 3053 had a linked positive test. Self-reported infection risk was greater in keyworkers versus not (RR=1.24 (95% CI 1.17, 1.31), among non-home working (1.08 (0.98, 1.19)) or some home working (1.06 (0.97, 1.17)) versus all home working. Part-time workers versus full time (0.94 (0.89, 0.99)) and furlough versus not (0.93 (0.88, 0.99)) had reduced risk. Results for the linked positive test outcome were comparable in direction but greater in magnitude, for example, a 1.85 (1.56, 2.20) in keyworkers.

CONCLUSION

The UK LLC provides new opportunities for researchers to investigate risk factors, including occupational factors, for ill-health events in multiple largescale UK cohorts. Risk of SARS-CoV-2 infection and COVID-19 illness appeared to be associated with work-related characteristics. Associations using linked diagnostic test data appeared stronger than self-reported infection status.

COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: A cross-sectional study

INTRODUCTION

The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda.

METHODS

This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics.

RESULTS

Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013).

CONCLUSION

Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

Risk factors for SARS-CoV-2 infection at a UK electricity-generating company: a test-negative design case-control study

OBJECTIVES

Identify workplace risk factors for SARS-CoV-2 infection, using data collected by a UK electricity-generating company.

METHODS

Using a test-negative design case-control study, we estimated the OR of infection by job category, site, test reason, sex, vaccination status, vulnerability, site outage and site COVID-19 weekly risk rating, adjusting for age, test date and test type.

RESULTS

From an original 80 077 COVID-19 tests, there were 70 646 included in the final analysis. Most exclusions were due to being visitor tests (5030) or tests after an individual first tested positive (2968).Women were less likely to test positive than men (OR=0.71; 95% CI 0.58 to 0.86). Test reason was strongly associated with positivity and although not a cause of infection itself, due to differing test regimes by area, it was a strong confounder for other variables. Compared with routine tests, tests due to symptoms were highest risk (94.99; 78.29 to 115.24), followed by close contact (16.73; 13.80 to 20.29) and broader-defined work contact 2.66 (1.99 to 3.56). After adjustment, we found little difference in risk by job category, but some differences by site with three sites showing substantially lower risks, and one site showing higher risks in the final model.

CONCLUSIONS

In general, infection risk was not associated with job category. Vulnerable individuals were at slightly lower risk, tests during outages were higher risk, vaccination showed no evidence of an effect on testing positive, and site COVID-19 risk rating did not show an ordered trend in positivity rates.

Potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: analysis of the ONS COVID-19 Infection Survey

OBJECTIVES

To assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection.

DESIGN

We analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from 1 December 2020 to 11 May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups.

RESULTS

Estimated rates of triple vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%) and retail (85%). High rates were observed for individuals working in health (95% for office based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios across all occupational groups reduced from 1.37 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups.

CONCLUSIONS

Variation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

Between-occupation differences in work-related COVID-19 mitigation strategies over time: Analysis of the Virus Watch Cohort in England and Wales

OBJECTIVES

COVID-19 mitigations have had a profound impact on workplaces, however, multisectoral comparisons of how work-related mitigations were applied are limited. This study aimed to investigate (i) occupational differences in the usage of key work-related mitigations over time and (ii) workers' perceptions of these mitigations.

METHODS

Employed/self-employed Virus Watch study participants (N=6279) responded to a mitigation-related online survey covering the periods of December 2020-February 2022. Logistic regression was used to investigate occupation- and time-related differences in the usage of work-related mitigation methods. Participants' perceptions of mitigation methods were investigated descriptively using proportions.

RESULTS

Usage of work-related mitigation methods differed between occupations and over time, likely reflecting variation in job roles, workplace environments, legislation and guidance. Healthcare workers had the highest predicted probabilities for several mitigations, including reporting frequent hand hygiene [predicted probability across all survey periods 0.61 (95% CI 0.56-0.66)] and always wearing face coverings [predicted probability range 0.71 (95% CI 0.66-0.75) - 0.80 (95% CI 0.76-0.84) across survey periods]. There were significant cross-occupational trends towards reduced mitigations during periods of less stringent national restrictions. The majority of participants across occupations (55-88%) agreed that most mitigations were reasonable and worthwhile even after the relaxation of national restrictions; agreement was lower for physical distancing (39-44%).

CONCLUSIONS

While usage of work-related mitigations appeared to vary alongside stringency of national restrictions, agreement that most mitigations were reasonable and worthwhile remained substantial. Further investigation into the factors underlying between-occupational differences could assist pandemic planning and prevention of workplace COVID-19 transmission.