Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, December 2023

Pharmacy and healthcare provider offices as convenient adult vaccination settings in the US: Patient experiences from a survey of recently-vaccinated adults

BACKGROUND

Adult vaccination rates in the United States (US) remain low, despite the availability of safe and effective vaccines. The objective of this study was to describe characteristics of US adults recently vaccinated in a pharmacy or healthcare provider (HCP) office, vaccination logistics, associated productivity losses, and preferences, barriers, and satisfaction related to vaccination visits in these settings.

METHODS

This was a non-interventional, cross-sectional study using a web-based survey administered during September-November 2023. Respondents were adults recently vaccinated in a pharmacy or HCP office in the US recruited from an online panel. The study targeted a sample of 900 adults, divided approximately equally among those aged 18-49, 50-64, and ≥65 years. Responses were analyzed descriptively and reported overall, by vaccination location, and by age group.

RESULTS

A total of 938 adults completed the survey, including 618 pharmacy-vaccinated and 320 HCP office-vaccinated respondents. Influenza (74.2%) and COVID-19 (44.6%) vaccines were most commonly administered, and coadministration of 2-3 vaccines occurred in 35.7% of vaccination visits. Vaccination visits often involved other activities (e.g., 40.5% of pharmacy-vaccinated respondents also picked up a prescription and/or shopped during their vaccination visit). Productivity losses due to vaccination visits were minimal; only 8.1% of all respondents took paid or unpaid time off work to get vaccinated (mean [standard deviation; SD]: 15.6 [69.9] minutes). Most respondents encountered no barriers to vaccination (76.1%) and reported high satisfaction (mean [SD]: 9.3 [1.4] on a 1-10 scale) with their visit.

CONCLUSIONS

Findings indicate that pharmacies and HCP offices are convenient locations for adult vaccinations in the US, including coadministration of multiple vaccines in the same visit. Adult vaccinations in these locations were associated with low productivity losses, limited difficulties, and high satisfaction. Enhancing access to vaccinations in these settings could help to increase vaccination uptake.

Measures to Prevent and Control COVID-19 in Skilled Nursing Facilities: A Scoping Review

Importance

Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. A critical appraisal of these measures is essential to support SNFs in managing future infectious disease outbreaks.

Objective

To perform a scoping review of data and evidence on the use and effectiveness of preventive measures implemented from 2020 to 2024 to prevent COVID-19 infection in SNFs in the US.

Evidence Review

Two analyses were performed. First, an analysis of the federal COVID-19 SNF Database was conducted to describe time trends in COVID-19 incidence, deaths, testing, vaccination, and treatment among SNF residents and staff, as well as shortages in staff and personal protective equipment (PPE). Then, a comprehensive literature search was conducted from May 2023 to April 2024 to identify high-quality evidence on the use and effectiveness of modifiable preventive measures used among SNF residents. Both nonpharmacologic (facility characteristics, PPE, cohorting, and isolation, visitation, staffing, testing) and pharmacologic (vaccination, treatment) measures were reviewed.

Findings

Nationwide data indicated early shortages of PPE, infrequent testing, and persistent staff shortages in SNFs. Other nonpharmacologic measures, such as visitor restrictions or ventilation modifications, were widely adopted but there were no available national data to quantify their effectiveness. These nonpharmacologic measures lacked high-quality studies to verify effectiveness. In contrast, the effectiveness of vaccination and antiviral treatment was shown in multiple studies. Evidence also showed associations between COVID-19 outcomes in residents and crowding, staff size, hours per residents and networks, and surveillance testing of residents and staff. Despite high initial uptake, up-to-date vaccination status was suboptimal in residents and staff from 2022 to 2024. Only a minority of infected residents received antiviral treatment.

Conclusions and Relevance

This scoping review found that although many preventive measures were implemented in SNFs in the US throughout the COVID-19 pandemic, few were based on clear evidence of their effectiveness. Pharmacologic measures, such as vaccination and antiviral treatment, had more robust evidence supporting their efficacy than nonpharmacologic interventions. Using the scarce resources and staff of SNFs on measures of questionable effectiveness could distract from known effective ones such as vaccination and antiviral treatment. When possible, implementation efforts should be commensurate with the demonstrated effectiveness of available preventive measures.

Assessing the determinants of influenza and COVID-19 vaccine co-administration decisions in the elderly

This research examines the low rate of co-administration of influenza and COVID-19 vaccines among seniors aged 65 and older in Korea, despite recommendations from authorities and academia worldwide. The study aimed to understand the influence of general characteristics and health beliefs on the vaccination choices of seniors, who were categorized into four groups based on their vaccination status: influenza only, COVID-19 only, both, or neither. A total of 400 participants, aged 65 and above, were selected through proportional stratified random sampling from five major Korean regions for a survey conducted between November 24th and December 15th, 2023. The results indicated no significant differences in general characteristics across these groups. However, regarding the health beliefs showed significant differences in perceived susceptibility and self-efficacy between the influenza-only and co-administration groups. Higher levels of perceived susceptibility and self-efficacy were associated with choosing co-administration. Contrary to previous studies focusing on safety concerns as a primary factor in vaccine hesitancy, this study highlights the role of individual health-related beliefs, particularly perceived susceptibility and self-efficacy, as critical in influencing the decision for co-administration among the elderly in Korea.

Coverage with Influenza, Respiratory Syncytial Virus, and COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, November 2024

Nursing home residents are at elevated risk for severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents early in the 2024-25 respiratory virus season. As of November 10, 2024, 29.7% of nursing home residents had received a 2024-2025 COVID-19 vaccine. Among residents at facilities that elected to report vaccination against influenza (59.4% of facilities) and RSV (51.8% of facilities), 58.4% had received influenza vaccination, and 17.9% had received RSV vaccination. Vaccination coverage varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. Addressing low coverage with COVID-19, influenza, and RSV vaccines is a priority to protect residents who are susceptible to severe outcomes associated with respiratory illnesses.

Burden of Respiratory Syncytial Virus-Associated Hospitalizations in US Adults, October 2016 to September 2023

Importance

Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.

Objective

To describe the demographic characteristics of adults hospitalized with laboratory-confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.

Design, Setting, and Participants

This cross-sectional study used data from the RSV Hospitalization Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022-2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.

Exposure

Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.

Main Outcomes and Measures

Hospitalization rates per 100 000 adult population, stratified by age group. After adjusting for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.

Results

From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]). Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 100 000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100 000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100 000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100 000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100 000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100 000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84 000-230 000) in 2016 to 2017 to 193 000 (95% CI, 140 000-311 000) in 2017 to 2018. Annual ICU admission estimates ranged from 24 400 (95% CI, 16 700-44 800) to 34 900 (95% CI, 25 500-55 600) for the same seasons. Estimated annual in-hospital deaths ranged from 4680 (95% CI, 3570-6820) in 2018 to 2019 to 8620 (95% CI, 6220-14 090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (range, 43.1%-48.8%) of all RSV-associated hospitalizations, 38.6% (range, 36.7%-41.0%) of all ICU admissions, and 58.7% (range, 51.9%-67.1%) of all in-hospital deaths.

Conclusions and Relevance

In this cross-sectional study of adults hospitalized with RSV before the 2023 introduction of RSV vaccines, RSV was associated with substantial burden of hospitalizations, ICU admissions, and in-hospital deaths in adults, with the highest rates occurring in adults 75 years or older. Increasing RSV vaccination of older adults has the potential to reduce associated hospitalizations and severe clinical outcomes.

Short-Term Immunogenicity of Licensed Subunit RSV Vaccines in Residents of Long-Term Care Facilities (LTCF) Compared to Community-Dwelling Older Adults

OBJECTIVES

Phase 3 licensing trials for the recently approved respiratory syncytial virus (RSV) vaccines did not include many residents of long-term care facilities (LTCF). Our primary objective was to assess humoral immune responses in LTCF residents, aged 60 and older, to the RSV vaccines, and demonstrate noninferiority to antibody responses in community-dwelling (CD) adults who were representative of the phase 3 trial participants in whom the vaccines were highly efficacious.

DESIGN

Prospective non-randomized intervention trial of RSV vaccines in LTCF residents.

SETTING AND PARTICIPANTS

Research clinic and 2 LTCFs. Adults aged ≥60 years old, free of immunosuppression and planning to receive an RSV vaccine were eligible.

METHODS

LTCF and CD participants received either the GSK or Pfizer RSV vaccine in equal numbers. Blood was collected before and 30 days after vaccination. Total immunoglobulin (Ig)G to the prefusion F protein of RSV group A (FA) and B (FB), and neutralizing activity were measured, and geometric mean titer (GMT) and geometric mean fold rise (GMFR) calculated. Intercurrent respiratory illnesses were tracked.

RESULTS

A total of 76 LTCF residents and 76 CD adults were enrolled. Day 30 blood was unavailable from 3 residents and 3 had RSV infection and vaccination was deferred, leaving data for 76 CD and 70 LTCF adults for analysis. Serum IgG GMFR prefusion FA (9.9 vs 12.5, P = .14), prefusion FB (8.7 vs 11.0, P = .17) were not statistically different in CD and LTCF cohorts, respectively, and also equivalent for GMFR in viral neutralization titers (12.8 vs. 15.5, P = .32). As measured by GMT or GMFR, RSV vaccine responses of LTCF residents met noninferiority criteria compared with the CD cohort.

CONCLUSIONS AND IMPLICATIONS

This small immunobridging study demonstrates robust antibody responses to RSV vaccines in LTCF residents providing support for their use in this high-risk population.

Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota

Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.

Leadership Perspectives on Nursing Home Operations From Crisis to Control: A Mixed Methods Study

OBJECTIVES

Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward.

DESIGN

This was a cross-sectional, parallel convergent mixed methods study.

SETTING AND PARTICIPANTS

This study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15).

METHODS

Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display.

RESULTS

NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities.

CONCLUSION AND IMPLICATIONS

NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.