Publications by authors named "Saad B Omer"

345 Publications

SARS-CoV-2 Vaccine Effectiveness in a High-Risk National Population in a Real-World Setting.

Ann Intern Med 2021 Jul 20. Epub 2021 Jul 20.

VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, and University of Pittsburgh, Pittsburgh, Pennsylvania (F.B.M.).

Background: With the emergency use authorization of multiple vaccines against SARS-CoV-2 infection, data are urgently needed to determine their effectiveness in a real-world setting.

Objective: To evaluate the short-term effectiveness of vaccines in preventing SARS-CoV-2 infection.

Design: Test-negative case-control study using conditional logistic regression.

Setting: U.S. Department of Veterans Affairs health care system.

Participants: All veterans who had testing for SARS-CoV-2 infection between 15 December 2020 and 4 March 2021 and no confirmed infection before 15 December 2020.

Intervention: SARS-CoV-2 vaccination with either the BNT-162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine as part of routine clinical care.

Measurements: Effectiveness of vaccination against confirmed SARS-CoV-2 infection.

Results: Among 54 360 persons who tested positive and 54 360 propensity score-matched control participants, the median age was 61 years, 83.6% were male, and 62% were White. Median body mass index was 31 kg/m among those who tested positive and 30 kg/m among those who tested negative. Among those who tested positive, 9800 (18.0%) had been vaccinated; among those who tested negative, 17 825 (32.8%) had been vaccinated. Overall vaccine effectiveness 7 or more days after the second dose was 97.1% (95% CI, 96.6% to 97.5%). Effectiveness was 96.2% (CI, 95.5% to 96.9%) for the Pfizer-BioNTech BNT-162b2 vaccine and 98.2% (CI, 97.5% to 98.6%) for the Moderna mRNA-1273 vaccine. Effectiveness remained above 95% regardless of age group, sex, race, or presence of comorbidities.

Limitations: Predominantly male population; lack of data on disease severity, mortality, and effectiveness by SARS-CoV-2 variants of concern; and short-term follow-up.

Conclusion: Currently used vaccines against SARS-CoV-2 infection are highly effective in preventing confirmed infection in a high-risk population in a real-world setting.

Primary Funding Source: None.
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http://dx.doi.org/10.7326/M21-1577DOI Listing
July 2021

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries.

Nat Med 2021 Jul 16. Epub 2021 Jul 16.

Trinity College Dublin, Dublin, Ireland.

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.
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http://dx.doi.org/10.1038/s41591-021-01454-yDOI Listing
July 2021

COVID-19 Vaccine Acceptance among Health Care Workers in the Kingdom of Saudi Arabia.

Int J Infect Dis 2021 Jul 7;109:286-293. Epub 2021 Jul 7.

Research and Innovation Center, King Saud Medical City, Ministry of Health, the Kingdom of Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, the Kingdom of Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address:

Objectives: The purpose of our study was to assess COVID-19 vaccine acceptance among health care workers (HCWs) in the Kingdom of Saudi Arabia (KSA) and identify: 1) vaccine acceptance barriers; 2) demographic differences; and 3) the most trusted COVID-19 sources of information.

Methods: Between October and December 2020, all registered HCWs in the KSA were emailed a survey questionnaire, using Qualtrics® and Google Forms®, evaluating their acceptance of a COVID-19 vaccine.

Results: Of the 23,582 participants surveyed, 15,299 (64.9%) said they would accept a COVID-19 vaccine. Vaccine acceptance among HCWs differed by several demographic characteristics, with males (69.7%), Christians (71.9%), and Pakistanis (81.6%) most likely to accept a COVID-19 vaccine. Of the 8,202 (35.1%) who said they would not accept a COVID-19 vaccine, the main reason reported was fear of potential side effects (58.5%). Participants reported health officials (84.6%) as the most reliable source of COVID-19 information. Additionally, participants reported the highest confidence in the KSA Ministry of Health (88.5%).

Conclusions: Overall, these findings provide KSA health care authorities with the information needed to develop public health messaging campaigns for HCWs to best address COVID-19 vaccine concerns-especially as the country prepares to vaccinate its general population.
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http://dx.doi.org/10.1016/j.ijid.2021.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260488PMC
July 2021

Vaccine package inserts and prescribing habits of obstetricians-gynecologists for maternal vaccination.

Hum Vaccin Immunother 2021 Jul 8:1-10. Epub 2021 Jul 8.

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.

Despite ample evidence of the safety and efficacy of the influenza vaccine and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy, two-thirds of pregnant women do not receive these vaccines. Providers have a significant role in increasing prenatal vaccine uptake. It is important to understand how different sources of vaccine prescribing information, such as Food and Drug Administration package inserts, influence provider recommendations. We aimed to examine the role of vaccine package inserts in provider recommendations and perceptions of safety and effectiveness of vaccines during pregnancy. A cross-sectional survey was mailed to a random, weighted sample of American College of Obstetricians and Gynecologists Fellows living in the United States in March 2019. Providers were asked about their attitudes toward package inserts, and to evaluate sample package insert statements following two different labeling rules. Their evaluations of each rule were then compared. Of the 321 respondents, the majority (90%, 288/321) recommended and/or administered maternal vaccinations. Few respondents (7.8%, 25/321) read package inserts for information regarding vaccination. Respondents were less likely to recommend sample vaccines with Pregnancy and Lactation Labeling Rule-complying inserts (46.1%, 148/321) than vaccines with Pregnancy Category inserts (87.5%, 282/321). Although most providers did not actively utilize vaccine package inserts to inform recommendations, the previous Pregnancy Categories rule was preferred compared to the Pregnancy and Lactation Labeling Rule. Collaborative efforts to update inserts with current clinical practices for pregnancy would be valuable in reducing apprehensiveness around package inserts to generate safer and more cogent recommendations for pregnant women.
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http://dx.doi.org/10.1080/21645515.2021.1942714DOI Listing
July 2021

Social contact patterns among employees in 3 U.S. companies during early phases of the COVID-19 pandemic, April to June 2020.

Epidemics 2021 Jun 17;36:100481. Epub 2021 Jun 17.

Yale University, CT, USA.

We measured contact patterns using online diaries for 304 employees of 3 U.S. companies working remotely. The median number of daily contacts was 2 (IQR 1-4); majority were conversation (55 %), occurred at home (64 %) and lasted >4 h (38 %). These data are crucial for modeling outbreak control among the workforces.
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http://dx.doi.org/10.1016/j.epidem.2021.100481DOI Listing
June 2021

Antenatal care providers' attitudes and beliefs towards maternal vaccination in Kenya.

Gates Open Res 2020 22;4:19. Epub 2021 Apr 22.

Department of Global Health, Emory University, Atlanta, GA, 30322, USA.

Maternal immunization is known to be one of the best strategies to protect both mothers and their infants from infectious diseases. Studies have shown that healthcare providers play a critical role in implementation of maternal immunization. However, little is known about providers' attitudes and beliefs towards vaccination that can influence their vaccine recommendations, specifically in low to middle income countries (LMIC). A self-administrated knowledge, attitude and behavior (KAB) survey was provided to 150 antenatal care providers across four different regions (Nairobi, Mombasa, Marsabit, and Siaya counties) of Kenya. The research staff visited the 150 clinics and hospitals and distributed a quantitative KAB survey. Nearly all of the antenatal care providers (99%) recommended tetanus maternal vaccination. Similarly, 99% of the providers agreed that they would agree to provide additional vaccinations for pregnant women and reported that they always advise their patients to get vaccinated. Between 80 and 90% of the providers reported that religious beliefs, ethnicity, cultural background and political leaders do not affect their attitude or beliefs towards recommending vaccines. Considering the positive responses of healthcare providers towards vaccine acceptance and recommendation, these results highlight an opportunity to work in partnership with these providers to improve coverage of maternal vaccination and to introduce additional vaccines (such as influenza). In order to achieve this, logistical barriers that have affected the coverage of the currently recommended vaccines, should be addressed as part of this partnership.
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http://dx.doi.org/10.12688/gatesopenres.13091.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181780PMC
April 2021

Strategies to increase uptake of maternal pertussis vaccination.

Expert Rev Vaccines 2021 Jul 21:1-18. Epub 2021 Jul 21.

Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA.

Introduction: Pertussis is a highly contagious respiratory disease that results in disproportionate morbidity and mortality in infants who have yet to receive the primary diphtheria-tetanus-pertussis vaccine series. In the preceding decades numerous countries began to pursue either prenatal vaccination of pregnant women or postpartum vaccination of caregivers to protect infants. Despite proven benefit, maternal uptake of pertussis vaccine continues to remain suboptimal.

Areas Covered: Many studies have been conducted to address the suboptimal uptake of maternal pertussis vaccination. This systematic review was undertaken to systematically identify those studies, highlight the most successful strategies and find the knowledge gaps that need to be filled over the coming years to improve vaccine uptake. Twenty-five studies were identified from six different databases.

Expert Opinion: Five different interventions were shown to be successful in promoting uptake of pertussis vaccination: (1) standing orders, (2) opt-in orders, (3) provider education, (4) on-site vaccination and (5) interactive patient education. Three major knowledge gaps were also identified that need to be filled over the coming years: (1) lack of studies in low- and middle-income countries, (2) lack of studies targeting midwives and/or home birth and (3) lack of studies on the process of vaccine communication.
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http://dx.doi.org/10.1080/14760584.2021.1940146DOI Listing
July 2021

Rate and risk factors for breakthrough SARS-CoV-2 infection after vaccination.

J Infect 2021 08 28;83(2):237-279. Epub 2021 May 28.

VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; University of Pittsburgh Medical Center, Pittsburgh, PA, USA; CRISMA Center, Department Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA.

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http://dx.doi.org/10.1016/j.jinf.2021.05.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159711PMC
August 2021

Adaptive immune determinants of viral clearance and protection in mouse models of SARS-CoV-2.

bioRxiv 2021 May 19. Epub 2021 May 19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused more than 160 million infections and more than 3 million deaths worldwide. While effective vaccines are currently being deployed, the adaptive immune determinants which promote viral clearance and confer protection remain poorly defined. Using mouse models of SARS-CoV-2, we demonstrate that both humoral and cellular adaptive immunity contributes to viral clearance in the setting of primary infection. Furthermore, we find that either convalescent mice, or mice that receive mRNA vaccination are protected from both homologous infection and infection with a variant of concern, B.1.351. Additionally, we find this protection to be largely mediated by antibody response and not cellular immunity. These results highlight the protective capacity of antibodies generated to both vaccine and natural infection.

One-sentence Summary: Defining the roles of humoral and cellular adaptive immunity in viral clearance and protection from SARS-CoV-2 and a variant of concern.
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http://dx.doi.org/10.1101/2021.05.19.444825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142653PMC
May 2021

Methodological frontiers in vaccine safety: qualifying available evidence for rare events, use of distributed data networks to monitor vaccine safety issues, and monitoring the safety of pregnancy interventions.

BMJ Glob Health 2021 05;6(Suppl 2)

Global Vaccine Data Network, Berkeley, California, USA.

While vaccines are rigorously tested for safety and efficacy in clinical trials, these trials do not include enough subjects to detect rare adverse events, and they generally exclude special populations such as pregnant women. It is therefore necessary to conduct postmarketing vaccine safety assessments using observational data sources. The study of rare events has been enabled in through large linked databases and distributed data networks, in combination with development of case-centred methods. Distributed data networks necessitate common protocols, definitions, data models and analytics and the processes of developing and employing these tools are rapidly evolving. Assessment of vaccine safety in pregnancy is complicated by physiological changes, the challenges of mother-child linkage and the need for long-term infant follow-up. Potential sources of bias including differential access to and utilisation of antenatal care, immortal time bias, seasonal timing of pregnancy and unmeasured determinants of pregnancy outcomes have yet to be fully explored. Available tools for assessment of evidence generated in postmarketing studies may downgrade evidence from observational data and prioritise evidence from randomised controlled trials. However, real-world evidence based on real-world data is increasingly being used for safety assessments, and new tools for evaluating real-world evidence have been developed. The future of vaccine safety surveillance, particularly for rare events and in special populations, comprises the use of big data in single countries as well as in collaborative networks. This move towards the use of real-world data requires continued development of methodologies to generate and assess real world evidence.
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http://dx.doi.org/10.1136/bmjgh-2020-003540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137251PMC
May 2021

Key ethical considerations to guide the adjudication of a single-dose HPV vaccine schedule.

Hum Vaccin Immunother 2021 May 19:1-6. Epub 2021 May 19.

Yale Institute for Global Health, New Haven, CT, USA.

There is a high burden of human papillomavirus (HPV) associated cancers in low- and middle-income countries (LMICs). Reducing the recommended dosing schedule from two doses to one makes the vaccine schedule logistically simpler and lowers the cost. This could make the distribution of the current vaccine supply more equitable and lead to the protection of more people. However, the clinical trials studying the efficacy of a single-dose schedule have not yet delivered final results. Against this background, the question is whether a single-dose HPV vaccine recommendation is appropriate now, and if so, what are the ethical considerations of such a recommendation? We developed three ethical recommendations: (1) adopt a holistic view of evidence to justify policy decisions; (2) prioritize the reduction in global disparities in decision-making at all levels; and (3) be transparent in the reporting of how key stakeholder interests have shaped the collection and interpretation of the evidence, and ultimate decisions. The complex discussion regarding the HPV single-dose vaccine schedule highlights the need for in-depth engagement globally to improve our understanding of country-specific contexts, and how those contexts influence decisions regarding the HPV vaccine single-dose recommendation.
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http://dx.doi.org/10.1080/21645515.2021.1917231DOI Listing
May 2021

Communicating With Vaccine-Hesitant Parents: A Narrative Review.

Acad Pediatr 2021 May-Jun;21(4S):S24-S29

University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo.

Although vaccines are considered one of the most effective medical interventions to prevent vaccine preventable disease and associated morbidity and mortality, a number of recent outbreaks are threatening the gains made by vaccines. Vaccine hesitancy is a key driver of vaccine refusal and has been associated with vaccine preventable outbreaks. While parents seek information from many sources to inform their vaccine decision-making process, they continue to view their child's pediatric provider as a trusted source of vaccine information. The communication that occurs between a provider and parent with regards to vaccination is critical in reducing concerns and nudging parents toward vaccine acceptance. However, vaccine-hesitant parents raise issues in this encounter that many providers feel ill-equipped to answer, due to lack of training on evidence-based communication strategies. We focus on promising approaches related to patient-provider communication within the context of vaccination. We found empirical evidence that the use of a presumptive format to recommend vaccines, motivational interviewing, and tailoring information to increase message salience are approaches that can positively affect vaccine acceptance. As providers continue to serve as important influencers in the vaccine decision-making process, it is evident that there is a need to continue to identify evidence-based, and practically implementable approaches to mitigate parental vaccine hesitancy. Providers play a key role in improving coverage rates, and therefore it is paramount to seek ways to improve how providers communicate about vaccines.
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http://dx.doi.org/10.1016/j.acap.2021.01.018DOI Listing
July 2021

Delayed production of neutralizing antibodies correlates with fatal COVID-19.

Nat Med 2021 07 5;27(7):1178-1186. Epub 2021 May 5.

Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.

Recent studies have provided insights into innate and adaptive immune dynamics in coronavirus disease 2019 (COVID-19). However, the exact features of antibody responses that govern COVID-19 disease outcomes remain unclear. In this study, we analyzed humoral immune responses in 229 patients with asymptomatic, mild, moderate and severe COVID-19 over time to probe the nature of antibody responses in disease severity and mortality. We observed a correlation between anti-spike (S) immunoglobulin G (IgG) levels, length of hospitalization and clinical parameters associated with worse clinical progression. Although high anti-S IgG levels correlated with worse disease severity, such correlation was time dependent. Deceased patients did not have higher overall humoral response than discharged patients. However, they mounted a robust, yet delayed, response, measured by anti-S, anti-receptor-binding domain IgG and neutralizing antibody (NAb) levels compared to survivors. Delayed seroconversion kinetics correlated with impaired viral control in deceased patients. Finally, although sera from 85% of patients displayed some neutralization capacity during their disease course, NAb generation before 14 d of disease onset emerged as a key factor for recovery. These data indicate that COVID-19 mortality does not correlate with the cross-sectional antiviral antibody levels per se but, rather, with the delayed kinetics of NAb production.
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http://dx.doi.org/10.1038/s41591-021-01355-0DOI Listing
July 2021

Fast Development of High-Quality Vaccines in a Pandemic.

Chest 2021 07 20;160(1):e1-e3. Epub 2021 Apr 20.

Department of Medicine, Section of Infectious Diseases, Orange, CT; Yale School of Public Health, Orange, CT; Yale Institute of Global Health, Orange, CT; Yale School of Nursing, Orange, CT.

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http://dx.doi.org/10.1016/j.chest.2021.03.063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102080PMC
July 2021

Decision-making process for introduction of maternal vaccines in Kenya, 2017-2018.

Implement Sci 2021 Apr 12;16(1):39. Epub 2021 Apr 12.

Department of Medicine, Division of Pediatrics, Emory University School of Medicine, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.

Background: Maternal immunization is a key strategy for reducing morbidity and mortality associated with infectious diseases in mothers and their newborns. Recent developments in the science and safety of maternal vaccinations have made possible development of new maternal vaccines ready for introduction in low- and middle-income countries. Decisions at the policy level remain the entry point for maternal immunization programs. We describe the policy and decision-making process in Kenya for the introduction of new vaccines, with particular emphasis on maternal vaccines, and identify opportunities to improve vaccine policy formulation and implementation process.

Methods: We conducted 29 formal interviews with government officials and policy makers, including high-level officials at the Kenya National Immunization Technical Advisory Group, and Ministry of Health officials at national and county levels. All interviews were recorded and transcribed. We analyzed the qualitative data using NVivo 11.0 software.

Results: All key informants understood the vaccine policy formulation and implementation processes, although national officials appeared more informed compared to county officials. County officials reported feeling left out of policy development. The recent health system decentralization had both positive and negative impacts on the policy process; however, the negative impacts outweighed the positive impacts. Other factors outside vaccine policy environment such as rumours, sociocultural practices, and anti-vaccine campaigns influenced the policy development and implementation process.

Conclusions: Public policy development process is complex and multifaceted by its nature. As Kenya prepares for introduction of other maternal vaccines, it is important that the identified policy gaps and challenges are addressed.
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http://dx.doi.org/10.1186/s13012-021-01101-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042952PMC
April 2021

Measuring voluntary and policy-induced social distancing behavior during the COVID-19 pandemic.

Proc Natl Acad Sci U S A 2021 04;118(16)

Yale Institute for Global Health, New Haven, CT 06510.

Staying home and avoiding unnecessary contact is an important part of the effort to contain COVID-19 and limit deaths. Every state in the United States enacted policies to encourage distancing and some mandated staying home. Understanding how these policies interact with individuals' voluntary responses to the COVID-19 epidemic is a critical initial step in understanding the role of these nonpharmaceutical interventions in transmission dynamics and assessing policy impacts. We use variation in policy responses along with smart device data that measures the amount of time Americans stayed home to disentangle the extent that observed shifts in staying home behavior are induced by policy. We find evidence that stay-at-home orders and voluntary response to locally reported COVID-19 cases and deaths led to behavioral change. For the median county, which implemented a stay-at-home order with about two cases, we find that the response to stay-at-home orders increased time at home as if the county had experienced 29 additional local cases. However, the relative effect of stay-at-home orders was much greater in select counties. On the one hand, the mandate can be viewed as displacing a voluntary response to this rise in cases. On the other hand, policy accelerated the response, which likely helped reduce spread in the early phase of the pandemic. It is important to be able to attribute the relative role of self-interested behavior or policy mandates to understand the limits and opportunities for relying on voluntary behavior as opposed to imposing stay-at-home orders.
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http://dx.doi.org/10.1073/pnas.2008814118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076999PMC
April 2021

COVID-19 Sources of Information, Knowledge, and Preventive Behaviors Among the US Adult Population.

J Public Health Manag Pract 2021 May-Jun 01;27(3):278-284

Yale Institute for Global Health, New Haven, Connecticut (Ms Shafiq, Mr Elharake, and Drs Malik, McFadden, Aguolu, and Omer); Columbia University Mailman School of Public Health, New York City, New York (Ms Shafiq); Yale School of Public Health, New Haven, Connecticut (Mr Elharake and Dr Omer); Yale School of Medicine, New Haven, Connecticut (Drs Malik, McFadden, Aguolu, and Omer); and Yale School of Nursing, Orange, Connecticut (Dr Omer).

Context: The COVID-19 pandemic has resulted in more than 20 million cases and 350 000 deaths in the United States. With the ongoing media coverage and spread of misinformation, public health authorities need to identify effective strategies and create culturally appropriate and evidence-based messaging that best encourage preventive health behaviors to control the spread of COVID-19.

Objective: The purpose of this study was to understand the relationship between COVID-19 sources of information and knowledge, and how US adults' knowledge may be associated with preventive health behaviors to help mitigate COVID-19 cases and deaths.

Design And Setting: For this cross-sectional study, survey data pertaining to COVID-19 were collected via online platform, Qualtrics, in February and May 2020.

Participants: Data responses included 718 US adults from the February survey and 672 US adults from the May survey-both representative of the US adult population.

Main Outcome Measures: Sociodemographic characteristics, COVID-19 knowledge score, COVID-19 reliable sources of information, and adherence to COVID-19 preventive health behaviors.

Results And Conclusions: The main findings showed that disseminating COVID-19 information across various sources, particularly television, health care providers, and health officials, to increase people's COVID-19 knowledge contributes to greater adherence to infection prevention behaviors. Across February and May 2020 survey data, participants 55 years and older and those with higher educational background reported a higher average COVID-19 knowledge score. In addition, among the racial and ethnic categories, Black/African American and Native American/Alaska Native participants reported a lower average COVID-19 knowledge score than white participants-signaling the need to establish COVID-19 communication that is culturally-tailored and community-based. Overall, health care authorities must deliver clear and concise messaging about the importance of adhering to preventive health behaviors, even as COVID-19 vaccines become widely available to the general public. Health officials must also focus on increasing COVID-19 knowledge and dispelling misinformation.
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http://dx.doi.org/10.1097/PHH.0000000000001348DOI Listing
April 2021

Studying attitudes towards vaccine hesitance and California law SB 277 in online discourse: A dataset and methodology.

Data Brief 2021 Apr 24;35:106841. Epub 2021 Feb 24.

Yale Institute for Global Health, Associate Dean (Global Health Research), Yale School of Medicine, Professor of Medicine (Infectious Diseases), Yale School of Medicine, Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases, Yale School of Public Health, 1 Church St., New Haven, CT 06510, United States.

This article presents data that are further analyzed and interpreted in "Shouting at Each Other into the Void: A Semantic Network Analysis of Vaccine Hesitance and Support in Online Discourse Regarding California Law SB277" [1]. This research modified snowball sampling, a technique usually used to generate chains of informants that illuminate the structure of social networks, to collect digital documents following a chain of web links and recommendations, thus illuminating the underlying social, technical, and linguistic structure of online discourse. The resulting documents were manually coded according to the attitude towards vaccines they represented and/or the position they took with regard to California Senate Bill 277, a vaccine mandate policy that banned all nonmedical exemptions from school immunization requirements. Each attitude category, as well as the dataset as a whole, was subjected to quantitative linguistic analysis to identify key words and phrases in the data according to the frequency with which they appeared. A combination of that technique and semantic network analysis were used to generate clusters of related words that could be used for qualitative and narrative analysis, as detailed in the companion paper. The data collection and analysis processes described here will be of use to researchers conducting mixed-method analysis of online discourse who want their data to reflect the potential information and digital resources available to individuals who attempt to inform themselves about a particular topic using Internet searches. The data presented here could be useful for anyone seeking deeper insight into the linguistic and narrative patterns surrounding online debates about vaccination, controversial government policies, or both.
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http://dx.doi.org/10.1016/j.dib.2021.106841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966830PMC
April 2021

The Association of COVID-19 Risk Perception, County Death Rates, and Voluntary Health Behaviors among U.S. Adult Population.

J Infect Dis 2021 Mar 10. Epub 2021 Mar 10.

Yale Institute for Global Health, New Haven, Connecticut, USA.

The COVID-19 pandemic continues to adversely impact the United States (U.S.) socially, culturally, and economically. The purpose of this study was to understand the relationship between COVID-19 county death rates, risk perception, and U.S. adults' voluntary behaviors-particularly physical distancing. Data were collected from CloudResearch/Qualtrics, Johns Hopkins University, the American Community Survey, and SafeGraph. Our results indicated that higher COVID-19 county death rates were associated with higher risk perceptions, leading to greater time spent at home. These findings will help public health officials identify strategies that best encourage voluntary health behaviors to help curb the spread of COVID-19.
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http://dx.doi.org/10.1093/infdis/jiab131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989350PMC
March 2021

Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID-19.

J Am Heart Assoc 2021 07 24;10(13):e018086. Epub 2021 Feb 24.

Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.

Background Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain. Methods and Results In a propensity score-matched outpatient cohort (January-May 2020) of 2263 Medicare Advantage and commercially insured individuals with hypertension and a positive outpatient SARS-CoV-2, we determined the association of ACE inhibitors and ARBs with COVID-19 hospitalization. In a concurrent inpatient cohort of 7933 hospitalized with COVID-19, we tested their association with in-hospital mortality. The robustness of the observations was assessed in a contemporary cohort (May-August). In the outpatient study, neither ACE inhibitors (hazard ratio [HR], 0.77; 0.53-1.13, =0.18) nor ARBs (HR, 0.88; 0.61-1.26, =0.48) were associated with hospitalization risk. ACE inhibitors were associated with lower hospitalization risk in the older Medicare group (HR, 0.61; 0.41-0.93, =0.02), but not the younger commercially insured group (HR, 2.14; 0.82-5.60, =0.12; -interaction 0.09). Neither ACE inhibitors nor ARBs were associated with lower hospitalization risk in either population in the validation cohort. In the primary inpatient study cohort, neither ACE inhibitors (HR, 0.97; 0.81-1.16; =0.74) nor ARBs (HR, 1.15; 0.95-1.38, =0.15) were associated with in-hospital mortality. These observations were consistent in the validation cohort. Conclusions ACE inhibitors and ARBs were not associated with COVID-19 hospitalization or mortality. Despite early evidence for a potential association between ACE inhibitors and severe COVID-19 prevention in older individuals, the inconsistency of this observation in recent data argues against a role for prophylaxis.
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http://dx.doi.org/10.1161/JAHA.120.018086DOI Listing
July 2021

Impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal carriage in children 2 years of age: Data from a four-year time series cross-sectional study from Pakistan.

Data Brief 2021 Apr 3;35:106828. Epub 2021 Feb 3.

Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.

The dataset described in this paper was collected for a time-series cross-sectional study exploring the impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal (NP) carriage in children under 2 years of age from a rural population in Sindh, Pakistan. The study was carried out in two union councils of Matiari - Khyber and Shah Alam Shah Jee Wasi (Latitude 25.680298 / Longitude 68.502711). Data was collected on socio-demographics, clinical characteristics and vaccination status using android phone-based application. NP samples were collected using standard World Health Organisation (WHO) techniques, culture and serotyping was done using sequential Multiplex PCR described by Centre for Disease Control, USA. We looked at the carriage rate of vaccine type (VT) and non-vaccine type (NVT) serotypes over time in vaccinated and unvaccinated children. We additionally looked at the predictors for pneumococcal carriage. The uploaded dataset, available on Mendeley data repository (Nisar, Muhammad Imran (2021), "Impact of PCV10 on nasopharyngeal carriage in children in Pakistan", Mendeley Data, V1, doi:10.17632/t79h6g97gr.1), has 3140 observations in CSV format. Additional files uploaded include a data dictionary and the set of questionnaires. The dataset and accompanying files can be used by other interested researchers to replicate our analysis, carry similar analysis under varying set of assumptions or perform additional exploratory or metanalysis.
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http://dx.doi.org/10.1016/j.dib.2021.106828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881212PMC
April 2021

The need for a global COVID-19 maternal immunisation research plan.

Lancet 2021 06 25;397(10293):e17-e18. Epub 2021 Jan 25.

Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.

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http://dx.doi.org/10.1016/S0140-6736(21)00146-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055754PMC
June 2021

Racial/Ethnic Disparities in Maternal Vaccine Knowledge, Attitudes, and Intentions.

Public Health Rep 2021 Jan 28:33354920974660. Epub 2021 Jan 28.

1371 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Objectives: Although disparities in maternal vaccine acceptance among racial/ethnic groups are well documented, the reasons for these disparities are unclear. The objective of this study was to describe differences in pregnant women's knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines by race/ethnicity.

Methods: We collected survey data from 1862 pregnant women from diverse prenatal care practices in Georgia and Colorado from June 2017 through July 2018. We performed multiple logistic regressions to determine differences in intentions, knowledge, attitudes, beliefs, and trust by race/ethnicity and calculated odds ratios (ORs) and 95% CIs.

Results: Compared with White women, Black and Hispanic women were less confident in vaccine safety and efficacy and less likely to perceive risk of acquiring vaccine-preventable diseases, report provaccine social norms, indicate having enough vaccine knowledge, and trust vaccine information from health care providers and public health authorities. Black women were the least confident in the safety of the maternal influenza vaccine (OR = 0.37; 95% CI, 0.27-0.49); maternal tetanus, diphtheria, and acellular pertussis vaccine (OR = 0.37; 95% CI, 0.27-0.52); and infant vaccines overall (OR = 0.40; 95% CI, 0.28-0.58), and were least likely to intend to receive both maternal vaccines (OR = 0.35; 95% CI, 0.27-0.47) or all infant vaccines on time (OR = 0.45; 95% CI, 0.34-0.61) as compared with White women.

Conclusions: Understanding differences in behavioral constructs integral to vaccine decision making among women of different races/ethnicities can lead to tailored interventions to improve vaccine acceptance.
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http://dx.doi.org/10.1177/0033354920974660DOI Listing
January 2021

School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California.

Hum Vaccin Immunother 2021 07 25;17(7):1986-1993. Epub 2021 Jan 25.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.
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http://dx.doi.org/10.1080/21645515.2020.1857202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189058PMC
July 2021

Direct and indirect effect of 10 valent pneumococcal vaccine on nasopharyngeal carriage in children under 2 years of age in Matiari, Pakistan.

Vaccine 2021 02 6;39(8):1319-1327. Epub 2021 Jan 6.

Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan.

Background: Pakistan introduced Ten-valent pneumococcal-conjugate-vaccine PCV10 in 2012 as a 3 + 0 schedule without catch-up.

Methods: Children <2 years old in Matiari, Sindh provided nasopharyngeal swabs between 2014 and 2018, which were cultured for pneumococcus and serotyped through multiplex PCR at the Aga Khan University Hospital. Carriage rates over time for Vaccine-Type (VT) and Non-VT (NVT) serotypes were used to estimate direct, indirect, total and overall effects of vaccination. Regression analysis was used to determine factors associated with VT carriage.

Results: Pneumococcus was detected in 2370/3140 (75%). VT carriage decreased overall, 16.1-9.6% (p-trend <0.001); vaccinated (all 3 doses of PCV10 received) 11.3-8.1% (p-trend 0.031) and unvaccinated (no PCV10 dose received) 17.4-10.3% (p-trend 0.003) with a decline in serotypes 6B, 9V/9A and 19F. Immunization increased from 41.0% to 68.4% (p-trend 0.001). Direct effect of vaccine was 32.8% (95% CI 14.7-47.0%) and indirect effect 44.6%(95% CI 40.6-48.6%). Factors associated with decreased VT colonization were education 1-5 years (aOR 0.7, 95%CI 0.6-1.0), history of difficulty breathing (aOR 0.7, 95%CI 0.5-1.0), exposure to smoke (aOR 0.8, 95% CI 0.6-1.0), child fully immunized (aOR 0.7, 95%CI 0.5-1.0) and enrolled in 3rd (aOR 0.6, 95%CI 0.4-0.8) and 4th (aOR 0.6, 95%CI 0.5-0.9) year of the study whereas history of runny nose (aOR 1.5, 95% CI 1.2-1.9) was positively associated.

Conclusions: Decrease in VT pneumococcal carriage in vaccinated and unvaccinated children indicates herd immunity. Sustained increase in vaccine coverage and close long-term surveillance is warranted.
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http://dx.doi.org/10.1016/j.vaccine.2020.12.066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910277PMC
February 2021

Timing of COVID-19 vaccine approval and endorsement by public figures.

Vaccine 2021 01 16;39(5):825-829. Epub 2020 Dec 16.

Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, West Haven, CT, USA. Electronic address:

The global spread of COVID-19 has created an urgent need for a safe and effective vaccine. However, in the United States, the politicization of the vaccine approval process, including which public figures are endorsing it, could undermine beliefs about its safety and efficacy and willingness to receive it. Using a pair of randomized survey experiments, we show that announcing approval of a COVID-19 vaccine one week before the presidential election compared to one week after considerably reduces both beliefs about its safety and efficacy and intended uptake. However, endorsement by Dr. Anthony Fauci increases confidence and uptake among all partisan subgroups. Further, an endorsement by Dr. Fauci increased uptake and confidence in safety even if a vaccine receives pre-election approval. The results here suggest that perceptions of political influence in COVID-19 vaccine approval could significantly undermine the viability of a vaccine as a strategy to end the pandemic.
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http://dx.doi.org/10.1016/j.vaccine.2020.12.048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744009PMC
January 2021
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