BACKGROUND:Older adults are more likely to develop severe respiratory syncytial virus (RSV) disease and need hospitalization. In 2024, RSV vaccination was recommended in the United States by ACIP. for adults aged 60-74 years at increased risk of severe RSV and all adults aged ≥75 years. METHODS:Data from the National Immunization Survey-Adult COVID Module collected during September 2024-April 2025 were analyzed to assess RSV vaccination coverage at national and state level using the Kaplan-Meier survival analysis procedure. Multivariable logistic regression analysis and predictive marginals were conducted to assess factors associated with RSV vaccination. RESULTS:RSV vaccination coverage by the end of the 2024-25 season among adults aged 60-74 years at increased risk of severe RSV and adults aged ≥75 years was 38.3% and 41.5%, respectively, and of those who had ever received RSV vaccination, 56.2% and 55.4%, respectively, reported receiving it before start of the 2024-25 season. Coverage ranged from 10.8% in Virgin Islands to 61.2% in Michigan among adults aged 60-74 years at increased risk, and 7.2% in Virgin Islands to 57.6% in Colorado among adults aged ≥75 years. Characteristics independently associated with increased RSV vaccination among both adults aged 60-74 years at increased risk of severe RSV and adults aged ≥75 years included household income above the poverty level, having college graduate or higher education, not having a disability, and receiving provider recommendation for RSV vaccination. CONCLUSIONS:By the end of the 2024-25 season, RSV vaccination coverage among adults aged 60-74 years at increased risk of severe RSV and adults aged ≥75 years remains low in the United States. Wide variation in coverage across states/territories were observed. Differences by demographic and other factors were observed in vaccination uptake. Healthcare providers can educate and encourage adults to receive vaccine when they are eligible.

BACKGROUND:Pharmacies are essential partners in administering recommended pediatric and adult vaccinations, including influenza (flu) and COVID-19 vaccines. The objective of this study is to assess trends in COVID-19, flu, and routine vaccinations administered in US retail pharmacies. METHODS:IQVIA's TPT data from 2015 through 2023 were analyzed by age group and calendar year or flu season. RESULTS:Since the 2015-16 flu season, the number and rate of children and adults receiving flu vaccinations at pharmacies has been increasing and peaked in 2020-21 with over 3.0 million vaccinations for children under 18 years of age (4% of this population) and 47.1 million vaccinations for adults ≥18 years (18%). Routine vaccinations administered in pharmacies increased overall from 3.4 million (2015) to 13.3 million vaccinations (2023). From December 2020 through December 2023, over 330.7 million vaccinations of COVID-19 vaccine were administered at pharmacies. DISCUSSION:The overall trend indicates that the number and rate of flu and routine vaccinations received at US retail pharmacies among all age groups and vaccine types were increasing before the COVID-19 pandemic. CONCLUSIONS:This analysis demonstrates the large magnitude and increase since 2015 of vaccinations administered in US retail pharmacies, especially for COVID-19 vaccinations.

PURPOSE:To investigate the percent of adolescents who receive human papillomavirus (HPV) vaccine with one or more other vaccines recommended for adolescents in a single medical visit. METHODS:Data from the 2023 National Immunization Survey-Teen were analyzed. Timing of receipt of HPV vaccine, tetanus, diphtheria, and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MenACWY), and influenza vaccine was assessed using provider-reported vaccination histories. RESULTS:In 2023, among adolescents aged 13-17 years, 69.5% received HPV vaccine with one or more other vaccines recommended for adolescents in a single medical visit. In addition, 47.8% received specifically HPV vaccine, Tdap, and MenACWY together in a single medical visit. DISCUSSION:The HPV vaccine is commonly given with other vaccines recommended for adolescents in a single medical visit. These findings demonstrate variation in simultaneous vaccination patterns, suggesting that flexibility in the recommended adolescent vaccination schedule allows for different approaches to vaccination across clinical settings and family preferences while maintaining adherence to the recommended schedule.

The National Immunization Survey-Flu (NIS-Flu) monitors influenza vaccination among children in the United States, and the accuracy of NIS-Flu estimates is important for evaluating influenza vaccination programs. Total survey error (TSE) provides a framework for assessing survey accuracy. NIS-Flu data from the 2015-16 through 2017-18 influenza seasons were examined to assess components of nonsampling error: noncoverage of households by the sampling frame; household nonresponse; and measurement error resulting from parental reporting of vaccination status. We estimated the distributional parameters of each source of error from related surveys and auxiliary data and employed simulation to estimate bias. We estimated bias in end-of-season estimates of influenza vaccination rates and quantified the extent to which each source of survey error contributed to total bias. Overall point estimates (and 95 percent interval estimates) of total estimated bias were 8.0 (1.3, 14.6), 8.9 (2.6, 15.2), and 6.1 (-0.5, 12.8) percentage points for the 2015-16, 2016-17, and 2017-18 influenza seasons, respectively. Measurement error resulting from parental recall of children's vaccination status was the largest contributor to bias; the average estimates of measurement error were 7.0, 8.2, and 5.5 percentage points for the three seasons, respectively. Errors due to noncoverage and nonresponse were relatively small (averaging <1 percentage point). Estimates of total bias were larger for Hispanic and non-Hispanic Black children and for the youngest children aged 6-23 months. Findings suggest NIS-Flu influenza vaccination rate estimates may be biased upward, primarily due to measurement error in the form of overreporting influenza vaccinations by parental respondents, with relatively little error due to noncoverage or nonresponse.

This study estimated accuracy of survey-reported hepatitis A and B vaccination among adults at increased risk. Survey responses from patients at 2 large health care systems in Colorado were compared with vaccination records in electronic health records and the state immunization registry. For hepatitis A vaccine, net bias was 5.6% (relative bias, 38.6%; sensitivity, 52.5%; specificity, 85.3%). For hepatitis B vaccine, net bias was 6.5% (relative bias, 28.6%; sensitivity, 43.4%; specificity, 75.1%). Despite low sensitivity, self-reported vaccination status may be sufficiently accurate for use in the development of vaccine policies and public health actions for improving hepatitis A and B coverage.

The National Immunization Survey-Child monitors coverage with recommended routine childhood vaccines. For data collected in survey year 2024, which include children born in 2021 and 2022, the household response rate (23.4%) and availability of adequate provider data for children with completed interviews (51.4%) were comparable to those from earlier survey years. For most vaccines, coverage by age 24 months was similar among children born in 2021 and 2022 and those born in 2019 and 2020. Declines in coverage of 1-2 percentage points were observed for the primary series of Haemophilus influenzae type b conjugate vaccine, the birth dose of hepatitis B vaccine, ≥4 doses of pneumococcal conjugate vaccine, and rotavirus vaccine. Coverage with ≥2 doses of influenza vaccine by age 24 months decreased from 61.0% among children born during 2019-2020 to 53.5% among those born during 2021-2022. Coverage was lower among Vaccines for Children (VFC) program-eligible children than among those who were not VFC-eligible and differed substantially by jurisdiction. Compared with non-Hispanic White children, coverage with many vaccines was lower among non-Hispanic Black or African American and Hispanic or Latino children; coverage was highest among non-Hispanic Asian children. Coverage was also lower among children living in poverty and those living in more rural areas. Maintaining high levels of vaccination and improving coverage among groups and in areas in which rates have declined could help protect children from vaccine-preventable morbidity and mortality. The Community Preventive Services Task Force recommends several interventions to increase vaccination, including standing orders for vaccination, immunization information systems, and vaccination programs in organized child care centers and in Special Supplemental Nutrition Program for Woman, Infants, and Children settings. Other factors demonstrated to be effective include strong provider recommendations, targeted messages from credible and trusted sources, and increased participation in the VFC program.

Abstract Background Human papillomavirus (HPV) causes approximately 37,000 cancers in the United States annually. HPV vaccine, recommended by CDC at age 11 or 12 years, prevents more than 90% of HPV-attributable cancers. We aim to identify coverage gaps to guide targeted interventions. Methods We conducted a birth cohort analysis among adolescents born 1999-2009 using National Immunization Survey-Teen (NIS-Teen), a random-digit dialed telephone survey which also collects vaccination data from providers. We analyzed 131,553 records from 2016 to 2022 NIS-Teen data to determine: 1) trends in coverage with ≥ 1 HPV vaccine dose before age 13 years (on-time initiation), 2) cumulative coverage from 13 to 17 years (catch-up), 3) on-time HPV vaccination up to date status (all recommended doses before age 13 years), 4) missed vaccination opportunities (provider visits before age 13 years where HPV unvaccinated adolescents received other recommended vaccine but not HPV vaccine), and achievable coverage if HPV vaccination opportunities were not missed. Regression analysis provided the average percentage increase in coverage across birth cohorts. Kaplan-Meier method provided cumulative HPV vaccination coverage from age 13 to 17 years, stratified by birth cohorts. Results HPV vaccination coverage before 13 years increased from 27.0% among adolescents born in 1999 to 69.8% among those born in 2009. Coverage for girls increased from 37.4% to 73.4%; coverage for boys increased from 16.9% to 65.9%. Overall, coverage increased from 33.1% before age 13 years to 74.9% before age 18 years. HPV vaccination up to date status increase from 10.3% among adolescents in 1999 to 42.2% among those born in 2009. Among the 38,568 (29.3%) who had not received any HPV vaccination, 31,513 (82.5%) had ≥ 1 missed HPV vaccination opportunity. The potential achievable vaccination coverage if opportunities were not missed was 94.8%. Conclusion Coverage with on-time HPV vaccination and HPV up to date increased by birth cohort among adolescents born 1999–2009 but remains suboptimal. Low uptake increases risk for HPV cancers. Opportunities for HPV vaccination before age 13 years are being missed and can be reduced by effective provider recommendations for HPV vaccination and by administering all recommended vaccines during the same visit. Disclosures All Authors: No reported disclosures

Objective: To evaluate human papillomavirus (HPV) vaccination coverage among adolescents in the U.S. using birth cohort analysis. Methods: We conducted a birth cohort analysis among adolescents born during 1999-2009 using National Immunization Survey-Teen (NIS-Teen), a random-digit dialed household telephone survey that also includes vaccination data from providers. We analyzed 131,553 records from 2016 to 2022 NIS-Teen data to determine: trends in coverage with >= 1 HPV vaccine dose before age 13 years and cumulative coverage from age 13-17 years; sociodemographic factors associated with HPV vaccination before age 13 years; missed HPV vaccination opportunities and the potential achievable coverage if opportunities were not missed; and trends in completion of HPV vaccination series. Regression analysis and Kaplan-Meier method provided the average percentage increase in coverage, and cumulative coverage from age 13-17 years stratified by birth cohorts, respectively. Results: HPV vaccination initiation before age 13 years increased from 27.0% among adolescents born in 1999 to 69.8 % among those born in 2009. Overall, cumulative percent with >= 1 HPV vaccine dose increased from 51.3 % before age 13 years to 74.9 % through age 17 years. Having a preventive visit at ages 11-12 years and being insured were associated with higher >= 1 HPV vaccine dose coverage. Among the 38,568 (29.3 %) adolescents unvaccinated for HPV, 31,513 (82.5 %) missed >= 1 HPV vaccination opportunity. The potential achievable coverage if opportunities were not missed was 94.8 %. Completion of HPV vaccination series before age 13 years increased from 10.3 % among adolescents born in 1999 to 42.2 % among those born in 2009. Conclusions: Coverage with >= 1 HPV vaccine dose increased by birth cohort among adolescents born 1999-2009 but remained suboptimal, especially among uninsured adolescents. Missed opportunities may be reduced by effective HPV vaccination implementation and uptake strategies and by administering all recommended vaccines during the same visit.

Three vaccines are recommended for routine administration to adolescents by the Advisory Committee on Immunization Practices: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine. Data from the 2024 National Immunization Survey-Teen were analyzed to determine national, state, and selected local area vaccination coverage in 2024. Household response rate (21.0%) and receipt of adequate provider data for adolescents with completed interviews (42.8%) were comparable to prior survey years. Among 16,325 adolescents aged 13-17 years with adequate provider data included in the survey, coverage with ≥1 Tdap dose increased from 89.0% in 2023 to 91.3% in 2024; coverage with ≥1 MenACWY dose increased from 88.4% to 90.1%. HPV vaccination coverage remained stable for the third consecutive year; 78.2% of adolescents had received ≥1 dose, and 62.9% were up to date with the HPV vaccination series. Coverage with ≥1 Tdap dose was ≥90% in 39 states, with ≥1 MenACWY dose was ≥90% in 30 states, and with ≥1 dose of HPV vaccine was ≥80% in 26 states and the District of Columbia. Since 2016, lower HPV vaccination coverage in nonmetropolitan statistical areas (MSAs) compared with that in MSA principal cities has persisted, with an 11 percentage point difference in coverage with ≥1 HPV vaccine dose and percentage of adolescents up to date with HPV vaccination in 2024. Health care providers can support adolescent health by discussing and recommending vaccines, as well as reviewing patient records to ascertain whether adolescents are up to date with recommended vaccines.

BACKGROUND:Vaccination surveys contribute to understanding coverage among adults, but recent information on self-report accuracy is limited. We aimed to validate vaccination status reported by survey for five adult vaccines. METHODS:Between June 2021 and April 2022, we conducted a survey in three Colorado health systems (safety-net, integrated, rural). We sampled 13,667 adults aged ≥19 years. All were assessed for influenza and tetanus vaccination status; those aged 19-45 years were assessed for HPV, those aged ≥50 years were assessed for zoster, and those aged ≥65 years were assessed for pneumococcal vaccination status. Sensitivity and specificity of self-reported vaccination status were estimated using survey-weighted logistic regression from electronic health record plus Colorado Immunization Information System data as criterion standard. Net bias was defined as coverage based on self-report minus coverage based on the criterion standard. Multivariable models evaluated variation in sensitivity and specificity by respondent and site characteristics. RESULTS:Survey response rate was 29 %. The sensitivity of self-reported vaccination status ranged from 75.2 % (HPV) to 90.4 % (influenza). Specificity varied from 40.9 % (tetanus) to 92.9 % (zoster). Net bias estimates varied from -11.0 (pneumococcal) to 8.1 (influenza) with negative values indicating underreporting and positive values indicating overreporting of vaccination. Sensitivity was lower for Non-Hispanic Black than Non-Hispanic White respondents for HPV, influenza, and tetanus vaccines. Sensitivity was higher in rural than integrated health systems for influenza, tetanus, and zoster vaccines. Additionally, specificity for influenza and zoster vaccines was lower in the rural and the safety-net than the integrated health system. CONCLUSIONS:Although sensitivity and specificity of self-report were relatively high for all vaccines, we observed lower sensitivity for HPV, a vaccination with a single lifetime series, and lower specificity for tetanus, a vaccine given infrequently. These findings have implications for interpreting national survey data and their use to guide vaccine delivery efforts.

Introduction: The Inflation Reduction Act (IRA) eliminated cost sharing for Medicare Part D-covered vaccines but did not address the cost burden faced by Medicare beneficiaries who did not have prescription drug coverage. This study aimed to determine the characteristics of beneficiaries without prescription drug coverage and to assess the association between the receipt of a herpes zoster vaccine and prescription drug coverage status. Methods: We used the 2019-2023 National Health Interview Survey and included Medicare beneficiaries aged 65 years and older who enrolled in both Parts A and B or a Medicare Advantage plan. Descriptive statistics were used to examine beneficiaries' characteristics. Logistic regressions were used to examine the associations between the receipt of a herpes zoster vaccine and Medicare prescription drug coverage. Results: The study included 33,578 beneficiaries and 93.5 % of beneficiaries had prescription drug coverage. The prevalence of lacking prescription drug coverage was higher among beneficiaries who did not have a college degree, had family income below the poverty level, had no flu shot and well visit within the past year, and had no usual place for care. The probability of receiving a herpes zoster vaccine was higher among beneficiaries with prescription drug coverage than those without prescription coverage (45.2 % versus 25.3 %). Conclusions: Herpes zoster vaccination disparities between beneficiaries with and without prescription drug coverage existed before the IRA. Because the IRA only addresses the cost barrier facing by beneficiaries with prescription drug coverage, vaccination disparities was greater after the IRA implementation.

Introduction Non-survey-based data sources (e.g. electronic health records, administrative claims) have been used to estimate vaccination coverage among US adults. However, these data sources were not collected for research or surveillance purposes and may have substantial limitations. The objectives of this narrative review were to: 1) identify published studies that used non-survey-based data sources to estimate adult vaccination coverage for one or more routinely recommended vaccines; and 2) summarize the strengths and limitations of these data sources for coverage assessments.Areas covered Thirty-four publications derived from 9 data sources were reviewed: 16 publications were in a general population (i.e. defined by age), 12 were among pregnant women, and 6 were among individuals with chronic health conditions. While several data sources used continuous health insurance enrollment to define the study population, doing so limited generalizability to stably insured populations. Methods for obtaining race and ethnicity data were complex and potentially subject to bias. None of the reviewed studies presented any formal assessment of vaccine data validity.Expert opinion While multiple non-survey-based data sources have been used to assess adult vaccination coverage in the United States, important limitations exist, including related to generalizability, data validity, and risk of bias.

We conducted exploratory data analyses of the National Immunization Survey-Child COVID Module (NIS-CCM). NIS-CCM is a random digit dialing survey of parents and guardians of 6-month- through 17-year-old children. We conducted latent class analysis to identify different population segments of children according to combinations of parental/guardian intent, attitudes, and behaviors regarding their children's COVID vaccinations. We analyzed data collected between October 2021 and April 2023. The latent class model variables with the greatest variation in conditional probabilities across latent classes included vaccination status, intent to vaccinate, and confidence in the safety of COVID vaccine. The latent classes included one with vaccinated children despite low confidence in vaccine safety and one with unvaccinated children despite high confidence in vaccine safety and high vaccination intent. The latent class that increased the most in size over the period studied was the class most hesitant to vaccination. We further analyzed demographic and environmental characteristics associated with membership in different latent classes using multinomial logistic regression, with the goal of informing strategies to increase vaccination coverage with different population segments. Socioeconomic status and race/ethnicity were associated with latent class membership. Specific social and environmental factors, such as having many family and friends' children vaccinated for COVID and receiving a provider's recommendation for vaccination were associated with more favorable-to-vaccination class membership. While the exploratory analyses do not establish causal relationships, the research shows the value of latent class analysis with high-quality survey data to inform further research on strategies to increase vaccination coverage.

INTRODUCTION:In 2019, shared clinical decision making was recommended by the Advisory Committee on Immunization Practices for consideration of human papillomavirus vaccination of adults aged 27-45 years. This study aims to assess human papillomavirus vaccination among adults aged 27-45 years 3 years after shared clinical decision making recommendation. METHODS:Human papillomavirus vaccination (≥1 dose) among adults aged 27-45 years was assessed from the 2022 National Health Interview Survey and compared with results from 2019; vaccination from the 2021-2023 National Health and Nutrition Examination Survey was assessed and compared with results from 2017-2018. Analyses were conducted in 2025. RESULTS:Human papillomavirus vaccination coverage among adults aged 27-45 years was 21.8% in 2022, 6.3 percentage points higher than 2019 based on the National Health Interview Survey; coverage was 26.6% in 2021-2023, 16.7 percentage points higher than 2017-2018 based on the National Health and Nutrition Examination Survey. Among adults aged 27-45 years who were not vaccinated before age 27 years, coverage based on the National Health Interview Survey was 2.7%, an increase of 0.9 percentage points compared with 2019. Factors independently associated with higher human papillomavirus vaccination among those not vaccinated before age 27 years included older age, female sex, not being married, and having a regular physician for health care. CONCLUSIONS:Human papillomavirus vaccination among adults aged 27-45 years in 2022 was low despite an increase in coverage from 2019. Few adults were vaccinated at age 27-45 years. As persons vaccinated in routinely recommended and catch-up age groups progress into this population, coverage is likely to increase. Further surveys in this age group can inform overall coverage as well as use of shared clinical decision making in different population subgroups.

Introduction:The Vaccines for Children (VFC) program was established in 1994 to provide recommended vaccines at no cost to eligible children and help ensure that all U.S. children are protected from life-threatening vaccine-preventable diseases. Methods:CDC analyzed data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2-3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics. VFC eligibility was defined as meeting at least one of the following criteria: 1) American Indian or Alaska Native; 2) insured by Medicaid, Indian Health Service (IHS), or uninsured; or 3) ever received at least one vaccination at an IHS-operated center, Tribal health center, or urban Indian health care facility. Results:Overall, approximately 52.2% of U.S. children were VFC eligible. Among VFC-eligible children born during 2011-2020, coverage by age 24 months was stable for ≥1 MMR dose (88.0%-89.9%) and the combined 7-vaccine series (61.4%-65.3%). Rotavirus vaccination coverage by age 8 months was 64.8%-71.1%, increasing by an average of 0.7 percentage points annually. Among all children born in 2020, coverage was 3.8 (≥1 MMR dose), 11.5 (2-3 doses of rotavirus vaccine), and 13.8 (combined 7-vaccine series) percentage points lower among VFC-eligible than among non-VFC-eligible children. Conclusions and implications for public health practice:Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain. Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.

In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses.

Using data from the nationally representative National Immunization Survey (NIS), we applied conditional linear regression tree methodology to examine relationships between demographic and geographic factors and propensity of receiving various doses of COVID-19 vaccine over time; these analyses identified temporal changes in these relationships that heretofore had not been identified using conventional logistical regression methodologies.Three regression tree models were built using an R package, Recursive Partitioning for Modeling Survey (rpms), to examine propensities over time of receiving a (1) first dose of a two-dose COVID-19 mRNA primary vaccination series or single dose of the Janssen vaccine (vaccine initiation), (2) primary series completion, and (3) monovalent booster dose, using a conditional linear effect model. Persons ≥50 years were more likely to complete a primary series and receive a first booster dose; persons reporting having received non-COVID-19 vaccines recently were more likely to initiate vaccination, complete the primary series, and get a first booster dose; persons reporting having work or school requirements were more likely to complete the primary series. Persons not reporting having received non-COVID-19 vaccines in 2 years but reporting having work or school vaccination requirements were more likely to initiate vaccination than those without work/school requirements. Among persons not reporting having received non-COVID-19 vaccines in 2 years and not reporting having work or school vaccination requirements, those aged ≥50 years were more likely to initiate vaccination than were younger adults. Propensity of receiving various doses was correlated with age, having recently received non-COVID 19 vaccines, and having vaccination requirements at work or school.Regression tree methodology enabled modeling of different COVID-19 vaccination dose propensities as a linear effect of time, revealed changes in relationships over time between demographic factors and propensity of receipt of different doses, and identified populations that may benefit from vaccination outreach efforts.

The National Immunization Survey-Child (NIS-Child) provides annual vaccination coverage estimates in the United States for children aged 19 through 35 months, nationally, for each state, and for select local areas and territories. There is a need for vaccination coverage estimates for smaller geographic areas to support local authority planning and identify counties with potentially low vaccination coverage for possible further intervention. We describe small area estimation methods using 2008-2018 NIS-Child data to generate county-level estimates for children up to two years of age born 2007-2011 and 2012-2016. We applied an empirical best linear unbiased prediction method to combine direct estimates of vaccination coverage with model-based prediction using county-level predictors regarding health and demographic characteristics. We review the predictors commonly selected for the small area models and note multiple predictors related to barriers to vaccination.

Multiple factors may influence parental vaccine hesitancy towards pediatric COVID-19 vaccines and routine childhood immunizations (RCIs). Using the United States National Immunization Survey-Child COVID Module data collected from parents/guardians of children aged 5-11 years, this cross-sectional study (1) identified the trends and prevalence estimates of parental hesitancy towards pediatric COVID-19 vaccines and RCIs, (2) examined the relationship between hesitancy towards pediatric COVID-19 vaccines and RCIs, and (3) assessed trends in parental hesitancy towards RCIs by sociodemographic characteristics and behavioral and social drivers of COVID-19 vaccination. From November 2021 to July 2022, 54,329 parents or guardians were interviewed. During this 9-month period, the proportion of parents hesitant about pediatric COVID-19 vaccines increased by 15.8 percentage points (24.8% to 40.6%). Additionally, the proportion of parents who reported RCIs hesitancy increased by 4.7 percentage points from November 2021 to May 2022 but returned to baseline by July 2022. Over nine months, parents' concerns about pediatric COVID-19 infections declined; however, parents were increasingly worried about pediatric COVID-19 vaccine safety and overall importance. Furthermore, pediatric COVID-19 vaccine hesitancy was more prevalent among parents of children who were White (43.2%) versus Black (29.3%) or Hispanic (26.9%) and those residing in rural (51.3%) compared to urban (28.9%) areas. In contrast, RCIs hesitancy was higher among parents of children who were Black (32.0%) versus Hispanic (24.5%) or White (23.6%). Pediatric COVID-19 vaccine hesitancy was 2-6 times as prevalent among parents who were RCIs hesitant compared to those who were RCIs non-hesitant. This positive correlation between parental hesitancy towards pediatric COVID-19 vaccines and RCIs was observed for all demographic and psychosocial factors for unadjusted and adjusted prevalence ratios. Parent-provider interactions should increase vaccine confidence, shape social norms, and facilitate behavior change to promote pediatric vaccination rates.

The COVID-19 pandemic has disproportionately affected the health of food system (FS) essential workers compared with other essential and non-essential workers. Even greater disparity exists for workers in certain FS work settings and for certain FS worker subpopulations. We analyzed essential worker respondents (n = 151,789) in May–Novem­ber 2021 data from the National Immu­nization Survey Adult COVID Module (NIS-ACM) to assess and characterize COVID-19 vaccination uptake (≥1 dose) and intent (reachable, reluctant), attitudes about COVID-19 and the vaccine, and experiences and difficulties getting the vaccine. We compared rates, overall and by certain character­istics, between workers of the same group, and between FS (n = 17,414) and non–food system (NFS) worker groups (n = 134,375), to determine if differences exist. FS worker groups were classi­fied as “agriculture, forestry, fishing, or hunting” (AFFH; n = 2,730); “food manufacturing facility” (FMF; n = 3,495); and “food and beverage store” (FBS; n = 11,189). Compared with NFS workers, significantly lower percentages of FS workers reported >1 dose of COVID-19 vaccine or vaccine requirements at work or school, but overall vaccine experiences and difficulties among vaccinated FS workers were statistically similar to NFS workers. When we examined intent regarding COVID-19 vaccination among unvaccinated FS workers com­pared with NFS counterparts, we found a higher percentage of FMF and FBS workers were reach­able whereas a higher percentage of AFFH workers were reluctant about vaccination, with differences by sociodemographic characteristics. Overall, results showed differences in uptake, intent, and attitudes between worker groups and by some sociodemographic characteristics. The findings reflect the diversity of FS workers and underscore the importance of collecting occupational data to assess health inequalities and of tailoring efforts to worker groups to improve confidence and uptake of vaccinations for infectious diseases such as COVID-19. The findings can inform future re­search, adult infectious disease interventions, and emergency management planning.