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A COVID-19 vaccine booster dose is intended to boost the immune system for better, long-lasting protection when the primary vaccine response decreases over time. Studies have shown that a booster increased the immune response in trial participants who completed a Pfizer-BioNTech (https://www.pfizer.com) or Moderna (https://www.modernatx.com) primary series 6 months earlier or who received a Johnson & Johnson/Janssen (https://www.jnj.com) singledose vaccine 2 months earlier (1,2).With an increased immune response, booster doses provide additional protection against both Delta and Omicron variants for clinical COVID-19 emergency department visits and hospitalization even for those persons who have received an initial vaccine series (1,3). For example, the mRNA vaccine effectiveness (VE) against emergency room visits during the period of Delta predominance was 76%-86% after the second initial dose and 94% after a booster dose; estimates of VE during Omicron variant predominance were 38%-52% after the second initial dose and 82% after a booster dose. VE against hospitalizations during the period of Delta predominance was 81%-90% after the second initial dose and 94% after a booster dose, and estimates of VE for during Omicron variant predominance were 57%-81% after the second initial dose and 90% after a booster dose (3).The Centers for Diseases Control and Prevention (CDC) first recommended booster doses for select populations in September 2021 and on November 29, 2021, recommended that all persons >18 years of age should get a booster dose when eligible (1,2). By March 2022, approximately 84% of American adults were fully vaccinated with the COVID-19 primary vaccine series; primary vaccine series completion rates varied by some social-demographic characteristics (4). Receiving a COVID-19 booster dose is useful both to prevent COVID-19-related illness and death and slow the spread of COVID-19 in the United States. The objective of this study was to assess COVID-19 booster dose vaccination coverage by demographics and behaviors and experiences

Purpose To inform expectations around the ongoing COVID-19 vaccination campaign, we analyzed associations of COVID-19 priority grouping, socio-demographics, and behavioral factors with receiving flu vaccine. Methods Using the 2018 National Health Interview Survey, we classified 24,772 adults into four COVID-19 vaccination priority groups: healthcare workers, medically vulnerable, non-healthcare essential workers, and the general population. We performed multiple logistic regression to compare the relative odds of receiving flu vaccine by priority group, socio-demographics, and health-related factors. Results Healthcare workers, medically vulnerable adults, essential workers, and the general population comprise 8.9%, 58.4%, 6.6%, and 26.1 % of the US population, respectively. Compared with healthcare workers, the adjusted odds ratio (aOR) of receiving flu vaccine were significantly lower in medically vulnerable adults (aOR=0.43, 95% CI=0.37, 0.48), essential workers (aOR=0.28, 95% CI=0.23, 0.34), and the general population (aOR=0.32, 95% CI=0.28, 0.37). Being young, male, Black, and having no health insurance were associated with lower relative odds of receiving the flu vaccine. Conclusions Patterns of seasonal flu vaccine portend slower coverage of the COVID-19 vaccine across the US as eligibility expands to the general population.

Background There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. Methods The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. Results Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. Conclusions IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.

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