, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED). † These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 * https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/peoplewith-medical-conditions.html. † Location of death for all cases (121): hospital (79 [65.3%]), home (16 [13.2%]), ED (23 [19.0%]), hospice (one [0.8%]), and unknown (2 [1.7%]).

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To examine the vaccine-related beliefs and behaviors associated with likely hesitancy toward vaccination against coronavirus disease 2019 (COVID-19) among nonelderly adults. Methods A cross-sectional survey was conducted in June 2020. Responses were sought from Tennessee adults 18 to 64 years of age who were not healthcare providers. The survey instrument focused on vaccine-related beliefs, prior and planned influenza and pneumococcal vaccine use, and attitudes toward receiving a COVID-19 vaccination. Inferential statistics assessed survey responses, and logistic regression determined predictors of the likelihood of COVID-19 vaccination. Results A total of 1,000 completed responses were analyzed (a 62.9% response rate), and respondents were mostly White (80.1%), insured (79.6%), and/or actively working (64.2%); the sample was well balanced by gender, age, income, and political leaning. Approximately one-third (34.4%) of respondents indicated some historical vaccine hesitancy, and only 21.4% indicated always getting a seasonal influenza vaccination. More than half (54.1%) indicated at least some hesitancy toward vaccination against COVID-19, with 32.1% citing lack of evidence of vaccine effectiveness as the leading reason. COVID-19 vaccine hesitancy was more likely among those with more moderate (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.749-3.607) or conservative (OR, 3.01; 95% CI, 2.048-4.421) political leanings, Black Americans (OR, 1.80; 95% CI, 1.182-2.742), and residents of nonmetropolitan areas (OR, 1.99; 95% CI, 1.386-2.865). Conclusion Subgroups of the population may prove more challenging to vaccinate against COVID-19, requiring targeted approaches to addressing hesitancy to ensure more-vulnerable populations are adequately covered.

Background: Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine's adverse effects or risks.Objective: This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies. Methods: In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the

Objective: The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations. Design: Case series. Setting: Community hospital. Participants: Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019. Methods: HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped. Results: We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b. Conclusions: A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.

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