Factors Associated With COVID-19 Non-vaccination in Adolescents Hospitalized Without COVID-19

Leila C Sahni; Ashley M Price; Samantha M Olson; Margaret M Newhams; Pia S Pannaraj; Aline B Maddux; Natasha B Halasa; Katherine E Bline; Melissa A Cameron; Stephanie P Schwartz; Tracie C Walker; Katherine Irby; Kathleen Chiotos; Ryan A Nofziger; Elizabeth H Mack; Laura Smallcomb; Tamara T Bradford; Satoshi Kamidani; Keiko M Tarquinio; Natalie Z Cvijanovich; Jennifer E Schuster; Samina S Bhumbra; Emily R Levy; Charlotte V Hobbs; Melissa L Cullimore; Bria M Coates; Sabrina M Heidemann; Shira J Gertz; Michele Kong; Heidi R Flori; Mary A Staat; Matt S Zinter; Janet R Hume; Brandon M Chatani; Mary G Gaspers; Mia Maamari; Adrienne G Randolph; Manish M Patel; Julie A Boom

doi:10.1093/jpids/piac113

Factors Associated With COVID-19 Non-vaccination in Adolescents Hospitalized Without COVID-19

J Pediatric Infect Dis Soc. 2023 Feb 9;12(1):29-35. doi: 10.1093/jpids/piac113.

Authors

Leila C Sahni¹, Ashley M Price², Samantha M Olson², Margaret M Newhams³, Pia S Pannaraj⁴, Aline B Maddux⁵, Natasha B Halasa⁶, Katherine E Bline⁷, Melissa A Cameron⁸, Stephanie P Schwartz⁹, Tracie C Walker⁹, Katherine Irby¹⁰, Kathleen Chiotos¹¹, Ryan A Nofziger¹², Elizabeth H Mack¹³, Laura Smallcomb¹⁴, Tamara T Bradford¹⁵, Satoshi Kamidani¹⁶, Keiko M Tarquinio¹⁷, Natalie Z Cvijanovich¹⁸, Jennifer E Schuster¹⁹, Samina S Bhumbra²⁰, Emily R Levy²¹, Charlotte V Hobbs²², Melissa L Cullimore²³, Bria M Coates²⁴, Sabrina M Heidemann²⁵, Shira J Gertz²⁶, Michele Kong²⁷, Heidi R Flori²⁸, Mary A Staat²⁹, Matt S Zinter³⁰, Janet R Hume³¹, Brandon M Chatani³², Mary G Gaspers³³, Mia Maamari³⁴, Adrienne G Randolph^{3

35}, Manish M Patel², Julie A Boom¹

Affiliations

¹ Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children's Hospital, Houston, Texas, USA.
² CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
⁴ Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California, USA.
⁵ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
⁶ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital Columbus, Columbus, Ohio, USA.
⁸ Division of Pediatric Hospital Medicine, UC San Diego-Rady Children's Hospital, San Diego, California, USA.
⁹ Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, North Carolina, USA.
¹⁰ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
¹¹ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹² Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA.
¹³ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁴ Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁵ Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, Los Angeles, USA.
¹⁶ The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹⁸ Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
¹⁹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
²⁰ The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
²¹ Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
²² Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA.
²³ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
²⁴ Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
²⁵ Division of Pediatric Critical Care Medicine, Children's Hospital of MI, Central Michigan University, Detroit, Michigan, USA.
²⁶ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA.
²⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁸ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan, USA.
²⁹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³⁰ Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, California, USA.
³¹ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
³² Division of Pediatric Infectious Diseases, Department of Pediatrics, UHealth/Holtz Children's Hospital, Miami, Florida, USA.
³³ University of Arizona, Diamond Children's Banner Children's Medical Center, Tucson, Arizona, USA.
³⁴ Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Medical Center Dallas, Dallas, Texas, USA.
³⁵ Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Background: Pfizer-BioNTech COVID-19 vaccine received emergency use authorization for persons ≥ 16 years in December 2020 and for adolescents 12-15 years in May 2021. Despite the clear benefits and favorable safety profile, vaccine uptake in adolescents has been suboptimal. We sought to assess factors associated with COVID-19 non-vaccination in adolescents 12-18 years of age.

Methods: Between June 1, 2021 and April 29, 2022, we assessed factors associated with COVID-19 non-vaccination in hospitalized adolescents ages 12-18 years enrolled in the Overcoming COVID-19 vaccine effectiveness network. Demographic characteristics and clinical information were captured through parent interviews and/or electronic medical record abstraction; COVID-19 vaccination was assessed through documented sources. We assessed associations between receipt of the COVID-19 vaccine and demographic and clinical factors using univariate and multivariable logistic regression and estimated adjusted odds ratios (aOR) for each factor associated with non-vaccination.

Results: Among 1665 hospitalized adolescents without COVID-19, 56% were unvaccinated. Unvaccinated adolescents were younger (median age 15.1 years vs. 15.4 years, p < .01) and resided in areas with higher social vulnerability index (SVI) scores (median 0.6 vs 0.5, p < .001) than vaccinated adolescents. Residence in the Midwest [aOR 2.60 (95% CI: 1.80, 3.79)] or South [aOR 2.49 (95% CI: 1.77, 3.54)] US census regions, rarely or never receiving influenza vaccine [aOR 5.31 (95% CI: 3.81, 7.47)], and rarely or never taking precautions against COVID-19 [aOR 3.17 (95% CI: 1.94, 5.31)] were associated with non-vaccination against COVID-19.

Conclusions: Efforts to increase COVID-19 vaccination of adolescents should focus on persons with geographic, socioeconomic, and medical risk factors associated with non-vaccination.

Keywords: COVID-19 vaccine; adolescent; risk factors.

© The Author(s) 2022. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MeSH terms

Adolescent
BNT162 Vaccine
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
Electronic Health Records
Humans
Vaccination

Substances

COVID-19 Vaccines
BNT162 Vaccine