Jeneita Bell, MD1,*; Lu Meng, PhD1,*; Kira Barbre, MPH1,2; Emily Haanschoten, MSPH1,3; Hannah E. Reses, MPH1; Minn Soe, MBBS1; Jonathan Edwards, MStat1; Jason Massey1,4; Gnanendra Reddy Tugu Yagama Reddy, MS1,2; Austin Woods1,4; Matthew J. Stuckey, PhD1; David T. Kuhar, MD1; Kayla Bolden, MPH1,5; Heather Dubendris, MSPH1,3; Emily Wong, MPH1; Theresa Rowe, DO1; Megan C. Lindley, MPH6; Elizabeth J. Kalayil, MPH1,3; Andrea Benin, MD1 (View author affiliations)
What is already known about this topic?
CDC and the Advisory Committee on Immunization Practices recommend that health care personnel (HCP) receive an annual influenza vaccine and stay up to date with recommended COVID-19 vaccination.
What is added by this report?
During the 202223 influenza season, influenza vaccination coverage was 81% among HCP at acute care hospitals and 47% among those at nursing homes. Up-to-date COVID-19 vaccination coverage was 17% among HCP at acute care hospitals and 23% among those at nursing homes.
What are the implications for public health practice?
There is a need to promote evidence-based strategies to improve vaccination coverage among HCP. Tailored strategies might be useful to reach all HCP with recommended vaccines to protect them and their patients from vaccine-preventable respiratory diseases.
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The Advisory Committee on Immunization Practices recommends that health care personnel (HCP) receive an annual influenza vaccine and that everyone aged 6 months stay up to date with recommended COVID-19 vaccination. Health care facilities report vaccination of HCP against influenza and COVID-19 to CDCs National Healthcare Safety Network (NHSN). During JanuaryJune 2023, NHSN defined up-to-date COVID-19 vaccination as receipt of a bivalent COVID-19 mRNA vaccine dose or completion of a primary series within the preceding 2 months. This analysis describes influenza and up-to-date COVID-19 vaccination coverage among HCP working in acute care hospitals and nursing homes during the 202223 influenza season (October 1, 2022March 31, 2023). Influenza vaccination coverage was 81.0% among HCP at acute care hospitals and 47.1% among those working at nursing homes. Up-to-date COVID-19 vaccination coverage was 17.2% among HCP working at acute care hospitals and 22.8% among those working at nursing homes. There is a need to promote evidence-based strategies to improve vaccination coverage among HCP. Tailored strategies might also be useful to reach all HCP with recommended vaccines and protect them and their patients from vaccine-preventable respiratory diseases.
Vaccination of health care personnel (HCP) is a critical strategy to minimize transmission of infection in health care settings (1,2). HCP are at high risk for work-related exposure to viruses such as influenza and SARS-CoV-2 but are less likely to transmit these infections when they are vaccinated (3). The Advisory Committee on Immunization Practices (ACIP) recommends that HCP receive an annual influenza vaccine (4). ACIP also recommends that persons aged 6 months stay up to date with recommended COVID-19 vaccination. The Centers for Medicare & Medicaid Services (CMS) monitors the implementation of these recommendations by requiring health care facilities such as nursing homes and acute care hospitals to report influenza and COVID-19 vaccination coverage among HCP** to CDCs National Healthcare Safety Network (NHSN). This study examined influenza and up-to-date COVID-19 vaccination coverage among HCP working in acute care hospitals and nursing homes during the 202223 influenza season.
Acute care hospitals and nursing homes report data to NHSN according to surveillance protocols for influenza and COVID-19 vaccination. Acute care hospitals and nursing homes began reporting COVID-19 vaccination among HCP in 2021; nursing homes were required to report influenza vaccination among HCP for the first time during the 202223 influenza season. To assess influenza vaccination coverage, facilities are required to report an annual count of HCP working in the facility for 1 day during an influenza season (October 1March 31) and the number of HCP who 1) received influenza vaccination, 2) had a medical contraindication to influenza vaccination, 3) declined vaccination, and 4) had unknown vaccination status. The protocol for COVID-19 vaccination coverage includes parallel data fields for COVID-19; however, data collection occurs at a different cadence. Nursing homes and acute care facilities report on schedules mandated by their respective regulatory programs at CMS. Nursing homes submit COVID-19 vaccination coverage weekly; acute care facilities submit 1 week of data per month.*** Both types of facilities report COVID-19 vaccination coverage data among HCP who were eligible to work in the facility 1 day during the reporting week.
To assess HCP vaccination coverage during the 202223 influenza season, analyses were conducted using influenza and up-to-date COVID-19 coverage data (specifically, up-to-date COVID-19 coverage data from the week ending March 26, 2023, or the last submitted week of data) reported to NHSN. NHSN defined up-to-date COVID-19 vaccination as the receipt of a bivalent booster dose or completion of a primary series within the previous 2 months (i.e., not yet eligible to receive a bivalent vaccine). Facilities reporting data for both vaccine types and employing at least five HCP were included in the analysis. Pooled mean influenza and up-to-date COVID-19 vaccination coverage rates were calculated as the number of HCP who had received each recommended vaccine or vaccination series divided by the number of HCP working in all facilities. HCP reported to have a medical contraindication to COVID-19 vaccination were subtracted from the denominator of the up-to-date COVID-19 vaccination coverage calculation, to align with the measure adopted by CMSs quality reporting programs. Coverage with each vaccine was calculated for HCP working at each facility type (nursing home or acute care hospital). Results were further stratified by employment category (employee, licensed practitioner, and student or volunteer); rural-urban classification (rural or urban); county-level social vulnerability index (SVI) tertile****; facility size tertile; state; and U.S. region. Counties in a lower SVI tertile are less socially vulnerable than are those in an upper SVI tertile. All analyses were conducted using SAS (version 9.4; SAS Institute). This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.
Among approximately 8.4 million HCP working in 4,057 acute care hospitals, influenza vaccination coverage was 81.0% overall (Table 1); coverage was lowest (67.2%) among nonemployee licensed practitioners and was substantially higher among employees (83.1%) and nonemployee students and volunteers (85.2%). Among HCP working in acute care hospitals, influenza vaccination coverage was highest in the Midwest (84.7%) and lowest in the Pacific region (74.4%).
Among approximately 2.0 million HCP working in 13,794 nursing homes, influenza vaccination coverage was 47.1% overall; coverage was lowest among employees (46.1%) and substantially higher among nonemployee licensed practitioners (55.3%) and nonemployee students and volunteers (57.7%). Among HCP working in nursing homes, influenza vaccination coverage was highest in the Pacific region (61.1%) and lowest in the South (39.7%). Influenza vaccination coverage among HCP was similar across facility size, urban-rural status, and SVI for both nursing homes and acute care hospitals. Nursing homes in six states reported influenza vaccination coverage of 75% among HCP, whereas this level of coverage was reported in acute care hospitals in 40 states (Figure) (Supplementary Table, https://stacks.cdc.gov/view/cdc/134928).
Among approximately 7.7 million HCP working in 4,057 acute care hospitals, up-to-date COVID-19 vaccination coverage was 17.2% overall (Table 2) and was highest in the Pacific region (28.9%) and lowest in the Mountain region (9.1%). No substantial differences by staff member type or urbanicity were observed.
Among approximately 1.6 million HCP working at 13,794 nursing homes, up-to-date COVID-19 vaccination coverage was 22.8% overall; coverage was highest among nonemployee licensed practitioners (28.2%) and lowest among employees (22.4%). Among HCP working in nursing homes, up-to-date COVID-19 vaccination coverage was highest among those working in the Pacific region (40.7%) and lowest among those working in the South (17.5%). Up-to-date COVID-19 vaccination was also substantially higher among HCP working at nursing homes in urban (24.2%) than in rural (17.5%) areas. No substantial differences in COVID-19 vaccination coverage among HCP by facility staff size or SVI were observed at either facility type. Up-to-date COVID-19 vaccination coverage was 20% among HCP working in nursing homes in 30 states but among HCP in acute care hospitals, approximately one half as many states (16) achieved this level of coverage (Supplementary Table, https://stacks.cdc.gov/view/cdc/134928).
During the 202223 influenza season, fewer than one quarter of HCP working in acute care hospitals and nursing homes were up to date with recommended COVID-19 vaccination, and fewer than one half of HCP working in nursing homes had received influenza vaccine. Coverage varied by geographic region, health care facility type, employment category, and urbanicity. Recent reports indicate that influenza and COVID-19 vaccination coverage among HCP has declined during the COVID-19 pandemic (5). During the 201718 and 201819 influenza seasons, influenza vaccination coverage among HCP in acute care hospitals was 88.6% and 90.0%, respectively (6). From November 2021 to June 2023, CMS required all HCP at CMS-certified facilities to be vaccinated for COVID-19*****; this requirement likely contributed to COVID-19 primary series vaccination coverage reaching 94.3% among HCP in nursing homes (7) and 91.2% among those at acute care hospitals (5). The current findings suggest that factors associated with low vaccination coverage might have been exacerbated by the COVID-19 pandemic and compounded by emerging concerns such as vaccine fatigue (8) and other as yet unidentified factors.
In this analysis, up-to-date COVID-19 vaccination coverage was higher among HCP working in nursing homes than among those working in acute care hospitals. CMS requires nursing homes to report weekly up-to-date COVID-19 vaccination status among HCP and publishes weekly results on a public-facing website; this might have resulted in higher coverage among HCP in nursing homes. CDC also worked with nursing homes to facilitate access to vaccination for both patients and staff members, which might have also improved coverage.
This report identified low up-to-date COVID-19 vaccination coverage among HCP in both acute care hospitals and nursing homes and low influenza vaccination coverage among HCP in nursing homes, both important threats to patient health and safety that need to be addressed. Implementation of vaccination recommendations for HCP has been a long-standing challenge for the public health and health care sectors. In an effort to improve vaccination coverage among HCP, health care facilities and federal and state governments have implemented interventions including jurisdiction-wide and facility-wide vaccination mandates (7,9). Mandates for HCP to receive influenza vaccination have been in place since before the COVID-19 pandemic and might contribute to the high vaccination rates reported to NHSN. However, such mandates might not be easily enforceable among nonemployee HCP in acute care hospitals, among whom coverage with both vaccines was lower than that among employees. Compared to influenza vaccines, COVID-19 vaccines are newer, and availability can be more sporadic; therefore, facilities do not have as much experience promoting vaccination and might not have the ability to conduct mass vaccination events. This might have contributed to lower COVID-19 vaccination coverage. Further, given the variations in vaccination coverage by region and urbanicity, campaign strategies tailored by region and focusing on rural areas might have the potential to increase vaccination coverage.
The findings in this report are subject to at least four limitations. First, influenza vaccination and up-to-date COVID-19 vaccination coverage rates were reported separately using different definitions of total HCP working within the facility. Whether the same personnel are represented in seasonal influenza vaccination coverage counts and weekly COVID-19 vaccination counts is unknown. This nuance limits the direct comparability of coverage with the two vaccines; therefore, statistical comparisons of vaccination coverage were not conducted. Second, this report includes data reported by facilities on behalf of HCP, which could have resulted in underestimates of vaccination acquired outside the health care facility, particularly by HCP not employed directly by the reporting facility. Third, vaccination coverage could not be stratified by recent history of SARS-CoV-2 infection. CDC recommendations state that persons may consider delaying an updated vaccine by 3 months after infection. Therefore, some persons might not have considered themselves eligible for vaccination, leading to an underestimate of COVID-19 vaccination coverage. Finally, this analysis was conducted using aggregate data reported to NHSN at the facility level. Therefore, vaccination coverage could not be stratified by person-level covariates that might have enabled an assessment of potential differences, such as age, race, and ethnicity.
Closely monitoring influenza and up-to-date COVID-19 vaccination coverage among HCP might help facilitate evaluation of effective implementation of vaccination promotion strategies. Studies are needed to identify additional factors associated with low vaccination coverage and approaches to improve coverage among HCP, with particular attention to geographic region, health care facility type, and employment category. Understanding these factors and promoting evidence-based strategies to increase vaccination coverage among HCP, such as making vaccines free and accessible at work (10), might allow for targeted interventions to improve coverage during future respiratory virus seasons. HCP should receive annual influenza vaccines and remain up to date with recommended COVID-19 vaccination to protect themselves and their patients from vaccine-preventable diseases.
1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 2Goldbelt C6, Chesapeake, Virginia; 3Lantana Consulting Group, East Thetford, Vermont; 4Chenega Enterprise Systems & Solutions, LLC, Chesapeake, Virginia; 5CACI International, Inc, Reston, Virginia; 6Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC.
Abbreviation: HCP=health care personnel. * Each facility reported summary influenza vaccination data among HCP working in the facility for 1 day during October 1, 2022March 31, 2023. Up-to-date COVID-19 vaccination coverage was reported to National Healthcare Safety Network each week; data from the week ending March 26, 2023, or the last submitted week of data, were used for analysis. Facility size was calculated separately for acute care hospitals and nursing homes and was based on the tertile distribution of the total number of staff members per facility. https://www.cdc.gov/nchs/data_access/urban_rural.htm https://www.atsdr.cdc.gov/placeandhealth/svi/index.html ** South: Alabama, Arizona, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Mountain: Colorado, Idaho, Montana, Nevada, Utah, and Wyoming; Pacific: Alaska, California, Hawaii, Oregon, and Washington; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
* Up-to-date COVID-19 vaccination coverage was defined by the National Healthcare Safety Network during the study period as the receipt of a bivalent booster dose, completion of a primary series, or receipt of a monovalent booster dose within the previous 2 months.
Each facility reported summary influenza vaccination data among health care personnel working in the facility for 1 day during October 1, 2022March 31, 2023. Up-to-date COVID-19 vaccination coverage was reported to the National Healthcare Safety Network each week; data from the week ending March 26, 2023, or the last week of submitted data, were used for analysis.
Abbreviations: HCP=health care personnel. * COVID-19 up-to-date coverage was defined by National Healthcare Safety Network during the study period as the receipt of a bivalent booster dose or completion of a primary series or receipt of a monovalent booster dose within the previous 2 months. Each facility reported summary influenza vaccination data among HCP working in the facility for 1 day during October 1, 2022March 31, 2023. Up-to-date COVID-19 vaccination coverage was reported to National Healthcare Safety Network each week; data from the week ending March 26, 2023, or the last submitted week of data, were used for analysis. Facility size was calculated separately for acute care hospitals and nursing homes and was based on the tertile distribution of the total number of staff members per facility. https://www.cdc.gov/nchs/data_access/urban_rural.htm ** https://www.atsdr.cdc.gov/placeandhealth/svi/index.html South: Alabama, Arizona, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Mountain: Colorado, Idaho, Montana, Nevada, Utah, and Wyoming; Pacific: Alaska, California, Hawaii, Oregon, and Washington; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
Suggested citation for this article: Bell J, Meng L, Barbre K, et al. Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel National Healthcare Safety Network, United States, 202223 Influenza Season. MMWR Morb Mortal Wkly Rep 2023;72:12371243. DOI: http://dx.doi.org/10.15585/mmwr.mm7245a5.
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Suffolk County reported the following information related to COVID-19 on November 7, 2023
According to CDC, hospital admission rates and the percentage of COVID-19 deaths among all deaths are now the primary surveillance metrics.
COVID-19 Hospitalizations for the week ending October 28, 2023
Daily Hospitalization Summary for Suffolk County From November 3, 2023
NOTE: HOSPITALS ARE NO LONGER REPORTING DATA TO NYSDOH ON WEEKENDS OR HOLIDAYS.
Fatalities 11/6/23
COVID-19 Case Tracker November 4, 2023
Note: As of May 11, 2023, COVID-19 Community Levels (CCLs) and COVID-19 Community Transmission Levels are no longer calculatable, according to the Centers for Disease Control and Prevention.
* As of 4/4/22, HHS no longer requires entities conducting COVID testing to report negative or indeterminate antigen test results. This may impact the number and interpretation of total test results reported to the state and also impacts calculation of test percent positivity. Because of this, as of 4/5/22, test percent positivity is calculated using PCR tests only. Reporting of total new daily cases (positive results) and cases per 100k will continue to include PCR and antigen tests.
COVID-19 Vaccination Information
Last updated 5/12/23
Vaccination Clinics
As of September 12, 2023, the Suffolk County Department of Health Services is not authorized to offer COVID-19 vaccines to ALL Suffolk County residents.
The department will offer the updated vaccine to only uninsured and underinsured patients through New York State's Vaccines for Children program and Vaccines for Adults program, also known as the Bridge Access Program.
Those with insurance that covers the COVID-19 vaccine are encouraged to receive their vaccines at their local pharmacies, health care providers offices, or local federally qualified health centers.
The department has ordered the updated COVID-19 vaccine and will announce when the vaccine becomes available.
FOR HEALTHCARE PROVIDERS
New York State Links
CDC COVID Data Tracker Rates of laboratory-confirmed COVID-19 hospitalizations by vaccination status
For additional information or explanation of data, click on the links provided in throughout this page.
Trending on Billboard
Nicki Minaj faced quite a bit of backlash in 2021 for sharing her stance against the coronavirus vaccine. Now, more than two years later, shes still not walking back.
In one of the rappers biggest controversies to date, Minaj was accused of spreading misinformation back when the government first started rolling out preventative shots about a year and a half deep into the global pandemic. Revealing at the time that she wouldnt be attending that years Met Gala because she hadnt been vaccinated, which was required of guests, the Barbie World artist also tweeted that a cousins friend in Trinidad had become impotent after the COVID-19 vaccine allegedly caused his testicles to swell.
Her tweets earned concerned responses from Dr. Anthony Fauci, the Trinidad & Tobago Health Minister and even the Philadelphia Health Department, each of them debunking her claim and emphasizing that there was no scientific basis to the side effects supposedly made by her cousins friend. She became the butt of late-night jokes and even went toe to toe with both the White House and Piers Morgan over the controversy. But in a new interview, Minaj had no regrets to share.
Im one of those people who doesnt go with a crowd, she told Vogue in her December cover story published Thursday (Nov. 9). I like to make my own assessment of everything without help from everyone.
Every time I talk about politics, people get mad, Minaj added. Im sorry, but I am not going to be told who I should get on social media and campaign for. Theres a lot we dont know thats going on in the government, and I dont think it changes whether you lean to the left or right.
The interview comes one month ahead of Minajs upcoming album, Pink Friday 2, which was originally scheduled to arrive Oct. 20 before being pushed back to Nov. 17. In late October, the Queen of Rap announced that the project would be postponed once more to Dec. 8, her 41st birthday.
See Nicki Minajs Vogue cover and photos below:
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Edmonton
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Posted: March 21, 2020
With the COVID-19 pandemic forcing businesses to shut down and workers to self-isolate, the provincial and federal governments are implementing measures that will provide Albertans with some financial relief. Here's what has been announced so far.
Those who have worked at least 600 hours in the last 52 weeks can qualify for Employment Insurance (EI).
EI benefits are available to those who have lost their job through no fault of their own and are available to work.
Those who qualify can also apply for the EI sickness benefit, which can giveup to 15 weeks of payment, worth 55 per cent of earnings to a maximum of $573 per week.
The federal government also removed the one-week waiting period for sickness benefits for those who have been told to self-isolate or quarantine.
If you qualify for EI and are also caring for someone who is critically ill, you can also apply for EI caregiver benefits. That adds between15 and35 weeks of payments, worth up to 55 per cent of the individual's usual pay or $573 per week, whichever is less. Those who qualifycan apply on the EI website.
In addition, the province is also offering emergency isolation support.That will give workers who had to self-isolate or care for a person who needed to self-isolate and don't have another source of payment,a one-time payment of $573 for two weeks while they're waiting for federal benefits. Albertans can apply online starting next week.
The federal government is offering the emergency care benefit for people who can't work because of self-isolation or for people caring for someone else who is ill. This benefit gives individuals up to 15 weeks of payment, worth up to $450 per week.
Another benefit offered by Canada is the emergency support benefit, offered to people who have lost their ability to work because of public health orders and don't qualify for EI. That includes self-employed individuals and contractors. The details of how much it is and how to get it is coming in the next few weeks.
Application for both benefits are done online through the CRA.
Canada has announced the new Business Credit Availability program, which will provide lending support to small, medium and large businesses experiencing cash-flow challenges.
The details of how much money businesses qualify for and how to get support are still being developed by the government.
"Businesses looking to take advantage of the recently announced $10B Business Credit Availability program should first see their own financial institution for support and assessment, and then, if the support required extends beyond what the financial institution can provide, the business will be referred to BDC or[Export Development Canada]," saidShawn Salewski, spokesperson for the Business Development Bank of Canada.
Ottawa also created,through the Office of the Superintendent of Financial Institutions, $300B in additional lending capacity for financial institutions to provide more credit to their clients,Salewski said.
Charles St-Arnaud, chief economist for Alberta Central,thecentral banking facility for Alberta's credit unions,said employers can also apply for a federal wage subsidy, which for the next 90 dayswill grant employers up to a maximum of $1,375 per employee and $25,000 per employer.
Businesses can also defer to pay their income tax for six months, untilAug. 31, without interestand penalties for tax amounts owing from now to September.
Canada's six big banks have agreed to allow people to defer mortgage payments for up to six months. Those are the Bank of Montreal, CIBC, National Bank of Canada, RBC Royal Bank, Scotiabank and TD Bank. Credit unions are also coming up with a similar program.
"It's really just lengthening your amortization schedule," said Lorne Rackel, general manager and broker of record withJayman Financial.
"By no means are those payments of interests being waived. They're just being tacked onto the back of the back of the mortgage," he said.
Rackel saidit's essentially the principal amount and interest that's being deferred.
He said most banks have now set up teams and call centres to deal with the requests, so people who want a deferral should look at the call options provided by their bank.
Alberta has announced a six month, interest-free moratorium on student loan payments. Payments can be paused for six months starting on March 30 and students don't have to apply for the repayment pause. The same applies for federal student loan debt. Borrowers can continue making payments during this period if they wish.
The province said residential, farm and small commercial customers can defer their utility bill payments for the next 90 days and no one will be cut off from these services during the crisis. This includes electricity and natural gas.
Rackel said it's possible for people to get deferral on other loans and credit card debts, so people should reach out directly to their bank and lenders for more information.
Jennifer Robson, associate professor in political management at Carleton University, said people who qualify for the GST credit and the Canada Child Benefit will also get a big top upsoon.
Robson urges people to file their taxes to get their returns, which could include those benefits.
"Make sure you're signing for those benefits you're entitled to," she said.
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For 10 days after the first dose, Jamie was fine. He went home and went about his normal life. Then, on the morning of May 3, his and the familys life fell apart. Kate recalls what happened next. Jamie complained of tiredness and Kate let him sleep in, taking the boys downstairs for breakfast. An hour later, he vomited, recalls Kate. The noise of his retching was unlike anything she had ever heard. It sounded different. I came upstairs to check on him. At this point his speech was impaired. I thought he was having a stroke. He just wasnt speaking a language and he didnt know where he was or who I was.
An ambulance was called, taking Jamie to the local hospital where physicians there diagnosed a suspected case of Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT). Their quick thinking helped to save Jamies life. The hospital knew it was too small and did not have the expertise to treat Jamie and, as he threatened to slip away, another ambulance took him to Coventry hospital.
His condition continued to deteriorate. Despite the Covid restrictions in place at the time, Jamies father was summoned to his bedside along with Kate, who was keeping vigil. By this time he was non-communicative and didnt know who I was, says Kate.
The situation was now desperate. Coventry hospital summoned an air ambulance to get Jamie to Birmingham for an emergency operation at the one hospital in the region with the expertise to carry it out. But a storm prevented the helicopter from flying and Jamie was rushed there by road instead. Queen Elizabeth Hospital in Birmingham was the third hospital to treat Jamie in the course of just one day. Doctors there would keep him alive.
Jamie was in surgery for three hours for what was a catastrophic bleed on the brain. An MRI scan showed the damage to an area of the brain 97mm by 47mm, almost four inches by almost two inches. It is equivalent to about the area of a credit card. That now is dead tissue, says Kate.
The reason this was so complicated to treat and the reason Jamie is lucky to be alive is this had never happened before. It [VITT] didnt exist. It is why she knows the vaccine was responsible for Jamies near death; why it was the cause of the bleed on the brain. The vaccine had caused both a massive clot at the entrance to the brain and a bleed on the inside. Treating the clot risked worsening the bleed, says Kate.
Jamie underwent a craniotomy, removing part of his skull to reduce the swelling. For the next four weeks and five days he was in a coma on a ventilator and with a tracheotomy put in his throat. Through the whole terrifying time, Kate was largely refused permission to see her husband because of strict Covid regulations inside the intensive care unit. Their children, at the time aged four and eight months, did not see their father for four months. Only the previous month, Downing Street staffers had been enjoying illegal parties inside the seat of power, including one on the eve of the Duke of Edinburghs funeral.
Kate saw her husband when the hospital was fairly sure he was dying. Three times I was called in to say goodbye; three times I was called in because they thought he wasnt going to make it, says Kate. But the boys didnt see him for 122 days. For them their dad just disappeared. He couldnt communicate and he couldnt Facetime. He was just gone. That was so hard.
Kate was persistent and in the end negotiated with the hospital authorities that she could visit Jamie for an hour each week. I was luckier than others, she says with an optimism born out of extreme hardship. Jamie is a medical miracle. If you see the damage on the MRI scan you can understand that.
Kate admits it is both hard and sad to talk about what happened to Jamie. She does a lot of talking for him. I still get goosebumps. He was my perfect partner, he was the perfect date. The hardest thing for Jamie now is he is not able to be that same dad and husband. We have two boys who are energetic. They love playing football and climbing trees and Jamie cant do that anymore. He remembers that he could. He has that constant internal battle with himself, knowing what life was like before and knowing his limitations and understanding he cant do anything about that because of the size of the bleed.
The U.S. Food and Drug Administration (FDA) on Thursday announced its approval of Ixchiq, the first chikungunya vaccine.
The vaccine, which is made by Valneva, is approved for anyone age 18 and older who has a risk of being exposed to the virus.
The chikungunya virus is transmitted to people through bites from infected mosquitoes.
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"This virus is in a similar category as dengue or Zika and is carried by the same mosquitoes," noted Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor.
The FDA described chikungunya as an "emerging global health threat," with at least five million cases reported over the past 15 years.
The chikungunya virus is transmitted to people through bites from infected mosquitoes. The FDA called chikungunya an "emerging global health threat." (iStock)
"Infection with chikungunya virus can lead to severe disease and prolonged health problems, particularly for older adults and individuals with underlying medical conditions," said Peter Marks, M.D., PhD, director of the FDAs Center for Biologics Evaluation and Research, in a press release on Thursday.
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"Todays approval addresses an unmet medical need and is an important advancement in the prevention of a potentially debilitating disease with limited treatment options," he also said.
Before the FDAs approval, the vaccines safety was tested in clinical trials that included 3,500 adults.
The Ixchiq vaccine is a single-dose injection that contains a weakened form of the virus. (REUTERS/Emily Elconin/File photo)
Participants most commonly reported headache, muscle pain, fatigue, joint pain, nausea, fever and tenderness at the injection site as side effects.
A small share of recipients (1.6%) experienced adverse reactions, with two of the recipients needing to be hospitalized, per the FDAs release.
In a separate study, the vaccines efficacy was measured based on the immune response data of 266 adult participants.
Almost all of them were shown to have protective antibody levels.
The most common symptoms are fever and joint pain, with some people also experiencing headache, muscle pain, joint swelling or rash, according to the Centers for Disease Control and Prevention (CDC).
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Symptoms usually begin within three to seven days after transmission.
Most people who contract the virus get better within a week.
In rare cases, the virus can cause severe and long-lasting joint pain.
Signage is seen outside the Food and Drug Administration (FDA) headquarters in White Oak, Maryland, on Aug. 29, 2020. The agency on Thursday announced its approval of Ixchiq, the first chikungunya vaccine. (REUTERS/Andrew Kelly/File Photo)
Those at highest risk for adverse health effects include older adults, newborns who contract the infection at birth, and people with heart disease, diabetes or high blood pressure, per the CDC.
Deaths from the virus are very rare.
Mosquitoes carrying the chikungunya virus are endemic in Africa, Southeast Asia and parts of the Americas, the FDA stated in its release.
Before 2013, cases of the chikungunya virus were primarily documented in Africa, Asia, Europe, and the Indian and Pacific Oceans.
DENGUE FEVER: WHAT YOU NEED TO KNOW ABOUT THE MOSQUITO-BORNE ILLNESS SWEEPING JAMAICA
In late 2013, the first local cases were documented in Caribbean countries, which then led to the virus spreading throughout the Americas, the CDC stated.
For those who have been exposed and have symptoms, a blood test can confirm the presence of chikungunya or other similar viruses.
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People who are infected and experience symptoms should rest, stay hydrated with fluids and take over-the-counter medications, such as acetaminophen or paracetamol, to relieve and reduce fever, according to the CDC.
People who are traveling to countries where the virus is prevalent can reduce their risk by using insect repellent, wearing long-sleeved shirts and pants, and staying indoors or in screened areas.
People who are traveling to countries where the virus is prevalent can reduce their risk by using insect repellent, wearing long-sleeved shirts and pants, and staying indoors or in screened areas. (iStock)
Siegel noted that the vaccine which he deems "safe and effective" contains a live weakened version of the virus vaccine.
"That means it is not intended for [the] immunocompromised, but it is useful for those at risk of severe cases of chikungunya," he told Fox News Digital.
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Added the doctor, "The vaccine is being fast-tracked, which for me means I would give it to those most at risk first, while watching post-marketing studies over next year."
For more Health articles, visit www.foxnews.com/health.
The legal action being brought against AstraZeneca over the side-effects of its Covid vaccine challenges the usual narrative surrounding the UKs inoculation programme. The drug was developed in Oxford and hailed as a triumph for British scientific endeavour.
However, scores of people have either died or been left disabled by brain injuries caused by the vaccine. The High Court is to hear two test cases for damages over a new condition known as Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT).
The vaccines role has been largely acknowledged and sums paid out under the Vaccine Compensation Scheme. But the families say the 120,000 tax-free payment is not enough to compensate for loss of a bread-winner or the ability to work.
The claim maintains that the AstraZeneca vaccine was defective in that it was not as safe as individuals were entitled to expect. However, this should not detract from the signal success of the vaccination programme which is credited with saving millions of lives. Adverse effects, while tragic for some, were extremely rare and not confined to Covid jabs.
People know that there are risks and side effects associated with most medicines, which always need to be balanced against the benefits of taking them. Furthermore, it is important that this does not play into the hands of those who seek to tarnish all vaccines.
One lesson to be learnt it is that young, healthy people should not have been forced, through restrictions on their movements, to be vaccinated against a disease that hardly affected them.
A BMJ investigation has raised concerns that the VAERS system isnt operating as intended and that signals are being missed. Jennifer Block reports
Three weeks after receiving a second dose of a covid vaccine, Robert Sullivan collapsed at home on his treadmill. An anaesthesiologist in Maryland, USA, he was a particularly fit 49 year old: the week before falling ill, hed been happily skiing at altitude in Colorado.
Sullivan was given a diagnosis of sudden onset pulmonary hypertension, which is generally progressive, can be fatal, and in most cases cant be cured. The condition is rare, especially in middle aged men. Sullivan decided to file a report in the Vaccine Adverse Event Reporting System (VAERS), which collects reports of symptoms, diagnoses, hospital admissions, and deaths after vaccination for the purpose of capturing post-market safety signals.
But the submission process was a glitchy race against the clock. The format is cumbersome and it times you out, he tells The BMJ. For his troubles, Sullivan received a confirmation by email and a temporary e-report number. He learnt from his doctors office that a VAERS representative had requested medical records. Then he didnt hear back for a year.
VAERS is supposed to be user friendly, responsive, and transparent. However, investigations by The BMJ have uncovered that its not meeting its own standards. Not only have staffing levels failed to keep pace with the unprecedented number of reports since the rollout of covid vaccines but there are signs that the system is overwhelmed, reports arent being followed up, and signals are being missed.
The BMJ has spoken to more than a dozen people, including physicians and a state medical examiner, who have filed VAERS reports of a serious nature on behalf of themselves or patients and were never contacted by clinical reviewers or were contacted months later.
Our investigation has also found that, in stark contrast to the US governments handling of adverse reaction reports on drugs and devices, the publicly accessible VAERS database on vaccines includes only initial reports, while case updates and corrections are kept on a separate, back end system. Officials told The BMJ that this was to protect patient confidentialitybut this means that patients, doctors, and other public users of the database have access only to an incomplete and uncorrected version.
Co-managed by the US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration, the VAERS reporting system relies on a mixture of voluntary adverse event reports from doctors and patients and mandatory reporting from vaccine manufacturers, which are required by law to report all adverse events they become aware of.
Good pharmacovigilance requires prompt data collection, review by people with clinical expertise, and adequate follow-up, says Marie Lindquist, former director of the Uppsala Monitoring Centre in Sweden, an internationally recognised non-profit pharmacovigilance body. We know that even the best clinical trials wont detect [rare adverse events], she tells The BMJ.
VAERSs standard operating procedure for covid-19 states that reports must be processed quickly, within days of receipt.12 Serious reports trigger the requisition of medical records and at minimum a manual review, while deaths and other adverse events of special interest may undergo a more in-depth clinical review by CDC staff.
However, The BMJ has learnt that in the face of an unprecedented 1.7 million reports since the rollout of covid vaccines, VAERSs staffing was likely not commensurate with the demands of reviewing the serious reports submitted, including reports of death. While other countries have acknowledged deaths that were likely or probably related to mRNA vaccination, the CDCwhich says that it has reviewed nearly 20000 preliminary reports of death using VAERS (far more than other countries)has not acknowledged a single death linked to mRNA vaccines.
Before the pandemic VAERS was receiving nearly 60000 adverse event reports each year. A 2015 CDC article suggests that the agency had the capacity to request records for just a few thousand serious reports each year.3 But in 2021 the total number of reports shot up to a million, and another 660000 have been filed since. Nearly one in five meet the criteria of serious. This surge reflects the unprecedented campaign to vaccinate against covid-19in the US alone some 675 million doses have been administeredand the vast majority of recent reports are related to covid vaccines. The CDC states that, in the event of a significant increase in VAERS reports warranting clinical review, the standard operating procedure requires additional CDC Immunization Safety Office staff to process cases.12
Freedom of Information Act documents seen by The BMJ suggest that Pfizer has around 1000 more full time employees working on vaccine surveillance than the CDC, despite the latters responsibility for handling adverse event reports on all products. The CDC didnt provide The BMJ with specific numbers, instead stating that its staffing reflects the needs of the office at any given time and can range from several dozen to hundreds, including contractors and individuals reassigned from across the agency. The latest confirmed number of staff, as of November 2022at the Immunization Safety Office, which houses VAERSis 70-80 full time equivalent workers.
In comparison, a February 2021 Pfizer analysis of adverse event reports showed that the company had onboarded 600 additional full time employees to handle the volume and planned to employ a total of 1800.4 Pfizer didnt respond to The BMJs requests for information on current staffing.
Interviews with more than a dozen VAERS users by The BMJall of whom were trying to file reports of a serious naturerevealed a patchy and frustrating experience. Some users heard back from clinical reviewers months after making their first report, while others never heard anything. Some of those making reports were told conflicting information about updating their report or were discouraged from making a report altogether.
Those people include Patrick Whelan, a rheumatologist and researcher at the University of California Los Angeles, who in 2022 reported how one of his patients, a 7 year old boy, had a cardiac arrest after covid vaccination. The patient was intubated when Whelan filed a VAERS report, and he expected a prompt follow-up call from a CDC investigator.
I assumed that, since it was a catastrophic event, the safety committee would want to hear about it right away, he says. But, to his knowledge, nobody called or requested medical records. In an email sent to Whelan months later the FDA said that it had followed up soon after receiving his report and had made several requests for medical records. The agency added, Generally speaking, staff might not reach out to providers unless they have specific questions about a case or a VAERS report.
James Gill has been a medical examiner and forensic pathologist for 25 years and is currently chief medical examiner for the state of Connecticut. In June 2021 he made the first VAERS report of his career. It was for a 15 year old boy who died suddenly days after getting a second jabwhat Gill concluded on autopsy was stress cardiomyopathy following second dose of the Pfizer-BioNTech covid-19 vaccine.567
Gill, who has appointments at Yale University and the University of Connecticut, cant recall getting any calls from VAERS after he filled out the online form, and he still has only a temporary e-report number. After he published the case reports in the Archives of Pathology & Laboratory Medicine in February 2022, however, the CDC did respondin the form of a letter to the editor contesting Gills findings.567
In November 2022, React19, an advocacy group of some 30000 people who have experienced prolonged illness after covid vaccination, reviewed 126 VAERS reports among its ranks. In its audit, which was conducted by volunteers inside and outside the organisation, 22% had never been given a permanent VAERS ID number and 12% had disappeared from the system entirelyin other words, one in three of the reports they looked for didnt show up in the publicly searchable database.8
A week after Whelan filed the VAERS report for his young patient in Los Angeles, he had cause to update it. The boys condition didnt improve, and the decision was made to terminate life support. But there was no mechanism for [updating] it, he tells The BMJ. The only option I had was to make a new VAERS report.
Three weeks later he met with the FDA in his capacity as a researcher to discuss a forthcoming paper, and without having planned to he mentioned the case and the lack of follow-up. Nair reached out by email the next day, and six weeks later Whelan discussed the case with Nair and a press officer for around 35 minutes.
Today, however, that VAERS report still shows the child as having been admitted to hospital. I made the false assumption that that conversation would result in an adjustment in the publicly reported case, says Whelan. Think of all the people who are using VAERS data as a means to assess whats happening with the vaccinesexcept in this case youd be left with the false impression that the child had had a serious adverse event, rather than seeing that hed died.
The BMJ has found that the FDA and CDC essentially maintain two separate VAERS databases: a public facing database, containing only initial reports; and a private, back end system containing all updates and correctionssuch as a formal diagnosis, recovery, or death.
In December last year Nair explained the situation at a meeting with advocates. He said, Theres two parts to VAERS, the front end system and the back end . . . Anything derived from medical records by law cant be posted on the public facing system. The CDC has told The BMJ that protecting patient confidentiality is a priority.
Interestingly, the FDA Adverse Event Reporting System (FAERS), which collects reports on drugs, does maintain a publicly accessible database that gets updated, as does the agencys Medical Device Reporting systemraising the question of why VAERS cant do the same. Neither the CDC nor the FDA provided an explanation. An FDA spokesperson told The BMJ that patients can submit formal requests under FOIA [Freedom of Information Act] to obtain the full record of their report.
For serious cases, reporters to VAERS are supposed to receive emails prompting them to provide updates. These emails include a code and upload link, but the reporters The BMJ spoke to didnt get confirmation emails, and if they searched for their report in the database it remained unchanged. Similarly, if a reporter successfully treated a diagnosis and the patient improved, or if they confirmed that the cause of the illness was unrelated to a vaccine, this wouldnt be reflected in the public database.
Nair acknowledged in a meeting with advocates that people get frustrated when they look for an updated report, find the original untouched, and feel ignored. He said, They never see it on the front end, because we dont alter that initial report.
Pharmacovigilance has been effective in alerting the public to unusual, acute reactions, even when based on few reports. For example, it took just six VAERS reports of thrombosis with thrombocytopenia syndrome after administration of the Janssen covid vaccine for regulators to issue a pause in April 2021.9
Ralph Edwards, former director of the Uppsala Monitoring Centre and until recently editor in chief of the International Journal of Risk & Safety in Medicine, explains that monitoring systems such as VAERS excel at detecting adverse reactions that occur very soon after vaccination or are known from other vaccines, such as anaphylaxis or Guillain-Barr syndrome. But detecting new and unusual reactions, especially those with latent effects, has been an ongoing challenge in the world of pharmacovigilance.
Edwards tells The BMJ, If something hasnt been heard of before, it tends to be ignored. He explains that regulators may be relying too heavily on epidemiological evidence to acknowledge a signal. VAERS alone is unlikely to capture such long term adverse outcomes unless reports are regularly updated and reviewers are closely following such casesa real catch 22, he says. Youll never get the evidence unless you have the idea to look for it in the first place.
Addressing an October 2021 meeting, Helen said that most doctors were only willing to talk about the FDA recognised vaccine adverse events. She asked the FDA to alert doctors to potential adverse neurological reactions, as had been done with myocarditis. But more than once the FDAs Peter Marks expressed confusion about why it would matter to doctors whether or not regulators acknowledged that a condition might be related to the vaccine. Arent they treating whats in front of them? he asked.
However, Svetlana Blitshteyn, a neurologist and researcher at the University at Buffalo, New York, who has been treating postural orthostatic tachycardia syndrome for around 20 years and has seen the condition present after vaccination, tells The BMJ that if physicians arent educated to look for the condition theyre unlikely to test for it or know how to treat it.
Helen is calling for an end to the negative feedback loop . . . the FDA is not naming additional adverse reactions to the vaccines because the passive surveillance systems arent displaying it. But the passive surveillance systems arent displaying it because physicians are blinded to the adverse reactions in their patients, and thus arent reporting them.
The European Union, for its part, has added hypoaesthesia and paraesthesia (reduced or abnormal sensation in the skin such as numbness, tingling, or burning) to the labelling on mRNA covid vaccinesbased on around 21000 cases reported by August 2021as well as including heavy menstrual bleeding.1011 Japan has also added paraesthesia and hypoaesthesia.
Harlan Krumholz, a cardiologist and researcher at Yale, has been recruiting members of React19 to study their reactions.12 We are working hard to understand the experience, clinical course, and potential mechanisms of the ailments reported by those who have had severe symptoms arise soon after the vaccination, he tells The BMJ. There are so many people whose lives have been changed dramaticallybut what I dont know is how many or why.
This feature has been funded by the BMJ Investigations Unit. For details see bmj.com/investigations
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
The FDA has approved a chikungunya vaccine (Ixchiq, Valneva), making it the first approved immunization for the illness, aimed to treat individuals that are 18 years and older at high risk of being exposed to the chikungunya virus.
Image credit: Mohammad | stock.adobe.com
The chikungunya vaccine is a single dose injection that is administrated into the muscle, injecting a live and weakened form of the chikungunya virus. Following the vaccine, individuals could experience symptoms like those that have the disease.
The press release noted that within the past 15 years, 5 million cases of the chikungunya virus have been reported. Individuals that were diagnosed with the virus transmitted it through the bite of an infected mosquito carrying the disease. Tropical and subtropical regions of Africa, Southeast Asia, and parts of the Americas have the highest rate of infection due to an increased number of virus-carrying mosquitoes in those areas. Despite this, researchers are aware that the infection has spread to new geographic areas.
The virus was also found in newborn babies, transmitted from pregnant individuals with the virus present in the blood at delivery, according to the press release. The infection was reported to cause severe and possibility fatal reactions in newborns.
Infection with chikungunya virus can lead to severe disease and prolonged health problems, particularly for older adults and individuals with underlying medical conditions, said Peter Marks, MD, PhD, director of the FDAs Center for Biologics Evaluation and Research, in a press release. Todays approval addresses an unmet medical need and is an important advancement in the prevention of a potentially debilitating disease with limited treatment options.
Symptoms include fever, joint pain, rash, headache, and muscle pain. The joint pain could occur for months or years in individuals with severe infection, with few available treatment options.
The approval was granted based on 2 clinical studies conducted in North America that evaluated the safety of the chikungunya vaccine. The first study included around 3500 individuals 18 years of age and older. About 1000 participants received a placebo and the remaining individuals received a dose of the chikungunya vaccine.
Individuals who received the chikungunya vaccine reported headache, fatigue, muscle pain, joint pain, fever, nausea, and tenderness at site injection. Notably, 1.6% of individuals that received the chikungunya vaccine needed medical attention because their adverse reactions limited their daily activity and 2 individuals needed to be hospitalized. Other individuals experienced prolonged reactions that extended for 30 days. However, none of these reactions were reported among individuals that received the placebo. This caused the FDA to require further studies to examine serious risk of severe adverse reactions after receiving the vaccine.
A separate clinical study focused on analyzing the effectiveness of the vaccine. The researchers used immune response data among individuals that were 18 years and older. The researchers compared the immune response of 266 individuals that received the chikungunya vaccine to 96 individuals that received the placebo.
The level of antibody evaluated in study participants was based on a level shown to be protective in non-human primates that had received blood from people who had been vaccinated. Almost all vaccine study participants achieved this antibody level, said the study authors, in a press release.
However, in another study that assessed if the vaccine virus was present in the bloodstream to transfer to newborns, the findings were inconclusive. The study authors noted that they were also unaware if the vaccine could have adverse reactions to the newborn and advised medical professionals to consider individuals risk of exposure to the virus before administering.
Reference
FDA Approves First Vaccine to Prevent Disease Caused by Chikungunya Virus. FDA. News release. November 9, 2023. Accessed November 10, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-prevent-disease-caused-chikungunya-virus.
