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 interview and/or electronic medical record abstraction; COVID-19 vaccination was assessed through documented sources. We assessed associations between receipt of 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 1,665 hospitalized adolescents without COVID-19, 56% were unvaccinated. Unvaccinated adolescents were younger (median age 15.1 years vs. 15.4 years, p<0.01) and resided in areas with higher social vulnerability index (SVI) scores (median 0.6 vs 0.5, p<0.001) 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, risk factors, adolescent
Contributor Information
Leila C Sahni, Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children’s Hospital, Houston, TX 77030, USA.
Ashley M Price, CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Samantha M Olson, CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Margaret M Newhams, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA.
Pia S Pannaraj, Division of Infectious Diseases, Children’s Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA 90027, USA.
Aline B Maddux, Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO 80045, USA.
Natasha B Halasa, Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Katherine E Bline, Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital Columbus, OH 43205, USA.
Melissa A Cameron, Division of Pediatric Hospital Medicine, UC San Diego-Rady Children’s Hospital, San Diego, CA 92123, USA.
Stephanie P Schwartz, Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC 27514, USA.
Tracie C Walker, Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC 27514, USA.
Katherine Irby, Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
Kathleen Chiotos, Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Ryan A Nofziger, Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USA.
Elizabeth H Mack, Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Laura Smallcomb, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA.
Tamara T Bradford, Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans, LA 70118, USA.
Satoshi Kamidani, The Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
Keiko M Tarquinio, Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
Natalie Z Cvijanovich, Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, CA 94609, USA.
Jennifer E Schuster, Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA.
Samina S Bhumbra, The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Emily R Levy, Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Charlotte V Hobbs, Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Melissa L Cullimore, Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE 68114, USA.
Bria M Coates, Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
Sabrina M Heidemann, Division of Pediatric Critical Care Medicine, Children’s Hospital of MI, Central Michigan University, Detroit, MI 48201, USA.
Shira J Gertz, Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, NJ 07039, USA.
Michele Kong, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Heidi R Flori, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children’s Hospital and University of Michigan, Ann Arbor, MI 48109, USA.
Mary A Staat, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 42559, USA.
Matt S Zinter, Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA 94143, USA.
Janet R Hume, Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN 55454, USA.
Brandon M Chatani, Division of Pediatric Infectious Diseases, Department of Pediatrics, UHealth/Holtz Children's Hospital, Miami, FL 33136, USA.
Mary G Gaspers, University of Arizona, Diamond Children’s Banner Children’s Medical Center, Tucson, AZ 85719, USA.
Mia Maamari, Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Medical Center Dallas, TX 75235, USA.
Adrienne G Randolph, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
Manish M Patel, CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Julie A Boom, Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children’s Hospital, Houston, TX 77030, USA.
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