Abstract and Introduction
Abstract
To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used July 21–August 2, 2021, data from a large, nationally representative survey (Household Pulse Survey). We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults when they receive a COVID-19 diagnosis, during clinic visits, or at the time of discharge if hospitalized and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 status.
Introduction
The goal of the US coronavirus disease (COVID-19) vaccination campaign is to substantially reduce the overall burden of COVID-19 by preventing severe acute respiratory syndrome coronavirus (SARS-CoV-2) infections, reducing virus transmission, and reducing hospitalizations and deaths. Data from the Centers for Disease Control and Prevention (CDC) have demonstrated that the number of COVID-19 patients in intensive care units is higher in states with the lowest vaccination levels than in states with highest vaccination levels.[1,2] However, as of September 10, 2021, ≈15% of US adults were not vaccinated, and 28% were not fully vaccinated.[3]
Whereas reasons for nonvaccination or undervaccination are multifactorial,[4–8] studies suggest that persons with a previous diagnosis of COVID-19 are less likely to be vaccinated than are those who have not previously had COVID-19.[9] However, CDC recommends that persons previously infected with SARS-CoV-2 still get the vaccine.[10] This recommendation reflects the knowledge that although the rate of reinfection among persons with previous COVID-19 illness is very low,[11–13] natural immunity from infection may not provide a sufficient level of protection, particularly among the elderly.[14] Persons who have had COVID-19 can still become severely ill if reinfected, and even those who were initially asymptomatic can have ongoing health problems several weeks or even longer after getting reinfected (long haulers).[10] Moreover, those who were previously infected with SARS-CoV-2 and became infected again can still transmit the infection to others.[10] Vaccination not only protects persons who have not been previously infected but also provides a strong boost in protection for those who have recovered from COVID-19;[10] a growing body of evidence demonstrates added protection against reinfection for persons who were previously infected with SARS-CoV-2 when they have a higher titer of antibodies resulting from vaccination.[15] It is vital that all persons be fully vaccinated, regardless of infection history. Without achieving this level of vaccination coverage, COVID-19 spikes and clusters will probably re-emerge in areas with low vaccination levels.
Vaccination coverage and intentions to be vaccinated among persons who had a previous diagnosis of COVID-19 is unknown. Our goals with this study were to 1) compare vaccination coverage (≥1 dose and receipt of all recommended doses) and intention to be vaccinated, by previous COVID-19 status; 2) examine factors associated with vaccination coverage and intention to be vaccinated and reasons for nonvaccination, by previous COVID-19 status; and 3) assess the correlation between state-level prevalence of previous COVID-19 diagnoses and COVID-19 vaccination coverage, by using data from a large, nationally representative household survey. Knowing the extent of gaps in vaccination coverage among those with and without a history of COVID-19, as well as reasons for these gaps, is necessary for designing and targeting effective interventions to improve vaccine uptake at the population level.
Emerging Infectious Diseases. 2022;28(3):631-638. © 2022 Centers for Disease Control and Prevention (CDC)
