Freeman Spogli Institute, Department of Health Policy, Stanford University School of Medicine, Stanford University, Stanford, California.
Stanford Law School, Stanford, California.
JAMA Health Forum. 2022 Mar 11;3(3):e220099. doi: 10.1001/jamahealthforum.2022.0099. eCollection 2022 Mar.
Prisons and jails are high-risk environments for COVID-19. Vaccination levels among workers in many such settings remain markedly lower than those of residents and members of surrounding communities. The situation is troubling because prison staff are a key vector for COVID-19 transmission.
To assess patterns and timing of staff vaccination in California state prisons and identify individual-level and community-level factors associated with remaining unvaccinated.
This cohort study used data from December 22, 2020, through June 30, 2021, to quantify the fractions of staff and incarcerated residents who remained unvaccinated among 23 472 custody and 7617 health care staff who worked in roles requiring direct contact with residents at 33 of the 35 prisons operated by the California Department of Corrections and Rehabilitation. Multivariable probit regressions assessed demographic, community, and peer factors associated with staff vaccination uptake.
Remaining unvaccinated throughout the study period.
Of 23 472 custody staff, 3751 (16%) were women, and 1454 (6%) were Asian/Pacific Islander individuals, 1571 (7%) Black individuals, 9008 (38%) Hispanic individuals, and 6666 (28%) White individuals. Of 7617 health care staff, 5434 (71%) were women, and 2148 (28%) were Asian/Pacific Islander individuals, 1201 (16%) Black individuals, 1409 (18%) Hispanic individuals, and 1771 (23%) White individuals. A total of 6103 custody staff (26%) and 3961 health care staff (52%) received 1 or more doses of a COVID-19 vaccine during the first 2 months vaccines were offered, but vaccination rates stagnated thereafter. By June 30, 2021, 14 317 custody staff (61%) and 2819 health care staff (37%) remained unvaccinated. In adjusted analyses, remaining unvaccinated was positively associated with younger age (custody staff: age, 18-29 years vs ≥60 years, 75% [95% CI, 73%-76%] vs 45% [95% CI, 42%-48%]; health care staff: 52% [95% CI, 48%-56%] vs 29% [95% CI, 27%-32%]), prior COVID-19 infection (custody staff: 67% [95% CI, 66%-68%] vs 59% [95% CI, 59%-60%]; health care staff: 44% [95% CI, 42%-47%] vs 36% [95% CI, 36%-36%]), residing in a community with relatively low rates of vaccination (custody staff: 75th vs 25th percentile:, 63% [95% CI, 62%-63%] vs 60% [95% CI, 59%-60%]; health care staff: 40% [95% CI, 39%-41%] vs 34% [95% CI, 33%-35%]), and sharing shifts with coworkers who had relatively low rates of vaccination (custody staff: 75th vs 25th percentile, 64% [95% CI, 62%-66%] vs 59% [95% CI, 57%-61%]; health care staff: 38% [95% CI, 36%-41%] vs 35% [95% CI, 31%-39%]).
This cohort study of California state prison custody and health care staff found that vaccination uptake plateaued at levels that posed ongoing risks of further outbreaks in the prisons and continuing transmission from prisons to surrounding communities. Prison staff decisions to forgo vaccination appear to be multifactorial, and vaccine mandates may be necessary to achieve adequate levels of immunity in this high-risk setting.
重要性：监狱和拘留所是 COVID-19 的高风险环境。许多此类场所的工作人员的疫苗接种率明显低于居民和周边社区成员。这种情况令人担忧，因为监狱工作人员是 COVID-19 传播的关键媒介。
目的：评估加利福尼亚州立监狱工作人员接种疫苗的模式和时间，并确定与未接种疫苗相关的个体和社区因素。
设计、地点和参与者：本队列研究使用了 2020 年 12 月 22 日至 2021 年 6 月 30 日的数据，量化了加利福尼亚惩教和康复部运营的 35 所监狱中的 33 所监狱中，23472 名监管人员和 7617 名医疗保健人员中，在与居民直接接触的角色中工作的员工中，仍有多少员工和被监禁的居民未接种疫苗。多变量概率回归评估了与员工疫苗接种率相关的人口统计学、社区和同伴因素。
主要结果和措施：在整个研究期间仍未接种疫苗。
结果：在 23472 名监管人员中，3751 人（16%）为女性，1454 人（6%）为亚太裔个人，1571 人（7%）为黑人，9008 人（38%）为西班牙裔或拉丁裔，6666 人（28%）为白人。在 7617 名医疗保健人员中，5434 人（71%）为女性，2148 人（28%）为亚太裔个人，1201 人（16%）为黑人，1409 人（18%）为西班牙裔或拉丁裔，1771 人（23%）为白人。共有 6103 名监管人员（26%）和 3961 名医疗保健人员（52%）在提供疫苗的头 2 个月内接种了 1 剂或多剂 COVID-19 疫苗，但此后疫苗接种率停滞不前。截至 2021 年 6 月 30 日，仍有 14317 名监管人员（61%）和 2819 名医疗保健人员（37%）未接种疫苗。在调整后的分析中，未接种疫苗与年龄较小（监管人员：18-29 岁与≥60 岁，75%[95%CI，73%-76%]与 45%[95%CI，42%-48%]；医疗保健人员：52%[95%CI，48%-56%]与 29%[95%CI，27%-32%]）、先前 COVID-19 感染（监管人员：67%[95%CI，66%-68%]与 59%[95%CI，59%-60%]；医疗保健人员：44%[95%CI，42%-47%]与 36%[95%CI，36%-36%]）、居住在疫苗接种率相对较低的社区（监管人员：第 75 百分位数与第 25 百分位数，63%[95%CI，62%-63%]与 60%[95%CI，59%-60%]；医疗保健人员：40%[95%CI，39%-41%]与 34%[95%CI，33%-35%]）以及与疫苗接种率相对较低的同事轮班（监管人员：第 75 百分位数与第 25 百分位数，64%[95%CI，62%-66%]与 59%[95%CI，57%-61%]；医疗保健人员：38%[95%CI，36%-41%]与 35%[95%CI，31%-39%]）的员工相关。
结论：这项对加利福尼亚州立监狱监管和医疗保健人员的队列研究发现，疫苗接种率达到了一个水平，这在监狱中继续爆发疫情和从监狱向周边社区持续传播方面存在持续风险。监狱工作人员决定不接种疫苗似乎是多方面的，在这种高风险环境中，可能需要疫苗接种来实现足够的免疫水平。
