Immunization Healthcare Division, Defense Health Agency, San Diego, CA 92134, USA.
Henry M. Jackson Foundation, Bethesda, MD, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):546-550. doi: 10.1093/milmed/usae182.
The World Health Organization identified vaccine hesitancy as one of the top 10 threats to global health. Vaccine hesitancy is defined as a delay in acceptance or refusal of vaccination despite the availability of vaccination services. Because vaccine safety concerns are important contributors to hesitancy, people who have experienced adverse events following immunization (AEFI) may be at especially high risk for subsequent vaccine hesitancy. The Defense Health Agency Immunization Healthcare Division (DHA IHD) provides specialized vaccine care to persons who have experienced AEFI. The impact of this specialized vaccine care on subsequent vaccine hesitancy has not been fully explored.
A cohort of patients (n= 146) was identified among those who received consultative care from DHA IHD clinicians for AEFI concerns between April 2017 and September 2022. Analyses were restricted to non-uniformed beneficiaries of the Military Health System (MHS). Uniformed beneficiaries of the MHS were excluded from this analysis since vaccination mandates preclude the use of vaccine uptake as a measure of vaccine hesitancy. Outcomes were evaluated by reviewing MHS vaccination records after initial AEFI consultation through January 2023. Vaccine acceptance was considered the inverse of hesitancy, and was defined by: (a) receipt of any subsequent vaccination, (b) receipt of seasonal influenza vaccine, (c) receipt of subsequent doses of the AEFI-associated vaccine, if clinically recommended, and (d) receipt of COVID-19 vaccine.
A diverse group of patients with a wide range of AEFI concerns received specialized vaccine care from DHA IHD clinicians during this period. Among the cohort, 78% of patients received any subsequent vaccination, 55.2% received seasonal influenza vaccine, 57.8% received a subsequent dose of their AEFI-associated vaccine when the vaccine was clinically recommended, and 48.9% received COVID-19 vaccine. The proportion of patients who received influenza vaccine exceeded the reported rate of influenza vaccine uptake by the general population during this time period.
Specialized vaccine care after AEFI concerns was associated with relatively high acceptance of subsequent vaccinations. The experiences of DHA IHD clinicians, in providing specialized vaccine care to AEFI patients, may serve as a model for other organizations that are working to reduce vaccine hesitancy, even beyond the MHS.
世界卫生组织将疫苗犹豫列为全球十大健康威胁之一。疫苗犹豫是指尽管提供了疫苗接种服务，但仍延迟接受或拒绝接种疫苗。由于对疫苗安全性的担忧是导致犹豫的重要因素，因此经历过疫苗接种后不良反应（AEFI）的人可能特别容易出现后续的疫苗犹豫。国防卫生局免疫保健司（DHA IHD）为经历过 AEFI 的人提供专门的疫苗护理。这种专门的疫苗护理对后续疫苗犹豫的影响尚未得到充分探索。
在 2017 年 4 月至 2022 年 9 月期间，从接受 DHA IHD 临床医生 AEFI 咨询的患者中确定了一个队列（n=146）。分析仅限于军事医疗系统（MHS）的非统一受益人的队列。MHS 的统一受益人被排除在这项分析之外，因为接种疫苗的规定排除了将疫苗接种率作为衡量疫苗犹豫的指标。通过回顾 2023 年 1 月前首次 AEFI 咨询后 MHS 的疫苗接种记录来评估结果。疫苗接受被认为是犹豫的反面，通过以下方式定义：（a）接受任何后续疫苗接种，（b）接受季节性流感疫苗，（c）如果临床推荐，接受后续剂量的与 AEFI 相关的疫苗，以及（d）接受 COVID-19 疫苗。
在这段时间内，来自不同背景的、对 AEFI 有广泛担忧的患者从 DHA IHD 临床医生那里接受了专门的疫苗护理。在队列中，78%的患者接受了任何后续疫苗接种，55.2%的患者接受了季节性流感疫苗，57.8%的患者在临床推荐时接受了与 AEFI 相关的疫苗的后续剂量，48.9%的患者接受了 COVID-19 疫苗。在此期间，接受流感疫苗的患者比例超过了一般人群报告的流感疫苗接种率。
在经历 AEFI 后提供专门的疫苗护理与后续疫苗接种的高接受率相关。DHA IHD 临床医生在为 AEFI 患者提供专门疫苗护理方面的经验，可能为其他正在努力减少疫苗犹豫的组织提供借鉴，即使是在 MHS 之外。
