A cluster-randomized clinical trial finds that educational messaging significantly boosted COVID-19 vaccine acceptance and uptake among 496 unvaccinated patients at US emergency departments (EDs) over 8 months.

In the study, published yesterday in JAMA Internal Medicine, a team led by University of California at San Francisco researchers showed a 4-minute video, gave a flyer, and had ED physicians or nurses deliver a scripted message on COVID-19 vaccination to patients waiting to be seen at seven EDs in four US cities from Dec 6, 2021, to Jul 28, 2022. The cities were Durham, North Carolina; Philadelphia; San Francisco; and Seattle.

The team developed the materials after conducting qualitative interviews with 65 vaccine-hesitant ED patients to determine the reasons behind their hesitancy and other barriers to vaccination, and to identify trusted messengers and messages that might increase vaccine uptake.

Of the 496 participants (221 during intervention weeks and 275 during control weeks with no messaging), the median age was 39 years, 41.3% were female, 38.9% were Black, 19.6% were Hispanic, and 44.0% didn't have a primary care physician. The patients were from traditionally underserved groups with disproportionately high rates of accessing primary healthcare in EDs and low vaccine uptake (eg, Black and Latino people, immigrants, those with no housing or insurance).

8% to 12% higher uptake

Relative to control participants, more intervention patients said they would accept a vaccine dose in the ED (25.8% vs 12.0%). More intervention patients also told follow-up telephone interviewers that they received a vaccine within 30 days after their ED visit (20.0% vs 8.7%).

The intervention group had larger outcome effect sizes than controls in terms of participants who didn't have a primary care physician (acceptance, 37.6% vs 13.7%; uptake, 30.7% vs 9.4%) and Hispanic patients (acceptance, 44.2% vs 10.4%; uptake, 42.3% vs 8.3%).

"If implemented nationally in EDs, an 8% to 12% increase in vaccine uptake and acceptance could lead to the delivery of tens of thousands of COVID-19 vaccines to people who would not otherwise get vaccinated," the study authors wrote.

The Columbus, Ohio, area measles outbreak has increased to 82 cases, with 32 hospitalized. Of the 82 patients, 74 were unvaccinated. The others had unknown status or were partly vaccinated.

Local news reports say 24 kids have required hospitalization.

So far, 36 children ages 1 or 2 years have been infected, followed by 23 infants under 1, 18 kids ages 3 to 5, and 5 children ages 6 to 17 years. Four patients have unknown vaccine status, and four were partially vaccinated with only one dose of the measles, mumps, rubella (MMR) vaccine.

Per the Centers for Disease Control and Prevention, "Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age."

One dose of MMR vaccine is 93% effective against measles, and two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.