What’s on the Menu Matters in Health Care for Diverse Patients

What’s on the Menu Matters in Health Care for Diverse Patients

Food is a powerful part of community and medicine. It has the potential to build connections, elicit nostalgia, spark joy, mark celebration and promote healing.

It also plays a role in determining whether the health care system is inclusive and equitable.

I study the challenges that older adults and their family caregivers face in the U.S. health care system, especially for those from racial or ethnic minority communities. Health disparities, such as unequal access to care based on race and ethnicity, affect many communities in the U.S.

Originally published in The Conversation - USE THIS LOGO

Sociocultural characteristics such as language, skin color, religious beliefs and immigrant status can present access barriers to high-quality health care. I’ve found that food can also be a source of alienation and exclusion in the U.S. health care system. To many patients, it is a salient reminder that the system was not built for them.

Current food standards at health facilities

Current regulations around food in health care environments such as hospitals and long-term care facilities emphasize occupational and food safety. Dietary quality standards are based on clinical need, and specialized foods cater to patients who have difficulty chewing or swallowing, for instance. Health care facilities and the organizations providing menu recommendations to them consistently advertise an alignment with taste preferences, allergy-related needs and nutritional quality.

Although some facilities offer kosher and halal options, culturally inclusive options are often neglected. For instance, some facility menus prominently feature sandwiches and salads that only reflect American cuisine. Without culturally inclusive menus, patients might be given foods that don’t align with their cultural or religious preferences. As one family caregiver I interviewed for my ongoing study of older Asian immigrants from multiple ethnic communities described, “My mother-in-law would get to the nursing home and my father-in-law hadn’t eaten all day until 5 o’clock. He likes to eat roti and curry for lunch and dinner, but they would just give him a sandwich.”

Another participant had to help her mother come to terms with a new diet in an assisted living facility. “So she’s in this new place and one day they served kielbasa and sauerkraut, and she’s looking at it like, ‘What’s that?’ and I was like ‘Oh, sausage, you’re not going to like that, and [sauerkraut] … you’re not going to like that either.’”

Subsequently, these patients may lack important nutrients to manage their health conditions and maintain their weight. Undernourishment can cause negative physical and mental health effects, including frailty, or an increased vulnerability to adverse health conditions and diseases, and depression. Functional decline due to undernourishment can also lead to an increased risk of falls, hospitalization and death.

The caregivers I interviewed believed that the health care system wouldn’t be able to accommodate their relatives’ needs and felt resigned that it would not change. As one caregiver said, “I would say that the hospitals need a lot more work. My mom is quite religious and also has diet restrictions. When she went to the hospital, all those days, most of the time she was not eating at all.”

Improving patient health and well-being

Offering culturally inclusive foods in health care facilities has the potential to support mental well-being and even promote joy among older adults. It can foster a sense of belonging and community in a place where it can be difficult to form relationships. It could also help patients and their families understand the types of treatment-aligned meals they can prepare and eat at home.

Culturally inclusive food may also be critical to helping patients feel they are respected and being treated with dignity. This is especially the case when they may be adjusting to language differences or unfamiliar healing traditions. It could build their trust in their clinicians and the health care system by demonstrating commitment to supporting diverse patients.

Supporting caregivers and the local community

A health care system that offers inclusive foods supports more than just patients.

Family caregivers have myriad responsibilities, including helping their relatives with transportation and dressing themselves. The caregivers in my study often must also prepare and transport food to ensure that their relatives are eating. One participant estimated that “it was about an extra half an hour to an hour every day to prepare the food and then bring it in … going straight from my workplace to the hospital.”

The local community could also benefit. Health care organizations could work with local vendors that supply ingredients from different ethnic traditions, economically supporting the community. Health care facilities could also employ chefs and dietitians from diverse backgrounds to ensure meal quality.

Finally, the U.S. health care workforce is becoming increasingly diverse and multicultural. But health care workers from racial and ethnic minority communities still grapple with hiding their cultural identities to belong in the workplace. Having access to traditional foods may help health care workers feel more included in their workplace, or at least alleviate some of the burden to “fit in” by beginning to build an organization that welcomes diversity.

Emerging approaches to cultural inclusion

Implementing culturally inclusive meals across the country’s health care system requires a concerted and long-term effort. In a health care environment where every penny is pinched, it might be hard for facilities to come up with multiple choices at mealtime. It requires revisiting regulations around dietary quality in health care facilities and ensuring cultural sensitivityamong care providers and staff. It also requires facilities to have the human resources, funding, knowledge and support to ensure these efforts can be sustained.

Some health care facilities have already dedicated considerable effort to provide culturally inclusive meals to patients and residents. Holy Name Medical Center in Teaneck, New Jerseyoffers a bowl of rice to its its Asian American patients instead of a sandwich, and warm instead of cold water to drink per cultural preference. Rather than depending solely on individual workers to modify their practices, they emphasize a system-level commitment to inclusion and educate clinicians and other health care workers on different aspects of Asian cultures.

Similarly, one of the assisted- and independent-living facilities owned by Bria Health Services near Chicago has a special unit catering to the dietary, language and cultural preferences of South Asian adults. It’s not clear that segregated units are necessarily the ideal answer – ideally anyone at any facility would be served culturally appropriate and appetizing food. But it’s a starting point.

Achieving a strong and inclusive health care system requires ensuring it is built for everyone. And food is one fundamental way to do it.

100 Years of VA Nursing History in 2 Minutes (or less!)

100 Years of VA Nursing History in 2 Minutes (or less!)

Nurses are the backbone of VA’s health system and make a profound impact on the lives of Veterans every day, just as they have for the last 100 years. As you consider a career in nursing with VA, take a look at how VA nurses have established a legacy of service and advancement throughout the decades…

 

A VA Nursing Timeline


1921 – In 1921, about 1,400 hospital nurses were transferred from the nation’s Public Health Service to the new Veterans’ Bureau (the predecessor to VA), paving the way for nursing at VA as we know it today. The move was necessitated by a need for long-term care as the bureau focused on its Veteran patients.


1930 – The modern nursing service took its present shape in 1930, when three federal agencies responsible for Veterans’ programs consolidated into the new Veterans Administration, and around 2,500 registered nurses went to work for VA.


1940s – During World War II, approximately 1,000 student cadet nurses were assigned to VA hospitals, spending 6 months or more of their academic programs gaining clinical nursing experience. Meanwhile, about 1,000 registered nurses were among the more than 7,000 VA employees who left to join the armed forces during the early years of the war.


1950s – As the 1950s arrived, VA’s first chief of nursing education was appointed, leading to the decade’s focus on continuing education ongoing to this day. Affiliations with schools of nursing expanded, resulting in a steady growth in the number of nursing students receiving VA clinical experience.


1963 – In 1963, the VA nursing service was first in the profession to establish a position for doctoral-prepared nurse researchers, formalizing the research function within the service. 

1973 – By 1973, nurses were performing a wider variety of health care functions than ever before throughout VA. They were delegated authority to function as primary providers of Veteran care while working closely with physicians and other members of interdisciplinary teams. That same year, 43 nurse practitioner positions were added to improve patient care in admissions areas – the first major use of nurse practitioners in VA.

1980s – Recruiting and retention became a key focus of the nursing service in the 1980s, a response to the regional and national nurse shortages that characterized the decade. We instituted a wide range of scholarship and tuition assistance programs to attract new nurses and boost employee career commitment.


1990s – At the start of the 1990s, some 2,300 VA nurses were in the ready reserve of the U.S. Armed Forces at the time of the Persian Gulf crisis. More than 600 were called to active duty, and another 300 were put on alert status.


2000s – In 2005 and 2006, VA nursing staff responded to hurricanes Katrina and Rita, assisting with evacuation and continuing care of hundreds of VA hospital patients. The service partnered with other federal agencies to establish and provide care at shelters in Texas.


2021 – In the modern era, over 112,000 nurses support the mission of the VA health care system by providing state-of-the-art, cost-effective nursing care to patients and families as they respond to health and illness.


Work at VA

As you plan to join our team, you now know that you’ll be part of a century-long tradition of professionalism and advancement that no other organization can beat.

NOTE: Positions listed in this post were open at the time of publication. All current available positions are listed at USAJobs.gov.

Nurse of the Week: Mary Starks Named New York’s Student NP of the Year

Nurse of the Week: Mary Starks Named New York’s Student NP of the Year

Nurse of the Week Mary Starks, BS., RN, CNOR, NP-S – now at the Rochester School of Nursing (URSON) studying for her dual DNP/Family NP master’s and doctorate – is a classic “Type N” personality. That “N” of course, stands for Nurse, NP, and the Nurse Practitioner Association for New York State’s Region 2 pick for the 2021 NP Student of the Year!*

After studying neuroscience and immunohistochemistry at UCLA, Starks apparently realized that she was a definite Type N and decided to become a nurse. Already bursting at the seams with undergraduate degrees, she flew to the East Coast to pursue her studies in nursing. In New York, she went for an accelerated bachelor’s degree program for non-nurses (APNN) at the University of Rochester School of Nursing. Upon graduation, Strong Memorial Hospital snapped her up before she had a chance to go west again and installed her in the adult operating room, where she now works as a skilled vascular surgery nurse and preceptor.

However, Starks does not spend all of her time lollygagging about the OR or burying her nose in a textbook; she wants to effect change and has already created a place for herself among the new generation of upcoming nurse leaders. She is an active member in her local National Black Nurses Association chapter, the Rochester Black Nurses Association (RBNA), a founding member of the local chapter, and the chapter’s first vice president.

But that isn’t all. Stark is paying it forward as the founder and chair of the RBNA mentoring program in partnership with the URSON’s APNN program, where she and other Black nurses mentor nursing students of color. In true Type N fashion, she also manages to make time to participate as a member of the NPA’s Diversity, Equity and Inclusion committee.

After she earns her degree, Starks plans to work as an FNP in primary care. Her passion is caring for those with chronic diseases, especially African American patients. She plans to continue her advocacy for Black patients and students through her continued work in RBNA and other organizations and mentoring programs.

Unlike many students during the pandemic, Starks has been very fortunate with regard to clinicals, and told a reporter that “Luckily, within my program, they didn’t stop us from doing any type of clinical rotation or any type of classes.” In her acceptance speech, the charismatic FNP-to-be graciously thanked everyone who made the award possible and declared her dedication to helping to further NPs’ scope of practice in New York State.

To see an interview with Starks at a local Rochester station, click here. Her acceptance speech is below.

*There are two NPA winners, actually, and we congratulate the Region 7 winner Margaret O’Donnell, DNP, FNP-BC, ANP-BC, FAANP, who will have a post of her own shortly.

Covid Immunity Through Infection or Vaccination: Are They Equal?

Covid Immunity Through Infection or Vaccination: Are They Equal?

Dr. Aaron Kheriaty, a University of California-Irvine psychiatry professor, felt he didn’t need to be vaccinated against covid because he’d fallen ill with the disease in July 2020.

So, in August, he sued to stop the university system’s vaccination mandate, saying “natural” immunity had given him and millions of others better protection than any vaccine could.

A judge on Sept. 28 dismissed Kheriaty’s request for an injunction against the university over its mandate, which took effect Sept. 3. While Kheriaty intends to pursue the case further, legal experts doubt that his and similar lawsuits filed around the country will ultimately succeed.Originally published in Kaiser Health News.

 

That said, evidence is growing that contracting SARS-CoV-2, the virus that causes covid-19, is generally as effective as vaccination at stimulating your immune system to prevent the disease. Yet federal officials have been reluctant to recognize any equivalency, citing the wide variation in covid patients’ immune response to infection.

Like many disputes during the covid pandemic, the uncertain value of a prior infection has prompted legal challenges, marketing offers and political grandstanding, even as scientists quietly work in the background to sort out the facts.

For decades, doctors have used blood tests to determine whether people are protected against infectious diseases. Pregnant mothers are tested for antibodies to rubella to help ensure their fetuses won’t be infected with the rubella virus, which causes devastating birth defects. Hospital workers are screened for measles and chickenpox antibodies to prevent the spread of those diseases. But immunity to covid seems trickier to discern than those diseases.

The Food and Drug Administration has authorized the use of covid antibody tests, which can cost about $70, to detect a past infection. Some tests can distinguish whether the antibodies came from an infection or a vaccine. But neither the FDA nor the Centers for Disease Control and Prevention recommend using the tests to assess whether you’re, in fact, immune to covid. For that, the tests are essentially useless because there’s no agreement on the amount or types of antibodies that would signal protection from the disease.

“We don’t yet have full understanding of what the presence of antibodies tells us about immunity,” said Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories.

By the same token, experts disagree on how much protection an infection delivers.

In the absence of certainty and as vaccination mandates are levied across the country, lawsuits seek to press the issue. Individuals who claim that vaccination mandates violate their civil liberties argue that infection-acquired immunity protects them. In Los Angeles, six police officers have sued the city, claiming they have natural immunity. In August, law professor Todd Zywicki alleged that George Mason University’s vaccine mandate violated his constitutional rights given he has natural immunity. He cited a number of antibody tests and an immunologist’s medical opinion that it was “medically unnecessary” for him to be vaccinated. Zywicki dropped the lawsuit after the university granted him a medical exemption, which it claims was unrelated to the suit.

Republican legislators have joined the crusade. The GOP Doctors Caucus, which consists of Republican physicians in Congress, has urged people leery of vaccination to instead seek an antibody test, contradicting CDC and FDA recommendations. In Kentucky, the state Senate passed a resolution granting equal immunity status to those who show proof of vaccination or a positive antibody test.

Hospitals were among the first institutions to impose vaccine mandates on their front-line workers because of the danger of them spreading the disease to vulnerable patients. Few have offered exemptions from vaccination to those previously infected. But there are exceptions.

Two Pennsylvania hospital systems allow clinical staff members to defer vaccination for a year after testing positive for covid. Another, in Michigan, allows employees to opt out of vaccination if they present evidence of previous infection and a positive antibody test in the previous three months. In these cases, the systems indicated they were keen to avoid staffing shortages that could result from the departure of vaccine-shunning nurses.

For Kheriaty, the question is simple. “The research on natural immunity is quite definitive now,” he told KHN. “It’s better than immunity conferred by vaccines.” But such categorical statements are clearly not shared by most in the scientific community.

Dr. Arthur Reingold, an epidemiologist at UC-Berkeley, and Shane Crotty, a virologist at the respected La Jolla Institute for Immunology in San Diego, gave expert witness testimony in Kheriaty’s lawsuit, saying the extent of immunity from reinfection, especially against newer variants of covid, is unknown. They noted that vaccination gives a huge immunity boost to people who’ve been ill previously.

Yet not all of those pushing for recognition of past infection are vaccine critics or torchbearers of the anti-vaccine movement.

Dr. Jeffrey Klausner, clinical professor of population and public health sciences at the University of Southern California, co-authored an analysis published last week that showed infection generally protects for 10 months or more. “From the public health perspective, denying jobs and access and travel to people who have recovered from infection doesn’t make sense,” he said.

In his testimony against Kheriaty’s case for “natural” immunity to covid, Crotty cited studies of the massive covid outbreak that swept through Manaus, Brazil, early this year that involved the gamma variant of the virus. One of the studies estimated, based on tests of blood donations, that three-quarters of the city’s population had already been infected before gamma’s arrival. That suggested that previous infection might not protect against new variants. But Klausner and others suspect the rate of prior infection presented in the study was a gross overestimate.

A large August study from Israel, which showed better protection from infection than from vaccination, may help turn the tide toward acceptance of prior infection, Klausner said. “Everyone is just waiting for Fauci to say, ‘Prior infection provides protection,’” he said.

When Dr. Anthony Fauci, the top federal expert on infectious diseases, was asked during a CNN interview last month whether infected people were as well protected as those who’ve been vaccinated, he hedged. “There could be an argument” that they are, he said. Fauci did not immediately respond to a KHN request for further comment.

CDC spokesperson Kristen Nordlund said in an email that “current evidence” shows wide variation in antibody responses after covid infection. “We hope to have some additional information on the protectiveness of vaccine immunity compared to natural immunity in the coming weeks.”

A “monumental effort” is underway to determine what level of antibodies is protective, said Dr. Robert Seder, chief of the cellular immunology section at the National Institute of Allergy and Infectious Diseases. Recent studies have taken a stab at a number.

Antibody tests will never provide a yes-or-no answer on covid protection, said Dr. George Siber, a vaccine industry consultant and co-author of one of the papers. “But there are people who are not going to be immunized. Trying to predict who is at low risk is a worthy undertaking.”

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

One U.S. child loses a parent or caregiver for every four COVID-19 deaths, a new modeling study published today in Pediatrics reveals.  The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era.

From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent, or grandparent caregiver who provided the child’s home and basic needs, including love, security, and daily care. Overall, the study shows that approximately 1 out of 500 children in the United States has experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic, and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65% of those who lost a primary caregiver due to the pandemic.

Children’s lives are permanently changed by the loss of a mother, father, or grandparent who provided their homes, basic needs, and care. Loss of a parent is among the adverse childhood experiences (ACEs) linked to mental health problems; shorter schooling; lower self-esteem; sexual risk behaviors; and increased risk of substance abuse, suicide, violence, sexual abuse, and exploitation.

“Children facing orphanhood as a result of COVID is a hidden, global pandemic that has sadly not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

“The magnitude of young people affected is a sobering reminder of the devastating impact of the past 18 months,” said Dr Alexandra Blenkinsop, co-lead researcher, Imperial College London. “These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed.”

The analysis used mortality, fertility, and census data to estimate COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents between April 1, 2020, and June 30, 2021, for the U.S. broadly, and for every state. “COVID-19-associated deaths” refers to the combination of deaths caused directly by COVID-19 and those caused indirectly by associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or quality of health care and of treatment for chronic diseases. The data were also separated and analyzed by race and ethnicity, including White, Black, Asian, and American Indian/Alaska Native populations, and Hispanic and non-Hispanic populations.

The study authors estimate that 120,630 children in the U.S. lost a primary caregiver, (a parent or grandparent responsible for providing housing, basic needs and care) due to COVID-19-associated death.  In addition, 22,007 children experienced the death of a secondary caregiver (grandparents providing housing but not most basic needs). Overall, 142,637 children are estimated to have experienced the death of at least one parent, or a custodial or other co-residing grandparent caregiver.

“The death of a parental figure is an enormous loss that can reshape a child’s life. We must work to ensure that all children have access to evidence-based prevention interventions that can help them navigate this trauma, to support their future mental health and wellbeing,” said NIDA Director Nora D. Volkow, MD. “At the same time, we must address the many underlying inequities and health disparities that put people of color at greater risk of getting COVID-19 and dying from COVID-19, which puts children of color at a greater risk of losing a parent or caregiver and related adverse effects on their development.”

Racial and ethnic disparities in COVID-related caregiver loss

There were significant racial and ethnic disparities in caregiver deaths due to COVID-19. White people represent 61% of the total U.S. population and people of racial and ethnic minorities represent 39%  of the total population. Yet, study results indicate that non-Hispanic White children account for 35% of those who lost a primary caregiver (51,381 children), while children of racial and ethnic minorities account for 65% of those who lost a primary caregiver (91,256 children).

When looking at both primary and secondary caregivers, the study found that findings varied greatly by race/ethnicity: 1 of every 168 American Indian/Alaska Native children, 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 White children experienced orphanhood or death of caregivers. Compared to white children, American Indian/Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver, Black children were 2.4 times more likely, and Hispanic children were nearly 2 times (1.8) more likely.

Overall, the states with large populations – California, Texas, and New York – had the highest number of children facing COVID-19 associated death of primary caregivers. However, when analyzed by geography and race/ethnicity, the authors were able to map how these deaths and disparities varied at the state level.

In southern states along the U.S.-Mexico border, including New Mexico, Texas, and California, between 49% and 67% of children who lost a primary caregiver were of Hispanic ethnicity. In the southeast, across Alabama, Louisiana, and Mississippi, between 45% to 57% of children who lost a primary caregiver were Black. And American Indian/Alaska Native children who lost a primary caregiver were more frequently represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%), and Arizona (18%).

The current study follows closely in line with a similar study published in The Lancet in July 2021, which found more than 1.5 million children around the world lost a primary or secondary caregiver during the first 14 months of the COVID-19 pandemic.  In both the global and US studies, researchers used the UNICEF definition of orphanhood, as including the death of one or both parents6. The definition includes children losing one parent, because they have increased risks of mental health problems, abuse, unstable housing, and household poverty. For children raised by single parents, the COVID-19-associated death of that parent may represent loss of the person primarily responsible for providing love, security, and daily care.

“We often think of the impact of COVID-19 in terms of the number of lives claimed by the disease, but as this study shows, it is critical to also address the broader impact – both in terms of those who have died, and those who have been left behind,” said study co-author Charles A. Nelson III, PhD. who studies the effects of adversity on brain and behavioral development at Boston Children’s Hospital. “We must ensure children who have lost a parent or caregiver have access to the support services they need, and that this additional impact of the COVID-19 pandemic is comprehensively addressed in both our rapid response and our overall public health response.”

There are evidence-based responses that can improve outcomes for children who experience the COVID-associated death of their caregivers:

  • Maintaining children in their families is a priority. This means families bereaved by the pandemic must be supported, and those needing kinship or foster care must rapidly receive services.
  • Child resilience can be bolstered via programs and policies that promote stable, nurturing relationships and address childhood adversity. Key strategies include:
    • Strengthening economic supports to families.
    • Quality childcare and educational support.
    • Evidence-based programs to improve parenting skills and family relationships.
  • All strategies must be age specific for children and must be sensitive to racial disparities and structural inequalities. They must reach the children who need them most.

In the closing words of the paper, “Effective action to reduce health disparities and protect children from direct and secondary harms from COVID-19 is a public health and moral imperative.”

U.S. Department of Health and Human Services(link is external)

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

mRNA Jabs Reduced Healthcare Personnel Covid Risk by 89-96%

mRNA Jabs Reduced Healthcare Personnel Covid Risk by 89-96%

COVID-19 vaccines are highly effective in preventing symptomatic illness among health care workers in real-world settings.

The study, published in the New England Journal of Medicine, found that health care personnel who received a two-dose regimen of Pfizer–BioNTech vaccine had an 89% lower risk for symptomatic illness than those who were unvaccinated. For those who received the two-dose regimen of the Moderna vaccine, the risk was reduced by 96%.

The researchers also found that the vaccines appeared to work just as well for people who are over age 50, are in racial or ethnic groups that have been disproportionately affected by COVID-19, have underlying medical conditions and have greater exposure to patients with COVID-19.

The vaccines’ effectiveness was, however, lower in immunocompromised people.

“That this study demonstrated the effectiveness of the Pfizer–BioNTech and Moderna COVID-19 vaccines to protect health care workers — people who worked tirelessly and at great potential risk to care for their friends and neighbors — is a major statement to address any remaining skepticism about the importance of everyone getting vaccinated,” said Dr. David Talan, a professor of emergency medicine and of medicine and infectious diseases at the David Geffen School of Medicine at UCLA, and the study’s co-lead author.

The project, Preventing Emerging Infections through Vaccine Effectiveness Testing, or PREVENT, was conducted with researchers from the University of Iowa’s Carver College of Medicine. The study evaluated nearly 5,000 health care workers — 1,482 who had tested positive for COVID-19 and displayed symptoms of the disease and 3,449 who had COVID-19–like symptoms but had tested negative for the disease. The participants were from 33 U.S. academic medical centers, including Olive View–UCLA Medical Center in Sylmar, California.

All of the participants completed surveys covering their demographic information, job type and risk factors for severe disease from COVID-19, as well as their vaccination status.

Other findings include:

  • A two-dose regimen of either of the mRNA vaccines reduced the risk of illness by 95% among Black and African American people, 89% among Hispanic people, 89% among Asian or Pacific Islander people, and 94% among American Indians and Alaskan Native people, compared to unvaccinated people.
  • Of all those who received a single dose of either of the two-dose mRNA vaccines, the risk of illness was reduced by 86% among Black and African American people, 82% among Hispanic people, 80% among Asian or Pacific Islander people, and 76% among American Indians and Alaskan Native people compared to unvaccinated people.
  • For people who are obese or overweight, a two-dose regimen reduced the risk of illness by 91%; among the same group, partial vaccination reduced the risk by 76% among partially vaccinated compared to unvaccinated.
  • For people who have hypertension, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 92%, and partial vaccination reduced the risk by 83% among partially vaccinated compared to unvaccinated.
  • For people who have asthma, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 91%, and partial vaccination reduced the risk by 78% among partially vaccinated compared to unvaccinated.
  • For immunocompromised people, the risk of illness was reduced by 39% whether they received a single dose or two doses of either mRNA vaccine.
  • Sixty-two people in the study were pregnant at the time they were surveyed. Vaccination was 77% effective in preventing symptomatic COVID-19 illness among pregnant people who had received at least one dose of one of the mRNA vaccines.

Because of the relatively short time period of the study — from December 2020 to May 2021 — the research does not address how long vaccines continue to provide protection against COVID-19. In addition, data was collected before the emergence of the delta variant, so the vaccines’ effectiveness today may be different than they would be against earlier variants.

PREVENT is a collaboration between EMERGEncy ID NET — a CDC-supported network led by Talan that comprises 12 U.S. emergency departments and focuses on studying emerging infectious diseases — and a previously assembled group of sites that worked under Project COVERED, another CDC-funded effort to assess the risk to emergency department providers of acquiring COVID-19 through direct contact with patients and to determine ways to mitigate that risk.

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