Vaccine uptake pre- and post-COVID-19 in American adults: a retrospective observational study using the Behavioral Risk Factor Surveillance System.

Abstract

Background: This study examined the impact of the COVID-19 pandemic on adult vaccination uptake, specifically recombinant zoster vaccine (RZV), influenza (FLU), and pneumococcal vaccines (PnV), and explored factors influencing COVID-19 vaccine receipt in US adults.

Methods: We conducted a retrospective analysis of nationally representative cross-sectional data from the 2019 and 2022 Behavioral Risk Factor Surveillance Systems (n=777,807). Multivariable regression models assessed vaccination status for COVID-19, RZV, FLU, and PnV, adjusting for sociodemographic factors, geography, and healthcare coverage.

Results: Among insured adults, RZV vaccination increased from 31.9% in 2019 to 41.5% in 2022, and FLU vaccination increased from 42.7% to 45.0%. Among uninsured individuals, FLU vaccination rates declined 3.2%, while RZV remained unchanged. PnV rates remained stable among the insured but decreased by 15.4% among the uninsured. Individuals with healthcare coverage were 2.9 times more likely (95% confidence interval, 2.6-3.2) to have received ≥1 dose of the COVID- 19 vaccine. Minorities reported higher uptake for 1 to 2 doses of the COVID-19 vaccine but lower uptake for FLU, RZV, and PnV than non-Hispanic Whites, who had higher rates of >4 doses of COVID-19 vaccine.

Conclusion: Despite free access to the COVID-19 vaccine, healthcare coverage significantly influenced its uptake. Increases in RZV and FLU vaccination among the insured, in contrast to minimal changes or decreases among the uninsured, highlight the critical role of healthcare access. While RZV and FLU uptake improved post-pandemic, PnV uptake remained stable. We found no evidence that COVID-19 vaccine safety affected RZV, FLU, and PnV vaccination rates.