Vaccine breakthrough infections with SARS-CoV-2: Why older adults need booster vaccinations.

Objectives: COVID-19 vaccinations are highly efficacious in preventing severe illness that can lead to hospitalizations and death, but incidents of vaccine breakthrough (VBT) infections persist. We examined VBT infections within a congregate setting to help guide public health practices. Study design: This is a retrospective cohort study of VBT infections identified via polymerase chain reaction (PCR) testing between 2/1/2021-11/1/2021. Methods: A VBT infection was defined as the detection of SARS-CoV-2 collected from a person ≥14 days after all recommended doses of a COVID-19 vaccine. VBT infections were examined in five California psychiatric inpatient hospitals with a workforce of more than 10,000 hospital staff and approximately 5500 patients. Results: 415 VBT infections out of 14,101 fully vaccinated individuals within our system (2.9%) were identified. Days since final vaccine date ranged from 16 to 291 days. Kruskal-Wallis nonparametric test revealed a statistically significant difference in age between individuals with VBT infections versus all other vaccinated individuals [U = 6.47, p = .01]. A chi-square test of independence revealed no significant sex differences between individuals with VBT infections (58.8% male and 41.2% female) versus all other vaccinated individuals (59.6% male and 40.4% female; X2 (3, N = 14101) = 5.059, p = .167). Out of 415 VBT cases, 65.1% received the Moderna vaccine, 33.2% received Pfizer, and 1.7% received J&J; and 38.1% were asymptomatic at time of VBT infection, 24.1% were symptomatic, while 37.8% were missing symptom data. Conclusions: Vaccination campaigns, including boosters and continued surveillance, are important complimentary strategies for reducing the proliferation of COVID-19 VBT cases and severity of symptoms associated with COVID-19.

Large-Scale Implementation of a Daily Rapid Antigen Testing Program in California for Detecting SARS-CoV-2.

Objectives. To evaluate a daily antigen testing program for health care personnel. Methods. We examined antigen testing results between December 13, 2020, and April 30, 2021, from 5 forensic psychiatric inpatient hospitals throughout California. Results. Among 471 023 antigen tests administered, 449 positives (0.0036% false positives) were detected. Conclusions. Antigen tests had low false-positive rates, high positive predictive value, and high levels of acceptability, important characteristics when considering their application in the community. Public Health Implications. Daily antigen testing was feasible and should be considered to reduce COVID-19 transmission. (Am J Public Health. 2022;112(3):467-471. https://doi.org/10.2105/AJPH.2021.306588).

The Cal-DSH diversion guidelines.

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

Developing policies for adult sexual minorities with mental health needs in secured settings.

Lesbian, Gay, Bisexual, and Transgender (LGBT) people are more likely to be disproportionally placed in a secured setting such jails, prisons, and forensic hospitals. These settings can be traumatizing, hostile, and dangerous-especially for those who are suffering from mental illness. Administrators are encouraged to develop institutional policies that undoubtedly include that LGBT residents should be free of discrimination, victimization, and abuse. LGBT residents should have equal access to safe housing, vocational programs, rehabilitation services, as well as medical and mental health treatments. Several organizations provide guidelines to ensure that LGBT residents are protected. This article provides a general roadmap for developing LGBT policies in secured settings synergizing the recommendations of some of these organizations with emphasis on policy guidelines for transgender people that are not only standards for good care but also very cost-effective interventions that can help reduce symptoms of mental illness for this population.