COVID-19 Booster Vaccination in the U.S. Military, August 2021-January 2022.

INTRODUCTION: A booster dose of messenger RNA vaccine protects against severe COVID-19 outcomes. This study examined the incidence of COVID-19 booster vaccination among active-duty U.S. military servicemembers between August 2021 and January 2022, factors associated with vaccination uptake, and trends over time. METHODS: This was a retrospective cohort study of active-duty military personnel using data from the Defense Medical Surveillance System. Participants were included if they served in the active component from August 2021 through January 2022 and were eligible to receive a COVID-19 booster dose by January 2022. Adjusted hazard ratio estimates of time to booster vaccination were calculated using Cox proportional hazards regression. RESULTS: Lower booster vaccine uptake was seen in the U.S. military (25%) than among the general U.S. population at the same time (45%). Booster vaccination increased with older age, with greater education, with higher income, among women, and among those stationed overseas; it decreased with previous COVID-19 infection and use of the Janssen vaccine. There were no significant racial or ethnic disparities in booster vaccination. CONCLUSIONS: In the absence of a compulsory vaccination policy, lower booster vaccine uptake was seen among servicemembers than among the general U.S. population, particularly among members who were younger, were male, Marines, and had a previous history of infection. Low vaccination rates not only increase the risk of acute and long-term health effects from COVID-19 among servicemembers, but they also degrade the overall readiness of the U.S. military.

Comparison of national antimicrobial treatment guidelines, African Union.

OBJECTIVE: To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States. METHODS: We reviewed national government agency and public health institutes' websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines. FINDINGS: We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes. CONCLUSION: AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.

Incident COVID-19 Infections, Active and Reserve Components, 1 January 2020-31 August 2021.

Between 1 January 2020 and 31 August 2021, a total of 189,239 service members were identified as confirmed or probable cases of COVID-19. The majority of cases were male (81.2%) and 57.3% were aged 20-29 years. Overall, 19.2% had a diagnosis of at least 1 of the pre-existing comorbidities of interest in the year prior to becoming a case. The most common pre-existing comorbidity was obesity or overweight (5.2%), followed by cardiovascular disease (4.2%), and substance use disorder including nicotine dependence (4.0%). Service members who were hospitalized for COVID-19 were twice as likely to have a diagnosis of any pre-existing comorbidity compared to those who were not hospitalized. There were a total of 1,760 hospitalizations (0.9%) and 45 deaths reported among service members. In addition, there were 11,899 cases observed among fully vaccinated individuals; however, only 0.4% of hospitalized cases were fully vaccinated and no service member deaths occurred among fully vaccinated individuals during the surveillance period, highlighting the importance of COVID-19 vaccination for force health protection.