How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value

doi:10.1016/j.jamda.2024.02.005

. 2024 Apr;25(4):639-646.e5.

doi: 10.1016/j.jamda.2024.02.005. Epub 2024 Mar 1.

How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value

Sarah M Bartsch¹, Colleen Weatherwax¹, Michael R Wasserman², Kevin L Chin¹, Marie F Martinez¹, Kavya Velmurugan¹, Raveena D Singh³, Danielle C John⁴, Jessie L Heneghan¹, Gabrielle M Gussin³, Sheryl A Scannell¹, Alexandra C Tsintsifas¹, Kelly J O'Shea¹, Alexis M Dibbs¹, Bruce Leff⁵, Susan S Huang³, Bruce Y Lee⁶

Affiliations

¹ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA.
² California Association of Long Term Care Medicine, Santa Clarita, CA, USA.
³ Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA.
⁴ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA.
⁵ Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA. Electronic address: bruceleemdmba@gmail.com.

PMID: 38432644
PMCID: PMC10990766 (available on 2025-04-01)
DOI: 10.1016/j.jamda.2024.02.005

How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value

Sarah M Bartsch et al. J Am Med Dir Assoc. 2024 Apr.

. 2024 Apr;25(4):639-646.e5.

doi: 10.1016/j.jamda.2024.02.005. Epub 2024 Mar 1.

Authors

Affiliations

¹ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA.
² California Association of Long Term Care Medicine, Santa Clarita, CA, USA.
³ Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA.
⁴ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA.
⁵ Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA. Electronic address: bruceleemdmba@gmail.com.

PMID: 38432644
PMCID: PMC10990766 (available on 2025-04-01)
DOI: 10.1016/j.jamda.2024.02.005

Abstract

Objectives: To evaluate the epidemiologic, clinical, and economic value of an annual nursing home (NH) COVID-19 vaccine campaign and the impact of when vaccination starts.

Design: Agent-based model representing a typical NH.

Setting and participants: NH residents and staff.

Methods: We used the model representing an NH with 100 residents, its staff, their interactions, COVID-19 spread, and its health and economic outcomes to evaluate the epidemiologic, clinical, and economic value of varying schedules of annual COVID-19 vaccine campaigns.

Results: Across a range of scenarios with a 60% vaccine efficacy that wanes starting 4 months after protection onset, vaccination was cost saving or cost-effective when initiated in the late summer or early fall. Annual vaccination averted 102 to 105 COVID-19 cases when 30-day vaccination campaigns began between July and October (varying with vaccination start), decreasing to 97 and 85 cases when starting in November and December, respectively. Starting vaccination between July and December saved $3340 to $4363 and $64,375 to $77,548 from the Centers for Medicare & Medicaid Services and societal perspectives, respectively (varying with vaccination start). Vaccination's value did not change when varying the COVID-19 peak between December and February. The ideal vaccine campaign timing was not affected by reducing COVID-19 levels in the community, or varying transmission probability, preexisting immunity, or COVID-19 severity. However, if vaccine efficacy wanes more quickly (over 1 month), earlier vaccination in July resulted in more cases compared with vaccinating later in October.

Conclusions and implications: Annual vaccination of NH staff and residents averted the most cases when initiated in the late summer through early fall, at least 2 months before the COVID-19 winter peak but remained cost saving or cost-effective when it starts in the same month as the peak. This supports tethering COVID vaccination to seasonal influenza campaigns (typically in September-October) for providing protection against SARS-CoV-2 winter surges in NHs.

Keywords: COVID-19; Nursing homes; SARS-CoV-2; annual vaccination; cost-effectiveness; economic.

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Conflict of interest statement

Disclosure The authors declare no conflicts of interest.

Cited by

Modeling Nursing Home Harms From COVID-19 Staff Furlough Policies.
Bartsch SM, Weatherwax C, Leff B, Wasserman MR, Singh RD, Velmurugan K, John DC, Chin KL, O'Shea KJ, Gussin GM, Martinez MF, Heneghan JL, Scannell SA, Shah TD, Huang SS, Lee BY. Bartsch SM, et al. JAMA Netw Open. 2024 Aug 1;7(8):e2429613. doi: 10.1001/jamanetworkopen.2024.29613. JAMA Netw Open. 2024. PMID: 39158906 Free PMC article.

References

1. U.S. Food and Drug Administration. Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023. https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-u.... Published 2023. Accessed.
1. Feikin DR, Higdon MM, Abu-Raddad LJ, et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet. 2022;399(10328):924–944. - PMC - PubMed
1. Lansbury LE, Brown CS, Nguyen-Van-Tam JS. Influenza in long-term care facilities. Influenza and Other Respiratory Viruses. 2017;11(5):356–366. - PMC - PubMed
1. Bartsch SM, Weatherwax C, Martinez MF, et al. Cost-Effectiveness of SARS-CoV-2 Testing and Isolation Strategies in Nursing Homes. Infect Control Hosp Epidemiol. In Press. - PMC - PubMed
1. Bartsch SM, Ferguson MC, McKinnell JA, et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Health Aff (Millwood). 2020;39(6):927–935. - PMC - PubMed

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[1] U.S. Food and Drug Administration. Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023. https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-u.... Published 2023. Accessed.

[2] U.S. Food and Drug Administration. Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023. https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-u.... Published 2023. Accessed.

[3] Feikin DR, Higdon MM, Abu-Raddad LJ, et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet. 2022;399(10328):924–944. - PMC - PubMed

[4] Feikin DR, Higdon MM, Abu-Raddad LJ, et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet. 2022;399(10328):924–944. - PMC - PubMed

[5] Lansbury LE, Brown CS, Nguyen-Van-Tam JS. Influenza in long-term care facilities. Influenza and Other Respiratory Viruses. 2017;11(5):356–366. - PMC - PubMed

[6] Lansbury LE, Brown CS, Nguyen-Van-Tam JS. Influenza in long-term care facilities. Influenza and Other Respiratory Viruses. 2017;11(5):356–366. - PMC - PubMed

[7] Bartsch SM, Weatherwax C, Martinez MF, et al. Cost-Effectiveness of SARS-CoV-2 Testing and Isolation Strategies in Nursing Homes. Infect Control Hosp Epidemiol. In Press. - PMC - PubMed

[8] Bartsch SM, Weatherwax C, Martinez MF, et al. Cost-Effectiveness of SARS-CoV-2 Testing and Isolation Strategies in Nursing Homes. Infect Control Hosp Epidemiol. In Press. - PMC - PubMed

[9] Bartsch SM, Ferguson MC, McKinnell JA, et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Health Aff (Millwood). 2020;39(6):927–935. - PMC - PubMed

[10] Bartsch SM, Ferguson MC, McKinnell JA, et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Health Aff (Millwood). 2020;39(6):927–935. - PMC - PubMed

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How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value

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How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value

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