1211. Incidence of All-Cause Community-Acquired Pneumonia in Ontario and British Columbia, Canada, 2002-2018; a Canadian Immunization Research Network (CIRN) study

Abstract Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There is a lack of data on the comprehensive burden of CAP across the life span in Canada. We estimated the incidence of all-cause CAP in all age groups in Ontario and British Columbia (BC), Canada. Methods We identified hospitalized and outpatient CAP episodes from the Discharge Abstract Database (DAD) and physician billing claims databases (Ontario Health Insurance Plan in Ontario and Medical Services Plan in BC) in both provinces. The National Ambulatory Care Reporting System was used to identify CAP episodes from emergency department visits in Ontario. CAP recorded with a primary or secondary diagnosis was identified using International Classification of Diseases 9 (480–486, 510, 513) and 10 (J10.0, J11.0, J12–J18, J86.9, J85.1) codes. We estimated the age and sex adjusted annual incidence of CAP overall, and by age groups (0–4, 5–17, 18–39, 40–64, 65–74, 75–84 and ≥85 years) according to routine childhood pneumococcal conjugate vaccine (PCV) immunization periods from 2005–2018 in Ontario and from 2002–2018 in BC. Poisson regression models were fitted with population denominators from Statistics Canada to estimate the incidence rates. Results Ontario had 3,607,186 CAP episodes from 2005–2015 with a mean annual incidence of 2,801 (95% confidence interval [CI]: 2,748, 2,854) per 100,000 population; incidence declined from 3,077/100,000 in 2005 to 2,604/100,000 in 2010 before increasing to 2,843/100,000 in 2018. BC had 1,146,172 CAP episodes from 2002–2008, with a mean annual incidence of 2,146 (95% CI: 2105, 2189); the incidence increased from 2,005 /100,000 in 2002 to 2,199/100,000 in 2018. A high incidence of CAP was observed in children aged 0–4 years and older adults, particularly in adults aged ≥85 years in both provinces across all PCV program periods (Figure 1). Figure 1: Age group-specific incidence of all-cause community-acquired pneumonia according to childhood pneumococcal conjugate vaccine (PCV) program periods in Ontario (PCV7 [1 Jan 2005–30 Sep 2009]), PCV10 [1 Oct 2009–31 Oct 2010] and PCV13 [1 Nov 2010–31 Dec 2018]) and British Columbia (PCV7 [1 Sep 2003–31 May 2010] and PCV13 [1 Jun 2010–31 Dec 2018]), Canada Conclusion CAP continues to be a public health burden in Canada despite publicly funded pneumococcal vaccination programs. Ontario seems to have higher CAP burden than British Columbia that warrants further investigation. The youngest cohort of children and older adults contribute significantly to the CAP burden. Disclosures Manish Sadarangani, BM BCh, DPhil, GlaxoSmithKline (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)Symvivo (Grant/Research Support)VBI Vaccines (Research Grant or Support) Allison McGeer, MSc,MD,FRCPC,FSHEA, GlaxoSmithKline (Advisor or Review Panel member)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) James D. Kellner, MD, FRCPC, FIDSA, Pfizer, Merck, GSK, Moderna (Grant/Research Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support) Shaza A. Fadel, PhD MPH, Merck (Other Financial or Material Support, Salary is paid by the University of Toronto via a donation by Merck to the Centre for Vaccine Preventable Diseases to support educational and operational activities.) Fawziah Marra, BSc(Pharm), PharmD, Pfizer Canada (Research Grant or Support)

Background. Institutional trust is a key component of the public health system's effectiveness. However, the COVID-19 pandemic highlighted gaps in institutional trust and hesitation. Analysis was conducted to understand correlates of institutional trust to inform communication strategies for the ongoing pandemic and future public health crises.
Methods. The Roper Center for Public Opinion/ America's Voice Project Coronavirus Index conducted a US online survey February 22-April 5, 2021 and included questions about COVID-19 experiences, attitudes and behaviors. Respondents also indicated trust in each of four institutions to provide accurate information about COVID-19: federal government, state government, CDC and national public health officials. Scores were summed to create an Institutional Trust (IT) index: the top third was classified as "High IT, " the middle third "Moderate IT" and the bottom third "Low IT. " Data were analyzed using χ2 tests, with z-tests for more granular between-group comparisons.
Results. Those with Low IT were significantly more likely than those with Moderate or High IT to be white, male, rural, politically conservative, married, and live with children under age 18. Low IT individuals were less likely to have been tested for COVID-19 themselves and less likely to know someone who had tested positive for COVID-19. However, Low IT respondents were more likely to have tested positive for COVID-19, even when controlling for their lower propensity to be tested. Low IT individuals were significantly more likely to have visited restaurants and stores in the past week and feel these activities posed no health risk; they also wore masks less often. Despite greater risk-taking, Low IT respondents were over five times more likely than High IT respondents to refuse the COVID-19 vaccine.
Conclusion. Low IT was associated with higher COVID-19 vaccine hesitancy as well as behavior that, at the time data was collected, put people at higher risk of contracting COVID-19. Public health officials should prioritize the development of more effective communications towards Low IT populations. Traditional methods of establishing message credibility may require modification in order to encourage Low IT individuals to participate in behaviors that enhance public health.
Disclosures. Background. Public health officials are concerned that adults may refuse to be vaccinated with an approved COVID-19 vaccine thereby limiting the community health benefit. Here, we studied the self-reported intent to be vaccinated of persons in North Carolina (NC) and then measured whether they did or did not get vaccinated.
Methods. The Community COVID-19 Research Partnership (CCRP) is a large prospective study exploring COVID-19 epidemiology and sequelae in participants of several mid-Atlantic and Southern States. All participants complete an online daily survey where they are asked questions about COVID-like symptoms, infections, and their vaccination status. In addition to the daily survey, in December 2020, we implemented a short online cross-sectional survey questioning NC participants on whether they intended to be vaccinated. After completing the cross-sectional survey, we used daily survey data through 15 May 2021 to see if participants reported receiving vaccine. Unvaccinated participants who did not complete the daily survey 30 days or more prior to 15 May 2021 were excluded.
Results. 18,874 participants completed the cross-sectional survey and reported vaccination status. Of these participants, 90% were white, 68% were female, 26% were healthcare workers, and 2% self-reported COVID-19 diagnosis The median age was 54 years (IQR: 41 -65). 79%, 13%, 9%, and 2% answered yes, unsure, no, and prefer not to answer, respectively, about intention to be vaccinated (Table). 99% of the participants who intended to receive the COVID-19 vaccine reporting being vaccinated. Those who were unsure or intended not to get vaccinated had vaccination rates of 80% and 53%, respectively. 78% of the participants who preferred not to answer were vaccinated.