The demand for COVID-19 vaccines has diminished as the pandemic lingers. Understanding vaccine hesitancy among essential workers is important in reducing the impact of future pandemics by providing effective immunization programs delivered expeditiously. Two surveys exploring COVID-19 vaccine acceptance in 2021 and 2022 were conducted in cohorts of health care providers (HCP) and education workers participating in prospective studies of COVID-19 illnesses and vaccine uptake. Demographic factors and opinions about vaccines (monovalent and bivalent) and public health measures were collected in these self-reported surveys. Modified multivariable Poisson regression was used to determine factors associated with hesitancy. In 2021, 3 % of 2061 HCP and 6 % of 3417 education workers reported hesitancy (p < 0.001). In December 2022, 21 % of 868 HCP and 24 % of 1457 education workers reported being hesitant to receive a bivalent vaccine (p = 0.09). Hesitance to be vaccinated with the monovalent vaccines was associated with earlier date of survey completion, later receipt of first COVID-19 vaccine dose, no influenza vaccination, and less worry about becoming ill with COVID-19. Factors associated with hesitance to be vaccinated with a bivalent vaccine that were common to both cohorts were receipt of two or fewer previous COVID-19 doses and lower certainty that the vaccines were safe and effective. Education workers were somewhat more likely than HCP to report being hesitant to receive COVID-19 vaccines but reasons for hesitancy were similar. Hesitancy was associated with non-receipt of previous vaccines (i.e., previous behaviour), less concern about being infected with SARS-CoV-2, and concerns about the safety and effectiveness of vaccines for both cohorts. Maintaining inter-pandemic trust in vaccines, ensuring rapid data generation during pandemics regarding vaccine safety and effectiveness, and effective and transparent communication about these data are all needed to support pandemic vaccination programs.

There is limited information regarding factors related to education workers’ responses to traumatic stress during the COVID-19 pandemic. The study goal was to determine whether personal factors, behaviours that mitigate viral spread, and work-related factors were associated with post-traumatic symptoms. This observational study, embedded within a cohort study, recruited Ontario education workers from February 2021 to June 2023. Exposure data were collected at enrollment and updated annually. Participants completed the Impact of Event Scale (IES) at withdrawal/study completion. Modified Poisson regression was used to build hierarchical models of dichotomized IES scores (≥26: moderate/severe post-traumatic symptoms). Of the 1518 education workers who submitted an IES between September 2022 and December 2023, the incidence rate ratio of IES scores ≥26 was significantly higher among participants who usually/always wore a mask at work (1.48; 95% confidence interval 1.23, 1.79), usually/always practiced physical distancing (1.31; 1.06, 1.62), lived in larger households (1.06; 1.01, 1.12), and reported poor/fair/good health (1.27; 1.11, 1.46). However, models accounted for little of the variance in IES scores, suggesting the need for future studies to collect data on other factors associated with the development of PTSD, such as pre-existing mental health challenges. Early identification of those experiencing traumatic stress and the implementation of stress reduction strategies are needed to ensure the ongoing health of education workers.

Background: Essential workers, including those working in healthcare and education, are at higher risk of exposure to communicable diseases, including SARS-CoV-2. Reducing the rates of infection is important for their personal health and for the ongoing safe operation of essential services. Methods: Data from participants in two prospective cohort studies who tested positive for SARS-CoV-2 in 2020 through 2023 were used to determine whether vaccination against SARS-CoV-2 is associated with the severity of symptoms in working-age adults. Results: SARS-CoV-2-positive tests (N = 3757) were reported by 3093 participants (mean: 1.2 per person); 1229 (33%) illnesses did not interfere with regular activities, 1926 (51%) made participants too unwell for regular activities, and 602 (16%) required participant bed rest. Compared with vaccine receipt more than 12 months earlier, receipt within six months of an infection was associated with lower risk ratios for more severe illness (too unwell: 0.69 and bed rest: 0.67) compared with being able to conduct regular activities. More recent vaccination was also associated with lower odds reporting of systemic symptoms (fever, myalgia, arthralgia) and fewer solicited symptoms. Conclusion: Staying current with COVID-19 vaccinations should continue to be recommended since receiving a recent immunization lessened the severity of illness. Also, as symptoms of COVID-19 are now largely similar to other respiratory viruses, practitioners need to use this evidence to inform diagnostic testing and return-to-work policies.

Objectives: to determine factors associated with rates of SARS-CoV-2 infection and to determine whether anti-receptor-binding domain (RBD) IgG levels were associated with the rates of infectionDesign: prospective cohort of 34 months’ duration (February 2021 to December 2023)Setting: teachers and education workers working ≥8 hours per week in the Canadian province of OntarioParticipants: 3155 education workers were eligible for the risk factor analysis; 2977 for the serological analysisPrimary outcome measure: SARS-CoV-2 infection, symptomatic or asymptomaticResults: 1909 SARS-CoV-2 infections were reported (0.93 per 1000 participant-days); the highest incidence occurred during the period dominated by the Omicron BA.2 variant (2.01/1000 participant-days). After a median of 740 (interquartile range 361, 971) days of follow-up, participants who received three (adjusted hazard ratio (aHR) 0.24; 95% CI 0.11, 0.50; p<0.001), four (aHR 0.14; 95% CI 0.07, 0.30; p<0.001), or five or more (aHR 0.14; 95% CI 0.06, 0.30; p<0.001) doses of COVID-19 vaccines had lower rates of infection than participants who received <2 doses. Likewise, those who had immunity from a previous infection had lower rates of infection (aHR 0.05; 95% CI 0.04, 0.07) than those without. Participants 30 years of age or older had a lower rate of infection than participants 20-29 years old and those with Caucasian/European ancestry had a lower rate of infection (aHR 0.83; 95% CI 0.71, 0.96; p=0.01) than others. Also, compared to participants without known contact with an infected person, those in close contact with an infected household member (aHR 1.54; 95% CI 1.39, 1.71; p<0.001), coworker or student (aHR 1.22; 95% CI 1.04, 1.42, p=0.012), or individuals from more than one setting (aHR 1.45; 95% CI 1.29, 1.63; p<0.001) had higher rates of infection. Blood samples with anti-RBD antibody levels in the highest quintile (≥5850 BAU/mL) were associated with a lower rate of subsequent infection (aHR 0.40; 95% CI 0.23, 0.72) compared to samples with RBD levels below the threshold of detection. Conclusions: COVID-19 vaccines continued to provide protection against infection with SARS-CoV-2 through December 2023. Infection following exposure to people with SARS-CoV-2 occurred in a variety of venues indicating the need to practice intervention strategies when the potential for transmission is high.

The use of non-pharmaceutical interventions (NPIs) was imperative to avoid prolonged school closures during the COVID-19 pandemic. The purpose of this study was to understand the levels of adherence to and attitudes towards NPIs from February 2021 to December 2023 in schools in Ontario, Canada. Participants reported how frequently they, their coworkers, and their students used five NPIs: hand hygiene, covering coughs, staying home when ill, wearing a mask, and physically distancing. Open text comments provided participants with the option to provide additional details. A mixed methods approach incorporated a series of descriptive statistics calculated at consecutive time points and thematic analysis. Participants reported higher adherence to NPIs than their coworkers and students, with less than perfect adherence that declined over time. Six themes emerged from the analysis on NPI use in schools: 1) the influence of time; 2) managing competing priorities; 3) lack of enabling factors; 4) lack of reinforcing factors; 5) responsive use of NPIs; and 6) emotional toll. Poor use of hand hygiene, covering coughs, and staying home when ill indicate a need to improve these in schools as it would help reduce the transmission of communicable diseases and thereby reduce sick days for staff and students.

The use of non-pharmaceutical interventions (NPIs) was imperative to avoid prolonged school closures during the COVID-19 pandemic. The purpose of this study was to understand the levels of adherence to and attitudes towards NPIs from February 2021 to December 2023 in schools in Ontario, Canada. Participants reported how frequently they, their coworkers, and their students used five NPIs: hand hygiene, covering coughs, staying home when ill, wearing a mask, and physically distancing. Open text comments provided participants with the option to provide additional details. Our mixed methods approach incorporated a series of descriptive statistics calculated at consecutive time points and thematic analysis. Participants reported higher adherence to NPIs than their coworkers and students, with less than perfect adherence that declined over time. Six themes emerged from the qualitative analysis on NPI use in schools: (1) the influence of time; (2) managing competing priorities; (3) a lack of enabling factors; (4) a lack of reinforcing factors; (5) the responsive use of NPIs; and (6) an emotional toll. To reduce the transmission of future communicable diseases and resultant staff and student sick days, ongoing commitment to hand hygiene, covering coughs, and staying home when ill is required.