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.

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.

Background: While testing healthcare workers (HCWs) for SARS-CoV-2 is important to reduce transmission within healthcare settings, understanding the self-reported patterns of testing is important for interpreting vaccine effectiveness and other COVID-19-related information. Objective: Using longitudinal data from the COVID-19 Cohort Study, this study described trends in SARS-CoV-2 testing among Canadian HCWs between June 2020 and November 2023. Methods: HCWs completed an illness report for each instance of SARS-CoV-2 testing and episodes of symptoms compatible with COVID-19 even if untested. Overall rates of testing were calculated along with rates stratified by participating province, reason for testing, and COVID-19 vaccination status. Results: Rates of testing for SARS-CoV-2 generally mirrored rates of hospitalization for COVID-19 among Canadians. Rates of testing were highest during the Omicron BA.1 wave and varied by region, while vaccination status did not impact rates. The most commonly reported reason for testing was for symptoms; testing for known/possible exposure or routine reasons greatly decreased after the Omicron BA.1 wave. In participants who were tested for episodes of symptomatic illness, the mean time to first test was 1.3 days. Reported retesting after an initial negative result remained low throughout the study period. Conclusions: Understanding testing behaviours is important for public health decision-making including the analysis and interpretation of case data and vaccine effectiveness studies. It can also highlight possible missed case-finding opportunities in healthcare settings.