RFA-IP-22-004, Platform to Assess Influenza and COVID-19 Vaccine Effectiveness in Underserved Arizona Populations

Component A - Abstract: Annual influenza vaccination is the primary prevention strategy for infection and severe disease. A constantly evolving influenza virus through antigenic drift dictates that vaccines are re-evaluated every year. COVID-19 has overlapping symptoms with influenza and has significantly complicated the healthcare burden associated with viral infections, morbidity, and mortality. While COVID-19 vaccines received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA), additional COVID-19 vaccines are under development due to emerging variants, some of which are known to evade currently authorized vaccines. As such, boosters are recommended to thwart spikes and new waves of variant infections which complicates assessment of the effectiveness of both COVID-19 and seasonal influenza vaccines simultaneously. Phoenix, Arizona is the fifth largest and fastest growing city in the nation, and, importantly, is home to an ethnically and socioeconomically diverse population. Twice during the COVID-19 pandemic, Arizona was #1 worldwide in per capita COVID-19 cases. Arizona has seen a mixed adoption of vaccine use for both COVID-19 and influenza, allowing for excellent local comparisons. In this project, leveraging Arizona State University's (ASU) core capabilities, we propose to study vaccine effectiveness (VE) in a diverse demographic and clinical population (including immunocompromised HIV patients) seen at outpatient clinics managed by ValleyWise Community Hospital, Phoenix Children's Hospital and ASU Student Health Services. Given identified health disparities in infection and vaccination, we propose to examine social determinants of health to identify the most vulnerable groups. We will collect specimens (nasopharyngeal and/or anterior nasal swabs) and relevant demographic and clinical data from laboratory-confirmed cases of influenza and COVID-19 in children and adults with acute respiratory infection, seeking care in ambulatory clinics, to calculate vaccine effectiveness for both influenza and COVID- 19 vaccines. We will also sequence viral genomes to identify subtype/variants using our deep expertise and incomparable resources in next-generation sequencing and viral genomic bioinformatics. We will use this genomic sequencing data to further investigate VE analyses and understand virus evolution. Importantly, to examine health disparities in vaccination and vaccine effectiveness, we will implement longitudinal surveys and geographical information systems mapping to measure and model social determinants of health. Overall, our multidisciplinary program provides a comprehensive approach to study VE and to understand social determinates that drives health disparities. We believe the findings will have important, long lasting policy implications towards vaccination and examination of VE.