{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:15:12Z","timestamp":1788315312519,"version":"build-2803163510"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Patient uptake of updated COVID-19 vaccines is crucial for reducing severe outcomes, yet national uptake remains low.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine if tailored messaging or simple inquiry about vaccine acceptance increases 30-day uptake of updated COVID-19 vaccines among emergency department (ED) patients.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This 3-arm, cluster randomized clinical trial conducted from January 29 to June 18, 2024, enrolled adult ED patients who had not received a COVID-19 vaccine in the prior 6 months across 6 EDs in San Francisco, California; Philadelphia, Pennsylvania; Houston, Texas; and Durham, North Carolina.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Intervention M involved tailored messaging about updated COVID-19 vaccines and inquiry about vaccine acceptance. Intervention Q involved only inquiry about vaccine acceptance. Usual care (no messaging or vaccine acceptance questions) served as the control.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was updated COVID-19 vaccine receipt within 30 days of the ED visit, assessed via electronic health record review and follow-up telephone calls. Secondary outcomes included vaccine acceptance and vaccination during the ED visit. Outcomes were also compared between study sites that had the updated COVID-19 vaccine available and those that did not.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 852 participants (median age, 47 years [IQR, 33-63 years]; 464 [54.5%] women), 247 (29.0%) were in the intervention M group, 273 (32.0%) in the intervention Q group, and 332 (39.0%) in the control group. Vaccine uptake at 30 days was not significantly higher in either the intervention M group compared with control (14 participants [5.7%] vs 10 [3.0%]; absolute difference, 2.7 percentage points [pp] [95% CI, \u22120.8 to 6.3 pp]) or the intervention Q group compared with control (11 [4.0%] vs 10 [3.0%]; absolute difference, 1.0 pp [95% CI, \u22122.0 to 4.2 pp]). However, at sites where vaccines were available, the intervention M group had higher uptake compared with control (13 of 132 [9.8%] vs 5 of 150 [3.3%]; absolute difference, 6.5 pp [95% CI, 0.5-12.5 pp]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cluster randomized clinical trial of adult ED patients, tailored messaging and simple inquiry alone did not significantly increase 30-day updated COVID-19 vaccine uptake among patients. The slight increase in uptake among participants in the EDs that had access to the updated COVID-19 vaccines suggested that vaccine availability was an effect modifier, underscoring the importance of opportunity and convenience in vaccine delivery.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT06156215<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.37655","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T15:01:56Z","timestamp":1760540516000},"page":"e2537655","source":"Crossref","is-referenced-by-count":2,"title":["COVID-19 Booster Vaccine Messaging in Emergency Departments"],"prefix":"10.1001","volume":"8","author":[{"given":"Melanie F.","family":"Molina","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A.","family":"Eucker","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin L.","family":"Rising","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania"},{"name":"Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efrat R.","family":"Kean","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubaid","family":"Rafique","sequence":"additional","affiliation":[{"name":"Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba","family":"Mesbah","sequence":"additional","affiliation":[{"name":"Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David V.","family":"Glidden","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireya I.","family":"Arreguin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of California, Riverside"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"6","key":"zoi251040r1","doi-asserted-by":"publisher","first-page":"688","DOI":"10.3390\/vaccines12060688","article-title":"COVID-19 booster vaccination status and long COVID in the United States: a nationally representative cross-sectional study.","volume":"12","author":"Romeiser","year":"2024","journal-title":"Vaccines (Basel)"},{"issue":"1","key":"zoi251040r2","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1038\/s41467-024-45549-9","article-title":"Comparing frequency of booster vaccination to prevent severe COVID-19 by risk group in the United States.","volume":"15","author":"Park","year":"2024","journal-title":"Nat Commun"},{"issue":"4","key":"zoi251040r6","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.annemergmed.2023.04.009","article-title":"COVID-19 booster vaccine hesitancy in the emergency department.","volume":"82","author":"Molina","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"2","key":"zoi251040r7","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1001\/jamainternmed.2022.5909","article-title":"Effect of COVID-19 vaccine messaging platforms in emergency departments on vaccine acceptance and uptake: a cluster randomized clinical trial.","volume":"183","author":"Rodriguez","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi251040r8","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2300197","article-title":"Promotion of influenza vaccination in the emergency department.","volume":"3","author":"Rodriguez","year":"2024","journal-title":"NEJM Evid"},{"issue":"11","key":"zoi251040r12","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1001\/jamapediatrics.2023.3260","article-title":"Cost-related barriers and ensuring equitable access to vaccines in the US.","volume":"177","author":"Essien","year":"2023","journal-title":"JAMA Pediatr"},{"issue":"1","key":"zoi251040r14","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/acem.14620","article-title":"Perspectives of COVID-19 vaccine-hesitant emergency department patients to inform messaging platforms to promote vaccine uptake.","volume":"30","author":"Gentsch","year":"2023","journal-title":"Acad Emerg Med"},{"issue":"9","key":"zoi251040r15","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1111\/acem.14933","article-title":"An evaluation of COVID-19 vaccine messaging platforms in the emergency department.","volume":"31","author":"Monzon","year":"2024","journal-title":"Acad Emerg Med"},{"issue":"4","key":"zoi251040r16","doi-asserted-by":"publisher","first-page":"484","DOI":"10.7326\/M20-6141","article-title":"Comparison of knowledge and information-seeking behavior after general COVID-19 public health messages and messages tailored for Black and Latinx communities: a randomized controlled trial.","volume":"174","author":"Alsan","year":"2021","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi251040r17","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.cct.2006.05.007","article-title":"Design and analysis of stepped wedge cluster randomized trials.","volume":"28","author":"Hussey","year":"2007","journal-title":"Contemp Clin Trials"},{"issue":"2","key":"zoi251040r18","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"22","key":"zoi251040r21","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1001\/jama.2024.7395","article-title":"Mortality in patients hospitalized for COVID-19 vs influenza in fall-winter 2023-2024.","volume":"331","author":"Xie","year":"2024","journal-title":"JAMA"},{"issue":"6","key":"zoi251040r22","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1056\/NEJMoa2403211","article-title":"Postacute sequelae of SARS-CoV-2 infection in the pre-Delta, Delta, and Omicron eras.","volume":"391","author":"Xie","year":"2024","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi251040r23","first-page":"374","article-title":"Operation Cover Saint Louis (COVID-19 Vaccine in the Emergency Room): impact of a vaccination program in the emergency department.","volume":"25","author":"Wessman","year":"2024","journal-title":"West J Emerg Med"},{"issue":"8","key":"zoi251040r24","doi-asserted-by":"publisher","first-page":"180","DOI":"10.15585\/mmwr.mm7308a5","article-title":"Interim effectiveness of updated 2023-2024 (monovalent XBB.1.5) COVID-19 vaccines against COVID-19\u2013associated emergency department and urgent care encounters and hospitalization among immunocompetent adults aged =18 years\u2014VISION and IVY networks, September 2023-January 2024.","volume":"73","author":"DeCuir","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi251040r3","unstructured":"Centers for Disease Control and Prevention. CDC recommends second dose of 2024-2025 COVID-19 vaccine for people 65 years and older and for people who are moderately or severely immunocompromised. CDC newsroom. October 23, 2024. Accessed November 17, 2024. https:\/\/www.cdc.gov\/media\/releases\/2024\/s1023-covid-19-vaccine.html"},{"key":"zoi251040r4","unstructured":"Centers for Disease Control and Prevention. Interim clinical considerations for use of COVID-19 vaccines in the United States. May 1, 2025. Accessed September 8, 2025. https:\/\/www.cdc.gov\/vaccines\/covid-19\/clinical-considerations\/interim-considerations-us.html"},{"key":"zoi251040r5","unstructured":"Centers for Disease Control and Prevention. COVID-19 vaccination coverage and intent for vaccination, adults 18 years and older, United States. May 7, 2025. Accessed September 8, 2025. https:\/\/www.cdc.gov\/covidvaxview\/weekly-dashboard\/adult-vaccination-coverage.html"},{"key":"zoi251040r9","unstructured":"Kates? J, Cox? C, Published? JM. How much could COVID-19 vaccines cost the US after commercialization? KFF. March 10, 2023. Accessed April 21, 2025. https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/how-much-could-covid-19-vaccines-cost-the-u-s-after-commercialization\/"},{"key":"zoi251040r10","unstructured":"Centers for Medicare & Medicaid Services. Accounting for federal COVID expenditures in the National Health Expenditure Accounts. Accessed July 14, 2025. https:\/\/www.cms.gov\/files\/document\/accounting-federal-covid-expenditures-national-health-expenditure-accounts.pdf"},{"key":"zoi251040r11","unstructured":"Assistant Secretary for Public Affairs. COVID-19 public health emergency. March 2, 2023. Accessed September 4, 2025. https:\/\/www.hhs.gov\/coronavirus\/covid-19-public-health-emergency\/index.html"},{"key":"zoi251040r13","unstructured":"Promotion of COVID-19 booster va(x)ccination in the emergency department\u2014PROBOOSTVAXED. ClinicalTrials.gov identifier: NCT06156215. Updated October 29, 2024. Accessed November 22, 2024. https:\/\/clinicaltrials.gov\/study\/NCT06156215"},{"key":"zoi251040r19","unstructured":"Tyson A, Pasquini G. 60% of Americans say they probably won\u2019t get an updated COVID-19 vaccine. Pew Research Center. November 19, 2024. Accessed December 5, 2024. https:\/\/www.pewresearch.org\/short-reads\/2024\/11\/19\/60-of-americans-say-they-probably-wont-get-an-updated-covid-19-vaccine\/"},{"key":"zoi251040r20","unstructured":"Centers for Disease Control and Prevention. The changing threat of COVID-19. National Center for Immunization and Respiratory Diseases. February 23, 2024. Accessed July 14, 2025. https:\/\/www.cdc.gov\/ncird\/whats-new\/changing-threat-covid-19.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2840135\/molina_2025_oi_251040_1759861249.77303.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T15:02:00Z","timestamp":1760540520000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2840135"}},"subtitle":["A Cluster Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":24,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.37655","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}