{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:11:44Z","timestamp":1760058704421,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute (NCI)","doi-asserted-by":"publisher","award":["CA260582"],"award-info":[{"award-number":["CA260582"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background\/Objectives: Emergency Medical Services (EMS) clinicians in the US have high COVID-19 vaccine hesitancy rates and often do not receive primary vaccinations or subsequent boosters. The extent of booster attrition following initial vaccination and first booster dose in EMS clinicians is unknown. Our objective was to evaluate the prevalence and drivers of COVID-19 booster attrition in EMS clinicians. We hypothesized that booster attrition is common among EMS clinicians and associated with various EMS characteristics. Methods: This study was a cross-sectional analysis of nationally certified civilian EMS clinicians aged 18\u201385 years old. An electronic survey was distributed, which included an evaluation of vaccination status, booster acceptance, willingness to receive future boosters, perceived risk of contracting COVID-19 from the Understanding America Survey (8 items), and mistrust of healthcare organizations using the Medical Mistrust Index (MMI) (7 items). These data were combined with demographic and work-related characteristics from the National Registry of EMTs dataset. A multivariable logistic regression model (OR, 95% CI) was used to describe booster attrition associations between demographics, work-related characteristics, perceived risk, and medical mistrust. Results: A total of 1902 respondents met initial inclusion criteria. Within this group, 78% were COVID-19 vaccinated, and an additional 65% received a booster. Of these, 37% reported not planning to receive any other booster treatments following the first booster. Primary reasons for not continuing with subsequent boosters include confusion among experts on efficacy (59%), severe side effects (38%), the belief that COVID-19 is not a threat (26%), the belief in natural immunity (25%), and the belief that boosters are not required (23%). Odds of planning to receive another booster increased with receiving a flu vaccine (5.03, 3.08\u20138.22) and urban environment (1.96, 1.19\u20133.24, referent rural). In comparison, the odds of planning to receive another booster were lower for paramedics (0.56, 0.38\u20130.83, referent EMT) and fire agencies (0.53, 0.31\u20130.89, referent hospital). As the perceived risk of COVID-19 and medical mistrust decrease, the odds of planning to receive another booster increase (perceived risk: 1.98, 1.41\u20132.78; trust: 4.12, 3.21\u20135.28). Conclusions: The rate of booster attrition following receipt of one booster is high, at 37%. While there are associations with EMS demographic and workforce characteristics, further exploration is necessary to define the drivers and potential consequences of high booster attrition in the EMS clinician community.<\/jats:p>","DOI":"10.3390\/vaccines13050457","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T06:10:13Z","timestamp":1745561413000},"page":"457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency Medical Services Clinicians and COVID-19 Booster Behavior\u2014A Cross-Sectional National Evaluation"],"prefix":"10.3390","volume":"13","author":[{"given":"Gregory","family":"Muller","sequence":"first","affiliation":[{"name":"Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Stanford University, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5150-0740","authenticated-orcid":false,"given":"Christopher B.","family":"Gage","sequence":"additional","affiliation":[{"name":"National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA"},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3443-0247","authenticated-orcid":false,"given":"Jonathan R.","family":"Powell","sequence":"additional","affiliation":[{"name":"National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA"},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4365-6232","authenticated-orcid":false,"given":"Sarah R.","family":"MacEwan","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"},{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3859-6885","authenticated-orcid":false,"given":"Laura J.","family":"Rush","sequence":"additional","affiliation":[{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eben","family":"Kenah","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2402-1925","authenticated-orcid":false,"given":"Gennaro","family":"Di Tosto","sequence":"additional","affiliation":[{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9107-5419","authenticated-orcid":false,"given":"Ann Scheck","family":"McAlearney","sequence":"additional","affiliation":[{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-982X","authenticated-orcid":false,"given":"Ashish R.","family":"Panchal","sequence":"additional","affiliation":[{"name":"National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA"},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA"},{"name":"The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/S1473-3099(24)00158-0","article-title":"Global Burden Associated with 85 Pathogens in 2019: A Systematic Analysis for the Global Burden of Disease Study 2019","volume":"24","author":"Naghavi","year":"2024","journal-title":"Lancet Infect. 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