---
title: "COVID-19 vaccine uptake in US individuals with Down syndrome — Tennessee Medicaid cohort"
id: "pubmed-42691822"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42691822"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42691822/"
doi: "10.1016/j.vaccine.2026.129128"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# COVID-19 vaccine uptake in US individuals with Down syndrome — Tennessee Medicaid cohort
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42691822
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42691822/)
- **DOI:** [10.1016/j.vaccine.2026.129128](https://doi.org/10.1016%2Fj.vaccine.2026.129128)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study evaluated **COVID-19 vaccine** uptake among individuals with **Down syndrome** enrolled in Tennessee Medicaid, born 1995–2021, and who had at least one visit to Vanderbilt University Medical Center between six months after initial vaccine eligibility and October 1, 2024. - Vaccine dates and types were obtained from the Tennessee Immunization Information System; demographic and clinical variables came from enrollment and clinical records described by the authors. - Among 438 individuals, first eligibility ages were distributed as: 16+ years (95 individuals), 12–15 years (88), 5–11 years (187), and 6 months–4 years (68). - Overall uptake was low: 152 people (35%) received at least one dose; among those vaccinated, 138 (91%) completed the primary series. - Multivariable logistic regression was used to identify characteristics associated with receipt of any COVID-19 vaccine and completion of the primary series. - Younger age at eligibility and absence of influenza vaccination history (either never vaccinated or not vaccinated during the pandemic) were strongly associated with lower likelihood of receiving **COVID-19 vaccine** and with failure to complete the primary series. - The authors propose that routinely available variables (age and influenza vaccine history) could help identify candidates for targeted outreach to improve vaccination coverage and reduce COVID-19 morbidity in this high-risk group. - The cohort was limited to Medicaid enrollees in Tennessee who sought care at a single medical center; the source reported these scope restrictions in the Methods section.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 3. # COVID-19 vaccine uptake among individuals with Down syndrome in the Unites States [Hui Nian](https://pubmed.ncbi.nlm.nih.gov/?term=Nian+H&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Tan Ding](https://pubmed.ncbi.nlm.nih.gov/?term=Ding+T&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Rees L Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+RL&cauthor_id=42691822)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-2 "Department of Pediatrics, University of Arizona, Tuson, AZ, USA."), [Tebeb Gebretsadik](https://pubmed.ncbi.nlm.nih.gov/?term=Gebretsadik+T&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Lin Ammar](https://pubmed.ncbi.nlm.nih.gov/?term=Ammar+L&cauthor_id=42691822)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-3 "Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA."), [Sharon C Enujioke](https://pubmed.ncbi.nlm.nih.gov/?term=Enujioke+SC&cauthor_id=42691822)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-4 "CDR MC USN Department of Pediatrics, Uniformed Services University, Navy Medical Center, Portsmouth, Virginia, USA."), [Allison B McCoy](https://pubmed.ncbi.nlm.nih.gov/?term=McCoy+AB&cauthor_id=42691822)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-5 "Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Donald G Sengstack](https://pubmed.ncbi.nlm.nih.gov/?term=Sengstack+DG&cauthor_id=42691822)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-5 "Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Corinne A Riddell](https://pubmed.ncbi.nlm.nih.gov/?term=Riddell+CA&cauthor_id=42691822)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-6 "Division of Epidemiology, University of California Berkeley, Berkeley, California, USA."), [Tina V Hartert](https://pubmed.ncbi.nlm.nih.gov/?term=Hartert+TV&cauthor_id=42691822)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-7 "Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Pingsheng Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+P&cauthor_id=42691822)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#full-view-affiliation-8 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Pingsheng.wu@vumc.org.") Affiliations Expand ### Affiliations * 1 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. * 2 Department of Pediatrics, University of Arizona, Tuson, AZ, USA. * 3 Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA. * 4 CDR MC USN Department of Pediatrics, Uniformed Services University, Navy Medical Center, Portsmouth, Virginia, USA. * 5 Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA. * 6 Division of Epidemiology, University of California Berkeley, Berkeley, California, USA. * 7 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. * 8 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Pingsheng.wu@vumc.org. * PMID: **42691822** * DOI: [ 10.1016/j.vaccine.2026.129128 ](https://doi.org/10.1016/j.vaccine.2026.129128) Free article Item in Clipboard # COVID-19 vaccine uptake among individuals with Down syndrome in the Unites States Hui Nian et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42691822/) . 2026 Oct 24:92:129128. doi: 10.1016/j.vaccine.2026.129128. Epub 2026 Sep 3. ### Authors [Hui Nian](https://pubmed.ncbi.nlm.nih.gov/?term=Nian+H&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Tan Ding](https://pubmed.ncbi.nlm.nih.gov/?term=Ding+T&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Rees L Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+RL&cauthor_id=42691822)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-2 "Department of Pediatrics, University of Arizona, Tuson, AZ, USA."), [Tebeb Gebretsadik](https://pubmed.ncbi.nlm.nih.gov/?term=Gebretsadik+T&cauthor_id=42691822)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-1 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Lin Ammar](https://pubmed.ncbi.nlm.nih.gov/?term=Ammar+L&cauthor_id=42691822)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-3 "Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA."), [Sharon C Enujioke](https://pubmed.ncbi.nlm.nih.gov/?term=Enujioke+SC&cauthor_id=42691822)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-4 "CDR MC USN Department of Pediatrics, Uniformed Services University, Navy Medical Center, Portsmouth, Virginia, USA."), [Allison B McCoy](https://pubmed.ncbi.nlm.nih.gov/?term=McCoy+AB&cauthor_id=42691822)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-5 "Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Donald G Sengstack](https://pubmed.ncbi.nlm.nih.gov/?term=Sengstack+DG&cauthor_id=42691822)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-5 "Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Corinne A Riddell](https://pubmed.ncbi.nlm.nih.gov/?term=Riddell+CA&cauthor_id=42691822)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-6 "Division of Epidemiology, University of California Berkeley, Berkeley, California, USA."), [Tina V Hartert](https://pubmed.ncbi.nlm.nih.gov/?term=Hartert+TV&cauthor_id=42691822)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-7 "Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA."), [Pingsheng Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+P&cauthor_id=42691822)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42691822/#short-view-affiliation-8 "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Pingsheng.wu@vumc.org.") ### Affiliations * 1 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. * 2 Department of Pediatrics, University of Arizona, Tuson, AZ, USA. * 3 Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA. * 4 CDR MC USN Department of Pediatrics, Uniformed Services University, Navy Medical Center, Portsmouth, Virginia, USA. * 5 Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA. * 6 Division of Epidemiology, University of California Berkeley, Berkeley, California, USA. * 7 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. * 8 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Pingsheng.wu@vumc.org. * PMID: **42691822** * DOI: [ 10.1016/j.vaccine.2026.129128 ](https://doi.org/10.1016/j.vaccine.2026.129128) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Introduction:** Individuals with Down syndrome are at increased risk for severe disease from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, making them a priority group for COVID-19 vaccination. Data on vaccine uptake and factors associated with vaccination are needed to inform strategies to improve uptake in this vulnerable population. **Objective:** To evaluate COVID-19 vaccine uptake and identify factors associated with vaccination among individuals with Down syndrome. **Methods:** The population included individuals with Down syndrome born during 1995-2021 and enrolled in the Tennessee Medicaid Program during the COVID-19 pandemic. We limited the study population to individuals who sought care at the Vanderbilt University Medical Center at least once between six months after their initial eligibility for the COVID-19 vaccine and October 1, 2024. Date and type of COVID-19 vaccine receipt were ascertained from the Tennessee Immunization Information System. Demographic and clinical characteristics associated with COVID-19 vaccine uptake and completion of the primary series were analyzed using multivariable logistic regression. **Results:** Among 438 individuals with Down syndrome, 95 (22%), 88 (20%), 187 (43%), and 68 (16%) first became eligible for COVID-19 vaccine at age 16+, 12-15, 5-11, and 6 months-4 years of age, respectively. Overall, 152 (35%) received at least one dose of the COVID-19 vaccine; of these, 138 (91%) completed the primary series. Younger age and lack of influenza vaccination history-either never or during the pandemic-were strongly associated with a reduced likelihood of receiving COVID-19 vaccine or completing the primary series. **Conclusions:** Only one-third of individuals with Down syndrome received any COVID-19 vaccine, indicating low uptake in this high-risk population. Readily available information on individuals' age and influenza vaccination history may help identify individuals at increased risk of remaining unvaccinated, thereby informing targeted strategies to improve coverage and reduce COVID-19-related morbidity. **Keywords:** COVID-19; Down syndrome; SARS-CoV-2; Vaccination. Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Assessing healthy vaccinee effect in COVID-19 vaccine effectiveness studies: a national cohort study in Qatar. ](https://pubmed.ncbi.nlm.nih.gov/40488740/) Chemaitelly H, Ayoub HH, Coyle P, Tang P, Hasan MR, Yassine HM, Al Thani AA, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Butt AA, Abu-Raddad LJ.Chemaitelly H, et al.Elife. 2025 Jun 9;14:e103690. doi: 10.7554/eLife.103690.Elife. 2025.PMID: 40488740Free PMC article. * [ Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies. ](https://pubmed.ncbi.nlm.nih.gov/36692910/) Cheetham NJ, Kibble M, Wong A, Silverwood RJ, Knuppel A, Williams DM, Hamilton OKL, Lee PH, Bridger Staatz C, Di Gessa G, Zhu J, Katikireddi SV, Ploubidis GB, Thompson EJ, Bowyer RCE, Zhang X, Abbasian G, Garcia MP, Hart D, Seow J, Graham C, Kouphou N, Acors S, Malim MH, Mitchell RE, Northstone K, Major-Smith D, Matthews S, Breeze T, Crawford M, Molloy L, Kwong ASF, Doores K, Chaturvedi N, Duncan EL, Timpson NJ, Steves CJ.Cheetham NJ, et al.Elife. 2023 Jan 24;12:e80428. doi: 10.7554/eLife.80428.Elife. 2023.PMID: 36692910Free PMC article. * [ COVID-19 Vaccination Coverage and Factors Associated With Vac
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