351
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Lipkin WI. Maternal prenatal Tdap not associated with autism development in the child. J Pediatr 2019; 204:320-323. [PMID: 30579469 DOI: 10.1016/j.jpeds.2018.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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352
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Immunization and Vaccination. PSYCHIATRY OF PANDEMICS 2019. [PMCID: PMC7124023 DOI: 10.1007/978-3-030-15346-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vaccines have been recognized as one of the most successful public health measures. In this chapter, we provide a historical overview of immunization measures and discuss the basics of immunization and vaccination in the context of a pandemic outbreak. We will also discuss vaccine hesitancy, the factors that lead to vaccine acceptance and refusal, the determinants of individual decision-making about vaccination, and strategies of how to approach it on an individual, community, and global level.
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353
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Ren J, Wagner AL, Zheng A, Sun X, Boulton ML, Huang Z, Zikmund-Fisher BJ. The demographics of vaccine hesitancy in Shanghai, China. PLoS One 2018; 13:e0209117. [PMID: 30543712 PMCID: PMC6292563 DOI: 10.1371/journal.pone.0209117] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vaccine hesitancy has been little studied in low- and middle-income countries but is a potential concern because vaccine refusal may increase the burden of infectious diseases and impede control efforts. The aim of this study was to compare vaccine hesitancy between locals, long-time city residents, and non-locals, who have more recently moved to the city from either other urban or rural areas, in Shanghai, China. METHODS Parents of infants ≤3 months of age were surveyed at immunization clinics in Shanghai, China. Participants completed a paper questionnaire utilizing the 10-item Vaccine Hesitancy Scale, which was developed by the World Health Organization Strategic Advisory Group of Experts on Immunization. Items were grouped based on internal consistency, and regressed onto demographic variables using a negative binomial model. RESULTS In total, 1,188 (92.5%) individuals participated. For most items on the scale, parents expressed positive beliefs about vaccines. However, about half of parents somewhat or strongly agreed that new vaccines carried more risks than older vaccines, and 71.6% somewhat or strongly agreed that they were concerned about serious adverse effects. Seven items from the Vaccine Hesitancy Scale were highly correlated and mapped onto "lack of confidence"; the other three items were analysed separately. Compared to mothers, fathers had less lack of confidence (β: -0.06, 95% CI: -0.12, -0.01), and individuals living in the outer suburbs (β: 0.13, 95% CI: 0.01, 0.25) and rural non-locals (β: 0.10, 95% CI: 0.02, 0.18) had greater lack of confidence in vaccines compared to their urban or local counterparts, respectively. DISCUSSION Shanghai parents professed confidence in certain vaccine benefits, but vaccine messaging could focus on addressing misconceptions about vaccines for diseases no longer common, newer vaccines, and adverse effects associated with vaccination. These messages may need to be separately tailored to locals and non-locals, who have differing concerns.
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Affiliation(s)
- Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, Shanghai, China
| | - Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Zheng
- School of Information, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, Shanghai, China
| | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, Shanghai, China
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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354
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Simon TL, FitzGerald P, Kühne M, Farrar C, Knowles J, Bycholski K, Zenker O. Longitudinal changes in measles antibody titers in plasma donors and minimum antibody levels of immunoglobulin products for treatment of primary immunodeficiency. Transfusion 2018; 58 Suppl 3:3065-3071. [PMID: 30536437 DOI: 10.1111/trf.15014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND To ensure that immunoglobulin (Ig) products have adequate functional antibody, the US Food and Drug Administration (FDA) requires that Ig lots contain minimum levels of measles neutralizing antibody; the current minimum is 0.48 x US Reference Ig 176. STUDY DESIGN AND METHODS In the first part of the study, measles antibody titers were measured in donor plasma samples collected in 2007, 2011, and 2017. In the second part, trough or steady-state serum levels of measles neutralizing antibody were measured in two studies of patients with primary immunodeficiency (PID) who were treated with intravenous (Study 1; N = 46) or subcutaneous (Study 2; N = 18) Ig replacement therapy, meeting previous requirements for lot potency (≥0.6 x US Reference Ig 176). Serum measles neutralizing antibody titers were then estimated for conditions in which the potency of the Ig replacement product was 0.48 or 0.30 x US Reference Ig 176. RESULTS Measles antibody titers in donated plasma samples declined in donors born after 1963. In the two studies of patients with PID who were treated with intravenous or subcutaneous Ig replacement therapy, all patients exhibited trough (intravenous Ig) or steady-state (subcutaneous Ig) measles neutralizing antibody titers above 0.12 IU/mL, which has been shown to protect against clinical measles in the general population. Estimates suggest that all patients except one would have continued to meet this standard if the Ig lot potency had been 0.48 or 0.30 x US Reference Ig 176. CONCLUSION These studies provide supporting evidence that the lot release specification can be safely lowered from 0.48 to 0.30 x US Reference Ig 176, which will accommodate declining measles neutralizing antibody levels in donor plasma.
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355
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Griffin DS, Muhlbauer G, Griffin DO. Adolescents trust physicians for vaccine information more than their parents or religious leaders. Heliyon 2018; 4:e01006. [PMID: 30619955 PMCID: PMC6313814 DOI: 10.1016/j.heliyon.2018.e01006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/27/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
Although, evidence clearly supports vaccination as the most cost effective approach to controlling infectious diseases there are many individuals questioning, delaying and refusing vaccines. The main purpose of this study was to find out what source of information adolescents trust the most on vaccines. We conducted a cross-sectional survey of public high school students using a paper-based questionnaire in a region with a high rate of vaccine acceptance to assess sources they trusted most for vaccine information. Surveys were administered over a one-week period in the fall of 2017. We gave forms to 200 students to obtain parental consent and student assent and then distributed our questionnaire to the 125 students who completed these consent/assent forms. A total of 105 completed questionnaires were returned. The major finding was that students reported physicians as their most trusted source for vaccine information. Secondary analysis was performed looking at the perceptions teenagers have relative to risks and effectiveness of vaccines for the prevention of communicable diseases. Most teenagers (62%) reported their physician or other medical professional as the most trusted source and 24% cited parents/guardians. We found that physicians were the most trusted source for information about vaccinations, above parents, in this group of high school students.
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Affiliation(s)
- Daisy S Griffin
- Schreiber High School, Department of Social Studies, Port Washington, NY 11050, USA
| | - George Muhlbauer
- Schreiber High School, Department of Social Studies, Port Washington, NY 11050, USA
| | - Daniel O Griffin
- Columbia University Medical Center, Department of Biochemistry and Molecular Biophysics, New York, NY 10032, USA.,Columbia University Medical Center, Department of Medicine-Division of Infectious Diseases, New York, NY 10032, USA
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356
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Frew PM, Murden R, Mehta CC, Chamberlain AT, Hinman AR, Nowak G, Mendel J, Aikin A, Randall LA, Hargreaves AL, Omer SB, Orenstein WA, Bednarczyk RA. Development of a US trust measure to assess and monitor parental confidence in the vaccine system. Vaccine 2018; 37:325-332. [PMID: 30503657 DOI: 10.1016/j.vaccine.2018.09.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. METHODS We used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., "Information Environment", "Trust", "Healthcare Provider", "Attitudes and Beliefs", and "Social Norms"). Reliability for EVCI was assessed using Cronbach's alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. RESULTS Respondents' EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. CONCLUSIONS We developed EVCI to reliably measure parental vaccine confidence, with individuals' scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.
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Affiliation(s)
- Paula M Frew
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Raphiel Murden
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - C Christina Mehta
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison T Chamberlain
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Alan R Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, United States
| | - Glen Nowak
- University of Georgia Grady College of Journalism and Mass Communication, 120 Hooper St, Athens, GA 30602, United States
| | - Judith Mendel
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Ann Aikin
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Laura A Randall
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison L Hargreaves
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Saad B Omer
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Walter A Orenstein
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States
| | - Robert A Bednarczyk
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
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357
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Sato APS. What is the importance of vaccine hesitancy in the drop of vaccination coverage in Brazil? Rev Saude Publica 2018; 52:96. [PMID: 30517523 PMCID: PMC6284490 DOI: 10.11606/s1518-8787.2018052001199] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/08/2018] [Indexed: 01/21/2023] Open
Abstract
The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.
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Affiliation(s)
- Ana Paula Sayuri Sato
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
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358
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Carroll MW, Kuenzig ME, Mack DR, Otley AR, Griffiths AM, Kaplan GG, Bernstein CN, Bitton A, Murthy SK, Nguyen GC, Lee K, Cooke-Lauder J, Benchimol EI. The Impact of Inflammatory Bowel Disease in Canada 2018: Children and Adolescents with IBD. J Can Assoc Gastroenterol 2018; 2:S49-S67. [PMID: 31294385 PMCID: PMC6512244 DOI: 10.1093/jcag/gwy056] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 12/15/2022] Open
Abstract
Canada has among the highest rates of childhood-onset IBD in the world. Over 7000 children and youth under 18 years old are living with IBD in Canada, and 600 to 650 children under 16 years old are diagnosed annually. While the peak age of onset of IBD is highest in the second and third decades of life, over the past two decades incidence has risen most rapidly in children under 5 years old. The treatment of children with IBD presents important challenges including therapeutic choices, risk of adverse events to medications, psychosocial impact on the child and family, increased cost of health care and the implications of the transition from pediatric to adult care. Despite the unique circumstances faced by children and their families, there is a lack of research to help understand the causes of the rising incidence and the best therapies for children with IBD. Scientific evidence—and specifically clinical trials of pharmaceuticals—are too often extrapolated from adult research. Health care providers must strive to understand the unique impact of childhood-onset IBD on patients and families, while researchers must expand work to address the important needs of this growing patient population. Highlights Key Summary Points Gaps in Knowledge and Future Research Directions
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Affiliation(s)
- Matthew W Carroll
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - M Ellen Kuenzig
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David R Mack
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony R Otley
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne M Griffiths
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,SickKids IBD Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Charles N Bernstein
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,McGill IBD Centre of Excellence, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sanjay K Murthy
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Ottawa Hospital Research Institute, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Geoffrey C Nguyen
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Mount Sinai Hospital Centre for IBD, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Lee
- Crohn's and Colitis Canada, Toronto, Ontario, Canada
| | | | - Eric I Benchimol
- Canadian Gastro-Intestinal Epidemiology Consortium Ottawa, Canada.,Children's Hospital of Eastern Ontario IBD Centre, Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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359
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Reich JA. "We are fierce, independent thinkers and intelligent": Social capital and stigma management among mothers who refuse vaccines. Soc Sci Med 2018; 257:112015. [PMID: 30442504 DOI: 10.1016/j.socscimed.2018.10.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/21/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
Despite measurable benefits of childhood vaccines, mothers with high levels of social privilege are increasingly refusing some or all vaccines for their children. These mothers are often clustered geographically or networked socially, providing information, emotional support, and validation for each other. Mothers who reject vaccines may face disapproval from others, criticism in popular culture, negative interactions with healthcare providers, and conflicts with people they know, which serve to stigmatize them. This article uses qualitative data from in-depth interviews with parents who reject vaccines, ethnographic observations, and analyses of online discussions to examine the role of social capital in networks of vaccine-refusing mothers. Specifically, this article explores how mothers provide each other information critical of vaccines, encourage a sense of one's self as empowered to question social expectations around vaccination, provide strategies for managing stigma that results from refusing vaccines, and define a sense of obligation to extend social capital to other mothers. In examining these strategies and tensions, we see how social capital can powerfully support subcultural norms that contradict broader social norms and provide sources of social support. Even as these forces are experienced as positive, they work in ways that actively undermine community health, particularly for those who are the most socially vulnerable to negative health outcomes from infection.
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360
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Muhamad Ramdan I, Susanti R, Ifroh RH, Noviasty R. Risk factors for diphtheria outbreak in children aged 1-10 years in East Kalimantan Province, Indonesia. F1000Res 2018; 7:1625. [PMID: 31723410 PMCID: PMC6844134 DOI: 10.12688/f1000research.16433.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Diphtheria remains a health problem, especially in developing countries. In November 2017, the Indonesian Ministry of Health stated that there was a diphtheria outbreak in Indonesia. East Kalimantan is one of the provinces that experienced this disease outbreak. This study analyzes the risk factors for diphtheria outbreak in children aged 1-10 years. Methods: A case-control study was conducted on 37 respondents. Research variables consist of immunization status against diphtheria, pertussis and tetanus (DPT), nutritional status, children mobility, source of transmission, physical home environment (natural lighting, ventilation area, occupancy density, wall and floor type), knowledge of diphtheria and attitudes towards the diphtheria prevention program. Results: We found that the most of the children who had diphtheria had been immunized against DPT. Additionally the nutritional status of children (p=0.049), mobility (p=0.000) and the source of transmission (p=0.020) were significantly associated with diphtheria. Conclusions: Child/parent mobility (OR=8.456) is the main risk factor for diphtheria outbreak. It is recommended to limit the mobility of children to travel to areas that are experiencing increased cases of diphtheria, improve the nutritional status, and further research on the effectiveness of diphtheria vaccine.
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Affiliation(s)
- Iwan Muhamad Ramdan
- Public Health Faculty, Mulawarman University, Samarinda, East Kalimantan, 75123, Indonesia
| | - Rahmi Susanti
- Public Health Faculty, Mulawarman University, Samarinda, East Kalimantan, 75123, Indonesia
| | - Riza Hayati Ifroh
- Public Health Faculty, Mulawarman University, Samarinda, East Kalimantan, 75123, Indonesia
| | - Reny Noviasty
- Public Health Faculty, Mulawarman University, Samarinda, East Kalimantan, 75123, Indonesia
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361
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Lysouvakon P. Vitamin K Administration. Pediatr Ann 2018; 47:e383-e384. [PMID: 30308671 DOI: 10.3928/19382359-20180926-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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362
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McCoy JD, Painter JE, Jacobsen KH. Perceptions of vaccination within a Christian homeschooling community in Pennsylvania. Vaccine 2018; 37:5770-5776. [PMID: 30253888 DOI: 10.1016/j.vaccine.2018.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND More than 1.8 million American children ages 5-17 are being educated at home. The percentage of school-aged children in the United States who are homeschooled increased from 1.7% in 1999 to 3.4% in 2012. Every state has established school-entry vaccination requirements for kindergarten students, but most states exempt homeschoolers from these regulations. The goal of this study was to use qualitative methods to examine the vaccination perceptions and practices of Christian homeschooling families in Pennsylvania. METHODS A qualitative study (focus groups) of Christian homeschooling parents representing a diversity of vaccination practices (full, partial/delayed, and no vaccination) was conducted in south-central Pennsylvania in 2017. An analysis using a grounded theory approach identified themes that strongly aligned with constructs from the Health Belief Model. RESULTS Many of the perspectives expressed by the study population aligned with those of the general American population, including uncertainty about the risk from vaccine-preventable diseases, concerns about the efficacy and safety of vaccines, and confusion about conflicting vaccine information. The Christian homeschooling parents expressed two especially prominent perceptions: a belief that they had a very low risk of contracting infectious diseases because God has provided them with the natural tools necessary for health and a stronger-than-typical sense of empowerment related to parental decision-making and autonomy. Participants expressed that they were generally open to honest communication about vaccination with physicians who respect parental authority. CONCLUSIONS Homeschooling families have diverse vaccination practices. Pediatricians and other healthcare practitioners should not make assumptions about health beliefs in this community, and should instead engage parents in conversations about their risk perceptions and vaccine decisions.
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Affiliation(s)
- Jeremiah D McCoy
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA
| | - Julia E Painter
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA
| | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA.
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363
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Brown AL, Sperandio M, Turssi CP, Leite RMA, Berton VF, Succi RM, Larson H, Napimoga MH. Vaccine confidence and hesitancy in Brazil. CAD SAUDE PUBLICA 2018; 34:e00011618. [PMID: 30281705 DOI: 10.1590/0102-311x00011618] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/18/2018] [Indexed: 11/22/2022] Open
Abstract
Despite the overall benefits of immunization, vaccine hesitancy has been a growing trend and has been associated with the resurgence of vaccine-preventable diseases. The aim of this study was to assess vaccine confidence and hesitancy in Brazil, as part of a wider project to map vaccine confidence globally. One thousand subjects were interviewed, either online or face-to-face, based on a general questionnaire regarding perceptions on vaccines and vaccination. Further exploratory questions were used with the subset of respondents who were parents of children aged under 5. Such questions extracted information regarding vaccination behavior, opinions on vaccination and government health services, and vaccine hesitancy. Reasons for hesitancy were classified as relating to confidence, convenience and/or complacency, and the population was also analyzed socio-demographically. The results showed that overall confidence in immunization was higher than confidence in family planning services, community health workers and emergency services. Seventy-six people reported hesitancy to vaccinate. The commonest reasons for hesitancy were issues with confidence (41.4%), efficacy/safety of the vaccine (25.5%) and concerns about adverse events (23.6%). The sociodemographic analysis revealed that vaccine hesitancy was associated with marital status, level of education and income. Despite overall vaccine confidence being high, a clear trend toward lower levels of confidence was associated with higher levels of hesitancy, which warrants on-going monitoring, due to the dynamic and changing nature of vaccine hesitancy.
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Affiliation(s)
| | | | | | | | | | | | - Heidi Larson
- London School of Hygiene and Tropical Medicine, London, U.K
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364
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Abstract
Vaccines have had a profound impact on public health; however, parents are increasingly refusing or delaying vaccines for their children. Population-based studies have demonstrated the safety and efficacy of vaccines. Pediatricians should be well informed about vaccine development, safety, and efficacy to inspire parental confidence in vaccines. Systemic challenges in discussing and providing immunizations exist. Discussions about immunizations may be lengthy and time spent discussing immunizations is not routinely reimbursed. Adolescents may be inadequately immunized because they do not routinely present for preventive health visits. Routine immunizations should be offered and discussed at sick visits, particularly for adolescents. Improving immunization rates requires a multifaceted approach. [Pediatr Ann. 2018;47(9):e366-e370.].
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365
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Lorton F, Chalumeau M, Assathiany R, Martinot A, Bucchia M, Roué JM, Bourgoin P, Chantreuil J, Boussicault G, Gaillot T, Saulnier JP, Caillon J, Levy C, Cohen R, Gras-Le Guen C, Launay E. Vaccine-preventable severe morbidity and mortality caused by meningococcus and pneumococcus: A population-based study in France. Paediatr Perinat Epidemiol 2018; 32:442-447. [PMID: 30170336 DOI: 10.1111/ppe.12500] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a context of suboptimal vaccination coverage and increasing vaccine hesitancy, we aimed to study morbidity and mortality in children related to missing or incomplete meningococcal C and pneumococcal conjugate vaccines. METHODS We conducted a prospective, observational, population-based study from 2009 to 2014 in a French administrative area that included all children from age 1 month to 16 years who died before admission or were admitted to an intensive care unit for a community-onset bacterial infection. Vaccine-preventable infection was defined as an infection with an identified serotype included in the national vaccine schedule at the time of infection and occurring in a non- or incompletely vaccinated child. Death and severe sequelae were studied at hospital discharge. Frequencies of vaccine-preventable morbidity and mortality caused by meningococcus and pneumococcus were calculated. RESULTS Among the 124 children with serotyped meningococcal (n = 75) or pneumococcal (n = 49) severe infections included (median age 26 months), 20 (16%) died and 12 (10%) had severe sequelae. Vaccine-preventable infections accounted for 18/124 infections (15%, 95% CI 9, 22), 5/20 deaths (25%, 95% CI 9, 49), and 3/12 severe sequelae cases (25%, 95% CI 0, 54). The vaccine schedule for meningococcal C and pneumococcal conjugate vaccinations was incomplete for 71/116 (61%) children targeted by at least one of these two vaccination programs. CONCLUSIONS Mortality and morbidity rates related to vaccine-preventable meningococcal or pneumococcal infection could be reduced by one quarter with better implementation of immunisation programs. Such information could help enhance the perception of vaccine benefits and fight vaccine hesitancy.
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Affiliation(s)
- Fleur Lorton
- Centre d'investigation clinique INSERM 1413, Femme Enfant Adolescent CHU de Nantes, Nantes, France.,Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.,Services d'urgences pédiatriques et de pédiatrie générale, Hôpital Femme Enfant Adolescent, Nantes, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Paris, France.,Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Rémy Assathiany
- Association pour le Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE), Versailles, France.,Cabinet de Pédiatrie, Association Française de Pédiatrie Ambulatoire (AFPA), Issy-les-Moulineaux, France
| | | | - Marie Bucchia
- Services d'urgences pédiatriques et de pédiatrie générale, Hôpital Femme Enfant Adolescent, Nantes, France
| | - Jean-Michel Roué
- Service de réanimation pédiatrique et néonatale, Hôpital Morvan, CHU de Brest, Brest, France
| | - Pierre Bourgoin
- Service de réanimation pédiatrique et néonatale, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France
| | - Julie Chantreuil
- Service de réanimation pédiatrique et néonatale, Hôpital Clocheville, CHU de Tours, Tours, France
| | | | - Théophile Gaillot
- Service de réanimation pédiatrique, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Jean-Pascal Saulnier
- Service de réanimation pédiatrique et néonatale, Tour Jean Bernard, CHU de Poitiers, Poitiers, France
| | - Jocelyne Caillon
- Laboratoire de microbiologie, Hôtel Dieu, CHU de Nantes, Nantes, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France.,Centre Hospitalier Intercommunal de Créteil, Centre de Recherche Clinique, Créteil, France
| | - Christèle Gras-Le Guen
- Centre d'investigation clinique INSERM 1413, Femme Enfant Adolescent CHU de Nantes, Nantes, France.,Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.,Services d'urgences pédiatriques et de pédiatrie générale, Hôpital Femme Enfant Adolescent, Nantes, France
| | - Elise Launay
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.,Services d'urgences pédiatriques et de pédiatrie générale, Hôpital Femme Enfant Adolescent, Nantes, France
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366
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Immunogenicity and safety of measles-mumps-rubella vaccine at two different potency levels administered to healthy children aged 12–15 months: A phase III, randomized, non-inferiority trial. Vaccine 2018; 36:5781-5788. [DOI: 10.1016/j.vaccine.2018.07.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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367
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Common Sense, Language, and Semantic Primes: Liminal or Constant Concepts of Psychology? HUMAN ARENAS 2018. [DOI: 10.1007/s42087-018-0014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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368
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Haut L, Wagers B. Challenges Encountered in the Emergency Department in the Unimmunized Pediatric Population. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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369
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Investigation of Predictors of Newborn Screening Refusal in a Large Birth Cohort in North Dakota, USA. Matern Child Health J 2018; 23:92-99. [DOI: 10.1007/s10995-018-2598-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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370
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Weithorn LA, Reiss DR. Legal approaches to promoting parental compliance with childhood immunization recommendations. Hum Vaccin Immunother 2018; 14:1610-1617. [PMID: 29319427 PMCID: PMC6067842 DOI: 10.1080/21645515.2018.1423929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/07/2017] [Accepted: 12/30/2017] [Indexed: 11/23/2022] Open
Abstract
Rates of vaccine-preventable diseases have increased in the United States in recent years, largely due to parental refusals of recommended childhood immunizations. Empirical studies have demonstrated a relationship between nonvaccination rates and permissive state vaccine exemption policies, indicating that legal reforms may promote higher immunization rates. This article reviews relevant data and considers the legal landscape. It analyzes federal and state Constitutional law, concluding that religious and personal belief exemptions to school-entry vaccine mandates are not constitutionally required. It identifies public health, bioethical, and policy considerations relevant to the choice among legal approaches employed by states to promote parental compliance. The article describes a range of legal tools that may help promote parental cooperation with immunization recommendations.
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371
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Daley MF, Narwaney KJ, Shoup JA, Wagner NM, Glanz JM. Addressing Parents' Vaccine Concerns: A Randomized Trial of a Social Media Intervention. Am J Prev Med 2018; 55:44-54. [PMID: 29773490 PMCID: PMC8606186 DOI: 10.1016/j.amepre.2018.04.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Successful strategies are needed to address parental vaccine hesitancy, a significant public health issue. The study objective was to assess whether an Internet-based platform with vaccine information and interactive social media components improved parents' vaccine-related attitudes. STUDY DESIGN A three-arm RCT. SETTING/PARTICIPANTS The study was conducted in a large Colorado integrated healthcare organization. Parents were enrolled during September 2013 through October 2015 and followed through November 2016; data were analyzed in 2017. Parents, recruited during pregnancy, were given a survey about vaccine-related attitudes at enrollment (i.e., baseline) and when their child was aged 3-5 months and 12-15 months (Timepoints 1 and 2, respectively). Parental vaccine hesitancy was assessed at baseline. INTERVENTION Study participants were randomized to the following: a study website with vaccine information and social media components (VSM arm); a website with vaccine information only (VI); or usual care. MAIN OUTCOME MEASURES Change in parental vaccine attitudes over time by baseline degree of vaccine hesitancy. RESULTS Among 1,093 study participants, 945 (86.5%) completed all three surveys. Comparing baseline with Timepoint 1 among vaccine-hesitant parents, the VSM and VI arms were associated with significant improvements in attitudes regarding vaccination benefits compared to usual care (VSM mean change 0.23 on a 5-point scale, 95% CI=0.05, 0.40, VI mean change 0.22, 95% CI=0.04, 0.40). Comparing baseline with Timepoint 2 among hesitant parents, the VSM and VI arms were also associated with significant reductions in parental concerns about vaccination risks compared to usual care (VSM mean change -0.37, 95% CI= -0.60, -0.14, VI mean change -0.31, 95% CI= -0.55, -0.07). Self-efficacy around vaccine decision making also improved among vaccine-hesitant parents. No intervention effect was observed among parents not vaccine-hesitant at baseline. CONCLUSIONS Among vaccine-hesitant parents, an Internet-based intervention improved parents' attitudes about vaccines. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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372
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Paternina-Caicedo A, Driessen J, Roberts M, van Panhuis WG. Heterogeneity Between States in the Health and Economic Impact of Measles Immunization in the United States. Open Forum Infect Dis 2018; 5:ofy137. [PMID: 30035150 PMCID: PMC6049022 DOI: 10.1093/ofid/ofy137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background Vaccines have been used successfully for disease elimination programs in many countries. Evidence on the impact of vaccination programs can support decision-making among medical practitioners and policy makers to improve immunization rates. We estimated the health and economic impact of measles vaccination for each of the 48 contiguous states and the District of Columbia since 1964. Methods For each state, we fitted multiple time-series models to prevaccination data and used the best-fitting model to predict counterfactual cases that would have occurred in the absence of vaccination. We then subtracted observed from counterfactual measles cases, deaths, and related costs to estimate the impact of vaccination. Results We estimated that 149 million children were vaccinated against measles in the United States between 1964 and 2014, at a cost of $12.2 billion, and that vaccination prevented 29.8 million cases, 32 000 deaths, and $25.8 billion in societal costs. The impact exceeded the national average in 70% of Western and Northeastern states, compared with only 24% of Southern and Midwestern states. Conclusions The significant health and economic benefit of measles vaccination in the United States should encourage continued investments to sustain and expand vaccination programs globally.
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Affiliation(s)
- Angel Paternina-Caicedo
- Departments of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Julia Driessen
- Departments of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark Roberts
- Departments of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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373
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Niederhauser VP, Lindley LC, Farabollini B. Changes in parental barriers to immunizations. Public Health Nurs 2018; 35:379-385. [PMID: 29877583 DOI: 10.1111/phn.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to explore if parental barriers to childhood immunizations change over time. DESIGN AND SAMPLE Using secondary data, a pretest post-test design was employed to measure changes in parental barriers to childhood immunizations in the first 7 months of life. Thirty-nine parent/infant dyads were included in this study. MEASURES The Searching for Hardship and Obstacles to Shots (SHOTS) Survey was completed by a parent when their infant was between one and 28 days old (prior to their first immunizations) and again when the child was 6-7 months of age. RESULTS In this study, parental barriers to immunizations decreased over time. Specifically, six individual items related to accessing immunizations decreased from baseline to 7 months of age. In addition, the Access to Shots subscale decreased significantly (p = 0.010) between the two time periods. In less educated parents, the Importance of Immunizations subscale decreased over time. CONCLUSION Given the findings and trends in changes identified in this study, more exploration is necessary to understand what parental barriers change over time and how these changes affect immunization rates in early infancy.
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Affiliation(s)
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee
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374
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Mallory ML, Lindesmith LC, Baric RS. Vaccination-induced herd immunity: Successes and challenges. J Allergy Clin Immunol 2018; 142:64-66. [PMID: 29803799 DOI: 10.1016/j.jaci.2018.05.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Michael L Mallory
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Lisa C Lindesmith
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Ralph S Baric
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
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375
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Opel DJ, Zhou C, Robinson JD, Henrikson N, Lepere K, Mangione-Smith R, Taylor JA. Impact of Childhood Vaccine Discussion Format Over Time on Immunization Status. Acad Pediatr 2018; 18:430-436. [PMID: 29325912 PMCID: PMC5936647 DOI: 10.1016/j.acap.2017.12.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Presumptive formats to initiate childhood vaccine discussions (eg, "Well, we have to do some shots") have been associated with increased vaccine acceptance after one visit compared to participatory formats (eg, "How do you feel about vaccines?"). We characterize discussion format patterns over time and the impact of their repeated use on vaccine acceptance. METHODS We conducted a longitudinal prospective cohort study of children of vaccine-hesitant parents enrolled in a Seattle-based integrated health system. After the child's 2-, 4-, and 6-month visits, parents reported the format their child's provider used to begin the vaccine discussion (presumptive, participatory, or other). Our outcome was the percentage of days underimmunized of the child at 8 months old for 6 recommended vaccines. We used linear regression and generalized estimating equations to test the association of discussion format and immunization status. RESULTS We enrolled 73 parent-child dyads and obtained data from 82%, 73%, and 53% after the 2-, 4-, and 6-month visits, respectively. Overall, 65% of parents received presumptive formats at ≥1 visit and 42% received participatory formats at ≥1 visit. Parental receipt of presumptive formats at 1 and ≥2 visits (vs no receipt) was associated with significantly less underimmunization of the child, while receipt of participatory formats at ≥2 visits was associated with significantly more underimmunization. Visit-specific use of participatory (vs presumptive) formats was associated with a child being 10.1% (95% confidence interval, 0.3, 19.8; P = .04) more days underimmunized (amounting to, on average, 98 more days underimmunized for all 6 vaccines combined). CONCLUSIONS Presumptive (vs participatory) discussion formats are associated with increased immunization.
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Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash.
| | - Chuan Zhou
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash
| | | | - Nora Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Wash
| | - Katherine Lepere
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash
| | - Rita Mangione-Smith
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash
| | - James A Taylor
- Department of Pediatrics, Child Health Institute, University of Washington School of Medicine, Seattle, Wash
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376
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Affiliation(s)
- Heather L Daniels
- Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, OH
| | - Camille Sabella
- Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, Cleveland, OH
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377
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Zerbo O, Modaressi S, Goddard K, Lewis E, Fireman BH, Daley MF, Irving SA, Jackson LA, Donahue JG, Qian L, Getahun D, DeStefano F, McNeil MM, Klein NP. Vaccination Patterns in Children After Autism Spectrum Disorder Diagnosis and in Their Younger Siblings. JAMA Pediatr 2018; 172:469-475. [PMID: 29582071 PMCID: PMC5875314 DOI: 10.1001/jamapediatrics.2018.0082] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE In recent years, rates of vaccination have been declining. Whether this phenomenon disproportionately affects children with autism spectrum disorder (ASD) or their younger siblings is unknown. OBJECTIVES To investigate if children after receiving an ASD diagnosis obtain their remaining scheduled vaccines according to the Advisory Committee on Immunization Practices (ACIP) recommendations and to compare the vaccination patterns of younger siblings of children with ASD with the vaccination patterns of younger siblings of children without ASD. DESIGN, SETTING, AND PARTICIPANTS This investigation was a retrospective matched cohort study. The setting was 6 integrated health care delivery systems across the United States within the Vaccine Safety Datalink. Participants were children born between January 1, 1995, and September 30, 2010, and their younger siblings born between January 1, 1997, and September 30, 2014. The end of follow-up was September 30, 2015. EXPOSURES Recommended childhood vaccines between ages 1 month and 12 years. MAIN OUTCOME AND MEASURE The proportion of children who received all of their vaccine doses according to ACIP recommendations. RESULTS The study included 3729 children with ASD (676 [18.1%] female), 592 907 children without ASD, and their respective younger siblings. Among children without ASD, 250 193 (42.2%) were female. For vaccines recommended between ages 4 and 6 years, children with ASD were significantly less likely to be fully vaccinated compared with children without ASD (adjusted rate ratio, 0.87; 95% CI, 0.85-0.88). Within each age category, vaccination rates were significantly lower among younger siblings of children with ASD compared with younger siblings of children without ASD. The adjusted rate ratios varied from 0.86 for siblings younger than 1 year to 0.96 for those 11 to 12 years old. Parents who had a child with ASD were more likely to refuse at least 1 recommended vaccine for that child's younger sibling and to limit the number of vaccines administered during the younger sibling's first year of life. CONCLUSIONS AND RELEVANCE Children with ASD and their younger siblings were undervaccinated compared with the general population. The results of this study suggest that children with ASD and their younger siblings are at increased risk of vaccine-preventable diseases.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | | | - Edwin Lewis
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | | | | | - James G. Donahue
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M. McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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378
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Kim KH, Kabir E, Jahan SA. Airborne bioaerosols and their impact on human health. J Environ Sci (China) 2018; 67:23-35. [PMID: 29778157 PMCID: PMC7128579 DOI: 10.1016/j.jes.2017.08.027] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 05/19/2023]
Abstract
Bioaerosols consist of aerosols originated biologically such as metabolites, toxins, or fragments of microorganisms that are present ubiquitously in the environment. International interests in bioaerosols have increased rapidly to broaden the pool of knowledge on their identification, quantification, distribution, and health impacts (e.g., infectious and respiratory diseases, allergies, and cancer). However, risk assessment of bioaerosols based on conventional culture methods has been hampered further by several factors such as: (1) the complexity of microorganisms or derivatives to be investigated; (2) the purpose, techniques, and locations of sampling; and (3) the lack of valid quantitative criteria (e.g., exposure standards and dose/effect relationships). Although exposure to some microbes is considered to be beneficial for health, more research is needed to properly assess their potential health hazards including inter-individual susceptibility, interactions with non-biological agents, and many proven/unproven health effects (e.g., atopy and atopic diseases).
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Affiliation(s)
- Ki-Hyun Kim
- Department of Civil and Environmental Engineering, Hanyang University, Seoul 04763, Republic of Korea.
| | - Ehsanul Kabir
- Department of Farm, Power & Machinery, Bangladesh Agricultural University, Mymensingh, Bangladesh
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379
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Newman PA, Logie CH, Lacombe-Duncan A, Baiden P, Tepjan S, Rubincam C, Doukas N, Asey F. Parents' uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies. BMJ Open 2018; 8:e019206. [PMID: 29678965 PMCID: PMC5914890 DOI: 10.1136/bmjopen-2017-019206] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine factors associated with parents' uptake of human papillomavirus (HPV) vaccines for their children. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Library, AIDSLINE, CINAHL, EMBASE, PsycINFO, Social Sciences Abstracts, Ovid MEDLINE, Scholars Portal, Social Sciences Citation Index and Dissertation Abstracts International from inception through November 2017. METHODS We included studies that sampled parents and assessed uptake of HPV vaccines for their children (≤18 years) and/or sociodemographics, knowledge, attitudes or other factors associated with uptake. Study risk of bias was assessed using the Effective Public Health Practice Project tool. We pooled data using random-effects meta-analysis and conducted moderation analyses to examine variance in uptake by sex of child and parent. RESULTS Seventy-nine studies on 840 838 parents across 15 countries were included. The pooled proportion of parents' uptake of HPV vaccines for their children was 41.5% (range: 0.7%-92.8%), twofold higher for girls (46.5%) than for boys (20.3%). In the meta-analysis of 62 studies, physician recommendation (r=0.46 (95% CI 0.34 to 0.56)) had the greatest influence on parents' uptake, followed by HPV vaccine safety concerns (r=-0.31 (95% CI -0.41 to -0.16)), routine child preventive check-up, past 12 months (r=0.22 (95% CI 0.11 to 0.33)) and parents' belief in vaccines (r=0.19 (95% CI 0.08 to 0.29)). Health insurance-covered HPV vaccination (r=0.16 (95% CI 0.04 to 0.29)) and lower out-of-pocket cost (r=-0.15 (95% CI -0.22 to -0.07)) had significant effects on uptake. We found significant moderator effects for sex of child. CONCLUSIONS Findings indicate suboptimal levels of HPV vaccine uptake, twofold lower among boys, that may be improved by increasing physician recommendations, addressing parental safety concerns and promoting parents' positive beliefs about vaccines, in addition to expanding insurance coverage and reducing out-of-pocket costs. Limitations of this meta-analysis include the lack of intervention studies and high risk of bias in most studies reviewed. Further studies should disaggregate HPV vaccine uptake by sex of child and parent.
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Affiliation(s)
- Peter A Newman
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Carmen H Logie
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Lacombe-Duncan
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Suchon Tepjan
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Clara Rubincam
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Nick Doukas
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Farid Asey
- Centre for Applied Social Research, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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380
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Abstract
Comments on the original article by Hornsey and colleagues (see record 2018-03974-001) which present findings on a 24-nation survey of the underlying roots of vaccine hesitancy and antivaccination attitudes. Their findings provide a solid foundation on which to build the next generation of research into vaccine communication and ways to address vaccine hesitancy. Where do we go from here? Although the work of Hornsey et al. (2018) is a good first step, their primary outcome was vaccination attitudes. Future research is needed to evaluate these findings in the context of actual vaccine uptake. (PsycINFO Database Record
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Affiliation(s)
- Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University
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381
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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382
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McKenna KC. Use of Aborted Fetal Tissue in Vaccines and Medical Research Obscures the Value of All Human Life. LINACRE QUARTERLY 2018; 85:13-17. [PMID: 29970932 DOI: 10.1177/0024363918761715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This opinion addresses the licitness, quasi-benefits, and consequences of using aborted fetal tissue in vaccines and in medical research. The Catholic Church permits temporary use of vaccines generated using aborted fetal tissue to protect children from preventable diseases until alternative vaccines that do not use aborted fetal tissue are available. In medical research, cell lines that were generated from elective abortions should be avoided and alternative cell lines of licit origin utilized. The association between in utero Zika virus infections and microcephaly has increased the demand for fetal tissue to establish causality and to understand disease progression. These studies require extensive oversight as they could directly encourage elective abortions. The consequence of the use of fetal tissue from elective abortions is desensitization of beneficiaries to the original illicit act of abortion thereby obscuring the value of all human life and potentially leading to scandal. Summary: The use of fetal tissue from elective abortions is commonplace in the pharmaceutical industry and in medical research. This opinion addresses the licitness, quasi-benefits, and consequences of using fetal tissue from elective abortions in vaccines and in medical research. All people of good conscience have the responsibility to voice opposition to the use of fetal tissue from elective abortions in order to promote development of alternatives, affirm the value of all human life and limit scandal.
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383
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Lewnard JA, Grad YH. Vaccine waning and mumps re-emergence in the United States. Sci Transl Med 2018; 10:eaao5945. [PMID: 29563321 PMCID: PMC5899613 DOI: 10.1126/scitranslmed.aao5945] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/10/2017] [Indexed: 11/02/2022]
Abstract
After decades of declining mumps incidence amid widespread vaccination, the United States and other developed countries have experienced a resurgence in mumps cases over the last decade. Outbreaks affecting vaccinated individuals and communities with high vaccine coverage have prompted concerns about the effectiveness of the live attenuated vaccine currently in use. It is unclear whether immune protection wanes or whether the vaccine protects inadequately against currently circulating mumps virus lineages. Synthesizing data from six studies of mumps vaccine effectiveness, we estimated that vaccine-derived immune protection against mumps wanes on average 27 years (95% confidence interval, 16 to 51 years) after vaccination. After accounting for this waning, we found no evidence that the emergence of heterologous virus genotypes contributed to changes in vaccine effectiveness over time. A mathematical model of mumps transmission confirmed the central role of waning immunity to the vaccine in the re-emergence of mumps cases. Outbreaks from 2006 to the present among young adults, and outbreaks in the late 1980s and early 1990s among adolescents, aligned with peaks in mumps susceptibility of these age groups predicted to be due to loss of vaccine-derived protection. In contrast, evolution of mumps virus strains escaping immune pressure would be expected to cause a higher proportion of cases among children, not adolescents and young adults as observed. Routine use of a third vaccine dose at 18 years of age, or booster dosing throughout adulthood, may be a strategy to prevent mumps re-emergence and should be assessed in clinical trials.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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384
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Ahmed A, Lee KS, Bukhsh A, Al-Worafi YM, Sarker MMR, Ming LC, Khan TM. Outbreak of vaccine-preventable diseases in Muslim majority countries. J Infect Public Health 2018; 11:153-155. [DOI: 10.1016/j.jiph.2017.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/18/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022] Open
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385
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Cunningham RM, Minard CG, Guffey D, Swaim LS, Opel DJ, Boom JA. Prevalence of Vaccine Hesitancy Among Expectant Mothers in Houston, Texas. Acad Pediatr 2018; 18:154-160. [PMID: 28826731 DOI: 10.1016/j.acap.2017.08.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Nonmedical exemptions continue to rise because of increasing proportions of vaccine-hesitant parents. The proportion of expectant parents who are vaccine-hesitant is currently unknown. We assessed the prevalence of vaccine hesitancy among expectant parents receiving care at an obstetrics clinic in Houston, Texas. METHODS We conducted a cross-sectional survey of expectant parents between 12 and 31 weeks gestation who received care at Texas Children's Pavilion for Women between July 2014 and September 2015. Using convenience sampling, participants completed a questionnaire that included questions on demographic items, self-assessed pregnancy risk, receipt of annual influenza vaccine, and the 15-item Parents Attitudes About Childhood Vaccines survey, a validated tool to identify vaccine-hesitant parents. We used multivariable logistic regression to determine the association of demographic characteristics, pregnancy risk, and influenza vaccine receipt with vaccine hesitancy after controlling for variables significant in univariable analyses. RESULTS Six hundred ten expectant mothers and 38 expectant fathers completed the Parents Attitudes About Childhood Vaccines survey. Overall, 50 of 610 expectant mothers (8.2%; 95% confidence interval [CI], 6.1%-10.7%) were vaccine-hesitant. Expectant mothers were primarily non-Hispanic white, 30 years old or older, and married. The odds of being vaccine-hesitant were 2.2 times greater (95% CI, 1.2-4.1) among expectant mothers with a college level of education or less compared with those with more than a 4-year degree. The odds of being vaccine-hesitant were 7.4 times greater (95% CI, 3.9-14.0) among expectant mothers who do not receive an annual influenza vaccine compared with those who do. CONCLUSIONS Our findings suggest the need to identify and address vaccine hesitancy among expectant parents before birth.
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Affiliation(s)
| | | | | | - Laurie S Swaim
- Baylor College of Medicine, Houston; Texas Children's Pavilion for Women, Houston
| | - Douglas J Opel
- Seattle Children's Research Institute, Seattle, Wash; University of Washington School of Medicine, Seattle, Wash
| | - Julie A Boom
- Texas Children's Hospital, Houston; Baylor College of Medicine, Houston
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386
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Jadhav ED, Winkler DL, Anderson BS. Vaccination Perceptions of College Students: With and without Vaccination Waiver. Front Public Health 2018. [PMID: 29515991 PMCID: PMC5826364 DOI: 10.3389/fpubh.2018.00036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction The resurgence of vaccine preventable diseases occurs more often among intentionally unvaccinated individuals, placing at direct risk young adults not caught up on vaccinations. The objectives of this study were to characterize the sociodemographic characteristics of young adults with and without vaccination waivers and identify their perceived benefits, barriers, and influencers of vaccination. Methods Young adults (n = 964) from a Midwestern rural university responded to a survey (fall 2015-spring 2016) designed to identify their perception toward vaccination. Instrument consistency was measured using the Cronbach α-scores. The Chi-square test was used to test any sociodemographic differences and Mann-Whitney U-tests results for differences between exempt and non-exempt students. Analysis occurred in spring 2017. Results A little over one-third of young adults with a vaccination waiver were not up to date on their vaccinations, and think that vaccinations can cause autism. The biggest identifiable benefit was effective control against disease. The surveyed young adults ranked the out of pocket cost associated with vaccination as the most important barrier and safe and easy to use vaccines as the most important influencer of vaccination. Conclusion Young adults who have had a vaccination waiver appear to not be up to date on their vaccinations. Vaccine administration programs, such as university campus clinics, would benefit from addressing perceptions unique to young adults with and without a vaccine waiver. This would subsequently better provide young adults a second shot for getting appropriately caught up on vaccinations.
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Affiliation(s)
- Emmanuel D Jadhav
- College of Health Professions, Ferris State University, Big Rapids, MI, United States
| | - Danielle L Winkler
- College of Health Professions, Ferris State University, Big Rapids, MI, United States
| | - Billie S Anderson
- College of Pharmacy, Ferris State University, Big Rapids, MI, United States
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387
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Mahroum N, Watad A, Rosselli R, Brigo F, Chiesa V, Siri A, Ben-Ami Shor D, Martini M, Bragazzi NL, Adawi M. An infodemiological investigation of the so-called "Fluad effect" during the 2014/2015 influenza vaccination campaign in Italy: Ethical and historical implications. Hum Vaccin Immunother 2018; 14:712-718. [PMID: 29293392 DOI: 10.1080/21645515.2017.1420448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Influenza vaccines represent a major tool to contain the clinical and epidemiological burden generated by influenza. However, in spite of their effectiveness, vaccines are victims of prejudices and false myths, which contribute to the increasing phenomenon of vaccine hesitancy and loss of confidence. Media and, mainly, new media, and information and communication technologies play a major role in disseminating health-related information. While, on the one hand, they can be extremely promising in promoting disease prevention, on the other hand, they can also have a negative impact on population's health attitudes and behaviors when delivering information not based on scientific evidences. The "Fluad-case" is an excellent example of the crucial role of an adequate information campaign. Following the cluster of deaths allegedly related to the administration of the adjuvanted influenza vaccine "Fluad" during the 2014-2015 influenza campaign, the Italian health authorities and regulatory bodies decided the withdrawal of two potentially contaminated Fluad batches. This fostered a huge media coverage, with resulted in negatively impacting on influenza vaccination coverage. Monitoring and tracking the Fluad-related web searches, we showed that Liguria resulted the Italian region with the highest number of Fluad-related website searches and that, interestingly, Fluad was searched also in Regions in which this vaccine was not distributed. A positive moderate correlation between accessing Fluad-related websites and overall influenza vaccination coverage was found (r = 0.66 ([95%CI 0.29-0.86], p = 0.0026). Considering subjects ≥65 years, who are the subjects for which the Fluad vaccination is recommended, the correlation resulted r = 0.49 ([95%CI 0.03-0.78], p = 0.0397). As such, health authorities and decision-makers should promote high-quality communication campaigns in order to raise awareness of vaccination practices.
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Affiliation(s)
- Naim Mahroum
- a Department of Medicine 'B' , Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Abdulla Watad
- a Department of Medicine 'B' , Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Roberto Rosselli
- b Local Health Unit 3 of Genoa (ASL3 Genovese), Hygiene and Public Health Unit , Genoa , Italy
| | - Francesco Brigo
- c Department of Neuroscience , Biomedicine and Movement Science, University of Verona, Verona and Division of Neurology, "Franz Tappeiner" Hospital , Merano , Italy
| | - Valentina Chiesa
- d Department of Biomedical , Biotechnological and Translational Sciences, University of Parma , Parma , Italy
| | - Anna Siri
- e UNESCO CHAIR "Anthropology of Health - Biosphere and Healing System", University of Genoa, Genoa and Department of Mathematics (DIMA) , University of Genoa , Genoa , Italy
| | - Dana Ben-Ami Shor
- f Department of Gastroenterology , Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Mariano Martini
- e UNESCO CHAIR "Anthropology of Health - Biosphere and Healing System", University of Genoa, Genoa and Department of Mathematics (DIMA) , University of Genoa , Genoa , Italy.,g Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy
| | - Nicola Luigi Bragazzi
- e UNESCO CHAIR "Anthropology of Health - Biosphere and Healing System", University of Genoa, Genoa and Department of Mathematics (DIMA) , University of Genoa , Genoa , Italy.,g Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy
| | - Mohammad Adawi
- h Padeh and Ziv hospitals, Bar-Ilan University, Faculty of Medicine , Zefat , Israel
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388
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Martin LR, Petrie KJ. Understanding the Dimensions of Anti-Vaccination Attitudes: the Vaccination Attitudes Examination (VAX) Scale. Ann Behav Med 2018; 51:652-660. [PMID: 28255934 DOI: 10.1007/s12160-017-9888-y] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anti-vaccination attitudes are important predictors of vaccination behavior. Existing measures of vaccination attitudes focus on specific age groups and/or particular vaccines; a more comprehensive measure would facilitate comparisons across studies. PURPOSE The aim of this study was to develop a short measure of general vaccination attitudes and establish its reliability and validity. METHODS Two studies were conducted using the VAX scale. For Study 1, participants were 409 individuals (53% female), with a mean age of 34.5 years. For Study 2, participants were 92 individuals (67% female) with a mean age of 28.6. Participants answered paper-and-pencil questions about their attitudes toward vaccines, prior and expected-future vaccination behaviors, perceived sensitivity to medicines, online behavior, and basic demographic information. Exploratory and confirmatory factor analyses were conducted with correlations and t tests then used to assess the scale's reliability and validity. RESULTS Four distinct but correlated vaccine attitudes were identified: (1) mistrust of vaccine benefit, (2) worries about unforeseen future effects, (3) concerns about commercial profiteering, and (4) preference for natural immunity. These factors were significantly related to prior vaccination behavior, future intentions to obtain recommended vaccinations, perceived sensitivity to medicines, and the tendency to obtain health information online. CONCLUSIONS The VAX scale provides an efficient method for identifying those with vaccination resistance, and the four subscales enable a more nuanced understanding of the nature of those views. It should be noted, however, that the strong correlations amongst the four subscales suggest that interventions should target all four attitude areas, and it remains to be seen whether differential emphasis across the four areas is warranted.
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Affiliation(s)
- Leslie R Martin
- Department of Psychology, La Sierra University, 4500 Riverwalk Parkway, Riverside, CA, 92515, USA.
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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389
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Abstract
Regardless of what legislation the federal government adopts to address health insurance coverage for nonelderly Americans, private insurance will likely play a major role. This article begins by listing some of the major reasons critics dislike the Affordable Care Act (ACA), then discusses the validity of these concerns from an economics perspective. Criticisms of the ACA include the increased role of government in health care, the ACA's implicit income redistribution, and concern about high and rising insurance premiums. Suggestions for refining the ACA and its market-based insurance system are then offered, with the goals of lowering insurance premiums, improving coverage rates, and/or addressing the concerns of ACA critics. Americans favor the increase in insurance coverage that has occurred under the ACA. In order to sustain this level of coverage, steps to lower Marketplace premiums through a variety of strategies affecting potential enrollees, insurers, and healthcare providers are offered.
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Affiliation(s)
- Vivian Ho
- Baker Institute for Public Policy, Rice University, Houston, Texas 77251
- Department of Economics, Rice University, Houston, Texas 77251
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030
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390
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Baumgaertner B, Carlisle JE, Justwan F. The influence of political ideology and trust on willingness to vaccinate. PLoS One 2018; 13:e0191728. [PMID: 29370265 PMCID: PMC5784985 DOI: 10.1371/journal.pone.0191728] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/10/2018] [Indexed: 11/24/2022] Open
Abstract
In light of the increasing refusal of some parents to vaccinate children, public health strategies have focused on increasing knowledge and awareness based on a "knowledge-deficit" approach. However, decisions about vaccination are based on more than mere knowledge of risks, costs, and benefits. Individual decision making about vaccinating involves many other factors including those related to emotion, culture, religion, and socio-political context. In this paper, we use a nationally representative internet survey in the U.S. to investigate socio-political characteristics to assess attitudes about vaccination. In particular, we consider how political ideology and trust affect opinions about vaccinations for flu, pertussis, and measles. Our findings demonstrate that ideology has a direct effect on vaccine attitudes. In particular, conservative respondents are less likely to express pro-vaccination beliefs than other individuals. Furthermore, ideology also has an indirect effect on immunization propensity. The ideology variable predicts an indicator capturing trust in government medical experts, which in turn helps to explain individual-level variation with regards to attitudes about vaccine choice.
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Affiliation(s)
- Bert Baumgaertner
- Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America
| | - Juliet E Carlisle
- Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America
| | - Florian Justwan
- Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America
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391
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Wagner AL, Eccleston AM, Potter RC, Swanson RG, Boulton ML. Vaccination Timeliness at Age 24 Months in Michigan Children Born 2006-2010. Am J Prev Med 2018; 54:96-102. [PMID: 29254557 DOI: 10.1016/j.amepre.2017.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/31/2017] [Accepted: 09/26/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Delays in vaccination can stymie the development of herd immunity, and a large proportion of children in the U.S. are known not to receive vaccines on time. This study quantifies delays in vaccination, compares vaccination timeliness to the proportion of children vaccinated, and evaluates the impact of combination vaccine use and timely administration of hepatitis B vaccine birth dose on vaccine timeliness among Michigan children. METHODS This retrospective cohort study used data from the Michigan Care Improvement Registry-the state immunization information system-for children born 2006-2010. Children aged 24 months as of December 31, 2012, were included. The proportion of children with timely administration of vaccine doses was calculated, and the mean days of vaccination delay with SD were reported. RESULTS Among 620,592 Michigan children, 42.2% had received all vaccines, but only 13.2% were vaccinated on time by age 24 months. Children's vaccinations were delayed an average of 59.2 (SD=91.2) days by age 24 months for all recommended vaccine doses. Children who received a timely hepatitis B vaccine birth dose or who received a combination vaccine had less delay in vaccination. CONCLUSIONS Michigan children have high vaccination coverage based on standard measures but few receive these vaccines on time. Promoting use of combination vaccines may improve parental compliance with timely vaccination of children.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Amanda M Eccleston
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rachel C Potter
- Division of Immunizations, Michigan Department of Health and Human Services, Lansing, Michigan
| | - Robert G Swanson
- Division of Immunizations, Michigan Department of Health and Human Services, Lansing, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan
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392
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Visser O, Hulscher ME, Antonise-Kamp L, Akkermans R, van der Velden K, Ruiter RA, Hautvast JL. Assessing determinants of the intention to accept a pertussis cocooning vaccination: A survey among healthcare workers in maternity and paediatric care. Vaccine 2018; 36:736-743. [DOI: 10.1016/j.vaccine.2017.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
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393
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Oster E. Does disease cause vaccination? Disease outbreaks and vaccination response. JOURNAL OF HEALTH ECONOMICS 2018; 57:90-101. [PMID: 29182938 PMCID: PMC6522133 DOI: 10.1016/j.jhealeco.2017.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/19/2017] [Accepted: 10/13/2017] [Indexed: 05/15/2023]
Abstract
Parental fear of vaccines has limited vaccination rates in the United States. I test whether disease outbreaks increase vaccination using a new dataset of county-level disease and vaccination data. I find that pertussis (whooping cough) outbreaks in a county decrease the share of unvaccinated children entering kindergarten. These responses do not reflect changes in the future disease risk. I argue that these facts are best fit by a model in which individuals are both myopic and irrational. This suggests that better promotion of information about outbreaks could enhance the response.
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Affiliation(s)
- Emily Oster
- Brown University, United States; NBER, United States.
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394
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Wadsworth P, Kothari C, Lubwama G, Brown CL, Frank Benton J. Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences. FAMILY & COMMUNITY HEALTH 2018; 41:123-133. [PMID: 29461361 DOI: 10.1097/fch.0000000000000186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.
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Affiliation(s)
- Pamela Wadsworth
- Bronson School of Nursing, Western Michigan University, Kalamazoo (Dr Wadsworth); Division of Epidemiology and Biostatistics, Biomedical Sciences Department, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo (Dr Kothari); and Kalamazoo YWCA, Kalamazoo, Michigan (Dr Lubwama and Mss Brown and Frank Benton)
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395
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Omer SB, Allen K, Chang D, Guterman LB, Bednarczyk RA, Jordan A, Buttenheim A, Jones M, Hannan C, deHart MP, Salmon DA. Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling. Pediatrics 2018; 141:peds.2017-2364. [PMID: 29255080 PMCID: PMC7153736 DOI: 10.1542/peds.2017-2364] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The success of health care provider counseling-based interventions to address vaccine hesitancy is not clear. In 2011, Washington State implemented Senate Bill 5005 (SB5005), requiring counseling and a signed form from a licensed health care provider to obtain an exemption. Evaluating the impact of a counseling intervention can provide important insight into population-level interventions that focus on interpersonal communication by a health care provider. METHODS We used segmented regression and interaction and aggregation indices to assess the impact of SB5005 on immunization coverage and exemption rates in Washington State from school years 1997-1998 through 2013-2014. RESULTS After SB5005 was implemented, there was a significant relative decrease of 40.2% (95% confidence interval: -43.6% to -36.6%) in exemption rates. This translates to a significant absolute reduction of 2.9 percentage points (95% confidence interval: -4.2% to -1.7%) in exemption rates. There were increases in vaccine coverage for all vaccines required for school entrance, with the exception of the hepatitis B vaccine. The probability that kindergarteners without exemptions would encounter kindergarteners with exemptions (interaction index) decreased, and the probability that kindergarteners with exemptions would encounter other such kindergarteners (aggregation index) also decreased after SB5005. Moreover, SB5005 was associated with a decline in geographic clustering of vaccine exemptors. CONCLUSIONS States in the United States and jurisdictions in other countries should consider adding parental counseling by health care provider as a requirement for obtaining exemptions to vaccination requirements.
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Affiliation(s)
- Saad B. Omer
- Hubert Department of Global Health,,Department of Epidemiology,,Department of Pediatrics, and,Emory Vaccine Center, Emory University, Atlanta, Georgia;,Address correspondence to Saad B. Omer, Departments of Global Health, Epidemiology, Pediatrics, and Emory Vaccine Center, Emory University, 1518 Clifton Rd, Atlanta, GA 30322. E-mail:
| | | | - D.H. Chang
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert A. Bednarczyk
- Hubert Department of Global Health,,Department of Epidemiology,,Emory Vaccine Center, Emory University, Atlanta, Georgia
| | | | - Alison Buttenheim
- Department of Family and Community Health, School of Nursing, and,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Malia Jones
- Applied Population Laboratory, Department of Community and Environmental Sociology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Claire Hannan
- Association for Immunization Managers, Rockville, Maryland
| | - M. Patricia deHart
- Office of Immunization and Child Profile, Washington State Department of Health, Olympia, Washington; and
| | - Daniel A. Salmon
- Department of International Health and Health Behavior Society, School of Public Health, Johns Hopkins University, Baltimore, Maryland
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396
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Abstract
A review of pulmonary infections of all types with diagnostic and morphological features.
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397
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McCarthy NL, Sukumaran L, Newcomer S, Glanz J, Daley MF, McClure D, Klein NP, Irving S, Jackson ML, Lewin B, Weintraub E. Patterns of childhood immunization and all-cause mortality. Vaccine 2017; 35:6643-6648. [PMID: 29061349 PMCID: PMC6506838 DOI: 10.1016/j.vaccine.2017.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence supports the safety of the recommended childhood immunization schedule as a whole. However, additional research is warranted as parents' refusing or delaying vaccinations has increased in recent years. All-cause mortality has been identified as a priority outcome to study in the context of the recommended immunization schedule. METHODS We included children born January 1, 2004 through December 31, 2009, enrolled in the Vaccine Safety Datalink (VSD) from birth through 18 months of age. We examined vaccination patterns during the first 18 months of life among 8 vaccines, and identified deaths occurring between 19 and 48 months of age. We excluded children with complex chronic conditions, contraindications to vaccination, and deaths due to injuries, congenital anomalies, or diseases with onset prior to 19 months of age. We calculated mortality rates among children with different patterns of immunization, and incidence rate ratios (IRR) using the Cox proportional hazards model for children vaccinated according to the schedule versus undervaccinated children, adjusting for outpatient healthcare utilization, influenza vaccination, sex, and VSD site. RESULTS Among 312,388 children in the study, 199,661 (64%) were vaccinated according to the schedule, and 112,727 (36%) were delayed or not vaccinated for at least one vaccine dose. Of 18 deaths eligible for analysis, 11 occurred in children following the schedule (2.28 per 100,000 person-years), and seven occurred in undervaccinated children (2.57 per 100,000 person-years). Mortality rates among children following the schedule were not significantly different from those of undervaccinated children when excluding deaths with unknown causes (IRR = 1.29, 95% CI = 0.33-4.99), as well as when including deaths with unknown causes (IRR = 0.84, 95% CI = 0.32-2.99). CONCLUSION Although there were few deaths, our results do not indicate a difference in risk of all-cause mortality among fully vaccinated versus undervaccinated children. Our findings support the safety of the currently recommended immunization schedule with regard to all-cause mortality.
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Affiliation(s)
- Natalie L McCarthy
- Immunization Safety Office (VSD), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lakshmi Sukumaran
- Immunization Safety Office (VSD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sophia Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Jason Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - David McClure
- Marshfield Clinic Research Foundation, Marshfield, WI, United States
| | - Nicola P Klein
- Kaiser Permanente Division of Research, Kaiser Permanente of Northern California, Oakland, CA, United States
| | - Stephanie Irving
- Kaiser Permanente Center for Health Research, Northwest Kaiser Permanente, Portland, OR, United States
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, United States
| | - Bruno Lewin
- Kaiser Permanente Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA, United States
| | - Eric Weintraub
- Immunization Safety Office (VSD), Centers for Disease Control and Prevention, Atlanta, Georgia
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398
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Abstract
Measles is a highly contagious disease that results from infection with measles virus and is still responsible for more than 100 000 deaths every year, down from more than 2 million deaths annually before the introduction and widespread use of measles vaccine. Measles virus is transmitted by the respiratory route and illness begins with fever, cough, coryza, and conjunctivitis followed by a characteristic rash. Complications of measles affect most organ systems, with pneumonia accounting for most measles-associated morbidity and mortality. The management of patients with measles includes provision of vitamin A. Measles is best prevented through vaccination, and the major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication. However, urgent efforts are needed to increase stagnating global coverage with two doses of measles vaccine through advocacy, education, and the strengthening of routine immunisation systems. Use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome. Ongoing research efforts, including the development of point-of-care diagnostics and microneedle patches, will facilitate progress towards measles elimination and eradication.
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Affiliation(s)
- William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; W Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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399
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Zolkefli Y. Evaluating the Concept of Choice in Healthcare. Malays J Med Sci 2017; 24:92-96. [PMID: 29379391 PMCID: PMC5771520 DOI: 10.21315/mjms2017.24.6.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022] Open
Abstract
Choice is what we all want, as most would say. There is a growing cognisance that patients can and should play an important role in deciding their own care, in defining optimal care, and in improving healthcare delivery. Popular concepts such as patient-centred care, patient empowerment, and patients as partners, shared decision making, and informed choice illustrate the emancipation of patient. The paper describes that choice is not necessarily a good thing in health care; however, that does not rebut the significance of choice. In order to support the overall argument, the paper focuses on why patient choice is important, and in each discussion, this is disputed with counter-arguments to demonstrate that in fact, to an extent, choice is not necessarily a good thing in healthcare.
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Affiliation(s)
- Yusrita Zolkefli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong BE1410, Brunei Darussalam
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400
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Glanz JM, Wagner NM, Narwaney KJ, Kraus CR, Shoup JA, Xu S, O’Leary ST, Omer SB, Gleason KS, Daley MF. Web-based Social Media Intervention to Increase Vaccine Acceptance: A Randomized Controlled Trial. Pediatrics 2017; 140:peds.2017-1117. [PMID: 29109107 PMCID: PMC8574135 DOI: 10.1542/peds.2017-1117] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Interventions to address vaccine hesitancy and increase vaccine acceptance are needed. This study sought to determine if a Web-based, social media intervention increases early childhood immunization. METHODS A 3-arm, randomized controlled trial was conducted in Colorado from September 2013 to July 2016. Participants were pregnant women, randomly assigned (3:2:1) to a Web site with vaccine information and interactive social media components (VSM), a Web site with vaccine information (VI), or usual care (UC). Vaccination was assessed in infants of participants from birth to age 200 days. The primary outcome was days undervaccinated, measured as a continuous and dichotomous variable. RESULTS Infants of 888 participants were managed for 200 days. By using a nonparametric rank-based analysis, mean ranks for days undervaccinated were significantly lower in the VSM arm versus UC (P = .02) but not statistically different between the VI and UC (P = .08) or between VSM and VI arms (P = .63). The proportions of infants up-to-date at age 200 days were 92.5, 91.3, and 86.6 in the VSM, VI, and UC arms, respectively. Infants in the VSM arm were more likely to be up-to-date than infants in the UC arm (odds ratio [OR] = 1.92; 95% confidence interval [CI], 1.07-3.47). Up-to-date status was not statistically different between VI and UC arms (OR = 1.62; 95% CI, 0.87-3.00) or between the VSM and VI arms (OR = 1.19, 95% CI, 0.70-2.03). CONCLUSIONS Providing Web-based vaccine information with social media applications during pregnancy can positively influence parental vaccine behaviors.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nicole M. Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Komal J. Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R. Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Stanley Xu
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Sean T. O’Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Saad B. Omer
- Department of Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kathy S. Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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