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Boschung K, Gill MJ, Krentz HB, Dalere J, Beckthold B, Fonseca K, Bakal JA, McMillan JM, Kanji J, Lang R. COVID-19 vaccine uptake among people with HIV: identifying characteristics associated with vaccine hesitancy. Sci Rep 2023; 13:20610. [PMID: 37996521 PMCID: PMC10667522 DOI: 10.1038/s41598-023-47106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.
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Affiliation(s)
- Karol Boschung
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | - Hartmut B Krentz
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
| | | | | | - Kevin Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Jeffrey A Bakal
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Calgary, AB, Canada
| | - Jacqueline M McMillan
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Clinic, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jamil Kanji
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB, Canada
- Section of Medical Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Southern Alberta Clinic, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Imp BM, Levine T, Satre DD, Skarbinski J, Luu MN, Sterling SA, Silverberg MJ. Influenza Vaccination Uptake and Associated Factors Among Adults With and Without Human Immunodeficiency Virus in a Large, Integrated Healthcare System. Clin Infect Dis 2023; 77:56-63. [PMID: 36857440 PMCID: PMC10320060 DOI: 10.1093/cid/ciad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Influenza vaccination is recommended for adults regardless of human immunodeficiency virus (HIV) status. There may be facilitators or barriers to vaccinating people with HIV (PWH) that differ from people without HIV (PWoH). We sought to describe the uptake of influenza vaccination by HIV status and identify factors associated with vaccination. METHODS We abstracted data from the electronic health records of PWH and PWoH in Kaiser Permanente Northern California during 6 influenza seasons (2013-2018). We determined vaccination uptake and used Poisson regression models to evaluate factors associated with vaccination in PWH and PWoH. RESULTS 9272 PWH and 194 393 PWoH matched by age, sex, and race/ethnicity were included (mean age: 48 vs 49 years; men: 91% vs 90%; White race: 53% for both groups). PWH were more likely to receive the influenza vaccine (65-69% across years for PWH and 37-41% for PWoH) with an adjusted risk ratio for all years of 1.48 (95% CI: 1.46-1.50). For PWH, lower vaccination uptake was associated with several factors that suggested more complex health needs, such as lower CD4 cell counts, higher HIV viral loads, prior depression diagnoses, having Medicare insurance, and having a higher number of comorbidities. Associations with vaccination uptake were attenuated in PWH, compared with PWoH, for smoking, alcohol, and demographic factors. CONCLUSIONS PWH had an almost 50% higher uptake of influenza vaccination than PWoH, possibly reflecting greater engagement with the healthcare system. We also found that PWH with more complex health needs had reduced vaccination uptake. Findings may inform outreach strategies to increase influenza vaccination in PWH.
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Affiliation(s)
- Brandon M Imp
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Tory Levine
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Mitchell N Luu
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Vaccine uptake and barriers to vaccination among at-risk adult populations in the US. Hum Vaccin Immunother 2022; 18:2055422. [PMID: 35536017 PMCID: PMC9248946 DOI: 10.1080/21645515.2022.2055422] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To reduce morbidity and mortality associated with vaccine-preventable diseases (VPD), it is imperative that vaccination programs are implemented and prioritized throughout all stages of life across all populations. This study aimed to determine vaccine uptake and barriers to vaccination against VPDs among at-risk adult populations in the United States. We conducted a systematic literature review for articles published between January 2010 and June 2020 and identified 153 publications. The review identified 17 at-risk populations. Vaccine uptake was suboptimal among many populations, with factors including age, gender, and disease severity, associated with uptake. This review identified several barriers that impact vaccine uptake among at-risk populations, with concerns over safety, vaccine costs, lack of insurance, and lack of provider recommendation commonly reported across populations. Embracing a national life-course immunization framework that integrates developing policies, guidelines, and education would be a step to addressing these barriers.
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Affiliation(s)
- Irina Kolobova
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Mawuli Kwame Nyaku
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Megan O'Brien
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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MALONEY PATRICK, RUNG ARIANE, BROYLES STEPHANIE, COUK JOHN, PETERS EDWARD, STRAIF-BOURGEOIS SUSANNE. Assessing influenza vaccination coverage and predictors in persons living with HIV/AIDS in Louisiana, June 2002-June 2013. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E115-E124. [PMID: 35647374 PMCID: PMC9121668 DOI: 10.15167/2421-4248/jpmh2022.63.1.2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
Background Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. Methods We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. Results Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. Conclusions Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.
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Affiliation(s)
- PATRICK MALONEY
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - ARIANE RUNG
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - STEPHANIE BROYLES
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, LA
| | - JOHN COUK
- Louisiana State University Health Care Services Division, New Orleans, LA
| | - EDWARD PETERS
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
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Jablonka A, Rößler S, Pletz MW, Schleenvoigt BT. [Vaccination of the immunocompromised patient]. MMW Fortschr Med 2019; 161:56-60. [PMID: 31313172 DOI: 10.1007/s15006-019-0715-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Alexandra Jablonka
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Institut für Infektionsmedizin und Krankenhaushygiene, Univ.-Klinikum Jena, Am Klinikum 1, D-07747, Jena, Deutschland
| | - Steve Rößler
- Institut für Infektionsmedizin und Krankenhaushygiene, Univ.-Klinikum Jena, Am Klinikum 1, D-07747, Jena, Deutschland
| | - Mathias W Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Univ.-Klinikum Jena, Am Klinikum 1, D-07747, Jena, Deutschland
| | - Benjamin T Schleenvoigt
- Institut für Infektionsmedizin und Krankenhaushygiene, Univ.-Klinikum Jena, Am Klinikum 1, D-07747, Jena, Deutschland.
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Hechter RC, Qian L, Tartof SY, Sy LS, Klein NP, Weintraub E, Mercado C, Naleway A, McLean HQ, Jacobsen SJ. Vaccine safety in HIV-infected adults within the Vaccine Safety Datalink Project. Vaccine 2019; 37:3296-3302. [PMID: 31064675 PMCID: PMC6538462 DOI: 10.1016/j.vaccine.2019.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS Routinely administered vaccines are generally safe for HIV-infected adults.
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Affiliation(s)
| | - Lei Qian
- Kaiser Permanente Southern California, USA.
| | | | - Lina S Sy
- Kaiser Permanente Southern California, USA.
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, USA.
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Harrison N, Poeppl W, Herkner H, Tillhof KD, Grabmeier-Pfistershammer K, Rieger A, Forstner C, Burgmann H, Lagler H. Predictors for and coverage of influenza vaccination among HIV-positive patients: a cross-sectional survey. HIV Med 2016; 18:500-506. [PMID: 28035738 DOI: 10.1111/hiv.12483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Influenza vaccination is recommended for HIV-infected patients, but limited data about vaccination rates are available. The aim of this study was to evaluate the coverage of and predictors for influenza vaccination among HIV-positive patients. METHODS All HIV-positive patients who visited the HIV out-patient department of the University Hospital of Vienna, Austria, between June and August 2015 were asked to participate in this survey by completing a questionnaire. RESULTS A total of 455 HIV-positive patients completed a questionnaire, with 359 male and 96 female participants with a mean age of 46 years. The influenza vaccination rate for the previous season (2014/2015) was 11.9% [n = 54/455; 95% confidence interval (CI) 9.2-15.2%]. Older age was significantly associated with a positive influenza vaccination status. Obtaining information through a medical consultation or receiving a direct recommendation for vaccination by a physician had a significant impact on vaccination behaviour. The probability of being vaccinated against influenza was about 13 times higher among patients who received a recommendation for vaccination by their family physician or by their HIV specialist (P < 0.001). Important reasons for declining vaccination were fear of side effects (39%), not considering influenza as a severe disease (36%) and reasons related to HIV: 17% were worried that the vaccine could worsen the course of HIV infection and 16% believed vaccination would fail because of their compromised immune system. CONCLUSIONS A low influenza vaccination rate of 11.9% was detected in this HIV-positive cohort. The most effective impact for a positive vaccination status was direct recommendation of the influenza vaccine by the attending physician.
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Affiliation(s)
- N Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - W Poeppl
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Division of General Dermatology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - K D Tillhof
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Grabmeier-Pfistershammer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Rieger
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Forstner
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Center of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - H Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - H Lagler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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An immunization update for HIV-infected adults in the United States: review of the literature. J Assoc Nurses AIDS Care 2015; 26:201-7. [PMID: 25665888 DOI: 10.1016/j.jana.2014.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 01/22/2023]
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Durham MD, Buchacz K, Armon C, Patel P, Wood K, Brooks JT. Seasonal influenza vaccination rates in the HIV outpatient study-United States, 1999-2013. Clin Infect Dis 2014; 60:976-7. [PMID: 25501987 PMCID: PMC10132178 DOI: 10.1093/cid/ciu979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marcus D Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Pragna Patel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - John T Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia Cerner Corporation, Vienna, Virginia
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Valour F, Cotte L, Voirin N, Godinot M, Ader F, Ferry T, Vanhems P, Chidiac C. Vaccination coverage against hepatitis A and B viruses, Streptococcus pneumoniae, seasonal flu, and A(H1N1)2009 pandemic influenza in HIV-infected patients. Vaccine 2014; 32:4558-4564. [PMID: 24951870 DOI: 10.1016/j.vaccine.2014.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/17/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several vaccines are recommended in HIV-infected patients due to an increased risk of vaccine-preventable infections, severe forms of the disease, or shared transmission routes. Few data are available regarding vaccination coverage and its determinants in this population. METHODS A cross-sectional study was performed in HIV-infected patients included in a hospital-based cohort in 2011. Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal and A(H1N1)2009 pandemic influenza, and invasive pneumococcal diseases (IPD) were recorded. Factors associated with vaccination were assessed by multivariate logistic regression. RESULTS 2467 patients were included (median age: 47 years; male gender 71.5%; men having sex with men (MSM): 43.9%; CDC stage C: 24.3%; HBV and/or hepatitis C virus co-infection: 14.4%). Median duration of HIV infection was 10 years and 93.1% of patients received combination antiretroviral therapy. At baseline, the median CD4 count was 527 cells/mm(3) and HIV viral load was <50 copies/mL in 83.3% of cases. Vaccination coverage for HBV, HAV, seasonal influenza, A(H1N1)2009 pandemic influenza, and IPD were 61.9%, 47.4%, 30.9, 48.3%, and 64.6%, respectively. Factors independently associated with vaccination were a younger (HBV) or an older age (influenza), male gender (HBV, HAV), MSM (HBV), CD4 count >200/mm(3) and HIV-RNA <50 copies/mL (IPD, influenza), longer duration of HIV infection (IPD, influenza), and follow-up by an experienced physician (HBV, IPD). CONCLUSIONS Vaccination coverage remained insufficient for all vaccine-preventable infections investigated in this study. Determinants for vaccination were largely not evidence-based, and efforts should be focused on improving physicians' knowledge about guidelines.
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Affiliation(s)
- Florent Valour
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Center for Research in Infectiology, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Laurent Cotte
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Lyon, France
| | - Nicolas Voirin
- Université Claude Bernard Lyon 1, Lyon, France; Department of Hygiene and Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Godinot
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Center for Research in Infectiology, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Tristan Ferry
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Center for Research in Infectiology, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Vanhems
- Université Claude Bernard Lyon 1, Lyon, France; Department of Hygiene and Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; INSERM U1111, International Center for Research in Infectiology, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
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Davila-Payan C, Swann J, Wortley PM. System factors to explain 2009 pandemic H1N1 state vaccination rates for children and high-risk adults in US emergency response to pandemic. Vaccine 2014; 32:246-51. [PMID: 24286836 PMCID: PMC6132055 DOI: 10.1016/j.vaccine.2013.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/26/2013] [Accepted: 11/06/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION During the 2009-2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions. OBJECTIVE To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine. METHODS Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data. RESULTS Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to "general access" locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population. CONCLUSION Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.
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Affiliation(s)
- Carlo Davila-Payan
- School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA.
| | - Julie Swann
- School of Industrial and Systems Engineering, Georgia Institute of Technology and School of Public Policy (by Courtesy), Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA.
| | - Pascale M Wortley
- Immunization Services Division, Centers for Disease Control and Prevention, CDC Corporate Square Building 8, Corporate Boulevard NE, Atlanta, GA 30329, USA.
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