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Patikorn C, Kategeaw W, Perdrizet J, Li X, Chaiyakunapruk N. Implementation challenges and real-world impacts of switching pediatric vaccines: A global systematic literature review. Hum Vaccin Immunother 2023; 19:2177459. [PMID: 36880656 PMCID: PMC10026932 DOI: 10.1080/21645515.2023.2177459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Switching a vaccine for another on a pediatric national immunization program is often done for the betterment of society. However, if poorly implemented, switching vaccines could result in suboptimal transitions with negative effects. A systematic review was conducted to evaluate the existing knowledge from identifiable documents on implementation challenges of pediatric vaccine switches and the real-world impact of those challenges. Thirty-three studies met the inclusion criteria. We synthesized three themes: vaccine availability, vaccination program deployment, and vaccine acceptability. Switching pediatric vaccines can pose unforeseen challenges to health-care systems worldwide and additional resources are often required to overcome those challenges. Yet, the magnitude of the impact, especially economic and societal, was frequently under-researched with variability in reporting. Therefore, an efficient vaccine switch requires a thorough consideration of the added benefits of replacing the existing vaccine, preparation, planning, additional resource allocation, implementation timing, public-private partnerships, outreach campaigns, and surveillance for program evaluation.
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Affiliation(s)
- Chanthawat Patikorn
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Johnna Perdrizet
- Global Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Xiuyan Li
- Global Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Hagan JE, Gaonkar N, Doshi V, Patni A, Vyas S, Mazumdar V, Kosambiya JK, Gupta S, Watkins M. Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India. Vaccine 2018; 36:36-42. [PMID: 29174674 PMCID: PMC11008497 DOI: 10.1016/j.vaccine.2017.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. METHODS We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. RESULTS The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. CONCLUSIONS Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services delivered and working through professional societies to adopt standards of practice.
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Affiliation(s)
- José E Hagan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Vikas Doshi
- Department of Preventive and Social Medicine, Medical College Baroda, Baroda, India.
| | - Anas Patni
- Department of Preventive and Social Medicine, Government Medical College, Surat, India.
| | - Shailee Vyas
- Department of Preventive and Social Medicine, Government Medical College, Surat, India.
| | - Vihang Mazumdar
- Department of Preventive and Social Medicine, Medical College Baroda, Baroda, India.
| | - J K Kosambiya
- Department of Preventive and Social Medicine, Government Medical College, Surat, India.
| | | | - Margaret Watkins
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA.
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Idoko OT, Hampton LM, Mboizi RB, Agbla SC, Wallace AS, Harris JB, Sowe D, Ehlman DC, Kampmann B, Ota MO, Hyde TB. Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine. Vaccine 2016; 34:5034-5039. [PMID: 27570237 DOI: 10.1016/j.vaccine.2016.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia. METHODS We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed. FINDINGS Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed. CONCLUSION Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.
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Affiliation(s)
| | - Lee M Hampton
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Robert B Mboizi
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Schadrac C Agbla
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia
| | - Aaron S Wallace
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Jennifer B Harris
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Dawda Sowe
- Ministry of Health and Social Welfare, Banjul, Gambia
| | - Daniel C Ehlman
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Gambia; Academic Department of Paediatrics, Imperial College London, UK
| | - Martin O Ota
- WHO Regional Office for Africa, Brazaville, Congo
| | - Terri B Hyde
- Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA
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Wallace AS, Mantel C, Mayers G, Mansoor O, Gindler JS, Hyde TB. Experiences with provider and parental attitudes and practices regarding the administration of multiple injections during infant vaccination visits: lessons for vaccine introduction. Vaccine 2014; 32:5301-10. [PMID: 25092632 DOI: 10.1016/j.vaccine.2014.07.076] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An increasing proportion of childhood immunization visits include administration of multiple injections. Future introduction of vaccines to protect against multiple diseases will further increase the number of injections at routine immunization childhood visits, particularly in developing countries that are still scaling up introductions. Parental and healthcare provider attitudes toward multiple injections may affect acceptance of recommended vaccines, and understanding these attitudes may help to inform critical decisions about vaccine introduction. METHODS We conducted a systematic review of the literature to examine factors underlying reported parental and healthcare provider concerns and practices related to administration of multiple injections during childhood vaccination visits. RESULTS Forty-four articles were identified; 42 (95%) were from high income countries, including 27 (61%) from the USA. Providers and parents report concerns about multiple injections, which tend to increase with increasing numbers of injections. Common parental and provider concerns included apprehension about the pain experienced by the child, worry about potential side effects, and uncertainty about vaccine effectiveness. Multiple studies reported that a positive provider recommendation to the parent and a high level of concern about the severity of the target disease were significantly associated with parental acceptance of all injections. Providers often significantly overestimated parental concerns about multiple injections. DISCUSSION Providers may play a critical role in the decision for a child to receive all recommended injections. Their overestimation of parental concerns may lead them to postpone recommended vaccinations, which may result in extra visits and delayed vaccination. More research is needed on interventions to overcome provider and parental concern about multiple injections, particularly in developing countries.
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Affiliation(s)
- Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States.
| | - Carsten Mantel
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Gill Mayers
- Immunizations, Vaccines and Biologicals Programme, World Health Organization, Geneva, Switzerland
| | - Osman Mansoor
- United National Children's Fund, New York, NY, United States
| | - Jacqueline S Gindler
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
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Orenstein WA, Rodewald LE, Hinman AR, Schuchat A. Immunization in the United States. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Szilagyi PG, Griffin MR, Shone LP, Barth R, Zhu Y, Schaffer S, Ambrose S, Roy J, Poehling KA, Edwards KM, Walker FJ, Schwartz B. The impact of conjugate pneumococcal vaccination on routine childhood vaccination and primary care use in 2 counties. Pediatrics 2006; 118:1394-402. [PMID: 17015528 DOI: 10.1542/peds.2006-0314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccine immunization recommendations were rapidly implemented by primary care providers. Before the recommendations, concern was expressed that adding pneumococcal conjugate vaccine might result in delays in other vaccinations or preventive services. OBJECTIVES The study objectives were to measure whether incorporation of pneumococcal conjugate vaccine by primary care providers delayed other vaccinations or added primary health care visits. DESIGN AND METHODS In 2 counties surrounding Rochester and Nashville, we reviewed a representative sample of primary care charts for children born before and after licensure of pneumococcal conjugate vaccine. Receipt of vaccinations and health care visits were compared for the 2 age-matched cohorts. RESULTS We reviewed 1459 records from Rochester and 1857 records from Nashville. The pre-pneumococcal conjugate vaccine and post-pneumococcal conjugate vaccine cohorts had similar demographic characteristics. The median age for receipt of any vaccination was not older for the postvaccine cohort than for the prevaccine cohort in either community. The percentage of children up-to-date for vaccinations by 18 months for postvaccine versus prevaccine cohorts was similar in Rochester (72% in each cohort) and in Nashville (58% postvaccine and 65% prevaccine). The number of well-child care visits or other health care visits during the first 18 months of life was not statistically different between the 2 cohorts. CONCLUSIONS Implementation of pneumococcal conjugate vaccine was not associated with delays in other childhood vaccinations or more primary care visits.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Abstract
OBJECTIVE On December 13, 2002, Pediarix, a combination vaccine that contains diphtheria, tetanus, acellular pertussis; hepatitis B; and inactivated polio vaccines, was licensed by the Food and Drug Administration for use in the primary immunization series. Use of this vaccine decreases the number of injections that children receive when completing their primary immunization series at the 2-, 4-, and 6-month well-child visits. The objective of this study was to determine the factors that influence the use of this combined vaccine in private pediatric practices, with particular attention to the perceived economic impact of Pediarix and actions taken to address this impact within the private pediatric setting. METHODS A mail survey study was conducted of a random sample of 565 practicing pediatricians that was obtained from the American Medical Association Masterfile. Frequency distributions were developed for all responses, and the vaccine financing policies of the state of practice for each respondent were determined. Chi2 analysis was performed to assess any associations of the predictor variables with the outcome variables of interest, use or consideration of use of the Pediarix vaccine. Logistic regression was used to determine the independent association of the predictor variables with use or consideration of use of Pediarix. Regression models that did and did not include practice ownership as a predictor variable were developed. RESULTS Response rate was 63% (N = 355). A total of 39% (n = 123) of the respondents' practices were purchasing Pediarix for use with their private patients. An additional 18% (n = 55) were considering purchasing the vaccine. Those who were in practices that were owned by hospitals or health systems were more likely than those who were in solo or group practices to purchase Pediarix for their private patients. Approximately half of the remaining respondents order Pediarix through their state immunization program. Among the 52% of respondents who did not, 23% reported that the vaccine was not yet available through their state program, and 47% stated that they did not want to use different vaccines for their public and private patients. Only 11% believed that Pediarix was not compatible with their other vaccine products. Physicians that currently were purchasing or considering purchasing Pediarix were more likely to be influenced by both parental and provider desire to decrease the number of injections at a single visit and the reduced time for immunization delivery. Fewer than 1% of respondents reported either having experienced or expecting to experience a significant decrease in practice revenue as a result of the use of Pediarix. CONCLUSIONS Although use of the vaccine results in fewer administration fees for most physicians, the magnitude of the change seemed not to be significant for the majority of respondents or was outweighed by other factors. It also is possible that larger practices or buying cooperatives were able to negotiate discounted rates for Pediarix relative to the constituent products. This may have been a strategy of manufacturers and/or distributors to provide incentive for practices to switch to the combination product. Of note was the appreciation of respondents for the preferences of patients for fewer vaccines and, to a lesser degree, for the decrease in office staff time required to provide vaccination with multiple antigens when using Pediarix. Also, the role of the availability of a given vaccine through the Vaccines for Children program is important in its adoption into practice.
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Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.
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Lin ND, Kleinman K, Chan KA, Yu XJ, France EK, Xu S, Wei F, Mullooly J, Santoli J, Lieu TA. Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants. BMC Pediatr 2005; 5:43. [PMID: 16313673 PMCID: PMC1314888 DOI: 10.1186/1471-2431-5-43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 11/28/2005] [Indexed: 12/03/2022] Open
Abstract
Background The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life. Surveys have suggested that the addition of PCV has led some immunization providers to move other routine childhood vaccinations to later ages, which could increase the possibility of missing these vaccines. The purpose of this study was to evaluate whether introduction of PCV affected immunization coverage for recommended childhood vaccinations among 13-month olds in four large provider groups. Methods In this retrospective cohort study, we analyzed computerized data on vaccinations for 33,319 children in four large provider groups before and after the introduction of PCV. The primary outcome was whether the child was up to date for all non-PCV recommended vaccinations at 13 months of age. Logistic regression was used to evaluate the association between PCV introduction and the primary outcome. The secondary outcome was the number of days spent underimmunized by 13 months. The association between PCV introduction and the secondary outcome was evaluated using a two-part modelling approach using logistic and negative binomial regression. Results Overall, 93% of children were up-to-date at 13 months, and 70% received all non-PCV vaccinations without any delay. Among the entire study population, immunization coverage was maintained or slightly increased from the pre-PCV to post-PCV periods. After multivariate adjustment, children born after PCV entered routine use were less likely to be up-to-date at 13 months in one provider group (Group C: OR = 0.5; 95% CI: 0.3 – 0.8) and were less likely to have received all vaccine doses without any delay in two Groups (Group B: OR = 0.4, 95% CI: 0.3 – 0.6; Group C: OR = 0.5, 95% CI: 0.4 – 0.7). This represented 3% fewer children in Group C who were up-to-date and 14% (Group C) to 16% (Group B) fewer children who spent no time underimmunized at 13 months after PCV entered routine use compared to the pre-PCV baseline. Some disruptions in immunization delivery were also observed concurrent with temporary recommendations to suspend the birth dose of hepatitis B vaccine, preceding the introduction of PCV. Conclusion These findings suggest that the introduction of PCV did not harm overall immunization coverage rates in populations with good access to primary care. However, we did observe some disruptions in the timely delivery of other vaccines coincident with the introduction of PCV and the suspension of the birth dose of hepatitis B vaccine. This study highlights the need for continued vigilance in coming years as the U.S. introduces new childhood vaccines and policies that may change the timing of existing vaccines.
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Affiliation(s)
- Nancy D Lin
- Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA, USA
| | - Ken Kleinman
- Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA, USA
| | | | - Xian-Jie Yu
- Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA, USA
| | - Eric K France
- Kaiser Permanente, Denver, Kaiser Permanente, Denver, CO, USA
| | - Stanley Xu
- Kaiser Permanente, Denver, Kaiser Permanente, Denver, CO, USA
| | - Feifei Wei
- HealthPartners Research Foundation, Minneapolis, MN, USA
| | - John Mullooly
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jeanne Santoli
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tracy A Lieu
- Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA, USA
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