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Tuckerman J, Riley K, Straube S, Mohammed H, Danchin M, Marshall HS. Interventions for increasing the uptake of immunisations in healthcare workers: A systematic review. Vaccine 2023; 41:5499-5506. [PMID: 37527954 DOI: 10.1016/j.vaccine.2023.07.064] [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] [Received: 09/19/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This systemic review aimed to evaluate the effectiveness of interventions for increasing the uptake of immunisation in healthcare workers (HCWs) compared to no or alternative interventions. METHODS A systematic review was undertaken (until March 2022) using a search strategy established a priori to capture studies that examined the effect of interventions on vaccination levels in HCWs. We included randomised controlled trials (RCT), cluster RCTs, controlled before-after (CBA) studies and interrupted time-series (ITS) studies. We described studies descriptively and synthesized results with a fixed-effect or random-effects model meta-analysis, where appropriate. The risk of bias was assessed for each study; the quality evidence per comparison was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We identified three RCTs, six cluster RCTs and four ITS studies. There was a diverse range of interventions; many included an educational component. Based on the evidence examined the following may be effective strategies in increasing the proportion of HCWs vaccinated: policy interventions, targeted and multicomponent strategies, tailored programs directed at management, physician delivered education with a vaccine 'champion' and individual decision analysis. Limited eligible studies restricted synthesis and interpretation of findings. No studies evaluated the effectiveness of legislation. Nor did we find studies evaluating the effectiveness of incentives on their own or studies focusing solely on improving access to vaccination. We judged all the studies as either unclear or high risk of bias. CONCLUSION Few robust studies that evaluate interventions to increase vaccination in HCWs are available. A limitation of this systematic review is that interventions are diverse, poorly reported and few were sufficiently alike to combine in an evaluation. More research on the effects of interventions to increase vaccination in HCWs is required, this should address a variety of vaccines and not just influenza vaccination.
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Affiliation(s)
- Jane Tuckerman
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Kathryn Riley
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia; Adelaide Medical School, University of Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, South Australia, Australia
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Mercogliano M, Fiorilla C, Esposito F, Sorrentino M, Mirizzi PD, Parisi A, Tajani A, Buonocore G, Triassi M, Palladino R. Knowledge and attitude factors associated with the prevalence of Tdap (tetanus, diphtheria, and acellular pertussis) booster vaccination in healthcare workers in a large academic hospital in Southern Italy in 2022: a cross-sectional study. Front Public Health 2023; 11:1173482. [PMID: 37522000 PMCID: PMC10374026 DOI: 10.3389/fpubh.2023.1173482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In Europe, there is still suboptimal tetanus, diphtheria, and acellular pertussis (Tdap) booster coverage. This study aimed to assess coverage status, knowledge, and attitude on Tdap vaccination in healthcare workers (HcWs) of the University Hospital "Federico II" in Naples, Southern Italy, in 2022, to improve current vaccination strategies. Methods A cross-sectional study was conducted using a validated anonymous questionnaire. Knowledge and attitude were measured as scores. Multivariable logistic and linear regression models were employed to identify correlates of Tdap booster and knowledge and attitude toward the vaccination, as appropriate. Models were controlled for age, sex, profession, department, and job seniority. Results A total of 206 questionnaires were administered among HcWs, and 143 (69.4%) were medical doctors. In total, 71 (34.47%) HcWs received the Tdap booster. Those who have worked 5-9 years at the hospital had a 78% lower likelihood of being vaccinated with the Tdap booster (5-9 years-OR: 0.22, CI: 0.06 | 0.85) as compared with newly hired HcWs. No differences in the average knowledge score were found. Other healthcare workers had a lower attitude as compared to medical doctors (Other-Coef. -2.15; CI: -4.14 | -0.15) and, as compared with those who worked in a clinical department, those who worked in a diagnostic-therapeutic department or medical management had 3.1 and 2.0 lower attitude scores, on average, respectively (diagnostic-therapeutic-Coef. -3.12, CI: -5.13 | -1.12; public health-Coef. -1.98, CI: -3.41 | -0.56). Discussion The study findings support the necessity to implement public health strategies and improve knowledge and attitude toward vaccinations and specifically highlight the importance of Tdap booster every 10 years as a prevention tool to protect high-risk populations.
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Affiliation(s)
| | - Claudio Fiorilla
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Federica Esposito
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Michele Sorrentino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | | | - Antonio Parisi
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Andrea Tajani
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Gaetano Buonocore
- Clinical Directorate, University Hospital “Federico II” of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), Naples, Italy
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom
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3
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Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
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Impfungen von Personal in medizinischen Einrichtungen in Deutschland: Empfehlung zur Umsetzung der gesetzlichen Regelung in § 23a Infektionsschutzgesetz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:636-642. [PMID: 33929567 PMCID: PMC8086965 DOI: 10.1007/s00103-021-03313-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Godinot LD, Sicsic J, Lachatre M, Bouvet E, Abiteboul D, Rouveix E, Pellissier G, Raude J, Mueller JE. Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers. Vaccine 2021; 39:805-814. [PMID: 33419603 DOI: 10.1016/j.vaccine.2020.12.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.
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Affiliation(s)
| | | | - Marie Lachatre
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Centre d'Investigation Clinique Cochin Pasteur CIC 1417, Hôpital Cochin, AP-HP, Paris, France
| | - Elisabeth Bouvet
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Haute autorité de santé (HAS), Commission technique des vaccinations (CTV), La Plaine Saint Denis, France
| | - Dominique Abiteboul
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Elisabeth Rouveix
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP,) Université Paris Saclay, France
| | - Gérard Pellissier
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Jocelyn Raude
- EHESP French School of Public Health, Paris and Rennes, France; Unité des Virus Émergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Judith E Mueller
- EHESP French School of Public Health, Paris and Rennes, France; Institut Pasteur, Paris, France
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Kalemaki D, Karakonstantis S, Galanakis E, Lionis C. Vaccination coverage of general practitioners: a cross-sectional study from Greece. Public Health 2020; 181:110-113. [PMID: 32000009 DOI: 10.1016/j.puhe.2019.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/06/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Vaccination coverage of general practitioners (GPs) is important for their own and for their colleagues' and patients' protection and has been associated with the coverage of the general population. Our study aims to evaluate the vaccination practices of GPs in Crete, Greece. STUDY DESIGN Cross-sectional, questionnaire-based survey. METHODS All practicing GPs in Crete (n = 294) were surveyed either by questionnaires or by phone call. We assessed the vaccination coverage and practices for influenza, measles, hepatitis B, and pertussis (booster Tdap dose) and the reasons for nonvaccination for influenza. RESULTS A total of 260 (88% response rate) GPs participated. Vaccination rates were 56% for influenza (current season), 26% for measles (two doses), 68% for hepatitis B (three doses), and 18% for the booster dose with Tdap. Negligence (47%) and perceived low risk (29.6%) were the most common reasons for nonvaccination for influenza. History of natural measles infection was reported by 169 (65%) GPs, but none of the interviewed 31 provided laboratory confirmation. GPs with self-reported natural measles infection were less vaccinated than their peers (10% vs 55%, P < 0.001). Finally, 23 of 130 (18%) GPs contacted by phone falsely reported vaccination with Tdap in their childhood, when Tdap was not yet available. CONCLUSION This study revealed insufficient vaccination rates and misconceptions among GPs that should be the focus of future evidence-based interventions with potential to significantly improve vaccination coverage of GPs and indirectly of their patients.
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Affiliation(s)
- D Kalemaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - S Karakonstantis
- Infectious Diseases Unit, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - E Galanakis
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - C Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, 71003, Greece.
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How Cities Cope in Outbreak Events? THE CITY IN NEED 2020. [PMCID: PMC7278263 DOI: 10.1007/978-981-15-5487-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An outbreak can cause more problems than just the spread of disease. It can be an antagonistic nemesis to our cities and communities, particularly if we lack preparedness and resilience. Its progress is usually unclear as it can be completely different from case to case, and can react differently in different contexts and with different groups of people. Such reactions may purely relate to climatic conditions, hygienic status, and environmental attributes of the context. Those reactions can also differ from one group of people to another, while the disease has to find its correct host as well the way it can transmit and evolve. Consequently, the magnitude of impacts would depend on many factors, of which the nature of the disease is very important during the whole outbreak progress.
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Cheshmehzangi A. Reflection on Early Lessons for Urban Resilience and Public Health Enhancement during the COVID-19. Health (London) 2020. [DOI: 10.4236/health.2020.1210101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil. Vaccine 2019; 38:46-53. [PMID: 31648911 DOI: 10.1016/j.vaccine.2019.09.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
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A systematic review of adult tetanus-diphtheria-acellular (Tdap) coverage among healthcare workers. Vaccine 2019; 37:1030-1037. [PMID: 30630694 DOI: 10.1016/j.vaccine.2018.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/28/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022]
Abstract
During the last decades pertussis incidence raised globally. Several vaccination strategies targeting adults to reduce pertussis among young infants have been proposed, including vaccination of healthcare workers (HCWs). The aim of this study was to analyse, by performing a systematic review of literature, published papers that evaluated Tdap coverage among HCWs, variables associated with vaccine uptake and efforts implemented to raise vaccination rates. We searched the MedLine, Embase, SCOPUS, LILACS, Web of Science and Cochrane for full-text studies that evaluated Tdap coverage in HCW. Two independent reviewers screened the articles and extracted the data.Twenty-eight studies published from 2009 to 2018 were reviewed. Most studies were conducted in the USA. Initial Tdap coverage varied from 6.1% to 63.9%. USA and France are the only two countries with studies evaluating Tdap coverage within HCWs using national data. In the USA, Tdap coverage in HCWs raised from 6.1% to 45.1% from 2007 to 2015. In the analysis of French national data, a Tdap coverage of 63.9% was observed. Five studies used interventions to raise Tdap coverage in HCWs. Two intervention studies implemented mandatory vaccination and three used educational strategies. All of them achieved coverages over 86%. Only eleven studies analysed the association of Tdap vaccination with variables of interest. Previous immunization with other vaccines recommended for HCWs (like influenza, hepatitis B and MMR) was positively associated with Tdap uptake in four studies. In conclusion, overall Tdap coverage among HCWs is low, but seems to increase over the years after the vaccine introduction and with implementation of interventions to increase coverage.
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Seroprevalence of pertussis among healthcare workers: A cross-sectional study from Tunisia. Vaccine 2018; 37:109-112. [PMID: 30459070 DOI: 10.1016/j.vaccine.2018.11.023] [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: 05/31/2018] [Revised: 10/15/2018] [Accepted: 11/12/2018] [Indexed: 01/14/2023]
Abstract
This cross-sectional study aimed to assess pertussis seroprevalence among healthy healthcare workers (HCW) of the Children's Hospital of Tunis, Tunisia. During the study period, 236 blood samples were obtained to determine HCW exposure to pertussis. Concentrations of immunoglobulin G (IgG) to pertussis toxin (PT) were measured using a commercial enzyme-linked immunosorbent assay. Cut-offs values used were 40 and 100 IU/ml, respectively indicative of an infection within the last year and a current/recent infection. Overall, seropositivity rate was 11.4% (95% CI 7.4-15.5) and 2.5% (95% CI 0.5-4.6) of ELISA results were indicative of a current infection. Seroprevalence was significantly most important in nurses (p = 0.03) and in participants aged 21-31y (p = 0.009). Our study confirmed that pertussis is circulating in hospital settings and affecting Tunisian HCW, in close contact with infants. Therefore, a booster dose of acellular pertussis vaccine needs to be considered.
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Fernandes EG, Rodrigues CCM, Sartori AMC, De Soárez PC, Novaes HMD. Economic evaluation of adolescents and adults' pertussis vaccination: A systematic review of current strategies. Hum Vaccin Immunother 2018; 15:14-27. [PMID: 30118618 PMCID: PMC6363086 DOI: 10.1080/21645515.2018.1509646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The reemergence of pertussis in the last two decades led to the introduction of adolescents and adults immunization strategies of tetanus–diphtheria–acellular pertussis vaccines (Tdap) in several countries. The health authorities must consider economic aspects when deciding to recommend and fund new programs. Here we present a systematic review of worldwide full economic evaluations of pertussis vaccination targeting adolescents or adults published from 2000. Studies were identified by searching MEDLINE, Excerpta Medica, CRD, and Lilacs databases. Twenty-seven economic evaluations of different strategies with Tdap were identified. Booster vaccination for adolescents and adults were the most frequent, followed by cocooning and pregnant women vaccination. Strategies performance varied considerably among different studies. Assumptions regarding underreporting correction, herd protection and vaccine coverage were crucial to cost-effectiveness results. Understanding the model and the parameters used is essential to understand the results, and identify the major issues important to public health decisions.
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Affiliation(s)
- Eder Gatti Fernandes
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil.,b Divisão de Imunização, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac" , Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo , São Paulo , SP , Brazil
| | - Camila Cristina Martini Rodrigues
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Ana Marli Christovam Sartori
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Patrícia Coelho De Soárez
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
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Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2018; 67:1-44. [PMID: 29702631 PMCID: PMC5919600 DOI: 10.15585/mmwr.rr6702a1] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks' gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.
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Affiliation(s)
- Jennifer L. Liang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Tejpratap Tiwari
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Pedro Moro
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Nancy E. Messonnier
- Office of the Director, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Mark Sawyer
- University of California, San Diego; La Jolla, California
| | - Thomas A. Clark
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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14
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van den Hoogen A, Duijn J, Bode L, Vijlbrief D, de Hooge L, Ockhuijsen H. Systematic review found that there was moderate evidence that vaccinating healthcare workers prevented pertussis in infants. Acta Paediatr 2018; 107:210-218. [PMID: 29055112 DOI: 10.1111/apa.14124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/11/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
This systematic review investigated the effectiveness of vaccinating healthcare workers against pertussis on the occurrence of nosocomial pertussis outbreaks or infections among unprotected infants. We focused on eight studies, with five different study designs, that involved 39,129 healthy adolescents and adults, 115 healthcare workers, 2000 simulated healthcare workers and a simulated population of 200,000 people. CONCLUSION There was moderate evidence that tetanus-diphtheria acellular pertussis vaccinations for healthcare workers were effective in preventing pertussis in all age groups and specifically in infants. The results must be interpreted with caution due to the low quality and heterogeneity of the studies.
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Affiliation(s)
- A. van den Hoogen
- Clinical Health Science; Utrecht University; Utrecht the Netherlands
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Centre Utrecht; Utrecht the Netherlands
| | - J.M. Duijn
- Clinical Health Science; Utrecht University; Utrecht the Netherlands
| | - L.G.M. Bode
- Department of Medical Microbiology and Infectious Diseases; Erasmus University Medical Center; Rotterdam the Netherlands
| | - D.C. Vijlbrief
- Department of Neonatology; Wilhelmina Children's Hospital; University Medical Centre Utrecht; Utrecht the Netherlands
| | - L. de Hooge
- Clinical Health Science; Utrecht University; Utrecht the Netherlands
| | - H.D.L. Ockhuijsen
- Clinical Health Science; Utrecht University; Utrecht the Netherlands
- Department of Reproductive Medicine and Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
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Petridou C, Gray H, Heard M, Sugden L, Davis-Blues K, Cortes N, Edwards M, Saeed K. Outbreak of pertussis among healthcare workers in a hospital maternity unit. J Infect Prev 2018; 18:253-255. [PMID: 29317903 DOI: 10.1177/1757177417693678] [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: 09/09/2016] [Accepted: 01/08/2017] [Indexed: 11/16/2022] Open
Abstract
In December 2015, an outbreak of pertussis was detected among staff working in the Maternity Unit of a district general hospital in Hampshire. This occurred in the background of increased pertussis activity in the community. The outbreak occurred over the Christmas holiday period causing staff shortages at a time when the departments were already overstretched. The high prevalence of upper respiratory tract infections at the time were difficult to distinguish from pertussis. This paper describes the outbreak, infection control measures implemented and the learning points.
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Affiliation(s)
- Christina Petridou
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Hazel Gray
- Infection Control Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Michael Heard
- Maternity Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Lorna Sugden
- Maternity Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Karen Davis-Blues
- Infection Control Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Nick Cortes
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Mary Edwards
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County hospital, UK
| | - Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
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O'Halloran AC, Lu PJ, Meyer SA, Williams WW, Schumacher PK, Sussell AL, Birdsey JE, Boal WL, Sweeney MH, Luckhaupt SE, Black CL, Santibanez TA. Tdap Vaccination Among Healthcare Personnel-21 States, 2013. Am J Prev Med 2018; 54:119-123. [PMID: 29174081 PMCID: PMC8978183 DOI: 10.1016/j.amepre.2017.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/09/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel.
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Affiliation(s)
- Alissa C O'Halloran
- Leidos, Inc., Atlanta, Georgia; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah A Meyer
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela K Schumacher
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Aaron L Sussell
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Jan E Birdsey
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Winifred L Boal
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Marie Haring Sweeney
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Sara E Luckhaupt
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tammy A Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jiang C, Whitmore-Sisco L, Gaur AH, Adderson EE. A quality improvement initiative to increase Tdap (tetanus, diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children's hospital. Vaccine 2017; 36:214-219. [PMID: 29217370 DOI: 10.1016/j.vaccine.2017.11.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Health care providers (HCP) are at high risk of acquiring and transmitting pertussis to susceptible family members, co-workers, and patients. Public health authorities recommend administering a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to all adults, including HCP, to increase adult immunity to pertussis. We set a quality improvement goal to increase Tdap vaccination coverage among HCP who provided direct patient care at a children's hospital from 58% to 90% over 18 months. DESIGN A multidisciplinary working group comprised of Occupational Health Program (OHP) staff and representatives of various medical services drew from a variety of qualitative methods and previous studies of vaccination programs in the healthcare system to understand barriers to Tdap vaccination within the institution and to develop interventions to increase vaccination rates. INTERVENTIONS Interventions included changes to OHP processes, a general education campaign, improved access to vaccine, and personal engagement of HCP by task force members. RESULTS Overall vaccination rates increased to 90% over 15 months, a rate that has been sustained by systematically assessing new employees' vaccination status and vaccinating those without documentation of previous Tdap vaccination. CONCLUSIONS Tdap vaccination coverage in our institution was significantly increased by an intensive, multipronged educational campaign, and by improving processes of screening and vaccination of HCP. The use of direct engagement of vaccine hesitant populations to increase vaccination rates warrants further study.
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Affiliation(s)
- Changhong Jiang
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - LaQuita Whitmore-Sisco
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Aditya H Gaur
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Pediatrics, University of Tennessee Health Sciences Center, 50 N. Dunlap, Memphis, TN 38103, USA
| | - Elisabeth E Adderson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Pediatrics, University of Tennessee Health Sciences Center, 50 N. Dunlap, Memphis, TN 38103, USA.
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Bloomberg School of Public Health, Johns Hopkins School of Medicine, 725 North Wolfe Street, Suite 228 PCTB, Baltimore, MD 21205, USA
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Kauhl B, Heil J, Hoebe CJPA, Schweikart J, Krafft T, Dukers-Muijrers NHTM. Is the current pertussis incidence only the results of testing? A spatial and space-time analysis of pertussis surveillance data using cluster detection methods and geographically weighted regression modelling. PLoS One 2017; 12:e0172383. [PMID: 28278180 PMCID: PMC5344341 DOI: 10.1371/journal.pone.0172383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/03/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite high vaccination coverage, pertussis incidence in the Netherlands is amongst the highest in Europe with a shifting tendency towards adults and elderly. Early detection of outbreaks and preventive actions are necessary to prevent severe complications in infants. Efficient pertussis control requires additional background knowledge about the determinants of testing and possible determinants of the current pertussis incidence. Therefore, the aim of our study is to examine the possibility of locating possible pertussis outbreaks using space-time cluster detection and to examine the determinants of pertussis testing and incidence using geographically weighted regression models. METHODS We analysed laboratory registry data including all geocoded pertussis tests in the southern area of the Netherlands between 2007 and 2013. Socio-demographic and infrastructure-related population data were matched to the geo-coded laboratory data. The spatial scan statistic was applied to detect spatial and space-time clusters of testing, incidence and test-positivity. Geographically weighted Poisson regression (GWPR) models were then constructed to model the associations between the age-specific rates of testing and incidence and possible population-based determinants. RESULTS Space-time clusters for pertussis incidence overlapped with space-time clusters for testing, reflecting a strong relationship between testing and incidence, irrespective of the examined age group. Testing for pertussis itself was overall associated with lower socio-economic status, multi-person-households, proximity to primary school and availability of healthcare. The current incidence in contradiction is mainly determined by testing and is not associated with a lower socioeconomic status. DISCUSSION Testing for pertussis follows to an extent the general healthcare seeking behaviour for common respiratory infections, whereas the current pertussis incidence is largely the result of testing. More testing would thus not necessarily improve pertussis control. Detecting outbreaks using space-time cluster detection is feasible but needs to adjust for the strong impact of testing on the detection of pertussis cases.
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Affiliation(s)
- Boris Kauhl
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Jeanne Heil
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jürgen Schweikart
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - Thomas Krafft
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Maltezou HC, Poland GA. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare (Basel) 2016; 4:E47. [PMID: 27490580 PMCID: PMC5041048 DOI: 10.3390/healthcare4030047] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/22/2016] [Accepted: 07/20/2016] [Indexed: 01/05/2023] Open
Abstract
Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, Athens 15123, Greece.
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, 611C Guggenheim Building, Mayo Clinic and Foundation, 200 First Street, SW Rochester, Rochester, MN 55905, USA.
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Parents' and staff's support for a childcare agency employee mandatory vaccination policy or agency certification program. Am J Infect Control 2016; 44:799-804. [PMID: 27021508 DOI: 10.1016/j.ajic.2016.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vaccine-preventable diseases pose a significant risk to children in childcare. However, few regulations exist regarding childcare staff vaccination. This study aimed to assess support for a childcare agency staff mandatory vaccination policy. METHODS Surveys were distributed to staff and parents at 23 St Louis, Mo, childcare agencies during fall 2014. Staff and parents' support for a mandatory vaccination and/or agency certification program were compared using χ(2) tests. Multivariate logistic regression was conducted using a 2-level nested design and controlling for gender, race, age, and income to determine predictive models for support for a mandatory staff vaccination policy and/or agency certification program. RESULTS Overall, 354 parents and staff participated (response rate, 32%). Most supported a mandatory staff vaccination policy (80.0%; n = 280) or agency certification program (81.2%; n = 285), and there were no differences between parents versus staff. Determinants of support for a mandatory policy included willingness to receive influenza vaccine annually, belief that vaccines are safe and effective, and support for the policy only if there were no costs. CONCLUSIONS There is strong support for some type of childcare agency staff vaccination policy. Implementing such a policy/program should be a collaborative endeavor that addresses vaccine cost and access.
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Edwards KM, Talbot TR. The Challenges of Pertussis Outbreaks in Healthcare Facilities: Is There A Light at the End of the Tunnel? Infect Control Hosp Epidemiol 2016; 27:537-40. [PMID: 16755470 DOI: 10.1086/506233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 04/14/2006] [Indexed: 11/03/2022]
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Williams WW, Lu PJ, O'Halloran A, Kim DK, Grohskopf LA, Pilishvili T, Skoff TH, Nelson NP, Harpaz R, Markowitz LE, Rodriguez-Lainz A, Bridges CB. Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2016; 65:1-36. [PMID: 26844596 DOI: 10.15585/mmwr.ss6501a1] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PROBLEM/CONDITION Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. REPORTING PERIOD August 2013-June 2014 (for influenza vaccination) and January-December 2014 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). DESCRIPTION OF SYSTEM The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. RESULTS Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012-13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19-64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19-26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19-64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19-64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19-49 years, and 19-59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60-64 years), and HPV vaccine (females aged 19-26 years and males aged 19-26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%-88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19-49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19-26 years]). INTERPRETATION Overall, increases in adult vaccination coverage are needed. Although modest gains occurred in Tdap vaccination coverage among adults aged ≥19 years and herpes zoster vaccination coverage among adults aged ≥60 years, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for health care are associated with higher vaccination coverage, these factors alone do not assure optimal adult vaccination coverage. PUBLIC HEALTH ACTIONS Assessing associations with vaccination is important for understanding factors that contribute to low coverage rates and to disparities in vaccination, and for implementing strategies to improve vaccination coverage. Practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination to be improved among those least likely to be up-to-date on recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.
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Affiliation(s)
- Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
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Recommended Health Care Personnel Immunization: Exploring Immunization Rates, Motivators, and Barriers to Immunization in Health Care Personnel. J Dr Nurs Pract 2016; 9:38-44. [PMID: 32751001 DOI: 10.1891/2380-9418.9.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immunization rates among health care personnel (HCP) have remained low despite advances in vaccine development with reported rates ranging from 27% to 72% for commonly recommended vaccines. Within the United States, HCP are placing patients, families, and themselves at considerable risk for vaccine-preventable diseases. A significant source of infection, HCP are carriers of infectious agents and often unknowingly transmit these contagious diseases while experiencing minimal or no symptoms. This study examined the current immunization rates of HCP for influenza, tetanus, diphtheria, and pertussis (Tdap), and hepatitis B in Nebraska, as well as identified motivators and barriers to vaccination. Nebraska HCP surveyed included physicians, physician assistants, nurse practitioners, registered nurses, licensed practical nurses, medical assistants, nursing assistants, and clerical or administrative staff of nonrestricted ethnic backgrounds age 19 years and older. Nebraska HCP immunization rates were statistically above the national rates. Motivators and barriers were also identified for each vaccine.
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Rodríguez de la Pinta ML, Castro Lareo MI, Ramon Torrell JM, García de Lomas J, Devadiga R, Reyes J, McCoig C, Tafalla M, García-Corbeira P. Seroprevalence of pertussis amongst healthcare professionals in Spain. Vaccine 2015; 34:1109-14. [PMID: 26718690 DOI: 10.1016/j.vaccine.2015.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This multi-center, hospital-based observational study determined the seroprevalence of pertussis antibodies amongst healthcare professionals from three different hospitals in Spain to ascertain the health status of professionals attending to susceptible groups who are at risk of contracting and transmitting pertussis. METHODS Medical professionals from three hospitals in Spain were recruited for this study (NCT01706224). Serum samples from subjects were assessed for anti-pertussis antibodies by ELISA. The percentage of subjects positive for anti-pertussis antibodies were determined by age-strata, gender, vaccination status, professional level (physicians, nurses, ancillary nurses and midwives), hospital department, number of working years, numbers of hours spent with the patient as well as number of children in the household. RESULTS Overall, 31.2% of subjects were seropositive; 3.3% of these healthcare professionals had ELISA values indicative of current or recent infection. There were no significant differences in terms of pertussis prevalence with respect to age, gender, hospital department, profession, number of working years and number of hours spent with patients. These levels of seronegativity amongst healthcare workers further strengthen the rationale for vaccination amongst this specific population against pertussis.
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Affiliation(s)
| | | | - Josep Maria Ramon Torrell
- IDIBELL; Hospital Universitario de Bellvitge, Feixa Llarga s/n, Hospitalet Llobregat, 08907 Barcelona, Spain.
| | - Juan García de Lomas
- Department of Microbiology, Facultad de Medicina, Av Blasco Ibañez 17, 46010 Valencia, Spain; Instituto Valenciano de Microbiología, Bétera, 46117 Valencia, Spain.
| | - Raghavendra Devadiga
- GSK Pharmaceuticals Pvt. Ltd., CDOC-B, #5 Embassy Links, S.R.T. Road, 560052 Bangalore, India.
| | - Janet Reyes
- GSK Vaccines, C/Severo Ochoa 2, Tres Cantos, 28760 Madrid, Spain.
| | - Cynthia McCoig
- GSK Vaccines, C/Severo Ochoa 2, Tres Cantos, 28760 Madrid, Spain.
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Calderón TA, Coffin SE, Sammons JS. Preventing the Spread of Pertussis in Pediatric Healthcare Settings. J Pediatric Infect Dis Soc 2015; 4:252-9. [PMID: 26407429 DOI: 10.1093/jpids/piu056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/09/2014] [Indexed: 11/13/2022]
Abstract
The surge in pertussis incidence in recent years underscores a critical need for effective plans to prevent transmission in pediatric healthcare settings. Adolescents and adults are common sources of infection for unimmunized or incompletely immunized infants and children with waning immunity. Despite documented outbreaks being limited in size, pertussis poses a threat to pediatric healthcare facilities due to the risk for widespread transmission, potentially severe complications among vulnerable patient populations, and high outbreak control-related costs. Healthcare personnel, visitors, and parents have been identified as sources of outbreaks, underscoring the importance of coordinated efforts to prevent transmission in these settings. This comprehensive review demonstrates that the risk of pertussis transmission in pediatric healthcare settings warrants heightened focus on strategies to recognize disease earlier, improve diagnostic evaluation, and facilitate effective contact tracing and post-exposure prophylaxis measures. This review suggests that healthcare personnel can play a significant role in the prevention of healthcare-associated pertussis.
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Affiliation(s)
- Tirza A Calderón
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
| | - Julia S Sammons
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
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Walther K, Burckhardt MA, Erb T, Heininger U. Implementation of pertussis immunization in health-care personnel. Vaccine 2015; 33:2009-14. [DOI: 10.1016/j.vaccine.2015.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Tariq L, Mangen MJJ, Hövels A, Frijstein G, de Boer H. Modelling the return on investment of preventively vaccinating healthcare workers against pertussis. BMC Infect Dis 2015; 15:75. [PMID: 25879422 PMCID: PMC4340637 DOI: 10.1186/s12879-015-0800-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 02/04/2015] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare workers (HCWs) are at particular risk of acquiring pertussis and transmitting the infection to high-risk susceptible patients and colleagues. In this paper, the return on investment (ROI) of preventively vaccinating HCWs against pertussis to prevent nosocomial pertussis outbreaks is estimated using a hospital ward perspective, presuming an outbreak occurs once in 10 years. Methods Data on the pertussis outbreak on the neonatology ward in 2004 in the Academic Medical Center Amsterdam (The Netherlands) was used to calculate control costs and other outbreak related costs. The study population was: neonatology ward staff members (n = 133), parents (n = 40), neonates (n = 20), and newborns transferred to other hospitals (n = 23). ROI is presented as the amount of Euros saved in averting outbreaks by investing one Euro in preventively vaccinating HCWs. Sensitivity analysis was performed to study the robustness of the ROI. Results are presented at 2012 price level. Results Total nosocomial pertussis outbreak costs were €48,682. Direct control costs (i.e. antibiotic therapy, laboratory investigation and outbreak management control) were €11,464. Other outbreak related costs (i.e. sick leave of HCWs; restrictions on the neonatology ward, savings due to reduced working force required) accounted for €37,218. Vaccination costs were estimated at €12,208. The ROI of preventively vaccinating HCWs against pertussis was 1:4, meaning 4 Euros could be saved by every Euro invested in vaccinating HCWs to avert outbreaks. ROI was sensitive to a lower vaccine price, considering direct control costs only, average length of stay of neonates on the neonatology ward, length of patient uptake restrictions, assuming no reduced work force due to ward closer and presuming more than one outbreak to occur in 10 years’ time. Conclusion From a hospital ward perspective, preventive vaccination of HCWs against pertussis to prevent nosocomial pertussis outbreaks results in a positive ROI, presuming an outbreak occurs once in 10 years. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0800-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luqman Tariq
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. .,GlaxoSmithKline BV, Zeist, The Netherlands.
| | - Marie-Josée J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Anke Hövels
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Gerard Frijstein
- Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Hero de Boer
- Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Maman K, Zöllner Y, Greco D, Duru G, Sendyona S, Remy V. The value of childhood combination vaccines: From beliefs to evidence. Hum Vaccin Immunother 2015; 11:2132-41. [PMID: 26075806 PMCID: PMC4635899 DOI: 10.1080/21645515.2015.1044180] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/26/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022] Open
Abstract
Although vaccination is one of the most cost-effective health care interventions, under-vaccination and variation in coverage rates lower than policy targets is rising in developed countries, partly due to concerns about vaccination value and benefits. By merging various antigens into a single product, combination vaccines represent a valuable tool to mitigate the burden associated with the numerous injections needed to protect against vaccine preventable infectious diseases and increase coverage rate, possibly through various behavioral mechanisms which have yet to be fully explored. Beyond their cost-effectiveness in protecting against more diseases with fewer injections, combination vaccines also have several other benefits, for children, their parents/carers, as well as for the health system and the population as a whole. The objectives of this review are to identify and illustrate the value of combination vaccines for childhood immunization. Evidence was classified into 2 groups: benefits for society and benefits for public health and healthcare systems. This article also highlights the value of innovation and challenges of combination vaccine development as well as the need for an increased number of suppliers to mitigate the impact of any potential vaccine shortage. Increasing public confidence in vaccines and combination vaccines is also critical to fully exploit their benefits.
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Affiliation(s)
| | - York Zöllner
- Health Economics; Hamburg University of Applied Sciences; Hamburg, Germany
| | - Donato Greco
- Centre for Science; Society and Citizenship; Rome, Italy
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Tuckerman JL, Collins JE, Marshall HS. Factors affecting uptake of recommended immunizations among health care workers in South Australia. Hum Vaccin Immunother 2015; 11:704-12. [PMID: 25715003 PMCID: PMC4514246 DOI: 10.1080/21645515.2015.1008886] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 10/23/2022] Open
Abstract
Despite the benefits of vaccination for health care workers (HCWs), uptake of recommended vaccinations is low, particularly for seasonal influenza and pertussis. In addition, there is variation in uptake within hospitals. While all vaccinations recommended for HCWs are important, vaccination against influenza and pertussis are particularly imperative, given HCWs are at risk of occupationally acquired influenza and pertussis, and may be asymptomatic, acting as a reservoir to vulnerable patients in their care. This study aimed to determine predictors of uptake of these vaccinations and explore the reasons for variation in uptake by HCWs working in different hospital wards. HCWs from wards with high and low influenza vaccine uptake in a tertiary pediatric and obstetric hospital completed a questionnaire to assess knowledge of HCW recommended immunizations. Multiple logistic regression was used to determine predictors of influenza and pertussis vaccination uptake. Of 92 HCWs who responded, 9.8% were able to identify correctly the vaccines recommended for HCWs. Overall 80% of respondents reported they had previously received influenza vaccine and 50.5% had received pertussis vaccine. Independent predictors of pertussis vaccination included length of time employed in health sector (P < 0.001), previously receiving hepatitis B/MMR (measles, mumps, rubella) vaccine (P < 0.001), and a respondent being aware influenza infections could be severe in infants (p = 0.023). Independent predictors of seasonal influenza vaccination included younger age (P < 0.001), English as first language (P < 0.001), considering it important to be vaccinated to protect themselves (P < 0.001), protect patients (p = 0.012) or awareness influenza could be serious in immunocompromised patients (p = 0.030). Independent predictors for receiving both influenza and pertussis vaccinations included younger age (P < 0.001), time in area of work (P = 0.020), previously receiving hepatitis B vaccine (P = 0.006) and awareness influenza could be severe in infants (P < 0.001). A knowledge gap exists around HCW awareness of vaccination recommendations. Assessment of the risk/benefit value for HCWs and their patients, determines uptake of HCW immunization programs and should be considered in promotional HCW vaccination programs.
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Affiliation(s)
- Jane L Tuckerman
- Vaccinology and Immunology Research Trials Unit; Women's and Children's Hospital; North Adelaide, South Australia, Australia
- School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide, South Australia, Australia
| | - Joanne E Collins
- Vaccinology and Immunology Research Trials Unit; Women's and Children's Hospital; North Adelaide, South Australia, Australia
- School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide, South Australia, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit; Women's and Children's Hospital; North Adelaide, South Australia, Australia
- School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide, South Australia, Australia
- School of Population Health; University of Adelaide; Adelaide, South Australia, Australia
- Robinson Research Institute; University of Adelaide; Adelaide, South Australia, Australia
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Tuckerman J, Marshall H, Snape M, Collins J, Straube S, Chambers AG. Interventions for increasing the uptake of immunisation in healthcare workers. Hippokratia 2014. [DOI: 10.1002/14651858.cd011394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jane Tuckerman
- Women's and Children's Hospital; Vaccinology and Immunology Research Trials Unit, Department of Paediatrics; 72 King William Road North Adelaide Adelaide South Australia Australia 5006
- The University of Adelaide; School of Paediatrics and Reproductive Health; Adelaide South Australia Australia 5000
| | - Helen Marshall
- Women's and Children's Hospital; Vaccinology and Immunology Research Trials Unit, Department of Paediatrics; 72 King William Road North Adelaide Adelaide South Australia Australia 5006
- The University of Adelaide; School of Paediatrics and Reproductive Health; Adelaide South Australia Australia 5000
- The University of Adelaide; Robinson Research Institute; North Adelaide South Australia Australia SA 5006
| | - Matthew Snape
- CCVTM, Churchill Hospital; Oxford Vaccine Group; Old Road Headington Oxford Oxon UK
| | - Joanne Collins
- Women's and Children's Hospital; Vaccinology and Immunology Research Trials Unit, Department of Paediatrics; 72 King William Road North Adelaide Adelaide South Australia Australia 5006
- The University of Adelaide; School of Paediatrics and Reproductive Health; Adelaide South Australia Australia 5000
| | - Sebastian Straube
- University of Alberta; Division of Preventive Medicine; 5-24 University Terrace 8303-112 Street Edmonton AB Canada T6G 2T4
| | - Andrea G Chambers
- Public Health Ontario; 480 University Avenue, Suite 900 Toronto Ontario Canada M5G 1V2
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Urbiztondo L, Broner S, Costa J, Rocamora L, Bayas JM, Campins M, Esteve M, Borras E, Domínguez A, For The Study Of The Immune Status In Health Care TWG. Seroprevalence study of B. pertussis infection in health care workers in Catalonia, Spain. Hum Vaccin Immunother 2014; 11:293-7. [PMID: 25483549 DOI: 10.4161/hv.36167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pertussis is a re-emerging infection in countries with high infant immunization coverage. Healthcare workers (HCW) are exposed and can transmit the infection to especially-vulnerable patients. Therefore, pertussis vaccination of HCW is recommended. Between June 2008 and December 2010, 460 HCW from hospital and primary healthcare centers were recruited to determine susceptibility to pertussis. IgG antibodies against pertussis (anti-pertussis ab) were measured, using a routine technique that detects antibodies against pertussis including pertussis toxin (PT) and filamentous hemagglutinin (FHA). Positive results were confirmed with a more-specific technique that only assesses anti-PT IgG antibodies. The median age was 42 years (range, 21-65), 77.3% were female. 172 were nurses, 133 physicians, 60 other clinical workers and 95 non-clinical workers. None had received pertussis vaccination since childhood. The overall prevalence of anti-pertussis antibodies was 51.7%, (95% CI 47.1-56.4). Anti-PT antibodies were determined in the 220 HCW with positive anti-pertussis antibodies: 4 (1.8%) were negative and 33 (15%) had a high titer (≥ 45 IU/mL). No significant differences between the prevalence of anti-pertussis antibodies or anti-TP antibodies were found according to age, type of occupation or type of center. Our study confirms the need for vaccination of HCW because at least half are susceptible to pertussis. High anti-PT titers found in 15% of seropositive HCW showed that they had had recent contact with B. pertussis.
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Affiliation(s)
- Luis Urbiztondo
- a Public Health Agency of Catalonia; Generalitat of Catalonia; Barcelona, Spain
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Heininger U. Vaccination of health care workers against pertussis: Meeting the need for safety within hospitals. Vaccine 2014; 32:4840-3. [DOI: 10.1016/j.vaccine.2013.10.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/17/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
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Update on immunizations for healthcare personnel in the United States. Vaccine 2014; 32:4869-75. [DOI: 10.1016/j.vaccine.2013.10.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/18/2013] [Accepted: 10/29/2013] [Indexed: 11/23/2022]
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Campins Martí M, Uriona Tuma S. [General epidemiology of infections acquired by health-care workers: immunization of health-care workers]. Enferm Infecc Microbiol Clin 2014; 32:259-65. [PMID: 24656968 DOI: 10.1016/j.eimc.2014.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
Healthcare workers are exposed to multiple occupational hazards, the most common being the biological risk. Moreover, colonized staff, or those in incubation period, or with an active infectious disease, could be at risk of transmitting these infections to others, such as patients, relatives or other workers. Therefore, measures to prevent biological risks in the healthcare environment are essential. In this chapter, the main recommendations for the prevention and control of infectious diseases that can affect health care personnel are reviewed. Specific measures recommended for each infection, including vaccination guidance, are described. These recommendations were updated according to the available evidence and the epidemiological changes described in recent years.
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Affiliation(s)
- Magda Campins Martí
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Universitat Autónoma de Barcelona, Barcelona, España.
| | - Sonia Uriona Tuma
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d'Hebron, Barcelona, España
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Wicker S, Rabenau HF, Groneberg DA, Gottschalk R. [Occupationally acquired infections among health care workers: Respiratory diseases]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2014; 59:82-91. [PMID: 32288301 PMCID: PMC7123063 DOI: 10.1007/bf03344206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In some medical departments, healthcare workers (HCWs) are at risk for aerogene transmitted infectious diseases. Numerous fatal causalities were described in the international environment. For example fatal causalities during the SARS-Epidemic as well as cases of death caused by influenza. METHODS AND RESULTS Selective literature review of occupationally acquired aerogene infections like SARS-coronavirus, influenza virus, parainfluenza virus, RSV, adenovirus, tuberculosis as well as pertussis. Currently available data demonstrate that personal protective measures (e.g. appropriate use of hand washing and oronasal mask), as well as vaccinations (if available) reduces the risk for transmission of infectious diseases. DISCUSSION The risk for occupationally acquired infections is sometimes an unavoidable part of daily patient care. From occupational medicine point of view and for control of infectious diseases preventive measures should be implemented to provide the best possible protection of HCW involved. With regard to a possible pandemic (e.g. influenza pandemic) this procedure is absolutely required.
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Affiliation(s)
- Sabine Wicker
- Betriebsärztlicher Dienst, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Deutschland
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
| | - Holger F. Rabenau
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
| | - David A. Groneberg
- Institut für Arbeitsmedizin, Charité — Universitätsmedizin Berlin, Zentrum für Human- und Gesundheitswissenschaften, Freie Universität & Humboldt-Universität zu Berlin, Thielallee 69-73, 14195 Berlin, Deutschland
| | - René Gottschalk
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
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Yasmin S, Sunenshine R, Bisgard KM, Wiedeman C, Carrigan A, Sylvester T, Garcia G, Rose K, Wright S, Miller S, Huerta RDL, Houser H, D'Souza A, Anderson S, Howard K, Komatsu K, Klein R. Healthcare-Associated Pertussis Outbreak in Arizona: Challenges and Economic Impact, 2011. J Pediatric Infect Dis Soc 2014; 3:81-4. [PMID: 26624909 DOI: 10.1093/jpids/pis136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/13/2012] [Indexed: 11/13/2022]
Abstract
An outbreak investigation identified 15 pertussis cases among 5 infants and 10 healthcare professionals at 1 hospital's neonatal intensive care unit (NICU). The cost of the outbreak to this hospital was $97 745. Heightened awareness of pertussis in NICUs is key to preventing healthcare-associated spread and minimizing outbreak-control-related costs. Bordetella pertussis is a highly communicable bacterial pathogen that causes a prolonged cough illness and is spread by respiratory droplet transmission. Infants aged ≤6 months are most susceptible to B pertussis infection and pertussis-associated complications, including pneumonia, encephalopathy, and death, and are commonly hospitalized for treatment [ 1]. Despite a universal pertussis vaccination program, 27 550 pertussis cases were reported in the United States during 2010 [ 2]. Pertussis outbreaks in healthcare settings can be challenging and costly to control [3]. On September 13, 2011 and September 15, 2011, 3 pertussis cases, including 2 confirmed by B pertussis isolation, among preterm infants discharged ≤30 days previously from a 71-bed NICU of a general hospital (NICU A) were reported by Hospital B, a large pediatric facility, to Maricopa County Department of Public Health. This report describes the outbreak, examines outbreak-associated costs and risk factors that might have contributed to healthcare-associated transmission, and provides guidance to prevent outbreaks in healthcare settings.
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Affiliation(s)
| | | | - Kristine M Bisgard
- Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Karen Rose
- Maricopa County Department of Public Health
| | - Sun Wright
- Maricopa County Department of Public Health
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Ulloa-Gutierrez R, Avila-Aguero ML. Pertussis in Latin America: current situation and future vaccination challenges. Expert Rev Vaccines 2014; 7:1569-80. [DOI: 10.1586/14760584.7.10.1569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wicker S, Zielen S, Rose MA. Attitudes of healthcare workers toward pertussis vaccination. Expert Rev Vaccines 2014; 7:1325-8. [DOI: 10.1586/14760584.7.9.1325] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kuncio DE, Middleton M, Cooney MG, Ramos M, Coffin SE, Feemster KA. Health care worker exposures to pertussis: missed opportunities for prevention. Pediatrics 2014; 133:15-21. [PMID: 24344101 DOI: 10.1542/peds.2013-0745] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines. METHODS We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records. RESULTS A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites. CONCLUSIONS Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.
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Affiliation(s)
- Danica E Kuncio
- MSHP, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Division of Infectious Diseases, The Children's Hospital of Philadelphia, CHOP North, 3535 Market Street, Room 1511, Philadelphia, PA 19104.
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Lloyd KL. Protecting pregnant women, newborns, and families from pertussis. J Midwifery Womens Health 2013; 58:288-96. [PMID: 23758718 DOI: 10.1111/jmwh.12045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pertussis has been on the rise worldwide for more than 20 years. Waning immunity may be the major cause for the resurgence of this disease. Adolescents and adults have become the vectors of pertussis, with newborns and infants less than 12 months of age at greatest risk for morbidity and mortality. Health care providers need to become aware of a vaccine strategy called cocooning that provides the needed vaccines to individuals who have contact with newborns and infants. Cocooning can protect our most vulnerable populations from pertussis and other vaccine -preventable diseases in the 21st Century.
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Affiliation(s)
- Kathie Lyn Lloyd
- Nevada State Health Division, Immunization Program, 4150 Technology Way, Carson City, NV 89706, USA.
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Rivero-Santana A, Cuéllar-Pompa L, Sánchez-Gómez LM, Perestelo-Pérez L, Serrano-Aguilar P. Effectiveness and cost-effectiveness of different immunization strategies against whooping cough to reduce child morbidity and mortality. Health Policy 2013; 115:82-91. [PMID: 24444703 DOI: 10.1016/j.healthpol.2013.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/30/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations. METHODS Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system. RESULTS There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used. CONCLUSIONS From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.
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Affiliation(s)
- Amado Rivero-Santana
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain.
| | - Leticia Cuéllar-Pompa
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain
| | - Luis M Sánchez-Gómez
- Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Health Technology Assessment Agency (AETS), Health Institute Carlos III (ISCIII), C/Sinesio Delgado, 4, 28029 Madrid, Spain; Health Research Institute of the University Hospital La Princesa, C/ Diego León, 62, 28006 Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Canarian Foundation of Health and Research (FUNCIS), Camino Candelaria, n° 44, 1ª planta, El Rosario, 38109 Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Campus de Ciencias de la Salud, s/n, 38071 La Laguna, Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Camino Candelaria, 44, El Rosario, 38109 Tenerife, Spain
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Tetanus, diphtheria and acellular pertussis (Tdap) vaccination among healthcare personnel-United States, 2011. Vaccine 2013; 32:572-8. [PMID: 24308960 DOI: 10.1016/j.vaccine.2013.11.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/13/2013] [Accepted: 11/21/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Receiving recommended vaccines is an essential prevention practice for HCP to protect themselves and their patients. The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for HCP in 2006 for protection against pertussis. We assessed the recent compliance of U.S. HCP in receiving Tdap vaccination. METHODS To estimate Tdap vaccination coverage among HCP, we analyzed data from the 2011 National Health Interview Survey (NHIS). Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination among HCP. RESULTS Overall, Tdap vaccination coverage was 26.9% among HCP aged 18-64 years (95% confidence interval (CI)=24.3%, 29.7%), which was significantly higher compared with non-HCP among the same age group (11.1%; 10.5-11.8%). Overall, vaccination coverage was significantly higher among physicians (41.5%) compared with nurses (36.5%) and other types of HCP (range 11.7-29.9%). Vaccination coverage was significantly higher among HCP aged 18-49 years compared with those 50-64 years (30.0% vs. 19.2%, respectively). Characteristics independently associated with an increased likelihood of Tdap vaccination among HCP were: younger age, higher education, living in the western United States, being hospitalized within past year, having a place for routine health care in clinic or health center, and receipt of influenza vaccination in the previous year. Marital status of widowed, divorced, or separated was independently associated with a decreased likelihood of Tdap vaccination among HCP. CONCLUSIONS By 2011, Tdap vaccination coverage was only 26.9% among HCP. Vaccination coverage varied widely by types of HCP and demographic characteristics. Emphasizing the benefits of HCP vaccination for staff and patients, providing vaccinations in the workplace and other non-traditional settings, and providing Tdap at no charge may help increase Tdap vaccination among HCP in all health-care settings.
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Maltezou HC, Ftika L, Theodoridou M. Nosocomial pertussis in neonatal units. J Hosp Infect 2013; 85:243-8. [PMID: 24156850 DOI: 10.1016/j.jhin.2013.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/19/2013] [Indexed: 11/25/2022]
Abstract
Pertussis remains a public health concern in many countries despite high vaccination coverage rates. Nosocomial outbreaks of pertussis continue to occur in neonatal units. Neonates and young infants admitted to neonatal intensive care units constitute a pool of susceptible high-risk patients given their prematurity, inadequate immune response and the fact that they are too young to have completed their primary vaccination series against pertussis. This article reviews nosocomial pertussis in neonates and infants, focusing on the role of healthcare workers (HCWs). Outbreaks in neonatal units are often traced to HCWs and are associated with serious morbidity or even a fatal outcome among susceptible young infants. A high index of suspicion is required for early recognition and isolation of patients admitted with suspected or proven pertussis, as well as for HCWs with a compatible clinical syndrome, regardless of vaccination status. Contact investigation is also essential in order to guide administration of post-exposure prophylaxis. Recommendations for a booster vaccination for HCWs are in place in several countries; however, the need of HCWs for lifelong immunity against pertussis cannot be fulfilled by the current vaccine.
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Affiliation(s)
- H C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
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Moraes JCD, Carvalhanas T, Bricks LF. Should acellular pertussis vaccine be recommended to healthcare professionals? CAD SAUDE PUBLICA 2013; 29:1277-90. [PMID: 23842996 DOI: 10.1590/s0102-311x2013000700003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/14/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.
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Abstract
Pertussis, or whopping cough, is an upper respiratory tract infection caused by Bordetella pertussis. It has long been a concern in pediatric populations, leading to aggressive vaccination strategies to help decrease pediatric disease. In recent years, recognition of pertussis infection in adult populations has increased, leading to more frequent diagnosis and recommendations for booster immunizations in the adult population. Early recognition and treatment as well as vaccination will help reduce the current increase in this disease.
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Affiliation(s)
- Tara B Spector
- Division of General Internal Medicine, University of Washington Medical Center, Health Science Building, B-503, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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Campins M, Moreno-Pérez D, Gil-de Miguel A, González-Romo F, Moraga-Llop FA, Arístegui-Fernández J, Goncé-Mellgren A, Bayas JM, Salleras-Sanmartí L. Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina. Enferm Infecc Microbiol Clin 2013; 31:240-53. [DOI: 10.1016/j.eimc.2012.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Use, location, and timeliness of clinical microbiology testing in Georgia for select infectious diseases. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 18:E4-E10. [PMID: 22635201 DOI: 10.1097/phh.0b013e3182368c74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although clinical microbiology testing facilitates both public health surveillance of infectious diseases and patient care, research on testing patterns is scant. We surveyed hospital laboratories in Georgia to assess their diagnostic testing practices. METHODS Using e-mail, all directors of hospital laboratories in Georgia were invited to participate. The survey focused on timing and location of diagnostic testing in 2006 for 6 reportable diseases: giardiasis, legionellosis, meningococcal disease, pertussis, Rocky Mountain spotted fever, and West Nile virus disease. RESULTS Of 141 laboratories, 62 (44%) responded to the survey. Hospitals varied widely in their use of diagnostic testing in 2006, with 95.1% testing for meningococcal disease, but only 66.1% and 63.3% testing for legionellosis and West Nile virus disease, respectively. Most laboratories (91%) performed gram stain/culture to diagnose meningococcal disease in-house and 23% performed ova and parasite panels for giardiasis were conducted in-house. Fewer than 11% of laboratories performed in-house testing for the remaining diseases. Laboratories affiliated with small hospitals (≤100 beds) were more likely to send specimens for outside testing compared with laboratories associated with large hospitals (>250 beds). Median turnaround time for ova and parasite panel testing for giardiasis was significantly shorter for in-house testing (1.0 days) than within-system (2.25 days) or outside laboratory (3.0 days) testing (P = .0003). No laboratories reported in-house testing for meningococcal disease, pertussis, or Rocky Mountain spotted fever using polymerase chain reaction. CONCLUSION Many hospitals did not order diagnostic tests for important infectious diseases during 2006, even for relatively common diseases. In addition, hospital laboratories were unlikely to perform diagnostic testing in-house; sending specimens to an outside laboratory may result in substantial delays in receiving results. These unsettling findings have adverse implications for both patient care and public health surveillance; they indicate an immediate need to study nationally the use and timeliness of clinical microbiologic testing.
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