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Eiden AL, Hartley L, Garbinsky D, Saande C, Russo J, Hufstader Gabriel M, Price M, Bhatti A. Adult vaccination coverage in the United States: A database analysis and literature review of improvement strategies. Hum Vaccin Immunother 2024; 20:2381283. [PMID: 39079694 DOI: 10.1080/21645515.2024.2381283] [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: 03/26/2024] [Revised: 06/19/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024] Open
Abstract
Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18-64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011-2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.
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Affiliation(s)
| | | | - Diana Garbinsky
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Cassondra Saande
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Jon Russo
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | - Mark Price
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
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Ciocca ET, Staggers KA, Carey J, Opekun AR, Hollinger FB, Keitel WA, Atmar RL, El Sahly HM, Whitaker JA. Delays in Hepatitis A vaccination in people with HIV in Houston, Texas between 2010 and 2018. Vaccine X 2024; 16:100422. [PMID: 38192618 PMCID: PMC10772366 DOI: 10.1016/j.jvacx.2023.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
Background Studies have demonstrated low hepatitis A virus (HAV) vaccination rates among persons with HIV (PWH). Methods We conducted a retrospective study of persons entering HIV care at two clinics in Houston, Texas between 2010 and 2018. We defined those eligible for HAV vaccination as those who had no history of HAV vaccination and had a negative anti-HAV IgG at entry to care. Kaplan-Meier curves summarized time to receipt of HAV vaccines. The proportions of patients who received 1 and 2 HAV vaccines at 6, 12, and 24 months were estimated. Cox proportional hazards regression evaluated associations between patient characteristics and vaccination. Significant factors were included in a multivariable Cox proportional hazards model. Results Of 6,515 patients, 1372 were eligible for HAV vaccination. Of eligible patients, 29.2 % received 1 HAV vaccination at 6 months, 37.1 % at 12 months, and 47.8 % at 24 months. At 6 months, 10 % received 2 HAV vaccinations, 21.1 % at 12 months, and 33.4 % at 24 months. In multivariable analysis, men who have sex with men (adjusted HR 1.35, 95 % CI 1.06, 1.73) or those who had CD4 count ≥ 200 cells/µl (adjusted HR 2.52, 95 % CI 1.89, 3.37) had their second vaccination sooner than those who were not men who have sex with men or who had CD4 counts < 200 cells/µl, respectively. Patients > 50 years of age had their second vaccination sooner than those aged 30-50 years (adjusted HR 1.47, 95 % CI 1.08, 1.99). Those with active substance history had a longer time to second vaccination compared to those with no substance use history (adjusted HR 0.57, 95 % CI 0.40, 0.82). Conclusions HAV vaccination rates were low and highlight the need for effective solutions to address HAV immunization gaps in PWH, especially among young patients, those with active substance use disorders, and those with significant immunocompromise.
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Affiliation(s)
- Emily T. Ciocca
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kristen A. Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | | | - Antone R. Opekun
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - F. Blaine Hollinger
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Wendy A. Keitel
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Robert L. Atmar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Hana M. El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer A. Whitaker
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
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Eiden AL, Barratt J, Nyaku MK. A review of factors influencing vaccination policies and programs for older adults globally. Hum Vaccin Immunother 2023; 19:2157164. [PMID: 36656057 PMCID: PMC9980618 DOI: 10.1080/21645515.2022.2157164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.
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Affiliation(s)
- Amanda L Eiden
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | - Jane Barratt
- International Federation on Ageing, Toronto, ON, Canada
| | - Mawuli K Nyaku
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
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Bert F, Russotto A, Pivi A, Mollero B, Voglino G, Orofino G, Siliquini R. Vaccination and Trust in the National Health System among HIV+ Patients: An Italian Cross-Sectional Survey. Vaccines (Basel) 2023; 11:1315. [PMID: 37631883 PMCID: PMC10458052 DOI: 10.3390/vaccines11081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the knowledge, attitudes, and practises (KAP) of individuals living with HIV (PLWH) regarding vaccines and their trust in the Italian national health system (NHS). METHODS A cross-sectional survey was conducted at Amedeo di Savoia Hospital in Turin, Italy, involving 160 HIV-positive patients. Descriptive statistics were utilised to analyse variables such as vaccination status and intention, perceived risk of infection, and disease severity. The infections were categorised into sexually transmitted diseases and other vaccine-preventable diseases. RESULTS Except for the perceived severity of infection, there were no significant differences in the percentages between the two infection groups for the variables examined. Concerning patients' perception of the Italian NHS, a high percentage of the sample believed in the information provided by healthcare workers (HCWs) (95.6%) and considered HCWs up-to-date on vaccines (93.1%). However, a considerable proportion expressed concerns about insufficient information on vaccine risks from HCWs (33.3%), perceived judgement by HCWs for vaccine refusal (40.3%), and suspected financial interests of HCWs in vaccination (19.5%). CONCLUSIONS Some HIV+ patients may hesitate to be vaccinated or hold misconceptions about the severity of certain infectious diseases. Additionally, there are concerns about trust in the Italian NHS and communication by HCWs.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health and Pediatrics Sciences, University of Turin, 10126 Turin, Italy
- Hygiene and Infection Control Unit, ASL TO3, 10098 Turin, Italy
| | - Antonino Russotto
- Department of Public Health and Pediatrics Sciences, University of Turin, 10126 Turin, Italy
| | - Alex Pivi
- Department of Public Health and Pediatrics Sciences, University of Turin, 10126 Turin, Italy
| | | | | | | | - Roberta Siliquini
- Department of Public Health and Pediatrics Sciences, University of Turin, 10126 Turin, Italy
- Hospital Molinette, City of Health and Science of Turin, 10126 Turin, Italy
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Gerin L, Antonini M, Santos KDS, Gir E, Reis RK. O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV – uma revisão integrativa. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar evidências na literatura acerca do conhecimento dos profissionais de saúde sobre vacinação das pessoas vivendo com HIV. Método Trata-se de uma revisão integrativa. Para a busca, foram utilizados os descritores: pessoal de saúde (health personnel), conhecimento (knowledge), vacinação (vaccination), HIV e seus sinônimos, sem utilização de filtros, nas bases de dados Pubmed, Biblioteca Virtual em Saúde, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct e Cochrane. Foram incluídos apenas artigos primários analisados por meio do aplicativo RAYYAN. Resultados De 601 publicações iniciais, apenas cinco constituíram a amostra final, todas identificadas no Pubmed publicadas entre 2013 e 2018, sendo nenhum estudo brasileiro. A maioria das publicações estava relacionada a alguma vacina específica e não abordava todo o calendário vacinal. Conclusão e implicações para a prática O déficit de conhecimento dos profissionais de saúde, em relação às vacinas indicadas às pessoas vivendo com HIV, foi o principal aspecto identificado, resultando em insegurança dos profissionais. Há a necessidade de educação permanente das equipes multiprofissionais dos serviços especializados e da atenção primária visando diminuir as barreiras e aumentar a cobertura vacinal desta clientela.
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Affiliation(s)
- Larissa Gerin
- Secretaria Municipal de Saúde de Ribeirão Preto, Brasil; Universidade de São Paulo, Brasil
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Impact of a pharmacist-driven recombinant zoster vaccine administration program. J Am Pharm Assoc (2003) 2020; 61:e136-e139. [PMID: 33309190 DOI: 10.1016/j.japh.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether a pharmacist-driven recombinant zoster vaccine (RZV) administration pilot program within a human immunodeficiency virus/infectious diseases clinic setting increased the completion of the 2-dose series when compared with standard care. METHODS In this retrospective cohort study, the patients enrolled in a pharmacist-driven RZV administration pilot program (intervention) were compared with those in provider-directed RZV education (standard care) for completion of the 2-dose vaccine series. RESULTS One hundred nineteen patients were included (standard care [n = 84], intervention intention to treat [ITT, n = 35], and intervention modified ITT [mITT, n = 23]). There was increased completion of the 2-dose vaccine series in the intervention cohort compared with the standard care cohort (ITT 66% and mITT 100% vs. 23%; P < 0.001). CONCLUSION The pharmacist-driven RZV administration program resulted in increased completion of the 2-dose series. However, the revenue generated did not justify the cost of a pharmacist salary for the allocated time commitment.
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Erlandson KM, Karris MY. HIV and Aging: Reconsidering the Approach to Management of Comorbidities. Infect Dis Clin North Am 2019; 33:769-786. [PMID: 31395144 PMCID: PMC6690376 DOI: 10.1016/j.idc.2019.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Health care for older adults with human immunodeficiency virus can be highly complex, resource intensive, and carry a high administrative burden. Data from aging longitudinal cohorts and feedback from the human immunodeficiency virus community suggest that the current model is not meeting the needs of these older adults. We introduce the 6 Ms approach, which acknowledges the multicomplexity of older adults with human immunodeficiency virus, simplifies geriatric principles for non-geriatrics-trained providers, and minimizes extensive training and specialized screening tests or tools. Implementing novel approaches to care requires support at local/national levels.
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Affiliation(s)
- Kristine M Erlandson
- University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA.
| | - Maile Y Karris
- University of California San Diego, 200 West Arbor Drive #8208, San Diego, CA 92103-8208, USA
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Gilbert L, Wang X, Deiss R, Okulicz J, Maves R, Schofield C, Ferguson T, Whitman T, Kronmann K, Agan B, Ganesan A. Herpes Zoster Rates Continue to Decline in People Living With Human Immunodeficiency Virus but Remain Higher Than Rates Reported in the General US Population. Clin Infect Dis 2019; 69:155-158. [PMID: 30561578 PMCID: PMC6579953 DOI: 10.1093/cid/ciy1041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/11/2018] [Indexed: 12/28/2022] Open
Abstract
In the antiretroviral therapy era, herpes zoster incidence continued to decline in people living with HIV (PLWH). However, at 0.9 cases/100 person-years, rates in PLWH are substantially higher than the general US population; emphasizing the needs for studies of the subunit vaccine in PLWH.
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Affiliation(s)
| | - Xun Wang
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Naval Medical Center San Diego, California
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Brooke Army Military Medical Center, Fort Sam Houston, Texas
| | - Ryan Maves
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Naval Medical Center San Diego, California
| | - Christina Schofield
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Madigan Army Medical Center, Tacoma, Washington
| | - Tomas Ferguson
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Tripler Army Medical Center, Honolulu, Hawaii
| | - Timothy Whitman
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Karl Kronmann
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Naval Medical Center Portsmouth, Virginia
| | - Brian Agan
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Hawkins KL, Gordon KS, Levin MJ, Weinberg A, Battaglia C, Rodriguez-Barradas MC, Brown ST, Rimland D, Justice A, Tate J, Erlandson KM. Herpes Zoster and Herpes Zoster Vaccine Rates Among Adults Living With and Without HIV in the Veterans Aging Cohort Study. J Acquir Immune Defic Syndr 2018; 79:527-533. [PMID: 30179984 PMCID: PMC6203599 DOI: 10.1097/qai.0000000000001846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite historically high rates of herpes zoster among people living with HIV (PLWH), comparative studies of herpes zoster by HIV serostatus are lacking since the advent of combination antiretroviral therapy and availability of zoster vaccine. METHODS Annual rates (2002-2015) of first-episode herpes zoster and zoster vaccination were calculated for PLWH and uninfected adults in the Veterans Aging Cohort Study and stratified by HIV serostatus and age. Herpes zoster was captured using ICD9 codes and vaccine receipt with procedural codes and pharmacy data. RESULTS Of 45,177 PLWH and 103,040 uninfected veterans, rates of herpes zoster decreased among PLWH (17.6-8.1/1000) over the study period but remained higher than uninfected adults (4.1/1000) at the end of study period. Rates were higher in PLWH with lower CD4 (<200 vs >500 cells/µL: 18.0 vs 6.8/1000) and unsuppressed vs suppressed HIV-1 RNA (21.8 vs 7.1/1000). Restricted to virologically suppressed participants with CD4 >350 cells per microliter, herpes zoster rates were similar among PLWH aged younger than 60 years and aged 60 years and older in 2015 (6.6 vs 6.7/1000) but higher than all uninfected age groups. At study end, cumulative receipt of zoster vaccine for PLWH aged 60 years and older was less than half that of uninfected veterans: 98.7 vs 215.2/1000. CONCLUSIONS Herpes zoster rates among PLWH have markedly decreased, but, even in cART-treated individuals, remain 50% higher than uninfected adults. Lower rates of zoster vaccine receipt combined with high rates of herpes zoster support the need for a safe and effective vaccine against herpes zoster for PLWH, formal zoster vaccine guidelines for PLWH, and consideration for expanded use at younger ages.
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Affiliation(s)
- Kellie L Hawkins
- Denver Public Health, Denver, CO
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Kirsha S Gordon
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Myron J Levin
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Adriana Weinberg
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Catherine Battaglia
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Maria C Rodriguez-Barradas
- Department of Medicine, Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX
| | - Sheldon T Brown
- Department of Medicine, James J. Peters Veterans Affairs Medical Center, Mount Sinai School of Medicine, New York, NY
| | - David Rimland
- Division of Infectious Diseases, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA
| | - Amy Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Janet Tate
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Kristine M Erlandson
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO
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