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Zornoza Moreno M, Pérez-Martín J, Robles Mañueco M. Parents and teachers' perspectives on a school-located influenza vaccination program: A pilot study in the Region of Murcia, Spain. Hum Vaccin Immunother 2024; 20:2328406. [PMID: 38573783 PMCID: PMC10996829 DOI: 10.1080/21645515.2024.2328406] [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: 01/03/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
During the 2022-2023 season, the Region of Murcia (an autonomous community of Spain) introduced the influenza vaccination campaign in children aged 24-59 months with the live-attenuated influenza nasal spray vaccine. To expand coverage, a pilot study was conducted to include the 3- to 4-year population in 24 public schools. The aim of the study was to assess the experiences of parents and teachers involved in the project. This was a psychosocial qualitative study in which information was collected from a cohort of 23 parents and 17 teachers who attended three and two focus group sessions, respectively. A high degree of satisfaction with the school-located influenza vaccination program was consistently reported. The teachers reported creating a friendly environment and acting as companions to support children in the absence of their parents. They also considered the intranasal route, which avoids intramuscular puncture, as a facilitating element that turned the vaccination process into a kind of game. Parents emphasized the importance of vaccination to protect their children, and secondarily, to ensure protection of the family nucleus. Some parents who had their children already vaccinated in the health care center reported preference for the school setting, probably selecting this option in the future. The availability of school-based influenza vaccination promoted greater equity in accessing the vaccine and facilitated family reconciliation. To optimize coverage and minimize potential reluctance, providing the necessary information to parents both before and after vaccination was considered. School-located influenza vaccination was feasible and is a valuable strategy to be implemented in future campaigns.
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Affiliation(s)
- Matilde Zornoza Moreno
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Jaime Pérez-Martín
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Marta Robles Mañueco
- Immunotherapy and Vaccines Unit, AstraZeneca Farmacéutica Spain SA, Medical Department, Madrid, Spain
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Pérez-Martín JJ, Iofrío de Arce A, Zornoza-Moreno M. The Attitudes of Healthcare Professionals in an Autonomous Community in Spain towards Paediatric Influenza Vaccination. Vaccines (Basel) 2024; 12:599. [PMID: 38932329 PMCID: PMC11209165 DOI: 10.3390/vaccines12060599] [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: 04/19/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
In the 2022-2023 influenza season, three autonomous communities anticipated the document approved by the Public Health Commission recommending influenza vaccination for all children aged 6 to 59 months. The primary objective of this study was to evaluate the attitude of healthcare professionals towards the first universal vaccination campaign in our region, as well as the acceptability of the vaccines used and their attitude towards pilot school vaccination. This was a cross-sectional, survey-based, descriptive study. All healthcare professionals involved in the campaign were invited to participate. Overall, 91.9% of surveyed professionals thought that influenza vaccination from 6 to 59 months was important or very important, and 89.8% had previous experience regarding the intramuscular vaccine. Healthcare professionals rated the intranasal vaccine significantly more positively, but there were no differences when asking about each vaccine without comparison. The inhaled vaccine was preferred by 97.5% for the following campaign. Pilot school vaccination had a 75% acceptance rate. The inhaled vaccine was preferred by most professionals, and pilot school vaccination was highly accepted and independently associated with the importance of vaccination as considered by physicians, being a medical doctor, and participation in the pilot programme.
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Affiliation(s)
- Jaime J. Pérez-Martín
- Prevention and Health Protection Service, Regional Ministry of Health, Ronda de Levante, 11, 30008 Murcia, Spain;
| | - Antonio Iofrío de Arce
- Murcia-El Ranero Primary Care Centre, Murcia Health Service, Paseo Duques de Lugo, 30009 Murcia, Spain;
| | - Matilde Zornoza-Moreno
- Prevention and Health Protection Service, Regional Ministry of Health, Ronda de Levante, 11, 30008 Murcia, Spain;
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Ahmed WS, Halboup AM, Alshargabi A, Al-Mohamadi A, Al-Ashbat YK, Al-Jamei S. Attitudes, motivators, and barriers toward influenza vaccination for children: a study from a conflict-ridden country. Confl Health 2024; 18:26. [PMID: 38566200 PMCID: PMC10988905 DOI: 10.1186/s13031-024-00590-9] [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: 10/21/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite the increased recommendations for influenza vaccination, particularly among high-risk groups such as young children, Yemen lacks an influenza vaccination program, and the influenza vaccine is not included in the national immunization regime. This is exacerbated by the country's fragile infrastructure, as well as the devastating consequences of the ongoing conflict, which include child undernutrition and strained healthcare resources. Thus, the objective of the current study is to assess the public attitudes and perceptions toward vaccinating children against influenza in Yemen. METHODS A cross-sectional study was conducted by distributing a validated survey questionnaire to potential participants using convenience sampling. Descriptive statistics were used to summarize sociodemographic data, knowledge of influenza vaccines, and attitudes and perceptions regarding vaccinating children against influenza. Logistic regression analysis was employed to identify associations between independent variables and the acceptance of vaccines for children. RESULTS A total of 853 eligible individuals, parents and non-parents, successfully completed the survey. The uptake of the influenza vaccine among the participants was notably low as the majority (69.2%) had not previously received the vaccine, although the majority expressed a willingness to get vaccinated in the future (59.4%). The majority (68.5%) were willing to vaccinate children. The largest percentage of the participants who expressed hesitancy toward children's vaccination cited multiple reasons to reject the vaccine (39.7%), with concerns regarding the safety of the vaccine being the predominant barrier to its acceptance for children (29.6%). On the other hand, motivating factors for vaccinating children included the validation of the vaccine's safety and efficacy, endorsement of the vaccine by the government and physicians, integration of the vaccine into the national immunization program, and the provision of the vaccine free of charge and through schools. Significant predictors for vaccine acceptance in children included male gender, knowledge of the protective effect of the influenza vaccine, previous receipt of the vaccine, and a willingness to receive the vaccine in the future. CONCLUSIONS The study highlights the need for educational health campaigns to raise awareness and remove misconceptions regarding influenza and the role, benefits, and availability of its vaccine. These findings can serve as a robust foundation for the future design and implementation of an influenza vaccination program for children in Yemen.
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Affiliation(s)
- Wesam S Ahmed
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Abdulsalam M Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Arwa Alshargabi
- Pharmacy Department, Faculty of Medical Sciences, Saba University, Sana'a, Yemen
| | - Ahmed Al-Mohamadi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
| | - Yousf K Al-Ashbat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Al-Razi University, Sana'a, Yemen
| | - Sayida Al-Jamei
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Al-Razi University, Sana'a, Yemen.
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Pérez Martín JJ, Zornoza Moreno M, Tornel Miñarro FI, Gómez Moreno MC, Valcárcel Gómez MDC, Pérez Martínez M. Influenza Vaccination in Children Younger than 5 Years in the Region of Murcia (Spain), a Comparative Analysis among Vaccinating and Non-Vaccinating Parents: Data from the FLUTETRA Study. Vaccines (Basel) 2024; 12:192. [PMID: 38400175 PMCID: PMC10892024 DOI: 10.3390/vaccines12020192] [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: 01/17/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The high burden of influenza in children has driven numerous countries towards universal vaccination of healthy children from 6 to 59 months of age. The Region of Murcia was one of the pioneer Spanish regions to conduct a universal vaccination campaign and to use live-attenuated intranasal vaccine (LAIV) if age appropriate. This study aims to evaluate the parents' likeliness to vaccinate their children and to compare the profile of vaccinating/non-vaccinating parents. This study was designed as a prospective, real-world, survey-based data collection in the 2022-2023 season campaign. This study's sample was selected from those children whose information was available in the local Public Health System databases PERSAN and VACUSAN. Children received LAIV or intramuscular vaccine (IIV) depending on their age as per standard practice. The parent self-vaccination/intention to vaccinate themselves in this campaign (OR = 4.75), the compliance with the official vaccination schedule (OR = 3.41), and the prescription of antibiotics more than twice in the previous year (OR = 2.24) were strongly associated with children's vaccination. Overall, vaccinating parents were very satisfied with the vaccine (IIV: 67.5% vs. LAIV: 68.8%, p = 0.320), and most parents would rather have their children vaccinated with LAIV for the next campaign (43.0%). The main reasons for vaccinating were to protect the child (LAIV: 85.9% vs. IIV: 89.4%), and the predominant reasons for not vaccinating were a lack of healthcare professional recommendation (30.9%), and lack of information about the vaccination campaign (21.5%) and the vaccine itself (21.0%). The clinical context of parents and children was determinant in decision making, which was also influenced by the presence or absence of recommendation by healthcare professionals. Parents were generally very satisfied with the vaccine and showed their preference towards LAIV for future campaigns.
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Affiliation(s)
| | - Matilde Zornoza Moreno
- Affiliation Vaccination Program, Prevention and Health Protection Service, Public Health and Addictions Directorate General, Region of Murcia Ministry of Health, 30008 Murcia, Spain; (J.J.P.M.); (F.I.T.M.); (M.C.G.M.); (M.d.C.V.G.); (M.P.M.)
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Yan R, Yin X, Hu Y, Wang H, Sun C, Gong E, Xin X, Zhang J. Identifying implementation strategies to address barriers of implementing a school-located influenza vaccination program in Beijing. Implement Sci Commun 2023; 4:123. [PMID: 37821918 PMCID: PMC10566160 DOI: 10.1186/s43058-023-00501-8] [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: 11/15/2022] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The school-located influenza vaccinations (SLIV) can increase influenza vaccination and reduce influenza infections among school-aged children. However, the vaccination rate has remained low and varied widely among schools in Beijing, China. This study aimed to ascertain barriers and facilitators of implementing SLIV and to identify implementation strategies for SLIV quality improvement programs in this context. METHODS Semi-structured interviews were conducted with diverse stakeholders (i.e., representatives of both the Department of Health and the Department of Education, school physicians, class headteachers, and parents) involved in SLIV implementation. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research was adopted to facilitate data collection and analysis. Themes and subthemes regarding barriers and facilitators were generated using deductive and inductive approaches. Based on the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool, practical implementation strategies were proposed to address the identified barriers of SLIV delivery. RESULTS Twenty-four participants were interviewed. Facilitators included easy access to SLIV, clear responsibilities and close collaboration among government sectors, top-down authority, integrating SLIV into the routine of schools, and priority given to SLIV. The main barriers were parents' misconception, inefficient coordination for vaccine supply and vaccination dates, the lack of planning, and inadequate access to knowledge and information about the SLIV. CFIR-ERIC Matching tool suggested implementation strategies at the system (i.e., developing an implementation blueprint, and promoting network weaving), school (i.e., training and educating school implementers), and consumer (i.e., engaging students and parents) levels to improve SLIV implementation. CONCLUSIONS There were substantial barriers to the delivery of the SLIV program. Theory-driven implementation strategies developed in this pre-implementation study should be considered to address those identified determinants for successful SLIV implementation.
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Affiliation(s)
- Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Huan Wang
- Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Chris Sun
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730 China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 5000 Oulu, Finland
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Dong M, Ip DKM, Yuan J, So HC, Cowling BJ, Liao Q. Assessing the longitudinal effects of the continuation and discontinuation of the school-located influenza vaccination programme on parental vaccine hesitancy in Hong Kong. J Public Health (Oxf) 2023; 45:e501-e509. [PMID: 37002942 DOI: 10.1093/pubmed/fdad018] [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: 08/17/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND School-located influenza vaccination programme (SIVP) can effectively promote childhood seasonal influenza vaccination (SIV). However, the longitudinal effects of continuation and discontinuation of the SIVP on parents' vaccine hesitancy remained unknown. METHODS A two-wave longitudinal study recruited adult parents who had at least one child attending a kindergarten or primary school using random-digital-dialled telephone interviews. Generalized estimating equation and structural equation modelling were used to examine the impact of changes in schools' SIVP participation status on parents' vaccine-related attitudes, and childhood SIV acceptance over 2 years in Hong Kong. RESULTS Children's SIV uptake varied by the schools' SIVP participation status. The highest SIV uptake was found in schools that consistently participated in SIVP (Consistent participation group) (2018/2019: 85.0%; 2019/2020: 83.0%) but lowest in the Consistent non-Participation group (2018/2019: 45.0%; 2019/2020: 39.0%). SIV uptake increased in the Late Initiation group but declined in the Discontinuation group. An increasing trend of parental vaccine-hesitant attitudes was observed in the Consistent non-Participation group. CONCLUSIONS Initiation and continuation of the SIVP can reduce parental vaccine hesitancy to achieve a high childhood SIV uptake. Conversely, discontinuation of the SIVP or persistent resistance to the implementation of SIVP can increase parental vaccine hesitancy and reduce childhood SIV uptake.
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Affiliation(s)
- Meihong Dong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dennis Kai Ming Ip
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jiehu Yuan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hau Chi So
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
| | - Qiuyan Liao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Stinchfield P, Kurland J, Gigi Chawla P. Optimizing Your Pediatric Office for Vaccine Confidence. Pediatr Clin North Am 2023; 70:343-357. [PMID: 36841601 DOI: 10.1016/j.pcl.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Parents trust their pediatric clinicians for up-to-date information about vaccines. To reduce vaccine hesitancy, clinics must promote confidence by building trust, communicating clearly, using patient safety and infection control principles to reduce errors, and reducing missed opportunities by having a vaccination infrastructure that makes every visit a vaccine visit. Education and communication must be consistent among all staff and culturally competent to optimize vaccine confidence. Parents have a role in seeking reliable resources, raising concerns, and seeking trusted, evidence-based experts for vaccination conversations. Safe, effective vaccines are vital; however, vaccination, a complex operational process, prevents disease and saves lives.
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Affiliation(s)
| | - Joseph Kurland
- Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN 55404, USA
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Rusic D, Nanasi D, Bozic J, Jurcev Savicevic A, Leskur D, Seselja Perisin A, Modun D, Vilovic M, Bukic J. Attitudes of Community Pharmacy Service Users towards Vaccination Programs in Pharmacy: A Cross-Sectional Survey-Based Study in Croatia. PHARMACY 2022; 10:pharmacy10060167. [PMID: 36548323 PMCID: PMC9788268 DOI: 10.3390/pharmacy10060167] [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: 10/29/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The aim of this study was to explore community pharmacy service users' attitudes and opinions towards vaccination programs in pharmacy conducted by a doctor of medicine or a pharmacist. METHODS The questionnaire used in this study comprised 40 items about demographics, sources of information, attitudes about vaccination, attitudes about vaccination in community pharmacies, and willingness to pay for such a service. RESULTS A total of 385 people participated in this study. Injection was the preferred route of administration of vaccine for more than half of study participants (50.6%). Univariate analysis showed that those who had a healthcare worker as a family member and those familiar with the HPV vaccine had better attitudes; however, those results were no longer significant after factoring in other variables in multivariate analysis. More than half (59.2%) of the study population would consider vaccination service in community pharmacies only if it were free or covered by the national health insurance. CONCLUSIONS More than half of the participants believed that providing vaccination services in community pharmacies would result in greater vaccination rates for seasonal illnesses. However, around half would prefer that it were conducted exclusively by a physician. Less than 10% of the study participants would pay out of their pocket for such a service.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
| | - Doris Nanasi
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21 000 Split, Croatia
| | - Anamarija Jurcev Savicevic
- Teaching Institute of Public Health of Split Dalmatian County, 21 000 Split, Croatia
- Department of Health Studies, University of Split, 21 000 Split, Croatia
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21 000 Split, Croatia
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21 000 Split, Croatia
- Correspondence:
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Meningococcal Disease in Pediatric Age: A Focus on Epidemiology and Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074035. [PMID: 35409716 PMCID: PMC8998454 DOI: 10.3390/ijerph19074035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
Meningococcal disease is caused by Neisseria meningitidis; 13 serogroups have been identified and differentiated from each other through their capsular polysaccharide. Serotypes A, B, C, W, X, and Y are responsible for nearly all infections worldwide. The most common clinical manifestations are meningitis and invasive meningococcal disease, both characterized by high mortality and long-term sequelae. The infection rate is higher in children younger than 1 year and in adolescents, who are frequently asymptomatic carriers. Vaccination is the most effective method of preventing infection and transmission. Currently, both monovalent meningococcal vaccines (against A, B, and C serotypes) and quadrivalent meningococcal vaccines (against serogroups ACYW) are available and recommended according to local epidemiology. The purpose of this article is to describe the meningococcal vaccines and to identify instruments that are useful for reducing transmission and implementing the vaccination coverage. This aim could be reached by switching from the monovalent to the quadrivalent vaccine in the first year of life, increasing vaccine promotion against ACYW serotypes among adolescents, and extending the free offer of the anti-meningococcal B vaccine to teens, co-administering it with others proposed in the same age group. Greater awareness of the severity of the disease and increased health education through web and social networks could represent the best strategies for promoting adhesion and active participation in the vaccination campaign. Finally, the development of a licensed universal meningococcal vaccine should be another important objective.
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Liao Q, Dong M, Yuan J, Lam WWT, Cowling BJ, So HC, Ip DKM. A Mixed-Methods Study to Evaluate Elementary School Staff's Acceptability, Delivery Challenges, and Communication Regarding the Implementation of School-Located Influenza Vaccination Program in Hong Kong. Vaccines (Basel) 2021; 9:vaccines9101175. [PMID: 34696283 PMCID: PMC8540161 DOI: 10.3390/vaccines9101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
This was a mixed-methods study comprising a questionnaire-based survey, a qualitative study, and analysis of school newsletters to evaluate elementary school staff's acceptability, delivery challenges and communication about school-located influenza vaccination program (SIVP) in Hong Kong. We found that school staff with lower intention to implement SIVP perceived greater logistical difficulties in arranging SIVP. Challenges regarding program delivery included schools' limited infrastructure, the burden of paperwork, the fear of being overwhelmed by multiple school-based vaccination schedules, lacking confidence in communicating with parents about influenza vaccines, and the difficulties in managing vaccination-related anxiety among children with intellectual disability. School staff were generally passive in communicating with parents and students about influenza vaccines. We also found that schools may use the school newsletters as a substitute of the formal informed consent forms. Good partnerships among government, service providers and schools should be established to minimize the burden of paperwork for school staff, facilitate early planning of SIVP, and support schools with limited infrastructure and the vaccination of children with intellectual disabilities. Training is needed to enhance school staff's confidence in communicating with parents and students about influenza vaccines and improve information delivery to support parents' informed decisions for children's vaccination.
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Affiliation(s)
- Qiuyan Liao
- Division of Behavioural Sciences, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (M.D.); (J.Y.); (W.W.T.L.)
- Correspondence: ; Tel.: +852-3917-9289; Fax: +852-2855-9528
| | - Meihong Dong
- Division of Behavioural Sciences, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (M.D.); (J.Y.); (W.W.T.L.)
| | - Jiehu Yuan
- Division of Behavioural Sciences, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (M.D.); (J.Y.); (W.W.T.L.)
| | - Wendy Wing Tak Lam
- Division of Behavioural Sciences, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (M.D.); (J.Y.); (W.W.T.L.)
| | - Benjamin J. Cowling
- Center for Infectious Disease Epidemiology and Control Collaborating with World Health Organization, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (B.J.C.); (H.C.S.); (D.K.M.I.)
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
| | - Hau Chi So
- Center for Infectious Disease Epidemiology and Control Collaborating with World Health Organization, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (B.J.C.); (H.C.S.); (D.K.M.I.)
| | - Dennis Kai Ming Ip
- Center for Infectious Disease Epidemiology and Control Collaborating with World Health Organization, Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China; (B.J.C.); (H.C.S.); (D.K.M.I.)
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National and State-Specific Estimates of Settings of Receiving Human Papillomavirus Vaccination Among Adolescents in the United States. J Adolesc Health 2021; 69:597-603. [PMID: 33867229 PMCID: PMC9080285 DOI: 10.1016/j.jadohealth.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination in the United States has been recommended for girls since 2006 and for boys since 2011. However, settings of receiving HPV vaccination have not been assessed. The purpose of this study is to assess settings of receiving HPV vaccination among adolescents in order to understand what strategies are needed to improve vaccination uptake. METHODS Data from the 2018 National Immunization Survey-Teen (NIS-Teen) were analyzed to assess place of HPV vaccination overall, and by gender, quarter, and other selected variables among adolescents in the United States. The 2016-2018 NIS-Teen data were combined to assess state-specific place of HPV vaccination. RESULTS Among vaccinated adolescents aged 13-17 years, a doctor's office was the most common place where HPV vaccination was received (79.2%), followed by clinics, health centers, or other medical facilities (13.5%), health department (4.1%), hospital or emergency room (2.3%), schools (.5%), and pharmacies or stores (.4%). Overall, 99.1% of adolescents aged 13-17 years received HPV vaccination at medical settings and only .9% at nonmedical settings. Reported vaccination in nonmedical settings by state ranged from less than .1% in Delaware, Florida, and New Hampshire to 4.1% in North Dakota, with a median of 1.0%. CONCLUSIONS Doctor's offices were the most common medical setting for adolescents to receive HPV vaccination. Less than 1% of adolescents received vaccination at nonmedical settings. Continuing work with medical and nonmedical settings to identify and implement appropriate strategies are needed to improve HPV vaccination coverage among adolescents.
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Leidner AJ, Maughan ED, Bjork A, Black C, Mazyck D, Underwood JM. Vaccination-Related Activities at Schools With Kindergartners: Evidence From a School Nurse Survey. J Sch Nurs 2020; 36:464-471. [PMID: 31088201 DOI: 10.1177/1059840519847730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vaccination coverage among children in kindergarten varies across the country and within states. We surveyed a convenience sample of kindergarten school nurses to investigate self-reported vaccination-related activities conducted at schools nationwide. The majority of the 1,435 kindergarten school nurses responding reported that their schools communicate with parents and guardians of undervaccinated students by phone (96%), postal mail (67%), newsletters (61%), and e-mail (59%). Most respondents reported documenting vaccination coverage in electronic systems (85%) and sharing coverage reports with health departments (69%). A total of 41% of school nurses worked with external partners for vaccination efforts, the most common support received from partners being vaccine administration (38%) and providing materials/vaccines (21%). School nurses also reported that 95% of kindergartners were up to date for all vaccines. School-based vaccination-related activities are essential to sustaining high levels of vaccination coverage for the protection of children at schools and in the broader community.
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Affiliation(s)
| | - Erin D Maughan
- 233071National Association of School Nurses, Silver Springs, MD, USA
| | - Adam Bjork
- Program Operations Branch, Immunization Services Division, National Center for Immunization Services and Respiratory Diseases, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA.,Commissioned Corps, United States Public Health Service, Atlanta, GA, USA
| | - Carla Black
- Commissioned Corps, United States Public Health Service, Atlanta, GA, USA
| | - Donna Mazyck
- 233071National Association of School Nurses, Silver Springs, MD, USA
| | - J Michael Underwood
- School-Based Surveillance Branch, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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Why the Anti-Meningococcal B Vaccination during Adolescence Should Be Implemented in Italy: An Overview of Available Evidence. Microorganisms 2020; 8:microorganisms8111681. [PMID: 33138142 PMCID: PMC7692044 DOI: 10.3390/microorganisms8111681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Although meningococcal disease has a low incidence in Italy, it is a public health concern owing to its high lethality rate and high frequency of transitory and/or permanent sequelae among survivors. The highest incidence rates are recorded in infants, children and adolescents, and most of the cases are due to Neisseria meningitidis B. In Italy, anti-meningococcal B (anti-MenB) vaccination is free for infants but, despite the considerable disease burden in adolescents, no national recommendation to vaccinate in this age-group is currently available. The aim of this study was to assess the main available scientific evidence to support the Italian health authorities in implementing a program of free anti-MenB vaccination for adolescents. We conducted an overview of the scientific literature on epidemiology, disease burden, immunogenicity and safety of available vaccines, and economic evaluations of vaccination strategies. Each case of invasive meningococcal disease generates a considerable health burden (lethality rate: 9%; up to 60% of patients experience at least one sequela) in terms of impaired quality of life for survivors and high direct and indirect costs (the mean overall cost of acute phase for a single case amounts to about EUR 13,952; the costs for post-acute and the long-term phases may vary widely depending of the type of sequela, reaching an annual cost of about EUR 100,000 in cases of severe neurological damage). Furthermore, vaccination against meningococcus B in adolescence proved cost-effective. The study highlights the need to actively offer the anti-MenB vaccination during adolescence at a national level. This would make it possible to avoid premature deaths and reduce the high costs borne by the National Health Service and by society of supporting survivors who suffer temporary and/or permanent sequelae.
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Rockliffe L, Stearns S, Forster AS. A qualitative exploration of using financial incentives to improve vaccination uptake via consent form return in female adolescents in London. PLoS One 2020; 15:e0237805. [PMID: 32822387 PMCID: PMC7446903 DOI: 10.1371/journal.pone.0237805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Incentivising vaccine consent form return may improve vaccine uptake and be seen as less coercive than incentivising vaccination itself. We assessed the acceptability of financial incentives in this context among adolescent females and explored potential mechanisms by which incentives might change behaviour. DESIGN Focus groups and analysis of free-text questionnaire responses. METHODS Study 1: 36 female secondary students in London (age 13-14) participated in six focus groups exploring the use of incentives in the context of vaccination. Data were analysed thematically. Study 2: was conducted to triangulate the findings of Study 1, by analysing free-text questionnaire responses from 181 female secondary students in London (age 12-13) reporting their opinion of incentivising consent form return. Data from Study 1 was also used to explore perceived potential mechanisms of action by which incentives might encourage consent form return. RESULTS Focus group participants had positive attitudes towards incentives, with 61% of free-text responses also expressing this. Most focus group participants thought that incentives would encourage consent form return (18% of free-text respondents spontaneously also mentioned this). While incentivising consent form return was seen as ethical, focus group participants who incorrectly thought that vaccine receipt was being incentivised raised concerns about bribery, although only 4% of free text respondents reported these concerns. Frequently raised mechanisms of action included incentives increasing engagement with, and the perceived value of consent form return. CONCLUSIONS Adolescents had positive views of financially incentivising consent form return to promote vaccine uptake, although care must be taken to reduce misconceptions regarding what is being incentivised. Incentivising vaccination was seen as coercive, but incentivising actions that increase the likelihood of vaccination (i.e. consent form return) were not. Incentives may encourage adolescents to return consent forms by helping them engage with this behaviour or increasing its' perceived value.
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Affiliation(s)
- Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, London, United Kingdom
| | - Selma Stearns
- Research Department of Behavioural Science and Health, UCL, London, United Kingdom
| | - Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, London, United Kingdom
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Abstract
BACKGROUND Adolescent vaccination has received increased attention since the Global Vaccine Action Plan's call to extend the benefits of immunisation more equitably beyond childhood. In recent years, many programmes have been launched to increase the uptake of different vaccines in adolescent populations; however, vaccination coverage among adolescents remains suboptimal. Therefore, understanding and evaluating the various interventions that can be used to improve adolescent vaccination is crucial. OBJECTIVES To evaluate the effects of interventions to improve vaccine uptake among adolescents. SEARCH METHODS In October 2018, we searched the following databases: CENTRAL, MEDLINE Ovid, Embase Ovid, and eight other databases. In addition, we searched two clinical trials platforms, electronic databases of grey literature, and reference lists of relevant articles. For related systematic reviews, we searched four databases. Furthermore, in May 2019, we performed a citation search of five other websites. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies of adolescents (girls or boys aged 10 to 19 years) eligible for World Health Organization-recommended vaccines and their parents or healthcare providers. DATA COLLECTION AND ANALYSIS Two review authors independently screened records, reviewed full-text articles to identify potentially eligible studies, extracted data, and assessed risk of bias, resolving discrepancies by consensus. For each included study, we calculated risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) where appropriate. We pooled study results using random-effects meta-analyses and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 16 studies (eight individually randomised trials, four cluster randomised trials, three non-randomised trials, and one controlled before-after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. We categorised interventions as recipient-oriented, provider-oriented, or health systems-oriented. The interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus-diphtheria-acellular-pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents. Health education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high-certainty evidence). In addition, one large study provided evidence that a complex multi-component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate-certainty evidence). Financial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low-certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence). Mandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate-certainty evidence). Provider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate-certainty evidence). Provider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non-participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low-certainty evidence). A class-based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age-based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate-certainty evidence). A multi-component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate-certainty evidence). A multi-component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class-based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. Therefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low- and middle-income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage.
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Affiliation(s)
- Leila H Abdullahi
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Benjamin M Kagina
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Valantine Ngum Ndze
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
| | - Gregory D Hussey
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Charles S Wiysonge
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
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Kaul S, Do TQN, Hsu E, Schmeler KM, Montealegre JR, Rodriguez AM. School-based human papillomavirus vaccination program for increasing vaccine uptake in an underserved area in Texas. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 8:100189. [PMID: 31654772 PMCID: PMC6838925 DOI: 10.1016/j.pvr.2019.100189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/20/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Compare the effectiveness of community-based HPV-related education and onsite school-based vaccination versus community-based education only for increasing HPV vaccine uptake in a rural, medically underserved area. METHODS Our cohort included 2307 Rio Grande City Consolidated Independent School District (RGCISD) middle school students from 3 schools enrolled in August 2016 and followed until April 2018. Using a quasi-experimental design, this study implemented an onsite school-based vaccination program and physician-led education on HPV and HPV vaccines for parents/guardians, school nurses/staff, and pediatric/family providers in the surrounding community (15-mile radius of RGCCISD) at 1 middle school ("intervention school"), and education-only for the remaining 2 schools ("comparison schools"). The Centers for Disease Control and Prevention's HPV-related educational materials supplemented the education. HPV vaccine status was obtained from school immunization records and the project's contracted vaccine vendor. HPV vaccine initiation and completion rates were compared pre and post intervention and between the intervention and comparison schools. Logistic regression was used to compare the odds of newly initiating/completing vaccination between the intervention and comparison schools. RESULTS At baseline, the intervention school had lower HPV vaccine initiation and completion rates than the comparison schools (20.00% and 8.70% vs 28.97% and 14.56%). Post intervention, the intervention school had higher initiation and completion rates than the comparison schools (53.67% and 28.36% vs 41.56% and 20.53%). Students from the intervention school were over 3.6-times more likely to newly initiate/complete the HPV vaccinations than students from the comparison schools. CONCLUSION The school with on-site vaccination events and community-based education had a higher adolescent HPV vaccination rate compared to schools that received community-based education only.
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Affiliation(s)
- Sapna Kaul
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Thuy Quynh N Do
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Enshuo Hsu
- Office of Biostatistics, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jane R Montealegre
- Department of Pediatrics, Section of Hematology-Oncology and Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, USA
| | - Ana M Rodriguez
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Sealy Institute for Vaccine Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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17
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Boccalini S, Bechini A, Sartor G, Paolini D, Innocenti M, Bonanni P, Panatto D, Lai PL, Zangrillo F, Marchini F, Lecini E, Iovine M, Amicizia D, Landa P. [Health Technology Assessment of meningococcal B vaccine (Trumenba ®) in adolescent in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E1-E94. [PMID: 32047867 PMCID: PMC7007189 DOI: 10.15167/2421-4248/jpmh2019.60.3s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - A Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - G Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Paolini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - M Innocenti
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - P Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P L Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Zangrillo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Marchini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - E Lecini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - M Iovine
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - D Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P Landa
- Dipartimento di Economia, Università degli Studi di Genova
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Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Serv Res 2019; 19:407. [PMID: 31234842 PMCID: PMC6591987 DOI: 10.1186/s12913-019-4228-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/07/2019] [Indexed: 12/04/2022] Open
Abstract
Background Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV’s cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV’s cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. Methods We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015–2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. Results The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009–2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015–2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. Conclusions SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. Trial Registration ClinicalTrials.govNCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017). Electronic supplementary material The online version of this article (10.1186/s12913-019-4228-5) contains supplementary material, which is available to authorized users.
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19
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Patel SA, Groom HC, Cho BH, Martin K, Moore R. Billing and Volunteers Substantially Reduced School-Located Influenza Vaccination Costs, 2 Oregon Counties, 2010-2011. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:558-566. [DOI: 10.1097/phh.0000000000000710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Head KJ, Biederman E, Sturm LA, Zimet GD. A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States. Hum Vaccin Immunother 2018; 14:1626-1635. [PMID: 29359986 PMCID: PMC6067847 DOI: 10.1080/21645515.2018.1430539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A. Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Bahri P, Castillon Melero M. Listen to the public and fulfil their information interests - translating vaccine communication research findings into guidance for regulators. Br J Clin Pharmacol 2018; 84:1696-1705. [PMID: 29573274 PMCID: PMC6046478 DOI: 10.1111/bcp.13587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Regulatory authorities have a crucial role in communicating about the vaccines they license. In terms of content and timing, their communication to the public is usually driven by data on quality, safety and efficacy. However, concerns over safety and vaccine hesitancy have emerged in some communities in various countries, and this demands a new approach to communication, starting with listening to the public debate. Reviewing communication research findings, coming in particular from the cognitive, decision‐making and media sciences, constitutes one mechanism of listening and has led the European Union (EU) regulatory network to developing guidance about which common concerns and information needs of the public to address through proactive and prepared communication. The guidance has been welcomed by EU and international fora. The current article summarizes the recommendations and shares the underlying research findings, as well as a proof of concept that communication research can be valuable for regulators. It is critical that regulators integrate the communication process with product risk assessment in the framework of pharmacovigilance, to ensure that public concerns are addressed in the assessments and that information about evidence and uncertainty relating to safety is provided to the public and vaccination policy makers in a specific, clear and accurate manner. Additionally, information from regulatory authorities should support healthcare professionals in their communication with patients. Meeting the information interests of the public is the principal prerequisite for informed decisions as well as safe and effective use of vaccines and medicines overall. This is also fundamental for trust in the authorities' commitment to patient and population health.
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Affiliation(s)
- Priya Bahri
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
| | - Mireia Castillon Melero
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NPN, Vincelli P, Hightower AD, Younge M, Eagan A, Blumkin A, Albertin CS, DiBitetto K, Yoo BK, Humiston SG. School-located Influenza Vaccinations for Adolescents: A Randomized Controlled Trial. J Adolesc Health 2018; 62:157-163. [PMID: 29248390 DOI: 10.1016/j.jadohealth.2017.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/09/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to evaluate the effect of school-located influenza vaccination (SLIV) on adolescents' influenza vaccination rates. METHODS In 2015-2016, we performed a cluster-randomized trial of adolescent SLIV in middle/high schools. We selected 10 pairs of schools (identical grades within pairs) and randomly allocated schools within pairs to SLIV or usual care control. At eight suburban SLIV schools, we sent parents e-mail notifications about upcoming SLIV clinics and promoted online immunization consent. At two urban SLIV schools, we sent parents (via student backpack fliers) paper immunization consent forms and information about SLIV. E-mails were unavailable at these schools. Local health department nurses administered nasal or injectable influenza vaccine at dedicated SLIV clinics and billed insurers. We compared influenza vaccination rates at SLIV versus control schools using school directories to identify the student sample in each school. We used the state immunization registry to determine receipt of influenza vaccination. RESULTS The final sample comprised 17,650 students enrolled in the 20 schools. Adolescents at suburban SLIV schools had higher overall influenza vaccination rates than did adolescents at control schools (51% vs. 46%, p < .001; adjusted odds ratio = 1.27, 95% confidence interval 1.18-1.38, controlling for vaccination during the prior two seasons). No effect of SLIV was noted among urbanschools on multivariate analysis. SLIV did not substitute for vaccinations in primary care or other settings; in suburban settings, SLIV was associated with increased vaccinations in primary care or other settings (adjusted odds ratio = 1.10, 95% confidence interval 1.02-1.19). CONCLUSIONS SLIV in this community increased influenza vaccination rates among adolescents attending suburban schools.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California.
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nicolas P N Goldstein
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Phyllis Vincelli
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, University of Rochester Children's Institute, Rochester, New York
| | - Mary Younge
- Department of Public Health, Monroe County, Rochester, New York
| | - Ashley Eagan
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Aaron Blumkin
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina S Albertin
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, California
| | - Kristine DiBitetto
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, California
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Basurto‐Dávila R, Meltzer MI, Mills DA, Beeler Asay GR, Cho B, Graitcer SB, Dube NL, Thompson MG, Patel SA, Peasah SK, Ferdinands JM, Gargiullo P, Messonnier M, Shay DK. School-Based Influenza Vaccination: Health and Economic Impact of Maine's 2009 Influenza Vaccination Program. Health Serv Res 2017; 52 Suppl 2:2307-2330. [PMID: 29130266 PMCID: PMC5682124 DOI: 10.1111/1475-6773.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic. DATA SOURCES Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons. STUDY DESIGN We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis. DATA COLLECTION We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model. PRINCIPAL FINDINGS The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations. CONCLUSIONS SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups.
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Affiliation(s)
| | | | | | | | - Bo‐Hyun Cho
- Centers for Disease Control and PreventionAtlantaGA
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Perman S, Turner S, Ramsay AIG, Baim-Lance A, Utley M, Fulop NJ. School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries. BMC Public Health 2017; 17:252. [PMID: 28288597 PMCID: PMC5348876 DOI: 10.1186/s12889-017-4168-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. Methods We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. Results We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent, and clinic organisation and delivery. Conclusions This is the first time that information has been brought together on the organisational factors influencing the delivery of vaccination programmes in school-based settings. An understanding of these factors, underpinned by robust theory-informed research, may help policy-makers and managers design and deliver better programmes. We identified several gaps in the research literature to propose a future research agenda, informed by theories of implementation and organisational change. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4168-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Perman
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.,Present address: Redbridge Clinical Commissioning Group, Becketts House, 2-14 Ilford Hill, Ilford, IG1 2QX, UK
| | - Simon Turner
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Abigail Baim-Lance
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Martin Utley
- Clinical Operational Research Unit, UCL, 4 Taviton Street, London, WC1H 0BT, UK
| | - Naomi J Fulop
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Crocker-Buque T, Edelstein M, Mounier-Jack S. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. J Epidemiol Community Health 2017; 71:87-97. [PMID: 27535769 PMCID: PMC5256276 DOI: 10.1136/jech-2016-207572] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND In high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents). METHODS We searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015. RESULTS The 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group. CONCLUSIONS Locally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.
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Affiliation(s)
- Tim Crocker-Buque
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Adolescent confidence in immunisation: Assessing and comparing attitudes of adolescents and adults. Vaccine 2016; 34:5595-5603. [PMID: 27692525 DOI: 10.1016/j.vaccine.2016.09.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/02/2016] [Accepted: 09/16/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is limited knowledge of adolescent views and attitudes towards immunisation. Our study investigated adolescent attitudes to immunisation and compared differences in vaccination attitudes between adolescents and adults. METHODS This study was a cross-sectional, national online survey. Recruitment was stratified by state and gender to ensure findings were nationally representative. Regression analyses were performed to assess and compare adolescent and adult views on vaccine benefits, community protection, risks, side effects, sources of information, and decision-making preference. RESULTS In 2013, 502 adolescents and 2003 adults completed the online survey. Lower levels of vaccine confidence were observed in adolescents with adolescents less likely to believe vaccines are beneficial and/or safe compared to adults (p=0.043). Compared to females, males were less confident of vaccine benefits (p<0.05) but less concern about vaccine side effects (p<0.05). Adolescents were more concerned about vaccine side effects than adults for pain (p<0.001), redness or swelling (p<0.001), and fever (p=0.006). Adolescents were less likely than adults to consider health professionals (p<0.001) and the media (e.g. internet) (p=0.010) as important sources of information, and were more likely to seek information from social networks (p<0.001) including families and schools. Although 62.0% of adolescents agreed that parents should make the decision about vaccination for them, adolescents were more likely to prefer a joint decision with parents (p<0.001) or by themselves (p=0.007) compared with adults. CONCLUSION Adolescents have a lesser understanding of vaccine safety and benefits than adults and have higher concerns about potential vaccine reactions. Improving adolescent awareness and knowledge of the benefits and risks of vaccination through school-based educational programs may improve confidence in and uptake of vaccines for adolescents and increase vaccine confidence in the next generation of parents.
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Gicquelais RE, Safi H, Butler S, Smith N, Haselow DT. Association of School-Based Influenza Vaccination Clinics and School Absenteeism--Arkansas, 2012-2013. THE JOURNAL OF SCHOOL HEALTH 2016; 86:235-241. [PMID: 26930234 DOI: 10.1111/josh.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 06/18/2015] [Accepted: 04/09/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Influenza is a major cause of seasonal viral respiratory illness among school-aged children. Accordingly, the Arkansas Department of Health (ADH) coordinates >800 school-based influenza immunization clinics before each influenza season. We quantified the relationship between student influenza vaccination in Arkansas public schools and school absenteeism during the 2012-2013 influenza season. METHODS The relationship between the percent of students vaccinated in Arkansas public schools during ADH-facilitated clinics and the average daily percent of students absent from school during the 2012-2013 influenza season was quantified using linear regression modeling. The effect of increasing vaccination coverage among students on absentee days in the Arkansas public school system was estimated. RESULTS For every 1% higher vaccination coverage, 0.027% fewer absenteeism days were predicted. Larger school size was associated with higher absenteeism and predicted decreases in absenteeism were larger in magnitude for larger schools compared with smaller schools. Extrapolation of the model showed that a 10% higher vaccination level was associated with a reduction of 16-163 student absentee days per school over a 12-week influenza season. CONCLUSIONS Influenza vaccination is an effective tool to reduce school absenteeism. School-based clinics are a feasible way to target influenza vaccinations to school-aged children.
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Affiliation(s)
| | - Haytham Safi
- Arkansas Department of Health, 4815W Markham St, Little Rock, AR 72205.
| | - Sandra Butler
- Arkansas Department of Health, Little Rock, AR 72205.
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Wong VWY, Lok KYW, Tarrant M. Interventions to increase the uptake of seasonal influenza vaccination among pregnant women: A systematic review. Vaccine 2015; 34:20-32. [PMID: 26602267 DOI: 10.1016/j.vaccine.2015.11.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/26/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population. METHODS We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies. RESULTS Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied. CONCLUSIONS There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.
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Affiliation(s)
- Valerie W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Kris Y W Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
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Cost effectiveness analysis of Year 2 of an elementary school-located influenza vaccination program-Results from a randomized controlled trial. BMC Health Serv Res 2015; 15:511. [PMID: 26573461 PMCID: PMC4647510 DOI: 10.1186/s12913-015-1169-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I’s cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009–2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010–2011, a more typical influenza season). Methods We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; Year 2 n = 9,145 children) with standard-of-care (no SLV-I) in control schools (Year 1 n = 4,534 (10 schools); Year 2 n = 4,796 children (11 schools)). We estimated the cost-per-vaccinated child, by dividing the incremental cost of the intervention by the incremental effectiveness (i.e., the number of additionally vaccinated students in intervention schools compared to control schools). Results In Years 1 and 2, respectively, the effectiveness measure (proportion of children vaccinated) was 11.2 and 12.0 percentage points higher in intervention (40.7 % and 40.4 %) than control schools. In year 2, the cost-per-vaccinated child excluding vaccine purchase ($59.88 in 2010 US $) consisted of three component costs: (A) the school costs ($8.25); (B) the project coordination costs ($32.33); and (C) the vendor costs excluding vaccine purchase ($16.68), summed through Monte Carlo simulation. Compared to Year 1, the two component costs (A) and (C) decreased, while the component cost (B) increased in Year 2. The cost-per-vaccinated child, excluding vaccine purchase, was $59.73 (Year 1) and $59.88 (Year 2, statistically indistinguishable from Year 1), higher than the published cost of providing influenza vaccination in medical practices ($39.54). However, taking indirect costs (e.g., averted parental costs to visit medical practices) into account, vaccination was less costly in SLV-I ($23.96 in Year 1, $24.07 in Year 2) than in medical practices. Conclusions Our two-year trial’s findings reinforced the evidence to support SLV-I as a potentially favorable system to increase childhood influenza vaccination rates in a cost-efficient way. Increased efficiencies in SLV-I are needed for a sustainable and scalable SLV-I program.
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Affiliation(s)
- Sarah K Wiley
- Sarah K. Wiley, who recently earned her BSN, is a former clinical nurse at TriValley Primary Care in Souderton, Pa
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Abdullahi LH, Kagina BMN, Wiysonge CS, Hussey GD. Improving vaccination uptake among adolescents. Hippokratia 2015. [DOI: 10.1002/14651858.cd011895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leila H Abdullahi
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
| | - Benjamin MN Kagina
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
| | - Charles S Wiysonge
- Stellenbosch University; Centre for Evidence-based Health Care; Francie van Zijl Drive Tygerberg Cape Town South Africa 7505
- South African Medical Research Council; Cochrane South Africa; Cape Town South Africa
| | - Gregory D Hussey
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
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Shlay JC, Rodgers S, Lyons J, Romero S, Vogt TM, McCormick EV. Implementing a School-Located Vaccination Program in Denver Public Schools. THE JOURNAL OF SCHOOL HEALTH 2015; 85:536-543. [PMID: 26149309 DOI: 10.1111/josh.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND School-located vaccination (SLV) offers an opportunity to deliver vaccines to students, particularly those without a primary care provider. METHODS This SLV program offered 2 clinics at each of 20 elementary schools (influenza vaccine) and 3 clinics at each of 7 middle/preschool-eighth-grade schools (adolescent platform plus catch-up vaccines) during the 2009-2010 and 2010-2011 school years. Established programmatic processes for immunization delivery in an outreach setting were used. Billing and vaccine inventory management processes were developed. Vaccines from the federal Vaccines for Children program were used for eligible students. Third-party payers were billed for insured students; parents were not billed for services. RESULTS The proportion of enrolled students who received at least 1 dose of vaccine increased from year 1 to year 2 (elementary: 28% to 31%; middle: 12% to 19%). Issues identified and addressed included program planning with partners, development and implementation of billing processes, development of a solution to adhere to the Family Educational Rights and Privacy Act requirements, development and utilization of an easy-to-comprehend consent form, and implementation of standard work procedures. CONCLUSIONS This SLV program offered an alternative approach for providing vaccinations to students outside of the primary care setting. To be successful, ongoing partnerships are needed.
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Affiliation(s)
- Judith C Shlay
- University of Colorado Denver, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045.
- Denver Public Health Department, Denver Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Sarah Rodgers
- Denver Public Health Department, Denver Public Health Immunization and Travel Clinic, 605 Bannock Street, Denver, CO 80204.
| | - Jean Lyons
- Division of Student Services, Department of Nursing and Student Health Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Scott Romero
- Division of Student Services, Denver Public Schools, 780 Grant Street, Denver, CO 80203.
| | - Tara M Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE., Atlanta, GA 30333.
| | - Emily V McCormick
- Denver Public Health Department, 605 Bannock Street, Denver, CO 80204.
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Braunack-Mayer A, Skinner SR, Collins J, Tooher R, Proeve C, O'Keefe M, Burgess T, Watson M, Marshall H. Ethical Challenges in School-Based Immunization Programs for Adolescents: A Qualitative Study. Am J Public Health 2015; 105:1399-403. [PMID: 25602867 PMCID: PMC4463388 DOI: 10.2105/ajph.2014.302280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed. METHODS We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups. RESULTS We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety. CONCLUSIONS We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements.
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Affiliation(s)
- Annette Braunack-Mayer
- Annette Braunack-Mayer, Joanne Collins, Rebecca Tooher, Claudia Proeve, and Teresa Burgess are with the School of Population Health, University of Adelaide, South Australia, Australia. Helen Marshall is with the School of Paediatric and Reproductive Health, University of Adelaide, South Australia. S. Rachel Skinner is with the Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia. Maree O'Keefe is with the Faculty of Health Sciences, University of Adelaide, South Australia. Maureen Watson is with the Communicable Disease Control Branch, South Australia Health, South Australia
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A literature review to identify factors that determine policies for influenza vaccination. Health Policy 2015; 119:697-708. [DOI: 10.1016/j.healthpol.2015.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
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Nodulman JA, Starling R, Kong AS, Buller DB, Wheeler CM, Woodall WG. Investigating stakeholder attitudes and opinions on school-based human papillomavirus vaccination programs. THE JOURNAL OF SCHOOL HEALTH 2015; 85:289-98. [PMID: 25846308 PMCID: PMC4576450 DOI: 10.1111/josh.12253] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 08/22/2014] [Accepted: 12/25/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders' acceptance toward school-based HPV vaccination programs. METHODS A total of 13 focus groups and 12 key informant interviews (N = 117; 85% females; 66% racial/ethnic minority) were conducted with 5 groups of stakeholders: parents of adolescent girls, parents of adolescent boys, adolescent girls, middle school nurses, and middle school administrators throughout the 5 public health regions of New Mexico. RESULTS All groups of stakeholders lacked knowledge on HPV and HPV vaccines. Stakeholders were interested in--but apprehensive about--the benefits of HPV vaccination. Despite previous literature showing the benefits of using middle schools as an HPV vaccination site, stakeholders did not deem middle schools as a viable site for vaccination. Nurses reported that using the school as an HPV vaccination site had not occurred to them; parents and adolescents stated they were uncertain about using this type of program. School administrators indicated that they lacked implementation authority. CONCLUSIONS Our study uncovered barriers to using middle schools as a site of HPV vaccination. Resources should be directed toward increased support and education for middle school nurses who function as opinion leaders relevant to the uptake of HPV vaccination.
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Affiliation(s)
- Jessica A. Nodulman
- Assistant Professor, Department of Communication Studies, Augustana College, Old Main Office 212, 639 38th Street, Rock Island, IL 61201
| | - Randall Starling
- Senior Research Scientist II, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd., SE MSC11-6280, Albuquerque, NM87106
| | - Alberta S. Kong
- Associate Professor, Department of Pediatrics, University of New Mexico School of Medicine, MSC10 5590 1 UNM, Albuquerque, NM87131
| | - David B. Buller
- Senior Scientist, Klein Buendel, Inc., 1667 Cole Suite 225, Golden, CO 80401
| | - Cosette M. Wheeler
- Professor, Center for HPV Prevention, University of New Mexico, Department of Pathology, MSC08 4640 Albuquerque, NM87131
| | - W. Gill Woodall
- Professor of Communication, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE MSC11-6280, Albuquerque, NM87106
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Won TL, Middleman AB, Auslander BA, Short MB. Trust and a school-located immunization program. J Adolesc Health 2015; 56:S33-9. [PMID: 25863553 DOI: 10.1016/j.jadohealth.2014.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine variables associated with parental trust in a school-located immunization program (SLIP) and the effect of trust-building interventions on trust and participation in SLIPs. METHODS Parents among eight schools randomized to a trust-building intervention or a control condition (four schools each) completed a five-item trust survey before SLIP implementation both in year 1 (fall 2012) and in year 2 (fall 2013). Mean trust scores were calculated. Associations between baseline demographic and experiential variables and mean trust scores were analyzed. Mean trust scores in intervention and control schools were compared before SLIP in years 1 and 2, and SLIP participation rates were noted. RESULTS From year 1, 1,608 parent surveys were analyzed. Baseline mean trust score across schools was 3.59 of 5 (5 = highest trust). In a multiple linear regression model, annual household income, survey language version, participation in a previous SLIP, child's health insurance status, and perceived vaccine importance were significantly associated with parental trust in SLIPs (R(2)= .06, p < .001). There was no difference in mean trust scores between intervention and control schools (p = .8). In year 2, 844 surveys were analyzed, and a modest difference was observed between intervention and control schools (mean trust score = 3.66 and 3.57, respectively, p = .07). SLIP participation rates appeared higher in intervention (7.7%) versus control schools (4.3%) in year 1. CONCLUSIONS Baseline trust in SLIPs among a low-income, largely Hispanic group of parents in Texas was moderately high. Factors associated with trust included demographic and experiential variables, and interventions aimed at increasing parents' perception of vaccine importance and participation in SLIPs may be effective in increasing parental trust in SLIPs.
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Affiliation(s)
| | - Amy B Middleman
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Beth A Auslander
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Mary B Short
- Department of Psychology, University of Houston-Clear Lake, Clear Lake, Texas
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Trogdon JG, Ahn T. Geospatial patterns in influenza vaccination: evidence from uninsured and publicly insured children in North Carolina. Am J Infect Control 2015; 43:234-40. [PMID: 25637432 DOI: 10.1016/j.ajic.2014.11.022] [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: 09/18/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to explore geospatial patterns in influenza vaccination. METHODS We conducted an ecological analysis of publicly funded influenza vaccinations at the ZIP code tabulation area (ZCTA) level using secondary data for publicly funded influenza vaccinations among eligible school-aged children (age range, 5-17 years) for the 2010-2011 and 2011-2012 influenza seasons from the North Carolina Immunization Registry (NCIR). NCIR data were merged by ZCTA with other publicly available data. We tested for spatial autocorrelation in unadjusted influenza vaccination rates using choropleth maps and Moran's I. We estimated nonspatial and spatial negative binomial models with spatially correlated random effects adjusted for demographic, economic, and health care variables. The study was conducted at the University of North Carolina at Chapel Hill in the spring of 2014. RESULTS The NCIR demonstrated spatial autocorrelation in publicly funded influenza vaccinations among uninsured and means-tested, publicly insured school-aged children; ZCTAs tended to have influenza vaccination rates that were similar to their neighbors. This result was partially explained by included ZCTA characteristics, but not wholly. CONCLUSION To the extent that the geospatial clustering of vaccination rates is the result of social influences, targeting interventions to increase influenza vaccination among school-aged children in one area could also lead to increases in neighboring areas.
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Esposito S, Montinaro V, Bosis S, Tagliabue C, Baggi E, Principi N. Recommendations for the use of influenza vaccine in pediatrics. Hum Vaccin Immunother 2014; 8:102-6. [DOI: 10.4161/hv.8.1.17957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bobo N. Increasing immunization rates through the immunization neighborhood recognizing school-located immunization programs. NASN Sch Nurse 2014; 29:224-8. [PMID: 25272406 DOI: 10.1177/1942602x14545330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vaccines are considered one of the top 10 public health achievements in the United States; however, coverage rates for many of the recommended child and adolescent vaccines fall short of Healthy People 2020 goals. The vaccine delivery infrastructure in our country might be the most important limiting factor in achieving the vaccine uptake targets. Renewing the focus on schools for both vaccine delivery and vaccine promotion has the potential to augment other emerging alternate vaccination sites within the immunization neighborhood. School nurses are leading the way, and three national award winners are recognized for their immunization programming efforts. All school nurses can be immunization champions, advocating for the role of schools as key sites to promote the importance of vaccines in protecting the health and ensuring academic success of the students they serve.
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Whelan NW, Steenbeek A, Martin-Misener R, Scott J, Smith B, D’Angelo-Scott H. Engaging parents and schools improves uptake of the human papillomavirus (HPV) vaccine: Examining the role of the public health nurse. Vaccine 2014; 32:4665-71. [DOI: 10.1016/j.vaccine.2014.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/27/2014] [Accepted: 06/06/2014] [Indexed: 11/15/2022]
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Moss JL, Feld AL, O'Malley B, Entzel P, Smith JS, Gilkey MB, Brewer NT. Opportunities for increasing human papillomavirus vaccine provision in school health centers. THE JOURNAL OF SCHOOL HEALTH 2014; 84:370-8. [PMID: 24749919 PMCID: PMC4325977 DOI: 10.1111/josh.12158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/21/2013] [Accepted: 11/01/2013] [Indexed: 05/09/2023]
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions. METHODS We conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine. RESULTS Centers had heterogeneous policies and procedures. Out-of-pocket costs for children and youth to receive privately purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all ps < .05). CONCLUSIONS Although school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low-cost interventions to increase HPV vaccine uptake among adolescents.
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Affiliation(s)
- Jennifer L Moss
- Doctoral Student, , Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440
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Kempe A, Daley MF, Pyrzanowski J, Vogt T, Fang H, Rinehart DJ, Morgan N, Riis M, Rodgers S, McCormick E, Hammer A, Campagna EJ, Kile D, Dickinson M, Hambidge SJ, Shlay JC. School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement. Acad Pediatr 2014; 14:234-40. [PMID: 24767776 DOI: 10.1016/j.acap.2014.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers. METHODS SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs. RESULTS Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed. CONCLUSIONS A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act.
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Affiliation(s)
- Allison Kempe
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Colorado Health Outcomes Program, University of Colorado, Aurora, Colo.
| | - Matthew F Daley
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo
| | | | - Tara Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Hai Fang
- Department of Health System, Management and Policy, University of Colorado, Aurora, Colo
| | | | | | - Mette Riis
- Denver Public Health, Denver Health, Denver, Colo
| | | | - Emily McCormick
- Institute for Health Research, Kaiser Permanente, Denver, Colo; Public Health Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga; Denver Public Health, Denver Health, Denver, Colo
| | - Anne Hammer
- Community Health Services, Denver Health, Denver, Colo
| | | | - Deidre Kile
- Colorado Health Outcomes Program, University of Colorado, Aurora, Colo
| | - Miriam Dickinson
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo; Community Health Services, Denver Health, Denver, Colo
| | - Judith C Shlay
- Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo
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Kempe A, Daley MF, Pyrzanowski J, Vogt TM, Campagna EJ, Dickinson LM, Hambidge SJ, Shlay JC. School-located influenza vaccination with third-party billing: what do parents think? Acad Pediatr 2014; 14:241-8. [PMID: 24767777 DOI: 10.1016/j.acap.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV. METHODS We conducted a survey (April 2010 to June 2010) of parents of 1000 randomly selected primarily low-income children at 20 elementary schools at which SLIV with billing had occurred. RESULTS Response rate was 70% (n = 699). Eighty-one percent agreed (61% strongly) they "would be okay" with SLIV for their child. Many agreed it was better to get vaccinated at their child's doctor's office because they could take care of other health issues (72%) and the doctor knows the child's medical history (65%). However, an equal percentage (47%) thought the best place for influenza vaccination was the child's doctor's office and the child's school. Twenty-five percent did not want to give health insurance information necessary for billing at school. Factors independently associated with strongly supporting SLIV included parental education of high school or less (relative risk 1.30; 95% confidence interval 1.09-1.58), Hispanic ethnicity (1.25; 1.08-1.45); believing the vaccine is efficacious (1.49; 1.23-1.84); and finding school delivery more convenient (2.37; 1.82-3.45). Having concerns about the safety of influenza vaccine (0.80; 0.72-0.88) and not wanting their child to be vaccinated without a parent (0.74; 0.64-0.83) were negatively associated. CONCLUSIONS The majority of parents were supportive of SLIV, although parental concerns about not being present for vaccination and about the safety and efficacy of the vaccine will need to be addressed.
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Affiliation(s)
- Allison Kempe
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo.
| | - Matthew F Daley
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo
| | | | - Tara M Vogt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | | | - L Miriam Dickinson
- Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado, Aurora, Colo; Community Health Services, Denver Health, Denver, Colo
| | - Judith C Shlay
- Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo
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Lind C, Russell ML, MacDonald J, Collins R, Frank CJ, Davis AE. School-based influenza vaccination: parents' perspectives. PLoS One 2014; 9:e93490. [PMID: 24686406 PMCID: PMC3970961 DOI: 10.1371/journal.pone.0093490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/06/2014] [Indexed: 12/04/2022] Open
Abstract
Background School-age children are important drivers of annual influenza epidemics yet influenza vaccination coverage of this population is low despite universal publicly funded influenza vaccination in Alberta, Canada. Immunizing children at school may potentially increase vaccine uptake. As parents are a key stakeholder group for such a program, it is important to consider their concerns. Purpose We explored parents’ perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools, and obtained suggestions for structuring such a program. Participants Forty-eight parents of children aged 5-18 years participated in 9 focus groups. Participants lived in urban areas of the Alberta Health Services Calgary Zone. Findings Three major themes emerged: Advantages of school-based influenza vaccination (SBIV), Disadvantages of SBIV, and Implications for program design & delivery. Advantages were perceived to occur for different populations: children (e.g. emotional support), families (e.g. convenience), the community (e.g. benefits for school and multicultural communities), the health sector (e.g. reductions in costs due to burden of illness) and to society at large (e.g. indirect conduit of information about health services, building structure for pandemic preparedness, building healthy lifestyles). Disadvantages, however, might also occur for children (e.g. older children less likely to be immunized), families (e.g. communication challenges, perceived loss of parental control over information, choices and decisions) and the education sector (loss of instructional time). Nine second-level themes emerged within the major theme of Implications for program design & delivery: program goals/objectives, consent process, stakeholder consultation, age-appropriate program, education, communication, logistics, immunizing agent, and clinic process. Conclusions Parents perceived advantages and disadvantages to delivering annual seasonal influenza immunizations to children at school. Their input gives a framework of issues to address in order to construct robust, acceptable programs for delivering influenza or other vaccines in schools.
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Affiliation(s)
- Candace Lind
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Margaret L. Russell
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy MacDonald
- Alberta Health Services and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ramona Collins
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Amy E. Davis
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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School-located vaccination of adolescents with insurance billing: cost, reimbursement, and vaccination outcomes. J Adolesc Health 2014; 54:282-8. [PMID: 24560036 DOI: 10.1016/j.jadohealth.2013.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination. METHODS During the 2010-2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh-eighth grades). RESULTS Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus-diphtheria-acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010-2011 school year, with similar results for seventh- to eighth-grade students. CONCLUSIONS Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.
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Shah PD, Gilkey MB, Pepper JK, Gottlieb SL, Brewer NT. Promising alternative settings for HPV vaccination of US adolescents. Expert Rev Vaccines 2014; 13:235-46. [PMID: 24405401 PMCID: PMC4267674 DOI: 10.1586/14760584.2013.871204] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vaccination in alternative settings, defined here as being outside of traditional primary care, can help address the pressing public health problem of low human papillomavirus vaccine coverage among adolescents in the United States. Pharmacies are promising because they are highly accessible and have well established immunization practices. However, pharmacies currently face policy and reimbursement challenges. School-located mass vaccination programs are also promising because of their high reach and demonstrated success in providing other vaccines, but control by local policymakers and challenges in establishing community partnerships complicate widespread implementation. Health centers in schools are currently too few to greatly increase access to human papillomavirus vaccine. Specialty clinics have experience with vaccination, but the older age of their patient populations limits their reach. Future steps to making alternative settings a success include expanding their use of statewide vaccine registries and improving their coordination with primary care providers.
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Affiliation(s)
- Parth D. Shah
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA
| | | | - Jessica K. Pepper
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Noel T. Brewer
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Brown DS, Arnold SE, Asay G, Lorick SA, Cho BH, Basurto-Davila R, Messonnier ML. Parent attitudes about school-located influenza vaccination clinics. Vaccine 2014; 32:1043-8. [PMID: 24440111 DOI: 10.1016/j.vaccine.2014.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/04/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
The use of alternative venues beyond physician offices may help to increase rates of population influenza vaccination. Schools provide a logical setting for reaching children, but most school-located vaccination (SLV) efforts to date have been limited to local areas. The potential reach and acceptability of SLV at the national level is unknown in the United States. To address this gap, we conducted a nationally representative online survey of 1088 parents of school-aged children. We estimate rates of, and factors associated with, future hypothetical parental consent for children to participate in SLV for influenza. Based on logistic regression analysis, we estimate that 51% of parents would be willing to consent to SLV for influenza. Among those who would consent, SLV was reported as more convenient than the regular location (42.1% vs. 19.9%, P<0.001). However the regular location was preferred over SLV for the child's well-being in case of side effects (46.4% vs. 20.9%, P<0.001) and proper administration of the vaccine (31.0% vs. 21.0%, P<0.001). Parents with college degrees and whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination were more likely to consent, as were parents of uninsured children. Several measures of concern about vaccine safety were negatively associated with consent for SLV. Of those not against SLV, schools were preferred as more convenient to the regular location by college graduates, those whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination, and those with greater travel and clinic time. With an estimated one-half of U.S. parents willing to consent to SLV, this study shows the potential to use schools for large-scale influenza vaccination programs in the U.S.
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Affiliation(s)
- Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Sarah E Arnold
- Public Health Economics Program, RTI International, Research Triangle Park, NC, USA
| | - Garrett Asay
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suchita A Lorick
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bo-Hyun Cho
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mark L Messonnier
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Stubbs BW, Panozzo CA, Moss JL, Reiter PL, Whitesell DH, Brewer NT. Evaluation of an intervention providing HPV vaccine in schools. Am J Health Behav 2014; 38:92-102. [PMID: 24034684 DOI: 10.5993/ajhb.38.1.10] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To conduct outcome and process evaluations of school-located HPV vaccination clinics in partnership with a local health department. METHODS Temporary clinics provided the HPV vaccine to middle school girls in Guilford County, North Carolina, in 2009-2010. RESULTS HPV vaccine initiation was higher among girls attending host schools than satellite schools (6% vs. 1%, OR = 6.56, CI = 3.99-10.78). Of the girls who initiated HPV vaccine, 80% received all 3 doses. Private insurance or federal programs paid for most vaccine doses. CONCLUSIONS Lessons learned for creating more effective school-health department partnerships include focusing on host schools and delivering several vaccines to adolescents, not just HPV vaccine alone.
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Affiliation(s)
- Brenda W Stubbs
- Guilford County Department of Public Health, Greensboro, NC, USA
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Elementary school-based influenza vaccination: evaluating impact on respiratory illness absenteeism and laboratory-confirmed influenza. PLoS One 2013; 8:e72243. [PMID: 23991071 PMCID: PMC3753312 DOI: 10.1371/journal.pone.0072243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies of influenza vaccine effectiveness in schools have assessed all-cause absenteeism rather than laboratory-confirmed influenza. We conducted an observational pilot study to identify absences due to respiratory illness and laboratory-confirmed influenza in schools with and without school-based vaccination. METHODS A local public health agency initiated school-based influenza vaccination in two Wisconsin elementary schools during October 2010 (exposed schools); two nearby schools served as a comparison group (non-exposed schools). Absences due to fever or cough illness were monitored for 12 weeks. During the 4 weeks of peak influenza activity, parents of absent children with fever/cough illness were contacted and offered influenza testing. RESULTS Parental consent for sharing absenteeism data was obtained for 937 (57%) of 1,640 students. Fifty-two percent and 28%, respectively, of all students in exposed and non-exposed schools were vaccinated. Absences due to fever or cough illness were significantly lower in the exposed schools during seven of 12 surveillance weeks. Twenty-seven percent of students at exposed schools and 39% at unexposed schools had one or more days of absence due to fever/cough illness (p<0.0001). There was no significant difference in the proportion of students absent for other reasons (p = 0.23). During the 4 week period of influenza testing, respiratory samples were obtained for 68 (42%) of 163 episodes of absence due to fever or cough illness. Influenza was detected in 6 students; 3 attended exposed schools. CONCLUSIONS Detection of laboratory-confirmed influenza in schools was challenging due to multiple consent requirements, difficulty obtaining samples from absent children, and a mild influenza season. School-based influenza vaccination was associated with reduced absenteeism due to fever or cough illness, but not absenteeism for other reasons. Although nonspecific, absence due to fever or cough illness may be a useful surrogate endpoint in school-based studies if identification of laboratory confirmed influenza is not feasible.
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Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine 2013; 31:4293-304. [PMID: 23859839 DOI: 10.1016/j.vaccine.2013.07.013] [Citation(s) in RCA: 248] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
Unvaccinated individuals pose a public health threat to communities. Research has identified many factors associated with parental vaccine refusal and hesitancy toward childhood and adolescent immunizations. However, data on the effectiveness of interventions to address parental refusal are limited. We conducted a systematic review of four online databases to identify interventional studies. We used criteria recommended by the WHO's Strategic Advisory Group of Experts on immunization (SAGE) for the quality assessment of studies. Intervention categories and outcomes were evaluated for each body of evidence and confidence in overall estimates of effect was determined. There is limited evidence to guide implementation of effective strategies to deal with the emerging threat of parental vaccine refusal. There is a need for appropriately designed, executed and evaluated intervention studies to address this gap in knowledge.
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Affiliation(s)
- Alina Sadaf
- Medical College, Aga Khan University, Karachi, Pakistan
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