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Valier MR, Yankey D, Elam-Evans LD, Chen M, Hill HA, Mu Y, Pingali C, Gomez JA, Arthur BC, Surtees T, Graitcer SB, Dowling NF, Stokley S, Peacock G, Singleton JA. Vital Signs: Trends and Disparities in Childhood Vaccination Coverage by Vaccines for Children Program Eligibility - National Immunization Survey-Child, United States, 2012-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:722-730. [PMID: 39173180 PMCID: PMC11349383 DOI: 10.15585/mmwr.mm7333e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Introduction The Vaccines for Children (VFC) program was established in 1994 to provide recommended vaccines at no cost to eligible children and help ensure that all U.S. children are protected from life-threatening vaccine-preventable diseases. Methods CDC analyzed data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2-3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics. VFC eligibility was defined as meeting at least one of the following criteria: 1) American Indian or Alaska Native; 2) insured by Medicaid, Indian Health Service (IHS), or uninsured; or 3) ever received at least one vaccination at an IHS-operated center, Tribal health center, or urban Indian health care facility. Results Overall, approximately 52.2% of U.S. children were VFC eligible. Among VFC-eligible children born during 2011-2020, coverage by age 24 months was stable for ≥1 MMR dose (88.0%-89.9%) and the combined 7-vaccine series (61.4%-65.3%). Rotavirus vaccination coverage by age 8 months was 64.8%-71.1%, increasing by an average of 0.7 percentage points annually. Among all children born in 2020, coverage was 3.8 (≥1 MMR dose), 11.5 (2-3 doses of rotavirus vaccine), and 13.8 (combined 7-vaccine series) percentage points lower among VFC-eligible than among non-VFC-eligible children. Conclusions and implications for public health practice Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain. Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.
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Domachowske JB. Understanding the Regulatory Pathways Used to Develop, Evaluate, Authorize, and Approve New Drugs and Vaccines in the United States. J Pediatric Infect Dis Soc 2024; 13:S93-S102. [PMID: 38995086 DOI: 10.1093/jpids/piae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 07/13/2024]
Abstract
The United States (U.S.) Food and Drug Administration (FDA) oversees the safety and quality of drugs and vaccines that are used in the U.S. Administration of the FDA falls under the jurisdiction of the U.S. Department of Health and Human Services (HHS). The regulatory oversight of the FDA is complex and comprehensive, requiring the various roles and responsibilities to be divided across six main centers. The activities of two of these centers, the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) are the primary focus of this review.
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Affiliation(s)
- Joseph B Domachowske
- Department of Pediatrics, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210, USA
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Higgins DM, Haynes AL, Jensen JC, O'Leary ST, Moss A, Calonge N. Planned Out-of-Hospital Birth as a Risk Factor for Nonreceipt of Hepatitis B Immunization. Pediatr Infect Dis J 2023; 42:819-823. [PMID: 37310892 DOI: 10.1097/inf.0000000000003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The hepatitis B vaccine (HBV) is recommended at birth to prevent perinatal hepatitis B transmission; however, many newborns still do not receive HBV. The extent to which planned out-of-hospital births, which have increased over the past decade, are associated with nonreceipt of the HBV birth dose is unknown. The purpose of this study was to determine whether a planned out-of-hospital birth location is associated with the nonreceipt of the HBV birth dose. METHODS We performed a retrospective cohort study of all births from 2007 to 2019 recorded in the Colorado birth registry. χ2 analyses were used to compare maternal demographics by birth location. Univariate and multiple logistic regression were used to evaluate the association of birth location with nonreceipt of the HBV birth dose. RESULTS In total 1.5% of neonates born in freestanding birth centers and 0.1% of neonates born at a planned home birth received HBV compared to 76.3% of neonates born in a hospital location. After adjusting for confounders, this translated to a large increase in the odds of not receiving HBV compared to in-hospital births [freestanding birth center (aodds ratio (aOR): 172.98, 95% confidence interval (CI): 136.98-219.88); planned home birth (aOR: 502.05, 95% CI: 363.04-694.29)]. Additionally, older maternal age, White/non-Hispanic race and ethnicity, higher income, and private or no insurance were associated with nonreceipt of the HBV birth dose. CONCLUSIONS Planned out-of-hospital birth is a risk factor for nonreceipt of the HBV birth dose. As births in these locations become more common, targeted policies and education are warranted.
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Affiliation(s)
- David M Higgins
- From the Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Allison L Haynes
- From the Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Julia C Jensen
- From the Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Ned Calonge
- From the Department of Epidemiology, Colorado School of Public Health, Aurora, CO
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Zhao R, Prizment A, Kulasingam S. Lower human papillomavirus vaccine initiation and completion among Asian American adolescents compared to their peers: National Health and Nutritional Examination Survey 2011-2018. Cancer Causes Control 2023; 34:543-552. [PMID: 36973601 PMCID: PMC10042420 DOI: 10.1007/s10552-023-01685-z] [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: 05/30/2021] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To compare human papillomavirus (HPV) vaccination initiation and completion between Asian American adolescents and their peers. METHODS HPV vaccine initiation and completion of adolescents aged 9-17 years old were analyzed using the National Health and Nutritional Examination Survey data from 2011 to 2018. The outcomes were HPV vaccine initiation percentage among all adolescents and completion percentage among initiators. Odds ratios for initiation or completion among Hispanics, Blacks, and Asians (referred to as racial/ethnic minorities) versus Whites were compared using logistic regression, adjusted for adolescent's age, annual family income, parent education, and insurance coverage. RESULTS From 2011 to 2018, overall initiation was less than 40% among U.S. adolescents. The initiation increased among boys (from 10% in 2011-12 to over 30% in 2017-2018) but not among girls. Compared to White girls, Black and Hispanic girls were more likely, while Asian girls were less likely to initiate vaccination. Although not statistically significant, Asian girls had ORs ranging from 0.65 to 0.99 for initiation compared to White girls in each of the four survey cycles. Black and Hispanic boys were more likely to initiate vaccination compared to White boys. Initiation among Asian boys increased to 39% in the 2017-2018 survey cycle. Racial/ethnic minority girls were less likely to complete the series compared to White girls, while the opposite was seen in Black boys. CONCLUSION HPV vaccination status varies among racial/ethnic groups. Future efforts should be made to achieve the Healthy People 2020 goal of 80% vaccination among U.S. adolescents and address the gap among Asian American girls.
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Affiliation(s)
- Ran Zhao
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S 2Nd St, Minneapolis, MN, 55454, USA.
| | - Anna Prizment
- Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School Masonic Cancer Center, 420 Delaware St, MMC 480, Minneapolis, MN, 55455, USA
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S 2Nd St, Minneapolis, MN, 55454, USA
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Newcomer SR, Glanz JM, Daley MF. Beyond Vaccination Coverage: Population-Based Measurement of Early Childhood Immunization Schedule Adherence. Acad Pediatr 2023; 23:24-34. [PMID: 35995410 PMCID: PMC10253042 DOI: 10.1016/j.acap.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023]
Abstract
The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States.
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Affiliation(s)
- Sophia R Newcomer
- University of Montana School of Public and Community Health Sciences (SR Newcomer), Missoula, Mont; University of Montana Center for Population Health Research (SR Newcomer), Missoula, Mont.
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, Colorado School of Public Health, Department of Epidemiology (JM Glanz), Aurora, Colo
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, School of Medicine, Department of Pediatrics (MF Daley), Aurora, Colo
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Angier H, Garvey B, DeVoe JE. Focus on Families to Improve Child Health During the COVID-19 Pandemic and Beyond. JAMA HEALTH FORUM 2021; 2. [PMID: 34913049 DOI: 10.1001/jamahealthforum.2021.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brian Garvey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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The role of epidemiology in informing United States childhood immunization policy and practice. Ann Epidemiol 2020; 62:100-114. [PMID: 33065268 PMCID: PMC7553935 DOI: 10.1016/j.annepidem.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/17/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022]
Abstract
One of the ten greatest public health achievements is childhood vaccination because of its impact on controlling and eliminating vaccine-preventable diseases (VPDs). Evidence-based immunization policies and practices are responsible for this success and are supported by epidemiology that has generated scientific evidence for informing policy and practice. The purpose of this report is to highlight the role of epidemiology in the development of immunization policy and successful intervention in public health practice that has resulted in a measurable public health impact: the control and elimination of VPDs in the United States. Examples in which epidemiology informed immunization policy were collected from a literature review and consultation with experts who have been working in this field for the past 30 years. Epidemiologic examples (e.g., thimerosal-containing vaccines and the alleged association between the measles, mumps, and rubella (MMR) vaccine and autism) are presented to describe challenges that epidemiologists have addressed. Finally, we describe ongoing challenges to the nation's ability to sustain high vaccination coverage, particularly with concerns about vaccine safety and effectiveness, increasing use of religious and philosophical belief exemptions to vaccination, and vaccine hesitancy. Learning from past and current experiences may help epidemiologists anticipate and address current and future challenges to respond to emerging infectious diseases, such as COVID-19, with new vaccines and enhance the public health impact of immunization programs for years to come.
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Varan AK, Rodriguez-Lainz A, Hill HA, Elam-Evans LD, Yankey D, Li Q. Vaccination Coverage Disparities Between Foreign-Born and U.S.-Born Children Aged 19-35 Months, United States, 2010-2012. J Immigr Minor Health 2018; 19:779-789. [PMID: 27480159 DOI: 10.1007/s10903-016-0465-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthy People 2020 targets high vaccination coverage among children. Although reductions in coverage disparities by race/ethnicity have been described, data by nativity are limited. The National Immunization Survey is a random-digit-dialed telephone survey that estimates vaccination coverage among U.S. children aged 19-35 months. We assessed coverage among 52,441 children from pooled 2010-2012 data for individual vaccines and the combined 4:3:1:3*:3:1:4 series (which includes ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine/diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 or ≥4 doses of Haemophilus influenzae type b vaccine (depending on product type of vaccine; denoted as 3* in the series name), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine). Coverage estimates controlling for sociodemographic factors and multivariable logistic regression modeling for 4:3:1:3*:3:1:4 series completion are presented. Significantly lower coverage among foreign-born children was detected for DTaP, hepatitis A, hepatitis B, Hib, pneumococcal conjugate, and rotavirus vaccines, and for the combined series. Series completion disparities persisted after control for demographic, access-to-care, poverty, and language effects. Substantial and potentially widening disparities in vaccination coverage exist among foreign-born children. Improved immunization strategies targeting this population and continued vaccination coverage monitoring by nativity are needed.
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Affiliation(s)
- Aiden K Varan
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 3851 Rosecrans St, Suite 715, San Diego, CA, 92110, USA
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Alfonso Rodriguez-Lainz
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 3851 Rosecrans St, Suite 715, San Diego, CA, 92110, USA.
| | - Holly A Hill
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Laurie D Elam-Evans
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - David Yankey
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Qian Li
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
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Developing the Evidence for Public Health Systems to Battle Vaccine Preventable Disease at the Local Level: Data Challenges and Strategies for Advancing Research. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 23:131-137. [PMID: 27798522 DOI: 10.1097/phh.0000000000000411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Generally decreasing local health department (LHD) resources devoted to immunization programs and changes in LHD roles in immunization services represent major shifts in a core LHD service. OBJECTIVE Within a rapidly changing immunization landscape and emerging vaccine preventable disease outbreaks, our objective was to examine how LHD immunization expenditures are related to county-level immunization coverage and pertussis rates. DESIGN We used a practice-based approach in which we collaborated with practice partners and uniquely detailed LHD immunization expenditure data. Our analyses modeled the ecologic relationship between LHD immunization expenditures and LHD system performance and health outcomes. SETTING This study was launched through a consortium of public health Practice-Based Research Network states as part of a suite of studies examining the relationship between various LHD service-related expenditures and health outcomes. PARTICIPANTS We investigated and sought to include all LHDs in the states of Florida, New York (except New York City's LHD), and Washington. OUTCOME MEASURES With LHD immunization expenditures as our independent variable, our outcomes were 1 year of jurisdiction-level rates of toddler immunization completeness, to measure immunization system performance, and 11 years of annual jurisdiction-level numbers of pertussis cases per 100 000 population, to measure related health outcomes. RESULTS Immunization completeness and pertussis rates varied greatly, but our models did not produce significant results despite numerous analytic approaches and while controlling for other factors. CONCLUSION While our study was part of a suite of studies using similar methods and producing significant results, this study was instead challenged by serious data limitations and highlighted the gap in consistent, standardized data that can support critically needed evidence regarding immunization rates and disease. With LHDs at the epicenter of reducing vaccine preventable disease, it is vital to utilize emerging opportunities to understand the nature of their efforts in immunization coverage and disease prevention.
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Thompson KM, Logan GE. Characterization of Heterogeneity in Childhood Immunization Coverage in Central Florida Using Immunization Registry Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1418-1426. [PMID: 26033542 DOI: 10.1111/risa.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
Despite high vaccine coverage in the United States in general, and in the State of Florida specifically, some children miss scheduled vaccines due to health system failures or vaccine refusal by their parents. Recent experiences with outbreaks in the United States suggest that geographic clustering of un(der)vaccinated populations represent a threat to the elimination status of some vaccine-preventable diseases. Immunization registries continue to expand and play an important role in efforts to track vaccine coverage and use. Using nearly 700,000 de-identified immunization records from the Florida Department of Health immunization information system (Florida SHOTS™) for children born during 2003-2014, we explored heterogeneity and potential clustering of un(der)vaccinated children in six counties in central Florida-Brevard, Lake, Orange, Oseola, Polk, and Seminole-that represent a high-risk area for importation due to family tourist attractions in the area. By zip code, we mapped the population density, the percent of children with religious exemptions, the percent of children on track or overdue for each vaccine series without and with exemptions, and the numbers of children with no recorded dose of each vaccine. Overall, we found some heterogeneity in coverage among the counties and zip codes, but relatively consistent and high coverage. We found that some children with an exemption in the system received the vaccines we analyzed, but exemption represents a clear risk factor for un(der)immunization. We identified many challenges associated with using immunization registry data for spatial analysis and potential opportunities to improve registries to better support future analyses.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Grace E Logan
- University of Central Florida, College of Medicine, Orlando, FL, USA
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11
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Smith PJ, Stokley S, Bednarczyk RA, Orenstein WA, Omer SB. HPV vaccination coverage of teen girls: the influence of health care providers. Vaccine 2016; 34:1604-1610. [PMID: 26854907 PMCID: PMC7285619 DOI: 10.1016/j.vaccine.2016.01.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%. OBJECTIVE To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status. METHODS Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records. RESULTS Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. CONCLUSION Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.
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Affiliation(s)
- Philip J Smith
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, MS A-19, 1600 Clifton Road, NE, Atlanta, GA 30333, United States.
| | - Shannon Stokley
- Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
| | | | | | - Saad B Omer
- Emory University, Atlanta, GA 30322, United States.
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Smith PJ, Marcuse EK, Seward JF, Zhao Z, Orenstein WA. Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities. Public Health Rep 2015; 130:485-504. [PMID: 26327727 PMCID: PMC4529833 DOI: 10.1177/003335491513000512] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the extent to which children and adolescents were not vaccinated against measles ("unvaccinated"), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities. METHODS We analyzed data from the 2010-2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status. RESULTS In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated. CONCLUSIONS Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents.
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Affiliation(s)
- Philip J. Smith
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Edgar K. Marcuse
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Jane F. Seward
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
| | - Zhen Zhao
- Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Disease, Immunization Services Division, Atlanta, GA
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Srivastav A, Zhai Y, Santibanez TA, Kahn KE, Smith PJ, Singleton JA. Influenza vaccination coverage of Vaccine for Children (VFC)-entitled versus privately insured children, United States, 2011-2013. Vaccine 2015; 33:3114-21. [PMID: 25979804 PMCID: PMC4847713 DOI: 10.1016/j.vaccine.2015.04.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/13/2015] [Accepted: 04/29/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Vaccines for Children (VFC) program provides vaccines at no cost to children who are Medicaid-eligible, uninsured, American Indian or Alaska Native (AI/AN), or underinsured and vaccinated at Federally Qualified Health Centers or Rural Health Clinics. The objective of this study was to compare influenza vaccination coverage of VFC-entitled to privately insured children in the United States, nationally, by state, and by selected socio-demographic variables. METHODS Data from the National Immunization Survey-Flu (NIS-Flu) surveys were analyzed for the 2011-2012 and 2012-2013 influenza seasons for households with children 6 months-17 years. VFC-entitlement and private insurance status were defined based upon questions asked of the parent during the telephone interview. Influenza vaccination coverage estimates of children VFC-entitled versus privately insured were compared by t-tests, both nationally and within state, and within selected socio-demographic variables. RESULTS For both seasons studied, influenza coverage for VFC-entitled children did not significantly differ from coverage for privately insured children (2011-2012: 52.0%±1.9% versus 50.7%±1.2%; 2012-2013: 56.0%±1.6% versus 57.2%±1.2%). Among VFC-entitled children, uninsured children had lower coverage (2011-2012: 38.9%±4.7%; 2012-2013: 44.8%±3.5%) than Medicaid-eligible (2011-2012: 55.2%±2.1%; 2012-2013: 58.6%±1.9%) and AI/AN children (2011-2012: 54.4%±11.3%; 2012-2013: 54.6%±7.0%). Significant differences in vaccination coverage among VFC-entitled and privately insured children were observed within some subgroups of race/ethnicity, income, age, region, and living in a metropolitan statistical area principle city. CONCLUSIONS Although finding few differences in influenza vaccination coverage among VFC-entitled versus privately insured children was encouraging, nearly half of all children were not vaccinated for influenza and coverage was particularly low among uninsured children. Additional public health interventions are needed to ensure that more children are vaccinated such as a strong recommendation from health care providers, utilization of immunization information systems, provider reminders, standing orders, and community-based interventions such as educational activities and expanded access to vaccination services.
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Affiliation(s)
- Anup Srivastav
- Leidos Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Yusheng Zhai
- Leidos Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katherine E Kahn
- Leidos Inc., Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kansagra SM, Papadouka V, Geevarughese A, Hansen MA, Konty KJ, Zucker JR. Reaching children never previously vaccinated for influenza through a school-located vaccination program. Am J Public Health 2014; 104:e45-9. [PMID: 24228652 PMCID: PMC3910058 DOI: 10.2105/ajph.2013.301671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the success of the school-located vaccination (SLV) program, implemented in 2009 in New York City to deliver pandemic influenza A (H1N1) monovalent vaccine (pH1N1), versus provider offices in reaching children who had never previously received influenza vaccine. METHODS We compared the immunization history of children vaccinated in school versus provider offices. We included records in the Citywide Immunization Registry with pH1N1 administered between October 2009 and March 2010 to elementary school-aged children. RESULTS In total, 96,524 children received pH1N1 vaccine in schools, and 102,933 children received pH1N1 vaccine in provider offices. Of children vaccinated in schools, 34% had never received seasonal influenza vaccination in the past, compared with only 10% of children vaccinated at provider offices (P < .001). Children vaccinated in schools were more likely to have received a second dose of pH1N1 in 2009-2010 than those vaccinated in provider offices (80% vs 45%). CONCLUSIONS The SLV program was more successful at reaching children who had never received influenza immunization in the past and should be considered as a strategy for delivering influenza vaccine in routine and emergency situations.
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Affiliation(s)
- Susan M Kansagra
- Susan M. Kansagra, Vikki Papadouka, Anita Geevarughese, and Kevin J. Konty are with and Michael A. Hansen was with the New York City Department of Health and Mental Hygiene, New York City, NY. Jane R. Zucker is with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, assigned to the Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, NY
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15
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Zhao Z, Murphy TV. Which newborns missed the hepatitis B birth dose vaccination among U.S. children? Prev Med 2013; 57:613-7. [PMID: 23988497 DOI: 10.1016/j.ypmed.2013.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/07/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hepatitis B birth dose vaccination is a critical step in preventing perinatal hepatitis B virus infection. This study assesses the prevalence of children who missed the birth dose of hepatitis B vaccination and identifies socio-demographic factors associated with non-receipt of the birth dose among children in the United States. METHODS A survey observation study was conducted with the national representative sample of 17,053 U.S. children aged 19-35 months obtained from the 2009 National Immunization Survey. Categorical data analysis and multivariable logistic regression in the context of complex sample survey were applied to evaluate the prevalence and determine the independent risk factors. RESULTS 39.2% of children missed the birth dose of hepatitis B vaccination. Children who reside in states without a universal hepatitis B vaccine supply policy, are not covered by health insurance, and have only 1 vaccination provider are significantly associated with non-receipt of the birth dose hepatitis B vaccination. CONCLUSIONS Children who reside in states without a universal hepatitis B vaccine supply policy, and who are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination. Future intervention studies could be needed to help control those modifiable risk factors.
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Affiliation(s)
- Zhen Zhao
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop A19, Atlanta, GA 30333, USA.
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16
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Régnier SA. Respiratory syncytial virus immunization program for the United States: impact of performance determinants of a theoretical vaccine. Vaccine 2013; 31:4347-54. [PMID: 23896421 DOI: 10.1016/j.vaccine.2013.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/02/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To inform strategic decisions on respiratory syncytial virus (RSV) vaccine development and identify critical endpoints likely to drive the vaccine's medical and economic impact. DESIGN A decision-analysis model populated using healthcare utilization data and costs from the literature; vaccine efficacy and duration based on assumptions. SETTING Vaccination in the physician office setting in the USA. PARTICIPANTS A hypothetical cohort of newborn infants. INTERVENTION Vaccination of children at low and high risk of respiratory sequelae with a theoretical RSV vaccine vs palivizumab prophylaxis for children at high risk. OUTCOME MEASURES Medical and economic value of RSV vaccination, including cost per quality adjusted life-year (QALY) gained. RESULTS Using base-case assumptions (efficacy 50% at birth; half-life 12 months), RSV vaccination would prevent 23,069 hospitalizations and 66 deaths per vaccinated birth cohort in the USA. Excluding vaccination costs, direct medical costs for RSV would reduce by $236 million, and income and productivity losses by $134 million. Assuming a vaccine cost per course similar to Rotarix® in the USA ($232 including administration fees), the cost per QALY gained would be $93,401 (95% CI: $65,815-$126,060) from the healthcare system perspective and $65,115 (95% CI: $41,003-$93,679) from the societal perspective. The net cost (healthcare system perspective) per life-year saved would be $216,120 (95% CI: $161,184-$263,981); the cost per hospitalization averted would be $19,172 (95% CI: $14,679-$22,093). Aside from efficacy, the vaccine's impact is sensitive to the start of protective immunity and the duration of protection. CONCLUSIONS Development of an RSV vaccine would substantially reduce inpatient hospitalizations and outpatient visits. It would also have an impact on infant mortality. To demonstrate the full medical and economic value of the vaccine, appropriate endpoints or endpoint surrogates for hospitalization, mortality, and total case reductions should be collected during vaccine development.
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Affiliation(s)
- Stephane A Régnier
- Université de Neuchâtel, Pierre-à-Mazel 7, CH-2000 Neuchâtel, Switzerland.
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17
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Zhao Z, Smith PJ. Trends in vaccination coverage disparities among children, United States, 2001–2010. Vaccine 2013; 31:2324-7. [DOI: 10.1016/j.vaccine.2013.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/03/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
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18
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Rodewald LE, Orenstein WA, Hinman AR, Schuchat A. Immunization in the United States. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00067-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Weinberg SH, Butchart AT, Davis MM. Size of clinical trials and Introductory prices of prophylactic vaccine series. Hum Vaccin Immunother 2012; 8:1066-70. [PMID: 22854668 PMCID: PMC3551877 DOI: 10.4161/hv.20506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Costs of completing the recommended immunization schedule have increased over the last decade. Access to prophylactic vaccines may become limited due to financing obstacles within current delivery systems. Vaccine prices reflect research and development expenses incurred by vaccine manufacturers, including costs associated with evaluating candidate vaccines in human subjects. If the number of subjects in clinical trials is increasing over time and associated with vaccine price, this may help explain increases in prices of vaccine series. We examined whether: (A) the initial public- and private-sector prices for recommended prophylactic vaccine series licensed and recommended in the US increased from 2000–2011, (B) the number of human subjects per licensed vaccine increased during the time period, and (C) the number of human subjects was associated with the initial public–and private–sector prices of the vaccine series. In regression analyses of 13 vaccines, approval year was not significantly associated with the number of human subjects, initial public-sector prices, or initial private-sector prices. While the number of phase II subjects was not significantly associated with prices, the numbers of phase III and combined late phase (phases II + III) subjects were significantly associated with initial public- and private-sector series prices (p < 0.05). The association between number of subjects and initial prices demonstrated diminishing marginal increases in price with increasing numbers of subjects. These findings may help guide the number of subjects required by the FDA in clinical trials, in order to reduce expenses for manufacturers and thereby help mitigate increases in initial vaccine series prices.
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Affiliation(s)
- Steven H Weinberg
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan; Ann Arbor, MI USA
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20
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Zhao Z, Smith PJ. WITHDRAWN: Trends in vaccination coverage disparities among children, United States, 2001-2010. Vaccine 2012:S0264-410X(12)00677-9. [PMID: 22609037 DOI: 10.1016/j.vaccine.2012.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/24/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Zhen Zhao
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, MS A19, Atlanta, GA 30333, USA.
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21
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Affiliation(s)
- Jane J Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, USA
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22
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Lindley MC, Smith PJ, Rodewald LE. Vaccination coverage among U.S. adolescents aged 13-17 years eligible for the Vaccines for Children program, 2009. Public Health Rep 2011; 126 Suppl 2:124-34. [PMID: 21815303 DOI: 10.1177/00333549111260s214] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared (1) characteristics of adolescents who are and are not entitled to receive free vaccines from the Vaccines for Children (VFC) program and (2) vaccination coverage with meningococcal conjugate (MCV4), quadrivalent human papillomavirus (HPV4), and tetanus-diphtheria-acellular pertussis (Tdap) vaccines among VFC-eligible and non-VFC-eligible adolescents. METHODS We analyzed data from the 2009 National Immunization Survey-Teen, a nationally representative, random-digit-dialed survey of households with adolescents aged 13-17 years (n = 20,066). Differences in sociodemographic characteristics and provider-reported vaccination coverage were evaluated using t-tests. RESULTS Overall, 32.1% (+/- 1.2%) of adolescents were VFC-eligible. VFC-eligible adolescents were significantly less likely than non-VFC-eligible adolescents to be white and to live in suburban areas, and more likely to live in poverty and to have younger and less educated mothers. Nationally, coverage among non-VFC-eligible adolescents was 57.1% (+/-1.5%) for > or = 1 dose of Tdap, 55.4% (+/-1.5%) for > or = 1 dose of MCV4, and 43.2% (+/- 2.2%) for > or = 1 dose of HPV4. Coverage among VFC-eligible adolescents was 52.5% (+/- 2.4%) for > or = 1 dose of Tdap, 50.1% (+/- 2.4%) for > or = 1 dose of MCV4, and 46.6% (+/- 3.5%) for > or =1 dose of HPV4. Only 27.5% (+/- 1.8%) of non-VFC-eligible adolescents and 25.0% (+/- 2.9%) of VFC-eligible adolescents received > or = 3 doses of HPV4. Vaccination coverage was significantly higher among non-VFC-eligible adolescents for Tdap and MCV4, but not for one-dose or three-dose HPV4. Conclusions. Coverage with some recommended vaccines is lower among VFC-eligible adolescents compared with non-VFC-eligible adolescents. Continued monitoring of adolescent vaccination rates, particularly among VFC-eligible populations, is needed to ensure that all adolescents receive all routinely recommended vaccines.
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Affiliation(s)
- Megan C Lindley
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA 30333, USA.
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Smith PJ, Wood D, Darden PM. Highlights of historical events leading to national surveillance of vaccination coverage in the United States. Public Health Rep 2011; 126 Suppl 2:3-12. [PMID: 21815302 PMCID: PMC3113425 DOI: 10.1177/00333549111260s202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The articles published in this special supplement of Public Health Reports provide examples of only some of the current efforts in the United States for evaluating vaccination coverage. So, how did we get here? The history of vaccination and assessment of vaccination coverage in the U.S. has its roots in the pre-Revolutionary War era. In many cases, development of vaccines, and attention devoted to the assessment of vaccination coverage, has grown from the impact of infectious disease on major world events such as wars. The purpose of this commentary is to provide a brief overview of the key historical events in the U.S. that influenced the development of vaccines and the efforts to track vaccination coverage, which laid the foundation for contemporary vaccination assessment efforts.
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Affiliation(s)
- Philip J Smith
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA 30333, USA.
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