1
|
Silva JBB, Howe CJ, Jackson JW, Riester MR, Bardenheier BH, Xu L, Puckrein G, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults. J Racial Ethn Health Disparities 2024; 11:1520-1529. [PMID: 37184814 PMCID: PMC10184628 DOI: 10.1007/s40615-023-01628-z] [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: 02/12/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs). METHODS We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group. RESULTS We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs). CONCLUSION Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.
Collapse
Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Westat LLC, Rockville, MD, USA
| | - Liou Xu
- National Minority Quality Forum, Washington, DC, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
2
|
Wolf RM, Antoon JW. Influenza in Children and Adolescents: Epidemiology, Management, and Prevention. Pediatr Rev 2023; 44:605-617. [PMID: 37907421 PMCID: PMC10676733 DOI: 10.1542/pir.2023-005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
EDUCATION GAP Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent, and treat influenza cases. Disease caused by influenza virus can be mitigated with appropriate treatment and prevention efforts. OBJECTIVES After completing this article, readers should be able to: 1. Describe the virology and epidemiology of influenza. 2. List the clinical features and complications of influenza infections. 3. List the benefits and limitations of testing modalities for the diagnosis of influenza. 4. Appropriately apply American Academy of Pediatrics, Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) treatment guidelines for influenza or suspected influenza. 5. Describe the importance of influenza vaccination.
Collapse
Affiliation(s)
- Ryan M Wolf
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Antoon
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
3
|
Racial and ethnic disparities in COVID-19 vaccine uptake: A mediation framework. Vaccine 2023; 41:2404-2411. [PMID: 36894396 PMCID: PMC9974364 DOI: 10.1016/j.vaccine.2023.02.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Previous research suggests that racial and ethnic minority groups especially Black Americans showed stronger COVID-19 vaccine hesitancy and resistance, which may result from a lack of trust toward the government and vaccine manufacturers, among other sociodemographic and health factors. OBJECTIVES The current study explored potential social and economic, clinical, and psychological factors that may have mediated racial and ethnic disparities in COVID-19 vaccine uptake among US adults. METHODS A sample of 6078 US individuals was selected from a national longitudinal survey administered in 2020-2021. Baseline characteristics were collected in December 2020, and respondents were followed up to July 2021. Racial and ethnic disparities in time to vaccine initiation and completion (based on a 2-dose regimen) were first assessed with the Kaplan-Meier Curve and log-rank test, and then explored with the Cox proportional hazards model adjusting for potential time-varying mediators, such as education, income, marital status, chronic health conditions, trust in vaccine development and approval processes, and perceived risk of infection. RESULTS Prior to mediator adjustment, Black and Hispanic Americans had slower vaccine initiation and completion than Asian Americans and Pacific Islanders and White Americans (p's < 0.0001). After accounting for the mediators, there were no significant differences in vaccine initiation or completion between each minoritized group as compared to White Americans. Education, household income, marital status, chronic health conditions, trust, and perceived infection risk were potential mediators. CONCLUSION Racial and ethnic disparities in COVID-19 vaccine uptake were mediated through social and economic conditions, psychological influences, and chronic health conditions. To address the racial and ethnic inequity in vaccination, it is important to target the social, economic, and psychological forces behind it.
Collapse
|
4
|
O'Bryant SC, Dongarwar D, Salihu HM, Gillespie S. Racial and Ethnic Differences of Influenza-Associated Pediatric Hospitalizations and Deaths, 2008-2017. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:102-108. [PMID: 35486863 DOI: 10.1089/ped.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Influenza is one of the most common causes of acute respiratory infections in children; its complications are a leading cause of morbidity and mortality. There is a paucity of pediatric data on influenza disparities among racial/ethnic minorities. Our study assesses if there are racial/ethnic differences in hospitalizations and mortality in children infected with influenza. Methods: This was a retrospective cohort study using the National Inpatient Sample (NIS) from January 1, 2008 to December 31, 2017. We included children 18 years and younger hospitalized with a primary or secondary diagnosis of influenza or its subtypes. We generated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to evaluate the associations between patient characteristics and influenza hospitalizations and influenza-related mortality. Results: There were 226,535 (0.04%) influenza-associated hospitalizations. When compared with non-Hispanic (NH) White children, minority children were more likely to be hospitalized with an influenza diagnosis [Hispanics (aOR = 1.25; 95% CI, 1.17 to 1.33), NH-Blacks (aOR = 1.21, 95% CI, 1.17 to 1.33) and NH-Others group (aOR = 1.11; 95% CI, 1.04 to 1.19)]. There was no racial/ethnic difference in mortality. Conclusions: Minority children experienced a higher likelihood of influenza-associated hospitalizations but not mortality. Further research is needed to reduce the racial/ethnic disparities of influenza's impact.
Collapse
Affiliation(s)
- Shelease C O'Bryant
- Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA
| | - Susan Gillespie
- Section of Retrovirology and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
5
|
Factors Influencing Health Equity of Influenza Vaccination in Pediatric Patients. Pediatr Qual Saf 2022; 7:e543. [PMID: 35369420 PMCID: PMC8970079 DOI: 10.1097/pq9.0000000000000543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022] Open
Abstract
Social factors can be a determinate for multiple health outcomes. We evaluated the association of numerous social factors on rates of influenza nonvaccination in a large pediatric primary and subspecialty care system.
Collapse
|
6
|
Upenieks L, Ford-Robertson J, Robertson JE. Trust in God and/or Science? Sociodemographic Differences in the Effects of Beliefs in an Engaged God and Mistrust of the COVID-19 Vaccine. JOURNAL OF RELIGION AND HEALTH 2022; 61:657-686. [PMID: 34843011 PMCID: PMC8628135 DOI: 10.1007/s10943-021-01466-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 05/26/2023]
Abstract
At present, COVID-19 vaccines are widely available in the USA, but large proportions of the American populace remain unvaccinated. One possible source of COVID-19 vaccine hesitancy is a lack of trust in science. In this study, drawing from the large literature at the intersection of science and religion, we ask whether beliefs in an engaged God (the belief that God is involved in daily human affairs) predict mistrust of the COVID-19 vaccine and whether any observed association differs across race, gender, and education. Using nationally representative data from Wave 6 of the Baylor Religion Survey (2021), our results suggest that beliefs in an engaged God were associated with greater mistrust in the COVID-19 vaccine. This association was amplified for Hispanic and lower educated Americans. We argue that beliefs in an engaged God may promote a distrust of science, reduce motivation to get vaccinated, and derive comfort and strength by placing control over one's life in the hands of a loving, involved deity. We also situate our findings within an emerging body of work on the "dark side" of religion and reflect on their implications for understanding the broader religion/health connection.
Collapse
Affiliation(s)
- Laura Upenieks
- Department of Sociology, Baylor University, One Bear Place, Waco, TX, 76798, USA.
| | | | | |
Collapse
|
7
|
Mihalek AJ, Hall M, Russell CJ, Wu S. Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery. Hosp Pediatr 2021:hpeds.2021-005924. [PMID: 34807982 DOI: 10.1542/hpeds.2021-005924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery. METHODS An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery. RESULTS Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery. CONCLUSIONS The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.
Collapse
Affiliation(s)
- Alexandra J Mihalek
- Hospitalist Division, Children's Hospital of Orange County, Orange, California
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Wu
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
8
|
Tran N, Cortright L, Buckman C, Tumin D, Syed S. Association between asthma and influenza vaccine uptake among US adolescents: a retrospective survey study. J Asthma 2021; 59:1256-1262. [PMID: 33761306 DOI: 10.1080/02770903.2021.1908349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite longstanding recommendations for children with asthma to receive the influenza vaccine, vaccine uptake in this population remains low. We used the nationally representative National Immunization Survey-Teen to analyze the impact of asthma on adolescent influenza vaccination rates. METHODS Adolescents ages 13-17 years with provider-reported data on vaccine coverage were included in the analysis. The primary outcome was being up-to-date on influenza vaccination, defined as receiving the seasonal influenza vaccine in at least one of the past 3 years, and was analyzed using logistic regression. Asthma was defined by parent report of whether the adolescent has ever been told by a health professional that he or she has asthma. Data were collected in 2016-2017 and analyzed in 2020. RESULTS Of 36,655 adolescents in the analytic sample (mean age 15 years, 49% female), 55% were up-to-date on influenza vaccination, and 21% had been diagnosed with asthma. On bivariate analysis, vaccination was more common among adolescents who had been diagnosed with asthma compared to those who were not (60% vs. 53%, P < 0.001). On multivariable analysis, asthma diagnosis was associated with greater likelihood of being up-to-date on seasonal influenza vaccination (adjusted odds ratio: 1.29; 95% confidence interval: 1.22, 1.36; P < 0.001). CONCLUSIONS Seasonal influenza vaccination rates remain low among adolescents. Despite concerns about vaccine effectiveness in children with asthma, this diagnosis was associated with increased likelihood of influenza vaccination, possibly in relation to increased health care use (and exposure to vaccine encouragement) among adolescents with asthma.
Collapse
Affiliation(s)
- Nga Tran
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA.,Vidant Medical Center, Greenville, NC, USA
| | - Lindsay Cortright
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Salma Syed
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| |
Collapse
|
9
|
Jungquist RM, Abuelezam NN. Disparities in influenza vaccination: Arab Americans in California. BMC Public Health 2021; 21:443. [PMID: 33663444 PMCID: PMC7932900 DOI: 10.1186/s12889-021-10476-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/18/2021] [Indexed: 01/24/2023] Open
Abstract
Background Influenza vaccination among minoritized groups remains below federal benchmarks in the United States (US). We used data from the 2004–2016 California Health Interview Surveys (CHIS) to characterize influenza vaccination patterns among Arab Americans in California. Methods Influenza vaccination was self-reported by Arab American adults (N = 1163) and non-Hispanic Whites (NHW, N = 166,955). Differences in influenza vaccination prevalence and odds were compared using chi-squared tests and survey-weighted logistic regression, respectively. Results Across all years, 30.3% of Arab Americans self-reported receiving an influenza vaccine (vs. 40.5% for NHW, p < 0.05). After sequential adjustment by sociodemographic, health behavior, and acculturation variables no differences in odds of self-reported influenza vaccination were observed between Arab Americans and NHW (odds ratio: 1.02, 95% confidence interval: 0.76–1.38). Male and unemployed Arab Americans had higher odds of reporting influenza vaccination than female and employed Arab Americans. Conclusions Future work should consider specific barriers to influenza vaccination in Arab American communities.
Collapse
Affiliation(s)
| | - Nadia N Abuelezam
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| |
Collapse
|
10
|
Sturm L, Kasting ML, Head KJ, Hartsock JA, Zimet GD. Influenza vaccination in the time of COVID-19: A national U.S. survey of adults. Vaccine 2021; 39:1921-1928. [PMID: 33715898 PMCID: PMC7931729 DOI: 10.1016/j.vaccine.2021.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Introduction Decisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did. Methods In May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome. Results Among participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23–2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88–2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49–2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03–1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36–0.999; and AOR = 0.45; 95% CI = 0.24–0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45–2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15–1.90). Conclusions The COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.
Collapse
Affiliation(s)
- Lynne Sturm
- Indiana University School of Medicine, Department of Pediatrics, Suite 3120 Riley Pediatric Care Center, 1002 Wishard Boulevard, Indianapolis, IN 46202, USA.
| | - Monica L Kasting
- Purdue University, Department of Public Health, Matthews Hall 216, 812 W. State Street, West Lafayette, IN 47907, USA.
| | - Katharine J Head
- Indiana University, Purdue University Indianapolis, Department of Communication Studies, 307C Cavanaugh Hall, 425 University Blvd, Indianapolis, IN, 46202 USA.
| | - Jane A Hartsock
- Indiana University Health, 1800 N. Capitol Ave., Noyes Pavilion Suite E644, Indianapolis, IN 46202, USA.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street. Ste 1001, Indianapolis, IN 46202, USA.
| |
Collapse
|
11
|
Wu MJ, Chung JR, Kim SS, Jackson ML, Jackson LA, Belongia EA, McLean HQ, Gaglani M, Reis M, Beeram M, Martin ET, Monto AS, Nowalk MP, Zimmerman R, Santibanez TA, Singleton JA, Patel M, Flannery B. Influenza vaccination coverage among persons seeking outpatient medical care for acute respiratory illness in five states in the United States, 2011-2012 through 2018-2019. Vaccine 2021; 39:1788-1796. [PMID: 33597114 DOI: 10.1016/j.vaccine.2021.01.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the United States (U.S.), annual influenza vaccination has been recommended for all persons aged ≥6 months with the Healthy People 2020 coverage target of 70%. However, vaccination coverage has remained around 42-49% during the past eight influenza seasons. We sought to quantify influenza vaccination coverage and factors associated with vaccination in persons seeking outpatient medical care for an acute respiratory illness (ARI). METHODS We enrolled outpatients aged ≥6 months with ARI from >50 U.S. clinics from 2011 to 2012 through 2018-2019 influenza seasons and tested for influenza with molecular assays. Vaccination status was based on documented receipt of the current season's influenza vaccine. We estimated vaccination coverage among influenza-negative study participants by study site, age, and season, and compared to state-level influenza coverage estimates in the general population based on annual immunization surveys. We used multivariable logistic regression to examine factors independently associated with receipt of influenza vaccines. RESULTS We enrolled 45,424 study participants with ARI who tested negative for influenza during the study period. Annual vaccination coverage among influenza-negative ARI patients and the general population in the participating states averaged 55% (range: 47-62%), and 52% (range: 46-54%), respectively. Among enrollees, coverage was highest among adults aged ≥65 years (82%; range, 80-85%) and lowest among adolescents aged 13-17 years (38%; range, 35-41%). Factors significantly associated with non-vaccination included non-White race, no college degree, exposure to cigarette smoke, absence of high-risk conditions, and not receiving prior season influenza vaccine. CONCLUSIONS Influenza vaccination coverage over eight seasons among outpatients with non-influenza respiratory illness was slightly higher than coverage in the general population but 15% lower than national targets. Increased efforts to promote vaccination especially in groups with lower coverage are warranted to attain optimal health benefits of influenza vaccine.
Collapse
Affiliation(s)
- Michael J Wu
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sara S Kim
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, United States
| | - Michael Reis
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, United States
| | - Madhava Beeram
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, United States
| | - Emily T Martin
- University of Michigan and Henry Ford Health System, Ann Arbor, MI, United States
| | - Arnold S Monto
- University of Michigan and Henry Ford Health System, Ann Arbor, MI, United States
| | - Mary Patricia Nowalk
- University of Pittsburgh Schools of the Health Sciences and UPMC, Pittsburgh, PA, United States
| | - Richard Zimmerman
- University of Pittsburgh Schools of the Health Sciences and UPMC, Pittsburgh, PA, United States
| | - Tammy A Santibanez
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Manish Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
12
|
Zemanek CE, Liu N, Sablak CH, Gaudet BA, Jarvill TL, Kayne AN, Downen JM, Kincaid H, Smith AB, Barraco RD, Cuadrado HM, Greenberg MR. Relationship Between Vaccination Status and Biopsychosocial Characteristics in Sheltered Adolescents. Cureus 2021; 13:e12575. [PMID: 33575140 PMCID: PMC7870128 DOI: 10.7759/cureus.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Homeless youth are a vulnerable population. A volunteer clinic supported by medical students in northeastern Pennsylvania provides shelter and healthcare to adolescents seeking refuge. We set out to determine the immunization status of youth in the shelter and evaluate for associations of immunization deficiency with demographics or biopsychosocial factors. Methods After IRB approval, a retrospective cohort study was performed from existing clinical records at the shelter 2/2015-9/2019. Chart abstraction included variables such as demographics (including age, sex, and race/ethnicity), biopsychosocial factors (including childhood trauma/abuse history, substance abuse history, and sexual activity), and immunization history. Results A total of 440 charts were analyzed. When comparing demographics of patients that had complete vaccine regimens versus those who did not, the race was statistically significant (p=.006). The most prominent difference in race was seen for Black/African American patients; only 19.57% had a completed vaccine regimen documented. Regarding immunization history, vaccine schedules of hepatitis B, measles mumps rubella (MMR), inactivated polio vaccine (IPV), and varicella were most likely to be complete; pneumococcal conjugate vaccine (PCV) 13, rotavirus, influenza, and human papillomavirus vaccine (HPV) were least likely. There was no association found between a completed vaccine regimen and biopsychosocial variables. A larger portion of females (37.35%) completed the HPV vaccine compared to males (23.14%) (p=.009). Conclusions In this single-site study, this vulnerable, at-risk population of sheltered adolescents lacked the vaccinations recommended by the Centers for Disease Control and Prevention. Racial disparities further compounded this vulnerability for Black/African American teens. Additionally, a significantly greater number of female patients received the HPV vaccine compared to males.
Collapse
Affiliation(s)
- Cecilia E Zemanek
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Nina Liu
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Ceyda H Sablak
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Brittney A Gaudet
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Taylor L Jarvill
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Allison N Kayne
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jeffrey M Downen
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hope Kincaid
- Network Office of Research and Innovation, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Amy B Smith
- Division of Education, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Robert D Barraco
- Surgery, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hoonani M Cuadrado
- Community Health and Health Studies, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Marna R Greenberg
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| |
Collapse
|
13
|
Hoffer EP. Sick While Black: An Unhealthy Combination. Am J Med 2021; 134:7-8. [PMID: 32798456 PMCID: PMC7426747 DOI: 10.1016/j.amjmed.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 10/30/2022]
Affiliation(s)
- Edward P Hoffer
- Massachusetts General Hospital, Department of Medicine, Harvard, Boston, Mass.
| |
Collapse
|
14
|
Cooper DM, Afghani B, Byington CL, Cunningham CK, Golub S, Lu KD, Radom-Aizik S, Ross LF, Singh J, Smoyer WE, Lucas CT, Tunney J, Zaldivar F, Ulloa ER. SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges. Pediatr Res 2021; 90:966-970. [PMID: 33627824 PMCID: PMC7903864 DOI: 10.1038/s41390-021-01402-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023]
Abstract
As the nation implements SARS-CoV-2 vaccination in adults at an unprecedented scale, it is now essential to focus on the prospect of SARS-CoV-2 vaccinations in pediatric populations. To date, no children younger than 12 years have been enrolled in clinical trials. Key challenges and knowledge gaps that must be addressed include (1) rationale for vaccines in children, (2) possible effects of immune maturation during childhood, (3) ethical concerns, (4) unique needs of children with developmental disorders and chronic conditions, (5) health inequities, and (6) vaccine hesitancy. Because COVID-19 is minimally symptomatic in the vast majority of children, a higher acceptable risk threshold is required when evaluating pediatric clinical trials. Profound differences in innate and adaptive immunity during childhood and adolescence are known to affect vaccine responsiveness for a variety of childhood diseases. COVID-19 and the accompanying social disruption, such as the school shutdowns, has been disproportionately damaging to minority and low-income children. In this commentary, we briefly address each of these key issues, specify research gaps, and suggest a broader learning health system approach to accelerate testing and clinical trial development for an ethical and effective strategy to implement a pediatric SARS-CoV-2 vaccine as rapidly and safely as possible. IMPACT: As the US begins an unprecedented implementation of SARS-CoV-2 vaccination, substantial knowledge gaps have yet to be addressed regarding vaccinations in the pediatric population. Maturational changes in the immune system during childhood have influenced the effectiveness of pediatric vaccines for other diseases and conditions, and could affect SARS-CoV-2 vaccine responsiveness in children. Given that COVID-19 disease is far milder in the majority of children than in adults, the risk-benefit of a pediatric SARS-CoV-2 vaccine must be carefully weighed. The needs of children with developmental disabilities and with chronic disease must be addressed. Minority and low-income children have been disproportionately adversely affected by the COVID-19 pandemic; care must be taken to address issues of health equity regarding pediatric SARS-CoV-2 vaccine trials and allocation. Research and strategies to address general vaccine hesitancy in communities must be addressed in the context of pediatric SARS-CoV-2 vaccines.
Collapse
Affiliation(s)
- Dan M. Cooper
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Behnoush Afghani
- grid.266093.80000 0001 0668 7243Department of Pediatrics, UC Irvine School of Medicine, Irvine, CA USA
| | | | - Coleen K. Cunningham
- grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, NC USA
| | - Sidney Golub
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | - Kim D. Lu
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Shlomit Radom-Aizik
- grid.266093.80000 0001 0668 7243Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, Irvine, CA USA
| | - Lainie Friedman Ross
- grid.170205.10000 0004 1936 7822Department of Pediatrics, University of Chicago, Chicago, IL USA
| | - Jasjit Singh
- grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
| | - William E. Smoyer
- grid.261331.40000 0001 2285 7943Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Candice Taylor Lucas
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA
| | | | | | - Erlinda R. Ulloa
- grid.266093.80000 0001 0668 7243Institute for Clinical and Translational Science, UC Irvine, Irvine, CA USA ,grid.414164.20000 0004 0442 4003Division of Infectious Diseases, CHOC Children’s Hospital, Orange, CA USA
| |
Collapse
|
15
|
Lin FY, Wang CH. Personality and individual attitudes toward vaccination: a nationally representative survey in the United States. BMC Public Health 2020; 20:1759. [PMID: 33228661 PMCID: PMC7685575 DOI: 10.1186/s12889-020-09840-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although past studies have identified factors associated with individual perceptions of vaccination, limited attention has been paid to the role of personality in individual attitudes toward vaccination. This study aimed to evaluate the effect of personality as measured by the Big Five personality traits on individual attitudes toward vaccination using a nationally representative survey in the United States. Methods A cross-sectional study was conducted with a sample of 3276 American citizens who were aged 18 and above and lived in 50 U.S. states and Washington D.C. from the American National Election Studies. The survey was collected through face-to-face and online interviews using structured questionnaires in 2016. The multistage stratified cluster sampling procedure was used for face-to-face interview, whereas the USPS DSF was used to select the sample for online interview. Multivariable ordinal logistic regression was used to assess how personality traits (extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience) as main explanatory variables influence the outcome variables – individual attitudes toward health benefits of vaccination and support for school vaccination. Results More than two-thirds of respondents perceive health benefit of vaccination and support vaccination requirements for school entry, whereas about one-tenth of respondents have safety concerns about vaccination and oppose the vaccination requirements. After adjusting for ideology, insurance status, and demographic variables, the traits of agreeableness, conscientiousness and emotional stability remain significantly associated with attitude toward vaccination; conscientiousness is significantly associated with support for school vaccination. The odds of reporting health benefits of vaccination associated with one-point increase in agreeableness, conscientiousness and emotional stability are 1.05 (95% confidence intervals [CI] = 1.01–1.08), 1.05 (95% CI = 1.02–1.09) and 1.03 (95% CI = 1.00–1.06), respectively. For a one-point increase in conscientiousness, the odds of supporting school vaccination increase by 1.08 (95% CI = 1.05–1.12). Conclusions People high in agreeableness, conscientiousness and emotional stability are more likely to regard vaccination as beneficial, whereas those high in conscientiousness are more likely to support school-based vaccine requirement. This study highlights the importance of personality in shaping individual attitudes toward vaccination. More research is needed to understand the role of personality in individual health attitudes and behavior.
Collapse
Affiliation(s)
- Fang-Yu Lin
- Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX, 77030, USA
| | - Ching-Hsing Wang
- Department of Political Science, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan, Republic of China.
| |
Collapse
|
16
|
Vaccinating in the Emergency Department, a Novel Approach to Improve Influenza Vaccination Rates via a Quality Improvement Initiative. Pediatr Qual Saf 2020; 5:e322. [PMID: 32766495 PMCID: PMC7351463 DOI: 10.1097/pq9.0000000000000322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Annual influenza vaccination is recommended for all US children 6 months and older to prevent morbidity and mortality. Despite these recommendations, only ~50% of US children are vaccinated annually. Influenza vaccine administration in the pediatric emergency department (ED) is an innovative solution to improve vaccination rates. However, during the 2017–2018 influenza season, only 75 influenza vaccinations were given in this tertiary care ED. We aimed to increase the number of influenza vaccines administered to ED patients from 75 to 1,000 between August 2018 and March 2019.s Methods: Process mapping identified potential barriers and solutions. Key interventions included mandatory vaccine screening, creation of a vaccine administration protocol, education for family, provider, and nursing, a revised pharmacy workflow, and weekly staff feedback. Interventions were tested using plan-do-study-act cycles. The process measure was the percent of patients screened for vaccine status. The primary outcome was the number of influenza vaccines administered. The balancing measures were ED length of stay (LOS), wasted vaccines, and financial impact on the institution. Results: We included 33,311 children in this study. Screening for vaccine status improved from 0% to 90%. Of those screened, 58% were eligible for vaccination, and 8.5% of eligible patients were vaccinated in the ED. In total, 1,323 vaccines were administered with no significant change in ED LOS (139 min) and no lost revenue to the hospital. Conclusions: We implemented an efficient, cost-effective, influenza vaccination program in the pediatric ED and successfully increased vaccinations in a population that might not otherwise receive the vaccine.
Collapse
|
17
|
Up-to-date coverage with meningococcal vaccine among adolescents age 17 years: Patterns and correlates in the United States, 2017. Vaccine 2019; 37:5934-5938. [DOI: 10.1016/j.vaccine.2019.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022]
|