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Ru B, Kujawski S, Lee Afanador N, Baumgartner R, Pawaskar M, Das A. Predicting Measles Outbreaks in the United States: Evaluation of Machine Learning Approaches (Preprint). JMIR Form Res 2022; 7:e42832. [PMID: 37014694 PMCID: PMC10131820 DOI: 10.2196/42832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Measles, a highly contagious viral infection, is resurging in the United States, driven by international importation and declining domestic vaccination coverage. Despite this resurgence, measles outbreaks are still rare events that are difficult to predict. Improved methods to predict outbreaks at the county level would facilitate the optimal allocation of public health resources. OBJECTIVE We aimed to validate and compare extreme gradient boosting (XGBoost) and logistic regression, 2 supervised learning approaches, to predict the US counties most likely to experience measles cases. We also aimed to assess the performance of hybrid versions of these models that incorporated additional predictors generated by 2 clustering algorithms, hierarchical density-based spatial clustering of applications with noise (HDBSCAN) and unsupervised random forest (uRF). METHODS We constructed a supervised machine learning model based on XGBoost and unsupervised models based on HDBSCAN and uRF. The unsupervised models were used to investigate clustering patterns among counties with measles outbreaks; these clustering data were also incorporated into hybrid XGBoost models as additional input variables. The machine learning models were then compared to logistic regression models with and without input from the unsupervised models. RESULTS Both HDBSCAN and uRF identified clusters that included a high percentage of counties with measles outbreaks. XGBoost and XGBoost hybrid models outperformed logistic regression and logistic regression hybrid models, with the area under the receiver operating curve values of 0.920-0.926 versus 0.900-0.908, the area under the precision-recall curve values of 0.522-0.532 versus 0.485-0.513, and F2 scores of 0.595-0.601 versus 0.385-0.426. Logistic regression or logistic regression hybrid models had higher sensitivity than XGBoost or XGBoost hybrid models (0.837-0.857 vs 0.704-0.735) but a lower positive predictive value (0.122-0.141 vs 0.340-0.367) and specificity (0.793-0.821 vs 0.952-0.958). The hybrid versions of the logistic regression and XGBoost models had slightly higher areas under the precision-recall curve, specificity, and positive predictive values than the respective models that did not include any unsupervised features. CONCLUSIONS XGBoost provided more accurate predictions of measles cases at the county level compared with logistic regression. The threshold of prediction in this model can be adjusted to align with each county's resources, priorities, and risk for measles. While clustering pattern data from unsupervised machine learning approaches improved some aspects of model performance in this imbalanced data set, the optimal approach for the integration of such approaches with supervised machine learning models requires further investigation.
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Affiliation(s)
- Boshu Ru
- Merck & Co, Inc, West Point, PA, United States
| | | | | | | | | | - Amar Das
- Merck & Co, Inc, Rahway, NJ, United States
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2
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Shahani R, Chu J, Rufai OH, Zawar A, Muhideen S, Dilawar S, Amosun TS. Understanding the Role of Psychosocial Factors in Pakistani Parents' Hesitancy to Vaccinate Their Kids: The Mediating Role of Knowledge and Mistrust of Science about the COVID-19 Vaccine. Vaccines (Basel) 2022; 10:1260. [PMID: 36016148 PMCID: PMC9413987 DOI: 10.3390/vaccines10081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccination is a vital component in the battle against outbreaks of infectious diseases. Recognizing parents' reluctance to vaccinate their children is even more critical now, given the ongoing threat of a COVID-19 pandemic. Conspiracy theories, vaccination safety concerns, parental efficacy and risk perception, and a lack of confidence in science all influence intention. To investigate how these variables interact with vaccination behavior against COVID-19, we developed a model with psychosocial factors serving as the predictor and mistrust in science and vaccine knowledge serving as the mediator. In order to validate the model, the parents' intentions regarding their children's vaccination with COVID-19 were used. The study included 454 Pakistani parents who completed an online questionnaire assessing their intention to vaccinate their children. We analyzed the data using structural equation modeling (SEM). A significant level of vaccine hesitation is due to belief in vaccine conspiracy theories, and vaccine safety concerns were investigated. A surprising correlation exists between risk perception and vaccination intentions, followed by parental self-efficacy. It is significant to note that vaccine knowledge mediated conspiracy beliefs, risk perceptions, and intentions fully but partially mediated parental self-efficacy. Conspiracy theories were mediated by a mistrust in science, while perceptions of risk and vaccine safety were partially mediated. The findings of this research were used to develop sensible policy reforms and public health campaigns to encourage vaccination against both common infections such as measles, human papillomaviruses, or pertussis, and novel diseases such as COVID-19.
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Affiliation(s)
- Riffat Shahani
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Jianxun Chu
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Olayemi Hafeez Rufai
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Asma Zawar
- School of Public Affairs, University of Science and Technology of China, Hefei 230052, China
| | - Sayibu Muhideen
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
| | - Sana Dilawar
- School of Public Affairs, University of Science and Technology of China, Hefei 230052, China
| | - Tunde Simeon Amosun
- School of Humaities and Social Sciences, University of Science and Technology of China, Hefei 230052, China
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3
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Pawaskar M, Fergie J, Harley C, Samant S, Veeranki P, Diaz O, Conway JH. Impact of universal varicella vaccination on the use and cost of antibiotics and antivirals for varicella management in the United States. PLoS One 2022; 17:e0269916. [PMID: 35687559 PMCID: PMC9187103 DOI: 10.1371/journal.pone.0269916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Our objective was to estimate the impact of universal varicella vaccination (UVV) on the use and costs of antibiotics and antivirals for the management of varicella among children in the United States (US).
Methods
A decision tree model of varicella vaccination, infections and treatment decisions was developed. Results were extrapolated to the 2017 population of 73.5 million US children. Model parameters were populated from published sources. Treatment decisions were derived from a survey of health care professionals’ recommendations. The base case modelled current vaccination coverage rates in the US with additional scenarios analyses conducted for 0%, 20%, and 80% coverage and did not account for herd immunity benefits.
Results
Our model estimated that 551,434 varicella cases occurred annually among children ≤ 18 years in 2017. Antivirals or antibiotics were prescribed in 23.9% of cases, with unvaccinated children receiving the majority for base case. The annual cost for varicella antiviral and antibiotic treatment was approximately $14 million ($26 per case), with cases with no complications accounting for $12 million. Compared with the no vaccination scenario, the current vaccination rates resulted in savings of $181 million (94.7%) for antivirals and $78 million (95.0%) for antibiotics annually. Scenario analyses showed that higher vaccination coverage (from 0% to 80%) resulted in reduced annual expenditures for antivirals (from $191 million to $41 million), and antibiotics ($82 million to $17 million).
Conclusions
UVV was associated with significant reductions in the use of antibiotics and antivirals and their associated costs in the US. Higher vaccination coverage was associated with lower use and costs of antibiotics and antivirals for varicella management.
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Affiliation(s)
- Manjiri Pawaskar
- Merck & Co. Inc., Rahway, New Jersey, United States of America
- * E-mail:
| | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas, United States of America
| | - Carolyn Harley
- PRECISIONheor, Los Angeles, California, United States of America
| | - Salome Samant
- Merck & Co. Inc., Rahway, New Jersey, United States of America
| | - Phani Veeranki
- PRECISIONheor, Los Angeles, California, United States of America
| | - Oliver Diaz
- PRECISIONheor, Los Angeles, California, United States of America
| | - James H. Conway
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
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4
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Rosas SL, Simpson HJ, Martinez C, Walker JA, Forster J, Deyo-Svendsen M, Phillips M, Evers K. Improving Immunization Rates During the 2019 Measles Outbreak. J Prim Care Community Health 2022; 13:21501319211069271. [PMID: 35144495 PMCID: PMC8841912 DOI: 10.1177/21501319211069271] [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: 11/25/2022] Open
Abstract
In 2019, there were multiple outbreaks of measles in the United States. In the context of the public awareness of these outbreaks, we performed an intervention with the intent to improve the rate of measles immunization in our pediatric population. Pediatric patients that were lacking adequate measles immunization were identified by electronic medical record (EMR) survey. Charts were reviewed and updated if records were found to be incomplete. Parents of the remaining children were sent a letter, personally signed by the child’s primary care provider, encouraging measles immunization. A measles fact sheet, produced by the United States Center for Disease Control, was also included with the letter. There were 44 patients in the study group whose parents received a letter and measles fact sheet. As a result, 5 of these children were brought in for a measles, mumps, and rubella (MMR) immunization. The 44 patients whose parents received a letter included 20 patients whose parents had previously expressed intent to not vaccinate their children as documented in the EMR. None of these children received an MMR immunization. Although small in scope, this project provides a glimpse into the importance of personal provider guidance to parents who are inclined to immunize their children. Unfortunately, it also demonstrated that provider advice did not change the opinions of parents who had already taken a stance against vaccination, even in the context of an urgent public health situation that had garnered widespread coverage in the lay press and social media.
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Affiliation(s)
| | - Henry J Simpson
- Mayo Clinic Health System Red Cedar-Family Medicine, Menomonie, WI, USA
| | | | - James A Walker
- Mayo Clinic Health System Red Cedar-Family Medicine, Menomonie, WI, USA
| | - Jeremy Forster
- Mayo Clinic Health System Red Cedar-Pediatrics, Menomonie, WI, USA
| | | | - Michael Phillips
- Mayo Clinic Health System Red Cedar-Family Medicine, Menomonie, WI, USA
| | - Kaylie Evers
- University of Minnesota Medical School Twin Cities, Minneapolis, MN, USA
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5
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McDuffie DC. Sacred immunity: religion, vaccines, and the protection of public health in America. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01254-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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6
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Immunization practices and risk of anaphylaxis: a current update, comprehensive of COVID-19 vaccination data. Curr Opin Allergy Clin Immunol 2021; 21:418-425. [PMID: 34269740 DOI: 10.1097/aci.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims to provide an updated report in regards to the correlation between vaccines and anaphylaxis and the related risk in the population. RECENT FINDINGS Initial reports showed higher incidence of anaphylaxis following messenger RNA COVID-19 vaccines compared with 'routine' vaccinations, likely influenced by the great attention paid to these 'new' vaccines. However, anaphylaxis has still to be considered quite rare and its incidence will be systematically reconsidered in the light of additional data collected. SUMMARY Adverse reactions to vaccines are commonly reported but most of them are nonspecific mild events, whereas vaccine-related anaphylaxis is considered a rare event, with an incidence rate equal to 1.3 cases per million vaccine doses administered. As anaphylaxis reports usually start to be reported to passive pharmacovigilance during postmarketing surveillance, the first data are used to be influenced by under- and over-reporting and lack of denominators and following studies are needed to confirm the causal relationship. This might create an initial overcautiously approach to new immunization practices but, being anaphylaxis a potential life-threatening event, every suspected contraindication has to be deepened to maximize effectiveness and safety profile and constantly redefined not to exclude an overestimated population group who could receive the vaccine uneventfully.
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7
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Scannell D, Desens L, Guadagno M, Tra Y, Acker E, Sheridan K, Rosner M, Mathieu J, Fulk M. COVID-19 Vaccine Discourse on Twitter: A Content Analysis of Persuasion Techniques, Sentiment and Mis/Disinformation. JOURNAL OF HEALTH COMMUNICATION 2021; 26:443-459. [PMID: 34346288 DOI: 10.1080/10810730.2021.1955050] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This research aims to understand the persuasion techniques used in Twitter posts about COVID-19 vaccines by the different vaccine sentiments (i.e., Pro-Vaccine, Anti-Vaccine, and Neutral) using the Elaboration Likelihood Model, Social judgment Theory, and the Extended Parallel Process Model as theoretical frameworks. A content analysis was conducted on a data set of 1,000 Twitter posts. The corpus of Tweets was examined using the persuasion frameworks; tweets that were identified as emanating from bots were further examined. Results found Anti-Vaccine messages predominantly used Anecdotal stories, Humor/Sarcasm, and Celebrity figures as persuasion techniques, while Pro-Vaccine messages primarily used Information, Celebrity figures, and Participation. Results also showed the Anti-Vaccine messages primarily focused on values related to the categories of Safety, Political/Conspiracy Theories, and Choice. Finally, results revealed Anti-Vaccine messages primarily used Perceived Severity and Perceived Susceptibility, which are fear appeal elements. The findings for messages by bots were comparable to the messages in the larger corpus of tweets. Based on the findings, a response framework-Health Information Persuasion Exploration (HIPE)-is proposed to address mis/disinformation and Anti-Vaccine messaging. The results of this study and the HIPE framework can inform a national COVID-19 vaccine health campaign to increase vaccine adoption.
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Affiliation(s)
- Denise Scannell
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Linda Desens
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Marie Guadagno
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Yolande Tra
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Emily Acker
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Kate Sheridan
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Margo Rosner
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Jennifer Mathieu
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
| | - Mike Fulk
- Health Innovation Center, The MITRE Corporation, McLean, Virginia, USA
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8
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Holroyd TA, Howa AC, Proveaux TM, Delamater PL, Klein NP, Buttenheim AM, Limaye RJ, Omer SB, Salmon DA. School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California. Hum Vaccin Immunother 2021; 17:1986-1993. [PMID: 33493075 DOI: 10.1080/21645515.2020.1857202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Howa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tina M Proveaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Feldman AG, Marsh R, Kempe A, Morris MA. Barriers to Pretransplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders. J Pediatr 2020; 227:60-68. [PMID: 32681988 PMCID: PMC7686014 DOI: 10.1016/j.jpeds.2020.07.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To describe the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pretransplant immunization rates. STUDY DESIGN Semistructured interviews were conducted with transplant team members (hepatologists, cardiologists, nephrologists, transplant nurse coordinators, and transplant infectious diseases physicians), primary care physicians, and parents of heart, liver, and kidney transplant recipients at 3 geographically diverse large pediatric transplant centers in the US. Interviews were conducted between July 2017 and February 2020 until thematic saturation was reached within each stakeholder subgroup. Content analysis methodology was used to identify themes. RESULTS Stakeholders participated in 30- to 60-minute interviews (16 transplant subspecialists, 3 transplant infectious diseases physicians, 11 transplant nurse coordinators, 12 primary care physicians, and 40 parents). Five central themes emerged: (1) gaps in knowledge about timing and safety of pretransplant immunizations, (2) lack of communication, coordination, and follow-up between team members regarding immunizations, (3) lack of centralized immunization records, (4) subspecialty clinic functioning as the medical home for transplant candidates but unable to provide all needed immunizations, and (5) differences between organ type in prioritization and completion of pretransplant immunization. CONCLUSIONS There are multiple factors that contribute to low immunization rates among pediatric transplant candidates. New tools are needed to overcome these barriers and increase immunization rates in transplant candidates.
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Affiliation(s)
- Amy G. Feldman
- Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine & Children’s Hospital Colorado
| | - Rebekah Marsh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado
| | - Allison Kempe
- Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine & Children’s Hospital Colorado
| | - Megan A. Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado & Children’s Hospital Colorado
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10
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The Importance of Prioritizing Pre and Posttransplant Immunizations in an Era of Vaccine Refusal and Epidemic Outbreaks. Transplantation 2020; 104:33-38. [PMID: 31876696 DOI: 10.1097/tp.0000000000002936] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vaccine-preventable infections are occurring at epidemic rates both nationally and internationally. At the same time, rates of vaccine hesitancy and refusal are increasing across the country leading to decreased herd immunity. For immunosuppressed transplant recipients, this situation poses great risk. Currently, 1 in 6 pediatric solid organ transplant recipients is hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. For many recipients, these infections result in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, despite this risk many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. As a transplant community, we must prioritize immunizations in both pre and posttransplant care. Research is needed to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. Finally, recommendations about administration of live vaccines posttransplant may need to be reevaluated in the setting of measles outbreaks and decreased herd immunity.
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11
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Connell AR, Connell J, Leahy TR, Hassan J. Mumps Outbreaks in Vaccinated Populations-Is It Time to Re-assess the Clinical Efficacy of Vaccines? Front Immunol 2020; 11:2089. [PMID: 33072071 PMCID: PMC7531022 DOI: 10.3389/fimmu.2020.02089] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/31/2020] [Indexed: 01/05/2023] Open
Abstract
History illustrates the remarkable public health impact of mass vaccination, by dramatically improving life expectancy and reducing the burden of infectious diseases and co-morbidities worldwide. It has been perceived that if an individual adhered to the MMR vaccine schedule that immunity to mumps virus (MuV) would be lifelong. Recent mumps outbreaks in individuals who had received two doses of the Measles Mumps Rubella (MMR) vaccine has challenged the efficacy of the MMR vaccine. However, clinical symptoms, complications, viral shedding and transmission associated with mumps infection has been shown to be reduced in vaccinated individuals, demonstrating a benefit of this vaccine. Therefore, the question of what constitutes a good mumps vaccine and how its impact is assessed in this modern era remains to be addressed. Epidemiology of the individuals most affected by the outbreaks (predominantly young adults) and variance in the circulating MuV genotype have been well-described alluding to a collection of influences such as vaccine hesitancy, heterogeneous vaccine uptake, primary, and/or secondary vaccine failures. This review aims to discuss in detail the interplay of factors thought to be contributing to the current mumps outbreaks seen in highly vaccinated populations. In addition, how mumps diagnoses has progressed and impacted the understanding of mumps infection since a mumps vaccine was first developed, the limitations of current laboratory tests in confirming protection in vaccinated individuals and how vaccine effectiveness is quantified are also considered. By highlighting knowledge gaps within this area, this state-of-the-art review proposes a change of perspective regarding the impact of a vaccine in a highly vaccinated population from a clinical, diagnostic and public perspective, highlighting a need for a paradigm shift on what is considered vaccine immunity.
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Affiliation(s)
- Anna R. Connell
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - T. Ronan Leahy
- Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, University of Dublin, Trinity College, Dublin, Ireland
| | - Jaythoon Hassan
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
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12
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Buckman C, Liu IC, Cortright L, Tumin D, Syed S. The influence of local political trends on childhood vaccine completion in North Carolina. Soc Sci Med 2020; 260:113187. [DOI: 10.1016/j.socscimed.2020.113187] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 01/13/2023]
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13
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Glanternik JR, McDonald JC, Yee AH, Howell Ba A, Saba KN, Mellor RG, Fireman B, Klein NP. Evaluation of a Vaccine-Communication Tool for Physicians. J Pediatr 2020; 224:72-78.e1. [PMID: 32522526 DOI: 10.1016/j.jpeds.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate a Kaiser Permanente Northern California physician training tool entitled "Effective Communication without Confrontation" aimed at improving communication with vaccine-hesitant parents, building trust, and alleviating physician stress surrounding vaccination visits. STUDY DESIGN Trainings were held May to July 2015. Pre- and post-training surveys assessed physician comfort and perceived effectiveness in communicating with vaccine-hesitant parents. We measured vaccination coverage at the 2-, 4-, and 6-month well-child visits, and days undervaccinated at 9 months of age. We compared vaccination rates before and after the training. RESULTS Of 415 physicians who received training, 249 completed post-training surveys. Physicians reported that the training helped them feel "much more or more" comfortable talking with parents who are unsure (72.3%), want to delay (73.9%), or refuse (63.5%) vaccinations and "much more or more" effective at persuading parents who are unsure (67.5%) or want to delay vaccinations (61.4%). They reported feeling "the same or less" effective persuading parents who refuse vaccinations (66.3%). Vaccine coverage remained unchanged and high from before to after the training (95%-96%), as did parent satisfaction with his or her child's provider (4.73/5.00). CONCLUSIONS The Effective Communication without Confrontation training did not increase vaccine coverage, but did improve physicians' comfort and perceived effectiveness communicating with most vaccine-hesitant parents and may help to ease potentially stressful vaccination visits.
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Affiliation(s)
- Julia R Glanternik
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA.
| | - Julia C McDonald
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Arnold H Yee
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
| | - Amanda Howell Ba
- Regional Health Education, Kaiser Permanente Northern California, Oakland, CA
| | - Katrina N Saba
- Department of Pediatrics, Kaiser Permanente, Oakland, CA
| | - R Grant Mellor
- Department of Pediatrics, Kaiser Permanente, Stockton, CA
| | - Bruce Fireman
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
| | - Nicola P Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA
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14
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Abstract
A significant minority of patients and parents are vaccine hesitant, defined as having the desire to delay or defer immunizations despite easy access to vaccines. Vaccine hesitancy exists along a spectrum, from patients who are concerned but willing to accept the recommended vaccine schedule to those who wish to use a delayed schedule to those who refuse vaccines altogether. A strong recommendation in favor of a vaccine is the most important reason a patient or parent accepts the immunization. Structural changes, such as removing personal and religious exemptions for vaccines required for attending school, are effective tools in increasing vaccination rates.
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Affiliation(s)
- Jamie Loehr
- Cayuga Family Medicine, 302 West Seneca Street, Ithaca, NY 14850, USA.
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15
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Lebrun-Harris LA, Mendel Van Alstyne JA, Sripipatana A. Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers. Vaccine 2020; 38:6120-6126. [PMID: 32713680 PMCID: PMC7378489 DOI: 10.1016/j.vaccine.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. METHODS Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination. RESULTS Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93). CONCLUSIONS Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.
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Affiliation(s)
- Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville MD, United States.
| | - Judith A Mendel Van Alstyne
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
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16
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Williams JT. The School Vaccination Assessment Program: A Physician’s Perspective. Am J Public Health 2020. [DOI: 10.2105/ajph.2020.305691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joshua T. B. Williams
- Joshua T. B. Williams is with the Department of Pediatrics, Ambulatory Care Services, Denver Health Medical Center, Denver, CO, and the Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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17
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Mellerson JL, Street E, Knighton C, Calhoun K, Seither R, Underwood JM. Centers for Disease Control and Prevention's School Vaccination Assessment: Collaboration With US State, Local, and Territorial Immunization Programs, 2012-2018. Am J Public Health 2020; 110:1092-1097. [PMID: 32437281 DOI: 10.2105/ajph.2020.305643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the ongoing collaboration of the Centers for Disease Control and Prevention's (CDC's) school vaccination assessment with state, local, and territorial immunization programs to provide data to monitor school entry vaccination.Methods. Departments of health and education partner to collect data from public school, private school, and homeschooled kindergartners in the 50 US states, the District of Columbia, 2 cities, and the US territories. Immunization programs submit vaccination coverage and exemption data to the CDC, and the CDC reports these data annually via multiple sources.Results. Among the 50 states and the District of Columbia, the number of programs using a census for vaccination coverage data increased from 39 to 41 during the school years 2012-2013 to 2017-2018 (which for most states was August or September through May or June), and the number using a census to collect exemption data increased from 40 to 46. The number of states that reported sharing their local-level vaccination coverage data online increased from 11 in 2012-2013 to 31 in 2017-2018.Conclusions. Coverage data can be used to address undervaccination among kindergartners to work with communities and schools that are susceptible to vaccine-preventable diseases. As more states publish local-level data online, access to improved data provides the public more valuable information.
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Affiliation(s)
- Jenelle L Mellerson
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Erica Street
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Cynthia Knighton
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Kayla Calhoun
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Ranee Seither
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - J Michael Underwood
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
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18
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Mehta RS, Rosenberg NA. Modelling anti-vaccine sentiment as a cultural pathogen. EVOLUTIONARY HUMAN SCIENCES 2020; 2:e21. [PMID: 37588376 PMCID: PMC10427458 DOI: 10.1017/ehs.2020.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Culturally transmitted traits that have deleterious effects on health-related traits can be regarded as cultural pathogens. A cultural pathogen can produce coupled dynamics with its associated health-related traits, so that understanding the dynamics of a health-related trait benefits from consideration of the dynamics of the associated cultural pathogen. Here, we treat anti-vaccine sentiment as a cultural pathogen, modelling its 'infection' dynamics with the infection dynamics of the associated vaccine-preventable disease. In a coupled susceptible-infected-resistant (SIR) model, consisting of an SIR model for the anti-vaccine sentiment and an interacting SIR model for the infectious disease, we explore the effect of anti-vaccine sentiment on disease dynamics. We find that disease endemism is contingent on the presence of the sentiment, and that presence of sentiment can enable diseases to become endemic when they would otherwise have disappeared. Furthermore, the sentiment dynamics can create situations in which the disease suddenly returns after a long period of dormancy. We study the effect of assortative sentiment-based interactions on the dynamics of sentiment and disease, identifying a tradeoff whereby assortative meeting aids the spread of a disease but hinders the spread of sentiment. Our results can contribute to finding strategies that reduce the impact of a cultural pathogen on disease, illuminating the value of cultural evolutionary modelling in the analysis of disease dynamics.
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Affiliation(s)
- Rohan S. Mehta
- Department of Biology, Stanford University, Stanford, CA94305, USA
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19
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Dudley MZ, Halsey NA, Omer SB, Orenstein WA, O'Leary ST, Limaye RJ, Salmon DA. The state of vaccine safety science: systematic reviews of the evidence. THE LANCET. INFECTIOUS DISEASES 2020; 20:e80-e89. [PMID: 32278359 DOI: 10.1016/s1473-3099(20)30130-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 11/24/2022]
Abstract
This Review updates the scientific evidence assessing possible causal associations of adverse events following immunisation (AEFI) compiled in the 2012 report from the Institute of Medicine and the 2014 report from the Agency for Healthcare Research and Quality. For 12 of 46 AEFI examined, a causal relationship has been established with at least one vaccine currently routinely recommended to the general USA population: anaphylaxis, arthralgia or arthritis (mild, acute, and transient, not chronic), deltoid bursitis (when vaccine is administered improperly), disseminated varicella infection (in immune deficient individuals for whom the varicella vaccine is contraindicated), encephalitis, febrile seizures, Guillain-Barré syndrome, hepatitis (in immune deficient individuals for whom the varicella vaccine is contraindicated), herpes zoster, immune thrombocytopenic purpura, meningitis, and syncope. Other than mild acute and transient arthralgia or arthritis, which is very common in adult women after rubella vaccine, these adverse reactions are rare or very rare. Vaccines have an excellent safety profile overall and provide protection against infectious diseases to individuals and the general population.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Institute of Vaccine Safety, Johns Hopkins University, Baltimore, MD, USA
| | - Neal A Halsey
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Institute of Vaccine Safety, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Saad B Omer
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale School for Global Health, and Yale School of Medicine, New Haven, CT, USA
| | - Walter A Orenstein
- Department of Pediatrics and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, USA
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and Department of Pediatrics, Anschutz Medical Campus and Children's Hospital, University of Colorado, Aurora, CO, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Institute of Vaccine Safety, Johns Hopkins University, Baltimore, MD, USA; Department of Health, Behavior & Society, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Institute of Vaccine Safety, Johns Hopkins University, Baltimore, MD, USA; Department of Health, Behavior & Society, Johns Hopkins University, Baltimore, MD, USA.
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20
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Abstract
Evidence consistently shows that vaccines are safe, effective, and cost-efficient. Yet preventable outbreaks of infectious diseases are occurring in the United States, leading to a strong public response and intense scrutiny of the antivaccine movement and its persistent spread of misinformation. Social media has been a major platform for such misinformation, and recent examinations have found that nurses are not exempt from engaging in antivaccine discourse.By practicing evidence-based care, addressing health literacy, and becoming involved in public health policy, nurses can be excellent advocates for immunization and may help prevent additional outbreaks of preventable diseases.
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Affiliation(s)
- Lindsey Danielson
- Lindsey Danielson is a recent graduate of the Georgetown University School of Nursing and Health Studies and resides in Houston, TX; Blima Marcus is an adjunct professor at the Hunter-Bellevue School of Nursing in New York City; and Lori Boyle is an NP at Associates in Vascular Care in Middletown, NJ. Contact author: Lindsey Danielson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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21
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Garnier R, Nedell ER, Omer SB, Bansal S. Getting Personal: How Childhood Vaccination Policies Shape the Landscape of Vaccine Exemptions. Open Forum Infect Dis 2020; 7:ofaa088. [PMID: 32258205 PMCID: PMC7111605 DOI: 10.1093/ofid/ofaa088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/12/2020] [Indexed: 02/02/2023] Open
Abstract
Background State-mandated school entry immunization requirements in the United States play an important role in achieving high vaccine coverage, but variations in vaccine exemption policies result in a patchwork of vaccine coverage across the country. Methods In this study, we evaluate epidemiological effects and spatial variations in nonmedical exemption (NME) rates in the context of vaccine policies. We first analyze the correlation between NME rates and vaccine coverage for 3 significant childhood vaccinations. Furthermore, we assess the effects of policy changes in a subset of states, using a correlative approach at the state level and performing a clustering analysis at the county level. Results We find that higher rates of exemptions are associated with lower vaccination rates of school-aged children in all cases. In a subset of states where exemption policy has recently changed, we show that the effects on statewide NME rates vary widely and that decreases in NMEs can lead to an increase in other types of exemptions. Finally, our clustering analysis in California, Illinois, and Connecticut shows that policy changes affect the spatial distribution of NMEs. Conclusions Our work suggests that vaccination policies have significant impacts on patterns of herd immunity. Our findings can be used to develop evidence-based vaccine legislation.
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Affiliation(s)
- Romain Garnier
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Emma R Nedell
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Conneticut, USA.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
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22
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Vassantachart JM, Yeo AH, Vassantachart AY, Jacob SE, Golkar L. Art of prevention: The importance of measles recognition and vaccination. Int J Womens Dermatol 2020; 6:89-93. [PMID: 32258338 PMCID: PMC7105691 DOI: 10.1016/j.ijwd.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022] Open
Abstract
Measles is a viral infection that has a characteristic pattern of prodromal symptoms followed by a rash. Previously considered an inevitable childhood condition, measles is known as the "first" classic childhood exanthem. For most children, measles was a one-time, short-term illness; however, some children developed complications that led to severe sequelae and death. The introduction of the measles vaccine dramatically decreased the number of cases, but the current trend against vaccination has caused outbreaks of the condition. We propose the implementation of the AAA approach (assume, advise, and answer) as a way for providers to directly encourage the administration of the vaccine and prevent future cases of measles.
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Affiliation(s)
| | - Anthony H. Yeo
- Department of Psychiatry, Loma Linda University, Loma Linda, California
| | | | - Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
| | - Linda Golkar
- Department of Dermatology, Loma Linda University, Loma Linda, California
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23
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Garcia TB, O'Leary ST. Dismissal policies for vaccine refusal among US physicians: a literature review. Hum Vaccin Immunother 2020; 16:1189-1193. [PMID: 32078411 DOI: 10.1080/21645515.2020.1724742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Childhood vaccination is one of the greatest public health achievements of the 20th century, yet increasingly, parents question the safety of and need for vaccines. This has led to increased rates of vaccine delay and refusal and outbreaks of vaccine-preventable diseases. Physicians struggle with how to respond to families who refuse vaccines, as there are few known effective interventions to convince a family to vaccinate. In the United States, the practice of dismissing families for vaccine refusal appears to be increasing as a strategy for dealing with vaccine refusal. In this review, we review the literature surrounding this controversial practice, starting with the impact that vaccine-refusing families have on medical practices, followed by a review of dismissal policies of US physicians, and ending with a discussion of the ethics of this practice.
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Affiliation(s)
- Tamara B Garcia
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
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24
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Sato R, Makino-Okamura C, Lin Q, Wang M, Shoemaker JE, Kurosaki T, Fukuyama H. Repurposing the psoriasis drug Oxarol to an ointment adjuvant for the influenza vaccine. Int Immunol 2020; 32:499-507. [PMID: 32060507 DOI: 10.1093/intimm/dxaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Aluminum precipitates have long been used as adjuvants for human vaccines, but there is a clear need for safer and more effective adjuvants. Here we report in a mouse model that the psoriasis drug Oxarol ointment is a highly effective vaccine adjuvant. By applying Oxarol ointment onto skin, humoral responses and germinal center (GC) reactions were augmented, and the treated mice were protected from death caused by influenza virus infection. Keratinocyte-specific vitamin D3 receptor (Vdr) gene expression was required for these responses through induction of the thymic stromal lymphopoietin (Tslp) gene. Experiments involving administration of recombinant TSLP or, conversely, anti-TSLP antibody demonstrated that TSLP plays a key role in the GC reactions. Furthermore, cell-type-specific Tslpr gene deletion or diphtheria toxin-mediated deletion of specific cell types revealed that CD11c+ cells excluding Langerhans cells were responsible for the Oxarol-mediated GC reactions. These results indicate that active vitamin D3 is able to enhance the humoral response via Tslp induction in the skin and serves as a new vaccine adjuvant.
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Affiliation(s)
- Ryota Sato
- Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan.,Cell Integrative Science Laboratory, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Chieko Makino-Okamura
- Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Quingshun Lin
- Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Muying Wang
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason E Shoemaker
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,The McGowan Institute for Regenerative Medicine (MIRM), University of Pittsburgh, Pittsburgh, PA, USA.,Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tomohiro Kurosaki
- Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan.,Laboratory of Lymphocyte Differentiation, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Hidehiro Fukuyama
- Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan.,Cell Integrative Science Laboratory, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan.,INSERM EST, France
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25
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of school-entry vaccination requirements and related exemption policies in the United States and examines recent changes to these policies. RECENT FINDINGS With recent infectious disease outbreaks in the United States, there has been heightened awareness on unvaccinated individuals, and the state-level policies that allow individuals to be exempted from school-entry vaccination requirements. Between 2015 and 2017, there have been eleven states that have altered their policies regarding school-entry vaccination requirements and related reporting for which no formal evaluations have been published. One policy change during that period, California SB 277, which became law in 2016, reduced the nonmedical exemption and increased the childhood vaccination coverage rate in that state, though with some evidence of exemption replacement through the use of medical exemptions. Through September 2019, five additional state law changes have been enacted. SUMMARY The large number of heterogeneous changes to state-level policies for school-entry vaccination requirements in recent years need rigorous evaluation to identify best practices for balancing public health authority and parental autonomy while seeking to achieve the highest level of infectious disease prevention for children.
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26
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Hyle EP, Rao SR, Bangs AC, Gastañaduy P, Fiebelkorn AP, Hagmann SH, Walker AT, Walensky RP, Ryan ET, LaRocque RC. Clinical Practices for Measles-Mumps-Rubella Vaccination Among US Pediatric International Travelers. JAMA Pediatr 2020; 174:e194515. [PMID: 31816033 PMCID: PMC6902185 DOI: 10.1001/jamapediatrics.2019.4515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE The US population is experiencing a resurgence of measles, with more than 1000 cases during the first 6 months of 2019. Imported measles cases among returning international travelers are the source of most US measles outbreaks, and these importations can be reduced with pretravel measles-mumps-rubella (MMR) vaccination of pediatric travelers. Although it is estimated that children account for less than 10% of US international travelers, pediatric travelers account for 47% of all known measles importations. OBJECTIVE To examine clinical practice regarding MMR vaccination of pediatric international travelers and to identify reasons for nonvaccination of pediatric travelers identified as MMR eligible. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of pediatric travelers (ages ≥6 months and <18 years) attending pretravel consultation at 29 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-supported consortium of clinical sites that provide pretravel consultations, was performed from January 1, 2009, through December 31, 2018. MAIN OUTCOMES AND MEASURES Measles-mumps-rubella vaccination among MMR vaccination-eligible pediatric travelers. RESULTS Of 14 602 pretravel consultations for pediatric international travelers, 2864 travelers (19.6%; 1475 [51.5%] males; 1389 [48.5%] females) were eligible to receive pretravel MMR vaccination at the time of the consultation: 365 of 398 infants aged 6 to 12 months (91.7%), 2161 of 3623 preschool-aged travelers aged 1 to 6 years (59.6%), and 338 of 10 581 school-aged travelers aged 6 to 18 years (3.2%). Of 2864 total MMR vaccination-eligible travelers, 1182 (41.3%) received the MMR vaccine and 1682 (58.7%) did not. The MMR vaccination-eligible travelers who did not receive vaccine included 161 of 365 infants (44.1%), 1222 of 2161 preschool-aged travelers (56.5%), and 299 of 338 school-aged travelers (88.5%). We observed a diversity of clinical practice at different GTEN sites. In multivariable analysis, MMR vaccination-eligible pediatric travelers were less likely to be vaccinated at the pretravel consultation if they were school-aged (model 1: odds ratio [OR], 0.32 [95% CI, 0.24-0.42; P < .001]; model 2: OR, 0.26 [95% CI, 0.14-0.47; P < .001]) or evaluated at specific GTEN sites (South: OR, 0.06 [95% CI, 0.01-0.52; P < .001]; West: OR, 0.10 [95% CI, 0.02-0.47; P < .001]). The most common reasons for nonvaccination were clinician decision not to administer MMR vaccine (621 of 1682 travelers [36.9%]) and guardian refusal (612 [36.4%]). CONCLUSIONS AND RELEVANCE Although most infant and preschool-aged travelers evaluated at GTEN sites were eligible for pretravel MMR vaccination, only 41.3% were vaccinated during pretravel consultation, mostly because of clinician decision or guardian refusal. Strategies may be needed to improve MMR vaccination among pediatric travelers and to reduce measles importations and outbreaks in the United States.
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Affiliation(s)
- Emily P. Hyle
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital, Boston,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston,Division of Infectious Diseases, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts
| | - Sowmya R. Rao
- Massachusetts General Hospital Biostatistics Center, Massachusetts General Hospital, Boston,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Audrey C. Bangs
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston
| | - Paul Gastañaduy
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan H.F. Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston,Division of Infectious Diseases, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts
| | - Edward T. Ryan
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital, Boston,Division of Infectious Diseases, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts
| | - Regina C. LaRocque
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital, Boston,Division of Infectious Diseases, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts
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27
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Abstract
PURPOSE OF REVIEW In September 2019, the United States was at risk of losing measles elimination status due to several large-scale outbreaks resulting in more than 1200 confirmed cases across 31 states. This resurgence caps approximately 10 years of increasing incidence, marked by a highly publicized outbreak in 2015 associated with Disneyland when an infected traveler from the Philippines unknowingly spread the virus to susceptible park visitors and the recently ended large outbreak in undervaccinated Orthodox Jewish communities in New York City and Rockland counties. This review highlights current literature elucidating factors associated with current trends in measles epidemiology in the United States, the public health implications of current measles outbreaks and a path forward for addressing challenges contributing to the resurgence of measles in the United States and globally. RECENT FINDINGS AND SUMMARY As the most highly transmissible vaccine preventable disease, measles is especially sensitive to changes in herd immunity, the impact of vaccine refusal and globalization. Results highlight the confluence of these factors in current outbreaks, provide tools to predict outbreak risk, demonstrate the growing impact of misinformation and evaluate the impact of policy approaches for outbreak control and prevention.
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28
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Srivastava T, Emmer K, Feemster KA. Impact of school-entry vaccination requirement changes on clinical practice implementation and adolescent vaccination rates in metropolitan Philadelphia. Hum Vaccin Immunother 2020; 16:1155-1165. [PMID: 31977274 DOI: 10.1080/21645515.2020.1712934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In 2017, Pennsylvania amended school-entry vaccination requirements including reduction of the provisional period from eight months to the first five days of school and requirement of meningococcal-conjugate vaccine (MCV4) for students entering 12th grade. This cross-sectional study evaluates the impact of these new requirements on clinical practice and vaccination rates among requirement-eligible adolescents within a large pediatric network in metropolitan Philadelphia. We surveyed providers from 24 pediatric primary care facilities across five Southeastern Pennsylvania counties to assess strategies for timely vaccination of children, facilitators and barriers to implementation of these strategies, and attitudes toward the new school vaccine requirements. Vaccination rates post-five-day grace period among eligible 12-18-year-old adolescents were calculated using aggregate electronic health record data and compared pre- and post-policy implementation (2016 vs. 2017) using two-sample tests of proportion. Overall, providers were supportive of the new vaccination requirements and reported that their facilities were equipped to accommodate the increased demand for vaccination visits prior to the beginning of the school year. There were modest increases in Tdap and MCV4 vaccination rates among 12-13-year-old adolescents by mid-September and a significant increase for MCV4 among 17-18-year-old adolescents (p > .001) in all regions. There were also statistically significant increases (p > .001) in MenB and HPV vaccination rates in this older age group. Our results suggest that these amended school-entry vaccination requirements may help improve timely vaccination rates for both required and non-required vaccines, increasing protection among students at the beginning of the school year.
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Affiliation(s)
- Tuhina Srivastava
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristel Emmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Immunization Program and Acute Communicable Diseases, Philadelphia Department of Public Health, Philadelphia, PA, USA
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Under-immunization of pediatric transplant recipients: a call to action for the pediatric community. Pediatr Res 2020; 87:277-281. [PMID: 31330527 PMCID: PMC6962534 DOI: 10.1038/s41390-019-0507-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
Vaccine-preventable infections (VPIs) are a common and serious complication following transplantation. One in six pediatric solid organ transplant recipients is hospitalized with a VPI in the first 5 years following transplant and these hospitalizations result in significant morbidity, mortality, graft injury, and cost. Immunizations are a minimally invasive, cost-effective approach to reducing the incidence of VPIs. Despite published recommendations for transplant candidates to receive all age-appropriate immunizations, under-immunization remains a significant problem, with the majority of transplant recipients not up-to-date on age-appropriate immunizations at the time of transplant. This is extremely concerning as the rate for non-medical vaccine exemptions in the United States (US) is increasing, decreasing the reliability of herd immunity to protect patients undergoing transplant from VPIs. There is an urgent need to better understand barriers to vaccinating this population of high-risk children and to develop effective interventions to overcome these barriers and improve immunization rates. Strengthened national policies requiring complete age-appropriate immunization for non-emergent transplant candidates, along with improved multi-disciplinary immunization practices and tools to facilitate and ensure complete immunization delivery to this high-risk population, are needed to ensure that we do everything possible to prevent infectious complications in pediatric transplant recipients.
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30
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Hodge JG, Wetter SA, White EN. Legal Crises in Public Health. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:778-782. [PMID: 31957581 DOI: 10.1177/1073110519897792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- James G Hodge
- James G. Hodge, Jr., J.D., LL.M., is the Peter Kiewit Foundation Professor of Law and Director, Center for Public Health Law and Policy (CPHLP), at the Sandra Day O'Connor College of Law, Arizona State University (ASU). Sarah A. Wetter, J.D., M.P.H., is Law and Policy Analyst, Center for Health and Homeland Security, University of Maryland. Erica N. White is a Senior Legal Researcher, CPHLP, and J.D. Candidate (2021) at the Sandra Day O'Connor College of Law, ASU
| | - Sarah A Wetter
- James G. Hodge, Jr., J.D., LL.M., is the Peter Kiewit Foundation Professor of Law and Director, Center for Public Health Law and Policy (CPHLP), at the Sandra Day O'Connor College of Law, Arizona State University (ASU). Sarah A. Wetter, J.D., M.P.H., is Law and Policy Analyst, Center for Health and Homeland Security, University of Maryland. Erica N. White is a Senior Legal Researcher, CPHLP, and J.D. Candidate (2021) at the Sandra Day O'Connor College of Law, ASU
| | - Erica N White
- James G. Hodge, Jr., J.D., LL.M., is the Peter Kiewit Foundation Professor of Law and Director, Center for Public Health Law and Policy (CPHLP), at the Sandra Day O'Connor College of Law, Arizona State University (ASU). Sarah A. Wetter, J.D., M.P.H., is Law and Policy Analyst, Center for Health and Homeland Security, University of Maryland. Erica N. White is a Senior Legal Researcher, CPHLP, and J.D. Candidate (2021) at the Sandra Day O'Connor College of Law, ASU
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31
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Williams JTB, Rice J, Cox-Martin M, Bayliss EA, O'Leary ST. Religious Vaccine Exemptions in Kindergartners: 2011-2018. Pediatrics 2019; 144:peds.2019-2710. [PMID: 31685698 DOI: 10.1542/peds.2019-2710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Forty-five states permit religious exemptions to school immunization laws; 15 allow personal belief exemptions. Updated religious exemption estimates are lacking, and it is unclear if personal belief exemption availability impacts religious exemption rates. We aimed to (1) update religious exemption trends in kindergartners, (2) compare states' proportions of kindergartners with religious exemptions by personal belief exemption availability, and (3) describe whether the proportion of kindergartners with religious exemptions changed in Vermont after it eliminated personal belief exemptions in 2016. METHODS We analyzed Centers for Disease Control and Prevention data on exemptions for children entering kindergarten from 2011 to 2018, including 295 state-years in our final analysis. Using a quasi-binomial regression analysis, we compared mean proportions of kindergartners with religious exemptions in states allowing both nonmedical exemptions against states with religious exemptions only, adjusting for policy strength and school year. RESULTS States with religious and personal belief exemptions were one-fourth as likely to have kindergartners with religious exemptions as states with religious exemptions only (risk ratio 0.25; 95% confidence interval 0.16-0.38). After Vermont's policy change, the mean proportion of kindergartners with a religious exemption increased from 0.5% to 3.7%. States were significantly more likely to have kindergartners with religious exemptions during the 2017-2018 school year compared with the 2011-2012 school year (P = .04). CONCLUSIONS Religious exemption rates appear to be associated with personal belief exemption availability, may be subject to a replacement effect on personal belief exemption elimination, and are increasing. Researchers and policy makers should confirm findings with individual-level studies and reconsider the purpose and nature of religious exemption laws.
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Affiliation(s)
- Joshua T B Williams
- Department of Pediatrics, Denver Health Medical Center, Denver, Colorado; .,Departments of Pediatrics
| | - John Rice
- Department of Biostatistics and Informatics, School of Public Health, and.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado; and
| | - Matt Cox-Martin
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado; and
| | - Elizabeth A Bayliss
- Family Medicine, and.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Sean T O'Leary
- Departments of Pediatrics.,Pediatric Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, Colorado.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado; and
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Nyathi S, Karpel HC, Sainani KL, Maldonado Y, Hotez PJ, Bendavid E, Lo NC. The 2016 California policy to eliminate nonmedical vaccine exemptions and changes in vaccine coverage: An empirical policy analysis. PLoS Med 2019; 16:e1002994. [PMID: 31869328 PMCID: PMC6927583 DOI: 10.1371/journal.pmed.1002994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/20/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical ("personal belief") exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California's 2016 policy and changes in vaccine coverage. METHODS AND FINDINGS We used a quasi-experimental state-level synthetic control analysis and a county-level difference-in-differences analysis to estimate the impact of the 2016 California policy on vaccination coverage and prevalence of exemptions to vaccine requirements (nonmedical and medical). We used publicly available state-level data from the US Centers for Disease Control and Prevention on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption in children entering kindergarten. We used county-level data individually requested from state departments of public health on overall vaccine coverage and exemptions. Based on data availability, we included state-level data for 45 states, including California, from 2011 to 2017 and county-level data for 17 states from 2010 to 2017. The prespecified primary study outcome was MMR vaccination in the state analysis and overall vaccine coverage in the county analysis. In the state-level synthetic control analysis, MMR coverage in California increased by 3.3% relative to its synthetic control in the postpolicy period (top 2 of 43 states evaluated in the placebo tests, top 5%), nonmedical exemptions decreased by 2.4% (top 2 of 43 states evaluated in the placebo tests, top 5%), and medical exemptions increased by 0.4% (top 1 of 44 states evaluated in the placebo tests, top 2%). In the county-level analysis, overall vaccination coverage increased by 4.3% (95% confidence interval [CI] 2.9%-5.8%, p < 0.001), nonmedical exemptions decreased by 3.9% (95% CI 2.4%-5.4%, p < 0.001), and medical exemptions increased by 2.4% (95% CI 2.0%-2.9%, p < 0.001). Changes in vaccination coverage across counties after the policy implementation from 2015 to 2017 ranged from -6% to 26%, with larger increases in coverage in counties with lower prepolicy vaccine coverage. Results were robust to alternative model specifications. The limitations of the study were the exclusion of a subset of US states from the analysis and the use of only 2 years of postpolicy data based on data availability. CONCLUSIONS In this study, implementation of the California policy that eliminated nonmedical childhood vaccine exemptions was associated with an estimated increase in vaccination coverage and a reduction in nonmedical exemptions at state and county levels. The observed increase in medical exemptions was offset by the larger reduction in nonmedical exemptions. The largest increases in vaccine coverage were observed in the most "high-risk" counties, meaning those with the lowest prepolicy vaccine coverage. Our findings suggest that government policies removing nonmedical exemptions can be effective at increasing vaccination coverage.
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Affiliation(s)
- Sindiso Nyathi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Hannah C. Karpel
- New York University School of Medicine, New York, New York, United States of America
| | - Kristin L. Sainani
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Peter J. Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
- James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
| | - Eran Bendavid
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Nathan C. Lo
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Duchon JM, Levin MJ, Gershon AA. Safety and Varicella Outcomes in In Utero-Exposed Newborns and Preterm Infants Treated With Varicella Zoster Immune Globulin (VARIZIG): A Subgroup Analysis of an Expanded-Access Program. J Pediatric Infect Dis Soc 2019; 9:449-453. [PMID: 31774916 PMCID: PMC7495903 DOI: 10.1093/jpids/piz070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/02/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Infants exposed to varicella zoster virus (VZV) in utero ≤5 days before or ≤48 hours after delivery and preterm infants are at high risk for varicella complications. An expanded-access program assessed varicella outcomes after administration of varicella zoster immune globulin (human) (VARIZIG) in a real-world setting. METHODS In this open-label, expanded-access program, high-risk infants received ≤125 IU/10 kg of VARIZIG (NCT00338442). VZV outcomes and safety were assessed. RESULTS There were 43 newborns exposed to VZV in utero and 80 preterm infants exposed to VZV; >80% received VARIZIG within 96 hours of reported exposure. When varicella outcomes were available, varicella occurred in 7 of 38 (18%) in utero-exposed newborns and zero of 65 preterm infants. Varicella-related complications were reported in 3 in utero-exposed newborns (3 with >100 lesions, 1 each with encephalitis and pneumonia). Adverse events were reported for 16% of in utero-exposed newborns and 25% of preterm infants, but few were considered related to VARIZIG. There were no deaths attributable to varicella or VARIZIG. CONCLUSIONS Varicella incidence and morbidity were low in in utero-exposed infants and zero in preterm infants who received prophylactic VARIZIG. There were few VARIZIG-related safety concerns.
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Affiliation(s)
- Jennifer M Duchon
- Division of Pediatric Infectious Diseases, Tufts Floating Hospital for Children, Boston, Massachusetts, USA,Division of Newborn Medicine, Tufts Floating Hospital for Children, Boston, Massachusetts, USA,Corresponding Author: Jennifer M. Duchon, MDCM, MPH, Tufts Floating Hospital for Children, Boston, MA 02111.
| | - Myron J Levin
- Department of Pediatrics (Infectious Diseases), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anne A Gershon
- Department of Pediatrics–Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
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34
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Delamater PL, Omer SB. Legislative and administrative actions to increase vaccination coverage in Washington schools. Hum Vaccin Immunother 2019; 16:1171-1177. [PMID: 31634042 PMCID: PMC7227713 DOI: 10.1080/21645515.2019.1678358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Current outbreaks of vaccine-preventable diseases in the U.S. highlight the consequences of declining levels of vaccination coverage. Attempts to increase coverage by banning or restricting nonmedical exemptions from school-entry vaccination requirements disregard children not up to date on vaccination who already attend school and those who are not up to date for reasons other than vaccine hesitancy. We analyze the potential effects of legislative and administrative options to increase vaccination coverage in Washington schools. We constructed a grade-specific model of the detailed vaccination status for all required vaccines and the MMR vaccine specifically for all children in the state's school system. We used scenario modeling to evaluate the effects of potential legislative and administrative actions on the percent of students up to date on all required vaccines and the MMR vaccine from 2018 to 2030. Our analysis shows that eliminating nonmedical exemptions may not be the optimal solution for reducing disease outbreak risk. Instead, focusing on children not up to date for reasons other than nonmedical exemption could have a larger impact and does not carry the controversy that accompanies attempts to ban or restrict nonmedical exemptions. Further, implementing a one-time catch-up period for all children not up to date would increase coverage promptly. Evidence-based policymaking is an essential component of efforts to reduce the risk of disease outbreaks in U.S. schools, and analysis of potential legislative and administrative actions complement these efforts.
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Affiliation(s)
- Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, CT, USA
| | - Saad B Omer
- Yale Institute for Global Health, Department of Medicine (Section of Infectious Diseases), Yale School of Medicine, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
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35
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Quinn SC, Jamison AM, Freimuth VS. Measles outbreaks and public attitudes towards vaccine exemptions: some cautions and strategies for addressing vaccine hesitancy. Hum Vaccin Immunother 2019; 16:1050-1054. [PMID: 31403354 DOI: 10.1080/21645515.2019.1646578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Today, the United States and countries throughout the world are experiencing measles outbreaks that have sickened thousands of children. From the Disneyland outbreak in 2014 to today, some states have responded with changes in laws on vaccine requirements and exemptions. In this article, we examine the history of vaccine laws, and using our 2015 survey data, explore to what extent the news coverage of the Disneyland outbreak altered parents' attitudes toward required vaccination and non-medical exemptions. We explore those results in the context of today's increasing polarized and politicalized battle over vaccine laws, and consider how health care providers and policy makers can work to improve public attitudes about vaccines.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.,Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA
| | - A M Jamison
- Center for Health Equity, School of Public Health, University of Maryland, College Park, MD, USA
| | - V S Freimuth
- Center for Health And Risk Communication (Emerita), University of Georgia, Athens, GA, USA
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36
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Seither R, Loretan C, Driver K, Mellerson JL, Knighton CL, Black CL. Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2018-19 School Year. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:905-912. [PMID: 31622283 PMCID: PMC6802678 DOI: 10.15585/mmwr.mm6841e1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
State and local school vaccination requirements exist to ensure that students are protected against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten in 49 states, exemptions for kindergartners in 50 states, and provisional enrollment and grace period status for kindergartners in 30 states. Nationally, vaccination coverage† was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 94.7% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required doses of varicella vaccine. Whereas 2.5% of kindergartners had an exemption from at least one vaccine,§ 2.8% of kindergartners were not up to date for MMR and did not have a vaccine exemption. Nearly all states could achieve the recommended ≥95% MMR coverage if all nonexempt kindergartners were vaccinated in accordance with local and state vaccination policies.
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Williams JTB, O'Leary ST. Denver Religious Leaders' Vaccine Attitudes, Practices, and Congregational Experiences. JOURNAL OF RELIGION AND HEALTH 2019; 58:1356-1367. [PMID: 30924100 DOI: 10.1007/s10943-019-00800-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Religious vaccine exemptions are widely available in America and increased in the past decade for unclear reasons. Religious leaders strive to influence their congregants' attitudes and practices. We sought to describe Denver religious leaders' vaccine attitudes, practices, and congregational experiences using a cross-sectional online survey. The response rate was 33% (109/334). Most respondents were Protestant, White, male, parents; 42% believed the Bible contained themes supportive of vaccination, 25% were vaccine hesitant, and only 10% had addressed vaccines in their congregations. Vaccine-hesitant religious leaders' attitudes and practices differed from those of non-hesitant leaders. Study implications and future research avenues are discussed.
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Affiliation(s)
- Joshua T B Williams
- Department of Pediatrics, Denver Health Medical Center, 301 W 6th Avenue, Denver, CO, 80204, USA.
- Department of Pediatrics, The University of Colorado Denver School of Medicine, Aurora, CO, USA.
| | - Sean T O'Leary
- Department of Pediatrics, The University of Colorado Denver School of Medicine, Aurora, CO, USA
- Department of Pediatric Infectious Diseases, The University of Colorado Denver School of Medicine, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
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38
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Newman AM, Jhaveri R. Myths and Misconceptions: Varicella-Zoster Virus Exposure, Infection Risks, Complications, and Treatments. Clin Ther 2019; 41:1816-1822. [PMID: 31326126 DOI: 10.1016/j.clinthera.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022]
Abstract
Varicella zoster and herpes zoster are infections caused by the highly contagious varicella-zoster virus (VZV). Despite widespread availability of vaccines against VZV, as well as varicella vaccination rates >95%, VZV remains a public health concern because of several common myths and misconceptions. Because of the success of routine varicella vaccination programs, some people mistakenly believe that varicella and herpes zoster are now no longer a threat to public health. Another common misconception is that shingles is less infectious than varicella; however, clinical evidence indicates otherwise. Several knowledge gaps exist around VZV transmission and the availability and use of varicella zoster immune globulin (human) for postexposure prophylaxis against VZV. To help reduce the incidence of severe disease in high-risk individuals (eg, elderly people, pregnant women, unvaccinated persons, infants, and immunocompromised children and adults), this article addresses misbeliefs and broadens awareness of VZV exposure, infection risks, complications, and treatments.
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Affiliation(s)
| | - Ravi Jhaveri
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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39
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Jackson MA, Harrison C. On the Brink: Why the U.S. is in Danger of Losing Measles Elimination Status. MISSOURI MEDICINE 2019; 116:260-264. [PMID: 31527963 PMCID: PMC6699811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mary Anne Jackson
- Mary Anne Jackson, Md, FAAp, FidsA, Fpids, is interim dean and professor of pediatrics; Christopher J. Harrison, Md, Director, infecti ous Disease Research laboratory, director, vaccine and Treatment Evaluati on unit, Professor of pediatrics; both at the university of Missouri-Kansas City school of Medicine, Kansas City, Mo
| | - Christopher Harrison
- Mary Anne Jackson, Md, FAAp, FidsA, Fpids, is interim dean and professor of pediatrics; Christopher J. Harrison, Md, Director, infecti ous Disease Research laboratory, director, vaccine and Treatment Evaluati on unit, Professor of pediatrics; both at the university of Missouri-Kansas City school of Medicine, Kansas City, Mo
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40
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Papachrisanthou MM, Davis RL. The Resurgence of Measles, Mumps, and Pertussis. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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41
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Hotez P. America and Europe's new normal: the return of vaccine-preventable diseases. Pediatr Res 2019; 85:912-914. [PMID: 30812027 DOI: 10.1038/s41390-019-0354-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Peter Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA. .,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA. .,Department of Biology, Baylor University, Waco, TX, USA. .,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA. .,Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA.
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Abstract
Autism is a developmental disability that can cause significant social, communication, and behavioral challenges. A report published in 1998, but subsequently retracted by the journal, suggested that measles, mumps, and rubella (MMR) vaccine causes autism. However, autism is a neurodevelopmental condition that has a strong genetic component with genesis before one year of age, when MMR vaccine is typically administered. Several epidemiologic studies have not found an association between MMR vaccination and autism, including a study that found that MMR vaccine was not associated with an increased risk of autism even among high-risk children whose older siblings had autism. Despite strong evidence of its safety, some parents are still hesitant to accept MMR vaccination of their children. Decreasing acceptance of MMR vaccination has led to outbreaks or resurgence of measles. Health-care providers have a vital role in maintaining confidence in vaccination and preventing suffering, disability, and death from measles and other vaccine-preventable diseases.
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Affiliation(s)
- Frank DeStefano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA;
| | - Tom T Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA;
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43
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Fu LY, Haimowitz R, Thompson D. Community members trusted by African American parents for vaccine advice. Hum Vaccin Immunother 2019; 15:1715-1722. [PMID: 30779691 DOI: 10.1080/21645515.2019.1581553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Exposure to pro-vaccination messages from nonmedical peers and others perceived to share a similar value system for society (referred to as worldview outlook) improves vaccination attitudes. Nonetheless, a minority of African American parents have friends and family members who provide them with vaccine advice. The aims of the current study were to identify the presumed worldview outlook of eight types of community figures as perceived by African American parents, and determine parents' trust in these figures for vaccine advice, and whether trust varied according to the figures' racial concordance. A cross-sectional survey was administered to 110 African American parents in 2015. Parents perceived the community figures to represent a spectrum of worldview outlooks. Although levels of trust in the community figures differed overall (p < .001), it was high in the school nurse, pediatrician, mother, father, disease survivor, and vaccine scientist. All trusted figures except the father were perceived to hold a communitarian outlook. Parents shown race-concordant figures had higher levels of trust in them than those who were shown race-discordant equivalents (p < .01). These findings suggest that vaccination campaigns geared toward African American parents may be strengthened by including other nonmedical, African American spokespersons who convey their community contributions in messages.
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Affiliation(s)
- Linda Y Fu
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
| | - Rachel Haimowitz
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
| | - Danielle Thompson
- a Department of Pediatrics, Children's National Health System , Washington , DC , USA
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Bednarczyk RA, King AR, Lahijani A, Omer SB. Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes. Expert Rev Vaccines 2019; 18:175-190. [PMID: 30572729 DOI: 10.1080/14760584.2019.1562344] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In the United States, high childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. The success of vaccination programs in achieving this high coverage is due, in part, to vaccination mandates for school entry. All states have such mandates, but there is heterogeneity across the states in the allowance of non-medical exemptions (e.g. religious or personal belief exemptions) to these mandates. AREAS COVERED We examine historical trends in non-medical exemption prevalence in the US, discuss recent state-level policy changes that may impact non-medical exemption prevalence, and review recent studies on the association between non-medical exemptions and infectious disease outbreaks. EXPERT COMMENTARY State-level implementation of mandates, and related allowances for medical and non-medical exemptions, varies greatly across the United States. Non-medical exemption rates have increased over the last two decades, with an increased risk of disease outbreaks in clusters of children with non-medical exemptions due to differences in state laws. Recent efforts to address non-medical exemption rates range from incorporating additional administrative requirements for exemptions and disallowance of any non-medical exemptions. Continued monitoring is needed to evaluate the impact of these changes on exemption rates, to develop optimal childhood vaccination policy across the United States.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA
| | - Adrian R King
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Ariana Lahijani
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Saad B Omer
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Emory Vaccine Center , Emory University , Atlanta , GA , USA.,d Department of Pediatrics , School of Medicine, Emory University , Atlanta , GA , USA
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On Patient Safety: The Importance of Vaccinations-Avoiding the Mistakes of the Past. Clin Orthop Relat Res 2019; 477:28-30. [PMID: 30586063 PMCID: PMC6345321 DOI: 10.1097/corr.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Dyer O. Number of unvaccinated US children has quadrupled since 2001. BMJ 2018; 363:k4358. [PMID: 30327315 DOI: 10.1136/bmj.k4358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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