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Chitnis AS, Wong RJ. Review of Updated Hepatitis B Vaccine Recommendations and Potential Challenges With Implementation. Gastroenterol Hepatol (N Y) 2022; 18:447-451. [PMID: 36397819 PMCID: PMC9666805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hepatitis B virus (HBV) infection is a vaccine-preventable disease associated with substantial morbidity and mortality. Although safe and effective hepatitis B vaccines are available, an increased number of adults must receive the hepatitis B vaccine in order to reach the goal of the US Department of Health and Human Services for HBV elimination. Previous guidelines from the US Centers for Disease Control and Prevention (CDC) for hepatitis B vaccination among adults utilized a risk-based approach that may have contributed to decreased uptake of the vaccine because the recommendations were difficult to adopt into clinical practice and assumed patients would recognize and disclose their risk factors. Based on review of epidemiologic and cost-effectiveness data, the CDC now recommends that all adults 19 to 59 years old receive the hepatitis B vaccine; however, a risk-based approach to hepatitis B vaccination was retained among adults age 60 years and older because universal vaccination in this age group would not lead to substantial reductions in acute HBV cases and be cost-effective. Implementation of these expanded hepatitis B vaccination recommendations in clinical and public health practice may pose challenges, including ensuring effective HBV screening practices, quality measures to track coverage of the hepatitis B vaccine, utilization of hepatitis B vaccines that have the highest completion rates for the vaccine series in a real-world setting, and sustained efforts to vaccinate high-risk groups such as individuals experiencing incarceration, utilizing sexually transmitted disease clinics, and injecting illicit drugs.
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Affiliation(s)
- Amit S. Chitnis
- Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
- Gastroenterology and Hepatology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
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Hurley LP, O'Leary ST, Kobayashi M, Crane LA, Cataldi J, Brtnikova M, Beaty BL, Gorman C, Lindley MC, Kempe A. Physician survey regarding updated PCV13 vaccine recommendations for adults ≥65 years. J Am Geriatr Soc 2021; 69:2612-2618. [PMID: 33989433 DOI: 10.1111/jgs.17274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In June 2019, the Advisory Committee on Immunization Practices recommended discontinuing the routine use of the pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years and instead recommended PCV13 be used based on shared clinical decision making (SCDM). OBJECTIVES We wanted to assess among primary care physicians (1) knowledge and attitudes regarding the new SCDM PCV13 recommendation and (2) how the new recommendation will affect their likelihood of recommending PCV13 to adults aged ≥65 years. DESIGN This was done by mail and internet-based survey, which was conducted October 2019 through January 2020. The study was carried out on a nationally representative sample of general internists (GIMs) and family physicians (FPs). RESULTS The response rate was 64% (617/968, GIM 57%, FP 71%). Only 41% of respondents were aware of the SCDM PCV13 recommendation in adults aged ≥65 years; 76% agreed (37% "Strongly," 39% "Somewhat") that their patients aged ≥65 years will get confused by having a SCDM recommendation for PCV13 and a routine recommendation for the pneumococcal polysaccharide vaccine (PPSV23); 60% agreed (18% "Strongly," 42% "Somewhat") that they were unsure of what points to emphasize when having a SCDM conversation with an adult aged ≥65 years about receiving PCV13. Just over 50% reported they would be less likely to recommend PCV13 for adults aged ≥65 years as a result of the new recommendation, but 42% reported that their recommendation for PCV13 would not change. CONCLUSIONS Word of the new ACIP recommendation for PCV13 for adults aged ≥65 years needs to be further disseminated. Investigation into why some physicians do not plan to change their recommendations is warranted.
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Affiliation(s)
- Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Division of General Internal Medicine, Denver Health, Denver, Colorado, USA
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Carol Gorman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
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Hyer RN, Janssen RS. Immunogenicity and safety of a 2-dose hepatitis B vaccine, HBsAg/CpG 1018, in persons with diabetes mellitus aged 60-70 years. Vaccine 2019; 37:5854-5861. [PMID: 31431412 DOI: 10.1016/j.vaccine.2019.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) remains a major public health issue, although it is a vaccine-preventable disease. Adults with diabetes are at greater risk of contracting HBV than the general population. Commonly used 3-dose HBV vaccines have reduced immunogenicity in older individuals and in those with diabetes mellitus. METHODS In this post hoc analysis of a phase 3 clinical trial, participants with type 2 diabetes mellitus aged 60-70 years received either 2-dose HBsAg/CpG 1018 (HEPLISAV-B®, n = 327) at 0 and 4 weeks and placebo at 24 weeks or 3-dose HBsAg/alum (Engerix-B®, n = 153) at 0, 4, and 24 weeks. Immunogenicity, including seroprotection rate (SPR) at week 28, and safety were assessed by subgroup (sex, body mass index, and smoking status). SPR was defined as antibody against hepatitis B surface antigen serum concentration ≥10 mIU/mL. RESULTS The SPR at week 28 was significantly higher with HBsAg/CpG 1018 (85.8% [235/274]) than with HBsAg/alum (58.5% [76/130]) in the per-protocol analysis, for an overall difference of 27.3% (95% CI, 18.0-36.8). SPRs with HBsAg/CpG 1018 were consistently markedly higher compared with HBsAg/alum, regardless of sex, body mass index, or smoking status. Adverse events and deaths were comparable between groups. CONCLUSIONS Two-dose HBsAg/CpG 1018 provides a higher level of seroprotection against HBV than does a 3-dose vaccine (HBsAg/alum) with a similar safety profile in patients aged 60-70 years with type 2 diabetes mellitus. Study identifier: NCT02117934.
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Affiliation(s)
- Randall N Hyer
- Dynavax Technologies Corporation, 2929 Seventh Street, Suite 100, Berkeley, CA 94710, United States.
| | - Robert S Janssen
- Dynavax Technologies Corporation, 2929 Seventh Street, Suite 100, Berkeley, CA 94710, United States.
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Pike J, Leidner AJ, MacNeil JR, Cohn AC. Review of the economic evidence presented to the United States Advisory Committee on Immunization Practices, 2012-2016. Vaccine 2019; 37:7-10. [PMID: 30473183 DOI: 10.1016/j.vaccine.2018.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 01/17/2023]
Abstract
We identified 16 Advisory Committee on Immunization Practices (ACIP) presentations from 2012 to 2016 that indicated 'cost' or 'economic' content. Characteristics were reviewed, abstracted, and tabulated to quantify and assess the transparency and consistency of economic evidence presented to ACIP. To assess transparency, we documented if each study identified author affiliation, conflicts of interest, study limitations, a clearly described model structure and other model attributes. To assess consistency, we identified the frequency of specific modeling choices, including the perspective, types of health outcomes considered, inclusion of specific types of costs, discount rate, and use of sensitivity analyses. Our results indicate that the content in these presentations appear to be transparent overall and consistent in several important areas, such as study perspective and health outcomes. However, we find the inclusion of particular types of direct costs, indirect costs, program costs, and sensitivity analyses are areas that could improve consistency.
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Abstract
The objective of this study was to examine correlates of human papillomavirus (HPV) vaccine use according to Advisory Committee on Immunization Practices (ACIP)'s recommendations among US adolescent girls. We used National Immunization Survey of Teens 2013 data. Based on provider-verified (n = 9403) information, 57.3, 39.1 and 19.0 % of adolescent girls, initiated, completed and completed the HPV vaccine according to ACIP's recommendation (by age 12), respectively. Hispanic race/ethnicity, a physician recommendation for HPV vaccine and ≥1 influenza vaccine in the past 3 years were all associated with a higher likelihood of compliance with ACIP's recommendation. Girls from a larger family and those whose immunization provider was a STD/school/teen clinic were less likely to receive the vaccine at the recommended age compared to a girl raised in a smaller sized family and received immunization from a hospital facility, respectively. Only one-fifth of 13-17 yo girls receive the HPV vaccine by age 12 as recommended by ACIP. Physician visits and influenza vaccination settings are opportunities to improve vaccine series completion at the recommended age.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA. .,Center for Clinical Epidemiology, St. Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Jacqueline M Hirth
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, USA
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Kempe A, Allison MA, MacNeil JR, O’Leary ST, Crane LA, Beaty BL, Hurley LP, Brtnikova M, Lindley MC, Liang JL, Albert AP, Smith JC. Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children. Acad Pediatr 2018; 18:763-768. [PMID: 29678594 PMCID: PMC6123258 DOI: 10.1016/j.acap.2018.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In 2015, the Advisory Committee on Immunization Practices (ACIP) made a category B recommendation for use of serogroup B meningococcal (MenB) vaccines, meaning individual clinical decision-making should guide recommendations. This was the first use of a category B recommendation pertaining to a large population and the first such recommendation for adolescents. As part of a survey regarding MenB vaccine, our objectives were to assess among pediatricians (Peds) and family physicians (FPs) nationally: 1) knowledge of the meaning of category A versus B recommendations and insurance coverage implications, and 2) attitudes about category A and B recommendations. METHODS We surveyed a nationally representative sample of Peds and FPs via e-mail and mail from October to December 2016. RESULTS The response rate was 72% (660 of 916). Although >80% correctly identified the definition of a category A recommendation, only 24% were correct about the definition for category B. Fifty-five percent did not know that private insurance would pay for vaccines recommended as category B, and 51% did not know that category B-recommended vaccines would be covered by the Vaccines for Children program. Fifty-nine percent found it difficult to explain category B recommendations to patients; 22% thought ACIP should not make category B recommendations; and 39% were in favor of category B recommendations because they provide leeway in decision-making. CONCLUSIONS For category B recommendations to be useful in guiding practice, primary care clinicians will need to have a better understanding of their meaning, their implications for insurance payment, and guidance on how to discuss them with parents and patients.
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Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo.
| | - Mandy A. Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 E. Montview Boulevard, Suite 300, Aurora, CO 80045,Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Aurora, CO 80045
| | - Jessica R. MacNeil
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027
| | | | - Lori A. Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 E. Montview Boulevard, Suite 300, Aurora, CO 80045,Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO 80045
| | - Brenda L. Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 E. Montview Boulevard, Suite 300, Aurora, CO 80045
| | - Laura P. Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 E. Montview Boulevard, Suite 300, Aurora, CO 80045,Division of General Internal Medicine, Denver Health, 777 Bannock St, Denver, CO 80204, United States
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, 13199 E. Montview Boulevard, Suite 300, Aurora, CO 80045
| | - Megan C. Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027
| | - Jennifer L. Liang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027
| | - Alison P. Albert
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027
| | - Jean C. Smith
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027
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O'Leary ST, Maldonado YA, Byington CL. Update From the Advisory Committee on Immunization Practices. J Pediatric Infect Dis Soc 2017; 6:215-218. [PMID: 28903515 DOI: 10.1093/jpids/pix040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 11/14/2022]
Abstract
The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. The group has 15 voting members, and each member's term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (C. L. B. and Y. A. M.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met February 22 and 23, 2017, to discuss proposed recommendations regarding vaccination for unprotected infants born to hepatitis B surface antigen (HBsAg)-positive mothers; topics included cost analysis, influenza surveillance, influenza vaccine effectiveness, herpes zoster vaccine, and considerations for meningococcal serogroup B booster doses in groups at increased risk. Updates on mumps epidemiology, Dengue virus vaccines, Zika virus vaccines, adult immunization, and yellow fever vaccine were also provided.
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Saslow D, Andrews KS, Manassaram-Baptiste D, Loomer L, Lam KE, Fisher-Borne M, Smith RA, Fontham ETH. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. CA Cancer J Clin 2016; 66:375-85. [PMID: 27434803 PMCID: PMC5555157 DOI: 10.3322/caac.21355] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Answer questions and earn CME/CNE The American Cancer Society (ACS) reviewed and updated its guideline on human papillomavirus (HPV) vaccination based on a methodologic and content review of the Advisory Committee on Immunization Practices (ACIP) HPV vaccination recommendations. A literature review was performed to supplement the evidence considered by the ACIP and to address new vaccine formulations and recommendations as well as new data on population outcomes since publication of the 2007 ACS guideline. The ACS Guideline Development Group determined that the evidence supports ACS endorsement of the ACIP recommendations, with one qualifying statement related to late vaccination. The ACS recommends vaccination of all children at ages 11 and 12 years to protect against HPV infections that lead to several cancers and precancers. Late vaccination for those not vaccinated at the recommended ages should be completed as soon as possible, and individuals should be informed that vaccination may not be effective at older ages. CA Cancer J Clin 2016;66:375-385. © 2016 American Cancer Society.
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Affiliation(s)
- Debbie Saslow
- Director, Cancer Control Intervention, Human Papillomavirus and Women’s Cancers, American Cancer Society, Atlanta, GA
| | | | | | - Lacey Loomer
- Graduate Student, Emory University Rollins School of Public Health, Atlanta, GA
| | - Kristina E. Lam
- Medical Epidemiologist, Georgia Department of Public Health, Atlanta, GA
| | - Marcie Fisher-Borne
- Program Director, Human Papillomavirus Vaccination, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Vice President, Cancer Screening, American Cancer Society, Atlanta, GA
| | - Elizabeth T. H. Fontham
- Founding Dean and Professor Emeritus, Louisiana State University School of Public Health, New Orleans, LA
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Walton LR, Orenstein WA, Pickering LK. The history of the United States Advisory Committee on Immunization Practices (ACIP). Vaccine 2014; 33:405-14. [PMID: 25446820 DOI: 10.1016/j.vaccine.2014.09.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 01/31/2023]
Abstract
The United States Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that develops written recommendations for use of vaccines licensed by the Food and Drug Administration (FDA) for the U.S. civilian population. Vaccine development and disease outbreaks contributed to the need for a systematized, science-based, formal mechanism for establishing national immunization policy in this country. Formed in 1964, the ACIP was charged with this role. The committee has undergone significant changes in structure and operational activities during its 50-year history. The ACIP works closely with many liaison organizations to develop its immunization recommendations, which are harmonized among key professional medical societies. ACIP vaccine recommendations form two immunization schedules, which are updated annually: (1) the childhood and adolescent immunization schedule and (2) the adult immunization schedule. Today, once ACIP recommendations are adopted by the Director of the Centers for Disease Control and Prevention and the Secretary of the Department of Health and Human Services, these recommendations are published in Morbidity and Mortality Weekly Report (MMWR), become official policy, and are incorporated into the appropriate immunization schedule.
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Affiliation(s)
- L Reed Walton
- Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, United States(1)
| | - Walter A Orenstein
- Emory Vaccine Center, Influenza Pathogenesis & Immunology Research, Emory University School of Medicine, United States
| | - Larry K Pickering
- National Center for Immunization and Respiratory Diseases, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, United States; Emory University School of Medicine, United States.
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Zhao Z, Murphy TV. Which newborns missed the hepatitis B birth dose vaccination among U.S. children? Prev Med 2013; 57:613-7. [PMID: 23988497 DOI: 10.1016/j.ypmed.2013.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/07/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hepatitis B birth dose vaccination is a critical step in preventing perinatal hepatitis B virus infection. This study assesses the prevalence of children who missed the birth dose of hepatitis B vaccination and identifies socio-demographic factors associated with non-receipt of the birth dose among children in the United States. METHODS A survey observation study was conducted with the national representative sample of 17,053 U.S. children aged 19-35 months obtained from the 2009 National Immunization Survey. Categorical data analysis and multivariable logistic regression in the context of complex sample survey were applied to evaluate the prevalence and determine the independent risk factors. RESULTS 39.2% of children missed the birth dose of hepatitis B vaccination. Children who reside in states without a universal hepatitis B vaccine supply policy, are not covered by health insurance, and have only 1 vaccination provider are significantly associated with non-receipt of the birth dose hepatitis B vaccination. CONCLUSIONS Children who reside in states without a universal hepatitis B vaccine supply policy, and who are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination. Future intervention studies could be needed to help control those modifiable risk factors.
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Affiliation(s)
- Zhen Zhao
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop A19, Atlanta, GA 30333, USA.
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Shakib JH, Korgenski K, Sheng X, Varner MW, Pavia AT, Byington CL. Tetanus, diphtheria, acellular pertussis vaccine during pregnancy: pregnancy and infant health outcomes. J Pediatr 2013; 163:1422-6.e1-4. [PMID: 23896191 PMCID: PMC4102585 DOI: 10.1016/j.jpeds.2013.06.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/10/2013] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess pregnancy and birth outcomes in infants born to women who did or did not receive tetanus, diphtheria, acellular pertussis (Tdap) vaccine during pregnancy. STUDY DESIGN Retrospective cohort. Pregnant women 12-45 years of age who received Tdap at Intermountain Healthcare facilities and their infants were identified and compared with mother-infant pairs without documented Tdap from May 2005 through August 2009. Primary measures included pregnancy outcomes and infant health outcomes at birth through 12 months. RESULTS From 162,448 pregnancies we identified 138 women (0.08%) with documented Tdap administration during pregnancy (cases); 552 pregnant women without documented Tdap were randomly selected as controls. Of 138 immunized women, 63% received Tdap in the first trimester and 37% after. Tdap was given most commonly as wound prophylaxis. The incidence of spontaneous or elective abortion was no greater in Tdap cases than in controls. There were no significant differences in preterm delivery, gestational age, or birth weight between groups. One or more congenital anomaly was identified in 3.7% (95% CI 1.2%-8.5%) of case infants and 4.4% (95% CI 2.7%-6.5%) of control infants (P = .749). In infants born to women receiving Tdap during pregnancy, 3.6% (0.8%-10.2%) had International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses consistent with complex chronic conditions within 12 months compared with 10.4% (95% CI 7.2%-14.4%) of infants of controls (P = .054). CONCLUSIONS Documented Tdap administration during pregnancy was uncommon and occurred most often in the first trimester as prophylaxis following trauma. No increase in adverse outcomes was identified in infants born to women receiving Tdap compared with infants of controls.
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Affiliation(s)
- Julie H. Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Xiaoming Sheng
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Michael W. Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Andrew T. Pavia
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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