RESUMEN
A prenatal care provider's recommendation for maternal vaccines is one of the strongest predictors of vaccine acceptance during pregnancy. Aside from basic talking points, few resources exist to help obstetric care providers effectively navigate conversations with vaccine hesitant patients. This paper describes the development and acceptability of "VaxChat," an hour-long, evidence-based video tutorial aimed at improving obstetric care providers' ability to promote maternal vaccines. Between June and November 2017, 62 obstetric care providers registered to receive continuing medical education credit for viewing VaxChat. Of the post-tutorial responses received, over 90% said VaxChat increased their knowledge of what to say to vaccine hesitant patients, increased their confidence in addressing vaccinations with their pregnant patients, and will help them improve their practice culture regarding maternal vaccine promotion. Eighty percent intend to change how they approach vaccine conversations. These data suggest VaxChat may be a welcome complement to existing provider-to-patient talking points.
Asunto(s)
Personal de Salud , Programas de Inmunización/métodos , Servicios de Salud Materna , Aceptación de la Atención de Salud , Medios de Comunicación Sociales , Femenino , Humanos , Masculino , Modelos TeóricosRESUMEN
KEY HIGHLIGHTS: 1. Measles eradication is the ultimate goal but it is premature to set a date for its accomplishment. Existing regional elimination goals should be vigorously pursued to enable setting a global target by 2020. 2. The basic strategic approaches articulated in the Global Measles and Rubella Strategic Plan 2012-2020 are valid to achieve the goals but have not been fully implemented (or not appropriately adapted to local situations). 3. The report recommends a shift from primary reliance on supplementary immunization activities (SIAs) to assure two doses of measles-containing vaccine (MCV) are delivered to the target population to primary reliance on ongoing services to assure administration of two doses of MCV. Regular high quality SIAs will still be necessary while ongoing services are being strengthened. 4. The report recommends a shift from primary reliance on coverage to measure progress to incorporating disease incidence as a major indicator. 5. The report recommends that the measles/rubella vaccination program be considered an indicator for the quality of the overall immunization program and that measles/rubella incidence and measles and rubella vaccination coverage be considered as primary indicators of immunization program performance. 6. Polio transition presents both risks and opportunities: risks should be minimized and opportunities maximized. 7. A school entry immunization check could contribute significantly to strengthening overall immunization services with assurance that recommended doses of measles and rubella vaccines as well as other vaccines have been delivered and providing those vaccines at that time if the child is un- or under-vaccinated. 8. Program decisions should increasingly be based on good quality data and appropriate analysis. 9. The incorporation of rubella vaccination into the immunization program needs to be accelerated - it should be accorded equivalent emphasis as measles. 10. Outbreak investigation and response are critical but the most important thing is to prevent outbreaks.
Asunto(s)
Salud Global , Planificación en Salud , Programas de Inmunización , Sarampión/prevención & control , Rubéola (Sarampión Alemán)/prevención & control , Erradicación de la Enfermedad , Salud Global/historia , Planificación en Salud/historia , Planificación en Salud/métodos , Historia del Siglo XXI , Humanos , Programas de Inmunización/historia , Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/inmunología , Prevalencia , Vacuna contra la Rubéola/administración & dosificación , Vacuna contra la Rubéola/inmunologíaRESUMEN
BACKGROUND: Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed. PURPOSE: To test the effectiveness of a practice-, provider-, and patient-focused influenza and Tdap vaccine promotion package on improving antenatal influenza and Tdap vaccination in the obstetric setting. METHODS: A cluster-randomized trial among 11 obstetric practices in Georgia was conducted in 2012-2013. Intervention practices adopted the intervention package that included identification of a vaccine champion, provider-to-patient talking points, educational brochures, posters, lapel buttons, and iPads loaded with a patient-centered tutorial. Participants were recruited from December 2012-April 2013 and included 325 unvaccinated pregnant women in Georgia. Random effects regression models were used to evaluate primary and secondary outcomes. RESULTS: Data on antenatal influenza and Tdap vaccine receipt were obtained for 300 (92.3%) and 291 (89.5%) women, respectively. Although antenatal influenza and Tdap vaccination rates were higher in the intervention group than the control group, improvements were not significant (For influenza: risk difference (RD)=3.6%, 95% confidence interval (CI): -4.0%, 11.2%; for Tdap: RD=1.3%, 95% CI: -10.7%, 13.2%). While the majority of intervention package components were positively associated with antenatal vaccine receipt, a provider's recommendation was the factor most strongly associated with actual receipt, regardless of study group or vaccine. CONCLUSIONS: The intervention package did not significantly improve antenatal influenza or Tdap vaccine coverage. More research is needed to determine what motivates women remaining unvaccinated against influenza late into the influenza season to get vaccinated. Future research should quantify the extent to which clinical interventions can bolster a provider's recommendation for vaccination. This study is registered with clinicaltrials.gov, study ID NCT01761799.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación/métodos , Adolescente , Adulto , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Femenino , Georgia , Humanos , Vacunas contra la Influenza/administración & dosificación , Persona de Mediana Edad , Embarazo , Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
As influenza vaccination is now widely recommended, randomized clinical trials are no longer ethical in many populations. Therefore, observational studies on patients seeking medical care for acute respiratory illnesses (ARIs) are a popular option for estimating influenza vaccine effectiveness (VE). We developed a probability model for evaluating and comparing bias and precision of estimates of VE against symptomatic influenza from two commonly used case-control study designs: the test-negative design and the traditional case-control design. We show that when vaccination does not affect the probability of developing non-influenza ARI then VE estimates from test-negative design studies are unbiased even if vaccinees and non-vaccinees have different probabilities of seeking medical care against ARI, as long as the ratio of these probabilities is the same for illnesses resulting from influenza and non-influenza infections. Our numerical results suggest that in general, estimates from the test-negative design have smaller bias compared to estimates from the traditional case-control design as long as the probability of non-influenza ARI is similar among vaccinated and unvaccinated individuals. We did not find consistent differences between the standard errors of the estimates from the two study designs.
Asunto(s)
Virus de la Influenza A/inmunología , Vacunas contra la Influenza/normas , Gripe Humana/prevención & control , Modelos Teóricos , Probabilidad , Vacunación/normas , Sesgo , Estudios de Casos y Controles , Humanos , Vacunas contra la Influenza/inmunología , Gripe Humana/virología , Proyectos de InvestigaciónRESUMEN
The Expanded Programme on Immunization (EPI) has succeeded in establishing a vaccine delivery system in all low and middle income (LMI) countries. Because EPI has focused on immunization delivery, its major outcome is measured in many countries only as vaccine coverage, not as disease reduction, the real goal of EPI. Monitoring disease reduction requires real-time case-based disease surveillance and appropriate interventions, for which a functional public health infrastructure is needed. If the highest priority for assessing impact of EPI shifts to disease prevention and control from vaccine coverage, the programme may be transformed to one of control of childhood communicable diseases (CCCD), with the potential of expanding the range of diseases of children and adults for control and of integrating all other current vertical (single disease) control efforts with it. EPI provides the essential platform on which CCCD can be built to create a public health infrastructure.
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Control de Enfermedades Transmisibles/organización & administración , Programas de Inmunización/organización & administración , Vacunas/administración & dosificación , Países en Desarrollo , Humanos , Salud Pública , Vigilancia de GuardiaRESUMEN
Immunization is one of the most effective and cost-effective prevention measures available. As a result of universal vaccination of children, polio has been eliminated in the United States and much of the world, measles and rubella are no longer endemic diseases in the United States, and most of the other vaccine-preventable diseases of childhood are at or near record lows. A recent review of clinical preventive services by Partnership for Prevention gave childhood immunization a perfect score of 10, based on clinically preventable burden and cost-effectiveness.
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Financiación Gubernamental , Política de Salud , Programas de Inmunización/economía , Inmunización/economía , Sector Privado , Sector Público , Adulto , Análisis Costo-Beneficio , Toxoide Diftérico/administración & dosificación , Toxoide Diftérico/economía , Honorarios Farmacéuticos , Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/economía , Humanos , Programas de Inmunización/métodos , Esquemas de Inmunización , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Seguro de Salud , Medicaid , Medicare , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/economía , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Sociedades Médicas , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/economía , Estados UnidosRESUMEN
Government agencies play a key role, from preclinical development to postlicensure monitoring, in making vaccinations one of the leading public health interventions. Important steps in this process include development and testing of vaccine antigens, evaluation of clinical and manufacturing data leading to licensure, formulation of recommendations, vaccine purchase, defining strategies to improve coverage, compensation of those injured by vaccine adverse reactions, and monitoring vaccine impact and safety. Using examples of newly recommended vaccines, this article describes the infrastructure that underlies a safe and effective program and highlights some of the opportunities and threats likely to impact the system in coming years.
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Aprobación de Drogas/organización & administración , Política de Salud , Programas de Inmunización/organización & administración , Administración en Salud Pública , United States Public Health Service/organización & administración , Vacunas/normas , Sistemas de Registro de Reacción Adversa a Medicamentos , Aprobación de Drogas/legislación & jurisprudencia , Femenino , Humanos , Masculino , Vigilancia de Productos Comercializados , Estados Unidos , United States Food and Drug Administration , Vacunas/efectos adversosAsunto(s)
Brotes de Enfermedades/prevención & control , Programas de Inmunización , Poliomielitis/epidemiología , Poliomielitis/prevención & control , Vacunas contra Poliovirus , Portador Sano , Heces/virología , Humanos , Programas de Inmunización/tendencias , Poliomielitis/diagnóstico , Poliomielitis/virología , Poliovirus/fisiología , Vacuna Antipolio de Virus Inactivados , Vacuna Antipolio Oral/efectos adversos , Factores de TiempoRESUMEN
Measles eradication would avert the current annual 1 million deaths and save the $1.5 billion in treatment and prevention costs due to measles in perpetuity. The authors evaluate the biological feasibility of eradicating measles according to 4 criteria: (1) the role of humans in maintaining transmission, (2) the availability of accurate diagnostic tests, (3) the existence of effective vaccines, and (4) the need to demonstrate elimination of measles from a large geographic area. Recent successes in interrupting measles transmission in the United States, most other countries in the Western Hemisphere, and selected countries in other regions provide evidence for the feasibility of global eradication. Potential impediments to eradication include (1) lack of political will in some industrialized countries, (2) transmission among adults, (3) increasing urbanization and population density, (4) the HIV epidemic, (5) waning immunity and the possibility of transmission from subclinical cases, and (6) risk of unsafe injections. Despite these challenges, a compelling case can be made in favor of measles eradication, and the authors believe that it is in our future. The question is when.
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Sarampión/prevención & control , Adulto , Niño , Salud Global , Infecciones por VIH/inmunología , Humanos , Sarampión/diagnóstico , Sarampión/inmunología , Sarampión/transmisión , Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/inmunología , Política , Factores de Riesgo , VacunaciónAsunto(s)
Control de Enfermedades Transmisibles/organización & administración , Programas de Inmunización/organización & administración , Adulto , Niño , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Vigilancia de la Población , Estados UnidosRESUMEN
School immunization laws have had a remarkable impact on vaccine-preventable diseases in the United States, particularly in school-aged populations. Enforcement of laws through the exclusion of unvaccinated children from school is a critical factor in assuring success. All laws have exemptions for medical contraindications, 47 states have exemptions for persons with strong religious beliefs against vaccination and 15 states have exemptions for persons philosophically opposed to vaccination. Fewer than 1% of students have any type of exemption in most states. School laws harness the resources of other programs such as education to the immunization effort. They establish a safety net to assure high levels of coverage each and every year. But they cannot replace efforts to assure age appropriate immunization in the first two years of life.
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Inmunización/legislación & jurisprudencia , Instituciones Académicas , Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Estados UnidosRESUMEN
PIP: This paper examines the role of epidemiology in reducing the health burden of infectious diseases through vaccination. Epidemiology has played a part in all aspects of immunization by: 1) defining the health burden of infectious diseases meriting prevention; 2) determining populations at risk for disease and disease complications; 3) evaluating modes of transmission and the groups critical to sustaining transmission of infectious agents; 4) estimating the effectiveness of a given vaccine and vaccine policy; 5) determining reasons for failure to control disease, and suggesting solutions; 6) assessing the safety of vaccines, and reevaluating risk-benefit analyses; and 7) determining the most effective strategies for vaccine delivery. The controlled studies, observational studies, and disease surveillance have produced advances in the control of vaccine-preventable diseases. The most effective use of vaccines would depend on the introduction of vaccines in areas where disease epidemiology finds it beneficial to health.^ieng
Asunto(s)
Vacunas , Control de Enfermedades Transmisibles , Humanos , VacunaciónRESUMEN
Transmission of pertussis among adults is being increasingly recognized. About 1 or 2 in 1,000 adolescents and adults develop pertussis each year, > or = 12% of persons with acute cough illnesses of at least 1-2 weeks' duration have evidence of pertussis infection, and adults have been the source of pertussis for younger children. The advent of acellular pertussis vaccines, if safe and effective in adults, offers the opportunity to prevent transmission of pertussis in older populations. Several issues should be clarified before routine immunization is recommended, including the health burden of pertussis in adults and adolescents to be prevented by vaccination and how much morbidity resulting from pertussis in infants and children would be indirectly prevented. Preliminary studies suggest that pertussis vaccines are safe and immunogenic in adults. Potential recommendations for future vaccination might include all adolescents and adults at 10-year intervals along with the adult tetanus-diphtheria toxoids booster. Cost-benefit or cost-effectiveness analyses would be useful in developing vaccination policies for adults.
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Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tos Ferina/prevención & control , Tos Ferina/transmisión , Adolescente , Adulto , Niño , Preescolar , Política de Salud/tendencias , Humanos , Lactante , Estados Unidos/epidemiología , Vacunación/normas , Tos Ferina/diagnóstico , Tos Ferina/epidemiologíaRESUMEN
The biotechnology revolution is producing a growing bounty of new vaccines which pose difficult choices in selecting among many products. Some major public and private purchasers of vaccine may offer individual physicians and clinics their choice in assembling vaccine inventories. Others might purchase only a limited stock of products that would satisfactorily immunize a typical child. In either case, current vaccine selection decisions are based principally on purchase price alone without systematic consideration of other factors of fiscal consequence. As a potential tool for decision making, we developed an economic algorithm for vaccine selection that would minimize the overall costs of disease control through immunization by considering: (1) purchase price, (2) number of doses needed, (3) preparation time, (4) route of administration, (5) cold storage needs, (6) shelf life, (7) earliest age of full immunity, (8) adverse events frequency, and (9) efficacy of protection. To demonstrate the algorithm, variables (1) to (4) above were incorporated into a pilot binary-integer linear programming model that satisfied the recommended immunization schedule for diphtheria, tetanus, pertussis, Haemophilus influenzae b, and hepatitis B, using eleven vaccines (DTaP, DTaP-Hib, Hib, HepB and Hib-HepB) from four manufacturers. Five (or six) opportunities to vaccinate were modeled at (1), 2, 4, 6, 12-18, and 60 months of life, assuming US$40 per clinic visit, $15 per injection, and $0.50 per minute of nurse preparation time. Vaccine costs were varied using actual March and September 1997 US Federal vaccine prices, as well as estimates for unpriced new vaccines. Over 16,000 distinct vaccine stocking lists by vaccine type and brand were possible. Including a 1-month visit, the lowest-cost 'solution' of the algorithm was $529.41 per child in the March cost-assumption case, and $490.32 in the September one (both included four doses of DTaP-Hib, three HepB, and one DTaP). Without a 1-month visit, the lowest-cost solution in the March case cost $486.67 (four DTaP, two Hib-HepB, one DTaP-Hib, and one HepB), while the September case cost $450.32 (four DTaP-Hib, three HepB, and one DTaP). Ensuring at least one product was selected from each of the four manufacturers increased costs about $13.00, and the needed injections rose from eight to nine. The most economical selection of vaccines to use cannot be intuitively predicted, as permutations are large and solutions are sensitive to minor changes in costs and constraints. A transparent, objective selection method that weighs the economic value of distinguishing features among competing vaccines might offer the 'best value' to vaccine purchasers, while also creating strong market incentives for continuing innovation and competition in the vaccine industry.
Asunto(s)
Algoritmos , Vacunación/economía , Adolescente , Cápsulas Bacterianas , Biotecnología , Niño , Preescolar , Control de Costos , Vacuna contra Difteria, Tétanos y Tos Ferina/economía , Vacuna contra Difteria, Tétanos y Tos Ferina/uso terapéutico , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Vacunas contra Haemophilus/economía , Vacunas contra Haemophilus/uso terapéutico , Vacunas contra Hepatitis B/economía , Vacunas contra Hepatitis B/uso terapéutico , Humanos , Esquemas de Inmunización , Lactante , Polisacáridos Bacterianos/economía , Polisacáridos Bacterianos/uso terapéutico , Programación Lineal , Vacunas Conjugadas/economía , Vacunas Conjugadas/uso terapéuticoRESUMEN
This is the third in a series of guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. It is presented as a standard of care rather than a practice guideline because the case for following these recommendations is very strong and it should be followed with rare exceptions. The purpose of this guideline is to provide assistance to clinicians when making decisions on providing immunizations to healthy infants, children, and adults. The document is a summary of guidelines already developed by national organizations. The targeted providers are pediatricians, family practitioners, internists, and other physicians who provide immunizations. The IDSA provided the funding. Panel members represent experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. Indicators for measuring compliance with the standards are included.