Immunization Guidelines Research Articles

Assessment of Vaccination Rates among Smokers and Non-Smokers at a Student-Run Free Clinic

Background: While student-run free clinics (SRFCs) increasingly serve as part of the safety net for the uninsured and underinsured, it is unknown whether SRFCs consistently follow immunization guidelines in patients that smoke. This study characterized the preventative care in our clinic by evaluating the rate of adult immunizations and referrals of patients that smoke to cessation treatment.
 Methods: We conducted a retrospective chart review of patients seen in 2016 at the LionCare Free Clinic. Data extracted included tobacco smoking status, desire to quit, smoking cessation treatment referrals, influenza and pneumococcal vaccination status, and demographics. Chi-square tests and Fisher Exact analysis were used to examine differences in influenza and pneumococcal vaccination rates in smokers versus non-smokers. We assessed the rate of interested smokers who received a referral to cessation therapy.
 Results: In 2016, 498 patients were evaluated, of whom 67% were smokers. Among smokers, 21% reported receiving the influenza vaccination compared to 20% of non-smokers (p=0.85). Seven percent of patients who smoke received the pneumococcal vaccine compared to 5% of non-smokers. Of the total patients who were vaccinated, a small percentage received the vaccines in the clinic. Although 66% of smokers reported interest in quitting during the first clinic visit, only 3% were referred to a smoking cessation program.
 Conclusion: SRFCs face challenges in providing preventative health care for the underserved population. Despite guidelines recommending smokers receive the pneumococcal vaccine before age 65, few patients received it. Quality improvement interventions are needed to improve preventative health services to this vulnerable population.

Coadministration of Anti-Viral Monoclonal Antibodies With Routine Pediatric Vaccines and Implications for Nirsevimab Use: A White Paper.

Routine childhood vaccinations are key for the protection of children from a variety of serious and potentially fatal diseases. Current pediatric vaccine schedules mainly cover active vaccines. Active vaccination in infants is a highly effective approach against several infectious diseases; however, thus far, for some important viral pathogens, including respiratory syncytial virus (RSV), vaccine development and license by healthcare authorities have not been accomplished. Nirsevimab is a human-derived, highly potent monoclonal antibody (mAb) with an extended half-life for RSV prophylaxis in all infants. In this manuscript, we consider the potential implications for the introduction of an anti-viral mAb, such as nirsevimab, into the routine pediatric vaccine schedule, as well as considerations for coadministration. Specifically, we present evidence on the general mechanism of action of anti-viral mAbs and experience with palivizumab, the only approved mAb for the prevention of RSV infection in preterm infants, infants with chronic lung disease of prematurity and certain infants with hemodynamically significant heart disease. Palivizumab has been used for over two decades in infants who also receive routine vaccinations without any alerts concerning the safety and efficacy of coadministration. Immunization guidelines (Advisory Committee on Immunization Practices, Joint Committee on Vaccination and Immunization, National Advisory Committee on Immunization, Centers for Disease Control and Prevention, American Academy of Pediatrics, The Association of the Scientific Medical Societies in Germany) support coadministration of palivizumab with routine pediatric vaccines, noting that immunobiologics, such as palivizumab, do not interfere with the immune response to licensed live or inactivated active vaccines. Based on the mechanism of action of the new generation of anti-viral mAbs, such as nirsevimab, which is highly specific targeting viral antigenic sites, it is unlikely that it could interfere with the immune response to other vaccines. Taken together, we anticipate that nirsevimab could be concomitantly administered to infants with routine pediatric vaccines during the same clinic visit.

Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers

The mRNA vaccines against COVID-19 infection have been effective in reducing the number of symptomatic cases worldwide. With widespread uptake, case series of vaccine-related myocarditis/pericarditis have been reported, particularly in adolescents and young adults. Men tend to be affected with greater frequency, and symptom onset is usually within 1 week after vaccination. Clinical course appears to be mild in most cases. On the basis of the available evidence, we highlight a clinical framework to guide providers on how to assess, investigate, diagnose, and report suspected and confirmed cases. In any patient with highly suggestive symptoms temporally related to COVID-19 mRNA vaccination, standardized workup includes serum troponin measurement and polymerase chain reaction testing for COVID-19 infection, routine additional lab work, and a 12-lead electrocardiogram. Echocardiography is recommended as the imaging modality of choice for patients with unexplained troponin elevation and/or pathologic electrocardiogram changes. Cardiovascular specialist consultation and hospitalization should be considered on the basis of the results of standard investigations. Treatment is largely supportive, and myocarditis/pericarditis that is diagnosed according to defined clinical criteria should be reported to public health authorities in every jurisdiction. Finally, we recommend COVID-19 vaccination in all individuals in accordance with the Health Canada and National Advisory Committee on Immunization guidelines. In patients with suspected myocarditis/pericarditis after the first dose of an mRNA vaccine, deferral of a second dose is recommended until additional reports become available.

Immunization Update 2021

Immunization Update 2021

“From my phone, I could rule the world”: Critical engagement with maternal vaccine information, vaccine confidence builders and post-Zika outbreak rumours in Brazil

Maternal immunization is key to protecting maternal and newborn health. We interviewed pregnant women in Brazil to identify barriers to and enablers of maternal immunization in the country. In-depth interviews and focus groups were conducted in Brazil with 60 pregnant women from São Paulo and Rio de Janeiro at different stages of their pregnancies. Participants were encouraged to discuss views on safety, efficacy and importance of maternal vaccines, access to vaccines, interactions with healthcare professionals, and sources of information on vaccine-related matters. There was generally a positive regard for maternal immunization among the interviewed women, many of whom associated vaccination with protection of their unborn child. The interviewees cited several reasons for adherence to immunization guidelines, including recommendations from healthcare professionals, targeted communication campaigns, and active use of a vaccination card or booklet. There were no reported barriers for maternal vaccines. Some women using private healthcare services reported not having been asked about vaccines at check-ups, which could adversely affect vaccination rates. A rumour that vaccines caused microcephaly which emerged during the Zika outbreak was the most commonly cited reason for choosing not to vaccinate among the interviewees. This study identified important vaccine confidence builders. Many of the interviewees critically reflected upon information received, placing themselves as the decision makers over their health choices. A prominent barrier to maternal immunization was a rumour linking vaccines to microcephaly. To the best of our knowledge, this has not been previously reported in the literature and requires further investigation into the extent of this issue and how it can be mitigated.

An alternative maximum reach strategy for routine immunization during the pandemic in Indonesia

Immunization plays a significant role in reducing the mortality rate for children under five. Immunization has been proven to be an efficient and effective health effort in preventing and reducing morbidity, disability, and death due to diseases that can be prevented by immunization. Increasing the coverage of immunization needs to be considered by the government by involving the community and health offices, and other stakeholders. Health centers should provide immunization services considering the immunization guidelines during the Covid-19 pandemic, ensuring adequate health workers (vaccinators). Provide information about safe immunization services and coordination and collaboration with stakeholders (private and public sectors).

Discrete geochemical behavior of Sr and Ba in the groundwater of Southern Mor Range, Balochistan, a tracer for igneous and sedimentary rocks weathering and related environmental issues

A comparative study of Strontium (Sr) and Barium (Ba) along with associated major ions of groundwater was made from the Southern Mor Range, Balochistan, where both igneous and sedimentary rocks are exposed. In the studied samples, Sr2+ varies from 237 to 6,723 with a mean of 1,688 μg/l, while Ba2+ ranged from 40 to 1,332 μg/l with a mean of 207 μg/l. TDS and Sr2+ displayed moderate positive, while Ba2+ showed a slight negative relation. Majority (80.85%) of the samples have existed in the narrow pH range (7.5–8.5). The impact of water-rock interaction is evidenced from the Gibbs diagram; showed influence of igneous and sedimentary rocks on the release of Sr2+ and Ba2+. It is also evidenced from molar ratio of Sr2+/Ca2+, Mg2+/Ca2+, Na+/Cl−, Mg2+/Cl− of the groundwater. Strontium possessed fairly high relative mobility (RM, av. 0.349) and mobility index (MI, av. 4.38), while RM (av. 0.003) and MI (av. 0.04) of Ba2+ was very low. The saturation indices (SI) plots barite vs. celestite, showed saturation of Ba, while Sr2+ ions are unsaturated. The low Ba2+/Sr2+ (av. 0.208) indicated the existence of aquifer in low elevation areas and the HCO3−/Cl− ratio (>1) demonstrated a short flow path and speedy flow. The suitability of groundwater was assessed for drinking purpose as per World Health Organization (WHO) and Expanded Programme on Immunization (EPI) guidelines and possible environmental issues were discussed.

Infovac-France survey in pediatric vaccinology: How does it compare with the literature?

BackgroundImmunization is experienced as painful and may be responsible for needle fear and noncompliance. There are rare evidence-based methods to reduce pain and improve comfort during immunization. There are no French immunization guidelines summarizing the good practices, based on recent studies. This study focused on the methods used by physicians and how they compared with those validated by clinical trials. MethodsAn online questionnaire was sent to the practitioners from the Infovac network, and a PubMed bibliographic search was conducted. ResultsAlmost 2000 doctors responded to this survey. Purging the needle was a habit in 77.9% of them and aspiration before injection in 21.1%. Only one-quarter of the responding doctors injected in the deltoid muscle between 15 and 24 months, and some injected in the buttocks at any age. Half of the physicians vaccinated infants in their parent's arms, children were seated with half of the pediatricians and only one-third of the general practitioners (GPs), and teenagers were seated when vaccinated by three-quarters of the doctors. Anesthetic creams were used by 46.6% of the physicians, mostly by pediatricians (61.9%), and for infants. Breastfeeding was suggested by three-quarters of the physicians for infants under 4 months of age, and sugared solutions were used by 55.5% of the pediatricians and 32.3% of the GPs. Half of the doctors used rocking and cuddling for babies under 24 months of age and toys between 11 and 24 months. ConclusionMany methods are available to distract and improve comfort during immunization. Physicians should choose those they prefer, adjusting for the child's age. There should be French guidelines for immunization techniques, based to the latest clinical surveys, to help improve immunization practice.

Vaccines in Children with Inflammatory Bowel Disease: Brief Review.

Incidence of inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing worldwide. Children with IBDs have a dysfunctional immune system and they are frequently treated with immunomodulating drugs and biological therapy, which significantly impair immune system functions and lead to an increased risk of infections. Vaccines are essential to prevent at least part of these infections and this explains why strict compliance to the immunization guidelines specifically prepared for IBD patients is strongly recommended. However, several factors might lead to insufficient immunization. In this paper, present knowledge on the use of vaccines in children with IBDs is discussed. Literature review showed that despite a lack of detailed quantification of the risk of infections in children with IBDs, these children might have infections more frequently than age-matched healthy subjects, and at least in some cases, these infections might be even more severe. Fortunately, most of these infections could be prevented when recommended schedules of immunization are carefully followed. Vaccines given to children with IBDs generally have adequate immunogenicity and safety. Attention must be paid to live attenuated vaccines that can be administered only to children without or with mild immune system function impairment. Vaccination of their caregivers is also recommended. Unfortunately, compliance to these recommendations is generally low and multidisciplinary educational programs to improve vaccination coverage must be planned, in order to protect children with IBD from vaccine-preventable diseases.

Gender-responsive language in the National Policy Guidelines for Immunization in Kenya and changes in prevalence of tetanus vaccination among women, 2008–09 to 2014: A mixed methods study

Global evidence suggests that maternal vaccination rates are partly related to intersectional gender-related disparities. Kenya recently eliminated maternal and neonatal tetanus, but previously had low rates of tetanus vaccination in many districts. Examining both national data and gender-responsive language in policies can potentially illuminate this progress. This study used mixed-methods approach: content analysis to identify gender-responsive language in Kenya's National Policy Guidelines for Immunization 2013, and logistic regression to analyze data from the Kenya Demographic and Health Surveys: 2008–09 (pre-policy) and 2014 (post-policy) to determine whether vaccination utilization significantly changed pre- and post-policy. Kenya's vaccine Guidelines highlighted a comprehensive life-cycle approach with several mentions of targeted immunization sensitization interventions for diverse sub-populations of women and gatekeepers. Logistic regression suggested an association between year of survey administration and prevalence of tetanus vaccination, with greater adjusted odds post policy implementation (e.g., 2014). Further in-depth research, like elite interviews, might prove valuable.

Seroprevalence of antibodies against varicella among medical students - a need for immunization record for medical school admission

Introduction and Aim:This study was conducted at a medical University in UAE to assess the risk of acquiring Varicella – a vaccine-preventable disease, by estimating antibody titers among the clinically exposed students to provide a scientific implementation of immunization guideline during admission to medical school.
 Materials and Methods: This cross-sectional study involved 88 students in clinical years attending a medical college in the UAE. The students' demographics, vaccination data, and history of natural infection with vaccine-preventable communicable infectious diseases were collected, with more significance on Varicella. Blood samples were collected to determine varicella IgG via ELISA.
 
 Results:Out of 88 medical students, 20.45% of students had vaccination during childhood and 60.22%of students had a natural infection in the last five years. Three students (3.4%), who had childhood vaccination acquired the infection which is statistically significant during their clinical study years. 70.4% of students who had childhood vaccination and natural infection are at risk of acquiring varicella infections due to the waning of antibodies. 13.64% were found to be negative for varicella antibody titers are at the highest risk.
 
 Conclusion:Medical students are most susceptible to acquiring the infection. Medical Universities should take up a policy, that each student needs to take booster vaccinations as a mandatory requirement before admission into the first year, which is practiced as an admission protocol in Western countries like the United States of America but not in Asian countries. Special emphasis should be placed on catch-up vaccination of students because the likelihood of severe infection increases with age.

Vaccination in Adults with Chronic Lung Disease – Revisiting 2019 Immunization Guidelines

Effective immunization programs have always resulted in successful eradication of targeted infectious diseases. Apart from childhood immunization, adult immunization is required for two major reasons: 1. failure of primary immunization, 2. to boost waning effect of childhood vaccines. Adult immunization gained its importance in the recent years with detailed recommendations laid down by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). In most countries, adult vaccination guidelines fall back on the WHO and CDC adult immunization schedules. With evolving number of chronic lung disease patients, it is mandatory to educate and encourage patients on available options for vaccination. A successful immunoprophylaxis given to high-risk group individuals will definitely improve their quality of life.

Developing Adult Vaccination Ecosystem in India: Current Perspective and the Way Forward.

Introduction:A high burden of vaccine-preventable diseases, increasing elderly population, immunosenescence, and emerging drug resistance emphasize the need for robust adult immunization in India. While immunization guidelines from various societies exist, there is inadequate implementation of the same.Aim:We undertook this narrative review of the adult vaccination ecosystem in India to (i) gain insights into existing adult vaccination practices, (ii) identify barriers to adult vaccination and possible solutions, and (iii) improve collaboration between various stakeholders to help establish adult vaccination centers in the country.Results:Besides the high cost and lack of insurance coverage, the lack of adult vaccination centers contributes to the low coverage of adult immunization.Discussion:These challenges can be addressed through multiple approaches including community awareness and immunization programs, setting up mobile vaccination vans, patient/consumer education, and adequate training of healthcare providers. Successful implementation of these strategies requires active collaboration between the government, hospitals, different stakeholders, and policymakers.

Advancing Research Methods for Common Problems in Family Medicine and Family Medicine Practice Management

Several research groups from multiple institutions provide structure and methods to improve research for family medicine. Colon cancer research includes which common screening test for colon cancer most often results in completed colonoscopy. Authors explore how some cardiovascular preventive medications are overused while others are underused. Three research papers specifically advance improvements for practice management, 3 articles address diabetes, 3 others cover family physicians caring for specific populations (pregnant women, children, and those with sports-related issues). There are practical research articles on practice management and others on common clinical problems. This issue also includes a clinical review on acute sensorineural hearing loss and human papilloma virus immunization guidelines that can cause confusion.

Splenektomi Yapılan Hastalarda Aşılanma Oranları ve Kılavuzlara Uyum: Gözlemsel, Kesitsel Bir Çalışma

Introduction: Splenectomy, whatever the reason, is an absolute indication for vaccination against encapsulated bacteria in order to prevent overwhelming post-splenectomy infections. This study aimed to determine compliance to immunization guidelines for splenectomy in General Surgery Clinics. Materials and Methods: In this observational cross-sectional study, we included patients who underwent splenectomy between April 2016 and April 2018, and recorded the patient data and vaccination status. Results: Splenectomy was performed in 65 patients, 40 (61.5%) were male and median age was 56 (19-90) years. Six of the operations were emergent, 21 were planned and 38 were urgent mostly due to solid organ malignancy. Only 14 (21.5%) patients were vaccinated with Haemophilus influenzae, meningococcal and pneumococcal vaccines according to the guidelines (≥2 weeks before the operation). 14 of the 21 patients (66.6%) who underwent planned splenectomy were vaccinated appropriately. Conclusion: Compliance with vaccination guidelines was low before splenectomy operations. There is a room for improvement particularly for patients undergoing elective splenectomy. A patient-centered team strategy is required to vaccinate patients at the stage of splenectomy planning.

Exploring Strategies to Improve Adherence to Immunization Schedule: A Study among Children Attending Maternal and Child Health Clinic at Kenyatta National Hospital, Nairobi, Kenya.

Background Globally, immunization is among the major contributors to public health, preventing 20% of childhood mortality annually. The highest fatality rates from vaccine preventable diseases are usually among children under five. Despite immunization guidelines put in place by the World Health Organization, globally, 1.5 million children die annually related to inadequate vaccination coverage. Existing literature indicate that there is an increase in nonadherence to immunization schedule in developing countries, and therefore, there is an increased demand to improve adherence to immunization schedule. Objective To explore strategies that will improve adherence to immunization schedule among children under 24 months attending the Maternal and Child Health clinic at Kenyatta National Hospital. Methods A cross-sectional mixed method study involving caregivers (n = 214) of well babies attending the Maternal and Child Health clinic. Data was collected using semistructured questionnaires, focus group discussions, and key informant interviews and analyzed using SPSS V.20. Results There was a significant relationship between the level of education and marital status of the caregivers and adherence to immunization schedule. Barriers found that is related to adherence to immunization schedule included far distance from health facility, baby's sickness, and vaccine stock-outs while employment of a caregiver was a constrainer factor. Conclusion The enabling factors to current strategies of improving adherence to immunization schedule were having more health facilities near residential areas, using text messages reminders a day before the clinic date to remind caregivers of the due date for the clinic, and constant availability of vaccines. The health system strategies that would improve adherence to immunization schedules were more flexible clinic hours, availability of vaccines on daily basis, phone call reminders by health care providers, and increasing awareness on the importance of both vaccinations and adherence to immunization schedule.

Strategies to Improve Vaccination among At-Risk Adults and the Elderly in Italy.

The World Health Organization (WHO), the United States (US) Centers for Disease Control and Prevention (CDC), the European Center for Disease Control (ECDC), and the immunization guidelines of many countries issue vaccination recommendations for adults and the elderly. However, the uptake of vaccination in these groups is generally low due to several reasons. The present study aimed to identify strategies implemented in Italy in unconventional settings to promote vaccination against influenza, pneumococcal, and herpes zoster virus (HZV) infections among these subjects, i.e., the at-risk adult population and the elderly. We conducted a literature review and a survey of experts. The literature search yielded seven strategies; all of these concerned influenza vaccination, while three also addressed pneumococcal and HZV vaccination. The survey of experts identified 15 strategies; 10 regarded influenza vaccination, while four regarded pneumococcal vaccination and one regarded HZV vaccination. Most of the strategies were implemented in hospital clinics and rest homes. Regarding influenza and pneumococcal vaccinations, the target population mainly comprised at-risk adults, while the elderly represented the main target population for HZV vaccination. Our results show that, in Italy, there are initiatives aimed at promoting vaccination in unconventional settings, but further efforts are required to assess their effectiveness and to further extend them.

A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations

For the successful implementation of population-level recommendations, it is critical to consider the full spectrum of public health science, including clinical and programmatic factors. Current frameworks may identify various factors that should be examined when making evidence-informed vaccine-related recommendations. However, while most immunization guidelines systematically assess clinical factors, such as efficacy and safety of vaccines, there is no published framework outlining how to systematically assess programmatic factors, such as the ethics, equity, feasibility, and acceptability of recommendations. We have addressed this gap with the development of the EEFA (Ethics, Equity Feasibility, Acceptability) Framework, supported by evidence-informed tools, including Ethics Integrated Filters, Equity Matrix, Feasibility Matrix, and an Acceptability Matrix. The Framework and tools are based on five years of environmental scans, systematic reviews and surveys, and refined by expert and stakeholder consultations and feedback. For each programmatic factor, the EEFA Framework summarizes the minimum threshold for consideration and when further in-depth analysis may be required, which aspects of the factor should be considered, how to assess the factor using the supporting evidence-informed tools, and who should be consulted to complete the assessment. Research, particularly in the fields of vaccine acceptability and equity, has validated the utility and comprehensiveness of the tools. The Framework has been successfully used in Canada for clear, timely, transparent vaccine guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Applying the EEFA Framework allows for the systematic consideration of the spectrum of public health science without a delay in recommendations, complementing existing decision-making frameworks. This Framework will therefore be useful for advisory groups worldwide to integrate critical factors that could impact the successful and timely implementation of comprehensive, transparent recommendations, and will further the global objective of developing practical and evidence-informed immunization policies.

Adherence to Recommended Post-Splenectomy Immunizations to Reduce the Risk of Sepsis: The University of Washington Experience.

Immunizations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b are recommended for patients undergoing splenectomy to decrease the risk of developing overwhelming infections. The authors sought to determine adherence to these recommendations by providers at UW Medicine. Regional immunization records for patients who underwent splenectomy between October 2015 and January 2019 were analyzed to measure compliance with immunization guidelines from the US Centers for Disease Control and Prevention (CDC). Among 253 patients who underwent splenectomy, 38 (15%) received all 7 immunizations against S pneumoniae, N meningitidis, and H influenzae type b recommended by the CDC; 95% of patients received at least 1 pneumococcal vaccine; 26% percent of patients did not receive MenB-4C vaccine. Many patients (3% to 10%) received redundant immunizations not in accordance with CDC recommendations. Development of state and national immunization registries and systems to improve adherence with post-splenectomy immunization guidelines may reduce risk for life-threatening infections.

222. Using Reproductive Health Visits to Engage Adolescent and Young Adult Women in Primary Care.

Adolescent/Young Adult (AYA) primary care visits are an opportune time to address physical, psychological, and social influences on developing health behaviors. However, many AYAs do not receive primary care despite available guidelines for screening, immunizations, and annual physical exams. Frequent interactions with the healthcare system by AYA women for family planning and other reproductive health services may be used to improve engagement in care and promote wellness; however, less cumbersome methods may require less interaction with the healthcare system. The purpose of this research is to examine differences in clinic engagement, receipt of primary care, STI/HIV screening, and immunizations by contraceptive use.