Immunization Adherence Research Articles

Comprehensive Interventions in HBV Care: Nursing-Sensitive Approach

Objectives: To evaluate the impact of a comprehensive intervention using nursing-sensitive quality indicators on pregnant women with hepatitis B and their newborns. Design: A randomized controlled monocentric trial conducted from January 2020 to May 2022. Participants/Materials: 80 pregnant women diagnosed with hepatitis B were randomly assigned to either a control group (n=40) or an experimental group (n=40). The experimental group received care-sensitive quality indicators during treatment. Setting: Department of Traditional Chinese Medicine, Nantong Third People's Hospital, affiliated with Nantong Hospital 3 of Nantong University, Jiangsu, China. Methods: Participants in the experimental group received daily Tenofovir from late pregnancy to early postpartum, and newborns received hepatitis B vaccine and immunoglobulin within 24 hours of birth. Healthcare personnel underwent six months of training on care-sensitive quality indicators. The effectiveness of the intervention was assessed using various indicators such as health education coverage, antiviral medication compliance, follow-up rates, and psychological health. Results: The results showed that after comprehensive intervention, the coverage rate of health education increased from 82.50% before intervention to 92.50% (P=0.033), and adherence to antiviral medication improved from 82.50% to 97.50% (P=0.000). The follow-up rate for hepatitis B mothers also significantly increased from 80.00% to 95.00% (P=0.001). In addition, the incidence of negative emotions such as anxiety and depression among pregnant women significantly decreased from 57.50% to 30.00% (P=0.000). These findings demonstrate the effectiveness of comprehensive interventions in improving health education coverage and participation, enhancing adherence to antiviral medication, and effectively reducing the psychological burden of pregnant women. Moreover, after the intervention, the awareness of mother-to-child transmission prevention for hepatitis B significantly increased from 82.36 points before intervention to 94.32 points after intervention (P=0.000). At the same time, adherence to neonatal immunization increased from 80.00% to 95.00%, and satisfaction with nursing services improved from 90.66 points to 98.64 points (P=0.000). These results indicate that comprehensive interventions significantly enhance knowledge related to mother-to-child transmission prevention, increase immunization adherence, and improve satisfaction with nursing services.

Factors Influencing Parental Practices Regarding Childhood Immunization in Lahore, Pakistan

Background: Childhood immunization is a key strategy of the World Health Organization (WHO) to reduce child mortality. The vaccine is intended to protect about 2 million and 3 million survivors per year. Despite this, Pakistan continues to struggle with vaccine-preventable diseases due to a significant number of unvaccinated children and is one of two states where the prevalence of poliovirus persists. This study aims to investigate the factors influencing parents’ decisions regarding childhood immunization in Pakistan, with a focus on understanding parental practices and perceptions surrounding vaccination Methods: A cross-sectional study was conducted to assess parent’s practices toward vaccination of their children in Lahore, Pakistan. Validated questionnaires was used to evaluate parent’s practices of childhood vaccination. The research population was 353 parents living in urban and rural areas of Lahore with children of different ages. The data collected through a questionnaire entered and analyzed by using SPSS program v21, IBM. P-values less than 0.05 were considered as statistically significant values. Results: Out of 353 parents surveyed, majority of the study subject were mothers (56.1%) with age 25-29 years with percentage 30.0%, stating that majority of the parents have poor practice (75.4%) and a few presented good practices i.e., 24.6%. Variables like occupation, number of children, residency, living class and health care providers in respondent family shows highly significant statistical association (p<0.001) with patient’s practice regarding their child immunization. Conclusion: The poor practice towards child immunization indicates a concerning gap in immunization adherence. The study revealed that a significant majority of parents demonstrated poor practices highlighting critical public health issues despite awareness campaigns. Factors such as limited access to healthcare facilities, socioeconomics challenges and cultural beliefs contribute to poor practice. The findings emphasize the need for improved support system and educational initiatives to bridge the gap between knowledge and practice, to enhance vaccination rates and improving public health outcomes.

Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study.

Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR=1.17; 95% CI, 1.04-1.31; p=.004) and the four-dose pneumococcal conjugate vaccine series (OR=1.36; 95% CI, 1.18-1.57; p<.001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.

The Correlation Between Behavioral and Psychological Factors with Booster Immunization Adherence for Children Aged &lt;24 Months

Background: Immunization status is considered complete when children receive all antigens types as recommended, including booster immunization, ensuring optimal protection. The high level of non-adherence is the main obstacle to immunization programs, further added by the fact that the number of children who receive partial or no immunization remains high. This study aims to analyze the correlation between behavioral and psychological factors with booster immunization adherence in children aged &lt;24 months.Method: A quantitative study with a cross-sectional approach. The population consists of parents with children aged 18-23 months, totaling a sample of 522 children. The data were collected through interviews using structured questionnaires, and observations using MCH-Book to measure booster immunization adherence. The collected data was analyzed through univariate, bivariate, and multivariate approaches with multiple logistic regression tests to identify the dominant variables.Results: Only 25.9% of children received two types of recommended booster vaccines (DPT/HB/HiB-4 and MR-2). Partially, behavioral factors that correlate with booster immunization adherence are knowledge, attitudes, and perceptions about multiple injections, while psychological factors that correlate are motivation and basic immunization status. Experience with previous basic immunization status is the most dominant factor influencing booster immunization adherence. The fear of disease infection and trust in healthcare providers are the keys to a successful immunization. Need to increase motivation through strengthening literacy and improving access to and health service system to reduce hesitation about, distrust, and refusal of immunization, while also providing a positive immunization experience.

Impact of Screening and Co-located Parent Coaching Within Pediatric Primary Care on Child Health Care Use: A Stepped Wedge Design.

Childhood adversity and toxic stress have been associated with poor mental and physical health. This study examined if Parent Connext, a program that integrates adversity screening and parent coaching by co-located specialists within pediatric primary care, had an impact on health care utilization. This stepped wedge cluster randomized controlled trial evaluated Parent Connext across six pediatric primary care practices. All practices (clusters) were in the control period during year 1. Three practices were randomized to begin the Parent Connext intervention in year 2, and three practices were randomized to begin in year 3. Medical records of all patients under age 8 treated at these practices during these 3years were queried retrospectively for participant-level primary outcomes (sick visits, emergency department visits, hospitalizations) and secondary outcomes (well-child and immunization adherence, referrals). The study sample included 27,419 patients followed for an average 1.39 (SD = 0.66) years in the control period and 1.07 (SD = 0.60) years in the intervention period. During the intervention period, patients had significantly fewer sick visits (IRR = 0.91, p < 0.001) which aligned with our hypothesis, decreased odds of well-child visit adherence (OR = 0.88, p < 0.001) which was unexpected, and increased odds of receiving a referral (OR = 1.45, p < 0.001). The odds of an emergency department visit, hospitalization, and 2-year immunization adherence did not differ between periods. Parent Connext resulted in a significant reduction in child sick visits, highlighting the potential benefit of two-generation approaches to pediatric care for child health.

Development of a Low Cost Mobile Phone-Based Intervention to Support Infants’ Vaccination among Nursing Mothers

In Nigeria, nursing mothers in rural communities lack public amenities such as safe water, adequate primary health care, good electricity supply, GSM network coverage and good road network. These often predispose them to be noncompliant to infants’ immunization uptakes and have high rates of morbidity in Vaccine Preventable Diseases (VPD) among infants. Mobile phones can be leveraged upon to provide a viable medium to support immunization uptakes and adherence using few mobile phone-based interventions which are available for low-income nursing mothers. Hence the study assessed development of a low cost mobile phone-based intervention to support infants’ vaccination among nursing mothers. The study developed a low cost mobile phone-based intervention to support infants’ vaccination among nursing mothers in an effort to alleviate the challenges of infant’s vaccination among nursing mothers, a low cost mobile phone-based application was designed and tested among nursing mothers. In the development of the app, incremental software development was adhered to using Java programming language in an Android Studio Integrated Development Environment (IDE). The software was pretested using pre and post experimental data collection. The app is a reminder system, preloaded with immunization awareness messages. It is simple to install and use and does not cost nursing mothers airtime or data. It only requires scheduling at-birth immunization’s date. The app can schedule and display all other immunization dates automatically; relate specific health benefits of each vaccine as a reminder messages both in English and Yoruba languages automatically as scheduled. The experiences of the nursing mothers with this software were gathered for six months through pre-test and post-test pre-experimental design. The app was found effective in reminding the nursing mothers about immunizations appointments, enlightening them about the immunization health benefits to their infants. The intervention has possibility of improving immunization compliances and attendants at clinic appointments. Since it is low cost software, it is therefore recommended for the nursing mothers. Keywords: Vaccine Preventable Diseases, immunization, Integrated Development Environment (IDE), intervention, mobile phone, nursing mother. Journal Reference Format: Onamade, A.A., Oyerinde, O.O., Oduwole, A.O. Lala, O.G. &amp; Longe, O.B. (2021): Development of a Low Cost Mobile Phone-Based Intervention to Support Infants’ Vaccination among Nursing Mothers. Journal of Behavioural Informatics, Digital Humanities and Development Research. Vol. 7.No. 2, Pp 1-8 Available online at https://www.behaviouralinformaticsjournal.info dx.doi.org/ 10.22624/AIMS/BHI/V7N1P10

The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform.

ObjectiveLearning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases.MethodsCosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification.ResultsIn 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection).DiscussionA low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an “all or none” contribution model, and the lack of control over queries run on an institution’s healthcare data.ConclusionCosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.

Immunization Adherence in Children With Sickle Cell Disease: A Single-Institution Experience.

The Advisory Committee on Immunization Practices (ACIP) recommends additional immunizations for people with asplenia or functional asplenia, such as children with sickle cell disease. Adherence rate to the recommended immunization schedule for functional asplenia remains low for children with sickle cell disease. The purpose of this study was to assess the immunization adherence for this population at a single institution in Kentucky and to evaluate the use of the Kentucky Immunization Registry (KYIR) by providers. A single-center retrospective chart review was conducted for 107 children with sickle cell disease ages 2 through 18 years. Immunization histories were obtained from the hospital EMRs, the sickle cell clinic EMR, the KYIR, and by requesting records from primary care physicians. Each patient was documented as either missing or having complete records in the KYIR. The complete adherence rate to the ACIP-recommended immunization schedule for children with functional asplenia was 6% (6 of 107). Nearly all children were compliant with the Haemophilus influenzae type B vaccination, whereas the adherence rate for the meningococcal and pneumococcal vaccines ranged from 25% to 77%. The lowest immunization rate was observed in children eligible for the meningococcal B vaccine (25%). Only 3 patients had a complete immunization history documented in the KYIR. Adherence to the ACIP-recommended immunization schedule for functionally asplenic patients is poor among children with sickle cell disease included in this study. Quality improvement measures should focus on increasing immunization adherence and improving documentation of immunization records in the KYIR for this patient population.

2487. Vaccination Rates in Post-Transplant Hematopoietic Stem Cell Transplant (HSCT) Patients: Where Do We Stand?

BackgroundHSCT patients are at an increased risk of developing infections after transplant due to the loss of immunogenicity from prior vaccinations. Current national and international guidelines recommend routine revaccinations at a fixed dosing schedule for HSCT patients post-transplant. Although immunization adherence is vital to prevent infections, compliance with post-transplant vaccinations is unknown. The primary endpoint of this study was the completion rate of the post-transplant vaccination series. Secondary endpoints included identifying reasons for noncompliance, rates of breakthrough vaccine-preventable infections, and assessing post-vaccination antibody responses based on titers.MethodsA single-center, retrospective study of adult HSCT patients at Yale New Haven Hospital between January 2010 and September 2015 was performed. Patients were excluded if: <18 years of age, deceased prior to one year post-transplant, transferred care to an outside facility, or were lost to follow-up.ResultsA total of 512 HSCT patients were evaluated. 390 (76%) patients were initiated on the vaccination series. Of the 390 patients, 275 (71%) patients were started at one year follow-up per institutional guidelines. The most common reasons for non-initiation or delayed initiation of the vaccine series included disease relapse (14%), active graft vs. host disease (9%), and the need for immunosuppressive therapy (5%). Of the patients initiated on the vaccination series, only 187 (48%) patients completed the entire vaccination series; with the majority of whom were autologous HSCT patients (72%). The most common reasons for an incomplete vaccination series included maintenance chemotherapy (19%), disease relapse (16%), and lost to follow-up (10%). Of the patients who completed the vaccination series, 19% had the appropriate post-vaccination titers obtained. Of the patients who received at least one or more doses of pneumococcal vaccine post-transplant, 8 patients (2%) developed a breakthrough infection with S. pneumoniae.ConclusionThis study adds important data to the limited body of literature on HSCT vaccine compliance rates. Future studies on the best interventions to improve compliance rates are warranted.Disclosures All authors: No reported disclosures.

Texting atopic dermatitis patients to optimize learning and eczema area and severity index scores: A pilot randomized control trial.

Atopic dermatitis is a common, chronic, debilitating disease. Poor adherence to treatment is the most important preventable contributor to adverse outcomes. Thus, improving adherence can improve patient outcomes. Text message reminders with embedded condition-specific information have been shown to improve pediatric immunization adherence but have not been assessed in atopic dermatitis. The objective was to assess the effect of daily text messages on Eczema Area Severity Index scores and caregiver knowledge of atopic dermatitis. In this pilot randomized controlled trial, caregivers of children with atopic dermatitis enrolled during their initial appointment with a pediatric dermatologist and randomized 1:1 to standard care or daily text messages with patient education material and treatment reminders. Participants completed a multiple-choice atopic dermatitis knowledge quiz at initial and follow-up visits, and Eczema Area Severity Index scores were assessed. Forty-two patients enrolled, and 30 completed the study: 16 standard care group, 14 text message group. There was no significant difference in Eczema Area Severity Index score between the standard care and text message groups at follow-up, with mean decreases in Eczema Area Severity Index score of 53% and 58%, respectively. Mean score on follow-up atopic dermatitis knowledge quiz was significantly higher in the text message group (84% correct) than in the standard care group (75% correct) (P=.04). This pilot study did not demonstrate a difference in Eczema Area Severity Index scores with text message reminders. The significantly higher follow-up atopic dermatitis quiz score in the text message group indicates that participants read and retained information from text messages. Limitations include small sample size and short duration of follow-up.

A cluster randomized trial to determine the effectiveness of a novel, digital pendant and voice reminder platform on increasing infant immunization adherence in rural Udaipur, India

BackgroundFive hundred thousand children under the age of 5 die from vaccine preventable diseases in India every year. More than just improving coverage, increasing timeliness of immunizations is critical to ensuring infant health in the first year of life. Novel, culturally appropriate community engagement strategies are worth exploring to close the immunization gap. In our study, a digital NFC (Near Field Communication) pendant worn on black thread and voice call reminder system was tested for the effectiveness in improving DTP3 adherence within 2 monthly camps from DTP1 administration. MethodA cluster randomized controlled trial was conducted in which 96 village health camps were randomized to 3 arms: NFC sticker, NFC pendant, and NFC pendant with voice call reminder in local dialect. Randomization was done across 5 blocks in the Udaipur District serviced by Seva Mandir from August 2015 to April 2016. ResultsIn terms of our three primary outcomes related to DTP3 adherence, point estimates show conflicting results. Two outcomes presented adherence in the control. DTP3 completion within two camps after DTP1 showed higher adherence in the Control (Sticker) (74.2%) arm compared to the Pendant (67.2%) and Pendant and Voice arms (69.3%). Likewise, the estimate for DTP3 completion within 180 days of birth in the Control (Sticker) (69.4%) arm was higher than estimates in the Pendant (57.4%) and Pendant and Voice arms (58.7%). However, one outcome displayed higher adherence in the intervention. DTP3 completion within two months from the time of registration was higher in the Pendant (37.7%) and Pendant and Voice arms (38.7%) compared to the Control (Sticker) arm (27.4%). In all primary outcomes, differences in adherence were statistically insignificant both before and after controlling for confounding factors. In terms of secondary outcomes, our results suggest that providing a necklace generated significant community discussion (H = 8.8796, df = 2, p = .0118), had strong satisfaction among users (χ2=26.039, df = 4, p < .0001), and resulted in increased visibility within families (grandmothers:χ2=34.023, df = 2, p < .0001, fathers: χ2=34.588, df = 2, p < .0001). ConclusionNeither the NFC necklace nor the necklace with additional voice call reminders in the local dialect directly resulted in an increase in infant immunization timeliness through DTP3, the primary outcome. Still our process outcomes suggest that our culturally symbolic necklace has potential to be an assistive tool in immunization campaigns. Follow-on work will seek to examine whether positive behavior change towards vaccines can be fostered with earlier engagement of this platform beginning in the prenatal stage, under a continuum of care framework.

Special Considerations in Pediatric Kidney Transplantation.

Universally accepted as the treatment of choice for children needing renal replacement therapy, kidney transplantation affords children the opportunity for an improved quality of life over dialysis therapy. Immunologic and surgical advances over the last 15years have improved the pediatric patient and kidney graft survival. Unique to pediatrics, congenital genitourinary anomalies are the most common primary diseases leading to kidney failure, many with urological issues. Early urological evaluation for post-transplant bladder dysfunction and emphasis on immunization adherence are the mainstays of pediatric pretransplant and post-transplant evaluations. A child's height can be challenging, sometimes requiring an intra-abdominally placed graft, particularly if the patient is <20kg. Maintenance immunosuppression regimens are similar to adult kidney graft recipients, although distinctive pharmacokinetics may change dosing intervals in children from twice a day to thrice a day. Viral infections and secondary malignancies are problematic for children relative to adults. Current trends to reduce/remove corticosteroid therapy from post-transplant protocols have produced improved linear growth with less steroid toxicity; although these studies are still ongoing, graft function and survival are considered acceptable. Finally, all children with a kidney transplant need a smooth transition to adult clinics. Future research in pertinent psychosocial aspects and continued technological advances will only serve to optimize the transition process. Although some aspects of kidney transplantation are similar in children and adults, for instance immunosuppression and immunosuppressive regimens, and rejection mechanisms and their diagnosis using the Banff criteria, there are important differences this review will focus on and which continue to drive innovation.

Taking a Shot at Immunization Adherence Group Visits for Vaccine-Averse Parents.

Decreased vaccination rates in children have played a role in the deaths of several children in the United States over the last decade. Interventions to date have been ineffective at changing vaccination patterns. No studies have evaluated a conciliatory patient-centered approach where parent concerns were acknowledged and addressed in a group setting. Vaccine-averse parents with incompletely vaccinated children were recruited from a family medicine practice. These parents attended three group visit sessions centered on vaccine safety and efficacy. Pre and post surveys were given at each session. The children's vaccination records were examined in the year prior and the year following the groups. One year after the group visits, parents were interviewed about their attitudes toward vaccination. There were no significant attitude changes in parents attending the group visits. In the year following the visits, the percentage of recommended vaccines that children had received did not increase. Interviews with parents revealed a broad range of concerns about vaccines and a widespread desire for a longer-term study designed to address these concerns. Surveys and vaccination records revealed no significant change in attitudes or behavior after three group visit sessions, consistent with other research on interventions with vaccine-averse parents. The phone interviews demonstrated a desire for further research into long-term effects of vaccines, with most parents stating that they would consider changing their beliefs if the research was free from commercial bias, addressed their concerns, and was extended out over a long period of time.

Using Text Reminder to Improve Childhood Immunization Adherence in the Philippines.

A comparative descriptive study was conducted to determine the effectiveness of text messages with pictures compared with plain text messages or verbal reminders in improving measles, mumps, and rubella immunization compliance in the rural areas of the Philippines. We found that text messaging with or without pictures is a feasible and useful tool in measles, mumps, rubella immunization compliance for childhood immunization. Texting with pictures (n = 23), however, was no more effective than plain text messaging (n = 19) or verbal reminder (n = 17) in improving measles, mumps, and rubella immunization compliance. Compared with parents who received verbal reminders alone, either type of text reminders was linked to parents bringing their child for measles, mumps, and rubella immunization on a timelier basis, as defined by the difference between the scheduled visit and the actual visit, although this was not statistically significant. Mobile technology that uses text reminders for immunization can potentially improve the communication process between parent, the public health nurse, and healthcare provider. Future studies can explore the application of plain text messages or text messages with pictures to improve compliance more broadly for maternal and child healthcare especially in rural areas of developing countries and may be a helpful tool for health promotion for this population.

HPV-associated oropharyngeal squamous cell carcinoma.

Human papillomavirus (HPV) can infect the tonsillar tissues of the oropharynx and is associated with oropharyngeal squamous cell carcinoma. This article provides an overview to guide primary care providers in screening patients for oropharyngeal cancer and making appropriate referrals. The article also reviews available HPV vaccines and immunization adherence rates.

Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil.

Crack cocaine users represent a target group for hepatitis B vaccination. We evaluate the HBV epidemiology, immunization status and compliance with a super-accelerated vaccination schedule among in-treatment crack cocaine users in central Brazil. Six hundred in-treatment crack cocaine users were interviewed, and serum samples were tested for HBV markers. A super-accelerated vaccination schedule of HBV vaccine was offered to all susceptible crack cocaine users. In total, 7.0% of those tested had at least one positive marker of HBV exposure. Age, use of crack cocaine through improvised pipe, exchange of sex for money/drugs and previous sexually transmitted infections (STIs) were predictors of HBV exposure. One hundred six (17.7%) individuals showed a serological profile of hepatitis B vaccination. Of these, 54.7% were less than 25 years old, and only 13% of individuals were more than 35 years old. Although 91.8% of crack users accepted the first vaccine dose, only 21.7% received all three doses. Of the 23 crack cocaine users who agreed to have their vaccine response evaluated, 78.3% developed protective anti-HBs titers. Premature termination of treatment was the most common reason for not receiving the full vaccine series. Despite the low prevalence of HBV exposure among in-treatment crack cocaine users in central Brazil, the low rate of immunization and the high frequency of high-risk behaviors highlight the potential for crack users to acquire and disseminate this infection and therefore maintain the viral reservoir. Health practitioners need to keep this in mind, taking advantage of all opportunities to access this population and vaccinate against HBV.

Increasing Immunization Adherence Among Infants of Low-income Parents: The Effects of Visually Enhanced Education

Many children do not receive their recommended immunizations in a timely manner. In this study we compare a visually enhanced educational (VEE) intervention to usual care (UC) among infants of low-income parents. Parents in the intervention group (n = 40) received VEE, whereas control group participants (n = 40) received UC. Adherence (yes/no) to the recommended immunization schedule measured and the VEE group was significantly more adherent to the recommended immunization schedule at 2 (P = .014), 4 (P = .041), and 6 (P = .042) months compared with the control group. Using VEE may increase adherence to the recommended immunization schedule.

Vaccination against influenza in the elderly: data from FIBRA, Campinas, São Paulo, Brazil.

The vaccine against influenza is the main preventative intervention in public health for this disease. The aim of this study was to establish the prevalence of influenza vaccination in senior citizens according to indicators for their functional capacity, frailty, social support and involvement and state of health. This cross-sectional study was conducted in Campinas in 2008-2009 (FIBRA network, Unicamp center) with a probability sampling of the elderly population(≥ 65 years old).The dependent variable was immunization against influenza in the twelve months prior to the research. The adjusted prevalence ratios were estimated by means of Poisson multiple regression analysis. Of the six hundred and seventy-nine senior citizens involved, 74.4% stated they had been vaccinated during the previous year. The prevalence of the vaccination was significantly higher among men and lower among those with a higher level of education. Slow gait speed is positively associated with immunization, as are most of the social involvement indicators. This can contribute towards improving immunization adherence against seasonal influenza and should be widely acknowledged in order to broaden immunization coverage in Campinas.

An enriched medical home intervention using community health workers improves adherence to immunization schedules

ImportanceDisparities in childhood vaccination rates persist. ObjectiveTo evaluate the impact of an enriched medical home intervention using community health workers on improving immunization adherence among young children. DesignThe intervention group received home visits from trained community health workers to support families in adhering to recommended care while the comparison group received usual care (i.e. no home visits/reminders). Immunization history and socio-demographic data were collected using medical records and a validated questionnaire. The doubly robust estimation of risk difference, which combines weighting via propensity score and outcome regression model, was used to compare immunization adherence rates between two groups. SettingPrimary care practices affiliated with a suburban tertiary care academic medical center serving a socioeconomically diverse population. ParticipantsThe study sample included children ≤2 years of age at enrollment who crossed at least one age time point of 3, 7, 15, or 24 months during their 6 months post-enrollment period. Main outcomes and measuresThe primary outcome was age-specific immunization up-to-date status defined by CDC guidelines. The primary predictor was participation in the intervention. ResultsThe analysis included 201 children in the usual care group and 110 children in the intervention group. The usual care and intervention groups were divided into subgroups of newborn and infant/toddler to account for prior immunization history. After adjusting for differences in group characteristics, we found a significant absolute increase in the up-to-date immunization likelihood for both newborns (20.9%, p=0.01) and infants/toddlers (16.8%, p=0.01) receiving the intervention when compared to their peers receiving usual clinical care. Conclusions and relevanceOur findings demonstrate the positive impact of an enriched medical home intervention using community health worker home visitation on early childhood immunization up-to-date status. With further study, this model may provide a cost-effective approach to improving childhood vaccination rates, especially for vulnerable groups.

Nurses as Primary Advocates for Immunization Adherence

Immunizations, one of the greatest public health achievements, are at times hindered by a history of powerful biological, social, and cultural reactions from the public. State laws require immunizations for school entry, however some parents choose a nonmedical exemption for their children. Although many vaccine-preventable diseases are practically extinct in the United States, nurses have a unique role in increasing parents' understanding that herd immunity may not protect their unimmunized children. By listening to and addressing parents' concerns about immunizations, nurses can dispel misconceptions and help change parents' perceptions about the risks associated with immunizations.