Immunization Guidelines Research Articles

Determining the Longitudinal Serologic Response to COVID-19 Vaccination in the Chronic Kidney Disease Population: A Clinical Research Protocol.

People living with chronic kidney disease (CKD) have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic, including higher rates of infection, hospitalization, and death. Data on responsiveness to COVID-19 vaccination strategies and immunogenicity are limited, yet required to inform vaccination strategies in this at-risk population. The objective of this study is to characterize the longitudinal serologic response to COVID-19 vaccination. This is a prospective observational cohort study. Participating outpatient kidney programs within Ontario and British Columbia. Up to 2500 participants with CKD G3b-5D receiving COVID-19 vaccination, including participants receiving dialysis and kidney transplant recipients (CKD G1T-5T). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies (anti-spike, anti-receptor binding domain, anti-nucleocapsid) will be detected by ELISA (enzyme-linked immunosorbent assay) from serum or dried blood spot testing. In a subset of participants, neutralizing antibodies against novel variants of concern will be evaluated. Peripheral blood mononuclear cells will be collected for exploratory immune profiling of SARS-CoV-2 specific cellular immunity. Participants will be recruited prior to or following any COVID-19 vaccine dose and have blood sampled for serological testing at multiple timepoints: 1, 3, 6, 9, and 12 months post vaccination. When possible, samples will be collected prior to a dose or booster. Participants will remain in the study for at least 1 year following their last COVID-19 vaccine dose. The adaptive design of this study allows for planned modification based on emerging evidence or rapid changes in public health policy surrounding vaccination. Limitations include incomplete earlier timepoints for blood collection due to rapid vaccination of the population. This large multicenter serologic study of participants living with kidney disease will generate data on the kinetics of SARS-CoV-2 immune response to vaccination across the spectrum of CKD, providing insights into the amplitude and duration of immunity conferred by COVID-19 vaccination and allowing for characterization of factors associated with immune response. The results of this study may be used to inform immunization guidelines and public health recommendations for the 4 million Canadians living with CKD.

Measurement of provider fidelity to immunization guidelines: a mixed-methods study on the feasibility of documenting patient refusals of the human papillomavirus vaccine

BackgroundAssessment and feedback is a common implementation strategy to improve healthcare provider fidelity to clinical guidelines. For immunization guidelines, fidelity is often measured with doses administered during eligible visits. Adding a patient refusal measure captures provider fidelity more completely (i.e., all instances of a provider recommending a vaccine, resulting in vaccination or refusal) and enables providers to track patient vaccine hesitancy patterns. However, many electronic health record (EHR) systems have no structured field to document multiple instances of refusals for specific vaccines, and existing billing codes for refusal are not vaccine specific. This study assessed the feasibility of a novel method for refusal documentation used in a study focused on human papillomavirus (HPV) vaccine.MethodsAn observational, descriptive-comparative, mixed-methods study design was used to conduct secondary data analysis from an implementation-effectiveness trial. The parent trial compared coach-based versus web-based practice facilitation, including assessment and feedback, to increase HPV vaccination in 21 community-based private pediatric practices. Providers were instructed to document initial HPV vaccine refusals in the EHR's immunization forms and subsequent refusals using dummy procedure codes, for use in assessment and feedback reports. This analysis examined adoption and maintenance of the refusal documentation method during eligible well visits, identified barriers and facilitators to documentation and described demographic patterns in patient refusals.ResultsSeven practices adopted the refusal documentation method. Among adopter practices, documented refusals started at 2.4% of eligible well visits at baseline, increased to 14.2% at the start of implementation, peaked at 24.0%, then declined to 18.8%. Barriers to refusal documentation included low prioritization, workflow integration and complication of the billing process. Facilitators included high motivation, documentation instructions and coach support. Among adopter practices, odds of refusing HPV vaccine were 25% higher for patients aged 15–17 years versus 11–12 years, and 18% lower for males versus females.ConclusionsWe demonstrated the value of patient refusal documentation for measuring HPV vaccination guideline fidelity and ways that it can be improved in future research. Creation of vaccine-specific refusal billing codes or EHR adaptations to enable documenting multiple instances of specific vaccine refusals would facilitate consistent refusal documentation.Trial Registration NCT03399396 Registered in ClinicalTrials.gov on 1/16/2018.

Immunization of children with congenital epidermolysis bullosa against Varicella‑zoster virus: results of prospective study

Severe chickenpox (CP) may occur in immunocompromised patients. The most common complication of chickenpox is bacterial superinfection. In children with congenital epidermolysis bullosa (CEB), infection with Varicella-zoster virus (VZV) increases the risk of skin infectious complications, and also aggravates the course of the underlying disease.Purpose of the study. To study the safety and efficacy of varicella vaccination in patients with CEB. Based on the data obtained, develop clinical guidelines for immunization of this category of patients against the VZV.Methods. A group of children was formed with an established diagnosis of CEB and who had previously received the first dose of the varicella vaccine. During the study, immunization with a second dose of vaccine against CP was carried out. Tolerability of vaccination was assessed by the number of adverse events in the post-vaccination period. The assessment of the immune response of the participants was determined by the level of serum IgG antibodies to VZV by enzyme immunoassay.Results. The study included 23 children with CEB who were immunized with a second dose of varicella vaccine. In all patients, after the introduction of the vaccine, there were no serious post-vaccination reactions and worsening of the underlying disease in the post-vaccination period. In 22 (96%) study participants, IgG to VZV was detected, indicating seroconversion. Conclusions. The results of the work showed a good safety and efficacy profile of the vaccine, which makes it possible to develop recommendations for vaccinating children with CEB against the VZV.

Two-Shots of Immunization Effectively Induce Protective IgG against Canine Parvo-Viral Infection

Regardless of good hygiene and management, a significant number of dogs are lost every year due to deadly attack of parvo virus. The immunization schedules recommended by the World Small Animal Veterinary Association (WSAVA) do not have exclusive suggestions on dogs living in Bangladesh. The WSAVA Vaccination Guidelines Group (VGG) suggested that vaccination recommendations that apply to a developed country may not be appropriate for a developing country. Due to inadequate sero-monitoring, emergence and re-emergence of Parvo viral infection following immunization is a common event. Therefore, the current study is designed to establish a definite guideline for Parvo viral immunization in dogs. We immunized group of dogs with commercially available parvo virus vaccine Nobivac Dog®, and a second dose was injected 14-days following the initial dose. Sera samples were collected before starting injections and 7-day following 1st and 2nd dose of vaccinations. We performed Enzyme Linked Immunosorbent Assay (ELISA) to detect protective serum IgG titer against the canine parvo virus type 2 antigen. Demographic data of the participated animals was compared to the status of antibody titer. Findings of this study revealed that two-shots of immunizations with a booster injection of 2-3 weeks apart from the primary immunization is essential to develop positive titer. The purebred female dogs of older than three-months had higher IgG when compared to local, crossbred, male and younger dogs. The results will provide valuable information to establish National Guidelines for Immunizations in Dogs of Bangladesh for effective prevention and control of this deadly disease.

Time for South Asian Countries to Accept Life-Course Immunization Concept and Develop National Immunization Guidelines for Adult Vaccination

Vaccine, a cost-effective medicine saves lives. Vaccination during childhood has been implemented worldwide through the expanded program of immunization (EPI) since 1974. It has saved million lives till 2019 globally. South Asian countries have equally benefitted from the EPI executing this strategy through their national immunization programs. The life-course immunization concept aims to extend the vaccination from birth to elderly; some counties have already started focusing on it. Adult vaccination is the process of vaccinating to peoples of 19 years and above. Most of the developed countries have their national policy guidelines on adult immunization but no such national policy for adult vaccination exists in most of the developing and underdeveloped countries including countries of South Asia. South Asian countries have to accept the concept Life-Course Immunization and develop National Adult Immunization Guidelines and vaccinate adults from vaccine preventable diseases highly prevalent in their countries. This could improve quality of human health at all stages of life.

Effectiveness of an intervention to overcome influenza vaccine hesitancy in specialty clinic patients.

Background:Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccine-preventable illnesses, but there are low rates of adherence to immunization guidelines within this population.Objective:To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies.Method:We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu seasons: 2017–2018 (preintervention), 2018–2019 (preintervention), and 2019–2020 (intervention).Intervention:Immunosuppressed patients initially declining an influenza vaccine were provided dermatologist-led education on the benefits of immunization. Dermatologists explored and addressed individual patients’ immunization concerns. Influenza vaccination was then offered immediately postdialogue.Results:Analyses included 201 dermatology patients who were prescribed or currently taking immunosuppressive medication (intervention group [72.6%], comparison group [27.4%]). During the intervention period, 91.1% of the intervention group received influenza vaccination compared to 56.4% of the comparison group. Vaccination trends from 2018–2019 (preintervention) to 2019–2020 (intervention) differed significantly between groups (χ2 = 22.92, P < .001), with greater improvement in the intervention group. In 2019–2020, influenza vaccination was more likely in the intervention group relative to the comparison group (odds ratio: 16.22, 95% confidence interval: 5.55–47.38). In the subset of patients that had never received an influenza vaccine, influenza immunization in 2019–2020 was more common in the intervention group (75.8%, 25/33) relative to the comparison group (13.3%, 2/15, P < .001).Conclusion:The intervention successfully addressed vaccine hesitancy and improved influenza immunization rates in an immunosuppressed population receiving care from a specialty clinic. Implementing a similar model across specialty clinics may improve vaccination rates for influenza, coronavirus disease 2019, and other vaccine-preventable illnesses in other populations.

Impact of SARS-CoV-2 infection on liver disease.

Abnormal liver biochemistry is not a rare finding in the context of SARS-CoV-2 infection, regardless of patients having pre-existing chronic disease or not. This review examines the current body of knowledge on the relationship between COVID-19 and liver injury, which is frequently found in this setting. Although the pathogenesis of liver injury is not fully understood, it has been suggested to be the result of a combination of multiple factors. These include direct injury caused by the virus, immune system hyperactivation, ischemic and drug-induced injury. The prognostic valor of these alterations is also the subject of intense research. Due to their potential impact, these alterations require proper management and treatment, especially in patients with chronic liver disease or liver transplant recipients. Some aspects associated with liver injury during COVID-19, especially in severe presentations, are not well understood. Studies assessing the clinical impact of COVID-19 on the healthy or diseased liver may help adjust treatment and immunization guidelines to the profile of the patient.

Deltoid Intramuscular Injections: A Systematic Review of Underlying Neurovascular Structures to the Muscle and Proposing a Relatively Safer Site.

The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images.The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.

Recommended Adult Immunization Schedule, United States, 2022.

Recommended Adult Immunization Schedule, United States, 2022.

Knowledge, attitudes, beliefs and barriers of healthcare professionals and adults ≥ 65 years about vaccine-preventable diseases in Spain: the ADult Vaccination drIverS and barriErs (ADVISE) study

ABSTRACT Since 2018, Spanish National Immunization Guidelines include vaccination recommendations for adults ≥65 years. To determine whether health-care professionals and the ≥65 years target group value the need for these recommendations, a cross-sectional study was conducted to capture and describe their knowledge, attitudes, beliefs and behaviors about vaccination. Online surveys were administered to representative groups of general practitioners (GPs), primary care nurses and adults ≥65 years from six major cities (and surrounding rural areas) in Spain. Main topics were attitudes and awareness of vaccines, perceptions about vaccination in adults ≥65 years, and impact of the COVID-19 pandemic on vaccination uptake. A total of 286 health-care professionals (185 GPs, 101 nurses) and 400 adults aged ≥65 years participated in the survey. GP and nurse groups agreed strongly about the importance of influenza and pneumococcal vaccination in the target population. Longer patient visit times were identified as a key factor toward promoting vaccination. The ≥65 years sample group, especially those ≥75+ years and/or with chronic diseases, was reasonably positive about the effectiveness and benefits of vaccines. Lower vaccination rates for the pneumococcal than influenza vaccine (29% vs. 80%) in the ≥65 years sample group suggest that efforts are needed to improve pneumococcal vaccine uptake. Aligning with other published works, GPs have a key role in promoting vaccination in the target population. The COVID-19 pandemic appears to have heightened awareness about the importance of vaccination among health-care professionals and adults ≥65 years.

Movement disorders, cerebral palsy and vaccination.

This review focused on vaccination in children with movement disorders, including cerebral palsy and the movement disorders triggered by vaccination in children with and without neurological disabilities. The following clinical questions were addressed: 1) Can children with movement disorders be vaccinated? 2) Can vaccination trigger movement disorders in children without neurological disabilities? 3) Can vaccination trigger movement disorders in children with neurological disabilities? and 4) Is there any consensus of care concerning vaccination in children with movement disorders? Following the PRISMA reporting guidelines, 1096 records were identified and 34 relevant papers were included. No evidence that vaccinations are contraindicated for children with movement disorders was noticed. Several reports of neurological adverse events, including movement disorders in children without neurological disabilities after various types of vaccination, were found. The reporting rates were low, the causality was controversial, and patient outcomes were mostly favourable. There was limited (if any) evidence in our search that any vaccination leads to any movement disorder exacerbation. Finally, no generally accepted consensus or standards of care concerning vaccination in patients with movement disorders were found. In summary, we found few precautions for vaccination in this group of patients and concluded that general best practice guidelines for immunization should be followed. In addition, influenza and pneumococcal vaccines are recommended because they can reduce morbidity and mortality in individuals severely affected by movement restrictions.

Pneumococcal Vaccine Recommendations for Old-Age Home Indian Residents: A Literature Review.

Advancing age is accompanied by decreased immunity, poor health, and physiological changes, which render the elderly population highly susceptible to infectious diseases. We aim to identify the guidelines for pneumococcal vaccines in old-age facilities in India. We performed an extensive review of Indian literature (indexed and non-indexed publications) from 2010 to 2020 using search strings “Pneumococcal vaccine AND Recommendations AND India,” “Pneumococcal vaccine AND Guidelines AND India,” followed by a hand search to identify the most updated versions of recommendations. We reviewed immunization guidelines recommended by nine medical associations and societies in India—Association of Physicians of India (API), Geriatric Society of India (GSI), Indian Society of Nephrology (ISN), Mass Gathering Advisory Board Consensus Recommendation, Indian Medical Association (IMA), Indian Chest Society and National College of Chest Physicians (ICS-NCCP), Research Society for Study of Diabetes in India (RSSDI), Indian Association of Occupational Health Guidelines for Working Adults (IAOH), and API guidelines for immunization during COVID19 pandemic. All bodies recommend pneumococcal vaccines, sequence and preference of which depend on factors such as age, underlying conditions, and immune status. Integration of society recommendations and their implementation into public and private vaccination programs are required to promote adult immunization.

Guidelines for immunization of children following multisystem inflammatory syndrome in children

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Ludwikowska KM, Okarska-Napierała M, Matkowska-Kocjan A, et al. Guidelines for immunization of children following multisystem inflammatory syndrome in children. Pediatria Polska - Polish Journal of Paediatrics. 2022;97(2):81-88. doi:10.5114/polp.2022.116576. APA Ludwikowska, K. M., Okarska-Napierała, M., Matkowska-Kocjan, A., Jackowska, T., Wysocki, J., & Kuchar, E. et al. (2022). Guidelines for immunization of children following multisystem inflammatory syndrome in children. Pediatria Polska - Polish Journal of Paediatrics, 97(2), 81-88. https://doi.org/10.5114/polp.2022.116576 Chicago Ludwikowska, Kamila M, Magdalena Okarska-Napierała, Agnieszka Matkowska-Kocjan, Teresa Jackowska, Jacek Wysocki, Ernest Kuchar, and Jarosław Peregud-Pogorzelski et al. 2022. "Guidelines for immunization of children following multisystem inflammatory syndrome in children". Pediatria Polska - Polish Journal of Paediatrics 97 (2): 81-88. doi:10.5114/polp.2022.116576. Harvard Ludwikowska, K., Okarska-Napierała, M., Matkowska-Kocjan, A., Jackowska, T., Wysocki, J., Kuchar, E., Peregud-Pogorzelski, J., and Szenborn, L. (2022). Guidelines for immunization of children following multisystem inflammatory syndrome in children. Pediatria Polska - Polish Journal of Paediatrics, 97(2), pp.81-88. https://doi.org/10.5114/polp.2022.116576 MLA Ludwikowska, Kamila et al. "Guidelines for immunization of children following multisystem inflammatory syndrome in children." Pediatria Polska - Polish Journal of Paediatrics, vol. 97, no. 2, 2022, pp. 81-88. doi:10.5114/polp.2022.116576. Vancouver Ludwikowska K, Okarska-Napierała M, Matkowska-Kocjan A, Jackowska T, Wysocki J, Kuchar E et al. Guidelines for immunization of children following multisystem inflammatory syndrome in children. Pediatria Polska - Polish Journal of Paediatrics. 2022;97(2):81-88. doi:10.5114/polp.2022.116576.

Vaccination Barriers for Adults

The growth of childhood vaccination in India has been increased over the past two decades as &gt;25% of deaths due to infections are prevented with the help of vaccines. Vaccination is also recommended for adults where adult vaccination is mostly ignored in India. In India, childhood vaccination is considered the main priority, WHO has also issued guidelines for childhood vaccination. Generally, adults have less susceptible to traditional infectious agents but the probability of exposure to the infectious agents has increased. SO the problem of adult immunization should be considered. Vaccine-preventable diseases (VPDs) in adults are more neglected. There are many reasons for the causes of the VPDs in adults. These can be prevented by immunization among adults. Each country should provide a proper guideline for adult vaccination. When it comes to India, our country doesn’t have proper guidelines for Adult immunization. As to decrease the morbidity and mortality in the life of a person the vaccine uptake for the immunization must be ensured. This article mainly focuses on the vaccine-preventable disease in India with the role of adult immunizations and the steps to ensure the betterment of the vaccine uptake among the adults.

Impact of Latent Tuberculosis on Severity and Outcomes in Admitted COVID-19 Patients.

BackgroundThere is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI).MethodologyWe analyzed data of admitted COVID-19 patients evaluated for LTBI to examine the impact of LTBI on severity, laboratory parameters, and COVID-19 outcome. Prospectively collected data were analyzed for 60 patients who were administered the Mantoux tuberculosis skin test (TST) using five tuberculin units of purified protein derivative. All patients were administered TST irrespective of Bacille Calmette-Guérin (BCG) vaccination status. Comorbidities, clinical features, radiologic involvement, laboratory parameters, and clinical course were analyzed concerning LTBI.ResultsThe mean age was 45.9 (±15.2) years, and 35 (58.3%) patients had non-severe disease. The vast majority (n = 56/60; 93.3%) had been vaccinated with single-dose BCG in infancy or early childhood, as per national immunization guidelines. LTBI was diagnosed in 15 (25%) patients. LTBI prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients. LTBI patients had lower percentage neutrophil count, higher lymphocyte percentage, higher monocyte count, lower neutrophil-lymphocyte (NL) ratio, lower alanine aminotransferase, lower C-reactive protein, and lesser radiologic involvement compared to those without LTBI (p < 0.05). Similarly, among the mild COVID-19 subgroup, those with LTBI had higher lymphocyte and monocyte counts and lesser radiologic involvement than those without LTBI (p < 0.05).ConclusionsLTBI patients appear to have milder disease, higher lymphocyte and monocyte count, higher NL ratio, and lesser radiographic involvement. This observation needs to be studied in larger studies using interferon release assays.

Select immunizations for adult women.

National standards for immunizations are set by the Advisory Committee on Immunization Practices in the United States and the National Advisory Committee on Immunizations in Canada. In Mexico, the National Immunization Technical Advisory Group sets standards for infants and adolescents but not for adults. In this Practice Pearl, guidelines for some adult immunizations in women and the recent and potential upcoming changes in vaccines are reviewed.

A Modern Perspective on Vaccinating Healthcare Service Providers in India: A Narrative Review.

Healthcare providers (HCPs) are at increased risk of acquisition and transmission of infectious disease. Vaccinating HCPs is an essential preventive measure to protect them and their patients against communicable diseases, while positively and directly impacting the functioning of the healthcare system. In India, healthcare represents one of the largest employment sectors with 3.8 million HCPs; however, there is limited awareness of national immunisation guidelines for the Indian HCP population. Data from communicable disease outbreaks across India suggest inadequate vaccination rates amongst HCPs; studies have reported influenza and varicella vaccination rates as low as 4.4% and 16%, respectively. In this review, we discuss data highlighting the impact of insufficient vaccination coverage, barriers to vaccination, and the lack of immunisation guidelines amongst HCPs in India. COVID-19 vaccination programmes for HCPs have been critical in slowing the pandemic in India. This provides an opportunity to raise awareness about the importance of vaccines amongst HCPs in India.

Vaccination rates in cochlear implant patients: a review of paediatric recipients.

This study aimed to investigate whether children with cochlear implants received the recommended vaccinations according to New Zealand national immunisation guidelines and to report the incidence of meningitis in this population after intervention. A retrospective review of the vaccination coverage of paediatric patients receiving cochlear implants between 2005 and 2019 was performed. Data were collected on 203 children. Evidence of immunisation against Haemophilus influenza B was documented in 94.1 per cent of this cohort and 21.2 per cent received the seasonal influenza vaccine. The pneumococcal conjugate vaccine was fully administered in 81.8 per cent of children; however, only 16.9 per cent of eligible children had received the pneumococcal polysaccharide vaccine. There was marked improvement in compliance to the pneumococcal conjugate vaccine once it became fully funded for cochlear implant patients. Despite established guidelines, the paediatric vaccination rates were less than expected. Work is in progress to address this.

Improving Adult Vaccination Status in the United States.

Adult immunization practices leave much to be desired. Misinformation has increased mistrust. As a result, Latino and African American populations have low rates of annual flu vaccinations and, during the COVID-19 pandemic, lag behind for COVID-19 vaccination. Historically, healthcare staff have failed to adhere to adult immunization guidelines contributing to patient infections. Healthcare staff, both clinical and non-clinical, must lead by example by making “prevention primary”. Most adults may not realize they need immunizations. We recommend the following steps to increase immunization uptake: Make adult immunization a standard of patient care as we do for children. Assess immunization status at every clinical opportunity. Strongly recommend vaccinations needed. Administer needed vaccinations, multiple if warranted. Document vaccines received by your patient. Participate in your state’s immunization registry and work with community organizations that can help make adult immunization the norm.

A prolonged, nationwide measles outbreak despite very high vaccination coverage in Israel, 2018-19

. A major, prolonged measles outbreak occurred in Israel during 2018-19, despite vaccination coverage rates of 97% and 96% for the first and second doses, respectively, of measles containing vaccine (MCV). . To study the causes and patterns of the outbreak through analysis of the epidemiological data, review the control measures taken, and identify lessons learned and efforts needed to prevent recurrences. . All reported cases of measles in Israel from 1 March 2018 through 30 September 2019 were analysed using the epidemiological, clinical, laboratory, and demographic data that are systematically reported to the Division of Epidemiology of the Ministry of Health. . A total of 4,311 measles cases were reported. 75% of case patients were children and 25% were adults. Pockets of undervaccination and delayed vaccination were identified: 72.6% of measles patients whose vaccination histories were known had not received any doses of MCV. Case importation was also a key factor, with a majority being adults coming from European countries and over half from Ukraine, a major locus of measles cases during the recent measles resurgence in Europe. Control measures were implemented at the local, district, and national levels. . Similarities were noted between the 2018-19 outbreak and the prior one in 2007-08, principally pockets of undervaccination in the Jewish ultra-orthodox community, and case importation. Efforts to improve timeliness and coverage in pockets of undervaccination, and compliance with travel immunization guidelines, will be continued.