Improve Immunization Rates Research Articles

Tailoring childhood immunisation services in a socioeconomically disadvantaged community in New South Wales, Australia: a cost analysis.

Using the World Health Organization's 'Guide to Tailoring Immunization Programmes' (TIP), a three-step program was developed by health services in partnership with a marginalised community in New South Wales, Australia. The aim was to improve immunisation rates of 1-year-old children. For Step 1, nurses identified and monitored local children overdue for immunisation from a national register, and sent parents or family doctors reminders by mail or telephone. For Step 2, parents were offered appointments at a local health centre; and for Step 3, they were offered home visits. An economic costing study was undertaken to examine the program's resource use. Costs were collected between 1 June 2020 and 31 May 2021. Case records were obtained for 139 children. A total of 56 children became up to date after receiving TIP services; most after receiving Step 1 services (n =37). Total annual costs (A$) for the program were $34250 or $246 per case; or $612 per case becoming up to date. At $44 per case and $98 per case becoming up to date, Step 1B: personalised reminders, was the lowest costing step. Sensitivity analysis showed a possible 8% program savings through employment of nurses with a lower salary and use of video conference meetings. This study provides information to the local health provider on the cost of TIP alongside their community-based programs. It also identified ways in which TIP could be made more cost-effective. Decision-makers can use this information to consider whether the investment in TIP is recommended.

Using Quality Measures to Drive Improvements in Immunization Rates: Findings from a Real-World Evaluation from 3 US Health Care Organizations

Adult immunization rates are low and continue to fail to meet national targets. The coronavirus disease 2019 pandemic halted routine health care services for many, including vaccinations. This study explored whether the National Committee for Quality Assurance's Adult Immunization Status (AIS) measure, which had previously only been evaluated for reporting by health plans, could be leveraged by health care organizations (HCOs) as a tactic to improve immunization rates. Methods included a quantitative analysis of deidentified patient electronic health record data from 3 HCOs, supplemented by qualitative interviews to further understand opportunities and barriers. The analysis indicated that the data necessary for calculation of the AIS measure are available within HCOs and that measure performance could be enhanced with supplemental data from external sources, such as state immunization registries. Although HCOs rates were consistent with national estimates, this research further validated that adult immunization rates in the United States are low and highlighted the profound disparities that exist. For instance, the likelihood of completing all age-appropriate vaccinations was lower if patients were Black or African American, enrolled in Medicaid, or without health insurance. As a result of this study, the authors concluded that the AIS measure is feasible for use in medical groups and could potentially help drive quality improvements in immunization rates; however, there are considerations for implementation particularly if providers are being held accountable for measure performance.

Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign.

Vaccinations used to prevent coronavirus disease (COVID-19)—the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060–11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Abstracts of the 30th Annual Pediatric Pharmacy Association (PPA) Meeting April 21 to 25, 2021

Abstracts of the 30th Annual Pediatric Pharmacy Association (PPA) Meeting April 21 to 25, 2021

The Contribution of Reminder-Recall to Vaccine Delivery Efforts: A Narrative Review.

Reminders, alerting patients to the need for vaccines that will be due in the future, and recall messages, informing patients about vaccines that are overdue, have been shown to improve immunization rates for children and adolescents in numerous systematic reviews. Therefore, reminder and recall interventions (R/R) are recommended by the Task Force on Community Preventive Services for increasing immunization rates on the basis of strong evidence. R/R messages can be delivered by mail (letter or postcard), via personal or auto-dialer phone calls, by text or e-mail or via patient-portals and can simply be alerts to action or can include educational material with the aim of motivating patients to seek vaccination. R/R has also been shown to be a relatively low-cost intervention with high cost-effectiveness compared with other recommended strategies. However, although R/R as a strategy is consistently effective and cost-effective overall, there is wide variation in the impact of R/R by 1) modality of how it is delivered, 2) the targeted vaccine, 3) the age group, and 4) whether the R/R is conducted centrally by a health system or Immunization Information System or by individual practices. This narrative review summarizes the literature about effectiveness of R/R within each of these categories. We also discuss limitations of R/R, with a focus on the potential impact of parental vaccine hesitancy in blunting its effectiveness and problems with data integrity, on which R/R relies. We also discuss challenges to sustaining R/R efforts, including potential methods of funding for R/R efforts.

Geografische Analysen f\xfcr evidenzbasierte Public-Health-Interventionen: Das Beispiel Identifikation und Typisierung von Risikoclustern f\xfcr Masern, Mumps und R\xf6teln

ZusammenfassungHintergrundIdealerweise sollten Gesundheitsangebote und -maßnahmen zur Verbesserung der Impfquoten auf lokale Zielpopulationen, z. B. in räumlichen Clustern, zugeschnitten werden. Bisher wurden räumliche Cluster der Unterimmunisierung jedoch kaum beachtet und auf Basis kleinräumiger Daten typisiert.Ziel der ArbeitAnhand des Beispiels der Impfung gegen Masern, Mumps und Röteln (MMR) bei Kindern sollen in der vorliegenden Studie 1. die räumliche Verteilung nicht ausreichender MMR-Impfungen in Westfalen-Lippe kleinräumig identifiziert, 2. spezifische, räumliche Risikocluster mit nicht ausreichendem Impfschutz aufgezeigt und 3. räumlich-nachbarschaftliche Einflussfaktoren der unterschiedlichen Risikocluster als Ansatzpunkte für Public-Health-Interventionen beschrieben werden.Material und MethodenGrundlage waren Abrechnungsdaten der Kassenärztlichen Vereinigung Westfalen-Lippe (KVWL). Es wurden Geburtsjahrgangskohorten 2013–2016 von gesetzlich versicherten Kindern gebildet und auf Postleitzahlenebene (n = 410) aggregiert. Es wurden statistisch signifikante, räumlich kompakte Cluster und relative Risiken (RR) der Unterimmunisierung identifiziert. Lokale Risikomodelle wurden in binär logistischen Regressionen auf Basis von räumlich-nachbarschaftlichen Variablen geschätzt.Ergebnisse und DiskussionFür die Impfquoten „mindestens eine MMR-Impfung“ und „beide MMR-Impfungen“ wurden jeweils 2 signifikante Cluster der Unterimmunisierung identifiziert. Signifikante Risikofaktoren für niedrige Impfquoten umfassten Altersstruktur, sozioökonomische Variablen, Einwohnerdichte, medizinische Versorgung und Werthaltung. Die vorgeschlagene Methodik ist geeignet, räumliche Variationen des Impfverhaltens auf Basis der identifizierten Typologien für gezielte evidenzbasierte Interventionen zu beschreiben.

Improving Vaccination Coverage in Children and Adolescents: The Role of Professional Societies.

Improving Vaccination Coverage in Children and Adolescents: The Role of Professional Societies.

Implications of anesthesia and vaccination

The current COVID-19 pandemic has had a global impact on vaccination rates. Delays in routine healthcare and immunization have led to a rise in concerns about resurgence of vaccine-preventable diseases around the world. With the release and distribution of COVID-19 vaccines, plans to improve immunization rates need to be explored and implemented across disciplines. One approach would be the consideration of perioperative vaccinations; however, the effects of anesthesia and surgery on the immune response and complications associated with vaccination during the perioperative period are still poorly understood, and opinions are divided. To ascertain the value of a perioperative vaccination program, it is important to understand the basics of immunization and common vaccinations; the potential vaccine complications in the pediatric cohort; the implications of anesthesia and surgery on the immune response; and current recommendations. In addition, we believe it is important to discuss the logistics and feasibility of coordinating perioperative immunization should this become a regular opportunity.

The Role of Intern Pharmacists in Implementing Innovative and Sustainable Practices to Enhance Rates of Non-influenza Immunizations

Background Intern pharmacists are likely an underutilized resource for addressing immunization barriers and improving immunization rates. Studies have addressed methods that pharmacists use to improve immunization rates, but few have focused on the role of intern pharmacists, with particular emphasis on non-influenza immunizations. Methods An online survey was distributed through email listservs associated with California pharmacy schools and organizations. Data collected included title (“pharmacist” or “intern pharmacist”), practice setting, perceptions of the intern pharmacists’ role in improving immunization rates (strongly agree to strongly disagree using a 5-point Likert scale), and opinions regarding potential implementations. Immunization barriers were assessed using a 9-point scale, from least to most feasible to be addressed. Statistical comparisons between intern pharmacist and pharmacist responses were made using chi-square or Fisher’s exact tests. Results A total of 133 respondents completed the survey. The immunization barrier most likely to be successfully overcome by intern pharmacists was lack of patient awareness. There was strong support in favor of intern pharmacists having greater involvement in programs that increase patient non-influenza immunization rates. The two most feasible implementations by intern pharmacists were determined to be intern-led college/university campus clinics providing free non-influenza immunizations and educational booths/outreaches that raise awareness about immunizations. Conclusion Identification of immunization barriers capable of being addressed by intern pharmacists and effective intern pharmacist-led initiatives may contribute to enhanced immunization outcomes. Future steps include the implementation of intern pharmacist-led activities and further evaluation of whether these intern pharmacist-specific initiatives contribute to increasing non-influenza immunizations.

40. The Role of Health Literacy in Vaccination Disparities: Do Patients Understand the Health Messages?

BackgroundNumerous public health campaigns are organized with the goal of improving immunization rates. However, vaccination uptake remains low among certain racial/ethnic minority groups including Hispanic patients. The level of health literacy (HL), ability to recognize the words used, may impact patients’ understanding of health-related messages and consequently health behavior and vaccination.MethodsWe conducted a HL survey among adult female attendees of a health fair in an underserved area of Los Angeles. Attendees visiting a youth education booth were surveyed using an electronic tool. Respondents were surveyed on their familiarity with and recognition of specific words including: measles, shingles, pertussis, hepatitis, meningitis, stroke, diabetes, pneumonia, and human papilloma virus (HPV). Comparisons were analyzed using chi-squared tests.ResultsForty-three women (n=28 Hispanic; n=15 Non-Hispanic) completed the survey. The mean ages of Hispanic and non-Hispanic (predominantly Caucasian and Asian) respondents were 35.4 ±14 years and 29.9 ±12 years, respectively. A significantly lower percentage of Hispanic vs. Non-Hispanic women reported recognition of words associated with vaccine-preventable diseases: “meningitis” (15% vs. 60%, p< .01), “hepatitis” (18% vs. 69%, p< .01), and “HPV” (33% vs 67%, p< .05). Substantially lower recognition was also reported for “pneumonia”, although this did not reach statistical significance (46% vs 77%, p=.06). The percentage reporting recognition of “diabetes” did not differ significantly between groups (68% vs 60%, p=0.43).ConclusionImmunization campaigns often use words that patients may not understand, potentially impacting patients’ relationship with the healthcare system and health behavior change. We found a lower level of recognition (health literacy) of words associated with vaccine-preventable diseases among Hispanic vs. Non-Hispanic women attending a community health fair. These findings have implications for developing culturally-tailored communication tools and educational strategies using a language easily recognized by a specific community to help reduce racial disparities in vaccination uptake.Disclosures All Authors: No reported disclosures

Using Quality Measurement to Support Healthy Aging: The Adult Immunization Status Composite Measure

Vaccine-preventable diseases remain a significant public health threat, especially for older adults and those with compromised immunity. Efforts to drive vaccine uptake can include quality measures, which help providers, health care organizations, payers, and others to benchmark and track immunization activities. To help address low immunization rates in adults, the National Committee for Quality Assurance (NCQA) released the Adult Immunization Status (AIS) composite measure, which calculates a single rate for health plan performance on influenza, Td/Tdap, shingles, and pneumococcal immunizations. Discern Health and the American Medical Group Association (AMGA) performed a mixed-methods study using de-identified patient data from three healthcare organizations to analyze feasibility of the AIS measure in quality programs at the medical group-level. The team also team conducted qualitative interviews with the organizations to understand best practices for improving immunization rates in adults. The study showed that the AIS measure is feasible for use at the medical-group level. It also revealed that adults 50 years of age and older were less likely to receive all age-appropriate vaccinations than those younger than 50. These findings indicate that there is a significant gap in rates of immunizations among older adults and point to potential solutions that can be supported through use of the AIS measure.

Do automated telephone communication systems (ATCSs) improve immunization rates?

Do automated telephone communication systems (ATCSs) improve immunization rates?

Duke Vaccinates: A Project to Increase Adult Immunization Rates for Four Major Vaccine Types Involving the Entire Primary Care Team

Current adult vaccination rates fall well below the Healthy People 2020 goals established by the Centers for Disease Control and Prevention for pneumococcal, influenza, pertussis, and herpes zoster vaccines. The objective of this study was to improve immunization rates in primary care through an enhanced, multi-component 'audit & feedback' (A&F) intervention.

Use of Deep Learning to Analyze Social Media Discussions About the Human Papillomavirus Vaccine

Human papillomavirus (HPV) vaccine hesitancy or refusal is common among parents of adolescents. An understanding of public perceptions from the perspective of behavior change theories can facilitate effective and targeted vaccine promotion strategies. To develop and validate deep learning models for understanding public perceptions of HPV vaccines from the perspective of behavior change theories using data from social media. This retrospective cohort study, conducted from April to August 2019, included longitudinal and geographic analyses of public perceptions regarding HPV vaccines, using sampled HPV vaccine-related Twitter discussions collected from January 2014 to October 2018. The prevalence of social media discussions related to the construct of health belief model (HBM) and theory of planned behavior (TPB), categorized by deep learning algorithms. Locally estimated scatterplot smoothing (LOESS) revealed trends of constructs. Social media users' US state-level home location information was extracted from their profiles, and geographic analyses were performed to identify the clustering of public perceptions of the HPV vaccine. A total of 1 431 463 English-language posts from 486 116 unique usernames were collected. Deep learning algorithms achieved F-1 scores ranging from 0.6805 (95% CI, 0.6516-0.7094) to 0.9421 (95% CI, 0.9380-0.9462) in mapping discussions to the constructs of behavior change theories. LOESS revealed trends in constructs; for example, prevalence of perceived barriers, a construct of HBM, deceased from its apex in July 2015 (56.2%) to its lowest prevalence in October 2018 (28.4%; difference, 27.8%; P < .001); Positive attitudes toward the HPV vaccine, a construct of TPB, increased from early 2017 (30.7%) to 41.9% at the end of the study (difference, 11.2%; P < .001), while negative attitudes decreased from 42.3% to 31.3% (difference, 11.0%; P < .001) during the same period. Interstate variations in public perceptions of the HPV vaccine were also identified; for example, the states of Ohio and Maine showed a relatively high prevalence of perceived barriers (11 531 of 17 106 [67.4%] and 1157 of 1684 [68.7%]) and negative attitudes (9655 of 17 197 [56.1%] and 1080 of 1793 [60.2%]). This cohort study provided a good understanding of public perceptions on social media and evolving trends in terms of multiple dimensions. The interstate variations of public perceptions could be associated with the rise of local antivaccine sentiment. The methods described in this study represent an early contribution to using existing empirically and theoretically based frameworks that describe human decision-making in conjunction with more intelligent deep learning algorithms. Furthermore, these data demonstrate the ability to collect large-scale HPV vaccine perception and intention data that can inform public health communication and education programs designed to improve immunization rates at the community, state, or even national level.

Longitudinal, multidisciplinary, resident-driven intervention to increase immunisation rates for Medicaid, low-income and uninsured patients

IntroductionMore payers are closely linking reimbursement to high-value care outcomes such as immunisation rates. Despite this, there remain high rates of pneumonia and influenza-related hospitalisations generating hospital expenditures as high...

Reducing the Risk of Vaccine Preventable Diseases During the COVID-19 Pandemic

Reducing the Risk of Vaccine Preventable Diseases During the COVID-19 Pandemic

Do fathers care about their own immunisation status? The Child-Parent-Immunisation Survey and a review of the literature.

We recently conducted a large survey amongst parents of young children exploring attitudes concerning immunisation and the general immunisation status of the children and their parents in Switzerland. Since little is known about the immunisation status of fathers of young children, we present our findings here; data on mothers were previously published elsewhere. We performed standardised interviews with parents of children born on or after 1 January 2013, and hospitalised at the University of Basel Children&rsquo;s Hospital, Switzerland, between January and June 2017. If participation was declined, partial consent was sought for four questions regarding age, education level, attitudes towards vaccinations in general and availability of vaccination records of the parents. To compare our study results with other studies focusing on the completeness of the immunisation status of fathers, we conducted a literature search using broad search terms for studies published between 1 April 2009 and 1 December 2019. Thirty-nine (20%) fathers of 199 enrolled children participated. The great majority had a positive or mostly positive attitude towards vaccinations, but only 2 (15%) of 13 fathers who participated in immunisation counselling were up-to-date with all generally recommended immunisations. Fifty-two percent of participating fathers reported that the last assessment of their immunisation status by a physician was &gt;5 years ago. After the birth of their child, 56% of fathers had received a recommendation for immunisation against pertussis and 65% of them followed the recommendation. We identified three studies matching our review&rsquo;s inclusion criteria. None of them reported specific findings for fathers. This is the first study to analyse the complete immunisation status of fathers of young children. It is often incomplete with potentially missed opportunities for updating vaccinations during recent physician consultations. The low participation rate of fathers is a limitation which prohibits generalisation of our findings. However, as healthcare personnel have been shown to have the strongest impact on vaccination uptake, we propose that this group be further sensitised and educated with the goal of improving immunisation rates in fathers of young children. &nbsp.

HPV Immunization in High School Student-Athletes Receiving Preparticipation Physical Evaluations at Mass Event Versus Other Venues.

The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. Retrospective cohort study. Level 3. The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.

Optimizing Human Papillomavirus Immunization: The Role of Centralized Reminder and Recall Systems.

* Abbreviation: HPV — : human papillomavirus Achieving adequate human papillomavirus (HPV) vaccine coverage has been challenging worldwide. In 2018 in the United States, 51.1% of adolescents completed the full vaccine series, and 68.1% had received ≥1 doses.1 Optimizing uptake among adolescents has been a focus of public health departments, federal advisory groups, health service researchers, and clinicians. Although the trend is toward continued improvement, much work is needed to achieve optimal immunization rates. Reminder and recall has been an important strategy for improving immunization rates and is included as a key quality improvement strategy in the Centers for Disease Control and Prevention’s Immunization Quality Improvement Program, yet some practices may not have adequate resources to perform reminder and recall activities. Leveraging immunization information systems to identify adolescents who are missing recommended vaccines for centralized reminder and recall provides an opportunity to broadly implement this approach. However, in the study by Szilagyi et al,2 published in this issue, centralized autodialer reminder and recall from state immunization information systems did not improve HPV vaccination initiation or completion in New York and had only a slight effect in Colorado … Address correspondence to Kristen Feemster, MD, MPH, MSPHR, Vaccine Education Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. E-mail: feemster{at}email.chop.edu

Food Insecurity and Influenza and Pneumonia Vaccines Uptake Among Community-Dwelling Older Adults in the United States.

Influenza and pneumonia vaccines can reduce morbidities and mortality associated with infectious diseases among older adults. Food security, good nutrition, and high-quality diets are critical for the wellbeing of older adults. However, little is known about the relationship between food insecurity and use of preventive health services, such as influenza and pneumonia vaccinations, among older adults. In this study, we analyzed data on 40,555 adults aged ≥ 65years from the 2014-2018 National Health Interview Survey in the United States. Through multiple hierarchical logistic regression models, we investigated the associations between food insecurity and influenza and pneumonia vaccines uptake in this population. We found that, during 2014-2018, about 12.6 million(5.3%) adults aged ≥ 65years lived in food-insecure households in the United States. Of those, 60.6% reported getting an influenza vaccine in the past 12months, and 54.2% reported ever getting a pneumonia vaccine. Compared to food-secure older adults, food-insecure individuals were not significantly different in terms of influenza vaccine uptake. However, they were 25% less likely to have ever gotten a pneumonia vaccine (adjusted odds ratio = 0.75, 95% CI 0.65-0.86, P < .001). Efforts should be made to develop strategies to improve immunization rates among food-insecure older adults. Healthcare providers could routinely assess their vaccination status and screen them for food insecurity. Also, community level screening and intervention programs should target food-insecure older adults, who often face structural disadvantages. Future studies could explore and identify the underlying predictive factors contributing to low pneumonia vaccination rates among food-insecure older adults.