Low Immunization Rates Research Articles

Improving Infant Vaccination Status in a Level IV Neonatal Intensive Care Unit.

Infants in NICUs are at risk for underimmunization. Adherence to the routine immunization schedule recommended by the Advisory Committee for Immunization Practices minimizes the risk of contracting vaccine-preventable illnesses in this vulnerable population. From January 2015 to June 2017, only 56% (419 of 754) of the infants in our Mayo Clinic level IV NICU were fully up to date for recommended immunizations at the time of discharge or hospital unit transfer. We aimed to increase this rate to 80% within 6 months. Using the quality improvement methodology of Define, Measure, Analyze, Improve, Control, we analyzed baseline data, including provider and nursing surveys using a fishbone diagram, the 5 Whys, and a Pareto chart. We identified 3 major root causes of the quality gap: lack of provider knowledge of the routine immunization schedule, failure of providers to order vaccines when due, and hesitancy of parents toward vaccination. Using plan-do-study-act cycles, 5 improvement interventions were implemented. These included an intranet resource for NICU providers on the routine immunization schedule, an Excel-based checklist to track when immunizations were due, and provider education on parental vaccine hesitancy and vaccine safety. During the 19-month improve and control phases of the project, the fully immunized rate at the time of NICU discharge or transfer rose from a baseline of 56% (419 of 754) to 93% (453 of 488), with a P value <.001. Our NICU significantly improved infant immunization rates with a small number of interventions. These interventions may be generalizable to other NICUs with low infant immunization rates.

CAKUPAN IMUNISASI BCG TERHADAP BAYI BARU LAHIR DI PROVINSI SUMATERA SELATAN

BCG immunization is a basic immunization given to reduce the risk of pulmonary TB. Children who are not immunized are at a risk of 1.13 times greater than those immunized. BCG immunization coverage in South Sumatra is 98.9%. This means that not all babies born with medical help get BCG immunization. Therefore it is necessary to do a study of the coverage of BCG immunization for newborns in South Sumatra. The purpose of this study was to determine the increase in the number of babies born, and increase the coverage of BCG immunization, as well as the distribution of districts in South Sumatra that meet BCG immunization coverage based on the number of babies born. This study uses a quantitative approach using descriptive statistical analysis methods. The variables analyzed in this study were the number of births and BCG immunization coverage. Data analysis continued with quadrant analysis to find out the distribution of districts based on immunization coverage rates and the number of babies born. The number of births of infants receiving medical assistance in South Sumatra tends to be stable with an average number of 9492.82 babies per district per year. The average percentage of BCG immunization coverage in South Sumatra tends to decrease, reaching 91.99% per district per year. The number of births of infants assisted by medical personnel has a very small relationship to BCG immunization coverage in South Sumatra Province which indicates that not every baby born with medical assistance receives BCG immunization. Based on quadrant analysis, it was found that there were 9 districts / cities that were included in Quadrant I & II which showed low BCG immunization rates. More specifically, there are 4 districts (Quadrant II) which have high rates of birth, but coverage of BCG immunization is low.

Hepatitis B and C prevalence and risk factors among young men presenting to the Brazilian Army: A STROBE-compliant national survey-based cross-sectional observational study.

Viral hepatitis is caused by different etiological agents with distinct epidemiological, clinical, and laboratory characteristics accounting for significant worldwide morbidity and mortality. Since 1996, the Brazilian Department of Sexually Transmitted Infections (STIs), Acquired Immune Deficiency Syndrome (AIDS) and Viral Hepatitis (DIAHV) in collaboration with the Ministry of Defense has been conducting periodic serosurveys of conscripts enlisted for the Brazilian army to assess STI prevalence and obtain data on knowledge and risk factors pertaining to STIs. This article aims to present the hepatitis B (hepatitis B surface antigen - HBsAg) and C (anti-HCV) seroprevalence estimates and risk factors as per the 8th edition of the Conscript Survey performed in 2016.This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, human immunodeficiency virus (HIV), and hepatitis B and C.In total 38,247 conscripts were enrolled; after applying exclusion criteria, 37,282 conscripts were included. The estimated HBsAg and anti-HCV prevalence rates were 0.22% and 0.28%, respectively. Higher HBsAg and anti-HCV prevalence rates were observed in the North Region (0.49%) and in the Central-west Region (0.65%), respectively. Regarding hepatitis B vaccination, 23.5% (n = 8412) of the individuals reported being unvaccinated and 47.4% (n = 16,970) did not know if they had been vaccinated. Among the anti-HCV positive conscripts, 53% (n = 51, 0.56%, P = .049) reported that they had never had sexual intercourse. Regarding self-reported STI status, most of the positive anti-HCV (n = 100, 0.29%, P < .01) and positive HBsAg (n = 76, 0.22%, P = .205) conscripts reported not having a STI. From those who tested positive for HBsAg, 89% (n = 42, 0.28%, P = .005) reported not making consistent use of condoms with steady partners.Our data suggest a low prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian young men, and relatively low rates of self-reported HBV immunization. History of STIs, higher number of partners, inconsistent use of condoms, and lack of awareness of routes of transmission were significantly associated with HBV and HCV infections. To achieve the World Health Organization's goal of viral hepatitis elimination, access to hepatitis information, testing, and surveillance need to be improved.

Is maternal HIV infection a risk factor for delayed or missed infant measles vaccination in western Kenya?

ABSTRACTMeasles is a highly infectious virus and one of the leading causes of childhood morbidity and mortality in areas with low immunization rates. Despite the introduction of the measles vaccine preventing about 20 million deaths between 2000 and 2016, there still is a low uptake of the vaccine, especially in low-income countries. Maternal HIV positive status is identified as one of the factors inhibiting the uptake of the measles vaccine in some settings. Using data from a Health and Demographic surveillance system (HDSS), and a Longitudinal Bio-behavioural Survey (LBBS), we assessed the effect of a mother’s HIV status on a child’s overall uptake of measles vaccine and timeliness in western Kenya. The findings did not show association between a mother’s HIV status and a child’s receipt of measles vaccine (OR = 0.84, 95% CI: 0.65, 1.08). However, higher socio-economic status (SES) was a positive factor for receipt of timely measles vaccine (OR = 1.34, 95% CI: 1.03, 1.75) for middle, (OR = 1.43, 95% CI: 1.10, 1.86) upper middle, and (OR = 1.51, 95% CI: 1.15, 1.98) higher quintiles as compared to the lower. Consequently, it is imperative to incorporate interventions that target low SES children and those that improve economic status.

Provider Education About Pneumococcal Vaccination Practices for Older Adults

OBJECTIVE: To describe an interdisciplinary academic detailing project implemented to address low pneumococcal immunization rates. SETTING: Two medical clinics and four community pharmacies in rural Washington state. PRACTICE DESCRIPTION: The two medical clinics and four community pharmacies were all located in two rural counties and serve geographically large rural areas. PRACTICE INNOVATION: Academic detailing is an evidence-based approach designed to change clinical practice and improve decision-making. Our team utilized the academic detailing model to provide educational outreach to local rural health care providers. The detailing team visited each clinic and pharmacy on a defined schedule and provided information to physicians, clinic administrators, nurses, pharmacists, pharmacy technicians, medical assistants, and clinic front-end staff. MAIN OUTCOME MEASUREMENTS: The project team maintained detailed field notes from each academic detailing the visit and met to debrief about each encounter. From the field notes, through the process of thematic analysis and analytic memoing, the project team produced a list of "lessons learned" that could be used to guide other interprofessional teams wishing to embark on an academic detailing project. RESULTS: We have identified four key "lessons learned": Interprofessional team members bring different strengths to the project; using same-discipline team members paved the way for success; involving students aids in educating future practitioners in interprofessional practice; and scheduling meetings in advance is important. CONCLUSION: We described an approach to enhanced academic detailing using interprofessional team delivery, bringing interprofessional practice into the real-world practice setting.

Provider Education About Pneumococcal Vaccination Practices for Older Adults.

OBJECTIVE: To describe an interdisciplinary academic detailing project implemented to address low pneumococcal immunization rates. SETTING: Two medical clinics and four community pharmacies in rural Washington state. PRACTICE DESCRIPTION: The two medical clinics and four community pharmacies were all located in two rural counties and serve geographically large rural areas. PRACTICE INNOVATION: Academic detailing is an evidence-based approach designed to change clinical practice and improve decision-making. Our team utilized the academic detailing model to provide educational outreach to local rural health care providers. The detailing team visited each clinic and pharmacy on a defined schedule and provided information to physicians, clinic administrators, nurses, pharmacists, pharmacy technicians, medical assistants, and clinic front-end staff. MAIN OUTCOME MEASUREMENTS: The project team maintained detailed field notes from each academic detailing the visit and met to debrief about each encounter. From the field notes, through the process of thematic analysis and analytic memoing, the project team produced a list of "lessons learned" that could be used to guide other interprofessional teams wishing to embark on an academic detailing project. RESULTS: We have identified four key "lessons learned": Interprofessional team members bring different strengths to the project; using same-discipline team members paved the way for success; involving students aids in educating future practitioners in interprofessional practice; and scheduling meetings in advance is important. CONCLUSION: We described an approach to enhanced academic detailing using interprofessional team delivery, bringing interprofessional practice into the real-world practice setting.

Pediatric Inpatient Immunizations: A Literature Review.

Timely vaccine uptake in children remains suboptimal. Eliminating missed opportunities is key to increasing childhood immunization rates, and hospitalization offers another potential setting to vaccinate. To better understand pediatric inpatient immunization programs, including vaccination rates of inpatients, parental and provider attitudes, barriers to vaccine delivery, and interventions to increase provision of inpatient vaccines. A search was conducted of PubMed, Embase, and Web of Science to identify articles and conference abstracts related to pediatric inpatient immunization. Inclusion criteria were studies published in English between January 1990 and January 2019 in which pediatric vaccination in the hospital setting was discussed. Findings from 30 articles and conference abstracts were summarized and organized by topic area. Abstracts were screened for relevance, articles were read, and themes were identified. Children who are hospitalized have been shown to have lower immunization rates compared with the general population, with 27% to 84% of pediatric inpatients due or overdue for vaccines nationally when verified with official records. Unfortunately, little is done to catch up these children once they have been identified. Access to accurate vaccine histories remains a major barrier in inpatient immunization programs because providers frequently under document and parents over recall a child's vaccine status. Strategies identified to increase inpatient vaccination included creation of a multidisciplinary immunization team, educational interventions, visual reminders, catch-up vaccine plans, order sets, and nursing-driven screening. When offered inpatient vaccination, a majority of parents accepted immunizations for their children. Hospitalization may provide an opportunity to augment vaccine uptake. Further research is needed to develop evidence-based strategies to overcome barriers to inpatient vaccination.

Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria

BackgroundSub-Saharan Africa has high under-5 mortality and low childhood immunisation rates. Vaccine-preventable diseases cause one-third of under-5 deaths. Text messaging reminders improve immunisation completion in urban but not rural settings...

“We are Muslims and these diseases don’t happen to us”: A qualitative study of the views of young Somali men and women concerning HPV immunization

BackgroundMinnesota is home to the largest Somali immigrant population in the United States. Despite high rates of cervical cancer in this population, immunization rates for the human papillomavirus (HPV) are among the lowest in the nation. Targeting Somali young adults for catch-up vaccinations may be an important strategy for addressing these low rates. This study sought to understand the views of Somali young adults regarding HPV immunization. MethodsFour focus groups (N = 34; 21 women) were conducted at an urban clinic in Minnesota. Two groups were all female, one all male, and one mixed gender. Participants in each group discussed their views on immunization in general, and then their views on HPV immunization. FindingsMost participants had prior negative experiences with immunization and were skeptical concerning its value. In general, participants had low knowledge about HPV, though they expressed interest in knowing more. Views about HPV were influenced by culture, with risk perceived as low due to interpretations of religious beliefs and expectations around sexual behavior. Low levels of trust in doctors and other healthcare providers influenced participants’ perceptions of the benefits of immunization. Participants also valued autonomy highly and resented having received required vaccinations without much choice, such as through their immigration experience or by school authorities. Participants suggested making more opportunities available for learning about HPV and how to prevent it, including via web-based platforms. ConclusionAn important opportunity exists to address low HPV immunization rates in the Somali American population by offering vaccination to young adults, who are interested in learning more about HPV. However, key barriers around HPV needs to be addressed in ways that respect the need for autonomy in this age group and that build trust with providers, which may mean avoiding authoritative approaches.

Identifying Ferrara's elderly people with low influenza immunization rates: the contribution of a local socio-economic deprivation index.

SummaryInfluenza immunization coverage rates remain far below the optimal value recommended by the World Health Organization, even in groups considered at high risk, such as the elderly. A possible explanation for this suboptimal vaccination uptake may be deprivation. A specifically developed local deprivation index was proposed for the classification of residents in the municipality of Ferrara in order to evaluate the characteristics of subjects over 65 years of age who accepted/refused influenza immunization (2010-2015). The variables building this deprivation index were primarily related to demographic aspects, such as age, widow/widower status, education, family composition and housing characteristics. Influenza immunization coverage rates were unsatisfactory in all categories of deprivation. A statistically significant decreasing trend in coverage rates was observed with decreasing deprivation in the general population and in males, but not in females. In addition to factors composing the local deprivation index, being separated, living in a family of three members and independent contractor were features that hindered immunization among very deprived elderly.

Recommendations for improving low influenza immunization rates: a cohort in Puerto Rico

Recommendations for improving low influenza immunization rates: a cohort in Puerto Rico

ASSESSMENT OF RISK FACTORS AND DETERMINATION OF VACCINE EFFICACY FOR MEASLES OUTBREAK DURING APRIL 2017 IN DHOK KAZIN, ISLAMABAD

Background: On 13th April 2017, 3 measles cases were reported in Dhok Kazin, Islamabad to National Institute of Health, Islamabad. Federal Disease Surveillance &amp; Response Unit on request of Islamabad Capital Territory (ICT) health administration started disease outbreak investigation and active case finding. The study was aimed to identify risk factors associated with disease outbreak, to assess vaccine coverage and vaccine efficacy in the outbreak area, and to suggest control measures. Methods: To determine possible risk factors age and sex matched case-control study was conducted in April, 2017. A case was defined as "Any resident of Dhok Kazin, presented with fever and maculopapular rash with any of signs/symptoms like coryza, conjunctivitis, cough, otitis media or pneumonia after March 20 to April 30, 2017". For each case 04 matched controls were selected. A structured questionnaire prepared to collect data. Vaccine coverage survey was conducted. Uni and multivariate analyses and vaccine efficacy were calculated. Results: A total of 14 cases identified including 11 cases found on active search. Cases were compared with 57 matched controls. Mean age was 39 months (range 08- 132 months). Among cases male to female ratio observed was 1:2.5. Overall attack rate was 1.2%, while most severely affected age-group was &lt;12 months (AR=10.3%). The most common complications were diarrhea n=8 (57.1%) and pneumonia n=1 (7.1%). On vaccine coverage survey in 230 households, 31(70.5%) out of 44 children checked were vaccinated. The un-vaccinated children had attack rate of 14.3% while vaccinated had attack rate of 6.7%. The vaccine efficacy calculated was 53%. Significant association found in risk factors were; contact with positive case [OR 19.5, 95% CI; 4.5-84, P=0.00], unvaccinated children [OR=10.0, 95%, CI;1.2.0-49.3, P= 0.003], Mother illiteracy [OR 10.2, 95% CI; 2.5-41, P=0.00], Misconception about vaccination [OR 13.2, 95%, CI;3.1-57.1, P=0.00), vaccinator not visited home as a part of outreach activity [OR=6.4, 95%CI;1.7-23.4, P=0.00]. Reasons for non-vaccination were found to be misconception about vaccination (OR=34.8, 95%CI=5.5-219.7) and mother's illiteracy (OR=6.4, 95%CI=1.2-34.8). Conclusion: Most severely affected age group was 12 months and below. Low immunization rates were the most probable cause of outbreak. Case contacts, partial vaccination, misconception of vaccination, no visit of vaccinator to home, and mother's education were risk factors significantly associated with Measles outbreak. Findings were shared with the district health authorities for implementation of control measures.

Low uptake of nasal influenza vaccine in Polish and other ethnic minority children in Edinburgh, Scotland

Failure to vaccinate is well-recognised in Europe as a contributing factor to outbreaks of infectious diseases. Low immunisation rates are often associated with religious, social and ethnic minorities, including refugees or migrant groups. Polish people form Scotland’s newest and largest migrant group. They have moved to Scotland since 2004, joining established ethnic minorities from China, the Indian subcontinent and Africa.Scotland has had a seasonal influenza nasal vaccination programme for all primary school children since 2013. We investigated three primary schools in Edinburgh, which had reported low influenza vaccination uptake rates in 2016 and 2017 and found that these schools contained many pupils from ethnic minorities, the majority of whom were Polish. Pupils were categorized as one of three ethnic groupings: White British, Polish and Other Identified Ethnic Minority (OIEM). We ascertained ethnicity using NHS and Education Department information sources and name recognition. We examined vaccine acceptance, declination and non-return of consent forms.In 2017, nasal influenza vaccine uptake was 70.7% (65.2–75.6%, p < 0.001) in White British, 60.9% (53.9–67.6%%, p < 0.001) in other identified ethnic minorities and 25.0% (20.9–29.6%, p > 0.001) in Polish children. White British children were more likely to return completed forms (78.9%) than other groups (OIEM 68.2% and Polish 61.8%). 36.8% of Polish families completed a consent form declining vaccination compared to 6.2% of White British families.These findings demonstrate that significant differences exist in nasal influenza vaccination uptake rates, which have important implications for the trans-national study of vaccine hesitancy. Further qualitative work and an investigation of uptake rates of other childhood immunisations in Polish and other migrant groups is required to assess differences in uptake and behaviours.

Determinants of low measles vaccination coverage in children living in an endemic area.

Measles outbreaks were recently reported in Europe due to low immunization rates. In this scenario, identifying the reasons of no vaccination is crucial to set up strategies to improve immunization rate. A cross-sectional study was conducted to investigate the determinants of missed vaccination in children living in Southern Italy, during the 2016 outbreak. A standardized face-to-face questionnaire was used to record demographic data, immunization status, and reasons for missed vaccination. A total of 1141 children (median age 86months, male 47.2%) was enrolled, 77.8% of the children were adequately vaccinated for age, 6.3% were incompletely vaccinated for age, and 15.9% did not receive any vaccine dose. Vaccination rate and reasons for not vaccinating significantly varied according to age, with children ≤ 24months showing the lowest rate (67.8%). Reasons for not vaccinating included fear for side effects (51%), presence of underlying chronic conditions (12.2%), skip scheduled appointment (12.2%), refusal of vaccination (10.3%), acute illnesses (7.2%), and allergy to eggs (4.6%). The presence of underlying condition was a risk factor for inadequate immunization (p < 0.0001). Only 4.7% of conditions were true contraindications to vaccine administration.Conclusion: We reported inadequate measles immunization rate in Southern Italy, with lowest rates in children ≤ 2years or with underlying conditions. Only a minority had true contraindications to vaccine uptake. Implementation strategies addressed to health-care professionals and families should focus on the reported determinants to increase measles vaccination coverage. What is Known: • Measles is a viral, highly communicable disease, preventable by vaccine. • Measles elimination in Europe failed as demonstrated by outbreaks in several countries, due to low immunization rates. What is New: • Inadequate measles immunization rate due to false contraindications in Southern Italy, with lowest rates in children ≤ 2years. • The presence of underlying disease is a risk factor for inadequate immunization.

Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal.

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country’s National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions’ performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014–2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy’s mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014–2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.

HCV Co-Infection in Patients With HBV Infection in Urban Minority Population in a U.S. Major City - A Closer Look

Introduction: Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) infections are major global health problems causing life threatening liver infections.The Model of End-stage Liver Disease (MELD) score used to predict mortality risk and the severity of chronic liver diseases. Many studies have shown dually infected patients to be at higher risk of more severe liver cirrhosis. However, few studies are conducted in U.S. major city involving urban minority population. Methods: Retrospective observational study- all patients with chronic HBV infection. Patients were divided into 2 groups: Group A- HBV infection; Group B- Coinfection with HBV and HCV. Demographics, epidemiology and disease severity were compared. Results: Total patients with chronic HBV infection were n=273, of which 151(55.3%) had HBV monoinfection (Group A) and 122 (44.7%) had co-infection with HCV (group B). Patients >40 years were higher in group B (92%) compared to group A (77%). Majority of the patients were males in both groups (55% and 66% respectively) and of African American ethnicity (88% and 74% respectively). Prevalence of smoking, alcohol and IV drug use (IVDU) was higher in Group B (76%, 80% and 49% respectively) compared to Group A (45%, 56% and 41% respectively). HBV immunization rates were low in both groups, group A (6.6%) and group B (1.6%). Majority of the patients were treatment naïve in both groups with Group A (92%) greater than Group B (78%). Group B had higher incidence of hepatic encephalopathy (15%) and ascites (18%) compared to group A (12% and 9% respectively). MELD scores distribution was similar in both groups for MELD 30, there were increased patients in Group B (18%) compared to group A (5%). Conclusion: A high number of patients with chronic HBV had co-infection with HCV, majority of them being males, over 40 years of age, and African American ethnicity. The incidence of smoking and alcohol use although higher in group B, IVDU was comparable similar in both groups.Both groups had comparable disease severity with moderately higher rates of hepatic encephalopathy and ascites among patients with co-infection. Patients with co-infection had a greater 3- month mortality prediction compared to mono-infection group.Overall this study throws light on the very low HBV immunization rates in the urban minority population and the high rate of co-infection, resulting in increased disease burden and mortality risk as considered by the measured MELD scores in this population.

Parental HPV knowledge and perceptions of HPV vaccines among Korean American parents

AimThe purpose of this study was to examine Korean-Americans (KA) parents' level of knowledge and perceptions of the HPV vaccination, and to identify the differences in parental knowledge and perceptions of the HPV vaccine between KA parents who have vaccinated their children versus those who have not. BackgroundWhile there are significant concerns about HPV infection, lower immunization rates, and higher cervical cancer risks facing KAs, limited attention has been paid to the specific concerns of KA parents and barriers that underlie parental reluctance to vaccinate their children. MethodsA descriptive comparative design was used in a convenience sample of 74 KA parents. The study questionnaire consisted of demographic items, general knowledge of HPV, and parental perception regarding HPV vaccination. ResultsThe level of general knowledge about HPV was very low with a mean score of 3.14 out of 10. Many participants reported negative perception toward HPV vaccination. HPV knowledge scores were not significantly different between parents who did vaccinate their children compared to parents who did not. However, scores for perceived benefits and perceived barriers to vaccination were found to be significantly different between the two groups. ConclusionsA lack of knowledge about HPV and negative perception of the HPV vaccination play a key role in preventing many KA parents from seeking appropriate information and delaying vaccination. Development of a culturally grounded and sensitive HPV education program is critical to improve and implement preventive measures for HPV in this population.

Should influenza vaccination be mandatory for healthcare workers?

Each year, many healthcare organizations deal with low influenza immunization rates among staff. Mandatory influenza vaccination programs may be considered in order to address this issue. These types of programs have caused controversy in the past, as staff has argued that they infringe upon their liberties and right to autonomy. However, if viewed from a public health perspective, mandatory vaccination programs are beneficial for both employees and patients and can be justified. When individuals make the decision to work in the medical field, it is assumed that their values align with those of the organization for which they work. This overrides their right to autonomy, since they are expected to put the safety of their patients ahead of their own personal interests. Although some may argue that receiving a flu shot is unsafe, evidence has demonstrated the opposite, and the minimal discomfort that may result from a vaccine is not enough to negate the responsibilities that healthcare workers have toward the patients they serve.

Impact of Race on Immunization Status in Long-Term Care Facilities.

This study examined the relationship between resident race and immunization status in long-term care facilities (LTCFs). Race was captured at the resident and the facility racial composition level. Thirty-six long-term care facilities varying in racial composition and size were selected for site visits. LTCFs were urban and rural, CMS certified, and non-hospital administered. Chart abstraction was used to determine race, immunization, and refusal status for the 2010-2011 flu season (influenza 1), the 2011-2012 flu season (influenza 2), and the pneumococcal pneumonia vaccine for all residents over 65years old. Thirty-five LTCFs submitted sufficient data for inclusion, and 2570 resident records were reviewed. Overall immunization rates were 70.5% for influenza 1, 74.1% for influenza 2, and 65.6% for pneumococcal pneumonia. Random effects logistic regression indicated that as the percent of Black residents increased, the immunization rate significantly decreased (immunization 1, p< 0.018, immunization 2, p< 0.002, pneumococcal pneumonia, p= 0.0059), independent of the effect of resident race which had less of an impact on rates. This study found considerable LTCF variation and racial disparities in immunization rates. Compared to Blacks, Whites were vaccinated at higher rates regardless of the LTCF racial composition. Facilities with a greater proportion of Black residents had lower immunization rates than those with primarily White residents. Facility racial mix is a stronger predictor of influenza immunization than resident race. Black residents had significantly higher vaccination refusal rates than White residents for immunization 2. Further studies examining LTCF-level factors that affect racial disparities in immunizations in LTCFs are needed.

Immunization in end stage renal disease: The perception of waiting list patients.

The number of patients with chronic kidney disease is increasing worldwide, as well as the number of patients in kidney transplant waiting lists. In order to prevent infections related to immunosuppressive therapy, immunization guidelines for CKD patients before transplantation have been proposed. The aim of the present study was to evaluate adherence to immunization in a cohort of CKD patients in transplant waiting list and their renal replacement therapy clinics. CKD patients older than 18years old, receiving renal replacement therapy longer than 12months and included in kidney transplant waiting list at University of Campinas (Unicamp) were enrolled. From February 2014 to December 2015, 105 patients fulfilled the inclusion criteria. Complete hepatitis B vaccination was observed in 73% and influenza vaccine in 67%. None of the other vaccine protocols reached 50% of coverage. Patients receiving immunization at primary health units presented higher coverage for diphtheria, tetanus (dT), measles, mumps, rubella (MMR), and hepatitis B vaccines, while patients immunized at renal replacement therapy clinics showed higher prevalence of pneumococcus (pneumo23). The low rates of immunization could reflect the RRT's clinics knowledge about the vaccines guidelines and its application on daily care. We suggest an integration between transplant center and RRT clinics, through lectures, periodic checking of vaccination cards, and easy to follow guidelines in order to provide a better vaccine coverage and to obtain higher immunization rates.