On-time Vaccination Research Articles

Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation.

The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented. Health care providers are encouraged to start offering the HPV vaccine series at age 9 or 10years. Catch-up HPV vaccination is recommended for all persons through age 26years who are not adequately vaccinated. Providers should inform individuals aged 22 to 26years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk. Catch-up HPV vaccination is not recommended for adults aged older than 26years. The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clinicians, and the lack of sufficient guidance on the selection of individuals who might benefit.

Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis

BackgroundTimely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia.MethodThis study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs).ResultsOf the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317–4.343), from richest households (AOR = 2.381; 95% CI: 1.502–3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310–6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377–3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048–0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033–0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities.ConclusionIn this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.

A qualitative study examining pediatric clinicians’ perceptions of delayed vaccine schedules

ObjectiveTo explore pediatric clinicians’ attitudes, beliefs, and perceived social norms about the impact of delayed vaccine schedules on the clinical management of their patients. MethodsWe conducted 30 semi-structured qualitative interviews with academic (Infectious Diseases, Emergency Medicine) and community pediatric clinicians (General Pediatrics) to explore clinicians’ perspectives on how delayed schedules influence their clinical management of patients. The interview guide was based on the Theory of Planned Behavior. We analyzed interview transcripts using both an inductive and deductive thematic approach. ResultsThe pediatric clinicians in our study overwhelmingly supported the recommended schedule, sought guidance on approaches to navigating conversations with vaccine hesitant families, and desired more evidence to effectively promote on-time vaccination. Clinicians described how delayed schedules have consequences for sick children (e.g., increased antibiotics, laboratory tests, emergency department visits) and healthy children (e.g., increased vaccine visits, out-of-pocket costs, fears among children receiving frequent shots). Clinicians stated that delayed schedules also negatively impact pediatric practices (e.g., increased time counseling patients, staff burden, clogged clinic space, unpredictable vaccine utilization, costs). ConclusionsPediatric clinicians perceive that delayed vaccine schedules negatively affect patients, pediatric practices, the healthcare system, and society. Future research should quantify the consequences of delayed schedules and identify strategies that promote vaccine adherence. Results from future studies can better support clinician-parent conversations about vaccine hesitancy, guide decision-makers about practice-level approaches to vaccine schedules, and advise payors and policymakers regarding vaccine-related policies.

Vaccine Hesitancy and Low Immunization Rates in Children with Down Syndrome

To determine the prevalence of vaccine hesitancy and refusal among parents of children with Down syndrome and to determine how well the Parent Attitudes about Childhood Vaccines Survey (PACV) is associated with vaccine receipt among children with Down syndrome. We mailed the PACV to parents of children with Down syndrome who attend the Down Syndrome Clinic at Akron Children's Hospital and examined associations between PACV scores and immunization status at 19months of age. Of 120 surveys sent, 63 parents completed the PACV (52% response rate) of which 60 were linked to vaccination records. Of these 60 respondents, 55 children were ≥19months old. PACV scores were significantly correlated with days of underimmunization at 19months of age. All parents who refused all vaccines had PACV scores of ≥50. Only 58% of children were up to date for the combined 7 vaccine series at 19months of age. The PACV may be a valuable tool to identify vaccine hesitancy among parents of young children with Down syndrome. Special emphasis is needed to increase adherence with on-time vaccine recommendations for children with Down syndrome to optimize their health and to potentially avoid hospitalizations.

A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants

BackgroundThe effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DesignUnblinded, randomised controlled trial with blocked sampling. Methods1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national “No jab No Pay” policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. ResultsThere was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01–1.18) or in combination with a personalised calendar (1.11, CI 1.03–1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants − 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the “No Jab, No Pay” policy. ConclusionsSMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.

Complete and on-time routine childhood immunisation: determinants and association with severe morbidity in urban informal settlements, Nairobi, Kenya

Background: Completion of the full series of childhood vaccines on-time is crucial to ensuring greater protection against vaccine-preventable diseases.Aim: To examine determinants of complete and on-time vaccination and evaluate the relationship between vaccination patterns and severe morbidity outcomes.Subjects and methods: Vaccination information from infants in Nairobi Urban Health and Demographic Surveillance System was used to evaluate full and on-time vaccination coverage of routine immunisation. Logistic regression was used to identify determinants of full and on-time vaccination coverage. Cox regression model was used to evaluate the relationship between vaccination status and subsequent severe morbidity. A shared frailty cox model was fitted to account for the heterogeneity in hospitalisation episodes.Results: Maternal age, post-natal care, parity, ethnicity, and residence place were identified as determinants of vaccination completion. Institutional deliveries and residence place were identified as the determinants of on-time vaccination. A significant 58% (confidence interval [CI]: 15–79%) (p = .017) lower mortality was observed among fully immunised children compared with not fully immunised. Lower mortality was observed among on-time immunised children, 64% (CI: 20–84%) compared to those with delays.Conclusions: Improving vaccination timeliness and completion schedule is critical for protection against vaccine preventable diseases and may potentially provide protection beyond these targets.

Trends in the Laboratory Detection of Rotavirus Before and After Implementation of Routine Rotavirus Vaccination - United States, 2000-2018.

Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection was the leading cause of severe gastroenteritis among U.S. children (1). To evaluate the long-term impact of rotavirus vaccination on disease prevalence and seasonality in the United States, CDC analyzed national laboratory testing data for rotavirus from laboratories participating in CDC's National Respiratory and Enteric Viruses Surveillance System (NREVSS) during the prevaccine (2000-2006) and postvaccine (2007-2018) periods. Nationally, the median annual percentage of tests positive for rotavirus declined from 25.6% (range=25.2-29.4) in the prevaccine period to 6.1% (range=2.6-11.1) in the postvaccine period. When compared with the prevaccine period, the postvaccine period saw declines in the annual peak in rotavirus positivity from a median of 43.1% (range=43.8-56.3) to a median of 14.0% (range=4.8-27.3) and in the season duration from a median of 26 weeks (range=23-27) to a median of 9 weeks (range=0-18). In the postvaccine period, a biennial pattern emerged, with alternating years of low and high rotavirus activity. Implementation of the rotavirus vaccination program has substantially reduced prevalence of the disease and altered seasonal patterns of rotavirus in the United States; these changes have been sustained over 11 seasons after vaccine introduction. Ongoing efforts to improve coverage and on-time vaccination (2) can help maximize the public health impact of rotavirus vaccination.

System within systems: challenges and opportunities for the Expanded Programme on Immunisation in Pakistan

BackgroundPakistan has one of the highest infant and child mortality rates in the world, half of these occurring due to vaccine-preventable diseases. The country started its Expanded Programme on immunisation (EPI) in 1978. However, the programme’s performance is often questioned, as the Immunisation rates have been chronically low and on-time vaccination unsatisfactory. We explored the programme’s insights about its structural and implementation arrangements within the larger governance system, and the ensuing challenges as well as opportunities.MethodsWe carried out a qualitative case study comprised of semi-structured, in-depth interviews with 34 purposively selected key informants from various tiers of immunisation policy and programme implementation. The interviews revolved around WHO’s six building blocks of a health system, their interactions with EPI counterparts, and with the outer ecological factors. Interviews were transcribed and content analysed for emergent themes.ResultsThe EPI faces several challenges in delivering routine immunisation (RI) to children, including lack of clarity on whether to provide vaccination through fixed centres or mobile teams, scarcity of human resource at various levels, lack of accurate population data, on-ground logistic issues, lack of a separate budget line for EPI, global pressure for polio, less priority to prevention by the policy, security risks for community-based activities, and community misconceptions about vaccines.ConclusionsThe fulcrum for most of the challenges lies where EPI service delivery interacts with components of the broader health system. The activities for polio eradication have had implications for RI. Socio-political issues from the national and global environment also impact this system. The interplay of these factors, while posing challenges to effective implementation of RI, also brings opportunities for improvement. Collective effort from local, national and global stakeholders is required for improving the immunisation status of Pakistani children, global health security and the sustainable development goals.

Immunisation coverage annual report, 2015

This 9th annual immunisation coverage report shows data for 2015 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus (HPV) Vaccination Program Register. This report includes coverage data for ‘fully immunised’ and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, ‘fully immunised’ coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, coverage reached its highest ever level of 93% during 2015. As in previous years, coverage for ‘fully immunised’ at 12 and 24 months of age among Indigenous children was 3.4% and 3.3% lower than for non-Indigenous children overall, respectively. In 2015, 77.8% of Australian females aged 15 years had 3 documented doses of HPV vaccine (jurisdictional range 68.0–85.6%), and 86.2% had at least one dose, compared to 73.4% and 82.7%, respectively, in 2014. The differential of on-time vaccination between Indigenous and non-Indigenous children in 2015 diminished progressively from 18.4% for vaccines due at 12 months to 15.7% for those due at 24 months of age. In 2015, the proportion of children whose parents had registered an objection to vaccination was 1.2% at the national level, with large regional variations. This was a marked decrease from 1.8% in 2014 and the lowest rate of registered vaccination objection nationally since 2007 when it was 1.1%. Medical contraindication exemptions for Australia were more than double in 2015 compared with the previous year (635 to 1,401).

Vaccine Education, Reasons for Refusal, and Vaccination Behavior

Little is known about associations between the reasons parents refuse or delay vaccines for their children, their responsiveness to vaccine counseling, and their children's vaccination status at various ages. Since 2015, Michigan has required parents to attend education sessions at local health departments to receive nonmedical exemptions. This requirement provides an opportunity to study otherwise opaque aspects of vaccine refusal. In 2017 and 2018, researchers analyzed a combined data set that included electronic medical records (n=4,098) generated by one Michigan health department during 2015 immunization education sessions, and immunization records from an August 2016 report of the Michigan Care Improvement Registry immunization registry. Analyses employed difference of proportions and ANOVAs to explore group differences in vaccination behaviors after education sessions and on-time vaccination status at various ages. Children whose parents stated a commitment to an alternative schedule at the education session subsequently received a vaccine their parents had refused at a much higher rate (39.2%) than did children whose parents refused for reasons of religion (4.4%), concerns about the risks of vaccines (8.1%), or beliefs that vaccines provide little benefit (10.5%). Different reasons for refusal are associated with different patterns of vaccination behavior. Furthermore, results suggest that education sessions may overcome vaccine refusal in some cases, and that distinct refusal reasons mark real differences in parental motivations regarding vaccination choices. These differences in parental motivations may indicate the existence of different sites for potential pro-vaccination interventions.

265. Missed Opportunities For HPV Vaccination In Indiana: Geographic Variability

Human papillomavirus (HPV) vaccination prevents infection with the types of HPV responsible for the large majority of cervical and anal cancers and precancers, as well as genital warts. Compared to 2016 U.S. national HPV vaccination rates for 13-17 year olds, Indiana lags substantially in HPV vaccine initiation, ranking 46th for females and last for males. However, rates likely vary substantially across Indiana’s 92 counties. The purpose of this study was to document variability across counties in missed opportunities to initiate HPV vaccination and to identify county-specific correlates of initiation rates among pre-adolescents ages 11-12, the targeted age range for on-time vaccination. The Indiana Immunization Surveillance System (IIS) provided 2017 county level data on HPV vaccine missed opportunity rates at ages 11-12. A missed opportunity was defined as a visit at which two vaccines were administered, but not HPV vaccine (in Indiana Tdap and MenACWY are required for middle school entry). County-specific socio-demographic and health data were derived from several sources, including the U.S. Census and countyhealthrankings.org, a program supported by the Robert Wood Johnson Foundation. Potential county-level correlates of missed opportunities included race, income, insurance status, population density, education, primary care provider (PCP) per capita, and rates of smoking, mammography screening, diabetes monitoring, and Pap testing. Data were analyzed via descriptive statistics and Pearson correlations. Each county was treated as an individual. The Mean HPV vaccine missed opportunity rate in Indiana for 11-12 years olds was 76% (SD=.07), but ranged widely from 58% to 94% across counties. There were significant negative correlations with mammography screening (r=-.34, p<.01) and diabetes monitoring (r=-.29, p<.01), indicating that counties with greater missed opportunities had lower mammography screening and diabetes monitoring rates. For the targeted ages of 11-12 there was wide variability in missed opportunities for HPV vaccination across the 92 Indiana counties, which emphasizes the need to not simply look at state-level HPV vaccination rates, but to examine small geographic regions. Variations in missed opportunity rates were associated with mammography screening rates and diabetes monitoring, which may reflect shared underlying issues related to access to health care across counties. There were no significant correlations to race, income, smoking, population density, per capita PCP, insurance status, and smoking rates. Clearly, then, more research is needed to fully explain variability across these smaller geographical regions. Further, interventions may be needed that target county-specific needs in increasing HPV vaccine uptake. Finally, the high rate of missed opportunities is consistent with previous research indicating the need for further education in promoting the HPV vaccine amongst primary care providers.

Assessment of on-time vaccination coverage in population subgroups: A record linkage cohort study

Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2–4–6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996–2012, combining individual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2–4–6 month dose; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7–10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2–4–6 month schedule is only 50–60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness.

Operationalizing outcome measures of human papillomavirus vaccination among adolescents

ObjectivesWhen examining vaccination coverage, researchers must make decisions about how to define outcome measures based on many factors, including the timing of doses. Different operationalizations of the same outcome can often lead to different findings and can affect the ability to make comparisons across studies. This methodological article aimed to illustrate the implications of two options for operationalizing human papillomavirus (HPV) vaccination based on timing: initiation of the first dose at any age vs before the 13th birthday (on time). Study designCross-sectional observational design. MethodsThe 2014 National Immunization Survey for Teens (N = 16,439 adolescents aged 13–17 years) was analyzed using multivariate logistic regression for each outcome measure and effect modification by gender. ResultsAge was positively associated with initiation at any age but negatively associated with on-time initiation. Gender modified the effect of race/ethnicity for both measures of initiation, but the pattern across groups was different for the two outcomes. Gender modified the effect of provider recommendation for initiation at any age, while gender modified the effects of age and region for on-time initiation. ConclusionDecisions of how to operationalize outcomes of HPV vaccine initiation among adolescents can lead to different conclusions about the role of age and gender differences for several predictive variables. To inform the development of public health efforts that promote on-time HPV vaccination among male and female adolescents, researchers should consider the importance of dose timing when operationalizing outcome measures. We recommend including on-time receipt of the HPV vaccine as an outcome measure.

The Prevalence of Occult HBV Infection Among Hemodialysis Patients of Tehran, Iran

Background: The presence of HBV DNA in the absence of hepatitis B surface antigen (HBsAg) in the serum of patients is called occult HBV infection (OBI). Because of the risk of hepatitis B transmission, OBI is an important subject for haemodialysis (HD) patients and centres. Objectives: The present study was conducted to determine the prevalence of OBI among haemodialysis patients. Methods: In this cross-sectional study, serum specimens were obtained from 200 haemodialysis patients who referred to HD centres of Iran University of Medical Sciences in Tehran (Iran) and were tested for HBsAg. They were then tested for HBV viral load in plasma and the presence of the HBV genome in peripheral blood mononuclear cell specimens using real-time PCR. Demographic data (age, sex, history of HBV vaccination, and blood transfusion), liver enzymes (AST, ALT), and duration of HD were recorded. Results: Among the 200 HD patients, 109 (54.5%) were male and 91 (45.5%) were female. The mean age of the patients was 56.09 ± 15.5 years (range: 22 to 88 years). A total of 38 patients (19%) had a history of blood transfusion and all patients had received 3 doses of hepatitis B vaccine (34 patients also received a booster dose after recording a low serum level of HBsAb.). The prevalence of OBI was 0.5% (1/200). Conclusions: Considering the moderate prevalence of hepatitis B virus infection in Iran, the prevalence of OBI in HD patients was very low, which could be due to regular and on-time vaccination for hepatitis B and the good preventive care in HD centres.

Evaluation of Combination Measles-Mumps-Rubella-Varicella Vaccine Introduction in Australia

Incorporating combination vaccines, such as the measles-mumps-rubella-varicella (MMRV) vaccine, into immunization schedules should be evaluated from a benefit-risk perspective. Use of MMRV vaccine poses challenges due to a recognized increased risk of febrile seizures (FSs) when used as the first dose in the second year of life. Conversely, completion by age 2 years of measles, mumps, rubella, and varicella immunization may offer improved disease control. To evaluate the effect on safety and coverage of earlier (age 18 months) scheduling of MMRV vaccine as the second dose of measles-containing vaccine (MCV) in Australia. Prospective active sentinel safety surveillance comparing the relative incidence (RI) of FSs in toddlers given MMRV and measles-mumps-rubella (MMR) and a national cohort study of vaccine coverage rates and timeliness before and after MMRV vaccine introduction were conducted. All Australian children aged 11 to 72 months were included in the coverage analysis, and 1471 Australian children aged 11 to 59 months were included in the FS analysis, with a focus on those aged 11 to 23 months. MMRV vaccine safety, specifically, the RI of FSs after MMRV vaccine at age 18 months, compared with risk following MMR vaccine and vaccine uptake for 2-dose MCV and single-dose varicella vaccine, focusing on timeliness. Of the 1471 children, the median age at first FS was 21 months (interquartile range [IQR], 14-31 months). Three hundred ninety-one children were aged 11 to 23 months and had at least 1 FS included in the analysis; of these, 207 (52.9%) were male. A total of 278 children (71.1%) had received MMR followed by MMRV vaccine, 97 (24.8%) had received MMR vaccine only, and 16 (4.1%) had received neither vaccine. There was no increased risk of FSs (RI, 1.08; 95% CI, 0.55-2.13) in the 5 to 12 days following MMRV vaccine given as the second MCV to toddlers. Febrile seizures occurred after dose 1 of MMR vaccine at a known low increased risk (RI, 2.71; 95% CI, 1.71- 4.29). Following program implementation, 2-dose MCV coverage at age 36 months exceeded that obtained at age 60 months in historical cohorts recommended to receive MMR vaccine before school entry, and on-time vaccination increased by 13.5% (from 58.9% to 72.4%). Despite no change in the scheduled age of varicella vaccine, use of MMRV vaccine was associated with a 4.0% increase in 1-dose varicella vaccine coverage. To our knowledge, this is the first study to provide evidence of the absence of an association between use of MMRV vaccine as the second dose of MCV in toddlers and an increased risk of FSs. Incorporation of MMRV vaccine has facilitated improvements in vaccine coverage that will potentially improve disease control.

Missed opportunities for simultaneous administration of the fourth dose of DTaP among children in the United States

BackgroundSimultaneous administration of all age-appropriate doses of vaccines is an effective strategy for raising vaccination coverage. Vaccination coverage for ≥4 dose of DTaP (diphtheria, tetanus toxoids, and acellular pertussis vaccine) among children 19–35months in the United States has not reached the Healthy People 2020 target of 90%. Risk factors for missed opportunities for simultaneous administration of the fourth dose of DTaP have not been investigated. MethodsA missed opportunity for simultaneous administration of the fourth dose of DTaP is defined as the failure to administer an age-eligible fourth dose of DTaP, and during the same age-eligible period for the fourth dose of DTaP other recommended and age-appropriate doses of vaccines are given to children. This study used 2001–2014 National Immunization Survey data to describe the trend in missed opportunities for simultaneous administration of the fourth dose of DTaP from 2001 through 2014, assess the prevalence of children who missed opportunities for simultaneous administration of the fourth dose of DTaP by selected factors, and recognize significant risk factors for missed opportunities for simultaneous administration of the fourth dose of DTaP. ResultsFrom 2001 to 2014, the prevalence of missed opportunities for simultaneous administration of the fourth dose of DTaP among children 19–35months in the United States ranged from 5.7% to 9.0%; across 13 factors considered, the prevalence of missed opportunities varied from 3.3% to 22.9%. Children who were late in receiving the first to third dose of DTaP had significantly higher prevalence of missed opportunities for simultaneous administration of the fourth dose of DTaP than children who received these doses on-time, with adjusted prevalence ratios for late vs. on-time of 1.7, 1.6, and 3.2, and all P-value<0.01. ConclusionsImproving on-time vaccination of the third dose of DTaP could substantially reduce missed opportunities for simultaneous administration of the fourth dose of DTaP.

Профілактика міксоматозу кролів

Rabbits Myxomatosis – highly contagious disease, which pathogen are epiteliotrophic virus from the family Poxviridae. The rapid spread of the disease contributes people's ignorance in realization of zoohygienic, veterinary and sanitary preventive measures during rabbit farming and breeding. Now, effective treatments against Rabbits Myxomatosis isn’t be in existence yet. Therefore, you must implement follow zoohygienic, veterinary and sanitary preventive measures: – to put on-time routine vaccination of all livestock rabbits. Rabbits vaccinated in month age old, in hazardous areas – in 28-th day age old, revaccination realized in 3 months. It is necessary to do the vaccination before the mass insects fly, the best is during late April – early May; – to conduct disinfections, disinsections and deratizations measures of animal buildings; – to conduct measures of manure decontamination (by biotermal way, to the liquid fraction – use follow chemicals: formaldehyde, bleaching powder) – to apply repellents – substances that repel insects (oksamat, benzymin (hexamid) and diethyltoluamid (DEET); – to be consistent with the principle «All Empty – All Occupation», which makes it possible to do preventive breaks, sanitary measures, maintenances and disinfection of animals buildings; – to conduct complex of disease epizootic data diagnostics with regard of: seasonality, the activity of blood-sucking insects, cases in the past, mass disease. There are use the living cultural lyophilized vaccine against Rabbits Myxomatosis in order to prevent disease in the Ukraine, which made in Ukraine and abroad. Currently, LLC «BIOTESTLAB» developed a live vaccine against Rabbits Myxomatosis - Lapinum Mix and Lapinum Hemix (complex against Rabbits Haemorrhagic Disease and Rabbits Myxomatosis). Lapinum lines vaccines provide rapid immune response and long protection against diseases. Tests showed high level of the rabbit blood antibodies from 4-th day of vaccination. In the production of vaccines used same completely homologous Ukrainian virus strains which effective vaccination guarantee.

Can mobile technologies improve on-time vaccination? A study piloting maternal use of ImmunizeCA, a Pan-Canadian immunization app

ABSTRACTMobile applications have the potential to influence vaccination behavior, including on-time vaccination. We sought to determine whether the use of a mobile immunization app was associated with the likelihood of reporting on-time vaccination in a cohort of 50 childbearing women. In this pilot study, we describe participant reported app use, knowledge, attitudes or beliefs regarding pediatric vaccination and technology readiness index (TRI) scores.To explore if app use is associated with change in attitudes, beliefs or behavior, participants were instructed complete a baseline survey at recruitment then download the app. A follow up survey followed 6-months later, reexamining concepts from the first survey as well as collecting participant TRI scores. Changes in Likert scores between pre and post survey questions were compared and multivariate logistic regression was used to assess the relationship between TRI score and select survey responses. Thirty-two percent of participants perceived that the app made them more likely to vaccinate on time. We found some individuals' attitudes toward vaccines improved, some became less supportive and in others there was no change. The mean participant TRI score was 3.25(IQR 0.78) out of a maximum score of 5, indicating a moderate level of technological adoption among the study cohort population. While the app was well received, these preliminary results showed participant attitudes toward vaccination moved dichotomously. Barriers to adoption remain in both usability and accessibility of mobile solutions, which are in part dependent on the user's innate characteristics such as technology readiness.

Younger age at initiation of the human papillomavirus (HPV) vaccination series is associated with higher rates of on-time completion

Vaccination rates for human papillomavirus (HPV) have remained disappointingly low. It is critical to identify methods to increase on-time vaccine series completion rates (before 13 or 15years). To determine whether younger age (9 to 10years of age) at HPV vaccine series initiation was associated with improved on-time completion rates compared to initiation at 11 to 12years, we examined the prevalence of on-time HPV vaccine series completion rates from August 2006 through December 2012 in a large, population-based cohort of children and adolescents (aged 9.5 to 27years) residing in Olmsted County, MN on December 31, 2012 (n=36,223). We compared age at vaccine initiation between individuals who successfully completed both 2 and 3 doses of the vaccination series on-time (before age 13.5 or 15.0years) using multivariate logistic regression. On-time completion of both 2 and 3 doses of the vaccine series by age 13.5 or 15.0years was significantly associated with initiation at 9 to 10years as compared to 11 to 12years after adjusting for sex, race, insurance status, frequent health care visits, and year of first vaccination (all p<.01). Interventions focused on beginning the vaccination series at 9 to 10years of age may result in higher rates of timely series completion.

Immunization Innovations: Improving Post-Transplant Vaccination Rates

The recent increased incidence of preventable communicable diseases has compromised “herd immunity”1 and places immunocompromised patients at increased risk of infection and mortality. The Centers for Disease Control reported over 600 cases of measles and 32,000 cases of pertussis in the United States in 20142, making post-transplant vaccination more important than ever before. We investigated barriers to timely vaccine adherence, and discovered that patient migration out of the transplant center area and an inability to return for follow up with the transplant physician, led to post-transplant care provided by oncologists that are less familiar with post-transplant guidelines. Additionally, complex order entry and scheduling processes for the multiple vaccine series were identified as another obstacle. Quality improvement initiatives were created to increase post-transplant vaccination adherence. A computerized order-entry PowerPlan was developed in Cerner® electronic medical record that was inclusive of all necessary components of re-vaccination orders. This simplification ensured that all doses are ordered for the complete series of re-immunization of patients that are vaccinated at the transplant center. Second, a printed record of re-immunization was designed based on CIBMTR3 vaccine recommendations. This served as a uniform communication of guidelines and a record of doses for patients and their non-transplant providers. Patients who underwent SCT between May 2013 and September 2015 were reviewed retrospectively (N=31). Eleven patients had post-transplant follow up prior to implementation of the implementation of the power plan and vaccine card, and 20 patients were vaccinated after the initiative. Prior to the initiative, 45% of the patients were >30 days late with starting their post-transplant vaccines. Following implementation, the on-time vaccine administration adherence increased by 67%, with only 15% of patients remaining >30 days late receiving the first dose. The rate of overall completion of vaccine series was 91% after the initiative. No patients acquired a vaccine-preventable illness during the study period. These data suggest that the interventions outlined are effective at improving timely post-transplant re-immunization rates. Larger studies with longer follow up are warranted to fully assess the clinical impact on the rate of developing communicable infections and mortality.Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)