Recommended Vaccination Schedule Research Articles

Varicella infection in the Middle East: Prevalence, complications, and vaccination.

Varicella (chickenpox) is the primary infection of varicella-zoster virus (VZV), it is a mild self-limiting infection, but it is also highly contagious and can cause severe complications among high-risk group of individuals. It is usually a childhood infection providing lifelong immunity, but adults without varicella history are also susceptible to infection. High-risk group of individuals is more likely to develop serious complications. Varicella vaccine was introduced to protect this group of individuals and to prevent epidemic spread of VZV infection in a community. Thus, it was added to the recommended vaccination schedules for children in most developed countries. This review aimed to outline varicella status, seroprevalence, complications, and vaccination in the Middle East region. Based on our findings, children were the most affected age group, but there are also adult cases due to high number of expatriates, especially in Gulf Cooperation Council countries. Central nervous system involvements and skin diseases followed by varicella pneumonia were the most varicella-associated complications. Varicella vaccine was introduced in most Middle East countries, either mandatory by the Ministries of Health or optional in the private clinics. Few numbers of studies have reported an obvious reduction in varicella prevalence, hospitalizations, and deaths in the Middle East following varicella vaccination. A basic database about varicella infection before the initiation and implementation of a vaccination policy is essential to determine the target group of individuals. As far as our knowledge, this is the first review about varicella infection in the Middle East.

Abortions in an organized dairy farm from North India reveal the possibility of breed susceptibility to Bovine Brucellosis

The present study was undertaken over a three year period (2012–2014) in an organized dairy farm located in North India to ascertain Brucella abortus as the putative cause of abortion. The dairy farm maintained cattle of Frieswal, Crossbred and Sahiwal breeds and followed calf-hood vaccination with Brucella abortus Strain 19 live vaccine in all the heifers. Even with the recommended vaccination schedule and good managemental practices in place, 88 cases of abortions clinically suspected of bovine brucellosis (40 from Frieswal breed, 17 from Crossbred cattle and 31 from Sahiwal breed) were reported from this farm. From these abortion cases, bacteriological isolation was possible in only four dams while 16 dams were found to be serologically positive in Serum Tube Agglutination Test (STAT). Molecular screening by PCR assay (specific for the bcsp31 gene of B. abortus) revealed that 24 dams were positive, out of which 20 were from Frieswal breed and rest four were from Crossbred herd. Prominently, all Sahiwal dams were found to be negative in bacteriological isolation and also in PCR assay. These results thus indicate towards the possibility of breed predisposition to abortions due to B. abortus infection. Statistical analysis by Fischer exact test (p<0.01) too substantiated that breed susceptibility exists among these PCR positive cases. This study is novel as breed variation in abortions due to B. abortus in cattle is being documented for the first time. Seven representative PCR amplicons generated during the study were also sequenced and submitted to NCBI GenBank. Moreover, this study also accentuates the importance of PCR screening especially in vaccinated herd and raises concerns on over-dependence of serological assays when intensive vaccination is practised without any concomitant DIVA strategy. Thus, besides assisting in planning pragmatic control strategies against bovine brucellosis these findings are also imperative from ‘One Health’ context, also.

A comparative cost analysis of the Vaccination Program for US-bound Refugees

BackgroundVaccination Program for US-bound Refugees (VPR) currently provides one or two doses of some age-specific Advisory Committee on Immunization Practices (ACIP)-recommended vaccines to US-bound refugees prior to departure. MethodsWe quantified and compared the full vaccination costs for refugees using two scenarios: (1) the baseline of no VPR and (2) the current situation with VPR. Under the first scenario, refugees would be fully vaccinated after arrival in the United States. For the second scenario, refugees would receive one or two doses of selected vaccines before departure and complete the recommended vaccination schedule after arrival in the United States. We evaluated costs for the full vaccination schedule and for the subset of vaccines provided by VPR by four age-stratified groups; all costs were reported in 2015 US dollars. We performed one-way and probabilistic sensitivity analyses and break-even analyses to evaluate the robustness of results. ResultsVaccination costs with the VPR scenario were lower than costs of the scenario without the VPR for refugees in all examined age groups. Net cost savings per person associated with the VPR were ranged from $225.93 with estimated Refugee Medical Assistance (RMA) or Medicaid payments for domestic costs to $498.42 with estimated private sector payments. Limiting the analyses to only the vaccines included in VPR, the average costs per person were 56% less for the VPR scenario with RMA/Medicaid payments. Net cost savings with the VPR scenario were sensitive to inputs for vaccination costs, domestic vaccine coverage rates, and revaccination rates, but the VPR scenario was cost savings across a range of plausible parameter estimates. ConclusionsVPR is a cost-saving program that would also reduce the risk of refugees arriving while infected with a vaccine preventable disease.

Illness Representations of Pertussis and Predictors of Child Vaccination Among Mothers in a Strict Vaccination Exemption State.

Background Vaccine preventable diseases are making a comeback in the US. However, research is lacking on illness representations of vaccine preventable diseases and their application in improving childhood immunization. Objective We utilized the common sense model of self-regulation to examine illness representations of pertussis and their associations with child's receipt of any vaccine, up-to-date vaccination status, and mothers' intentions to follow the recommended vaccination schedule in the future. Methods We developed vaccine worry and vaccine hassles scales to assess mothers' worries and hassles for child vaccination, and used an open ended question to assess mother's illness representations of pertussis. We surveyed mothers with children <3 years old (N = 160) in the Appalachian state of West Virginia, which only allows medical vaccine exemptions. Results Some children (5.0%) had received no vaccination, 15.0% were not up-to-date with the recommended vaccination schedule, and 13.8% mothers reported no intention to follow the recommended schedule in future (future intention). Illness representations included identity (17.8%), timeline (61.8%), consequences (58.6%), cause (35.0%), and cure/control (56.7%). Higher vaccine worry was associated with child receiving no vaccine. Not using daycare, higher vaccine worry, and difficulty breathing (identity) were associated with child not being up-to-date. Higher vaccine worry, cough (identity), and belief that vaccines are ineffective (cure/control) were associated with no future intention. Conclusions Vaccination interventions need to address mothers' worry regarding vaccine safety. 'Common Sense' beliefs regarding vaccines need to be reconciled with scientific data about vaccine safety and effectiveness, even among those with high socio-economic status in a strict vaccination state.

Evaluation of optic neuritis following human papillomavirus vaccination

ABSTRACTTo assess the relationship between human papillomavirus (HPV) vaccination and occurrence of optic neuritis (ON) and to evaluate a claims-based algorithm for identification of ON. Females of 9–26 year olds in the HealthCore's Integrated Research Database (HIRDSM) with and without claims evidence of HPV vaccination between 2007 and 2012 were included in this study. Potential ON cases were identified using the claims-based algorithm, positive predictive value (PPV) was determined using medical chart review. For the claims analysis, two study designs, a self-controlled temporal scan statistic and a retrospective matched cohort analysis, were used. ON was defined based on an algorithm developed using diagnosis and procedure codes from the medical claims. The PPV for ON cases using charts that had enough information for reviewers to make a determination was 62.5% (95% CI: 49.5%–74.3%). With the self-controlled temporal scan statistic, the primary analysis restricting on recommended vaccination schedule timing showed an increased risk of potential ON after second dose (RR = 3.39; p = 0.03), this finding was not confirmed for any of the additional analyses performed for individual or combined doses. With the cohort design, there was no increased risk of potential ON following vaccination in either individual or combined dose analyses. The risk of potential ON was higher among participants with a history of prior autoimmune diseases. In conclusion, identifying confirmed ON cases through administrative claims data proved challenging. The claims-based analysis in this study did not provide evidence for an association of ON with HPV vaccination.

We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP).

The eradication of smallpox and the elimination of several other infectious diseases from much of the world has provided convincing evidence that vaccines are among the most effective interventions for promoting health. The current scepticism about immunisation among members of the new US administration carries a risk of decreasing immunisation rates also in Europe. While only a small minority of the population are strongly anti-vaccine, their public activities have significantly influenced an uncertainty among the general population about both the safety of and the necessity for vaccination. Therefore, the EAP calls for greater publically available, scientifically supported information on vaccination, particularly targeted at health care providers, for the further development of electronically based immunisation information systems (IIS). We further call on all European countries to work together both in legislative and public health arenas in order to increase vaccination coverage among the paediatric population. In the interest of children and their parents, the EAP expresses its strong support for childhood immunisation and recommended vaccination schedules. We are prepared to work with governments and media and share the extensive evidence demonstrating the effectiveness and safety of vaccines.

Determination of factors affecting the vaccination status of children aged 12-35 months in Lao People's Democratic Republic.

Vaccines are one of the most important achievements in public health, and a major contributor to this success is the Expanded Programme on Immunization. The utilisation of vaccination services and completion of the recommended schedule are determined by numerous factors. In Lao People’s Democratic Republic (Lao PDR), the overall immunisation coverage has been improving. However, notwithstanding the improvement in immunisation coverage and the supplementary immunisation activities, there have been measles, diphtheria, and polio outbreaks in the country. The recent multicounty study of household health surveys revealed that the within-country economic-related inequality in the delivery of a vaccine was still high in Lao PDR.Our previous work evaluated the factors associated with vaccination status among the children aged 5–9 years old, which was older age group for this type of study. This study evaluated factors that affect vaccination status among children aged between 12 and 35 months. It is a nationwide population-based cross-sectional study that used data obtained through multistage cluster sampling. We found that the proportion of infants who were fully immunised was lower than the national target and that “maternal ethnicity” (odds ratio (OR) 0.34, 95% confidence interval [CI]: 0.20–0.60), “paternal education” (OR 1.87, 95% CI: 1.12–3.10), and “source of information about vaccination date by medical staff” (OR 1.65, 95% CI: 1.01–2.71) were significantly associated with the children’s vaccination status. Numerous factors are associated with the completion of the recommended vaccine schedule, and some factors are location-specific. Identification of these factors should lead to actions for facilitating the optimal use of vaccination services by all the children in Lao PDR.

Efficacy of vaccination for bluetongue virus serotype 8 performed shortly before challenge and implications for animal trade

Vaccination is the most effective strategy for controlling Bluetongue virus (BTV) spread and economic consequences thereof. In this study we verified in sheep, using one commercially available inactivated vaccine for BTV-8 (BTVPUR AlSap 8), when, during the recommended vaccination schedule, animals start to be effectively protected against challenge with wild-type strain. To this aim, sheep were challenged at different time points shortly after the first vaccine injection. Twenty-four Sarda sheep were divided into four groups vaccinated two weeks before challenge (Group A), one week before challenge (Group B) and concurrently with challenge (Group C). A second vaccine was performed twenty-eight days later with respect the first vaccine administration in each experimental group. The last group consisted of six non vaccinated-infected animals (NVIA). Virological and serological examinations were performed before and after challenge up to 42 and 77days post challenge, respectively. The results of the study show that vaccination commenced as little as two weeks before challenge (Group A) prevented viremia and RNAemia in challenged sheep altogether. Conversely, Group B was partially protected from challenge and Group C showed viraemia and RNAemia similar to NVIA. This study indicates that the first administration of inactivated vaccine performed two weeks before challenge was able to prevent viraemia. Overall, our findings may have direct consequences for the management of an unexpected BTV-8 outbreak in sheep and for the legislation on sheep trade from BTV restriction areas.

Pneumococcal Vaccines in Preterm Infants: Are More Doses Better? Implications for Other Vaccines.

* Abbreviations: IPD — : invasive pneumococcal disease PCV — : pneumococcal conjugate vaccine Pneumococcal conjugate vaccines (PCVs) have significantly decreased invasive pneumococcal disease (IPD) in whole populations, and they are among the many ongoing stories of vaccine successes around the world. However, IPDs remain far too common, especially in certain populations. When it comes to the timing of PCV administration, most physicians follow their nationally recommended vaccine schedules, which have been well studied in specific and well-defined populations. In the United States the recommended immunization schedule for children is the one approved by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and endorsed by the major professional societies including the American Academy of Pediatrics.1 The timing of vaccine doses in the schedule recommended by the Centers for Disease Control and Prevention is based on a thorough evaluation of available science, age-dependent variation in the immune system, vaccine interactions, and practical considerations related to vaccine delivery, but we have more to learn to truly optimize vaccine delivery.2 It turns out for PCV that the levels of … Address correspondence to Mark H. Sawyer, MD, FAAP, 3020 Children’s Way, #5124, San Diego, CA 92123. E-mail: mhsawyer{at}ucsd.edu

Car Seat Safety: Typologies of Protective Health and Safety Behaviors for Mothers in West Virginia.

Objective Parenting practices differ for a variety of reasons, and three parenting behaviors may be directly influenced by research, policy, and overall parenting trends: car safety seats, vaccination, and breastfeeding. Mothers were categorized in terms of their rear-facing car safety seat utilization and its relationship to other parental health and safety behaviors. Methods A cross-sectional, online survey of mothers of children under 3years of age (n=124) was conducted. Items assessed mother's perceived risk and worry about being in an automobile accident, as well as duration of rear-facing car seat utilization. A cluster analysis based on these variables was performed to differentiate the sample into four distinct groups. Outcomes were knowledge of car safety seats, breastfeeding duration, and adherence to vaccination schedules. Results The sample was predominantly White, had an average age of 32years, had breastfed, and had at least some college education. Two groups of interest had (Group 1) long duration of rear-facing use with low perceived risk and worry and (Group 2) short use with high perceived risk and worry. Fisher's Exact test indicated Group 1 had higher knowledge of airbag use with car seats (p=0.035), lower intentions to use the recommended vaccinations schedule (p=0.005), and were more likely to breastfeed (p=0.044) for longer duration (p=0.012). Conclusion Propensity for mothers' risk aversion may be the crucial element in both an appropriate duration of rear-facing car safety seat use and refusal of recommended vaccination schedule.

Vaccinations, response, and controls before and after intestinal transplantation in children.

Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine-preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP-IPV and HBV. After transplantation, the negative antibodies against vaccine-preventable diseases were mostly related to an antirejection therapy: for DTaP-IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post-transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine-preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.

CBPP: Pastoralist Perception Survey on the Problems Associated with T1/44 Vaccine Administration in Abuja, Nigeria

Contagious bovine pleuropneumonia (CBPP) is a disease of cattle that has been difficult to control in Nigeria. This study was done to assess the problem associated with the use of the OIE recommended vaccine against the disease in Nigeria. A total of 180 closed ended questionnaires were administered to pastoralists from the six area councils of Federal Capital Territory, to study the problem associated with T1/44 vaccine administration in Abuja, Nigeria. Data was managed using Microsoft excel and SPSS version 21. The study revealed that out of 172 respondents that were aware that a vaccine exists, 93.9% (95%CI: 90.4-97.4%) do vaccinate their cattle against Contagious Bovine Pleuropneumonia; out of which 46.7% (95%CI: 39.41-53.99%) do an annual vaccination, 4.1% (95%CI: 1.2-7%) vaccinate biennially and 49.1% (95CI: 41.8-56.4%) vaccinate animals once in 5 years. Among the 90 pastoralists that do either a biennial or once in 5 years vaccination, 74.4% (95%CI: 65.38-83.42%) do not follow the recommended vaccination schedule due to post vaccination reactions, which occurred 7- 14 days after vaccination. Majority of these affected respondents manage the reaction by branding with hot objects, while others made use of antibiotics and anti-inflammatory agent.

Serologic Profiles of Classical Swine Fever Vaccinated Backyard Pig Farms in Khon Kaen Province, Thailand

Small and marginal farmers with low livestock holdings do not strictly follow recommended vaccination schedules and procedures. The aim of this study was to follow antibody titers against Classical Swine Fever (CSF) virus before and after vaccination of cross-bred pigs from three farms in Khon Kaen. One dose of vaccine was given to the pigs at 41, 49, and 52 days age. It is a modified lived vaccine containing 102 PD50 (50% protective dose) of the CSF virus (government produced Lapinized Chinese-strain, Department of Livestock Disease, Thailand). Blood samples were collected at 0, 14, and 22 days post-vaccination (dpv). Neutralization test was performed in cell cultures using a constant-virus/varying-serum method. In Pigs born to sows that had been vaccinated once a year, geometric mean titers at 0 dpv of 41, 49, and 52 days old pigs were 2.05, 1.24, and 0.72, respectively. The lowest/highest maternal antibody titers were 1: 32/1: 512, 1: 8/1: 64, 1: 2/1: 16, the median titers were 1: 32, 1: 16, and 1: 8, in farms 1, 2, and 3, respectively. At 14 dpv, SN antibody titres of pigs in farm 1 decreased but that of farm 3 increased. Consequently, SN antibody titers of pigs in farms 2 and 3 increased after vaccination and had GMT of 1.82 and 1.09 (p<0.05) at 22 dpv, respectively. General vaccination guideline is not applicable to all farms. Higher SN titers at the day of first vaccination impeded antibody response (14 days old). However, the lowest titer (1: 8) and the oldest pigs (52 days old) did not have the best SN titer after CSF vaccination. There should be laboratory confirmations of CSF antibody titers before and after vaccination in order to assure successful outcome of vaccination practice.

Limited benefit of hepatitis B immunoglobulin prophylaxis in children of hepatitis B e antigen-negative mothers.

In 2006, Singapore adopted the universal hepatitis B immunoglobulin (HBIg) policy. Since then, all infants of hepatitis B surface antigen (HBsAg)-positive mothers receive HBIg, irrespective of maternal hepatitis B e antigen (HBeAg) status. However, the benefits of HBIg for infants of HBeAg-negative mothers are unclear. We compared the vertical transmission rates among children of HBeAg-negative mothers who were given HBIg versus a retrospective cohort who were not given HBIg, to determine its protective effect. This observational study involved pregnant HBsAg-positive women seen at National University Hospital, Singapore, between June 2009 and December 2013. If the infants of these mothers completed the recommended vaccination schedule, they were recruited into the study, along with their older siblings. Serological testing for the children was performed three months after completion of the last dose of vaccine, and hepatitis B virus (HBV) surface gene sequencing was carried out if HBV DNA was detected. A total of 111 infants and 47 siblings were recruited. 2 (1.5%) children were found to have vertical transmission despite receiving HBIg, while no incidences of vertical transmission were found among the historical controls who did not receive HBIg (p = 1.00). The overall effectiveness of the hepatitis B vaccination programme for children of HBsAg-positive mothers was high, regardless of HBIg administration. The addition of HBIg did not appear to confer additional benefits, in terms of vertical transmission rate, among infants born to HBeAg-negative mothers.

Childhood immunizations: First-time expectant mothers’ knowledge, beliefs, intentions, and behaviors

IntroductionThis study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. MethodsThis was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. ResultsData were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were “very satisfied” with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. ConclusionsOverall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions.

“Everybody just wants to do what's best for their child”: Understanding how pro-vaccine parents can support a culture of vaccine hesitancy

BackgroundAlthough a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents’ decisions about vaccine schedules. ObjectiveWe sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines. MethodsOpen-ended, in-depth interviews (N=23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making. ResultsParents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule. ConclusionThese findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.

Childhood Immunizations: First-Time Expectant Mothers' Knowledge, Beliefs, Intentions, and Behaviors.

This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions.

Physician response to parental requests to spread out the recommended vaccine schedule.

To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests. An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012. The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥ 10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective. Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

Hepatitis B immunoprophylaxis failure and the presence of hepatitis B surface gene mutants in the affected children.

Hepatitis B virus (HBV) infection is usually vertically transmitted from the mother to child during birth in Asian countries. Despite immunization, immunoprophylaxis failure is well-documented. The aim of the study was to study immunoprophylaxis failure rate in the cohort of infants delivered by chronic HBV-infected mothers and to determine risk factors for failure. This was an observational study involving chronic hepatitis B infected mothers seen at a tertiary care center in Singapore between June 2009 and December 2013. Infants born to these mothers were recruited after they had completed the recommended vaccination schedule. Serological testing for the children was performed 3 months after completion of the last dose of vaccine. HBV surface gene sequencing was carried out if HBV DNA was detectable in the children. Among the 161 mothers enrolled, most were HBeAg negative. HBeAg positive mothers were younger and had a significantly higher viral load (6.5 log) as compared to HBeAg negative mothers (1.35 log) (P < 0.001). Four children (2.6%) were found to have immunoprophylaxis failure. Two occurred in children delivered by mothers with extremely high viral load of more than 5 × 10(7) IU/ml. HBV surface gene mutations were detected in most children (3 out of 4) with immunoprophylaxis failure. The overall effectiveness of the hepatitis B vaccination program was high. High maternal viral load and presence of surface gene mutants may be potential contributors.

Perception of safety, importance, and effectiveness of vaccinations among urban school employees in Utah.

School employees are in direct contact with children in confined areas, a setting in which communicable infection can quickly spread. Therefore, it is important for school employees to be fully vaccinated. The purpose of this study is to ascertain the current vaccination status and perceptions of school employees in an urban school district. The study employed a nonexperimental mixed-method design. School employee participants (N = 1400) completed a questionnaire to evaluate vaccination status, availability of vaccination records, and vaccination awareness. Participants were randomly selected from 85 schools within one urban school district. Two common perceptions about vaccines emerged from the questionnaire: (a) vaccines are only for children and (b) vaccinations received during childhood are still effective. School employees are unaware of their own vaccination status and the recommended vaccination schedule for adults. Additionally, accessibility to immunization records for adults is frequently inadequate. Healthcare providers (HCPs), including nurse practitioners (NPs), are the first line of defense to ensure adults are adequately vaccinated. When vaccinations are tracked and recommended by HCPs, vaccination uptake is improved. NPs who discuss recommended vaccinations with adult patients are instrumental in improving vaccination rates among school employees.