Series Completion Rates Research Articles

Addressing Adolescent Immunization Disparities: A Retrospective Analysis of School-Based Health Center Immunization Delivery

We compared completion rates for adolescent immunization series administered at school-based health centers (SBHCs) to completion rates for series administered at community health centers (CHCs) within a single integrated delivery system. We performed a retrospective analysis of data from an immunization registry for patients aged 12-18 years. Patients were assigned to either an SBHC or a CHC during the study interval based on utilization. We used bivariate analysis to compare immunization series completion rates between the 2 groups and multivariate analysis to compare risk factors for underimmunization. We performed subanalyses by ages 12-15 years versus ages 16-18 years for human papillomavirus (HPV) and for the combination of HPV; tetanus, diptheria, and pertussis (Tdap); and tetravalent meningococcus virus. SBHC users had significantly higher completion rates (P<.001) for hepatitis B, Tdap, inactivated poliovirus, varicella, measles/mumps/rubella, and HPV for ages 16-18 years, and for the combination of HPV, Tdap, and MCV4 for ages 16-18 years. CHC users had higher completion rates for tetanus and diphtheria. SBHCs had higher completion rates than did CHCs for immunization series among those aged 12-18 years, despite serving a population with limited insurance coverage.

Hepatitis B Vaccination of Men Who Have Sex With Men Attending an Urban STD Clinic: Impact of an Ongoing Vaccination Program, 1998–2003

To evaluate the impact of an ongoing hepatitis B vaccination service offered in an urban sexually transmitted disease (STD) clinic. During the period 1998-2003, hepatitis B vaccine acceptance, series completion, and vaccine coverage rates were evaluated among men who have sex with men (MSM) and other clients attending the main STD clinic in San Diego County, California. Among 21,631 STD clinic attendees, 81% were eligible to start and 69% accepted hepatitis B vaccination. Among a cohort of MSM starting vaccination in 1998, 76% and 55% received 2 doses and 3 doses, respectively, after 1 year follow-up and coverage then increased 1-2 percentage points annually to a final 2-dose and 3-dose coverage of 80% and 62%, respectively. Vaccine coverage (>=1 prior vaccine dose) among STD clinic attendees in 2003 was 45% compared to only 11% in 1998, the first year of the program. Hepatitis B vaccination can be integrated into STD clinic services with reasonable levels of vaccine acceptance and series completion. The increase in vaccination coverage over time indicates that a sustained hepatitis B immunization program can achieve acceptable vaccine coverage in high-risk populations.

Viral Hepatitis Vaccination in an Opioid Treatment Program: Hartford, Connecticut, 2002–2005

Hartford Dispensary, a private, not-for-profit behavioral health care organization specializing in opioid treatment program services, serves more than 4,200 clients per day in seven licensed facilities. In May 2002, the Dispensary began offering free combined hepatitis A and B vaccine for all eligible clients in two Hartford clinics. Initial eligibility criteria required a client to be hepatitis C antibody positive, hepatitis B virus (HBV) surface antigen (HBsAg) negative, not pregnant, and not have a contraindication due to a medical condition. From May 2002 through April 2005, 5,419 doses of combined vaccine were given. Of the 2,072 clients who received a first dose, 92% (1,914) received the second dose and 69% (1,433) completed the series. Long treatment duration, frequent client visits, availability of medical staff, and counseling support contributed to high rates of combined vaccine series completion in the two programs. Opioid treatment programs appear to be good settings in which to provide hepatitis vaccination for high-risk adults.

Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months.

We examined the effects of maternal and provider characteristics on the up-to-date immunization status of children. We used data from the 2003 National Immunization Survey to determine variations in children's up-to-date status in the 4:3:1:3 immunization series. Low maternal educational levels and low socioeconomic status were associated with high 4:3:1:3 series completion rates. Also, completion rates were high in Hispanic and non-Hispanic Black families with low income-to-poverty ratios. We found that children of less educated mothers and children in Hispanic and non-Hispanic Black families with low income-to-poverty ratios were more likely to have completed the 4:3:1:3 series. Although the reasons for these results need further exploration in other data sets, possible factors are Hispanics' positive cultural attitudes regarding the needs and importance of young children and provision of information on immunizations to low-income minority mothers who access government-subsidized health care programs.

N-Terminal pro-Brain Natriuretic Peptide on admission has prognostic value across the whole spectrum of Acute Coronary Syndromes

Human papillomavirus (HPV) vaccine has been recommended for male patients for the prevention of genital warts and precancerous anal lesions since 2009. Our objective was to characterize race and insurance-based disparities in HPV vaccine completion among male patients who initiated the HPV vaccine series.This was a retrospective cohort study of adolescent male patients in a primary care network who initiated the HPV vaccine series from October 2009 to December 2013. We measured vaccine series completion as the primary outcome. We evaluated associations between outcomes and race and insurance status, controlling for potential confounders and effect modification with multivariable logistic regression. Analyses were stratified by vaccine recommendation era (permissive vs routine).In total, 42% of males in the cohort (16,691) completed the vaccine series. In the permissive vaccine era (2009–2011), non-black patients (53%) were more likely to complete than black patients (32%) and non-Medicaid patients (49%) were more likely to complete than Medicaid patients (33%). These differences persisted in the routine recommendation era (2012–2013). In both the permissive and routine eras, Medicaid insurance was associated with a larger reduction in the predicted probability of vaccine series completion for non-black patients. Adherence to the recommended vaccination schedule was low, with a median time to completion of 8.9 months. Using the updated completion schedule (2016), we found that completion rates were greater (54.1%) with continued differences based on race (60% vs 45.7% for non-black vs black patients) and insurance (57.4% vs 46.4% completion for non-Medicaid vs Medicaid patients).We found significant disparities in HPV vaccine series completion rates among male patients based on race and insurance, unchanged based on era of initiation or visit frequency.

A statewide hepatitis B vaccination program for school children in Hawaii: vaccination series completion and participation rates over consecutive school years

b SYNOPSIS Objectives. The authors assessed a statewide school-based Hepatitis B (HepB) vaccination program for preadolescents in Hawaii over three consecutive school years. Factors assessed included number of schools and students participating and number of students receiving three doses of hepatitis B vaccine. Methods. Records of the program, which targeted 4th and/or 5th graders in public and private schools, were reviewed for the period from 1996 to 1999. Results. The proportion of participating schools increased from 76% of all schools in the state in School Year 1 to 94% in School Year 3. The proportion of children with completed consent forms who received three doses of HepB vaccine at school exceeded 80% throughout the project. In School Year 1, 10,003 (70%) of 14,333 children enrolled at participating schools received three vaccine doses in school; however, this proportion declined over subsequent school years to 51% (7,722/15,013) in School Year 2 and 24% (7,344/30,429) in School Year 3. A survey of 477 parents not consenting to school vaccination indicated that 84% of their children completed the vaccine series at a private provider office. Conclusions. Statewide school-based HepB vaccination campaigns for at-risk populations can result in a majority of children in targeted age groups receiv- ing three doses of hepatitis B vaccine, though declining participation may be observed as uptake in the private sector increases.

Assessment of a Universal, School-Based Hepatitis B Vaccination Program

To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992. Cohort study. British Columbia, Canada. All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively. The vaccine used was Engerix-B, 20 micrograms, given at intervals of 0, 1, and 6 months. Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples. A total of 127,922 vaccine doses were administered. Initial enrollment totaled 43,358 students or 95.4% of those eligible. The series was completed by 41,594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (> or = 10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L). Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.