Vaccine-preventable Illnesses Research Articles

P-616. Sociodemographic and Clinical Factors Affecting Vaccination after Pediatric Solid Organ Transplantation at Duke University

Abstract Background Pediatric solid organ transplant (SOT) recipients are at increased risk for vaccine preventable illnesses (VPI). They frequently receive vaccines after transplantation when immunosuppressive medications and cytopenias may impact their immune response to routine childhood vaccines. Current guidelines recommend monitoring vaccine-specific serologies to ensure optimal vaccine responses and to guide the need for repeat doses. Methods In this single-center retrospective cohort study, a multivariate logistic regression model was used to determine the sociodemographic and clinical factors associated with delays in starting post-transplant vaccines and adherence to post-vaccine serologic monitoring among 199 pediatric patients who received a SOT at Duke University between 2014-2023. The prevalence of cytopenias at the time of post-transplant vaccination was also described. Results Out of 150 children eligible for post-transplant vaccines (Table1), 48 (32%) failed to start catch-up vaccines within 2 years of transplantation. Older children (OR=0.877, 0.83-0.927) and children with private insurance (OR=0.458, 0.211-0.993) had significantly decreased odds of early catch-up vaccines (Table 2). Hepatitis B serologies were obtained in 23% of patients after post-transplant vaccination, but titers against the remaining non-live childhood vaccines were only obtained in 1-8% of children (Table 3). Approximately 53% of all children had neutropenia or lymphopenia (less than 1500 x 10^6 cells/L) at the time of post-transplant vaccination, with heart and intestinal/multi-visceral transplant recipients having the highest rates at ∼75% (Table 4). Conclusion These findings identify pediatric SOT recipients most at risk for delayed post-transplant vaccines. The associations between vaccine delay and private insurance and older age warrant further investigation. The extremely low rates of vaccine-specific serologic monitoring and the high prevalence of cytopenias at the time of vaccination raise concerns that pediatric SOT recipients are insufficiently protected from VPI. Future work will determine the impact of cytopenias on vaccine response and will address inequities in vaccination among pediatric SOT recipients. Disclosures All Authors: No reported disclosures

Motivational Interviewing to Address Vaccine Hesitancy in a Rural Population.

Background: Individuals experience vaccination hesitancy for many reasons. However, not receiving vaccinations leaves individuals at increased risk for vaccine-preventable illnesses. Individuals in rural areas are more likely to experience vaccine hesitancy. Objective: Motivational interviewing is an effective strategy for addressing behavior change, including vaccine hesitancy. This evidence-based practice project provided an education session for Michigan State University Extension Vaccine Team members, who deliver health care information statewide. Methods: An educational information session on motivational interviewing was delivered via Zoom. This session focused on employing motivational interviewing in rural populations to address vaccine hesitancy. A survey was administered to participants pre and postmotivational interviewing educational sessions to assess changes in knowledge and confidence in using motivational interviewing. Results: Participants' knowledge and confidence regarding motivational interviewing improved. They reported an increased understanding of the concept and confidence in deploying this technique to the rural population. Conclusions: This project highlights the process and need for delivering an educational motivational interviewing session to health care team members who regularly interact with the rural population regarding vaccine hesitancy. Implications for Nursing: Teaching individuals who regularly interact with the rural population the technique of motivational interviewing can help expand the reach of the discussions in health care settings.

Factors Associated With Appropriateness of Vaccination Age Coverage For Measles Vaccine In Kufa District, Najaf Governorate, Iraq

Measles is one of the diseases that can be effectively managed with vaccination. Herd immunity is a concept that describes the situation where a large proportion of a population is vaccinated, resulting in high coverage rates. Measles infections persist at high levels in specific areas despite the general vaccination rates. Administering the vaccination at the recommended age is crucial for attaining protection and reducing the transmission of vaccine-preventable illnesses . Cross –sectional study was conducted from 1st of OCT .2023 until 25th of JAN. 2024 among mothers with their child aged 12-23 month. The purpose of this study was to assess age-appropriate measles vaccination coverage and associated factors. Collected data using pre-tested questionnaires also data on measles vaccination were taken from vaccination card.This study analyzed 388 mothers, revealing that the majority of father age were between 20-34y, with 41.2% having primary education. Mother age found to be 258(66.5%) between 20-34y .225(57.9%) of father occupation were free job and 334(86.1%) were house wife by occupation, the sex of child 201(51.8%) were found to be female .68.61% were vaccinated with measles vaccine on time, (29.38%) were delayed and (1.80%) were found to be unvaccinated. The education level, number of children in the family and child order are significantly associated with measles vaccination status of child. As we revealed that the proportion of individuals receiving the vaccine within the designated timeframe is below 70%. We should focus on enhancing on time of routine children immunization. This can be achieved by reinforcing existing techniques, developing new approaches, and emphasizing the media's role in promoting the significance of timely vaccine administration.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study.

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

Banana Lectin: A Novel Immunomodulatory Strategy for Mitigating Inflammatory Bowel Disease.

Compared to the general population, patients with inflammatory bowel disease (IBD) are less likely to be vaccinated, putting them at an increased risk of vaccine-preventable illnesses. This risk is further compounded by the immunosuppressive therapies commonly used in IBD management. Therefore, developing new treatments for IBD that maintain immune function is crucial, as successful management can lead to better vaccination outcomes and overall health for these patients. Here, we investigate the potential of recombinant banana lectin (rBanLec) as a supporting therapeutic measure to improve IBD control and possibly increase vaccination rates among IBD patients. By examining the therapeutic efficacy of rBanLec in a murine model of experimental colitis, we aim to lay the foundation for its application in improving vaccination outcomes. After inducing experimental colitis in C57BL/6 and BALB/c mice with 2,4,6-trinitrobenzene sulfonic acid, we treated animals orally with varying doses of rBanLec 0.1-10 µg/mL (0.01-1 µg/dose) during the course of the disease. We assessed the severity of colitis and rBanLec's modulation of the immune response compared to control groups. rBanLec administration resulted in an inverse dose-response reduction in colitis severity (less pronounced weight loss, less shortening of the colon) and an improved recovery profile, highlighting its therapeutic potential. Notably, rBanLec-treated mice exhibited significant modulation of the immune response, favoring anti-inflammatory pathways (primarily reduction in a local [TNFα]/[IL-10]) crucial for effective vaccination. Our findings suggest that rBanLec could mitigate the adverse effects of immunosuppressive therapy on vaccine responsiveness in IBD patients. By improving the underlying immune response, rBanLec may increase the efficacy of vaccinations, offering a dual benefit of disease management and prevention of vaccine-preventable illnesses. Further studies are required to translate these findings into clinical practice.

Assessment of Maternal Knowledge, Attitudes, and Practices towards Childhood Immunisation: A Cross-sectional Study at Hoima Regional Referral Hospital

Public health continues to place a high priority on childhood vaccination, but successful immunisation programmes depend on an understanding of mothers' knowledge, attitudes, and behaviors (KAB) towards vaccination. The purpose of this study was to evaluate the mothers' knowledge of kid immunisation at Hoima Regional Referral Hospital (KAB). A cross-sectional survey was carried out on a sample of women who visited the pediatric clinics of the hospital. Employing structured questionnaires, data were gathered and then subjected to both descriptive and inferential analysis. The findings showed that people's understanding varied, and certain misconceptions were noted. Although worries regarding the effectiveness and safety of vaccinations remained, attitudes towards them were largely positive. High vaccination rates were found in practice; however, accessibility and awareness issues were also recognised as impediments. The aforementioned results highlight the significance of customised educational initiatives and enhanced accessibility in achieving maximum vaccination rates and successfully addressing vaccine-preventable illnesses. Keywords: Assessment, Knowledge, Attitude, Practice, Childhood Vaccination.

Viruses associated with measles-like illnesses in Uganda

In this study, we investigated the causes of measles-like illnesses (MLI) in the Uganda national surveillance program in order to inform diagnostic assay selection and vaccination strategies. We used metagenomic next-generation sequencing (M-NGS) on the Illumina platform to identify viruses associated with MLI (defined as fever and rash in the presence of either cough, coryza or conjunctivitis) in patient samples that had tested IgM negative for measles between 2010 and 2019. Viral genomes were identified in 87/271 (32%) of samples, of which 44/271 (16%) contained 12 known viral pathogens. Expected viruses included rubella, human parvovirus B19, Epstein Barr virus, human herpesvirus 6B, human cytomegalovirus, varicella zoster virus and measles virus (detected within the seronegative window-period of infection) and the blood-borne hepatitis B virus. We also detected Saffold virus, human parvovirus type 4, the human adenovirus C2 and vaccine-associated poliovirus type 1. The study highlights the presence of undiagnosed viruses causing MLI in Uganda, including vaccine-preventable illnesses. NGS can be used to monitor common viral infections at a population level, especially in regions where such infections are prevalent, including low and middle income countries to guide vaccination policy and optimize diagnostic assays.

Immunisation deferral practices surrounding congenital heart surgery.

Perioperative immunisation administration surrounding congenital heart surgery is controversial. Delayed immunisation administration results in children being at risk of vaccine-preventable illnesses and is associated with failure to complete immunisation schedules. Among children with CHD, many of whom are medically fragile, vaccine-preventable illnesses can be devastating. Limited research shows perioperative immunisation may be safe and effective. We surveyed Pediatric Acute Care Cardiology Collaborative member centres and explored perioperative immunisation practices. We analysed responses using descriptive statistics. Complete responses were submitted by 35/46 (76%) centres. Immunisations were deferred for any period prior to surgery by 23 (66%) centres and after surgery by 31 (89%) centres. Among those who deferred post-operative immunisation, 20 (65%) required deferral only for patients whose operations required cardiopulmonary bypass. Duration of deferral in the pre- and post-operative periods was variable. Many centres included exceptions to their policy for specific vaccine-preventable illnesses. Almost all (34, 97%) centres administer routine childhood immunisation to patients who remain admitted for prolonged periods. Most centres defer routine childhood immunisation for some period before and after congenital heart surgery. Centre specific practices vary. Immunisation deferral confers risk to patients and may not be warranted in this population. Further research would be necessary to understand the immunologic impact of these practices.

The status of immunization program and challenges in Ethiopia: A mixed method study.

Immunization helps reduce morbidity and mortality attributable to severe vaccine-preventable childhood illnesses. However, vaccination coverage and the quality of immunization data remain challenging in Ethiopia. This has led to poor planning, suboptimal vaccination coverage, and the resurgence of vaccine-preventable disease outbreaks in under-immunized pocket areas. The problem is further compounded by the occurrence of the COVID-19 pandemic and the disruption of the health information system due to recurrent conflict. This study assessed the current status of the immunization service and its challenges in Ethiopia. A mixed-methods study was conducted in three regions of Ethiopia from 21 to 31 May, 2023. A survey of administrative reports was done in a total of 69 health facilities in 14 woredas (districts). Nine KIIs were conducted at a district level among immunization coordinators selected from three regions to explore the challenges of the immunization program. Linear regression and descriptive statistics were used to analyze the quantitative data. Thematic analysis was applied to analyze the qualitative data. The findings from the qualitative data were triangulated to supplement the quantitative results. Two-thirds (66.4%) of the children were fully vaccinated, having received all vaccines, including the first dose of the MCV1, by 12 months of age, as reported through administrative reports collected from health facility records. Catchment area population size and region were significantly associated with the number of fully immunized children (p < 0.001 and p = 0.005, respectively). The vaccination dropout rates of the first to third dose of pentavalent vaccine and the first dose of pentavalent vaccine to the first dose of MCV1 were 8.6% and 7.4%, respectively. A considerable proportion of health facilities lack accurate data to calculate vaccination coverage, while most of them lack accurate data for dropout rates. Longer waiting time, interruptions in vaccine supply or shortage, inaccessibility of health facilities, internal conflict and displacement, power interruption and refrigerator breakdown, poor counseling practice, and caretakers' lack of awareness, fear of side effects, and forgetfulness were the reasons for the dropout rate and low coverage. The result also showed that internal conflict and displacement have significantly affected immunization coverage, with the worst effects seen on the most marginalized populations. The study revealed low vaccination coverage, a high dropout rate, and poor quality of immunization data. Access and vaccination coverage among marginalized community groups (e.g., orphans and street children) were also low. Hence, interventions to address organizational, behavioral, technical, and contextual (conflict and the resulting internal displacement) bottlenecks affecting the immunization program should be addressed.

Muslim Communities’ Healthcare Needs and Barriers

Despite being nearly a quarter of the population, Muslim communities’ unique healthcare needs are largely unmet. In this literature review, we highlight the largely unsatisfied and growing healthcare needs of Muslims by examining the unique illnesses that Muslims are commonly susceptible to because of their religious or socioeconomic conditions. We examine their vulnerability to diabetes, vitamin D deficiency, and vaccine-preventable illnesses. We also analyze the numerous healthcare barriers present in developing, Muslim-majority countries and in developed countries in the West. Drawing from published studies, we emphasize the importance of government investment in healthcare and cultural awareness in health workers to address barriers and ensure Muslims’ equitable access to care. We explore the complexities of healthcare access and delivery for Muslims, particularly in contexts where religious practices intersect with medical requirements. We also highlight gaps in current research, urging further investigation into unexplored areas such as broad, global studies and the involvement of religious leaders in Muslim communities.

National vaccination program compliance in northern Lisbon's primary healthcare: 2022 assessment

Abstract Background The National Vaccination Program (NVP) aims to protect all citizens and residents of Portugal from communicable diseases, safeguarding public health. It is coordinated by the Directorate-General of Health and locally implemented by the primary healthcare centers. Currently, a 95% vaccination coverage is set for all vaccines, except for human papillomavirus (HPV) which is 85%. Methods Assess the accomplishment of NVP in 2022, based on the national vaccination platform, for the 15 primary healthcare units of Northern Lisbon. The evaluation included the proportion of users who I) completed vaccination schedule at the recommended age (recommended NVP), and II) completed vaccination schedule, regardless administration date (fulfilled NVP), according to birth cohort. Results The 2021 and 2022 cohorts achieved a 95% vaccination coverage target for the 4 evaluated vaccines; the 2020 cohort only achieved for 3/5 vaccines evaluated, due to a lower vaccination against tetanus (93.42%) and Neisseria meningitidis B (94.58%). Both 2015 and 2016 cohorts missed the vaccination target for tetanus (89.75% and 88.89%, respectively) and measles (92.84% and 91.12%, respectively). The vaccination target for HPV was not achieved in any of the evaluated cohorts, highlighting the low coverage in males (46.26%) and females (52.34%) from 2012. Concerning tetanus, an increasing trend coverage was found along the cohorts from 1956 (54.47%) to 2016 (91.23%). Conclusions Globally, the NVP targets were achieved in several cohorts. However, immunization against HPV and among older cohorts fell short of expectations. Several factors contribute to explain this low coverage, such as vaccine stock-out (for HPV and N. meningitidis B); residing abroad; private health care follow up without proper vaccine registration; vaccine hesitancy. On the other hand, the positive variation in immunization coverage for most of the assessed vaccines reflects some strategies used to increase adherence. Key messages • The accomplishment of vaccination schedules is key to safeguard individuals and communities from vaccine-preventable illnesses. • The continuous assessment of vaccination targets and trend monitoring is critical to implement strategies to increase vaccine coverage and safeguard public health.

Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis.

Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.

Parents' Decision-making Experience in Choosing the MMR Vaccine in Banten, Indonesia

Research has extensively studied parental vaccination decision-making drivers and barriers. The most powerful predictors of vaccination actions include the understanding of the risks posed by the disease; and the side effects of vaccination; vaccine beliefs and attitudes; and their effectiveness and safety concerns. Thus, this study aimed to explore the parents decision-making experience in choosing MMR vaccine in Banten, Indonesia. In qualitative study, a purposeful sampling process was used to identify parents with a variety of expected MMR decisions: (1) accept MMR on time, (2) accept MMR late, (3) receive one or more individuals, (4) obtain no MMR or individuals. A qualitative quality analysis was used to interpret the transcribed text. A total of 25 participants from 5 different FGDs were included in this study. This qualitative interview resulted in 4 themes, namely: healthy life, own health perceptions, disease history, perceived severity, and susceptibility of vaccine-preventable illnesses. Research on the MMR vaccination should move a step forward and include studies looking at similarities and differences in the factors predicting parents’ intention to follow MMR vaccination recommendations by comparing parents of very young children, being the primary target group of MMR vaccination campaigns and interventions, with parents of adolescent children.&#x0D; Keywords: decision process, MMR vaccine, qualitative study

Quality Improvement Initiative to Improve Time and Adherence to Revaccination after Hematopoietic Cell Transplantation: Implementation of a Revaccination Clinic within the Transplantation Program

Revaccination after hematopoietic cell transplantation (HCT) is critical to prevent morbidity and mortality from vaccine preventable illnesses. The global aim of our quality improvement initiative was to enhance timely, correct, and effective revaccination after pediatric HCT. The SMART aim of our project was to decrease median unvaccinated time by four months, by decreasing time to vaccine eligibility, time from eligibility to vaccine start and time to completion of vaccine series. A multidisciplinary group performed a cross-sectional quantitative and qualitative evaluation of revaccination practices at our institution, we identified factors associated with delayed, incorrect, or incomplete revaccination. Several plan-do-study-act interventions were implemented to address these drivers including revising immune readiness criteria, increased auditing of primary care administered immunizations and importantly, establishing a dedicated revaccination clinic within the HCT clinic at our center. Time to vaccine eligibility decreased from 12.6 months to 10 months (20% decrease) and time to complete vaccine series decreased from 19.3 months to 15.7 months (19% decrease). With a quality improvement initiative, we addressed the many causes of delayed or incomplete revaccination post-HCT and through a team-based approach successfully decreased time to vaccine start and vaccine completion at our center.

Mapping the international ecosystem of national health data spaces. A scoping review protocol

Background: The reuse of participant-level health data by public health and surveillance institutions, hospitals, doctors, and patients is an emerging priority for a number of national governments. Technical and semantic interoperability of health data ecosystems is important for detecting and responding to global health challenges, including emerging infectious diseases, antimicrobial resistance, and vaccine-preventable illnesses. In this scoping review, we will identify and describe health data ecosystems, spaces, clouds, and commons, national-level mechanisms for enabling the reuse of participant-level health data. Methods and analysis: We will apply the Arskey and O’Malley scoping review approach to describe governance, content, and semantic and technical interoperability of data and metadata in national health data ecosystems. We selected a scoping rather than a systematic review methodology to provide a high-level analysis of the current state of health data ecosystems’ implementation of the FAIR principles for data resources. The systematic search strategy was pilot tested and tailored for Ovid(Medline), CINAHL, and Web of Science. We will also conduct web scraping and consult stakeholders to identify additional health data ecosystems. Two reviewers will conduct the title-abstract and full-text screening and data charting independently. Discrepancies will be resolved by consensus, and results will be summarized in narrative form. Ethics and dissemination: Ethical approval is not required for this scoping review of published studies and grey literature. The scoping review protocol was registered prior to initiating the search strategy. Study results will be submitted for publication in an Open Access journal.

Vaccinazione e sport: una revisione sistematica

INTRODUCTION: Infectious diseases pose a significant risk to athletes, especially professional athletes, due to the nature of their training, travel, and close contact with other individuals. The athletic environment, characterized by crowded training facilities, shared equipment, and frequent exposure to large groups of people, can create a setting at increased risk for the transmission and spread of various infectious agents.EVIDENCE ACQUISITION: Our study aims to systematically review the role of vaccination in athletes, mainly focusing on professional athletes. We will focus on the evidence in the literature regarding the infectious risk of vaccine-preventable diseases and the recommendations relating to vaccine prophylaxis. The Scopus, MEDLINE/PubMed, and ISI Web of Knowledge were systematically searched. Research articles, brief reports, letters, and editorials published between January 1st, 2003, and May 15th, 2023, were included in our search.EVIDENCE SYNTHESIS: Vaccination plays a pivotal role in reducing the incidence and severity of vaccine-preventable illnesses among athletes. Infectious diseases can profoundly impact athletes’ health and disrupt their training schedules and competitions, leading to financial losses and posing a risk to the broader sports community.CONCLUSIONS: Sports federations have a responsibility to provide guidelines and support to athletes regarding vaccination and preventive measures. By prioritizing athletes’ health and implementing comprehensive strategies, the impact of infectious diseases on athletes can be minimized, and safe and secure competitions can be ensured.

Counteracting Vaccine Misinformation: An Active Learning Module.

Rises in vaccine hesitancy and the incidence of vaccine-preventable illnesses is, in part, due to an increase in vaccine misinformation. Consequently, many patients express skepticism and mistrust of vaccines. It is important that future clinicians are well equipped to understand vaccine-related literature to prepare them for difficult conversations with patients. This module incorporated various active learning approaches to evaluate vaccine-related literature, discuss true contraindications for vaccination, and aid students in approaching patient-clinician conversations about vaccines. Data gained from delivery of this module suggests that students benefit from gaining knowledge and cultivating communication skills about vaccines early in health professions education.

Challenges and opportunities to provide immunization services: Analysis of data from a cross-sectional study on a sample of pharmacists in a developing country.

Vaccine-preventable illnesses continue to be a global health concern as immunization coverage remains below its targets. National plans emphasize on the essential role of multidisciplinary efforts and approaches to vaccination programs. Pharmacists are globally getting involved in immunization services as important members of the healthcare team. This study aimed to determine barriers, and assess challenges and possible opportunities to provide immunization in the Lebanese pharmacy practice. This was a cross-sectional study that included pharmacists from all over Lebanon, as part of a national research to assess the role of pharmacists as immunizers. All registered pharmacists in Lebanon practicing in community, hospital, or other clinical settings were considered eligible for participation. A web-based self-administered validated questionnaire, which is initially developed by the American Pharmacists Association, was adapted with permission. A total of 315 pharmacists responded to the survey. Only 23.1% declared completing an immunization training program. Over half of pharmacists (58.4%) administer vaccines to patients. A significant association between lack of support from physicians to pharmacists (adjusted odds ratio [ORa] = 2.099, 95% confidence interval [CI] = 1.290-3.414, p = 0.003) and vaccine administration was found, while cost associated with professional development and additional training (ORa = 0.533, 95% CI = 0.287-0.989, p = 0.046) was inversely associated to it. Logistic, financial, and legislative requirements as essential necessities were determined to successfully expand pharmacist-led immunization services. The major barriers and challenges to vaccine administration by pharmacists comprised a lack of physicians' support and expenses associated with professional development and additional training. Pharmacists administer more vaccination despite lack of support from physicians; whereas they administer less vaccination due to cost associated with professional development and further training. The scope of pharmacy practice in Lebanon is not well recognized by other healthcare providers and stakeholders to include immunization services.

An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak

BackgroundIn response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention...

Vaccination considerations for patients receiving cancer therapy.

Vaccination rates in patients with cancer remain low, yet these individuals are at increased risk of severe outcomes from vaccine-preventable illnesses.[1][1] Primary care providers are often uncertain about the safety of vaccines in this population and vaccine recommendations for these patients.[2