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Liu S, Wang J, Liu Y, Xu Y, Che X, Gu W, Du J, Zhang X, Xu E. Survey of contraindications in children's routine vaccination in Hangzhou, China. Hum Vaccin Immunother 2017; 13:1539-1543. [PMID: 28406739 PMCID: PMC5512785 DOI: 10.1080/21645515.2017.1304868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022] Open
Abstract
Objective To describe the epidemiological characteristics of contraindications in children routine vaccination, to evaluate vaccination doctors' ability to determine contraindications. Method Using cross-section study, 34 urban and 15 suburb units were selected from 206 Community Health Center (CHC) in Hangzhou, China. Subjects were all children coming to CHCs for routine vaccination. All situations considered to be unsuitable for vaccination were recorded as contraindications. 3 experts were used to classify these abnormal records as true or false contraindications. Then, the multi-analysis was used to find factors related with the rate of false contraindications. Results There were 2801 children with 2969 contraindications in the present study. The prevalence of contraindications was 3.03‰ by dose of vaccines. Cough (24.78%), fever (21.86%) and medication (19.54%) were the most common contraindications in children routine vaccination. Measles-rubella vaccine (MR) (6.78‰), measles-mumps-rubella vaccine (MMR) (5.87‰) and hepatitis B vaccine (Hep B) (5.25‰) had higher prevalence of contraindications than other vaccines. According to the evaluation of 3 experts, about 13.53% of contraindications were misdiagnosed by vaccination doctor. The rate of misdiagnosed contraindications was correlated with the sex, age and educational background of vaccination doctor, total dose of vaccination of CHC. Conclusion A portion of children might miss the routine vaccination because of misdiagnosed contraindications. More investigations are needed to report the epidemiological distribution of contraindication in routine vaccination of children.
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Affiliation(s)
- Shijun Liu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jun Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yuyang Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Erping Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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2
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Cameron MA, Bigos D, Festa C, Topol H, Rhee KE. Missed Opportunity: Why Parents Refuse Influenza Vaccination for Their Hospitalized Children. Hosp Pediatr 2016; 6:507-12. [PMID: 27484464 DOI: 10.1542/hpeds.2015-0219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Hospitals are required to screen and administer the influenza vaccine to all admitted children unless contraindicated or refused by parents, yet vaccination rates remain low. Our goal was to examine reasons for refusal among pediatric patients admitted during influenza season. METHODS All children age 6 months to 18 years admitted to 2 network community hospitals from October 1, 2013 to March 31, 2014, without contraindications, were offered influenza vaccination prior to discharge. Parents who refused vaccination were asked their reason for refusal. Chi-square tests and logistic regression were used to determine factors associated with refusing the vaccine in the inpatient setting. RESULTS Three hundred twenty-five of 786 unique patients admitted during influenza season were eligible for vaccination. Of these, 49.8% refused. Parents of females, whites, and those with private insurance were more likely to refuse vaccination. Patients whose immunization status was otherwise up to date were more likely to accept (Odds Ratio 2.39, 95% Confidence Interval 1.05-5.41). Commonly cited reasons for refusal were: preference to have vaccination by the primary care provider (24.1%), concern for side effects (16.1%), not wanting vaccination (13%), doubt in efficacy (8%), concern that the child was already sick (6.8%), no prior influenza vaccination (6.7%) and feeling that it was not needed (5.6%). CONCLUSIONS Hospitalization during influenza season provides an opportunity for health-care providers to educate families about influenza and vaccinate patients if appropriate. However, nearly half of parents of eligible children declined vaccination. More study is required to determine strategies that can increase influenza vaccination acceptance.
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Affiliation(s)
- Melissa A Cameron
- Department of Pediatrics, Division of Hospitalist Medicine, Rady Children's Hospital-San Diego, San Diego, California;
| | - David Bigos
- Departments of Anesthesia and Critical Care and
| | | | - Howard Topol
- Departments of Anesthesia and Critical Care and Hospital Medicine, Children's Hospital of Philadelphia at Virtua, Voorhees, New Jersey; and
| | - Kyung E Rhee
- Department of Pediatrics, Division of Hospitalist Medicine, Rady Children's Hospital-San Diego, San Diego, California; Department of Pediatrics, Division of Academic General Pediatrics and Community Health, University of California, San Diego, La Jolla, California
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3
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Abstract
Vaccines are one of the greatest public health achievements, preventing both mortality and morbidity. However, overall immunization rates are still below the 90% target for Healthy People 2020. There remain significant disparities in immunization rates between children of different racial/ethnic groups, as well as among economically disadvantaged populations. There are systemic issues and challenges in providing access to immunization opportunities. In addition, vaccine hesitancy contributes to underimmunization. Multiple strategies are needed to improve immunization rates, including improving access to vaccines and minimizing financial barriers to families. Vaccine status should be assessed and vaccines given at all possible opportunities.
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Affiliation(s)
- Svapna S Sabnis
- Department of Pediatrics, Downtown Health Center, Medical College of Wisconsin, 1020 North 12th Street, Milwaukee, WI 53233, USA.
| | - James H Conway
- Division of Pediatric Infectious Diseases, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, H4/450 CSC, Madison, WI 53792, USA
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Fu LY, Zook K, Gingold J, Gillespie CW, Briccetti C, Cora-Bramble D, Joseph JG, Moon RY. Frequent vaccination missed opportunities at primary care encounters contribute to underimmunization. J Pediatr 2015; 166:412-7. [PMID: 25465848 DOI: 10.1016/j.jpeds.2014.10.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/10/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine missed opportunities to administer an eligible vaccination (MOs) and their contribution to underimmunization in contemporary pediatric practices. STUDY DESIGN This study was a retrospective analysis from 42 diverse pediatric practices located throughout the US. Medical records of 50 randomly selected children 3-18 months of age per practice were reviewed in Spring 2013. Immunization status for age and MOs were assessed as of each encounter and as of March 1, 2013. RESULTS Of 2076 eligible patients, 72.7% (95% CI 67.6-77.9) were up-to-date with receipt of standard vaccines. Most children (82.4%; 95% CI 78.3-85.9) had at least 1 MO, and 37.8% (95% CI 30.0-46.2) had at least one MO to administer an overdue vaccination. After adjustment, risk of underimmunization was 3.5 times greater for patients who had ever experienced an MO for an overdue vaccination compared with those who had not (adjusted relative risk = 3.5; 95% CI 2.8-4.3). If all age-appropriate vaccinations had been administered at the last recorded encounter, 45.5% (95% CI 36.8-54.5) of the underimmunized patients would have been up to date at the time of assessment. CONCLUSION MOs were common and contributed substantially to underimmunization in this contemporary sample of diverse primary care practice settings.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC.
| | - Kathleen Zook
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Janet Gingold
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | | | - Christine Briccetti
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Denice Cora-Bramble
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC
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5
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Brousseau N, Sauvageau C, Ouakki M, Audet D, Kiely M, Couture C, Paré A, Deceuninck G. Feasibility and impact of providing feedback to vaccinating medical clinics: evaluating a public health intervention. BMC Public Health 2010; 10:750. [PMID: 21129216 PMCID: PMC3017028 DOI: 10.1186/1471-2458-10-750] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 12/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background Vaccine coverage (VC) at a given age is a widely-used indicator for measuring the performance of vaccination programs. However, there is increasing data suggesting that measuring delays in administering vaccines complements the measure of VC. Providing feedback to vaccinators is recognized as an effective strategy for improving vaccine coverage, but its implementation has not been widely documented in Canada. The objective of this study was to evaluate the feasibility of providing personalized feedback to vaccinators and its impact on vaccination delays (VD). Methods In April and May 2008, a one-hour personalized feedback session was provided to health professionals in vaccinating medical clinics in the Quebec City region. VD for vaccines administered at two and twelve months of age were presented. Data from the regional vaccination registry were analysed for participating clinics. Two 12-month periods before and after the intervention were compared, namely from April 1st, 2007 to March 31st, 2008 and from June 1st, 2008 to May 31st, 2009. Results Ten medical clinics out of the twelve approached (83%), representing more than 2500 vaccinated children, participated in the project. Preparing and conducting the feedback involved 20 hours of work and expenses of $1000 per clinic. Based on a delay of one month, 94% of first doses of DTaP-Polio-Hib and 77% of meningococcal vaccine doses respected the vaccination schedule both before and after the intervention. Following the feedback, respect of the vaccination schedule increased for vaccines planned at 12 months for the four clinics that had modified their vaccination practices related to multiple injections (depending on the clinic, VD decreased by 24.4%, 32.0%, 40.2% and 44.6% respectively, p < 0.001 for all comparisons). Conclusions The present study shows that it is feasible to provide personalized feedback to vaccinating clinics. While it may have encouraged positive changes in practice concerning multiple injections, this intervention on its own did not impact vaccination delays of the clinics visited. It is possible that feedback integrated into other types of effective interventions and sustained over time may have more impact on VD.
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Pelly LP, Pierrynowski MacDougall DM, Halperin BA, Strang RA, Bowles SK, Baxendale DM, McNeil SA. THE VAXED PROJECT: an assessment of immunization education in Canadian health professional programs. BMC MEDICAL EDUCATION 2010; 10:86. [PMID: 21110845 PMCID: PMC3002370 DOI: 10.1186/1472-6920-10-86] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/26/2010] [Indexed: 05/15/2023]
Abstract
BACKGROUND Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula. METHODS (i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum. RESULTS The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training. CONCLUSIONS Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.
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Affiliation(s)
- Lorine P Pelly
- Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Donna M Pierrynowski MacDougall
- St. Francis Xavier University, Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Beth A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Robert A Strang
- Nova Scotia Department of Health Promotion and Protection; Maritime Center, 1505 Barrington St., PO BOXC 2734, B3J 3P7, Canada
| | - Susan K Bowles
- Department of Medicine, QEII Health Sciences Centre, School of Pharmacy, Dalhousie University; Halifax, Nova Scotia, B3 H 3J5, Canada
| | - Darlene M Baxendale
- Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Shelly A McNeil
- Department of Medicine, QEII Health Sciences Centre, Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
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7
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Usman HR, Kristensen S, Rahbar MH, Vermund SH, Habib F, Chamot E. Determinants of third dose of diphtheria-tetanus-pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study. Trop Med Int Health 2009; 15:140-7. [PMID: 19930140 DOI: 10.1111/j.1365-3156.2009.02432.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria-tetanus-pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan. METHOD We analyzed a cohort of mother-child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrollment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion. RESULTS Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrollment in multivariable analysis, DTP3 completion was higher among children who were < or =60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06-1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16-2.65), and who were living < or =10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04-1.66). CONCLUSIONS Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.
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Affiliation(s)
- Hussain R Usman
- Department of Epidemiology, University of Alabama at Birmingham, AL 35294-0022, USA.
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8
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Orenstein WA, Rodewald LE, Hinman AR, Schuchat A. Immunization in the United States. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Mills EJ, Montori VM, Ross CP, Shea B, Wilson K, Guyatt GH. Systematically reviewing qualitative studies complements survey design: an exploratory study of barriers to paediatric immunisations. J Clin Epidemiol 2006; 58:1101-8. [PMID: 16223652 DOI: 10.1016/j.jclinepi.2005.01.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 01/02/2005] [Accepted: 01/31/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Designing survey questions requires content expertise, awareness of previous qualitative literature, and piloting. We examined surveys addressing parental barriers to vaccinating children to determine if they comprehensively included themes identified in published qualitative studies. METHODS We performed a systematic literature search of 12 electronic databases and compared questions asked in eligible surveys identified to issues raised in qualitative studies. Issues included nine themes related to harm, six related to distrust, eight to issues of access, and three other issues. RESULTS The 29 eligible surveys failed to adequately address several important themes identified in qualitative studies. The number that failed to address the following themes were as follows: beliefs that vaccines cause diseases (n = 26); painful (n = 25); distrust of medical community (n = 28); communication problems with staff (n = 25); memories of their own or others adverse experiences (n = 28); fear of long-term effects (n = 26); belief the medical community does not understand adverse events associated with vaccines (n = 28); and parent's own lack of knowledge about diseases (n = 29). CONCLUSIONS Many surveys of parental barriers to immunization failed to address a number of important themes identified in qualitative studies. To the extent this is true in other areas, ensuring that investigators have conducted an adequate number and variety of qualitative studies, and systematically reviewing those studies, will improve surveys' content validity.
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Affiliation(s)
- Edward J Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Health Science Centre, Hamilton, Ontario, Canada.
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10
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Mills E, Jadad AR, Ross C, Wilson K. Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol 2005; 58:1081-8. [PMID: 16223649 DOI: 10.1016/j.jclinepi.2005.09.002] [Citation(s) in RCA: 256] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether a systematic review of qualitative studies can lead to identification of consistent themes across studies, using barriers toward childhood vaccination as an example. STUDY DESIGN AND SETTING We performed a systematic literature search of studies identified in 10 electronic databases. Two independent reviewers selected the relevant abstracts and articles, then extracted information. Content analysis methodology was used to create a coding template for barriers and then to identify how many studies identified specific barriers. RESULTS Fifteen studies were included in this overview. Eight studies used semistructured interviews, five used focus groups, and two used both methodologies. Themes fell under four major headings: issues of harm, issues of distrust, access issues, and other issues. Barriers identified in more than half of the studies included concern about the risk of adverse effects, concern that vaccinations are painful, distrust of by those advocating vaccines (including belief in conspiracy), belief that vaccination should not occur when the child has a minor illness, unpleasant staff or poor communication, and lack of awareness of the vaccination schedule. CONCLUSION Systematically reviewing qualitative studies on barriers to childhood vaccination provided important information on barriers that are consistently identified by parents in several different studies.
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Irigoyen M, Findley SE, Chen S, Vaughan R, Sternfels P, Caesar A, Metroka A. Early continuity of care and immunization coverage. ACTA ACUST UNITED AC 2004; 4:199-203. [PMID: 15153055 DOI: 10.1367/a03-138r1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We examined the relationship between early and exclusive continuity of care at the initial source of care and immunization coverage. METHODS We used a cohort study design with 641 randomly selected children initiating care before 3 months and making 2 or more visits to an inner-city practice network. We used 2 complementary data sources: medical records and the New York City Department of Health Citywide Immunization Registry. Immunization measures were cumulative age appropriate and up-to-date at 18 months (UTD18). RESULTS There was a gradual attrition from the initial source of care. By 18 months, less than half the children (46%) remained in care. Regardless of continuity, nearly half (42%) had used other immunization providers. The initial source of care contributed most immunizations (89%-94%); however, across all levels of continuity, children who also used other providers had higher immunization rates. We found a threshold effect of continuity beginning at 12 months: children in care from 12 to 14 months were 17.5 times more likely to be UTD18 than those in care less than 6 months. Each additional period in care increased the time remaining current with immunizations. Among children UTD18, 88% were in care at 11 months compared with 38% among those not UTD18, a 50% difference. CONCLUSIONS Continuity of care at the initial source of care had a significant and lasting impact on immunization coverage, even if not used exclusively. Interventions promoting continued use of the medical home over the first 2 years of life may help improve immunization coverage.
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Affiliation(s)
- Matilde Irigoyen
- Division of General Pediatrics, Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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12
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Meyerhoff A, Jacobs RJ, Greenberg DP, Yagoda B, Castles CG. Clinician satisfaction with vaccination visits and the role of multiple injections, results from the COVISE Study (Combination Vaccines Impact on Satisfaction and Epidemiology). Clin Pediatr (Phila) 2004; 43:87-93. [PMID: 14968898 DOI: 10.1177/000992280404300112] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because little is known about clinician satisfaction with infant vaccination visits, we measured satistaction and the effects of the number of injections on satisfaction. Clinicians from 35 pediatric centers self-administered a questionnaire using visual analog scales augmented by a Likert scale. All 95 pediatricians and 137 nonphysician vaccinators responded. In both populations, increased injections predicted decreased overall satisfaction, and decreased satisfaction with obtaining consent, time to prepare/administer, getting upset during administration, and time to update records (each p<0.01). Satisfaction decreased markedly, on each measure, at 4-injection visits, 5-injection visits, or both.
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Affiliation(s)
- A Meyerhoff
- Capitol Outcomes Research, Inc., Alexandria, VA 22310, USA
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13
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[Why are some children incompletely vaccinated at the age of 2?]. Canadian Journal of Public Health 2003. [PMID: 12790498 DOI: 10.1007/bf03405070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A survey was conducted in the Province of Quebec to document the factors associated with an incomplete immunization status among 2-year-old children. METHODS Parents of 430 completely and 266 partially vaccinated children selected from the computerized vaccination register agreed to participate. RESULTS The non-simultaneous administration of the 2nd MMR and 4th DPT-P-Hib at 18 months of age was responsible for 46% of incompleteness. The following characteristics were significantly associated with an incomplete immunization status: being a single parent, > or = 2 children in the family, an older age at first immunization (> or = 3 months), parent's preference for postponing the second vaccine when two injections are scheduled for the same visit, perception of lack of information about vaccination, and disagreement with immunization recommendations. CONCLUSION One of the key points of this study is the impact of the non-simultaneous administration of the two vaccines at 18 months. Factors such as being a single parent and older age at first immunization might be used to design an early intervention for children who are most likely to be incompletely immunized. Even if parents are favourable towards immunization, they need to be well informed about the associated risks and benefits.
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14
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Boulianne N, Deceuninck G, Duval B, Lavoie F, Dionne M, Carsley J, Valiquette L, Rochette L, De Serres G. [Why are some children incompletely vaccinated at the age of 2?]. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2003; 94:218-23. [PMID: 12790498 PMCID: PMC6979796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE A survey was conducted in the Province of Quebec to document the factors associated with an incomplete immunization status among 2-year-old children. METHODS Parents of 430 completely and 266 partially vaccinated children selected from the computerized vaccination register agreed to participate. RESULTS The non-simultaneous administration of the 2nd MMR and 4th DPT-P-Hib at 18 months of age was responsible for 46% of incompleteness. The following characteristics were significantly associated with an incomplete immunization status: being a single parent, > or = 2 children in the family, an older age at first immunization (> or = 3 months), parent's preference for postponing the second vaccine when two injections are scheduled for the same visit, perception of lack of information about vaccination, and disagreement with immunization recommendations. CONCLUSION One of the key points of this study is the impact of the non-simultaneous administration of the two vaccines at 18 months. Factors such as being a single parent and older age at first immunization might be used to design an early intervention for children who are most likely to be incompletely immunized. Even if parents are favourable towards immunization, they need to be well informed about the associated risks and benefits.
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15
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Schempf AH, Politzer RM, Wulu J. Immunization coverage of vulnerable children: a comparison of health center and national rates. Med Care Res Rev 2003; 60:85-100. [PMID: 12674021 DOI: 10.1177/1077558702250246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Serving a predominantly poor and minority population, health centers are positioned to address national immunization disparities in the context of comprehensive primary care. Having demonstrated success in eliminating disparities for other preventive services, this study evaluates health center effectiveness in mitigating immunization disparities. Up-to-date health center and national immunization rates were obtained from the 1995 User and the 1995 National Health Interview Surveys. For the most part, national immunization disparities were not found among health center children. However, black children served at health centers were still significantly less likely to be vaccinated for polio and Medicaid children significantly less likely for measles. Health center outreach and enabling services are hypothesized to facilitate regular access to care and thus timely immunization. Additional health center analysis is necessary to establish factors responsible for the relative absence of disparties, uncover persistent barriers to immunization, and identify structural attributes that may further raise immunization coverage.
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Prislin R, Sawyer MH, Nader PR, Goerlitz M, De Guire M, Ho S. Provider-staff discrepancies in reported immunization knowledge and practices. Prev Med 2002; 34:554-61. [PMID: 11969357 DOI: 10.1006/pmed.2002.1019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics. METHODS A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff. RESULTS Providers were significantly more knowledgeable than staff (P < 0.001); however, they were not more certain about their knowledge (P = 0.52) nor were they more confident in their capability to properly immunize all children in their practice (P = 0.10). Providers reported lower vested interest in immunizations than clinical staff (P < 0.05). Both groups were equally likely to immunize a child with a cold. Providers were less likely to defer needed immunizations for a 15-month-old child, and they were more likely to administer multiple injections to an 18-month-old (both P < 0.05). Providers were more likely than staff to immunize during acute and chronic illness visits (both P < 0.001), and both groups were equally likely to immunize during preventive visits. CONCLUSIONS Discrepancies in reported immunization practices between providers and staff may be a barrier to full immunization.
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Affiliation(s)
- Radmila Prislin
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, California 92182-4611, USA.
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Meyerhoff AS, Weniger BG, Jacobs RJ. Economic value to parents of reducing the pain and emotional distress of childhood vaccine injections. Pediatr Infect Dis J 2001; 20:S57-62. [PMID: 11704725 DOI: 10.1097/00006454-200111001-00009] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One reason that recommended childhood immunizations due at child health visits are deferred is to avoid the pain and emotional distress associated with the increasing number of injections required. This deferral leads to additional visits and costs and reduced immunoprotection against vaccine-preventable illnesses. To assess the economic value of combination vaccines that address this problem, we surveyed parents to determine the amount they would be willing to pay to avoid the pain and emotional distress experienced by their infants from injections. METHODS A self-administered questionnaire was completed within 24 h of the vaccinations by 294 parents of children ages 11/2 to 7 months receiving vaccine injections at 26 outpatient child health centers. The willingness-to-pay (WTP) method was used to estimate the intangible cost of the pain and emotional distress of the 1 to 4 injections their child had received. Parents were asked how much of their own money they would have paid to avoid these injections, without any compromise in the safety and efficacy of the vaccinations. RESULTS Wide variations in WTP amounts were observed, ranging from median values of $10 to $25 and average values of $57.06 to $79.28 to avoid the pain and emotional distress associated with eliminating all injections at visits in which one to four injections were administered. Parents placed greater value on reductions that avoided all injections than on reductions that avoided only some injections. Overall the median cost per injection avoided was $8.14, and the mean was $30.28. CONCLUSIONS Parents have strong preferences for limiting vaccine injections. The economic cost of the pain and distress associated with such injections, reflected in the amounts they report they would be willing to pay to avoid them, represents a substantial component of the cost of disease control through immunization.
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Affiliation(s)
- A S Meyerhoff
- Capitol Outcomes Research, Inc., Alexandria, VA 22310, USA.
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Brenner RA, Simons-Morton BG, Bhaskar B, Das A, Clemens JD. Prevalence and predictors of immunization among inner-city infants: a birth cohort study. Pediatrics 2001; 108:661-70. [PMID: 11533333 DOI: 10.1542/peds.108.3.661] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although the proportion of US children who are appropriately immunized increased dramatically in the past decade, rates remain suboptimal among low-income, inner-city youth. Timely initiation of immunization is an important predictor of immunization status later in childhood; however, prospective studies identifying predictors of initiation are lacking. OBJECTIVES The objectives of this study were to: 1) describe immunization patterns in a cohort of infants born to predominantly low-income, inner-city mothers; 2) identify determinants, as measured at birth, of immunization status at 3 and 7 months of age; and 3) identify determinants of continuation of immunization among those who initiate immunization by 3 months of age. DESIGN Prospective, birth cohort study. METHODS Maternal/infant dyads were systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996. Three hundred sixty-nine mothers were interviewed shortly after delivery, at 3 to 7 months postpartum, and at 7 to 12 months postpartum. Medical records were reviewed at all reported sites of care for 324 (88%) infants. Vaccinations assessed included diphtheria, tetanus, and pertussis; polio; and Haemophilus influenzae type B. Multivariate logistic regression analyses were used to determine factors associated with immunization status of infants at 3 and 7 months of age. RESULTS At 3 months of age, 75% of infants were up-to-date (UTD) versus only 41% at 7 months. In adjusted analyses, baseline factors associated with being UTD at 3 months included enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy, intention to breastfeed, and presence of the infant's grandmother in the household. Infants were less likely to be UTD if their mothers perceived higher barriers to immunization. Baseline factors associated with being UTD at 7 months included lower birth order and maternal employment. Among the subset of infants who were UTD at 3 months, only 53% remained UTD at 7 months. Factors measured at the first follow-up interview that were associated with continuation of immunization at 7 months included maternal employment and lower perceived barriers. CONCLUSIONS Immunization rates during the first 7 months of life were low in this inner-city population. Factors associated with immunization status that are potentially amenable to change included perceived barriers to immunization and enrollment in WIC during pregnancy.
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Affiliation(s)
- R A Brenner
- National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA.
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Daniels D, Jiles RB, Klevens RM, Herrera GA. Undervaccinated African-American preschoolers: a case of missed opportunities. Am J Prev Med 2001; 20:61-8. [PMID: 11331134 DOI: 10.1016/s0749-3797(01)00278-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify factors associated with undervaccination of African-American preschoolers, to describe the number of vaccination visits made by undervaccinated children and the number of visits needed to be series complete, and to describe the children who did not receive the single dose of measles-containing vaccine recommended for preschoolers. METHODS We used the 1999 National Immunization Survey (NIS) to describe vaccination coverage for the 4:3:1:3 vaccine series (four doses of diphtheria and tetanus toxoids and pertussis vaccine, three doses of poliovirus vaccine, one dose of any measles-containing vaccine, and three doses of Haemophilus influenzae type b vaccine) among non-Hispanic, African-American preschoolers due to concerns that they may be at risk of undervaccination. Children who did not complete this basic vaccine series were classified for further analysis according to the number of doses they lacked (i.e., one dose missed, two or three doses missed, or four or more doses missed). Significant associations between demographic characteristics and vaccination status or degree of undervaccination were determined. RESULTS Of the 26.2% of African-American preschoolers who did not complete the 4:3:1:3 vaccine series, 40.3% lacked one, 35.3% lacked two or three, and 25.0% lacked four or more doses of vaccine. Children who did not complete the 4:3:1:3 vaccine series were less likely to have married mothers, were less likely to have mothers aged > or = 35 years, or were less likely to be up to date at age 3 months than the children who completed the 4:3:1:3 vaccine series. Among the undervaccinated, 63.7% had a sufficient number of vaccination visits to have completed the basic series. However, most (78.7%) of the severely undervaccinated (children who lacked more than three doses of vaccine) had three or fewer vaccination visits. For 72.6% of the undervaccinated preschoolers, only one additional vaccination visit was needed to complete the 4:3:1:3 vaccine series; among these, 78.3% had an adequate number of vaccination visits to have completed the series. Overall, 9.9% of the African-American children aged 19 to 35 months (i.e., approximately 85,000 African-American children aged 19 to 35 months) were at risk for measles. Among the children who lacked more than three doses of vaccine, 68.1% were at risk. CONCLUSIONS Our study suggests that the estimated coverage of 73.8% for the 4:3:1:3 vaccine series among African-American children aged 19 to 35 months was not a result of limited access to care. On the contrary, 90.5% of African-American children had enough vaccination visits to complete the series. To raise coverage and prevent potential outbreaks, providers should assess each child's vaccination status at every visit, and administer all needed vaccinations at that time. For the most severely undervaccinated children, this strategy may not be adequate, because they did not have the minimum number of vaccination visits required for series completion. For these children, other strategies are needed for increasing vaccination coverage.
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Affiliation(s)
- D Daniels
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Ronsaville DS, Hakim RB. Well child care in the United States: racial differences in compliance with guidelines. Am J Public Health 2000; 90:1436-43. [PMID: 10983203 PMCID: PMC1447611 DOI: 10.2105/ajph.90.9.1436] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study sought to estimate the rate of compliance with American Academy of Pediatrics guidelines for well child care in the first 6 months of life and to determine risks for inadequate care. METHODS The study included 7776 infants whose mothers participated in both the 1988 National Maternal and Infant Health Survey and its 1991 longitudinal follow-up and whose mothers or pediatric providers supplied information about their medical care. Regression analysis was used to determine the probability of incomplete compliance with guidelines for well child care in relation to several socioeconomic risks. RESULTS Fifty-eight percent of White infants, 35% of African American infants, and 37% of Hispanic infants obtained all recommended well child care. African American race was the biggest risk for inadequate care (odds ratio = 1.7, 95% confidence interval = 1.5, 1.9), followed by low levels of maternal education, low income, and poor prenatal care. The risk for African American infants persisted across socioeconomic levels. CONCLUSIONS The racial disparities identified suggest that cultural barriers to seeking preventive care need further study and that programs aimed at reducing these barriers need to be developed.
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Affiliation(s)
- D S Ronsaville
- Health Care Financing Administration, Baltimore, Md. 21244, USA.
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21
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Shefer A, Webb E, Wilmoth T. Determination of up-to-date vaccination status for preschool-aged children: how accurate is manual assessment conducted by paraprofessional staff? Pediatrics 2000; 106:493-6. [PMID: 10969093 DOI: 10.1542/peds.106.3.493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Accurate identification of underimmunized children is needed to determine which children need vaccination. Previous studies have found the accuracy of manually determining the immunization status from a personal vaccination record to be low (<50%). OBJECTIVE To determine the accuracy of manual immunization status assessment for preschool-aged children. SUBJECTS AND SETTING Children </=32 months old (n = 21 263) seen over 1 year at 12 women, infants, and children (WIC) sites in San Diego, California. Age at evaluation was between 0 and 24 months. METHODS Paraprofessional immunization specialists conducted manual immunization status assessment using the WIC client's personal vaccination record. Immunization status as recorded in the WIC record was compared with computerized assessment (the gold standard). MEASURES AND RESULTS For all patient encounters, 29 078 (80%) of 36 368 were assessed correctly; manual assessment outcome was not recorded in the WIC record for 2171 (6%) of encounters. Accuracy varied by WIC site (range: 70%-90%). The sensitivity at correctly identifying an underimmunized child per encounter was 53.6%; the specificity at correctly identifying a fully vaccinated child per encounter was 89. 4%. The 3 most common vaccines that were incorrectly assessed in identifying an underimmunized child were Haemophilus influenzae type b (43%), hepatitis B (37%), and diphtheria-tetanus toxoids and (cellular or acellular) pertussis vaccine (24%). Children with no outcome as recorded in the WIC record were 5 times as likely to be up-to-date. CONCLUSIONS Manual immunization assessment was specific but only moderately sensitive at identifying underimmunized children. Thus, many underimmunized children will by missed but only 10% of children will be referred inappropriately.
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Affiliation(s)
- A Shefer
- Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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BEHAVIORAL AND PSYCHOLOGICAL FACTORS ASSOCIATED WITH STD RISK. Sex Transm Dis 2000. [DOI: 10.1016/b978-012663330-6/50006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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da Silva AA, Gomes UA, Tonial SR, da Silva RA. [Vaccination coverage and risk factors associated to non-vaccination in a urban area of northeastern Brazil, 1994]. Rev Saude Publica 1999; 33:147-56. [PMID: 10413932 DOI: 10.1590/s0034-89101999000200006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The assessment of vaccination coverage and risk factors for non-vaccination is important to evaluate vaccination programs and to identify children not properly vaccinated. METHODS A cross-sectional household survey was carried out in the municipality of S. Luís, Maranhão, Brazil by means of a standardized questionnaire. Multistage cluster sampling was used to identify children of 12-59 months of age residing in the city in 1994. The mother or other person responsible for the children was interviewed. Fifty census clusters were visited and 40 households were sampled in each. On average, 15 children were found in each cluster. Design effect was calculated for each estimate. Health service utilization was analyzed according to socioeconomic and demographic indicators, and perceived morbidity using proportional hazard modeling (Cox's regression). RESULTS Vaccination coverage levels were 72.4% for BCG, 59.9% for three doses of polio vaccine, 57% for three doses of DTP vaccine and 54.7% for measles vaccine. Vaccination levels have remained statistically unchanged over the last three years. Lower maternal schooling continues to be associated with increased risk of non-vaccination in the multivariable analysis. CONCLUSION Vaccination levels were low. Health education activities are one of the suggested strategies to increase vaccination coverage.
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Affiliation(s)
- A A da Silva
- Departamento de Saúde Pública da Universidade Federal do Maranhão, São Luís, MA, Brasil.
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Mahony A, Percival P, Condon R. Vaccine know-how. Kimberley immunisation study: community nurses immunisation education, knowledge and practice. Collegian 1999; 6:16-22. [PMID: 10409969 DOI: 10.1016/s1322-7696(08)60325-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the remote Kimberley Region of Western Australia, community nurses administer almost all childhood vaccines. This paper discusses the immunisation education, knowledge and practice of this group of nurses. This research was part of a larger Kimberley immunisation study. The first phase investigated the immunisation cover and timing of vaccine administration to children in the 0-18 month age group in the Kimberley Region of Western Australia. Phase two investigated immunisation education, knowledge and practice. The study findings suggest that community nurses are knowledgeable about vaccine administration, and administer vaccines appropriately to children with multiple infections, weight loss and failure to thrive. They are also 'active' in following up children due and overdue for vaccines. However, a lack of on-going nursing immunisation education was reported.
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Affiliation(s)
- A Mahony
- TVW Telethon Institute for Child Health Research, Subiaco, WA, USA
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Irigoyen M, See D, Findley SE. Annotation: children's disengagement from medical homes--a neglected public health imperative. Am J Public Health 1999; 89:157-9. [PMID: 9949741 PMCID: PMC1508541 DOI: 10.2105/ajph.89.2.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hughart N, Strobino D, Holt E, Guyer B, Hou W, Huq A, Ross A. The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland. Med Care 1999; 37:44-55. [PMID: 10413392 DOI: 10.1097/00005650-199901000-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to identify provider practices and policies in private pediatric settings that relate to vaccination status, controlling for the characteristics of the children served. METHODS Vaccination data came from the medical records of 709 randomly selected 2-year-old children at 18 private practices and managed care organizations in Maryland, family data from 466 telephone interviews with the children's parents, and provider characteristics from 18 site questionnaires and 42 individual physician and nurse practitioner questionnaires. Logistic regression and generalized estimating equations were used to estimate the relation of provider characteristics to vaccination status. Three age-appropriate (AA) and two up-to-date (UTD) vaccination status variables characterized successful vaccination. RESULTS Approximately 70% of the study children were up-to-date by age 2 years for the full vaccination series, excluding hepatitis B vaccine. Family demographic characteristics were the strongest correlates of undervaccination. Neither parents' knowledge and attitudes about immunization nor the children's insurance coverage was statistically related to vaccination status. Site reminder or follow-up systems and provider perceptions about appointment scheduling and receipt of vaccine information from health departments were positively related to vaccination. Concern for liability was associated with a reduced odds of age-appropriate and up-to-date vaccination. CONCLUSIONS Family demographics strongly correlate with vaccination status; however, they are generally not modifiable. This study's findings encourage providers to operate a tracking system, to remain current on immunization recommendations, to use all clinical encounters to screen and vaccinate children, and to ensure the availability and convenience of vaccination services.
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Affiliation(s)
- N Hughart
- Department of Maternal and Child Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA.
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Udovic SL, Lieu TA, Black SB, Ray PM, Ray GT, Shinefield HR. Parent reports on willingness to accept childhood immunizations during urgent care visits. Pediatrics 1998; 102:E47. [PMID: 9755284 DOI: 10.1542/peds.102.4.e47] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To 1) describe whether parents would be willing to accept childhood immunizations at urgent care visits; and 2) identify predictors of parents' willingness to accept childhood immunizations at urgent care visits. DESIGN AND PARTICIPANTS Cross-sectional telephone survey of parents of children aged 18 to 24 months who were underimmunized according to a computerized immunization tracking system and who had recently made an urgent care visit in a regional group-model health maintenance organization in Northern California. Chart review was conducted to confirm immunization status and to identify contraindications to vaccination. RESULTS Of the 424 eligible participants, 351 (83%) completed interviews. Children with contraindications to vaccination and children who were actually up-to-date at the time of the urgent care visit were excluded, leaving 263 families in the final analysis. Among these parents, 75% said they would have been willing to have their child immunized at the urgent care visit in question if the physician had suggested it. An additional 11% said they would have accepted vaccination if the physician told them that the shot would be safe and strongly encouraged them to accept it. Overall, 86% reported they theoretically would have accepted an immunization during the urgent care visit. In the multivariate analysis, the strongest predictors of stated willingness to accept shots at the urgent care visit were the parent: 1) not being aware that their child was underimmunized (odds ratio [OR] 3.5, 95% confidence interval [CI], 1.6-7.7); 2) perceiving that the child was not very sick at the visit (OR 1.8, 95% CI, 1.1-3.0); 3) being less concerned about the risk of shots (OR 1.8, 95% CI, 1.2-2.5); and 4) being of nonwhite race (OR 3.6, 95% CI, 1.6-7.7). Income and education were not significantly associated with reported willingness to accept immunization. CONCLUSIONS We conclude that most parents of underimmunized toddlers report being willing to accept immunizations during urgent care visits if the clinician recommends it. More effective ways of alerting providers in urgent care settings when immunizations are due, such as indications on a chart or registration form, hold promise for improving immunization coverage rates.
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Affiliation(s)
- S L Udovic
- Joint Medical Program, University of California, Berkeley and San Francisco, California, USA
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Affiliation(s)
- A Shefer
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Sabnis SS, Pomeranz AJ, Lye PS, Amateau MM. Do missed opportunities stay missed? A 6-month follow-up of missed vaccine opportunities in inner city Milwaukee children. Pediatrics 1998; 101:E5. [PMID: 9565438 DOI: 10.1542/peds.101.5.e5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine 1) the frequency of missed vaccine opportunities (VOs) in inner city children </=3 years of age; 2) whether the recommended vaccine(s) were given within 6 months of the missed opportunity (MO); 3) whether these vaccinations were age-appropriate according to the guidelines of the Advisory Committee on Immunization Practices; and 4) variables associated with MOs. DESIGN Retrospective chart review with a nested retrospective cohort of children with MOs. SETTING Two inner city practice settings in Milwaukee: a community health center and an academic continuity care practice. PATIENTS/SELECTION PROCEDURE: A consecutive sample of 710 visits of inner city children </=3 years of age with VOs, seen between January 1 and March 31, 1995. A VO was defined as any encounter when the child was vaccine-eligible according to Advisory Committee on Immunization Practices guidelines. RESULTS MOs occurred in 47% (330/710) of the VOs. Only 40% of the children with MOs received age-appropriate immunizations within 6 months; 30% received the vaccinations beyond the age-appropriate time. The remaining 30% either did not return or were not vaccinated on return. The variables significantly associated with MOs were 1) age: children with MOs were older than those without, with a mean age of 15.5 months vs 10.9 months; 2) minor febrile illness; 3) moderate/severe illness; 4) acute illness encounters; and 5) patient's being seen at the community health center. Only 15.5% of all MOs were justified by the presence of moderate/severe illness. CONCLUSIONS VOs are frequently missed in inner city children. Most of the MOs were not justified by the valid contraindication of moderate/severe illness. Sixty percent of the children with MOs did not receive age-appropriate immunizations within 6 months. These children are vulnerable to vaccine-preventable diseases such as measles and pertussis.
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Affiliation(s)
- S S Sabnis
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Liau A, Zimet GD, Fortenberry JD. Attitudes about human immunodeficiency virus immunization: the influence of health beliefs and vaccine characteristics. Sex Transm Dis 1998; 25:76-81. [PMID: 9518382 DOI: 10.1097/00007435-199802000-00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The development of a vaccine to prevent human immunodeficiency virus (HIV) infection is a highly desirable goal. However, there may be a number of psychosocial barriers to HIV vaccine acceptance. The purpose of this study was to begin to examine some factors that might influence attitudes about HIV immunization. GOAL To evaluate the relationship of health beliefs and vaccine characteristics to acceptability of hypothetical HIV immunization. STUDY DESIGN The subjects were 222 college students who completed self-administered questionnaires that addressed health beliefs, vaccine characteristics, and acceptability of hypothetical HIV vaccines. RESULTS Health beliefs independently predictive of HIV vaccine acceptability included perceived susceptibility to HIV, perceived nonmembership in a traditionally defined acquired immune deficiency syndrome (AIDS) risk group, and fear of the vaccine causing AIDS. Of the vaccine characteristics, efficacy influenced vaccine acceptability most strongly, followed by type of vaccine. CONCLUSION These results suggest that universal HIV vaccine acceptance cannot be assumed and that vaccine characteristics and individuals' health beliefs are likely to influence decisions regarding HIV immunization.
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Affiliation(s)
- A Liau
- Department of Psychology, Indiana University Purdue University--Indianapolis, USA
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31
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Zimet GD, Fortenberry JD, Fife KH, Tyring SK, Herne K, Douglas JM. Acceptability of genital herpes immunization. The role of health beliefs and health behaviors. Sex Transm Dis 1997; 24:555-60. [PMID: 9383842 DOI: 10.1097/00007435-199711000-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the acceptability of vaccines for prevention of sexually transmitted diseases (STDs). The purpose of this study was to examine potential predictors of genital herpes simplex virus type 2 (HSV-2) vaccine acceptability. GOALS To evaluate the relationship of health beliefs and health behaviors to HSV-2 vaccine acceptability. STUDY DESIGN Three hundred twenty-one subjects participating in two phase III clinical trials for an HSV-2 vaccine completed surveys addressing health beliefs, health behaviors, and acceptability of hypothetical HSV-2 vaccines. RESULTS Bivariate analyses found that perceived benefits of vaccination, seatbelt use, a healthy diet, and having had cholesterol levels checked were associated with higher acceptability. Perceived limitations of HSV-2 immunization, alcohol use, and exercise were associated with lower acceptability. Multiple regression analysis identified perceived benefits of vaccination, decreased exercise, and lower alcohol use as significant independent predictors of greater HSV-2 vaccine acceptability. CONCLUSIONS In groups of high-risk individuals who had completed participation in HSV-2 clinical trials, health beliefs and health behaviors influenced acceptability of hypothetical HSV-2 vaccination. The findings support the need to understand determinants of acceptance of vaccines for HSV-2 and other STDs.
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Affiliation(s)
- G D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, USA
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Abstract
PURPOSE The purpose of this study was to evaluate the relationship of health beliefs to intention to accept human immunodeficiency virus (HIV) vaccination. METHODS Respondents were 81 female and 44 male college students who completed self-administered questionnaires. Questionnaires included items assessing intention to get vaccinated for HIV and the following health beliefs: perceived susceptibility to HIV infection, severity of AIDS, benefits of HIV immunization, pragmatic obstacles to vaccination, conditional nonmembership in a risk group, fear of the vaccine, and fear of needles. RESULTS Nearly 30% of the subjects were uncertain about or opposed to getting immunized for HIV. Susceptibility, severity, pragmatic obstacles, conditional nonmembership in a risk group, and fear of the vaccine were significantly correlated with intent to get vaccinated. Fear of needles, gender, and race were not associated with intent to get an HIV vaccine. Multiple regression analysis identified susceptibility, benefits, pragmatic obstacles, nonmembership in risk group, and fear of the vaccine as significant independent predictors of intent to vaccinate. CONCLUSIONS These preliminary survey findings demonstrate that intention to accept HIV immunization is not universal and that health beliefs may influence HIV vaccine acceptance. They suggest that it may be important to consider the effects of psychological factors in future research on HIV vaccine acceptance and in the ultimate implementation of HIV immunization programs.
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Affiliation(s)
- G D Zimet
- Department of Pediatrics, Indiana University School of Medicine Indianapolis, USA
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Wood D, Halfon N, Pereyra M, Hamlin JS, Grabowsky M. Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public providers in Los Angeles. Pediatr Infect Dis J 1996; 15:140-5. [PMID: 8822287 DOI: 10.1097/00006454-199602000-00010] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Missed opportunities to vaccinate occur commonly and contribute to the underimmunization of young children. They are related to provider knowledge of the immunization schedule and contraindications to vaccination. METHODS We surveyed private physicians (n = 50) and public health department physicians and nurses (n = 47). The questionnaire presented two sets of clinical scenarios in which they had to assess what immunizations were due and assess whether there were any contraindications to vaccination. RESULTS The mean percent correct responses on the immunization schedule questions was 64% (sd = 3.6%) for the private physicians, 71% (SD = 4.7%) for the public physicians and 78% (SD = 2.8%) for the public nurses (P = 0.04). The mean percent correct responses on the contraindications to vaccinate questions was 73% (SD = 5.4%) for public physicians, 58% (SD = 3.3%) for private physicians, and 55% (SD = 4.7%) for public health nurses (P = 0.02). CONCLUSIONS Our survey shows that providers in the public and private sectors have important deficits in their knowledge of the immunization schedule and the appropriate contraindications to vaccinate which might lead to missed opportunities to vaccinate and low immunization coverage.
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Affiliation(s)
- D Wood
- RAND, Santa Monica, CA, USA.
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