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Mohanty S, Tsai JH, Ning N, Martinez A, Verma RP, Heisen M, Weaver J, Feemster KA, Chun B, Weiss TW, Schmier JK. Understanding healthcare providers' preferred attributes of pediatric pneumococcal conjugate vaccines in the United States. Hum Vaccin Immunother 2024; 20:2325745. [PMID: 38566496 PMCID: PMC10993915 DOI: 10.1080/21645515.2024.2325745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
As higher-valent pneumococcal conjugate vaccines (PCVs) become available for pediatric populations in the US, it is important to understand healthcare provider (HCP) preferences for and acceptability of PCVs. US HCPs (pediatricians, family medicine physicians and advanced practitioners) completed an online, cross-sectional survey between March and April 2023. HCPs were eligible if they recommended or prescribed vaccines to children age <24 months, spent ≥25% of their time in direct patient care, and had ≥2 y of experience in their profession. The survey included a discrete choice experiment (DCE) in which HCPs selected preferred options from different hypothetical vaccine profiles with systematic variation in the levels of five attributes. Relative attribute importance was quantified. Among 548 HCP respondents, the median age was 43.2 y, and the majority were male (57.9%) and practiced in urban areas (69.7%). DCE results showed that attributes with the greatest impact on HCP decision-making were 1) immune response for the shared serotypes covered by PCV13 (31.4%), 2) percent of invasive pneumococcal disease (IPD) covered by vaccine serotypes (21.3%), 3) acute otitis media (AOM) label indication (20.3%), 4) effectiveness against serotype 3 (17.6%), and 5) number of serotypes in the vaccine (9.5%). Among US HCPs, the most important attribute of PCVs was comparability of immune response for PCV13 shared serotypes, while the number of serotypes was least important. Findings suggest new PCVs eliciting high immune responses for serotypes that contribute substantially to IPD burden and maintaining immunogenicity against serotypes in existing PCVs are preferred by HCPs.
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Affiliation(s)
- Salini Mohanty
- Merck Research Laboratories, Merck & Co. Inc, Rahway, NJ, USA
| | - Jui-Hua Tsai
- Evidence & Access, OPEN Health, Bethesda, MD, USA
| | - Ning Ning
- Evidence & Access, OPEN Health, Newton, MA, USA
| | - Ana Martinez
- Evidence & Access, OPEN Health, Bethesda, MD, USA
| | | | - Marieke Heisen
- Evidence & Access, OPEN Health, Rotterdam, The Netherlands
| | - Jessica Weaver
- Merck Research Laboratories, Merck & Co. Inc, Rahway, NJ, USA
| | | | - Bianca Chun
- Merck Research Laboratories, Merck & Co. Inc, Rahway, NJ, USA
| | - Thomas W. Weiss
- Merck Research Laboratories, Merck & Co. Inc, Rahway, NJ, USA
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Geoghegan S, Faerber J, Stephens L, Gillan H, Drew RJ, Eogan M, Feemster KA, Butler KM. Preparing for Group B Streptococcus vaccine. Attitudes of pregnant women in two countries. Hum Vaccin Immunother 2023; 19:2195331. [PMID: 37036198 PMCID: PMC10132231 DOI: 10.1080/21645515.2023.2195331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Group B Streptococcus (GBS) vaccines, designed to be given to pregnant women, are in clinical trials. There is an opportunity to conduct preparatory research now to understand the drivers of and barriers to GBS vaccine acceptance. This will enable targeted interventions so that delays in vaccine uptake might be avoided. A multicenter, mixed-methodology, cross-sectional study evaluated the acceptability of a hypothetical GBS vaccine among pregnant women in two countries with differing health systems. Pregnant women in Philadelphia, US, and Dublin, Ireland, completed an electronic survey and a Discrete Choice Experiment. Five hundred and two women were included in the final analysis. Fifty-three percent of US and 30% of Irish participants reported both awareness and understanding of GBS. The median likelihood score for vaccine receipt (measured on a 10-point scale) was 9 (US: 9 (IQR 7-10), IRL: 9 (IQR 6-10)). Among the US participants, identifying as Black or African American was associated with a lower likelihood of vaccine receipt. Possession of a college degree was associated with increased likelihood of vaccine receipt. Perceived infant benefit was the most important driver of GBS vaccine acceptance. Safety concerns about a novel vaccine was the most prominent barrier identified. Good GBS vaccine uptake is achievable through strong messaging that highlights vaccine safety and the potential infant benefits. Preparation for vaccine implementation should include efforts to increase awareness among pregnant women about GBS infection and a continued focus on improving acceptability of currently recommended maternal vaccines, particularly in population subgroups with low uptake of maternal immunizations.
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Affiliation(s)
- Sarah Geoghegan
- Department of Paediatric Infectious Diseases and Immunology, Children's Health Ireland at Crumlin & Temple Street, Dublin, Ireland
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jennifer Faerber
- Biostatistics, Children's Hospital of Philadelphia, Philadelphia, Dublin, Ireland
| | - Laura Stephens
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Hannah Gillan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Richard J Drew
- Clinical Innovation Unit, The Rotunda Hospital, Dublin, Ireland
- Irish Meningitis and Sepsis Reference laboratory, Children's health Ireland at Temple Street, Dublin, Ireland
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maeve Eogan
- Division of Obstetrics & Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Kristen A Feemster
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, Upper Gwynedd, PA, USA
| | - Karina M Butler
- School of Medicine, University College Dublin, Dublin, Ireland
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Srivastava T, Head KJ, O'Dell SM, Feemster KA, Panozzo CA, Zimet GD, Kornides ML. Characterizing U.S. mothers with high human papillomavirus vaccine intent yet unvaccinated adolescents. Prev Med 2023; 169:107472. [PMID: 36854366 DOI: 10.1016/j.ypmed.2023.107472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/03/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
HPV vaccination rates remain suboptimal in the United States. While the current literature focuses on expressly hesitant parents, few studies have examined parents with "high intent", or those indicating they definitely will vaccinate and have had the opportunity but not yet vaccinated their adolescents. Our objective was to differentiate characteristics of mothers with high intent from those who already vaccinated their adolescents using various socioeconomic, previous vaccine decision-making, and healthcare provider relationship-related variables. English-speaking mothers or female guardians of adolescents ages 11-14 years living in low HPV vaccine uptake states within the U.S. in September 2018 were recruited from a national survey panel as part of a larger study. We assessed HPV vaccine status of their adolescents and categorized respondents into two categories: Already Vaccinated and High Intent. We assessed differences using a multivariable logistic regression model. Among 2406 mothers, 18% reported high intent vs. 82% already having vaccinated. Mothers with high intent were more likely to identify as non-Hispanic White (p = 0.01), to have a younger adolescent (p < 0.001), and to report not receiving a provider HPV vaccination recommendation (p < 0.001). Mothers who estimated that half/more (vs. less) of their child's friends have received/will receive the vaccine had higher odds of already vaccinating (p < 0.001). Our findings suggest that clinicians may be able to improve HPV vaccination uptake within their practices by giving repeated, high-quality recommendations to parents of children who are not yet vaccinated. Additionally, these findings indicate perceived social norms may play a large role in on-time vaccine uptake. Reassuring hesitant parents that most parents accept the vaccine may also improve uptake in clinical practice.
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Affiliation(s)
- Tuhina Srivastava
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Cavanaugh Hall 307C, 425 University Boulevard, Indianapolis, IN 46202, USA
| | - Sean M O'Dell
- Department of Population Health Sciences, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA; Department of Psychiatry and Behavioral Health, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10(th) Street, HS 1001, Indianapolis, IN 46202, USA
| | - Melanie L Kornides
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, USA.
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Mohanty S, Tsai JH, Ning N, Pena-Molina A, Verma RP, Heisen M, Weaver J, Feemster KA, Weiss T, Schmier J. 583. Preferences and Attitudes of Healthcare Providers towards Pneumococcal Conjugate Vaccines (PCVs) for Children Ages Two and Under in the United States (US). Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
As higher-valent PCVs are currently in late-stage clinical development for pediatric use, it is important to understand how healthcare providers (HCPs) evaluate vaccine attributes when making recommendations for newer PCVs. The Advisory Committee on Immunization Practices considers feasibility and stakeholder acceptability in making vaccine recommendations; this study examined HCP preferences and attitudes towards new, higher-valent PCVs in children in the US.
Methods
Semi-structured qualitative interviews were conducted with 13 HCPs (6 pediatricians, 3 family practitioners, 3 nurse practitioners, and 1 physician assistant). US HCPs were recruited from an online panel and were eligible if they recommended or prescribed vaccines to children ≤ 2 years and spent ≥ 2 days a week providing care to pediatric patients. Providers were asked to rate a list of PCV attributes (generated by literature search) by their importance in influencing their PCV choices (1, not important; 10, most important). Interviews were recorded, transcribed, and analyzed.
Results
Among HCPs (mean age=49 years; 62% women; 38% urban, 38% suburban; mean years in practice=18 years), three main themes emerged: 1) Preferred attributes: The three most important PCV characteristics that affect HCPs’ recommendations are effectiveness against serotype 3 (rated 9.1), percent serotype coverage for invasive pneumococcal disease (IPD) (rated 8.9), and immune response for the shared PCV13 serotypes (rated 8.2). 2) PCV choice: Most respondents are interested in having more PCV options, particularly options with higher efficacy or broader serotype coverage. 3) Immunogenicity vs serotype coverage: Between a higher immune response to certain serotypes and broader serotype coverage, 46% of HCPs prefer PCVs that elicit a higher immune response but narrower coverage, 31% prefer a PCV with broader serotype coverage, and 23% require more data before making a determination.
Conclusion
Both immune response and breadth of serotype coverage may influence HCPs decisions when recommending new PCVs. Additional analyses and interviews are underway to validate these findings and further explore other factors that may influence their preferences for recommending PCVs.
Disclosures
Salini Mohanty, DrPH, MPH, Merck & Co., Inc.: Employee Jui-Hua Tsai, MD, MHS, OPEN Health: Employee of OPEN Health, which received funding from Merck & Co., Inc. to conduct this research Ning Ning, PhD, MS, Open Health: I am an employee of OPEN Health, which received funding from Merck Ana Pena-Molina, MPH, OPEN Health: I am an employee of OPEN Health, which received funding from Merck Rishi P. Verma, MPH, OPEN Health: I am an employee of OPEN Health, which received funding from Merck Marieke Heisen, PhD, MSc, OPEN Health: I am an employee of OPEN Health, which received funding from Merck Jessica Weaver, PhD, MPH, Merck & Co., Inc.: Employee Kristen A. Feemster, MD, MPH, MSHPR, FAAP, Merck & Co., Inc.: Employee Thomas Weiss, DrPH, MPH, Merck & Co., Inc.: Employee Jordana Schmier, MA, OPEN Health: I am an employee of OPEN Health, which received funding from Merck.
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Abstract
While most children with coronavirus 2019 (COVID-19) experience mild illness, some are vulnerable to severe disease and develop long-term complications. Children with disabilities, those from lower-income homes, and those from racial and ethnic minority groups are more likely to be hospitalized and to have poor outcomes following an infection. For many of these same children, a wide range of social, economic, and environmental disadvantages have made it more difficult for them to access COVID-19 vaccines. Ensuring vaccine equity in children and decreasing health disparities promotes the common good and serves society as a whole. In this article, we discuss how the pandemic has exposed long-standing injustices in historically marginalized groups and provide a summary of the research describing the disparities associated with COVID-19 infection, severity, and vaccine uptake. Last, we outline several strategies for addressing some of the issues that can give rise to vaccine inequity in the pediatric population.
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Affiliation(s)
- Carlos R Oliveira
- Corresponding Author: Carlos R. Oliveira, M.D., Ph.D., 15 York Street, PO Box 208064, New Haven, CT 06520-8064, USA. E-mail:
| | - Kristen A Feemster
- Vaccine Education Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erlinda R Ulloa
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Division of Infectious Diseases, Children’s Health of Orange County, Orange, CA 92868, USA
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Browne SK, Feemster KA, Shen AK, Green-McKenzie J, Momplaisir FM, Faig W, Offit PA, Kuter BJ. Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia. Infect Control Hosp Epidemiol 2022; 43:1424-1432. [PMID: 34538290 PMCID: PMC8503076 DOI: 10.1017/ice.2021.410] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania. DESIGN, SETTING, AND PARTICIPANTS HCP were surveyed in November-December 2020 about their intention to receive the COVID-19 vaccine. METHODS The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines. RESULTS Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2). CONCLUSIONS Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.
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Affiliation(s)
- Safa K. Browne
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A. Feemster
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela K. Shen
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith Green-McKenzie
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Florence M. Momplaisir
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter Faig
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul A. Offit
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Geoghegan S, Shuster S, Butler KM, Feemster KA. Understanding Barriers and Facilitators to Maternal Immunization: A Systematic Narrative Synthesis of the Published Literature. Matern Child Health J 2022; 26:2198-2209. [PMID: 36173503 PMCID: PMC9521012 DOI: 10.1007/s10995-022-03508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction Vaccines are being developed against Group B Streptococcus and respiratory syncytial virus. These vaccines are designed to be given to pregnant women to protect infants; thus, their success depends on uptake in this population. Maternal immunization programs have struggled to achieve target coverage rates. This systematic narrative synthesis aims to define the most important barriers and facilitators for maternal immunization and to identify priority areas for future research. Methods A search strategy was developed in Medline and adapted according to the requirements of additional search engines. Two reviewers independently reviewed the studies, using pre-specified inclusion and exclusion criteria. Results sections of included studies were coded, and thematic analysis was used to identify prominent themes. Results 321 studies were included in the final review. Most studies came from North America (37%), Europe (26%) or East Asia, Australia and New Zealand (22%). Low-and middle-income countries were under-represented. Five percent of studies came from Sub-Saharan Africa, and 2% came from South Asia. The prominent factors impacting maternal immunization were provider recommendation, perceived risks and benefits of maternal vaccines for the infant, race, birthplace, and access to healthcare. Few studies explored reasons behind racial and socioeconomic disparities in maternal immunization rates. Discussion A strong provider recommendation, equitable access to prenatal care and messaging that focuses on vaccine safety and infant benefits emerged as the key components for optimising vaccine uptake among pregnant women. Research among healthcare providers, minority groups and in low- and-middle-income countries was lacking. In anticipation of the expansion of maternal immunization programmes, focused research is needed to address these gaps and inform a successful public health strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03508-0.
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Affiliation(s)
- Sarah Geoghegan
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Sydney Shuster
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Karina M Butler
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.,Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Kristen A Feemster
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Building 421, Philadelphia, PA, 19104, USA.,Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, 351 North Sumneytown Pike, Upper Gwynedd, PA, 19454, USA
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8
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Browne S, Feemster KA. Human papillomavirus: optimizing opportunities for prevention. Curr Opin Pediatr 2022; 34:132-139. [PMID: 35152231 DOI: 10.1097/mop.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is a precursor to anogenital and oropharyngeal cancers. Effective prevention is available through HPV vaccination and emerging evidence demonstrates the potential to significantly impact HPV-associated disease through reductions in the incidence of genital warts, precancerous cervical lesions, and cervical cancer. Indications have also recently expanded to include the prevention of oropharyngeal cancer, an outcome that has been increasing in incidence for men and women. Yet despite demonstrated effectiveness, the potential for broader impact and well-established routine recommendations for administration to adolescents, barriers to vaccine uptake persist. The purpose of this review is to provide an update on HPV prevention in the US, including trends in disease burden, HPV vaccine effectiveness, evolving vaccine recommendations and opportunities and barriers to their implementation. RECENT FINDINGS Several studies have demonstrated that HPV vaccination has the potential to prevent most HPV-attributable cancers. Ongoing research addresses questions related to duration of protection, effectiveness in vulnerable populations, vaccine schedules and strategies to improve access and optimize uptake. SUMMARY To ensure continued impact on the prevention of HPV-associated disease and subsequent cancer, it is crucial to address gaps in vaccine uptake. A strong recommendation for all persons for whom HPV vaccines are indicated, alongside initiatives to increase awareness of HPV vaccination and address specific concerns, can improve uptake among hesitant populations. Globally, efforts to bolster immunization programs are needed to broaden access to HPV vaccination.
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Affiliation(s)
- Safa Browne
- Vaccine Education Center, The Children's Hospital of Philadelphia
| | - Kristen A Feemster
- Vaccine Education Center, The Children's Hospital of Philadelphia
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
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Kelly MS, Plunkett C, Yu Y, Aquino JN, Patel SM, Hurst JH, Young RR, Smieja M, Steenhoff AP, Arscott-Mills T, Feemster KA, Boiditswe S, Leburu T, Mazhani T, Patel MZ, Rawls JF, Jawahar J, Shah SS, Polage CR, Cunningham CK, Seed PC. Non-diphtheriae Corynebacterium species are associated with decreased risk of pneumococcal colonization during infancy. ISME J 2022; 16:655-665. [PMID: 34511605 PMCID: PMC8857224 DOI: 10.1038/s41396-021-01108-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 02/08/2023]
Abstract
Streptococcus pneumoniae (pneumococcus) is a leading cause of severe infections among children and adults. Interactions between commensal microbes in the upper respiratory tract and S. pneumoniae are poorly described. In this study, we sought to identify interspecies interactions that modify the risk of S. pneumoniae colonization during infancy and to describe development of the upper respiratory microbiome during infancy in a sub-Saharan African setting. We collected nasopharyngeal swabs monthly (0-6 months of age) or bimonthly (6-12 months of age) from 179 mother-infant dyads in Botswana. We used 16S ribosomal RNA gene sequencing to characterize the nasopharyngeal microbiome and identified S. pneumoniae colonization using a species-specific PCR assay. We detect S. pneumoniae colonization in 144 (80%) infants at a median age of 71 days and identify a strong negative association between the relative abundance of the bacterial genera Corynebacterium within the infant nasopharyngeal microbiome and the risk of S. pneumoniae colonization. Using in vitro cultivation experiments, we demonstrate growth inhibition of S. pneumoniae by secreted factors from strains of several Corynebacterium species isolated from these infants. Finally, we demonstrate that antibiotic exposures and the winter season are associated with a decline in the relative abundance of Corynebacterium within the nasopharyngeal microbiome, while breastfeeding is associated with an increase in the Corynebacterium relative abundance. Our findings provide novel insights into the interspecies interactions that contribute to colonization resistance to S. pneumoniae and suggest that the nasopharyngeal microbiome may be a previously unrecognized mechanism by which environmental factors influence the risk of pneumococcal infections during childhood. Moreover, this work lays the foundation for future studies seeking to use targeted manipulation of the nasopharyngeal microbiome to prevent infections caused by S. pneumoniae.
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Affiliation(s)
- Matthew S. Kelly
- grid.7621.20000 0004 0635 5486Botswana-University of Pennsylvania Partnership, Gaborone, Botswana ,grid.26009.3d0000 0004 1936 7961Division of Pediatric Infectious Diseases, Duke University, Durham, NC USA
| | - Catherine Plunkett
- grid.16753.360000 0001 2299 3507Division of Pediatric Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Yahe Yu
- grid.40803.3f0000 0001 2173 6074Department of Mathematics, North Carolina State University, Raleigh, NC USA
| | - Jhoanna N. Aquino
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Infectious Diseases, Duke University, Durham, NC USA
| | - Sweta M. Patel
- grid.26009.3d0000 0004 1936 7961Division of Pulmonary Allergy, and Critical Care Medicine, Duke University, Durham, NC USA
| | - Jillian H. Hurst
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Infectious Diseases, Duke University, Durham, NC USA
| | - Rebecca R. Young
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Infectious Diseases, Duke University, Durham, NC USA
| | - Marek Smieja
- grid.25073.330000 0004 1936 8227Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
| | - Andrew P. Steenhoff
- grid.7621.20000 0004 0635 5486Botswana-University of Pennsylvania Partnership, Gaborone, Botswana ,grid.239552.a0000 0001 0680 8770Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Tonya Arscott-Mills
- grid.7621.20000 0004 0635 5486Botswana-University of Pennsylvania Partnership, Gaborone, Botswana ,grid.239552.a0000 0001 0680 8770Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kristen A. Feemster
- grid.239552.a0000 0001 0680 8770Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Sefelani Boiditswe
- grid.7621.20000 0004 0635 5486Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Tirayaone Leburu
- grid.7621.20000 0004 0635 5486Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Tiny Mazhani
- grid.7621.20000 0004 0635 5486University of Botswana School of Medicine, Gaborone, Botswana
| | - Mohamed Z. Patel
- grid.7621.20000 0004 0635 5486University of Botswana School of Medicine, Gaborone, Botswana
| | - John F. Rawls
- grid.26009.3d0000 0004 1936 7961Department of Molecular Genetics and Microbiology, Duke University, Durham, NC USA
| | - Jayanth Jawahar
- grid.26009.3d0000 0004 1936 7961Department of Molecular Genetics and Microbiology, Duke University, Durham, NC USA
| | - Samir S. Shah
- grid.239573.90000 0000 9025 8099Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Christopher R. Polage
- grid.26009.3d0000 0004 1936 7961Department of Pathology, Duke University, Durham, NC USA
| | - Coleen K. Cunningham
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Infectious Diseases, Duke University, Durham, NC USA
| | - Patrick C. Seed
- grid.16753.360000 0001 2299 3507Division of Pediatric Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Feemster KA, Kim Y, Abe M, Johnson K, Sasaki S. Response to Igarashi, et al, cost-effectiveness analysis for PCV13 in adults 60 years and over with underlying medical conditions which put them at an elevated risk of pneumococcal disease in Japan. Expert Rev Vaccines 2022; 21:589-590. [PMID: 35172667 DOI: 10.1080/14760584.2022.2036127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kristen A Feemster
- Global Medical and Scientific Affairs, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Youngju Kim
- Medical Affairs- Vaccines, Merck Sharp & Dohme Corp. K.K., Tokyo, Japan
| | - Machiko Abe
- Medical Affairs- Vaccines, Merck Sharp & Dohme Corp. K.K., Tokyo, Japan
| | - Kelly Johnson
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Shin Sasaki
- Medical Affairs- Vaccines, Merck Sharp & Dohme Corp. K.K., Tokyo, Japan
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11
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Patel SM, Shaik-Dasthagirisaheb YB, Congdon M, Young RR, Patel MZ, Mazhani T, Boiditswe S, Leburu T, Lechiile K, Arscott-Mills T, Steenhoff AP, Feemster KA, Shah SS, Cunningham CK, Pelton SI, Kelly MS. Evolution of pneumococcal serotype epidemiology in Botswana following introduction of 13-valent pneumococcal conjugate vaccine. PLoS One 2022; 17:e0262225. [PMID: 34986196 PMCID: PMC8730465 DOI: 10.1371/journal.pone.0262225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Pneumococcal conjugate vaccines reduce the burden of invasive pneumococcal disease, but the sustained effect of these vaccines can be diminished by an increase in disease caused by non-vaccine serotypes. To describe pneumococcal serotype epidemiology in Botswana following introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in July 2012, we performed molecular serotyping of 268 pneumococcal strains isolated from 221 children between 2012 and 2017. The median (interquartile range) age of the children included in this analysis was 6 (3,12) months. Fifty-nine percent of the children had received at least one dose of PCV-13 and 35% were fully vaccinated with PCV-13. While colonization by vaccine serotypes steadily declined following PCV-13 introduction, 25% of strains isolated more than 3 years after vaccine introduction were PCV-13 serotypes. We also observed an increase in colonization by non-vaccine serotypes 21 and 23B, which have been associated with invasive pneumococcal disease and antibiotic resistance in other settings.
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Affiliation(s)
- Sweta M. Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | - Morgan Congdon
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Rebecca R. Young
- Division of Pediatric Infectious Diseases, Duke University, Durham, NC, United States of America
| | - Mohamed Z. Patel
- Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tiny Mazhani
- Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Tirayaone Leburu
- Botswana—University of Pennsylvania Partnership, Gaborone, Botswana
| | - Kwana Lechiile
- Botswana—University of Pennsylvania Partnership, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana—University of Pennsylvania Partnership, Gaborone, Botswana
| | - Andrew P. Steenhoff
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Division of Pediatric Infectious Diseases and Global Health Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Kristen A. Feemster
- Division of Pediatric Infectious Diseases and Global Health Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Medical Center, Cincinnati, OH, United States of America
| | - Coleen K. Cunningham
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States of America
| | - Stephen I. Pelton
- Division of Pediatric Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Matthew S. Kelly
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Pediatric Infectious Diseases, Duke University, Durham, NC, United States of America
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12
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Dunn MG, Lessa FC, Sánchez J, Cordero R, Feris-Iglesias J, Cedano D, Carvalho MDG, Fernández J, Feemster KA. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic. J Infect Dis 2021; 224:S237-S247. [PMID: 34469551 PMCID: PMC8409531 DOI: 10.1093/infdis/jiab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post–PCV13 introduction. Methods A prospective cohort study of 125 children aged 2–35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4–6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point. Results Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18–.79], and 0.14 [95% CI, .04–.45], respectively). The same associations were not found at follow-up assessment. Conclusions Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.
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Affiliation(s)
- Maria G Dunn
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Correspondence: Maria Dunn, DO, Children’s Hospital of Philadelphia Global Health Center, 2716 South St, Seventh Floor #7410, Philadelphia PA 19146, USA ()
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline Sánchez
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Ramona Cordero
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | | | - Doraliza Cedano
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Maria da Glória Carvalho
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Josefina Fernández
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Kristen A Feemster
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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13
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Momplaisir FM, Kuter BJ, Ghadimi F, Browne S, Nkwihoreze H, Feemster KA, Frank I, Faig W, Shen AK, Offit PA, Green-McKenzie J. Racial/Ethnic Differences in COVID-19 Vaccine Hesitancy Among Health Care Workers in 2 Large Academic Hospitals. JAMA Netw Open 2021; 4:e2121931. [PMID: 34459907 PMCID: PMC8406078 DOI: 10.1001/jamanetworkopen.2021.21931] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Significant differences in hesitancy to receive COVID-19 vaccination by race/ethnicity have been observed in several settings. Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers (HCWs), who face occupational and community exposure to COVID-19, have not been well described. OBJECTIVE To assess hesitancy to COVID-19 vaccination among HCWs across different racial/ethnic groups and assess factors associated with vaccine hesitancy. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted among HCWs from 2 large academic hospitals (ie, a children's hospital and an adult hospital) over a 3-week period in November and December 2020. Eligible participants were HCWs with and without direct patient contact. A 3-step hierarchical multivariable logistic regression was used to evaluate associations between race/ethnicity and vaccine hesitancy controlling for demographic characteristics, employment characteristics, COVID-19 exposure risk, and being up to date with routine vaccinations. Data were analyzed from February through March 2021. MAIN OUTCOMES AND MEASURES Vaccine hesitancy, defined as not planning on, being unsure about, or planning to delay vaccination, served as the outcome. RESULTS Among 34 865 HCWs eligible for this study, 12 034 individuals (34.5%) completed the survey and 10 871 individuals (32.2%) completed the survey and reported their race/ethnicity. Among 10 866 of these HCWs with data on sex, 8362 individuals (76.9%) were women, and among 10 833 HCWs with age data, 5923 individuals (54.5%) were younger than age 40 years. (Percentages for demographic and clinical characteristics are among the number of respondents for each type of question.) There were 8388 White individuals (77.2%), 882 Black individuals (8.1%), 845 Asian individuals (7.8%), and 449 individuals with other or mixed race/ethnicity (4.1%), and there were 307 Hispanic or Latino individuals (2.8%). Vaccine hesitancy was highest among Black HCWs (732 individuals [83.0%]) and Hispanic or Latino HCWs (195 individuals [63.5%]) (P < .001). Among 5440 HCWs with vaccine hesitancy, reasons given for hesitancy included concerns about side effects (4737 individuals [87.1%]), newness of the vaccine (4306 individuals [79.2%]), and lack of vaccine knowledge (4091 individuals [75.2%]). The adjusted odds ratio (aOR) for vaccine hesitancy was 4.98 (95% CI, 4.11-6.03) among Black HCWs, 2.10 (95% CI, 1.63-2.70) among Hispanic or Latino HCWs, 1.48 (95% CI, 1.21-1.82) among HCWs with other or mixed race/ethnicity, and 1.47 (95% CI, 1.26-1.71) among Asian HCWs compared with White HCWs (P < .001). The aOR was decreased among Black HCWs when adjusting for employment characteristics and COVID-19 exposure risk (aOR, 4.87; 95% CI, 3.96-6.00; P < .001) and being up to date with prior vaccines (aOR, 4.48; 95% CI, 3.62-5.53; P < .001) but not among HCWs with other racial/ethnic backgrounds. CONCLUSIONS AND RELEVANCE This study found that vaccine hesitancy before the authorization of the COVID-19 vaccine was increased among Black, Hispanic or Latino, and Asian HCWs compared with White HCWs. These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed.
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Affiliation(s)
- Florence M. Momplaisir
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Safa Browne
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kristen A. Feemster
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ian Frank
- Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Walter Faig
- Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Angela K. Shen
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul A. Offit
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judith Green-McKenzie
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of Occupational and Environmental Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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14
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Affiliation(s)
- Kristen A Feemster
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine; Division of Infectious Diseases, The Children's Hospital of Philadelphia; Philadelphia Department of Public Health Division of Disease Control, Philadelphia, PA
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15
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Feemster KA, Head KJ, Panozzo CA, O'Dell SM, Zimet GD, Kornides ML. Efficacy of tailored messages to improve behavioral intent to accept HPV vaccination among mothers may be moderated by sociodemographics. Prev Med Rep 2021; 23:101413. [PMID: 34150474 PMCID: PMC8192722 DOI: 10.1016/j.pmedr.2021.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
The efficacy of a tailored video intervention differed by sociodemographics. Further research should evaluate interventions tailored by sociodemographics. Tailoring interventions by child age and other factors may improve efficacy.
We assessed differences in response to a tailored recommendation intervention for HPV vaccine by participants’ sociodemographic characteristics in this exploratory sub-analysis of a larger web-based, randomized-controlled trial on tailored messaging among mothers with low intent to vaccinate their 11–14-year-old child against HPV. The intervention consisted of pre-recorded video messages tailored to 1–5 common concerns about HPV vaccine. In these exploratory analyses, we used generalized linear models to assess differences in post-intervention intent across intervention arms, stratified by sociodemographic characteristics among 496 trial participants. We found significantly higher post-intervention intent in the intervention participants versus the control group among mothers: 1) with younger children; 2) with white vs. black children; 3) with Non-Hispanic children; 4) who were younger; 5) with some college or vocational training; with household incomes of ≥$100,000; and 7) with 1–2 children. Our findings of effect modification by certain sociodemographic factors such as age, race/ethnicity, and household income should be considered when designing similar tailored messaging interventions.
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Affiliation(s)
- Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Katharine J Head
- Indiana University School of Liberal Arts, Department of Communication Studies, Cavanaugh Hall 307C, 425 University Boulevard, Indianapolis, IN 46202, USA
| | | | - Sean M O'Dell
- Department of Psychiatry and Behavioral Health, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA.,Department of Population Health Sciences, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10 Street Suite 1001, Indianapolis, IN 46202, USA
| | - Melanie L Kornides
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Division of Adolescent Medicine, Perelman School of Medicine, 418 Curie Boulevard, Office 401, Philadelphia, PA 19104, USA
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16
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Geoghegan S, Stephens LC, Feemster KA, Drew RJ, Eogan M, Butler KM. "This choice does not just affect me." Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study. Hum Vaccin Immunother 2021; 17:3371-3376. [PMID: 34009096 DOI: 10.1080/21645515.2021.1924018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Public health experts agree that pregnant women who fall into priority groups may be offered a Coronavirus Disease 2019 (COVID-19) vaccine. However, little is known about attitudes of pregnant women toward COVID-19 vaccination. We surveyed 300 pregnant women during the roll out of the Pfizer-BioNTech vaccine in Ireland. Women rated likelihood of receipt of a vaccine during pregnancy, on a 1-10 scale (1 = very unlikely, 10 = very likely). One hundred and thirteen (38%) women responded with a score of ≥8, while a similar proportion (36%) selected a score of ≤2. Safety of their unborn infant was the primary driver of decision making among survey participants, but specific safety concerns differed according to likely acceptance of a vaccine. Communication about COVID-19 vaccines to pregnant women must explicitly address safety. Pregnant women and their health-care providers should be supported with accessible interpretations of data so that they can make the best choice for their individual risk profile.
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Affiliation(s)
- Sarah Geoghegan
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Paediatric Infectious Diseases, Children's Health Ireland at Crumlin & Temple Street, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Laura C Stephens
- Department of Medicine, Mater Misericordiae Hospital, Dublin, Ireland
| | - Kristen A Feemster
- Division of Paediatric Infectious Diseases, Children's Health Ireland at Crumlin & Temple Street, Dublin, Ireland.,Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, Upper Gwynedd, PA, USA
| | - Richard J Drew
- Clinical Innovation Unit, The Rotunda Hospital, Dublin, Ireland
| | - Maeve Eogan
- Division of Obstetrics & Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Karina M Butler
- School of Medicine, University College Dublin, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
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17
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Felt SA, Sun Y, Jozwik A, Paras A, Habibi MS, Nickle D, Anderson L, Achouri E, Feemster KA, Cárdenas AM, Turi KN, Chang M, Hartert TV, Sengupta S, Chiu C, López CB. Detection of respiratory syncytial virus defective genomes in nasal secretions is associated with distinct clinical outcomes. Nat Microbiol 2021; 6:672-681. [PMID: 33795879 PMCID: PMC9098209 DOI: 10.1038/s41564-021-00882-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/23/2021] [Indexed: 02/01/2023]
Abstract
Respiratory syncytial virus (RSV) causes respiratory illness in children, immunosuppressed individuals and the elderly. However, the viral factors influencing the clinical outcome of RSV infections remain poorly defined. Defective viral genomes (DVGs) can suppress virus replication by competing for viral proteins and by stimulating antiviral immunity. We studied the association between detection of DVGs of the copy-back type and disease severity in three RSV A-confirmed cohorts. In hospitalized children, detection of DVGs in respiratory samples at or around the time of admission associated strongly with more severe disease, higher viral load and a stronger pro-inflammatory response. Interestingly, in experimentally infected adults, the presence of DVGs in respiratory secretions differentially associated with RSV disease severity depending on when DVGs were detected. Detection of DVGs early after infection associated with low viral loads and mild disease, whereas detection of DVGs late after infection, especially if DVGs were present for prolonged periods, associated with high viral loads and severe disease. Taken together, we demonstrate that the kinetics of DVG accumulation and duration could predict clinical outcome of RSV A infection in humans, and thus could be used as a prognostic tool to identify patients at risk of worse clinical disease.
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Affiliation(s)
- Sébastien A. Felt
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Present address: Department of Molecular Microbiology and Center for Women Infectious Disease Research, Washington University School of Medicine, St Louis, MO, USA.,These authors contributed equally: Sébastien A. Felt, Yan Sun
| | - Yan Sun
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Present address: Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA.,These authors contributed equally: Sébastien A. Felt, Yan Sun
| | - Agnieszka Jozwik
- Department of Infectious Disease, Imperial College London, London, UK
| | - Allan Paras
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - Larry Anderson
- Pediatric Infectious Disease, Emory University, Atlanta, GA, USA
| | - Emna Achouri
- Department of Molecular Microbiology and Center for Women Infectious Disease Research, Washington University School of Medicine, St Louis, MO, USA
| | - Kristen A. Feemster
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ana María Cárdenas
- Infectious Disease Diagnostics Laboratory, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Present address: Becton, Dickinson and Company, Sparks, MD, USA
| | - Kedir N. Turi
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Tina V. Hartert
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaon Sengupta
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK
| | - Carolina B. López
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Present address: Department of Molecular Microbiology and Center for Women Infectious Disease Research, Washington University School of Medicine, St Louis, MO, USA
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18
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Kuter BJ, Browne S, Momplaisir FM, Feemster KA, Shen AK, Green-McKenzie J, Faig W, Offit PA. Perspectives on the receipt of a COVID-19 vaccine: A survey of employees in two large hospitals in Philadelphia. Vaccine 2021; 39:1693-1700. [PMID: 33632563 PMCID: PMC7885691 DOI: 10.1016/j.vaccine.2021.02.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Background Health care personnel have been identified by the ACIP as a priority group for COVID-19 vaccination. We conducted a survey in November-December 2020 at two large, academic hospitals in Philadelphia to evaluate the intention of hospital employees to be vaccinated. Methods The survey was sent electronically to all employees (clinical and nonclinical staff) at a children’s hospital and an adult hospital. The survey was voluntary and confidential. Questions focused on plans to receive a COVID-19 vaccine when available, reasons why employees would/would not get vaccinated, when employees planned to be vaccinated, vaccine safety and efficacy features that would be acceptable, and past history of receipt of other vaccines by the employee and family. Responses were analyzed using univariate and multiple logistic regression methods. Results A total of 12,034 hospital employees completed the survey (a 34.5% response rate). Overall, 63.7% of employees reported that they planned to receive a COVID-19 vaccine, 26.3% were unsure, and 10.0% did not plan to be vaccinated. Over 80% of those unsure or unwilling to be vaccinated expressed concerns about vaccine side effects and the vaccines’ newness. In multivariable logistic regression, persons planning to take a COVID-19 vaccine were more likely to be older, male, more educated, Asian or White, up-to-date on vaccinations, without direct patient contact, and tested for COVID-19 in the past. No significant difference in intention to be vaccinated was found between those with higher versus lower levels of exposure to COVID-19 patients or the number of previous exposures to patients with COVID-19. Conclusions While the majority of hospital employees are planning to receive a COVID-19 vaccine, many are unsure or not planning to do so. Further education of hospital employees about the safety, efficacy, and value of the currently available COVID-19 vaccines is critical to vaccine acceptance in this population.
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Affiliation(s)
- Barbara J Kuter
- Vaccine Education Center, Children's Hospital of Philadelphia, United States.
| | - Safa Browne
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | - Angela K Shen
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
| | | | - Walter Faig
- Children's Hospital of Philadelphia, United States
| | - Paul A Offit
- Vaccine Education Center, Children's Hospital of Philadelphia, United States
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19
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Katsuta T, Moser CA, Feemster KA, Saitoh A, Offit PA. Comparison of immunization systems in Japan and the United States - What can be learned? Vaccine 2020; 38:7401-7408. [PMID: 33004240 DOI: 10.1016/j.vaccine.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
Recently, efforts have been made to fill a so-called "vaccine gap" between Japan and other countries; however, more work remains. Concerns about adverse events following immunization (AEFI) resulted in an historically passive approach to policy making in the National Immunization Program (NIP). For example, reports of AEFI following human papillomavirus vaccine (HPVV) in 2013 led the Japanese government to withdraw its proactive recommendations, resulting in a sharp drop in HPVV coverage rate to less than 1.0%. In this report, we review key historical incidents that led to the current immunization system in Japan, compare it to that in the United States, and discuss strategies for improving the Japanese immunization system. By strengthening existing policies and programs, such as National Immunization Technical Advisory Groups and AEFI reporting, compensation laws, and immunization education, the remaining vaccine gap in Japan could be filled.
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Affiliation(s)
- Tomohiro Katsuta
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan. katsuta-7-@marianna-u.ac.jp
| | - Charlotte A Moser
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Immunization Program and Acute Communicable Diseases, Philadelphia Department of Public Health, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Paul A Offit
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Sandler K, Srivastava T, Fawole OA, Fasano C, Feemster KA. Understanding vaccine knowledge, attitudes, and decision-making through college student interviews. J Am Coll Health 2020; 68:593-602. [PMID: 30908142 DOI: 10.1080/07448481.2019.1583660] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/26/2018] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Objective: We aimed to explore knowledge, attitudes, and beliefs about vaccines required for college-entry and vaccine-related behaviors among college students. Participants: Thirty-three full-time undergraduate students, ≥ 18 years old, enrolled at public (2) and private (3) colleges and universities in metropolitan Philadelphia in fall 2016. Methods: We conducted semistructured interviews, which were double-coded with 5,015 comments overall and 99.3% intercoder reliability (κ = 0.779) using NVivo 11 software. Results: Six key themes emerged: (1) low knowledge about vaccines and requirements; (2) mixed attitudes about required vs. recommended vaccines; (3) high trust in medical professionals; (4) low perceived risk for vaccine-preventable disease outbreaks; (5) substantial parental influence on students' decision-making; and (6) low utilization of Student Health Services. Conclusions: This study revealed lack of knowledge about and low prioritization of vaccination despite overall positive attitudes towards vaccines. Prematriculation education of college students is critical to increasing vaccine knowledge and use.
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Affiliation(s)
- Kayla Sandler
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tuhina Srivastava
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, Pennsylvania, USA
| | - Oluwatunmise A Fawole
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, Pennsylvania, USA
| | - Caitlin Fasano
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, Pennsylvania, USA
| | - Kristen A Feemster
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
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21
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Patel SM, Jallow S, Boiditswe S, Madhi SA, Feemster KA, Steenhoff AP, Arscott-Mills T, Muthoga C, Ajibola G, Shapiro R, Shah SS, Cunningham CK, Kelly MS. Placental Transfer of Respiratory Syncytial Virus Antibody Among HIV-Exposed, Uninfected Infants. J Pediatric Infect Dis Soc 2020; 9:349-356. [PMID: 31549157 PMCID: PMC7358043 DOI: 10.1093/jpids/piz056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Maternal human immunodeficiency virus (HIV) infection is associated with lower placental transfer of antibodies specific to several childhood pathogens. Our objective for this study was to evaluate the effect of maternal HIV infection on the placental transfer of respiratory syncytial virus (RSV)-neutralizing antibodies. METHODS We conducted a cross-sectional study of mothers and their newborn infants at a tertiary hospital in Gaborone, Botswana, between March 2015 and December 2015. We measured serum RSV antibody levels by using a microneutralization assay. We used multivariable linear regression to evaluate the effect of maternal HIV infection on maternal RSV antibody levels, placental transfer of RSV antibodies, and newborn RSV antibody levels. RESULTS Of 316 mothers, 154 (49%) were infected with HIV. The placental transfer ratios for RSV antibodies to HIV-exposed, uninfected (HEU) and HIV-unexposed, uninfected infants were 1.02 and 1.15, respectively. The geometric mean titer (95% confidence interval) of RSV-neutralizing antibodies was 2657 (2251-3136) among HEU newborns and 2911 (2543-3331) among HIV-unexposed, uninfected newborns. In multivariable analyses, maternal HIV infection was associated with lower placental transfer of RSV antibodies (P = .02) and a lower level of RSV antibodies among newborns (P = .002). Among HEU newborns, higher birth weight (P = .004) and an undetectable maternal antenatal viral load (P = .01) were associated with more effective placental transfer of RSV antibodies. CONCLUSIONS Maternal human immunodeficiency virus (HIV) infection is associated with lower mother-to-fetus transfer of serum RSV-neutralizing antibodies. HEU infants should be prioritized for preventive interventions for RSV. Maternal viral suppression through combination antiretroviral therapy has the potential to improve immunity to RSV among HIV-exposed infants.
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Affiliation(s)
- Sweta M Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina
| | - Sabelle Jallow
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Research Chair, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kristen A Feemster
- Global Health Center, Children’s Hospital of Philadelphia, Pennsylvania
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania
| | - Andrew P Steenhoff
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
- Global Health Center, Children’s Hospital of Philadelphia, Pennsylvania
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania
| | - Tonya Arscott-Mills
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
- Global Health Center, Children’s Hospital of Philadelphia, Pennsylvania
| | - Charles Muthoga
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Roger Shapiro
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Ohio
| | - Coleen K Cunningham
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
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22
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Fawole OA, Kelly MS, Steenhoff AP, Feemster KA, Crotty EJ, Rattan MS, David T, Mazhani T, Shah SS, Andronikou S, Arscott-Mills T. Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia. Pediatr Radiol 2020; 50:913-922. [PMID: 32524176 PMCID: PMC7539136 DOI: 10.1007/s00247-020-04625-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/16/2019] [Accepted: 01/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In low- and middle-income countries, chest radiographs are most frequently interpreted by non-radiologist clinicians. OBJECTIVE We examined the reliability of chest radiograph interpretations performed by non-radiologist clinicians in Botswana and conducted an educational intervention aimed at improving chest radiograph interpretation accuracy among non-radiologist clinicians. MATERIALS AND METHODS We recruited non-radiologist clinicians at a referral hospital in Gaborone, Botswana, to interpret de-identified chest radiographs for children with clinical pneumonia. We compared their interpretations with those of two board-certified pediatric radiologists in the United States. We evaluated associations between level of medical training and the accuracy of chest radiograph findings between groups, using logistic regression and kappa statistics. We then developed an in-person training intervention led by a pediatric radiologist. We asked participants to interpret 20 radiographs before and immediately after the intervention, and we compared their responses to those of the facilitating radiologist. For both objectives, our primary outcome was the identification of primary endpoint pneumonia, defined by the World Health Organization as presence of endpoint consolidation or endpoint effusion. RESULTS Twenty-two clinicians interpreted chest radiographs in the primary objective; there were no significant associations between level of training and correct identification of endpoint pneumonia; concordance between respondents and radiologists was moderate (κ=0.43). After the training intervention, participants improved agreement with the facilitating radiologist for endpoint pneumonia from fair to moderate (κ=0.34 to κ=0.49). CONCLUSION Non-radiologist clinicians in Botswana do not consistently identify key chest radiographic findings of pneumonia. A targeted training intervention might improve non-radiologist clinicians' ability to interpret chest radiographs.
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Affiliation(s)
- Oluwatunmise A. Fawole
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,New York University School of Medicine, New York, NY, USA
| | - Matthew S. Kelly
- Botswana-UPenn Partnership, Gaborone, Botswana,Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Andrew P. Steenhoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Botswana-UPenn Partnership, Gaborone, Botswana,Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristen A. Feemster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Eric J. Crotty
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mantosh S. Rattan
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thuso David
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tiny Mazhani
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Savvas Andronikou
- Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Radiology, University of Cape Town, Cape Town, South Africa
| | - Tonya Arscott-Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Botswana-UPenn Partnership, University of Botswana Main Campus, P.O. Box AC 157 ACH, Gaborone, Botswana. .,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana. .,Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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23
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Finkelstein SR, Boland WA, Vallen B, Connell PM, Sherman GD, Feemster KA. Psychological reactance impacts ratings of pediatrician vaccine-related communication quality, perceived vaccine safety, and vaccination priority among U.S. parents. Hum Vaccin Immunother 2020; 16:1024-1029. [PMID: 31738632 DOI: 10.1080/21645515.2019.1694815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Physician communication surrounding vaccination is important in driving patient compliance with schedules and recommendations, but patient psychological factors suggest that communication strategies may have differential effects on patients. This paper investigates how psychological reactance, defined as an individuals' propensity to restore their autonomy when they perceive that others are trying to impose their will on them, impacts perceptions about physician communication and perceptions and prioritizations of vaccination. We propose and describe the results of a study that was conducted to assess the relationship between individual differences in reactance, perceived quality of pediatrician communication, perceptions of vaccination safety, and vaccination prioritization using a sample of parents. We recruited 300 parent participants via the online platform Prolific Academic in which they completed a computer-mediated survey. Results show that compared to those who are low in psychological reactance, those high in psychological reactance place less of a priority on vaccination, and that this relationship is driven by evaluations of physician communication quality and perceived vaccine safety. Our findings suggest that physicians should not adopt a one-size-fits-all approach when interacting with patients and should tailor messaging to patients based on psychological factors including reactance.
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Affiliation(s)
- Stacey R Finkelstein
- College of Business, Stony Brook University, Stony Brook, NY, USA.,Zicklin School of Business, City University of New York, Baruch College, New York, NY, USA
| | | | - Beth Vallen
- School of Business, Villanova University, Radnor, PA, USA
| | - Paul M Connell
- College of Business, Stony Brook University, Stony Brook, NY, USA
| | - Gary D Sherman
- College of Business, Stony Brook University, Stony Brook, NY, USA
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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24
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Caplan H, Srivastava T, Feemster KA. Perspectives on state vaccine education mandate policy and implementation among public health department officials: a qualitative study. Hum Vaccin Immunother 2020; 16:1145-1154. [PMID: 31424331 PMCID: PMC7227698 DOI: 10.1080/21645515.2019.1654352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/26/2019] [Accepted: 08/04/2019] [Indexed: 01/26/2023] Open
Abstract
In response to the increase in non-medical vaccine exemptions (NME), many states have adopted education mandates (EM), required vaccine education for parents requesting NMEs for their school-age children, but these EMs vary greatly in implementation. In order to learn about the administrative aspects of each state's EM, we interviewed fourteen health department officials from nine states with EMs. Interviews were conducted over the phone, transcribed by a professional transcription service, and double-coded using NVivo 12 by two members of the study staff. The coding resulted in 3698 comments overall, 98.5% inter-coder reliability, and a κ statistic of 0.691. We found no consistent format for content delivery, and methods used included in-person dialogs, web-based education, and video modules. Content of the education is not standardized, and education length ranges from 15 to 60 minutes. Four major themes about the EM policies emerged: (1) the use of EMs to eliminate "convenience exemptions;" (2) the importance of health department communication with health-care providers; (3) facilitators and barriers to implementation; and (4) the positive recommendation for other states to adopt EM policies. We concluded that current EM implementation varies greatly, but officials in states which have adopted EMs for parents requesting NMEs for school-entry vaccinations overwhelmingly recommend other states to adopt them as well. Key features of successful programs may include conversations with parents requesting NMEs and strong communication channels with health-care providers. Systematic tracking of vaccine status after exemption requests and education is necessary to quantitatively determine the effectiveness of EM programs.
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Affiliation(s)
- Holden Caplan
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Tuhina Srivastava
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristen A. Feemster
- Immunization Program and Acute Communicable Diseases, Philadelphia Department of Public Health, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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25
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Agawu A, Hanlon AL, Buttenheim AM, Song L, Fiks AG, Feemster KA. Disparities in Human Papillomavirus Vaccine Series Completion by Adolescent Males: A Retrospective Cohort Study. Acad Pediatr 2020; 20:364-373. [PMID: 31108236 DOI: 10.1016/j.acap.2019.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine has been recommended for male patients for the prevention of genital warts and precancerous anal lesions since 2009. Our objective was to characterize race and insurance-based disparities in HPV vaccine completion among male patients who initiated the HPV vaccine series. METHODS This was a retrospective cohort study of adolescent male patients in a primary care network who initiated the HPV vaccine series from October 2009 to December 2013. We measured vaccine series completion as the primary outcome. We evaluated associations between outcomes and race and insurance status, controlling for potential confounders and effect modification with multivariable logistic regression. Analyses were stratified by vaccine recommendation era (permissive vs routine). RESULTS In total, 42% of males in the cohort (16,691) completed the vaccine series. In the permissive vaccine era (2009-2011), non-black patients (53%) were more likely to complete than black patients (32%) and non-Medicaid patients (49%) were more likely to complete than Medicaid patients (33%). These differences persisted in the routine recommendation era (2012-2013). In both the permissive and routine eras, Medicaid insurance was associated with a larger reduction in the predicted probability of vaccine series completion for non-black patients. Adherence to the recommended vaccination schedule was low, with a median time to completion of 8.9 months. Using the updated completion schedule (2016), we found that completion rates were greater (54.1%) with continued differences based on race (60% vs 45.7% for non-black vs black patients) and insurance (57.4% vs 46.4% completion for non-Medicaid vs Medicaid patients). CONCLUSIONS We found significant disparities in HPV vaccine series completion rates among male patients based on race and insurance, unchanged based on era of initiation or visit frequency.
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Affiliation(s)
- Atu Agawu
- Division of General Pediatrics (A Agawu, AG Fiks).
| | - Alexandra L Hanlon
- School of Nursing, University of Pennsylvania (AL Hanlon, AM Buttenheim)
| | | | - Lihai Song
- Healthcare Analytics Unit, PolicyLab (L Song), Children's Hospital of Philadelphia
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26
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Srivastava T, Emmer K, Feemster KA. Impact of school-entry vaccination requirement changes on clinical practice implementation and adolescent vaccination rates in metropolitan Philadelphia. Hum Vaccin Immunother 2020; 16:1155-1165. [PMID: 31977274 DOI: 10.1080/21645515.2020.1712934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In 2017, Pennsylvania amended school-entry vaccination requirements including reduction of the provisional period from eight months to the first five days of school and requirement of meningococcal-conjugate vaccine (MCV4) for students entering 12th grade. This cross-sectional study evaluates the impact of these new requirements on clinical practice and vaccination rates among requirement-eligible adolescents within a large pediatric network in metropolitan Philadelphia. We surveyed providers from 24 pediatric primary care facilities across five Southeastern Pennsylvania counties to assess strategies for timely vaccination of children, facilitators and barriers to implementation of these strategies, and attitudes toward the new school vaccine requirements. Vaccination rates post-five-day grace period among eligible 12-18-year-old adolescents were calculated using aggregate electronic health record data and compared pre- and post-policy implementation (2016 vs. 2017) using two-sample tests of proportion. Overall, providers were supportive of the new vaccination requirements and reported that their facilities were equipped to accommodate the increased demand for vaccination visits prior to the beginning of the school year. There were modest increases in Tdap and MCV4 vaccination rates among 12-13-year-old adolescents by mid-September and a significant increase for MCV4 among 17-18-year-old adolescents (p > .001) in all regions. There were also statistically significant increases (p > .001) in MenB and HPV vaccination rates in this older age group. Our results suggest that these amended school-entry vaccination requirements may help improve timely vaccination rates for both required and non-required vaccines, increasing protection among students at the beginning of the school year.
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Affiliation(s)
- Tuhina Srivastava
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristel Emmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Immunization Program and Acute Communicable Diseases, Philadelphia Department of Public Health, Philadelphia, PA, USA
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27
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Teitelman AM, Gregory EF, Jayasinghe J, Wermers Z, Koo JH, Morone JF, Leri DC, Davis A, Feemster KA. Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study. JMIR Nurs 2020; 3:e19503. [PMID: 34345789 PMCID: PMC8279454 DOI: 10.2196/19503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. OBJECTIVE The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. METHODS Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. RESULTS Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI -2.15 to 0.15). CONCLUSIONS mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.
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Affiliation(s)
- Anne M Teitelman
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Emily F Gregory
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
| | - Joshua Jayasinghe
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | | | - Ja H Koo
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Jennifer F Morone
- Yale University New Haven, CT United States
- Veterans Affairs West Haven, CT United States
| | - Damien C Leri
- Big Yellow Star, Inc. Philadelphia, PA United States
| | - Annet Davis
- University of Pennsylvania School of Nursing Philadelphia, PA United States
| | - Kristen A Feemster
- Children's Hospital of Philadelphia Philadelphia, PA United States
- Perelman School of Medicine University of Pennsylvania Philadelphia, PA United States
- Division of Disease Control Department of Public Health Philadelphia, PA United States
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Abu-Raya B, Goldfarb DM, Smieja M, Luinstra K, Richard-Greenblatt M, Steenhoff AP, Feemster KA, Arscott-Mills T, Cunningham CK, Shah SS, Patel MZ, Kelly MS, Sadarangani M. The prevalence and clinical characteristics of pertussis-associated pneumonia among infants in Botswana. BMC Pediatr 2019; 19:444. [PMID: 31733643 PMCID: PMC6858628 DOI: 10.1186/s12887-019-1820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023] Open
Abstract
Background There are scant data on the prevalence and clinical course of pertussis disease among infants with pneumonia in low- and middle-income countries. While pertussis vaccination coverage is high (≥90%) among infants in Botswana, human immunodeficiency virus (HIV) infection affects nearly one-third of pregnancies. We aimed to evaluate the prevalence and clinical course of pertussis disease in a cohort of HIV-unexposed uninfected (HUU), HIV-exposed uninfected (HEU), and HIV-infected infants with pneumonia in Botswana. Methods We recruited children 1–23 months of age with clinical pneumonia at a tertiary care hospital in Gaborone, Botswana between April 2012 and June 2016. We obtained nasopharyngeal swab specimens at enrollment and tested these samples using a previously validated in-house real-time PCR assay that detects a unique sequence of the porin gene of Bordetella pertussis. Results B. pertussis was identified in 1/248 (0.4%) HUU, 3/110 (2.7%) HEU, and 0/33 (0.0%) HIV-infected children. All pertussis-associated pneumonia cases occurred in infants 1–5 months of age (prevalence, 1.0% [1/103] in HUU and 4.8% [3/62] in HEU infants). No HEU infants with pertussis-associated pneumonia were taking cotrimoxazole prophylaxis at the time of hospital presentation. One HUU infant with pertussis-associated pneumonia required intensive care unit admission for mechanical ventilation, but there were no deaths. Conclusions The prevalence of pertussis was low among infants and young children with pneumonia in Botswana. Although vaccination against pertussis in pregnancy is designed to prevent classical pertussis disease, reduction of pertussis-associated pneumonia might be an important additional benefit.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada. .,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - David M Goldfarb
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Luinstra
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Andrew P Steenhoff
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen A Feemster
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Tonya Arscott-Mills
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Coleen K Cunningham
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mohamed Zaakir Patel
- Department of Paediatrics and Adolescent Health, University of Botswana School of Medicine, Gaborone, Botswana
| | - Matthew S Kelly
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abstract
Rotavirus is a non-enveloped double-stranded RNA virus that causes severe gastroenteritis in children, but complications are rarely reported. Some reports have shown that rotavirus can induce diverse complications of the central nervous system, such as seizures, encephalopathy with a reversible splenial lesion, encephalitis, cerebral white matter abnormalities, and cerebellitis. Here, we present a 2-year-old patient with seizures, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and the rotavirus antigen detected in faeces.
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Affiliation(s)
- Gunta Laizane
- Riga Stradins University, Riga, Latvia.,Department of Infectiology, Children's Clinical University Hospital, Riga, Latvia
| | - Liene Smane
- Department of Infectiology, Children's Clinical University Hospital, Riga, Latvia
| | - Ieva Nokalna
- Riga Stradins University, Riga, Latvia.,Department of Infectiology, Children's Clinical University Hospital, Riga, Latvia
| | - Dace Gardovska
- Riga Stradins University, Riga, Latvia.,Department of Infectiology, Children's Clinical University Hospital, Riga, Latvia
| | - Kristen A Feemster
- Children's Hospital of Philadelphia, Philadelphia Department of Public Health Philadelphia, USA
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Fawole OA, Srivastava T, Feemster KA. Student health administrator perspectives on college vaccine policy development and implementation. Vaccine 2019; 37:4118-4123. [PMID: 31164307 DOI: 10.1016/j.vaccine.2019.05.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/14/2019] [Accepted: 05/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Immunization policies at colleges and universities differ greatly for many reasons, including prior experience with disease outbreaks and state immunization requirements. Few studies comprehensively explore the range of factors that influence the development of college vaccine policies or facilitators and barriers to their implementation. OBJECTIVE To explore the perceptions and decision-making process that influence college vaccine policy development and implementation from the perspective of student health administrators. METHODS This qualitative study used semi-structured interviews with student health administrators (N = 10) from ten U.S. colleges and universities purposefully sampled by school type (public vs. private) and geographic region. A descriptive codebook was developed from the interview guide, and each interview was double-coded using NVivo 11 software (κ = 0.87; inter-observer reliability = 99.4%). RESULTS We coded 5785 phrases. Administrators positively viewed their institutions' vaccine requirements, but some expressed concerns about the acceptance of philosophical and religious exemptions. They noted that students were generally ambivalent towards vaccine requirements, and while students recognized the benefits of vaccination, they did not prioritize immunizations. All administrators cited reliance on governmental and professional organizations as well as state regulations for decisions regarding vaccine requirements and recommendations at their institutions. Partnerships with other school departments, pharmaceutical companies, immunization coalitions, and healthcare providers were frequently cited as facilitators of college vaccine programs. Costs of purchasing, storing, and tracking vaccines were identified as major barriers. CONCLUSIONS We identified key themes that can be evaluated in subsequent studies to identify factors associated with successful implementation of university immunization programs and inform initiatives to increase vaccine acceptance and optimize immunization rates on college and university campuses.
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Affiliation(s)
- Oluwatunmise A Fawole
- Children's Hospital of Philadelphia, Vaccine Education Center, 3615 Civic Center Boulevard, Suite 1202 ARC, Philadelphia, PA 19104, United States.
| | - Tuhina Srivastava
- Children's Hospital of Philadelphia, Vaccine Education Center, 3615 Civic Center Boulevard, Suite 1202 ARC, Philadelphia, PA 19104, United States.
| | - Kristen A Feemster
- Children's Hospital of Philadelphia, Vaccine Education Center, 3615 Civic Center Boulevard, Suite 1202 ARC, Philadelphia, PA 19104, United States; University of Pennsylvania, Philadelphia, PA 19104, United States; Philadelphia Department of Public Health, 1101 Market St, Philadelphia, PA 19107, United States.
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31
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Mohanty S, Buttenheim AM, Feemster KA, Moser CA, Field RI, Yudell M, Turchi RM, Carroll-Scott A. Pediatricians' vaccine attitudes and practices before and after a major measles outbreak. J Child Health Care 2019; 23:266-277. [PMID: 30009615 DOI: 10.1177/1367493518786011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to describe how a sample of pediatricians were impacted by and responded to the Disneyland measles outbreak in the United States. We conducted three repeated cross-sectional, online surveys in 2014 (before the outbreak), 2015, and 2016 (after the outbreak) among members of three state chapters of the American Academy of Pediatrics. We assessed pediatricians' level of willingness and length of time comfortable delaying the measles-mumps-rubella (MMR) vaccine before and after the outbreak. Frequency of alternative immunization schedule requests and creation of office immunization policies due to the outbreak were measured. The sample included 304 pediatricians in 2014, 270 in 2015, and 221 in 2016. We found no significant changes in willingness or comfort delaying the MMR vaccine before and after the outbreak. In 2015, 38% of pediatricians reported fewer requests for alternative immunization schedules and 20% created stricter office immunization policies. A subsample of pediatricians reported administering the MMR vaccine earlier in the recommended time frame and taking extra precautions in waiting rooms due to the outbreak. Our results suggest that this measles outbreak did not lead to significant changes in attitudes or practices among this sample, but did modestly affect office immunization policies and practices.
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Affiliation(s)
- Salini Mohanty
- 1 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Robert I Field
- 3 Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Michael Yudell
- 3 Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Renee M Turchi
- 3 Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amy Carroll-Scott
- 3 Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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32
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Katsuta T, Moser CA, Offit PA, Feemster KA. Japanese physicians' attitudes and intentions regarding human papillomavirus vaccine compared with other adolescent vaccines. Papillomavirus Res 2019; 7:193-200. [PMID: 31051270 PMCID: PMC6520551 DOI: 10.1016/j.pvr.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Japan has experienced extremely low human papillomavirus vaccine (HPVV) coverage following the suspension of proactive governmental recommendations in 2013. Several studies have reported that recommendations from physicians increase adolescents' vaccine acceptance. In this survey, we evaluated the attitudes and intentions of Japanese physicians related to adolescent immunizations, particularly HPVV. METHODS We conducted a cross-sectional study using a mailed questionnaire targeting 330 Japanese physicians including 78 pediatricians, 225 internists and 27 obstetricians and gynecologists (OB/GYNs) in Kawasaki City, Japan in 2016. The survey measured physicians' reported frequency of educating adolescents about vaccines as well as their own perceptions and intentions related to adolescent immunizations. RESULTS Valid responses were obtained from 148 (45%) physicians. Though 53% agreed that the HPVV should be recommended, only 21% reported educating about HPVV. The majority of respondents (90%) agreed that they would restart HPVV for adolescents if the government reinstated its recommendation. CONCLUSIONS Although Japanese physicians reported support for adolescent immunizations, they were less likely to recommend or discuss HPVV compared with other adolescent vaccines. Responses indicated this was, at least in part, due to the lack of governmental support for HPVV, indicating that their recommendations would improve with government endorsement of the vaccine.
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Affiliation(s)
- Tomohiro Katsuta
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan; Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States. katsuta-7-@marianna-u.ac.jp
| | - Charlotte A Moser
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Paul A Offit
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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33
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Enane LA, Sullivan KV, Spyridakis E, Feemster KA. Clinical Impact of Malaria Rapid Diagnostic Testing at a US Children's Hospital. J Pediatric Infect Dis Soc 2019; 9:298-304. [PMID: 30989220 PMCID: PMC7358041 DOI: 10.1093/jpids/piz022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/12/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Children who develop malaria after returning to a setting in which the disease is not endemic are at high risk for critical delays in diagnosis and initiation of antimalarial therapy. We assessed the clinical impact of the implementation of malaria rapid diagnostic testing (RDT) on the management of children with malaria at an urban US children's hospital that serves a large immigrant population. METHODS This was a retrospective cohort study of all children diagnosed with laboratory-confirmed malaria at the Children's Hospital of Philadelphia (CHOP) between 2000 and 2014. RDT using a US Food and Drug Administration-approved immunochromatographic assay was introduced at CHOP on August 1, 2007. We compared clinical management and outcomes of patients with malaria diagnosed before and after RDT introduction. RESULTS We analyzed 82 pediatric malaria cases (32 before and 50 after RDT implementation). The majority of these patients had traveled to West Africa (91.5%) and were infected with Plasmodium falciparum (80.5%). The mean time to a positive result decreased from 10.4 to 0.9 hours (P < .001) after the introduction of RDT for patients with P falciparum. The mean time to antimalarial therapy decreased from 13.1 to 6.9 hours (P =; .023) in hospitalized patients. We found no significant reduction in the mean number of clinical signs of severe malaria between 0 and 48 hours of hospitalization and no difference in the need for exchange transfusion, time to resolution of parasitemia, or length of hospital stay. CONCLUSIONS Implementation of RDT for malaria was associated with shorter times to malaria diagnosis and initiation of antimalarial therapy. The results of this study support RDT in the optimal management of patients with malaria who present in settings in which the disease is not endemic.
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Affiliation(s)
- Leslie A Enane
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania,Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania,Correspondence: L. A. Enane, MD, 1044 W. Walnut St, Room 402A, Indianapolis, IN 46202 ()
| | - Kaede V Sullivan
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Pennsylvania
| | - Evangelos Spyridakis
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Kristen A Feemster
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania,Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis,Perelman School of Medicine, University of Pennsylvania, Philadelphia,Division of Disease Control, Philadelphia Department of Public Health, Pennsylvania
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34
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Fawole OA, Srivastava T, Fasano C, Feemster KA. Evaluating Variability in Immunization Requirements and Policy Among U.S. Colleges and Universities. J Adolesc Health 2018; 63:286-292. [PMID: 30236997 DOI: 10.1016/j.jadohealth.2018.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate variation in vaccine requirements, recommendations, and enforcement strategies among U.S. four-year colleges and universities. METHODS We conducted a cross-sectional study abstracting information from Web sites among a sample of 216 four-year colleges and universities from all 50 states and District of Columbia. Our primary outcomes of interest included: type and number of vaccines required for school entry, vaccines recommended by schools for students, and vaccines supplied through student health services. Covariates of interest included: school type, region, school size, mention of American College Health Association recommendations, presence of an accredited health center, mention of state requirements, presence of an enforcement strategy, and exemption stringency of the state in which the school was located. RESULTS Almost all (94%) schools required at least one vaccine for school entry, and 48% required three or more vaccines. The most commonly required vaccines were measles, mumps, and rubella (88.4%) and meningococcal vaccine (51.9%). All schools required the same vaccines included in state requirements but 65% also required additional vaccines. Most schools (67.1%) used registration hold to enforce requirements, while 14.8% restricted students from campus housing and 2.8% dismissed noncompliant students. Seventeen percent of schools had no published enforcement strategies. A higher proportion of private compared to public universities required three or more vaccines (57% vs. 37.3%, p = .014). CONCLUSIONS While most schools have immunization requirements, there is significant variation in number and type of vaccines required. This suggests potential inconsistent uptake of recommended vaccines for college students and underlies the need to characterize facilitators and barriers to immunization program implementation on college campuses.
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Affiliation(s)
- Oluwatunmise A Fawole
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tuhina Srivastava
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Caitlin Fasano
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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35
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Mohanty S, Feemster KA, Buttenheim A, Moser CA, Field RI, Mayer W, Carroll-Scott A. Factors Associated With Pediatrician Responses to Alternative Immunization Schedule Requests. Clin Pediatr (Phila) 2018; 57:180-188. [PMID: 28952327 DOI: 10.1177/0009922817696467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a cross-sectional online survey among 4 chapters of the American Academy of Pediatrics from July through October 2014 to describe characteristics of pediatricians and practices associated with practice-level responses to alternative immunization schedule requests. Among 374 pediatricians, 58% reported frequent alternative immunization schedule requests and 24% reported feeling comfortable using them. Pediatricians who work in practices that accommodate alternative immunization schedule requests have increased odds of having a high frequency of alternative immunization schedule requests, and beliefs that relationships with families would be negatively affected if they refused requests. Practices that discontinue care to families who request alternative immunization schedules have increased odds of being a private group practice and having a formal office vaccine policy. Pediatricians are frequently asked to use alternative immunization schedules and many are not comfortable using them. Practice-level responses to alternative immunization schedules are associated with characteristics of pediatricians and practices.
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36
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Abstract
Despite the challenges of increasing vaccine hesitancy among the public, vaccines remain one of society’s most important and influential tools for promoting public health. Accordingly, the immunization schedule will continue to evolve and expand in response to ongoing shifts in the diseases that threaten us,...
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37
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Feemster KA. Vaccine Financing and Distribution. Vaccines (Basel) 2017. [DOI: 10.1093/wentk/9780190277901.003.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Making and manufacturing vaccines is only the first part of the story in getting vaccines into public health programs and health care facilities: Someone has to pay for them and facilitate their distribution. These practices and decisions can vary significantly by region and country.
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38
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Feemster KA. Laws and Standard Practices for Vaccine Administration. Vaccines (Basel) 2017. [DOI: 10.1093/wentk/9780190277901.003.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite the fact that vaccines have been shown to drastically improve health outcomes at both individual and public health levels, their implementation as a civic requirement has been a longtime source of conflict. At the heart of this issue is the dual nature of vaccines...
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39
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Abstract
Vaccines represent one of the greatest public health advances of the past 100 years. Their development has brought about the global eradication of smallpox as well as large reductions in poliomyelitis, measles, tetanus, Haemophilus influenzae type b (Hib—a leading cause of childhood infections),...
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40
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Abstract
The centerpiece of any immunization program is its immunization schedule, a national standard of practice for which vaccines are administered and when. The governmental groups that create immunization schedules consider a range of factors in doing so, including the vaccine’s potential to improve the country’s...
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41
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Feemster KA. A Brief History of Vaccines. Vaccines (Basel) 2017. [DOI: 10.1093/wentk/9780190277901.003.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The conceptual foundations of vaccination were first documented in ancient Greece, where physicians observed that getting infected with a virus could prevent reinfection with that same virus. In 900–1000 a.d., early forms of the modern vaccine were developed in China when physicians first noted that...
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42
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Feemster KA. What is a Vaccine and How do Vaccines Work? Vaccines (Basel) 2017. [DOI: 10.1093/wentk/9780190277901.003.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A vaccine is a substance that is given to a person or animal to protect it from a particular pathogen—a bacterium, virus, or other microorganism that can cause disease. The vaccine prompts an immune response in the body that produces antibodies, which are proteins that...
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43
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Abstract
Vaccine development is a long process that requires numerous highly regulated steps, many years, and significant scientific and financial resources. Given the breadth of infections that affect children and adults, how are decisions made about which ones to prevent with vaccination? Once vaccine development begins,...
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44
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Abstract
“Are vaccines safe?” has become one of the most hotly contested and politically charged questions in contemporary culture, fueled in no small part by voracious online debates, peer-to-peer influence, and source information of varying degrees of quality and accuracy. Along with questions related to possible...
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45
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Abstract
Questions regarding the benefits of vaccines and their safety have persisted since vaccines were first introduced during the 18th century. As widespread vaccination has caused the prevalence of vaccine-preventable diseases to decrease, public concern for the threat of these diseases has decreased, too. This has...
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46
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Katsuta T, Miyaji Y, Offit PA, Feemster KA. Treatment With Quadrivalent Human Papillomavirus Vaccine for Juvenile-Onset Recurrent Respiratory Papillomatosis: Case Report and Review of the Literature. J Pediatric Infect Dis Soc 2017; 6:380-385. [PMID: 28992265 DOI: 10.1093/jpids/pix063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022]
Abstract
Although juvenile-onset recurrent respiratory papillomatosis (JoRRP) generally involves a benign tumor on the larynx and other respiratory tract areas, almost all patients with this disease require repeated surgical intervention (to prevent airway obstruction during the course of illness) and various adjuvant therapies such as interferon, cidofovir, acyclovir, ribavirin, indole-3-carbinol, HspE7, mumps vaccine, photodynamic therapy, propranolol, cimetidine, and bevacizumab. Some case reports recently described the effectiveness of the quadrivalent human papillomavirus vaccine (HPV4) as an adjuvant therapy. On the basis of these reports, we administered HPV4 to a 2-year-old boy with JoRRP. However, no therapeutic effect was found. A review of the available literature revealed that current evidence for the effectiveness of therapeutic HPV4 and other adjuvant therapies for JoRRP is inconsistent. Therefore, the prophylactic use of currently available HPV vaccine for adolescents is the most effective strategy for preventing not only anogenital cancers but also genital warts, which might be a risk factor for JoRRP among their children in the future.
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Affiliation(s)
- Tomohiro Katsuta
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Japan.,Vaccine Education Center
| | - Yusuke Miyaji
- Department of Pediatrics, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Paul A Offit
- Vaccine Education Center.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen A Feemster
- Vaccine Education Center.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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47
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Kelly MS, Zheng J, Boiditswe S, Steenhoff AP, Feemster KA, Arscott-Mills T, Seme B, Ratshaa B, Rulaganyang I, Patel MZ, Mantzor S, Shah SS, Cunningham CK. Investigating Mediators of the Poor Pneumonia Outcomes of Human Immunodeficiency Virus-Exposed but Uninfected Children. J Pediatric Infect Dis Soc 2017; 8:13-20. [PMID: 29165579 PMCID: PMC6437836 DOI: 10.1093/jpids/pix092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/04/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Human immunodeficiency virus-exposed but uninfected (HIV-EU) children have a higher mortality rate than the children of HIV-negative mothers (HIV-unexposed). Causal mediators of the poor health outcomes of HIV-EU children remain poorly defined. METHODS We conducted a hospital-based prospective cohort study of children aged 1 to 23 months with clinically defined pneumonia. The children were recruited at a referral hospital in Gaborone, Botswana, between April 2012 and June 2016. The primary outcome, treatment failure at 48 hours, was assessed by an investigator blinded to the children's HIV-exposure status. We examined associations between HIV exposure and pneumonia outcomes in HIV-uninfected children. We next determined whether the effect of HIV exposure on outcomes was mediated by low-birth-weight status, nonbreastfeeding, malnutrition, in utero exposure to combination antiretroviral therapy, or pneumonia severity. RESULTS A total of 352 HIV-uninfected children were included in these analyses, including 245 (70%) HIV-unexposed and 107 (30%) HIV-EU children. Their median age was 7.4 months, and 57% were male. Treatment failure occurred in 111 (32%) children, and 19 (5.4%) children died. HIV-EU children were more likely to fail treatment (risk ratio [RR], 1.57 [95% confidence interval (CI), 1.19-2.07]; P = .002) and had a higher in-hospital mortality rate (RR, 4.50 [95% CI, 1.86-10.85]; P = .001) than HIV-unexposed children. Nonbreastfeeding mediated 47% of the effect of HIV exposure on the risk of in-hospital death. CONCLUSIONS HIV-EU children have worse pneumonia outcomes than HIV-unexposed children. Nonbreastfeeding mediates nearly half of the effect of HIV exposure on pneumonia mortality. Our findings provide additional evidence for a mortality benefit of breastfeeding by HIV-EU children.
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Affiliation(s)
- Matthew S Kelly
- Botswana–UPenn Partnership, Gaborone, Botswana,Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina,Correspondence: M. S. Kelly, MD, MPH, Box 3499, Duke University Medical Center, Durham, NC 27710 ()
| | - Jiayin Zheng
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | - Andrew P Steenhoff
- Botswana–UPenn Partnership, Gaborone, Botswana,Global Health Center,Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania,University of Botswana School of Medicine, Gaborone, Botswana
| | - Kristen A Feemster
- Global Health Center,Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Pennsylvania
| | - Tonya Arscott-Mills
- Botswana–UPenn Partnership, Gaborone, Botswana,Global Health Center,University of Botswana School of Medicine, Gaborone, Botswana
| | | | | | | | - Mohamed Z Patel
- University of Botswana School of Medicine, Gaborone, Botswana
| | - Savarra Mantzor
- Botswana–UPenn Partnership, Gaborone, Botswana,Global Health Center
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Ohio
| | - Coleen K Cunningham
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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48
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Chang C, Feemster KA, Coffin S, Handy LK. Treatment-Related Complications in Children Hospitalized With Disseminated Lyme Disease. J Pediatric Infect Dis Soc 2017; 6:e152-e154. [PMID: 28903521 PMCID: PMC5907847 DOI: 10.1093/jpids/pix060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022]
Abstract
We describe here treatment approaches and treatment-related complications in 138 hospitalized children with disseminated Lyme disease. The patients who received parenteral antibiotics had a higher rate of complications than those who received oral therapy (15.4 vs 4.2 per 1000 days of therapy, respectively; P < .05). Oral therapy should be used preferentially if either route is supported by current guidelines.
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Affiliation(s)
- Christine Chang
- Department of General Pediatrics, Children’s Hospital Los Angeles, California
| | - Kristen A Feemster
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Susan Coffin
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Lori K Handy
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania,Correspondence: L. K. Handy, MD, Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, PO Box 269, Wilmington, DE 19899 ()
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49
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Handy LK, Maroudi S, Powell M, Nfila B, Moser C, Japa I, Monyatsi N, Tzortzi E, Kouzeli I, Luberti A, Theodoridou M, Offit P, Steenhoff A, Shea JA, Feemster KA. The impact of access to immunization information on vaccine acceptance in three countries. PLoS One 2017; 12:e0180759. [PMID: 28771485 PMCID: PMC5542683 DOI: 10.1371/journal.pone.0180759] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/21/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Vaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs. Objective The objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance. Methods We conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes. Results Dominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece. Conclusions In Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.
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Affiliation(s)
- Lori K. Handy
- Department of Pediatrics, The Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Stefania Maroudi
- Collaborative Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Maura Powell
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Charlotte Moser
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Ingrid Japa
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic
| | - Ndibo Monyatsi
- Child Health Division, Ministry of Health, Gaborone, Botswana
| | - Elena Tzortzi
- Collaborative Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Ismini Kouzeli
- Collaborative Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Anthony Luberti
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Maria Theodoridou
- Collaborative Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Paul Offit
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Andrew Steenhoff
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-UPenn Partnership & Department of Pediatric & Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kristen A. Feemster
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Handy LK, Bryan M, Gerber JS, Zaoutis T, Feemster KA. Variability in Antibiotic Prescribing for Community-Acquired Pneumonia. Pediatrics 2017; 139:peds.2016-2331. [PMID: 28270546 PMCID: PMC5369668 DOI: 10.1542/peds.2016-2331] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Published guidelines recommend amoxicillin for most children with community-acquired pneumonia (CAP), yet macrolides and broad-spectrum antibiotics are more commonly prescribed. We aimed to determine the patient and clinician characteristics associated with the prescription of amoxicillin versus macrolide or broad-spectrum antibiotics for CAP. METHODS Retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients prescribed amoxicillin, macrolides, or a broad-spectrum antibiotic (amoxicillin-clavulanic acid, cephalosporin, or fluoroquinolone) for CAP were included. Multivariable logistic regression models were implemented to identify predictors of antibiotic choice for CAP based on patient- and clinician-level characteristics, controlling for practice. RESULTS Of 10 414 children, 4239 (40.7%) received amoxicillin, 4430 (42.5%) received macrolides and 1745 (16.8%) received broad-spectrum antibiotics. The factors associated with an increased odds of receipt of macrolides compared with amoxicillin included patient age ≥5 years (adjusted odds ratio [aOR]: 6.18; 95% confidence interval [CI]: 5.53-6.91), previous antibiotic receipt (aOR: 1.79; 95% CI: 1.56-2.04), and private insurance (aOR: 1.47; 95% CI: 1.28-1.70). The predicted probability of a child being prescribed a macrolide ranged significantly between 0.22 and 0.83 across clinics. The nonclinical characteristics associated with an increased odds of receipt of broad-spectrum antibiotics compared with amoxicillin included suburban practice (aOR: 7.50; 95% CI: 4.16-13.55) and private insurance (aOR: 1.42; 95% CI: 1.18-1.71). CONCLUSIONS Antibiotic choice for CAP varied widely across practices. Factors unlikely related to the microbiologic etiology of CAP were significant drivers of antibiotic choice. Understanding drivers of off-guideline prescribing can inform targeted antimicrobial stewardship initiatives.
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Affiliation(s)
- Lori K. Handy
- Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware;,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Bryan
- Center for Pediatric Clinical Effectiveness and,Department of Biostatistics and Epidemiology,,Center for Clinical Epidemiology and Biostatistics, and
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness and,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Department of Biostatistics and Epidemiology,,Center for Clinical Epidemiology and Biostatistics, and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theoklis Zaoutis
- Center for Pediatric Clinical Effectiveness and,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Department of Biostatistics and Epidemiology,,Center for Clinical Epidemiology and Biostatistics, and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen A. Feemster
- Center for Pediatric Clinical Effectiveness and,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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