A pathway to developing and testing quality measures aimed at improving adult vaccination rates in the United States.

Despite recommendations for vaccinating adults and widespread availability of immunization services (e.g., pharmacy venues, workplace wellness clinics), vaccination rates in the United States remain low.

Promoting Adult Immunization Using Population-Based Data for a Composite Measure.

Introduction: A composite adult immunization status measure is currently under consideration for adoption into the Healthcare Effectiveness Data and Information Set. This paper complements the Healthcare Effectiveness Data and Information Set health plan-level measure testing efforts by examining use of survey-based self-reported vaccination data to assess composite adult immunization coverage and identify limitations to using survey data to measure progress.

Methods: The 2015 National Health Interview Survey data were used in 2017 to calculate estimates for a composite of selected vaccines routinely recommended for adults aged ≥19 years, overall and in three age groups: 19-59, 60-64, and ≥65 years for tetanus and diphtheria toxoids (Td); tetanus toxoid; reduced diphtheria toxoid; and tetanus, diphtheria, acellular pertussis vaccine (Tdap); and herpes zoster, pneumococcal, and influenza vaccines.

Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013-2015.

Introduction: Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare facilities have higher human papillomavirus (HPV) vaccine series initiation and completion rates among adolescent patients aged 13-17 years than the general U.S. population, challenges remain.

Causes and Disparities in Death Rates Among Urban American Indian and Alaska Native Populations, 1999-2009.

Objectives: To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations.

Methods: We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates.

Meeting the Challenges of Immunizing Adults.

The overall burden of illness from diseases for which vaccines are available disproportionately falls on adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccine recommendations from CDC are published annually in the U.

Meeting the Challenges of Immunizing Adults.

The overall burden of illness from diseases for which vaccines are available disproportionately falls on adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccine recommendations from CDC are published annually in the U.

Immunization information systems to increase vaccination rates: a community guide systematic review.

Context: Immunizations are the most effective way to reduce incidence of vaccine-preventable diseases. Immunization information systems (IISs) are confidential, population-based, computerized databases that record all vaccination doses administered by participating providers to people residing within a given geopolitical area. They facilitate consolidation of vaccination histories for use by health care providers in determining appropriate client vaccinations.

Pneumonia and influenza mortality among American Indian and Alaska Native people, 1990-2009.

Objectives: We compared pneumonia and influenza death rates among American Indian/Alaska Native (AI/AN) people with rates among Whites and examined geographic differences in pneumonia and influenza death rates for AI/AN persons.

Methods: We adjusted National Vital Statistics Surveillance mortality data for racial misclassification of AI/AN people through linkages with Indian Health Service (IHS) registration records. Pneumonia and influenza deaths were defined as those who died from 1990 through 1998 and 1999 through 2009 according to codes for pneumonia and influenza from the International Classification of Diseases, 9th and 10th Revision, respectively.

Influenza surveillance using electronic health records in the American Indian and Alaska Native population.

Objective: Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed.

Vaccination coverage among American Indian and Alaska native children, 2006-2010.

Background And Objectives: A previous study on vaccination coverage in the American Indian/Alaska Native (AI/AN) population found that disparities in coverage between AI/AN and white children existed from 2001 to 2004 but were absent in 2005. The objective of this study was to describe vaccination coverage levels for AI/AN children aged 19-35 months in the United States between 2006 and 2010, examining whether gains found for AI/AN children in 2005 have been sustained.

Methods: Data from the 2006 through 2010 National Immunization Surveys were analyzed.

Impact of rotavirus vaccine on diarrhea-associated disease burden among American Indian and Alaska Native children.

Objective: Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (AI/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among AI/AN children in the pre- and postrotavirus vaccine era.

Methods: Diarrhea-associated hospitalizations and outpatient visits among AI/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010.

Human papillomavirus vaccination practices among providers in Indian health service, tribal and urban Indian healthcare facilities.

Purpose: The human papillomavirus (HPV) vaccine is of particular importance in American Indian/Alaska Native women because of the higher rate of cervical cancer incidence compared to non-Hispanic white women. To better understand HPV vaccine knowledge, attitudes, and practices among providers working with American Indian/Alaska Native populations, we conducted a provider survey in Indian Health Service, Tribal and Urban Indian (I/T/U) facilities.

Methods: During December 2009 and January 2010, we distributed an on-line survey to providers working in I/T/U facilities.

Effects of a nationwide Hib vaccine shortage on vaccination coverage in the United States.

Background: A shortage of Haemophilus influenzae type b (Hib) vaccine that occurred in the United States during December 2007 to September 2009 resulted in an interim recommendation to defer the booster dose, but to continue to vaccinate as recommended with the primary series during the first year of life.

Objectives: To quantify effects of the Hib shortage on vaccination coverage and to determine if any demographic subgroups were disproportionately affected.

Methods: Data from the 2009 National Immunization Survey (NIS) were divided based on child's age at the onset of the shortage.

Validation of algorithm to identify American Indian/Alaska Native pregnant women at risk from pandemic H1N1 influenza.

Pregnant women and American Indian and Alaska Native people are at elevated risk of severe disease and mortality from 2009 pandemic influenza A/H1N1. We validated an electronic health record-based algorithm used by Indian Health Service to identify pregnant women in near real-time surveillance of pandemic influenza A/H1N1. We randomly selected a stratified sample of 515 patients at 3 Indian Health Service-funded hospitals with varied characteristics.

Pandemic influenza preparedness and vulnerable populations in tribal communities.

American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their communities and will be critical partners in national efforts to prepare for pandemic influenza. Within AIAN communities, some subpopulations will be particularly vulnerable during an influenza pandemic because of their underlying health conditions, whereas others will be at increased risk because of limited access to prevention or treatment interventions.We outline potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within tribal communities.

Underimmunization of American Indian and Alaska Native children.

Objective: The goal was to determine whether disparities in childhood immunization coverage exist between American Indian/Alaska Native children and non-Hispanic white children.

Methods: We compared immunization coverage with the 4 diphtheria-tetanus-pertussis, 3 poliovirus, 1 measles-mumps-rubella, 3 Haemophilus influenza type b, and 3 hepatitis B(4:3:1:3:3) series and its individual vaccine components (> or = 4 doses of diphtheria, tetanus, and pertussis vaccine; > or = 3 doses of oral or inactivated polio vaccine; > or = 1 dose of measles, mumps, and rubella vaccine; > or = 3 doses of Haemophilus influenzae type b vaccine; and > or = 3 doses of hepatitis B vaccine) between American Indian/Alaska Native children and non-Hispanic white children from 2000 to 2005, using data from the National Immunization Survey.

Results: Although immunization coverage increased for both populations from 2001 to 2004, American Indian/Alaska Native children had significantly lower immunization coverage, compared with non-Hispanic white children, over that time period.

Status of influenza and pneumococcal vaccination among older American Indians and Alaska Natives.

Objectives: We sought to estimate the influenza and pneumococcal vaccination coverage among older American Indian and Alaska Native (AIAN) adults nationally and the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage.

Methods: We obtained our sample of 1981 AIAN and 179845 White respondents 65 years and older from Behavioral Risk Factor Surveillance System data from 2003 to 2005. Logistic regression provided predictive marginal vaccination coverage for each covariate and adjusted for demographic characteristics and access to care.

Effect of a national vaccine shortage on vaccine coverage for American Indian/Alaska Native children.

Objectives: We determined the effect of national vaccine shortages on coverage with 4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for American Indian/Alaska Native (AIAN) children.

Methods: Data on DTaP coverage for children aged 19 to 27 months were abstracted from Indian Health Service (IHS) immunization reports. Coverage with the fourth DTaP dose (DTaP4) was compared for different periods to determine coverage levels before, during, and after the shortage.

Factors associated with fulminant liver failure during an outbreak among injection drug users with acute hepatitis B.

Death related to acute hepatitis B occurs in approximately 1% of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection drug users (IDUs) resulting in several deaths. We conducted a case-control study of fulminant (case patients) and nonfulminant (control patients) HBV infections.