Factorial design for improving influenza vaccination among employees of a large health system.

Objective: As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare facilities, effective interventions are needed. This study was designed to test a factorial design to improve HCP vaccination rates.

Design: A before-after trial with education, publicity, and free and easily accessible influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie, business and/or administrative role, indirect patient contact, and direct patient contact).

Addressing immunization barriers, benefits, and risks.

Vaccines have been highly effective in eliminating or significantly decreasing the occurrence of many once-common diseases. Barriers to immunization are a significant factor in the rising incidence rates of some vaccine-preventable diseases. Cost, reduced accessibility to immunizations, increasingly complex childhood and adolescent/adult immunization schedules, and increasing focus on the potential adverse effects of vaccines all contribute to difficulty in meeting the 2010 immunization goals.

Vaccine schedules and procedures, 2007.

This article reviews the 2007 recommended childhood and adolescent immunization schedules; the catch-up immunization schedules for children and adolescents; the 2006-2007 recommended adult immunization schedule; recommended and minimum ages and intervals between vaccine doses; contraindications for immunization; and general guidelines on immunization procedures. With the exception of some formulations of influenza vaccines, all recommended childhood vaccines are thimerosal-free. Since 2005, changes in vaccine schedules affect the following vaccinations: hepatitis A, rotavirus, human papillomavirus, varicella, meningococcal, adult tetanus and diphtheria toxoids and acellular pertussis, and influenza.

Vaccines for persons at high risk, 2007.

Morbidity and mortality due to vaccine-preventable diseases are high among persons with underlying medical conditions. Thus, inactivated influenza and pneumococcal polysaccharide vaccines are recommended for individuals with cardiac disease, diabetes mellitus, chronic obstructive pulmonary disease, immunosuppression, and other chronic illnesses. Inactivated influenza vaccine is recommended for pregnant women and for persons with asthma and neuromuscular disease.

Routine vaccines across the life span, 2007.

Routine vaccines are listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule published by the Centers for Disease Control and Prevention and reviewed and updated by the Advisory Committee on Immunization Practices. For these vaccines, we discuss the disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations. Some new vaccines are discussed here (Tdap and zoster), whereas others (rotavirus and human papillomavirus) are discussed elsewhere in the supplement.

Recent changes in influenza vaccination recommendations, 2007.

Influenza disease continues to cause thousands of deaths in the United States. Due to the burden of influenza hospitalizations among children, inactivated influenza vaccine is now routinely recommended for children age 6 to 59 months. Live attenuated influenza vaccine is available for healthy persons 5 to 49 years of age.

HPV vaccine and its recommendations, 2007.

Quadrivalent human papillomavirus vaccine against the viral types most likely to cause cervical cancer (types 16 and 18) and genital warts (types 6 and 11) has been licensed in the United States. The vaccine is 95% to 100% efficacious against cervical intraepithelial neoplasia and adenocarcinoma in situ and 99% efficacious against genital warts caused by serotypes in the vaccine. Local pain injection site pain and swelling are the main adverse reactions.

Rationing of influenza vaccine during a pandemic: ethical analyses.

Rationing of scarce vaccine supplies will likely be required when the next pandemic occurs, raising the questions about how to ration and upon what principles. Because influenza pandemics have differing mortality patterns, such as the 1918 pandemic's "W" shaped curve that effected healthy young adults, the particular pattern should inform rationing. Competing ethical principles for vaccine rationing are utilitarianism and egalitarianism.

Tailored interventions to introduce influenza vaccination among 6- to 23-month-old children at inner-city health centers.

Background: Because of high rates of hospitalization for influenza infections among very young children (< 2 years), the Advisory Committee on Immunization Practices initiated a new policy in 2002 that encouraged vaccination of healthy children aged 6 to 23 months against influenza.

Objective: To evaluate the effectiveness of implementing tailored interventions to introduce influenza vaccination of children 6 to 23 months of age in inner-city practices.

Study Design: A before-after trial with historical and concurrent controls was conducted in 6 health centers in low-income urban locations.

What predicts influenza vaccination status in older Americans over several years?

Objectives: To examine the correlates of repeat influenza vaccination and determine whether there are age-group (50-64, > or =65) differences in decision-making behavior.

Design: Longitudinal survey study.

Setting: Two community health centers in Pittsburgh, Pennsylvania.

The 2002 United States varicella vaccine shortage and physician recommendations for vaccination.

Background: The US experienced a shortage of varicella vaccine in 2002, leading to the concerns about its impact.

Methods: 204 Minnesota and Pennsylvania physicians, most (164) of whom were interviewed in 1999 on the topic of varicella vaccine, responded to a 2003 survey.

Results: Although 67% were aware of the 2002 varicella vaccine shortage, 24% experienced it and only 45% were aware of the 2002 temporary change in national vaccination recommendations.

If pneumonia is the "old man's friend", should it be prevented by vaccination? An ethical analysis.

Because pneumococcal disease is a major problem among the elderly, pneumococcal polysaccharide vaccination is widely promoted. However, Sir William Osler called pneumonia the friend of the aged, leading to an ethical discussion. Mortality from pneumonia is higher with increasing degrees of underlying illness, outweighing the age effect.

Missed opportunities to vaccinate older adults in primary care.

Objective: During the 2000 to 2001 influenza season, distribution of influenza vaccine was delayed, and national self-reported vaccination rates declined. The purposes of this study were to characterize missed opportunities for adult vaccinations and assess the impact of the vaccine delay on missed opportunities for influenza vaccination as recorded in medical records.

Methods: In a cross-sectional analysis, medical record data from 217 adult patients aged > or =65 years in primary care practices that received influenza vaccine supplies late in 2000 were used to assess rates and missed opportunities to vaccinate.

Routine vaccines across the life span, 2005.

Routine vaccines include those listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule. The disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations are discussed in relation to each vaccine. Pictures of vaccine-preventable diseases are included.

Immunization barriers and solutions.

Too many children and adults in the United States develop vaccine-preventable diseases each year. Patients, parents, and providers face a variety of barriers that cause us to fall short of our immunization goals. This article discusses ways in which providers can surmount those barriers and improve immunization rates.

Vaccine schedules and procedures.

This article presents the 2005 Recommended Childhood and Adolescent Immunization Schedule; the catch-up schedule; the 2004-2005 Recommended Adult Immunization Schedule, which will stay in effect for 2005; contraindications for immunization; and general guidelines on immunization procedures. Recent changes for children include institution of thimerosal-free hepatitis B vaccination either before hospital discharge or as soon after birth as possible and the recommendation to give inactivated influenza vaccine to all children who will be between the ages of 6 and 23 months during the influenza season. Minimal intervals between vaccines and vaccine precautions, contraindications, administration, and storage are reviewed.

Vaccines for persons at high risk due to medical conditions, occupation, environment, or lifestyle, 2005.

The rates of morbidity and mortality due to influenza and pneumococcal diseases are high among persons with underlying medical conditions; thus, influenza and pneumococcal polysaccharide vaccines are recommended for those with cardiac disease, diabetes mellitus, chronic obstructive pulmonary disease, and other chronic illnesses. For the same reasons, influenza vaccine is recommended for pregnant women and for persons with asthma. Health care workers are at high risk for acquiring and transmitting hepatitis B, measles, varicella, and influenza; hence, vaccination against these diseases is recommended.

Recent changes in influenza epidemiology and vaccination recommendations.

Influenza disease continues to cause thousands of deaths in the United States. Due to the burden of influenza hospitalizations among children, inactivated influenza vaccine is now routinely recommended for children age 6-23 months. A live, attenuated influenza vaccine was licensed in 2003 for healthy persons age 5-49 years.

Ethical analyses of vaccines grown in human cell strains derived from abortion: arguments and Internet search.

The fact that certain vaccines are grown in cell strains derived decades ago from an aborted fetus is a concern for some. To understand such concerns, a standardized search identified internet sites discussing vaccines and abortion. Ethical concerns raised include autonomy, conscience, coherence, and immoral material complicity.

Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status.

Background: Barriers to adult immunizations persist as current rates for pneumococcal polysaccharide vaccine (PPV) receipt among eligible adults remain below national goals. This study investigated potential barriers to patients receiving the PPV, including predisposing, enabling, environmental and reinforcing factors among physicians from a variety of practice and geographic settings.

Methods: Participants were 60 primary care physicians from inner-city, rural, suburban, and Veterans Affairs practices, which included adults aged 65 years and older.

Physician and practice factors related to influenza vaccination among the elderly.

Background: Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective.

Methods: Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years.