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This article is a summary of the first AGS Symposium entitled “Update on Vaccination Strategies for Older Adults: Matching the Approach to the Individual and the Care Setting.” Given declines in host defenses and immune function with aging, vaccinations play a pivotal role in fortifying older adults against preventable infections, resulting diseases, disability, and death. Current guidelines generally list recommendations applicable for an average older adult of a given chronological age. However, growing evidence indicates that heterogeneity in terms of factors as varied as biological sex, frailty, functional status, and multimorbidity may impact vaccine responses and clinical outcomes. As a result, clinicians will increasingly need to take these additional factors into consideration as they seek to improve outcomes through improved targeting of such aging‐related heterogeneity. Moreover, efforts at protecting older citizens through vaccination must also include strategies to overcome barriers to the adoption of vaccine recommendations in varied settings including long‐term care. This 2023 AGS Plenary Symposium sought to commence a broader dialogue across AGS and beyond on optimizing vaccinations for older adults, ensuring not only extended lifespans but also healthier and more active lives. This report is not a systematic review, and thus should not be considered comprehensive. [ABSTRACT FROM AUTHOR]

Maternal vaccines during pregnancy offer crucial protection against infections for both the pregnant person and their newborn. Vaccines against influenza, pertussis, coronavirus disease 2019, and respiratory syncytial virus are routinely recommended by the Centers for Disease Control and Prevention to safeguard pregnant women and their infants from potentially severe complications. Administering these vaccines during pregnancy helps transfer protective antibodies from the mother to the baby, enhancing immunity during the vulnerable early months of life. Extensive research supports the safety and efficacy of maternal vaccines, with numerous studies demonstrating their protective benefits for both pregnant people and newborns. [ABSTRACT FROM AUTHOR]

The objective of this analysis was to evaluate and compare the effects of the COVID-19 pandemic on routine and annual influenza vaccination in Iowa, Minnesota, and North Dakota. Routine and annual influenza vaccination uptake and coverage between 2017 and 2021 was collected from each state's immunization information system (IIS) by age group and stratified by provider and vaccine type. Data from 2017 to 2019 were averaged to obtain a pre-pandemic baseline and compared to 2020 and 2021 data. Percent changes were calculated to evaluate differences in uptake and coverage. Changes in coverage and administration varied by state, but each state had some level of decreased administration across the different age groups and vaccine types. The most consistent decreases in vaccine administration occurred in the 15-year-old cohort with each state finding decreased administrations in 2020 and 2021. The 12-year-old age group had decreased administration of hepatitis B, measles, mumps, and rubella, and varicella vaccine while the 2-year-old age group had the most consistent decrease in coverage across all vaccines analyzed. Trends by provider type were also noted in all three states, with local public health (LPH) experiencing the largest and most consistent declines in vaccine administrations by age group. Adult influenza coverage improved to varying degrees in 2020 (+ 14.1% IA, + 2.1% MN, + 1.5% ND), but either decreased or approached the 2017-19 average in 2021. All three states saw some level of decreased vaccine administration across the age groups, vaccines, and provider types assessed. The COVID-19 pandemic affected how many children and adults received recommended immunizations, leaving communities vulnerable to vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

The potential of primary prevention to prevent, delay, or ameliorate disease is immense. However, the total spending on preventive services in the United States remains astoundingly small and represents a meager 3.5% of total health care spending. Moreover, training focused on prevention in medical schools is often neglected, and time-constrained primary providers frequently omit effective preventive and early detection measures, or perform them perfunctorily. Indeed, preventable conditions of serious consequences including "premature" mortality, cardiovascular events, and major organ failure are ubiquitous with the global obesity and diabetes epidemics, and the ongoing high prevalence of noxious habits and drug abuse. Although each aspect has been the subject of extensive research, a succinct evidence-based summary is scarce. We have conducted a review of high-quality evidence (systematic reviews, meta-analyses, and practice guidelines) over the last 20 years to extract the best updated recommendations on comprehensive disease prevention and approved screening, briefly citing significant risk reductions by lifestyle interventions, pharmacological prevention, cancer screening, other endorsed screening, immunizations, and issues in the patient-provider interface. [ABSTRACT FROM AUTHOR]

Importance: The likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult's life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit. Objective: To examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy. Design: Analysis of 2019 National Health Interview Survey. Participants: 8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults. Main Measures: Proportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors. Key Results: Overall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination. Conclusions: Despite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults' life expectancy may improve care of older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Using data from the Rhode Island immunization registry from January 2019 through September 2022, we assessed whether adolescent routine vaccination rates are catching up on losses experienced early in the pandemic. METHODS: For Q1 2020--Q3 2022, we calculated the number of adolescents ages 11--18 receiving a routine vaccine as a percentage of the same quarter in 2019 along with the cumulative difference through Q3 2022. Human papillomavirus (HPV) vaccine trends were further stratified by racial/ethnic identity and by sex. RESULTS: Except for Q1 2021, the number of adolescents receiving each vaccine in each calendar quarter since Q1 2020 was below 100% of the same quarter in 2019, resulting in cumulative "losses" or "deficits" relative to pre-pandemic numbers. CONCLUSIONS: We describe ways Rhode Island can expand on its existing partnerships between primary care providers, public health, and schools to address the decline in adolescent routine vaccination. [ABSTRACT FROM AUTHOR]

Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children (N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents' or adolescents' choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one's vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent's decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients' and parents' vaccine decisions. [ABSTRACT FROM AUTHOR]

Chronic otitis media is an inflammatory process of the mucoperiosteum of the structures of the middle ear cavity, with an evolution of more than 3 months, with involvement of the tympanic membrane, either with perforation or scarring that will lead to conductive hearing loss. In pediatrics, it is considered a Public Health problem due to the permanent sequelae that affect language and hearing in young children, with repercussions on their learning. This is a basic review of recent concepts and the importance of a timely and early diagnosis of a picture of acute otitis media to prevent it from becoming chronic, with the primary care physician being the one who must correctly manage the first picture of otitis media. The current management of chronic otitis media is reviewed, as well as risk and protection factors, highlighting breastfeeding, the complete immunization schedule, and optimal antimicrobial management. [ABSTRACT FROM AUTHOR]

Background: Utilization of under 5 year old child health care services in Egypt is considered low, the highest proportion of well-baby visits is mainly for immunization in the first two years of age. Parents may rely upon the internet and mobile applications (apps) for support in handling day to day parenting situations. mHealth (Mobile Health) interventions have the potential to be a useful and low-cost way to disseminate information about proper nutrition, can be used to monitor children's growth using the official charts of World Health Organization, also can help in accessing vaccine-related information and recommended immunization schedules. Objectives: To assess needs and requirements for a new comprehensive well-baby clinic mobile app. Also, to develop a mobile app prototype covering all well baby clinic service com-ponents which are: Physical growth, Developmental milestones, Immunizations, Nutrition and Safety & emergency measures. Methods: This work is done over two phases. In Exploratory phase, we assessed the need for the new app by performing bibliographic review of previous mHealth interventions in childcare field, market search of the available related apps and an online survey to assess the need and expectations of the new app. In preparatory phase, we developed the novel well baby clinic app that constituted all well baby clinic services for children's health monitoring which are: Physical growth, Developmental milestones, Immunizations, Nutrition and Safety & emergency measures relying on evidence-based information and honoring data safety. Results: 13 Arabic apps were downloaded and extracted for review. All of these apps (100%~13/13) were in the form of written articles that offered no interactive features for parents. All offered general health education not tailored according to the status of the child. None of them were developed by a university or a certified health organization. Almost all of them (92.3%~12/ 13) were commercial apps as they included ads. Our online survey on 374 mothers showed that almost all of them (97.5%) reported the need of a new app to regularly follow their children's health. They also reported the need of nutrition, developmental milestones and physical growth services in the app. We developed "Sehhat Tefly" app constituting caregiver information, child sociodemographic characteristics and the 6 previously mentioned services, it also included health education videos and a conclusive report section. Conclusion: After vigorous review of literature, market search and user requirement assessment, apps reviewed didn't provide any comprehensive approach to well-baby clinic services on a scientific basis. Upon market requirement for child m-health, we developed "Sehhat Tefly" app. The full potential of this app is yet to be defined. Further studies are needed to assess accessibility and usability of the app and to explore difficulties and barriers faced by users in different services. [ABSTRACT FROM AUTHOR]

Vaccine refusal is increasing. Objectives were to assess frequency of declining or dismissing patients who refuse vaccines, which vaccine(s) prompt pediatricians to decline/dismiss patients, and demographics of pediatricians who decline/dismiss patients. Active members of the Oklahoma American Academy of Pediatricians (AAP) were surveyed. Chi-square tests with non-overlapping 95% confidence intervals compared proportions of providers across various metrics. In all, 47% (48/103) versus 35% (34/98) reported declining versus dismissing patients for refusing vaccines, respectively. Pediatricians were unlikely to decline/dismiss patients if they refused influenza, human papilloma virus (HPV), or MenB vaccines. Pediatricians with more years in practice were less likely to decline 15% (9/62) versus 44% (16/36), P = 0.002 and dismiss 8% (5/62) versus 33% (12/36), P = 0.002 patients. Rural pediatricians were less likely than urban to decline 12% (2/17) versus 29% (26/89), P = NS and dismiss patients 0% (0/17) versus 21% (19/89), P = 0.04. Dismissing/declining patients for vaccine refusal is more common among Oklahoma pediatricians than nationally reported. Patterns differ by practice setting, years in practice, and specific vaccine refused. [ABSTRACT FROM AUTHOR]

Background: Immunizations are a common source of pain and anxiety within the pediatric population. Implementation of lidocaine 4% cream, which has a short onset of action, as a standard of care for immunization practices may be feasible. Objective: The objective of this study was to assess the efficacy of lidocaine 4% cream as pain management during immunizations and to evaluate satisfaction of caregivers and nursing staff. Methods: This study was a prospective, randomized, placebo-controlled trial in an urban clinic, which included patients who were ≤ 14 months old accompanied by a caregiver who witnessed the patient receiving an immunization within the previous 7 months. Patients were randomized to receive either lidocaine 4% cream or placebo cream prior to vaccination. Time to cry and duration of cry were recorded. Caregivers completed surveys evaluating attitudes toward pain associated with immunizations as well as their satisfaction with the immunization process through Likert Scale ratings. Nurses completed a questionnaire assessing efficacy and feasibility of lidocaine 4% cream for pain management. Results: A total of 44 patients were included in the analysis in order to achieve 80% power with a p-value < 0.05. Mean duration of cry in patients receiving lidocaine 4% cream was 48.6 seconds in comparison to 65.9 seconds in patients receiving placebo (95%CI, −33.97 seconds to −0.48 seconds; p < 0.05). Conclusions: Lidocaine 4% cream decreased total duration of cry following vaccinations in comparison to placebo with both caregivers and nurses willing to utilize lidocaine 4% cream in a clinic setting if available [ABSTRACT FROM AUTHOR]

Objective  Our objective was to identify factors which underline nonadherence to childhood immunizations provided by the Department of Health and outlined in the Expanded Program on Immunizations in South Africa. Methods  A cross-sectional descriptive study was conducted at Dora Nginza Hospital, a regional hospital in the Eastern Cape Province, which provides free health care in resource-limited settings. It included patients under the age of 5 years and their primary caregivers. A piloted questionnaire was used to collect data, and comparisons were made between children under the age of 5 years who missed one or more immunizations and those with complete immunizations. Data on maternal/caregiver and health system-related characteristics were also collected, and comparisons were made between the two groups. Results  Of the 200 participants enrolled in the study, 47 (23.5%) had incomplete immunizations. Prematurity (odds ratio [OR] = 0.33, p  = 0.001), vaccine shortages (OR = 0.22, p  < 0.005), and a low maternal/caregiver level of education (OR = 0.32, p  = 0.002) were significantly associated with incomplete immunization status. Conclusion  Strategies to improve supply chain management of vaccines and to optimize follow-up care of high-risk children, specifically those born prematurely and those born to women of lower education level, need to be identified and implemented to reduce vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

• 13/20 LMICs and 14/20 HICs included refugees in their national routine immunization policies. • Refugees should be included in national routine immunization policies. • Refugees should be provided with accessible and affordable immunizations. • Efforts would reduce vaccine-preventable diseases and protect the health of refugee populations—especially during the COVID-19 pandemic. In 2020, 26 million refugees resettled in a new country—fleeing their homes due to conflict and persecution. Due to low immunization coverage and underlying health conditions, refugees commonly face an increased risk of contracting vaccine-preventable diseases. We collected and analyzed existing routine immunization policies for refugees across 20 low- and middle-income countries (LMICs) and 20 high-income countries (HICs), each with the highest number of refugees per 1000 residents. Primary and secondary data sources were used to collect policy evidence. Across 20 LMICs, 13 countries specified standing nationwide routine immunization policies for refugees, while 14 out of the 20 HICs included refugees in their national routine immunization programs. LMICs and HICs should include refugees in their national routine immunization policies and provide accessible and affordable immunizations. Such efforts would reduce vaccine-preventable diseases and protect the health of refugee populations—especially during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Clinicians caring for persons with mental illness should be aware of increased mortality, physical problems, and health disparities in this population. This article provides a brief overview of physical health problems in the context of mental illness as well as those related to psychotropic medications, and discusses strategies to manage treatment effectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased cardiorespiratory events with bradycardia and oxygen desaturation have been reported in very low birthweight (VLBW) infants following stressors such as immunizations. These events are difficult to quantify and may be mild. Our group developed an automated algorithm to analyze bedside monitor data from NICU patients for events with bradycardia and prolonged oxygen desaturation (BDs) and used this to compare BDs 24 hours before and after potentially stressful interventions. METHODS: We included VLBW infants from 2012–2017 with data available around at least one of four interventions: two-month immunizations, retinopathy of prematurity (ROP) examinations, ROP therapy, and inguinal hernia surgery. We used a validated algorithm to analyze electrocardiogram heart rate and pulse oximeter saturation data (HR, SpO2) to quantify BD events of HR < 100 beats/minute for≥4 seconds with oxygen desaturation < 80%SpO2 for≥10 seconds. BDs were analyzed 24 hours before and after interventions using Wilcoxon rank-sum tests. RESULTS: In 354 of 493 (72%) interventions, BD frequency stayed the same or decreased in the 24 hours after the event. An increase of at least five BD's occurred in 17/146 (12%) after immunizations, 85/290 (29%) after ROP examinations, 4/33 (12%) after ROP therapy, and 3/25 (12%) after hernia surgery. Infants with an increase in BDs after interventions had similar demographics compared to those without. More infants with an increase in BDs following immunizations were on CPAP or caffeine than those without. CONCLUSIONS: Most VLBW infants in our cohort had no increase in significant cardiorespiratory events in the 24 hours following potentially stressful interventions. [ABSTRACT FROM AUTHOR]

Vaccination is the most important mechanism to improve childhood survival. However, immunization coverage is very low and unevenly distributed throughout the country. Therefore, this study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia. Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to 2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the national immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages. The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for 2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005 and 2019 EDHS. The population density was positively associated with immunization coverage in 2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in 2016. Moreover, mean annual temperature was positively associated with immunization coverage in 2000, 2005 and 2019 EDHSs. Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005, 2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage in all the five EDHSs. This study found that immunization coverage in Ethiopia substantially varied across the subnational and local levels. Spatial clustering of low immunization coverage was observed in Southern, Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density, precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers in Ethiopia to design geographically targeted interventions to increase programs to achieve maximum immunization coverage. [ABSTRACT FROM AUTHOR]

Pediatric solid organ transplant (SOT) recipients are at a uniquely elevated risk for vaccine preventable illness (VPI) secondary to a multitude of factors including incomplete immunization at the time of transplant, inadequate response to vaccines with immunosuppression, waning antibody titers observed post‐SOT, and uncertainty among providers on the correct immunization schedule to utilize post‐SOT. Multiple guidelines are in existence from the Infectious Diseases Society of America and the American Society of Transplantation, which require use in adjunct with additional published references. We summarize the present state of SOT vaccine recommendations from relevant resources in tandem with the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidance utilizing both routine and rapid catch‐up schedules. The purpose of this all‐inclusive review is to provide improved clarity on the most optimal pre‐ and post‐transplant vaccine management within a one‐stop‐shop for the immunizing clinician. [ABSTRACT FROM AUTHOR]

Objectives: Despite the substantial reduction of child mortality in recent decades, Kenya still strives to provide universal healthcare access and to meet other international benchmarks for child health. This study aimed to describe child health service coverage among children visiting six maternal and child health (MCH) clinics in western Kenya. Methods: In a cross-sectional study of Kenyan children who are under the age of 5 years presenting to MCH clinics, child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, and deworming. Among 78 children and their caregivers, nearly 70% of children were fully vaccinated for their age. Results: We found a significant disparity in full vaccination coverage by gender (p = 0.017), as males had 3.5 × higher odds of being fully vaccinated compared to females. Further, full vaccination coverage also varied across MCH clinic sites ranging from 43.8 to 92.9%. Conclusions for Practice: Health service coverage for Kenyan children in this study is consistent with national and sub-national findings; however, our study found a significant gender equity gap in coverage at these six clinics that warrants further investigation to ensure that all children receive critical preventative services. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination. Design: Cross-sectional survey data. Setting: Online Qualtrics recruitment panel. Subject: Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%). Measures: Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors. Analysis: We conducted multivariate linear regressions on each outcome variable after controlling for covariates. Result: Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β =.37, 95% confidence interval [CI] =.25–.48), child (β =.32,.21–.44), and HPV for child (β =.38,.27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β =.46,.33–.59), child (β =.41,.28–.53), and HPV for child (β =.75,.64–.85). Conclusion: Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior. [ABSTRACT FROM AUTHOR]

Purpose: Childhood cancer survivors are at higher risk of human papillomavirus (HPV)-related second cancers than adolescents without cancer, yet their HPV vaccination uptake is lower. Using a statewide sample, we evaluated whether survivors are at higher risk of missed opportunities for concomitant HPV vaccination. Methods: From statewide healthcare data, we identified encounters where vaccines were received. Concomitant HPV vaccine missed opportunities were defined as a vaccine encounter where the HPV vaccine was not administered, although eligibility criteria were met. From these encounters, our sample included 327 survivors identified from the Utah Cancer Registry, diagnosed 2000-2016 at ages 0-9, and a birth year and sex-matched sample without cancer from the general population (n = 1,911). Mixed-effects Poisson regression estimated the rate of concomitant missed opportunities per vaccine encounter and 95% confidence intervals by vaccine encounter type (all vaccines, flu shot only, or adolescent/catch-up) from 2013 to 2016. Results: Survivors had more concomitant HPV vaccine missed opportunities than the population sample (70.0% vs. 59.0%). On average, survivors were 12% more likely to have missed opportunities at vaccine encounters and 4% more likely at flu shot only encounters. The predicted excess risk of concomitant missed opportunities for survivors ranged from 0.5 per10 vaccine encounters to 1.1 per10 vaccine encounters. Higher parental education, rurality, younger first vaccine age, and chemotherapy were associated with missed opportunities. Conclusions: Childhood cancer survivors have more missed opportunities for concomitant HPV vaccination than a population sample. As flu shots should be administered annually, providers have a regular opportunity to recommend and deliver the HPV vaccine to survivors. [ABSTRACT FROM AUTHOR]

Objectives: A quality improvement approach was used to increase pediatric liver transplant recipient live and inactive vaccination rates by assessing titers and recommending vaccinations. Methods: A new screening and immunization process for both live and inactive vaccines was discussed with families at their annual visit. Antibody titers for varicella, measles, mumps, rubella, Haemophilus influenzae type B, hepatitis A, and hepatitis B were obtained. Specific criteria were developed for live virus vaccination candidacy. Vaccines were recommended based on patient titers and vaccination candidacy criteria. Surveillance for adverse effects to live vaccines was performed. Repeat titers were obtained approximately 1‐month post‐vaccine administration. Results: After PDSA cycle 1, 99% (71/72) of pediatric liver transplant patients had titers obtained. Live vaccines were recommended for 32 patients and 16 (50%) were vaccinated. Inactive vaccines were recommended to 64 patients, and 31 (48%) were vaccinated. Eight of 13 (62%) patients with follow‐up titers achieved immunity for inactive vaccines. Zero patients had an adverse reaction to any live vaccine. Ten of 12 (83%) patients with follow‐up titers achieved immunity from live vaccines. The most common barriers to receive live vaccines included not scheduling appointment with primary care provider (n = 3) and "non‐vaccinators" (n = 3). Conclusions: Administering live and inactive vaccines to select pediatric liver transplant patients appears to be safe and effective in our studied population. For PDSA cycle 2, we will continue our current practice and consider offering vaccines in transplant clinic, since this was a barrier to vaccination identified during PDSA cycle 1. [ABSTRACT FROM AUTHOR]

Few topics in medicine have been studied more thoroughly than vaccines. The science is clear on the public and global health benefits of vaccinations; however, the topic still results in vigorous discussion about their efficacy, safety, and possible adverse effects. Anti-vaccination groups and conspiracy theorists have found a place in the online world and on social media sites to spread misinformation. Parents want the best for their children, but when they are influenced by the anti-vaccination movement, the health of their children when not vaccinated can be compromised. They also present a risk to the health of others in the community. Health professionals, including nurses, have a responsibility to educate themselves and others about the science of vaccination, and take active steps to dispel misinformation. [ABSTRACT FROM AUTHOR]

Parents of children with autism spectrum disorder (ASD) may be at greater risk for developing antivaccine beliefs that lead to vaccine delays and/or refusals for their children. We investigated current parental vaccine hesitancy, parents' beliefs about causes of children's developmental delays, and children's vaccination histories among parents of children with ASD or non-ASD developmental delays. Data were analyzed from 89/511 parents (17.4%) who completed the Parent Attitudes About Childhood Vaccines questionnaire and the Revised Illness Perception Questionnaire; 46.1% had childhood vaccination records available. Overall, 21/89 (23.6%, 95% confidence interval [CI]: 15.0-34.0) of parents were vaccine hesitant (ASD n = 19/21 [90.5%], non-ASD n = 2/21 [9.5%]). Parents of children with ASD were significantly more likely to agree with "toxins in vaccines" as a cause of their child's developmental delays (28.4% vs 5.0%, P =.034). The odds of being vaccine hesitant were 11.9 times (95% CI 2.9-48.0) greater among parents who agreed versus disagreed that toxins in vaccines caused their children's developmental delays. Rates of prior vaccine receipt did not differ between hesitant and nonhesitant groups. [ABSTRACT FROM AUTHOR]

In the United States, the growing population of older adults with limited English language proficiency (LEP) faces profound health care disparities. Previous research on vaccination of older adults has been based on self-reported data, without clinical verification. We compared pneumococcal vaccination rates between a patient group with LEP and a group of English speakers in an older community-dwelling population. A population-nested matched cohort of participants age 65 years and older was identified in Minnesota. Patients with LEP were identified through an electronic alert within the electronic health record, designed to determine the need for an interpreter. Patients were matched 1 to 1 for age, sex, and Charlson comorbidity index. We used conditional logistic regression for the final analysis. In total, 24,052 patients were identified as older patients (mean [SD] age, 74 [7] years). Of them, 617 patients (2.6%) had LEP. The most common primary languages were Somali (24%), Vietnamese (15%), and Spanish (13%). We found lower rates of vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) in the LEP group compared with English speakers [62% vs 77%; odds ratio (OR) (95% CI) 2.07 (1.61–2.66); P < 0.001]. Results were similar for 23-valent pneumococcal polysaccharide vaccine (PPSV23) [60% vs 75%; OR (95% CI) 1.97 91.54–2.51); P < 0.001]. These data are suggestive that older adults who required a language interpreter during health care encounters were less likely to be vaccinated with PCV13 and PPSV23 than older adults who did not require an interpreter. Effectiveness studies are needed to determine which interventions can help improve vaccination rates in the LEP population of elderly patients. [ABSTRACT FROM AUTHOR]

This study determined the predictors of intention to obtain HPV vaccination among Thai female college students. The participants of this study were Thai female college students aged 18 - 26 years who were unvaccinated (N = 191). The study used a cross-sectional survey conducted from October to November of 2018. Seven predictors were included in the conceptual framework and analyzed for their relative contribution using multiple regression. The questionnaire reliability was > 0.80 for each construct, except knowledge (0.714). Significant predictors for intention to obtain HPV vaccine were found to be attitude to obtain HPV vaccination (β = 0.31, p < 0.001); perceived behavioral control (β = 0.31, p < 0.001); and perceived susceptibility (β = 0.22, p = 0.005), accounting for 40 % of its variance. Increasing intention to obtain the vaccine of HPV among Thai female college students should focus on enhancing positive attitudes toward obtaining the HPV vaccination, boosting perceived behavioral control, and increasing perceived susceptibility to its infection and diseases. [ABSTRACT FROM AUTHOR]

Purpose: Identify factors associated with school nurses' professional practice to provide parents with (1) Information about HPV vaccination providers, and (2) resources about HPV vaccination. Methods. Data were collected from the Ohio Association of School Nurses conference attendees. Results. School nurses' who served 9th -- 12th grade and who perceived themselves as an opinion leader were more likely to provide HPV education resources. School nurses' who served prekindergarten through 5th graders were more likely to provide parents with HPV vaccine resources. Conclusion. The current study provides insight into key factors associated with school nurses providing vaccine education and resources to parents. [ABSTRACT FROM AUTHOR]

Background Outbreaks of vaccine-derived poliovirus type 2 (VDPV2) continue to expand across Africa. We conducted a serological survey of polio antibodies in high–polio risk areas of Niger to assess risk of poliovirus outbreaks. Methods Children between 1 and 5 years of age were enrolled from structures randomly selected using satellite imaging enumeration in Diffa Province, Niger, in July 2019. After obtaining informed consent, dried blood spot cards were collected. Neutralizing antibodies against 3 poliovirus serotypes were detected using microneutralization assay at the Centers for Disease Control and Prevention. Results We obtained analyzable data from 309/322 (95.9%) enrolled children. Seroprevalence of polio antibodies was 290/309 (93.9%), 272/309 (88.0%), and 254/309 (82.2%) for serotypes 1, 2, and 3, respectively. For serotypes 1 and 2, the seroprevalence did not significantly change with age (P  = .09 and P  = .44, respectively); for serotype 3, it increased with age (from 65% in 1–2-year-olds to 91.1% in 4–5-year olds; P  < .001). We did not identify any risk factors for type 2 seronegativity. Conclusions With type 2 seroprevalence close to 90%, the risk of emergence of new cVDPV2 outbreaks in Niger is low; however, the risk of cVDPV2 importations from neighboring countries leading to local transmission persists. Niger should maintain its outbreak response readiness capacity and further strengthen its routine immunization. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate immunization-related experiences among Karen and Karenni refugees from the Thai-Myanmar border currently living in the U.S. Exploration of knowledge, beliefs, and experiences of immunization among Karen and Karenni refugees will help strategize education programs to enhance immunization. Karen and Karenni refugees resettled in the United States from the Thai-Myanmar (Burma) border (n = 120) completed a survey on their perceptions and experiences related to immunizations. Older age was associated with higher levels of perceptions that immunizations were safe and longer-term residence in the U.S. was associated with lower levels of perceptions that immunizations were safe. While long-term side effects of immunizations are not commonly perceived, perceived short-term side effects are prevalent. With improved understanding of demographic factors related to immunization belief and perception, the healthcare system in the United States can strategize culturally fit intervention programs that alleviate potential concerns Karen and Karenni refugees might have regarding vaccination. [ABSTRACT FROM AUTHOR]

Background: Refugees are frequently not immune to vaccine-preventable infections. Adherence to consensus guidelines on vaccination and infectious diseases screening among refugees resettling in the U.S. is unknown. We sought to determine rates of vaccine completion and infectious diseases screening in refugees following resettlement.Methods: We conducted a retrospective cohort study of refugees resettling in a region in the U.S. using medical data from June 2013-April 2015. We determined the proportion of vaccine-eligible refugees vaccinated with measles-mumps-rubella (MMR), hepatitis A/B, tetanus, diphtheria, and acellular pertussis (Tdap), and human papillomavirus (HPV) following resettlement. We also determined the proportion of refugees who completed HIV and hepatitis C (HCV) screening.Results: One hundred and eleven subjects were included, primarily from Iraq (53%), Afghanistan (19%), and Eritrea (11%). Of the 84 subjects who were vaccine-eligible, 78 (93%) initiated and 42 (50%) completed vaccinations within one year of resettlement. Odds of completing vaccination were higher for men (OR: 2.38; 95%CI:1.02-5.71) and for subjects with English proficiency (OR: 3.70; 95%CI:1.04-17.49). Of the 78 subjects (70%) completing HIV screening, two (3%) were diagnosed with HIV. Nearly all subjects completed screening for HCV, and one had active infection.Conclusion: While most refugees initiate vaccinations, only 50% completed vaccinations and 70% completed HIV screening within 1 year of resettlement. There is a need to emphasize vaccine completion and HIV screening in refugee patients following resettlement. [ABSTRACT FROM AUTHOR]

Objective: California's Senate Bill 277 (SB277) was mandated to reduce the prevalence of measles by eliminating personal belief exemptions. This study evaluated seven county‐level records to determine the impact of SB277 on immunizations among kindergarteners in Northern California. Design: This study used a quantitative postintervention secondary data analysis. Sample: This study included three kindergarten schools in seven Northern California counties during three academic years from 2015 to 2019. Measurements: Sixty‐three previously collected school measurements involving 4,626 students were included in a secondary analysis. The study used grouped logistic regression to evaluate the variations in immunization compliance records (2015–16 vs. 2017–18 and 2018–19) among kindergartners in seven counties. Results: This study found no significant differences in (1) overall county‐level measures and (2) the likelihood that kindergartners would be current with measles–mumps–rubella (MMR; OR = 1.12, CI = 0.79–1.62) or be up‐to‐date with five immunizations (OR = 1.08, CI = 0.77–1.52) post‐SB277 versus pre‐SB277. Conclusion: This study showed that SB277 had a small clinical but nonstatistically significant impact on kindergartners' up‐to‐date with up‐to‐date rates of compliance with five immunizations and those current with two doses of MMR in seven Northern California counties. Despite the passing of SB277, vaccine‐hesitant parents have continued to seek alternatives to immunizations. [ABSTRACT FROM AUTHOR]

CD4 expression identifies a subset of mature T cells primarily assisting the germinal center reaction and contributing to CD8+ T-cell and B-cell activation, functions, and longevity. Herein, we present a family in which a novel variant disrupting the translation-initiation codon of the CD4 gene resulted in complete loss of membrane and plasma soluble CD4 in peripheral blood, lymph node, bone marrow, skin, and ileum of a homozygous proband. This inherited CD4 knockout disease illustrates the clinical and immunological features of a complete deficiency of any functional component of CD4 and its similarities and differences with other clinical models of primary or acquired loss of CD4+ T cells. The first inherited loss of any functional component of CD4, including soluble CD4, is clinically distinct from any other congenital or acquired CD4 T-cell defect and characterized by compensatory changes in T-cell subsets and functional impairment of B cells, monocytes, and natural killer cells. [ABSTRACT FROM AUTHOR]

BACKGROUND Nurses in an urban school district completed a brief survey about their knowledge, attitudes, and practices related to human papillomavirus (HPV) vaccination. METHODS: Descriptive and bivariate analyses examined trends and differences. RESULTS: Among 208 nurses, only 3% correctly answered all 5 knowledge questions. Nurses with greater than 10 years of experience were more confident about where to refer a student for vaccination (p <.01) and less likely to be interested in providing the vaccine at their school (p <.001) compared to those with less than 10 years of experience. Almost one third (32%) of nurses reported having access to educational material about the HPV vaccine at their schools. CONCLUSIONS: Whereas most nurses had positive attitudes about the vaccine, fewer were interested in administering the HPV vaccine in school. Educational resources for school nurses could increase awareness of the vaccine and promote linkages to care outside of school. [ABSTRACT FROM AUTHOR]

The Vaccine Education Center is a web site created by Children's Hospital of Philadelphia. It provides users with trustworthy information about vaccines directed toward parents and other health care professionals. This web site examines specific vaccines and diseases, as well as provides a timeline of when to receive each vaccine. There are sections geared toward different audiences, including interactive activities for children, downloadable resources for parents, and up-to-date vaccine news for health care professionals. The main purpose of the web site is to empower parents with information about vaccines, leading them to make informed decisions about their children's health. [ABSTRACT FROM AUTHOR]

• Vaccine exemption cluster areas can help identify communities at high risk for disease outbreaks. • Heterogeneity of vaccine exemptions clusters exists in Michigan. • Vaccine exemption clusters can be delineated by exemption type (medical, religious and philosophical) in Michigan. • Michigan's administrative rule change for vaccine exemptions impacted exemption clusters. • Vaccine exemption cluster type specific interventions may make best use of limited resources. This study explored vaccine exemption clustering in Michigan and examined whether vaccine exemptions clustered by exemption type (medical, religious, and philosophical). Furthermore, the study investigated whether Michigan's nonmedical vaccine exemption policy change had an impact on type-specific vaccine exemption clusters following its implementation. The study used the ArcGIS optimized hot spot analysis tool to visually examine vaccine exemption clustering by type in Michigan. The study analyzed secondary kindergarten vaccine exemption data from 2301 elementary school buildings in Michigan for years spanning 2008 to 2015 and 2016 to 2017 post policy change. Clustering of vaccine exemptions by type was present both before and after implementation of the policy with fewer statistically significant features and differences regarding the distribution of hot spot clusters following the policy change. Considering the heterogeneity in vaccine exemption hot spot clustering by type can help to inform public health officials to areas/communities at high risk for vaccine preventable disease outbreaks. Such analysis can allow for the implementation of vaccine exemption interventions that are exemption type specific and tailored for a given area, thus maximizing impact and making best use of limited public health resources. This analysis was also able to showcase the impact of Michigan's nonmedical vaccine exemption policy on vaccine exemption hot spot clusters. [ABSTRACT FROM AUTHOR]

The research objective was to rapidly scale up and spread a proven learning collaborative approach (intervention) for adult vaccination rates for influenza and pneumococcal disease from 7 to 39 US health care organizations and to examine improvement in adult immunization rates after scale-up. Comparative analyses were conducted between intervention and nonintervention propensity score-matched providers on vaccination rates using a difference-in-differences approach. Qualitative data, collected during site visits and in-person and virtual meetings, were used to enhance understanding of quantitative results. In 2017–2018, an analysis of a subset of sites (n = 9) from 2 intervention cohorts (∼20 sites each) demonstrated greater improvement than their matched providers in pneumococcal vaccinations (PV) for patients ages ≥65 years (treatment effect range: 1.4%-3.7%, P < 0.01) and PV for high-risk patients (eg, with immunocompromising conditions) aged 19–64 years (0.8%-1.6%, P < 0.01). Significant effects were observed in one of the study cohorts for PV for at-risk patients (eg, with diabetes) aged 19–64 years (1.7%, P < 0.01), and influenza vaccination rates (2.4%, P < 0.001). Individual health systems demonstrated even greater improvements across all 4 vaccinations: 9.5% influenza; 8.7% PV ages ≥65 years; 11.8% PV high-risk; 16.3% PV at-risk (all P < 0.01). Results demonstrated that a 7-site pilot could be successfully scaled to 39 additional sites, with similar improvements in vaccination rates. Between 2014 and 2018, vaccination improvements among all 46 groups (7 pilot, 39 in subsequent cohorts) resulted in an estimated 5.5 million adult vaccinations administered or documented in 27 states. [ABSTRACT FROM AUTHOR]

Background: In July 2015, King Faisal Hospital Family Medicine clinics (KFH-FMC) successfully implemented a paperless, fully integrated, electronic healthcare system. The aim of this study is to evaluate the impact of moving to a fully integrated electronic medical record system, with clinical decision support (CDS) systems, on the quality of healthcare services in a primary care setting. We aim to evaluate the impact of CDS on clinical outcomes such as screening and diagnosis of breast and colorectal cancers, as well as the management of chronic diseases such as diabetes and hypertension, and the uptake of immunizations. Inclusion and Exclusion Criteria: Our study included all adult patients, over the age of 18, registered in the Family Medicine clinic linked to King Faisal Hospital, seen between January 2012 and December 2018. Design: Retrospective cohort study. Setting: Family Medicine clinics at King Faisal Hospital (KFH-FMC). Materials and Methods: Data were collected retrospectively from the electronic health records of all adult patients above 18 years of age, who were seen in KFH-FMC between January 2012 and December 2018. We analyzed several processes of care and a number of clinical outcomes, comparing results for the three and a half years before CDS implementation with the three and a half years after implementation. Data collected included blood pressure measurements, lipid levels, HbA1c for diabetic patients, screening tests done, including PAP smear, mammogram, fecal occult blood tests, and bone densitometry. Other data included cancer diagnoses and immunizations received. Results: Significant increases were found in adult vaccine uptake ranging from an 11-fold increase in influenza uptake, to a 22-fold increase in pneumococcal 23 uptake. The uptake of all the cancer screening tests increased (FOB 66%, mammogram 33%, PAP smear 16%). Diagnoses of breast and colorectal cancer showed significant increases. Breast cancer diagnoses increased from 2 to 14, and colorectal cancer from 3 to 11. No significant improvement was found in chronic disease outcomes. Discussion: The electronic health record with CDS led to significantly improved uptake of immunizations and screening tests, with earlier diagnoses of breast and colon cancer. Evidence of improvement in chronic disease outcomes is still lacking. [ABSTRACT FROM AUTHOR]

Background: Historically, the IDSA and the AST have recommended that live vaccines not be administered post-transplant due to concern for induction of vaccinestrain disease in immunocompromised hosts. However, recent prospective studies and revised AST guidelines published in April 2019 suggest that in the current era of immunosuppression minimization, live vaccines may be safely administered to select transplant recipients with resulting immunoprotection. The goal of this study was to assess current post-transplant live vaccine practices at individual pediatric liver transplant centers following the updated AST guidelines. Methods: A six-item email survey detailing center-specific post-transplant live vaccine practices followed by up to three response-specific questions were distributed between July 2019 and May 2020 to a representative from each center participating in the SPLIT consortium. Results: The overall survey response rate was 93% (41/44 centers). Only 29% (12/41) of centers offer live vaccines post-transplant; each of these 12 centers uses different eligibility criteria for live vaccines. There was no difference between large (ten or more transplants per year) and small (less than ten transplants per year) centers in likelihood to offer live vaccines post-transplant. The main reasons for a center not offering post-transplant live vaccines were safety concerns and inability to reach group consensus. Conclusions: The majority of pediatric liver transplant centers are reluctant to offer live vaccines post-transplant despite the updated AST guidelines. Prospective multicenter studies are needed to confirm safety and immunogenicity of live vaccines post-transplant. [ABSTRACT FROM AUTHOR]

Although the etiology of type 1 diabetes (T1D) is not well understood, it is believed to comprise both genetic and environmental factors. Viruses are the most well studied environmental trigger, and there is a small but growing body of research on the potential influence of rotavirus on T1D. Rotavirus infections were initially identified as possible triggers of T1D given similarities between viral peptide sequences and T1D autoantigen peptide sequences. Furthermore, rotavirus infection has been shown to modify T1D risk in T1D-prone mice. However, research into associations of rotavirus infections with T1D development in humans have yielded mixed findings and suggested interactions with age and diet. As global availability of rotavirus vaccines increases, recent studies have assessed whether rotavirus vaccination modifies T1D development, finding null or protective associations. Overall, evidence to date suggests a possible triggering relationship between some wild-type rotavirus infections and T1D, but the potential effect of rotavirus vaccination remains unclear. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy may be more common among parents of children with autism spectrum disorder (ASD). We examined factors associated with ASD-specific vaccine hesitancy among caregivers of children with ASD who participated in the SPARK study (Simons Foundation Powering Autism Research for Knowledge). 225 participants completed an online survey containing the Parent Attitudes About Childhood Vaccines (PACV) questionnaire (measure of vaccine hesitancy) and the Illness Perception Questionnaire revised for parents of children with ASD (IPQ-R-ASD; measure of parents' views about ASD). 65 participants (28.8%) were vaccine hesitant (PACV score ≥ 50); children of vaccine-hesitant parents (VHPs) were less likely to be first born (n = 27, 41.5%), had greater ASD-symptom severity (mean Social Communication Questionnaire score = 23.9, SD = 6.9), and were more likely to have experienced developmental regression (n = 27, 50.9%) or plateau (n = 37, 69.8%). Compared to non-hesitant parents, VHPs significantly more often endorsed accident/injury, deterioration of the child's immune system, diet, environmental pollution, general stress, parents' negative views, parents' behaviors/decisions, parents' emotional state, and vaccines as causes for ASD. VHPs also had higher scores on the Personal Control, Treatment Control, Illness Coherence, and Emotional Representations subscales of the IPQ-R than did non-hesitant parents. In the final model, ASD-related vaccine hesitancy was significantly associated with higher scores on the Emotional Representations subscale (OR = 1.13, p = 0.10), agreement with deterioration of the child's immunity as a cause of ASD (OR = 12.47, p < 0.001), the child not having achieved fluent speech (OR = 2.67, p = 0.17), and the child experiencing a developmental plateau (OR = 3.89, p = 0.002). Findings suggest that a combination of child functioning and developmental history, as well as parents' negative views about and their sense of control over ASD, influence vaccine hesitancy among parents of children with ASD. [ABSTRACT FROM AUTHOR]

Nine years elapsed between Gavi's investment decision to support typhoid conjugate vaccines (TCVs) in 2008 and Gavi support becoming available for countries to introduce TCV. The protracted path toward Gavi support for TCV highlights the challenges of vaccine development for lower-income countries and the importance of Gavi engagement as early as possible in product development processes to support the alignment of manufacturing, global policy, and program implementation. Early engagement would provide inputs to inform strategic vaccine investment decisions that transition more efficiently toward country implementation. Several countries have been approved for Gavi support to introduce TCV in 2019–2020. The paucity of generalizable typhoid epidemiological data in early introducing countries has reinforced the need for continued evidence generation regarding typhoid epidemiology and TCV impact. This has led to the development of guidance and tools to support country decision making for TCV introduction based on enhanced understanding of local typhoid burden and risk. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Past research has focused on understanding influenza vaccine acceptance in non-Hispanic white populations; however, research on the social causes of influenza vaccine acceptance rates in Hispanic populations is slowly developing. Objective: The purpose of this study was to assess theoretically driven predictors (i.e. attitudes, perceptions, behaviors, etc.) on influenza and the intention to vaccinate. Methods: A survey was administered to assess predictors of intentions to receive the influenza vaccine. The survey included items adapted from the National Flu Survey. Results: Key constructs common in models of health behaviors emerged as predictors of behavioral intentions to receive the flu vaccine. Recent vaccination within the past year (P < 0.001), perceived effectiveness of the flu vaccine (P < 0.004), and perceived safety of the flu vaccine (P = 0.009) were predictors of intentions to vaccinate. Exploratory analyses revealed that government distrust was a statistically significant predictor of intentions to vaccinate (P = 0.044). Conclusion: The above results have important implications for health-care providers and public health educators. The better we understand the relationship between theoretically driven predictors and vaccine behaviors, the more educators and health-care providers can focus on meaningful, culturally sensitive, targeted-vaccine education. [ABSTRACT FROM AUTHOR]

Rotavirus vaccination has been associated with a short-term increased risk of intussusception. Our analysis of insurance claims for 1 858 827 US children with 544 recorded cases of intussusception found a nonsignificant decrease in intussusception (hazard ratio, 0.79 [95% confidence interval, 0.57–1.09]) in fully rotavirus-vaccinated children followed up to the age of 2 years. [ABSTRACT FROM AUTHOR]

Vaccine therapeutics and the practice of immunization provision are ever-changing. As pharmacy-based immunization services continue to flourish in the United States, more and more patients are requesting both routine and travel vaccines in community pharmacies. However, vaccine recommendations from the Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices (CDC/ACIP) can sometimes differ from product-specific US Food and Drug Administration (FDA)-indicated uses. In addition, changes in vaccine schedules, product availability, and disease outbreaks can present immunizing pharmacists with scenarios requiring a high level of clinical judgment. Thus, it is of paramount importance that all immunizing pharmacists maintain competency in the most recent evidence in vaccine therapeutics, as well as practice standards for vaccine provision and administration. This review provides an update of the most recent literature surrounding emerging topics in adolescent and adult immunizations—highlighting influential studies and recent developments in the prevention of herpes zoster, human papillomavirus (HPV), measles, mumps, rubella (MMR), meningococcal disease, tetanus, diphtheria, and pertussis. Key concepts discussed include the emergence of the new recombinant zoster vaccine (RZV), meningococcal vaccine product selection, MMR revaccination during disease outbreaks, tetanus vaccine product selection, and duration of pertussis immunity with vaccination. [ABSTRACT FROM AUTHOR]

Fear of autism has led to a decline in childhood-immunization uptake and to a resurgence of preventable infectious diseases. Identifying characteristics of parents who believe in a causal role of vaccines for autism spectrum disorder (ASD) in their child may help targeting educational activities and improve adherence to the immunization schedule. To compare caregivers of children with ASD who agree or disagree that vaccines play an etiological role in autism for 1) socio-demographics characteristics and 2) developmental and clinical profiles of their children. Data from 16,525 participants with ASD under age 18 were obtained from SPARK, a national research cohort started in 2016. Caregivers completed questionnaires at registration that included questions on beliefs about the etiologic role of childhood immunizations and other factors in ASD. Data were available about family socio-demographic characteristics, first symptoms of autism, developmental regression, co-occurring psychiatric disorders, seizures, and current levels of functioning. Participants with ASD were 80.4% male with a mean age of 8.1 years (SD = 4.1). Overall, 16.5% of caregivers endorsed immunizations as perceived causes of autism. Compared to caregivers who disagreed with vaccines as a cause for ASD, those who believed in vaccine causation came disproportionately from ethnic minority, less educated, and less wealthy backgrounds. More often their children had experienced developmental regression involving language and other skills, were diagnosed earlier, had lost skills during the second year of life, and had worse language, adaptive, and cognitive outcomes. One in six caregivers who participate in a national research cohort believe that child immunizations could be a cause of autism in their child. Parent social background (non-White, less educated) and child developmental features (regression in second year, poorer language skills, and worse adaptive outcomes) index caregivers who are more likely to harbor these beliefs and could benefit from targeted educational activities. [ABSTRACT FROM AUTHOR]

County health departments typically bear responsibility for implementing immunization programs. In 2011, the Florida state legislature made significant reductions in state health department funding, and responsibility for routine childhood immunizations in some counties was shifted to local federally qualified health centers. This study was conducted to assess the impact of these administrative changes on childhood immunization rates in one county. A secondary analysis of data in the state immunization registry was conducted to assess changes and patterns in childhood immunization rates within the local health department, federally qualified health centers, and private pediatric practices. These changes were compared in the 3-year period before, during, and after the change. Results revealed that there was no net negative change in the vaccination rates of 0- to 7-year-old children in the county. There was a shift in the proportion of vaccinations administered by each health care delivery setting. The majority of immunizations were administered in private pediatric practices. When state funding for the local public health department ceased, other delivery settings covered the immunizations previously provided in the public health sector. [ABSTRACT FROM AUTHOR]

Deaths from cervical cancer are common in lower middle‐income countries and are preventable. This commentary describes advances in the rollout of cervical cancer prevention and suggests strategies to continue progress. [ABSTRACT FROM AUTHOR]

OBJECTIVES The Advisory Committee on Immunization Practices (ACIP) recommends additional immunizations for people with asplenia or functional asplenia, such as children with sickle cell disease. Adherence rate to the recommended immunization schedule for functional asplenia remains low for children with sickle cell disease. The purpose of this study was to assess the immunization adherence for this population at a single institution in Kentucky and to evaluate the use of the Kentucky Immunization Registry (KYIR) by providers. METHODS A single-center retrospective chart review was conducted for 107 children with sickle cell disease ages 2 through 18 years. Immunization histories were obtained from the hospital EMRs, the sickle cell clinic EMR, the KYIR, and by requesting records from primary care physicians. Each patient was documented as either missing or having complete records in the KYIR. RESULTS The complete adherence rate to the ACIP-recommended immunization schedule for children with functional asplenia was 6% (6 of 107). Nearly all children were compliant with the Haemophilus influenzae type B vaccination, whereas the adherence rate for the meningococcal and pneumococcal vaccines ranged from 25% to 77%. The lowest immunization rate was observed in children eligible for the meningococcal B vaccine (25%). Only 3 patients had a complete immunization history documented in the KYIR. CONCLUSIONS Adherence to the ACIP-recommended immunization schedule for functionally asplenic patients is poor among children with sickle cell disease included in this study. Quality improvement measures should focus on increasing immunization adherence and improving documentation of immunization records in the KYIR for this patient population. [ABSTRACT FROM AUTHOR]

Recent outbreaks of measles cases in the United States have generated concern regarding the developing trend of vaccine hesitancy. While previous research has examined the pro- and anti-vaccination messages that information seekers may produce when searching online, research has not specifically examined how individuals precisely access, search, and evaluate online vaccination information. This qualitative study used semi-structured interviews with 20 parents who chose not to vaccinate their children to examine how parents search online to make decisions regarding vaccinations. Relying primarily on Google as a search engine, parents searched using negative phrases and questions, often demonstrating a confirmation bias throughout the search process. Three themes emerged within evaluation of sources: confirmation seekers, exhaustive seekers, and casual seekers. Evaluation and validation processes varied for each group. Suggestions for the construction of online vaccination messages are discussed. [ABSTRACT FROM AUTHOR]