Publications

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    ABSTRACT: Maine implemented a statewide pre-K through 12-school vaccination program during the 2009-2010 H1N1 influenza pandemic. The main objective of this study was to determine which school, nurse, consent form, and clinic factors were associated with school-level vaccination rates for the first dose of the 2009 H1N1 pandemic vaccine.
    Journal of public health management and practice: JPHMP 10/2014; · 1.47 Impact Factor
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    ABSTRACT: The use of alternative venues beyond physician offices may help to increase rates of population influenza vaccination. Schools provide a logical setting for reaching children, but most school-located vaccination (SLV) efforts to date have been limited to local areas. The potential reach and acceptability of SLV at the national level is unknown in the United States. To address this gap, we conducted a nationally representative online survey of 1088 parents of school-aged children. We estimate rates of, and factors associated with, future hypothetical parental consent for children to participate in SLV for influenza. Based on logistic regression analysis, we estimate that 51% of parents would be willing to consent to SLV for influenza. Among those who would consent, SLV was reported as more convenient than the regular location (42.1% vs. 19.9%, P<0.001). However the regular location was preferred over SLV for the child's well-being in case of side effects (46.4% vs. 20.9%, P<0.001) and proper administration of the vaccine (31.0% vs. 21.0%, P<0.001). Parents with college degrees and whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination were more likely to consent, as were parents of uninsured children. Several measures of concern about vaccine safety were negatively associated with consent for SLV. Of those not against SLV, schools were preferred as more convenient to the regular location by college graduates, those whose child received the 2009-2010 seasonal or 2009 H1N1 influenza vaccination, and those with greater travel and clinic time. With an estimated one-half of U.S. parents willing to consent to SLV, this study shows the potential to use schools for large-scale influenza vaccination programs in the U.S.
    Vaccine 01/2014; · 3.77 Impact Factor
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    ABSTRACT: Background Seasonal influenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks. Objectives We evaluated the impact of California’s 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP. Methods We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples. Results We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated. Conclusion Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.
    American journal of infection control 01/2014; 42(3):288–293. · 3.01 Impact Factor
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    ABSTRACT: Methods of measuring influenza vaccination of healthcare personnel (HCP) vary substantially, as do the groups of HCP that are included in any given set of measurements. Thus, comparison of vaccination rates across healthcare facilities is difficult. The goal of the study was to determine the feasibility of implementing a standardized measure for reporting HCP influenza vaccination data in various types of healthcare facilities. A total of 318 facilities recruited in four U.S. jurisdictions agreed to participate in the evaluation, including hospitals, long-term care facilities, dialysis clinics, ambulatory surgery centers, and physician practices. HCP in participating facilities were categorized as employees, credentialed non-employees, or other non-employees using standard definitions. Data were gathered using cross-sectional web-based surveys completed at three intervals between October 2010 and May 2011; data were analyzed in February 2012. 234 facilities (74%) completed all three surveys. Most facilities could report on-site employee vaccination; almost one third could not provide complete data on HCP vaccinated outside the facility, contraindications, or declinations, primarily due to missing non-employee data. Inability to determine vaccination status of credentialed and other non-employees was cited as a major barrier to measure implementation by 24% and 27% of respondents, respectively. Using the measure to report employee vaccination status was feasible for most facilities; tracking non-employee HCP was more challenging. Based on evaluation findings, the measure was revised to limit the types of non-employees included. Although the revised measure is less comprehensive, it is more likely to produce valid vaccination coverage estimates. Use of this standardized measure can inform quality improvement efforts and facilitate comparison of HCP influenza vaccination among facilities.
    American journal of preventive medicine 09/2013; 45(3):297-303. · 4.24 Impact Factor
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    ABSTRACT: Using qualitative methods, we explore the implementation of California's 2007 influenza immunization requirements of hospital-based health care personnel (HCP). We conducted nine case studies of California hospitals with different HCP vaccination rates and policies. Case studies consisted of interviewing 13 hospital representatives and analyzing relevant hospital documents, including influenza policies. We also conducted 13 semi-structured phone interviews with key state and county public health officials, union representatives, and officials of various professional healthcare organizations. Our qualitative results complement our quantitative findings reported elsewhere and suggest that California's vaccination requirements likely did not increase influenza vaccination uptake among HCP. The law was not strong enough to compel hospitals with low and medium vaccination rates to improve their vaccination efforts, and hospitals with high vaccination rates were able to comply fully with the law by continuing to do what they were already doing - namely offering vaccinations to HCP, providing education about the risks of influenza and the benefits of vaccination, and obtaining signed declinations from those who refuse vaccination. Nonetheless, we found that by publicly raising the issue of influenza vaccination in the context of public safety and healthcare quality, California's law encouraged hospitals to develop and implement data systems to monitor the effectiveness of vaccination promotion efforts and prompted discussions, and, in some cases, adoption of stricter vaccination requirements at hospital or county levels. Our findings generally support the literature that suggests that permissive influenza vaccination requirements, though politically feasible, provide little direct incentive for hospitals to focus efforts on increasing HCP vaccination rates.
    Vaccine 07/2013; · 3.77 Impact Factor
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    ABSTRACT: (See the commentary by Sickbert-Bennett and Weber, on pages 346-348 .) Objective. To evaluate the reliability and validity of a standardized measure of healthcare personnel (HCP) influenza vaccination. Setting. Acute care hospitals, long-term care facilities, ambulatory surgery centers, physician practices, and dialysis centers from 3 US jurisdictions. Participants. Staff from 96 healthcare facilities randomly sampled from 234 facilities that completed pilot testing to assess the feasibility of the measure. Methods. Reliability was assessed by comparing agreement between facility staff and project staff on the classification of HCP numerator (vaccinated at facility, vaccinated elsewhere, contraindicated, declined) and denominator (employees, credentialed nonemployees, other nonemployees) categories. To assess validity, facility staff completed a series of case studies to evaluate how closely classification of HCP groups aligned with the measure's specifications. In a modified Delphi process, experts rated face validity of the proposed measure elements on a Likert-type scale. Results. Percent agreement was high for HCP vaccinated at the facility (99%) and elsewhere (95%) and was lower for HCP who declined vaccination (64%) or were medically contraindicated (64%). While agreement was high (more than 90%) for all denominator categories, many facilities' staff excluded nonemployees for whom numerator and denominator status was difficult to determine. Validity was lowest for credentialed and other nonemployees. Conclusions. The standardized measure of HCP influenza vaccination yields reproducible results for employees vaccinated at the facility and elsewhere. Adhering to true medical contraindications and tracking declinations should improve reliability. Difficulties in establishing denominators and determining vaccination status for credentialed and other nonemployees challenged the measure's validity and prompted revision to include a more limited group of nonemployees.
    Infection Control and Hospital Epidemiology 04/2013; 34(4):335-45. · 4.02 Impact Factor
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    ABSTRACT: Background: Significant variation in measurement of healthcare personnel (HCP) influenza vaccination makes it difficult to compare vaccination rates across healthcare facilities. Our evaluation objectives were to determine the feasibility of implementing a Centers for Disease Control and Prevention-sponsored standardized measure of HCP influenza vaccination in various healthcare facility types and to identify barriers to data collection and reporting. Methods: A total of 318 healthcare facilities recruited by four U.S. jurisdictions volunteered for the evaluation and were asked to complete web-based surveys at three points during the 2010-2011 influenza season. Reportable data included influenza vaccine receipt (at or outside the facility), reported medical contraindications, documented non-medical declinations, facility characteristics, and reporting barriers. HCP were categorized as “employees”, “credentialed non-employees”, or “other non-employees”, based on whether they were paid directly by the facility in which they worked and whether their job duties required professional licensure or credentialing. Results: 234 facilities (74%) completed all three surveys. Most facilities could easily report on-site vaccination, but almost one-third could not provide complete data on HCP vaccinated outside the facility, contraindications, or declinations, primarily due to missing data for non-employees. Inability to determine vaccination status of credentialed and other non-employees was cited as a major barrier to measure implementation by 24% and 27% of respondents, respectively, versus 7% for employees. Conclusion: Reporting employee influenza vaccination data using a standardized measure was feasible for most facilities; tracking non-employee HCP was more challenging. Based on these findings, revisions to the measure included limiting the types of non-employee personnel covered. Use of this measure can inform quality improvement efforts in healthcare facilities and facilitate national comparisons of HCP influenza vaccination rates. The Centers for Medicare and Medicaid Services recently issued a rule including the measure in its quality reporting program for acute care hospitals beginning in January 2013.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: To understand the feasibility of implementing a standardized performance measure for collecting and reporting influenza vaccination rates among healthcare personnel, qualitative, semistructured interviews were conducted with key informants in 32 healthcare facilities. Despite practical and logistical challenges to implementing the measure, respondents perceived clear benefits to its use.
    Infection Control and Hospital Epidemiology 09/2012; 33(9):945-8. · 4.02 Impact Factor
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    ABSTRACT: This study retrospectively estimated costs for a convenience sample of school-located vaccination (SLV) clinics conducted in Maine during the 2009-2010 influenza season. Surveys were developed to capture the cost of labor including unpaid volunteers as well as supplies and materials used in SLV clinics. Six nurses from different school districts completed a clinic day survey on staff time; four of the six also provided data for materials and supplies. For all clinics, average per-dose labor cost was estimated at $5.95. Average per-dose material cost, excluding vaccine, was $5.76. From the four complete clinic survey responses, total per-dose cost was estimated to be an average of $13.51 (range = $4.91-$32.39). Use of donated materials and uncompensated volunteer staff could substantially reduce per-dose cost. Average per-dose cost could also be lowered by increasing the number of doses administered in a clinic.
    The Journal of School Nursing 08/2012; 28(5):336-43. · 1.01 Impact Factor
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    ABSTRACT: To describe the trend of Acanthamoeba keratitis case reports following an outbreak and the recall of a multipurpose contact lens disinfection solution. Acanthamoeba keratitis is a serious eye infection caused by the free-living amoeba Acanthamoeba that primarily affects contact lens users. A convenience sample of 13 ophthalmology centers and laboratories in the USA, provided annual numbers of Acanthamoeba keratitis cases diagnosed between 1999-2009 and monthly numbers of cases diagnosed between 2007-2009. Data on ophthalmic preparations of anti-Acanthamoeba therapies were collected from a national compounding pharmacy. Data from sentinel site ophthalmology centers and laboratories revealed that the yearly number of cases gradually increased from 22 in 1999 to 43 in 2003, with a marked increase beginning in 2004 (93 cases) that continued through 2007 (170 cases; p < 0.0001). The outbreak identified from these sentinel sites resulted in the recall of a contact lens disinfecting solution. There was a statistically significant (p ≤ 0.0001) decrease in monthly cases reported from 28 cases in June 2007 (following the recall) to seven cases in June 2008, followed by an increase (p = 0.0004) in reported cases thereafter; cases have remained higher than pre-outbreak levels. A similar trend was seen in prescriptions for Acanthamoeba keratitis chemotherapy. Cases were significantly more likely to be reported during summer than during other seasons. The persistently elevated number of reported cases supports the need to understand the risk factors and environmental exposures associated with Acanthamoeba keratitis. Further prevention efforts are needed to reduce the number of cases occurring among contact lens wearers.
    Ophthalmic epidemiology 08/2012; 19(4):221-5. · 1.93 Impact Factor
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    ABSTRACT: School nurses played a key role in Maine's school-located influenza vaccination (SLV) clinics during the 2009-2010 pandemic season. The objective of this study was to determine, from the school district perspective, the labor hours and costs associated with outside-clinic coordination activities (OCA). The authors defined OCA as labor hours spent by staff outside of clinic operations. The authors surveyed a convenience sample of 10 school nurses from nine school districts. Eight nurses responded to the survey, representing seven districts, 45 schools and 84 SLV clinics that provided a total of 22,596 vaccine doses (H1N1 and seasonal combined) to children and adolescents. The mean total OCA time per clinic was 69 hours: out of total hours, 22 (36%) were spent outside regular clinic operation time. The authors estimated the mean cost of OCA to be $15.36 per dose. Survey respondents reported that costs would be lower during non-pandemic seasons and as schools become more proficient at planning clinics.
    The Journal of School Nursing 06/2012; 28(5):328-35. · 1.01 Impact Factor
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    ABSTRACT: Background: Oregon’s Local Health Departments (LHD) have been coordinating with schools to provide influenza vaccination in school-located clinics at no cost to schools and parents since 2006. In 2010, after a 3-yr pilot to assist LHDs in developing partnerships, the Oregon Immunization Program ceased providing LHDs influenza vaccine at no cost for school-located clinics. In an effort to develop more sustainable approaches for vaccine delivery to school-aged children, two counties piloted a project in the 2010-2011 influenza season to bill for influenza vaccine and/or vaccine administration in school clinics. Setting: Two elementary schools in Marion County and 1 elementary-middle school, 1 high school and 1 charter school (grades 4-12) in Yamhill County (Sheridan school district). Population: Approximately 440 children between 5 and 17 yrs of age in participating schools in Yamhill and Marion counties of Oregon. Project Description: Evaluation of the resources utilized and the effectiveness of the billing process for school-located clinics. Evaluation measures include the amount of time staff spent capturing and tracking the billing process, and outcomes achieved, including; the number of claims submitted, the number of claims denied, the number resubmitted, the number with changed codes (billable to VFC), and the number of claims reimbursed from each of the clinics. An additional measure includes the number/percent of uninsured students who paid the requested administration fees for VFC vaccine. Results/Lessons Learned: Preliminary data show that 63% of students vaccinated in Marion County and 78% vaccinated in Yamhill County were covered under either Medicaid or private insurance. 5% of individuals (n=5) who did not provide billing information either paid the $15 administration fee or applied for a reduced fee in Marion County, compared to 100% (n=36) in Yamhill. The billing process is occurring now, so final tallies for time spent and billing outcomes are pending.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: Significant variation in measurement of influenza vaccination among healthcare personnel (HCP) makes it difficult to compare vaccination rates across healthcare institutions. The National Quality Forum (NQF) gave time-limited endorsement to a CDC-sponsored standardized measure of HCP influenza vaccination. NQF measures that receive full endorsement following pilot testing may become part of national reporting requirements for some types of healthcare institutions. Setting: 314 healthcare institutions (91 acute care hospitals, 88 long-term care facilities, 49 dialysis centers, 30 ambulatory surgery centers, and 56 physician practices) in four U.S. states or localities. Population: HCP working in a healthcare institution were categorized as employees, credentialed non-employees, or other non-employees. “Employees” included all HCP who received paychecks from the institution. “Credentialed non-employees” included licensed practitioners affiliated with the healthcare institution who did not receive paychecks from the institution. “Other non-employees” included non-credentialed HCP affiliated with the healthcare institution who did not receive paychecks from the institution such as contract workers, students, and volunteers. Project Description: The goals of the pilot were (1) to determine the feasibility of implementing the CDC measure in various healthcare institutions and (2) to identify barriers and facilitators to implementation, using a mixed-methods approach employing qualitative interviews and quantitative data collection. Participating institutions were asked to complete web-based surveys at three intervals during the 2010-2011 influenza season. Reportable data included influenza vaccine receipt by HCP (at the institution or elsewhere), reported medical contraindications, and documented declinations for non-medical reasons. Respondents also answered questions about institution characteristics, process limitations, and data sources used. Results/Lessons Learned: Divergent interpretation of protocol definitions resulted in inconsistent designation of HCP in different states. Some healthcare institutions are not able to monitor influenza vaccination rates in certain HCP categories. Additional findings will be reported as more data are expected in February 2011.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: School influenza vaccination (SIV) clinics have been used for seasonal influenza vaccination and also for public health emergency response to reach school-aged children rapidly as demonstrated during the past influenza season. Maine is one of the few states in which a state-wide SIV program was implemented in 2009-2010; additionally, Maine’s SIV clinics offered both seasonal and H1N1 vaccines and used both LAIV and inactivated vaccines. Objectives: To retrospectively estimate the cost of SIV clinics in Maine during the 2009-2010 influenza season. Methods: A survey instrument was developed to capture the time and resources used during SIV clinics. The information of cost data include both labor such as time spent on various activities by type of clinic worker, and medical and non-medical supplies/materials used. Vaccine cost, and the time and resources spent outside the clinic (e.g. planning clinics, collection of consents, Immunization Registry data entry) were not included. Results: During May –August 2010, six nurses from convenience sample completed a clinic day survey. 4 of the 6 clinics offered both H1N1 and seasonal vaccines and 4 of the 6 clinics offered both LAIV and inactivated vaccines. Data on materials/supplies were available only for 4 of the 6 clinics. On average, each clinic had 18 staff including 7 vaccinators. On average, 17 doses of H1N1 and/or seasonal vaccine (range=4-40) were administered per vaccinator-hour. Average labor cost per dose was estimated at $6.22 (range= $1.93-$20.42) and average material cost $5.72 (range=$2.36-$12.28). From the complete 4 clinic survey responses, average per dose cost for each clinic was estimated $4.75, $8.03, $8.62 and $32.70, an average of $13.52. Conclusions: The per-dose average cost estimate from Maine is within the range of the SIV cost estimates for vaccine administration from the literature. Data are being analyzed to investigate the factors associated with clinic costs.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: During the 2009 H1N1 influenza pandemic, children and adolescents were identified as being at higher risk for infection. Maine, in collaboration with local health jurisdictions and other key partners, implemented a state-wide vaccination program targeting students in grades K-12 through mass clinics located primarily at school. Objectives: A school survey was developed to 1) determine the scope of school influenza vaccination (SIV) clinics 2) characterize clinic approaches and 3) identify associations between clinic, school and other characteristics and school-level vaccination coverage. Methods: Public and private schools were invited to participate in the survey. The web-based, survey was sent to the school nurse or contact via email and fielded from April through June 2010. Questions included characteristics of the first H1N1 SIV clinic and all first H1N1 doses administered during student-focused school efforts. Results: Of the 646 schools surveyed 82% (531) fully or partially completed the survey, and of these 98% (520) reported either conducting or participating in at least one H1N1 SIV clinic. A majority of the first H1N1 SIV clinics were conducted during school hours (77%), did not require parent presence (76%), were held at the school (77%), and did not require students to be transported to another location (70%). For 14% of clinics, parental presence was required for all grades and 6% reported student bussing to another location, Overall mean and median school coverage was 49% (range 2%-92%; data available for 414 schools). For half the schools, coverage ranged 40%-60%. Bivariate and multivariable analyses are pending. Conclusions: A majority of Maine’s first H1N1 SIV clinics were conducted at school, during school hours though other models were also utilized. Although overall mean school coverage was high in Maine, there was substantial variation in school coverage levels.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Background: During the 2009-2010 pandemic influenza season, the state of Maine was one of the states that held school located influenza clinics (SLVs). Of Maine’s schools, more than 90% conducted SLV clinics. Children were vaccinated by primarily by school nurses with both seasonal and H1N1 vaccine. Most SLV clinics were held during school hours at school. Objectives: To determine school nurse activities, labor hours, and cost needed to conduct SLV clinics in Maine during the H1N1 influenza season (2009-2010). We also seek to identify activities and resources needed outside of regular clinic hours, including activities related to planning, implementation, and post-implementation of SLV clinics. Methods: We conducted interviews with a convenience sample of school nurses and then fielded a retrospective survey covering three periods: planning, implementation, and post-implementation. The planning period covered activities before the first clinic, the implementation period covered activities from the first clinic until the last clinic, and the post-implementation period covered activities after last clinic. Results: Seven school nurses responded to the survey, representing six school districts, 32 schools, 70 school clinics, and 19,268 doses of H1N1 and seasonal influenza vaccine. School nurse average total hours per clinic was 48.7. As a percent of total time, the planning period was greatest (51%); 15% of school nurse time was spent running clinics and 47% of school nurse time was outside of regular working hours. Conclusions: In the setting we examined, school nurses put a substantial amount of time into planning SLV clinics and played an integral role in SLV activities. Because only 15% of school nurse time was spent running clinics, the outside clinic were a substantial portion of time. Finally, school nurses spent an average of 47% of their time outside of regular working hours, implying the sustainability of clinics should address nurse time.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
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    ABSTRACT: Unvaccinated health care personnel are at increased risk for transmitting vaccine-preventable diseases to their patients. The Advisory Committee on Immunization Practices (ACIP) recommends that health care personnel, including students, receive measles, mumps, rubella, hepatitis B, varicella, influenza, and pertussis vaccines. Prematriculation vaccination requirements of health professional schools represent an early opportunity to ensure that health care personnel receive recommended vaccines. To examine prematriculation vaccination requirements and related policies at selected health professional schools in the United States and compare requirements with current ACIP recommendations. Cross-sectional study using an Internet-based survey. Medical and baccalaureate nursing schools in the United States and its territories. Deans of accredited medical schools granting MD (n = 130) and DO (n = 26) degrees and of baccalaureate nursing programs (n = 603). Proportion of MD-granting and DO-granting schools and baccalaureate nursing programs that require that entering students receive vaccines recommended by the ACIP for health care personnel. 563 schools (75%) responded. More than 90% of all school types required measles, mumps, rubella, and hepatitis B vaccines for entering students; varicella vaccination also was commonly required. Tetanus, diphtheria, and acellular pertussis vaccination was required by 66%, 70%, and 75% of nursing, MD-granting, and DO-granting schools, respectively. Nursing and DO-granting schools (31% and 45%, respectively) were less likely than MD-granting schools (78%) to offer students influenza vaccines free of charge. Estimates were conservative, because schools that reported that they did not require proof of immunity for a given vaccine were considered not to require that vaccine. Estimates also were restricted to schools that train physicians and nurses. The majority of schools now require most ACIP-recommended vaccines for students. Medical and nursing schools should adopt policies on student vaccination and serologic testing that conform to ACIP recommendations and should encourage annual influenza vaccination by offering influenza vaccination to students at no cost. None.
    Annals of internal medicine 03/2011; 154(6):391-400. · 13.98 Impact Factor
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    ABSTRACT: Background: The Advisory Committee on Immunization Practices (ACIP) recommends healthcare personnel (HCP), including students, receive measles, mumps, rubella (MMR), hepatitis B, varicella, influenza, and pertussis-containing vaccines. Unvaccinated HCP are at increased risk for acquiring and transmitting vaccine-preventable diseases (VPD) in their workplaces. Vaccination policies of schools training HCP may impact future vaccine uptake by HCP and their patients. Objective: Characterize student immunization policies' compliance with ACIP recommendations at selected U.S. health professional schools. Methods: Internet-based survey distributed to deans of all accredited medical, baccalaureate nursing, and osteopathic medical programs in the U.S. and Puerto Rico (n=755), fielded November 2008-March 2009. Results: 563 schools (75%) responded. Commonly reported influences on school vaccination policies were clinical rotation sites' requirements (78%) and ACIP recommendations for HCP (65%). Most schools (≥90%) required students to receive MMR, hepatitis B, and varicella vaccines. Only 66% required pertussis-containing vaccine and, although 78% of schools offered influenza vaccination to students, only 18% required it. Requirements were similar by school type, region, public/private status, and program age. Medical (82%) and osteopathic medical (78%) schools were more likely than nursing schools (47%, p<0.05) to require compliance with vaccination requirements within 30 days of classes starting. Inability to undertake clinical work was the most common consequence of noncompliance (90% of schools). Conclusions: Vaccination requirements at most health professional schools do not include all ACIP-recommended vaccines. Aligning requirements with ACIP recommendations could reduce HCP VPD infections and nosocomial VPD transmission, increase quality of care, and decrease employee illness.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
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    ABSTRACT: In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines. We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005.
    BMC Infectious Diseases 11/2009; 9:175. · 3.03 Impact Factor

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