Bridget C. Griffith’s research while affiliated with McGill University and other places

Introduction On-time measles vaccination is essential for preventing measles infection among children as early in life as possible, especially in areas where measles outbreaks occur frequently. Characterizing the timing of routine measles vaccination (MCV1) among children and identifying risk factors for delayed measles vaccination is important for addressing barriers to recommended childhood vaccination and increasing on-time MCV1 coverage. We aim to assess the timing of children's MCV1 vaccination and to investigate the association between demographic and healthcare factors, mothers'/caregivers' ability to identify information on their child’s vaccination card, and achieving on-time (vs. delayed) MCV1 vaccination. Methods We conducted a population-based, door-to-door survey in Kampala, Uganda, from June–August of 2019. We surveyed mothers/caregivers of children aged one to five years to determine how familiar they were with their child’s vaccination card and to determine their child’s MCV1 vaccination status and timing. We assessed the proportion of children vaccinated for MCV1 on-time and delayed, and we evaluated the association between mothers'/caregivers' ability to identify key pieces of information (child’s birth date, sex, and MCV1 date) on their child’s vaccination card and achieving on-time MCV1 vaccination. Results Of the 999 mothers/caregivers enrolled, the median age was 27 years (17–50), and median child age was 29 months (12–72). Information on vaccination status was available for 66.0% ( n = 659) of children. Of those who had documentation of MCV1 vaccination ( n = 475), less than half (46.5%; n = 221) achieved on-time MCV1 vaccination and 53.5% ( n = 254) were delayed. We found that only 47.9% ( n = 264) of the 551 mothers/caregivers who were asked to identify key pieces of information on their child's vaccination card were able to identify the information, but ability to identify the key pieces of information on the card was not independently associated with achieving on-time MCV1 vaccination. Conclusion Mothers'/caregivers' ability to identify key pieces of information on their child’s vaccination card was not associated with achieving on-time MCV1 vaccination. Further research can shed light on interventions that may prompt or remind mothers/caregivers of the time and age when their child is due for measles vaccine to increase the chance of the child receiving it at the recommended time.

Background: Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. Methods: We conducted a retrospective, cross-sectional survey of patients with CD4 < 100 at seven urban and seven rural facilities after 1 year of program implementation. We quantified the number of patients who transitioned through the steps of the CrAg screening cascade over six-months follow-up. We defined cascade completion as a pre-emptive fluconazole prescription for the first 10 weeks. We conducted semi-structured interviews with lab personnel and clinic staff to assess functionality of the CrAg screening program. Data was collected using REDCap. Results: We evaluated 359 patient records between April 2016 to March 2017; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of < 50 cell/μL. Overall, CrAg screening had been performed in 255/359 (71.0, 95% CI, 66.0-75.7) of patients' records reviewed, with a higher proportion among urban facilities (170/209 (81.3, 95% CI, 75.4-86.4)) than rural facilities (85/150 (56.7, 95% CI, 48.3-64.7)). Among those who were CrAg screened, 56/255 (22.0, 95% CI, 17.0-27.5%) had cryptococcal antigenemia, of whom 47/56 (83.9, 95% CI, 71.7-92.4%) were initiated on pre-emptive therapy with fluconazole and 8/47 (17.0, 95% CI, 7.6-30.8%) of these were still receiving antifungal therapy at 6 months follow up. At least one CNS symptom was present in 70% (39/56) of those with antigenemia. In patients who had started ART, almost 40% initiated ART prior to CrAg screening. Inadequacy of equipment/supplies was reported by 15/26 (58%) of personnel as a program barrier, while 13/26 (50%) reported a need for training about CM and CrAg screening. Conclusion: There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening.. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.

Background: Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis(CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks, and ART initiation in a subset of facilities. Methods: We conducted a retrospective, cross-sectional survey of patients with CD4<100 at seven urban and seven rural facilities after one year of program implementation. We quantified the number of patients who transitioned through the steps of the CrAg screening cascade over six-months follow-up. We defined cascade completion as a prophylactic fluconazole prescription. We conducted semi-structured interviews with lab personnel and clinic staff to assess functionality of the CrAg screening program. Data was collected using REDCap. Results: We evaluated 359 patient records; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of <50 cell/µL. Overall, CrAg screening had been performed in 255/359 (71.0%, 95% CI, 66.0-75.7) of patients’ records reviewed, with a higher proportion among urban facilities (170/209 (81.3%, 95% CI, 75.4-86.4)) than rural facilities (85/150 (56.7%, 95% CI, 48.3-64.7)). Among those who were CrAg screened, 56/255 (22.0%, 95% CI, 17.0-27.5%) had cryptococcal antigenemia, of whom 47/56 (83.9%, 95% CI, 71.7-92.4%) were initiated on pre-emptive therapy with fluconazole and 8/47 (17.0%, 95% CI, 7.6-30.8%) of these were still receiving antifungal therapy at 6 months follow up. Atleast one CNS symptom was present in 70% (39/56) of those with antigenemia. In patients who had started ART, almost 40% initiated ART prior to CrAg screening. Inadequacy of equipment/supplies was reported by 15/26 (58%) of personnel as a program barrier, while 13/26 (50%) reported a need for training about CM and CrAg screening. Conclusion: There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening, which predisposes them to unmasking Cryptococcal IRIS. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.

It is unclear how broadly aware parents are of the concept of herd immunity and whether parents consider community benefits of vaccination when making decisions about their child’s vaccinations. We aimed to determine whether educating parents about community-level benefits of measles, mumps, and rubella (MMR) vaccination and local vaccination rates would impact concern about their child’s risk of measles and risk of a measles outbreak. We conducted an electronic survey among Minnesota parents of children aged 6–18 years in August 2016. We assessed baseline knowledge of herd immunity, asked participants to estimate MMR vaccination coverage in their county, and asked participants to estimate the minimum coverage needed to prevent measles outbreaks. We then delivered a short, educational intervention via the survey to inform participants about the benefits of herd immunity, the actual MMR vaccination coverage in their county, and that at least 95% MMR vaccination coverage is needed to prevent measles outbreaks. Pre- and post-intervention, participants were asked to report how concerned they were that their child might get measles. We used logistic regression models to assess factors associated with awareness of herd immunity, change in concern about one’s child’s measles risk, and overall concern for a measles outbreak. Among 493 participants, 67.8% were aware of herd immunity at baseline. Post-intervention, 40.2% (n = 198) of parents learned that MMR vaccination rates in their county were higher than they expected. All participants found out that their county MMR rates were lower than the measles herd immunity threshold of 95%. Overall, 27.0% (n = 133) of participants reported an increase in concern that their child might get measles after learning about local vaccination coverage and the coverage needed to achieve herd immunity. We found that our short, educational intervention aimed to increase awareness about herd immunity and local vaccination led to an increase in concern about disease risk among less than a third of parents.

Background Maintaining high coverage of measles, mumps, and rubella (MMR) vaccination is important for preventing outbreaks and maintaining herd immunity (HI), which benefits both individuals and communities. We aimed to determine whether information about the benefits of HI and local MMR vaccination rates could change a parent’s concern about their child’s risk of contracting measles. Methods We conducted a survey at the 2016 Minnesota State Fair among Minnesota residents ≥18 years who had at least one child aged 6–18 years. Participants were asked to choose the correct definition of HI, to estimate the MMR vaccination coverage in their county, and guess the minimum MMR vaccination coverage needed to prevent measles outbreaks. We delivered an educational intervention through the interactive survey informing participants about the benefits of herd immunity, the actual MMR coverage in their county, and that ≥95% coverage is needed to prevent outbreaks. Before and after the educational intervention, participants were asked to report their level of concern about their child contracting measles. We calculated adjusted predicted percentages from logistic regression models to evaluate changes in concern about risk pre- and post-intervention and to assess factors associated with concern about measles. Results Among the 493 participants, 92.7% reported vaccinating their child with MMR, though one third were not familiar with HI. Prior to receiving information, those knowledgeable about HI were significantly more likely to be concerned about their child getting measles (predicted percentage 80.2% [95% CI: 75.7–84.6]) than those who were unfamiliar with HI (predicted percentage 69.8% [95% CI: 62.1–77.5]), P-value for the difference = 0.027. Participants believed that MMR vaccination was, on average, 9.0% [95% CI: 6.9–11.0] lower than the actual coverage in their local area. Conclusion Information about HI and local vaccination coverage rates did not impact parental concern about their child being at risk for getting measles. Overall, parents learned that local MMR vaccination rates were higher than they had expected. Disclosures All authors: No reported disclosures.

Background: Vaccination protects individuals directly and communities indirectly by reducing transmission. We aimed to determine whether information about herd immunity and local vaccination coverage could change an individual's vaccination plans and concern about influenza. Methods: We surveyed Minnesota residents ≥18 years during the 2016 Minnesota State Fair. Participants were asked to identify the definition of herd immunity, to report their history of and plans to receive influenza vaccine, to report their concern about influenza, and to estimate the reported influenza vaccination coverage in their county. After providing educational information about herd immunity and local vaccination rates, we reassessed vaccination plans and concerns. We used logistic regression to estimate predicted percentages for those willing to be vaccinated, for concern about influenza, and for changes in these outcomes after the intervention. We then compared those individuals with and without prior knowledge of herd immunity, accounting for other characteristics. Results: Among 554 participants, the median age was 57 years; most were female (65.9%), white (91.0%), and non-Hispanic/Latino (93.9%). Overall, 37.2% of participants did not know about herd immunity and 75.6% thought that the influenza vaccination coverage in their county was higher than it was reported. Those not knowledgeable about herd immunity were significantly less likely than those knowledgeable about the concept to report plans to be vaccinated at baseline (67.8% versus 78.9%; p = 0.004). After learning about herd immunity and influenza vaccination coverage, the proportion of those not knowledgeable about herd immunity who were willing to be vaccinated increased significantly by 7.3 percentage points (p = 0.001). Educating participants eliminated the significant difference in the proportion planning to be vaccinated between these two groups (80.1% of those knowledgeable and 75.1% of those who were not initially knowledgeable became willing; p = 0.148). Conclusions: Education about herd immunity and local vaccination coverage could be a useful tool for increasing willingness to vaccinate, generating benefits both to individuals and communities.