Influenza Vaccination Coverage Among Health Care Personnel--United States, 2014-15 Influenza Season.

The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel (HCP) to reduce influenza-related morbidity and mortality among both HCP and their patients and to decrease absenteeism among HCP. To estimate influenza vaccination coverage among U.S. HCP for the 2014­15 influenza season, CDC conducted an opt-in Internet panel survey of 1,914 HCP during March 31­April 15, 2015. Overall, 77.3% of HCP survey participants reported receiving an influenza vaccination during the 2014­15 season, similar to the 75.2% coverage among HCP reported for the 2013­14 season. Vaccination coverage was highest among HCP working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). By occupation, coverage was highest among pharmacists (95.3%) and lowest among assistants and aides (64.4%). Influenza vaccination coverage was highest among HCP who were required by their employer to be vaccinated (96.0%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (73.6%) or multiple days (83.9%) and lowest among HCP working in settings where vaccine was neither required, promoted, nor offered on-site (44.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might help increase vaccination coverage among HCP and reduce the risk for influenza to HCP and their patients.

Influenza vaccination coverage among health care personnel--United States, 2013-14 influenza season.

The Advisory Committee on Immunization Practices recommends that all health care personnel (HCP) be vaccinated annually against influenza. Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients. To estimate influenza vaccination coverage among HCP during the 2013-14 season, CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1-16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013-14 season, similar to the 72.0% coverage among participating HCP reported in the 2012-13 season. Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%) compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, janitors, and food service workers) (68.6%). HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%) or settings where there was no requirement or promotion of vaccination (47.9%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (61.6%) or multiple days (80.4%) compared with HCP working in settings not offering free on-site vaccination (49.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might be needed to increase vaccination coverage among HCP and minimize the risk for influenza to HCP and their patients.

Influenza vaccination coverage among pregnant women--United States, 2013-14 influenza season.

Pregnant women and infants are at increased risk for influenza-related complications and hospitalization. Influenza vaccination among pregnant women can reduce their risk for respiratory illness and reduce the risk for influenza in their infants aged <6 months. Since 2004, the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester. To assess influenza vaccination coverage among pregnant women during the 2013-14 influenza season, CDC analyzed data from an Internet panel survey conducted March 31-April 11, 2014. Among 1,619 survey respondents pregnant at any time during October 2013-January 2014, 52.2% reported vaccination before or during pregnancy (17.6% before and 34.6% during pregnancy), similar to the coverage in the preceding season. Overall, 65.1% of women reported receiving a clinician recommendation and offer of influenza vaccination, 15.1% received a clinician recommendation but no offer of vaccination, and 19.8% received no clinician recommendation or offer. Vaccination coverage among these women was 70.5%, 32.0%, and 9.7%, respectively. Continued efforts are needed to encourage clinicians to strongly recommend and offer influenza vaccination to their pregnant patients.

Probabilistic risk analysis and terrorism risk.

Since the terrorist attacks of September 11, 2001, and the subsequent establishment of the U.S. Department of Homeland Security (DHS), considerable efforts have been made to estimate the risks of terrorism and the cost effectiveness of security policies to reduce these risks. DHS, industry, and the academic risk analysis communities have all invested heavily in the development of tools and approaches that can assist decisionmakers in effectively allocating limited resources across the vast array of potential investments that could mitigate risks from terrorism and other threats to the homeland. Decisionmakers demand models, analyses, and decision support that are useful for this task and based on the state of the art. Since terrorism risk analysis is new, no single method is likely to meet this challenge. In this article we explore a number of existing and potential approaches for terrorism risk analysis, focusing particularly on recent discussions regarding the applicability of probabilistic and decision analytic approaches to bioterrorism risks and the Bioterrorism Risk Assessment methodology used by the DHS and criticized by the National Academies and others.

HAZUS modeling for hurricane effect on a healthcare campus: implications for health care planning.

The purpose of this study was to model the damage sustained by the healthcare campus, in the aftermath of a hurricane, as a tool to facilitate pre- and post-storm planning for provision of healthcare services or campus evacuation. Using HAZUS analysis for estimating disaster associated losses, storm surge, residual flooding, and wind damage were modeled for hurricane categories 1 thru 5. The ability of the healthcare campus to deliver services was assessed as a function of the residual functional infrastructure. Implications for peristorm planning were developed. A Category 2 storm surge of 6 to 8 feet would completely isolate the campus and flood the adult hospital while leaving the adjacent pediatric hospital as a dry island. Residual 8 foot flooding would allow campus access via two of the four entrances but only after damage from the storm surge had been incurred. When combined with winds exceeding 100 mph, sufficient damage would occur to predict that the campus is not useable for a minimum of 44 days. A low intensity hurricane has the potential to render our healthcare campus nonoperational. Disaster planning needs to allow a realistic assessment of the post storm capability to deliver care so that alternatives and prestorm evacuation plans can be developed.

The Second Society for Simulation in Healthcare Research Summit: Beyond our Boundaries.

STATEMENT: In this article, we report on the Second Society for Simulation in Healthcare Research Summit held in 2017. This meeting succeeded the First Research Summit from 2011 with the goal of advancing the scope of healthcare simulation research. During the one and a half day summit, some of the world's leading experts in simulation, healthcare, and simulation in healthcare convened to discuss ideas about what research goals would be most beneficial to the healthcare simulation community, and what could be done to achieve them. We describe the rationale for the meeting, the organization, the program, and the articles that emerged from the Summit, which are found in this supplemental issue of Simulation in Healthcare.

From War on Drugs to War against Terrorism: modeling the evolution of Colombia's counter-insurgency.

Strategic and tactical planning for military intervention needs revision as the causes, methods, and means of conflict have evolved. Counter-insurgent engagement is one such intervention that governments, militaries, and non-governmental organizations seek to better understand. Modeling insurgencies is an acceptable means to gain insight into the various characteristics of asymmetric warfare to proffer prescriptive resolutions for mitigating their effects. Colombia's insurgency poses the challenge of assessing population behavior in a non-traditional revolutionary climate. Factors prevalent in traditional insurgency are not applicable in Colombia, specifically between the years 1993 and 2001 with the democratization of the drug cartels. The catastrophic events of September 11th reverberated in Colombia resulting in a new policy and strategy to the waging the counter-insurgency there. This research introduces a structured methodology to modeling the Colombian counter-insurgency incorporating qualitative assessment, mathematical representation, and a System Dynamics approach to represent the effects of the policy change.