Documenting the Full Value of Vaccination: A Systematic Review of Value Frameworks.

OBJECTIVES: Economic evaluations of vaccination may not fully account for nonhealth patient impacts on families, communities, and society (ie, broader value elements). Omission of broader value elements may reflect a lack of established measurement methodology, lack of agreement over which value elements to include in economic evaluations, and a lack of consensus on whether the value elements included should vary by vaccination type or condition. We conducted a systematic review of value frameworks to identify broader value elements and measurement guidance that may be useful for capturing the full value of vaccination. METHODS: We searched Ovid MEDLINE, PubMed, Embase, and the gray literature to identify value frameworks for all health interventions, and we extracted information on each framework's context, value elements, and any available guidance on how these elements should be measured. We used descriptive statistics to analyze and compare the prevalence of broader value elements in vaccination value frameworks and other healthcare-related value frameworks. RESULTS: Our search identified 62 value frameworks that met inclusion criteria, 9 of which were vaccination specific. Although vaccination frameworks included several broader value elements, such as reduced transmissibility and public health benefits, the elements were represented inconsistently across the frameworks. Vaccination frameworks omitted several value elements included in nonvaccination-specific frameworks, including dosing and administration complexity and affordability. In addition, guidance for measuring broader value elements was underdeveloped. CONCLUSIONS: Future efforts should further evaluate inclusion of broader value elements in economic evaluations of vaccination and develop standards for their subsequent measurement.

Exploring perspectives on vaccinations delivered in complementary non-clinical settings and by non-physician healthcare professionals: A qualitative interview study.

OBJECTIVE: To understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by non-physician healthcare providers (NPHPs), and the policies/barriers surrounding administration. METHODS: We performed interviews with healthcare providers (HCPs) and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. RESULTS: Thirty-eight participants completed interviews. Participants reported that US individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. CONCLUSIONS: NPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the US.

Intersection of policy and Immunization Information Systems (IIS).

BACKGROUND: Immunization information systems (IIS) are confidential, population-based computerized databases that record vaccination doses administered to persons residing within a given geopolitical area. We sought to highlight the evolution of IIS policy over the last two decades, as IIS play a pivotal role in achieving equitable and high vaccine uptake. METHODS: Legal epidemiological research methods were used to assess relevant IIS statutes and administrative codes across all 50 states, the District of Columbia, Philadelphia, and New York City. Where relevant, laws were cross-checked or supplemented with state and local health department resources. Comparisons to previous legal studies enabled evaluation of trends in IIS laws over time. RESULTS: The compilation of current laws provides an updated overview of the diverse interstate and intrastate policies within the US that govern the capabilities and implementation of IIS. The findings of this study show the progress that has been made in the past decade in improving policies that enable IIS to be utilized across the life-course. Conversely, gaps in IIS data collection, limited interoperability with local and national health information systems, and inconsistent access to view or utilize IIS records due to existing policies, continue to limit the full potential of IIS. CONCLUSIONS: In the United States (US), IIS are implemented and managed at the state and local level, creating variability in IIS policies and implementation. Findings from this study serve as a comprehensive benchmark of current IIS laws that may aid policy stakeholders who are exploring amendments to jurisdictional IIS laws.

Avoidance Behavior to Essential Oils by Anopheles minimus, a Malaria Vector in Thailand.

Essential oils extracted from 4 different plant species--citronella (Cymbopogon nardus), hairy basil (Ocimum americanum), sweet basil (Ocimum basilicum), and vetiver (Vetiveria zizanioides)-were investigated for their irritant and repellent activities against Anopheles minimus, using an excito-repellency test system. Pure essential oils were used in absolute ethanol at the concentrations of 0.5%, 1%, 2.5%, and 5% (v/v) compared with deet. At the lowest concentration of 0.5%, hairy basil displayed the best irritant and repellent effects against An. minimus. Citronella and vetiver at 1-5% showed strong irritant effects with>80% escape, while repellent effects of both oils were observed at 1% and 2.5% citronella (73-89% escape) and at 5% vetiver (83.9% escape). Sweet basil had only moderate irritant action at 5% concentration (69.6% escape) and slightly repellent on test mosquitoes (<50% escape). The results found that hairy basil, citronella, and vetiver are promising potential mosquito repellent products for protection against An. minimus.

Detection of Permethrin Resistance and Fipronil Tolerance in Rhipicephalus sanguineus (Acari: Ixodidae) in the United States.

Permethrin is a commonly used acaricide for tick control on domestic animals and in residential environments, while fipronil use is restricted to on-animal treatment. Following widespread reports of permethrin and fipronil application failures to control indoor infestations of Rhipicephalus sanguineus (Latreille), the brown dog tick, 31 tick populations were obtained from Florida and Texas for acaricide resistance screening. These field-collected ticks from kennels and residential facilities were challenged with technical grade permethrin and fipronil to create dose response curves that were compared with an acaricide-susceptible strain. Permethrin resistance was successfully screened in nine populations, all of which were resistant or highly resistant. Tick susceptibility to fipronil was conducted on four populations, which were found to be tolerant, with resistance ratios below 10. This is the first documentation of R. sanguineus permethrin resistance and fipronil tolerance in the United States. Potential causes of resistance development and recommendations on future brown dog tick control management plans are discussed.

Attitudes and beliefs of healthcare providers toward vaccination in the United States: A cross-sectional online survey.

BACKGROUND: Healthcare providers' (HCPs') beliefs and practices regarding vaccination influence vaccine acceptance in patients. OBJECTIVE: To describe HCPs' beliefs and practices regarding vaccines and perceptions of patient perspectives related to vaccine hesitancy. METHODS: This was a non-interventional, cross-sectional, online survey administered to 1213 HCPs based in the United States from December 2021 through January 2022. HCPs provided responses regarding their demographic and professional characteristics, beliefs about vaccine safety and effectiveness, vaccination practices, and their views regarding patients' willingness to receive vaccination. RESULTS: Study participants included doctors (55.4 %); physician assistants (11.2 %); pharmacists (11.7 %); nurse practitioners (11.1 %); and registered nurses (10.6 %) from across the United States (West, 35.6 %; Midwest, 27.0 %; South, 25.6 %; Northeast, 11.9 %). HCPs belonged to group practices or clinics (34.5 %), private practices (31.9 %), hospital-based practices (21.9 %), or pharmacies (11.7 %). Most HCPs strongly believed it was their duty to promote vaccination (78.1 %) and used in-person conversations to educate patients about vaccines (85.0 %); 95.1 % had been vaccinated against COVID-19. HCPs reported that 54.9 % of patients accept all vaccines without hesitation, 21.0 % accept all vaccines but hesitate, 16.8 % accept only select vaccines, and 7.2 % reject all vaccines. Reasons commonly cited by patients for being hesitant to accept vaccines or refusal included negative media (hesitancy: 64.6 %; refusal: 73.2 %), the influence of friends or family (hesitancy: 60.5 %; refusal: 68.7 %), distrust of the government (hesitancy: 45.8 %; refusal: 68.4 %), concerns over long-term side effects (hesitancy: 56.1 %; refusal: 68.3 %), and worries about vaccine-related autism or infertility (hesitancy: 49.7 %; refusal: 71.9 %). HCPs reported that the largest contributors to vaccine misinformation among patients were social media (91.0 %), celebrities/TV personalities (63.5 %), and mass media (61.1 %). CONCLUSIONS: Despite most HCPs being active proponents of vaccination, misconceptions about vaccination and vaccine hesitancy persists. Consideration should be given to HCP training to support their efforts to promote vaccine acceptance.

Identifying factors that can be used to assess a country's readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review.

OBJECTIVES: Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine. DESIGN: Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. DATA SOURCES: Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion. ELIGIBILITY CRITERIA: Articles published in any year or language that included tools or guidance to identify factors that influence a country's readiness to deploy a new or underutilised vaccine. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis. RESULTS: 38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country's readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals. CONCLUSIONS: This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.

Adult vaccination coverage in the United States: A database analysis and literature review of improvement strategies.

Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18-64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011-2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.

Natural Language Processing-Powered Real-Time Monitoring Solution for Vaccine Sentiments and Hesitancy on Social Media: System Development and Validation.

BACKGROUND: Vaccines serve as a crucial public health tool, although vaccine hesitancy continues to pose a significant threat to full vaccine uptake and, consequently, community health. Understanding and tracking vaccine hesitancy is essential for effective public health interventions; however, traditional survey methods present various limitations. OBJECTIVE: This study aimed to create a real-time, natural language processing (NLP)-based tool to assess vaccine sentiment and hesitancy across 3 prominent social media platforms. METHODS: We mined and curated discussions in English from Twitter (subsequently rebranded as X), Reddit, and YouTube social media platforms posted between January 1, 2011, and October 31, 2021, concerning human papillomavirus; measles, mumps, and rubella; and unspecified vaccines. We tested multiple NLP algorithms to classify vaccine sentiment into positive, neutral, or negative and to classify vaccine hesitancy using the World Health Organization's (WHO) 3Cs (confidence, complacency, and convenience) hesitancy model, conceptualizing an online dashboard to illustrate and contextualize trends. RESULTS: We compiled over 86 million discussions. Our top-performing NLP models displayed accuracies ranging from 0.51 to 0.78 for sentiment classification and from 0.69 to 0.91 for hesitancy classification. Explorative analysis on our platform highlighted variations in online activity about vaccine sentiment and hesitancy, suggesting unique patterns for different vaccines. CONCLUSIONS: Our innovative system performs real-time analysis of sentiment and hesitancy on 3 vaccine topics across major social networks, providing crucial trend insights to assist campaigns aimed at enhancing vaccine uptake and public health.

Identifying characteristics that enable resilient immunisation programmes: a scoping review.

OBJECTIVES: The COVID-19 pandemic highlighted the fragility of immunisation programmes and resulted in a significant reduction in vaccination rates, with increasing vaccine-preventable disease outbreaks consequently reported. These vulnerabilities underscore the importance of resilient immunisation programmes to ensure optimal performance during crises. To date, a framework for assessing immunisation programme resilience does not exist. We conducted a scoping review of immunisation programmes during times of crisis to identify factors that characterise resilient immunisation programmes, which may inform an Immunisation Programme Resilience Tool. DESIGN: Scoping review design followed the Arksey and O'Malley framework, and manuscript reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. DATA SOURCES: CINAHL, CENTRAL, Embase, Google Scholar, MEDLINE, PsycINFO and Web of Science and databases were searched between 1 January 2011 and 2 September 2023. Citation searching of identified studies was also performed. ELIGIBILITY CRITERIA: We included primary empirical peer-reviewed studies that discussed the resilience of immunisation programme to crises, shocks or disruptions. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened records and performed data extraction. We extracted data on study location and design, crisis description, and resilience characteristics discussed, and identified evidence gaps in the literature. Findings were synthesised using tabulation and an evidence gap map. RESULTS: Thirty-seven studies met the eligibility criteria. These studies captured research conducted across six continents, with most concentrated in Africa, Asia and Europe. One study had a randomised controlled trial design, while 36 studies had observational designs (15 analytical and 21 descriptive). We identified five characteristics of resilient immunisation programmes drawing on the Health System Resilience Index (Integration, Awareness, Resource Availability and Access, Adaptiveness and Self-regulation) and several evidence gaps in the literature. CONCLUSIONS: To our knowledge, no immunisation programme resilience tool exists. We identified factors from the Health System Resilience Index coupled with factors identified through primary empirical evidence, which may inform development of an immunisation programme resilience tool.

State Medicaid Coverage and Reimbursement of Adult Vaccines Administered by Physicians and Pharmacists.

Introduction: Effective from October 2023, federal law requires Medicaid programs to cover all recommended adult vaccines administered by physicians with no cost sharing for all eligibility groups. However, uniform coverage does not always translate to optimal uptake. Rather, other factors such as Medicaid reimbursement rates influence vaccine access and ultimately patient uptake. This study reviewed Medicaid policies to understand vaccine coverage and reimbursement, for both physicians and pharmacists, in all 50 U.S. states; Washington, DC; and Puerto Rico (collectively referred to as states). Methods: Between March and September 2022, the researchers reviewed states' public Medicaid policies regarding adult vaccines, focusing on the service of injectable vaccine administration and 3 products: hepatitis A, 9-valent human papilloma virus, and 23-valent pneumococcal polysaccharide. Results: Among 50 states with available data, 7 (14%) restricted Medicaid coverage for hepatitis A, 9-valent human papilloma virus, and/or 23-valent pneumococcal polysaccharide administered by physicians, and 15 (30%) did so for pharmacists. Median physician reimbursement rate was below the private sector rate for hepatitis A (89%) and 9-valent human papilloma virus (94%) but above the rate for 23-valent pneumococcal polysaccharide (108%). Median physician reimbursement for vaccine administration during an office visit was $11.86; the median pharmacist administration fee was $10.67. Conclusions: Although federal law now requires all state Medicaid programs to cover, without cost sharing, all recommended adult vaccines administered by physicians, equitable vaccine access may be hindered by state coverage restrictions for pharmacists and by relatively low reimbursement rates relative to Medicare and commercial coverage for both physicians and pharmacists.

A review of factors influencing vaccination policies and programs for older adults globally.

Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.

Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature.

The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.

The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: A review.

The COVID-19 pandemic disrupted routine healthcare delivery, causing declines in CDC-recommended vaccination rates across the life-course in the United States (US). Ensuring protection against disease outbreaks and associated morbidity and mortality depends on improving vaccine coverage rates (VCRs) and uptake. The authors conducted a targeted literature review to assess the pandemic's effects on routine vaccination rates across different populations, evaluating VCR recovery and improvement efforts. The review highlights articles published with data measuring or evaluating VCR decline across the US during the COVID-19 pandemic from January 2020 to April 2022, associated health impacts, and policy and programmatic strategies to recover routine VCRs. While vaccination rates stagnated or declined across some populations pre-pandemic, the review indicated there were further VCR declines in 2020 and 2021 compared to 2019 across numerous CDC-recommended vaccines, ages, and geographies, with some vaccines and sub-populations disproportionally impacted. The review additionally identified declines in patient healthcare visit frequency and increases in morbidity and mortality associated with vaccine-preventable disease (VPD) complications. Reviewed publications highlighted multifaceted strategies that could aid in recovering VCRs. Overall, findings demonstrate a significant reduction in VCRs across all age groups and highlight promising solutions to inform vaccine uptake efforts and ensure broader protection against VPDs.

Changes in vaccine administration trends across the life-course during the COVID-19 pandemic in the United States: a claims database study.

BACKGROUND: This study provides an updated and expanded analysis of the impact of the COVID-19 pandemic on routine vaccinations across the life-course in the United States. RESEARCH DESIGN AND METHODS: Routine wellness visits and vaccination rates were calculated using structured claims data for each month during the impact period (January 2020 to August 2022) and compared to the respective baseline period (January 2018 to December 2019). Monthly rates were aggregated as annual accumulated and cumulative percent changes. RESULTS: The complete monthly rate interactive dataset can be viewed at https://vaccinationtrends.com. The greatest decrease in annual accumulated administration rates in the 0-2 and 4-6 years age groups was for the measles, mumps, and rubella vaccine; for adolescents and older adults, it was for human papillomavirus and pneumococcal vaccines, respectively. Routine in-person wellness visit rates recovered faster and more completely than vaccination rates in all age groups, indicating potential missed opportunities to administer vaccines during visits. CONCLUSIONS: This updated analysis reveals that the negative impact of the COVID-19 pandemic on routine vaccination continued through 2021 and into 2022. Proactive efforts to reverse this decline are needed to increase individual- and population-level vaccination coverage and avoid the associated preventable morbidity, mortality, and health care costs.

Public health impact and return on investment of the pediatric immunization program in Poland.

BACKGROUND: This study aims to evaluate the epidemiological impact and return on investment of the pediatric immunization program (PIP) in Poland from the healthcare-sector and societal perspectives. RESEARCH DESIGN AND METHODS: A health-economic model was developed focusing on the nine vaccines, targeting 11 pathogens, recommended by the public health authorities for children aged 0-6 years in Poland. The 2019 birth cohort (388,178) was followed over their lifetime, with the model estimating discounted health outcomes, life-years gained, quality-adjusted life-years, and direct and indirect costs with and without the PIP based on current and pre-vaccine - era disease incidence estimates, respectively. RESULTS: Across 11 targeted pathogens, the Polish PIP prevented more than 452,300 cases of disease, 1,600 deaths, 37,900 life-years lost, and 38,800 quality-adjusted life-years lost. The PIP was associated with vaccination costs of €54 million. Pediatric immunization averted €65 million from a healthcare-sector perspective (benefit-cost ratio [BCR], 2.2) and averted €358 million from a societal perspective (BCR, 7.6). The BCRs from both perspectives remained >1.0 in scenario analyses. CONCLUSIONS: The Polish PIP, which has not previously been systematically assessed, brings large-scale prevention of disease-related morbidity, premature mortality, and associated costs. This analysis highlights the value of continued investment in pediatric immunization in Poland.

Drivers of and barriers to routine adult vaccination: A systematic literature review.

We performed a systematic literature review in PubMed and Embase (2016-2021) to investigate the drivers of and barriers to routine vaccination in adults aged 50 and older globally. A thematic assessment identified three categories across 61 publications: sociodemographic, health-related, and attitudinal. The most common sociodemographic determinants (factors identified in studies; n = 47) associated with vaccination uptake were economic status, age, education, and household composition, which had mixed effects on vaccine uptake. For health-related determinants (n = 27), individuals with comorbidities and health care consumption were the most common factors, both increased vaccine uptake. The most common attitudinal factors (n = 42) were self-efficacy, provider or other's recommendations, and vaccine-preventable disease awareness; across studies, all attitude factors had a positive effect, unlike the sociodemographic and health status categories. Findings suggest that patient and provider awareness and education campaigns are effective ways to increase uptake of routine vaccinations in older adults.

Attitudes and Beliefs around the Value of Vaccination in the United States.

Despite the benefits of immunization, differences in attitudes persist toward vaccines. We captured individuals' perceptions of vaccines and vaccination across the United States (US) to inform vaccine-related policy development. A survey was completed by 5000 respondents from 10 states. Respondents were screened for inclusion, which included individuals ≥ 18 years of age that had received a vaccine or were unvaccinated but indicated a favorable or neutral attitude towards vaccinations. Participants were excluded if they indicated they did not support the idea of vaccinations. Questions explored perceptions of vaccines for all age groups. Among unvaccinated individuals, the most common concerns were about safety (38%). Most respondents (95%) highlighted the importance of state immunization programs for disease prevention. Access to health and immunization records and immunization information systems were important to 96% and 88% of respondents, respectively, for future health planning. Doctors and healthcare professionals (HCPs) were considered trusted sources for vaccine information (95%). Overall, respondents recognized the importance of vaccination, but documented concerns among the unvaccinated indicated a need for greater promotion regarding vaccine safety. Doctors and HCPs, as trusted information sources, should continue to and increasingly advocate for the importance of immunization to increase vaccine uptake.

Residents Attitudes and Home Sanitation Predict Presence of German Cockroaches (Blattodea: Ectobiidae) in Apartments for Low-Income Senior Residents.

The German cockroach, Blattella germanica (L.), is a common pest found in apartment buildings. Prevalence of cockroach infestations is affected by both environmental conditions and building occupant behavior, but their relationships are not well studied. The objective of this study was to analyze the presence of German cockroaches in relation to environmental conditions, resident demographics, and residents' tolerance of cockroaches. We conducted resident interviews, placed sticky traps to detect the presence of German cockroaches, and assessed apartment conditions. A total of 388 apartments from seven low-income apartment buildings, occupied by senior citizens in New Jersey, United States, were included. Among the 344 apartments where trap count data were obtained, 30% had German cockroaches. Among interviewed residents whose apartments had existing cockroach infestations, 36% were unaware of the presence of cockroaches. The odds of having cockroaches in apartments with a 'poor' sanitation rating in kitchens and bathrooms was 2.7 times greater than that in apartments with better sanitation conditions. Residents' tolerance to cockroaches is significantly associated with presence of cockroaches and cockroach population size. The median cockroach count when residents were bothered by cockroaches was ≥3, based on deployment of 4 sticky traps per apartment, over a 2-wk period. Assessing and reducing cockroach tolerance thresholds and improving housekeeping through resident education and assistance from community and housing management should be incorporated in future cockroach management programs in order to reduce high cockroach infestation rates found in similar communities.

Efficacy of three different steamers for control of bed bugs (Cimex lectularius L.).

BACKGROUND: Bed bugs, Cimex lectularius L., have become one of the most difficult urban pests to control. Steam treatment is reported to be an effective method to kill bed bugs and is considered to be an important component of bed bug integrated pest management (IPM). We evaluated and compared the efficacies of two affordable consumer-grade commercial steamers and a commonly used professional-grade steamer for killing bed bugs. RESULTS: In laboratory experiments, the consumer-grade steamers at affordable prices achieved the same high control efficacy as the professional-grade steamer for treating bed bugs exposed on mattresses (100% bed bug mortality for all steamers), located beneath a fabric cover (>89% bed bug mortality for all steamers), or hiding in cracks (100% bed bug mortality for all steamers). Bed bugs located behind a leather cover did not suffer significant mortality from steam treatment regardless of the type of steamers used and the treatment duration. CONCLUSION: Proper use of steamers can kill all life stages of bed bugs. Affordable consumer-grade steamers are as effective as professional-grade steam machines for eliminating bed bugs resting on mattresses and hiding behind fabric materials or in cracks. © 2018 Society of Chemical Industry.