Cost-effectiveness of using Quantiferon Gold (QFT-G)® versus tuberculin skin test (TST) among U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis.

OBJECTIVE: The purpose of this study was to determine the cost benefit to routinely using QFT-G versus the standard TST for screening U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis. DESIGN AND SAMPLE: A comparative cost analysis of the monetization between QFT-G and TST was conducted: Data from the health department's Chest Clinic patients seen in 2007 were used to model cost predictions. MEASURES: The net costs of screening, x-rays, the standard 9 months of latent tuberculosis infection treatment, laboratory, and administration for U.S. born patients and foreign born patients were investigated. RESULTS: There are no apparent cost savings for U.S. born individuals, but due to the higher specificity of QFT-G for foreign born BCG-vaccinated individuals, there are unnecessary expenditures associated with the higher number of false positives incurred when using TST compared with QFT-G on 1,000 foreign born individuals (69%, 18%). CONCLUSION: QFT-G is cost-effective and should be used at local health department clinics that want to achieve savings in screening and treating those suspected of having TB infection, especially for high-risk populations such as foreign born individuals.

Outcomes, Approaches, and Challenges to Developing and Passing a Countywide Mandatory Vaccination Policy: St. Louis County's Experience with Hepatitis A Vaccine for Food Service Personnel.

In the early 1990s, St. Louis County had multiple foodservice worker-related hepatitis A outbreaks uncontrolled by standard outbreak interventions. Restaurant interest groups and the general public applied political pressure to local public health officials for more stringent interventions, including a mandatory vaccination policy. Local health departments can enact mandatory vaccination policies, but this has rarely been done. The study objectives were to describe the approach used to pass a mandatory vaccination policy at the local jurisdiction level and illustrate the outcome from this ordinance 15 years later. A case study design was used. In-depth, semi-structured interviews using guided questions were conducted in spring, 2015, with six key informants who had direct knowledge of the mandatory vaccination policy process. Meeting minutes and/or reports were also analyzed. A Poisson distribution analysis was used to calculate the rate of outbreaks before and after mandatory vaccination policy implementation. The policy appears to have reduced the number of hepatitis A outbreaks, lowering the morbidity and economic burden in St. Louis County. The lessons learned by local public health officials in passing a mandatory hepatitis A vaccination policy are important and relevant in today's environment. The experience and lessons learned may assist other local health departments when faced with the potential need for mandatory policies for any vaccine preventable disease.

A functional needs approach to emergency planning.

OBJECTIVE: This study was conducted to test the ability of the St Louis County Department of Health to efficiently dispense medication to individuals with functional needs during a public health emergency and develop new guidelines for future emergency planning. Historically, people with functional needs have been vulnerable in emergency situations, and emergency planners are responsible for creating equal access for mass prophylaxis events. METHODS: Measures to create access for individuals with functional needs were tested in a countywide exercise in which 40 volunteers with functional needs walked through an open point of dispensing location to collect medication as if it were a real emergency. Actions were informed by representatives from the functional needs community in the St Louis area. RESULTS: During the exercise, medications were successfully dispensed to all participants. Many participants offered feedback for future program design. CONCLUSIONS: Outcomes indicated the importance of working closely with the community organizations that serve people with functional needs in designing appropriate response measures, providing sensitivity training to staff members, employing useful technology, and using visual and verbal cues. The lessons learned from this exercise apply to emergency planning nationwide, as planning efforts for persons with functional needs still lag significantly.(Disaster Med Public Health Preparedness. 2014;0:1-9).

Seasonal influenza vaccine compliance among hospital-based and nonhospital-based healthcare workers.

BACKGROUND: Influenza vaccination among nonhospital healthcare workers (HCWs) is imperative, but only limited data are available for factors affecting their compliance. OBJECTIVE: To examine the factors influencing influenza vaccine compliance among hospital and nonhospital HCWs. Design and Setting. A vaccine compliance questionnaire was administered to HCWs working in myriad healthcare settings in March-June 2011. METHODS: Online and paper surveys were used to assess compliance with the 2010/2011, 2009/2010, and H1N1 influenza vaccines and to examine factors that predicted the uptake of the 2010/2011 seasonal influenza vaccine. RESULTS: In all, 3,188 HCWs completed the survey; half of these ([Formula: see text]) reported no hospital work time. Compliance rates for all 3 vaccines were significantly higher ([Formula: see text]) among hospital versus nonhospital HCWs. In logistic regression stratified by hospital versus nonhospital setting, and when controlling for demographics and past behavior, the determinants of vaccination against the 2010/2011 seasonal influenza among nonhospital-based HCWs included having a mandatory vaccination policy, perceived importance, no fear of vaccine adverse effects, free and on-site access, and perceived susceptibility to influenza. Determinants of hospital-based HCW vaccine compliance included having a mandatory vaccination policy, belief that HCWs should be vaccinated every year, occupational health encouragement, perceived importance of vaccination, on-site access, and no fear of vaccine adverse effects. The strongest predictor of compliance for both worker groups was existence of a mandatory vaccination policy. CONCLUSIONS: The reasons for vaccine uptake among nonhospital-based versus hospital-based HCWs differed. Targeted interventions should be aimed at workers in these settings to increase their vaccine compliance, including implementing a mandatory vaccination policy.

Seasonal and H1N1 influenza vaccine compliance and intent to be vaccinated among emergency medical services personnel.

BACKGROUND: Only limited data are available on emergency medical technicians' (EMT) influenza vaccination compliance. METHODS: A questionnaire was administered to St. Louis EMTs during March to June 2011 to assess compliance with the 2010/2011 and 2009/2010 seasonal and pandemic H1N1 influenza vaccinations, factors that predicted uptake of 2010/2011 seasonal influenza vaccine, and intent to be vaccinated. RESULTS: In all, 265 EMTs participated. EMTs' attitudes and beliefs toward influenza vaccines differed significantly when comparing vaccinated to nonvaccinated EMTs. EMTs whose employer had a mandatory vaccination policy were significantly more likely to receive the seasonal influenza vaccine (100% vs 75.6%, respectively) or the H1N1 vaccine (100% vs 66.8%, respectively) compared with those without such a policy (χ(2) = 8.8, P < .001 and χ(2) = 6.7, P < .01, respectively). In logistic regression controlling for demographics, determinants of 2010/2011 seasonal influenza vaccination included belief that EMTs should be vaccinated every year, perceived importance of vaccination, perception that influenza vaccine has few adverse effects, and past vaccine-seeking behavior. In logistic regression controlling for demographics, determinants of intent to be vaccinated included having the vaccine available on-site and free of charge and belief that EMTs should be vaccinated every year. CONCLUSION: EMT-targeted interventions should be used to increase vaccine compliance, including implementing a mandatory vaccination policy and addressing EMTs' beliefs and attitudes about vaccine in an education campaign.

H1N1 influenza vaccine compliance among hospital- and non-hospital-based healthcare personnel.

BACKGROUND: The 2009 pandemic H1N1 influenza vaccine had lower uptake compared to seasonal influenza vaccine, and most studies examining uptake of H1N1 vaccine focused on hospital-based healthcare personnel (HCP). Determinants of H1N1 vaccine uptake among HCP in all work settings need to be identified so that interventions can be developed for use in encouraging uptake of future pandemic or emerging infectious disease vaccines. OBJECTIVE: To identify factors influencing nonhospital HCP H1N1 influenza vaccine compliance. DESIGN AND SETTING: An H1N1 influenza vaccine compliance questionnaire was administered to HCP working in myriad healthcare settings in March-June 2011. METHODS: Surveys were used to assess H1N1 influenza vaccine compliance and examine factors that predicted H1N1 influenza vaccine uptake. RESULTS: In all, 3,188 HCP completed the survey. Hospital-based HCP had higher compliance than did non-hospital-based personnel (Χ2 = 142.2, P < .001). In logistic regression stratified by hospital setting versus nonhospital setting, determinants of H1N1 vaccination among non-hospital-based HCP included extent to which H1N1 vaccination was mandated or encouraged, perceived importance of vaccination, access to no-cost vaccine provided on-site, no fear of vaccine side effects, and trust in public health officials when they say that the influenza vaccine is safe. Determinants of hospital-based HCP H1N1 vaccine compliance included having a mandatory vaccination policy, perceived importance of vaccination, no fear of vaccine side effects, free vaccine, perceived seriousness of H1N1 influenza, and trust in public health officials. CONCLUSIONS: Non-hospital-based HCP versus hospital-based HCP reasons for H1N1 vaccine uptake differed. Targeted interventions are needed to increase compliance with pandemic-related vaccines.