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1.
MMWR Morb Mortal Wkly Rep ; 69(27): 859-863, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32644980

RESUMEN

Recent reports suggest that routine childhood immunization coverage might have decreased during the coronavirus disease 2019 (COVID-19) pandemic (1,2). To assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic, a survey of practices participating in the Vaccines for Children (VFC) program was conducted during May 12-20, 2020. Data were weighted to account for the sampling design; thus, all percentages reported are weighted. Among 1,933 responding practices, 1,727 (89.8%) were currently open; 1,397 (81.1%) of these reported offering immunization services to all of their patients. When asked whether the practice would likely be able to accommodate new patients to assist with provision of immunization services through August, 1,135 (59.1%) respondents answered affirmatively. These results suggest that health care providers appear to have the capacity to deliver routinely recommended childhood vaccines, allowing children to catch up on vaccines that might have been delayed as a result of COVID-19-related effects on the provision of or demand for routine well child care. Health care providers and immunization programs should educate parents on the need to return for well-child and immunization visits or refer patients to other practices, if they are unable to provide services (3).


Asunto(s)
Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Pandemias , Pediatría , Neumonía Viral/epidemiología , Adolescente , Niño , Preescolar , Encuestas de Atención de la Salud , Humanos , Programas de Inmunización , Lactante , Recién Nacido , Evaluación de Programas y Proyectos de Salud , Estados Unidos/epidemiología
2.
Artículo en Inglés | MEDLINE | ID: mdl-32536336

RESUMEN

Background: SAEFVIC is the Victorian surveillance system for adverse events following immunisation (AEFI). It enhances passive surveillance by also providing clinical support and education to vaccinees and immunisation providers. This report summarises surveillance, clinical and vaccine pharmacovigilance activities of SAEFVIC in 2018. Methods: A retrospective observational cohort study of AEFI reports received by SAEFVIC in 2018, compared with previous years since 2008. Data were categorised by vaccinee demographics of age, sex, pregnancy and Indigenous status, vaccines administered and AEFI reactions reported. Age cohorts were defined as infant (0-12 months); young child (1-4 years); school-aged (5-17 years); adult (18-64 years); and older person (65+ years). Proportional reporting ratios were calculated for signal investigation of serious adverse neurological events with all vaccines and with influenza vaccines. Clinical support services and educational activities are described. Results: SAEFVIC received 1730 AEFI reports (26.8 per 100,000 population), with 9.3% considered serious. Nineteen percent (n = 329) attended clinical review. Annual AEFI reporting trends increased for infants, children and older persons, but were stable for school-aged and adult cohorts. Females comprised 55% of all reports and over 80% of reports among adults. There were 17 reports of AEFI in pregnant women and 12 (0.7%) in persons identifying as Indigenous Australians. A possible signal regarding serious adverse neurological events (SANE) was detected, but was not supported by signal validation testing. A clinical investigation is ongoing. Two deaths were reported coincident to immunisation with no evidence of causal association. Conclusion: SAEFVIC continues to provide robust AEFI surveillance supporting vaccine safety monitoring in Victoria and Australia, with new signal detection and validation methodologies strengthening capabilities.


Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Sistemas de Registro de Reacción Adversa a Medicamentos/tendencias , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Inmunización/efectos adversos , Inmunización/estadística & datos numéricos , Farmacovigilancia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estudios Retrospectivos , Victoria/epidemiología , Adulto Joven
3.
Cancer Sci ; 111(6): 2156-2162, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32248632

RESUMEN

In Japan, the serious adverse events after human papillomavirus (HPV) vaccination were widely reported in the media. The Ministry of Health, Labour and Welfare of Japan (MHLW) announced the suspension of the governmental recommendation of HPV vaccine in 2013, and the inoculation rate has since sharply declined. The estimated inoculation rate for each birth fiscal year (FY) announced by the MHLW and the actual numbers for each birth FY surveyed by local governments were very different. In particular, the cumulative vaccination rate of girls born in FY2000 was regarded to be as high as 42.9% by the Council of the MHLW. However, this estimation included a confusion. When the suspension of the governmental recommendation was announced in FY2013, the girls born in FY2000 turned 13 years old, the targeted starting age of the HPV vaccination. The vaccination rate of this generation is considered to be quite low. The numbers were recalculated in this study. This study revealed that the real vaccination rate is only 14.3%. Female individuals born in or after FY2000 have been confirmed to be exposed to the same cervical cancer risk as before the HPV vaccine was introduced in Japan.


Asunto(s)
Inmunización/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/efectos adversos , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Adolescente , Niño , Femenino , Humanos , Japón/epidemiología
4.
Am J Public Health ; 110(4): 527-529, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32078344

RESUMEN

The Minnesota Department of Health used its Immunization Information System-the Minnesota Immunization Information Connection-to respond to an outbreak of measles in the state in 2017 by assisting with the exclusion of unvaccinated exposed individuals from public activities, providing members of the public with their immunization records, and monitoring measles, mumps, and rubella vaccine uptake. Use of the Immunization Information System was found to be an efficient and sustainable tool in responding to the outbreak.


Asunto(s)
Brotes de Enfermedades/prevención & control , Sistemas de Información en Salud/organización & administración , Sarampión/prevención & control , Humanos , Inmunización/estadística & datos numéricos , Sarampión/epidemiología , Vacuna contra el Sarampión-Parotiditis-Rubéola , Registros Médicos , Minnesota/epidemiología
5.
BMC Public Health ; 20(1): 100, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973691

RESUMEN

BACKGROUND: Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessment that aimed to document immunization service provision so as to review a new national strategy, and consider how routine immunization could be better strengthened. METHODS: In East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools. RESULTS: We documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found an immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, included more reliable on-demand services, integration of other family health services and increased involvement of men. CONCLUSIONS: The national strategy addresses most local gaps, but implementation and resourcing requires greater commitment. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization especially through better population-based local planning, and stronger community engagement. Our results also suggest areas where vaccination campaigns in PNG can contribute to routine immunization services.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Servicios de Salud/estadística & datos numéricos , Programas de Inmunización/organización & administración , Inmunización/estadística & datos numéricos , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Programas de Inmunización/estadística & datos numéricos , Papúa Nueva Guinea
6.
Public Health ; 179: 38-44, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31726399

RESUMEN

OBJECTIVE: Pertussis morbidity and mortality disproportionately affect infants younger than 1 year, who constitute 70% of deaths from pertussis. In 2017, 43% of infants younger than 6 months diagnosed with pertussis were hospitalized. In 2012, the Advisory Committee on Immunization Practices recommended that all pregnant women should receive Tdap (tetanus-diphtheria-acellular pertussis) vaccine between 27- and 36-weeks gestation in an effort to reduce infant pertussis morbidity and mortality. However, Tdap vaccination rates among pregnant women remain far from robust. The aim of this study was to assess factors associated with maternal Tdap uptake to help providers identify best practices that can improve Tdap receipt and identify women at risk for not receiving this important vaccine. STUDY DESIGN: A retrospective cross-sectional study. METHODS: A review of prenatal and delivery records was performed on all maternal-infant dyads with infants older than 36 weeks gestation admitted to the term nursery at Albany Medical Center from January 1, 2016 to April 16, 2016. A chi-squared analysis using STATA®, version 14.1, was performed to determine if any variables were associated with Tdap uptake, with statistical significance defined as P < 0.05. Multivariate analysis was performed to identify the variables which had the greatest effect on Tdap receipt. RESULTS: Tdap vaccine was received by 65.8% of pregnant women (n = 400) in the study; median gestational age of receipt was 30 weeks. Maternal influenza vaccine receipt, infant hepatitis B vaccine receipt, provider recommendation of Tdap vaccination, and on-site availability of Tdap vaccine were all positively associated with maternal Tdap receipt during pregnancy. CONCLUSION: Receipt of Tdap by pregnant women was highest in those who had received a provider recommendation about its benefits and who also received influenza vaccine during pregnancy. Because women who received the influenza vaccine themselves and also consented to have their infants receive the hepatitis B vaccine had significantly higher uptake rates, encouraging vaccines usage and combating vaccine hesitancy in general can improve Tdap uptake rates. A small, but statistically significant association with receipt of assisted reproductive technologies was also seen, meriting future research.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Inmunización/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Tos Ferina/prevención & control , Adulto , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Lactante , Vacunas contra la Influenza , Embarazo , Mujeres Embarazadas , Estudios Retrospectivos , Adulto Joven
8.
BMC Health Serv Res ; 19(1): 798, 2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690298

RESUMEN

BACKGROUND: Improved immunization rates have reduced the incidence of vaccine-preventable diseases (VPDs) in advanced nations. Japan's unique vaccination system classifies vaccines into routine vaccines ostensibly required under the Preventive Vaccination Law and recommended but optional vaccines, although all vaccines are in fact voluntary. In Japan, low immunization rates, particularly for optional vaccines, have resulted in high rates of sequelae and death. The decision as to whether a child will receive a vaccine depends on the parents, who must obtain information, make inquiries, and make the required payment, the last of which is a major barrier. This randomized, controlled trial was conducted to evaluate the effectiveness of an immunization education program designed to meet mothers' needs. METHODS: This randomized controlled trial assigned pregnant women to intervention or control groups. The intervention was individual education sessions involving the children's fathers in shared decision-making on whether or not to immunize their child. A survey was conducted before and after the intervention. Data were analyzed using the intention-to-treat principle. RESULTS: Of 225 pregnant women, 175 (78%) participated and 171 replied to the post-survey. At age 3 months, intervention infants had higher self-reported immunization rates for hepatitis B virus vaccine (76% vs. 49%; P < 0.001) and rotavirus vaccine (84% vs. 68%; P = 0.019) than control group infants. The percentage of parents intending to vaccinate their infants was higher in the intervention group (77% vs. 52%; P < 0.01). Improvements in scores for basic knowledge (mean [SD]: 5.5 [3.6] vs. 3.0 [3.8], range: 10-30; P < 0.001), advanced knowledge (mean [SD]: 5.1 [2.4] vs. 2.8 [2.5], range: 5-15; P < 0.001), and health literacy regarding immunization (mean [SD]: 0.5 [0.8] vs. 0.2 [0.6], range: 1-5; P < 0.01) were higher in the intervention group. The rate of decision making by both parents (68% vs. 52%; P < 0.05) was higher in the intervention group. CONCLUSIONS: Our findings confirmed the program's effectiveness. The intervention improved immunization rates, the percentage of parents intending to vaccinate their infants and knowledge scores. Interventions which directly and indirectly involved fathers in shared decision-making on whether to immunize their child were effective, as were individualized interventions that provided parents with access to up-to-date information. TRIAL REGISTRATION: UMIN000012575 . Registered 14 December 2013 (The study was prospectively registered).


Asunto(s)
Educación en Salud , Inmunización , Padres/educación , Adulto , Toma de Decisiones , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Inmunización/psicología , Inmunización/estadística & datos numéricos , Lactante , Intención , Japón , Masculino , Padres/psicología , Periodo Posparto , Embarazo , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios
10.
PLoS One ; 14(11): e0225639, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31774859

RESUMEN

BACKGROUND: Only 40% of World Health Assembly member states achieved 90% national full vaccination coverage in 2015. In the African region, 79% of the countries had not achieved the target in 2015. In Ethiopia, only 39% of children 12-23 months of age were fully vaccinated. Though different studies were conducted in Ethiopia, they were limited in scope and used single level analysis. Therefore, this study aimed to assess individual and community level factors associated with full immunization among children 12-23 months of age in Ethiopia. METHODS: The data was obtained from Ethiopia Demographic and Health Survey 2016, conducted from January 2016 to June 2016. The sample was taken using two stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected systematically. Weighted sample of 1929 children 12-23 months of age were included in the study. Data was extracted from http://www.DHSprogram.com. Multilevel logistic regression was employed. Akaike Information Criteria was used to select best fit model. RESULTS: Mother's education, husband employment, mother's religion, mother's antenatal care visit, presence of vaccination document, region and community antenatal care utilization were significantly associated with children full vaccination. The odds of full vaccination were 2.5 [AOR = 2.48 95% CI: 1.35, 4.56] and 1.6 [AOR = 1.58 95% CI: 1.1, 2.28] times higher in children of mothers with secondary or higher and primary education respectively than children of mothers with no education. CONCLUSION: This study showed that children full vaccination is affected both by the individual and community level factors. Therefore, efforts to increase children full vaccination status need to target both at individual and community level.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Madres/psicología , Aceptación de la Atención de Salud , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
11.
BMC Public Health ; 19(1): 1275, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533790

RESUMEN

BACKGROUND: Immunization is an effective public health intervention to reduce morbidity and mortality among children and it will become more effective if the child can receive the full course of recommended immunization doses. The objective of this study was to determine the prevalence of childhood immunization defaulters and its associated factors among children below 5 years attending registered child care centers in Petaling District, Selangor. METHODS: This was a cross-sectional survey among mothers with children below 5 years from 60 registered child care centers in District of Petaling, Selangor. Data was collected by a self-administered questionnaire from a total of 1015 mothers. Simple Logistic Regression, Chi-square or Fisher's exact test were performed to determine the association between individual categorical variables and childhood immunization defaulters. Multivariate logistic regression was used to determine the predictors of childhood immunization defaulters. RESULTS: The study showed that the prevalence rate for defaulting immunization was 20.7%. After adjusting all confounders, six statistically significant predictors of childhood immunization defaulters were determined. They were non-Muslims (aOR = 1.669, 95% CI = 1.173, 2.377, p = 0.004), mothers with diploma and below educational background (aOR = 2.296, 95% CI = 1.460, 3.610, p < 0.0001), multiple children of 5 and above in a family (aOR = 2.656, 95% CI = 1.004, 7.029, p = 0.040), mothers with younger children aged 2 years and below (aOR = 1.700, 95% CI = 1.163, 2.486, p = 0.006), long travelling time of more than 30 min to the immunization health facility (aOR = 2.303, 95% CI = 1.474, 3.599, p < 0.0001) and had delayed at least one of the immunization schedule (aOR = 2.747, 95% CI = 1.918, 3.933, p < 0.0001). CONCLUSION: This study highlights the need of implementation of intervention programs should be intensified to improve the childhood immunization status, focusing on the Non-Muslim community, mothers with low educational level, mothers with multiple children and mothers with children aged 2 years and below. In light of the growing problem of immunization defaulters in Malaysian children, identifying mothers at risk of not completing their children immunization schedule and educating them is an important strategy to recurrent outbreaks of infectious disease in the country.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Programas de Inmunización/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Preescolar , Estudios Transversales , Femenino , Humanos , Esquemas de Inmunización , Lactante , Modelos Logísticos , Malasia , Masculino , Madres/estadística & datos numéricos , Prevalencia , Encuestas y Cuestionarios
12.
Int Arch Allergy Immunol ; 180(3): 195-201, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31505505

RESUMEN

BACKGROUND: Previous studies have used serum periostin levels as a biomarker of Th2-driven inflammatory responses. However, no population-based study has yet examined the association of serum periostin levels with the allergic status of children. OBJECTIVES: The aim of this study was to determine the usefulness of periostin as a biomarker for allergy in a group of 7-year-old Korean children. METHOD: This prospective cross-sectional study examined 451 children (aged 7 years to 7 years and 11 months) from the general pediatric population who attended 6 different schools between June and July 2016. A total of 249 children, all of whom completed the questionnaire and skin prick test and provided blood samples, were included in the final analysis. RESULTS: The geometric mean serum periostin level was 107.6 ng/mL (95% CI 104.5-110.7). After adjustment for confounding, serum periostin levels were significantly associated with sensitization to poly-allergens (adjusted odds ratio, aOR 1.032, 95% CI 1.006-1.059, p = 0.016) and pollen (aOR 1.020, 95% CI 1.002-1.039, p = 0.026). Serum periostin levels were also associated with eosinophil levels (adjusted ß = 0.023, SE = 0.009, p = 0.010), but were unrelated to body mass index, sex, obesity, or presence of an allergic disease. CONCLUSIONS: Our results suggest thatserum periostin level may have limited usefulness as a biomarker of allergic disease in children.


Asunto(s)
Biomarcadores/sangre , Moléculas de Adhesión Celular/sangre , Eosinófilos/inmunología , Hipersensibilidad/diagnóstico , Inmunización/estadística & datos numéricos , Alérgenos/inmunología , Niño , Estudios Transversales , Femenino , Humanos , Hipersensibilidad/epidemiología , Corea (Geográfico)/epidemiología , Masculino , Grupos de Población , Estudios Prospectivos , Pruebas Cutáneas
13.
Allergol Immunopathol (Madr) ; 47(6): 579-584, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31477404

RESUMEN

BACKGROUND: In Portugal, the pollen types most implicated in respiratory allergy are grasses, olive and parietaria. The knowledge of sensitizations to molecular allergens in children and adults can contribute to better diagnosis and treatment of this pathology. METHODS: ImmunoCAP singleplex technology was used for molecular allergens and Phadia 250® automatic equipment. g205 (Phl p1); g215 (Phl p5b); g210 (Phl p7); and g212 (Phl p12) allergen determinations were made in 45 patients with positive grass sensitization tests. RESULTS: The majority of patients are sensitized to Phl p1 (91%) and Phl p1+/Phl p5-/Phl p7-/Phl p12- was the most dominant profile (40%). In the adult group, the IgE averages for Phl p1 were approximately 10.46, while they were 8.43 for Phl p5, 0.69 for Phl p7, and 0.06 for Phl p12. In the child group, these values were higher: 22.49, 20.23, 3.89, and 0.35, respectively. For allergens Phl p1, Phl p5, and Phl p7, these differences between the child and adult population were not statistically significant (p=0.754, p=0.806 and p=0.102, respectively), but for Phl p12, a statistically significant difference (p=0.018) was observed. CONCLUSIONS: IgE antibodies Phl p1 is the most important allergic marker and sensitivities caused by Phl p12 give rise to higher IgE values in children.


Asunto(s)
Alérgenos/inmunología , Antígenos de Plantas/inmunología , Inmunización/estadística & datos numéricos , Proteínas de Plantas/inmunología , Profilinas/inmunología , Rinitis Alérgica Estacional/inmunología , Adolescente , Adulto , Anciano , Biomarcadores , Proteínas de Unión al Calcio/inmunología , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina E/metabolismo , Masculino , Persona de Mediana Edad , Polen/inmunología , Portugal/epidemiología , Rinitis Alérgica Estacional/epidemiología , Adulto Joven
14.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 951-954, 2019 Sep 06.
Artículo en Chino | MEDLINE | ID: mdl-31474081

RESUMEN

Construction and application of immunization information system is an important part of health information, which is very useful to improve the quality, efficiency and safety of vaccination. The background, system architecture, functions and applications, working conditions and characteristics of Shandong province Immunization Information System (IIS) are introduced in this article. It is expected to provide experiences for the development of immunization information system of other provinces.


Asunto(s)
Inmunización , Sistemas de Información , Vacunación , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Niño , China , Humanos , Inmunización/estadística & datos numéricos , Sistemas de Información/tendencias
15.
Hosp Pediatr ; 9(9): 673-680, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31383715

RESUMEN

OBJECTIVES: Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge. METHODS: We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children's center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. χ2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance. RESULTS: Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03-18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio = 2.73; P = .001), with no differences seen when comparing race, sex, or insurance. CONCLUSIONS: Pediatric hospitalizations provide important opportunities to screen and immunize children.


Asunto(s)
Hospitalización , Inmunización/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Inmunización/métodos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Cobertura de Vacunación/estadística & datos numéricos , Adulto Joven
16.
J Manag Care Spec Pharm ; 25(9): 989-994, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31456496

RESUMEN

BACKGROUND: Pharmacies have a unique opportunity to address suboptimal adult vaccination rates, but few solutions have proven effective. Such strategies are challenged by the lack of access that many pharmacies have to a patient's complete immunization history; consequently, they are unable to identify which of their patients actually require vaccination. A pharmacy-based strategy that leverages such information could enhance efforts to increase rates of guideline-based vaccination. OBJECTIVE: To determine the effect on vaccination rates of an automated telephonic intervention for adults in need of either pneumococcal vaccination or herpes zoster vaccination, or both. METHODS: Over a 1-year period, patients with identified vaccine gaps at 246 pharmacies of 3 pharmacy chains were randomly assigned to receive either usual care or an automated telephonic prompt for pneumococcal and/or herpes zoster vaccines based on patient records contained in state immunization registries and pharmacy data. The primary outcome was the proportion with administration of at least one of the vaccines offered between March 2016 and January 2017 based on intention-to-treat principles. Subgroup analyses included vaccination rates by age and sex. An as-treated analysis was also performed. RESULTS: 21,971 patients were included in the study, 57% of whom were female, with a mean age of 63 years. Vaccine administration proportions were 0.0214 (236/11,009) in the intervention group, and 0.0205 (225/10,962) in the control group (OR = 1.05, 95% CI = 0.87-1.26). Results did not differ in subgroup analyses based on patient age, sex, or individual pharmacy chain. Among intervention patients, 3,666 (0.333) completed the call by listening to the entire prompt. In an as-treated analysis comparing individuals who completed calls versus control, the intervention increased the odds of vaccination by 26% (OR = 1.26, 95% CI = 1.00-1.61). CONCLUSIONS: The automated prompt did not significantly increase vaccination rates. Potential barriers included intervention technical flaws, low rates of connecting with patients, insufficient follow-up by the pharmacy, and patients placing a relatively low priority on being vaccinated. DISCLOSURES: This project was funded by Pfizer and Merck through a grant from the Pharmacy Quality Alliance. Stolpe was an employee of the Pharmacy Quality Alliance at the onset of this project and an employee of Scientific Technologies Corporation during the data collection phase of the project. Stolpe has also served on the advisory board for Merck. Choudhry has no conflicts of interest to declare.


Asunto(s)
Servicios Comunitarios de Farmacia/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Teléfono/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Femenino , Vacuna contra el Herpes Zóster/inmunología , Humanos , Vacunas contra la Influenza/inmunología , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Vacunas Neumococicas/inmunología , Sistema de Registros , Encuestas y Cuestionarios
17.
PLoS One ; 14(7): e0220144, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31339939

RESUMEN

INTRODUCTION: Immunization is a cost-effective intervention that prevented more than 5 million deaths worldwide from 2010 to 2015. Despite increased vaccination coverage over the past four decades in many African countries, including Ethiopia, universal coverage has not yet been reached. Only 39% of children aged 12-23 months received full vaccinations in Ethiopia, according to the 2016 Ethiopian Demographic Health Survey. This study aimed to evaluate immunization coverage and identify individual and community factors that explain incomplete vaccination coverage among children aged 6-36 months in the Wonago district of southern Ethiopia. METHODS: We conducted a community-based, cross-sectional study in three randomly selected kebeles in the Wonago district from June to July 2017. Our nested sample of 1,116 children aged 6-36 months included 923 child-mother pairs (level 1) within kebeles (level 2). We conducted multilevel regression analysis using STATA software. RESULTS: Among participants, 85.0% of children aged 12-36 months received at least one vaccine, and 52.4% had complete immunization coverage. After controlling for several individual and community variables, we identified six significant predictor variables for complete immunization: Older mothers' age (AOR = 1.05, 95% CI: 1.00-1.09), higher utilization of antenatal care (AOR = 1.36, 95% CI: 1.14-1.62), one or more tetanus-toxoid vaccination during pregnancy (AOR = 2.64, 95% CI: 1.43-4.86), mothers knowing the age at which to complete child's vaccinations (AOR = 2.00, 95% CI: 1.25-3.20), being a female (AOR = 0.64, 95% CI: 0.43-0.95), and child receiving vitamin A supplementation within the last 6 months (AOR = 2.79, 95% CI: 1.59-4.90). We observed a clustering effect at the individual and community levels with an intra-cluster correlation coefficient of 48.1%. CONCLUSIONS: We found low immunization coverage among children in the Wonago district of southern Ethiopia, with significant differences across communities. Promoting maternal health care and community service could enhance immunization coverage.


Asunto(s)
Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Preescolar , Estudios Transversales , Escolaridad , Etiopía/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Inmunización/estadística & datos numéricos , Lactante , Masculino , Edad Materna , Persona de Mediana Edad , Relaciones Madre-Hijo , Madres/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Pregnancy Childbirth ; 19(1): 250, 2019 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-31311501

RESUMEN

BACKGROUND: China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. METHODS: We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women's education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. RESULTS: Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75-1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36-0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06-0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. CONCLUSION: Lessons can be learned from China's successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women's homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital.


Asunto(s)
Disparidades en Atención de Salud/etnología , Inmunización/estadística & datos numéricos , Servicios de Salud Materna , Aceptación de la Atención de Salud , Adulto , Preescolar , China/epidemiología , Grupos Étnicos , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , Inmunización/métodos , Lactante , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Factores Socioeconómicos
19.
Rev Saude Publica ; 53: 59, 2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31340351

RESUMEN

OBJECTIVE: To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005-2009) and post-vaccination (2011-2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS: The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS: From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination - one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002-1.052). CONCLUSIONS: Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.


Asunto(s)
Inmunización/estadística & datos numéricos , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/prevención & control , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Brasil/epidemiología , Niño , Preescolar , Mapeo Geográfico , Humanos , Incidencia , Lactante , Persona de Mediana Edad , Características de la Residencia , Adulto Joven
20.
Afr Health Sci ; 19(1): 1582-1593, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31148987

RESUMEN

Background: Childhood immunization rate is lowest in the core-North Nigeria. We examined the relationship between inequality in household wealth and complete childhood immunization in that part of the country. Methods: A cross-sectional survey was conducted among 4079 mothers with children 12-23 months of age. Children were considered 'fully-immunized' if they received all the vaccines included in the immunization schedule. Data were analyzed using descriptive statistics and logistic regression models (α=5.0%). Results: About 39% and 5.0% children of the rich and poor received complete immunization respectively. Also, 64.2% and 49.6% children of the rich women received BCG and DPT 3 compared to 15.9% and 8.7% observed among the children of the poor. Higher proportion of children from poor households (40.6%) received no immunization than 20.8% found from the rich households. The likelihood of receiving complete immunization was 1.95(C.I=1.35-2.80, p<0.001) times higher among the children of the rich than the poor. Other important predictors of childhood immunization were age, religion, media access, working status, husband's education, prenatal attendants and delivery place. Conclusion: Disparities existed in childhood immunization between the poor and rich in the core-North part of Nigeria. Policy makers should institute effective interventions that will assist children from poor households to improve their immunization access.


Asunto(s)
Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Inmunización/estadística & datos numéricos , Pobreza , Adulto , Niño , Preescolar , Estudios Transversales , Composición Familiar , Femenino , Humanos , Programas de Inmunización , Renta , Masculino , Madres , Nigeria , Factores Socioeconómicos , Adulto Joven
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