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1.
PLoS One ; 15(5): e0232652, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32407329

RESUMEN

Would the affected communities voluntarily obtain herd immunity if a cure for COVID-19 was available? This paper experimentally investigates people's vaccination choices in the context of a nonlinear public good game. A "vaccination game" is defined in which costly commitments (vaccination) are required of a fraction of the population to reach the critical level needed for herd immunity, without which defectors are punished by the natural contagion of epidemics. Our experimental implementation of a vaccination game in a controlled laboratory setting reveals that endogenous epidemic punishment is a credible threat, resulting in voluntary vaccination to obtain herd immunity, for which the orthodox principle of positive externalities fails to account. The concave nature of the infection probability plays a key role in facilitating the elimination of an epidemic.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Juegos Experimentales , Inmunidad Colectiva , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vacunación/estadística & datos numéricos , Betacoronavirus , Toma de Decisiones , Humanos , Castigo
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(4): 425-429, 2020 Apr 06.
Artículo en Chino | MEDLINE | ID: mdl-32268652

RESUMEN

Objective: To analyze the effect of influenza vaccination intervention among key populations of chronic disease management in communities of Shanghai. Methods: A total of 50 787 patients aged ≥60 with diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in Huangpu, Yangpu, Baoshan and Qingpu districts of Shanghai from January 2013 to August 2017 were selected as the intervention group, and 52 268 people from key populations with chronic disease management in Xuhui, Hongkou, Jiading and Fengxian districts were selected as the control group according to the geographical location and economic level. The intervention group accepted follow-up and health education of influenza vaccination via chronic disease outpatient based on information system. The implementation time of the intervention was from September 2017 to January 2018. The basic information and diagnosis information of two groups, and intervention completion of the intervention group were obtained from Shanghai chronic disease management information system and hospital record system. Results: The age of the intervention group and the control group were (76.76±8.33) and (77.97±8.51) years old, respectively (P<0.001); and there were statistical differences in gender, occupational and influenza vaccination rate between the two groups (P<0.001). A total of 28 644 (56.40%) subjects of the intervention group received intervention. There was no significant difference in age composition between finished and unfinished intervention groups (P=0.095), and there was significant difference in gender composition (P=0.044). Before the intervention, the vaccination rate of the intervention group was 0.75% (382 subjects) which was lower than that of the control group with 1.02% (533 subjects) (χ(2)=20.96, P<0.001). After the intervention, the vaccination rate of the intervention group was 1.73% (496 subjects) which was higher than that of the control group with 1.42% (744 subjects) (χ(2)=11.65, P=0.001). Subjects that were male, younger, uptake of influenza vaccine before the intervention, received intervention and professional and technical personnel were more likely to take influenza vaccine, with OR (95%CI) 1.29 (1.13-1.47), 0.97 (0.96-0.98), 260.30 (215.21-314.83), 1.85 (1.61-2.11) and 1.48 (1.10-1.99), respectively. Conclusion: Influenza vaccination intervetion raised the vaccination rate of key population of chronic disease management. Male, younger, those who had been vaccinated before the intervention, who received the intervention, and professional and technical personnel were more likely to be vaccinated.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , China , Enfermedad Crónica , Diabetes Mellitus , Femenino , Humanos , Hipertensión , Masculino , Educación del Paciente como Asunto , Enfermedad Pulmonar Obstructiva Crónica
3.
Zhonghua Er Ke Za Zhi ; 58(4): 308-313, 2020 Apr 02.
Artículo en Chino | MEDLINE | ID: mdl-32234138

RESUMEN

Objective: To investigate the coverage rate and the adverse reactions of National Immunization Program vaccines in children with spinal muscular atrophy (SMA). Methods: A cross-sectional retrospective cohort study was carried out from July 2016 to June 2019, 192 children (116 boys and 76 girls) with SMA registered by Capital Institute of Pediatrics and 191 healthy children (115 boys and 76 girls) vaccinated in Chaoyang Olympic Village Community Health Service Center from July 2016 to December 2018 were included. Questionnaire survey was designed to investigate the vaccination coverage rate and associated adverse events. The t-test and χ(2) test were used to compare the difference between SMA patients and healthy children. Results: The coverage rate of age-appropriate immunization in SMA children was 62.0% (119/192) in general, and were 52.2% (12/23), 55.7% (68/122), and 83.0% (39/47) for SMA type 1-3 patients, respectively (χ(2)=12.23, P=0.002). The vaccination coverage rates of Bacillus Calmette-Guerin (BCG) vaccine, the 3(rd) dose of hepatitis B, the 3(rd) dose of polio, the 3(rd) dose of diphtheria-pertussis-tetanus, the 1(st) dose of meningococcal polysaccharide group A, the 1(st) dose of measles or measles and rubella vaccine, the 1(st) dose of Japanese encephalitis vaccine, hepatitis A, measles-mumps-rubella, and group A+C meningococcal polysaccharide vaccine were 100.0% (192 cases), 94.3% (181 cases), 81.8% (157 cases), 88.5% (170 cases), 83.9% (161 cases), 76.6% (147 cases), 80.2% (154 cases), 68.2% (131 cases), 69.8% (134 cases), 54.7% (105 cases), respectively. Among the 73 patients who did not have their planned immunization completed, 57 cases (78.1%) gave up the vaccination due to parents' concern of potential aggravation of their disease, and 16 cases (21.9%) had the plan discontinued by the immunization department because of the disease. Fever, local redness and swelling were the most common side-effects after vaccination both in SMA patients and healthy children (19.8% (38/192) vs. 18.8% (36/191) , χ(2)=0.055, P=0.815). The main abnormal reactions of vaccination were rash and neurovascular edema, without significant difference between these two groups (2.6% (5/192) vs. 3.7% (7/191), χ(2)=0.355, P=0.551). The coverage rate of Influenza and pneumococcal vaccine in SMA patients were 22.4% (43 cases) and 31.8% (61 cases), respectively. The incidence of pneumonia in the SMA patients decreased from 59.0% (23/39) to 41.0% (16/39) after vaccination. And none of the Influenza vaccinated patients had the flu in the year of vaccination. Conclusions: The coverage rate of National Immunization Program vaccines in the SMA children is low, especially in type 1 SMA patients, which is mainly due to their guardians' concern of potential adverse events, even though the incidence of adverse reactions is similar in SMA patients and healthy children. Influenza and pneumococcal vaccine can reduce the risk of pneumonia and flu in children with SMA effectively.


Asunto(s)
Programas de Inmunización , Atrofia Muscular Espinal , Vacunación/estadística & datos numéricos , Vacunas/efectos adversos , Niño , China , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Retrospectivos
4.
J Korean Med Sci ; 35(12): e76, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32233157

RESUMEN

BACKGROUND: Healthcare personnel (HCP) are at risk of being exposed to or transmitting infections in hospitals, and vaccination against vaccine-preventable diseases (VPDs) is a well-known preventive strategy. Vaccination against influenza, hepatitis B virus, measles-mumps-rubella, varicella, and pertussis is recommended for HCP. However, there is no information on the current status of hospitals' vaccination policies for HCP in Korea. METHODS: We conducted a nationwide survey on hospital vaccination policies and barriers to implementing recommended vaccination programs in 2018. The online survey questionnaire was distributed to 652 hospitals, and 200 of them responded. RESULTS: Of the 200 surveyed hospitals, 151 (75.5%) conducted a pre-employment screening program for at least one VPD, and 196 (98%) had vaccination programs that included at least one vaccine. Influenza vaccine was most commonly included in their programs (97.5%, n = 195), followed by hepatitis B vaccines (69%, n = 138). However, < 25% of the hospitals included other vaccines in their policies (measles-mumps-rubella, 24.5%; varicella, 18.5%; pertussis, 11%). Only 13 hospitals (6.5%) included the five recommended vaccines for HCP in their policies. Influenza vaccination coverage had a mean of 89.9% and was significantly higher in hospitals fully funding the vaccination cost (91.8% vs. 80.4%, P < 0.001). Among hospitals funding influenza vaccines, the coverage was lower in hospitals with ≥ 700 beds (-6.5%, P = 0.003). Hospitals' financial burden was the most important barrier to implementing vaccination polices as recommended (78.6%, 121/154), followed by lack of awareness (21%) or campaign (21%) and lack of leadership (17%). CONCLUSION: Despite the recommendations on vaccination for HCP, the vaccination policies for HCP differ in hospitals and appear to be insufficient to protect HCP and prevent nosocomial transmission. Strong leadership of each hospital to protect HCP and financial support from the government are required to implement appropriate vaccination policies in hospitals.


Asunto(s)
Hospitales/estadística & datos numéricos , Política Organizacional , Vacunación/estadística & datos numéricos , Enfermedades Prevenibles por Vacunación , Vacunas , Vacuna contra la Varicela , Infección Hospitalaria/prevención & control , Humanos , Vacunas contra la Influenza , Vacuna contra el Sarampión-Parotiditis-Rubéola , Vacuna contra la Tos Ferina , República de Corea , Enfermedades Prevenibles por Vacunación/prevención & control , Vacunas/uso terapéutico
5.
Isr Med Assoc J ; 22(3): 148-153, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147978

RESUMEN

BACKGROUND: Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel. OBJECTIVES: To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns. METHODS: This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate. RESULTS: Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities. CONCLUSIONS: Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Vacunas contra Hepatitis B/uso terapéutico , Cuidado del Lactante/métodos , Educación del Paciente como Asunto/métodos , Vacunación/estadística & datos numéricos , Adulto , Femenino , Humanos , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Israel , Masculino , Embarazo , Estudios Prospectivos
7.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32152616

RESUMEN

Objectives and importance: Influenza vaccination in pregnancy has been funded under the Australian National Immunisation Program since 2010, yet uptake is suboptimal. We evaluated the 2016 New South Wales (NSW) Health influenza vaccination in pregnancy public information campaign. STUDY TYPE: Mixed methods. METHODS: We searched Factiva, ProQuest Global Newsstream and Google News for news articles relevant to the 2016 campaign. We reviewed information provided by NSW Health about NSW Health-initiated social media activity relevant to the campaign, and also assessed engagement with campaign messages using publicly available information. Between September and October 2016, we surveyed pregnant women at the antenatal clinic of a large tertiary hospital in Sydney to estimate influenza vaccine uptake during pregnancy, identify key information sources, and understand knowledge and attitudes regarding influenza vaccination. RESULTS: Thirty-one news articles were published in traditional media between April and August 2016. A single campaign advertisement on the NSW Health Facebook page had 449 609 impressions, with a click-through rate to the NSW Health website of 0.4%percnt;. Sixteen sponsored articles were posted on Facebook and six sponsored images were posted on Instagram, with relatively limited engagement. A total of 71 pregnant women participated in the survey. Of these, 90%percnt; were aware that pregnant women can receive an influenza vaccine during pregnancy, with 54%percnt; reporting that they had been vaccinated in their current pregnancy. Fifty-five per cent had read a brochure about influenza vaccination in pregnancy. Many women, particularly those who were unvaccinated, were uncertain about the effectiveness and safety of influenza vaccination in pregnancy. CONCLUSION: Both traditional and social media platforms can be used to promote influenza vaccination for pregnant women, although there are challenges to achieving high reach of messages via both methods. Self-reported vaccination coverage in our study was higher than previous NSW estimates, but still suboptimal. Further efforts are required to understand and address provider and patient attitudes and concerns about influenza vaccination in pregnancy, especially regarding effectiveness and safety. Our findings and recommendations should be of interest to healthcare providers and public health agencies Australia-wide, to inform campaigns and programs to improve uptake of antenatal influenza vaccination.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Programas de Inmunización/estadística & datos numéricos , Gripe Humana/prevención & control , Cooperación del Paciente , Vacunación/estadística & datos numéricos , Adulto , Femenino , Humanos , Nueva Gales del Sur , Datos de Salud Generados por el Paciente , Embarazo , Mujeres Embarazadas , Medios de Comunicación Sociales , Encuestas y Cuestionarios
8.
N Engl J Med ; 382(11): 1009-1017, 2020 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-32160662

RESUMEN

BACKGROUND: Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home. METHODS: We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated. RESULTS: A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million. CONCLUSIONS: Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.


Asunto(s)
Vacuna contra el Sarampión-Parotiditis-Rubéola , Sarampión , Vacunación , Adolescente , Adulto , Anciano , Niño , Preescolar , Brotes de Enfermedades , Femenino , Recursos en Salud/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Anamnesis , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Índice de Severidad de la Enfermedad , Vacunación/estadística & datos numéricos , Adulto Joven
9.
PLoS Biol ; 18(2): e3000611, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32045407

RESUMEN

Unusually large outbreaks of mumps across the United States in 2016 and 2017 raised questions about the extent of mumps circulation and the relationship between these and prior outbreaks. We paired epidemiological data from public health investigations with analysis of mumps virus whole genome sequences from 201 infected individuals, focusing on Massachusetts university communities. Our analysis suggests continuous, undetected circulation of mumps locally and nationally, including multiple independent introductions into Massachusetts and into individual communities. Despite the presence of these multiple mumps virus lineages, the genomic data show that one lineage has dominated in the US since at least 2006. Widespread transmission was surprising given high vaccination rates, but we found no genetic evidence that variants arising during this outbreak contributed to vaccine escape. Viral genomic data allowed us to reconstruct mumps transmission links not evident from epidemiological data or standard single-gene surveillance efforts and also revealed connections between apparently unrelated mumps outbreaks.


Asunto(s)
Brotes de Enfermedades , Genoma Viral/genética , Virus de la Parotiditis/genética , Paperas/epidemiología , Paperas/transmisión , Genotipo , Humanos , Epidemiología Molecular , Paperas/virología , Virus de la Parotiditis/clasificación , Mutación , Filogenia , Análisis de Secuencia de ADN , Estados Unidos/epidemiología , Vacunación/estadística & datos numéricos , Proteínas Virales/genética
10.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32086389

RESUMEN

OBJECTIVES: To estimate (1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and (2) associations between schedule adherence, sociodemographic characteristics, and up-to-date immunization status by 19 to 35 months of age. METHODS: We used 2014 National Immunization Survey provider-verified vaccination data to classify vaccination patterns as "recommended" (ie, in line with ACIP dose- and age-specific recommendations), "alternate" (ie, in line with either limiting the number of shots per visit or skipping at least 1 vaccine series), or "unknown or unclassifiable" (ie, not in line with ACIP recommendations or clearly limiting shots per visit or vaccine series). We evaluated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. RESULTS: The majority of children's patterns were classified as "recommended" (63%), with 23% and 14% following alternate or unknown or unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19 to 35 months. Not being up-to-date was associated with alternate (prevalence ratio = 4.2, 95% confidence interval: 3.9-4.5) and unknown or unclassifiable (prevalence ratio = 2.4, 95% confidence interval: 2.2-2.7) patterns. CONCLUSIONS: High vaccine coverage by 19 to 35 months of age may miss nonadherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.


Asunto(s)
Esquemas de Inmunización , Cooperación del Paciente/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Niño , Preescolar , Humanos , Lactante , Factores de Tiempo , Estados Unidos
11.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32107285

RESUMEN

OBJECTIVES: Children with asthma are at increased risk of complications from influenza; hospitalization represents an important opportunity for vaccination. We aimed to increase the influenza vaccination rate among eligible hospitalized patients with asthma on the pediatric hospital medicine (PHM) service from 13% to 80% over a 4-year period. METHODS: Serial Plan-Do-Study-Act cycles were implemented to improve influenza vaccination rates among children admitted with status asthmaticus and included modifications to the electronic health record (EHR) and provider and family education. Success of the initial PHM pilot led to the development of a hospital-wide vaccination tracking tool and an institutional, nurse-driven vaccine protocol by a multidisciplinary team. Our primary outcome metric was the inpatient influenza vaccination rate among PHM patients admitted with status asthmaticus. Process measures included documentation of influenza vaccination status and use of the EHR asthma order set and a history and physical template. The balance measure was adverse vaccine reaction within 24 hours. Data analysis was performed by using statistical process control charts. RESULTS: The inpatient influenza vaccination rate increased from 13% to 57% over 4 years; special cause variation was achieved. Overall, 50% of eligible patients were vaccinated during asthma hospitalization in the postintervention period. Documentation of influenza vaccination status significantly increased from 51% to 96%, and asthma history and physical and order set use also improved. No adverse vaccine reactions were documented. CONCLUSIONS: A bundle of interventions, including EHR modifications, provider and family education, hospital-wide tracking, and a nurse-driven vaccine protocol, increased influenza vaccination rates among eligible children hospitalized with status asthmaticus.


Asunto(s)
Hospitalización , Vacunas contra la Influenza , Gripe Humana/prevención & control , Estado Asmático , Vacunación/estadística & datos numéricos , Niño , Estudios de Cohortes , Femenino , Humanos , Gripe Humana/etiología , Masculino , Estado Asmático/complicaciones
12.
PLoS One ; 15(2): e0229279, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32101582

RESUMEN

There is concern that influenza vaccine effectiveness (VE) may be attenuated by passage in eggs during manufacture. We compared quadrivalent cell-culture vaccine with egg-based vaccines, most of which were trivalent, against influenza A and B during 2017-2018 when A(H3N2) and B/Yamagata (present only in quadrivalent vaccines) predominated. We retrospectively examined risk of PCR-confirmed influenza A and B in members of Kaiser Permanente Northern California aged 4-64 years. We estimated the relative VE (rVE) of cell-culture vaccine versus egg-based vaccines, and the absolute VE (aVE) of each vaccine comparing vaccinated to unvaccinated individuals. Analyses used Cox regression with a calendar timeline, stratified by birth year, and adjusted for demographics, co-morbidities and utilization. One-third (1,016,965/3,053,248) of the population was vaccinated; 932,545 (91.7% of vaccinees) received egg-based and 84,420 (8.3%) received cell-culture vaccines. The rVE against influenza A was 8.0% (95% CI: -10, 23); aVE was 31.7% (CI: 18.7, 42.6) for cell-culture and 20.1% (CI: 14.5, 25.4) for egg-based vaccines. The rVE against influenza B was 39.6% (CI: 27.9, 49.3); aVE was 40.9% (CI: 30, 50.1) for cell-culture and 9.7% (CI 3.5, 15.6) for egg-based trivalent vaccines. Inclusion of the B/Yamagata lineage in the quadrivalent cell-based vaccine provided better protection against influenza B but vaccine effectiveness against influenza A was low for both the cell-culture vaccine and the egg-based vaccines. Improving influenza vaccines requires ongoing comparative vaccine effectiveness monitoring.


Asunto(s)
Huevos , Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación/estadística & datos numéricos , Vacunas de Productos Inactivados/administración & dosificación , Adolescente , Adulto , California/epidemiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Estaciones del Año , Factores de Tiempo , Adulto Joven
13.
J Korean Med Sci ; 35(5): e45, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32030923

RESUMEN

BACKGROUND: Annual vaccination is the principal way to reduce the mortality and morbidity associated with influenza. In the 2016-2017 influenza seasons, the influenza epidemic appeared to exhibit a different pattern from the previous years. Because of the unusual trend, the incidence of influenza-like patients among school-aged children had increased, causing doubts about the effectiveness of the influenza vaccine. Therefore, this study aimed to evaluate the effectiveness of the influenza vaccine among elementary school students in Korea. METHODS: The study was conducted in elementary schools in each province of Korea in cooperation with the Student Health Policy Division of the Ministry of Education. Each Provincial Office of Education of Korea, except for Jeju, randomly selected one to two elementary schools for each District Office of Education. A total of 2,739 elementary school students were enrolled and vaccination and influenza infection status were collected from the subjects' parents through questionnaires, from February 13th to 21st in 2017. Vaccine effectiveness was defined as calculating the infection rate of influenza among the vaccinated and unvaccinated groups and determining the decreased infection rate of the vaccinated group relative to the unvaccinated group, while adjusting for time of vaccination and infection. RESULTS: Adjusting for the interval between vaccination and infection, vaccine effectiveness of influenza was 17.6% (95% confidence interval [CI], 4.6% to 28.9%), 22.5% (95% CI, 10.3% to 33%), and 28.7% (95% CI, 17.5% to 38.3%) at 2 or more weeks, 3 or more weeks, and 4 or more weeks after vaccination, respectively. CONCLUSION: In conclusion, considering the time required for adequate immunogenicity, the 2016-2017 seasonal influenza vaccine effectiveness in Korean elementary school students was 17.6%-28.7%, which was less effective than that of previous years.


Asunto(s)
Vacunas contra la Influenza , Gripe Humana , Vacunación , Niño , Estudios Transversales , Femenino , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Masculino , Padres , República de Corea , Instituciones Académicas , Estaciones del Año , Estudiantes , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricos
14.
Isr Med Assoc J ; 22(2): 71-74, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043321

RESUMEN

BACKGROUND: The introduction of pneumococcal conjugate vaccine-13 (PCV-13) has reduced the burden of invasive pneumococcal disease. OBJECTIVES: To characterize true positive blood cultures of children who presented to our hospital following implementation of the PCV-13 vaccine. METHODS: A retrospective study was conducted on positive blood cultures of children presenting with fever from 2010-2017. Subjects were divided into two age groups: a younger group 3-36 months and an older group 3-18 years. Patients were classified as either having or not having a focus of infection at the time of their bacteremia. Pneumococcal isolates were typed at Israel's Streptococcal Reference Laboratory. RESULTS: The samples included 94 true positive blood cultures. Focal infection with concomitant bacteremia was more common than bacteremia without a focus both overall: 67/94 (71%) vs. 27/94 (28.7%), P <0.001 as well as in the two groups: 32/48 (66%) vs. 16/48 (33%), P = 0.02 in the younger group and 35/46 (76%) vs. 11/46 (24%), P = 0.001 in the older group. Streptococcus pneumoniae was the most common pathogen overall, 27/94 (29%), and in the younger group, 21/48 (44%), but rare in the older group, 6/46 (13%). In the latter, Brucella species predominated, 12/46 (26%), along with Staphylococcus aureus 12/46 (26%). CONCLUSIONS: Our findings are consistent with other studies reporting decreased pneumococcal bacteremia, bacteremia primarily accompanying focal infection, and changing etiological agents among PCV-13-vaccinated children. Brucella species was prominent in older children with osteoarticular infections. Ongoing surveillance is warranted to better understand the implications of PCV-13.


Asunto(s)
Bacteriemia , Infecciones Neumocócicas , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae , Vacunación , Adolescente , Bacteriemia/epidemiología , Bacteriemia/microbiología , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Factores Inmunológicos/administración & dosificación , Incidencia , Lactante , Israel/epidemiología , Masculino , Infecciones Neumocócicas/sangre , Infecciones Neumocócicas/diagnóstico , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Estudios Retrospectivos , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Vacunación/métodos , Vacunación/estadística & datos numéricos , Vacunas Conjugadas/administración & dosificación
15.
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
17.
BMC Public Health ; 20(1): 48, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931751

RESUMEN

BACKGROUND: Hepatitis B Virus (HBV) is highly endemic in Sub-Saharan Africa with 70 to 90% of the population becoming infected before the age of 40 years. Healthcare workers (HCWs) including healthcare students (HCSs) are at an increased risk of contracting HBV due to occupational exposure. HCSs are especially at a high risk because of their inexperience with infection control procedures and insufficient knowledge about the level of risk when dealing with patients. Despite the availability of an effective vaccine, and its recommendation by Kenya's Ministry of Health, few HCW and students are vaccinated. The aim of this study was to evaluate the influence of awareness, attitude, practices, and access factors on hepatitis B vaccination uptake by HCSs at Kenya Medical Training College (KMTC). METHODS: This was a concurrent mixed methods study. For the quantitative arm, a structured questionnaire was used to assess the awareness, knowledge, attitudes and practices towards HBV disease and vaccination. Accessibility of the HBV vaccine in the participating campuses was also assessed. Two FGDs were carried out: one comprised of student representatives of the participating campuses while the second comprised of members of staff. Quantitative data was analysed using STATA (version 15) while NVIVO (version 11) was used for qualitative data. RESULTS: Out of 634 students invited to participate in the study, 487 participated (response rate 76.8%). Majority of the respondents were from Nairobi Campus (44.2%) and from the Department of Nursing (31.2%). HBV vaccine uptake rate was 85.8% while the non-vaccination rate was 14.3%. Full vaccination was reported by only 20.2% of respondents. The major reason for not receiving the recommended doses was the unavailability of the vaccine when students went for it. The qualitative study revealed challenges in the implementation of the vaccination program at KMTC. CONCLUSIONS: Full vaccination rates remained low despite good knowledge of HBV infection and positive attitude towards vaccination. There is therefore need to streamline vaccination programs in medical colleges to ensure availability and accessibility of the vaccine to healthcare students.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Vacunas contra Hepatitis B/administración & dosificación , Estudiantes del Área de la Salud/psicología , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Humanos , Kenia/epidemiología , Masculino , Investigación Cualitativa , Facultades de Medicina , Estudiantes del Área de la Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
18.
Int J Equity Health ; 19(1): 10, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937328

RESUMEN

BACKGROUND: Although the beneficial effects of vaccines on equity by socioeconomic status and geography are increasingly well-documented, little has been done to extend these analyses to examine the linkage between vaccination and gender equity. In this paper, evidence from the published literature is used to develop a conceptual framework demonstrating the potential impact of vaccination on measures of gender equity. This framework is then applied to human papillomavirus (HPV) vaccination in three countries with different economic and disease burden profiles to establish a proof of concept in a variety of contexts. METHODS: We conducted a literature review examining evidence on the linkage between health outcomes and dimensions of gender equity. We utilized the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to estimate cervical cancer incidence and deaths due to HPV types 16/18 by age in each country. We estimated labor force participation and fertility effects from improvements in health, and converted these into inputs consistent with those used to calculate the United Nations Gender Inequality Index to assess gender equity. RESULTS: In our case study, we found that HPV vaccination among girls could help narrow socioeconomic gender disparities by quantifying the main pathways by which HPV vaccination improves health, which enables improvement in gender equity indicators such as labor force participation and maternal mortality ratios. While these improvements are small when averaged over the entire population, the components measured - labor force participation and maternal mortality ratio - account for 50% of the index scores. CONCLUSIONS: This proof of concept model is a starting point to inform future health and economic analyses that might incorporate the impact of gender equity as an additional impact of vaccination in improving the health and well-being of the population.


Asunto(s)
Equidad en Salud , Vacunas contra Papillomavirus/administración & dosificación , Factores Sexuales , Vacunación/estadística & datos numéricos , Femenino , Humanos , Infecciones por Papillomavirus/prevención & control , Factores Socioeconómicos , Neoplasias del Cuello Uterino/prevención & control
19.
Med J Aust ; 212(2): 89-93, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31909501

RESUMEN

Invasive meningococcal disease (IMD) is an uncommon but life-threatening infection caused by Neisseria meningitidis. Serogroups B, C, W and Y cause most IMD cases in Australia. The highest incidence occurs in children under 5 years of age. A second peak occurs in adolescents and young adults, which is also the age of highest carriage prevalence of N. meningitidis. Meningococcal serogroup B (MenB) disease predominated nationally before 2016 and has remained the predominant cause of IMD in South Australia with 82% of cases, compared with 35% in New South Wales, 35% in Queensland, 9% in Victoria, 29% in Western Australia and 36% nationally in 2016. MenB vaccination is recommended by the Australian Technical Advisory Group on Immunisation for infants up to 2 years of age and adolescents aged 15-19 years (age 15-24 years for at-risk groups, such as people living in close quarters or smokers), laboratory workers with exposure to N. meningitidis, and Aboriginal and Torres Strait Islander children from age 2 months to 19 years. Due to the epidemiology and disease burden from MenB, a meningococcal B vaccine program has been implemented in South Australia for individuals with age-specific incidence rates higher than the mean rate of 2.8/100 000 population in South Australia in the period 2000-2017, including infants, young children (< 4 years) and adolescents (15-20 years). Program evaluation of vaccine effectiveness against IMD is important. As observational evidence also suggests 4CMenB may have an impact on Neisseria gonorrhoeae with genetic homology between bacterial species, the vaccine impact on gonorrhoea will also be assessed.


Asunto(s)
Programas de Inmunización , Infecciones Meningocócicas/epidemiología , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/administración & dosificación , Vacunación/estadística & datos numéricos , Adolescente , Niño , Preescolar , Humanos , Incidencia , Lactante , Vacunas Meningococicas/inmunología , Neisseria meningitidis/clasificación , Prevalencia , Serogrupo , Australia del Sur/epidemiología , Adulto Joven
20.
Adv Exp Med Biol ; 1251: 115-121, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31989546

RESUMEN

The objective of this review was to elaborate on changes in the virological characteristics of influenza seasons in Poland in the past decade. The elaboration was based on the international influenza surveillance system consisting of Sentinel and non-Sentinel programs, recently adopted by Poland, in which professionals engaged in health care had reported tens of thousands of cases of acute upper airway infections. The reporting was followed by the provision of biological specimens collected from patients with suspected influenza and influenza-like infection, in which the causative contagion was then verified with molecular methods. The peak incidence of influenza infections has regularly been in January-March each epidemic season. The number of tested specimens ranged from 2066 to 8367 per season from 2008/2009 to 2017/2018. Type A virus predominated in nine out of the ten seasons and type B virus of the Yamagata lineage in the 2017/2018 season. Concerning the influenza-like infection, respiratory syncytial virus predominated in all the seasons. There was a sharp increase in the proportion of laboratory confirmations of influenza infection from season to season in relation to the number of specimens examined, from 3.2% to 42.4% over the decade. The number of confirmations, enabling a prompt commencement of antiviral treatment, related to the number of specimens collected from patients and on the virological situation in a given season. Yet influenza remains a health scourge, with a dismally low yearly vaccination rate, which recently reaches just about 3.5% of the general population in Poland.


Asunto(s)
Gripe Humana/epidemiología , Gripe Humana/virología , Estaciones del Año , Humanos , Virus de la Influenza B/aislamiento & purificación , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Polonia/epidemiología , Vacunación/estadística & datos numéricos
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