Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment.

PURPOSE: Immunization rates in many cities in the United States remain suboptimal compared to Healthy People 2020 Goals and are lower than national averages. This study aimed to determine whether a lecture-based educational intervention targeted at nurses and medical assistants would improve vaccination rates. METHODS: We conducted a quality improvement study in two urban academic family medicine clinics serving a predominantly Medicaid patient population as well as a sizable proportion of refugees. The intervention consisted of 3 lectures that were delivered to clinic nurses and medical assistants. Vaccinations in 1689 patients - 872 in the 3-month preintervention period, 817 in the 3-month postintervention period - were analyzed. RESULTS: Following the educational intervention, a statistically significant increase was seen only in human papillomavirus vaccine immunization rates for 13-18-year-olds (from 90.7% [n=54] to 100% [n=45]; P=0.036). When the results were stratified by clinic, only 1 site showed statistically significant increases in: pneumococcal polysaccharide vaccine (23-valent) for high-risk 19-to-64-year-olds (from 36.4% [n=154] to 47.8% [n=136]; P=0.049); Haemophilus influenzae type B vaccine for 2-month-to-5-year-olds (from 91.1% [n=112] to 97.3% [n=111]; P=0.048); and meningococcal conjugate vaccine (quadrivalent) for 13-18-year olds (from 85.2% [n=27] to 100% [n=26]; P=0.042). No increases were seen for our study's refugee patient population (n=171), and a significant decrease of the second-dose measles, mumps, and rubella vaccine (P=0.036) occurred in this subcohort. CONCLUSIONS: Ultimately, this quality improvement study demonstrated that educational interventions alone have a limited impact on increasing immunization rates.

Social Network Diagramming as an Applied Tool for Public Health: Lessons Learned From an HCV Cluster.

OBJECTIVES: We present an applied example of social network diagramming from 2010 to 2012 that was used to guide follow-up in a large HCV cluster in rural Wisconsin. METHODS: In addition to collecting standard individual-level attributes, we also obtained partner-level information. Both sets of data were input into a network diagramming program to create a series of diagrams that emphasized variables, such as risk factors, key location in the network, and number of partners. RESULTS: The visualization and cluster analysis guided testing and intervention priorities, were useful in sharing de-identified information about the cluster between health departments and community organizations and illustrated the key role young females played in holding the cluster together. CONCLUSIONS: Social network diagramming should be considered a practical and important public health tool for use in cluster management.

Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012.

BACKGROUND: Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the US epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years). METHODS: We examined trends in incidence of acute hepatitis C among young persons reported to the Centers for Disease Control and Prevention (CDC) during 2006-2012 by state, county, and urbanicity. Sociodemographic and behavioral characteristics of HCV-infected young persons newly reported from 2011 to 2012 were analyzed from case interviews and provider follow-up at 6 jurisdictions. RESULTS: From 2006 to 2012, reported incidence of acute hepatitis C increased significantly in young persons-13% annually in nonurban counties (P = .003) vs 5% annually in urban counties (P = .028). Thirty (88%) of 34 reporting states observed higher incidence in 2012 than 2006, most noticeably in nonurban counties east of the Mississippi River. Of 1202 newly reported HCV-infected young persons, 52% were female and 85% were white. In 635 interviews, 75% of respondents reported injection drug use. Of respondents reporting drug use, 75% had abused prescription opioids, with first use on average 2.0 years before heroin. CONCLUSIONS: These data indicate an emerging US epidemic of HCV infection among young nonurban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in nonurban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention.

Notes from the field: Increase in reported legionellosis - Milwaukee, Wisconsin, June-September 2013.

In early July 2013, the City of Milwaukee Health Department (MHD) was notified by the Wisconsin Division of Public Health of an increase in reported cases of legionellosis in southeastern Wisconsin. Legionellosis is a reportable disease to state and local public health authorities in Wisconsin. During June 1-September 30, 2013, a total of 58 clinically diagnosed cases of Legionnaires' disease, confirmed by laboratory testing, were reported in Milwaukee County, more than twice the number of total annual case reports in each of the previous 5 years. Forty-five (78%) of these cases were reported in the city of Milwaukee. The median age of county patients was 53 years (range = 29-77 years); all but one was hospitalized, and no deaths were reported. MHD received one report of a death attributed to legionellosis in the county during this period.

Evaluating hepatitis B universal birth dose vaccination at Minnesota birthing hospitals by utilizing immunization information systems, birth certificates, and chart reviews, 2007-2008.

OBJECTIVES: The Minnesota Department of Health (MDH) examined hospital practices as recommended by the Advisory Committee on Immunization Practice in 2005 that hepatitis B vaccine should be administered universally to newborn infants prior to hospital discharge and within 12 hours of birth if their mothers test positive or are admitted with unknown status for hepatitis B surface antigen. METHODS: The MDH conducted a survey of perinatal hepatitis B birth dosing policies in Minnesota birthing hospitals, which prompted (1) and investigation of hospital birth dose rates from the Immunization Information System (IIS) and (2) a chart review of three selected hospitals with low rates. RESULTS: The (IIS) records of children born in Minnesota during 2007 and the first 5 months of 2008 showed a hepatitis B birth dose rate that was lower than expected (2007: 37%; 2008: 48%). The chart review of three hospitals with low birth does rates showed rates for the first 6 months of 2008 of 94%, 89%, and 91% compared with IIS rates of 1.4%, 40%, and 39% respectively, during the same time period. CONCLUSIONS: These results prompted MDH to increase efforts to provide education to birth registrars on the importance of hepatitis B vaccine data on the birth certificate and to promote regular transmission of hospital vaccination data to the IIS.

Development of antibodies to human embryonic stem cell antigens.

BACKGROUND: Using antibodies to specific protein antigens is the method of choice to assign and identify cell lineage through simultaneous analysis of surface molecules and intracellular markers. Embryonic stem cell research can be benefited from using antibodies specific to transcriptional factors/markers that contribute to the "stemness" phenotype or critical for cell lineage. RESULTS: In this report, we have developed and validated antibodies (either monoclonal or polyclonal) specific to human embryonic stem cell antigens and early differentiation transcriptional factors/markers that are critical for cell differentiation into definite lineage. CONCLUSION: These antibodies enable stem cell biologists to conveniently identify stem cell characteristics and to quantitatively assess differentiation.