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1.
Vaccine ; 38(45): 7146-7155, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-32943265

RESUMO

BACKGROUND: COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. METHODS: We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. RESULTS: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. CONCLUSION: One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.


Assuntos
Infecções por Coronavirus/psicologia , Sarampo/prevenção & controle , Pandemias , Pneumonia Viral/psicologia , Quarentena , Infecções por Rotavirus/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , Vacinação/estatística & dados numéricos , Vacina BCG/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Processamento Eletrônico de Dados , Feminino , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Sarampo/epidemiologia , Sarampo/imunologia , Vacina contra Sarampo/administração & dosagem , Paquistão/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Sistema de Registros , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/imunologia , Vacinas contra Rotavirus/administração & dosagem , População Rural , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/imunologia , População Urbana , Vacinação/psicologia , Cobertura Vacinal/estatística & dados numéricos , Vacinas Atenuadas/administração & dosagem
2.
PLoS One ; 15(8): e0237525, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776972

RESUMO

Hepatitis B is a global epidemic that requires carefully orchestrated vaccination initiatives in geographical regions of medium to high endemicity to reach the World Health Organization's elimination targets by 2030. This study compares two widely-used deterministic hepatitis B models-the Imperial HBV model and the CDA Foundation's PRoGReSs-based on their predicted outcomes in four countries. The impact of scaling up of the timely birth dose of the hepatitis B vaccine is also investigated. The two models predicted largely similar outcomes for the impact of vaccination programmes on the projected numbers of new cases and deaths under high levels of the infant hepatitis B vaccine series. However, scenarios for the scaling up of the infant hepatitis B vaccine series had a larger impact in the PRoGReSs model than in the Imperial model due to the infant vaccine series directly leading to the reduction of perinatal transmission in the PRoGReSs model, but not in the Imperial model. Meanwhile, scaling up of the timely birth dose vaccine had a greater impact on the outcomes of the Imperial hepatitis B model than in the PRoGReSs model due to the greater protection that the birth dose vaccine confers to infants in the Imperial model compared to the PRoGReSs model. These differences underlie the differences in projections made by the models under some circumstances. Both sets of assumptions are consistent with available data and reveal a structural uncertainty that was not apparent in either model in isolation. Those relying on projections from models should consider outputs from both models and this analysis provides further evidence of the benefits of systematic model comparison for enhancing modelling analyses.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Modelos Estatísticos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global , Hepatite B/epidemiologia , Hepatite B/virologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Organização Mundial da Saúde , Adulto Jovem
3.
PLoS One ; 15(8): e0236955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764770

RESUMO

BACKGROUND: Childhood vaccination plays a key role in reducing morbidity and mortality from vaccine-preventable diseases. Numerous studies have assessed the influence of demographic and socioeconomic factors on child immunization around the world. There are few such studies in Afghanistan, however. Therefore, this study aimed to identify factors influencing vaccination status among children age 12-23 months in Afghanistan. MATERIALS AND METHODS: Nationally representative data from the 2015 Afghanistan Demographic and Health Survey were used for this study. A sample of 5,708 children age 12-23 months with a vaccine card and immunization history was analyzed. Multinomial logistic regression was used to identify significant relationships between cofactors and vaccination status. RESULTS: In the study, 51% the subjects were boys, 48% were born at home, and 76% were residents of rural areas. Background characteristics positively associated with vaccination status included delivery in a health facility (RRR = 2.5, 95% CI = 1.9-3.3), maternal age of 30-39 years (RRR = 2.2, 95% CI = 1.2-4.1), attending at least four visits for antenatal care (RRR = 2.7, 95% CI = 1.7-4.5), health facility visit in the past 12 months (RRR = 1.9, 95% CI = 1.4-2.5), paternal professional occupation (RRR = 4.9, 95% CI = 2.0-12.3), family with richer wealth index (RRR = 2.4, 95% CI = 1.4-4.1), and living in the northeast region (RRR = 2.2, 95% CI = 1.2-3.9)were positively associated with vaccination status. Living in the southern region (RRR = 0.3, 95% CI = 0.2-0.5) was negatively associated with vaccination status. CONCLUSION: This study identified maternal age, ANC visits, place of delivery, health facility visits in past 12 months, paternal occupation, wealth quintile, and geographic region as the factors influencing child's vaccination status in Afghanistan.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Adulto , Afeganistão , Estudos Transversais , Demografia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos , Adulto Jovem
4.
Niger Postgrad Med J ; 27(3): 209-214, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687121

RESUMO

Introduction: Immunisation and vaccination programmes are preventive and cost-effective child health interventions for reducing childhood mortality and disability from infectious diseases. Timely administration of these vaccines is important to ensure their effectiveness in disease prevention. Aim: The aim was to determine the timeliness, barriers and predictors of at-birth vaccinations. Materials and Methods: This was a cross-sectional study of 355 mother-newborn pairs using simple random sampling technique by balloting. SPSS version 23.0 was used for data analysis. Crude and adjusted odds ratios (AORs) were used as point estimates in the binary logistic regression model, while 95% confidence interval (CI) was used as the interval estimate. A P < 0.05 was considered statistically significant for the study. Results: The mean age of the mothers was 31.0 ± 6 years. The median age of newborns at vaccination was 18 h (IQR = 1 - 17) h. About 185 (52.1%) of the newborns studied were males. Only 191 (53.8%) newborns received at-birth vaccination within 24 h of life. Weekend delivery, birth outside vaccination days, delivery during public holidays and vaccine stock-outs were barriers to timely vaccinations. Private hospital delivery was an independent predictor of delayed at-birth vaccinations (AOR = 2.616; 95% CI = 1.382-4.951). Conclusions: Our study has identified weekend delivery, preterm birth, delivery outside vaccination days and vaccines stock-outs as barriers to timely at-birth vaccinations. Private hospital delivery is a significant predictor of delayed at-birth vaccinations.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Mães/psicologia , Cobertura Vacinal/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Controle de Doenças Transmissíveis , Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Esquemas de Imunização , Recém-Nascido , Masculino , Nigéria , Vigilância em Saúde Pública , Fatores de Tempo
5.
Tex Med ; 116(5): 47, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32645186

RESUMO

In 2003, the Texas Legislature allowed parents to opt their children out of getting mandatory public school vaccines. Since then, exemptions have jumped more than 3,000%, to 72,743 statewide, according to the Texas Department of State Health Services. That number of exemptions threatens "herd" or "community" immunity for vaccine-preventable diseases.


Assuntos
Programas de Imunização/legislação & jurisprudência , Programas de Imunização/estatística & dados numéricos , Educação de Pacientes como Assunto , Instituições Acadêmicas , Recusa de Vacinação/legislação & jurisprudência , Recusa de Vacinação/estatística & dados numéricos , Vacinação/legislação & jurisprudência , Doenças Preveníveis por Vacina/prevenção & controle , Vacinas , Criança , Humanos , Texas/epidemiologia
7.
Infect Dis Poverty ; 9(1): 62, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503667

RESUMO

BACKGROUND: Rabies is a fatal but preventable viral disease, which causes an estimated 59 000 human deaths globally every year. The vast majority of human rabies cases are attributable to bites from infected domestic dogs and consequently control of rabies in the dog population through mass vaccination campaigns is considered the most effective method of eliminating the disease. Achieving the WHO target of 70% vaccination coverage has proven challenging in low-resource settings such as Sub Saharan Africa, and lack of public awareness about rabies vaccination campaigns is a major barrier to their success. In this study we surveyed communities in three districts in Southern Malawi to assess the extent of and socio-economic factors associated with mobile phone ownership and explore the attitudes of communities towards the use of short message service (SMS) to inform them of upcoming rabies vaccination clinics. METHODS: This study was carried out between 1 October-3 December 2018 during the post-vaccination assessment of the annual dog rabies campaign in Blantyre, Zomba and Chiradzulu districts, Malawi. 1882 questionnaires were administered to households in 90 vaccination zones. The surveys gathered data on mobile phone ownership and use, and barriers to mobile phone access. A multivariable regression model was used to understand factors related to mobile phone ownership. RESULTS: Most survey respondents owned or had use of a mobile phone, however there was evidence of an inequality of access, with higher education level, living in Blantyre district and being male positively associated with mobile phone ownership. The principal barrier to mobile phone ownership was the cost of the phone itself. Basic feature phones were most common and few owned smartphones. SMS was commonly used and the main reason for not using SMS was illiteracy. Attitudes to receiving SMS reminders about future rabies vaccination campaigns were positive. CONCLUSIONS: The study showed a majority of those surveyed have the use of a mobile phone and most mobile phone owners indicated they would like to receive SMS messages about future rabies vaccination campaigns. This study provides insight into the feasibility of distributing information about rabies vaccination campaigns using mobile phones in Malawi.


Assuntos
Atitude , Telefone Celular/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Raiva/prevenção & controle , Fatores Socioeconômicos , Vacinação/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
BMC Public Health ; 20(1): 658, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397985

RESUMO

BACKGROUND: The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers' presentation of vaccination cards. METHODS: The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years, with a questionnaire focusing on children's health. This analysis was restricted to children aged 12-35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months). RESULTS: Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5-10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers' attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on. CONCLUSIONS: Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.


Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Senegal , Inquéritos e Questionários , Adulto Jovem
9.
BMC Public Health ; 20(1): 671, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398057

RESUMO

BACKGROUND: An infection with high-risk human papillomavirus (HPV) is the obligatory aetiological factor for the development of cervical cancer. In Switzerland, the prevention strategy for cervical cancer is based on primary prevention via HPV vaccination and secondary prevention with an opportunistic screening programme for precancerous lesions. Vaccination is recommended to 11-26 years old male and female persons. The objective of the study was to assess the epidemiological impact on cervical cancer of switching from the currently implemented programme with the 4-valent vaccine to the 9-valent vaccine, in an 11-26 years old gender-neutral vaccination programme in Switzerland. METHODS: A previously validated dynamic transmission model of HPV infections was adapted and calibrated to the Swiss setting assuming an 80% coverage rate in HPV-vaccination and lifelong vaccine type-specific protection. A gender-neutral vaccination programme (males and females) for 11-26 years old with a 9-valent HPV vaccine was compared with the current 11-26 years old gender-neutral 4-valent vaccination programme. Sensitivity analyses were conducted in order to test the impact of lower vaccination coverage rates and a shorter duration of protection on the model outcomes. RESULTS: In Switzerland, a 9-valent gender-neutral vaccination programme would result in an additional prevention of 2979 cervical cancer cases, 13,862 CIN3 and 15,000 CIN2 cases, compared with the 4-valent gender-neutral vaccination programme over 100 years. These additional disease cases avoided would correspond to a 24, 36 and 48% cumulative incidence decrease in cervical cancer, CIN3 and CIN2 cases, respectively. It would also prevent additional 741 cervical cancer-related deaths over 100 years. A substantial additional reduction in cervical cancer and precancerous lesions burden is still observed when varying the vaccination coverage rate from 30 to 60% or reducing the duration of protection from lifelong to 20 years. CONCLUSIONS: The switch to the 9-valent vaccine in Switzerland to prevent cervical diseases showed an important contribution in terms of public health impact compared with the 4-valent vaccine in an 11-26 years old gender-neutral population, even with very conservative assumptions such as low coverage rates or low duration of protection and limiting analysis to only cervical disease.


Assuntos
Neoplasia Intraepitelial Cervical/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/economia , Vacinas contra Papillomavirus/uso terapêutico , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Criança , Análise Custo-Benefício , Feminino , Humanos , Incidência , Programas de Rastreamento/estatística & dados numéricos , Suíça/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
10.
Proc Natl Acad Sci U S A ; 117(23): 13138-13144, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32457142

RESUMO

Regions with insufficient vaccination have hindered worldwide poliomyelitis eradication, as they are vulnerable to sporadic outbreaks through reintroduction of the disease. Despite Israel's having been declared polio-free in 1988, a routine sewage surveillance program detected polio in 2013. To curtail transmission, the Israel Ministry of Health launched a vaccine campaign to vaccinate children-who had only received the inactivated polio vaccine-with the oral polio vaccine (OPV). Determining the degree of prosocial motivation in vaccination behavior is challenging because vaccination typically provides direct benefits to the individual as well as indirect benefits to the community by curtailing transmission. However, the Israel OPV campaign provides a unique and excellent opportunity to quantify and model prosocial vaccination as its primary objective was to avert transmission. Using primary survey data and a game-theoretical model, we examine and quantify prosocial behavior during the OPV campaign. We found that the observed vaccination behavior in the Israeli OPV campaign is attributable to prosocial behavior and heterogeneous perceived risk of paralysis based on the individual's comprehension of the prosocial nature of the campaign. We also found that the benefit of increasing comprehension of the prosocial nature of the campaign would be limited if even 24% of the population acts primarily from self-interest, as greater vaccination coverage provides no personal utility to them. Our results suggest that to improve coverage, communication efforts should also focus on alleviating perceived fears surrounding the vaccine.


Assuntos
Altruísmo , Surtos de Doenças/prevenção & controle , Vacinação em Massa/psicologia , Poliomielite/prevenção & controle , Vacina Antipólio Oral/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Teoria do Jogo , Humanos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Israel/epidemiologia , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Neurológicos , Poliomielite/epidemiologia , Poliomielite/virologia , Poliovirus/isolamento & purificação , Vacina Antipólio de Vírus Inativado/uso terapêutico , Esgotos/virologia , Inquéritos e Questionários , Cobertura Vacinal/estatística & dados numéricos , Adulto Jovem
11.
Am J Public Health ; 110(7): 1092-1097, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437281

RESUMO

Objectives. To describe the ongoing collaboration of the Centers for Disease Control and Prevention's (CDC's) school vaccination assessment with state, local, and territorial immunization programs to provide data to monitor school entry vaccination.Methods. Departments of health and education partner to collect data from public school, private school, and homeschooled kindergartners in the 50 US states, the District of Columbia, 2 cities, and the US territories. Immunization programs submit vaccination coverage and exemption data to the CDC, and the CDC reports these data annually via multiple sources.Results. Among the 50 states and the District of Columbia, the number of programs using a census for vaccination coverage data increased from 39 to 41 during the school years 2012-2013 to 2017-2018 (which for most states was August or September through May or June), and the number using a census to collect exemption data increased from 40 to 46. The number of states that reported sharing their local-level vaccination coverage data online increased from 11 in 2012-2013 to 31 in 2017-2018.Conclusions. Coverage data can be used to address undervaccination among kindergartners to work with communities and schools that are susceptible to vaccine-preventable diseases. As more states publish local-level data online, access to improved data provides the public more valuable information.


Assuntos
Centers for Disease Control and Prevention, U.S./organização & administração , Programas de Imunização/organização & administração , Cobertura Vacinal/organização & administração , Vacinação/estatística & dados numéricos , Pré-Escolar , Coleta de Dados , Humanos , Programas de Imunização/estatística & dados numéricos , Instituições Acadêmicas , Estados Unidos
13.
BMC Public Health ; 20(1): 691, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32460747

RESUMO

BACKGROUND: The quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Our main question was whether HPV vaccine has any effects on the prevention of GW reported in randomised controlled clinical trials (RCTs) and time-trend analyses. METHODS: This meta-analysis was performed according to the PRISMA guidelines using the PICO format. We searched in three electronic databases (PubMed, Embase, Cochrane Trials), and assessed heterogeneity using the Q-test and I-squared statistics, meta-regression was also performed. Odds ratios (OR) and their confidence intervals (CI) were calculated. The sensitivity was tested by leave-one-out method. We evaluated the presence of publication bias using the funnel plot graph and the Copas selection model. The strength of evidence was assessed using the GRADE approach. RESULTS: Eight RCTs (per-protocol populations) and eight time-trend ecological studies were included in this meta-analysis. A significant reduction (pooled OR = 0.03, 95% CI: 0.01-0.09; I-squared = 53.6%) of GW in young women was recorded in RCTs, and in time-trend analyses both in young women (pooled OR = 0.36, CI 95% = 0.26-0.51; I-squared = 98.2%), and in young men (pooled OR = 0.69, 95% CI = 0.61-0.78; I-squared = 92.7%). In subgroup analysis, a significant reduction of the number of GW events was observed especially in women under 21 years (pooled OR = 0.33, 95% CI = 0.17-0.63). Leave-one-out analysis showed that similar results could be obtained after excluding one study, meta-regression did not show significant difference. CONCLUSIONS: Prophylactic, quadrivalent HPV vaccination can prevent GW in healthy women and men, therefore, it should be included in routine immunization programme.


Assuntos
Condiloma Acuminado/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Criança , Condiloma Acuminado/epidemiologia , Feminino , Humanos , Masculino , Infecções por Papillomavirus/epidemiologia , Vacinas contra Papillomavirus/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
14.
JAMA Netw Open ; 3(4): e203316, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32338751

RESUMO

Importance: State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly insured adults compared with privately insured adults. Objective: To evaluate adult Medicaid beneficiaries' access to adult immunization services through review of vaccination benefits coverage in Medicaid programs across the 50 states and the District of Columbia. Design, Setting, and Participants: A public domain document review with supplemental semistructured telephone survey was conducted between June 1, 2018, and June 14, 2019, to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements for adult Medicaid beneficiaries in the 50 states and the District of Columbia (total, 51 Medicaid programs). Exposures: Document review of benefits coverage for adult immunization services and supplemental survey with validation of document review findings. Main Outcomes and Measures: Benefits coverage for adult Medicaid beneficiaries and reimbursement amounts for vaccine purchase and administration. Results: Public domain document review was completed for all 51 jurisdictions. Among these, 44 Medicaid programs (86%) validated document review findings and completed the survey. Only 22 Medicaid programs (43%) covered all 13 Advisory Committee on Immunization Practices-recommended adult immunizations under both fee-for-service and managed care organization arrangements. Most fee-for-service arrangements (37 of 49) reimbursed health care professionals using any of the 4 approved vaccine administration codes; however, 8 of 49 programs did not separately reimburse for vaccine administration to adult Medicaid beneficiaries. Depending on administration route, median reimbursement for adult vaccine administration ranged from $9.81 to $13.98 per dose. Median per-dose reimbursement for adult vaccine purchase was highest for 9-valent human papillomavirus vaccine ($204.87) and lowest for Haemophilus influenzae type b vaccine ($18.09). Median reimbursement was below the private sector price for 7 of the 13 included vaccines. Conclusions and Relevance: Even in programs with complete vaccination benefits coverage, reimbursement amounts to health care professionals for vaccine purchase and administration may not fully cover vaccination provision costs. Reimbursement amounts below costs may reduce incentives for health care professionals to vaccinate low-income adults and thereby limit Medicaid adult beneficiary access to vaccination.


Assuntos
Acesso aos Serviços de Saúde , Programas de Imunização , Medicaid , Adulto , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/economia , Programas de Imunização/legislação & jurisprudência , Programas de Imunização/estatística & dados numéricos , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Pobreza , Estados Unidos , Vacinação
15.
BMC Public Health ; 20(1): 458, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252705

RESUMO

BACKGROUND: Since March 2014, the quadrivalent HPV vaccine has been incorporated into the Brazilian Unified Health Care System and began to be offered, without direct costs, for girls from 9 to 13 years of age. Older female adolescents would have the option to be vaccinated at private health care system being responsible for the payment of HPV vaccine. The present study aimed to evaluate the coverage rates and predictors of HPV vaccination in Brazil among two groups of female adolescents: eligible and non-eligible for the HPV vaccination public program. METHODS: We used data from the 2015 Brazilian National Adolescent School-Based Health Survey, which involved a probabilistic sample of 5404 female adolescents students at public and private schools. Using a questionnaire, we gathered information on sociodemographic characteristics, sexual behavior, and respondent perception of parental supervision and have been vaccinated for HPV. Age-specific vaccination rates were analyzed in girls aged 9 to 13 at the time of public vaccination (eligible for public policy), as well among those 14 to 17 years old not eligible by the Ministry of Health for vaccination. We used Poisson regression models to investigate associated factors. RESULTS: HPV vaccine coverage was 83.5 and 21.8% among eligible and non-eligible populations, respectively. In both populations, the chance of being vaccinated decreased with older age. In the eligible population there is a greater chance of being vaccinated among ethnic group "pardas" but not with other indicators of socioeconomic status. In the non-eligible population, there was a clear association between higher vaccine coverage and greater maternal education and living with the mother. CONCLUSION: Our findings highlight the importance of public policies to minimize inequities in access to cancer prevention measures in vulnerable adolescents. A public policy of HPV vaccination for older female adolescents would increase coverage with possible reduction of HPV-related diseases in this group of women.


Assuntos
Programas de Imunização/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Estudantes/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Brasil , Criança , Assistência à Saúde/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Pais , Distribuição de Poisson , Análise de Regressão , Instituições Acadêmicas , Comportamento Sexual , Classe Social , Inquéritos e Questionários
16.
PLoS One ; 15(3): e0230332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182260

RESUMO

BACKGROUND: Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011-2017. METHODS AND FINDINGS: All pneumococcal isolates identified at the Landspítali University Hospital in 2011-2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/54 respectively. CONCLUSIONS: PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multi-resistant lineage. However, emerging multi-resistant NVT isolates are of concern.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Islândia/epidemiologia , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Otite Média , Resistência às Penicilinas , Faringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Avaliação de Programas e Projetos de Saúde , Sorotipagem/estatística & dados numéricos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/imunologia
17.
Am J Public Health ; 110(5): 693-695, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32191525

RESUMO

The objective of the Los Angeles County, California (LAC), health care personnel (HCP) influenza vaccination improvement intervention was to increase HCP influenza vaccination coverage during the 2016-2017 influenza season via targeted outreach to LAC acute care hospitals. We selected 13 facilities for intervention and received tailored recommendations from a menu of evidence-based practices. Following the season, each hospital in the intervention group experienced a significant increase in vaccination coverage, which increased the LAC countywide average for all hospitals by 5%, from 74% to 79%.


Assuntos
Hospitais de Condado/estatística & dados numéricos , Programas de Imunização/organização & administração , Vacinas contra Influenza/administração & dosagem , Recursos Humanos em Hospital/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Los Angeles , Avaliação de Programas e Projetos de Saúde , Estações do Ano
18.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32152616

RESUMO

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.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Programas de Imunização/estatística & dados numéricos , Influenza Humana/prevenção & controle , Cooperação do Paciente , Vacinação/estatística & dados numéricos , Adulto , Feminino , Humanos , New South Wales , Dados de Saúde Gerados pelo Paciente , Gravidez , Gestantes , Mídias Sociais , Inquéritos e Questionários
19.
J Public Health Manag Pract ; 26(2): 148-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995547

RESUMO

OBJECTIVE: To determine the impact of using a person locator service to reduce undeliverable addresses for an immunization information system (IIS)-based reminder project. DESIGN: Return mail was compared at address-difference levels between original IIS addresses and updated addresses. SETTING: Minnesota residents were targeted for an immunization reminder postcard based on address. PARTICIPANTS: Both 11- and 12-year-olds with a Minnesota address in Minnesota's IIS. INTERVENTION: An immunization reminder postcard was mailed to households of participants. MAIN OUTCOME MEASURE(S): Reminder postcard return rates were tracked for address-difference levels between original IIS addresses and updated addresses. Return mail rates were track at the ZIP Code Tabulation Area (ZCTA) level and analyzed for demographic characteristic associations. RESULTS: Postcards had significantly lower odds of return when an address was confirmed (odds ratio [OR] = 0.09; 95% confidence interval [CI], 0.08-0.1; P < .001) or had major updates (OR = 0.47; 95% CI, 0.44-0.49; P < .001) than when no new address information was obtained. Significant, positive associations were found between return rate and both ZCTA-level poverty rate (γ = 0.235, P < .001) and ZCTA-level percentage of nonwhite residents (γ = 0.301, P < .001). CONCLUSIONS: Use of a person locator service is a promising method for reducing the barrier incorrect address information poses to successful reminder/recall notification. Implementation of person locator services could improve the data quality of address information in the IIS and success of outreach attempts by IIS users.


Assuntos
Programas de Imunização/normas , Imunização/psicologia , Sistemas de Alerta/normas , Criança , Estudos de Coortes , Feminino , Humanos , Imunização/normas , Imunização/estatística & dados numéricos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Masculino , Minnesota , Sistemas de Alerta/estatística & dados numéricos
20.
BMC Public Health ; 20(1): 100, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973691

RESUMO

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.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde/estatística & dados numéricos , Programas de Imunização/organização & administração , Imunização/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Papua Nova Guiné
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