Hepatitis A outbreak in a refugee shelter in Kiel, northern Germany.

In the spring of 2023, three Ukrainian war refugees from a municipal community shelter and a volunteer caregiver at an affiliated daycare center in Kiel, Germany, were diagnosed with infectious jaundice attributable to a single hepatitis A virus (HAV) subgenotype IA strain. Similar HAV sequences have been observed in Germany and other European countries for several years. One refugee and the volunteer required hospitalization. Four children were asymptomatically infected but excreted high levels of HAV ribonucleic acid in the stool. The infections were probably acquired in Germany, but a source could not be determined. The outbreak was contained through vaccination, increased hygiene, and education. The existing HAV vaccination recommendation for refugee shelter staff and volunteers should be consistently implemented.

[Once vaccinated, always vaccinated? A claims data analysis on repeated influenza vaccinations among individuals aged ≥ 60 years]. / Einmal geimpft, immer geimpft? Routinedatenanalyse zur wiederholten Influenzaimpfung von ≥ 60-Jährigen.

BACKGROUND: The Standing Committee on Vaccination recommends the seasonal influenza vaccination as a standard vaccination for individuals aged ≥ 60 years and as an indication vaccination independent of age. Empirical data on repeated vaccination are not available for Germany. The aim of this study was therefore to investigate the frequency and influencing factors of repeated vaccinations. METHODS: We conducted a longitudinal retrospective observational study with claims data from ≥ 60­year-olds insured with the statutory health insurance AOK Plus in Thuringia between 2012 and 2018. The number of seasons with influenza vaccination was described and the association with various individual characteristics was analysed in a regression model. RESULTS: Included were 103,163 individuals with at least one influenza vaccination in the 2014/2015 season, of whom 75.3% had been vaccinated in ≥ 6 of 7 seasons. We found repeated vaccinations more frequently among nursing home residents (rate ratio (RR) 1.27), individuals with increased health risk due to underlying diseases (RR 1.21) and higher age groups (vs. 60-69 years: RR 1.17-1.25). With each additional year of participating in a disease management program, the number of vaccinations increased (RR 1.03). Women (RR 0.91), individuals with nursing care level 1 (vs. no nursing care level: RR 0.90) and people with a comorbidity (vs. no comorbidity: RR 0.97) were less likely to receive repeated vaccinations. DISCUSSION: A large proportion of individuals aged ≥ 60 years who have been vaccinated against influenza once is likely to repeatedly receive vaccinations. In accordance with vaccination recommendations, nursing home residents and in particular individuals with an increased health risk are vaccinated repeatedly. General practitioners play a central role: non-acute patient contacts should be used to offer vaccinations, especially to women and individuals in need of care who are living at home.

Knowledge, attitudes and practices (KAP) towards vaccinations in the school settings: an explorative survey.

BACKGROUND: Past researches have shown that schoolteachers' (STs) interventions maximize the consent for vaccination programs. European data regarding knowledge, attitudes and practices of STs towards vaccination are otherwise lacking. OBJECTIVES: The aim of this study was therefore to evaluate knowledge and attitudes of STs regarding vaccinations in a sample from North Italy. MATERIAL AND METHODS: In this cross sectional study, 154 STs from Lombardy region (Northern Italy) responded to a specific questionnaire assessing their attitude towards vaccination and vaccine related knowledge. RESULTS: In general, 88.3% of subjects were somehow favourable to vaccinations. The main reason for declining vaccination was the risk of side effects whereas the main reason to be vaccinated was to avoid to be infected by VPDs (67.6%). Main information sources were health professionals (75.3%), and new media (13.1%), and the latter were STs more frequently associated with a negative attitude towards vaccinations (p < 0.001). Eventually, regression analysis identified risk perception as positively associated with propensity towards vaccinations, both for Students- and STs-recommended vaccinations (B = 0.372, 95% CI 0.247 to 0.496 and B = 0.005, 95%CI 0.004 to 0.006, respectively). CONCLUSIONS: Our results are consistent with previous reports suggesting a significant knowledge gap in STs, with the risk perception of infectious diseases as the main predictor for vaccine propensity. Moreover, the better knowledge of official vaccination recommendations and policies among STs identifying Health Professionals as information source enlightens the role of the School Physicians and Occupational Physicians, whose intervention may ultimately increase the vaccination acceptance and vaccination rates.

Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease.

In December 2013 Bexsero® became available in Germany for vaccination against serogroup B meningococci (MenB). In August 2015 the German Standing Committee on Vaccination (STIKO) endorsed a recommendation for use of this vaccine in persons at increased risk of invasive meningococcal disease (IMD). This background paper summarizes the evidence underlying the recommendation. Bexsero® is based on surface protein antigens expressed by about 80% of circulating serogroup B meningococci in Germany. The paper reviews available data on immunogenicity and safety of Bexsero® in healthy children and adolescents; data in persons with underlying illness and on the effectiveness in preventing clinical outcomes are thus far unavailable.STIKO recommends MenB vaccination for the following persons based on an individual risk assessment: (1) Persons with congenital or acquired immune deficiency or suppression. Among these, persons with terminal complement defects and properdin deficiency, including those under eculizumab therapy, are at highest risk with reported invasive meningococcal disease (IMD) incidences up 10,000-fold higher than in the general population. Persons with asplenia were estimated to have a ~ 20-30-fold increased risk of IMD, while the risk in individuals with other immune defects such as HIV infection or hypogammaglobulinaemia was estimated at no more than 5-10-fold higher than the background risk. (2) Laboratory staff with a risk of exposure to N. meningitidis aerosols, for whom an up to 271-fold increased risk for IMD has been reported. (3) Unvaccinated household (-like) contacts of a MenB IMD index case, who have a roughly 100-200-fold increased IMD risk in the year after the contact despite chemoprophylaxis. Because the risk is highest in the first 3 months and full protective immunity requires more than one dose (particularly in infants and toddlers), MenB vaccine should be administered as soon as possible following identification of the serogroup of the index case.

Cell-based influenza vaccines: An effective vaccine option for under 60-year-olds.

Aim: Seasonal influenza poses a significant burden of disease, affecting not only older adults but also individuals under the age of 60. It carries a high economic burden, mainly driven by influenza-associated productivity losses in the working population. Conventional egg-based influenza vaccines may have reduced effectiveness due to antigen adaptation in eggs. In contrast, cell-based influenza vaccines are less likely to be affected by such antigen adaptation. This review aims to present real-world data (RWD) comparing the effectiveness of quadrivalent cell-based (QIVc) and egg-based (QIVe) influenza vaccines over three consecutive seasons. Methods: A comprehensive review was conducted, analyzing RWD from retrospective cohort and case-control studies on the relative vaccine effectiveness (rVE) of QIVc versus QIVe during the 2017/18-2019/20 seasons. Results: This study included six retrospective cohort studies and one case-control study, with a combined total of approximately 29 million participants. A cohort study involving people aged ≥4 years during the 2017/18 season showed a statistically significant rVE of QIVc compared to QIVe in preventing influenza-like illness, with a value of 36.2%. QIVc demonstrated statistically significant superiority over QIVe in preventing outpatient and inpatient medical encounters as observed in two cohort studies conducted during the 2018/19 and 2019/20 seasons. The rVE of QIVc compared to QIVe was found to be 7.6% in individuals aged ≥4 years and 9.5% in individuals aged ≥18 years. Three additional cohort studies conducted between 2017/18-2019/20 reported a statistically significant improvement in rVE (5.3-14.4%) of QIVc compared to QIVe in preventing influenza-related hospitalizations and emergency department visits due to influenza in individuals aged 4-64 years. In a case-control study across all three seasons, QIVc showed statistically significantly higher effectiveness compared to QIVe in preventing test-confirmed influenza, with rVEs of 10.0-14.8%. Conclusions: RWD from the 2017/18-2019/20 seasons demonstrated that QIVc is more effective than QIVe in preventing influenza-related outcomes in individuals aged 4-64 years. Preferential use of cell-based influenza vaccines, as opposed to conventional egg-based vaccines, could reduce the burden of influenza-related symptoms on individuals and alleviate the economic impact on the German population under 60 years of age.

[Cell-based influenza vaccines: an effective vaccine option for under 60-year-olds]. / Zellkulturbasierte Influenzaimpfstoffe: eine effektive Impfstoffoption für unter 60-Jährige.

The population < 60 years of age is also affected by a significant disease burden from seasonal influenza. It carries a high economic burden, mainly driven by influenza-associated productivity losses in the working population. Conventional egg-based influenza vaccines may experience reduced effectiveness due to antigen adaptation in eggs. In contrast, cell-based influenza vaccines are less likely to be affected by antigenic adaptations to the host system and showed better effectiveness in individuals 4-64 years old over several seasons compared to conventional egg-based influenza vaccines under real-world conditions. Preferential use of cell-based influenza vaccines, as opposed to conventional egg-based vaccines, could reduce the burden of influenza-related symptoms on individuals and alleviate the economic impact on the German population < 60 years of age.

[Invasive meningococcal disease: increased risk and vaccination prevention for immunocompromised patients]. / Invasive Meningokokken-Erkrankungen : Erhöhtes Risiko und Impfprävention für immunsupprimierte Patientinnen und Patienten.

BACKGROUND: The development of evidence-based guidelines for the prevention of infectious diseases through vaccination requires an understanding of populations that most likely may obtain an infection, severe illness or disease. Targeted vaccination recommendations are made possible by identifying risk groups, as is the case with meningococcal infections. Despite falling case numbers, meningococcal sepsis and meningococcal meningitis remain a major health problem. METHOD: A systematic literature search was carried out on the research platform Ovid. RESULTS: Vulnerable groups of people whose immune system is limited by primary and secondary immunodeficiency, such as asplenia, renal failure, human immunodeficiency virus (HIV) infection, diabetes, complement deficiency, organ and stem cell transplants, or immunomodulatory therapy (e.g., in rheumatic, hematological or oncological diseases), are exposed to an increased risk of infection and more severe courses of disease. Despite adequate medical care, the mortality rate is high and patients that survived the infection are often suffering from severe long-term sequelae. In such cases, the vaccination recommendations of the Standing Committee on Vaccination (STIKO) for indication vaccinations and the application instructions for vaccination in the case of immune deficiency should be consistently implemented in Germany. CONCLUSIONS: Increased responsibility for comprehensive protection must be assumed for persons with underlying diseases. Reducing invasive meningococcal infections can be achieved through widespread education of patients and contacts, as well as practicing physicians on available vaccinations.

Can primary care physician recommendation improve influenza vaccine uptake among older adults? A community health centre-based experimental study in China.

BACKGROUND: To promote influenza vaccination coverage, a Chinese megacity, Shenzhen provides free influenza vaccination to its residents aged 60 years and above through community health centres (CHCs) since October 2016. A community health centre-based experiment was conducted by asking primary care physicians (PCPs) working in the intervention health centres to proactively recommend influenza vaccination to their patients aged 60 and above during their patients' visits. METHODS: This study used an experimental design and a survey design. The experimental design evaluated the effect of PCP recommendation on influenza vaccination. A total of 24 CHCs were randomly selected as the intervention (involving 3814 participants) and control (3072 participants) group evenly. The intervention study period was during the 2017-2018 flu season. The 2016-2017 flu season was considered as the baseline comparison. The survey design examined changes in knowledge, attitude, and practice of influenza vaccination among older participants before and after the free influenza vaccination implementation. We randomly invited 1200 participants aged 60 and above during their visits to CHCs in October 2016 and followed them up until October 2017; among them, 958 participants completed the follow-up survey using the same questionnaire. RESULTS: In the 2017-2018 flu season, 1,100 more patients got vaccinated in the intervention group under PCP recommendation compared with the 2016-2017 flu season. Among the 958 older adults in the post-implementation period, 77.5% had heard about the influenza vaccine, which was 24.7% higher than in the pre-implementation period; 84.8% of participants were aware where to take influenza vaccines, with the most improvement of 37.2% among all knowledge related questions; 62.5% of them agreed that patients with chronic diseases should have influenza vaccine, which was 19.1% higher than those being surveyed before the implementation period. About 83.6% of participants agreed older adults should have influenza vaccine, but there were still 58.4% who considered themselves too healthy to get vaccinated. CONCLUSION: PCP recommendation improved influenza vaccine uptake and knowledge, attitude, and practice levels regarding influenza vaccination among older adults. More health policies and health education should be made to raise vaccination willingness and improve vaccination coverage among older adults.

Barriers and determinants of consistent offering of HPV vaccination by healthcare facilities.

Expanding access to HPV vaccination is critical to increasing HPV vaccine uptake. We assessed the determinants and barriers to consistent offering of HPV vaccine among healthcare facilities. This was a cross-sectional survey of healthcare providers (HCPs) in Texas. Prevalence of the reasons healthcare practices do not consistently offer HPV vaccination was estimated. Multivariable regression analyses were conducted. Of 1169 HCPs included in the study, 47.5% (95% CI: 44.6-50.3%) reported their practices do not provide HPV vaccination or do not offer it consistently. Compared to physicians, nurses had 77% lower odds (Adjusted Odds Ratio (AOR): 0.23, 95% CI: 0.16-0.32, p-value: < .001), and physician assistants had 89% lower odds (AOR: 0.11, 95% CI: 0.07-0.16, p-value: < .001) of their healthcare practices consistently offering HPV vaccination. Compared to university/teaching hospitals, the odds of healthcare practices consistently offering HPV vaccination were 44% lower (AOR: 0.56, 95% CI: 0.35-0.91, p-value: 0.019) in solo practices but 266% higher (AOR: 3.66, 95% CI: 2.04-6.58, p-value: < .001) in FQHC/public facilities. The common reasons healthcare practices do not consistently offer HPV vaccination were; HPV vaccination is not within the scope of the practice (48.1%), referrals to other clinics (27.7%), and limited personnel (11.4%). Non-physicians were more likely to report that HPV vaccination was not in their scope and to refer patients than physicians. Moreover, solo practices were more likely to report challenges with acquisition and storage of the vaccine and referral of patients as reasons for not consistently offering HPV vaccination than university/teaching hospitals, FQHC/public facilities, or group practices. System-level interventions including training of non-physicians and expansion of practice enrollment in programs that support HPV vaccine acquisition and storage are needed.

Association of provider HPV vaccination training with provider assessment of HPV vaccination status and recommendation of HPV vaccination.

The delivery of strong HPV vaccine recommendations hinges on the expertise of healthcare providers (HCPs) in assessing patients' status and recommending HPV vaccination. We conducted a population-based cross-sectional study of HCPs practicing in Texas to examine the relationship between HPV vaccination training of HCPs and HPV vaccination status assessment and recommendation. Logistic regression analyses were used to assess the association between HCPs' formal training and recency of training in HPV vaccination promotion or counseling with HPV vaccination status assessment and recommendation. Of the 1,283 HCPs who completed the online survey, 43% had received training in HPV vaccination promotion or counseling, 47% often/always assess HPV vaccination status, and 59% often/always recommend HPV vaccination. Compared with HCPs who received no training, those who received training had over four times higher odds (adjusted odds ratio [AOR]: 4.32; 95% CI: 3.06-6.10) of often/always assessing HPV vaccination status and over three and half times higher odds (AOR: 3.66; 95% CI: 2.73-4.90) of often/always recommending HPV vaccination. Furthermore, HCPs who recently received HPV vaccination training had higher odds of HPV vaccination status assessment and recommendations than those without training. Hispanic HCPs had higher odds of often/always assessing HPV vaccination status and recommending vaccination than did non-Hispanic White HCPs. Also, nurses and physician assistants had lower odds of often/always assessing HPV vaccination status and recommending HPV vaccination than did physicians. Targeted and continuous training of HCPs in HPV vaccination promotion or counseling is needed to increase HPV vaccination status assessment, recommendation, and uptake rates.

Importance and value of adjuvanted influenza vaccine in the care of older adults from a European perspective - A systematic review of recently published literature on real-world data.

BACKGROUND: There is an urgent need for improved influenza vaccines especially for older adults due to the presence of immunosenescence. It is therefore highly relevant to compare enhanced influenza vaccines with traditional influenza vaccines with respect to their effectiveness. OBJECTIVE: To compare vaccine efficacy and effectiveness of adjuvanted influenza vaccines (aTIV/aQIV) vs. non-adjuvanted standard-dose (TIV/QIV) and high-dose (TIV-HD/QIV-HD) influenza vaccines regarding influenza-related outcomes in older adults, complementing findings from the European Centre for Disease Prevention and Control (ECDC)'s systematic review of enhanced seasonal influenza vaccines from February 2020. METHODS: A systematic literature search was conducted in Embase and MEDLINE to identify randomised controlled trials, observational studies and systematic reviews, published since ECDC's systematic review (between 7 February 2020 and 6 September 2021). Included studies were appraised with either the Cochrane Risk of Bias tool, ROBINS-I or AMSTAR 2. RESULTS: Eleven analyses from nine real-world evidence (RWE) studies comprising ∼53 million participants and assessing the relative vaccine effectiveness (rVE) of aTIV vs. TIV, QIV and/or TIV-HD in adults aged ≥65 years over the 2006/07-2008/09 and 2011/12-2019/20 influenza seasons were identified. Nine analyses found that aTIV was significantly more effective than TIV and QIV in reducing influenza-related outcomes by clinical setting and suspected influenza outbreaks (rVE ranging from 7.5% to 25.6% for aTIV vs. TIV and 7.1% to 36.3% for aTIV vs. QIV). Seven analyses found similar effectiveness of aTIV vs. TIV-HD in reducing influenza-related medical encounters, inpatient stays and hospitalisations/emergency room visits. In three analyses, aTIV was significantly more effective than TIV-HD in reducing influenza-related medical encounters and office visits (rVE ranging from 6.6% to 16.6%). Risk of bias of identified studies was moderate to high. CONCLUSIONS: Our study suggests that both adjuvanted and high-dose vaccines are effective alternatives for vaccination programmes in older adults and preferable over conventional standard-dose vaccines.

[What (general/abdominal) surgeons should know about occupational medicine? : General vaccine recommendations and postexposure prophylaxis of hepatitis B, C and HIV]. / Was sollte der (Allgemein­/Viszeral­)Chirurg über Arbeitsmedizin wissen? : Allgemeine Impfempfehlungen und postexpositionelle Prophylaxe von Hepatitis B, C und HIV.

This article deals with the general recommendations on vaccination and postexposure prophylaxis, which can be utilized for cuts and needlestick injuries. Cuts and needlestick injuries among surgeons are common occupational accidents. These should be interpreted as acute or emergency situations, especially if there was contact with infectious index patients or the danger of infection cannot be excluded. This results in high economic costs but also in the individual confrontation with an infectious disease that is definitely incurable. The aim of this review is to highlight the general and occupational vaccine recommendations for surgeons. In addition, background information and legal principles are presented. There is a duty to provide and to obtain information about effective protective measures against infectious diseases from cuts and needlestick injuries even for surgeons. In addition, primary prophylaxis, vaccination recommendations, and postexposure prophylaxis after cuts and needlestick injuries as well as the TOP principle are presented. The TOP principle comprises technical, organizational and person-related protective measures.

Vaccine-preventable diseases other than tuberculosis, and homelessness: A scoping review of the published literature, 1980 to 2020.

BACKGROUND: Homelessness may result in the breakdown of regular health services, including routine vaccination programmes. A scoping review was conducted to describe vaccine-preventable diseases (VPD) other than tuberculosis in people experiencing homelessness (PEH). METHODS: We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched peer-reviewed literature published in English, French, Spanish or Portuguese reporting the outbreak of VPD or VPD prevalence in both infant and adult homeless populations published between 1980 and 2020, using PubMed/Medline, SciELO, Google Scholar, and Web of Science databases. Relevant information from the studies was charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS: Eighty-one articles were included. A high prevalence of past hepatitis B virus (HBV) and hepatitis A virus (HAV) infections were observed through serosurveys, mostly in high income countries or high-middle income countries (USA, Canada, France, Iran or Brazil). Ten outbreaks of HAV infection were also reported, with lethality rates ranging from 0 to 4.8%. The studies identified numerous risk factors positively associated with HBV infection, including older age, homosexual or bisexual practice, injected drug use (IDU), and, with HAV infection including IDU, having sexual partner(s) with a history of unspecified hepatitis, insertive anal penetration, or originating from a country with a high prevalence of anti-HAV antibody. Eleven outbreaks of pneumococcal infection affecting PEH were reported in Canada and USA, with lethality rates from 0 to 15.6%. Six diphtheria outbreaks were reported. Vaccination status was rarely documented in these studies. CONCLUSIONS: The literature suggests that homeless populations generally experience a high VPD burden suggesting the need for a national vaccination programme and planning for delivering vaccines in this population.

Hepatitis B virus elimination status and strategies in circumpolar countries, 2020.

Hepatitis B virus (HBV) infection remains a global health threat. The World Health Organization (WHO) established a goal to eliminate HBV infection as a public health threat by 2030, and defined targets for key interventions to achieve that goal. We evaluated HBV burden and relevant national recommendations for progress towards WHO targets in circumpolar countries. Viral hepatitis experts of circumpolar countries were surveyed regarding their country's burden of HBV, achievement of WHO targets and national public health authority recommendations for HBV prevention and control. Eight of nine circumpolar countries responded. All countries continue to see new HBV infections. Data about HBV prevalence and progress in reaching WHO 2030 elimination targets are lacking. No country was able to report data for all seven WHO target measures. All countries have recommendations targeting the prevention of mother-to-child transmission. Only the USA and Greenland recommend universal birth dose vaccination. Four countries have recommendations to screen persons at high risk for HBV. Existing recommendations largely address prevention; however, recommendations for universal birth dose vaccination have not been widely introduced. Opportunities remain for the development of trackable targets and national elimination planning to screen and treat for HBV to reduce incidence and mortality.

Knowledge, attitudes, beliefs and practices of occupational physicians towards vaccinations of health care workers: A cross sectional pilot study in North-Eastern Italy.

OBJECTIVES: This study aims to characterize personal attitudes and knowledge of a sample of Italian occupational physicians (OPhs) towards immunization practice in the case of healthcare workers (HCWs). MATERIAL AND METHODS: A total of 90 OPhs (42.2% of males, 57.8% of females, mean age of 50.1±8.3 years old) compiled a structured questionnaire through a telephonic interview. They were asked about the official Italian recommendations for HCWs, their general knowledge of vaccine practice, their propensity towards vaccines (both in general and about specific immunizations), their risk perception about the vaccine-preventable infectious diseases. Eventually, a regression analysis was performed in order to identify factors predictive for vaccine propensity. RESULTS: Only 12 out of 90 subjects correctly identified all the 7 recommended immunizations. The hepatitis B virus (HBV) vaccine was correctly identified by 95.6% of the sample, and was also associated with the more positive attitude and the more accurate risk perception. Influenza vaccine had the lowest acceptance (75.9%). Eventually, pertussis, measles, parotitis and varicella vaccines were insufficiently recognized as recommended ones (all cases < 50% of the sample). General knowledge of vaccine and knowledge of official recommendations were significantly correlated with the attitude towards immunization practice (r = 0.259, p = 0.014 and r = 0.438, p < 0.0001). In the regression analysis general knowledge (unstandardized coefficient (B) = 0.300, 95% confidence interval (CI): 0.090-0.510, p = 0.006) and risk perception (B = 0.579, 95% CI: 0.155-1.003, p = 0.008) were significant predictors of the propensity to vaccinate. CONCLUSIONS: Vaccinations gaps in HCWs may found their roots in OPhs incomplete knowledge of evidence-based recommendations. Specific training programs and formations courses should then be planned. Int J Occup Med Environ Health 2017;30(5):775-790.

Knowledge of influenza vaccination recommendation and early vaccination uptake during the 2015-16 season among adults aged ≥18years - United States.

BACKGROUND: Since 2010, the Advisory Committee on Immunization Practices (ACIP) has recommended that all persons aged ≥6months receive annual influenza vaccination. METHODS: We analyzed data from the 2015 National Internet Flu Survey (NIFS), to assess knowledge and awareness of the influenza vaccination recommendation and early influenza vaccination coverage during the 2015-16 season among adults. Predictive marginals from a multivariable logistic regression model were used to identify factors independently associated with adults' knowledge and awareness of the vaccination recommendation and early vaccine uptake during the 2015-16 influenza season. RESULTS: Among the 3301 respondents aged ≥18years, 19.6% indicated knowing that influenza vaccination is recommended for all persons aged ≥6months. Of respondents, 62.3% indicated awareness that there was a recommendation for influenza vaccination, but did not indicate correct knowledge of the recommended age group. Overall, 39.9% of adults aged ≥18years reported having an influenza vaccination. Age 65years and older, being female, having a college or higher education, not being in work force, having annual household income ≥$75,000, reporting having received an influenza vaccination early in the 2015-16 season, having children aged ≤17years in the household, and having high-risk conditions were independently associated with a higher correct knowledge of the influenza vaccination recommendation. CONCLUSIONS: Approximately 1 in 5 had correct knowledge of the recommendation that all persons aged ≥6months should receive an influenza vaccination annually, with some socio-economic groups being even less aware. Clinic based education in combination with strategies known to increase uptake of recommended vaccines, such as patient reminder/recall systems and other healthcare system-based interventions are needed to improve vaccination, which could also improve awareness.

Personal attitudes and misconceptions, not official recommendations guide occupational physicians' vaccination decisions.

INTRODUCTION: Healthcare personnel (HCP) are often under-vaccinated. The aim of this study was to evaluate occupational physicians' potential role by assessing relations between their knowledge and attitudes regarding HCP vaccination and the extent to which official vaccination recommendations are communicated. METHODS: Cross-sectional survey, n=135 occupational physicians. RESULTS: Occupational physicians who treat HCP recommend vaccinations more often to HCP when they have better knowledge of official vaccination recommendations and a more positive attitude towards vaccination compared to physicians with less such knowledge or a more negative attitude. The attitude towards vaccination most strongly affects whether occupational physicians recommend the measles, mumps, and rubella (MMR) vaccination: physicians with less positive attitudes recommend MMR to HCP in a more restricted way. A more positive attitude towards vaccination also relates to fewer misconceptions. Occupational physicians' knowledge and attitude further influence the extent to which pregnant HCP receive vaccinations against influenza. Knowledge about official recommendations does not influence the recommendation of influenza vaccination for pregnant women. CONCLUSIONS: Reasons for vaccination gaps in HCP might have their roots in occupational physicians' incomplete knowledge of vaccination recommendations. Attitudes, which are related to misperceptions, also influence which vaccinations are recommended to HCP. Official recommendations, and not personal attitudes and misconceptions, should guide occupational vaccination behavior.

Varicella: efficacy of two-dose vaccination in childhood.

INTRODUCTION: Experience with one-dose varicella vaccination of children in the USA has shown that with high immunization coverage a marked decline in morbidity and mortality occurs. However, about one quarter of the vaccinees may develop breakthrough varicella. Although breakthrough infections are usually mild, the patients are potentially contagious. METHODS: Selective literature search, review of congress papers, and evaluation of the consensus statement of an expert panel on the use of monovalent varicella vaccines. RESULTS: Recent studies on the causes, effects, and consequences of breakthrough varicella after one-dose vaccination show that varicella vaccine should be given in two doses at least four to six weeks apart to achieve effective, long-lasting protection against chickenpox. Breakthrough disease cannot always be prevented, but two-dose vaccination offers significantly better protection than a single dose. These findings were considered in the approval process for the measles-mumps-rubella-varicella combination vaccines, which are licensed only for use in a two-dose schedule. DISCUSSION: The authors recommend the general implementation of a two-dose schedule for single-antigen varicella vaccines, which will continue to be available.