Patterns of Influenza Vaccination Coverage in the United States from 2009 to 2015

Background: Globally, influenza is a major cause of morbidity, hospitalization and mortality. Influenza vaccination has shown substantial protective effectiveness in the United States. We investigated state-level patterns of coverage rates of seasonal and pandemic influenza vaccination, among the overall population in the U.S. and specifically among children and the elderly, from 2009/10 to 2014/15, and associations with ecological factors. Methods and Findings: We obtained state-level influenza vaccination coverage rates from national surveys, and state-level socio-demographic and health data from a variety of sources. We employed a retrospective ecological study design, and used mixed-model regression to determine the levels of ecological association of the state-level vaccinations rates with these factors, both with and without region as a factor for the three populations. We found that health-care access is positively and significantly associated with mean influenza vaccination coverage rates across all populations and models. We also found that prevalence of asthma in adults are negatively and significantly associated with mean influenza vaccination coverage rates in the elderly populations. Conclusions: Health-care access has a robust, positive association with state-level vaccination rates across different populations. This highlights a potential population-level advantage of expanding health-care access.Comment: 10 pages, 2 figure

The Expected Mass Function for Low Mass Galaxies in a CDM Cosmology: Is There a Problem?

It is well known that the mass function for_halos_ in CDM cosmology is a relatively steep power law for low masses, possibly too steep to be consistent with observations. But how steep is the_galaxy_ mass function? We have analyzed the stellar and gas mass functions of the first massive luminous objects formed in a \Lambda CDM universe, as calculated in the numerical simulation described in Gnedin (2000ab). We found that while the dark matter mass function is steep, the stellar and gas mass functions are flatter for low mass objects. The stellar mass function is consistently flat at the low mass end. Moreover, while the gas mass function follows the dark matter mass function until reionization at z~7, between z=7 and z=4, the gas mass function also flattens considerably at the low mass end. At z=4, the gas and stellar mass functions are fit by a Schechter function with \alpha ~ -1.2 +/- 0.1, significantly shallower than the dark matter halo mass function and consistent with some recent observations. The baryonic mass functions are shallower because (a) the dark matter halo mass function is consistent with the Press-Schechter formulation at low masses n(M) M^-2 and (b) heating/cooling and ionization processes appear to cause baryons to collect in halos with the relationship M_b M_d^4 at low masses. Combining (a) and (b) gives n(M_b) M_b^-5/4, comparable to the simulation results. Thus, the well known observational fact that low mass galaxies are underabundant as compared to expectations from numerical dark matter simulations or Press-Schechter modeling of CDM universes emerges naturally from these results, implying that perhaps no ``new physics'' beyond the standard model is needed.Comment: Submitted to ApJ, 17 pages including 6 figure