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

Letter: Ira M. Dushoff, MD to G. Dekle Taylor, MD November 22, 1968

This letter is a response to G. Dekle Taylor\u27s memo to all Duval County Medical Center employees that asked for criticisms and recommendations for improvements in the hospita

Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi

Background: Age disparities in sexual relationships have been proposed as a key risk factor for HIV transmission in Sub-Saharan Africa, but evidence remains inconclusive. The SIHR study, a cluster randomised trial of a cash transfer programme in Malawi, found that young women in the intervention groups were less likely to have had a sexual partner aged 25 or older, and less likely to test positive for HIV and HSV-2 at follow-up compared to control groups. We examined the hypotheses that girls in the intervention groups had smaller age differences than control groups and that large age differences were associated with relationship-level HIV transmission risk factors: inconsistent condom use, sex frequency, and relationship duration. Methods: We conducted an analysis of schoolgirls in the Schooling, Income, and Health Risk (SIHR) study aged 13-22 at baseline (n = 2907). We investigated the effects of study arm, trial stage and participant age on age differences in sexual relationships using a linear mixed-effects model. Cumulative-link mixed-effects models were used to estimate the effect of relationship age difference on condom use and sex frequency, and a Cox proportional hazard model was used to estimate the effect of relationship age difference on relationship duration. We controlled for the girl's age, number of partners, study group and study round. Results: Girls receiving cash transfers, on average, had smaller age differences in relationships compared to controls, though the estimated difference was not statistically significant (-0.43 years; 95% CI: -1.03, 0.17). The older the participant was, the smaller her age differences (-0.67 per 4-year increase in age; 95% CI: -0.99, - 0.35). Among controls, after the cash transfers had ended the average age difference was 0.82 years larger than during the intervention (95% CI: 0.43, 1.21), suggesting a possible indirect effect of the study on behaviour in the community as a whole. Across treatment groups, larger age differences in relationships were associated with lower levels of condom use, more frequent sex, and longer relationship durations. Conclusions: Cash-transfer programmes may prevent HIV transmission in part by encouraging young women to form age-similar relationships, which are characterised by increased condom use and reduced sex frequency. The benefits of these programmes may extend to those who are not directly receiving the cash

Transmission dynamics and prospects for the elimination of canine rabies

Rabies has been eliminated from domestic dog populations in Western Europe and North America, but continues to kill many thousands of people throughout Africa and Asia every year. A quantitative understanding of transmission dynamics in domestic dog populations provides critical information to assess whether global elimination of canine rabies is possible. We report extensive observations of individual rabid animals in Tanzania and generate a uniquely detailed analysis of transmission biology, which explains important epidemiological features, including the level of variation in epidemic trajectories. We found that the basic reproductive number for rabies, R<sub>0</sub>, is very low in our study area in rural Africa (∼1.2) and throughout its historic global range (<2). This finding provides strong support for the feasibility of controlling endemic canine rabies by vaccination, even near wildlife areas with large wild carnivore populations. However, we show that rapid turnover of domestic dog populations has been a major obstacle to successful control in developing countries, thus regular pulse vaccinations will be required to maintain population-level immunity between campaigns. Nonetheless our analyses suggest that with sustained, international commitment, global elimination of rabies from domestic dog populations, the most dangerous vector to humans, is a realistic goal