Patterns of rotavirus vaccine uptake, use, and effectiveness in privately-insured US children, 2006-2010

Objectives. Our study examines predictors and timeliness of rotavirus vaccine administration among privately-insured US infants and children from 2006 to 2010. We also calculate direct, indirect, total, and overall rotavirus vaccine effectiveness estimates as well as the number of rotavirus and acute gastroenteritis hospitalizations prevented among infants and children aged 8 to 20 months. Methods. Bivariate analyses and multivariable log-risk models were used to determine predictors of rotavirus vaccine series initiation and completion among infants in the MarketScan Research Databases. Vaccine effectiveness estimates were derived using Cox proportional hazards regression, stratifying by calendar year and adjusting for month of birth. Incidence rate differences were calculated to determine the absolute number of rotavirus and acute gastroenteritis hospitalizations prevented in the cohort. Results. Most infants received the rotavirus vaccines at the recommended ages, but more infants completed the series for monovalent rotavirus vaccine than pentavalent rotavirus vaccine or a mix of the two vaccines (87% versus 79% versus 73%). In multivariable analyses, the strongest predictors of rotavirus vaccine series initiation and completion were receipt of the diphtheria, tetanus and acellular pertussis vaccine (Initiation: RR=7.50, 95% CI=7.30-7.71; Completion: RR=1.26, 95% CI=1.23-1.29), visiting a pediatrician versus family physician (Initiation: RR=1.51, 95% CI=1.49-1.52; Completion: RR=1.13, 95% CI=1.11-1.14), and living in a large metropolitan versus smaller metropolitan, urban, or rural area. Direct vaccine effectiveness of one or more doses of any rotavirus vaccine in preventing rotavirus gastroenteritis hospitalizations in children 8 to 20 months ranged from 87 to 92% for each calendar year, 2007-2010. Accounting for indirect protection increased the total vaccine effectiveness by an additional 3 to 8%. Failing to account for indirect protection underestimated the absolute number of rotavirus gastroenteritis hospitalizations prevented in rotavirus-vaccinated children by 1.5 to 5.3-fold. Conclusions. Accounting for only the direct effectiveness of the rotavirus vaccine severely underestimated the total number of rotavirus gastroenteritis hospitalizations prevented by the US rotavirus vaccine program. Interventions to further increase rotavirus vaccine coverage should consider targeting family physicians and encouraging completion of the vaccine series.Doctor of Philosoph

HPV and HPV Vaccine Education Intervention: Effects on Parents, Healthcare Staff, and School Staff

Increasing knowledge about HPV and HPV vaccine is a potentially important way to increase vaccination rates, yet few education interventions have addressed these topics. We report the results of an education intervention targeting three key groups who have contact with adolescent females

Geographic Variation in Pneumonia and Influenza in Long-Term Care Facilities:A National Study

There is large county-level geographic variation in pneumonia and influenza hospitalizations among short-stay and long-stay long-term care facility residents in the United States. Long-term care facilities in counties in the Southern and Midwestern regions had the highest rates of pneumonia and influenza from 2013 to 2015. Future research should identify reasons for these geographic differences

Invasive Pneumococcal Pneumonia and Respiratory Virus Co-infections

Each year, especially in the winter, many get sick and some die of invasive pneumococcal pneumonia. Does this type of pneumonia increase in the winter because people are in closer contact indoors?  Or are people more susceptible to this bacterial disease after having had a seasonal respiratory virus infection?  A season-by-season analysis found an association between pneumococcal pneumonia and two viruses (influenza and respiratory syncytial virus). The association varied by season and was strongest when the predominant influenza virus subtype was H3N2. Vaccination against influenza and RSV should also help protect against pneumococcal pneumonia

Evaluation of an Intervention Providing HPV Vaccine in Schools

To conduct outcome and process evaluations of school-located HPV vaccination clinics in partnership with a local health department

Direct, Indirect, Total, and Overall Effectiveness of the Rotavirus Vaccines for the Prevention of Gastroenteritis Hospitalizations in Privately Insured US Children, 2007-2010

We demonstrate how direct, indirect, total, and overall effectiveness estimates and absolute benefits of rotavirus vaccines vary through the years following vaccine introduction. Privately insured US children in a large claims database were followed from age 8 months until they 1) experienced a hospitalization for rotavirus or acute gastroenteritis; 2) lost continuous health plan enrollment; 3) turned 20 months of age; or 4) reached the end of the study period. Vaccine effectiveness estimates in preventing rotavirus and acute gastroenteritis hospitalizations were estimated using Cox proportional hazards regression, stratified by calendar year and adjusted for birth month. Incidence rate differences were estimated to determine the absolute number of gastroenteritis hospitalizations prevented in the cohort. Among 905,718 children, 51%, 66%, 80%, and 86% received 1 or more doses of rotavirus vaccine in each year from 2007 to 2010. The direct vaccine effectiveness of 1 or more doses of rotavirus vaccine in preventing rotavirus gastroenteritis hospitalizations ranged from 87% to 92% each year. Accounting for indirect protection increased estimates of vaccine effectiveness by an additional 3%–8% among those vaccinated. Failing to account for population-level vaccine benefits in 2010, when circulation of rotavirus was low, could underestimate the sustained impact of the vaccine program

Cervical Cancer Awareness and Screening in Botswana

Cervical cancer remains a leading cause of death in many developing countries due to limited screening by Papanicolaou (Pap) smear. We sought to better understand women’s beliefs about cervical cancer and screening in Botswana, a middle income African country with high rates of cervical cancer

A Cross-Sectional Study of HPV Vaccine Acceptability in Gaborone, Botswana

Background Cervical cancer is the most common cancer among women in Botswana and elsewhere in Sub-Saharan Africa. We sought to examine whether HPV vaccine is acceptable among parents in Botswana, which recently licensed the vaccine to prevent cervical cancer. Methods and Findings We conducted a cross-sectional survey in 2009, around the time the vaccine was first licensed, with adults recruited in general medicine and HIV clinics in Gaborone, the capital of Botswana. Although only 9% (32/376) of respondents had heard of HPV vaccine prior to the survey, 88% (329/376) said they definitely will have their adolescent daughters receive HPV vaccine. Most respondents would get the vaccine for their daughters at a public or community clinic (42%) or a gynecology or obstetrician\u27s office (39%), and 74% would get it for a daughter if it were available at her school. Respondents were more likely to say that they definitely will get HPV vaccine for their daughters if they had less education (OR = 0.20, 95% CI = 0.07–0.58) or lived more than 30 kilometers from the capital, Gaborone (OR = 2.29, 95% CI = 1.06–4.93). Other correlates of acceptability were expecting to be involved in the decision to get HPV vaccine, thinking the vaccine would be hard to obtain, and perceiving greater severity of HPV-related diseases. Conclusions HPV vaccination of adolescent girls would be highly acceptable if the vaccine became widely available to the daughters of healthcare seeking parents in Gaborone, Botswana. Potential HPV vaccination campaigns should provide more information about HPV and the vaccine as well as work to minimize barriers

Predicting the start week of respiratory syncytial virus outbreaks using real time weather variables

<p>Abstract</p> <p>Background</p> <p>Respiratory Syncytial Virus (RSV), a major cause of bronchiolitis, has a large impact on the census of pediatric hospitals during outbreak seasons. Reliable prediction of the week these outbreaks will start, based on readily available data, could help pediatric hospitals better prepare for large outbreaks.</p> <p>Methods</p> <p>Naïve Bayes (NB) classifier models were constructed using weather data from 1985-2008 considering only variables that are available in real time and that could be used to forecast the week in which an RSV outbreak will occur in Salt Lake County, Utah. Outbreak start dates were determined by a panel of experts using 32,509 records with ICD-9 coded RSV and bronchiolitis diagnoses from Intermountain Healthcare hospitals and clinics for the RSV seasons from 1985 to 2008.</p> <p>Results</p> <p>NB models predicted RSV outbreaks up to 3 weeks in advance with an estimated sensitivity of up to 67% and estimated specificities as high as 94% to 100%. Temperature and wind speed were the best overall predictors, but other weather variables also showed relevance depending on how far in advance the predictions were made. The weather conditions predictive of an RSV outbreak in our study were similar to those that lead to temperature inversions in the Salt Lake Valley.</p> <p>Conclusions</p> <p>We demonstrate that Naïve Bayes (NB) classifier models based on weather data available in real time have the potential to be used as effective predictive models. These models may be able to predict the week that an RSV outbreak will occur with clinical relevance. Their clinical usefulness will be field tested during the next five years.</p