HPV Vaccination: Should It Be Recommended or Required?

Legislation introduced by two members of the District of Columbia Council on January 9, 2007 would require all girls to be vaccinated against the human papillomavirus (HPV), the primary cause of cervical cancer, by the time they enter the sixth grade, unless a parent or guardian specifically opts out of the mandate. A similar bill was introduced last week in Virginia, and Maryland and West Virginia are poised to consider legislation. To place the proposals in a broader context, this paper reviews some of the scientific, legal, ethical and financial issues surrounding the HPV vaccine and compulsory vaccinations

Mandating HPV vaccination--Private rights, public good

New York State\u27s regulations require health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza. Courts must take into account constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community\u27s health and safety. Health care workers have a profound effect on patients\u27 health. Although they have the same rights as all private citizens, it is likely that courts will continue to make the health and safety of patients the priority in permitting exceptions to individual rights

Vaccines and Autism: The Evidence and the Law

A potential link between the measles-mumps-rubella vaccine and autism was dismissed by a federal vaccine court in February 2009. The U.S. Department of Health and Human Services said the findings demonstrate a lack of medical evidence for any association, while Autism Speaks, a patient advocacy group, said questions remain about potential risks for certain subgroups. Other legal actions are pending as the scientific and patient advocacy communities debate the need to conduct further research on the vaccine-autism link. Meanwhile, public health advocates worry that continuing concerns about the safety of vaccines may depress the population immunization rate. A small rise in reported measles cases may be linked to exemptions that allow families to opt out of vaccine mandates. This paper reviews the scientific research on vaccines and autism, the legal decisions to date, and the importance of continued attentio

The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake

ncome persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts) on vaccine uptake in the fee-for-service Medicaid population 19–64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. Each additional dollar of copayment for vaccination decreased influenza vaccination coverage 1–6 percentage points. The effects of covering vaccines or prohibiting cost-sharing were mixed. Imposing copayments for vaccination is associated with lower vaccination coverage. These findings have implications for the implementation of Medicaid expansion in states that currently impose copayments

Health Insurance Benefits Advisors: Understanding Responsibilities, Regulations, Restrictions and the Relevance to Implementing the Affordable Care Act

This brief describes the operational differences among six different types of benefits advisors including: 1) Commercial agents and brokers, 2) Medicaid enrollment brokers, 3) navigators, 4) non-navigator assistance personnel (or in-person assisters), 5) certified applications assisters, and 6) health center outreach and enrollment assistance workers. We will address: 1) the role of each benefits advisor 2) the health plans with which benefits advisors are authorized to work 3) training requirements, 4) compensation 5) conflict of interest requirements, and 6) the impact benefits advisors have on consumer enrollment decisions

Influenza Vaccination of the Health Care Workforce: A Literature Review

Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers (HCWs) receive an annual influenza vaccination. The Healthy People objectives aimed for 60% coverage of HCW influenza vaccination by 2010 and 90% coverage by 2020. Although influenza vaccine uptake among HCWs has trended upward over the past several years, the percentage of immunized HCWs has remained approximately 40% between 2004 and 2008. In order to complete the literature review, researchers identified and analyzed peer reviewed literature, news articles, professional organization position statements, and institutional policies published between 1991 and 2011. In the absence of evidence from the United States experience, materials relevant to Canada, France and the United Kingdom were reviewed. Defining Health Care Workers and Settings: The healthcare workforce could be individuals who have direct exposure or have the potential for indirect exposure to patients or infectious materials including: body substances, contaminated medical supplies and equipment, environmental surfaces or air. They may be paid or unpaid, an employee, contractor, volunteer, visitor, or student. Health care workers work in a broad range of institutional and community settings. Health Care Workers Impact Patient Safety: HCWs who have direct contact with patients are the primary source of infectious disease outbreaks in health-care facilities. During an average season, 23% of HCWs are infected with the virus, show mild symptoms, and continue to work despite being infectious. Over the past 30 years, nosocomial influenza outbreaks have been documented throughout the United States and abroad. Strategies to Encourage Voluntary Vaccination Among HCWs: Healthcare facilities, and government and professional organizations have developed and supported various strategies to encourage voluntary influenza vaccination among HCWs, including: 1) educational and promotional campaigns, 2) increased access to the seasonal influenza vaccine, 3) declination statements, and 4) health programs that incorporate several strategies. State–Mandated School Immunization and Exemption Policies: State laws that require vaccination as a condition for school attendance translate national recommendations into immunization practice. These laws have proven to be the most effective mechanism to protect children and their families from the effects of vaccine-preventable disease. Historical and modern examination of school vaccination laws provides a context for understanding the benefits of compulsory vaccination policy when applied to the health workforce. All jurisdictions include opt-out or exemption provisions that permit parents to refuse immunizations for their children for one of three reasons: 1) medical contraindication, 2) religious beliefs, or 3) personal, moral, or philosophical beliefs. Two jurisdictions employ declination statements as a fourth option to allow refusal. 1 Mandatory Influenza Vaccination Policies in Healthcare Facilities: Beginning in 2004, healthcare facilities and local health departments began to require influenza vaccination as a condition of employment. Currently, 87 facilities in 30 states and the District of Columbia have implemented HCW mandatory influenza vaccination programs. Professional and Government Organizations Position Statements Related to Health Care Worker Influenza Vaccination: Several professional, government, non-profit organizations have indicated their support of mandatory influenza vaccination of HCWs as the most effective strategy to protect patients. However, the largest health care union, representing several categories of the health care workforce, opposes mandatory influenza vaccination. Health Care Workers’ Attitudes and Beliefs Related to Influenza Vaccination: The workforce continues to present several common arguments against influenza vaccination, including: 1) fear, 2) a belief in popular myths and misinformation, and 3) inconvenience. However, others accept the vaccination as an effective method to protect themselves, their families, and their patients

The Epidemiology of U.S. Immunization Law: Translating CDC Immunization Guidelines into Practice: State Laws Related to the Use of Standing Orders Covering Immunization Practice

This pilot study examines how five states -- Georgia, Massachusetts, New York, Oregon, and Texas – approach the legal question of delegation of medical practice powers in an immunization practice context

Overrepresented and Under Discussed: From Conceptual Analysis to Practical Implications for Crossover among Black Girls

Crossover youth are young people who have experiences of maltreatment and exhibit delinquency, which may or may not come to the formal attention of the child welfare and juvenile justice systems. Black youth are overrepresented among the crossover youth population, and evidence suggests that Black girls who experience crossover are particularly in need of specialized attention. Black girls’ experiences within child welfare, juvenile justice, and related systems are unique given the intersection of race and gender in light of issues such as discrimination, disparate treatment, and abuse undergone while in the care of agencies touted to protect them. Guided by a Black Feminism perspective and Critical Race Theory that acknowledge the intersection of race, gender, and additional social identities as well as structural racism and power, this manuscript provides an overview of the aforementioned issues and focuses on practical implications for better serving Black girls who experience crossover and their mental health. The authors offer a strengths-based, community framework to better understand the mental health needs of Black girls who experience maltreatment and exhibit delinquent behavior. In particular, the aim is to recognize the role that systemic racism and gendered experiences and obstacles have on individuals navigating the child welfare and juvenile justice systems. Finally, the authors present tangible implications for individuals and communities that are unique to the intersectional needs of Black system-involved girls

The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws

Immunizations represent both basic clinical care as well as an essential public health activity with population-wide health implications, and for a number of reasons, the focus on national immunization policy has intensified in recent years. Insurers and employee health plans may cover immunization services as a matter of benefit design choice. Federal and state insurance laws also may mandate coverage of one or more classes of immunization services. For approximately 100 million persons who are members of state-regulated health insurance plans, state law plays a primary role in determining coverage. Thus the extent of state immunization health insurance mandates is essential in examining the overall adequacy of health insurance financing for immunization services. This analysis is part of a comprehensive study of the epidemiology of U.S. immunization law. It provides a detailed assessment of state immunization statutes in force as of winter 2003