Mandates Improve With Influenza Vaccination Rates of Hospital Personnel

Megan C. Lindley, MPHDeputy Associate Director for ScienceImmunization Services DivisionCDC

Megan C. Lindley

MedicalResearch.com Interview with:
Megan C. Lindley, MPH

Deputy Associate Director for Science
Immunization Services Division
CDC

MedicalResearch.com: What is the background for this study?

Response: Despite longstanding recommendations from the Advisory Committee on Immunization Practices, healthcare personnel influenza vaccination coverage remains below the Healthy People 2020 target of 90%. Healthcare employers use a variety of strategies to promote influenza vaccination among healthcare personnel, including facility-level mandates for vaccination. Several U.S. states have also enacted laws related to healthcare personnel influenza vaccination, but the effect of these laws on vaccination uptake is unclear.

Our study used influenza vaccination coverage data reported by over 4,000 U.S. hospitals to examine three kinds of laws:
(1) Assessment laws, which require hospitals to assess healthcare personnel influenza vaccination status;
(2) Offer laws, which require hospitals to offer the influenza vaccine to healthcare personnel; and
(3) Ensure laws, which require hospitals to require healthcare personnel to demonstrate proof of influenza vaccination. Continue reading

End of Honeymoon Period Means Whooping Cough Can Resurge

MedicalResearch.com Interview with:

This Gram-stained photomicrograph depicts numbers of Bordetella pertussis bacteria, which is the etiologic pathogen for pertussis, also known as whooping cough.

This Gram-stained photomicrograph depicts numbers of Bordetella pertussis bacteria, which is the etiologic pathogen for pertussis, also known as whooping cough.
CDC image

Matthieu Domenech de Cellès PhD
Department of Ecology and Evolutionary Biology
University of Michigan, Ann Arbor, MI, USA.
Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases Unit
Institut Pasteur, Inserm,
University of Versailles St-Quentin-en-Yvelines,
Versailles, France.

MedicalResearch.com: What is the background for this study? What are the main findings?

 

Response: Our main motivation was to elucidate an apparent paradox: Why has the US experienced a resurgence of pertussis (whooping cough) since the mid-1970s, despite persistently high vaccine coverage? A variety of hypotheses have been proposed to explain this resurgence, but most attention has focused on the potential shortcomings of the new generation of pertussis vaccines (called acellular pertussis vaccines). However, there remains considerable uncertainty about the degree and the mechanisms of protection conferred by pertussis vaccines.

Via a collaboration with the local department of public health, we used detailed surveillance data in the state of Massachusetts to test a number of hypotheses about pertussis vaccines. We found that, although pertussis vaccines are imperfect (in the sense that they do not provide lifelong, 100% protection to 100% of children vaccinated), they are still highly efficacious. Specifically, we estimated that vaccine protection wanes over time, but slowly, with about 85% of children still protected 10 years after vaccination. Despite this high vaccine efficacy, we showed that the resurgence of pertussis was, in fact, to be expected. What happens is that the introduction of routine vaccination leads to an overall reduction in transmission, not only in vaccinated children but also in the population at large. Accordingly, those who escaped vaccination as children (as a consequence of incomplete vaccine coverage or imperfect vaccine protection) increasingly age having also avoided natural infection. As a result, the number of individuals susceptible to contract pertussis gradually increases. Because such people are the “fuel” of epidemics, this sets the stage for pertussis’ resurgence, with increasing incidence among older individuals.

This overall effect is called the “end-of-honeymoon” and means that resurgence is therefore a predictable consequence of incomplete vaccination with efficacious, but imperfect, vaccines. Importantly, these results show that recent trends do not necessarily reflect recent changes in the epidemiology of pertussis. Rather, they may be interpreted as a legacy of past immunization practices, with long-to-manifest effects. This is a significant shift of perspective about pertussis epidemiology.  Continue reading

Less Than Half of Health Care Workers Receive Tdap Vaccine

MedicalResearch.com Interview with:
“Syringe and Vaccine” by NIAID is licensed under CC BY 2.0
Alissa C. O’Halloran, MSPH
Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta GA 30329 

MedicalResearch.com: What is the background for this study?

Response: Outbreaks of pertussis (whooping cough) can occur in healthcare settings. Vaccinating healthcare personnel (HCP) may be helpful in protecting HCP from pertussis and potentially limiting spread to others in healthcare settings.

The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for all adults, including pregnant women during each pregnancy, to protect themselves and reduce the risk for transmitting pertussis to infants too young to be vaccinated. To assure high Tdap coverage and disease prevention among HCP, patients, and others, ACIP recommends that healthcare employers provide Tdap vaccination to HCP and use approaches that maximize vaccination rates.

In this study, we assessed Tdap vaccination coverage among healthcare personnel  by occupation, industry, demographics, access-to-care characteristics, and by the 21 states in the study.

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Most Health Care Personnel Not Getting Tdap Vaccination

MedicalResearch.com Interview with:
Anup Srivastav, DVM, MPVM, PhD

National Center for Immunization and Respiratory Diseases (NCIRD)
Centers for Disease Control and Prevention
Atlanta GA

MedicalResearch.com: What is the background for this study?

Response: Healthcare personnel (HCP) are at risk for being exposed to pertussis (whooping cough) and spreading the disease to patients in their work settings. CDC recommends tetanus, diphtheria, acellular pertussis (Tdap) vaccination for healthcare personnel to reduce their risk of getting the disease and spreading it to patients. This is the first report of Tdap vaccination coverage among healthcare personnel by occupational setting.

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Breast Feeding Educates Baby’s Immune System

MedicalResearch.com Interview with:
Ameae M. Walker
Vice Provost for Academic Personnel
Distinguished Teaching Professor
Biomedical Sciences
School of Medicine
University of California, Riverside

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has previously been some evidence that immune cells in breast milk could pass through the wall of the immature gut, but if active they, like antibodies in milk, were considered likely a form of passive immunity. We now show that in addition to some maternal cells being active in the newborn (i.e. that they do contribute to passive cellular immunity), there are, more importantly, others that go to the thymus where they participate in selection of the neonate’s T cells. In this fashion, the neonate develops cells that recognize antigens against which the mother has been vaccinated – a process we have dubbed maternal educational immunity.

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Statins May Dampen Efficacy of Flu Vaccination

Saad Omer MBBS MPH PhD Associate Professor Emory Vaccine Center Associate Professor Global Health and Epidemiology Rollins School of Public Health Emory University

Dr. Saad Omer

MedicalResearch.com Interview with:
Saad Omer MBBS MPH PhD

Associate Professor Emory Vaccine Center
Associate Professor Global Health and Epidemiology
Rollins School of Public Health
Emory University

MedicalResearch: Can you give us a little background on this study?

Dr. Omer: My background is in global health, epidemiology and pediatrics and I have been fortunate to conduct field and clinical vaccine trials in a number of countries and with multiple infectious diseases including influenza, polio, measles and pneumococcal vaccines.

We were familiar with the data on investigating the potential effects of statins on other infections i.e. sepsis and community acquire pneumonia including

Dr. Vandermeer’s study in 2012 suggesting that “statin use may be associated with reduced mortality in patients hospitalized with influenza”.

Statins have lipid-lowering effects but they also exhibit anti-inflammatory and immunomodulatory properties. For lack of a better image, I think of statins as acting like a ‘big hammer made of Jell-O’: they have a broad, small dampening effect on immune response (as opposed to a narrow or deep effect).

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All Health Care Workers Should Receive Flu Vaccination Every Year

MedicalResearch.com Interview with:
Carla L. Black PhD Immunization Services Division National Center for Immunization and Respiratory Diseases CDC
Carla L. Black PhD
Immunization Services Division
National Center for Immunization and Respiratory Diseases
CDC 

Medical Research: What is the background for this study? What are the main findings?

Dr. Black: The Advisory Committee on Immunization Practices (ACIP) recommends that all health-care personnel (HCP) be vaccinated annually against influenza. Vaccination of health-care personnel can reduce influenza-related morbidity and mortality among HCP and their patients. Overall, 77.3% of HCP reported receiving an influenza vaccination in the 2014-15 season, similar to the 75.2% coverage among HCP reported in the 2013-14 season. Coverage was highest among  health-care personnel working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%).

Flu vaccination coverage was highest in settings with employer flu vaccination requirements and promotion of flu vaccination. Vaccination coverage was 96% among HCP with an employer requirement for vaccination. Among HCP without an employer requirement for vaccination, vaccination coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for one day (73.6%) or multiple days (83.9%) compared with  health-care personnel  working in settings where vaccination was promoted but not offered on-site (59.5%) or not promoted in any manner (44.0%).

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Easing of Pet Travel Restrictions Means More Dogs At Risk Of Rabies Entering Europe

MedicalResearch.com Interview with:
Siv Klevar, DVM,PhD.
Norwegian Veterinary Institute
Department of Diagnostics
Section of Immunology
Oslo

Medical Research: What is the background for this study?

Dr. Klevar:  Border control veterinary officers reported a surge in the number of imported dogs after the pet travel regulations were relaxed in 2012. At the same time rescue groups, through social media advertisement, encouraged and facilitated the adoption of dogs from shelters in Eastern Europe. The removal of the requirement regarding individual serological testing for antibodies to rabies before importing pets into UK, Ireland, Sweden, Malta and Norway, made it much easier to import pets into these countries. Previously import required several months of preparation and additional costs whereas under the new regulations it could be done after a single vaccination and a 3 week wait. The Norwegian Food Authority initiated a project to look at exotic pathogens in these re-homed dogs. This study reports the rabies antibody levels detected in some of the rehomed stray dogs entering Norway during 2012. The Norwegian Veterinary Institute and National Veterinary Institute in Sweden carried out the study.

Medical Research: What are the main findings?

Dr. Klevar: Our results showed that a high proportion of stray dogs, compared to a control group of pet dogs from Sweden, didn’t have sufficient protection against rabies virus after vaccination. Although we do not know exactly why this was the case, the exceedingly low levels of antibodies detected in some of the stray animals would suggest that they were not properly vaccinated, even though all the paperwork showed they were fully compliant with Pet Travel Regulations.

The main issue highlighted by this study is that the current regulations are not sufficient to prevent rabies introduction when importing rescue dogs from countries where the virus is present to countries free from the disease. The reason for this is that the current regulations do not require a check to see if the pet has been properly vaccinated (by testing the animal’s blood for antibodies). In addition to this, the 21 day waiting period after vaccination isn’t long enough for rabies to develop if the dog had been infected prior to vaccination.

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HPV Vaccination of Boys Can Yield Substantial Health Benefits

MedicalResearch.com Interview with:
Dr. Johannes Berkhof
Department of Epidemiology and Biostatistics, VU University Medical Centre
Amsterdam
Centre for Infectious Disease Control,
National Institute for Public Health and the Environment, Bilthoven, Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Vaccination against the sexually transmitted human papillomavirus (HPV) is offered free-of-charge to 12-year-old girls in the Netherlands.
There is strong evidence that HPV also causes cancer in men: the virus is associated with cancers of the penis, anus, and oropharynx, and possibly with a small proportion of oral cancers. A number of these cancers will be prevented because vaccination of girls leads to a decrease of  HPV in the general population and thus provides indirect protection to heterosexual men.

However, vaccine uptake among girls is only about 60 percent in the Netherlands. Moreover, men who have sex with men are at increased risk of HPV-related cancer and will not be protected by vaccination of girls.

On the basis of data from several epidemiological studies and a dynamic model for virus transmission, we calculated that, if the vaccine uptake is low, about 200 girls need to be vaccinated to prevent one case of cervical cancer and 470 boys need to be vaccinated to prevent one case of cancer in men.

An increase in vaccine uptake in girls will decrease the HPV infection risk in heterosexual men and if the uptake in girls is 60 percent, around 800 boys need to be vaccinated to prevent one additional case of cancer in men.

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Strong Evidence HPV Vaccination Highly Effective Outside Trial Settings

MedicalResearch.com Interview with: Marc Brisson Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease Associate Professor, Université LavalMedicalResearch.com Interview with:
Marc Brisson

Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease
Associate Professor, Université Laval

Medical Research: What is the background for this study? What are the main findings?

Response: Since 2007, 52 countries have implemented human papillomavirus vaccination (HPV) programmes. Two HPV vaccines are currently available worldwide: the bivalent vaccine, which targets HPV types 16 and 18, causing 70-80% of cervical cancer, and the quadrivalent vaccine, which also targets HPV types 6 and 11, associated with 85-95% of anogenital wart cases. Large international randomised controlled clinical trials have shown both vaccines to be safe, well tolerated and highly efficacious against vaccine-type persistent infections and precancerous cervical lesions.  Furthermore, both vaccines have shown some level of cross-protection against 3 HPV types (HPV 31, 33 and 45) not included in the vaccine and associated with a supplementary 10-15% of cervical cancers worldwide. Now that 7 years have elapsed since the implementation of the first HPV vaccination program, we verified whether the promising results from clinical trials are materialising at the population level. We conducted a meta-analysis to examine the population-level impact in countries that have introduced HPV vaccination programs.

In countries with high female vaccination coverage (<50%), our main findings indicate:

  • sharp declines in HPV-related outcomes among females targeted for vaccination (e.g., HPV-16/18 infection and anogenital warts declined by more than 60% in females younger than 20 years), and
  • evidence of cross-protection with significant reductions in HPV-31/33/45 infection among females younger than 20 years
  • evidence of herd effects (indirect benefit of vaccination among unvaccinated individuals) with significant reductions in anogenital warts among males and older females.

In countries with low coverage (<50%), we report:

  • significant reductions in HPV-16/18 infection and anogenital warts among young females, with no indication of herd effects or cross-protection. Continue reading

Many Parents Who Refuse Infant Vitamin K Refuse All Vaccinations For Their Children

dr_shannon_macdonaldMedicalResearch.com interview with:
Dr. Shannon MacDonald PhD
Department of Pediatrics, University of Calgary, Calgary and
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada


Medical Research: What are the main findings of the study?

Dr. MacDonald: We found that vitamin K was refused by only a very small number of parents in our study population (0.3%) but that the number appears to be increasing (almost doubling in the past 7 years). The parents that refused vitamin K for their child were more likely to be those that delivered at home and/or with a midwife. We also found that parents who refused vitamin K for their child were also much more likely to go on to refuse all vaccinations by 15 months of age.

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Private School Kids Less Likely To Receive All Vaccinations

Jana Shaw MD, MPH, FAAP Associate Professor of Pediatrics Pediatric Infectious Diseases SUNY Upstate Medical University 750 East Adams Street Syracuse, NY 13210MedicalResearch.com Interview with:
Jana Shaw MD, MPH, FAAP
Associate Professor of Pediatrics
Pediatric Infectious Diseases
SUNY Upstate Medical University
750 East Adams Street
Syracuse, NY 13210

Medical Research: What are the main findings of the study?

Dr. Shaw: In this study, we looked at exemptions to school immunization requirements in the US during 2009-2010 school year. We found that private schools have higher rates for all types of exemptions (medical, religious, and personal belief/philosophical). In addition, states that permitted personal belief exemptions had higher rates of exemptions overall compared to states that did not allow them.
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Hepatitis B: Preventing Transmission from Mother to Baby

Ai Kubo, MPH PhD Kaiser Permanente Division of Research 2000 Broadway Oakland, CA 94612MedicalResearch.com Interview with:
Ai Kubo, MPH PhD
Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612


MedicalResearch: What are the main findings of the study?

Dr. Kubo: The main findings of the study are three folds:

1)  The CDC guideline works for the majority of infants in preventing vertical transmission, if the immunizations are done according to the recommended schedule.

2) It takes an organized effort to case-manage each mother-infant pairs in order to achieve almost complete immunization rates and very low transmission rates.

3) Highest risk group was mothers with extremely high viral load and e-antigen positivity.  This group of women may benefit from additional therapy to prevent the vertical transmission. However, for others, the risk of transmission is extremely low as long as the infants are immunized according to the guideline.
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Vaccination Mortality No Different For Boys or Girls

Tessa Schurink-van 't Klooster Epidemioloog Rijksvaccinatieprogramma Epidemiologie en Surveillance RIVM - Centrum Infectieziektebestrijding 3720 BA BilthovenMedicalResearch.com Interview with
Tessa Schurink-van ‘t Klooster
Epidemioloog Rijksvaccinatieprogramma
Epidemiologie en Surveillance
RIVM – Centrum Infectieziektebestrijding
3720 BA Bilthoven

MedicalResearch: What are the main findings of the study?

Answer: The main finding of this study was that we observed no differences in mortality rate ratios for females compared to males related to the type of last offered vaccination in DTP- and MMR-eligible age groups.
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Fewer Infant Hospitalizations for Whooping Cough after Tdap Universal Recommendation

MedicalResearch.com Interview with
Katherine Auger, MD, MSc
Assistant Professor of Pediatrics
Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center

MedicalResearch.com: What are the main findings of the study?

Dr. Auger: We examined hospitalization rates in infants for pertussis before versus after the recommendation to universally vaccinate all adolescents with Tdap.  We used mathematical modeling to predict the number of infant hospitalizations that would be expected without the Tdap vaccine policy.  We then compared these predicted numbers to the actual observed numbers of infant hospitalizations.  In 3 of the 4 years after Tdap vaccine policy, there were significantly fewer infant hospitalizations for pertussis than expected base on the predictions.
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Idiopathic Juvenile Arthritis: Effects of MMR Booster Vaccination

Marloes Heijstek MD  University Medical Center, Wilhelmina Children's Hospital Department of Pediatric Immunology and Rheumatology Room number KC 03.063.0 P.O. Box 85090 Lundlaan 6 3508 AB UtrechtMedicalResearch.com Interview with:
Marloes Heijstek MD

University Medical Center, Wilhelmina Children’s Hospital
Department of Pediatric Immunology and Rheumatology
Room number KC 03.063.0
P.O. Box 85090 Lundlaan 6
3508 AB Utrecht

MedicalResearch.com: What are the main findings of the study?

Dr. Heijstek: The main findings of our study are that MMR booster vaccination does not affect JIA disease, does not cause flares of arthritis and induces high rates of protective immunity.
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