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Bishai D.,Family and Reproductive Health | Nair D.,Family and Reproductive Health | Nabyonga-Orem J.,World Health Organization | Fiona-Makmot B.,Immunization Program | And 2 more authors.
Journal of Infectious Diseases | Year: 2011

Supplemental Immunization Activities (SIAs) have become an important adjunct to measles control efforts in countries that endeavor to achieve higher levels of population immunity than can be achieved in a growing routine immunization system. Because SIAs are often supported with funds that have alternative uses, decision makers need to know how cost-effective they are compared with other options. This study integrated a dynamic stochastic model of measles transmission in Uganda (2010-2050) with a cost model to compare a strategy of maintaining Uganda's current (2008) levels of the first dose of routine measles-containing vaccine (MCV1) coverage at 68% with SIAs with a strategy using the same levels of MCV1 coverage without SIAs. The stochastic model was fitted with parameters drawn from district-level measles case reports from Uganda, and the cost model was fitted to administrative data from the Ugandan Expanded Program on Immunization and from the literature. A discount rate of 0.03, time horizon of 2010-2050, and a societal perspective on costs were assumed. Costs expressed in US dollars (2010) included vaccination costs, disease treatment costs including lost productivity of mothers, as well as costs of outbreaks and surveillance. The model estimated that adding on triennial SIAs that covered 95% of children aged 12-59 months to a system that achieved routine coverage rates of 68% would have an incremental cost-effectiveness ratio (ICER) of $1.50 ($US 2010) per disability-adjusted life year averted. The ICER was somewhat higher if the discount rate was set at either 0 or 0.06. The addition of SIAs was found to make outbreaks less frequent and lower in magnitude. The benefit was reduced if routine coverage rates were higher. This cost-effectiveness ratio compares favorably to that of other commonly accepted public health interventions in sub-Saharan Africa. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. Source

Fagnan L.J.,Oregon Health And Science University | Gaudino J.A.,Immunization Program | Mahler J.,Oregon Health And Science University | Sussman A.L.,University of New Mexico | Holub J.,Oregon Health And Science University
Journal of Rural Health | Year: 2011

Context: Little is known about rural clinicians' perspectives regarding early childhood immunization delivery, their adherence to recommended best immunization practices, or the specific barriers they confront. Purpose: To examine immunization practices, beliefs, and barriers among rural primary care clinicians for children in Oregon and compare those who deliver all recommended immunizations in their practices with those who do not. Methods: A mailed questionnaire was sent to all physicians, nurse practitioners, and physician assistants practicing primary care in rural communities throughout Oregon. Findings: While 39% of rural clinicians reported delivering all childhood immunizations in their clinic, 43% of clinicians reported that they refer patients elsewhere for some vaccinations, and 18% provided no immunizations in the clinic whatsoever. Leading reasons for referral include inadequate reimbursement, parental request, and storage and stocking difficulties. Nearly a third of respondents reported that they had some level of concern about the safety of immunizations, and 14% reported that concerns about safety were a specific reason for referring. Clinicians who delivered only some of the recommended immunizations were less likely than nonreferring clinicians to have adopted evidence-based best immunization practices. Conclusions: This study of rural clinicians in Oregon demonstrates the prevalence of barriers to primary care based immunization delivery in rural regions. While some barriers may be difficult to overcome, others may be amenable to educational outreach and support. Thus, efforts to improve population immunization rates should focus on promoting immunization "best practices" and enhancing the capacity of practices to provide immunizations and ensuring that any alternative means of delivering immunizations are effective. © 2011 National Rural Health Association. Source

Mahdi I.,Immunization Program | Jevertson J.,Santa Fe Mountain Center | Schrader R.,University of New Mexico | Nelson A.,New Mexico Forum for Youth in Community | Ramos M.M.,University of New Mexico
Journal of School Health | Year: 2014

BACKGROUND: For schools to be safe and supportive for students, school health professionals should be aware of the particular challenges lesbian, gay, bisexual, transgender, or questioning (LGBTQ) students face, especially the risk for discrimination, violent victimization, and depression in the school setting. We assessed school health professionals' preparedness to address needs of LGBTQ students. METHODS: We conducted a secondary analysis of data collected during a New Mexico school health conference. This analysis focused on the preparedness of 183 school nurses, counselors, and social workers to address needs of LGBTQ students. Data were analyzed by using chi-square tests, other non-parametric tests, and logistic regression. RESULTS: Social workers (84.6%) and counselors (81.5%) were more likely than school nurses (55.8%) to report moderate or high knowledge of LGBTQ youth health risks, including suicide and depression (p < .001). Approximately half of school counselors and social workers reported no or low knowledge of LGBTQ community-based organizations or knowledge of counselors experienced with LGBTQ concerns. CONCLUSION: School health professionals in New Mexico do not appear prepared to address needs of LGBTQ students. Schools should consider integrating specific content about LGBTQ health risks and health disparities in trainings regarding bullying, violence, cultural competency, and suicide prevention. © 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. Source

Hanson M.P.,Centers for Disease Control and Prevention | Hanson M.P.,University of Washington | Hanson M.P.,Bill and Melinda Gates Foundation | Kwan-Gett T.S.,University of Washington | And 4 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objectives: To describe the epidemiology of infant pertussis in King County, Washington, and to better understand the implications for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination among older children, adolescents, and adults. Design: Retrospective analysis of reported pertussis cases among infants younger than 1 year, January 1, 2002, through December 31, 2007. Setting: King County, Washington. Participants: Reported pertussis cases among infants younger than 1 year between 2002 and 2007. Main Outcome Measures: Bordetella pertussis from a household member or close contact was the primary exposure. The main outcome measures were age and vaccination status, incidence by race/ethnicity, suspected exposure, and Tdap eligibility of household members and close contacts. Results: Among 176 confirmed cases of infants with pertussis, the median age was 3 months (age range, 0-11 months); 80.1% were younger than 6 months. Seventy-seven percent were age-appropriately vaccinated. Between 2002 and 2007, the overall mean annual incidence was 136 cases per 100 000 infant population. Compared with a mean annual incidence of 73 cases per 100 000 infant population among whites, the incidence was 246 cases per 100 000 infant population among blacks (rate ratio [RR], 3.37; 95% confidence interval [CI], 2.59-4.44) and 194 cases per 100 000 infant population among Hispanics (RR, 2.66;95% CI, 2.02-3.53). Households were the suspected exposure location for 70.0% of cases. Case households had a median of 3 (range, 1-15) Tdap-eligible persons. Conclusions: The burden of infant pertussis in King County, Washington, was high between 2002 and 2007, especially among racial/ethnic minorities. Tdap vaccination of eligible household members and close contacts should be promoted as an additional means of protecting infants from pertussis. ©2011 American Medical Association. All rights reserved. Source

Kattan J.A.,Centers for Disease Control and Prevention | Kudish K.S.,Immunization Program | Cadwell B.L.,Laboratory Services | Soto K.,Infectious Diseases Section | Hadler J.L.,Connecticut Emerging Infections Program
American Journal of Public Health | Year: 2014

Objectives: We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. Methods: We examined predictors of underimmunization among the 2006 birth cohort (n= 34 568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. Results: Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. Conclusions: SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities. Source

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