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Vadaparampil S.T.,Moffitt Cancer Center | Kahn J.A.,Cincinnati Childrens Hospital Medical Center | Salmon D.,National Vaccine Program Office | Lee J.-H.,Moffitt Cancer Center | And 8 more authors.
Vaccine | Year: 2011

Objective: The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus (HPV) vaccination in early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) female patients by physician specialty, and to identify factors associated with recommendation in early adolescents. Methods: A 38-item survey was conducted April 2009 through August 2009 among a nationally representative random sample of 1538 Family Physicians, Pediatricians, and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile. A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination (" always" = 76-100% of the time vs. other = 0-75%) within the past 12. months. Results: Completed surveys were received from 1013 physicians, including 500 Family Physicians, 287 Pediatricians, and 226 Obstetricians and Gynecologists (response rate = 67.8%). Across the specialties, 34.6% of physicians reported they " always" recommend the HPV vaccine to early adolescents, 52.7% to middle adolescents, and 50.2% to late adolescents/young adults. The likelihood of " always" recommending the HPV vaccine was highest among Pediatricians for all age groups (P< 0.001). Physician specialty, age, ethnicity, reported barriers, and Vaccines for Children provider status were significantly associated with " always" recommending HPV vaccination for early adolescents. Conclusions: Findings suggest missed clinical opportunities for HPV vaccination, and perceived barriers to vaccination may drive decisions about recommendation. Results suggest the need for age and specialty targeted practice and policy level interventions to increase HPV vaccination among US females. © 2011 Elsevier Ltd.


Shen A.K.,National Vaccine Program Office | Mead P.S.,National Center for Emerging and Zoonotic Infectious Diseases | Beard C.B.,National Center for Emerging and Zoonotic Infectious Diseases
Clinical Infectious Diseases | Year: 2011

Lyme disease, which is caused by the spirochetal agent Borrelia burgdoferi, is the most common vector-borne illness in the United States. In 1998, the US Food and Drug Administration approved a recombinant Lyme disease vaccine that was later voluntarily withdrawn from the market by the manufacturer. Current Lyme disease prevention efforts focus on a combination of methods and approaches, including area acaricides, landscape management, host-targeted interventions, management of deer populations, and personal protective measures, such as the use of insect repellant and tick checks. Although these methods are generally safe and relatively inexpensive, the primary limitations of these methods are that their effectiveness has been difficult to demonstrate conclusively and that rates of compliance are generally poor. An effective human Lyme disease vaccine that has been adequately evaluated in the highest-risk population groups could be very beneficial in preventing Lyme disease; however, it would need to meet high standards regarding safety, efficacy, cost, and public acceptance. © 2011 The Author.


Wu L.A.,National Vaccine Program Office | Wu L.A.,Johns Hopkins University | Katz J.,Johns Hopkins University | Mullany L.C.,Johns Hopkins University | And 4 more authors.
Child: Care, Health and Development | Year: 2012

Context The Ten Questions tool was developed in 1984 as a low-cost, simple screen for childhood disability and referral for diagnosis in low-resource settings, and its use in Nepal has not been previously evaluated. Preterm birth and intrauterine growth restriction are potential risk factors for child disability and loss of developmental potential, but there are few studies examining this relationship from developing settings. Objective To examine the associations of small for gestational age and preterm birth as predictors of Ten Questions Plus positivity. Design, setting and participants The Ten Questions Plus questionnaire was administered to caregivers of 680 children between 2 and 5 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had previously been enrolled in a randomized trial of chlorhexidine cleansing at birth. At 1 month of age, children were then enrolled into a randomized 2 × 2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006. Intervention None. Main outcome measure Positive screen on the Ten Questions Plus tool defined as a positive response to one or more questions. Results Of preterm children, 37 (33.6%) had a positive response to at least one question on the Ten Questions Plus and were considered at risk for disability. One hundred and seventy term children (29.8%) were at risk for disability. Conclusions The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for mental and physical disability to be targeted for further examination. The prevalence of parent-reported disabilities is high in this population (almost one-third of children); children who are both preterm and small-for-gestational age are at increased risk for motor milestone delay, reported learning difficulty, speech and behavioural problems. Intrauterine growth restriction may affect child development and result in disabilities later in childhood. © 2011 Blackwell Publishing Ltd.


Libby T.E.,California Emerging Infections Program | Stevenson J.,Centers for Disease Control and Prevention | Lindley M.C.,Centers for Disease Control and Prevention | Grabowsky M.,National Vaccine Program Office | And 2 more authors.
Journal of Allied Health | Year: 2014

To help protect healthcare personnel (HCP) from infection and to prevent possible disease transmission to their patients, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination of all HCP, including students. We sought to gather information on the vaccination policies of U.S. health professional (i.e., non-physician HCP) programs and to compare those requirements to current ACIP recommendations. METHODS. A self-administered, internetbased survey sent to 2,779 U.S. health professional programs was used to collect data on program demographics; student vaccination requirements; deadlines for adherence, consequences for non-adherence, and permitted exemptions to these requirements; and factors influencing the program's vaccination policy. RESULTS. The response rate was 75%. Among 2,077 responding programs, 19% required all ACIP-recommended vaccines for HCP - 87% required measles, mumps, and rubella; 84% required hepatitis B; 75% required varicella; 48% required tetanus, diphtheria, and acellular pertussis (Tdap); and 32% required influenza. Programs reviewing requirements at least annually and those that reported the ACIP influenced requirements were significantly more likely to require varicella, Tdap, and influenza vaccine. During the 2009-2010 influenza season, only 59% of programs offered influenza vaccine to students. CONCLUSION. Health professional schools should update their vaccination requirements annually to be consistent with ACIP recommendations. © 2014 Association of Schools of Allied Health Professions, Wash., DC.


Shen A.K.,National Vaccine Program Office | Andrus J.K.,Sabin Vaccine Institute | Pecenka C.,PATH | Atherly D.,PATH | And 2 more authors.
Health Affairs | Year: 2016

Since the mid-2000s low- and lower-middle-income countries have been focusing on developing and using evidence for immunization policy making, with an increasing emphasis on cost-effectiveness analysis, program costing, and financial flows-particularly for the introduction of newer, more expensive vaccines. While this is critical to informing decisions, countries still need to increase national immunization investment and explore innovative approaches to augment financing of immunization programs. The need for increased financing is especially strong in countries transitioning from support by Gavi, the Vaccine Alliance. With increased fiscal space to finance health and immunization programs as a result of improved economic performance, low- and lowermiddle- income countries can reach the health status enjoyed by wealthier nations within a generation. However, new strategies and approaches related to domestic resources for immunization programs are needed to achieve this goal. Governments will need to increase their investments and modify existing external immunization financing arrangements if country ownership of immunization programs and the full promise of new vaccines are to be realized. © 2016 by Project HOPE- The People-to-People Health Foundation.

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