Publications by authors named "Carla Black"

64 Publications

Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity - United States, December 14, 2020-May 1, 2021.

MMWR Morb Mortal Wkly Rep 2021 Jun 4;70(22):818-824. Epub 2021 Jun 4.

Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category. SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties. During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. Vaccination coverage disparities were largest for two SVI themes: socioeconomic status (Q4 = 44.3% versus Q1 = 61.0%) and household composition and disability (Q4 = 42.0% versus Q1 = 60.1%). Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in high-SVI counties.
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http://dx.doi.org/10.15585/mmwr.mm7022e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174677PMC
June 2021

COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons - United States, December 14, 2020-February 14, 2021.

MMWR Morb Mortal Wkly Rep 2021 Mar 19;70(11):389-395. Epub 2021 Mar 19.

CDC COVID-19 Response Team.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.* Both vaccines require 2 doses for a completed series. The recommended interval between doses is 21 days for Pfizer-BioNTech and 28 days for Moderna; however, up to 42 days between doses is permissible when a delay is unavoidable. Two analyses of COVID-19 vaccine administration data were conducted among persons who initiated the vaccination series during December 14, 2020-February 14, 2021, and whose doses were reported to CDC through February 20, 2021. The first analysis was conducted to determine whether persons who received a first dose and had sufficient time to receive the second dose (i.e., as of February 14, 2021, >25 days from receipt of Pfizer-BioNTech vaccine or >32 days from receipt of Moderna vaccine had elapsed) had received the second dose. A second analysis was conducted among persons who received a second COVID-19 dose by February 14, 2021, to determine whether the dose was received during the recommended dosing interval, which in this study was defined as 17-25 days (Pfizer-BioNTech) and 24-32 days (Moderna) after the first dose. Analyses were stratified by jurisdiction and by demographic characteristics. In the first analysis, among 12,496,258 persons who received the first vaccine dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series, 8.6% had not received the second dose but remained within the allowable interval (≤42 days since the first dose), and 3.4% had missed the second dose (outside the allowable interval, >42 days since the first dose). The percentage of persons who missed the second dose varied by jurisdiction (range = 0.0%-9.1%) and among demographic groups was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (5.1%) and persons aged 16-44 years (4.0%). In the second analysis, among 14,205,768 persons who received a second dose, 95.6% received the dose within the recommended interval, although percentages varied by jurisdiction (range = 79.0%-99.9%). Public health officials should identify and address possible barriers to completing the COVID-19 vaccination series to ensure equitable coverage across communities and maximum health benefits for recipients. Strategies to ensure series completion could include scheduling second-dose appointments at the first-dose administration and sending reminders for second-dose visits.
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http://dx.doi.org/10.15585/mmwr.mm7011e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976616PMC
March 2021

Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2019-20 School Year.

MMWR Morb Mortal Wkly Rep 2021 Jan 22;70(3):75-82. Epub 2021 Jan 22.

State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten (kindergartners) in 48 states, exemptions for kindergartners in 49 states, and provisional enrollment and grace period status for kindergartners in 28 states for the 2019-20 school year, which was more than halfway completed when most schools moved to virtual learning in the spring because of the coronavirus 2019 (COVID-19) pandemic. Nationally, vaccination coverage was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 95.2% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required number of varicella vaccine doses. Although 2.5% of kindergartners had an exemption from at least one vaccine, another 2.3% were not up to date for MMR and did not have a vaccine exemption. Schools and immunization programs can work together to ensure that undervaccinated students are caught up on vaccinations in preparation for returning to in-person learning. This follow-up is especially important in the current school year, in which undervaccination is likely higher because of disruptions in vaccination during the ongoing COVID-19 pandemic (2-4).
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http://dx.doi.org/10.15585/mmwr.mm7003a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821768PMC
January 2021

Detection of Simulated Tactile Gratings by Electro-Static Friction Show a Dependency on Bar Width for Blind and Sighted Observers, and Preliminary Neural Correlates in Sighted Observers.

Front Neurosci 2020 14;14:548030. Epub 2020 Oct 14.

Biomedical Engineering Department, Faculty of Engineering, Helwan University, Helwan, Egypt.

The three-dimensional micro-structure of physical surfaces produces frictional forces that provide sensory cues about properties of felt surfaces such as roughness. This tactile information activates somatosensory cortices, and frontal and temporal brain regions. Recent advances in haptic-feedback technologies allow the simulation of surface micro-structures via electro-static friction to produce touch sensations on otherwise flat screens. These sensations may benefit those with visual impairment or blindness. The primary aim of the current study was to test blind and sighted participants' perceptual sensitivity to simulated tactile gratings. A secondary aim was to explore which brain regions were involved in simulated touch to further understand the somatosensory brain network for touch. We used a haptic-feedback touchscreen which simulated tactile gratings using digitally manipulated electro-static friction. In Experiment 1, we compared blind and sighted participants' ability to detect the gratings by touch alone as a function of their spatial frequency (bar width) and intensity. Both blind and sighted participants showed high sensitivity to detect simulated tactile gratings, and their tactile sensitivity functions showed both linear and quadratic dependency on spatial frequency. In Experiment 2, using functional magnetic resonance imaging, we conducted a preliminary investigation to explore whether brain activation to physical vibrations correlated with blindfolded (but sighted) participants' performance with simulated tactile gratings outside the scanner. At the neural level, blindfolded (but sighted) participants' detection performance correlated with brain activation in bi-lateral supplementary motor cortex, left frontal cortex and right occipital cortex. Taken together with previous studies, these results suggest that there are similar perceptual and neural mechanisms for real and simulated touch sensations.
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http://dx.doi.org/10.3389/fnins.2020.548030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591789PMC
October 2020

Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2020.

MMWR Morb Mortal Wkly Rep 2020 Oct 2;69(39):1391-1397. Epub 2020 Oct 2.

Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage.
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http://dx.doi.org/10.15585/mmwr.mm6939a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537555PMC
October 2020

Changing Age Distribution of the COVID-19 Pandemic - United States, May-August 2020.

MMWR Morb Mortal Wkly Rep 2020 Oct 2;69(39):1404-1409. Epub 2020 Oct 2.

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in more than 6,800,000 reported U.S. cases and more than 199,000 associated deaths.* Early in the pandemic, COVID-19 incidence was highest among older adults (1). CDC examined the changing age distribution of the COVID-19 pandemic in the United States during May-August by assessing three indicators: COVID-19-like illness-related emergency department (ED) visits, positive reverse transcription-polymerase chain reaction (RT-PCR) test results for SARS-CoV-2, the virus that causes COVID-19, and confirmed COVID-19 cases. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19-like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. Census regions. During June-August, COVID-19 incidence was highest in persons aged 20-29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20-39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range = 4-15 days), suggesting that younger adults likely contributed to community transmission of COVID-19. Given the role of asymptomatic and presymptomatic transmission (2), strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and subsequent transmission of SARS-CoV-2 to persons at higher risk for severe illness.
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http://dx.doi.org/10.15585/mmwr.mm6939e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537561PMC
October 2020

Provision of Pediatric Immunization Services During the COVID-19 Pandemic: an Assessment of Capacity Among Pediatric Immunization Providers Participating in the Vaccines for Children Program - United States, May 2020.

MMWR Morb Mortal Wkly Rep 2020 Jul 10;69(27):859-863. Epub 2020 Jul 10.

CDC COVID-19 Emergency Response Team.

Recent reports suggest that routine childhood immunization coverage might have decreased during the coronavirus disease 2019 (COVID-19) pandemic (1,2). To assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic, a survey of practices participating in the Vaccines for Children (VFC) program was conducted during May 12-20, 2020. Data were weighted to account for the sampling design; thus, all percentages reported are weighted. Among 1,933 responding practices, 1,727 (89.8%) were currently open; 1,397 (81.1%) of these reported offering immunization services to all of their patients. When asked whether the practice would likely be able to accommodate new patients to assist with provision of immunization services through August, 1,135 (59.1%) respondents answered affirmatively. These results suggest that health care providers appear to have the capacity to deliver routinely recommended childhood vaccines, allowing children to catch up on vaccines that might have been delayed as a result of COVID-19-related effects on the provision of or demand for routine well child care. Health care providers and immunization programs should educate parents on the need to return for well-child and immunization visits or refer patients to other practices, if they are unable to provide services (3).
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http://dx.doi.org/10.15585/mmwr.mm6927a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727596PMC
July 2020

Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers.

Vaccine 2020 07 22;38(33):5305-5312. Epub 2020 Jun 22.

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-4, Atlanta, GA 30326, United States; United States Department of Health and Human Services, 200 Independence Ave S.W., Washington, DC. 20201, United States. Electronic address:

The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.
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http://dx.doi.org/10.1016/j.vaccine.2020.05.073DOI Listing
July 2020

The impact of active research involvement of young children in the design of a new stereotest.

Res Involv Engagem 2020 6;6:29. Epub 2020 Jun 6.

Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK.

Background: Although considered important, the direct involvement of young children in research design is scarce and to our knowledge its impact has never been measured. We aim to demonstrate impact of young children's involvement in improving the understanding of a new 3D eye test or stereotest.

Methods: After a pre-measure of understanding was taken, we explored issues with the test instructions in patient and public involvement (PPI) sessions where children acted as advisers in the test design. Feedback was collected via observations, rating scales and verbal comments. An interdisciplinary panel reviewed the feedback, discussed potential changes to the test design, and decided on the implementation. Subsequently, a post-measure of understanding (Study 1-2) and engagement (Study 3) was collected in a pre-post study design. Six hundred fifty children (2-11.8 years old) took part in the pre-measure, 111 children (1-12 years old) in the subsequent PPI sessions, and 52 children (4-6 years old) in the first post-measure. One hundred twenty-two children (1-12 years old) and unrelated adults took then part in a second series of PPI sessions, and 53 people (2-39 years old) in the final post-measure. Adults were involved to obtain verbal descriptions of the target that could be used to explain the task to children.

Results: Following feedback in Study 1, we added a frame cue and included a shuffle animation. This increased the percentage of correct practice trials from 76 to 97% (t (231) = 14.29,  < .001), but more encouragements like 'Keep going!' were needed (t (64) = 8.25,  < .001). After adding a cardboard demo in Study 2, the percentage of correct trials remained stable but the number of additional instructions given decreased (t (103) = 3.72,  < .001) as did the number of encouragements (t (103) = 8.32,  < .001). Therefore, changes in test design following children's feedback significantly improved task understanding.

Conclusions: Our study demonstrates measurable impact of involvement of very young children in research design through accessible activities. The changes implemented following their feedback significantly improved the understanding of our test. Our approach can inform researchers on how to involve young children in research design and can contribute to developing guidelines for involvement of young children in research.
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http://dx.doi.org/10.1186/s40900-020-00194-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276065PMC
June 2020

Tetanus, Diphtheria, and Acellular Pertussis and Influenza Vaccinations among Women With a Live Birth, Internet Panel Survey, 2017-2018.

Infect Dis (Auckl) 2020 10;13:1178633720904099. Epub 2020 Feb 10.

Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Objectives: Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth.

Methods: An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs.

Results: Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy.

Conclusions: Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.
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http://dx.doi.org/10.1177/1178633720904099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011328PMC
February 2020

Characterizing the Randot Preschool stereotest: Testability, norms, reliability, specificity and sensitivity in children aged 2-11 years.

PLoS One 2019 7;14(11):e0224402. Epub 2019 Nov 7.

Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom.

Purpose: To comprehensively assess the Randot Preschool stereo test in young children, including testability, normative values, test/retest reliability and sensitivity and specificity for detecting binocular vision disorders.

Methods: We tested 1005 children aged 2-11 years with the Randot Preschool stereo test, plus a cover/uncover test to detect heterotropia. Monocular visual acuity was assessed in both eyes using Keeler Crowded LogMAR visual acuity test for children aged 4 and over.

Results: Testability was very high: 65% in two-year-olds, 92% in three-year-olds and ~100% in older children. Normative values: In 389 children aged 2-5 with apparently normal vision, 6% of children scored nil (stereoblind). In those who obtained a threshold, the mean log threshold was 2.06 log10 arcsec, corresponding to 114 arcsec, and the median threshold was 100 arcsec. Most older children score 40 arcsec, the best available score. We found a small sex difference, with girls scoring slightly but significantly better. Test/retest reliability: ~99% for obtaining any score vs nil. Agreement between stereo thresholds is poor in children aged 2-5; 95% limit of agreement = 0.7 log10 arcsec: five-fold change in stereo threshold may occur without any change in vision. In children over 5, the test essentially acts only as a binary classifier since almost all non-stereoblind children score 40 arcsec. Specificity (true negative rate): >95%. Sensitivity (true positive rate): poor, <50%, i.e. around half of children with a demonstrable binocular vision abnormality score well on the Randot Preschool.

Conclusions: The Randot Preschool is extremely accessible for even very young children, and is very reliable at classifying children into those who have any stereo vision vs those who are stereoblind. However, its ability to quantify stereo vision is limited by poor repeatability in children aged 5 and under, and a very limited range of scores relevant to children aged over 5.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224402PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837395PMC
March 2020

Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2018-19 School Year.

MMWR Morb Mortal Wkly Rep 2019 Oct 18;68(41):905-912. Epub 2019 Oct 18.

State and local school vaccination requirements exist to ensure that students are protected against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten in 49 states, exemptions for kindergartners in 50 states, and provisional enrollment and grace period status for kindergartners in 30 states. Nationally, vaccination coverage was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 94.7% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required doses of varicella vaccine. Whereas 2.5% of kindergartners had an exemption from at least one vaccine, 2.8% of kindergartners were not up to date for MMR and did not have a vaccine exemption. Nearly all states could achieve the recommended ≥95% MMR coverage if all nonexempt kindergartners were vaccinated in accordance with local and state vaccination policies.
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http://dx.doi.org/10.15585/mmwr.mm6841e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802678PMC
October 2019

Vaccination-Related Activities at Schools With Kindergartners: Evidence From a School Nurse Survey.

J Sch Nurs 2020 Dec 14;36(6):464-471. Epub 2019 May 14.

School-Based Surveillance Branch, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA.

Vaccination coverage among children in kindergarten varies across the country and within states. We surveyed a convenience sample of kindergarten school nurses to investigate self-reported vaccination-related activities conducted at schools nationwide. The majority of the 1,435 kindergarten school nurses responding reported that their schools communicate with parents and guardians of undervaccinated students by phone (96%), postal mail (67%), newsletters (61%), and e-mail (59%). Most respondents reported documenting vaccination coverage in electronic systems (85%) and sharing coverage reports with health departments (69%). A total of 41% of school nurses worked with external partners for vaccination efforts, the most common support received from partners being vaccine administration (38%) and providing materials/vaccines (21%). School nurses also reported that 95% of kindergartners were up to date for all vaccines. School-based vaccination-related activities are essential to sustaining high levels of vaccination coverage for the protection of children at schools and in the broader community.
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http://dx.doi.org/10.1177/1059840519847730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854288PMC
December 2020

ASTEROID: A New Clinical Stereotest on an Autostereo 3D Tablet.

Transl Vis Sci Technol 2019 Jan 28;8(1):25. Epub 2019 Feb 28.

Institute of Neuroscience, Newcastle University, Framlington Place, Newcastle upon Tyne, UK.

Purpose: To describe a new stereotest in the form of a game on an autostereoscopic tablet computer designed to be suitable for use in the eye clinic and present data on its reliability and the distribution of stereo thresholds in adults.

Methods: Test stimuli were four dynamic random-dot stereograms, one of which contained a disparate target. Feedback was given after each trial presentation. A Bayesian adaptive staircase adjusted target disparity. Threshold was estimated from the mean of the posterior distribution after 20 responses. Viewing distance was monitored via a forehead sticker viewed by the tablet's front camera, and screen parallax was adjusted dynamically so as to achieve the desired retinal disparity.

Results: The tablet must be viewed at a distance of greater than ∼35 cm to produce a good depth percept. Log thresholds were roughly normally distributed with a mean of 1.75 log arcsec = 56 arcsec and SD of 0.34 log arcsec = a factor of 2.2. The standard deviation agrees with previous studies, but ASTEROID thresholds are approximately 1.5 times higher than a similar stereotest on stereoscopic 3D TV or on Randot Preschool stereotests. Pearson correlation between successive tests in same observer was 0.80. Bland-Altman 95% limits of reliability were ±0.64 log arcsec = a factor of 4.3, corresponding to an SD of 0.32 log arcsec on individual threshold estimates. This is similar to other stereotests and close to the statistical limit for 20 responses.

Conclusions: ASTEROID is reliable, easy, and portable and thus well-suited for clinical stereoacuity measurements.

Translational Relevance: New 3D digital technology means that research-quality psychophysical measurement of stereoacuity is now feasible in the clinic.
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http://dx.doi.org/10.1167/tvst.8.1.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396686PMC
January 2019

Trends in Tdap vaccination among privately insured pregnant women in the United States, 2009-2016.

Vaccine 2019 03 27;37(14):1972-1977. Epub 2019 Feb 27.

Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States.

Background: Infants younger than 6 months are at increased risk of complications and mortality from pertussis infection. In October 2012, the Advisory Committee on Immunization Practices revised its recommendation to include a Tdap dose during each pregnancy, ideally between 27 and 36 weeks gestation.

Objective: Assess trends in Tdap vaccination coverage among privately insured pregnant women from 2009 to 2016 including timing of Tdap vaccination (before, during, or after pregnancy), trimester of vaccination for women vaccinated during pregnancy, and missed vaccination opportunities for unvaccinated women. Identify factors associated with vaccination during the optimal period of 27-36 weeks gestation.

Study Design: Retrospective analysis of privately insured women 15-49 years who delivered live births during 2009-2016 conducted using 2009-2016 MarketScan data. Tdap vaccination coverage and the timing of Tdap vaccine administration were assessed for women continuously enrolled from 6 months before pregnancy to 1 month after delivery. Multivariable logistic regression was performed to identify factors independently associated with receipt of Tdap vaccine at 27-36 weeks gestation.

Results: Tdap vaccination coverage during pregnancy increased from 0.4% in 2009 to 6.2% in 2012 and to 53.2% in 2016. The proportion of vaccinated women receiving Tdap at 27-36 weeks gestation increased from <10% in 2009 to nearly 90% in 2016, with most vaccination occurring at 27-32 weeks gestation. Women of older age, residing in a metropolitan statistical area, residing outside the South, and having a capitated health insurance plan were more likely to receive Tdap at 27-36 weeks gestation than their counterparts. Among women not vaccinated during pregnancy, 77.7% had a pregnancy-related medical claim between 27 and 36 weeks gestation.

Conclusion: Tdap vaccination coverage during pregnancy increased significantly from 2009 to 2016, with the greatest increase occurring after the revised Advisory Committee on Immunization Practices recommendation. Most women who did not receive Tdap vaccine had a missed vaccination opportunity during pregnancy, indicating potential for much higher vaccination coverage and consequent infant protection against pertussis.
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http://dx.doi.org/10.1016/j.vaccine.2019.02.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557580PMC
March 2019

Influenza Vaccination Coverage Among Pregnant Women in the U.S., 2012-2015.

Am J Prev Med 2019 04 16;56(4):477-486. Epub 2019 Feb 16.

Immunization Service Division, Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Pregnant women are at increased risk for severe illness from influenza and influenza-related complications. Vaccinating pregnant women is the primary strategy to protect them and their infants from influenza. This study aims to assess influenza vaccination coverage during three influenza seasons (2012-2015) from a national probability-based sampling survey and evaluate potential factors that influence vaccination uptake among pregnant women.

Methods: Data from the 2012 through 2015 National Health Interview Surveys were analyzed in 2017. Pregnant women aged 18-49 years were included in the analysis. The Kaplan-Meier survival analysis procedure was used for vaccination coverage in each season. Bivariate and multivariable logistic regression analyses were performed to examine factors associated with vaccination. Adjusted vaccination coverage and adjusted prevalence ratios are reported with corresponding 95% CIs.

Results: In the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, 40.4%, 45.4%, and 43.1% of pregnant women were vaccinated, respectively. Multivariable analysis indicated that factors independently associated with a lower likelihood of vaccination included having only a high school education, having three or less provider visits, and having no usual place of care (p<0.05). Less than half of women with ten or more visits were vaccinated (48.6%).

Conclusions: Vaccination coverage among pregnant women from this nationally representative sample was suboptimal during recent influenza seasons. Vaccination coverage was lower among certain sociodemographic, access-to-care subgroups. Multifactorial vaccination barriers may exist. Interventions, such as assessing vaccination history at every visit and implementing reminder-recall systems, standing orders, and addressing vaccination hesitancy, are needed to increase vaccination uptake among pregnant women.
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http://dx.doi.org/10.1016/j.amepre.2018.11.020DOI Listing
April 2019

Workplace Interventions and Vaccination-Related Attitudes Associated With Influenza Vaccination Coverage Among Healthcare Personnel Working in Long-Term Care Facilities, 2015‒2016 Influenza Season.

J Am Med Dir Assoc 2019 06 30;20(6):718-724. Epub 2019 Jan 30.

Assessment Branch, Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.

Objectives: Influenza vaccination of healthcare personnel working in long-term care (LTC) facilities can reduce influenza-related morbidity and mortality among healthcare personnel and among resident populations who are at increased risk for complications from influenza and who may respond poorly to vaccination. The objective of this study was to investigate workplace interventions and healthcare personnel vaccination-related attitudes associated with higher influenza vaccination coverage among healthcare personnel working in LTC facilities.

Setting And Participants: Data were obtained from an online survey of healthcare personnel conducted in April 2016 among a nonprobability sample of 2258 healthcare personnel recruited from 2 preexisting national opt-in Internet panels. Respondents were asked about influenza vaccination status, workplace vaccination policies and interventions, and their attitudes toward vaccination. Analyses were restricted to the 332 healthcare personnel who worked in nursing homes, assisted living facilities, or other LTC facilities.

Measures: Logistic regression models were used to assess the independent associations between each workplace intervention and higher influenza vaccination coverage compared with referent levels, controlling for occupation, age, and race/ethnicity. Prevalence ratios were calculated under the assumption of simple random sampling.

Results: Approximately 77% of healthcare personnel working in LTC facilities reported receiving influenza vaccination in the 2015‒2016 influenza season. Influenza vaccination was independently associated with an employer vaccination requirement (prevalence ratio (PR) [95% confidence interval] = 1.28 [1.11, 1.47]), being offered free onsite vaccination (PR = 1.20 [1.04, 1.39]), and employers publicizing vaccination coverage level to employees (PR = 1.24 [1.09, 1.41]). Vaccination was most highly associated with a combination of 3 or more workplace interventions. Most healthcare personnel working in LTC facilities reported positive attitudes toward the safety and effectiveness of influenza vaccination.

Conclusions/implications: Implementing employer vaccination interventions in LTC facilities, including employer vaccination requirements and free on-site influenza vaccination that is actively promoted, could increase influenza vaccination among healthcare personnel.
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http://dx.doi.org/10.1016/j.jamda.2018.11.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538419PMC
June 2019

Influenza vaccination among adults living with persons at high-risk for complications from influenza during early 2016-17 influenza season.

Vaccine 2018 12 15;36(52):7987-7992. Epub 2018 Nov 15.

RTI International, Research Triangle Park, NC, USA.

Background: The Advisory Committee on Immunization Practices (ACIP) recommends all persons aged ≥6 months get vaccinated for influenza annually, placing particular emphasis on persons who are at increased risk for influenza-related complications and persons living with or caring for them.

Methods: Data from the 2016 National Internet Flu Survey (NIFS), a nationally representative, probability-based Internet panel survey of the noninstitutionalized U.S. civilian population aged ≥18 years, was used to compare influenza vaccination coverage among adults who live with household members at high-risk for complications from influenza with those who do not. Logistic regression was used to evaluate the difference in the adjusted vaccination coverage prevalence between persons living with and without high-risk household members.

Results: From the 2016 NIFS (n = 4,113), we estimated that 29.2% of noninstitutionalized U.S. adults had at least one household member at increased risk for influenza-related complications. Unadjusted influenza vaccination coverage was significantly higher for adults with a high-risk household member compared with those without (46.7% vs 38.6%, respectively). After adjustment for demographic and access-to-care factors, adults with high-risk household members were more likely to be vaccinated than those without (adjusted prevalence difference = 5.3 [0.3, 10.3]). Among vaccinated respondents with high-risk household members, 88.7% reported that protection of their family and close contacts was one of the reasons they were vaccinated.

Conclusion: Approximately half of adults living with someone at increased risk of complications from influenza did not report receiving an influenza vaccination. Vaccination reminder/recall for persons at increased risk should include reminders for their household contacts.
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http://dx.doi.org/10.1016/j.vaccine.2018.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478164PMC
December 2018

Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers.

Vaccine 2018 11 22;36(48):7316-7323. Epub 2018 Oct 22.

National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.

Introduction: Staying home when sick can reduce the spread of influenza. The objectives of this study were to quantify the percentage of workers who had paid sick leave (PSL) benefits, examine sociodemographic characteristics that may be associated with having these benefits, and examine the association between having PSL benefits and use of sick days and influenza vaccination status.

Methods: The public-use dataset from the 2009 National H1N1 Flu Survey (NHFS) were analyzed in 2017. Wald chi-square tests and t-tests were used to test for associations between having PSL benefits and sociodemographic characteristics and industry and occupation groups, the associations between having PSL benefits and seeking treatment when sick with influenza-like illness (ILI), and taking days off work when sick with ILI. Logistic regression was used to determine variables associated with having PSL benefits and the association between having PSL benefits and influenza vaccination status.

Results: Sixty-one percent of employed adults reported having PSL benefits during the 2009-10 influenza season. Being younger, female, Hispanic, less educated, or a farm/blue collar worker were associated with reduced likelihood of having PSL benefits. Not having PSL benefits was associated with a lower likelihood of receiving an influenza vaccination and visiting a health professional when sick with ILI.

Conclusions: The percentage of workers who have PSL benefits differs by sociodemographic characteristics and industry/occupation groups. Offering PSL benefits along with promoting influenza vaccination and encouraging employees with ILI to stay home can increase influenza vaccination coverage and help control the spread of influenza.
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http://dx.doi.org/10.1016/j.vaccine.2018.10.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433122PMC
November 2018

Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2017-18 School Year.

MMWR Morb Mortal Wkly Rep 2018 Oct 12;67(40):1115-1122. Epub 2018 Oct 12.

State and local school vaccination requirements exist to ensure that students are protected from vaccine-preventable diseases (1). This report summarizes vaccination coverage and exemption estimates collected by state and local immunization programs* for children in kindergarten (kindergartners) in 49 states and the District of Columbia (DC) and kindergartners provisionally enrolled (attending school without complete vaccination or exemption while completing a catch-up vaccination schedule) or in a grace period (a set interval during which a student may be enrolled and attend school without proof of complete vaccination or exemption) for 28 states. Median vaccination coverage was 95.1% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 94.3% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 93.8% for 2 doses of varicella vaccine. The median percentage of kindergartners with an exemption from at least one vaccine was 2.2%, and the median percentage provisionally enrolled or attending school during a grace period was 1.8%. Vaccination coverage among kindergartners remained high; however, schools can improve coverage by following up with students who are provisionally enrolled, in a grace period, or lacking complete documentation of required vaccinations.
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http://dx.doi.org/10.15585/mmwr.mm6740a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181259PMC
October 2018

Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2018.

MMWR Morb Mortal Wkly Rep 2018 Sep 28;67(38):1055-1059. Epub 2018 Sep 28.

Vaccinating pregnant women with influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines can reduce the risk for influenza and pertussis for themselves and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered any time during pregnancy (1). The ACIP also recommends that women receive Tdap during each pregnancy, preferably from 27 through 36 weeks' gestation (2). To assess influenza and Tdap vaccination coverage among women pregnant during the 2017-18 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 10, 2018. Among 1,771 survey respondents pregnant during the peak influenza vaccination period (October 2017-January 2018), 49.1% reported receiving influenza vaccine before or during their pregnancy. Among 700 respondents who had a live birth, 54.4% reported receiving Tdap during their pregnancy. Women who reported receiving a provider offer of vaccination had higher vaccination coverage than did women who received a recommendation but no offer and women who did not receive a recommendation. Reasons for nonvaccination included concern about effectiveness of the influenza vaccine and lack of knowledge regarding the need for Tdap vaccination during every pregnancy. Provider offers or referrals for vaccination in combination with patient education could reduce missed opportunities for vaccination and increase vaccination coverage among pregnant women.
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http://dx.doi.org/10.15585/mmwr.mm6738a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188122PMC
September 2018

Influenza Vaccination Coverage Among Health Care Personnel - United States, 2017-18 Influenza Season.

MMWR Morb Mortal Wkly Rep 2018 Sep 28;67(38):1050-1054. Epub 2018 Sep 28.

The Advisory Committee on Immunization Practices (ACIP) recommends that all health care personnel receive an annual influenza vaccination to reduce influenza-related morbidity and mortality among health care personnel and their patients and to reduce absenteeism among health care personnel (1-4). CDC conducted an opt-in Internet panel survey of 2,265 U.S. health care personnel to estimate influenza vaccination coverage among these persons during the 2017-18 influenza season. Overall, 78.4% of health care personnel reported receiving influenza vaccination during the 2017-18 season, similar to reported coverage in the previous four influenza seasons (5). As in previous seasons, coverage was highest among personnel who were required by their employer to be vaccinated (94.8%) and lowest among those working in settings where vaccination was not required, promoted, or offered on-site (47.6%). Health care personnel working in long-term care settings, the majority of whom work as assistants or aides, have lower influenza vaccination coverage than do health care personnel working in all other health care settings, which puts the elderly in long-term settings at increased risk for severe complications for influenza. Implementing workplace strategies shown to improve vaccination coverage among health care personnel, including vaccination requirements and active promotion of on-site vaccinations at no cost, can help ensure health care personnel and patients are protected against influenza (6). CDC's long-term care web-based toolkit* provides resources, strategies, and educational materials for increasing influenza vaccination among health care personnel in long-term care settings.
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http://dx.doi.org/10.15585/mmwr.mm6738a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188123PMC
September 2018

U.S. clinicians' and pharmacists' reported barriers to implementation of the Standards for Adult Immunization Practice.

Vaccine 2018 10 20;36(45):6772-6781. Epub 2018 Sep 20.

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329-4027, USA.

Background: The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated.

Methods: Data from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated.

Results: High percentages (70.0%-97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS.

Conclusion: Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.
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http://dx.doi.org/10.1016/j.vaccine.2018.09.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397956PMC
October 2018

Clinicians' and Pharmacists' Reported Implementation of Vaccination Practices for Adults.

Am J Prev Med 2018 09 24;55(3):308-318. Epub 2018 Jul 24.

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Berry Technology Solutions, Inc., Peachtree City, Georgia.

Introduction: Despite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians' and pharmacists' self-reported implementation of the Standards for Adult Immunization Practice ("the Standards"; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems).

Methods: Two Internet panel surveys (one among clinicians and one among pharmacists) were conducted during February-March 2017 and asked respondents about their practice's implementation of the Standards. T-tests assessed associations between clinician medical specialty, vaccine type, and each component of the Standards (March-August 2017).

Results: Implementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines.

Conclusions: This report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.
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http://dx.doi.org/10.1016/j.amepre.2018.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166242PMC
September 2018

Agreement with employer influenza vaccination requirements among us healthcare personnel during the 2016-2017 season.

Infect Control Hosp Epidemiol 2018 08 20;39(8):1019-1020. Epub 2018 Jun 20.

4Immunization Services Division,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.

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http://dx.doi.org/10.1017/ice.2018.111DOI Listing
August 2018

Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease.

Vaccine 2018 02;36(9):1183-1189

Division of Viral Hepatitis, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.

Background: Infection with hepatitis A and hepatitis B virus can increase the risk of morbidity and mortality in persons with chronic liver disease (CLD). The Advisory Committee on Immunization Practices recommends hepatitis A (HepA) and hepatitis B (HepB) vaccination for persons with CLD.

Methods: Data from the 2014 and 2015 National Health Interview Surveys (NHIS), nationally representative, in-person interview surveys of the non-institutionalized US civilian population, were used to assess self-reported HepA (≥1 and ≥2 doses) and HepB vaccination (≥1 and ≥3 doses) coverage among adults who reported a chronic or long-term liver condition. Multivariable logistic regression was used to identify factors independently associated with HepA and HepB vaccination among adults with CLD.

Results: Overall, 19.4% and 11.5% of adults aged ≥ 18 years with CLD reported receiving ≥1 dose and ≥2 doses of HepA vaccine, respectively, compared with 14.7% and 9.1% of adults without CLD (p < .05 comparing those with and without CLD, ≥1dose). Age, education, geographic region, and international travel were associated with receipt of ≥2 doses HepA vaccine among adults with CLD. Overall, 35.7% and 29.1% of adults with CLD reported receiving ≥1 dose and ≥3 doses of HepB vaccine, respectively, compared with 30.2% and 24.7% of adults without CLD (p < .05 comparing those with and without CLD, ≥1 dose). Age, education, and receipt of influenza vaccination in the past 12 months were associated with receipt of ≥3 doses HepB vaccine among adults with CLD. Among adults with CLD and ≥10 provider visits, only 13.8% and 35.3% had received ≥2 doses HepA and ≥3 doses HepB vaccine, respectively.

Conclusions: HepA and HepB vaccination among adults with CLD is suboptimal and missed opportunities to vaccinate occurred. Providers should adhere to recommendations to vaccinate persons with CLD to increase vaccination among this population.
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http://dx.doi.org/10.1016/j.vaccine.2018.01.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805590PMC
February 2018

Tdap Vaccination Among Healthcare Personnel-21 States, 2013.

Am J Prev Med 2018 Jan 21;54(1):119-123. Epub 2017 Nov 21.

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings.

Methods: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%.

Results: Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington.

Conclusions: Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel.
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http://dx.doi.org/10.1016/j.amepre.2017.09.017DOI Listing
January 2018

Influenza Vaccination Coverage Among Pregnant Women - United States, 2016-17 Influenza Season.

MMWR Morb Mortal Wkly Rep 2017 Sep 29;66(38):1016-1022. Epub 2017 Sep 29.

Pregnant women and their infants are at increased risk for severe influenza-associated illness (1), and since 2004, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for all women who are or might be pregnant during the influenza season, regardless of the trimester of the pregnancy (2). To assess influenza vaccination coverage among pregnant women during the 2016-17 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 7, 2017. Among 1,893 survey respondents pregnant at any time during October 2016-January 2017, 53.6% reported having received influenza vaccination before (16.2%) or during (37.4%) pregnancy, similar to coverage during the preceding four influenza seasons. Also similar to the preceding influenza season, 67.3% of women reported receiving a provider offer for influenza vaccination, 11.9% reported receiving a recommendation but no offer, and 20.7% reported receiving no recommendation; among these women, reported influenza vaccination coverage was 70.5%, 43.7%, and 14.8%, respectively. Among women who received a provider offer for vaccination, vaccination coverage differed by race/ethnicity, education, insurance type, and other sociodemographic factors. Use of evidence-based practices such as provider reminders and standing orders could reduce missed opportunities for vaccination and increase vaccination coverage among pregnant women.
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http://dx.doi.org/10.15585/mmwr.mm6638a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657675PMC
September 2017

Influenza Vaccination Coverage Among Health Care Personnel - United States, 2016-17 Influenza Season.

MMWR Morb Mortal Wkly Rep 2017 Sep 29;66(38):1009-1015. Epub 2017 Sep 29.

The Advisory Committee on Immunization Practices (ACIP) recommends that all health care personnel (HCP) receive an annual influenza vaccination to reduce influenza-related morbidity and mortality among HCP and their patients and to reduce absenteeism among HCP (1-4). To estimate influenza vaccination coverage among HCP in the United States during the 2016-17 influenza season, CDC conducted an opt-in Internet panel survey of 2,438 HCP. Overall, 78.6% of survey respondents reported receiving vaccination during the 2016-17 season, similar to reported coverage in the previous three influenza seasons (5). Vaccination coverage continued to be higher among HCP working in hospitals (92.3%) and lower among HCP working in ambulatory (76.1%) and long-term care (LTC) (68.0%) settings. As in previous seasons, coverage was highest among HCP who were required by their employer to be vaccinated (96.7%) and lowest among HCP working in settings where vaccination was not required, promoted, or offered on-site (45.8%). Implementing workplace strategies found to improve vaccination coverage among HCP, including vaccination requirements or active promotion of on-site vaccinations at no cost, can help ensure that HCP and patients are protected against influenza (6).
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http://dx.doi.org/10.15585/mmwr.mm6638a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657674PMC
September 2017

Text4baby Influenza Messaging and Influenza Vaccination Among Pregnant Women.

Am J Prev Med 2017 Dec 30;53(6):845-853. Epub 2017 Aug 30.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: Pregnant women are at risk for severe influenza-related complications; however, only 52% reported receiving an influenza vaccination during the 2013-2014 influenza season. Text4baby, a free national text service, provides influenza vaccination education and reminders to pregnant women. This study examined reported influenza vaccination during pregnancy among Text4baby participants who reported receiving influenza messages and women who reported never participating in Text4baby.

Methods: Opt-in Internet Panel Surveys (April 2013 and 2014) of pregnant women collected demographic and other characteristics; influenza vaccination knowledge, attitudes, and behaviors; and Text4baby participation. Women aged 18-49 years, pregnant anytime from October to January (N=3,321) were included. Text4baby influenza message recallers reported receiving Text4baby influenza messages during their current/most recent pregnancy (n=377). Text4baby non-participants reported never receiving Text4baby messages (n=2,824). Multivariable logistic regression was performed (2014-2016) controlling for demographic and other characteristics, high-risk conditions, and provider recommendation and offer to vaccinate. Adjusted prevalence ratios (APRs) were calculated. Random sampling was assumed for this non-probability sample.

Results: Text4baby recallers were more likely than non-participants to report influenza vaccination regardless of receipt of provider recommendation and/or offer to vaccinate (provider recommendation/offer APR=1.29, 95% CI=1.21, 1.37, provider recommendation/no offer APR=1.52, 95% CI=1.07, 2.17). Among women receiving neither a provider recommendation nor offer to vaccinate, Text4baby recallers were more than three times as likely to report influenza vaccination compared with non-participants (APR=3.39, 95% CI=2.03, 5.67).

Conclusions: Text4baby status was associated with higher influenza vaccination, especially among women whose provider did not recommend or offer the vaccine. Encouraging Text4baby enrollment may help ensure influenza vaccination is given to protect mothers and infants.
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http://dx.doi.org/10.1016/j.amepre.2017.06.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813485PMC
December 2017