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1.
Aiden Kennedy Varan Alejandra Esteves-Jaramillo Vesta Richardson Marcelino Esparza-Aguilar Patricia Cervantes-Powell Saad B. Omer 《Vaccine》2014
Objective
Adult booster vaccination against pertussis can help prevent severe infections in young infants. We examined influences on intention to accept pertussis booster vaccination among pregnant women in Mexico City.Methods
We conducted a cross-sectional survey, recruiting convenience samples of pregnant women receiving prenatal care from three public healthcare centers between March and May 2012. Our primary outcome was intention to accept pertussis vaccination during pregnancy. We examined socio-demographic factors, vaccination history, pertussis knowledge, perceptions of vaccine information sources, and other potential influences on vaccine decision-making.Results
A total of 402 pregnant women agreed to participate, of which 387 (96%) provided their intention to accept or decline pertussis vaccination. Among respondents, 57% intended to accept a pertussis booster vaccine if offered, but only 16% had ever heard of pertussis, and only 2% knew someone who had contracted this disease. Over 80% of respondents would accept pertussis vaccination if recommended by an obstetrician-gynecologist. The most frequently selected reasons to refuse pertussis vaccination were concerns that the vaccine might harm the unborn baby or pregnant woman. In multivariate analysis, rating doctors and nurses as good sources of vaccine information, and having ever heard of pertussis, were independently associated with intention to accept pertussis vaccination.Conclusions
Promoting patient awareness about pertussis disease and vaccine safety, and encouraging general practitioners, nurses and obstetricians to recommend pertussis booster vaccine, may increase vaccine uptake among pregnant women. 相似文献2.
Background
Pertussis is an acute infectious illness, caused by the bacteria Bordetella pertussis and commonly known as “whooping cough”. Waning immunity after vaccination or after natural infection contributes significantly to the increasing incidence rates in adolescents and adults. Prevention of pertussis in industrialized countries is mainly based on immunization with acellular vaccines in combination with other antigens. A booster dose with an adult-formulation tetanus-diphtheria toxoid and acellular pertussis vaccine (Tdap) is now recommended for all adolescents by several countries, and replacement of the decennial Td dose with a single or more doses of Tdap is recommended for adults.Objective
Our review aims at describing the current knowledge on the impact of acellular pertussis vaccination in adolescents and adults, with particular focus on specific risk groups: adolescents, pregnant women and their newborns, and health care workers (HCWs), and secondly at suggesting possible immunization strategies.Methods
Data were retrieved by searches of Pubmed, references, from relevant articles and open-access websites.Results
In countries where an adolescent booster dose was adopted, a certain decrease of incidence rates was observed. No serologic correlate of protection after immunization exists, but subjects with high antibody levels against pertussis antigens are less likely to develop the disease. Tdap vaccine was demonstrated to induce antibodies to pertussis antigens exceeding those associated with efficacy in infants, in both adolescents and adults. Tdap use in pregnant women seems to be safe and might represent a useful tool in order to prevent pertussis cases in the first months of life. Neonatal immunization with monovalent acellular pertussis vaccine can efficiently prime T and B cells and act as a basis for future immune responses. Cocooning strategies involving all those surrounding newborns have started to be implemented. Their impact on infant pertussis cases will be evaluated in the coming years. Coverage in HCWs should be increased, given their important role in pertussis transmission in health care settings.Conclusions
Despite the more recent position paper of WHO gives priority to infant and childhood vaccination against pertussis and leaves adolescent, adult and risk group immunization as an option for the future, data are quickly accumulating to support the need to consider pertussis vaccination as a crucial preventative intervention even in adolescents and special risk groups. 相似文献3.
Background
The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for U.S. adults in 2005. Our objective was to identify barriers to early uptake of Tdap among adult populations.Methods
The 2007 National Immunization Survey (NIS)-Adult was a telephone survey sponsored by the Centers for Disease Control and Prevention (CDC). Immunization information was collected for persons aged ≥18 years on all ACIP-recommended vaccines. A weighted analysis accounted for the complex survey design and non-response.Results
Overall, 3.6% of adults aged 18-64 years reported receipt of a Tdap vaccination. Of unvaccinated respondents, 18.8% had heard of Tdap, of which 9.4% reported that a healthcare provider had recommended it. A low perceived risk of contracting pertussis was the single most common reason for either not vaccinating with Tdap or being unwilling to do so (44.7%). Most unvaccinated respondents (81.8%) indicated a willingness to receive Tdap if it was recommended by a provider.Conclusions
During the first two years of availability, Tdap uptake was likely inhibited by a low collective awareness of Tdap and a low perceived risk of contracting pertussis among U.S. adults, as well as a paucity of provider-to-patient vaccination recommendations. Significant potential exists for improved coverage, as many adults were receptive to vaccination. 相似文献4.
Background
Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance.Methods
A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy.Results
Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers’ (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients.Conclusions
Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance. 相似文献5.
Louise Maher Kirsty Hope Siranda Torvaldsen Glenda Lawrence Angela Dawson Kerrie Wiley Deborah Thomson Andrew Hayen Stephen Conaty 《Vaccine》2013
Background
Pregnant women have an increased risk of complications from influenza. Influenza vaccination during pregnancy is considered effective and safe; however estimates of vaccine coverage are low. This study aimed to determine influenza vaccination coverage and factors associated with vaccine uptake in pregnant women in two Sydney-based health districts.Methods
A random sample of women who delivered a baby in a public hospital in Sydney and South-Western Sydney Local Health Districts between June and September 2012 were surveyed using a computer assisted telephone interviewing service.Results
Of the 462 participants (participation rate 92%), 116 (25%) reported receiving the influenza vaccine during their pregnancy. In univariate analysis, vaccination coverage varied significantly depending on antenatal care type, hospital of birth, and parity (p<0.05), but not for age category, highest level of education, country of birth, language spoken at home, or Aboriginal status. Women who received antenatal care through a general practitioner (GP) had 2.3 (95% CI 1.4–3.6) times the odds (unadjusted) of receiving the influenza vaccination than those who received their antenatal care through a public hospital. The main reason cited for vaccination was GP recommendation (37%), while non-recommendation (33%) and lack of knowledge (26%) were cited as main reasons for not receiving the vaccination. 30% of women recalled receiving a provider recommendation for the vaccination and these women had 33.0 times the odds (unadjusted) of receiving the vaccination than women who had not received a recommendation. In a multivariate model a provider recommendation was the only variable that was significantly associated with vaccination (OR 41.9; 95% CI 20.7–84.9).Conclusion
Rates of influenza vaccination during pregnancy are low. There is a significant relationship between healthcare provider recommendation for the vaccination and vaccine uptake. Increasing provider recommendation rates has the potential to increase coverage rates of influenza vaccination in pregnant women. 相似文献6.
Background and purpose
The United States’ Centers for Disease Control and Prevention recommends that boys aged 11–12 be vaccinated against HPV to reduce the risk of genital warts and HPV-related cancers. No recommendation has been made in England although there have been calls to widen access to the vaccine. This study aimed to assess boys’ willingness to have HPV vaccination, eliciting reasons for their decisions.Methods
528 boys aged 16–18 years completed a questionnaire in school. Measures included demographic characteristics, HPV awareness, willingness to have the vaccine, and reasons for the vaccine decision. Coding of open responses was informed by social cognition model constructs.Results
A large proportion of the sample (41%) intended to have the vaccine, however, slightly more were unsure (49%) and a small number (10%) would not get vaccinated. Uncertainty was associated with lack of previous awareness of HPV and perceived lack of adequate information. Boys who would not have the vaccine did not feel at risk or did not see the need for it.Conclusion
These preliminary data suggest that HPV vaccination may be acceptable to boys, and confirm previous findings that information is vital in the decision-making process. 相似文献7.
Background
Approximately one million new cases of shingles (herpes zoster [HZ]), a severely painful and debilitating disease caused by reactivation of varicella-zoster virus (VZV), occur in the United States each year. HZ incidence increases with age, especially after age 50. A vaccine to prevent HZ and its sequelae was licensed in May 2006 for those aged 60 years or older, making it the first new vaccine targeted to this age group in many years. In October 2006 the Advisory Committee on Immunization Practices (ACIP) recommended HZ vaccination of persons aged ≥60 years; these recommendations were published in 2008. We examined HZ vaccination coverage among persons aged ≥60 years in the U.S. in 2007, and evaluated factors affecting the uptake of HZ vaccine in this population.Methods
Data from the 2007 National Immunization Survey-Adult (NIS-Adult) restricted to individuals aged ≥60 years were analyzed using SUDAAN software to estimate national HZ vaccination coverage, and reasons for not receiving the HZ vaccine. We used multivariable logistic regression analysis to identify factors independently associated with HZ vaccination.Results
Of 3662 respondents, 1.9% (95% confidence interval = 1.3%, 2.8%) reported having received the HZ vaccine. A total of 72.9% of respondents were unaware of the HZ vaccine but 77.8% stated that they would accept HZ vaccination if their doctor recommended it. Of the remaining 556 respondents, key reasons reported for not accepting HZ vaccine included ‘vaccination not needed’ (34.8%), ‘not at risk’ (12.5%), and ‘don’t trust in doctors or medicine’ (9.5%).Conclusions
Soon after its availability in the United States, coverage among adults recommended to receive the HZ vaccine was low. Our data provide evidence that the lack of patient awareness and of physician recommendations were barriers to vaccine uptake. 相似文献8.
Objective
Adult vaccination coverage is low and current strategies are unlikely to achieve Healthy People 2020 targets. We determined the attitude of adult infant contacts toward recommended adult vaccines and their willingness to receive vaccines should they be available during hospital visits or prenatal or infant clinic appointments.Methods
Survey of predominantly Hispanic, underinsured and medically underserved infant contacts at a county hospital in Houston, Texas where a pertussis cocooning program is offered.Results
Two hundred and eighty-five contacts (mean age 32.8 years [18–73]; 94.8% Hispanic) participated. Most were fathers (58.2%), followed by aunts (19%), and grandparents (12.3%). Participants used many health information sources. 221 (77.5%) considered healthcare providers the most influential on their decisions but only 51.6% reported healthcare visits within the prior year. Forty-one (14.4%) discussed family vaccinations during prenatal visits. Preferred locations for adult vaccination were hospital or clinic-based (96.5%). Lack of knowledge (22.8%), fear of pain/needles (14.7%), work commitments (14%), lack of transport (11.2%), cost (10.2%) and fear of side effects (5.3%) were barriers to vaccination. More males than females reported fear of pain/needles and work commitments (P 0.01 and P 0.02, respectively), and more females lack of transport (P < 0.001) as barriers. Most planned to (76.1%) or had received (7%) pertussis vaccine; if available, 73.3%, 53.3% and 50.5% expressed willingness to receive vaccines against influenza, pneumonia and meningitis, respectively. Age, ethnicity or education was not associated with willingness to be vaccinated. Vaccine acceptance was higher in females than males for pertussis (P 0.04), influenza (P 0.008), pneumonia (P 0.04), and meningitis (P 0.006) vaccines by multiple regression analysis.Conclusions
Most adults were willing to be vaccinated if offered during hospital visits or clinic appointments for mother or infant. Development and expansion of recommended immunization platforms, such as the cocooning platform, offers the opportunity to increase adult vaccination coverage. 相似文献9.
Introduction
Healthcare personnel (HCP) are often under-vaccinated. The aim of this study was to evaluate occupational physicians’ potential role by assessing relations between their knowledge and attitudes regarding HCP vaccination and the extent to which official vaccination recommendations are communicated.Methods
Cross-sectional survey, n = 135 occupational physicians.Results
Occupational physicians who treat HCP recommend vaccinations more often to HCP when they have better knowledge of official vaccination recommendations and a more positive attitude towards vaccination compared to physicians with less such knowledge or a more negative attitude. The attitude towards vaccination most strongly affects whether occupational physicians recommend the measles, mumps, and rubella (MMR) vaccination: physicians with less positive attitudes recommend MMR to HCP in a more restricted way. A more positive attitude towards vaccination also relates to fewer misconceptions. Occupational physicians’ knowledge and attitude further influence the extent to which pregnant HCP receive vaccinations against influenza. Knowledge about official recommendations does not influence the recommendation of influenza vaccination for pregnant women.Conclusions
Reasons for vaccination gaps in HCP might have their roots in occupational physicians’ incomplete knowledge of vaccination recommendations. Attitudes, which are related to misperceptions, also influence which vaccinations are recommended to HCP. Official recommendations, and not personal attitudes and misconceptions, should guide occupational vaccination behavior. 相似文献10.
Amado Rivero-Santana Leticia Cuéllar-Pompa Luis M. Sánchez-Gómez Lilisbeth Perestelo-Pérez Pedro Serrano-Aguilar 《Health policy (Amsterdam, Netherlands)》2014
Introduction
In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations.Methods
Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system.Results
There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used.Conclusions
From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated. 相似文献11.
Background
In June, 2012 a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) was added to the recommendation for immunocompromised adults who were previously recommended to receive only 23-valent pneumococcal polysaccharide vaccine (PPSV23). PCV13 may be more effective, though it covers fewer disease-causing strains.Objective
We examined the incremental cost-effectiveness of adding one dose of PCV13 to the pre-2012 recommendation of PPSV23 for adults with 4 immunocompromising conditions who are at increased risk of pneumococcal disease: HIV/AIDS, hematologic cancer, solid organ transplants, and end stage renal disease.Methods
We used a probabilistic model following a single cohort of 302,397 immunocompromised adults. We used vaccination coverage and disease incidence data specific to each immunocompromising condition. Assumptions about PPSV23 and PCV13 vaccine effectiveness were based on two randomized controlled trials and several observational studies conducted among HIV-infected adults. Because no such studies have been conducted among other immunocompromised populations, we made further assumptions about the relative vaccine effectiveness in those groups. Cost-effectiveness ratios were determined for each condition and for all 4 groups in total.Results
Our model indicated that adding one dose of PCV13 to adults in the United States with 4 immunocompromising conditions would cost $16 million (in 2009$) but provide off-setting savings of $21 million per cohort from the societal perspective. These savings come largely from decreased medical costs among adults with end stage renal disease. This dose of PCV13 would prevent 57 cases of invasive pneumococcal disease, 619 cases of hospitalized all-cause pneumonia, avert 93 deaths, and save 1360 quality adjusted life years per cohort.Conclusion
The addition of one dose of PCV13 to the previously recommended PPSV23 doses for adults with selected immunocompromised conditions potentially reduces both disease and costs. 相似文献12.
Objective
Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group.Design
Markov model-based cost-effectiveness analysis.Methods
The model considered immunocompromised persons aged 19–64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia.Results
In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario.Conclusions
One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised. 相似文献13.
Objective
To identify factors associated with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine in adolescent females.Design
Cross-sectional analysis of 2007 National Survey of Children's Health.Participants
Parents of 12–17 year-old US adolescent females.Main outcome measures
Associations of sociodemographic and healthcare factors with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine.Results
Data were analyzed for 16,139 adolescent females. Almost 20% of adolescent females initiated the HPV vaccine series. Significantly higher proportions of adolescent females who initiated the human papillomavirus vaccine series vs. those who did not initiate the human papillomavirus vaccine series had a parental report of their healthcare provider recommending the human papillomavirus vaccine (84% vs. 20%). In multivariable analyses, adolescent females who were American Indian/Alaska Native, were multiracial, received the meningococcal vaccine, received the tetanus/tetanus–diphtheria/tetanus–diphtheria–acellular pertussis vaccine, or were poor had higher adjusted odds of initiating the human papillomavirus vaccine series; parental report of a healthcare provider recommendation of the human papillomavirus vaccine was associated with about 18 times the adjusted odds of initiating the human papillomavirus vaccine series. In separate multivariable analyses, adolescent females who were African-American and uninsured had lower adjusted odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine.Conclusion
Parental report of a healthcare provider recommendation is significantly associated with human papillomavirus vaccine-series initiation. African-American race/ethnicity and uninsurance were associated with lower odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine. Routine healthcare provider recommendation of human papillomavirus vaccination might improve adolescent females’ human papillomavirus vaccination rates. 相似文献14.
Background
Guidelines recommend influenza vaccination for pregnant women, but vaccine uptake in this population is far below the goal set by Healthy People 2020. The purpose of this study was to examine predictors of seasonal influenza vaccination among pregnant women.Methods
Between 2009 and 2012, the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) conducted a prospective cohort study of influenza vaccine safety among pregnant women in the US and Canada that oversampled vaccinated women. Data for the present paper are from an additional cross-sectional telephone survey completed during the 2010–2011 influenza season. We examined predictors of influenza vaccination, focusing on Health Belief Model (HBM) constructs.Results
We surveyed 199 pregnant women, 81% of whom had received a seasonal influenza vaccine. Vaccination was more common among women who felt more susceptible to influenza (OR = 1.82, 95% CI 1.10–3.01), who perceived greater vaccine effectiveness (OR = 3.92, 95% CI 1.48–10.43), and whose doctors recommended they have flu shots (OR = 3.06, 95% CI 1.27–7.38). Those who perceived greater barriers of influenza vaccination had lower odds of vaccination (OR = 0.19, 95% CI 0.05–0.75). Perceived social norms, anticipated inaction regret, and worry also predicted uptake, though demographic characteristics of respondents did not.Conclusion
The HBM provides a valuable framework for exploring influenza vaccination among pregnant women. Our results suggest several potential areas of intervention to improve vaccination rates. 相似文献15.
Introduction
In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations.Methods
Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated.Results
93% of providers recommended the HPV vaccine, most frequently for females aged 13–26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%).Conclusion
Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9–12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women. 相似文献16.
Background
Human papillomavirus (HPV) infection and associated cervical disease are common among all women, regardless of sexual identity, yet limited research has examined HPV vaccination among lesbian and bisexual women.Methods
A national sample of lesbian and bisexual women ages 18–26 (n = 543) completed our online survey during Fall 2013. We used multivariable logistic regression to identify correlates of HPV vaccine initiation (receipt of at least 1 dose) and completion (receipt of all 3 recommended doses among initiators).Results
Overall, 45% of respondents had initiated HPV vaccine and 70% of initiators reported completing the series. HPV vaccine initiation was higher among respondents who were students, had received a healthcare provider's recommendation, perceived greater positive social vaccination norms, or anticipated greater regret if they did not get vaccinated and later got HPV. Initiation was lower among those who perceived greater HPV vaccine harms or greater barriers to getting the vaccine (all p < .05). HPV vaccine completion was higher among initiators who had a college degree while it was lower among those who perceived a greater likelihood of acquiring HPV or who anticipated greater regret if they got the vaccine and fainted (all p < .05). Among HPV vaccine initiators who had not yet completed the series, about half (47%) intended to get the remaining doses.Conclusions
Many lesbian and bisexual women are not getting vaccinated against HPV. Healthcare provider recommendations and women's health beliefs may be important leverage points for increasing vaccination among this population. 相似文献17.
Background
Between July 1997 and April 1998, Canadian public health agencies switched from the whole cell vaccine to the acellular vaccine for pertussis immunization. The acellular vaccine provided better efficacy and fewer adverse events than the whole cell vaccine did.Objective
To determine the economic impact of replacing the whole cell vaccine with an acellular vaccine in Canada.Methods
A decision analytic model was developed comparing costs and outcomes of pertussis vaccination for Canadian children born in the years 1991–2004. Effectiveness was measured as number of avoided pertussis cases as well as the number of avoided hospital admissions. Incremental costs per avoided pertussis case and per avoided hospital admission were calculated for Ministry of Health (MoH) and societal (SOC) perspectives. Various one-way sensitivity analyses as well as a Monte Carlo simulation were performed by varying key model parameters.Results
The switch in immunization programs resulted in an incremental cost to the MoH of CAD $108 per pertussis case avoided (CAD $0.96 per child-year). From the SOC perspective, there was a savings of CAD $184 per pertussis case avoided (CAD $0.13 per child-year). The one-way sensitivity analyses provided incremental cost-effective ratios (ICERs) ranging from an incremental cost of CAD $1034 per avoided pertussis case from the MoH perspective to a saving of CAD $1583 per avoided case from the SOC perspective. The Monte Carlo simulation confirmed the robustness of these results.Conclusions
Pertussis vaccination with AcE was cost-saving from the societal perspective and cost-effective from the Ministry of Health perspective. 相似文献18.
Gregory D. Zimet Zeev Rosberger William A. Fisher Samara Perez Nathan W. Stupiansky 《Preventive medicine》2013
Objective
Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived “newness” of HPV vaccines.Methods
Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake.Results
There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered “new”. Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination.Conclusion
Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination. 相似文献19.
Objectives
In 2009, the Dutch government advised pregnant women to get vaccinated against influenza A (H1N1). A study was set up to gain insight into vaccination coverage and reasons why pregnant women seek vaccination or not.Methods
We invited 14,529 pregnant women to complete an internet survey on vaccination during pregnancy in general and against 2009 influenza A (H1N1). Differences in background characteristics between unvaccinated and vaccinated women were investigated. Prediction analyses were carried out to determine which survey statement had the greatest impact on vaccination status or intention to get vaccinated during pregnancy.Results
Of the 2993 included respondents, 63% reported to be vaccinated against 2009 influenza A (H1N1). Vaccination coverage was higher among older birth cohorts, women who had been pregnant before, women with underlying medical conditions, and women who reported no defined ‘life philosophy’. Protection of the child (after birth), the government's advice and possible harmful effects of the vaccine for the unborn child had the greatest predictive value for vaccination status. With regards vaccination during future pregnancies, 39% had a positive intention to obtain vaccination and 45% were neutral. The government's advice was the strongest predictor for intention. Furthermore, women expressed concern over lack of sufficient knowledge about vaccine safety.Conclusions
A considerable number of pregnant women in the Netherlands reported to be vaccinated against 2009 influenza A (H1N1). The challenge for the government in the future will be to provide pregnant women and health care professionals with sufficient and clear information about disease severity and the benefits and safety of vaccination. 相似文献20.