长沙市甲型Ｈ１Ｎ１流感抗体水平趋势数学模型模拟研究

摘要：目的　采用常微分方程（ｏｒｄｉｎａｒｙｄｉｆｆｅｒｅｎｔｉａｌｅｑｕａｔｉｏｎ,ＯＤＥ）模型模拟长沙市甲型Ｈ１Ｎ１流感抗体
水平。方法　根据甲型Ｈ１Ｎ１流感在人群中的传播及抗体消长特点,建立全人群及各年龄组人群抗体水平
变化趋势的ＯＤＥ 模型,利用长沙市人口学资料、以及长沙市人群血清学横断面调查资料拟合模型参数,并
模拟长沙市人群的抗体水平变化趋势、以及抗体水平低于人群最低免疫屏障的具体时间。结果　大流行结
束后疫苗接种者抗体水平高于未接种者,但前者的抗体消失速度高于后者,两者抗体水平分别在２０１０ 年
１２月和２０１３年１月开始接近人群最低免疫屏障。在疫苗接种人群中,抗体消失速度最快的是“≥６０ 岁”
年龄组,最慢的是“０～５岁”年龄组,而“６～１５岁”、“１６～２４岁”、“２５～５９岁”３个年龄组人群抗体水
平消失速度较为接近。在未接种疫苗人群中,抗体消失速度最快的是“６～１５ 岁” 年龄组,其次是“１６～
２４岁”、“０～５岁”、“≥６０岁”年龄组,最慢的是“２５～５９岁” 年龄组。长沙市流感监测数据显示,２０１３
年１月开始甲型Ｈ１Ｎ１流感成为优势毒株,并在１～４月份发生４起甲型Ｈ１Ｎ１流感暴发疫情和１起流感样
病例暴发疫情,这与模型预测结果相似。结论　本研究建立的ＯＤＥ 模型可以较好地模拟长沙市甲型Ｈ１Ｎ１
流感抗体水平变化特点。疫苗接种获得的免疫屏障维持时间比自然感染短。不同年龄组获得免疫屏障水平
不同、消减速度亦不同。
关键词：甲型Ｈ１Ｎ１流感;抗体;常微分方程模型;模拟
中图分类号：Ｒ１８１．２　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０３ ０１７３ ０８     

接种甲型H1N1流感疫苗人群血清抗体阳性率及相关因素分析

目的 分析甲型H1N1流感疫苗接种效果和影响因素,为流感疫苗接种规划制定提供依据.方法 采用分层随机抽样的方法,在2010年1月、4月、8月共抽取1 941名甲型H1N1流感疫苗接种者进行问卷调查,并运用血清抗凝实验方法检测抗体水平.结果 接种甲型H1N1流感疫苗抗体阳性率为59.51%,0～岁和60岁及以上人群抗体阳性率较低,6～岁和16～岁人群抗体阳性率较高,抗体水平随时间推移逐渐下降.结论 流感疫苗是防止疫情最有效措施之一,在流感高峰期来临前,要加强疫苗接种、补种,特别是60岁及以上的老年人和5岁以下儿童.     

Influenza vaccination coverage among pregnant women --- United States, 2010-11 influenza season

Women are at increased risk for morbidity and mortality from influenza during pregnancy. Vaccinating pregnant women for influenza can protect both the women and their infants, especially infants aged <6 months who are not old enough to receive influenza vaccination. Since 2004, the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists have recommended inactivated influenza vaccine for all women who are pregnant during influenza season, regardless of trimester. Before 2009, estimated influenza vaccination coverage among pregnant women had been consistently low (approximately 15%). However, vaccination levels increased substantially in response to the 2009 influenza A (H1N1) pandemic to nearly 50%. To estimate influenza vaccination coverage among pregnant women for the 2010-11 season, CDC analyzed data from an Internet panel survey conducted in April 2011 among women who were pregnant any time during October 2010-January 2011. Among 1,457 survey respondents, 49% reported that they had received influenza vaccination: 12% were vaccinated before pregnancy, 32% during pregnancy, and 5% after pregnancy. Women offered influenza vaccination by a health-care provider (62%) were more likely to be vaccinated (71%) than other women (14%) and were more likely to have positive attitudes about vaccine effectiveness and safety. These results indicate that the higher vaccination level achieved the previous season (2009-10) was sustained and emphasize the critical role of health-care providers in promoting influenza vaccination. Continued efforts are needed to encourage health-care providers to strongly recommend and offer influenza vaccination to pregnant patients to protect both the mothers and their infants.     

Acceptance of vaccination during pregnancy: experience with 2009 influenza A (H1N1) in the Netherlands

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.     

Student utilization of a university 2009 H1N1 vaccination clinic

The 2009 H1N1 influenza resulted in widespread outbreaks on college campuses. Once sufficient quantity of vaccine became available, many universities held vaccination clinics for students. We sought to examine factors associated with participation in an on-campus vaccination effort. A self-administered questionnaire was completed by students in January 2010. Our results suggest a high degree of awareness of the 2009 H1N1 virus among students. The odds of being vaccinated were higher for students who believed the H1N1 virus was a greater public health threat and for students who had friends and family that were vaccinated after controlling for sex, ethnicity, age, and living conditions.     

Self-reported pH1N1 influenza vaccination coverage for Ontario

BACKGROUND: In the fall of 2009, Canada undertook a mass vaccination campaign against pH1N1. This report provides an overview of self-reported pH1N1 vaccination coverage of the Ontario population, building on an existing random digit-dialling telephone survey, in which 9,010 Ontario adults participated. Based on the results, 34.5% of Ontario residents were vaccinated: 33.3% of adults aged 18 or older and 38.6% of children and adolescents younger than age 18. Respondents reporting high-risk chronic conditions were significantly more likely to report being vaccinated than were people who did not report such conditions. Determining vaccination uptake for the Ontario population is important in the evaluation of the province's pH1N1 prevention program.     

Impact of prior infection and repeated vaccination on post-vaccination antibody titers of the influenza A(H1N1)pdm09 strain in Taiwan schoolchildren: Implications for public health

BackgroundThe objective of this study was to evaluate the effects of prior-infection and repeated vaccination on post-vaccination antibody titers.MethodsA(H1N1)pdm09 strain was included in 2009 pandemic monovalent, 2010–2011, and 2011–2012 trivalent influenza vaccines (MIVpdm09, TIV10/11, TIV11/12) in Taiwan. During the 2011–2012 influenza season, we conducted a prospective sero-epidemiological cohort study among schoolchildren from grades 1 – 6 in the two elementary schools in Taipei with documented A(H1N1)pdm09 vaccination records since 2009. Serum samples were collected at pre-vaccination, 1-month, and 4-months post-vaccination (T1, T2, T3). Anti-A(H1N1)pdm09 hemagglutination inhibition titers (HI-Ab-titers) were examined. We also investigated the impact of four vaccination histories [(1) no previous vaccination (None), (2) vaccinated in 2009–2010 season (09v), (3) vaccinated in 2010–2011 season (10v), and (4) vaccinated consecutively in 2009–2010 and 2010–2011 seasons (09v + 10v)] and pre-vaccination HI-Ab levels on post-vaccination HI-Ab responses as well as adjusted vaccine effectiveness (aVE) against serologically-defined infection from T2 to T3.ResultsTIV11/12 had zero serious adverse events reported. A(H1N1)pdm09 strain in TIV11/12 elicited seroprotective Ab-titers in 98% of children and showed promising protection (aVE: 70.3% [95% confidence interval (CI): 51.0–82.1%]). Previously unvaccinated but infected children had a 3.96 times higher T2 geometric mean titer (T2-GMT) of HI-Ab than those naïve to A(H1N1)pdm09 (GMT [95% CI]: 1039.7[585.3–1845.9] vs. 262.5[65.9–1045], p = 0.046). Previously vaccinated children with seroprotective T1-Ab-titers had a higher T2-GMT and a greater aVE than those with non-seroprotective T1-Ab-titers. Repeatedly vaccinated children had lower T2-GMT than those receiving primary doses of TIV11/12. However, after controlling prior infection and T1-Ab-titers, differences in T2-GMT among the four vaccination histories became insignificant (p = 0.16).ConclusionThis study supports the implementation of annual mass-vaccination with A(H1N1)pdm09 in schoolchildren for three consecutive influenza seasons when vaccine and circulating strains were well matched, and found that prior infection and pre-vaccination HI-Ab levels positively impacted post-vaccination HI-Ab responses.     

Nurses' vaccination against pandemic H1N1 influenza and their knowledge and other factors

This study aimed to estimate the vaccination coverage against the pandemic H1N1 influenza in a group of nurses and determine the factors associated with their vaccination behaviours. An anonymous, self-administered questionnaire was distributed to a convenience sample of nurses who were enrolled on continuing professional education courses in a university in London. The survey response rate was 77.7% (n=522). A total of 172 (35.2%) nurses reported receiving the pandemic H1N1 vaccine in the 2009-2010 influenza season and only 22.3% of them had the intent to accept the vaccine in the next season. Compared to nurses with low knowledge scores, those with high knowledge scores were more likely to receive the pandemic H1N1 vaccine (p=0.017), recommend the vaccine to their patients (p=0.003), and have the willingness to recommend vaccination to patients in the future (p=0.009). There was a higher vaccination rate among nurses with higher risk perception scores than with lower scores (p=0.001). A small, positive correlation between H1N1 knowledge and risk perception scores was identified (p<0.001) indicating that a high knowledge level was associated with high levels of risk perception. More male nurses received the H1N1 vaccine than females (p<0.001) and there were a significant differences in the uptake among nurses from different clinical specialty groups (p<0.001). About half of the vaccinated nurses reported the intent to be vaccinated again but only 8.1% of the unvaccinated nurses had the intent to receive the vaccine in the next season (p<0.001). The pandemic H1N1 2009 influenza vaccination coverage among this nurse sample was sub-optional. Lack of knowledge and risk perception were predictors associated with the nurses' vaccination behaviours. The identified knowledge items should be addressed in future vaccination campaigns. The hindrances associated with continuing vaccination decision-making and factors contributing to the different vaccination coverage among clinical specialty groups require further exploration.     

Risk of convulsions in children after monovalent H1N1 (2009) and trivalent influenza vaccines: a database study

The monovalent H1N1 (2009) pandemic influenza vaccine used predominantly in the UK in 2009/10 was a split virion vaccine with a novel oil-in-water adjuvant (ASO3). While this was highly immunogenic it was also reactogenic especially for fever in children. There is a paucity of comparative data on reactogenicity of trivalent influenza vaccine (TIV). Using the General Practice Research Database (GPRD) we investigated whether there was an increased risk of convulsions in children vaccinated with monovalent H1N1 influenza vaccine in the 2009/10 season and also the risk after vaccination with the seasonal TIVs using the self-controlled case-series method. A total of 2366 children aged under 10 years with at least one convulsion recorded in the GPRD and who had received at least one influenza vaccine at anytime (2858 doses of TIV and 1895 doses of the monovalent H1N1 influenza vaccine) were identified between May 2000 and April 2010. Over this period these 2366 children had a total of 3846 convulsion episodes. There was no increase in the incidence rate ratio (IRR) in the week after vaccination for either the monovalent H1N1 influenza vaccine (IRR 0.99, 95% CI 0.61-1.60) or the first dose of TIV (IRR 0.89, 95% CI 0.53-1.52). A signal of an elevated risk in the first few days after the second dose of monovalent H1N1 influenza vaccine was seen with an IRR for days 1-3 post vaccination of 3.48 (95% CI 0.86-14.07). This is consistent with findings of increased fever in a clinical trial. These results neither provide evidence of an increased risk of convulsions following TIV over a 10-year surveillance period nor following a single dose of the ASO3 adjuvanted monovalent H1N1 vaccine in 2009/10.     

甲型H1N1流感疫苗大规模人群应急接种分析

目的 控制甲型H1N1流感疫情的传播,为规范有序地应急接种提供依据.方法 按照分步实施、保证重点、知情同意、自愿接种的原则,分4个批次对浙江省象山县重点人群进行应急接种.结果 从2009年11月1日-2010年4月30日,共接种40 734人,接种率达49.83%,其中学生接种26 595人,接种率为64.34%,占总接种人数的65.29%;累计报告预防接种疑似异常反应(AEFI)15例,AEFI报告发生率为34.93/10万.结论 应用甲型H1N1流感疫苗(简称甲流疫苗)对易感人群进行应急接种是防控甲流疫情的有效手段,人群大规模甲流疫苗接种安全可行.     

Trends in Risk Perceptions and Vaccination Intentions: A Longitudinal Study of the First Year of the H1N1 Pandemic

Objectives. We sought to evaluate longitudinal trends in people’s risk perceptions and vaccination intentions during the 2009 H1N1 pandemic.Methods. We used data from 10 waves of a US national survey focusing on the H1N1 pandemic (administered between May 2009 and January 2010) to conduct a longitudinal analysis of adult respondents’ risk perceptions and vaccination intentions.Results. Self-reported perceived risk of becoming infected with H1N1 paralleled H1N1 activity throughout the pandemic’s first year. However, intention to be vaccinated declined from 50% (May 2009) to 16% (January 2010) among those who remained unvaccinated (27% had been vaccinated by January 2010). Respondents who indicated that they had previously been vaccinated against seasonal influenza reported significantly higher H1N1 vaccination intentions than those who had not been vaccinated (67% vs 26%; P < .001).Conclusions. Reported intention to be vaccinated declined well before vaccine became available and decreased throughout the pandemic year. To the extent that prior vaccination for seasonal influenza vaccination is a strong correlate of H1N1 risk perceptions, encouraging seasonal influenza vaccination may benefit pandemic preparedness efforts.Vaccination is one of the most effective means of controlling illness caused by influenza. At no time is control more critical than when a new strain of influenza emerges, causing a pandemic. Willingness to be immunized against a novel strain of influenza appears to change over time,1 yet little is known about how willingness changes with perceived risk as a pandemic evolves from an early threat of unknown severity to a more mature threat with known parameters. To be effective in limiting the spread of the disease, strategies to optimize vaccination rates during a pandemic must take into account the public’s changing perceptions of risk to target those who are hesitant to be vaccinated. Opportunities to gain an in-depth understanding of vaccination behaviors are hampered by the infrequency of pandemics and the lack of longitudinal data on risk perceptions.The recent H1N1 pandemic offered an opportunity to study evolving vaccination behaviors. On March 28, 2009, a 9-year-old California girl became the first individual with a confirmed case of H1N1 influenza in the United States.2 Within 1 month the United States declared a public health emergency,3 and within 2 months the World Health Organization declared a phase 6 pandemic (the highest level possible).4 Fortunately, by August 2009 it became clear that the death rate from H1N1 was only about 0.1% to 0.3%, comparable to that expected from seasonal influenza, according to a report by the President’s Council of Advisors on Science and Technology.5However, there was ongoing concern that up to half of the population could become infected, with the number of deaths expected to range from 30 000 to 90 000. By September 2009, a vaccine for the novel H1N1 strain had been approved by the Food and Drug Administration.6 In anticipation of this development, the Advisory Committee on Immunization Practices released criteria for vaccine prioritization in late July 2009.7 Vaccination began in October 2009. Although production delays impeded initial distribution, more than 61 million vaccine doses were ready by November 2009.8Despite the availability of a safe and effective H1N1 vaccine6 and an unprecedented public health campaign to promote its use, uptake by December 2009 was disappointingly low. Only 24% of the entire US population had been vaccinated, and the percentage was only somewhat higher (33%) for priority vaccination groups.9The failure to achieve widespread vaccination uptake has many possible causes. We speculate that some of the failure reflects the public’s evolving perceptions of H1N1 risk. Previous research has highlighted subjective risk as a key predictor of vaccine uptake.10 Yet, almost nothing is known about how the public’s perceptions of novel risks such as H1N1 track the actual evolution of a pandemic or whether variations in risk perceptions explain subsequent patterns in vaccination intentions and behaviors. Previous studies have examined the relationship between risk perceptions and intentions at a single point in time,11,12 but a longitudinal perspective is more policy relevant given that risk perception evolves over time.We sought to chronicle the US public’s evolving risk perceptions regarding the 2009 H1N1 influenza pandemic and the relationship of these perceptions to vaccination intentions. We drew on the ability of RAND’s American Life Panel (ALP) to field frequent interviews with a common sample to generate a detailed, longitudinal perspective of risk perceptions and vaccination intentions throughout the 2009 H1N1 pandemic. Our research questions were as follows: How did perceived risk of H1N1 infection and of death given H1N1 infection relate to measured disease activity in the US population? Did perceived risk of H1N1 correlate with reported intention to be vaccinated against H1N1? and What other policy-relevant factors were associated with H1N1 vaccination intentions over time?     

Antibodies cross-reactive to influenza A (H3N2) variant virus and impact of 2010-11 seasonal influenza vaccine on cross-reactive antibodies - United States

Since August 2011, a total of 12 human infections with influenza A (H3N2) variant viruses with genes from avian, swine, and human viruses (i.e., A [H3N2]v) that had acquired the M gene from influenza A (H1N1)pdm09 virus have been reported to CDC. Eleven of the cases occurred in children aged <10 years. In six cases, no history of recent exposure to swine was noted, suggesting that human-to-human transmission had occurred. This new gene constellation for A (H3N2)v viruses and its temporal association with an increase in human cases of A (H3N2)v highlight the need to better understand the risk for human infection with these viruses and the extent to which current seasonal vaccines might elicit cross-reactive antibodies to them. CDC conducted a preliminary analysis to evaluate the age-specific presence of serum cross-reactive antibody in U.S. populations vaccinated or not vaccinated with the 2010-11 seasonal trivalent influenza vaccine (TIV). The results indicated that 1) little or no cross-reactive antibody to A (H3N2)v exists among children aged <10 years, 2) immunization with the 2010-11 TIV had no impact on cross-reactive antibody levels in those aged <3 years, 3) cross-reactive antibody was detected in 20%-30% of those aged ≥10 years, and 4) among adults, vaccination with TIV provided a modest boost to the level of cross-reactive A (H3N2)v antibodies. Receipt of seasonal influenza vaccine continues to be recommended to protect against circulating human influenza viruses for all age groups and might provide limited protection against A (H3N2)v infection in the adult population. A vaccine virus specific for A (H3N2)v has been developed and could be used to produce an H3N2v vaccine, if needed.     

Pandemic influenza A(H1N1)pdm09 improves vaccination routine in subsequent years: A cohort study from 2009 to 2011

Background

In 2009 the pandemic influenza virus A(H1N1)pdm09 emerged with guidance that people at risk should be vaccinated. It is unclear how this event affected the underlying seasonal vaccination rate in subsequent years.

Purpose

To investigate the association of pandemic influenza A(H1N1)pdm09 and seasonal flu vaccination status in 2009 with vaccination rates in 2010 and 2011.

Methods

Data were collected in 40 Dutch family practices on patients at risk for influenza during 2009–2011; data analysis was conducted in 2012.

Results

A multilevel logistic regression model (n = 41,843 patients) adjusted for practice and patient characteristics (age and gender, as well as those patient groups at risk), showed that people who were vaccinated against A(H1N1)pdm09 in 2009 were more likely to have been vaccinated in 2010 (OR 6.02; 95%CI 5.62–6.45, p < .0001). This likelihood was even more for people who were vaccinated against seasonal flu in 2009 (OR 13.83; 95%CI 12.93–14.78, p < .0001). A second analysis on the uptake rate in 2011 (n = 39,468 patients) showed that the influence of the vaccination state in 2009 declined after two years, but the diminishing effect was smaller for people vaccinated against A(H1N1)pdm09 than for seasonal flu (OR 5.50; 95%CI 5.13–5.90, p < .0001; OR 10.98; 95%CI 10.26–11.75, p < .0001, respectively).

Conclusion

Being vaccinated against A(H1N1)pdm09 and seasonal influenza in the pandemic year 2009 enhanced the probability of vaccination in the next year and this was still effective in 2011. This suggests that peoples’ vaccination routines were not changed by the rumor around the outbreak of A(H1N1)pdm09, but rather confirmed underlying behavior.     

Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain

This study aimed to ascertain the coverage of vaccination against pandemic influenza in individuals aged over 6 months for whom vaccination is indicated due to a chronic health condition using as data source clinical information recorded in the primary care clinical history.Of all those for whom vaccination was indicated (1,114,632), 14.6% (162,616) finally received the vaccine. There were statistically significance differences in coverage for sex (16.5% for men and 13.1% for women), age groups (5% for people under 30 years and 20% for those over 60), number of chronic conditions (11.1% for one condition, 22.5% for two conditions, and 31.3% for three or more conditions) and depending on the chronic health condition considered.The probability of being vaccinated increased with male sex, age, number of indications, type of medical card (lower among no income) and having been vaccinated against 2009 season influenza.We concluded that the coverage finally reached for those people with an indication due to chronic health condition in the H1N1 campaign was much lower than expected and wished. It is essential to investigate the different factors that could have intervened in the behavior of the population so that more efficient approaches can be adopted in future influenza pandemics.     

Long term effectiveness of adjuvanted influenza A(H1N1)pdm09 vaccine in children

BackgroundImmunological studies have indicated that the effectiveness of AS03 adjuvanted monovalent influenza A(H1N1)pdm09 vaccine (Pandemrix^®) may be of longer duration than what is seen for non-adjuvanted seasonal influenza vaccines. Sixty-nine percent of children 6 months–18 years of age in Stockholm County received at least one dose of Pandemrix^® during the 2009 pandemic. We studied the effectiveness of the vaccine during the influenza seasons 2010–2011 and 2012–2013 in children hospitalized with virologically confirmed influenza. The season 2011–2012 was not included, since influenza A(H3N2) was the predominant circulating strain.MethodsIn a retrospective case-control study using a modified test-negative design we compared the percentage vaccinated with Pandemrix^® among children diagnosed with influenza A(H1N1)pdm09 (cases), with that of those diagnosed with influenza A(H3N2) or influenza B (controls) during the two seasons. We excluded children born after July 1, 2009, since only children who were 6 months of age or older received the pandemic vaccine in October–December 2009.ResultsDuring the 2010–2011 season, 3/16 (19%) of children diagnosed with influenza A(H1N1)pdm09, vs. 32/41 (78%) of those with influenza A(H3N2) or influenza B had been vaccinated with Pandemrix^® in 2009. The odds ratio, after adjustment for sex, age and underlying diseases, for becoming a case when vaccinated with Pandemrix^® was 0.083 (95%CI 0.014, 0.36), corresponding to a VE of 91.7%. During the season 2012–2013, there was no difference between the two groups; 59% of children diagnosed with influenza A(H3N2)/B and 60% of those with influenza A(H1N1)pdm09 had been vaccinated with Pandemrix^® in 2009.ConclusionThe AS03 adjuvanted monovalent influenza A(H1N1) pdm09 vaccine (Pandemrix^®) was effective in preventing hospital admission for influenza A(H1N1)pdm09 in children during at least two seasons.     

Timeliness of 2009 H1N1 vaccine coverage in a low-income pediatric and adolescent population

Despite being at highest risk for 2009 H1N1 virus morbidity and mortality, many children were not immunized with the vaccine. Identification of factors that put certain children at higher risk for under-immunization could reveal populations who may need to be specifically targeted for vaccination interventions in future pandemics. Little is known about the prevalence of, or factors associated with, 2009 H1N1 vaccine coverage in low-income, urban pediatric populations. This study evaluated 2009 H1N1 vaccination coverage in 19,643 children aged 6 months to 18 years receiving care at one of five community clinics associated with an academic medical center in a low-income community. Any (≥1 dose) and full coverage (1 dose for children ≥10 years old, 2 doses for those <10 years) was determined as of December 1, 2009 and the end of vaccination period (June 30, 2010). Multivariable analyses were used to assess the impact of race/ethnicity, age, insurance, gender, and language on vaccine coverage and timeliness. By December 1, only 16.6% of children had received one dose, and 5.3% had full coverage. By the end of the vaccination period, 36.2% had received at least one H1N1 dose and 23.6% had full coverage. On multivariable analysis, older age, minority race/ethnicity, and private insurance were negatively associated with vaccination by December 1 and end of vaccination period, even after accounting for attendance at a clinic visit. In future pandemics, when timely receipt of a new vaccine in large populations may be imperative, general vaccination programs as well as special targeted education and vaccine reminders for these at risk groups may be warranted.     

Reaching Children Never Previously Vaccinated for Influenza Through a School-Located Vaccination Program

Objectives. We determined the success of the school-located vaccination (SLV) program, implemented in 2009 in New York City to deliver pandemic influenza A (H1N1) monovalent vaccine (pH1N1), versus provider offices in reaching children who had never previously received influenza vaccine.Methods. We compared the immunization history of children vaccinated in school versus provider offices. We included records in the Citywide Immunization Registry with pH1N1 administered between October 2009 and March 2010 to elementary school-aged children.Results. In total, 96 524 children received pH1N1 vaccine in schools, and 102 933 children received pH1N1 vaccine in provider offices. Of children vaccinated in schools, 34% had never received seasonal influenza vaccination in the past, compared with only 10% of children vaccinated at provider offices (P < .001). Children vaccinated in schools were more likely to have received a second dose of pH1N1 in 2009–2010 than those vaccinated in provider offices (80% vs 45%).Conclusions. The SLV program was more successful at reaching children who had never received influenza immunization in the past and should be considered as a strategy for delivering influenza vaccine in routine and emergency situations.Improving vaccination coverage in children may lead to decreased morbidity and mortality in the general population, including decreasing influenza deaths and illness in adults.1–4 In 2006, the Advisory Committee on Immunization Practices recommended influenza vaccine for healthy children aged 6 months to 4 years5 and expanded their recommendation in subsequent years to include children aged 5 to 18 years.6 The goal of vaccinating all children annually raises a significant operational question of how to target children most effectively.Pediatricians provide the majority of immunizations given to children. However, after the 4- to 6-year-old well child visits, children may not visit medical providers regularly. School-located vaccination (SLV) offers a convenient alternative because it reaches the majority of children regardless of their access to medical care,7 and schools have been successfully used for hepatitis B vaccination administration in the past.8,9 SLV also offers parents the convenience of not having to make a trip to the provider’s office or even be present. Jurisdictions such as Hawaii have routinely offered influenza vaccine through schools and have achieved vaccination rates as high as 46% in children aged 5 to 13 years.10Despite the potential advantages of SLV, to our knowledge, whether it successfully reaches children who otherwise would have gone unvaccinated is unknown. We examined this issue in New York City (NYC) in 2009 when the NYC Department of Health and Mental Hygiene offered pandemic influenza A (H1N1) monovalent vaccine (pH1N1) through an elementary school–located campaign. During this influenza season, because of a late-emerging strain of novel H1N1, pH1N1 vaccine was developed and offered separately from routine seasonal influenza vaccination. Using data on pH1N1 vaccination from the Citywide Immunization Registry (CIR), the NYC Department of Health and Mental Hygiene’s Immunization Information System, we compared the demographic characteristics and immunization history of children vaccinated through the SLV campaign with those of children vaccinated in medical provider offices. We examined the proportion of children in each setting for whom the pH1N1 vaccine was the first influenza vaccine ever received to determine the potential for SLV programs to effectively reach children who have not previously received an influenza vaccination and who therefore might be unlikely to get vaccinated in the current season as well. We also predicted the probability of being vaccinated at schools controlling for demographic characteristics and immunization history.     

2009～2010年平湖市甲型H1N1流感病毒裂解疫苗疑似预防接种异常反应监测分析

[目的]了解甲型H1N1流感病毒裂解疫苗接种后疑似预防接种异常反应(AEFI)发生情况,为制定相关策略提供依据。[方法]2009年10月至2010年4月,平湖市在大规模开展接种工作的同时,开展了甲流疫苗的安全性监测工作。[结果]接种40 744人,报告AEFI发生25例,报告发生率为61.35/10万。报告发生率,一般反应为36.81/10万,异常反应为9.81/10万,偶合反应为7.36/10万,心因反应为7.36/10万。AEFI发生率,女性为96.58/10万,男性为21.05/10万;15~20岁为61.39/10万,20~50岁为59.05/10万,≥60岁为78.98/10万;学生为61.39/10万,医务人员为78.86/10万,教师为83.33/10万,其他职业为52.01/10万。AEFI在接种后10 min至24 h出现,临床表现以低热、局部红肿、疼痛为主,病例均治愈。[结论]接种甲型H1N1流感病毒裂解疫苗AEFI发生率较低。     

Place of influenza vaccination among adults --- United States, 2010-11 influenza season

The 2010-11 influenza season was the first season after the 2009 influenza A (H1N1) pandemic and the first season that the Advisory Committee on Immunization Practices (ACIP) recommended influenza vaccination for all persons aged ≥6 months (1). During the pandemic, many new partnerships between public health agencies and medical and nonmedical vaccination providers were formed, increasing the number of vaccination providers (2). To provide a baseline for places where adults received influenza vaccination since the new ACIP recommendation and to help vaccination providers plan for the 2011-12 influenza season, CDC analyzed information from 46 states and the District of Columbia (DC) on influenza vaccination of adults aged ≥18 years for the 2010-11 season, collected during January-March 2011 by the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which found that, for adults overall, a doctor's office was the most common place (39.8%) for receipt of the 2010-11 influenza vaccine, with stores (e.g., supermarkets or drug stores) (18.4%) and workplaces (17.4%) the next most common. For those aged 18-49 years and 50-64 years, a workplace was the second most common place of vaccination (25.7% and 21.1%, respectively). Persons aged ≥65 years who were not vaccinated at a doctor's office were most likely (24.3%) to have been vaccinated at a store. The results indicate that both medical and nonmedical settings are common places for adults to receive influenza vaccinations, that a doctor's office is the most important medical setting, and that workplaces and stores are important nonmedical settings.     

Acceptability of pandemic A(H1N1) influenza vaccination by Essential Community Workers in 2010 Alicante (Spain), perceived seriousness and sources of information

Objective

Describe acceptability of pandemic A(H1N1) influenza vaccination by Essential Community Workers (ECWs) from Alicante province (Spain) in January 2010. Evaluate the correlation with attitudes, beliefs, professional advice and information broadcasted by media.

Method

In this cross-sectional study, face-to-face interviews were conducted with 742 ECWs to assess their attitudes towards vaccination against the pandemic influenza strain. A multivariable regression model was made to adjust the Odds Ratios (ORs).

Results

Some ECWs reported having been vaccinated with seasonal vaccine, 21.5% (95%IC 18.6–24.9); only 15.4% (95%IC 12.8–18.4) with the pandemic one. ECWs vaccinated regularly against seasonal flu (OR 5.1; 95%IC 2.9–9.1), those who considered pandemic influenza as a severe or more serious disease than seasonal flu (OR 3.8; 95%IC 2.1–6.7) and those who never had doubts about vaccine safety (OR 3.7; 95%IC2.1–6.7) had a better acceptance of pandemic vaccine. Finally, 78.7% (95%IC 75.1–81.4) had doubts about pandemic vaccine's effectiveness.

Conclusion

The vast amount of information provided by the media did not seem to be decisive to prevent doubts or to improve the acceptability of the vaccine in ECWs. Professional advice should be the focus of interest in future influenza vaccination campaigns. These results should be taken into account by health authorities.