Influenza vaccination of healthcare workers in the United States, 1989-2002.

OBJECTIVES: We sought to estimate influenza vaccination coverage among healthcare workers (HCWs) in the United States during 1989-2002 and to identify factors associated with vaccination in this group. The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for HCWs to reduce transmission of influenza to patients at high risk for serious complications of influenza. DESIGN: Analysis of cross-sectional data from 1989-2002 surveys conducted by the National Health Interview Survey (NHIS). The outcome measure was self-reported influenza vaccination in the past 12 months. Bivariate and multivariate analysis of 2002 NHIS data. SETTING: Household interviews conducted during 1989-2002, weighted to reflect the noninstitutionalized, civilian US population. PARTICIPANTS: Adults aged 18 years or older participated in the study. A total of 2,089 were employed in healthcare occupations or settings in 2002, and 17,160 were employed in nonhealthcare occupations or settings. RESULTS: The influenza vaccination rate among US HCWs increased from 10.0% in 1989 to 38.4% in 2002, with no significant change since 1997. In a multivariate model that included data from the 2002 NHIS, factors associated with a higher rate of influenza vaccination among HCWs aged 18-64 years included age of 50 years or older (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.1), hospital employee status (OR, 1.5; 95% CI, 1.2-1.9), 1 or more visits to the office of a healthcare professional in the past 12 months (OR, 1.5; 95% CI, 1.1-2.2), receipt of employer-provided health insurance (OR, 1.5; 95% CI, 1.1-2.1), a history of pneumococcal vaccination (OR, 3.9; 95% CI, 2.5-6.1), and history of hepatitis B vaccination (OR, 1.9; 95% CI, 1.4-2.4). Non-Hispanic black persons were less likely to be vaccinated (OR, 0.6; 95% CI, 0.5-0.9) than non-Hispanic white persons. There were no significant differences in vaccination levels according to HCW occupation category. CONCLUSIONS: Influenza immunization among HCWs reached a plateau during 1997-2002. New strategies are needed to encourage US HCWs to receive influenza vaccination to prevent influenza illness in themselves and transmission of influenza to vulnerable patients.     

U.S. Healthcare personnel and influenza vaccination during the 2004-2005 vaccine shortage

BACKGROUND: Healthcare personnel with direct patient contact were prioritized for influenza vaccination during the 2004-2005 vaccine shortage. Data about vaccination coverage among healthcare personnel during vaccine shortages are limited. METHODS: Behavioral Risk Factor Surveillance System 2005 data were analyzed in 2007 for a sample of healthcare facility workers (HCFW) aged 18-64 with (n=3456) and without (n=1153) direct patient contact and non-HCFWs (n=39,405). Chi-square tests and logistic regression were used to identify factors associated with influenza vaccination among HCFWs and to compare HCFWs with non-HCFWs with regard to the main reason for nonvaccination during the shortage. RESULTS: Vaccination coverage was 37% (SE +/- 3.1) among HCFWs with direct patient contact and 25% (SE +/- 5.7) among those without. In multivariate analysis, coverage was higher among HCFWs who were older, more educated, and with higher incomes and better access to health care. The reason most commonly reported by HCFWs and non-HCFWs for nonvaccination was the belief that they did not need vaccination (35% versus 40%, respectively; p<0.05). CONCLUSIONS: Even in a time of influenza-vaccine shortage, when most healthcare personnel were targeted for vaccination, their uptake of the vaccine remained suboptimal. Continued efforts are needed to develop effective interventions to improve the use of influenza vaccination among healthcare workers.     

Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009

Background

Approximately 43,000 new hepatitis B virus (HBV) infections occurred in 2007. Although hepB vaccination has been recommended for adults at high-risk for incident HBV infection for many years, coverage remains low.

Methods

We used the 2009 National Health Interview Survey to assess self-reported HepB vaccine uptake (≥1 dose), series completion (≥3 dose), and independent predictors of vaccination among high-risk adults aged 18-49 years. High-risk adults were defined as those reporting male sex with men; injection drug use; hemophilia with receipt of clotting factors; sexually transmitted disease in prior five years; sex for money or drugs; HIV positive; sex with persons having any above risk factors; or who “felt they were at high risk for HIV”. Persons with none of the aforementioned risk factors were considered non-high risk. Bivariate analysis was conducted to assess vaccination coverage. Independent predictors of vaccine uptake and series completion were determined using a logistic regression.

Results

Overall, 7.0% adults aged 18-49 years had high-risk behaviors. Unadjusted coverage with ≥1 dose was 50.5% among high-risk compared to 40.5% among non-high-risk adults (p-values <0.001) while series completion (≥3 doses) was 41.8% and 34.2%, respectively (p-values <0.001). On multivariable analysis, ≥1 dose coverage, but not series completion, was higher (Risk Ratio 1.1, 95% CI = 1.0-1.2, p-value = 0.021) among high-risk compared to non-high risk adults. Other characteristics independently associated with a higher likelihood of HepB vaccination among persons 18-49 years included younger age groups, females, higher education, ≥2 physician contacts in the past year, ever tested for HIV, health care personnel, received influenza vaccination in the previous year, and ever received hepatitis A vaccination. Vaccine uptake with ≥1 dose increased by 5.1% (p = 0.047) among high-risk adults between 2004 and 2009.

Conclusions

A small increase in ≥1 dose HepB vaccination coverage among high-risk adults compared with non-high risk adults was documented for the first time in 2009. Higher coverage among persons 18-30 years may reflect aging of persons vaccinated when they were children and adolescents. To improve protection against hepatitis B among high-risk adults, healthcare providers should offer hepatitis B vaccination to persons at high risk and those who seek vaccination to protect themselves and facilitate timely completion of the three (3) dose HepB series.     

Cancer screening behaviors among U.S. women: breast cancer, 1987-1989, and cervical cancer, 1988-1989.

Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to examine trends in breast and cervical cancer screening behaviors among U.S. women in selected states. Data reported are from the 1987, 1988, and 1989 BRFSS for breast cancer screening (mammography) and from the 1988 and 1989 BRFSS for cervical cancer screening (Papanicolaou [Pap] smear). Results are presented as either state-specific or state-aggregate data for the years noted above. State-specific analyses indicated that self-reported mammography utilization increased between 1987 and 1989. Although whites and blacks reported similar mammography utilization rates both for screening and for a current or previous breast problem, disparities were evident among women of different ages and incomes. The proportion of women who reported ever having had a Pap smear and having heard of a Pap smear were extremely high and remained fairly consistent across the 2 survey years. State-aggregate analyses, however, showed that the percentage of women who had had a Pap smear within the previous year was negatively associated with age and positively associated with income. A higher proportion of blacks than whites obtained Pap smears. These results indicate that certain segments of the population are not taking full advantage of available breast and cervical cancer screening technologies. Public health strategies, such as those outlined in the Breast and Cervical Cancer Mortality Prevention Act of 1990 (Public Law 101-354), should enhance screening opportunities for these women.     

Influenza vaccination coverage among persons with asthma--United States, 2005-06 influenza season

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits.     

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

IntroductionDuring the 2018–2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers.MethodsCross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2–17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination.ResultsInfluenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02–1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54–0.93).ConclusionsInfluenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018–2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.     

Infant health among Puerto Ricans--Puerto Rico and U.S. mainland, 1989-2000

Although the overall U.S. infant mortality rate (IMR) declined dramatically during the 1900s, striking racial/ethnic disparities in infant mortality remain. Infant health disparities associated with maternal place of birth also exist within some racial/ethnic populations. Eliminating disparities in infant health is crucial to achieving the 2010 national health objective of reducing the infant death rate to 4.5 per 1,000 live births (objective 16-1c). Hispanics comprise the largest racial/ethnic minority population in the United States. Among U.S. Hispanics, considerable heterogeneity exists in infant health, with the poorest outcomes reported among Puerto Rican infants. This report compares trends during the previous decade in IMRs and major determinants of these rates such as low birthweight (LBW), preterm delivery (PTD), and selected maternal characteristics among infants born to Puerto Rican women on the U.S. mainland (50 states and the District of Columbia) with corresponding trends among infants born in Puerto Rico. The findings indicate that despite having lower prevalence of selected maternal risk factors, Puerto Rico-born infants are at greater risk for LBW, PTD, and infant death than mainland-born Puerto Rican infants. This report also highlights a persistent disparity in IMRs and an emerging disparity in LBW and PTD rates between Puerto Rico-born infants and mainland-born Puerto Rican infants. Future research should focus on identifying factors responsible for these disparities to improve infant health in Puerto Rico.     

Influenza vaccination coverage among children aged 6-23 months--United States, 2005-06 influenza season

Children aged <2 years are at increased risk for influenza-related hospitalizations, and those aged <5 years have more influenza-related health-care visits than older children. In 2004, the Advisory Committee on Immunization Practices (ACIP) recommended annual influenza vaccination of children aged 6-23 months. Two doses, at least 4 weeks apart, were recommended to fully vaccinate children aged <9 years who were receiving influenza vaccination for the first time. To assess influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season, data from the 2006 National Immunization Survey (NIS) were analyzed. This report describes the results of that analysis, which indicated that 31.9% of children in this age group received at least 1 dose of influenza vaccine and 20.6% were fully vaccinated according to ACIP recommendations; however, results varied substantially among states. The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health-care providers and caregivers about the effectiveness of influenza vaccination among young children.     

Kidney disease mortality--Michigan, 1989-2005

Kidney disease was the ninth leading cause of death in Michigan in 2005 and in the United States in 2004. In 2004, the incidence rate for kidney failure (i.e., end-stage renal disease) was higher in Michigan than in the United States (365 versus 353 per 1 million population). A total of 3,695 Michigan residents started treatment (i.e., dialysis or transplant) for kidney failure in 2004; by the end of that year, 11,002 Michigan residents were receiving dialysis, and 614 had received a transplant. Many of these persons had a diagnosis of diabetes (40%) or hypertension (30%) as the primary cause of kidney failure. To examine recent trends in kidney disease mortality, the Michigan Department of Community Health (MDCH) analyzed vital statistics data from the period 1989--2005. This report describes the results of that analysis, which indicated that kidney disease mortality is a growing public health problem in Michigan and that blacks were more likely than whites to die from kidney disease. Continued disease-prevention and health-promotion activities, including targeted interventions among populations at greatest risk, are needed by MDCH and other organizations to reduce the burden of kidney disease in Michigan.     

Cancer information disparities between U.S.- and foreign-born populations

Immigrant health is an important component of American public health. But relatively little is known about immigrants' cancer information use. Using the 2005 Health Information National Trends Survey (HINTS) data, this study examined potential disparities between foreign-born (n?=?563) and U.S.-born (n?=?4,830) populations in their access to and experience with cancer information. Logistic regressions showed that foreign-born Hispanics were less likely than the U.S.-born to have ever sought cancer information (adjusted odds ratio [OR]?=?.51). Foreign-born individuals overall were also less likely to have had somebody else look for cancer information for them (OR?=?.66). Compared with the U.S.-born, foreign-born individuals in general faced greater obstacles during the process of cancer information seeking (ORs?=?1.98-2.27). They were also less trusting of some important sources of health information (ORs?=?.50-.64), a pattern that was particularly pronounced among Hispanics (ORs?=?.20-.43). Implications of these disparities were explored through multiple linear regressions that revealed negative associations between cancer information use and undesirable cancer beliefs.     

Influenza vaccination in the time of COVID-19: A national U.S. survey of adults

IntroductionDecisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did.MethodsIn May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome.ResultsAmong participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23–2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88–2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49–2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03–1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36–0.999; and AOR = 0.45; 95% CI = 0.24–0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45–2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15–1.90).ConclusionsThe COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.     

Influenza and adult hospital admissions for respiratory conditions in England 1989-2001

Influenza is recognised as a major cause of excess hospital admissions during winter months. This study sets out to quantify admissions related to influenza during the last twelve winters and to examine the importance of age. Total admission data for respiratory disorders in adults for England during the years 1989 to 2001 have been used. Weekly admission data were examined in five-year age bands. Influenza epidemics were identified from clinical incidence data in the community. Baseline admission levels were determined by averaging weekly incidence data from weeks in which there was no clinical evidence of influenza activity. Excess admissions were estimated from the difference between observed and baseline admissions after adjusting the baseline in each group and year for the secular trend. Estimates for all adults were consolidated from the five-year age bands. Bed occupancy was estimated by applying data on average bed stay to excess admissions in age- and year-specific groups. We estimated 2.7% of all respiratory admissions were related to influenza. Excess admissions were strongly age related. Of the 16,227 annual average excess, 52% occurred in persons over 75 years. The excess admissions account for an average 145,544 bed days annually, two thirds (69%) in persons over 75 years. Annual excess bed occupancy was highest in 1999/2000 (39,512) though 30,000 excess admissions per year is not unusual. Hospital admissions due to influenza remain a major problem for health service delivery particularly in elderly populations. Though robust programmes of vaccination are needed, vaccination by itself will not eliminate the impact of influenza on hospital admissions in winter.     

Cigarette smoking and self-reported health problems among U.S. high school seniors, 1982-1989

PURPOSE: To estimate the independent effect of cigarette smoking on respiratory tract symptoms and health status indicators among high school seniors. DESIGN: Consolidated data sets from one-time cross-sectional survey designs. SETTING: High schools in the United States, 1982-1989. SAMPLE: A total of 26,504 high school seniors, with an 83% response rate. MEASURES: Odds ratios for respiratory tract symptoms and health status indicators for cigarette smokers compared with nonsmokers, while controlling for sex, socioeconomic status, and use of other drugs. RESULTS: High school seniors who were regular cigarette smokers and who began smoking by grade nine were significantly more likely than never smokers to report shortness of breath when not exercising (adjusted odds ratio [OR] = 2.7), coughing spells (OR = 2.1), productive cough (OR = 2.4), and wheezing or gasping (OR = 2.6). These smokers were also more likely to have seen a doctor or other health professional for an emotional or psychologic complaint (OR = 3.0) and to rate their overall health as poorer than average (OR = 2.4). We found strong dose-response relationships for most outcome measures. CONCLUSIONS: Cigarette smoking among high school seniors is associated with respiratory tract symptoms and poorer overall physical health and may be a marker for underlying mental health problems. Smoking prevention activities directed at adolescents should include information on the early adverse health consequences of cigarette smoking.     

Influenza: relation of mortality to morbidity parameters--Netherlands, 1970-1989.

The purpose of this study is to investigate the relationship between the number of influenza-like illness (ILI), weekly registered by the general practitioners (sentinel stations), and the monthly overall influenza mortality in people over 60 years of age, provided by the Dutch Statistical Bureau during the period July 1970 to June 1989. The quantitative impact of influenza-morbidity is expressed by three summary parameters, calculated from the 52 (53) weekly ILI-figures per season-year, (i) their sum (i.e. global extent of an epidemic), (ii) their standard deviation, and (iii) their maximum (i.e. peak number of ILI during an epidemic). In the analysis influenza A subtype is also included. These four parameters are mutually compared with respect to their predictability for yearly total influenza mortality in the 19 season-years available. In most cases, the standard deviation and the peak number of ILI are more powerful for prediction of mortality, than the global extent of the epidemic. The peak number of ILI is of special interest. It is particularly useful for estimating the effect on current influenza mortality during an ongoing epidemic. From the model it is possible to calculate a threshold (of weekly ILI) beyond which mortality increases proportionately more than the number of illness episodes. By using the peak value of morbidity it is possible to calculate the minimal impact of epidemic mortality. This study indicates that the weekly number of influenza-like illnesses has a certain prognostic value for the real impact of influenza. An electronic surveillance system could detect immediately the threshold above which influenza mortality increases more than proportionally.(ABSTRACT TRUNCATED AT 250 WORDS)     

U.S.S.R. and U.S. nutrient intake, plasma lipids, and lipoproteins in men ages 40-59 sampled from Lipid Research Clinics populations

Correlates of high-density lipoprotein (HDL) cholesterol and other lipids and lipoproteins were studied in white men ages 40-59 who were part of the 15% random sample recalled to Visit 2 of the Lipid Research Clinics Program Prevalence Study. Standardized examinations were conducted by two U.S.S.R. and nine U.S. clinics. Mean plasma lipid and lipoprotein cholesterol levels differed significantly between the two countries, with the U.S.S.R. subpopulations having higher mean total plasma and HDL cholesterol levels and HDL/total cholesterol ratios and lower mean triglyceride levels and low-density lipoprotein (LDL)/HDL cholesterol ratios than the U.S. subpopulations. Small, but statistically significant, differences were found in some dietary components. The U.S.S.R. sample had a significantly higher intake of saturated fatty acids, carbohydrates, complex carbohydrates, and kilocalories/kilogram body weight and a significantly lower intake of total fat, polyunsaturated fatty acids, protein, and polyunsaturated/saturated fat ratio. The multiple regression models tested were not major predictors for total plasma cholesterol or LDL cholesterol. Characteristics associated with higher HDL cholesterol levels in both countries were lean body mass, ethanol consumption, abstinence from cigarette smoking, and lower dietary consumption of carbohydrates.