Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded Services

ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations.
DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews.
RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change.
PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it.     

What's new in child and adolescent immunizations?

Nurse practitioners can play a critical role in minimizing vaccine-preventable diseases by keeping abreast of changes in immunization schedules and recommendations, minimizing barriers to immunizations, and advocating for children, adolescents and families.     

Vaccine adverse events: separating myth from reality

Vaccines have turned many childhood diseases into distant memories in industrialized countries. However, questions have been raised about the safety of some vaccines because of rare but serious adverse effects that have been attributed to them. Pain, swelling, and redness at the injection site are common local reactions to vaccines. Fever and irritability may occur after some immunizations. Currently, no substantial evidence links measles-mumps-rubella vaccine to autism, or hepatitis B vaccine to multiple sclerosis. Thimerosal is being eliminated from routine childhood vaccines because of concerns that multiple immunizations with vaccines containing this preservative could exceed recommended mercury exposures. Family physicians should be knowledgeable about vaccines so that they can inform their patients of the benefits of immunization and any proven risks. If immunization rates fall, the incidence of vaccine-preventable illnesses may rise.     

Focus Groups Among Public, Military, and Private Sector Mothers: Insights to Improve the Immunization Process

Abstract The underimmunization of children younger than 2 years old is a major health problem in U.S. cities. Innovative methods to increase immunization rates are being researched and implemented. In 1993, six focus groups were conducted with 41 mothers (25 African Americans and 16 Caucasians) to discuss their views regarding immunizations and the services they received from health care providers in the public health ( n = 27), military ( n = 4), and private ( n = 10) sectors. Participants viewed immunizations positively, but perceived many barriers to immunization. They suggested the following ways to improve the immunization process: enhancing knowledge acquisition, improving reminder and appointment systems, providing transportation and child care, decreasing waiting times, improving the clinic environment, and making the immunizations less traumatic. According to mothers in this study, obtaining an immunization on time is a complex task that requires planning and resources. The fewer resources that are available to mothers, the more difficult it is to succeed. Health care providers must help mothers identify and remove barriers if immunization rates are to be increased.     

Pediatric immunization update 2002

The field of pediatric immunizations is growing and changing as new vaccines are becoming available and previous diseases are being eradicated. Due to the complexity and evolution of vaccine-preventable diseases, pediatric health care providers must routinely review the current childhood immunization recommendations. A review of immunology and the principles of vaccination provide background knowledge for information pertaining to disease transmission and the current recommended vaccine schedule. Vaccine administration guidelines and techniques are presented in table format. An overview of new vaccine research and development and a discussion of vaccine safety and immunization resources are also included.     

Immunization status of children born to human immunodeficiency virus (HIV)-infected mothers in two Texas cities

BACKGROUND: Because HIV-infected and HIV-exposed children are at risk of acquiring infectious diseases, they should be immunized. METHODS: We abstracted charts at pediatric HIV clinics in Dallas and San Antonio, matched the children to birth certificates and assessed up-to-date immunization status. RESULTS: Of the 178 children, 108 (61%) were up to date for the diphtheria-tetanus-pertussis (DTP), polio, and measles-mumps-rubella (MMR) series. In multivariate analysis, predictors of delayed immunization included maternal high-risk sexual partners and infant antiretroviral therapy. CONCLUSION: In this population of children born to HIV-infected mothers, immunizations were up to date in 61%, a figure that exceeds or equals immunization levels for other Texas children. Texas falls short of the recommended goal of 90% immunization for children of HIV-infected mothers and healthy children.     

Frequency and Nature of Recorded Childhood Immunization‐Related Errors in Greece

Background: While routine immunizations are very safe, their administration to healthy children requires minimization of immunization programmatic errors. In order to estimate the incidence and ascertain the nature of reported immunization errors in the Greek childhood population, we have undertaken a study using data from the National Poison Information Center in Greece, which also has the responsibility to address medication‐induced errors. Methods: All immunization errors concerning children and reported to the National Poison Information Center during the 2‐yr period 1999–2000 were retrieved and the conditions of their occurrence were examined. The incidence of reported errors was calculated under the assumption that during each year 100,000 children are born in Greece, and during their childhood they receive a total of about 20 immunization doses of all childhood immunizations. Results: There were 40 immunization errors reported, corresponding to a reported incidence of about 11 per million immunization doses. Of these errors, 20 concerned OPV, 13 DTP, 5 MMR, 1 Haemophilus influenza and 1 Hepatitis B immunizations. In 12 instances an erroneous route was used (out of which 11 concerned OPV), whereas overdose was documented in 13 instances (out of which 8 concerned OPV). The third most common error was administration of DTP instead of the recommended Td vaccine. No adverse patient outcomes were reported. Conclusions: In Greece, reported errors in immunization practice are relatively rare. Packaging modifications (about one in three errors in this study) of the OPV and DTP could further reduce their incidence.     

The effect of lack of insurance, poverty and paediatrician supply on immunization rates among children 19-35 months of age in the United States

Rational, aims and objectives Previous studies found that the increasing number of paediatricians in the United States was associated with improved childhood immunization coverage, while the increasing poverty level and the lack of health insurance reduced access to health care. We evaluated whether changes in the number of paediatricians, poverty level and health insurance affected national childhood immunization coverage in the state levels of the United States. Methods Data were collected primarily from the US National Immunization Surveys, series 4:3:1:3:3 from years 1995 and 2003. Ordinal logistic regression analysis was used to analyse the relationships among variables. Results Over 8 years studied, immunization coverage increased for children aged 19–35 months from 52.3% to 79.8% in the 50 states. The average number of paediatricians per 1000 births increased 28.7% while the percentage of children without health insurance declined 15.6%, and the percentage of children who lived in poverty level declined 17.3%. In 1995, the states with higher immunization coverage were associated with higher numbers of paediatricians [odds ratio (OR), 32.73; 95% confidence interval (CI), 5.96–179.77]. In 2003, the higher numbers of paediatricians still played a role in the increased immunization coverage (OR, 4.69; 95% CI, 1.01–21.78); however, the higher rate of uninsured children in 2003 had an even greater effect upon immunization coverage. Compared with states with lower rates of uninsured children, states with intermediate and higher rates of uninsured children had sixfold (OR, 0.16; 95% CI, 0.03–0.81) and 16‐fold (OR, 0.06; 95% CI, 0.01–0.40) decreased childhood immunization coverage, respectively. Conclusion Between 1995 and 2003 in the United States, the lack of health insurance became more prominent than the supply of paediatricians in affecting immunization coverage for children aged 19–35 months. Future improvements in insurance coverage for children will likely lead to greater immunization coverage.     

Adult immunizations: recommendations for practice

Each year in the United States, 50,000 to 90,000 adults die of pneumococcal disease, influenza, and hepatitis infections. These figures vastly exceed mortality due to vaccine-preventable diseases in children. In addition, adult immunizations are cost-effective and lifesaving measures. Nonetheless, surveys reveal that both physicians and patients underuse adult immunizations as an effective means of disease prevention. The goal of achieving higher adult immunization rates is critically dependent on improving the attitudes and practices of health-care providers. In this article, we review several vaccines routinely used in the practice of adult medicine.     

Impact of COVID-19 pandemic on routine immunization

The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals.

Key messages

• The COVID-19 pandemic has a substantial impact on essential immunization activities.
• Disruption to mass vaccination campaigns increase risk of VPD resurgence.
• Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake.
• Guidance to mitigate these effects continues to evolve.

     

Disability as a "family affair": parental disability and childhood immunization

BACKGROUND: There is a substantial body of research focusing on the health and healthcare utilization of individuals with a disability but less has been done to examine the impact of disability on nondisabled family members. OBJECTIVE: We sought to investigate the influence of parental disability on children's healthcare as measured by the timely receipt of childhood immunizations. RESEARCH DESIGN: Observations on 11,997 children between the ages 2 and 5 years were obtained from the 1994 and 1995 United States National Health Interview Surveys representing 27,534,841 children when weighted. Children are determined to be in compliance with the Centers for Disease Control immunization protocol at age 24 months if they have received 4 DTP, 3 polio, and 1 MMR vaccine dose. Disability is characterized using the activity and personal care scales from the National Health Interview Surveys. The data were analyzed using logistic regression controlling for factors identified in prior research to be related to timely receipt of immunization. RESULTS: Children living with a parent who is unable to provide his or her own personal care are 65% less likely (odds ratio = 0.35; 95% confidence interval = 0.17-0.70) to be immunized on time than children who live with parent(s) who do not have a disability. Children of parents who are limited in their personal care, and children of parents who have work limitations, are not less likely than children of nondisabled parents to receive immunizations on time. CONCLUSIONS: The impact of a parent's severe disability extends to the health care of dependent children. These findings argue for research to investigate the full scope of the effects of parental disability on children's health and for policies that address this impact.     

Can Easy-to-Read Immunization Information Increase Knowledge in Urban Low-Income Mothers?

This article describes a pilot study that (1) assessed the self-report of highest grade completed in school and the actual reading and comprehension skills of low-income mothers whose children receive immunizations in urban public clinics and (2) tested the effectiveness of a nursing intervention on immunization knowledge using revised easy-to-read written education materials. Thirty-seven mothers were randomized either to a control group (asked to read the standard vaccine information sheets) or to an experimental group (asked to read the revised immunization pamphlets). Although there was a modest increase in immunization knowledge for both groups, it was not significant. Thus, simplifying information alone may not increase parental knowledge.     

Summary of New Guidance on Selected Immunizations

In 2022, the Centers for Disease Control and Prevention (CDC) updated its Adult Immunization Schedule Recommendations for Ages 19 Years or Older to provide the most current evidence-based recommendations following comprehensive reviews of data related to vaccines. In its report, the CDC highlighted the importance of health care professionals staying up to date on the latest evidence. During the novel coronavirus pandemic, the ability to provide routine vaccinations to the adult population was limited and even halted at times. As in-person health care visits continue to resume, it is imperative for nurses to refocus on and be familiar with the most up-to-date vaccine recommendations. Here, we summarize information on vaccine guidelines, safety, and special considerations for women, and we highlight changes to the 2022 adult immunization schedule. Keeping individuals free of vaccine-preventable diseases is one of the most effective and important public health interventions in health care.     

Barriers to effective uptake of cancer screening among Black and minority ethnic groups

AIM: To describe some of the factors that act as barriers to effective uptake of breast and cervical cancer screening services among black minority ethnic (BME) groups living in Brent and Harrow in the UK. DESIGN: A series of focus groups among African Caribbean, African, Gujarati, Pakistani, Greek and Arabic groups were held to discover their perceptions of cancer screening, the barriers to effective uptake and some strategies for intervention. SAMPLE: This consisted of 135 participants: 85 women and 50 men. RESULTS: Analysis of focus group data has revealed poor knowledge, underlying health and cultural beliefs, attitudes, language and unhelpful attitudes of health professionals to be important barriers. In terms of strategies for effective intervention, the most popular strategy for improving uptake of screening services was community-based cancer awareness education that is sensitive to religious and cultural needs. CONCLUSION: There is a need to provide community-based education to increase the uptake of screening services among BME groups. It is essential to plan concurrently to educate GPs and other health professionals in cultural beliefs and customs, language needs, racial awareness and communication skills.     

Health indicators for mothers and children in rural Herat Province, Afghanistan

INTRODUCTION: Following years of conflict and neglect, major efforts now are underway to develop health policy and rehabilitate the health facilities in Afghanistan. As part of these efforts, there is a need to better understand the health status and health-seeking behaviors. As part of an effort to assist local non-governmental organizations (NGOs), a household survey of mothers with children under the age of five years was conducted in two rural districts of Herat Province, Karokh and Chesht-e-Sharif. METHODS: A two-stage, 30-cluster approach was used for each district. This included 622 mothers of 926 children under the age of five years living in the two districts. Outcome measures included demographic characteristics, antenatal services, immunization coverage, hemoglobin levels of the mothers, nutritional status and practices, environmental health indicators, recent illness, and health seeking behaviors. RESULTS: The mean value of ages of the mothers was 27 years with an average parity of 6.1. Less than 5% of mothers ever had attended school. Half of women had lost at least one child before the child reached the age of five years. Under-five-year mortality was estimated at 325. Only 29% of the women had attended an antenatal clinic during their last pregnancy. Virtually all deliveries occurred at home. Only 7.6% of women had received three doses of tetanus toxoid. Less than 9% of the children 12-59 months of age were fully immunized. According to the measurements of mid-upper-arm circumference (MUAC), 11% of children were malnourished. Although breastfeeding almost was universal, greater than one-third of the women did not start breastfeeding until the second day after delivery. Protected water sources and appropriate control of feces were lacking in both districts. In the previous two weeks, 45.7% of children had experienced diarrhea, and dysentery had occurred in 10%. Fever had been present in one-quarter of the children. CONCLUSIONS: Household health indicators indicate serious maternal and child health concerns in these two districts. Of particular concern is the poor immunization coverage, lack of reproductive health service, and the prevalence of common childhood illness in these populations. The feeding practices for children and the anemia among mothers also raised concerns. Poor environmental health contributes substantially to childhood illness. Without special emphasis, efforts to rebuild the health sector are likely to reach the household level only late in the process. An aggressive program to integrate community development and promotion of sound health practices is needed to improve the health of the Afghanistan people.     

Affecting change through continuing education: improving vaccine administration technique

The practice of aspiration before administering intramuscular immunization has been identified as causing increased pain. The latest evidence shows that this is no longer best practice. Some nurses believe that aspiration is necessary for patient safety. An education session was provided to 150 participants, most of whom were community health nurses attending an immunization conference. Nurses were invited to complete a pre-education questionnaire on current knowledge, attitudes, and beliefs related to the administration of intramuscular immunizations as well as a posteducation questionnaire to identify changes in knowledge, attitudes, and beliefs. On the pre-education questionnaire, 32.4% of respondents indicated that injecting slowly causes the most pain during intramuscular immunization. On the posteducation questionnaire, 94.2% indicated that injecting the vaccine slowly caused more pain than injecting the vaccine swiftly. After the education session, most of the participants showed an understanding of current best practice recommendations for aspiration during the administration of intramuscular immunizations.     

Recommendations for Pneumococcal Immunization Outside Routine Childhood Immunization Programs in Western Europe

The global burden of pneumococcal diseases is high, with young children and adults ≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals.     

Parental refusal or delay of childhood immunization: Implications for nursing and health education

The purpose of this article is to review the current literature to ascertain reasons behind parental refusal or delay of childhood immunizations. Recurring themes highlighted issues involving parents and health care providers. Strategies to improve immunization compliance were proposed. Health care professionals and health educators were identified as instrumental in the effort to educate and positively influence immunization. As one of the most highly trusted members of the health care team, a nurse is vital to the success of this endeavor.