Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

Objective

Identifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement.

Method

A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n = 332], outpatient specialty care [n = 410] and hospital emergency care [n = 413]) to measure user satisfaction and assess the importance given to the aspects analyzed.

Results

The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions.

Conclusions

The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.     

Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe

Objective

The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health.

Study Design

HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n= 33) or intervention (n= 65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher’s Exact Tests, binomial tests and t tests.

Results

The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~ 2% at baseline to > 80% at 3 months postpartum (p<.001).

Conclusions

FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.

Implications

This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.     

An analysis of the suitability of public spaces to physical activity practice in Rio de Janeiro,Brazil

Objectives

To assess the physical characteristics of public spaces designed for sport/physical activity/leisure in Rio de Janeiro, Brazil, and their relationship to the socioeconomic indicators.

Methods

Public spaces (n = 38) spread across the city were evaluated between December 2011 and January 2012 using the Physical Activity Resource Assessment (PARA) instrument. Based on PARA results, a Quality Indicator (QI) was prepared and the sample was grouped into “High QI” and “Low QI” using a k-means clustering algorithm. The association between QI and the local Social Development Index (SDI) was tested using a Chi-square test.

Results

The average QI was 13.6 ± 4.91 and the median was equal to 13 points. The High QI group, composed of sites with a QI above median, reached 17.9 ± 2.35 points, while the Low QI group reached 9.3 ± 2.16 points. Pearson's Chi-square tests identified a significant association between QI and SDI when the value of SDI 0.7 was used as a criterion for separation (χ² = 17.84, p < 0.001). In neighborhoods with lower levels of SDI, public spaces usually had a lower QI.

Conclusions

Policies to encourage physical activity need to focus attention on the built environment also, particularly in socially vulnerable areas.     

Who is unlikely to report adverse events after vaccinations to the Vaccine Adverse Event Reporting System (VAERS)?

Background

Healthcare provider (HCP) reporting to the Vaccine Adverse Event Reporting System (VAERS) is important to assuring the safety of U.S. licensed vaccines. HCP awareness of and practices regarding reporting of adverse events following immunization (AEFI) is understudied.

Methods

A large, nationally representative sample of U.S. office-based HCP across three occupational groups (physicians, mid-level providers [physician assistants, advanced practice nurses] and nurses) and three primary care practice areas (pediatrics, family medicine, internal medicine) were surveyed utilizing standardized methodology. We assessed HCP familiarity with VAERS, the situations under which they were likely to report an AEFI, and the methods they used and preferred for reporting. We used logistic regression to determine factors associated with HCP not reporting AEFI to VAERS.

Results

Our survey response rate was 54.9%. The percentage of HCP aware of VAERS (71%) varied by occupation and primary care practice area. About 37% of HCP had identified at least one AEFI with only 17% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP not reporting AEFI included: HCP not familiar versus very familiar with filing a paper VAERS report (OR = 12.84; p < 0.0001), primary care practice area of internal medicine versus pediatrics (OR = 4.22; p = 0.0005), and HCP not familiar versus very familiar with when it was required to file a VAERS report (OR = 5.52; p = 0.0013).

Conclusions

Specific educational interventions targeted to HCP likely to see AEFI but not currently reporting may improve vaccine safety reporting practices.     

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys

Objectives

Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11–12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys.

Methods

We targeted parents and providers of 9–13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9–13 year old boys increased during the intervention period in targeted counties compared to control counties (n = 15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered.

Results

The Cox model showed an intervention effect (β = 0.29, HR = 1.34, p = .0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p < .0001 for all). HPV vaccination rates were highest in the 11–12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously.

Conclusions

Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.     

Correlates of seasonal flu vaccination among U.S. home health aides

Introduction

Home health aides (HAs) receive limited training and reach many older patient populations highly susceptible to influenza virus. We sought to examine socio-demographic correlates of seasonal flu vaccination receipt among HAs.

Methods

We analyzed data from the 2007 U.S. National Home Health Aide Survey, a nationally representative sample of HAs reporting on occupational status, job and demographic characteristics and receipt of seasonal flu vaccine (n = 3377).

Results

Seasonal flu vaccine receipt was low among all types of HAs (43.9%). After adjustment for socio-demographic indicators (i.e. age, gender, race and health insurance), home health, home care, hospice and personal care attendants were significantly less likely to report receiving seasonal flu vaccine as compared to licensed nursing assistants (adjusted odds ratio, AOR = 0.42, 95% CI [0.20–0.85]; 0.41, [0.17–0.99]; 0.50, [0.26–0.97], and 0.53, [0.26–0.99], respectively).

Conclusion

Targeted effective vaccination campaigns are needed to improve vaccination rates among home health aides.     

Willingness to participate in HIV vaccine efficacy trials among high risk men and women from fishing communities along Lake Victoria in Uganda

Introduction

HIV vaccine efficacy trials conducted in suitable populations are anticipated in sub-Saharan Africa. We assessed the willingness to participate in future vaccine trials among individuals from fishing communities along Lake Victoria, Uganda.

Methods

From July to October 2012, we described a hypothetical vaccine trial to 328 (62.2% men) adults (18–49 years), at risk of HIV infection within 6 months of enrolment in a cohort and assessed their willingness to participate in the trial. Chi-square and logistic regression models were fitted to assess associations between vaccine trial attributes, participants’ characteristics and willingness to participate.

Results

Overall, 99.4% expressed willingness to participate in the hypothetical HIV vaccine trial. This decreased marginally with introduction of particular vaccine trial attributes. Delaying pregnancy for 10 months and large blood draw had the largest effects on reducing willingness to participate to 93.5% (p = 0.02) and 94.5% (p = 0.01) respectively. All the vaccine trial attributes in combination reduced willingness to participate to 90.6%. This overall reduction in willingness to participate was significantly associated with gender and exchange of gifts for sex in multivariable analysis; women were more than three times as likely to have expressed unwillingness to participate in future vaccine trials as men (aOR = 3.4, 95% CI: 1.55, 7.33) and participants who never received gifts in exchange for sex were more than four times as likely to have expressed unwillingness as those who received gifts for sex (aOR = 4.5; 95%CI 1.30, 16.70). The main motivators of participation were access to HIV counselling and testing services (31.9%), HIV education (18.0%), hope of being prevented from acquiring HIV (16.6%) and health care (12.5%).

Conclusion

Our study identifies an important population for inclusion in future HIV prevention trials and provides important insights into acceptability of trial procedures, differences in decisions of women and men and areas for further participant education.     

Negative trends from 2008/9 to 2011/12 seasons in influenza vaccination coverages among high risk subjects and health care workers in Spain

Objectives

We aim to describe influenza vaccination coverage for the Spanish population across four consecutive campaigns (2008/2009 to 2011/2012). The data was analyzed by high risk groups and health care workers (HCWs). Also, coverage trends were analyzed to assess uptake in post-pandemic seasons.

Methods

We used data from two nation-wide representative health surveys namely the 2009/10 European Health Interview Survey for Spain (N = 22,188) and the 2011–12 Spanish National Health Survey (N = 21,007) Influenza vaccination status was self-reported. We analyzed influenza vaccine coverage by age, sex, number of chronic conditions, being a heath care worker (HCWs) and nationality. Time trends for campaigns among high risk groups were estimated by a multivariate logistic regression model.

Results

We analyzed data from 43,072 subjects aged ≥16 years. As a whole, coverage decreased by 3.31% (22.57–19.26%) between the 2008/2009 and 2011/2012 campaigns with a significant decreasing trend (OR 0.92; 95% CI: 0.90–0.94).Coverage in people under 60 years with a chronic disease decreased significantly (OR 0.92: 95% CI: 0.85–0.99) during the analyzed period from 21.02% in 2008/2009 to 17.40% in 2011/2012. Among HCWs, the highest influenza vaccination coverage was achieved in 2009/2010 (31.08%) in the latest campaign coverage has almost halved (17.88%). For the 2011/2012 season and for all age groups the variables associated with a higher probability of having received the influenza vaccine were older age and presence of associated chronic conditions. Among those aged ≥60 years, immigrants had lower uptake (OR 0.60; 95% CI: 0.32–0.99).

Conclusions

Seasonal influenza vaccine uptake rates in the recommended target groups in Spain are unacceptably low and seem to be decreasing in the post pandemic seasons. Further studies are necessary to precisely identify reasons for non-compliance and barriers to influenza vaccination. Meanwhile urgent strategies to improve seasonal vaccination uptake must be discussed and implemented.     

Association of vaccine-related attitudes and beliefs between parents and health care providers

Objectives

Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods

We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results

Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions

The beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.     

Provider knowledge of trivalent inactivated and high-dose influenza vaccines

Objective

The objective of this study was to assess provider knowledge about trivalent inactivated and high dose influenza vaccines. Hence, a 20-item survey was distributed to providers within the Internal Medicine department at an urban academic medical center.

Results

Two hundred and eighty-one (24.5%) providers responded. The correct response rate was 63.2%. The highest performing subspecialties were infectious diseases (80.5%), endocrinology (69.2%), and pulmonary (68%). Those who received an influenza vaccine during the most recent season scored significantly higher than those who did not (63.6% vs. 43.6%, p = .001). Areas where respondents did poorly included questions pertaining to contraindications to immunizations (27.4%), common adverse events after immunization (29.2%), target antigen (73.5%), number of strains in the trivalent inactivated vaccine (62.9%), and time to immunity (61.4%). High dose vaccine knowledge was poor, with 37% of providers unaware of its existence.

Conclusion

Significant gaps in provider knowledge exist regarding both trivalent inactivated and high dose influenza vaccines.     

Sustained high influenza vaccination rates and decreased safety concerns among pregnant women during the 2010–2011 influenza season

Objective

Intense efforts to vaccinate pregnant women against 2009 H1N1 influenza resulted in much higher vaccine uptake than previously reported. We surveyed postpartum women to determine whether high vaccination rates were sustained during the 2010–11 influenza season.

Methods

We performed cross-sectional surveys of postpartum women delivering at our institution during February–April 2010 and February–March 2011. The surveys ascertained maternal characteristics, history of influenza vaccination, and reasons for lack of vaccination.

Results

During the 2010–11 season, 165 (55%) of 300 women surveyed reported receiving influenza vaccination, compared to 191 of 307 (62%) during 2009–10 (p = 0.08). Vaccination by an obstetrical provider was common, but decreased compared to 2009–10 (60% vs. 71%, p = 0.04). While most women (76%) in 2010–11 reported that their provider recommended influenza vaccination, significantly more reported lack of discussion about vaccination (24% vs. 11%, p < 0.01) compared to 2009–10. Vaccine safety concerns were cited by most (66%) women declining vaccination during 2009–10 but only 27% of women who declined in 2010–11.

Conclusion

The vaccination rate among pregnant women at our institution was relatively sustained, although fewer providers appear to be discussing influenza vaccination in pregnancy. Concern about vaccine safety, the primary barrier during 2009–10, was much less prominent.     

Pharmacist-led Tdap vaccination of close contacts of neonates in a women's hospital

Background

Pertussis can cause severe illness and death in infants. Immunization of family members with the tetanus toxoid, reduced diphtheria toxoids, and acellular pertussis (Tdap) vaccine can decrease risk of pertussis infection among infants. A community pharmacy on a women's hospital campus implemented a Tdap vaccination pilot program.

Objective

To investigate the rate of Tdap vaccination among close contacts of neonates in a women's hospital pharmacy and to assess the impact of a coordinated pharmacy and hospital Tdap vaccination program.

Methods

The intervention entailed education from hospital staff who explained the risks of pertussis, advocated the benefits of vaccination, and encouraged family members to be vaccinated. In the on-site clinic or in the pharmacy, pharmacists administered vaccine to eligible patients. Rates of Tdap vaccinations in the intervention pharmacy with in-hospital vaccination were compared to comparison pharmacies without Tdap interventions.

Results

In the pre-study period (December 2008–November 2010), there were 31 Tdap vaccinations administered at the intervention pharmacy (mean = 1.3/month); during the study period (December 2010–November 2012), 2045 Tdap vaccinations were administered (mean = 85.2/month). In four comparison hospital-campus pharmacies, there were 77 vaccinations (mean = 0.8/month) during the pre-study period and 817 vaccinations (mean = 8.5/month) during the study period. There were 155 vaccinations administered in 44 area-community pharmacies (mean = 0.1/month) during the pre-study period and 2930 (mean = 2.8/month) during the study period. The intervention pharmacy had the highest average monthly rate of change in Tdap volume from pre-study to study period (83.9), compared to comparison hospital-campus pharmacies (7.7, p < .001) and area-community pharmacies (2.7, p < .001). During the study period, the estimated Tdap vaccination coverage per live births was 8.1% in the intervention pharmacy versus 5.5% in the comparison hospital-campus pharmacies (p < .001).

Conclusions

Tdap vaccination rates increased after implementation of the intervention program. This project illustrates how health systems and community pharmacists can collaborate to improve patient care.     

The missing link: Family physician perspectives on barriers and enablers to prescribing a new Meningococcal B vaccine and other recommended,non-government funded vaccines

Objectives

To determine factors influencing Family Physician (FP) uptake of non government-funded vaccines, and to explore FP attitudes towards the introduction and use of a new vaccine to protect against serogroup B meningococcal disease to inform its future introduction into the Australian Immunisation Schedule.

Design setting and participants

Quantitative, self-administered state-wide questionnaire mailed to all FPs in South Australia (n = 1786). Results from 523 FP respondents in South Australia, collected between June and October 2013.

Main outcome measures

Self-reported immunisation counselling practices; and knowledge, attitudes and barriers to prescribing of Meningococcal B (Men B) vaccine and other recommended, non-funded immunisations.

Results

The response rate was 30% (n = 523). While most (59%) respondents had worked in general practice for over 20 years, only 39% of all respondents had ever had personal or professional experience with a case of invasive meningococcal disease (IMD). Most FPs (63%) were aware that a meningococcal B vaccine was being developed, and 93% of respondents agreed that this vaccine should be government-funded. FPs ranked Men B vaccine as the highest priority to receive funding of eight currently non-funded immunisation strategies. High vaccine cost and low patient socioeconomic status were identified as definite barriers to prescribing non-funded vaccines by 59% of respondents. Past IMD experience significantly affected attitudes and prescribing practices.

Conclusions

IMD, while encountered rarely in clinical practice, is considered an important disease to vaccinate against by FPs. Cost and perceived low socioeconomic status of patients are substantial barriers to FPs prescribing Men B and other non-funded vaccines, and inclusion of such vaccines on the National Immunisation Program is likely to improve equity of access.     

Pesticide exposure and low birth weight prevalence in Brazil

Introduction

Brazil is one of the major global consumers of pesticides and exposure to these substances can affect fetal growth.

Objective

To estimate the correlation between pesticide sales in 1996 and the prevalence of low birth weight during the period 1996–1998 in Brazil.

Method

This ecological study employed secondary data aggregated at the level of Brazilian micro-regions (cluster of cities). Prevalence of low birth weight in 1996, 1997, and 1998 was obtained from the Brazilian health databases, and per capita pesticides sales in 1996 obtained from the Brazilian Institute of Geography and Statistics were utilized as an indirect measure of population exposure to these chemicals. Spearman correlation coefficient and Prevalence Ratio by quartiles were estimated, considering per capita pesticide sales and the prevalence of low birth weight.

Results

A total of 552 micro-regions were analyzed (446 non-urban and 106 urban). In rural areas, the per capita pesticide sales were directly associated with higher prevalence of children born with low birth weight (r = 0.403), with birth weights between 1500 and 2500 grams (r = 0.366), and very low birth weight birth (r = 0.476). All correlations were statistically significant (p < 0.001). On the other hand, in urban areas there was no significant correlation. There was a gradual increase in the prevalence of low birth weight according to the quartiles of pesticide consumption.

Conclusions

Pesticide per capita sales may affect the prevalence of newborns with low birth weight in non-urban micro-regions of Brazil, indicating the need to strengthen policies and actions to protect the health of populations exposed to pesticides.     

Patient–provider communication and timely receipt of preventive services

Objective

To estimate the association between how patients rate their health care provider's communication and the receipt of six clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP).

Methods

This study used national data from the 2009 Medical Expenditure Panel Survey (MEPS). The samples (sizes vary by service) included individuals aged 18 years and older who have a usual source of care (USC). The outcomes indicated whether or not individuals received screening for breast cancer, cervical cancer, colon cancer, high cholesterol, hypertension, or were vaccinated against influenza per clinical guidelines. Multivariate logistic regression models were created for each dependent variable. The main independent variables consisted of ratings of four patient–provider communication behaviors.

Results

In unadjusted analyses, respondents who rated their providers' communication higher reported greater utilization of preventive services. After controlling for confounding variables, only receipt of mammograms remained significantly associated with better communication (p < 0.05). Screening for cervical cancer, colon cancer, high cholesterol, and influenza vaccination approached significance with better communication (p < 0.10).

Conclusions

Patient–provider communication is associated with receipt of regular mammograms. Clinicians should consider their medical dialogue with patients as a stimulus for appropriate screenings and vaccinations.     

Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers

Objectives

Numerous interventions seeking to increase preparedness for pandemic influenza have been implemented, but low compliance of healthcare providers has been reported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital managers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time.

Study design

A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' perceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters.

Methods

Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sciences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza.

Results

All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R² = 0.346, P = 0.002). Inclusion of preparedness evaluations explained an additional 15% of the variance (R² change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation.

Conclusions

Familiarity with guidelines and preparedness evaluations affect the perceptions of healthcare managers regarding preparedness and capability to manage pandemic influenza.     

Contribution of systematic RT-PCR screening for influenza during the epidemic season

Objective

We assessed the systematic RT-PCR screening of patients admitted to an infectious diseases department (IDD), during the 2012–2013 influenza outbreak.

Methodology

Patients admitted with cough and fever underwent a nasopharyngeal smear for RT-PCR screening.

Results

Ninety-eight patients were admitted in the IDD, from January 1st to February 22nd, 46 were screened; 11 male and 6 female patients (17.3%, mean age of 68 years) were positive. The diagnoses made in the emergency department, before RT-PCR screening, were most frequently lung infection and sepsis, but influenza in only 4 cases. The diagnosis of influenza led to stopping antibiotics (n = 4), initiating curative (n = 4) and preventive (n = 4) treatments with oseltamivir, and isolating patients to prevent a hospital outbreak.

Conclusion

Systematic RT-PCR screening allows a rapid therapeutic management and the prevention of hospital epidemic through appropriate isolation measures.     

Socioecological and message framing factors influencing maternal influenza immunization among minority women

Objective

A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination (“gain-frame”), or messages which emphasize negative outcomes of forgoing vaccination (“loss-frame”). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

Study design

Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

Results

Neither gain- [OR = 0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR = 0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR = 3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR = 2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR = 3.405, 95% CI: (1.412,8.212)].

Conclusion

Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.     

Meta-analysis of vaccine effectiveness of mumps-containing vaccine under different immunization srategies in China

Objective

To evaluate vaccine effectiveness (VE) of mumps-containing vaccine (MuV) under different immunization strategies.

Methods

We conducted Medline, Embase, China National Knowledge Internet (CNKI), and Wan Fang Database (WF) searches for Chinese and English language articles describing studies of mumps VE in a Chinese population. Evaluated articles were scored on quality using the Newcastle–Ottawa Scale. Meta-analysis was conducted using random effects models. Sensitivity analysis, subgroup analysis and meta-regression were conducted to explore heterogeneity.

Results

A total of 32 studies in 19 papers were included; 14 were case-control studies, and 18 were cohort studies. Half of the studies were of high quality; 41% were of moderate quality. The overall VE for mumps containing vaccine (either one dose or two doses) was 85% (95% CI 76–90%) for cohort studies and 88% (95% CI 82–92%) for case-control studies. Using random effects meta-regression we found significant differences in some study covariates; for instance, VE varied by population (VE = 88% in day care versus 69% in pupil, p = 0.008) and emergency versus routine immunization (VE = 80% for routine immunization versus 95% for emergency immunization, p = 0.041). However, these results must be interpreted with caution due to the low number of studies in subgroups, with the permutation test giving non-significant results that indicated that the results may be due to chance.

Conclusions

MuV provides good protection from mumps infection. Further studies of mumps VE with larger sample sizes enabling subgroup analyses will be needed to confirm our findings.     

Safety and immunogenicity of a pneumococcal histidine triad protein D vaccine candidate in adults

Background

Pneumococcal vaccines based on conserved protein antigens have the potential to offer expanded protection against Streptococcus pneumoniae.

Objective

To explore safety and immunogenicity of a recombinant protein vaccine candidate against S. pneumoniae composed of adjuvanted pneumococcal histidine triad protein D (PhtD).

Methods

This phase I, exploratory, open-label, single-center clinical study enrolled adults (18–50 years). Participants in a pilot safety cohort received a single intramuscular injection of 6 μg. Following safety review, 3 dose cohorts were enrolled (6, 25, and 100 μg); participants received 2 injections administered approximately 30 days apart. Assignment of the second injection and successive dose cohorts were made after blinded safety reviews after each injection at each dose level. Safety endpoints included rates of solicited injection site and systemic reactions, unsolicited adverse events, serious adverse events, and safety laboratory tests. Immunogenicity endpoints included levels of anti-PhtD antibodies as measured by ELISA.

Results

Sixty-three participants were enrolled and received the pilot safety dose (n = 3) or at least 1 dose of PhtD vaccine candidate at 6 μg (n = 20), 25 μg (n = 20), or 100 μg (n = 20). No safety concerns were identified. No vaccine-related serious adverse event was reported. The most common solicited injection site reaction was pain and most common solicited systemic reactions were myalgia and headache; most reactions were mild and transient. Observed geometric mean concentrations (95% CI) were 200.99 ELISA units (148.46, 272.10), 352.07 (193.49, 640.63), and 699.15 (405.49, 1205.48) post-injection 1 in the 6, 25, and 100 μg dose cohorts, respectively, and 378.25 (275.56, 519.21), 837.32 (539.29, 1300.04), and 1568.62 (1082.92, 2272.16) post-injection 2.

Conclusions

All dose levels were safe and immunogenic. The frequency of solicited reactions was highest at the 100 μg dose. Administration of a second injection significantly increased the levels of anti-PhtD antibodies (ClinicalTrials.gov registry no. NCT01444001).