Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Volume 29, Issue 2 (16 December 2010)

Regular Papers
Influenza vaccination for healthcare workers who work with the elderly: Systematic review

Original Research Article
Pages 344-356
Roger E. Thomas, Tom Jefferson, Toby J. Lasserson
Abstract
Aim
To identify studies of influenza vaccination of HCWs and influenza in elderly residents in long-term care facilities.

Scope
We searched seven electronic databases for randomised controlled trials (RCTs) and non-RCTs. Two reviewers independently extracted data and assessed trial quality.

Conclusions
The key outcomes are serologically proven influenza, pneumonia, and deaths from pneumonia, and pooled data from three C-RCTs showed no effect. Pooled data from three C-RCTs showed lower resident all-cause mortality, but as influenza constituted less than 10% of all deaths even in epidemic years we question the appropriateness of this outcome measure. Pooled data from three C-RCTs showed vaccination of HCWs reduced ILI and data from one C-RCT that HCW vaccination reduced GP consultations for ILI, but as influenza constitutes less than 25% of ILI and we did not show that HCW influenza vaccination reduced serologically proven influenza we question whether this effect is due to confounding.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 1 pp. 1-152 (10 December 2010)

Regular Papers
Pragmatic management of programmatic vaccination errors—Lessons learnt from incidents in London
Original Research Article
Pages 65-69
Laura Craig, David Elliman, Rachel Heathcock, Deborah Turbitt, Barry Walsh, Natasha Crowcroft

Abstract
Correct storage, handling and administration of vaccines are vital components of a successful immunisation programme. However, with the large number of different healthcare professionals now involved in delivering the vaccine programme on a daily basis, it is inevitable that programmatic errors will occur. Decisions as to how best to rectify these errors can be difficult however, as often they are unprecedented and there may be no hard evidence on which to base their management. These decisions must therefore be based on what is known and any available previous experience. They also often take place in an environment of concern about litigation and liability which puts pressure on health care workers to take a defensive or conservative approach. Management decisions may ultimately also have to be a pragmatic choice based on the individual situation and what is deemed to be the best way to minimise adverse reactions, ensure patients are adequately protected and maintain public confidence in the immunisation programme. Here, we describe our experiences of managing vaccine programmatic errors and some of the many factors that we had to consider.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 1 pp. 1-152 (10 December 2010)

Regular Papers
The uptake of rotavirus vaccine and its effectiveness in preventing acute gastroenteritis in the community
Original Research Article
Pages 91-94
Khitam Muhsen, Gabriel Chodick, Sophy Goren, Varda Shalev, Dani Cohen

Abstract
We examined the uptake of rotavirus vaccine and its effectiveness in preventing acute gastroenteritis (AGE) in the community. Data on rotavirus vaccines purchases and AGE were extracted from the computerized database of a large health maintenance organization in Israel. The incidence of AGE requiring a physician visit during 2008–09 rotavirus season among vaccinated and non-vaccinated children were compared, and vaccine effectiveness was calculated as: (1 − Relative Risk) × 100. During the study period, the uptake of rotavirus vaccine (mostly monovalent) reached 55.1% (N = 19,108) of the studied cohort. The risk of AGE requiring a physician visit was 23.2% and 46.4% among vaccinated and unvaccinated children, respectively, yielding an effectiveness of 50.1% (95% CI: 47.5%, 52.6%). Rotavirus monovalent vaccine was highly effective in preventing AGE in the community.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 1 pp. 1-152 (10 December 2010)

Regular Papers
Factors associated with protective antibody levels to vaccine preventable diseases in internationally adopted children
Original Research Article
Pages 95-103
Laura Patricia Stadler, Stephanie Donauer, Marilyn Rice, Indi Trehan, Shelia Salisbury, Mary Allen Staat

Abstract
To determine which factors are predictive of protective antibody against vaccine-preventable diseases in internationally adopted children, we evaluated 562 children with serologic testing for at least one vaccine antigen before receiving a US vaccination. Vaccination status was defined as the number-of-doses recorded and as the presence of an up-to-date and valid record according to the American Academy of Pediatrics and the Advisory Committee on Immunization Practices guidelines. The number-of-doses recorded was the best predictor of protective antibody. These findings suggest that other options for immunization verification guidelines for internationally adopted children should be considered by policy makers.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 52 pp. 8227-8352 (6 December 2010)

Editorial
Developing the next generation of vaccinologists
Pages 8227-8228
Gregory A. Poland, Myron M. Levine, John D. Clemens

[no abstract]

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Reviews
Reflections on the influenza vaccination of healthcare workers
Review Article
Pages 8061-8064
Stuart McLennan, Sabine Wicker

Abstract
Despite all that is known about the dangers of nosocomial transmission of influenza to the vulnerable patient populations in our healthcare facilities, and the benefits of the influenza vaccination, the low rates of influenza vaccination among healthcare workers (HCWs) internationally shows no sign of significant improvement. With the current voluntary ‘opt-in’ programmes clearly failing to adequately address this issue, the time has undoubtedly come for a new approach to vaccination to be implemented. Two different approaches to vaccination delivery have been suggested to rectify this situation, mandatory vaccination and ‘opt-out’ declination forms. It is suggested, however, that these two approaches are inadequate when used by themselves. In order to protect the most vulnerable patients in our healthcare facilities as best we can from serious harm or death caused by nosocomial transmission of influenza, while at the same time respecting HCWs autonomy, and in many jurisdictions, the related legal right to refuse medical treatment, it is recommended that ‘op-out’ declination forms should be used in conjunction with restricted mandatory vaccination. This ‘combined’ approach would allow any HCW to refuse the influenza vaccination, but would make the influenza vaccination a mandatory requirement for working in areas where the most vulnerable patients are cared for. Those HCWs not willing to be vaccinated should be required to work in other areas of healthcare.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Benefits of vaccinating young adult women with a prophylactic quadrivalent human papillomavirus (types 6, 11, 16 and 18) vaccine
Review Article
Pages 8065-8072
J. Monsonego, J. Cortes, C. Greppe, M. Hampl, E. Joura, A. Singer

Abstract
Cervical cancer is a leading cause of cancer-related deaths worldwide. The causal role of human papillomavirus (HPV) infection in the pathogenesis of cervical cancer has prompted the development of vaccines against HPV. The highest risk of HPV infection is in women aged 16–25 years. Almost all young adult women can benefit from HPV vaccination. There is strong epidemiological and clinical support for vaccination programmes that target sexually active women in this age group to prevent HPV infection, and thus avert the development of HPV-related disease. Furthermore, the implementation of HPV vaccination programmes may benefit the development or awareness of cervical cancer prevention strategies and ultimately reduce the burden of cervical cancer and improve cervical cancer control.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Is it time for a new yellow fever vaccine?
Review Article
Pages 8073-8076
Edward B. Hayes

Abstract
An inexpensive live attenuated vaccine (the 17D vaccine) against yellow fever has been effectively used to prevent yellow fever for more than 70 years. Interest in developing new inactivated vaccines has been spurred by recognition of rare but serious, sometimes fatal adverse events following live virus vaccination. A safer inactivated yellow fever vaccine could be useful for vaccinating people at higher risk of adverse events from the live vaccine, but could also have broader global health utility by lowering the risk-benefit threshold for assuring high levels of yellow fever vaccine coverage. If ongoing trials demonstrate favorable immunogenicity and safety compared to the current vaccine, the practical global health utility of an inactivated vaccine is likely to be determined mostly by cost.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Regular Papers
Hepatitis A and travel amongst Nova Scotia postsecondary students: Evidence for a targeted vs. universal immunization strategy

Original Research Article
Pages 8105-8111
Katherine Matheson, Beth Halperin, Shelly McNeil, Joanne M. Langley, Donna MacKinnon-Cameron, Scott A. Halperin
Abstract
Background
Canadian guidelines recommend hepatitis A virus (HAV) vaccination for high-risk persons, such as travelers to HAV-endemic areas. The US CDC advocates universal immunization.

Objectives
To explore whether a universal strategy for HAV immunization rather than the Canadian targeted approach for travelers is justified by measuring compliance of postsecondary students with Canadian guidelines.

Methods
A cross-sectional study using an electronic survey method elicited HAV risk factors, immunization history, disease status, and factors affecting immunization status from postsecondary students. Seropositivity was determined by measuring HAV antibodies in saliva from a convenience sample of survey participants within each study group. Statistical analysis used Fisher’s exact test and logistic regression.

Results
We received 2279 completed surveys (10.6% response) and 235 saliva samples (58.7% response). A total of 1380 (60.6%) participants had traveled to HAV-endemic regions and 1851 (81.2%) were planning to do so within the next 5 years. Less than half who traveled to HAV-endemic areas reported a history of HAV vaccination (48.0%). HAV seropositivity rates were higher amongst those who traveled to (63.6%) or were planning to travel to (55.0%) HAV-endemic areas than those who had never traveled or had no plans to travel to such areas (17.4%). Only 8.9% of unvaccinated students were seropositive (5.3% of Canadian-born students). Amongst unvaccinated, seropositive students, there was a nonsignificant trend for higher seropositivity in those who had previously traveled to HAV-endemic areas (14.7%) than those who had not traveled abroad (4.4%), suggesting an exposure to HAV during travel. Nearly all (96.5%) unvaccinated students, who were willing to be vaccinated based on current knowledge or if their doctor recommended it, indicated a willingness to receive vaccine if it were provided free of charge.

Conclusions
Current Canadian guidelines for HAV vaccination are not being followed within the postsecondary student population. Given high rates of travel to HAV-endemic areas in this population, a universal approach to HAV vaccination may be warranted.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Resistance to vaccination: The attitudes and practices of primary healthcare workers confronting the H1N1 pandemic

Original Research Article
Pages 8120-8124
Seyhan Hidiroglu, Pinar Ay, Ahmet Topuzoglu, Cem Kalafat, Melda Karavus

Abstract
During the H1N1 pandemic, most healthcare workers in Turkey were not willing to take up the vaccine. This qualitative study aims to explore the factors that lead to vaccination resistance among a group of primary healthcare workers in Istanbul. Data were collected through focus group discussions. Thematic content analysis was conducted. All participants considered themselves at risk for infection, yet most of them were not vaccinated. Only persons with a “poor” immune system were considered by the respondents at risk for severe disease and death. Health personnel mostly did not realize their potential role in the transmission of influenza to patients. The decision of vaccination was dependent on the information source. The personnel who depended mainly on the media either did not accept vaccination or was undecided. They believed that the vaccine went through an accelerated authorization procedure. Yet the ones who accepted vaccination relied mostly on evidence-based sources and accessed information from the guidelines of the Ministry of Health, Professional Medical Associations and the World Health Organization. Social networks were also influential factors in the decision-making process. It is important to empower healthcare workers through supporting the skills of acquiring and using evidence-based information. This is particularly important for physicians who also serve as opinion leaders.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 51 pp. 8049-8226 (29 November 2010)

Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009–2010: Results of a national vaccination campaign

Original Research Article
Pages 8157-8161
Angie Bone, Jean-Paul Guthmann, Javier Nicolau, Daniel Lévy-Bruhl

Abstract
A mass vaccination campaign against influenza A/H1N1 was launched in France in October 2009. Vaccination was offered free of charge to the entire population according to a pre-defined order of priority. Demographic data and data on vaccinations given were recorded in a dedicated database. We analysed vaccine uptake by age, sex and region in the overall population and in certain risk groups, including pregnant women. Overall vaccine uptake was 8% and varied by age-group and sex. Vaccine uptake in pregnant women was 22.7%. These low uptakes may reflect controversies around the vaccine and vaccination policy and have important implications for future pandemic vaccination strategies.