Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center

American Journal of Infection Control
Vol 41 | No. 9 | September 2013 | Pages 759-852

Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center
Kathleen A. Crowley, RPA-C, MPH; Ronnie Myers, DDS; Lori A. Magda, MA; Stephen S. Morse, PhD; Paul Brandt-Rauf, MD, DrPH, SciD; Robyn R.M. Gershon, MT, MHS, DrPH

Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting.

A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center.

Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institution’s written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001).

Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies

EDITORIAL: At the crossroads: transforming health systems to address women’s health across the life course

Bulletin of the World Health Organization
Volume 91, Number 9, September 2013, 621-715

Special theme: women’s health beyond reproduction – a new agenda
At the crossroads: transforming health systems to address women’s health across the life course
Flavia Bustreo, Oleg Chestnov, Felicia Marie Knaul, Islene Araujo de Carvalho, Mario Merialdi, Marleen Temmerman & John R Beard
doi: 10.2471/BLT.13.128439

Article [HTML]

A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries

Cost Effectiveness and Resource Allocation
(Accessed 31 August 2013)

A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries
Martí SG, Colantonio L, Bardach A, Galante J, Lopez A, Caporale J, Knerer G, Gomez JA et al. Cost Effectiveness and Resource Allocation 2013, 11:21 (30 August 2013)

Abstract (provisional)
A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru.

We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries.

The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity.

The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.

Current issues in dengue vaccination

Current Opinion in Infectious Diseases.
October 2013 – Volume 26 – Issue 5  pp: v-vi,399-492

Current issues in dengue vaccination
Thomas, Stephen J.; Endy, Timothy P.

Purpose of review: Dengue is a global health problem and of concern to travelers and deploying military personnel, with development and licensure of an effective tetravalent dengue vaccine a public health priority. The recent performance of the lead dengue vaccine in a phase 2b efficacy trial underscores dengue vaccine development challenges. This review focuses on current issues in dengue vaccination.

Recent findings: The dengue viruses (DENVs) are mosquito-borne flaviviruses transmitted by infected Aedes mosquitoes. Illness manifests across a clinical spectrum with severe disease characterized by intravascular volume depletion and hemorrhage. Recent estimates on the burden of DENV infection determined that there are 390 million dengue infections per year, three times the current estimate by the WHO. There are no licensed antivirals or vaccines to treat or prevent dengue though many are in preclinical or clinical development. DENV illness results from a complex interaction of viral properties and host immune responses. Immunologic complexity, lack of an adequate animal model of disease, absence of an immune correlate of protection, and only partially informative immunogenicity assays are challenging dengue vaccine development efforts.

Summary: Dengue vaccine development efforts have numerous complex challenges to overcome before a well-tolerated and effective vaccine is licensed and available. In this review, the authors discuss the current issues in dengue vaccination.

Open innovation as a new paradigm for global collaborations in health

Globalization and Health
[Accessed 31 August 2013]

Open innovation as a new paradigm for global collaborations in health
Patricia Dandonoli
Globalization and Health 2013, 9:41 doi:10.1186/1744-8603-9-41
Published: 30 August 2013

Abstract (provisional)
Open innovation, which refers to combining internal and external ideas and internal and external paths to market in order to achieve advances in processes or technologies, is an attractive paradigm for structuring collaborations between developed and developing country entities and people. Such open innovation collaborations can be designed to foster true co-creation among partners in rich and poor settings, thereby breaking down hierarchies and creating greater impact and value for each partner. Using an example from Concern Worldwide’s Innovations for Maternal, Newborn & Child Health initiative, this commentary describes an early-stage pilot project built around open innovation in a low resource setting, which puts communities at the center of a process involving a wide range of partners and expertise, and considers how it could be adapted and make more impactful and sustainable by extending the collaboration to include developed country partners.

Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV in India

Health Policy and Planning
Volume 28 Issue 6 September 2013

Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV in India
Anuj Kapilashrami1,* and Barbara McPake2
Author Affiliations
1Global Public Health Unit, University of Edinburgh, Edinburgh EH8 9LD, UK and 2Institute for International Health & Development, Queen Margaret University, Edinburgh EH21 6UU, UK
*Corresponding author. Global Public Health Unit, University of Edinburgh, Edinburgh, UK. E-mail:
Accepted September 10, 2012.

Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechanisms to tackle global health priorities. More recent literature reveals governance-related challenges and their unintended health system effects. Much less attention is received by the relationship between these mechanisms, the ideas that underpin them and the country-level practices they generate. The Global Fund has leveraged significant funding and taken a lead in harmonizing disparate efforts to control HIV/AIDS. Its growing influence in recipient countries makes it a useful case to examine this relationship and evaluate the extent to which the dominant public discourse on Global Fund departs from the hidden resistances and conflicts in its operation. Drawing on insights from ethnographic fieldwork and 70 interviews with multiple stakeholders, this article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India. We argue that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario. Its organizing principles prompt diverse actors with conflicting agendas to come together in response to the availability of funds. Multiple and discrete projects emerge, each leveraging control and resources and acting as conduits of power. We examine how management of HIV is punctuated with conflicts of power and interests in a competitive environment set off by the Fund protocol and discuss its system-wide effects. The findings also underscore the need for similar ethnographic research on the financing and policy-making architecture of GHIs.

A School-Located Vaccination Adolescent Pilot Initiative in Chicago: Lessons Learned

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 2 Issue 3 September 2013

A School-Located Vaccination Adolescent Pilot Initiative in Chicago: Lessons Learned
Rachel N. Caskey1, Everly Macario2, Daniel C. Johnson2, Tamara Hamlish2 and Kenneth A. Alexander2
Author Affiliations
1Department of Pediatrics, University of Illinois at Chicago;
2Department of Pediatrics, University of Chicago
Corresponding Author: Everly Macario, ScD, MS, EdM, Department of Pediatrics, University of Chicago, 5629 S Dorchester Ave, Chicago, IL 60637. E-mail:
Received July 25, 2012.
Accepted November 9, 2012.

Many adolescents underutilize preventive services and are underimmunized.

To promote medical homes and increase immunization rates, we conceptualized and implemented a 3-year, 8-school pilot school-located vaccination collaborative program. We sought community, parent, and school nurse input the year prior to implementation. We selected schools with predominantly Medicaid-enrolled or Medicaid-eligible students to receive Vaccines For Children stock vaccines. Nurses employed by a mass immunizer delivered these vaccines at participating schools 3 times a year.

Over 3 years, we delivered approximately 1800 vaccines at schools. School administrators, health centers, and neighboring private physicians generally welcomed the program. Parents did not express overt concerns about school-located vaccination. School nurses were not able to participate because of multiple school assignments. Obtaining parental consent via backpack mail was an inefficient process, and classroom incentives did not increase consent form return rate. The influenza vaccine had the most prolific uptake. The optimal time for administering vaccines was during regular school hours.

Although school-located vaccination for adolescents is feasible, this is a paradigm shift for community members and thus accompanies challenges in implementation. High principal or school personnel turnover led to a consequent lack of institutional memory. It was difficult to communicate directly with parents. Because we were uncertain about the proportion of parents who received consent forms, we are exploring Internet-based and back-to-school registration options for making the consent form distribution and return process more rigorous. Securing an immunization champion at each school helped the immunization processes. Identifying a financially sustainable school-located vaccination model is critical for national expansion of school-located vaccination.