Understanding HPV Vaccine Uptake Among Cambodian American Girls

Journal of Community Health
Volume 39, Issue 1, February 2014

Online First
Understanding HPV Vaccine Uptake Among Cambodian American Girls
Victoria M. Taylor, Nancy J. Burke, Linda K. Ko, Channdara Sos, Qi Liu, H. Hoai Do, Jocelyn Talbot, Yutaka Yasui, Roshan Bastani

Cervical cancer incidence rates vary substantially among racial/ethnic groups in the United States (US) with women of Southeast Asian descent having the highest rates. Up to 70 % of cervical cancers could be prevented by widespread use of the human papillomavirus (HPV) vaccine. However, there is a lack of information about HPV vaccine uptake among Southeast Asian girls in the US. We conducted a telephone survey of Cambodian women with daughters who were age-eligible for HPV vaccination. Survey items addressed HPV vaccination barriers, facilitators and uptake. Our study group included 86 Cambodian mothers who lived in the Seattle metropolitan area. The proportions of survey participants who reported their daughter had initiated and completed the HPV vaccine series were only 29 and 14 %, respectively. Higher levels of vaccine uptake were significantly associated with mothers having heard about the HPV vaccine from a health professional and having received a recent Pap test. Commonly cited barriers to HPV vaccination included lack of knowledge about the HPV vaccine, not having received a physician recommendation for HPV vaccination and thinking the HPV vaccine is unnecessary in the absence of health problems. Linguistically and culturally appropriate HPV educational programs should be developed and implemented in Cambodian American communities. These programs should aim to enhance understanding of disease prevention measures, increase knowledge about the HPV vaccine and empower women to ask their daughter’s doctors for HPV vaccination.

Update From the Advisory Committee on Immunization Practices

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 3 Issue 1 March 2014

Update From the Advisory Committee on Immunization Practices
Elizabeth P. Schlaudecker1, Mark H. Sawyer2 and David W. Kimberlin3
Author Affiliations
1Division of Infectious Diseases, Global Health Center, Cincinnati Children’s Hospital Medical Center, Ohio
2Division of Infectious Diseases, University of California San Diego, School of Medicine and Rady Children’s Hospital
3Division of Pediatric Infectious Diseases, University of Alabama at Birmingham

The Advisory Committee on Immunization Practices (ACIP) is composed of medical and public health experts and one community representative that meets 3 times a year to develop vaccine recommendations for the civilian population in the United States. The Advisory Committee on Immunization Practices recommendations become official recommendations of the Centers for Disease Control and Prevention (CDC) when adopted by the CDC Director and published in the Morbidity and Mortality Weekly Report (http://www.cdc.gov/vaccines/hcp/acip-recs/recs-by-date.html). Members of ACIP include people with expertise in vaccines, public health, and various aspects of medicine and preventive medicine (http://annals.org/article.aspx?articleid=744177

Members of the Pediatric Infectious Diseases Society frequently serve on this committee and on ACIP work groups, and our society serves as one of 31 ex officio organizations that participates as a nonvoting representative. The American Academy of Pediatrics (AAP) Committee on Infectious Diseases works closely with the ACIP to maximize harmonization between the CDC and the AAP. The ACIP last met at the CDC on October 23–24, 2013. During this meeting, there were 3 votes taken: meningococcal vaccine for high-risk infants; child/adolescent immunization schedule; and adult immunization schedule. Several other topics were discussed. All ACIP vaccine recommendations will have Grading of Recommendations, Assessment, Development and Evaluation methods applied (http://www.cdc.gov/vaccines/acip/recs/GRADE/table-refs.html

Automated Screening of Hospitalized Children for Influenza Vaccination

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 3 Issue 1 March 2014

Automated Screening of Hospitalized Children for Influenza Vaccination
Ari H. Pollack, Matthew P. Kronman, Chuan Zhou, and Danielle M. Zerr
J Ped Infect Dis (2014) 3 (1): 7-14 doi:10.1093/jpids/pit044

This study was designed to determine whether an automated hospital-based influenza vaccination screening program leveraging the electronic medical record (EMR) increases vaccination rates.

We performed a retrospective cohort study of all children ≥6 months old admitted to medical, surgical, rehabilitation, or psychiatry services during influenza seasons between 2003 and 2012 at a tertiary care pediatric hospital. We compared influenza vaccination rates before (preintervention phase) and after (intervention phase) the introduction of an automated EMR intervention that utilized a nursing-based electronic screening tool to determine eligibility for influenza vaccine and facilitated vaccine ordering without requiring involvement of a physician or other provider.

Overall, 42 716 (72.8%) of the 58,648 subjects admitted during the study period met inclusion criteria. The intervention phase included 20,651 admissions, of which 11 194 (54.2%) were screened. Screening increased significantly over time in the intervention phase (19.8%–77.1%; P < .001). In-hospital influenza vaccination rates increased from a mean of 2.1% (n = 472) of all subjects preintervention phase to 8.0% (n = 1645) in the intervention phase (odds ratio = 6.8; 95% confidence interval, 6.14–7.47). Of the 11 194 screened subjects, 5505 (49.2%) were found to have already been vaccinated at the time of screening. The screening process identified 478 (4.3%) subjects who were unable to receive vaccine for medical reasons, and an additional 2865 (25.6%) whose caregiver refused the vaccine.

An automated, hospital-based influenza vaccination program integrated into the EMR can increase vaccinations of hospitalized patients and provide insight into the vaccination history and declination reasons for children not receiving the vaccine.

World View: WHO plans for neglected diseases are wrong

Volume 506 Number 7488 pp265-402  20 February 2014

Nature | Column: World View
WHO plans for neglected diseases are wrong
Research and development into diseases affecting the world’s poorest people will not benefit from the agency’s policy, warns Mary Moran.
19 February 2014

After more than a decade of trying to find a way to fund research on diseases that affect the developing world, the World Health Organization (WHO) made a decisive move last month when it announced its first pilot projects. As Nature reported (see Nature 505, 142; 2014), the WHO hopes that these projects will break the stalemate over research on neglected conditions such as kala-azar, a deadly parasitic disease that afflicts hundreds of thousands of the world’s poorest people.

The WHO is taking giant strides, but they are in the wrong direction. The projects are based on flawed logic and will waste time and money. Worse, this initiative could actively damage existing projects to develop such medicines. The WHO pilot should be stopped.

I do not make these claims lightly. I was involved in the WHO analysis, drafting and recommendations, and know how difficult it has been.

The pilot projects are the culmination of a ten-year negotiation that aimed to achieve two goals: to make commercial medicines more affordable for the developing world, and to stimulate public (non-profit) development of medicines for neglected diseases…

Informed Consent, Comparative Effectiveness, and Learning Health Care :: Informed Consent for Pragmatic Trials — The Integrated Consent Model

New England Journal of Medicine
February 20, 2014  Vol. 370 No. 8

Health Law, Ethics, and Human Rights
Informed Consent, Comparative Effectiveness, and Learning Health Care
Ruth R. Faden, Ph.D., M.P.H., Tom L. Beauchamp, Ph.D., and Nancy E. Kass, Sc.D.
N Engl J Med 2014; 370:766-768February 20, 2014DOI: 10.1056/NEJMhle1313674
The authors argue that in a learning health care system with ethically robust oversight policies, a streamlined consent process could replace formal written informed-consent procedures for many studies, and patient consent would not be required at all for some trials.

Health Law, Ethics, and Human Rights
Informed Consent for Pragmatic Trials — The Integrated Consent Model
Scott Y.H. Kim, M.D., Ph.D., and Franklin G. Miller, Ph.D.
N Engl J Med 2014; 370:769-772February 20, 2014DOI: 10.1056/NEJMhle1312508
The authors argue that informed consent is ethically necessary in pragmatic trials that randomly assign individual patients to treatments, even when treatment options are within the standard of care. They propose integration of a streamlined consent process into routine practice.

The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions

PLoS One
[Accessed 22 February 2014]

Research Article
The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions
Daniel Jolley mail, Karen M. Douglas mail
Published: February 20, 2014
DOI: 10.1371/journal.pone.0089177

The current studies investigated the potential impact of anti-vaccine conspiracy beliefs, and exposure to anti-vaccine conspiracy theories, on vaccination intentions. In Study 1, British parents completed a questionnaire measuring beliefs in anti-vaccine conspiracy theories and the likelihood that they would have a fictitious child vaccinated. Results revealed a significant negative relationship between anti-vaccine conspiracy beliefs and vaccination intentions. This effect was mediated by the perceived dangers of vaccines, and feelings of powerlessness, disillusionment and mistrust in authorities. In Study 2, participants were exposed to information that either supported or refuted anti-vaccine conspiracy theories, or a control condition. Results revealed that participants who had been exposed to material supporting anti-vaccine conspiracy theories showed less intention to vaccinate than those in the anti-conspiracy condition or controls. This effect was mediated by the same variables as in Study 1. These findings point to the potentially detrimental consequences of anti-vaccine conspiracy theories, and highlight their potential role in shaping health-related behaviors.

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children

PNAS – Proceedings of the National Academy of Sciences of the United States
of America

(Accessed 22 February 2014)

Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children
Elisabeth Dowling Roota,1, Marilla Lucerob, Hanna Nohynekc, Peter Anthamattend, Deborah S. K. Thomasd, Veronica Tallob, Antti Tanskanenc,e, Beatriz P. Quiambaob, Taneli Puumalainenf,
Socorro P. Lupisanb, Petri Ruutug, Erma Ladesmab, Gail M. Williamsh, Ian Rileyh, and Eric A. F. Simõesi
Author Affiliations
Edited by Burton H. Singer, University of Florida, Gainesville, FL, and approved January 21, 2014 (received for review July 22, 2013)

Although pneumococcal conjugate vaccines (PCVs) are widely available in industrialized nations, the cost of these vaccines and the strategy of universal vaccination of infants, as endorsed by the World Health Organization, are daunting obstacles to the adoption of these vaccines in developing countries. Using spatial epidemiological methods to examine the spatial variation in vaccine efficacy (VE) in an 11-valent PCV trial in Bohol, Philippines, we suggest an alternative strategy to universal vaccination. Our main finding suggests that areas with poor access to healthcare have the highest VE. An alternative vaccination strategy could target vaccination to areas where children are most likely to benefit, rather than focus on nationwide immunization.

Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at greater risk for pneumococcal pneumonia. We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent PCV among children less than 2 y of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographic information system. We use spatial interpolation methods to create smoothed surface maps of vaccination rates and local-level vaccine efficacy across the study area. We then measure the relationship between distance to the main study hospital and local-level vaccine efficacy, controlling for ecological factors, using spatial autoregressive models with spatial autoregressive disturbances. We find a significant amount of spatial variation in vaccination rates across the study area. For the primary study endpoint vaccine efficacy increased with distance from the main study hospital from −14% for children living less than 1.5 km from Bohol Regional Hospital (BRH) to 55% for children living greater than 8.5 km from BRH. Spatial regression models indicated that after adjustment for ecological factors, distance to the main study hospital was positively related to vaccine efficacy, increasing at a rate of 4.5% per kilometer distance. Because areas with poor access to care have significantly higher VE, targeted vaccination of children in these areas might allow for a more effective implementation of global programs.