Vaccine – Volume 33, Issue 5, Pages 585-748 (29 January 2015)

Volume 33, Issue 5, Pages 585-748 (29 January 2015)

Age at HPV vaccine initiation and completion among US adolescent girls: Trend from 2008 to 2012
Pages 585-587
Mahbubur Rahman, Christine J. McGrath, Jacqueline M. Hirth, Abbey B. Berenson
:: We analyzed National Immunization Survey of Teens 2008–2012 data to examine what proportion of adolescent girls receives HPV vaccine at <13 years of age.
:: The weighted proportion of girls who initiated the vaccine at <13 years of age increased from 14.1% in 2008 to 55.9% in 2012.
:: Additional efforts are needed to increase HPV vaccine uptake among adolescent girls as only half of them receive this vaccine at ACIP recommended age.

Supporting countries in establishing and strengthening NITAGs: Lessons learned from 5 years of the SIVAC initiative
Review Article
Pages 588-595
Alex Adjagba, Kamel Senouci, Robin Biellik, Nyambat Batmunkh, Pape Coumba Faye, Antoine Durupt, Bradford D. Gessner, Alfred da Silva
To empower governments to formulate rational policies without pressure from any group, and to increase the use of evidence-based decision-making to adapt global recommendations on immunization to their local context, the WHO has recommended on multiple occasions that countries should establish National Immunization Technical Advisory Groups (NITAGs). The World Health Assembly (WHA) reinforced those recommendations in 2012 when Member States endorsed the Decade of Vaccines Global Vaccine Action Plan (GVAP). NITAGs are multidisciplinary groups of national experts responsible for providing independent, evidence-informed advice to health authorities on all policy-related issues for all vaccines across all populations. In 2012, according to the WHO–UNICEF Joint Reporting Form, among 57 countries eligible for immunization program financial support from the GAVI Alliance, only 9 reported having a functional NITAG. Since 2008, the Supporting Independent Immunization and Vaccine Advisory Committees (SIVAC) Initiative (at the Agence de Médecine Préventive or AMP) in close collaboration with the WHO and other partners has been working to accelerate and systematize the establishment of NITAGs in low- and middle-income countries. In addition to providing direct support to countries to establish advisory groups, the initiative also supports existing NITAGs to strengthen their capacity in the use of evidence-based processes for decision-making aligned with international standards. After 5 years of implementation and based on lessons learned, we recommend that future efforts should target both expanding new NITAGs and strengthening existing NITAGs in individual countries, along three strategic lines: (i) reinforce NITAG institutional integration to promote sustainability and credibility, (ii) build technical capacity within NITAG secretariats and evaluate NITAG performance, and (iii) increase networking and regional collaborations. These should be done through the development and dissemination of tools and guidelines, and information through a variety of adapted mechanisms.

The role of parental attitudes and provider discussions in uptake of adolescent vaccines
Original Research Article
Pages 642-647
Vaughn I. Rickert, Susan J. Rehm, Matthew C. Aalsma, Gregory D. Zimet
The purpose of this study was to examine the relationship between parental vaccine attitudes, the number of specific vaccines discussed with a provider, and immunization outcomes including discussing immunization with their teen, knowledge of adolescent vaccine schedule, and their son or daughter being up-to-date on recommended vaccines using a nationally weight sample. Parents completed an internet-based survey between December 2012 and January 2013 and we computed a vaccine attitude scale (higher scores indicating stronger and more positive attitudes toward vaccination of teen) for each parent and categorized them into one of three groups: low (n = 76), medium (n = 207) or high (n = 215). We also constructed a vaccine discussion scale representing the number of vaccines discussed with their adolescent’s physician. Parents who were identified as having high vaccine attitudes were significantly more likely to report their physician talked with them about a particular vaccine. Using logistic regression and controlling for respondent’s gender and age, income, and teen’s gender, we found medium as compared to low-attitude parents had a 6.21 (95%CI = 3.08, 12.51) greater odds of reporting that their teen had all recommended vaccines. Similarly, high as compared to low-attitude parents reported a 23.02 (95% CI = 11.27, 46.99) greater odds of having a teen who was up-to-date on recommended vaccines. We detected that for each additional vaccine discussed, there was a 1.24 (95%CI = 1.11, 1.39) increase in odds of the teen having all recommended vaccines. Parental immunization attitudes and provider discussion about vaccines are key ingredients to improving immunization rates among adolescents. While some parents may be reluctant to immunize their son or daughter with a recommended vaccine, vaccine-specific discussions between physicians and parents represent an important first step to continued discussions with providers regarding vaccination. Moreover, vaccine discussions must occur within the context of ongoing conversations about health and disease prevention.

Using a school-based approach to deliver immunization—Global update
Original Research Article
Pages 719-725
Jos Vandelaer, Marianne Olaniran
:: In 2012, school-based immunization was used in 95 out of 174 countries.
:: Tetanus and diphtheria toxoids are the most frequently administered antigens.
:: All school grades are targeted, but most countries give doses in first and sixth grade.
:: The approach can be a platform to reach school-aged children with immunization and other interventions but special approaches are needed to reach out-of-school and absent children.

Expected cost effectiveness of high-dose trivalent influenza vaccine in US seniors
Pages 734-741
Ayman Chit, Julie Roiz, Benjamin Briquet, David P. Greenberg
Seniors are particularly vulnerable to complications resulting from influenza infection. Numerous influenza vaccines are available to immunize US seniors, and practitioners must decide which product to use. Options include trivalent and quadrivalent standard-dose inactivated influenza vaccines (IIV3 and IIV4 respectively), as well as a high-dose IIV3 (HD). Our research examines the public health impact, budget impact, and cost-utility of HD versus IIV3 and IIV4 for immunization of US seniors 65 years of age and older.
Our model was based on US influenza-related health outcome data. Health care costs and vaccine prices were obtained from the Centers for Medicare and Medicaid Services. Efficacies of IIV3 and IIV4 were estimated from various meta-analyses of IIV3 efficacy. The results of a head-to-head randomized controlled trial of HD vs. IIV3 were used to estimate relative efficacy of HD. Conservatively, herd protection was not considered.
Compared to IIV3, HD would avert 195,958 cases of influenza, 22,567 influenza-related hospitalizations, and 5423 influenza-related deaths among US seniors. HD generates 29,023 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $154 million. The Incremental Cost Effectiveness Ratio (ICER) for this comparison is $5299/QALY. 71% of the probabilistic sensitivity analysis (PSA) simulations were <$100,000/QALY.
Compared to IIV4, HD would avert 169,257 cases of influenza, 21,222 hospitalizations and 5212 deaths. HD generates 27,718 more QALYs and a net societal budget impact of −$17 million and as such dominates IIV4. For this comparison, 81% of PSA simulations were <$100,000/QALY.
HD is expected to achieve significant reductions in influenza-related morbidity and mortality. Further, HD is a cost effective alternative to both IIV3 and IIV4 in seniors. Our conclusions were robust in the face of sensitivity analyses.