Vaccine
Volume 33, Issue 9, Pages 1099-1230 (25 February 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/9

Considerations for developing an immunization strategy with enterovirus 71 vaccine
Review Article
Pages 1107-1112
Li Li, Hongzhang Yin, Zhijie An, Zijian Feng
Abstract
Enterovirus 71 (EV71) is a common pathogen for hand, foot, and mouth disease (HFMD), which has significant morbidity and mortality, and for which children aged 6–59 months age are at highest risk. Due to lack of effective treatment options, control of EV71 epidemics has mainly focused on development of EV71 vaccines. Clinical trials have been completed on 3 EV71 vaccines, with trial results demonstrating good vaccine efficacy and safety. When EV71 vaccine is approved by China’s national regulatory authority, an evidence-based strategy should be developed to optimize impact and safety. An immunization strategy for EV71 vaccine should consider several factors, including the target population age group, the number of doses for primary immunization, the need for a booster dose, concomitant administration of other vaccines, economic value, program capacity and logistics, and public acceptance. Once EV71 vaccines are in use, vaccine effectiveness and safety must be monitored in large populations, and the epidemiology of HFMD must be evaluated to assure a match between vaccination strategy and epidemiology. Evaluation in China is especially important because there are no other EV71 vaccines globally.

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Conceptual frameworks and key dimensions to support coverage decisions for vaccines
Original Research Article
Pages 1206-1217
Marien González-Lorenzo, Alessandra Piatti, Liliana Coppola, Maria Gramegna, Vittorio Demicheli, Alessia Melegaro, Marcello Tirani, Elena Parmelli, Francesco Auxilia, Lorenzo Moja, the Vaccine Decision Group
Abstract
Background
Health policy makers often have to face decisions on whether and how to incorporate new vaccines into immunisation plans. This study aims to review and catalogue the relevant current frameworks and taxonomies on vaccines and connect these to the DECIDE Evidence to Decision framework (EtD), a general framework based on evidence-based criteria to guide decision-making on intervention adoption.
Methods
We systematically searched MEDLINE, EMBASE, Cochrane Library and funding agency websites from 1990 to 2013. We included systematic reviews and primary studies presenting decision-making tools for community vaccine adoption. We qualitatively summarised the reports by purpose, targeted country, principal results, and decisional models. We then extracted and compared the dimensions adopted by vaccine frameworks across studies.
Results
Fourteen studies (five systematic reviews and nine primary studies) were included. Several factors frequently influenced decision-makers’ views on vaccines: the most frequent political-context factors considered were Importance of illness or problem, Vaccine characteristics, Resource use, and Feasibility. Others such as Values and preferences and Acceptability were less consistently reported. We did not find evidence on the reasons why a framework for vaccine adoption differs from that for decisions on the adoption of an intervention in general, such as the EtD. There are limited data on how dimensions are explained in practical factors and directly linked to coverage decisions.
Conclusions
This review summarises conceptual models and taxonomy of a heterogeneous and evolving area in health policy decisions. A shared and comprehensive framework on vaccine coverage remains to be achieved with its single dimensions (epidemiologic, effectiveness, economic, and social) valued differently across studies. A generic tool such as the EtD conceptualises all relevant dimensions, and might reduce inconsistencies.

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Is there an association between the coverage of immunisation boosters by the age of 5 and deprivation? An ecological study
Original Research Article
Pages 1218-1222
Helena Sandford, Laila J. Tata, Ivan Browne, Catherine Pritchard
Abstract
Objective
To determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11.
Design
Ecological study.
Data
Routinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD).
Setting
Primary Care Trust (PCT) areas in England between 2007/08 and 2010/11.
Outcome Measures
Population coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5.
Results
Over the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period (r = −0.298, p < 0.001 in 2007/08 and r = −0.179, p = 0.028 in 2010/11). This was similar for the second MMR in 2007/08 (r = −0.225, p = 0.008) and 2008/09 (r = −0.216, p = 0.008) but there was no statistically significant correlation in 2009/10 (r = −0.108, p = 0.186) or 2010/11 (r = −0.078, p = 0.343).
Conclusion
Lower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe.

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Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls
Original Research Article
Pages 1223-1229
Rebecca B. Perkins, Lara Zisblatt, Aaron Legler, Emma Trucks, Amresh Hanchate, Sherri Sheinfeld Gorin
Abstract
Background
HPV vaccination is universally recommended for boys and girls, yet vaccination rates remain low nationwide.
Methods
We conducted a provider-focused intervention that included repeated contacts, education, individualized feedback, and strong quality improvement incentives to raise HPV vaccination rates at two federally qualified community health centers. To estimate the effectiveness of the intervention, rates of initiation of vaccination, and completion of the next needed HPV vaccination (dose 1, 2 or 3) among boys and girls ages 11–21 were compared at baseline and two follow-up periods in two intervention health centers (n 4093 patients) and six control health centers (n 9025 patients). We conducted multivariable logistic regression accounting for clustering by practice.
Results
Girls and boys in intervention practices significantly increased HPV vaccine initiation during the active intervention period relative to control practices (girls OR 1.6, boys OR 11; p < 0.001 for both). Boys at intervention practices were also more likely to continue to initiate vaccination during the post-intervention/maintenance period (OR 8.5; p < 0.01). Girls and boys at intervention practices were more also likely to complete their next needed HPV vaccination (dose 1, 2 or 3) than those at control practices (girls OR 1.4, boys OR 23; p < 0.05 for both). These improvements were sustained for both boys and girls in the post-intervention/maintenance period (girls OR 1.6, boys OR 25; p < 0.05 for both).
Conclusions
Provider-focused interventions including repeated contacts, education, individualized feedback, and strong quality improvement incentives have the potential to produce sustained improvements in HPV vaccination rates.