Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 111 Records) |
Query Trace: Stokley S[original query] |
---|
Federal retail pharmacy program contributions to bivalent mRNA COVID-19 vaccinations across sociodemographic characteristics - United States, September 1, 2022-September 30, 2023
El Kalach R , Jones-Jack N , Elam MA , Olorukooba A , Vazquez M , Stokley S , Meyer S , McGarvey S , Nguyen K , Scharf LG , Harris LQ , Duggar C , Moore LB . MMWR Morb Mortal Wkly Rep 2024 73 (13) 286-290 The Federal Retail Pharmacy Program (FRPP) facilitated integration of pharmacies as partners in national efforts to scale up vaccination capacity during the COVID-19 pandemic emergency response. To evaluate FRPP's contribution to vaccination efforts across various sociodemographic groups, data on COVID-19 bivalent mRNA vaccine doses administered during September 1, 2022-September 30, 2023, were evaluated from two sources: 1) FRPP data reported directly to CDC and 2) jurisdictional immunization information systems data reported to CDC from all 50 states, the District of Columbia, U.S. territories, and freely associated states. Among 59.8 million COVID-19 bivalent vaccine doses administered in the United States during this period, 40.5 million (67.7%) were administered by FRPP partners. The proportion of COVID-19 bivalent doses administered by FRPP partners ranged from 5.9% among children aged 6 months-4 years to 70.6% among adults aged 18-49 years. Among some racial and ethnic minority groups (e.g., Hispanic or Latino, non-Hispanic Black or African American, non-Hispanic Native Hawaiian or other Pacific Islander, and non-Hispanic Asian persons), ≥45% of COVID-19 bivalent vaccine doses were administered by FRPP partners. Further, in urban and rural areas, FRPP partners administered 81.6% and 60.0% of bivalent vaccine doses, respectively. The FRPP partnership administered approximately two thirds of all bivalent COVID-19 vaccine doses in the United States and provided vaccine access for persons across a wide range of sociodemographic groups, demonstrating that this program could serve as a model to address vaccination services needs for routine vaccines and to provide health services in other public health emergencies. |
An overview of the COVID-19 pediatric vaccine program - The U.S. experience vaccinating children ages 6 months through 17 years
Chatham-Stephens K , Carter RJ , Duggar C , Woodworth KR , Carnes CA , Bhatt A , Ottis C , Voegeli C , Stokley S , Vogt T . Vaccine 2024 COVID-19 vaccination decreases risk for COVID-19 illness and severe disease in children, including multisystem inflammatory syndrome (MIS-C) and death. On December 13, 2020, CDC recommended COVID-19 vaccination for persons ages ≥16 years, with expansion on May 12, 2021, to adolescents ages 12-15 years; to children ages 5-11 years on November 2, 2021; and to children ages 6 months-4 years on June 18, 2022. Following each age-specific recommendation, the U.S. government collaborated with state and local governments, vaccine manufacturers, and numerous other public and private entities, to ensure rapid, broad, and equitable COVID-19 vaccine distribution to strategic locations across the country to maximize access. However, vaccination coverage among children has been lower than among adults and lower among younger children than adolescents. As of May 10, 2023, COVID-19 primary series vaccination coverage was 61.8% among U.S. children ages 12-17 years, 32.9% among those ages 5-11 years, and 5.5% among those ages 6 months-4 years. This manuscript describes the planning and implementation of the U.S. COVID-19 pediatric vaccine program, including successes (e.g., the availability of pharmacy vaccination to extend access beyond more traditional pediatric vaccine providers) and challenges (e.g., multi-dose vaccine vials instead of single-dose vials, leading to concerns about wastage) to provide a historical record of the program and to help inform planning and implementation of future routine or pandemic-related pediatric vaccination campaigns. |
Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults - United States, Fall 2023
Black CL , Kriss JL , Razzaghi H , Patel SA , Santibanez TA , Meghani M , Tippins A , Stokley S , Chatham-Stephens K , Dowling NF , Peacock G , Singleton JA . MMWR Morb Mortal Wkly Rep 2023 72 (51) 1377-1382 During the 2023-24 respiratory virus season, the Advisory Committee on Immunization Practices recommends influenza and COVID-19 vaccines for all persons aged ≥6 months, and respiratory syncytial virus (RSV) vaccine is recommended for persons aged ≥60 years (using shared clinical decision-making), and for pregnant persons. Data from the National Immunization Survey-Adult COVID Module, a random-digit-dialed cellular telephone survey of U.S. adults aged ≥18 years, are used to monitor influenza, COVID-19, and RSV vaccination coverage. By December 9, 2023, an estimated 42.2% and 18.3% of adults aged ≥18 years reported receiving an influenza and updated 2023-2024 COVID-19 vaccine, respectively; 17.0% of adults aged ≥60 years had received RSV vaccine. Coverage varied by demographic characteristics. Overall, approximately 27% and 41% of adults aged ≥18 years and 53% of adults aged ≥60 years reported that they definitely or probably will be vaccinated or were unsure whether they would be vaccinated against influenza, COVID-19, and RSV, respectively. Strong provider recommendations for and offers of vaccination could increase influenza, COVID-19, and RSV vaccination coverage. Immunization programs and vaccination partners are encouraged to use these data to understand vaccination patterns and attitudes toward vaccination in their jurisdictions to guide planning, implementation, strengthening, and evaluation of vaccination activities. |
Vaccination coverage among adolescents aged 13-17 years - National Immunization Survey-Teen, United States, 2022
Pingali C , Yankey D , Elam-Evans LD , Markowitz LE , Valier MR , Fredua B , Crowe SJ , DeSisto CL , Stokley S , Singleton JA . MMWR Morb Mortal Wkly Rep 2023 72 (34) 912-919 Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey-Teen for 16,043 adolescents aged 13-17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13-17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13-17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines. |
Poliovirus outbreak in New York State, August 2022: qualitative assessment of immediate public health responses and priorities for improving vaccine coverage
Kasstan B , Mounier-Jack S , Chantler T , Masters N , Flores SA , Stokley S , Meek H , Easton D , De Luna-Evans T , Souto M , Punjabi C , Ruppert PS , Rosenberg E , Routh J . Epidemiol Infect 2023 151 e120 In 2022, a case of paralysis was reported in an unvaccinated adult in Rockland County (RC), New York. Genetically linked detections of vaccine-derived poliovirus type 2 (VDPV2) were reported in multiple New York counties, England, Israel, and Canada. The aims of this qualitative study were to: i) review immediate public health responses in New York to assess the challenges in addressing gaps in vaccination coverage; ii) inform a longer-term strategy to improving vaccination coverage in under-vaccinated communities, and iii) collect data to support comparative evaluations of transnational poliovirus outbreaks. Twenty-three semi-structured interviews were conducted with public health professionals, healthcare professionals, and community partners. Results indicate that i) addressing suboptimal vaccination coverage in RC remains a significant challenge after recent disease outbreaks; ii) the poliovirus outbreak was not unexpected and effort should be invested to engage mothers, the key decision-makers on childhood vaccination; iii) healthcare providers (especially paediatricians) received technical support during the outbreak, and may require resources and guidance to effectively contribute to longer-term vaccine engagement strategies; vi) data systems strengthening is required to help track under-vaccinated children. Public health departments should prioritize long-term investments in appropriate communication strategies, countering misinformation, and promoting the importance of the routine immunization schedule. |
COVID-19 surveillance after expiration of the public health emergency declaration - United States, May 11, 2023
Silk BJ , Scobie HM , Duck WM , Palmer T , Ahmad FB , Binder AM , Cisewski JA , Kroop S , Soetebier K , Park M , Kite-Powell A , Cool A , Connelly E , Dietz S , Kirby AE , Hartnett K , Johnston J , Khan D , Stokley S , Paden CR , Sheppard M , Sutton P , Razzaghi H , Anderson RN , Thornburg N , Meyer S , Womack C , Weakland AP , McMorrow M , Broeker LR , Winn A , Hall AJ , Jackson B , Mahon BE , Ritchey MD . MMWR Morb Mortal Wkly Rep 2023 72 (19) 523-528 On January 31, 2020, the U.S. Department of Health and Human Services (HHS) declared, under Section 319 of the Public Health Service Act, a U.S. public health emergency because of the emergence of a novel virus, SARS-CoV-2.* After 13 renewals, the public health emergency will expire on May 11, 2023. Authorizations to collect certain public health data will expire on that date as well. Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies remains a public health priority, and a number of surveillance indicators have been identified to facilitate ongoing monitoring. After expiration of the public health emergency, COVID-19-associated hospital admission levels will be the primary indicator of COVID-19 trends to help guide community and personal decisions related to risk and prevention behaviors; the percentage of COVID-19-associated deaths among all reported deaths, based on provisional death certificate data, will be the primary indicator used to monitor COVID-19 mortality. Emergency department (ED) visits with a COVID-19 diagnosis and the percentage of positive SARS-CoV-2 test results, derived from an established sentinel network, will help detect early changes in trends. National genomic surveillance will continue to be used to estimate SARS-CoV-2 variant proportions; wastewater surveillance and traveler-based genomic surveillance will also continue to be used to monitor SARS-CoV-2 variants. Disease severity and hospitalization-related outcomes are monitored via sentinel surveillance and large health care databases. Monitoring of COVID-19 vaccination coverage, vaccine effectiveness (VE), and vaccine safety will also continue. Integrated strategies for surveillance of COVID-19 and other respiratory viruses can further guide prevention efforts. COVID-19-associated hospitalizations and deaths are largely preventable through receipt of updated vaccines and timely administration of therapeutics (1-4). |
National vaccination coverage among adolescents aged 13-17 Years - National Immunization Survey-Teen, United States, 2021
Pingali C , Yankey D , Elam-Evans LD , Markowitz LE , Valier MR , Fredua B , Crowe SJ , Stokley S , Singleton JA . MMWR Morb Mortal Wkly Rep 2022 71 (35) 1101-1108 CDC’s Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11–12 years with tetanus, diphtheria, and acellular pertussis vaccine (Tdap), human papillomavirus (HPV) vaccine, and quadrivalent meningococcal conjugate vaccine (MenACWY). A second (booster) dose of MenACWY is recommended at age 16 years. On the basis of shared clinical decision-making, adolescents aged 16–23 years may receive a serogroup B meningococcal vaccine (MenB) series. Catch-up vaccination is recommended for hepatitis A vaccine (HepA); hepatitis B vaccine (HepB); measles, mumps, and rubella vaccine (MMR); and varicella vaccine (VAR) for adolescents whose childhood vaccinations are not up to date (1). Although COVID-19 vaccination and influenza vaccination coverage estimates are not presented in this report, vaccination with a COVID-19 vaccine and annual influenza vaccination are also recommended by ACIP for adolescents* (2). To estimate vaccination coverage, CDC analyzed data for 18,002 adolescents aged 13–17 years from the 2021 National Immunization Survey-Teen (NIS-Teen).† Coverage with ≥1 dose of Tdap§ (89.6%) and ≥1 dose of MenACWY¶ (89.0%) remained high and stable compared with the previous year. Increases in coverage with the following vaccines occurred from 2020 to 2021: ≥1 dose of HPV** vaccine (from 75.1% to 76.9%); adolescents who were up to date with HPV vaccination (HPV UTD)†† (from 58.6% to 61.7%); and ≥2 MenACWY doses among adolescents aged 17 years (from 54.4% to 60.0%). Coverage with MenACWY, HPV vaccine, and ≥2 HepA doses was lower among adolescents living in nonmetropolitan statistical areas (non-MSAs)§§ than among those living in MSA principal cities. The potential impact of the COVID-19 pandemic was assessed by comparing vaccination coverage by age and birth year before and during the COVID-19 pandemic. Coverage with ≥1 MenACWY dose by age 13 years was 5.1 percentage points lower among adolescents who reached age 13 years during the pandemic (2021) compared with those who reached age 13 in 2019. Coverage with ≥1 Tdap dose by age 12 years was 4.1 percentage points lower among children who reached age 12 years during the pandemic (2020) compared with those who reached age 12 before the pandemic. Coverage with ≥1 HPV vaccine dose by ages 12 and 13 years among children and adolescents who reached age 12 or 13 during the pandemic did not differ from coverage before the pandemic. Many children and adolescents might have missed routine medical care and recommended vaccinations during the COVID-19 pandemic. Review of patient vaccination records is important for providers to ensure that children and adolescents are up to date with all recommended vaccinations. |
Public health response to a case of paralytic poliomyelitis in an unvaccinated person and detection of poliovirus in wastewater - New York, June-August 2022
Link-Gelles R , Lutterloh E , Schnabel Ruppert P , Backenson PB , St George K , Rosenberg ES , Anderson BJ , Fuschino M , Popowich M , Punjabi C , Souto M , McKay K , Rulli S , Insaf T , Hill D , Kumar J , Gelman I , Jorba J , Ng TFF , Gerloff N , Masters NB , Lopez A , Dooling K , Stokley S , Kidd S , Oberste MS , Routh J . MMWR Morb Mortal Wkly Rep 2022 71 (33) 1065-1068 On July 18, 2022, the New York State Department of Health (NYSDOH) notified CDC of detection of poliovirus type 2 in stool specimens from an unvaccinated immunocompetent young adult from Rockland County, New York, who was experiencing acute flaccid weakness. The patient initially experienced fever, neck stiffness, gastrointestinal symptoms, and limb weakness. The patient was hospitalized with possible acute flaccid myelitis (AFM). Vaccine-derived poliovirus type 2 (VDPV2) was detected in stool specimens obtained on days 11 and 12 after initial symptom onset. To date, related Sabin-like type 2 polioviruses have been detected in wastewater* in the patient's county of residence and in neighboring Orange County up to 25 days before (from samples originally collected for SARS-CoV-2 wastewater monitoring) and 41 days after the patient's symptom onset. The last U.S. case of polio caused by wild poliovirus occurred in 1979, and the World Health Organization Region of the Americas was declared polio-free in 1994. This report describes the second identification of community transmission of poliovirus in the United States since 1979; the previous instance, in 2005, was a type 1 VDPV (1). The occurrence of this case, combined with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in persons of all ages. |
A decade of data: Adolescent vaccination in the vaccine safety datalink, 2007 through 2016.
Irving SA , Groom HC , Dandamudi P , Daley MF , Donahue JG , Gee J , Hechter R , Jackson LA , Klein NP , Liles E , Myers TR , Stokley S . Vaccine 2022 40 (9) 1246-1252 BACKGROUND: Between May 2005 and March 2007, three vaccines were recommended by the Advisory Committee on Immunization Practices for routine use in adolescents in the United States: quadrivalent meningococcal conjugate vaccine (MenACWY), tetanus, diphtheria and acellular pertussis vaccine (Tdap), and human papillomavirus vaccine (HPV). Understanding historical adolescent vaccination patterns may inform future vaccination coverage efforts for these and emerging adolescent vaccines, including COVID-19 vaccines. METHODS: This was a descriptive, retrospective cohort study. All vaccines administered to adolescents aged 11 through 18years in the Vaccine Safety Datalink population between January 1, 2007 and December 31, 2016 were examined. Vaccination coverage was assessed by study year for 1 dose Tdap or Td, 1 dose Tdap, 1 dose MenACWY, 1 dose HPV, and 3 dose HPV. The proportion of vaccine visits with concurrent vaccination (2 vaccines administered at the same visit) was calculated by sex and study year. The most common vaccine combinations administered in the study population were described by sex for two time periods: 2007-2010 and 2011-2016. RESULTS: The number of 11-18-year-olds in the study population averaged 522,565 males and 503,112 females per study year. Between January 2007 and December 2016 there were 4,884,553 vaccine visits in this population (45% among males). The overall proportion of concurrent vaccine visits among males was 43% (33-61% by study year). Among females, 39% of all vaccine visits included concurrent vaccination (32-48% by study year). Vaccine coverage for Tdap, MenACWY, and 1- and 3-dose HPV increased across the study period. A wide variety of vaccine combinations were administered among both sexes and in both time periods. CONCLUSIONS: The high vaccine uptake and multitude of vaccine combinations administered concurrently in the adolescent population of the Vaccine Safety Datalink provide historical patterns with which to compare future adolescent vaccination campaigns. |
National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2020.
Pingali C , Yankey D , Elam-Evans LD , Markowitz LE , Williams CL , Fredua B , McNamara LA , Stokley S , Singleton JA . MMWR Morb Mortal Wkly Rep 2021 70 (35) 1183-1190 The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11-12 years routinely receive tetanus, diphtheria, and acellular pertussis (Tdap); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) vaccines. Catch-up vaccination is recommended for hepatitis B (HepB); hepatitis A (HepA); measles, mumps, and rubella (MMR); and varicella (VAR) vaccines for adolescents whose childhood vaccinations are not current. Adolescents are also recommended to receive a booster dose of MenACWY vaccine at age 16 years, and shared clinical decision-making is recommended for the serogroup B meningococcal vaccine (MenB) for persons aged 16-23 years (1). To estimate coverage with recommended vaccines, CDC analyzed data from the 2020 National Immunization Survey-Teen (NIS-Teen) for 20,163 adolescents aged 13-17 years.* Coverage with ≥1 dose of HPV vaccine increased from 71.5% in 2019 to 75.1% in 2020. The percentage of adolescents who were up to date(†) with HPV vaccination (HPV UTD) increased from 54.2% in 2019 to 58.6% in 2020. Coverage with ≥1 dose of Tdap, ≥1 dose (and among adolescents aged 17 years, ≥2 doses) of MenACWY remained similar to coverage in 2019 (90.1%, 89.3%, and 54.4% respectively). Coverage increased for ≥2 doses of HepA among adolescents aged 13-17 years and ≥1 dose of MenB among adolescents aged 17 years. Adolescents living below the federal poverty level(§) had higher HPV vaccination coverage than adolescents living at or above the poverty level. Adolescents living outside a metropolitan statistical area (MSA)(¶) had lower coverage with ≥1 MenACWY and ≥1 HPV dose, and a lower proportion being HPV UTD than adolescents in MSA principal cities. In 2020, the COVID-19 pandemic disrupted routine immunization services. Results from the 2020 NIS-Teen reflect adolescent vaccination coverage before the COVID-19 pandemic. The 2020 NIS-Teen data could be used to assess the impact of the COVID-19 pandemic on catch-up vaccination but not on routine adolescent vaccination because adolescents included in the survey were aged ≥13 years, past the age when most routine adolescent vaccines are recommended, and most vaccinations occurred before March 2020. Continued efforts to reach adolescents whose routine medical care has been affected by the COVID-19 pandemic are necessary to protect persons and communities from vaccine-preventable diseases and outbreaks. |
COVID-19 Vaccination Coverage Among Adolescents Aged 12-17 Years - United States, December 14, 2020-July 31, 2021.
Murthy BP , Zell E , Saelee R , Murthy N , Meng L , Meador S , Reed K , Shaw L , Gibbs-Scharf L , McNaghten AD , Patel A , Stokley S , Flores S , Yoder JS , Black CL , Harris LQ . MMWR Morb Mortal Wkly Rep 2021 70 (35) 1206-1213 Although severe COVID-19 illness and hospitalization are more common among adults, these outcomes can occur in adolescents (1). Nearly one third of adolescents aged 12-17 years hospitalized with COVID-19 during March 2020-April 2021 required intensive care, and 5% of those hospitalized required endotracheal intubation and mechanical ventilation (2). On December 11, 2020, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 16-17 years; on May 10, 2021, the EUA was expanded to include adolescents aged 12-15 years; and on August 23, 2021, FDA granted approval of the vaccine for persons aged ≥16 years. To assess progress in adolescent COVID-19 vaccination in the United States, CDC assessed coverage with ≥1 dose* and completion of the 2-dose vaccination series(†) among adolescents aged 12-17 years using vaccine administration data for 49 U.S. states (all except Idaho) and the District of Columbia (DC) during December 14, 2020-July 31, 2021. As of July 31, 2021, COVID-19 vaccination coverage among U.S. adolescents aged 12-17 years was 42.4% for ≥1 dose and 31.9% for series completion. Vaccination coverage with ≥1 dose varied by state (range = 20.2% [Mississippi] to 70.1% [Vermont]) and for series completion (range = 10.7% [Mississippi] to 60.3% [Vermont]). By age group, 36.0%, 40.9%, and 50.6% of adolescents aged 12-13, 14-15, and 16-17 years, respectively, received ≥1 dose; 25.4%, 30.5%, and 40.3%, respectively, completed the vaccine series. Improving vaccination coverage and implementing COVID-19 prevention strategies are crucial to reduce COVID-19-associated morbidity and mortality among adolescents and to facilitate safer reopening of schools for in-person learning. |
Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021.
Murthy BP , Sterrett N , Weller D , Zell E , Reynolds L , Toblin RL , Murthy N , Kriss J , Rose C , Cadwell B , Wang A , Ritchey MD , Gibbs-Scharf L , Qualters JR , Shaw L , Brookmeyer KA , Clayton H , Eke P , Adams L , Zajac J , Patel A , Fox K , Williams C , Stokley S , Flores S , Barbour KE , Harris LQ . MMWR Morb Mortal Wkly Rep 2021 70 (20) 759-764 Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas (2). |
Demographic and Social Factors Associated with COVID-19 Vaccination Initiation Among Adults Aged ≥65 Years - United States, December 14, 2020-April 10, 2021.
Whiteman A , Wang A , McCain K , Gunnels B , Toblin R , Lee JT , Bridges C , Reynolds L , Murthy BP , Qualters J , Singleton JA , Fox K , Stokley S , Harris L , Gibbs-Scharf L , Abad N , Brookmeyer KA , Farrall S , Pingali C , Patel A , Link-Gelles R , Dasgupta S , Gharpure R , Ritchey MD , Barbour KE . MMWR Morb Mortal Wkly Rep 2021 70 (19) 725-730 Compared with other age groups, older adults (defined here as persons aged ≥65 years) are at higher risk for COVID-19-associated morbidity and mortality and have therefore been prioritized for COVID-19 vaccination (1,2). Ensuring access to vaccines for older adults has been a focus of federal, state, and local response efforts, and CDC has been monitoring vaccination coverage to identify and address disparities among subpopulations of older adults (2). Vaccine administration data submitted to CDC were analyzed to determine the prevalence of COVID-19 vaccination initiation among adults aged ≥65 years by demographic characteristics and overall. Characteristics of counties with low vaccination initiation rates were quantified using indicators of social vulnerability data from the 2019 American Community Survey.* During December 14, 2020-April 10, 2021, nationwide, a total of 42,736,710 (79.1%) older adults had initiated vaccination. The initiation rate was higher among men than among women and varied by state. On average, counties with low vaccination initiation rates (<50% of older adults having received at least 1 vaccine dose), compared with those with high rates (≥75%), had higher percentages of older adults without a computer, living in poverty, without Internet access, and living alone. CDC, state, and local jurisdictions in partnerships with communities should continue to identify and implement strategies to improve access to COVID-19 vaccination for older adults, such as assistance with scheduling vaccination appointments and transportation to vaccination sites, or vaccination at home if needed for persons who are homebound.(†) Monitoring demographic and social factors affecting COVID-19 vaccine access for older adults and prioritizing efforts to ensure equitable access to COVID-19 vaccine are needed to ensure high coverage among this group. |
Improving Pediatric Vaccination Coverage in the United States.
Stokley S , Kempe A , Stockwell MS , Szilagyi PG . Acad Pediatr 2021 21 S1-s2 Despite the success the US vaccination program has achieved in eliminating measles, polio, and rubella, there remain gaps in vaccination coverage for some vaccines and populations.1 Even before the COVID-19 pandemic impacted well child visits and delivery of routine vaccines,2 there were indicators that vaccination coverage needed to be strengthened, including persistent disparities in coverage by sociodemographic characteristics.1 This special issue of Academic Pediatrics includes a collection of commentaries and review articles from noted experts highlighting effective strategies immunization providers and programs can use for improving vaccination coverage among children and adolescents in the United States. |
Costs of Interventions to Increase Vaccination Coverage Among Children in the United States: A Systematic Review
Hong K , Leidner AJ , Tsai Y , Tang Z , Cho BH , Stokley S . Acad Pediatr 2021 21 S67-s77 BACKGROUND: The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage. OBJECTIVE: Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United States. DATA SOURCES: PubMed, EconLit, Embase, and Cochrane. STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS: Peer-reviewed articles from January 1, 2009 to August 31, 2019. APPRAISAL AND SYNTHESIS METHODS: Studies were identified with systematic searches of the literature, reviewed for inclusion criteria, abstracted for data on intervention, target population, costs, and risk of bias. Cost measures were reported as costs per child in the target population, costs per vaccinated child, incremental costs per vaccinated child, and costs per vaccine dose administered. Results were stratified by intervention type, vaccine, and age group. RESULTS: Thirty-seven studies were identified for full-text review. Across all interventions and age groups, the cost per child ranged from $0.10 to $537.38, and the incremental cost per vaccinated child ranged from $6.52 to $5,098.57. Provider assessment and feedback interventions had the lowest (median) cost per child ($0.17) and a healthcare system-based combined intervention with multiple components had the lowest (median) incremental cost per vaccinated child ($26.65). A community-based combined intervention with multiple components had the highest median cost per child ($537.38) and the highest median incremental cost per vaccinated child ($5,098.57). LIMITATIONS: A small number of included intervention types and inconsistent cost definition. CONCLUSIONS: There is substantial variability in the costs of CPSTF-recommended interventions. |
Implementing Effective Vaccination Interventions Into Sustainable 'Real World' Practice
Stockwell MS , Stokley S , Kempe A . Acad Pediatr 2021 21 S78-s80 Numerous interventions have proven to be effective in increasing vaccination coverage levels across different vaccinations, such as those against influenza or human papillomavirus, and different populations such as young children or adolescents, including many outlined in this supplement. However, national vaccination coverage levels for some vaccines are still below the Healthy People 2020 goals with persistent differences by income.1,2 Research has shown us that although interventions to improve immunizations may be effective in one setting, they may not work in another. Even if evidence-based, interventions may not be sustainable over time in different settings or populations or may be missing an element that is key to implementation. If we are to collectively reach the Healthy People 2030 immunization goals,3 the next step will need to be a focus on how to implement effective interventions into sustainable “real world” practice. |
Parental vaccine hesitancy and its association with adolescent HPV vaccination
Nguyen KH , Santibanez TA , Stokley S , Lindley MC , Fisher A , Kim D , Greby S , Srivastav A , Singleton J . Vaccine 2021 39 (17) 2416-2423 Despite the Advisory Committee on Immunization Practices’ (ACIP) recommendations for routine vaccination of adolescents, vaccination coverage remains low for many adolescent vaccines, particularly the human papillomavirus (HPV) vaccine [1]. In 2018, 68.1% of adolescents aged 13–17 years had received ≥ 1 dose of HPV vaccine, and only 51.1% were up to date with the HPV vaccine series, well below the Healthy People 2020 target of 80% [2,3]. More efforts are needed to understand barriers to vaccination and improve coverage for all recommended vaccines in this population. |
County-Level COVID-19 Vaccination Coverage and Social Vulnerability - United States, December 14, 2020-March 1, 2021.
Hughes MM , Wang A , Grossman MK , Pun E , Whiteman A , Deng L , Hallisey E , Sharpe JD , Ussery EN , Stokley S , Musial T , Weller DL , Murthy BP , Reynolds L , Gibbs-Scharf L , Harris L , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (12) 431-436 The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine. |
COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons - United States, December 14, 2020-February 14, 2021.
Kriss JL , Reynolds LE , Wang A , Stokley S , Cole MM , Harris LQ , Shaw LK , Black CL , Singleton JA , Fitter DL , Rose DA , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (11) 389-395 In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.*(,)(†) Both vaccines require 2 doses for a completed series. The recommended interval between doses is 21 days for Pfizer-BioNTech and 28 days for Moderna; however, up to 42 days between doses is permissible when a delay is unavoidable.(§) Two analyses of COVID-19 vaccine administration data were conducted among persons who initiated the vaccination series during December 14, 2020-February 14, 2021, and whose doses were reported to CDC through February 20, 2021. The first analysis was conducted to determine whether persons who received a first dose and had sufficient time to receive the second dose (i.e., as of February 14, 2021, >25 days from receipt of Pfizer-BioNTech vaccine or >32 days from receipt of Moderna vaccine had elapsed) had received the second dose. A second analysis was conducted among persons who received a second COVID-19 dose by February 14, 2021, to determine whether the dose was received during the recommended dosing interval, which in this study was defined as 17-25 days (Pfizer-BioNTech) and 24-32 days (Moderna) after the first dose. Analyses were stratified by jurisdiction and by demographic characteristics. In the first analysis, among 12,496,258 persons who received the first vaccine dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series, 8.6% had not received the second dose but remained within the allowable interval (≤42 days since the first dose), and 3.4% had missed the second dose (outside the allowable interval, >42 days since the first dose). The percentage of persons who missed the second dose varied by jurisdiction (range = 0.0%-9.1%) and among demographic groups was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (5.1%) and persons aged 16-44 years (4.0%). In the second analysis, among 14,205,768 persons who received a second dose, 95.6% received the dose within the recommended interval, although percentages varied by jurisdiction (range = 79.0%-99.9%). Public health officials should identify and address possible barriers to completing the COVID-19 vaccination series to ensure equitable coverage across communities and maximum health benefits for recipients. Strategies to ensure series completion could include scheduling second-dose appointments at the first-dose administration and sending reminders for second-dose visits. |
Urban-rural disparities in vaccination service use among low-income adolescents
Tsai Y , Lindley MC , Zhou F , Stokley S . J Adolesc Health 2020 69 (1) 114-120 OBJECTIVE: To access urban-rural disparities in vaccination service use among Medicaid-enrolled adolescents and examine its association with residence county characteristics. STUDY DESIGN: We used the 2016 Medicaid T-MSIS Analytic File to estimate adolescents' use of vaccination services, defined as the proportion of adolescents aged 11-18 years with ≥ 1 vaccination visit in a county. We used linear regression and the Oaxaca-Blinder decomposition method to examine the association between county characteristics and urban-rural disparities in vaccination service use. RESULTS: The analysis included 2,473 counties located in 38 states. The mean proportion of adolescents making ≥ 1 vaccination visit at the county level was low (36.09%) and was lower in rural than in urban counties (31.99% vs. 36.85%, p < .01). The number of primary care physicians (PCPs) was positively associated with vaccination service use in rural counties; in urban counties, % of households without a vehicle was negatively associated with vaccination service use. The decomposition results showed that 66.78% (3.24 percentage points) of the urban-rural disparities in vaccination service use could be attributed to urban-rural differences in the county characteristics included in the study. Characteristics measuring access to care (number of PCPs), social and economic factors (% adults with at least a bachelor's degree and % children in poverty), quality of care (influenza vaccination rates and preventable hospital stays), and demographics (% non-Hispanic black, % Hispanic, and % females) played a role in urban-rural disparities. CONCLUSIONS: Differences in county characteristics could partly explain the observed urban-rural disparities in vaccination service use among low-income adolescents. |
National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2019
Elam-Evans LD , Yankey D , Singleton JA , Sterrett N , Markowitz LE , Williams CL , Fredua B , McNamara L , Stokley S . MMWR Morb Mortal Wkly Rep 2020 69 (33) 1109-1116 Three vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents aged 11-12 years to protect against 1) pertussis; 2) meningococcal disease caused by types A, C, W, and Y; and 3) human papillomavirus (HPV)-associated cancers (1). At age 16 years, a booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended. Persons aged 16-23 years can receive serogroup B meningococcal vaccine (MenB), if determined to be appropriate through shared clinical decision-making. CDC analyzed data from the 2019 National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage among adolescents aged 13-17 years in the United States.* Coverage with ≥1 dose of HPV vaccine increased from 68.1% in 2018 to 71.5% in 2019, and the percentage of adolescents who were up to date(†) with the HPV vaccination series (HPV UTD) increased from 51.1% in 2018 to 54.2% in 2019. Both HPV vaccination coverage measures improved among females and males. An increase in adolescent coverage with ≥1 dose of MenACWY (from 86.6% in 2018 to 88.9% in 2019) also was observed. Among adolescents aged 17 years, 53.7% received the booster dose of MenACWY in 2019, not statistically different from 50.8% in 2018; 21.8% received ≥1 dose of MenB, a 4.6 percentage point increase from 17.2% in 2018. Among adolescents living at or above the poverty level,(§) those living outside a metropolitan statistical area (MSA)(¶) had lower coverage with ≥1 dose of MenACWY and with ≥1 HPV vaccine dose, and a lower percentage were HPV UTD, compared with those living in MSA principal cities. In early 2020, the coronavirus disease 2019 (COVID-19) pandemic changed the way health care providers operate and provide routine and essential services. An examination of Vaccines for Children (VFC) provider ordering data showed that vaccine orders for HPV vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); and MenACWY decreased in mid-March when COVID-19 was declared a national emergency (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/91795). Ensuring that routine immunization services for adolescents are maintained or reinitiated is essential to continuing progress in protecting persons and communities from vaccine-preventable diseases and outbreaks. |
Primary care physician support for harmonizing HPV vaccination recommendations across genders - United States, 2018
Meites E , Markowitz LE , Kempe A , O'Leary ST , Crane LA , Hurley LP , Brtnikova M , Beaty BL , Stokley S , Lindley MC . Vaccine 2020 38 (21) 3699-3701 In the United States, human papillomavirus (HPV) catch-up vaccination has been nationally recommended for women and men of different ages. We surveyed national networks of primary care physicians specializing in family medicine, pediatrics, and internal medicine to assess attitudes about HPV vaccination. Of 785 physicians, 730 (93.0%), were in favor of a change to harmonize the recommended catch-up vaccination age across genders; the most commonly cited reason was to simplify the immunization schedule (97.9%). After considering these and other data, the Advisory Committee on Immunization Practices updated national policy to recommend catch-up vaccination for all persons through age 26 years. |
Human papillomavirus vaccination estimates among adolescents in the Mississippi Delta Region: National Immunization Survey-Teen, 2015-2017
Yankey D , Elam-Evans LD , Bish CL , Stokley SK . Prev Chronic Dis 2020 17 E31 INTRODUCTION: The Delta Regional Authority (DRA) consists of 252 counties and parishes in 8 states in the US Mississippi Delta region. DRA areas have high rates of disease, including cancers related to the human papillomavirus (HPV). HPV vaccination coverage in the DRA region has not been documented. METHODS: We analyzed data for 63,299 adolescents aged 13 to 17 years in the National Immunization Survey-Teen, 2015-2017. We compared HPV vaccination initiation coverage estimates (>/=1 dose) in the DRA region with coverage estimates in areas in the 8 Delta states outside the DRA region and non-Delta states. We examined correlates of HPV vaccination coverage initiation and reasons parents did not intend to vaccinate adolescents. RESULTS: Vaccination rates in the DRA region (n = 2,317; 54.3%) and in Delta areas outside the DRA region (n = 6,028; 56.2%) were similar, but these rates were significantly lower than rates in non-Delta states (n = 54,954; 61.4%). Inside the DRA region, reasons for parents' vaccine hesitancy or refusal were similar to those expressed by parents in the Delta areas outside the DRA region. Some parents believed that the vaccine was not necessary or had concerns about vaccine safety. CONCLUSION: HPV vaccination coverage in the DRA region is similar to coverage in other Delta counties and parishes, but it is significantly lower than in non-Delta states. Activities to address parental concerns and improve provider recommendations for the vaccine in the DRA region are needed to increase HPV vaccination rates. |
Impact of media reports regarding influenza vaccine on obstetricians' vaccination practices
O'Leary ST , Cataldi JR , Lindley MC , Hurley LP , Riley LE , Brtnikova M , Crane LA , Beaty B , Stokley S , Fisher A , Kempe A . Vaccine 2020 38 (18) 3474-3479 BACKGROUND: In 2017, three media stories regarding influenza vaccine may have impacted obstetricians' (OB) influenza vaccination practices: reports of reduced influenza vaccine effectiveness, a severe influenza season, and a possible increased risk of miscarriage among pregnant women receiving 2009 H1N1 vaccine in the 1st trimester who had received H1N1 vaccine the previous season (later disproven). OBJECTIVE: Describe OB's: (1) awareness of; (2) attitudes and experiences related to; and (3) reported alterations in practice as a result of these reports. METHODS: A survey among a nationally representative sample of OBs April to June 2018. RESULTS: Response rate was 65% (302/468). 88% of OBs were "very aware" of the severe season, 74% of lower effectiveness, and 25% of the miscarriage study (47% "completely unaware" of miscarriage study). Among those aware, 58%, 57%, and 16% reported >/=10% of pregnant patients initiated discussions about the severe season, lower effectiveness, and miscarriage study, respectively. Most (83%) agreed reports about increased severity increased their enthusiasm for recommending influenza vaccine; fewer agreed reports about the miscarriage study (18%) and lower vaccine effectiveness (12%) decreased their enthusiasm for recommending influenza vaccine. Providers were more likely to initiate discussion with patients about increased severity of the season than the other reports. However, 35% agreed the miscarriage study reports increased their concerns about influenza vaccine safety; 18% (n = 48) reported changing the way they recommended influenza vaccine. Of those, 17 (6% of all respondents) reported not recommending influenza vaccine to women during the 1st trimester and 26 (10% of all respondents) recommended it but were willing to delay until the 2nd trimester. CONCLUSIONS: During a season in which media stories could have influenced OB influenza vaccination behaviors in different directions, reports underscoring importance of influenza vaccine may have had more impact on OBs' recommendations than reports questioning vaccine safety or effectiveness. |
Pediatricians' experiences with and perceptions of the Vaccines for Children Program
O'Leary ST , Allison MA , Vogt T , Hurley LP , Crane LA , Brtnikova M , McBurney E , Beaty BL , Crawford N , Lindley MC , Stokley SK , Kempe A . Pediatrics 2020 145 (3) BACKGROUND AND OBJECTIVES: The Vaccines for Children Program (VFC) provides vaccines for children who may not otherwise be vaccinated because of financial barriers. Pediatrician participation is crucial to the VFC's ongoing success. Our objectives were to assess, among a national sample of pediatricians, (1) VFC program participation, (2) perceived burden versus benefit of participation, and (3) knowledge and perception of a time-limited increased payment for VFC vaccine administration under the Patient Protection and Affordable Care Act. METHODS: An electronic and mail survey was conducted from June 2017 to September 2017. RESULTS: Response rate was 79% (372 of 471); 86% of pediatricians reported currently participating in the VFC; among those, 85% reported never having considered stopping, 10% considered it but not seriously, and 5% seriously considered it. Among those who had considered no longer participating (n = 47), the most commonly reported reasons included difficulty meeting VFC record-keeping requirements (74%), concern about action by the VFC for noncompliance (61%), and unpredictable VFC vaccine supplies (59%). Participating pediatricians rated, on a scale from -5 (high burden) to +5 (high benefit), their overall perception of the VFC: 63% reported +4 or +5, 23% reported +1 to +3, 5% reported 0, and 9% reported -1 to -5. Of pediatricians, 39% reported awareness of temporary increased payment for VFC vaccine administration. Among those, 10% reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients served on the basis of this change. CONCLUSIONS: For most pediatricians, perceived benefits of VFC participation far outweigh perceived burdens. To ensure the program's ongoing success, it will be important to monitor factors influencing provider participation. |
Trends in human papillomavirus (HPV) vaccination initiation among adolescents aged 13-17 by metropolitan statistical area (MSA) status, National Immunization Survey - Teen, 2013 - 2017
Walker TY , Elam-Evans LD , Williams CL , Fredua B , Yankey D , Markowitz LE , Stokley S . Hum Vaccin Immunother 2019 16 (3) 1-8 Disparities in HPV vaccination coverage by metropolitan statistical area (MSA) status were observed in the 2016 and 2017 National Immunization Survey - Teen (NIS-Teen). In 2017, HPV vaccination initiation (>/=1dose) coverage was 11 percentage points lower for adolescents living in non-MSAs (mostly rural areas) and 7 percentage points lower among those living in MSA, non-principal cities (suburban areas) compared to those living in MSA, principal cities (mostly urban areas). In order to understand how this disparity has changed over time, we examined trends in HPV vaccine initiation by MSA status from 2013 to 2017. Weighted linear regression by survey year was used to estimate annual percentage point changes in HPV vaccination initiation. The five-year average annual percentage point increases in HPV vaccination initiation coverage were 5.2 in mostly urban areas, 4.9 for suburban areas, and 5.2 for mostly rural areas. Despite increases in each MSA area, coverage in mostly rural areas was consistently and significantly lower than coverage in mostly urban areas. Coverage was significantly lower among teens living in mostly rural areas regardless of poverty status, sex, and race/ethnicity except among black, non-Hispanic adolescents. There was no significant change in the magnitude of the disparity between mostly urban areas and mostly rural areas over time (p = .98). A better understanding of the facilitators and barriers to HPV vaccination in mostly rural areas is needed to identify and implement targeted strategies to improve HPV vaccination coverage and reduce these disparities. |
Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey-Teen, 2016-2017
Williams CL , Walker TY , Elam-Evans LD , Yankey D , Fredua B , Saraiya M , Stokley S . Hum Vaccin Immunother 2019 16 (3) 562-572 The 2016 and 2017 National Immunization Surveys-Teen (NIS-Teen) highlighted disparities in human papillomavirus (HPV) vaccination coverage by metropolitan statistical area (MSA) status. Coverage with >/=1 dose of HPV vaccine was significantly lower among teens in suburban and mostly- rural areas than it was among those in mostly-urban areas. Reasons underlying this disparity are poorly understood; this analysis sought to identify sociodemographic factors associated with not initiating the HPV vaccine series and to determine whether these factors differed by MSA status. Using NIS-Teen data for a sample of 41,424 adolescents from the 2016 and 2017 survey years, multivariate logistic regression was utilized to assess associations between various sociodemographic factors and non-initiation of the HPV vaccine series by MSA status. Adjusted prevalence ratios and 95% confidence intervals are reported. A secondary analysis assessed missed opportunities for HPV vaccination by MSA status and estimated what coverage could be if these missed opportunities had not occurred. Most factors associated with not receiving HPV vaccine were similar across all three MSAs, including living in the South, having a mother with some college education, not having an 11-12 year old well-child visit, and not receiving a provider recommendation for vaccination. Others were associated with non-initiation of the HPV vaccine series in only specific MSAs. Teens in suburban areas (82.2%) were more likely to miss opportunities for HPV vaccination than those in mostly-urban (79.3%) areas. Coverage with >/=1 dose of HPV vaccine in all three MSAs would be substantially higher if these missed opportunities had been eliminated. |
HPV vaccine delivery practices by primary care physicians
Kempe A , O'Leary ST , Markowitz LE , Crane LA , Hurley LP , Brtnikova M , Beaty BL , Meites E , Stokley S , Lindley MC . Pediatrics 2019 144 (4) BACKGROUND AND OBJECTIVES: To examine, among pediatricians and family physicians (FPs) (1) human papillomavirus (HPV) vaccine delivery practices, (2) delivery experiences, and (3) attitudes regarding new 2-dose HPV vaccination schedules. METHODS: We surveyed nationally representative networks of pediatricians and FPs by Internet or mail from July 2018 to September 2018. Multivariable regression was used to assess factors associated with refusal or deferral rates of >/=50% among 11- to 12-year-old patients. RESULTS: The response rate was 65% (302 pediatricians and 228 FPs included). Pediatricians who strongly recommended the HPV vaccine ranged from 99% for patients >/=15 years old (female) to 83% for those 11 to 12 years old (male); FPs ranged from 90% for patients >/=15 years old (female) to 66% for those 11 to 12 years old (male) (P < .0001 between specialties). Sixty-five percent of pediatricians and 42% of FPs always or almost always used presumptive style when discussing the HPV vaccine (P < .0001). Overall, 40% used standing orders and 42% had electronic alerts. Among pediatricians, the proportion reporting a refusal or deferral rate >/=50% was 19% for female patients and 23% for male patients 11 to 12 years old; FPs reported 27% and 36%, respectively. In the multivariable regression (both sexes), refusal or deferral was associated with physicians not strongly recommending the HPV vaccine to 11- to 12-year-old patients, not using a presumptive style, perceiving less resistance when introducing the HPV vaccine to a 13-year-old patient versus an 11- or 12-year-old patient, and anticipating an uncomfortable conversation when recommending the HPV vaccine to an 11- or 12-year-old patient. Eighty-nine percent of pediatricians and 79% of FPs reported that more adolescents <15 years old are completing the HPV series now that only 2 doses are recommended. CONCLUSIONS: Although most physicians strongly recommend the HPV vaccine to 11- to 12-year-old patients, our data reveal areas for improvement in recommendation and delivery methods. Most physicians perceive that the 2-dose schedule is resulting in higher HPV completion rates. |
National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018
Walker TY , Elam-Evans LD , Yankey D , Markowitz LE , Williams CL , Fredua B , Singleton JA , Stokley S . MMWR Morb Mortal Wkly Rep 2019 68 (33) 718-723 The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11-12 years to protect against certain diseases, including human papillomavirus (HPV)-associated cancers, meningococcal disease, and pertussis (1). A booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended at age 16 years, and serogroup B meningococcal vaccine (MenB) may be administered to persons aged 16-23 years (1). To estimate vaccination coverage among adolescents in the United States, CDC analyzed data from the 2018 National Immunization Survey-Teen (NIS-Teen) which included 18,700 adolescents aged 13-17 years.* During 2017-2018, coverage with >/=1 dose of HPV vaccine increased from 65.5% to 68.1%, and the percentage of adolescents up-to-date(dagger) with the HPV vaccine series increased from 48.6% to 51.1%, although the increases were only observed among males. Vaccination coverage increases were also observed for >/=1 MenACWY dose (from 85.1% to 86.6%) and >/=2 MenACWY doses (from 44.3% to 50.8%). Coverage with tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap) remained stable at 89%. Disparities in coverage by metropolitan statistical area (MSA)( section sign) and health insurance status identified in previous years persisted (2). Coverage with >/=1 dose of HPV vaccine was higher among adolescents whose parents reported receiving a provider recommendation; however, prevalence of parents reporting receiving a recommendation for adolescent HPV vaccination varied by state (range = 60%-91%). Supporting providers to give strong recommendations and effectively address parental concerns remains a priority, especially in states and rural areas where provider recommendations were less commonly reported. |
Use of a choice survey to identify adult, adolescent and parent preferences for vaccination in the United States
Lavelle TA , Messonnier M , Stokley S , Kim D , Ramakrishnan A , Gebremariam A , Simon NE , Rose AM , Prosser LA . J Patient Rep Outcomes 2019 3 (1) 51 BACKGROUND: Adult and adolescent vaccination rates are far below coverage targets in the United States. Our objective was to identify the most influential factors related to vaccine uptake among adults, adolescents, and parents of adolescents (parents) in the United States. METHODS: We used a fractional factorial design to create a binary choice survey to evaluate preferences for vaccination. The national survey was fielded to a sample of adults, adolescents ages 13-17 years, and parents, using a national probability-based online research panel in November 2015. Respondents were presented with 5 profiles of a hypothetical vaccine and asked in a series of questions whether they would accept each vaccine. We analyzed the binary choice data using logistic regression in STATA v13 (College Station, TX) to calculate the odds that a participant would choose to accept the vaccine. RESULTS: We received completed responses from 334 (51%) of 652 adults, 316 (21%) of 1516 adolescents, and 339 (33%) of 1030 parents. Respondents were generally representative of the U.S. POPULATION: Vaccine effectiveness was the most influential factor in the choice to vaccinate for all groups. Other most influential factors were primary care provider (PCP) recommendation and the out-of-pocket cost of the vaccine. Other factors such as risk of illness, risk of vaccine side effects, vaccination location, and time for vaccination were not important in the decision to get vaccinated. CONCLUSIONS: Adults, adolescents, and parents are most sensitive to vaccine effectiveness, PCP recommendation, and out-of-pocket cost for vaccination in their decision to get vaccinated. Strong PCP recommendations that focus on vaccine effectiveness and health care policies that minimize out-of-pocket costs for vaccinations may increase vaccine uptake by adults and adolescents. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 06, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure