This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. Interviews were audio recorded, transcribed, and translated, if needed. Initial data analyses were conducted rapidly in the field to inform public health actions. We then conducted additional analyses including line-by-line coding of the interview transcripts using a thematic analytic approach. We identified four main themes. First, inequity in language access was a predominant barrier. Second, multiple social and structural barriers existed. Third, HLMSM encountered intersectional stigma. Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.

HIV-associated immunosuppression may increase risk of hospitalization with mpox. Among persons diagnosed with mpox in the state of Georgia, we characterized the association between hospitalization with mpox and HIV status. People with HIV and CD4 < 350 cells/mm3 or who were not engaged in HIV care had increased risk of hospitalization.

During February 2021-June 2022, the Georgia Department of Public Health (GDPH) detected five clusters of rapid HIV transmission concentrated among Hispanic or Latino (Hispanic) gay, bisexual, and other men who have sex with men (MSM) in metropolitan Atlanta. The clusters were detected through routine analysis of HIV-1 nucleotide sequence data obtained through public health surveillance (1,2). Beginning in spring 2021, GDPH partnered with health districts with jurisdiction in four metropolitan Atlanta counties (Cobb, DeKalb, Fulton, and Gwinnett) and CDC to investigate factors contributing to HIV spread, epidemiologic characteristics, and transmission patterns. Activities included review of surveillance and partner services interview data,(†) medical chart reviews, and qualitative interviews with service providers and Hispanic MSM community members. By June 2022, these clusters included 75 persons, including 56% who identified as Hispanic, 96% who reported male sex at birth, 81% who reported male-to-male sexual contact, and 84% of whom resided in the four metropolitan Atlanta counties. Qualitative interviews identified barriers to accessing HIV prevention and care services, including language barriers, immigration- and deportation-related concerns, and cultural norms regarding sexuality-related stigma. GDPH and the health districts expanded coordination, initiated culturally concordant HIV prevention marketing and educational activities, developed partnerships with organizations serving Hispanic communities to enhance outreach and services, and obtained funding for a bilingual patient navigation program with academic partners to provide staff members to help persons overcome barriers and understand the health care system. HIV molecular cluster detection can identify rapid HIV transmission among sexual networks involving ethnic and sexual minority groups, draw attention to the needs of affected populations, and advance health equity through tailored responses that address those needs.

Since the early 1980s, substantial progress has been made in the prevention and treatment of human immunodeficiency virus (HIV) infection in the United States. However, HIV remains a major public health concern due in part to significant disparities1 in rates of infection among racial/ethnic minority communities, with black/African American (hereinafter referred to as African American) and Hispanic/Latino populations being the most affected subgroups.2 African Americans comprised 44% of new HIV diagnoses in 2014, despite representing only 12% of the population; 23% of new HIV diagnoses were among Hispanics/Latinos, who represent about 16% of the U.S. population. Gay, bisexual, and other men who have sex with men (MSM) are the most disproportionately affected subpopulations among African Americans and Hispanics/Latinos. In 2014, an estimated 78% of diagnosed HIV infections among African American males and 84% of diagnosed HIV infections among Hispanic/Latino males resulted from male-to-male sexual contact.2 The causes of these disparities are complex and interrelated and can be attributed to myriad individual, social, contextual, and environmental factors. Accordingly, prevention strategies to reduce disparities must be based on an integrated, targeted approach that addresses the individual, social, structural, and contextual environments in which disparities occur.3 | The White House released the National HIV/AIDS Strategy (NHAS) for the United States in 2010 and updated it in July 2015. Both the 2010 and 2015 NHAS provide a plan for federal agencies to address HIV-related disparities by reducing mortality in communities at high risk for HIV, adopting community approaches to reduce new HIV infections, and reducing HIV-related stigma and discrimination. The updated NHAS lists action steps to reduce HIV-related disparities, including scaling up effective, evidence-based programs that address social determinants of health and promoting evidence-based public health approaches to HIV prevention and care.4,5

Recent advances in science, program, and policy could better position the nation to achieve its vision of the USA as a place where new HIV infections are rare. Among these developments, passage of the Patient Protection and Affordable Care Act (ACA) in 2010 may prove particularly important, as the health system transformations it has launched offer a supportive foundation for realizing the potential of other advances, both within and beyond the clinical arena. This article summarizes opportunities to expand access to high-impact HIV prevention interventions under the ACA, examines whether available evidence indicates that these opportunities are being realized, and considers potential challenges to further gains for HIV prevention in an era of health reform. This article also highlights the new roles that HIV prevention programs and providers may assume in a health system no longer defined by fragmentation among public health, medical care, and community service providers.

Partnership for Health (PfH) is an evidence-based, clinician-delivered HIV prevention program conducted in the United States for HIV-positive patients. This intervention strives to reduce risky sexual behaviors through provider-patient discussions on safer sex and HIV status disclosure. A cross-sectional, mixed-methods design was used to evaluate the dissemination and implementation of PfH, including training evaluations, an online trainee survey, and interviews with national trainers for PfH. Descriptive statistics were calculated with the categorical data, whereas thematic analysis was completed with the qualitative data. Between 2007 and 2013, PfH was disseminated to 776 individuals from 104 different organizations in 21 states/territories. The smallest proportion of trainees was physicians (6.9%). More than three-fourths of survey respondents (78.6%) reported using PfH, but less than one-third (31.8%) used the intervention with every patient. The PfH training supports the implementation of the intervention; however, challenges were experienced in clinician engagement. Tailored strategies to recruit and train clinicians providing care to HIV-positive patients are required.

BACKGROUND: The Ryan White HIV/AIDS Program (RWHAP) provides HIV-infected persons with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA). METHODS: We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project (MMP), a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013from 18,095patients. RESULTS: Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% versus 94%; P<0.01) and virally suppressed (39% versus 77%; P<0.01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P<0.01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P≤0.02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P≤0.01). CONCLUSIONS: Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.

Accessibility and equity across populations are important measures in public health. This paper is specifically concerned with potential spatial accessibility, or the opportunity to receive care as moderated by geographic factors, and with horizontal equity, or fairness across populations regardless of need. Both accessibility and equity were goals of the 2009 vaccination campaign for the novel H1N1a influenza virus, including during the period when demand for vaccine exceeded supply. Distribution system design can influence equity and accessibility at the local level. We develop a general methodology that integrates optimization, game theory, and spatial statistics to measure potential spatial accessibility across a network, where we quantify spatial accessibility by travel distance and scarcity. We estimate and make inference on local (census-tract level) associations between accessibility and geographic, socioeconomic, and health care infrastructure factors to identify potential inequities in vaccine accessibility during the 2009 H1N1 vaccination campaign in the U.S. We find that there were inequities in access to vaccine at the local level and that these were associated with factors including population density and health care infrastructure. Our methodology for measuring and explaining accessibility leads to policy recommendations for federal, state, and local public health officials. The spatial-specific results inform the development of equitable distribution plans for future public health efforts.

CONTEXT: Immunizations are the most effective way to reduce incidence of vaccine-preventable diseases. Immunization information systems (IISs) are confidential, population-based, computerized databases that record all vaccination doses administered by participating providers to people residing within a given geopolitical area. They facilitate consolidation of vaccination histories for use by health care providers in determining appropriate client vaccinations. Immunization information systems also provide aggregate data on immunizations for use in monitoring coverage and program operations and to guide public health action. EVIDENCE ACQUISITION: Methods for conducting systematic reviews for the Guide to Community Preventive Services were used to assess the effectiveness of IISs. Reviewed evidence examined changes in vaccination rates in client populations or described expanded IIS capabilities related to improving vaccinations. The literature search identified 108 published articles and 132 conference abstracts describing or evaluating the use of IISs in different assessment categories. EVIDENCE SYNTHESIS: Studies described or evaluated IIS capabilities to (1) create or support effective interventions to increase vaccination rates, such as client reminder and recall, provider assessment and feedback, and provider reminders; (2) determine client vaccination status to inform decisions by clinicians, health care systems, and schools; (3) guide public health responses to outbreaks of vaccine-preventable disease; (4) inform assessments of vaccination coverage, missed vaccination opportunities, invalid dose administration, and disparities; and (5) facilitate vaccine management and accountability. CONCLUSIONS: Findings from 240 articles and abstracts demonstrate IIS capabilities and actions in increasing vaccination rates with the goal of reducing vaccine-preventable disease.

INTRODUCTION: During the 2009-2010 H1N1 pandemic, vaccine in short supply was allocated to states pro rata by population, yet the vaccination rates of adults differed by state. States also differed in their campaign processes and decisions. Analyzing the campaign provides an opportunity to identify specific approaches that may result in higher vaccine uptake in a future event of this nature. OBJECTIVE: To determine supply chain and system factors associated with higher state H1N1 vaccination coverage for adults in a system where vaccine was in short supply. METHODS: Regression analysis of factors predicting state-specific H1N1 vaccination coverage in adults. Independent variables included state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and H1N1-specific state data. RESULTS: The best model explained the variation in state-specific adult vaccination coverage with an adjusted R-squared of 0.76. We found that higher H1N1 coverage of adults is associated with program aspects including shorter lead-times (i.e., the number of days between when doses were allocated to a state and were shipped, including the time for states to order the doses) and less vaccine directed to specialist locations. Higher vaccination coverage is also positively associated with the maximum number of ship-to locations, past seasonal influenza vaccination coverage, the percentage of women with a Pap smear, the percentage of the population that is Hispanic, and negatively associated with a long duration of the epidemic peak. CONCLUSION: Long lead-times may be a function of system structure or of efficiency and may suggest monitoring or redesign of distribution processes. Sending vaccine to sites with broad access could be useful when covering a general population. Existing infrastructure may be reflected in the maximum number of ship-to locations, so strengthening routine influenza vaccination programs may help during emergency vaccinations also. Future research could continue to inform program decisions.

INTRODUCTION: During the 2009-2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions. OBJECTIVE: To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine. METHODS: Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data. RESULTS: Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to "general access" locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population. CONCLUSION: Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.

OBJECTIVE: To examine preventive care visit patterns among commercially insured adolescents during 2003-2010. In 2005-2007, the Advisory Committee on Immunization Practices (ACIP) recommended 3 vaccines targeted at adolescents. We also investigate the relationship between preventive care visits and immunization. STUDY DESIGN: Data were drawn from the MarketScan database. Adolescents aged 11-21 continuously enrolled in the same insurance plan during the calendar year were included. We calculated the annual proportion of adolescents with at least 1 preventive and 1 vaccination-related visit. Longitudinal analyses were conducted by following the 1992 birth cohort for 8 consecutive years. RESULTS: The proportion of adolescents making at least 1 preventive visit increased from 24.6%-41.1% during 2003-2010. The rate of vaccination-related visits increased from 12.9%-26.3%. The magnitude of the increase in preventive and vaccination-related visits was greater during the years in which ACIP issued recommendations. The rates of preventive and vaccination-related visits were considerably higher among female and early adolescents and adolescents in managed care plans. Longitudinal analyses indicated that only 2.4% of adolescents had an annual preventive visit during the 8 years. CONCLUSIONS: Yearly improvements in preventive care visits by adolescents were substantial. ACIP recommendations may be associated with this improvement. However, ongoing efforts are needed to improve the use and delivery of preventive care services.

BACKGROUND: Racial/ethnic disparities in influenza vaccination among adults are longstanding, and research suggests they result from multiple factors. Influenza vaccine-seeking behavior may be an important aspect to consider when evaluating disparities in vaccination coverage. OBJECTIVE: To determine whether there are differences between blacks and whites in influenza vaccine-seeking behavior among adults 65 years and older. METHODS: Data were analyzed from a national sample of 3138 adults 65 years and older collected through the adult module of the 2007 National Immunization Survey, a random digit dialing telephone survey, which included an oversample of non-Hispanic blacks. Analysis included influenza vaccination rate, location of vaccination, and whether vaccinated individuals specifically went to the location to receive the vaccine (vaccine seekers) by race. The relationship between attitudes about influenza vaccination and vaccine-seeking behavior by race was also examined. RESULTS: White adults 65 years and older were significantly more likely to receive influenza vaccine than blacks, during the 2006-2007 influenza season (68% +/- 4% vs 54% +/- 3%, respectively), and a significantly higher proportion of vaccinated whites reported seeking out the vaccine than vaccinated blacks (66% +/- 4% vs 47% +/- 4%, respectively). Blacks were less likely to be vaccine seekers, regardless of education or poverty levels. Among persons vaccinated in a doctor's office, 52% of whites specifically went there to get vaccinated, compared with 37% of blacks. Among persons who believe the vaccine is very effective, 66% +/- 5% of whites versus 50% +/- 6% of blacks were vaccine seekers. CONCLUSIONS: This study points to the importance of improving our understanding of what factors, in addition to beliefs about vaccination, lead to vaccine seeking and reinforces the need for systematically offering vaccine.

BACKGROUND: Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. OBJECTIVE: To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. METHODS: Data from a national telephone survey conducted in 2004 were used for this study. Reponses for 3875 adults ≥65 years of age were analyzed using logistic regression methods. RESULTS: Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. CONCLUSIONS: Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups.

OBJECTIVE: To assess the level of participation of endocrinologists in the United States in the 2009 to 2010 H1N1 vaccination campaign and explore their perspectives on H1N1 vaccination. METHODS: We conducted a cross-sectional, mailed survey of a national sample of 1,991 endocrinologists in June through September 2010. The extent of the response and the survey responses are reported and analyzed. RESULTS: The overall response rate was 59%. The majority of endocrinologists strongly recommended H1N1 vaccine for children, whereas about a third did so for both nonelderly adults and seniors. Just over half (52%) of the responding endocrinologists had agreed to participate in the 2009 to 2010 H1N1 vaccine campaign and received vaccine, in comparison with 73% who offered seasonal influenza vaccine. The supply of H1N1 vaccine was a significant challenge, but otherwise endocrinologists reported few major problems with administration of H1N1 vaccine. Overall, less than half of the respondents thought that they would be "very likely" to provide vaccine in the event of a future influenza pandemic, with a much higher proportion among those endocrinologists who offered seasonal influenza vaccine and H1N1 vaccine. CONCLUSION: Although the experiences of endocrinologists who provided H1N1 vaccine were generally positive, many did not offer the vaccine and indicated that they are hesitant about providing vaccine during a future influenza pandemic. Approaches to increase their participation in future pandemics in an effort to reach persons at high risk for influenza and its complications, such as those with diabetes, should be further explored.

OBJECTIVES: Determine among a representative sample of pediatricians (Peds), family medicine (FM), and general internal medicine (GIM) physicians in the 2009-2010 influenza season physicians': 1) practices and experiences with delivery of seasonal and pH1N1 influenza vaccines; and 2) anticipated and experienced barriers. METHODS: Two US national surveys administered 7/2009-10/2009 (before pH1N1 distribution) and 3/2010-6/2010 (after pH1N1 distribution) to 416 Peds, 424 FM and 432 GIM. RESULTS: Of respondents who received both surveys, 62% (776/1253) completed both. Overall, 98% reported administering seasonal influenza vaccine and 86% pH1N1, with 70% reporting that working with public health in delivery of pH1N1 was a positive experience. Due to limited supplies of pH1N1, 63% of providers reported prioritizing who received vaccine even within high risk groups. Pre-distribution, 71% perceived that patient/parental safety concerns about pH1N1 would be a barrier, and post-distribution 72% perceived it had been a barrier. Physician concern about safety decreased, with 44% reporting safety a barrier pre-distribution and 12% post-distribution (p<0.001). CONCLUSIONS: In the setting of a pandemic most primary care physicians collaborated with public health in delivery of pH1N1. Physicians faced challenges with patient/parent safety concerns about pH1N1 and supply issues with pH1N1 that required physicians to prioritize who received vaccine.

OBJECTIVES: Nationwide among nursing home residents, receipt of the influenza vaccine is 8 to 9 percentage points lower among blacks than among whites. The objective of this study was to determine if the national inequity in vaccination is because of the characteristics of facilities and/or residents. DESIGN: Cross-sectional study with multilevel modeling. SETTING AND PARTICIPANTS: States in which 1% or more of nursing home residents were black and the difference in influenza vaccination coverage between white and black nursing home residents was 1 percentage point or higher (n = 39 states and the District of Columbia). Data on residents (n = 2,359,321) were obtained from the Centers for Medicare & Medicaid Service's Minimum Data Set for October 1, 2008, through March 31, 2009. MEASUREMENTS: Residents' influenza vaccination status (vaccinated, refused vaccine, or not offered vaccination). RESULTS: States with higher overall influenza vaccination coverage among nursing home residents had smaller racial inequities. In nursing homes with higher proportions of black residents, vaccination coverage was lower for both blacks and whites. The most dramatic inequities existed between whites in nursing homes with 0% blacks (L1) and blacks in nursing homes with 50% or more blacks (L5) in states with overall racial inequities of 10 percentage points or more. In these states, more black nursing home residents lived in nursing homes with 50% or more blacks (L5); in general, the same homes with low overall coverage. CONCLUSION: Inequities in influenza vaccination coverage among nursing home residents are largely because of low vaccination coverage in nursing homes with a high proportion of black residents. Findings indicate that implementation of culturally appropriate interventions to increase vaccination in facilities with larger proportions of black residents may reduce the racial gap in influenza vaccination as well as increase overall state-level vaccination.

BACKGROUND: In April 2009, a novel influenza A virus emerged in the United States. By the end of July, influenza A (H1N1) 2009 monovalent (2009 H1N1) vaccine had been developed, licensed, and recommended by the Advisory Committee on Immunization Practices. Initial target groups for vaccination were identified and the first vaccine was publicly available in early October 2009. OBJECTIVE: This study examines socio-demographic differences in opinions about 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza disease and vaccines and the association with receipt of influenza vaccinations during the 2009-2010 influenza season. Changes in opinions over the course of the pH1N1 pandemic were also examined. METHODS: Data from the 2009 National H1N1 Flu Survey (NHFS) were analyzed. The NHFS was a CDC-sponsored telephone survey initiated in response to the 2009 pH1N1 pandemic to obtain weekly within-season estimates of vaccination coverage, opinions, and other information. RESULTS: Opinions about influenza vaccine and disease varied significantly by race/ethnicity, income, and education level. In multivariable logistic regression analysis, adjusted 2009 H1N1 vaccination coverage was most strongly associated with opinions about the effectiveness of the vaccine and personal risk of disease, varying from 7 to 11% among adults who believed the vaccine to have low effectiveness and themselves at low risk of influenza, to 50-53% among those who thought vaccine effectiveness to be high and themselves at high risk of influenza. CONCLUSION: Improving communication about personal risk and the effectiveness of influenza vaccines may improve vaccination coverage. The findings of difference in opinions could be used to target communication.

Persons with high-risk conditions such as asthma were a target group for H1N1 vaccine recommendations. We conducted a mailed survey of a national sample of pulmonologists to understand their participation in the 2009-2010 H1N1 vaccine campaign. The response rate was 59%. The majority of pulmonologists strongly recommended H1N1 vaccine for children (73%) and adults aged 25-64 years (51%). Only 60% of respondents administered H1N1 vaccine in their practice compared to 87% who offered seasonal influenza vaccine. Other than vaccine supply, respondents who provided H1N1 vaccine reported few logistical problems. Two-thirds of respondents would be very likely to vaccinate during a future influenza pandemic; this rate was higher among those who provided H1N1 vaccine and/or seasonal flu vaccine. In total, the H1N1 vaccine-related experiences of pulmonologists seemed to be positive. However, additional efforts are needed to increase participation in future pandemic vaccination campaigns.

As the preceding articles indicate, school-located vaccination (SLV) shows great promise as a method to quickly and efficiently vaccinate large numbers of school-aged children against influenza. This approach can both relieve health care providers who lack sufficient capacity to effectively vaccinate their patients annually, in accordance with the 2008 recommendations of Advisory Committee on Immunization Practices (ACIP),1 as well as provide a convenient option for parents and an opportunity for children without a medical home to be vaccinated. Importantly, SLV may be appropriate for routine vaccination against seasonal influenza, as well as during a public health emergency or pandemic. | The utility of SLV was demonstrated on a large scale in response to the 2009–2010 H1N1 influenza pandemic. In July 2009, intense efforts were underway to procure H1N1 vaccine and prepare for implementing a large-scale national vaccination program. At that time, the ACIP published recommendations that defined the highest-priority target groups to receive vaccine when it first became available, which included school-aged children.2 Accordingly, public health units, educational institutions, and others in local communities joined together to hold SLV clinics throughout the United States, with several states implementing SLV statewide. Based on a National Association of County and City Health Officials survey of local health department officials that was conducted in the summer of 2010, an estimated 85% of local health departments held at least 1 H1N1 influenza SLV clinic in their jurisdiction (National Association of County and City Health Officials, unpublished data). The Centers for Disease Control and Prevention’s (CDC) National 2009 H1N1 Flu Survey is a nationally representative telephone-based survey designed to collect vaccination coverage from US households.3 This survey indicated that 37% of school-aged children 5- to17-years-old received 2009 H1N1 influenza vaccination; approximately one-third of these children were vaccinated at school (CDC, unpublished data).

BACKGROUND: Persons with high-risk conditions such as asthma were a target group for national H1N1 vaccine recommendations. Allergists/immunologists (allergists) are a provider group that could vaccinate persons with asthma and other high-risk conditions. Their level of participation in and experiences with the 2009-2010 H1N1 vaccination campaign are unknown. OBJECTIVE: To describe the experiences of allergists related to the 2009-2010 H1N1 vaccination campaign. METHODS: A cross-sectional, mailed survey of a national sample of 1955 allergists providing outpatient care was conducted in June-September 2010. RESULTS: The overall response rate was 72%. Most allergists "strongly recommended" H1N1 vaccine for children, and most "recommended" or "strongly recommended" vaccine for adults. The majority (71%) agreed to participate in the H1N1 vaccine campaign and received vaccine. Vaccine supply was a significant challenge, but otherwise few major problems were experienced with administering H1N1 vaccine. The majority of respondents, particularly among those who participated in the 2009-2010 H1N1 vaccination campaign, felt they would be very likely to vaccinate in the event of future influenza pandemic. CONCLUSION: The experiences of allergists in the H1N1 vaccine campaign were generally positive. Most allergists are willing to serve as vaccinators in future influenza pandemics, which will help facilitate broad access to vaccine for patients with asthma and other high-risk conditions.

OBJECTIVE: To assess practices regarding the expanded Advisory Committee on Immunization Practices (ACIP) recommendations for influenza vaccination in children among US pediatricians and family medicine physicians (FMs) and strategies to promote vaccination. STUDY DESIGN: We administered a survey between July and October 2009 to 416 pediatricians and 424 FMs from nationally representative networks. RESULTS: The response rate was 75% (79% pediatricians, 70% FMs). FMs were less likely than pediatricians to report adherence to ACIP recommendations (35% vs 65%; adjusted risk ratio [RR], 0.60; 95% CI, 0.50-0.72). Most physicians (89% pediatricians and 89% FMs) reported using posters or pamphlets to encourage influenza vaccination, and 57% pediatricians and 41% FMs reported offering after hours dedicated influenza vaccination clinics. Only 23% pediatricians and 14% FMs reported providing written, telephone, or e-mail reminders to all children. Having dedicated influenza vaccination clinics after hours or weekends was associated with routine vaccination of all children (adjusted RR, 1.33; 95% CI, 1.15-1.57). CONCLUSION: In the first year of the expanded ACIP recommendations to immunize all eligible children against influenza, two-thirds of pediatricians and one-half of FMs reported adherence, although less than one-quarter were actively engaging in reminder/recall efforts. Practices that adhered to the ACIP recommendations were more likely to put a substantial effort into promoting vaccination opportunities.

During the 2009 H1N1 influenza pandemic, the CDC contacted the 50 state, New York City, and District of Columbia health departments and the health department in Puerto Rico through the Association of State and Territorial Health Officials (ASTHO), to discuss distributing 2009 H1N1 influenza vaccine directly to large pharmacy chains (“pharmacies”) to supplement state vaccination efforts. By the end of December 2009, most states had opened vaccination to all members of the public and a vaccine surplus was projected. All but three states opted to take part in this CDC 2009 H1N1 Vaccine Pharmacy Initiative.* The CDC subsequently invited the largest 15 US pharmacies (by prescription share) to participate, 12 of these pharmacies expressed interest and 10 ultimately participated.1 From December 2009-February 2010, the CDC distributed 5 483 900 doses of 2009 H1N1 vaccine to these pharmacy chains; they in turn, distributed it to more than 10 700 retail stores nationwide. The amount of 2009 H1N1 vaccine that the CDC directly distributed to pharmacy chains comprised approximately 23% of all vaccine distributed during the same time period to the same states and accounted for approximately 4.3% of all 2009 H1N1 vaccine distributed during October 2009-February 2010. Approximately 10% of adults who received 2009 H1N1 influenza vaccine reported getting vaccinated at a pharmacy.2 This included vaccinations given with vaccine provided to pharmacies by state health officials and directly by the CDC (Figure).

BACKGROUND: From 2005 through 2007, 3 vaccines were added to the adolescent vaccination schedule: tetanus-diphtheria-acellular pertussis (TdaP); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) for girls. OBJECTIVE: To assess implementation of new adolescent vaccination recommendations. METHODS: Data from the 2006-2009 National Immunization Survey-Teen, an annual provider-verified random-digit-dial survey of vaccination coverage in US adolescents aged 13 to 17 years, were analyzed. Main outcome measures included percentage of adolescents who received each vaccine according to survey year; potential coverage if all vaccines were administered during the same vaccination visit; and, among unvaccinated adolescents, the reasons for not receiving vaccine. RESULTS: Between 2006 and 2009, ≥1 TdaP and ≥1 MenACWY coverage increased from 11% to 56% and 12% to 54%, respectively. Between 2007 and 2009, ≥1 HPV coverage among girls increased from 25% to 44%; between 2008 and 2009, ≥3 HPV coverage increased from 18% to 27%. In 2009, vaccination coverage could have been >80% for Td/TdaP and MenACWY and as high as 74% for the first HPV dose if providers had administered all recommended vaccines during the same vaccination visit. For all years, the top reported reasons for not vaccinating were no knowledge about the vaccine, provider did not recommend, and vaccine is not needed/necessary (for TdaP and MenACWY) and adolescent is not sexually active, no knowledge about the vaccine, and vaccine is not needed/necessary (for HPV). CONCLUSIONS: Adolescent vaccination coverage is increasing but could be improved. Strategies are needed to increase parental knowledge about adolescent vaccines and improve provider recommendation and administration of all vaccines during the same visit.

In 2011, institutional requirements for pertussis vaccination of healthcare personnel were reported by nearly one-third of surveyed US hospitals. Requirements often applied to personnel with certain clinical responsibilities, such as those caring for infants. Healthcare personnel who were not on an institution's payroll were rarely subject to pertussis vaccination requirements.

BACKGROUND: Many health professional organizations now endorse influenza vaccination as a condition of employment in healthcare settings. Our objective was to describe institutional requirements for influenza vaccination of healthcare personnel (HCP) among US hospitals during the 2010-2011 influenza season. METHODS: A survey was mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as "a policy that requires HCP to receive or decline influenza vaccination, with or without consequences for vaccine refusal." A weighted analysis included univariate analyses and logistic regression. RESULTS: Of responding hospitals (n = 808; 81.0%), 440 (55.6%) reported institutional requirements for influenza vaccination. Although employees were uniformly subject to requirements, nonemployees often were not. The proportion of requirements with consequences for vaccine refusal was 44.4% (n = 194); where consequences were imposed, nonmedical exemptions were often granted (69.3%). Wearing a mask was the most common consequence (74.2% of 194 requirements); by contrast, 29 hospitals (14.4%) terminated unvaccinated HCP. After adjustment for demographic factors, the following characteristics remained significantly associated with requirements: location in a state requiring HCP to receive or decline influenza vaccine, caring for inpatients that are potentially vulnerable to influenza, use of ≥9 Advisory Committee on Immunization Practices-recommended, evidence-based influenza vaccination campaign strategies, and for-profit ownership. CONCLUSIONS: Influenza vaccination requirements were prevalent among hospitals of varying size and location. However, few policies were as stringent or as comprehensive as those endorsed by health professional organizations. Because influenza vaccination requirements are a viable alternative for hospitals unable to achieve high coverage through voluntary policies, there is still substantial room for improvement.

BACKGROUND: Institutional requirements for influenza vaccination, ranging from policies that mandate declinations to those terminating unvaccinated healthcare personnel (HCP), are increasingly common in the US. Our objective was to determine HCP vaccine uptake following requirements for influenza vaccination at US hospitals. METHODS: Survey mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as an institutional policy that requires receipt or declination of influenza vaccination, with or without consequences for vaccine refusal. Respondents reported institutional-level, seasonal influenza vaccination coverage, if known, during two consecutive influenza seasons: the season prior to (i.e., pre-requirement), and the first season of requirement (i.e., post-requirement). Weighted univariate and multivariate analyses accounted for sampling design and non-response. RESULTS: 808 (81.0%) hospitals responded. Of hospitals with institutional requirements for influenza vaccination (n=440), 228 hospitals met analytic inclusion criteria. Overall, mean reported institutional-level influenza vaccination coverage among HCP rose from 62.0% in the pre-requirement season to 76.6% in the post-requirement season, representing a single-season increase of 14.7 (95% CI: 12.6-16.7) percentage points. After adjusting for potential confounders, single-season increases in influenza vaccination uptake remained greater among hospitals that imposed consequences for vaccine refusal, and among hospitals with lower pre-requirement vaccination coverage. Institutional characteristics were not associated with vaccination increases of differential magnitude. CONCLUSION: Hospitals that are unable to improve suboptimal influenza vaccination coverage through multi-faceted, voluntary vaccination campaigns may consider institutional requirements for influenza vaccination. Rapid and measurable increases in vaccination coverage followed institutional requirements at hospitals of varying demographic characteristics.

OBJECTIVE: Achieving universal influenza vaccination among children may necessitate collaborative delivery involving both practices and community vaccinators. We assessed among pediatricians nationally their preferences regarding location of influenza vaccination for patient subgroups and their attitudes about collaborative delivery methods. METHODS: The design/setting was a national survey conducted from July 2009 to October 2009. Participants included a representative sample of pediatricians from the American Academy of Pediatrics. RESULTS: The response rate was 79% (330 of 416). Physicians felt strongly that vaccination should occur in their practice for children with chronic conditions (52%) and healthy 6-24-month-old infants (48%), but few felt strongly about healthy 5-18-year-olds (17%). Most (78%) thought having multiple delivery sites increased vaccination rates, and 86% thought that influenza vaccine should be available at school. Physicians reported being very/somewhat willing to hold joint community clinics with public health entities (76%) and to suggest to patient subgroups that they receive vaccine at community sites, including public clinics or pharmacies (76%). The most frequently reported barriers to collaborative delivery with community sites or school-located delivery included concerns about the following: estimating the amount of vaccine to order if children are vaccinated elsewhere (community 56%; school 80%); transfer of vaccine records (community 57%; school 78%); and reluctance of families to go outside of the office (community 45%; school 74%). CONCLUSIONS: Most physicians are in favor of school-located or collaborative influenza vaccine delivery with community vaccinators, especially for healthy school-aged children. Collaborative approaches will require planning to ensure transfer of records, effective targeting of subgroups, and provisions to protect providers from being left with extra influenza supply.

US health professional schools with student immunity requirements for recommended vaccines frequently accept evidence of immunity other than vaccination but vary widely on the types of evidence that are accepted. Exemptions for nonmedical reasons and, to a lesser extent, medical reasons are often obtainable by a student-written document.