Biomedical subjects

Francisco Averhoff

Publications and source records attributed to Francisco Averhoff.

13 recordsLinked to original sources

PubMed2006

Adequacy of surveillance to detect endemic rubella transmission in the United States.

BACKGROUND: Reported rubella cases in the United States are at the lowest numbers since the introduction of vaccine, suggesting that endemic transmission may have been interrupted. It is necessary to validate that the observed absence of rubella is due to the disappearance of disease rather than a failure of rubella surveillance. METHODS: Adequate rubella surveillance to detect ongoing transmission is characterized by evidence that rubella investigations are being conducted, detection of importations, and lack of spread from confirmed cases. We reviewed rubella surveillance data and activities from 5 sources: (1) data reported to the national surveillance system; (2) a survey of health departments and public health laboratories, including questions regarding any links between measles and rubella surveillance; (3) enhanced rubella surveillance activities in California and in New York City; (4) sentinel surveillance along the US-Mexico border; and (5) case detection in 8 large health maintenance organizations (HMOs). RESULTS: During 2002-2004, 35 cases of rubella were reported to the national system, including 12 (34%) imported cases. The 39 programs that responded to our survey reported conducting 1482 investigations for rubella; according to another national survey, 1921 investigations were conducted for measles. Forty-one laboratories responded to our survey and reported conducting 6428 tests for acute rubella. No previously undetected (or unreported) cases of rubella or congenital rubella syndrome were identified by our survey or reviews of surveillance in California, New York, and along the US-Mexico border, and no additional cases were detected in the HMO database. CONCLUSIONS: No previously unrecognized spread cases or outbreaks of rubella were detected. Surveillance in the United States is sufficiently sensitive to identify indigenous cases of rubella, if they were occurring, supporting the contention that rubella has been eliminated from the United States.

Disease Notification↗

PubMed2006

Influenza vaccine effectiveness among 50-64-year-old persons during a season of poor antigenic match between vaccine and circulating influenza virus strains: Colorado, United States, 2003-2004.

During the 2003-2004 influenza season, we conducted a case-control study of influenza vaccine effectiveness (VE) among Colorado residents aged 50-64 years. Cases (n=330) were identified from laboratory-confirmed influenza reports to the Colorado Department of Public Health and Environment (CDPHE). Controls (n=1055) were recruited by random-digit dial telephone survey. VE was 60% (43-72%) and 48% (21-66%) among those without and with high-risk medical conditions, respectively. VE was 90% (68-97%) and 36% (0-63%) against influenza-related hospitalization for persons without and with high-risk conditions, respectively.

Antigenic Variation↗

PubMed2006

Effect of telephone reminder/recall on adolescent immunization and preventive visits: results from a randomized clinical trial.

OBJECTIVE: To measure the effect of telephone-based reminder/recall on immunization and well-child care (WCC) visit rates among adolescents in urban practices. DESIGN: Randomized clinical trial of telephone-based reminder/recall over 18 months. SETTING: Four urban primary care practices. PARTICIPANTS: Adolescents aged 11 to 14 years.Intervention Adolescents within practices were randomized to study (n = 1496) or control groups (n = 1510). The study group was sent audiotaped telephone reminders about a scheduled or needed immunization or WCC visit. Households were called weekly if there was no response; telephone numbers were updated weekly. Controls received standard care. RESULTS: Baseline demographics and immunization and WCC visit rates were similar for study and control groups. The intervention was largely ineffective in improving immunization or WCC visit rates. Although at the end of the study, the study group had slightly higher hepatitis B coverage (3 vaccinations) (62% vs 57.8%; P = .02), WCC visits were the same (53% and 54%), and impact on other vaccinations was minimal. The effect of reminder/recall was equivalent across demographic subgroups (e.g., age, race/ethnicity, insurance). The major factor limiting intervention effectiveness was inaccurate telephone numbers. Seventy-one percent of study subjects with single telephone numbers throughout the study had a WCC visit vs 25% of study subjects with multiple/changed telephone numbers and 54% of controls (P<.001). CONCLUSIONS: An intensive telephone reminder and recall system was only minimally successful in improving immunization and WCC visit rates among urban adolescents. Lack of success was largely owing to changed or inaccurate telephone numbers.

Adolescent↗

PubMed2005

Generalized vaccinia, progressive vaccinia, and eczema vaccinatum are rare following smallpox (vaccinia) vaccination: United States surveillance, 2003.

Generalized vaccinia (GV), progressive vaccinia (PV), and eczema vaccinatum (EV) are adverse reactions following smallpox vaccination. We investigated all reports suggestive of GV, PV, or EV among United States civilian smallpox vaccinees during 2003 and applied standard case definitions. We identified 29 reports of possible GV among 38,440 vaccinees; 2 (7%) of the reports met the case definition. One case of GV was confirmed by identifying vaccinia from a lesion distant from the vaccine site using polymerase chain reaction. The other case was classified as probable GV, because confirmatory testing was not done. We identified 3 potential EV cases and 7 potential PV cases, none of which met the standard case definition. GV, PV, and EV were rare or absent following smallpox vaccination after careful screening of potential vaccinees. GV may be difficult to distinguish from other rashes, and confirmatory testing is recommended. Careful prevaccination screening probably contributed to the low incidence of these adverse reactions following smallpox vaccination.

Adolescent↗

PubMed2004

Superinfection following smallpox vaccination (Vaccinia), United States: surveillance January 2003 through January 2004.

BACKGROUND: Superinfection is an adverse event following smallpox vaccination. The clinical presentation is similar to that of a large normal vaccine reaction or "robust take," and the frequency is unknown. METHODS: We retrospectively reviewed all reported severe local reactions consistent with superinfection among United States civilian smallpox vaccinees from January 2003 through January 2004. We applied a standard case definition and estimated the frequency of superinfection following smallpox vaccination. RESULTS: We identified 48 reported cases for further review among 39,350 [corrected] smallpox vaccinees. Two (4%) of the 48 reported cases met the case definition for superinfection; neither of the patients had a pathogenic organism isolated from their infection site. Both were treated with antibiotics and resolved their infection. Of the 46 cases determined not to be superinfection, 41 (89%) were temporally consistent with a large normal vaccine reaction. Thirty (75%) of 40 reported case patients for whom data were available received antibiotic therapy. CONCLUSIONS: Superinfection following smallpox vaccination is rare. Most of the reported superinfection cases were probably large normal smallpox vaccine reactions. Educating providers about the normal response to smallpox vaccine may decrease the overdiagnosis of superinfection and the unnecessary use of antimicrobials.

Adult↗

PubMed2004

Adolescent immunizations. are we ready for a new wave?

CONTEXT: Factors associated with vaccination coverage rates for the 20% of U.S. adolescents enrolled in managed care organizations (MCOs) are not known. OBJECTIVES: To examine recent trends in receipt of two doses of measles-mumps-rubella (MMR2) and three doses of hepatitis B (Hep B3) among U.S. adolescents enrolled in managed care organizations (MCOs); to determine whether specific characteristics of MCOs are associated with higher vaccination rates; and to assess the impact of state middle school immunization requirements on these rates. DESIGN: Longitudinal (1996-1999) and cross-sectional (1999) analyses of National Committee for Quality Assurance (NCQA) data to estimate adolescent vaccination coverage rates for MMR2 and Hep B3. In 2002, using 1999 data only, a cross-sectional analysis examined the relationship of specific plan characteristics and state immunization laws with immunization coverage. MAIN OUTCOME MEASURES: Percentage of 13 year olds in MCOs with documented receipt of MMR2 and Hep B3. RESULTS: From 1996 to 1999, MMR2 rates increased from 56% to 64%, and from 1997 to 1999, Hep B3 rates increased from 23% to 38%. By 1999, higher rates for both vaccines had been achieved in larger plans (p<0.001 and p<0.003 for MMR2 and Hep B3, respectively), those with the highest NCQA accreditation status (p<0.003), those in New England (p<0.001), and those in states with middle school immunization requirements (p<0.001). CONCLUSIONS: Despite encouraging increases, adolescent immunization rates are significantly below the Healthy People 2010 goal of 90%. State laws and accreditation incentives are effective. Research is needed to identify additional interventions to increase vaccination coverage in the adolescent population.

Accreditation↗

PubMed2004

A middle school immunization law rapidly and substantially increases immunization coverage among adolescents.

OBJECTIVES: This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents. METHODS: Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif. RESULTS: Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P <.001), and 8th- through 12th-grade students not subject to the requirement (27%, P <.0001). CONCLUSIONS: Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.

Adolescent↗

PubMed2003

Outbreak of hepatitis A among men who have sex with men: implications for hepatitis A vaccination strategies.

Between November 1998 and May 1999, 136 cases of hepatitis A were reported in Columbus, Ohio. Eighty-nine (65%) case patients were reinterviewed. Of 74 male case patients, 47 (66%) were men who have sex with men (MSM). These 47 MSM were compared with 88 MSM control subjects, to identify risk factors for infection and potential opportunities for vaccination. During the exposure period, 6 (13%) case patients reported contact with a person who had hepatitis A, compared with 2 (2%) control subjects (odds ratio, 6.15; 95% confidence interval, 1.04-48.02); neither number of sex partners nor any sex practice was associated with illness. Most case patients and control subjects (68% and 77%, respectively) saw a health care provider at least annually, and 93% of control subjects reported a willingness to receive hepatitis A vaccine. MSM are accessible and amenable to vaccination; increased efforts are needed to provide vaccination, regardless of reported sex practices.

Adolescent↗

PubMed2003

The effectiveness of assessment and referral on immunization coverage in the special supplemental nutrition program for women, infants, and children.

BACKGROUND: The use of immunization assessment and referral (A/R) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to produce dramatic improvements in vaccination coverage when coupled with parental incentive; however, data are lacking to support the use of A/R alone. OBJECTIVE: To determine the effectiveness of A/R in increasing immunization coverage among WIC participants. DESIGN: Participating WIC centers were assigned to1 of 3 interventions that delivered A/R of varying frequency or a control group. SETTING: Twenty of the largest Public Health Foundation Enterprises-WIC centers in Los Angeles County. PARTICIPANTS: Children continuously enrolled in participating WIC centers from 6 to 24 months of age. INTERVENTION: Assessment of child's vaccination status followed by referral to a health care provider for those lacking indicated vaccinations. MAIN OUTCOME MEASURE: Up-to-date (UTD) status at 24 months of age for all recommended vaccines. RESULTS: Baseline coverage rates were similar among all study sites (overall, 77% UTD). After the study period, compared with the controls (88% UTD), we found no differences in immunization coverage among WIC centers that administered A/R at every visit (every 2 months) to all children (90% UTD; adjusted odds ratio [OR], 1.02; 95% confidence interval [CI], 0.54-1.94), every 6 months to all children (89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or every visit to children found to be behind at 8 months of age (89% UTD; OR, 0.89; 95% CI, 0.48-1.68). CONCLUSION: In this urban population of WIC children with high baseline immunization coverage, A/R was not effective in increasing immunization coverage.

Child Health Services↗

PubMed2003

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations.

OBJECTIVES: We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS: The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS: In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS: In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.

Adolescent↗

PubMed2003

Parental knowledge, attitudes, and practices associated with not receiving hepatitis A vaccine in a demonstration project in Butte County, California.

OBJECTIVE: To determine hepatitis A vaccination coverage and factors associated with not receiving hepatitis A vaccine among children. METHODS: A random cluster sample survey was conducted of parents of children who attended kindergarten in Butte County, California, in 2000. Because of a history of recurrent epidemics, an aggressive hepatitis A vaccination program was ongoing during the time this study was conducted. Receipt of 1 or 2 doses of hepatitis A vaccine was studied. RESULTS: Of 896 surveys sent, 648 (72%) were completed. The vaccination coverage for at least 1 dose of hepatitis A vaccine was 398 (62%) and for 2 doses was 272 (42%). Factors associated with not receiving the vaccine included lack of provider recommendation (vs having recommendation; odds ratio [OR]: 7.8; 95% confidence interval [CI]: 4.9-12.2), not having heard of the vaccine (OR: 2.4; 95% CI: 1.2-4.9), and parent's not perceiving child is likely to get hepatitis A (vs perceiving child might get disease; OR: 2.1; CI: 1.6-2.9). CONCLUSIONS: Vaccination coverage among kindergartners did not reach high levels (ie, >90%), despite aggressive vaccination efforts in this community. Lack of provider recommendation and lack of parental awareness of hepatitis A vaccine were the 2 most significant factors associated with failure to receive vaccine. These findings will facilitate the development of vaccination strategies for communities in which hepatitis A vaccination is recommended.

Adult↗

PubMedDate not supplied

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the child's parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.

Adolescent↗

PubMedDate not supplied

Barriers to adolescent immunization: a survey of family physicians and pediatricians.

BACKGROUND: Although early childhood vaccination rates have increased, many adolescents are not up to date on recommended vaccinations. We assessed attitudes and practices of family physicians and pediatricians regarding adolescent vaccination to identify provider-level barriers that may contribute to low immunization rates. METHODS: A 94-item self-report questionnaire was mailed to 400 physicians contracted with a managed care organization. Physicians were queried about demographic characteristics, source of vaccine recommendations, adolescent immunization practices, barriers to immunizing adolescents, and use of reminder/recall systems. RESULTS: Response rate was 59%. Most respondents reported routinely recommending vaccines for tetanus and diphtheria toxoids (98%), Hepatitis B (90%), and measles, mumps, and rubella (84%), whereas 60% routinely recommended varicella vaccine. Physicians reported that they were more likely to assess immunization status, administer indicated immunizations, and schedule return immunization visits to younger adolescents (11 to 13 years old) than to older adolescents (14 to 18 and 19 to 21 years old). CONCLUSION: Most respondents reported recommending the appropriate vaccinations during preventive health visits; however, older adolescents were least likely to be targeted for immunization assessment and administration of all recommended vaccines.

Adolescent↗