Biomedical subjects

Tammy A Santibanez

Publications and source records attributed to Tammy A Santibanez.

15 recordsLinked to original sources

PubMed2006

Differential effects of the DTaP and MMR vaccine shortages on timeliness of childhood vaccination coverage.

OBJECTIVES: We determined the effect of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) and measles, mumps, rubella (MMR) vaccine shortages on timeliness of the third dose of DTaP (DTaP3), the fourth dose of DTaP (DTaP4), and the first dose of MMR (MMR1) among subgroups of preschool children. METHODS: Data from the 2001 and 2002 National Immunization Surveys were analyzed. Children age-eligible to receive DTaP3, DTaP4, or MMR1 during the shortages were considered subject to the shortage, and those not age-eligible were not subject to the shortage; timeliness of vaccinations was compared. RESULTS: Among children vaccinated only at public clinics, children residing outside metropolitan statistical areas, and children in the Southern Census Region, those age-eligible to receive DTaP4 during the shortage were less likely to be vaccinated by 19 months of age than children not subject to the shortage. CONCLUSIONS: There was notable disparity in the effects of the recent vaccine shortages; children vaccinated only in public clinics, in rural areas, or in the Southern United States were differentially affected by the shortages.

Child, Preschool↗

PubMed2006

Influenza vaccination coverage of children aged 6 to 23 months: the 2002-2003 and 2003-2004 influenza seasons.

BACKGROUND: Beginning in 2002 the Advisory Committee on Immunization Practices encouraged, when feasible, annual influenza vaccination of all children aged 6 to 23 months and household contacts and out-of-home caregivers of children < 2 years of age. OBJECTIVE: We sought to report influenza vaccination coverage for the 2002-2003 and 2003-2004 influenza seasons among children aged 6 to 23 months according to demographic and immunization-provider characteristics. METHODS: Data from the 2003 and 2004 National Immunization Survey were analyzed. Two measures of childhood influenza vaccination are reported: receipt of > or = 1 influenza vaccination and full vaccination (ie, receipt of the appropriate number of doses on the basis of previous vaccination history). chi2 tests and logistic-regression analyses to test for associations between influenza vaccination status and demographic characteristics were performed. RESULTS: In the 2002-2003 and 2003-2004 influenza seasons only 7.4% and 17.5%, respectively, of children aged 6 to 23 months received > or = 1 influenza vaccination, whereas only 4.4% and 8.4%, respectively, were fully vaccinated. In both seasons, adjusted influenza vaccination coverage was significantly lower among children living below the poverty level; non-Hispanic black children; older children; children with less-educated mothers; children vaccinated only at public clinics; and children not residing in a metropolitan statistical area. CONCLUSION: During the first 2 years of the Advisory Committee on Immunization Practices' encouragement for children aged 6 to 23 months to receive influenza vaccination, coverage was low, with significant demographic differences in receipt of vaccination. Beginning with the 2004-2005 influenza season, they replaced the encouragement with a recommendation that children aged 6 to 23 months receive annual influenza vaccination. Substantial work remains to fully and equitably implement this new recommendation and ensure vaccination with 2 doses for previously unvaccinated children.

Age Factors↗

PubMed2005

Measurement of vaccination coverage at age 24 and 19-35 months: a case study of multiple imputation in public health.

AIM: Childhood immunization coverage in the United States (US) is often measured at age 24 months or, in the National Immunization Survey (NIS) at age of interview, which is between 19 and 35 months. This paper compares these standards. METHODS: Data from the NIS is used to compare immunization coverage at time of interview, retrospectively among all children aged 24 or more months at time of interview, and obtained via multiple imputation (with 10 imputations) for all children, both nationally, by state, and by demographic groups. RESULTS: At the national level, the difference between the 19-35 month estimate and the 24 month complete-case estimate was 1.9 percentage points. For most but not all states and subgroups, the 19-35 month estimate was higher than the 24 month complete-case estimate. The difference between vaccination coverage measured at 19-35 months and 24 months ranged from -2.3 to 7.5 percentage points among states. For three states, the difference between the 19-35 month and 24 month complete-case estimate was more than 6 percentage points, in twelve states there was a 4-6 percentage point difference, and in sixteen states a 2-4 percentage point difference. Conversely, five states had higher 24 month complete-case estimates than 19-35 month estimates. CONCLUSION: We found that the coverages at 19-35 and 24 months differ such that they would rarely be adequate surrogates for one another, particularly at a state level. Multiple imputation, which is easily implemented, increases precision of estimates of coverage at age 24 months.

Journal Article↗

PubMed2005

Parental vaccine safety concerns: results from the National Immunization Survey, 2001-2002.

BACKGROUND: According to the 2002 National Immunization Survey (NIS), vaccination coverage with recommended vaccines among U.S. children aged 19 to 35 months remained near all-time highs. Sustaining this high coverage requires significant effort, including consideration of parental vaccine safety concerns that have led to decreasing coverage in other countries. METHODS: The Parental Knowledge and Experiences module was administered to a random subset of NIS respondents from July 2001 to December 2002. The module included questions regarding attitudes toward vaccine safety and side effects, simultaneous vaccine administration, and acceptance of new vaccines. Multivariate logistic regression analyses examined associations between attitudes and up-to-date (UTD) vaccination coverage (four or more doses of diphtheria and tetanus toxoids and pertussis vaccine, three or more doses of poliovirus vaccine, one or more doses of any measles-containing vaccine, three or more doses of Haemophilus influenzae type b vaccine, and three or more doses of hepatitis B vaccine), while controlling for demographics. RESULTS: Ninety-three percent of parents rated vaccines as safe, 6% as neither safe nor unsafe, and 1% as unsafe. After adjusting for demographics, parental safety belief was significantly associated with the child's vaccination status. For children whose parents believed vaccines are safe, the odds of being UTD were 2.9 times the odds of being UTD for children of parents who believed vaccines are unsafe (75% vs 53%, respectively). Children whose parents were neutral about the safety of vaccines had vaccination coverage similar to children whose parents believed vaccines are unsafe. CONCLUSIONS: A significant association with vaccine coverage was found for a small group of parents with high vaccine safety concerns. Strategies focused on safety concerns may yield better protection for these children.

Adult↗

PubMed2005

Influenza and pneumococcal vaccination of adults aged > or = 65: racial/ethnic differences.

BACKGROUND: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged > or = 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. METHODS: A national sample of 1839 community-dwelling adults aged > or = 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. RESULTS: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was > or = 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. CONCLUSIONS: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.

Aged↗

PubMed2004

Vaccine policy changes and epidemiology of poliomyelitis in the United States.

CONTEXT: The last case of poliomyelitis in the United States due to indigenously acquired wild poliovirus occurred in 1979; however, as a consequence of oral poliovirus vaccine (OPV) use that began in 1961, an average of 9 cases of vaccine-associated paralytic poliomyelitis (VAPP) were confirmed each year from 1961 through 1989. To reduce the VAPP burden, national vaccination policy changed in 1997 from reliance on OPV to options for a sequential schedule of inactivated poliovirus vaccine (IPV) followed by OPV. In 2000, an exclusive IPV schedule was adopted. OBJECTIVE: To review the epidemiology of paralytic poliomyelitis and document the association between the vaccine schedule changes and VAPP in the United States. DESIGN AND SETTING: Review of national surveillance data from 1990 through 2003 for cases of confirmed paralytic poliomyelitis. MAIN OUTCOME MEASURES: Number of confirmed paralytic poliomyelitis cases, including VAPP, and ratio of VAPP cases to number of doses of OPV distributed that occurred before, during, and after implementation of policy changes. RESULTS: From 1990 through 1999, 61 cases of paralytic poliomyelitis were reported; 59 (97%) of these were VAPP (1 case per 2.9 million OPV doses distributed), 1 case was imported, and 1 case was indeterminate. Thirteen cases occurred during the 1997-1999 transitional policy period and were associated with the all-OPV schedule; none occurred with the IPV-OPV schedule. No cases occurred after the United States implemented the all-IPV policy in 2000. The last imported poliomyelitis case occurred in 1993 and the last case of VAPP occurred in 1999. CONCLUSION: The change in polio vaccination policy from OPV to exclusive use of IPV was successfully implemented; this change led to the elimination of VAPP in the United States.

Health Policy↗

PubMed2004

Physician and practice factors related to influenza vaccination among the elderly.

BACKGROUND: Influenza vaccination rates among adults, especially in minority populations, remain below national goals of 90%. This study investigated in diverse settings, facilitators of and barriers to patient influenza vaccination from the physician's perspective. METHODS: Two-stage, stratified, random-cluster sampling was employed to select 71 clinicians from inner-city, rural, suburban, and Veterans Affairs (VA) practices, and a random sample of 925 of their patients aged >/=65 years. Questionnaires and interviews based on the PRECEDE-PROCEED framework assessed clinician factors. Associations among clinician beliefs, practice characteristics, patient beliefs, and self-reported influenza vaccination status were determined. RESULTS: The clinician response rate was 85% (60/71). Several factors of the PRECEDE-PROCEED framework were associated with higher influenza vaccination rates. For instance, patients at practices with express vaccination clinics had higher vaccination rates than at clinics without such immunization programs (87% v 76%, p =0.01). Using multivariate models, influenza vaccination status was related to several patient factors, including plans to receive influenza vaccination next year (p <0.001); belief that those who are not vaccinated will contract influenza (p =0.049); and history of being screened for colon cancer (p =0.023). Influenza vaccination status was also related to several physician factors, including awareness of recommendation to vaccinate asthmatics (p =0.024); agreement with these recommendations (p =0.004); and practice type and setting ("strata"), of which the VA was highest. CONCLUSION: Through proactive office systems and education, physicians may influence patients' intentions to be vaccinated and thereby increase influenza vaccination rates.

Aged↗

PubMed2003

Barriers and facilitators of pneumococcal vaccination among the elderly.

Despite the burden of disease caused by pneumococcus, adult immunization rates are modest. To understand barriers in diverse settings, we surveyed patients age > or =66 years at: (1) inner-city health centers; (2) Veterans Affairs (VA) outpatient clinics; (3) rural practices; and (4) suburban practices. Among the 1007 respondents, self-reported pneumococcal vaccination rates were: 85% VA; 62% rural; 66% suburban; and 57% inner-city with substantial variability among practices. Half of the unvaccinated (50%) did not know they needed vaccination. Most vaccinees (90%) thought that their doctor believed they should be vaccinated, compared with 23% of the unvaccinated (P<0.0001). More of the vaccinees (75%) believed that the vaccine "keeps a person from getting pneumonia" than the unvaccinated (54%; P=0.0001). In regression analysis, predictors of vaccination included: belief that doctor recommends vaccine, feeling that vaccination is wise, recommendation by someone in the physician's office, and receipt of influenza vaccine.

Aged↗

PubMed2003

What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and Veterans Affairs practices.

BACKGROUND: Despite strong evidence of the effectiveness of influenza vaccination, immunization rates have reached a plateau that is below the 2010 national goals. Our objective was to identify facilitators of, and barriers to, vaccination in diverse groups of older patients. METHODS: A survey was conducted in 2000 by computer-assisted telephone interviewing of patients from inner-city health centers, Veterans Affairs (VA) outpatient clinics, rural practices, and suburban practices. The inclusion criteria were age > or =66 years and an office visit after September 30, 1998. RESULTS: Overall, 1007 (73%) interviews were completed among 1383 patients. Influenza vaccination rates were 91% at VA clinics, 79% at rural practices, 79% at suburban practices, and 67% at inner-city health centers. There was substantial variability in vaccination rates among practices, except at the VA. Nearly all persons who were vaccinated reported that their physicians recommended influenza vaccinations, compared with 63% of unvaccinated patients (P <0.001). Thirty-eight percent of unvaccinated patients were concerned that they would get influenza from the vaccine, compared with only 6% of vaccinated persons (P <0.001). Sixty-three percent of those vaccinated, in contrast with 22% of unvaccinated persons, thought that an unvaccinated person would probably contract influenza (P <0.001). CONCLUSION: Older patients need intentional messages from physicians that recommend vaccination. Furthermore, more patient education is needed to counter myths about adverse reactions.

Aged↗

PubMed2003

Effects of the year 2000 influenza vaccine delay on elderly patients' attitudes and behaviors.

BACKGROUND: A substantial delay in distribution of influenza vaccine occurred in the 2000-2001 influenza season. Our objective was to quantify the impact of this delay on immunization rates, location of receipt of immunization, and patient attitudes and beliefs about the influenza vaccine. METHODS: Inner-city and suburban medical practices that received influenza vaccine supply on-time or late in the season (late-receipt) were selected. A random sample of elderly patients from each practice completed telephone interviews. RESULTS: Of 775 eligible patients, we interviewed 72%. The odds of receiving influenza vaccine in late-receipt practices compared to on-time practices did not significantly differ in either the suburban stratum (adjusted OR = 0.9, 95% CI 0.5-1.6) or the inner-city stratum (adjusted OR = 1.5, 95% CI 0.8-2.8). Very few respondents (4%-11%) reported changes in their beliefs about the vaccine, its safety or efficacy, from previous years. More patients in late-receipt practices reported receiving influenza vaccine at locations other than their regular doctor's offices in the shortage year compared with the previous year. CONCLUSIONS: The 2000-2001 influenza vaccine delay changed vaccination location, but did not change influenza vaccination rates.

Aged↗

PubMed2003

Shortage of influenza vaccine in 2000-2001: did it change patient beliefs?

OBJECTIVE: To determine which patient beliefs associated with influenza vaccination changed during a vaccine shortage year (2000-2001) from a nonshortage year (1999-2000). METHODS: Elderly patients (n=319), who had been previously interviewed about the 1999-2000 influenza season, were interviewed regarding the 2000-2001 season. Participants were from inner-city and suburban medical practices receiving influenza vaccine supply on time or late in the season. RESULTS: Although vaccination rates did not diminish due to the influenza vaccine shortage (73% in 1999-2000 vs 74% in 2000-2001), some patient attitudes changed. More respondents expressed concerns about the influenza vaccine (3% in 1999-2000 vs 12% in 2000-2001, p<0.0001), and fewer responded that friends thought that they should get the vaccine (75% 1999-2000 vs 66% 2000-2001, p=0.005); that if one person in the household "got the flu" others would also (71% 1999-2000 vs 67% 2000-2001, p<0.0001), and that "a person who does not get the flu shot will get influenza" (36% 1999-2000 vs 30% 2000-2001, p=0.02). CONCLUSIONS: The influenza vaccine shortage resulted in a small increase in concerns about influenza vaccine, even in a population with good access to vaccine and high vaccination rates. Vaccine availability updates should include reassurances of vaccine safety and efficacy.

Aged↗

PubMed2002

Immunizations in adulthood.

Vaccine preventable diseases continue to be a sizable burden to adults in the United States. Despite availability of safe and effective vaccines, immunization rates remain low. While various patient, clinician, and system factors can be barriers to adult vaccination, physicians recommendations to their patients to receive the vaccinations for which they are indicated is strongly related to a patient's receipt of these immunizations.

Adult↗

PubMed2002

Knowledge and beliefs about influenza, pneumococcal disease, and immunizations among older people.

OBJECTIVES: Despite the burden of disease caused by influenza and pneumococcus, immunization rates are moderate and have not reached national goals set for 2010. This study's objective was to identify patient knowledge, attitudes, and beliefs that serve as facilitators of and barriers to influenza and pneumococcal vaccination. DESIGN: A survey conducted in 2000 by computer-assisted telephone interviewing. SETTING: To encounter a broad spectrum of patients and healthcare systems, we sampled patients at inner-city health centers, Department of Veterans Affairs outpatient clinics, and rural and suburban practices. PARTICIPANTS: Inclusion criteria were patients aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Responses to questionnaire. RESULTS: Overall, 1,007 (82%) interviews were completed among 1,234 people contacted by phone. Vaccination against pneumococcal disease was significantly related to being able to accurately describe one or more classic symptoms of pneumonia (P =.05). Vaccination against influenza and pneumococcal disease was significantly related to belief that vaccination was the best way to prevent these diseases (P <.001). The unvaccinated reported that they felt they were not likely to contract influenza and that they did not know they needed the pneumococcal vaccine. Access was not related to vaccination status. CONCLUSIONS: Educational campaigns to increase vaccination rates among older adults should focus on symptoms of, risk for, and severity of influenza and pneumococcal diseases and encouraging physicians to recommend the vaccines to their patients.

Aged↗

PubMed2002

Effectiveness of chart prompt about immunizations in an urban health center.

OBJECTIVE: To determine whether a nurse-initiated chart review and prompt to physicians is an effective method to increase immunization rates. STUDY DESIGN: This study was a controlled trial with systematic assignment of children to intervention or control groups based on chart number. Each day, a nurse reviewed the charts of children to be seen that day who were in the intervention group. The nurse prepared a 1-page form about the child's immunization status that requested permission from the physician to administer needed vaccines and attached the form to the chart. The duration of the study period was 1 year. POPULATION: Nine hundred ninety-seven pediatric patients attending 2 inner-city primary care health centers. OUTCOME MEASURED: On-time immunization rates in both groups. RESULTS: Among children eligible to receive vaccines during the study period, a higher percentage in the intervention group received on-time vaccines for diphtheria/tetanus/pertussis-4 (DTP4; 51% vs 36%; P=.03), oral polio vaccine-3 (OPV3; 70% vs 56%, P=.04), and measles/mumps/rubella-1 (42% vs 26%; P=.01) than did children in the control group. No statistically significant differences were noted for DTP3, DTP5, hepatitis B3, or OPV4. No statistically significant difference was noted for the combined series (ie, all age-appropriate immunizations as recommended by the 1995 Childhood Immunization Schedule of the Centers for Disease Control and Prevention). CONCLUSIONS: The chart prompt increased on-time immunizations for some antigens.

Child, Preschool↗

PubMedDate not supplied

Physician attitudes and beliefs associated with patient pneumococcal polysaccharide vaccination status.

BACKGROUND: Barriers to adult immunizations persist as current rates for pneumococcal polysaccharide vaccine (PPV) receipt among eligible adults remain below national goals. This study investigated potential barriers to patients receiving the PPV, including predisposing, enabling, environmental and reinforcing factors among physicians from a variety of practice and geographic settings. METHODS: Participants were 60 primary care physicians from inner-city, rural, suburban, and Veterans Affairs practices, which included adults aged 65 years and older. Elderly patients able to complete a telephone interview were randomly selected from each physician's practice. RESULTS: Self-reported PPV vaccination status was significantly related to physician report of routinely providing PPV to their patients and to the practice providing immunization clinics or other immunization promotion programs. Physicians who were highly unlikely to refer uninsured adults to health departments for immunizations had a significantly higher percentage of patients reporting receipt of PPV (P = .03). CONCLUSIONS: Enabling and environmental factors related to physicians, such as economic and insurance issues, were significant barriers to PPV vaccination. Vaccination rates might be improved through efforts that reduce likelihood of referral for immunizations and office systems that support immunization, such as patient and provider reminders and express vaccination clinics.

Adult↗