Lori Uscher-Pines

Perceived seriousness of seasonal and A(H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S. adults: does the source of information matter?

OBJECTIVE We estimated uptake of seasonal and 2009 influenza A(H1N1) vaccine among U.S. adults and assessed their perceptions of the seriousness of both types of influenza and corresponding attitudes toward vaccination during the 2009-2010 influenza season. We further documented how vaccine uptake and attitudes varied by main information source used in vaccination decisions. METHODS We analyzed nationally representative data from U.S. adults age 18 and older (N=3,917) who completed an influenza vaccination survey between March 4th and March 24th, 2010. RESULTS 2009 influenza A(H1N1) vaccine uptake was considerably lower than seasonal vaccine uptake. While 2009 influenza A(H1N1) was perceived to be more serious than seasonal influenza, the pandemic vaccine was perceived to be less safe than the seasonal vaccine. Vaccine uptake and attitudes displayed large variation between adults who relied on different information sources for making their vaccination decisions. CONCLUSION The information launched during the response to the 2009 pandemic appear to have generated higher levels of concern about pandemic than seasonal influenza, but did not appear to reassure adults of the safety and value of the pandemic vaccine. Differences in perceived vaccination safety may be an important factor for explaining the lower uptake of pandemic relative to seasonal vaccine.

Health effects of relocation following disaster: a systematic review of the literature

This paper reviews the literature on the effects of post-disaster relocation on physical and mental heath, and develops a conceptual framework to guide future research. Forty articles were selected for full-text review and incorporation into the conceptual framework. Twenty-four articles were reviewed for results and methodology. These overwhelmingly tracked mental health outcomes. Only four (16 per cent) focused on physical health. Eight of ten showed an association between relocation and psychological morbidity. Certain outcomes (such as mortality, injury and cardiovascular disease risk factors) revealed inconsistent results, but these were rarely studied. Despite the frequency of post-disaster relocation and evidence of its effect on psychological morbidity, there is a relative paucity of studies; the few examples in the literature reveal weak study designs, inconsistent results, and inattention to physical health impacts and the challenges facing vulnerable populations. Further research guided by theory is needed to inform emergency preparedness and recovery policy.

Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza

To learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic, we examined nationally representative survey data of US adults. We found disparities in 2009-H1N1 vaccine uptake between Blacks and Whites (13.8% vs 20.4%); Whites and Hispanics had similar 2009-H1N1 vaccination rates. Physician offices were the dominant location for 2009-H1N1 and seasonal influenza vaccinations, especially among minorities. Our results highlight the need for a better understanding of how communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.

Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans

The authors provide a targeted review of national pandemic influenza plans from the developed and developing world, describing national variations in prioritization of vaccines and antiviral medications.

A survey of usage protocols of syndromic surveillance systems by state public health departments in the United States

OBJECTIVE To broadly describe current syndromic surveillance systems in use throughout the United States and to provide basic descriptive information on responses to syndromic system signals. METHODS Cross-sectional survey (telephone and e-mail) of state epidemiologists in all 50 states and the District of Columbia. RESULTS Forty-one states participated in the survey for a response rate of 80 percent. Thirty-three states (80%) had at least one syndromic surveillance system in addition to BioSense operating within the state. Every state with an urban area at highest risk of a terrorist attack reported monitoring syndromic surveillance data, and a states overall preparedness level was not related to the presence (or lack) of operational syndromic surveillance systems. The most common syndromic surveillance systems included BioSense (n = 20, 61%) and RODS (n = 13, 39%). Seventy-six percent of states with syndromic surveillance initiated investigations at the state level, 64 percent at the county level, and 45 percent at both the state and county levels. CONCLUSIONS The majority of states reported using syndromic surveillance systems, with greatest penetration in those at highest risk for a terrorist attack. Most states used multiple systems and had varied methods (central and local) of responding to alerts, indicating the need for detailed response protocols.

The growth of retail clinics in vaccination delivery in the U.S.

BACKGROUND Retail clinics are a promising venue in which to promote and administer vaccinations; however, little is known about who receives vaccinations at a retail clinic. PURPOSE The aim of this paper was to describe the use of retail clinics in the delivery of recommended vaccinations. METHODS The three largest retail clinic operators in the U.S.--MinuteClinic, TakeCare, and LittleClinic--provided de-identified clinic data for 2007-2009. Descriptive statistics were generated in 2011 on visit type, type of vaccination, patient age, and payment method. RESULTS From 2007 to 2009, there were 8.9 million retail clinic visits across the three largest clinic operators. In 2009, vaccinations were administered at 1,952,610 visits, up from 469,330 visits in 2007. Visits in which vaccinations were administered accounted for 39.9%, 36.4%, and 42.0% of total visits in 2007, 2008, and 2009, respectively. In 2009, 1.8 million influenza vaccinations (including seasonal and H1N1 vaccinations) were administered by the two largest retail clinic operators (94% of all vaccination visits). Pneumococcal vaccination was administered at 59,849 visits (3% of all vaccination visits). In 2009, vaccinations were also administered in 0.8% of acute care visits (n=18,807); 0.8% of chronic care visits (n=261); and 1.3% of general medical exams (n=2497). CONCLUSIONS Results suggest that retail clinics play a growing role in vaccination delivery, and vaccinations constitute a substantial share of the business conducted by retail clinics. As such, retail clinics have the potential to play an important role in vaccination delivery in the U.S. Retail clinics potentially could deliver more vaccinations if they reviewed vaccination histories and counseled patients regarding the benefits of vaccination during acute care visits.

Barriers and Facilitators to Pediatric Emergency Telemedicine in the United States

BACKGROUND Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use. MATERIALS AND METHODS We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States. RESULTS We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites. CONCLUSIONS Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.

Healthy young and middle age adults: what will it take to vaccinate them for influenza?

Starting in 2010, healthy adults age 19-49 will be recommended for annual influenza vaccination. Because they were not previously targeted, little is known about their vaccine-related attitudes and behaviors. Using nationally representative survey data from 2009 to 2010, we found that adults newly recommended for influenza vaccination (as compared to previously recommended groups) are less likely to believe flu vaccines are safe (44% vs. 63%), to have ever been vaccinated (36% vs. 64%), to be vaccinated following a healthcare provider recommendation (44% vs. 52%), and to visit a doctors office during vaccination season (41% vs. 69%). To boost rates of influenza vaccination in this population, new and untraditional strategies aimed at encouraging first-time vaccination are needed.

Racial Differences in Bacterial Vaginosis among Pregnant Women: The Relationship between Demographic and Behavioral Predictors and Individual BV-Related Microorganism Levels

Objective To determine predictors of bacterial vaginosis (BV) and the level of three common BV-related microorganisms by racial group. Methods Prospective cohort study of 1,886 pregnant women. BV was measured with Nugent’s Gram Stain criteria, smoking status with urinalysis of cotinine levels, and stress with Cohen’s perceived stress scale. Results 73% of the cohort were African-American and 37% were BV positive. Smoking, numerous sexual partners, and single status were related to both BV positivity as well as higher levels of Gardnerella ssp. among African-American pregnant women. Age and history of STD were associated with BV positivity, and history of STD and insurance status were associated with Gardnerella ssp. levels in non-African-American pregnant women. Contrary to prior research, perceived stress and douching were not associated with BV positivity or the level of any of the BV-related microorganisms in this cohort. Conclusions A greater number of modifiable, behavioral-related risk factors predicted BV and the level of BV-related microorganisms among African-American compared to non-African-American pregnant women. A deeper understanding of predictors of BV and related microorganism levels by racial group may help eliminate critical disparities with respect to BV positivity and adverse pregnancy outcomes, including spontaneous preterm birth.

Framework for the development of response protocols for public health syndromic surveillance systems: case studies of 8 US states.

OBJECTIVES To describe current syndromic surveillance system response protocols in health departments from 8 diverse states in the United States and to develop a framework for health departments to use as a guide in initial design and/or enhancement of response protocols. METHODS Case study design that incorporated in-depth interviews with health department staff, textual analysis of response plans, and a Delphi survey of syndromic surveillance response experts. RESULTS All 8 states and 30 of the 33 eligible health departments agreed to participate (91% response rate). Fewer than half (48%) of surveyed health departments had a written response protocol, and health departments reported conducting in-depth investigations on fewer than 15% of syndromic surveillance alerts. A convened panel of experts identified 32 essential elements for inclusion in public health protocols for response to syndromic surveillance system alerts. CONCLUSIONS Because of the lack of guidance, limited resources for development of response protocols, and few examples of syndromic surveillance detecting previously unknown events of public health significance, health departments have not prioritized the development and refinement of response protocols. Systems alone, however, are not effective without an organized public health response. The framework proposed here can guide health departments in creating protocols that will be standardized, tested, and relevant given their goals with such systems.