Rachel M. Cunningham

Developing VISO: Vaccine Information Statement Ontology for patient education

ObjectiveTo construct a comprehensive vaccine information ontology that can support personal health information applications using patient-consumer lexicon, and lead to outcomes that can improve patient education.MethodsThe authors composed the Vaccine Information Statement Ontology (VISO) using the web ontology language (OWL). We started with 6 Vaccine Information Statement (VIS) documents collected from the Centers for Disease Control and Prevention (CDC) website. Important and relevant selections from the documents were recorded, and knowledge triples were derived. Based on the collection of knowledge triples, the meta-level formalization of the vaccine information domain was developed. Relevant instances and their relationships were created to represent vaccine domain knowledgeResultsThe initial iteration of the VISO was realized, based on the 6 Vaccine Information Statements and coded into OWL2 with Protégé. The ontology consisted of 132 concepts (classes and subclasses) with 33 types of relationships between the concepts. The total number of instances from classes totaled at 460, along with 429 knowledge triples in total. Semiotic-based metric scoring was applied to evaluate quality of the ontology.

Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset?

A contentious theory espoused by some parents is that regressive-onset of autism spectrum disorder (ASD) is triggered by vaccines. If this were true, then vaccine receipt should be higher in children with regressive-onset ASD compared with other patterns of onset. Parental report of rate of receipt for six vaccines (DPT/DTaP, HepB, Hib, polio, MMR, varicella) was examined in children with ASD (N=2755) who were categorized by pattern of ASD onset (early onset, plateau, delay-plus-regression, regression). All pairwise comparisons were significantly equivalent within a 10% margin for all vaccines except varicella, for which the delay-plus-regression group had lower rates of receipt (81%) than the early-onset (87%) and regression (87%) groups. Findings do not support a connection between regressive-onset ASD and vaccines in this cohort.

Prevalence of Vaccine Hesitancy Among Expectant Mothers in Houston, Texas

OBJECTIVE Nonmedical exemptions continue to rise because of increasing proportions of vaccine-hesitant parents. The proportion of expectant parents who are vaccine-hesitant is currently unknown. We assessed the prevalence of vaccine hesitancy among expectant parents receiving care at an obstetrics clinic in Houston, Texas. METHODS We conducted a cross-sectional survey of expectant parents between 12 and 31 weeks gestation who received care at Texas Childrens Pavilion for Women between July 2014 and September 2015. Using convenience sampling, participants completed a questionnaire that included questions on demographic items, self-assessed pregnancy risk, receipt of annual influenza vaccine, and the 15-item Parents Attitudes About Childhood Vaccines survey, a validated tool to identify vaccine-hesitant parents. We used multivariable logistic regression to determine the association of demographic characteristics, pregnancy risk, and influenza vaccine receipt with vaccine hesitancy after controlling for variables significant in univariable analyses. RESULTS Six hundred ten expectant mothers and 38 expectant fathers completed the Parents Attitudes About Childhood Vaccines survey. Overall, 50 of 610 expectant mothers (8.2%; 95% confidence interval [CI], 6.1%-10.7%) were vaccine-hesitant. Expectant mothers were primarily non-Hispanic white, 30 years old or older, and married. The odds of being vaccine-hesitant were 2.2 times greater (95% CI, 1.2-4.1) among expectant mothers with a college level of education or less compared with those with more than a 4-year degree. The odds of being vaccine-hesitant were 7.4 times greater (95% CI, 3.9-14.0) among expectant mothers who do not receive an annual influenza vaccine compared with those who do. CONCLUSIONS Our findings suggest the need to identify and address vaccine hesitancy among expectant parents before birth.

The Texas Children’s Hospital Immunization Forecaster: Conceptualization to Implementation

OBJECTIVES Immunization forecasting systems evaluate patient vaccination histories and recommend the dates and vaccines that should be administered. We described the conceptualization, development, implementation, and distribution of a novel immunization forecaster, the Texas Childrens Hospital (TCH) Forecaster. METHODS In 2007, TCH convened an internal expert team that included a pediatrician, immunization nurse, software engineer, and immunization subject matter experts to develop the TCH Forecaster. Our team developed the design of the model, wrote the software, populated the Excel tables, integrated the software, and tested the Forecaster. We created a table of rules that contained each vaccines recommendations, minimum ages and intervals, and contraindications, which served as the basis for the TCH Forecaster. RESULTS We created 15 vaccine tables that incorporated 79 unique dose states and 84 vaccine types to operationalize the entire United States recommended immunization schedule. The TCH Forecaster was implemented throughout the TCH system, the Indian Health Service, and the Virginia Department of Health. The TCH Forecast Tester is currently being used nationally. CONCLUSIONS Immunization forecasting systems might positively affect adherence to vaccine recommendations. Efforts to support health care provider utilization of immunization forecasting systems and to evaluate their impact on patient care are needed.

Using Pathfinder networks to discover alignment between expert and consumer conceptual knowledge from online vaccine content

This study demonstrates the use of distributed vector representations and Pathfinder Network Scaling (PFNETS) to represent online vaccine content created by health experts and by laypeople. By analyzing a target audiences conceptualization of a topic, domain experts can develop targeted interventions to improve the basic health knowledge of consumers. The underlying assumption is that the content created by different groups reflects the mental organization of their knowledge. Applying automated text analysis to this content may elucidate differences between the knowledge structures of laypeople (heath consumers) and professionals (health experts). This paper utilizes vaccine information generated by laypeople and health experts to investigate the utility of this approach. We used an established technique from cognitive psychology, Pathfinder Network Scaling to infer the structure of the associational networks between concepts learned from online content using methods of distributional semantics. In doing so, we extend the original application of PFNETS to infer knowledge structures from individual participants, to infer the prevailing knowledge structures within communities of content authors. The resulting graphs reveal opportunities for public health and vaccination education experts to improve communication and intervention efforts directed towards health consumers. Our efforts demonstrate the feasibility of using an automated procedure to examine the manifestation of conceptual models within large bodies of free text, revealing evidence of conflicting understanding of vaccine concepts among health consumers as compared with health experts. Additionally, this study provides insight into the differences between consumer and expert abstraction of domain knowledge, revealing vaccine-related knowledge gaps that suggest opportunities to improve provider-patient communication.

Towards a HPV Vaccine Knowledgebase for Patient Education Content.

Human papillomavirus is a widespread sexually transmitted infection that can be prevented with vaccination. However, HPV vaccination rates in the United States are disappointingly low. This paper will introduce a patient oriented web ontology intended to provide an interactive way to educate patients about HPV and the HPV vaccine that will to empower patients to make the right vaccination decision. The information gathered for this initial draft of the ontology was primarily taken from the Centers for Disease Control and Prevention’s Vaccine Information Statements. The ontology currently consists of 160 triples, 141 classes, 52 properties and 55 individuals. For future iterations, we aim to incorporate more information as well as obtain subject matter expert feedback to improve the overall quality of the ontology.

History of Vaccine Concerns

Vaccine concerns date back to the eighteenth century during a time of smallpox epidemics in colonial America. Despite increased survival rates among those who were inoculated by variolation, opposition to this procedure was strong. Modern day vaccine fears were fueled by the Cutter Incident when incompletely inactivated polio vaccine was inadvertently administered to children resulting in significant morbidity and mortality. This incident was followed in the 1980s by the release of “DPT: Vaccine Roulette,” a television documentary that engendered fears about the DTP vaccine and galvanized the formation of a well-known anti-vaccine group, National Vaccine Information Center. Parental vaccine safety concerns were fueled by this group and further strengthened with the publication of a controversial paper by Dr. Andrew Wakefield in which he suggested that the MMR vaccine was linked to autism. Despite the retraction of this paper and the discovery that many of its findings were fraudulent, others joined the anti-vaccine movement, including actress Jenny McCarthy and Dr. Bob Sears. These outspoken individuals have influenced many parents by suggesting that parents choose non-scientifically based alternative vaccination schedules that delay or omit vaccines.

Characteristics and Beliefs of Vaccine-Concerned Parents

Parents who delay or refuse vaccination tend to share common characteristics such as maternal age over 30, white race, higher income levels, and higher educational levels. These parents are also more likely to report distrust in their medical provider and more likely to seek care from a complementary and alternative medical (CAM) professional. Parents who delayed or refused vaccines are significantly less likely to believe vaccines are safe and effective. In addition, they are more likely to report misconceptions about vaccines such as beliefs about dangerous side effects, overload to the immune system, excessive number of doses, and causation of developmental disorders. In order to appropriately tailor vaccine education, it is important to understand the characteristics and beliefs of parents with strong vaccine concerns.

Management Strategy for Vaccine-Concerned Parents: The C.A.S.E Approach

It is essential that the medical and public health communities respond to vaccine concerns and make every effort to maintain and improve vaccination coverage rates. As increasing numbers of providers encounter parents with vaccine concerns, they are faced with the challenge of how to best communicate with such parents while caring for their children. One method that has been suggested for organizing conversations with vaccine-concerned parents is the C.A.S.E approach.

Current Trends in Vaccine Hesitancy and Refusal

Increasing numbers of parents demonstrate high levels of vaccine concerns. Concurrently, increasing numbers of states allow personal belief exemptions for school required vaccinations. Unvaccinated individuals and communities with high rates of nonmedical vaccine exemptions are at greater risk for vaccine-preventable diseases. Rates of nonmedical vaccine exemptions have continually increased during the last two decades resulting in outbreaks of vaccine-preventable diseases such as measles and pertussis.