Tara Haelle

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Inconsistent recommendation of the HPV vaccine and discomfort discussing the HPV vaccine are common among primary care providers, likely contributing to its poor uptake, according to a recent study.

“Half of the primary care physicians in our national sample reported at least two communication practices that likely compromise their ability to meet guidelines for the routine delivery of the HPV vaccine,” reported Melissa B. Gilkey, Ph.D., of Harvard Medical School in Boston, and her associates.

©dina2001/thinkstockphotos.com

“Many pediatricians and family physicians in our national sample reported recommending the HPV vaccine inconsistently, behind schedule, or without urgency,” they wrote (Cancer Epidemiol Biomarkers Prev. 2015 Oct 22. doi: 10.1158/1055-9965.EPI-15-0326).

Of 2,368 pediatricians and family physicians sent an online survey for the study, 1,022 responded and 776 met the criteria and completed the survey about provider beliefs, attitudes and behaviors surrounding HPV vaccine administration. Two-thirds (68%) of respondents were male, and more than half (55%) had at least 2 decades of practice; the group was nearly evenly split between pediatricians (53%) and family doctors (47%). Most of them (83%) saw 10 or more adolescent patients per week.

Just over a quarter (26%) did not recommend the vaccine on time – between ages 11 and 12 years – for female patients, and 39% did not recommend it on time for male patients. Well over half (59%) used a risk-based approach in recommending the HPV rather than a consistent routine recommendation. Similarly, half (49%) did not recommend the vaccine the same day. About a third (34%) anticipated uncomfortable conversations about the vaccine or about HPV as a sexually transmitted infection (32%), and 47% felt parents saw the vaccine as unimportant or only slightly important for their preteens.

A large majority of doctors (84%) felt the tone of the conversation to be at least as important as the content of what they say. They perceived greater parent receptivity to the vaccine with an informative (76%) or nonjudgmental tone (44%). Fewer doctors reported high receptivity with a concerned (23%), warm (22%), or upbeat (13%) tone.

A third of the doctors (34%) start the conversation with information, 30% start saying the child is due for the vaccine, and 29% start by suggesting the vaccine. While 99% of the doctors told patients and parents that the HPV vaccine prevents cervical cancer, 84% mentioned prevention of genital warts, and 55% mentioned preventing other cancers.

“Interventions are urgently needed to help physicians improve their HPV vaccine recommendations, and the quality indicators of timeliness, consistency, urgency and strength of endorsement offer one framework for guiding these efforts,” Dr. Gilkey and her associates wrote. “By improving how physicians recommend HPV vaccine, we can raise national coverage, thereby ensuring that today’s youth enjoy the full benefit of a potent tool for cancer prevention.”

The research was funded by Pfizer, the University of North Carolina Lineberger Comprehensive Cancer Center, and the National Cancer Institute. Dr. Brewer reports research grants from Merck, Pfizer, and GlaxoSmithKline, speaker honoraria from Merck, and consultancy for Merck.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Receiving the tetanus, diphtheria, acellular pertussis vaccine during pregnancy does not increase the risk of adverse events for mother or baby, even if the mother has previously received the vaccine within the past 2 years, according to a report published Oct. 20 in JAMA.

Women should receive a Tdap vaccination during each pregnancy – preferably in the third trimester – so that the fetus receives some maternal antibodies against pertussis for limited protection until the first DTaP vaccine at age 2 months, according to 2012 recommendation from the Advisory Committee on Immunization Practices (ACIP). Yet previous research has not clarified the safety of repeated doses of maternal Tdap immunization.

©AvailableLight/istockphoto.com

“These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy,” wrote Dr. Lakshmi Sukumaran of the Centers for Disease Control and Prevention Immunization Safety Office, and colleagues. “Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination.”

In the retrospective cohort study involving pregnancies between Jan. 1, 2007, through Nov. 15, 2013, the researchers examined data from 29,155 pregnant women, aged 14-49, who enrolled in seven Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin.

The researchers compared the 49% of women who had received a tetanus-containing vaccine more than 5 years before their current pregnancy (controls) with the 17% of women who had received a tetanus-containing vaccine less than 2 years before, and the 34% of women who had been vaccinated 2-5 years earlier. More than two-thirds of the women (67.4%) received the Tdap during the third trimester, compared with 27.5% in the second trimester, and 5.1% in the first trimester (JAMA. 2015;314[15]:1581-7. doi: 10.1001/jama.2015.12790).

The researchers evaluated several adverse events including fever, allergy, and local reactions in mothers in the week following immunization, as well as preterm birth, low birth weight and small for gestational age in newborns. Local reactions included limb pain, limb swelling, cellulitis, lymphadenitis, and Arthus reaction. The researchers also looked for Guillain-Barré syndrome through day 42 after vaccination.

Few acute adverse events occurred after vaccination, and no statistically significant differences occurred across the three groups in terms of fever, allergic reactions, and local reactions.

Women who had received a tetanus-containing vaccine less than 2 years earlier had fevers at a rate of 2.1 per 10,000 women, compared with 3.5 per 10,000 women among controls (adjusted relative rate: 0.66; P = .70). Similarly, allergic reactions occurred at a rate of 2.1 per 10,000 women for those who had a vaccine less than 2 years prior, compared to 1 per 10,000 women who had the vaccine 2-5 years earlier, and 1.4 per 10,000 women among controls.

Local reactions occurred at a rate of 4.2, 7.0 and 11.2 per 10,000 women for those who had the vaccine less than 2 years prior, between 2-5 years prior, and more than 5 years prior, respectively. Preterm delivery rates, low birth weight, and small for gestation age were all similar across the three groups.

The Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases funded the study. Dr. Sukumaran reported receiving research support from the National Institutes of Health. The other researchers reported receiving research support from GlaxoSmithKline, Sanofi Pasteur, Merck, Pfizer, Nuron Biotech, MedImmune, Novartis, and Protein Science.

Pediatricians play an important role in preparing for natural and man-made disasters as well as treating families during and after such unpredictable and unpreventable events, the American Academy of Pediatrics reported in a policy statement.

Despite the unpredictability of disasters, “pediatricians and others involved in the care and well-being of children can prepare for and mitigate their effects, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special health care needs, are not neglected in planning, response, and recovery efforts,” wrote the Disaster Preparedness Advisory Council of the AAP Committee on Pediatric Emergency Medicine (Pediatrics. 2015 Oct 19 doi: 10.1542/peds.2015-3112).

zdravinjo/Thinkstock.com

The policy statement contains a list of resources available online to help families prepare for disasters, develop emergency plans, and deal with the fallout and effects of disasters. Another table lists educational and training resources available for pediatricians.

First among the dozen policy recommendations is the need for all levels of government – national, state, tribal, local, and regional – to address the “unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs of all children.” This recommendation requires the participation of pediatricians in disaster planning, response, and recovery in multiple roles, including as representatives of practices or institutions.

The unique needs of children need to be considered. “Children’s rapid minute ventilation, large surface area relative to body mass, more permeable skin, and proximity to the ground increase their risk of adverse outcomes from exposure to environmental hazards. … Children are in a critical period of development when toxic exposures can have profound negative effects.

“Children may lack the developmental ability to flee hazards, or they may even approach them out of curiosity or inadequate comprehension of risk. Limited ability to understand the nature of the disaster can also lead to stress, fear, anxiety, inability to cope, and exaggerated response to media exposure. All of these responses can manifest as developmental regression, withdrawal, clinginess, tantrums, enuresis, or somatic complaints, among other symptoms,” the committee explained.

Sufficient equipment, medications, and supplies for children should be on hand so that children’s needs can be met to the same degree as adults’ needs during a disaster. Because this has not always been true in the past, the committee called for more research into knowledge gaps and best practices regarding the treatment of children in disasters.

In addition to training children in disaster drills how to respond as victims and responders during a disaster, communities must consider children’s needs, physiology, and development during mass casualty triage, the committee recommended. Providers also can play a role in teaching children and families how to prepare for disasters and strategies for resiliency in their presence and their aftermath.

The committee encourages pediatricians to seek ongoing postgraduate education on disaster issues and to sign up with various public health disaster response systems, including Health Alert Network communications, the Centers for Disease Control and Prevention Clinician Outreach and Communication Activity announcements, the Emergency System for Advance Registration of Volunteer Health Professionals registries, the Medical Reserve Corps teams, state medical assistance teams, and disaster medical assistance teams.

“Finally, pediatricians should remember that they are not immune to the stress of disaster,” the committee wrote. “Pediatricians may have experienced their own losses, yet they will still be tasked with delivering care in difficult environments, all the while hearing of others’ tragic stories. Caregiver fatigue threatens the pediatrician’s well-being; the ability to provide consistent, high-quality care to others; and the desire to continue serving the community.” Resources for providers’ mental and physical health and resiliency include the AAP, local AAP chapters, medical societies, and state and federal governments, as well as other pediatricians monitoring the well-being of their colleagues.

During potentially lengthy recovery processes, pediatricians “can provide a crucial source of stability by quickly restoring access to routine and familiar medical care” as well as serving as advisers and advocates for the needs of children in the community, the committee advised.

No external funding or disclosures were reported.

Pediatricians play an important role in preparing for natural and man-made disasters as well as treating families during and after such unpredictable and unpreventable events, the American Academy of Pediatrics reported in a policy statement.

Despite the unpredictability of disasters, “pediatricians and others involved in the care and well-being of children can prepare for and mitigate their effects, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special health care needs, are not neglected in planning, response, and recovery efforts,” wrote the Disaster Preparedness Advisory Council of the AAP Committee on Pediatric Emergency Medicine (Pediatrics. 2015 Oct 19 doi: 10.1542/peds.2015-3112).

zdravinjo/Thinkstock.com

The policy statement contains a list of resources available online to help families prepare for disasters, develop emergency plans, and deal with the fallout and effects of disasters. Another table lists educational and training resources available for pediatricians.

First among the dozen policy recommendations is the need for all levels of government – national, state, tribal, local, and regional – to address the “unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs of all children.” This recommendation requires the participation of pediatricians in disaster planning, response, and recovery in multiple roles, including as representatives of practices or institutions.

The unique needs of children need to be considered. “Children’s rapid minute ventilation, large surface area relative to body mass, more permeable skin, and proximity to the ground increase their risk of adverse outcomes from exposure to environmental hazards. … Children are in a critical period of development when toxic exposures can have profound negative effects.

“Children may lack the developmental ability to flee hazards, or they may even approach them out of curiosity or inadequate comprehension of risk. Limited ability to understand the nature of the disaster can also lead to stress, fear, anxiety, inability to cope, and exaggerated response to media exposure. All of these responses can manifest as developmental regression, withdrawal, clinginess, tantrums, enuresis, or somatic complaints, among other symptoms,” the committee explained.

Sufficient equipment, medications, and supplies for children should be on hand so that children’s needs can be met to the same degree as adults’ needs during a disaster. Because this has not always been true in the past, the committee called for more research into knowledge gaps and best practices regarding the treatment of children in disasters.

In addition to training children in disaster drills how to respond as victims and responders during a disaster, communities must consider children’s needs, physiology, and development during mass casualty triage, the committee recommended. Providers also can play a role in teaching children and families how to prepare for disasters and strategies for resiliency in their presence and their aftermath.

The committee encourages pediatricians to seek ongoing postgraduate education on disaster issues and to sign up with various public health disaster response systems, including Health Alert Network communications, the Centers for Disease Control and Prevention Clinician Outreach and Communication Activity announcements, the Emergency System for Advance Registration of Volunteer Health Professionals registries, the Medical Reserve Corps teams, state medical assistance teams, and disaster medical assistance teams.

“Finally, pediatricians should remember that they are not immune to the stress of disaster,” the committee wrote. “Pediatricians may have experienced their own losses, yet they will still be tasked with delivering care in difficult environments, all the while hearing of others’ tragic stories. Caregiver fatigue threatens the pediatrician’s well-being; the ability to provide consistent, high-quality care to others; and the desire to continue serving the community.” Resources for providers’ mental and physical health and resiliency include the AAP, local AAP chapters, medical societies, and state and federal governments, as well as other pediatricians monitoring the well-being of their colleagues.

During potentially lengthy recovery processes, pediatricians “can provide a crucial source of stability by quickly restoring access to routine and familiar medical care” as well as serving as advisers and advocates for the needs of children in the community, the committee advised.

No external funding or disclosures were reported.

Pediatricians play an important role in preparing for natural and man-made disasters as well as treating families during and after such unpredictable and unpreventable events, the American Academy of Pediatrics reported in a policy statement.

Despite the unpredictability of disasters, “pediatricians and others involved in the care and well-being of children can prepare for and mitigate their effects, encourage preparedness and resiliency among children and families and within communities, and ensure that children’s needs, including those of children and youth with special health care needs, are not neglected in planning, response, and recovery efforts,” wrote the Disaster Preparedness Advisory Council of the AAP Committee on Pediatric Emergency Medicine (Pediatrics. 2015 Oct 19 doi: 10.1542/peds.2015-3112).

zdravinjo/Thinkstock.com

The policy statement contains a list of resources available online to help families prepare for disasters, develop emergency plans, and deal with the fallout and effects of disasters. Another table lists educational and training resources available for pediatricians.

First among the dozen policy recommendations is the need for all levels of government – national, state, tribal, local, and regional – to address the “unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs of all children.” This recommendation requires the participation of pediatricians in disaster planning, response, and recovery in multiple roles, including as representatives of practices or institutions.

The unique needs of children need to be considered. “Children’s rapid minute ventilation, large surface area relative to body mass, more permeable skin, and proximity to the ground increase their risk of adverse outcomes from exposure to environmental hazards. … Children are in a critical period of development when toxic exposures can have profound negative effects.

“Children may lack the developmental ability to flee hazards, or they may even approach them out of curiosity or inadequate comprehension of risk. Limited ability to understand the nature of the disaster can also lead to stress, fear, anxiety, inability to cope, and exaggerated response to media exposure. All of these responses can manifest as developmental regression, withdrawal, clinginess, tantrums, enuresis, or somatic complaints, among other symptoms,” the committee explained.

Sufficient equipment, medications, and supplies for children should be on hand so that children’s needs can be met to the same degree as adults’ needs during a disaster. Because this has not always been true in the past, the committee called for more research into knowledge gaps and best practices regarding the treatment of children in disasters.

In addition to training children in disaster drills how to respond as victims and responders during a disaster, communities must consider children’s needs, physiology, and development during mass casualty triage, the committee recommended. Providers also can play a role in teaching children and families how to prepare for disasters and strategies for resiliency in their presence and their aftermath.

The committee encourages pediatricians to seek ongoing postgraduate education on disaster issues and to sign up with various public health disaster response systems, including Health Alert Network communications, the Centers for Disease Control and Prevention Clinician Outreach and Communication Activity announcements, the Emergency System for Advance Registration of Volunteer Health Professionals registries, the Medical Reserve Corps teams, state medical assistance teams, and disaster medical assistance teams.

“Finally, pediatricians should remember that they are not immune to the stress of disaster,” the committee wrote. “Pediatricians may have experienced their own losses, yet they will still be tasked with delivering care in difficult environments, all the while hearing of others’ tragic stories. Caregiver fatigue threatens the pediatrician’s well-being; the ability to provide consistent, high-quality care to others; and the desire to continue serving the community.” Resources for providers’ mental and physical health and resiliency include the AAP, local AAP chapters, medical societies, and state and federal governments, as well as other pediatricians monitoring the well-being of their colleagues.

During potentially lengthy recovery processes, pediatricians “can provide a crucial source of stability by quickly restoring access to routine and familiar medical care” as well as serving as advisers and advocates for the needs of children in the community, the committee advised.

No external funding or disclosures were reported.

Sending parents text messages that request a response increased the likelihood that their adolescent children would receive all their needed vaccinations and other well-child services, according to a recent study.

Receipt of all services was highest among children whose parents texted back requesting that the pediatric office call them to set up an appointment.

“Providers in diverse settings should consider text messaging as a viable method of reminder/recall in their adolescent patient populations, and the use of bidirectionality as a prompt for an intended action deserves further study,” Dr. Sean T. O’Leary, of the University of Colorado at Denver, Aurora, and his associates wrote. “Text messaging, because of its potential for automation and scalability, may represent the future of reminder/ recall.”

ponsulak/ThinkStock

The randomized controlled trial ran from September 2012 to August 2013 and included 4,587 adolescents, aged 11 to 17, whose parents had a cell phone number and who were patients at one of five private or two safety-net pediatric practices in the greater Denver area.

All participating patients were due for either a well-child care visit and/or one of the recommended adolescent vaccines (tetanus-diphtheria-acellular pertussis, meningococcal conjugate 4, or human papillomavirus).

The parents of the 2,228 adolescents randomized to the intervention received up to three personalized text messages asking for a response. Parents had three response options: clinic will call to schedule; parents will call clinic; or STOP, which would opt them out of the text service.

Parents who responded to the original message did not receive further texts. The other 2,359 adolescents formed the control group and received usual care with no reminders during the study (Pediatrics. 2015 Oct 5, doi: 10.1542/peds.2015-1089.).

According to mobile phone carrier data, 84% of the parents received the text reminder that was sent to them. Among all parents who were sent a message, 30% responded by text. Nearly two-thirds of responses occurred after the first text attempt.

More than 40% of parents requested a call from the clinic, 28% said they would call the clinic later, and 22% texted STOP to opt out of the text service. Another 9% responded in some other way, such as asking a question, according to the researchers.

Adolescents whose parents received the text messages were 31% more likely than those in the control group to receive all their needed services, including well-child care and all recommended vaccinations (risk ratio: 1.31). Patients in the intervention group were 29% more likely to receive all needed vaccinations (RR: 1.29) and 36% more likely to receive any vaccination (RR: 1.36).

Adolescents were 89% more likely to receive all needed services if their parents responded with option 1, indicating that the clinic should call them to schedule a visit (RR: 1.89).

For individual vaccines, no difference existed between groups for the MCV booster. However, intervention group patients were significantly more likely than controls to get any of the needed HPV doses (16% vs. 12%, P less than .0001). The effect of the text intervention on first HPV dose was significant, but modest (11% intervention vs. 9% control, P = .04).

Rates of well-child care visits did not significantly differ between the two groups, but 69% of adolescents in the text intervention group missed an opportunity for vaccination, compared with 75% of the control group adolescents (P = .002).

The cost of the text reminder program ranged from $855 to $3,394 per practice.

“It is not clear if the bidirectional nature of our intervention offered much advantage over a unidirectional text message. Parents who responded with an intention, though, were more likely to have their child vaccinated compared with those who did not respond,” the authors wrote. “Psychology research has shown that simply prompting people to develop a plan for a desired action can increase the likelihood of success.”

The research was funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention. The authors reported having no financial disclosures.

Sending parents text messages that request a response increased the likelihood that their adolescent children would receive all their needed vaccinations and other well-child services, according to a recent study.

Receipt of all services was highest among children whose parents texted back requesting that the pediatric office call them to set up an appointment.

“Providers in diverse settings should consider text messaging as a viable method of reminder/recall in their adolescent patient populations, and the use of bidirectionality as a prompt for an intended action deserves further study,” Dr. Sean T. O’Leary, of the University of Colorado at Denver, Aurora, and his associates wrote. “Text messaging, because of its potential for automation and scalability, may represent the future of reminder/ recall.”

ponsulak/ThinkStock

The randomized controlled trial ran from September 2012 to August 2013 and included 4,587 adolescents, aged 11 to 17, whose parents had a cell phone number and who were patients at one of five private or two safety-net pediatric practices in the greater Denver area.

All participating patients were due for either a well-child care visit and/or one of the recommended adolescent vaccines (tetanus-diphtheria-acellular pertussis, meningococcal conjugate 4, or human papillomavirus).

The parents of the 2,228 adolescents randomized to the intervention received up to three personalized text messages asking for a response. Parents had three response options: clinic will call to schedule; parents will call clinic; or STOP, which would opt them out of the text service.

Parents who responded to the original message did not receive further texts. The other 2,359 adolescents formed the control group and received usual care with no reminders during the study (Pediatrics. 2015 Oct 5, doi: 10.1542/peds.2015-1089.).

According to mobile phone carrier data, 84% of the parents received the text reminder that was sent to them. Among all parents who were sent a message, 30% responded by text. Nearly two-thirds of responses occurred after the first text attempt.

More than 40% of parents requested a call from the clinic, 28% said they would call the clinic later, and 22% texted STOP to opt out of the text service. Another 9% responded in some other way, such as asking a question, according to the researchers.

Adolescents whose parents received the text messages were 31% more likely than those in the control group to receive all their needed services, including well-child care and all recommended vaccinations (risk ratio: 1.31). Patients in the intervention group were 29% more likely to receive all needed vaccinations (RR: 1.29) and 36% more likely to receive any vaccination (RR: 1.36).

Adolescents were 89% more likely to receive all needed services if their parents responded with option 1, indicating that the clinic should call them to schedule a visit (RR: 1.89).

For individual vaccines, no difference existed between groups for the MCV booster. However, intervention group patients were significantly more likely than controls to get any of the needed HPV doses (16% vs. 12%, P less than .0001). The effect of the text intervention on first HPV dose was significant, but modest (11% intervention vs. 9% control, P = .04).

Rates of well-child care visits did not significantly differ between the two groups, but 69% of adolescents in the text intervention group missed an opportunity for vaccination, compared with 75% of the control group adolescents (P = .002).

The cost of the text reminder program ranged from $855 to $3,394 per practice.

“It is not clear if the bidirectional nature of our intervention offered much advantage over a unidirectional text message. Parents who responded with an intention, though, were more likely to have their child vaccinated compared with those who did not respond,” the authors wrote. “Psychology research has shown that simply prompting people to develop a plan for a desired action can increase the likelihood of success.”

The research was funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention. The authors reported having no financial disclosures.

Sending parents text messages that request a response increased the likelihood that their adolescent children would receive all their needed vaccinations and other well-child services, according to a recent study.

Receipt of all services was highest among children whose parents texted back requesting that the pediatric office call them to set up an appointment.

“Providers in diverse settings should consider text messaging as a viable method of reminder/recall in their adolescent patient populations, and the use of bidirectionality as a prompt for an intended action deserves further study,” Dr. Sean T. O’Leary, of the University of Colorado at Denver, Aurora, and his associates wrote. “Text messaging, because of its potential for automation and scalability, may represent the future of reminder/ recall.”

ponsulak/ThinkStock

The randomized controlled trial ran from September 2012 to August 2013 and included 4,587 adolescents, aged 11 to 17, whose parents had a cell phone number and who were patients at one of five private or two safety-net pediatric practices in the greater Denver area.

All participating patients were due for either a well-child care visit and/or one of the recommended adolescent vaccines (tetanus-diphtheria-acellular pertussis, meningococcal conjugate 4, or human papillomavirus).

The parents of the 2,228 adolescents randomized to the intervention received up to three personalized text messages asking for a response. Parents had three response options: clinic will call to schedule; parents will call clinic; or STOP, which would opt them out of the text service.

Parents who responded to the original message did not receive further texts. The other 2,359 adolescents formed the control group and received usual care with no reminders during the study (Pediatrics. 2015 Oct 5, doi: 10.1542/peds.2015-1089.).

According to mobile phone carrier data, 84% of the parents received the text reminder that was sent to them. Among all parents who were sent a message, 30% responded by text. Nearly two-thirds of responses occurred after the first text attempt.

More than 40% of parents requested a call from the clinic, 28% said they would call the clinic later, and 22% texted STOP to opt out of the text service. Another 9% responded in some other way, such as asking a question, according to the researchers.

Adolescents whose parents received the text messages were 31% more likely than those in the control group to receive all their needed services, including well-child care and all recommended vaccinations (risk ratio: 1.31). Patients in the intervention group were 29% more likely to receive all needed vaccinations (RR: 1.29) and 36% more likely to receive any vaccination (RR: 1.36).

Adolescents were 89% more likely to receive all needed services if their parents responded with option 1, indicating that the clinic should call them to schedule a visit (RR: 1.89).

For individual vaccines, no difference existed between groups for the MCV booster. However, intervention group patients were significantly more likely than controls to get any of the needed HPV doses (16% vs. 12%, P less than .0001). The effect of the text intervention on first HPV dose was significant, but modest (11% intervention vs. 9% control, P = .04).

Rates of well-child care visits did not significantly differ between the two groups, but 69% of adolescents in the text intervention group missed an opportunity for vaccination, compared with 75% of the control group adolescents (P = .002).

The cost of the text reminder program ranged from $855 to $3,394 per practice.

“It is not clear if the bidirectional nature of our intervention offered much advantage over a unidirectional text message. Parents who responded with an intention, though, were more likely to have their child vaccinated compared with those who did not respond,” the authors wrote. “Psychology research has shown that simply prompting people to develop a plan for a desired action can increase the likelihood of success.”

The research was funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention. The authors reported having no financial disclosures.

A standardized protocol for screening children with suspected sentinel injuries – those suggesting risk for child abuse – could increase the accurate identification of abused children and reduce missed cases, new research suggests.

“It has been well-described that abused children frequently present with subtle signs and symptoms, and that the history may be incomplete or misleading,” Dr. Daniel M. Lindberg, of the University of Colorado, Denver, and his associates wrote. “Our data reveal an overall high rate of diagnosed abuse, but tremendous variability in evaluation and diagnosis of abuse across hospitals and injury categories. Together, these facts suggest that increased, routine, or protocolized testing for children with these injuries can identify other children with abuse that might otherwise be missed.”

©drpnncpp/thinkstockphotos.com

In a retrospective secondary analysis of the Pediatric Health Information System database, the researchers examined records for more than 4 million patient visits for children under 24 months old who were seen at 18 institutions between Jan. 1, 2004 and Dec. 31, 2011. Overall, 0.17% (7,062 visits) were associated with a diagnosis of abuse. But the rates of abuse diagnosis ranged widely between hospitals, from 0.04% to 0.46% (Pediatrics. 2015 Oct. 5, doi: 10.1542/peds.2015-1487.).

The researchers identified 34,564 sentinel injuries among 30,766 visits (0.7%). Nearly 90% of patients had only one sentinel injury, nearly 8% had two sentinel injuries, and nearly 3% had 3-6 sentinel injuries identified. In the 4,100,411 visits in which a sentinel injury was not identified, abuse was diagnosed in 0.03% of visits.

The researchers excluded children with a previous child abuse diagnosis or who were involved in a motor vehicle accident.

Sentinel injuries – designed to flag injuries that are unusual for the child’s age – included rib fracture, abdominal trauma, genital injury, or subconjunctival hemorrhage for children under 24 months; femur/humerus fracture, radius/ulna/tibia/fibula fracture, isolated skull fracture or intracranial hemorrhage for children under 12 months; and bruising, burns, or oropharyngeal injury for children under 6 months.

Among children with sentinel injuries, abuse diagnosis ranged from a low of 3.5% among infants with burns to 56.1% of children with rib fractures.

For children under 6 months, the rates of abuse diagnosis were 8.3% for bruises and 17% for oropharyngeal injuries. In children under 12 months, the abuse diagnosis rates were 4.3% for isolated skull fracture, 26.3% for intracranial hemorrhage, and between 18%-19% for arm or leg fracture. In children under 24 months, the abuse diagnosis rates were 8.6% in cases of subconjunctival hemorrhage, 12.3% for genital injury, and 24.5% for abdominal trauma.

Across all hospitals, 46% of children with suspected sentinel injuries received a skeletal survey, 68.6% received neuroimaging with CT or MRI, and 24.9% had hepatic transaminases tested. The American Academy of Pediatrics considers the radiographic skeletal survey to be “mandatory” for children with concern for abuse, the authors noted.

Dr. Lindberg reported providing paid expert testimony in cases of alleged child maltreatment. Two of the coauthors reported that their institutions received payment for expert witnes testimony they provided in suspected child abuse cases.

A standardized protocol for screening children with suspected sentinel injuries – those suggesting risk for child abuse – could increase the accurate identification of abused children and reduce missed cases, new research suggests.

“It has been well-described that abused children frequently present with subtle signs and symptoms, and that the history may be incomplete or misleading,” Dr. Daniel M. Lindberg, of the University of Colorado, Denver, and his associates wrote. “Our data reveal an overall high rate of diagnosed abuse, but tremendous variability in evaluation and diagnosis of abuse across hospitals and injury categories. Together, these facts suggest that increased, routine, or protocolized testing for children with these injuries can identify other children with abuse that might otherwise be missed.”

©drpnncpp/thinkstockphotos.com

In a retrospective secondary analysis of the Pediatric Health Information System database, the researchers examined records for more than 4 million patient visits for children under 24 months old who were seen at 18 institutions between Jan. 1, 2004 and Dec. 31, 2011. Overall, 0.17% (7,062 visits) were associated with a diagnosis of abuse. But the rates of abuse diagnosis ranged widely between hospitals, from 0.04% to 0.46% (Pediatrics. 2015 Oct. 5, doi: 10.1542/peds.2015-1487.).

The researchers identified 34,564 sentinel injuries among 30,766 visits (0.7%). Nearly 90% of patients had only one sentinel injury, nearly 8% had two sentinel injuries, and nearly 3% had 3-6 sentinel injuries identified. In the 4,100,411 visits in which a sentinel injury was not identified, abuse was diagnosed in 0.03% of visits.

The researchers excluded children with a previous child abuse diagnosis or who were involved in a motor vehicle accident.

Sentinel injuries – designed to flag injuries that are unusual for the child’s age – included rib fracture, abdominal trauma, genital injury, or subconjunctival hemorrhage for children under 24 months; femur/humerus fracture, radius/ulna/tibia/fibula fracture, isolated skull fracture or intracranial hemorrhage for children under 12 months; and bruising, burns, or oropharyngeal injury for children under 6 months.

Among children with sentinel injuries, abuse diagnosis ranged from a low of 3.5% among infants with burns to 56.1% of children with rib fractures.

For children under 6 months, the rates of abuse diagnosis were 8.3% for bruises and 17% for oropharyngeal injuries. In children under 12 months, the abuse diagnosis rates were 4.3% for isolated skull fracture, 26.3% for intracranial hemorrhage, and between 18%-19% for arm or leg fracture. In children under 24 months, the abuse diagnosis rates were 8.6% in cases of subconjunctival hemorrhage, 12.3% for genital injury, and 24.5% for abdominal trauma.

Across all hospitals, 46% of children with suspected sentinel injuries received a skeletal survey, 68.6% received neuroimaging with CT or MRI, and 24.9% had hepatic transaminases tested. The American Academy of Pediatrics considers the radiographic skeletal survey to be “mandatory” for children with concern for abuse, the authors noted.

Dr. Lindberg reported providing paid expert testimony in cases of alleged child maltreatment. Two of the coauthors reported that their institutions received payment for expert witnes testimony they provided in suspected child abuse cases.

A standardized protocol for screening children with suspected sentinel injuries – those suggesting risk for child abuse – could increase the accurate identification of abused children and reduce missed cases, new research suggests.

“It has been well-described that abused children frequently present with subtle signs and symptoms, and that the history may be incomplete or misleading,” Dr. Daniel M. Lindberg, of the University of Colorado, Denver, and his associates wrote. “Our data reveal an overall high rate of diagnosed abuse, but tremendous variability in evaluation and diagnosis of abuse across hospitals and injury categories. Together, these facts suggest that increased, routine, or protocolized testing for children with these injuries can identify other children with abuse that might otherwise be missed.”

©drpnncpp/thinkstockphotos.com

In a retrospective secondary analysis of the Pediatric Health Information System database, the researchers examined records for more than 4 million patient visits for children under 24 months old who were seen at 18 institutions between Jan. 1, 2004 and Dec. 31, 2011. Overall, 0.17% (7,062 visits) were associated with a diagnosis of abuse. But the rates of abuse diagnosis ranged widely between hospitals, from 0.04% to 0.46% (Pediatrics. 2015 Oct. 5, doi: 10.1542/peds.2015-1487.).

The researchers identified 34,564 sentinel injuries among 30,766 visits (0.7%). Nearly 90% of patients had only one sentinel injury, nearly 8% had two sentinel injuries, and nearly 3% had 3-6 sentinel injuries identified. In the 4,100,411 visits in which a sentinel injury was not identified, abuse was diagnosed in 0.03% of visits.

The researchers excluded children with a previous child abuse diagnosis or who were involved in a motor vehicle accident.

Sentinel injuries – designed to flag injuries that are unusual for the child’s age – included rib fracture, abdominal trauma, genital injury, or subconjunctival hemorrhage for children under 24 months; femur/humerus fracture, radius/ulna/tibia/fibula fracture, isolated skull fracture or intracranial hemorrhage for children under 12 months; and bruising, burns, or oropharyngeal injury for children under 6 months.

Among children with sentinel injuries, abuse diagnosis ranged from a low of 3.5% among infants with burns to 56.1% of children with rib fractures.

For children under 6 months, the rates of abuse diagnosis were 8.3% for bruises and 17% for oropharyngeal injuries. In children under 12 months, the abuse diagnosis rates were 4.3% for isolated skull fracture, 26.3% for intracranial hemorrhage, and between 18%-19% for arm or leg fracture. In children under 24 months, the abuse diagnosis rates were 8.6% in cases of subconjunctival hemorrhage, 12.3% for genital injury, and 24.5% for abdominal trauma.

Across all hospitals, 46% of children with suspected sentinel injuries received a skeletal survey, 68.6% received neuroimaging with CT or MRI, and 24.9% had hepatic transaminases tested. The American Academy of Pediatrics considers the radiographic skeletal survey to be “mandatory” for children with concern for abuse, the authors noted.

Dr. Lindberg reported providing paid expert testimony in cases of alleged child maltreatment. Two of the coauthors reported that their institutions received payment for expert witnes testimony they provided in suspected child abuse cases.

Adolescent girls who reach puberty early and have inadequate parental supervision began drinking alcohol earlier and getting drunk sooner than their peers, forecasting further adjustment problems down the line, according to results of a new study.

“Adolescent alcohol consumption is not simply a matter of normative experimentation. Early adolescent drinking forecasts a host of long-term adjustment difficulties,” reported Daniel J. Dickson of Florida Atlantic University in Fort Lauderdale and his associates (Pediatrics 2015 Sep 21. doi: 10.1542/peds.2015-1258]).

“Practitioners presented with early-maturing girls may well consider advising parents about the unique risks confronting these children,” the authors wrote. “Heightened risks imply the need for heightened vigilance, and parents of early-maturing girls should be reminded that it is possible to project warmth and support, without retreating from supervision.”

Dickson’s team tracked 957 Swedish girls for 4 years, starting in their first year of secondary school (a mean 13 years old) and giving them surveys once a year regarding how often they had been intoxicated from alcohol and how much autonomy they perceived that their parents gave them. Previous research had already shown that inadequate supervision from parents increased the likelihood that adolescent girls would illegally consume alcohol.

They also assessed their first menarche. The 184 girls classified as early maturing got their first period before age 12 years. On-time maturing included the 587 whose first menarche was between ages 12 and 13, and late maturing included the 186 who first got their period after age 13 years.

©kiatipol/thinkstockphotos.com

As in past research, “higher initial levels of adolescent alcohol abuse corresponded with lower initial levels of autonomy granting,” but this association did not reach statistical significance, the authors found. However, there was a statistically significant association between poor parent supervision and increasing alcohol abuse among early-maturing girls. Alcohol abuse rates for early-maturing girls with the most freedom increased three times faster than for early-maturing girls with the least autonomy.

Further, “the higher the initial level of adolescent alcohol abuse, the greater the increase in autonomy granting” for early-maturing girls. Low levels of alcohol abuse from seventh to tenth grades involved a 12% increase in perceived parent autonomy granting; Medium levels led to an 18% increase, and high levels to a 24% increase.

Early-maturing girls tended to befriend older peers who also had high levels of alcohol abuse, and the association held after controlling for friends’ ages and alcohol abuse levels. The authors speculate that early-maturing girls experience more dissatisfaction with their appearance, more conflict with parents, and more depressive symptoms, leading to self-medication.

The research was funded by the Swedish Research Council, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the U.S. National Science Foundation, and the U.S. National Institutes of Health. The authors reported no disclosures.

Adolescent girls who reach puberty early and have inadequate parental supervision began drinking alcohol earlier and getting drunk sooner than their peers, forecasting further adjustment problems down the line, according to results of a new study.

“Adolescent alcohol consumption is not simply a matter of normative experimentation. Early adolescent drinking forecasts a host of long-term adjustment difficulties,” reported Daniel J. Dickson of Florida Atlantic University in Fort Lauderdale and his associates (Pediatrics 2015 Sep 21. doi: 10.1542/peds.2015-1258]).

“Practitioners presented with early-maturing girls may well consider advising parents about the unique risks confronting these children,” the authors wrote. “Heightened risks imply the need for heightened vigilance, and parents of early-maturing girls should be reminded that it is possible to project warmth and support, without retreating from supervision.”

Dickson’s team tracked 957 Swedish girls for 4 years, starting in their first year of secondary school (a mean 13 years old) and giving them surveys once a year regarding how often they had been intoxicated from alcohol and how much autonomy they perceived that their parents gave them. Previous research had already shown that inadequate supervision from parents increased the likelihood that adolescent girls would illegally consume alcohol.

They also assessed their first menarche. The 184 girls classified as early maturing got their first period before age 12 years. On-time maturing included the 587 whose first menarche was between ages 12 and 13, and late maturing included the 186 who first got their period after age 13 years.

©kiatipol/thinkstockphotos.com

As in past research, “higher initial levels of adolescent alcohol abuse corresponded with lower initial levels of autonomy granting,” but this association did not reach statistical significance, the authors found. However, there was a statistically significant association between poor parent supervision and increasing alcohol abuse among early-maturing girls. Alcohol abuse rates for early-maturing girls with the most freedom increased three times faster than for early-maturing girls with the least autonomy.

Further, “the higher the initial level of adolescent alcohol abuse, the greater the increase in autonomy granting” for early-maturing girls. Low levels of alcohol abuse from seventh to tenth grades involved a 12% increase in perceived parent autonomy granting; Medium levels led to an 18% increase, and high levels to a 24% increase.

Early-maturing girls tended to befriend older peers who also had high levels of alcohol abuse, and the association held after controlling for friends’ ages and alcohol abuse levels. The authors speculate that early-maturing girls experience more dissatisfaction with their appearance, more conflict with parents, and more depressive symptoms, leading to self-medication.

The research was funded by the Swedish Research Council, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the U.S. National Science Foundation, and the U.S. National Institutes of Health. The authors reported no disclosures.

Adolescent girls who reach puberty early and have inadequate parental supervision began drinking alcohol earlier and getting drunk sooner than their peers, forecasting further adjustment problems down the line, according to results of a new study.

“Adolescent alcohol consumption is not simply a matter of normative experimentation. Early adolescent drinking forecasts a host of long-term adjustment difficulties,” reported Daniel J. Dickson of Florida Atlantic University in Fort Lauderdale and his associates (Pediatrics 2015 Sep 21. doi: 10.1542/peds.2015-1258]).

“Practitioners presented with early-maturing girls may well consider advising parents about the unique risks confronting these children,” the authors wrote. “Heightened risks imply the need for heightened vigilance, and parents of early-maturing girls should be reminded that it is possible to project warmth and support, without retreating from supervision.”

Dickson’s team tracked 957 Swedish girls for 4 years, starting in their first year of secondary school (a mean 13 years old) and giving them surveys once a year regarding how often they had been intoxicated from alcohol and how much autonomy they perceived that their parents gave them. Previous research had already shown that inadequate supervision from parents increased the likelihood that adolescent girls would illegally consume alcohol.

They also assessed their first menarche. The 184 girls classified as early maturing got their first period before age 12 years. On-time maturing included the 587 whose first menarche was between ages 12 and 13, and late maturing included the 186 who first got their period after age 13 years.

©kiatipol/thinkstockphotos.com

As in past research, “higher initial levels of adolescent alcohol abuse corresponded with lower initial levels of autonomy granting,” but this association did not reach statistical significance, the authors found. However, there was a statistically significant association between poor parent supervision and increasing alcohol abuse among early-maturing girls. Alcohol abuse rates for early-maturing girls with the most freedom increased three times faster than for early-maturing girls with the least autonomy.

Further, “the higher the initial level of adolescent alcohol abuse, the greater the increase in autonomy granting” for early-maturing girls. Low levels of alcohol abuse from seventh to tenth grades involved a 12% increase in perceived parent autonomy granting; Medium levels led to an 18% increase, and high levels to a 24% increase.

Early-maturing girls tended to befriend older peers who also had high levels of alcohol abuse, and the association held after controlling for friends’ ages and alcohol abuse levels. The authors speculate that early-maturing girls experience more dissatisfaction with their appearance, more conflict with parents, and more depressive symptoms, leading to self-medication.

The research was funded by the Swedish Research Council, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the U.S. National Science Foundation, and the U.S. National Institutes of Health. The authors reported no disclosures.

A pediatric rheumatology clinic substantially increased the pneumococcal vaccination rates of their high-risk patients through a targeted, multipart yearlong intervention, according to a recent study.

“This single-center quality improvement project to increase pneumococcal vaccination rates in eligible pediatric rheumatology clinic patients was a success that can serve as a model for other hospitals and divisions,” reported Dr. Julia G. Harris of Children’s Mercy-Kansas City in Missouri, and her associates (Pediatrics 2015 Aug. 24. [doi:10.1542/peds.2014-2512]). “Through simple quality improvement initiatives, our vaccination rates statistically increased over time and were sustained indicating a true change in practice.”

©Steve Mann/ ThinkStockphotos.com

The Centers for Disease Control and Prevention recommends that all infants receive the 13-valent pneumococcal conjugate vaccine (PCV13) four times in early childhood, with high-risk patients aged 2-5 years receiving at least one dose. High-risk patients at least 2 years old should also receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and continue to receive a dose every 5 years if they remain at high risk.

The researchers designed an intervention aimed at improving pneumococcal vaccination rates among children at least 2 years old and adults who had systemic lupus erythematosus and/or who were taking immunosuppressive medication.

Before the intervention, retrospective analysis of 90 patient visits in 88 patients during 4 weeks revealed that 6.7% of the patients had received the PCV13, and 8.9% had received PPSV23, but none had received both.

The intervention, which ran from September 2012 to October 2013, involved multiple components, beginning with stocking PCV13 and PPSV23 and then a formal presentation to providers and nurses about the recommendations for pneumococcal vaccines. An immunization algorithm posted throughout the clinic helped clinicians determine whether pneumococcal vaccination was indicated.

The office created a weekly email identifying patients in need of either vaccine; then the nurses would attach brightly colored pieces of paper with either PCV13 or PPSV23 written on them to patients’ clinic encounter forms to flag which patients should be immunized.

“Pneumococcal vaccines were often administered in clinic, and nurses provided an educational document regarding the specific vaccine to the patient and family,” the authors explained. Patients living out of state or who lacked an immunization record also received letters requesting immunization records to determine if they needed the pneumococcal vaccine.

During the year (53 weeks) after the intervention began, the coverage increased to 48.4% of 299 patients with 1,033 patient visits (P less than .001). Similarly, the vaccination rate with PPSV23 increased from 8.9% to 28.4%, and the combined vaccination rate for receiving both vaccines increased from 0% to 23.2%.

A pediatric rheumatology clinic substantially increased the pneumococcal vaccination rates of their high-risk patients through a targeted, multipart yearlong intervention, according to a recent study.

“This single-center quality improvement project to increase pneumococcal vaccination rates in eligible pediatric rheumatology clinic patients was a success that can serve as a model for other hospitals and divisions,” reported Dr. Julia G. Harris of Children’s Mercy-Kansas City in Missouri, and her associates (Pediatrics 2015 Aug. 24. [doi:10.1542/peds.2014-2512]). “Through simple quality improvement initiatives, our vaccination rates statistically increased over time and were sustained indicating a true change in practice.”

©Steve Mann/ ThinkStockphotos.com

The Centers for Disease Control and Prevention recommends that all infants receive the 13-valent pneumococcal conjugate vaccine (PCV13) four times in early childhood, with high-risk patients aged 2-5 years receiving at least one dose. High-risk patients at least 2 years old should also receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and continue to receive a dose every 5 years if they remain at high risk.

The researchers designed an intervention aimed at improving pneumococcal vaccination rates among children at least 2 years old and adults who had systemic lupus erythematosus and/or who were taking immunosuppressive medication.

Before the intervention, retrospective analysis of 90 patient visits in 88 patients during 4 weeks revealed that 6.7% of the patients had received the PCV13, and 8.9% had received PPSV23, but none had received both.

The intervention, which ran from September 2012 to October 2013, involved multiple components, beginning with stocking PCV13 and PPSV23 and then a formal presentation to providers and nurses about the recommendations for pneumococcal vaccines. An immunization algorithm posted throughout the clinic helped clinicians determine whether pneumococcal vaccination was indicated.

The office created a weekly email identifying patients in need of either vaccine; then the nurses would attach brightly colored pieces of paper with either PCV13 or PPSV23 written on them to patients’ clinic encounter forms to flag which patients should be immunized.

“Pneumococcal vaccines were often administered in clinic, and nurses provided an educational document regarding the specific vaccine to the patient and family,” the authors explained. Patients living out of state or who lacked an immunization record also received letters requesting immunization records to determine if they needed the pneumococcal vaccine.

During the year (53 weeks) after the intervention began, the coverage increased to 48.4% of 299 patients with 1,033 patient visits (P less than .001). Similarly, the vaccination rate with PPSV23 increased from 8.9% to 28.4%, and the combined vaccination rate for receiving both vaccines increased from 0% to 23.2%.

A pediatric rheumatology clinic substantially increased the pneumococcal vaccination rates of their high-risk patients through a targeted, multipart yearlong intervention, according to a recent study.

“This single-center quality improvement project to increase pneumococcal vaccination rates in eligible pediatric rheumatology clinic patients was a success that can serve as a model for other hospitals and divisions,” reported Dr. Julia G. Harris of Children’s Mercy-Kansas City in Missouri, and her associates (Pediatrics 2015 Aug. 24. [doi:10.1542/peds.2014-2512]). “Through simple quality improvement initiatives, our vaccination rates statistically increased over time and were sustained indicating a true change in practice.”

©Steve Mann/ ThinkStockphotos.com

The Centers for Disease Control and Prevention recommends that all infants receive the 13-valent pneumococcal conjugate vaccine (PCV13) four times in early childhood, with high-risk patients aged 2-5 years receiving at least one dose. High-risk patients at least 2 years old should also receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and continue to receive a dose every 5 years if they remain at high risk.

The researchers designed an intervention aimed at improving pneumococcal vaccination rates among children at least 2 years old and adults who had systemic lupus erythematosus and/or who were taking immunosuppressive medication.

Before the intervention, retrospective analysis of 90 patient visits in 88 patients during 4 weeks revealed that 6.7% of the patients had received the PCV13, and 8.9% had received PPSV23, but none had received both.

The intervention, which ran from September 2012 to October 2013, involved multiple components, beginning with stocking PCV13 and PPSV23 and then a formal presentation to providers and nurses about the recommendations for pneumococcal vaccines. An immunization algorithm posted throughout the clinic helped clinicians determine whether pneumococcal vaccination was indicated.

The office created a weekly email identifying patients in need of either vaccine; then the nurses would attach brightly colored pieces of paper with either PCV13 or PPSV23 written on them to patients’ clinic encounter forms to flag which patients should be immunized.

“Pneumococcal vaccines were often administered in clinic, and nurses provided an educational document regarding the specific vaccine to the patient and family,” the authors explained. Patients living out of state or who lacked an immunization record also received letters requesting immunization records to determine if they needed the pneumococcal vaccine.

During the year (53 weeks) after the intervention began, the coverage increased to 48.4% of 299 patients with 1,033 patient visits (P less than .001). Similarly, the vaccination rate with PPSV23 increased from 8.9% to 28.4%, and the combined vaccination rate for receiving both vaccines increased from 0% to 23.2%.