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Item ‘Clustering of exemptions’ as a collective action threat to herd immunity(2003-03) May, Thomas; Silverman, Ross D.In this paper, we examine the phenomenon of ‘clustering of exemptions’ to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can “self-select” in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.Item Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines(AAP, 2015-07) Schilling, Andrea; Parra, Mercedes Macias; Gutierrez, Maricruz; Restrepo, Jaime; Ucros, Santiago; Herrera, Teobaldo; Engel, Eli; Huicho, Luis; Shew, Marcia; Maansson, Roger; Caldwell, Nicole; Luxembourg, Alain; ter Meulen, Ajoke Sobanjo; Department of Pediatrics, IU School of MedicineBACKGROUND: This study in 11- to 15-year-old boys and girls compared the immunogenicity and safety of GARDASIL 9 (9-valent human papillomavirus [9vHPV] vaccine) administered either concomitantly or nonconcomitantly with 2 vaccines routinely administered in this age group (Menactra [MCV4; Neisseria meningitidis serotypes A/C/Y/W-135] or Adacel [Tdap; diphtheria/tetanus/acellular pertussis]). METHODS: Participants received 9vHPV vaccine at day 1 and months 2 and 6; the concomitant group (n = 621) received MCV4/Tdap concomitantly with 9vHPV vaccine at day 1; the nonconcomitant group (n = 620) received MCV4/Tdap at month 1. Antibodies to HPV-, MCV4-, and Tdap-relevant antigens were determined. Injection-site and systemic adverse events (AEs) were monitored for 15 days after any vaccination; serious AEs were monitored throughout the study. RESULTS: The geometric mean titers for all HPV types in 9vHPV vaccine 4 weeks after dose 3, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes 4 weeks after injection with MCV4, proportion of subjects with antibody titers to diphtheria and tetanus ≥0.1 IU/mL, and geometric mean titers for pertussis antigens 4 weeks after injection with Tdap were all noninferior in the concomitant group compared with the nonconcomitant group. Injection-site swelling occurred more frequently in the concomitant group. There were no vaccine-related serious AEs. CONCLUSIONS: Concomitant administration of 9vHPV vaccine with MCV4/Tdap was generally well tolerated and did not interfere with the antibody response to any of these vaccines. This strategy would minimize the number of visits required to deliver each vaccine individually.Item Daily Situational Brief, December 29, 2014(MESH Coalition, 12/29/14) MESH CoalitionItem Litigation, Regulation, and Education — Protecting the Public’s Health through Childhood Immunization(2009) Silverman, Ross D.Item The lived experience of obtaining required childhood vaccinations from Latino immigrants’ perspective(2014-07-07) deRose, Barbara Sue; Sims, Sharon L.; Sloan, Rebecca S.; Mays, Rose M.; Ward, Richard E.Vaccinations are an important step in preventing childhood illnesses and disease outbreaks in the community. Complete immunizations before school assure eligibility for enrollment and protect children against severe illness. The fact that foreign-born children of Latino immigrants face health disparities in receiving vaccinations is well documented. However, there is little information in the literature about the actual experience of immigrants facing the complexities of the health system, and through their eyes, which factors ultimately affect vaccination rates of immigrant Latino children. The purpose of this study is to give voice to Latino immigrant families who have recently immigrated to the United States, in terms of the issues they encountered when engaging the health care system for vaccinations.Item A model of health care provider decision making about HPV vaccination in adolescent males(Elsevier, 2015-08) Alexander, Andreia B.; Best, Candace; Stupiansky, Nathan; Zimet, Gregory D.; Department of Pediatrics, IU School of MedicineIntroduction In the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended. Method A total of 20 U.S. pediatric HCPs participated in 20–30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis. Results The providers had been in practice for 1–35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers’ preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the “newness” and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated. Conclusions Providers’ opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.