Causes of Low Preschool Immunization Coverage in the United States

AbstractWidespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

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State-level trends in sudden unexpected infant death and immunization in the United States: an ecological study

BMC Pediatrics ◽

10.1186/s12887-021-02733-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jacqueline Müller-Nordhorn ◽

Konrad Neumann ◽

Thomas Keil ◽

Stefan N. Willich ◽

Sylvia Binting

Keyword(s):

United States ◽

Infant Mortality ◽

Infant Death ◽

Immunization Coverage ◽

The United States ◽

Mortality Rates ◽

Sleep Position ◽

Live Births ◽

Unexpected Infant Death ◽

Rate Ratios

Abstract Background Sudden unexpected infant death (SUID) continues to be a major contributor to infant mortality in the United States. The objective was to analyze time trends in SUID and their association with immunization coverage. Methods The number of deaths and live births per year and per state (1992–2015) was obtained from the Centers for Disease Control and Prevention (CDC). We calculated infant mortality rates (i.e., deaths below one year of age) per 1000 live births for SUID. We obtained data on immunization in children aged 19–35 months with three doses or more of diphtheria-tetanus-pertussis (3+ DTP), polio (3+ Polio), and Haemophilus influenzae type b (3+ Hib) as well as four doses or more of DTP (4+ DTP) from the National Immunization Survey, and data on infant sleep position from the Pregnancy Risk Assessment Monitoring System (PRAMS) Study. Data on poverty and race were derived from the Current Population and American Community Surveys of the U.S. Census Bureau. We calculated mean SUID mortality rates with 95% confidence interval (CI) as well as the annual percentage change using breakpoint analysis. We used Poisson regression with random effects to examine the dependence of SUID rates on immunization coverage, adjusting for sleep position and poverty (1996–2015). In a second model, we additionally adjusted for race (2000–2015). Results Overall, SUID mortality decreased in the United States. The mean annual percent change was − 9.6 (95% CI = − 10.5, − 8.6) between 1992 and 1996, and − 0.3 (95% CI = − 0.4, − 0.1) from 1996 onwards. The adjusted rate ratios for SUID mortality were 0.91 (95% CI = 0.80, 1.03) per 10% increase for 3+ DTP, 0.88 (95% CI = 0.83, 0.95) for 4+ DTP, 1.00 (95% CI = 0.90, 1.10) for 3+ polio, and 0.95 (95% CI = 0.89, 1.02) for 3+ Hib. After additionally adjusting for race, the rate ratios were 0.76 (95% CI = 0.67, 0.85) for 3+ DTP, 0.83 (95% CI = 0.78, 0.89) for 4+ DTP, 0.81 (95% CI = 0.73, 0.90) for 3+ polio, and 0.94 (95% CI = 0.88, 1.00) for 3+ Hib. Conclusions SUID mortality is decreasing, and inversely related to immunization coverage. However, since 1996, the decline has slowed down.

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Immunization Coverage Among Preschool Children: The United States and Selected European Countries

PEDIATRICS ◽

10.1542/peds.86.6.1052 ◽

1990 ◽

Vol 86 (6) ◽

pp. 1052-1056

Author(s):

Bret C. Williams

Keyword(s):

United States ◽

Preschool Children ◽

International Comparisons ◽

Immunization Coverage ◽

The United States ◽

Immunization Rates ◽

National Immunization ◽

National Initiative ◽

Coverage Rates ◽

Us Children

In spite of difficulty measuring the effects of varying national immunization coverage rates, attaining high levels of immunization is a high priority for all countries. In addition, immunization rates among preschool children serve as a useful index of overall well child and preventive care. International comparisons reveal relatively low rates among all US children, especially minorities, attributable in part to poor utilization of routine preventive services. In the absence of a national initiative, various attempts to improve performance at local and state levels deserve attention. Renewed monitoring of immunization rates among preschool children in the United States is essential to assess current programs and future efforts.

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Increasing the Precision of Estimates of Immunization Coverage Among 19- to 35-Month-Old Children in the United States

Journal of Data Science ◽

10.6339/jds.2005.03(1).196 ◽

2021 ◽

Vol 3 (1) ◽

pp. 35-45

Author(s):

Lawrence E. Barker ◽

Mary M. McCauley ◽

Qian Li

Keyword(s):

United States ◽

Immunization Coverage ◽

The United States

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Free Vaccination and Immunization Coverage of Uninsured Children: The Case of the Vaccines for Children Program in the United States

10.21203/rs.3.rs-18765/v1 ◽

2020 ◽

Author(s):

Akihiro Kawase

Keyword(s):

United States ◽

Low Income ◽

Immunization Coverage ◽

The United States ◽

Contagious Diseases ◽

Positive Externalities ◽

Low Income Families ◽

Uninsured Children ◽

Vaccines For Children ◽

Using Data

Abstract Objective : Vaccines against contagious diseases have strong positive externalities as immunization protects not just the immunized but those around them. Out-of-pocket immunization costs are a common barrier to obtaining vaccines, especially for low-income families or those without health insurance in the United States. The Vaccines for Children (VFC) Program, initiated in October 1994, allows all uninsured children in the United States to receive free vaccinations. Despite its importance, few studies have focused on the effectiveness of this program. Using data from the National Immunization Survey (NIS) from 1995–1997 (N=51902), this study investigates how the introduction of this program affected the immunization coverage of uninsured children aged 19–35 months.Results : Accounting for variation in a child’s exposure to the program, I found that providing free vaccination correlated with an increase in the uptake of the entire spectrum of recommended vaccines, which included hepatitis B (Hep b) vaccine added to the recommended immunization schedule at the time. Further, despite the introduction of the program, uninsured children continue to have low immunization coverage. These findings suggest that improving immunization coverage for uninsured children by only reducing out-of-pocket vaccination costs may be insufficient and other factors may still influence vaccination decisions.

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Party Strength in the United States: Some Corrections

The Journal of Politics ◽

10.1017/s0022381600041591 ◽

1975 ◽

Vol 37 (2) ◽

pp. 641-642 ◽

Cited By ~ 1

Author(s):

Paul T. David

Keyword(s):

United States ◽

The United States ◽

Party Strength

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Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100139780 ◽

1995 ◽

Vol 53 ◽

pp. 682-683

Author(s):

A. Hakam ◽

J.T. Gau ◽

M.L. Grove ◽

B.A. Evans ◽

M. Shuman ◽

...

Keyword(s):

United States ◽

Cell Biology ◽

Tissue Bank ◽

The United States ◽

Prostate Adenocarcinoma ◽

Correlative Microscopy ◽

Client Server ◽

Critical Elements ◽

Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

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