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Chronic hepatitis B virus (HBV) infection causes substantial morbidity, with up to 40% of infected individuals developing cirrhosis, hepatocellular carcinoma, or liver failure. Approximately 25% of individuals with chronic hepatitis B will die prematurely from these complications. Hepatitis B vaccines are safe and more than 90% effective in preventing infection in at-risk adults, yet only approximately 25% of US adults for whom vaccination is recommended by the Centers for Disease Control and Prevention are vaccinated. The rate of new HBV infections dropped substantially in the United States after the introduction and high uptake of hepatitis B vaccines in infants and children, and the burden of disease has shifted primarily to adults. There has been a resurgence of hepatitis B cases in US adults in recent years, with sharp increases in new cases noted in states highly impacted by the opioid epidemic. Improved hepatitis B vaccination coverage rates in US adults can help slow the rate of acute infections and reduce the reservoir of infection in US adults.

Objective.The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.Design.A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey.Setting.National single-payer healthcare system with 152 hospitals.Participants.Employees of the healthcare system in 2010 who responded to the survey.Methods.Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability.Results.Four factors were identified related to vaccine declination and were labeled as (1) “don't care,” (2) “don't want,” (3) “don't believe,” and (4) “don't know.” Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor.Conclusions.Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.

Invasive pneumococcal disease (IPD) is responsible for substantial clinical and economic burden in adults. Despite the safety and effectiveness of pneumococcal vaccines in protecting against these serious infections, immunization of eligible adults remains largely underused. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has recently expanded the use of the pneumococcal vaccine to include adults with asthma and all cigarette smokers, in addition to persons previously designated as at-risk. Improving adult pneumococcal immunization rates will require efforts from a broad range of healthcare providers. Clinicians should take a proactive approach in recommending the vaccine to eligible adults and should implement strategies that remove barriers to immunization efforts.

OBJECTIVE To assess influenza vaccine effectiveness against influenzalike illness (ILI) and ILI impact on health care use and school performance among college and university students. DESIGN Pooled analysis of 4 consecutive cohorts for the 2002-2003 through 2005-2006 seasons. SETTING Twin Cities campus of the University of Minnesota (2002-2003 through 2005-2006 seasons) and St. Olaf College in Northfield, Minnesota (2005-2006 season). PARTICIPANTS Full-time students received e-mail invitations to participate in single-season cohorts. Internet-based surveys collected baseline (October) and follow-up (November-April) data. MAIN EXPOSURE Influenza vaccination. MAIN OUTCOME MEASURE Proportion of students with ILI. Multivariable regression models assessed the effectiveness of vaccination for reducing ILI during months when influenza was circulating while controlling for confounders and after pooling data across the 4 cohorts. RESULTS There were 2804, 2783, 3534, and 3674 participants in the 2002-2003, 2003-2004, 2004-2005, and 2005-2006 cohorts respectively, and overall, 30.2% were vaccinated. In the pooled analysis, 24.1% of students experienced at least 1 ILI during influenza seasons. Vaccination was associated with a significant reduction in the likelihood of ILI during influenza seasons (adjusted odds ratio, 0.70; 95% confidence interval, 0.56-0.89) but not during noninfluenza periods (adjusted odds ratio, 0.98; 95% confidence interval, 0.73-1.30). Vaccination was also associated with significant reductions in ILI-associated provider visits, antibiotic use, impaired school performance, and numbers of days of missed class, missed work, and illness during the influenza seasons. CONCLUSIONS Influenza vaccination was associated with substantial reductions in ILI and ILI-associated health care use and impairment of school performance. College and university students can experience substantial benefits from influenza vaccinations.Arch Pediatr Adolesc Med. 2008;162(12):1113-1118--

We assessed the effects of an influenza season on patients with COPD. Data from 2,215 veterans in a multicenter, randomized, double-blind influenza vaccine efficacy study were analyzed for changes in spirometric and functional status, comparing patients with laboratory-documented influenza (LDI)-caused illness, non-LDI-caused respiratory illness, or no illness, and for association with influenza vaccination.

AbstractObjective:To better understand work-site–based programs for influenza vaccination.Design:Self-administered, mailed questionnaire.Setting:Healthcare and non-healthcare companies.Participants:Random sample of 2,000 members of the American Association of Occupational Health Nurses.Results:The response rate was 55%, and 88% of the respondents were employed by companies sponsoring work-site influenza vaccination. Thirty-two percent of respondents worked for healthcare and healthcare-related services companies. Healthcare companies were more likely to sponsor worksite-based vaccination (94% vs 85%; P< .0001) compared with non-healthcare companies. Healthcare companies were also more likely to encourage vaccination of high-risk employees (70% vs 55%; P< .0001) and cover its cost (86% vs 61%; P< .0001). Multivariate logistic regression was used to determine factors associated with highly successful vaccination. Being a healthcare-related company (OR, 2.1; CI951.4–3.2; P< .0001), employers covering the vaccination cost (OR, 3.1; CI95, 1.4–6.6; P= .004), having more experience with work-site vaccination (OR, 1.6; CI95, 1.0–2.4; P= .036), and management encouraging vaccination (OR, 2.6; CI95, 1.4–4.9; P= .002) were associated with highly successful programs.Conclusions:Most of the occupational health nurses surveyed work for employers sponsoring work-site vaccination, and 32% were employed by healthcare and related services companies. Healthcare companies were more likely to sponsor worksite–based vaccination and to vaccinate most of their employees; however, only 18% had vaccination rates higher than 50%. Strategies need to be developed to increase vaccination rates so that benefits of vaccination can be realized by employers and employees.

AbstractObjective:To better understand work-site–based programs for influenza vaccination.Design:Self-administered, mailed questionnaire.Setting:Healthcare and non-healthcare companies.Participants:Random sample of 2,000 members of the American Association of Occupational Health Nurses.Results:The response rate was 55%, and 88% of the respondents were employed by companies sponsoring work-site influenza vaccination. Thirty-two percent of respondents worked for healthcare and healthcare-related services companies. Healthcare companies were more likely to sponsor worksite-based vaccination (94% vs 85%; P< .0001) compared with non-healthcare companies. Healthcare companies were also more likely to encourage vaccination of high-risk employees (70% vs 55%; P< .0001) and cover its cost (86% vs 61%; P< .0001). Multivariate logistic regression was used to determine factors associated with highly successful vaccination. Being a healthcare-related company (OR, 2.1; CI951.4–3.2; P< .0001), employers covering the vaccination cost (OR, 3.1; CI95, 1.4–6.6; P= .004), having more experience with work-site vaccination (OR, 1.6; CI95, 1.0–2.4; P= .036), and management encouraging vaccination (OR, 2.6; CI95, 1.4–4.9; P= .002) were associated with highly successful programs.Conclusions:Most of the occupational health nurses surveyed work for employers sponsoring work-site vaccination, and 32% were employed by healthcare and related services companies. Healthcare companies were more likely to sponsor worksite–based vaccination and to vaccinate most of their employees; however, only 18% had vaccination rates higher than 50%. Strategies need to be developed to increase vaccination rates so that benefits of vaccination can be realized by employers and employees.

Six of 106 older men with hemoptysis and a nonsuspicious chest roentgenogram who underwent fiberoptic bronchoscopy were found to have cancer. Four of the five bronchogenic carcinomas appeared to be surgically resectable. Cancer patients were significantly older, had smoked within the last five years, and had a significantly higher frequency of central abnormalities on chest roentgenogram. Six additional bronchogenic carcinomas were diagnosed at follow-up. Two of these were probably present but not detected at the time of bronchoscopy. We conclude that (1) hemoptysis with a nonsuspicious chest roentgenogram carries an appreciable risk of cancer in older men with substantial smoking histories, (2) these cancers are often resectable, (3) a chest roentgenogram in which the central lung fields are obscured in any way should not be considered negative in patients with hemoptysis, and (4) a negative bronchoscopic examination does not exclude the possibility of cancer in these patients.

BACKGROUND: This study was conducted to assess medical students' immunity to vaccine-preventable diseases, their exposure to these diseases, and their attitudes toward immunity to vaccine-preventable diseases. METHODS: A cross-sectional, mailed survey was conducted of all 249 senior medical students in the 1991 graduating class at the University of Minnesota, Minneapolis. Two mailings were sent during the autumn of their senior year. RESULTS: The response rate was 77.5%. More than 90% of the students reported that they were immune to measles, mumps, rubella, and hepatitis B but only 23% were immune to influenza. Fewer than half of the students had ever been queried about their immune status prior to clinical clerkships. One third of the students had had a needlestick exposure during their clinical training (including 8% to a known hepatitis B carrier) and only 52% of these were reported by the student. Ten percent to 20% of the students felt that immunity to measles, mumps, and rubella was only somewhat or not very important. Less than one third of the students felt that immunity to influenza was important for themselves as health care providers. CONCLUSION: This study documented inadequate levels of immunity among medical students to certain vaccine-preventable diseases, that exposure to vaccine-preventable diseases was fairly common during clinical training, and that medical students often had inadequate attitudes about immunity to vaccine-preventable diseases. These findings have implications for medical school immunization policies and curriculum content.(Arch Intern Med. 1993;153:1913-1916)

The Minneapolis and Pittsburgh Veterans Affairs Medical Centers conduct virtually identical institution-wide influenza vaccination programs that include annual educational and publicity mailings to all outpatients. Despite these efforts, 40% to 50% of high-risk outpatients at both centers fail to receive influenza vaccine each year. To assess differences between high-risk vaccine recipients and nonrecipients, a self-administered questionnaire was mailed to 500 randomly selected outpatients from each site. The questionnaire asked about risk factors, vaccination status, and knowledge and attitudes regarding influenza and "flu shots." Patient risk characteristics and vaccination rates in Minneapolis and Pittsburgh were similar with 75.6% and 76.3% reporting high-risk conditions and 65.6% and 56.1% of high-risk respondents reporting influenza vaccination, respectively. High-risk vaccine recipients and nonrecipients had similar knowledge but different attitudes about influenza and "flu shots." Using stepwise logistic regression, factors positively associated with vaccination behavior were: intention to follow physician or nurse recommendations for "flu shots" (odds ratio [OR] = 7.09); previous vaccination behavior (OR = 6.36); and physician or nurse recommendations for a "flu shot" (OR = 4.29). Factors negatively associated with vaccination behavior were difficulty in coming to the medical center (OR = 0.42) and previous side effects from the vaccine (OR = 0.19). These findings suggest areas in need of additional emphasis if influenza vaccination rates are to be improved.(Arch Intern Med. 1992;152:106-110)

This study assesses the ability of a blood donor cholesterol screening program to enhance awareness of cholesterol levels among screenees and to promote lifestyle changes and physician follow-up. Beginning in November 1990, all blood donors at the Minneapolis Veterans Affairs Medical Center were offered free cholesterol screening. Each screenee also received educational materials and brief counseling from a nurse. Two weeks after donation, screenees received a postcard with their cholesterol level and information regarding recommended follow-up. Baseline information for all screenees was obtained at the time of donation through a self-administered questionnaire. Follow-up data were collected through structured telephone interviews. During the program’s first four months, 1,039 donors (33%) requested cholesterol screening. At baseline, 82.6% of screenees had at least one risk factor for coronary heart disease, and 37% had two or more risk factors. More than one third were unaware of their cholesterol levels. At follow-up, more than 95% indicated that they were aware of their cholesterol levels, and 90% of those with high cholesterol levels had followed up with their physician or made dietary or other lifestyle changes. We conclude that a cholesterol screening and minimal intervention program for blood donors enhances awareness of cholesterol levels and encourages dietary or other lifestyle changes.

As part of an effort to evaluate the effectiveness of a multifaceted, institution-wide influenza vaccination program, we mailed a self-administered postcard questionnaire to 500 randomly selected outpatients following both the 1987-1988 and 1988-1989 immunization seasons. The postcard asked if the patients received influenza vaccine, where they were immunized, whether they had any high-risk medical illnesses, their age at their last birthday, and their name. To assess the validity of the questionnaire, following the 1988 survey, we selected a 25% systematic sample of respondents and compared survey responses with medical record documentation. Response rates for the surveys were 77.6% for the 1988 survey (two mailings) and 86.5% for the 1989 survey (three mailings). Ninety-four percent (n= 89) of charts selected for audit were successfully reviewed. Agreement between questionnaire responses and medical records was excellent, with greater than 90% agreement and kappas of .8 to .9 for classifying patients as high-risk and receipt of vaccine at the Department of Veterans' Affairs Medical Center. For other data, agreement ranged from 84% to 96% with kappas of .6 to .75. Responses to the 1989 survey also demonstrated the importance of sample frame definition and response wave on estimates of risk characteristics and vaccination rates. A self-administered postcard questionnaire is a valid tool for estimating outpatient risk characteristics and influenza vaccination rates.

AbstractObjective:To assess factors associated with influenza vaccination of healthcare workers.Design:Cross-sectional survey.Setting:University-affiliated Veterans' Affairs medical center.Participants:Staff physicians and nurses employed by the medical center.Methods:A mailed, self-administered questionnaire.Results:The response rate was 38.0%. The mean age of the respondents was 43.6 years, 71.5% were females, and 26.2% were physicians. Nearly all of the practitioners had daily or weekly contact with elderly or high-risk patients. The influenza vaccination rate of the respondents was 61.2%. More than 50% of vaccine recipients indicated that avoiding illness, protecting patients, and being able to receive the vaccine conveniently and free of charge all were very important factors influencing their decisions to receive the vaccine. Avoiding illness was rated the most important factor by 58.8% of vaccine recipients. Among vaccine nonrecipients, concern about side effects was identified as a very important factor by 36.2% and as the most important factor by 30.9%.Vaccine recipients were significantly more likely than were vaccine nonrecipients to indicate that influenza and its complications are very serious for high-risk patients. They also were more likely to report that the vaccine is very effective, that influenza vaccination is uncommonly associated with side effects, that healthcare workers' risk for contracting influenza is higher than the general public's risk, and that it is very important for healthcare workers to receive the vaccine to decrease risk for transmission to high-risk patients. After stepwise logistic regression, variables independently associated with receipt of vaccine were age, prior receipt of vaccine, being a physician, considering the vaccine to be very effective, believing that systemic side effects are uncommon, and indicating that it is very important for healthcare workers to receive vaccine for the protection of their patients.Conclusion:Many healthcare workers fail to receive influenza vaccine each year. Strategies to improve immunization levels should address concerns about vaccine safety and efficacy, barriers to vaccination including inconvenience and cost, and the reasons for targeting healthcare workers.

A serologic survey of antibodies to Legionella pneumophilaserogroups 1 through 6 was performed to assess the prevalence of positive antibody titers among outpatients and to evaluate the association between elevated antibody titers and previously identified risk factors for legionellosis. Subjects were recruited from outpatient clinics at the Minneapolis VA Medical Center. Each participant completed a self-administered questionnaire which asked about their general health and any recent symptoms of illness. Medical records were also audited for all participants to provide additional information on medical history and known risk factors for Legionella infection. Single samples of serum were obtained from each subject, and antibody titers to L pneumophilaserogroups 1 through 6 were assayed. Three hundred ninety-six subjects were enrolled in the study. They had a mean age of 67 years, and 98 percent were male subjects. Overall, 36 percent of the subjects had positive antibody titers (≥1:128) to L pneumophila.There were no differences between those with and without elevated titers with respect to recent systemic symptoms or other previously established risk factors for legkmellosis. We conclude that positive anti-Legionella antibodies are a frequent occurrence among these outpatients. This has important implications for the interpretation of single or static antibody titers from patients who are acutely ill. (Chest 1991; 100:663-66)

• Medical students demonstrate a high degree of susceptibility to rubella and measles, and hence are at risk for infection and transmission of these viruses. The purpose of our study was to examine the role medical students play as sources or vectors in rubella and measles outbreaks. We conducted a survey of all US and Canadian public health departments to determine how often students were implicated in outbreaks (response rate, 88.7%). We also performed a literature search to identify any cases not reported to health departments, as well as examined the medical, social, and economic consequences of such outbreaks in the medical setting. Since 1981, 9% of health departments have recorded at least one outbreak of rubella or measles in which medical students were specifically implicated as sources or vectors. Increased morbidity, mortality, and adverse economic consequences resulted from these outbreaks. Our data confirm that medical students are important sources/vectors in rubella and measles outbreaks. We recommend that all medical students be immune to these viruses.(Arch Intern Med. 1990;150:44-46)