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A study aims to evaluate the effectiveness of the influenza vaccine among persons 65 years or older. The results conclude that the vaccine is effective in reducing significantly the need for hospitalization due to pneumonia or influenza.

OBJECTIVES. Children POPULATION AND SETTING. We evaluated 125 928 children 6 months through 8 years of age who were enrolled in health maintenance organizations in the United States participating in the Vaccine Safety Datalink project and who received their first dose of trivalent inactivated influenza vaccine in the 2001-2002, 2002-2003, or 2003-2004 influenza seasons. RESULTS. Compliance with the 2 dose recommendations varied by age group and influenza season. Among children 6 to 23 months of age, the proportion of first-vaccinated children who received a second vaccination was 44% in 2001-2002, 54% in 2002-2003, and 29% in 2003-2004. Among children 2 to 8 years of age, the corresponding proportions were 15%, 24%, and 12%, respectively. In all seasons, compliance with the second vaccination was highest in children first vaccinated by mid-November. CONCLUSIONS. The majority of children who received their first dose of trivalent inactivated influenza vaccine did not complete the 2-dose series. The recently expanded recommendation for universal vaccination of children 6 to 59 months of age and their household contacts will substantially increase the number of children targeted for a first influenza vaccination. Noncompliance with the 2-dose trivalent inactivated influenza vaccine series may be associated with suboptimal protection against infection, which may impact the magnitude of the direct and indirect benefits achieved by the vaccination program. Key Words influenza, influenza vaccine Abbreviations TIV--trivalent inactivated influenza vaccine HAI--hemagglutination-inhibition HMO--health maintenance organization, CHILDREN Children who have not been exposed previously to influenza viruses, either as a consequence of vaccination or natural infection, do not respond optimally to a single dose of trivalent [...]

A study was conducted to screen for medically attended events in the clinic, emergency department or hospital after administration of trivalent inactivated influenza vaccine in children 6 to 23 months old. It is found that in the largest population-based study to date of the safety of trivalent inactivated influenza vaccine in young children, there were very few medically attended events, none of which were serious, significantly associated with the vaccine.

Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care. Methods. Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization. Of 3747 teens invited at [greater than or equal to] 1 visits, 2526 (67%) consented and were randomized to tobacco intervention or brief dietary advice. The tobacco intervention was individually tailored on the basis of smoking status and stage of change. It included a 30-second clinician advice message, a 10-minute interactive computer program, a 5-minute motivational interview, and up to two 10-minute telephone or in-person booster sessions. The control intervention was a 5-minute motivational intervention to promote increased consumption of fruits and vegetables. Follow-up smoking status was assessed after 1 and 2 years. Results. Abstinence rates after 2 years were significantly higher for the tobacco intervention arm, relative to the control group, in the combined sample of baseline smokers and nonsmokers (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03-1.47). Treatment effects were particularly strong among baseline self-described smokers (OR: 2.42; 95% CI: 1.40-4.16) but were not significant for baseline nonsmokers (OR: 1.25; 95% Ch 0.97-1.61) or for those who had "experimented" in the past month at baseline (OR: 0.95; 95% CI: 0.45-1.98). Conclusions. Brief, computer-assisted, tobacco intervention during routine medical care increased the smoking cessation rate among self-described smokers but was less effective in preventing smoking onset. Pediatrics 2005;115:981-989; tobacco, adolescents, intervention, cessation, primary care., ABBREVIATIONS. OR, odds ratio; CI, confidence interval; GEE, generalized estimating equations; PTC, Pathways to Change. Tobacco use remains the number I cause of preventable morbidity and death in the United [...]

Objectives. To evaluate compliance with national immunization guidelines among a large cohort of children cared for at health maintenance organizations (HMOs) and to examine effects on immunization status. Methods. A cohort study of 176 134 children born between January 1, 1994, and December 31, 1997, and monitored from birth to the second birthday was performed. Subjects belonged to the Vaccine Safety Datalink Project, a study of children enrolled in 1 of 4 HMOs. Children were continuously enrolled in a HMO for the first 2 years of life. Prevailing recommendations regarding optimal ages of immunization and intervals between doses were applied to define appropriate immunization timing and immunization status. Noncompliance was defined as having a missing or late immunization or an immunization error. Immunization errors included invalid immunizations (too early to be acceptable), extra immunizations (superfluous immunizations or make-up immunizations for invalid immunizations), and missed opportunities resulting in late or missing immunizations. Results. Although 75.4% of children in these HMOs were up to date for all immunizations at 2 years, only 35.6% of children were fully compliant with recommended immunization practices. Less than 8% of children received all immunizations in accordance with strict interpretation of recommended guidelines. Fifty-one percent of children had at least 1 immunization error by age 2 years; 29.7% had a missed opportunity with subsequent late or missing immunization, 20.4% had an invalid immunization, and 11.6% had an extra immunization. Common reasons for noncompliance included missed opportunities for the fourth Haemophilus influenzae type b vaccine (14.6%), invalid fourth diphtheria-tetanus-pertussis/acellular pertussis immunizations (11.0%), and superfluous polio immunizations (9.8%). Conclusions. Approximately 35.6% of children were compliant with prevailing childhood immunization recommendations from 1996 to 1999. Efforts to improve compliance with guidelines are recommended, to optimize childhood infectious disease prevention. Pediatrics 2005; 115:461-467; compliance, immunization, guidelines, health maintenance organization., ABBREVIATIONS. HMO, health maintenance organization; Hib, Haemophilus influenzae type b; DTP, diphtheria-tetanus-pertussis; DTaP, diphtheria-tetanus-acellular pertussis; HBV, hepatitis B virus; IPV, inactivated polio vaccine; OPV, oral polio vaccine; MMR, measles-mumps-rubella; VSD, [...]

Objective. To quantify the risk of anaphylaxis after vaccination of children and adolescents. Methods. The study population consisted of children and adolescents who were enrolled at 4 health maintenance organizations that participated in the Vaccine Safety Datalink Project. For the period 1991-1997, we identified potential cases by searching for occurrences of International Classification of Diseases, Ninth Revision (ICD-9) code 995.0 (anaphylactic shock), E948.0 through E948.9 (adverse reaction from bacterial vaccines), and E949.0 through E949.9 (adverse reaction from other vaccines and biological substances). At 1 study site, we also included a range of other allergy codes. We restricted to diagnoses on days 0 to 2 after vaccination (ICD-9 995.0) or day 0 (all other ICD-9 codes). We then reviewed the medical record to confirm the diagnosis. Results. We identified 5 cases of potentially vaccine-associated anaphylaxis after administration of 7 644 049 vaccine doses, for a risk of 0.65 cases/million doses (95% confidence interval: 0.21-1.53). None of the episodes resulted in death. Vaccines that were administered before the anaphylactic episodes were generally given in combination and included measles-mumps-rubella, hepatitis B, diphtheria-tetanus, diphtheria-tetanus-pertussis, Haemophilus influenzae type b, and oral polio vaccine. One case of anaphylaxis followed measles-mumps-rubella vaccine alone. At the site at which we reviewed additional allergy codes, we identified 1 case after 653 990 vaccine doses, for a risk of 1.53 cases/million doses (95% confidence interval: 0.04-8.52). Conclusions. Patients and health care providers can be reassured that vaccine-associated anaphylaxis is a rare event. Nevertheless, providers should be prepared to provide immediate medical treatment should it occur. Pediatrics 2003;112:815-820; anaphylaxis, vaccination, vaccine adverse reactions., ABBREVIATIONS. MMR, measles-mumps-rubella; HMO, health maintenance organization; VSD, Vaccine Safety Datalink; ICD-9, International Classification of Diseases, Ninth Revision; CI, confidence interval; DT, pediatric diphtheria-tetanus; DTP, diphtheria-tetanus-whole cell pertussis; Hib, Haemophilus [...]

Vaccination against influenza can lower the risk of death from any cause in elderly people by up to 50%, according to a study of about 300,000 people 65 years old and older. It also reduces the risk of hospitalization for heart disease, stroke, and pneumonia, as well as influenza. Only 60% of the elderly people in this study had been vaccinated against influenza.

Objective. To investigate trends over time in polio extraimmunization among children in 4 large health maintenance organizations and to study the association with recent changes in polio immunization policy. Methods. Using 176 169 children who were born after 1994 and enrolled for their first 2 years of life, we assessed rates and trends of polio extraimmunization in the Vaccine Safety Datalink project. We used logistic regression to test the association of extraimmunization with different polio immunization schedules and with sociodemographic characteristics and used Poisson regression to test changes in rates over time. Results. Overall, 10.5% were extraimmunized for poliovirus; children on the all inactivated polio virus or sequential schedule were one half as likely as those on the all oral polio virus schedule to be extraimmunized by 2 years of age. There was a significant decrease in extraimmunization over time, with < 5% of children born at the end of 1997 being extraimmunized, compared with > 15% at the beginning of 1994. Conclusions. Poliovirus extraimmunization rates have fallen dramatically in association with the changeover to the all inactivated polio virus schedule. Pediatrics 2003;111:296-301; extraimmunization, polio vaccine., ABBREVIATIONS. OPV, oral polio virus; IPV, inactivated polio virus; DTP, diphtheria and tetanus toxoids and whole-cell pertussis; DTaP, diphtheria and tetanus toxoids and acellular pertussis; Hib, Haemophilus influenzae type b; [...]

Objective. In 1995, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis B (HB) vaccination of all unvaccinated 11- to 12-year-old adolescents. Little is known about the implementation of these recommendations in a managed care setting. The objective of this study was to determine the impact of ACIP recommendations on HB vaccination among adolescents in 3 managed care settings. Methods. We assessed HB vaccination coverage among adolescents who were enrolled in 3 large health maintenance organizations (HMOs) and who turned 13 years old after the 1995 ACIP recommendations. Children who were 8 to 10 years of age during May 1993 and were continuously enrolled through December 1998 were eligible. We used the HMOs&apos; computerized immunization tracking system to collect HB vaccination dates. The percentage of adolescents who received 3 doses of HB vaccine was determined. Results. In HMOs A, B, and C, coverage levels for 3 doses of HB vaccine were 43.4%, 65.5%, and 25.7%, respectively, among 13-year-olds in 1998 compared with 26.1%, 50.4%, and 5.5% among 13-year-olds in 1996. Between the ages of 11 and 13 years, coverage rates among adolescents aged 13 in 1998 rose more than the coverage among adolescents aged 13 in 1996. The proportion of 13-year-olds in 1998 who received the first dose of HB vaccine by December 1998 was much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B, and C, respectively, compared with the proportion who completed the 3-dose series (43.4%, 65.5%, and 25.7%, respectively). Conclusions. After the 1995 ACIP recommendations, HB vaccination coverage levels among 13-year-olds increased in each of the HMOs, suggesting adherence with national recommendations. Differences among the 3 HMOs may reflect differences in internal policies. More effective strategies may be needed to achieve the Healthy People 2010 goal of 90% vaccination coverage rates among adolescents. Pediatrics 2002;110:929-934; hepatitis B vaccine, adolescence, health maintenance organizations, managed care, vaccination, immunization., Prevention of hepatitis B virus (HBV) infection through vaccination of adolescents before they enter adulthood is crucial because young adults have the highest incidence of HBV infection in the United [...]

The DTP and MMR vaccines may cause fever and a seizure in children a few days after vaccination, but this side effect will not last and does not produce long-term neurological disability. This was the conclusion of a study of 679,942 children vaccinated at four large HMOs.

Data collected by the Vaccine Safety Datalink Project appears to be consistent with known vaccine safety characteristics and may prove useful for monitoring and studying vaccine safety. This database links vaccine data on over 500,000 children at four health maintenance organizations. Three years of data collection has shown that a measles-mumps-rubella vaccine triples the seizure risk eight to 14 days after vaccination and a diphtheria-tetanus-pertussis vaccine doubles the seizure risk on the day of vaccination. There appears to be no increased seizure risk associated with the influenza type b vaccine., Objective. To fill the large "gaps and limitations" in current scientific knowledge of rare vaccine adverse events identified in recent reviews of the Institute of Medicine. Methods. Computerized information on immunization, medical outcomes, and potential confounders on more than 500 000 children 0 to 6 years of age is linked annually at several health maintenance organizations to create a large cohort for multiple epidemiologic studies of vaccine safety. Results. Analysis of 3 years of follow-up data shows that 549 488 doses of diphtheria-tetanus-pertussis (DTP) and 310 618 doses of measles-mumps-rubella (MMR) vaccines have been administered to children in the study cohort. Analyses for associations between vaccines and 34 medical outcomes are underway. Screening of automated data shows that seizures are associated with receipt of DTP on the same day (relative risk [RR], 2.1; 95% confidence interval [CI], 1.1 to 4.0) and 8 to 14 days after receipt of MMR (RR, 3.0; 95% CI, 2.1 to 4.2). The diversity of vaccination exposures in this large cohort permits us to show that an apparent association of seizures 8 to 14 days after Haemophilus influenzae type b vaccine (RR, 1.6; 95% CI, 1.2 to 2.1) was attributable to confounding by simultaneous MMR vaccination; the association disappears with appropriate adjustment (RR, 1.0; 95% CI, 0.7 to 1.4). Conclusion. Preliminary design, data collection, and analytic capability of the Vaccine Safety Datalink project has been validated by replication of previous known associations between seizures and DTP and MMR vaccines. The diversity in vaccine administration schedules permits potential disentangling of effects of simultaneous and combined vaccinations. The project provides a model of public health-managed care collaborations in addition to an excellent :infrastructure for safety and other studies of vaccines. Pediatrics 1997;99:765-773; vaccines, immunization, adverse reactions, databases, record linkage, vaccine safety., ABBREVIATIONS. VAERS, Vaccine Adverse Event Reporting System; IOM, Institute of Medicine; CDC, Centers for Disease Control and Prevention; LLDB, large linked database; VSD, Vaccine Safety Datalink; HMO, health maintenance organization; [...]

Primary care physicians who improve their communication skills may be less likely to be sued. Researchers videotaped 10 consecutive office visits of 124 physicians, 59 of whom were primary care physicians and 65 were surgeons. About half of the primary care physicians had been sued as had two-thirds of the surgeons. Primary care physicians who had never been sued spent more time with the patient, used humor often and encouraged the patient to talk. No such differences could be found among the surgeons. These communication skills can easily be learned., Objective.--To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. Design.--Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. Settings.--ne hundred twenty-four physician offices in Oregon and Colorado. Participants.--Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims ([Greater than or equal to] 2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. Main Outcome Measures.--Audiotape analysis using the Roter Interaction Analysis System. Results.--Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients&apos; opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. Conclusions.--Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. MalpraCtice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups. JAMA. 1997;277:553-559