The course and management of the 2009 H1N1 pandemic influenza.

The 2009 influenza A (H1N1) pandemic provided a major test to the public health system in the United States and abroad. Although the virus was rapidly identified, it took longer than expected to bring an effective vaccine to market. During the interim the virus demonstrated a predilection for infecting younger persons, particularly those with medical conditions such as asthma or pregnancy, placing them at risk. Early treatment with neuraminidase inhibitors was found to be of some benefit. When the 2009 H1N1 influenza A vaccine became available, there were distribution issues in matching the number of doses to areas of need.

Using the tetravalent meningococcal polysaccharide-protein conjugate vaccine in the prevention of meningococcal disease.

Invasive meningococcal disease occurs worldwide causing an estimated 50,000-135,000 deaths each year in addition to significant sequelae. In developed countries the disease is usually sporadic but outbreaks and epidemics, usually due to serogroups B and C, have occurred. In the US, an increasing number of cases are due to serogroup Y. In developing nations, epidemics due to serogroups A and more recently W-135, are common. The tetravalent meningococcal conjugate vaccine to serogroups A, C, Y, and W-135 (MCV4) has been demonstrated to be highly immunogenic and promote immune memory. This article will describe the rationale for the vaccine and its potential role to significantly decrease mortality and morbidity of meningococcal disease in those areas and populations at greatest risk from these serogroups.

An evaluation of immunization education resources by family medicine residency directors.

BACKGROUND AND OBJECTIVES: Immunization is a rapidly evolving field, and teachers of family medicine are responsible for ensuring that they and their students are knowledgeable about the latest vaccine recommendations. METHODS: A survey was mailed to 456 family medicine residency directors across the United States to obtain their evaluation of immunization resources developed by the Society of Teachers of Family Medicine's Group on Immunization Education. Frequencies, measures of central tendency, and differences between responses from 2001 to 2005 were analyzed. RESULTS: Directors of 261 (57%) family medicine residencies responded, with >80% reporting satisfaction with immunization teaching resources. The popularity of bound resources decreased from 2001 to 2005, while immunization Web sites increased in importance. The journal supplement, "Vaccines Across the Lifespan, 2005" was less frequently read in 2005 than its predecessor published in 2001, but quality ratings remained high. Use of the Web site, www.ImmunizationEd.org, and the Shots software for both desktop and handheld computers has increased since their creation. CONCLUSIONS: Electronic immunization teaching resources are increasingly popular among family medicine residencies. As the field continues to change, the use of electronic resources is expected to continue, since they are easily updated and, in the case of www.ImmunizationEd.org and Shots software, are available free of charge.

Routine vaccines across the life span, 2007.

Routine vaccines are listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule published by the Centers for Disease Control and Prevention and reviewed and updated by the Advisory Committee on Immunization Practices. For these vaccines, we discuss the disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations. Some new vaccines are discussed here (Tdap and zoster), whereas others (rotavirus and human papillomavirus) are discussed elsewhere in the supplement.

Addressing immunization barriers, benefits, and risks.

Vaccines have been highly effective in eliminating or significantly decreasing the occurrence of many once-common diseases. Barriers to immunization are a significant factor in the rising incidence rates of some vaccine-preventable diseases. Cost, reduced accessibility to immunizations, increasingly complex childhood and adolescent/adult immunization schedules, and increasing focus on the potential adverse effects of vaccines all contribute to difficulty in meeting the 2010 immunization goals. Physicians must not only be knowledgeable about vaccines but they must incorporate systems in their offices to record, remind, and recall patients for vaccinations. They must also clearly communicate vaccine benefits and risks while understanding those factors that affect an individual's acceptance and perception of those benefits and risks.

Practical implementation of HPV vaccines in clinical practice.

Human papillomavirus (HPV) currently infects approximately 20 million people in the United States. An effective new vaccine has been approved for girls and young women aged 9 to 26 years that can decrease the spread of infection due to HPV and the future incidence of cervical cancer and genital warts. Family physicians should be aware of parental or patient attitudes and knowledge about HPV and concerns about HPV vaccination if they are to successfully implement HPV vaccination in their practices.

Prevention of meningococcal disease.

Invasive disease caused by Neisseria meningitidis has an average annual incidence of one case per 100,000 in the United States. The disease can be rapidly fatal or result in severe neurologic and vascular sequelae despite antibiotic therapy. Antibiotic chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone is required for household and other close contacts. Although the majority of cases of meningococcal disease are sporadic, outbreaks can occur, and vaccination of the affected population often is necessary. Serogroup B accounts for the highest incidence of disease in young infants but is not contained in any vaccine licensed in the United States. Adolescents and young adults 15 to 24 years of age have a higher incidence of disease and a higher fatality rate than other populations. Because 70 to 80 percent of these infections in the United States are caused by meningococcal serogroups C, Y, and W-135, which are contained in the tetravalent meningococcal vaccines, they are potentially preventable. The U.S. Food and Drug Administration recently approved a meningococcal conjugate vaccine containing serogroups A, C, Y, and W-135. This T-cell-dependent vaccine induces bactericidal antibody production and promotes immunologic memory that should result in a longer duration of immunity. The Advisory Committee on Immunization Practices recommends that this vaccine be given to 11- and 12-year-old adolescents, to adolescents entering high school, and to college freshmen living in dormitories. The vaccine also may be given to persons 11 to 55 years of age who belong to certain high-risk groups.

Communicating the benefits and risks of vaccines.

Vaccines have been highly effective at eliminating or significantly decreasing the incidence of many once-common diseases. However, the public is now focusing on the potential adverse effects of vaccines. Proper communication of vaccine benefits and risks requires an understanding of factors that affect an individual's acceptance and perception of those benefits and risks. Physicians should be prepared to answer patients' or parents' questions about common as well as alleged vaccine-related adverse events and must utilize the Vaccine Information Statements for vaccines covered under the National Vaccine Injury Compensation Program.

Routine vaccines across the life span, 2005.

Routine vaccines include those listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule. The disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations are discussed in relation to each vaccine. Pictures of vaccine-preventable diseases are included.

Educating grade school children using a structured bicycle safety program.

BACKGROUND: Prevention is understudied in trauma care. Furthermore, the effectiveness of prevention outreach programs is not well documented. We attempted to verify that elementary school educational programs effectively create retained knowledge. METHODS: Three hundred fifty-one students (grades 1-3) viewed a bicycle safety videotape and then listened to a structured discussion of bicycle safety rules. Coded pretests were given before and identical posttests were given immediately after the session. Tests were readministered 1 month later to evaluate retained knowledge. Two hundred fifty-one students completed all three tests. RESULTS: Students showed significant (p < 0.01) improvement in retained knowledge about riding with traffic, wearing a bicycle helmet, warning pedestrians when riding on sidewalks, and stopping before riding into the street. CONCLUSION: We conclude that prevention programs are effective and result in retained knowledge. Further analysis is recommended to evaluate retained knowledge at greater intervals after the original education.

Immunization education among family practice residency programs.

BACKGROUND AND OBJECTIVES: The dynamic nature of immunization schedules, shortages, and administration techniques makes keeping up to date with current national recommendations difficult and necessitates periodic evaluation of immunization teaching resources. METHODS: This study surveyed family practice residency program directors in 1998 to assess their satisfaction with immunization teaching resources and interest in new resources. Subsequently, with funding from the Centers for Disease Control and Prevention, the Society of Teachers of Family Medicine Group on Immunization Education developed a series of educational materials devoted to educating family physicians about immunizations. In 2001, residency directors were surveyed again to evaluate the educational resources. RESULTS: Most program directors reported satisfaction with resources currently available to them for teaching residents about childhood immunizations, but about half (41% in 1998 versus 55% in 2001) agreed that keeping up to date on childhood immunizations was difficult. The corresponding figures for adult immunizations were 27% in 1998 and 36% in 2001. Pocket-size immunization schedules were ranked highly important (53% in 1998 versus 45% in 2001). Many would use handheld computer immunization schedules (53%). Although satisfaction with available resources did not increase following introduction of a newly developed journal supplement and Web site, the limited response received was favorable. CONCLUSIONS: Immunization teaching materials developed by family physicians, especially those that make use of evolving technologies, can be useful resources for individuals teaching family practice residents and for keeping up to date on recommendations for immunizations.

Vaccines and bioterrorism: smallpox and anthrax.

Because of the success of vaccination and the ring strategy in eradicating smallpox from the world, smallpox vaccine has not been recommended for the United States civilian populations for decades. Given the low but possible threat of bioterrorism, smallpox vaccination is now recommended for those teams investigating potential smallpox cases and for selected personnel of acute-care hospitals who would be needed to care for victims in the event of a terrorist attack. Treatment and post-exposure prophylaxis for anthrax are ciprofloxacin or doxycycline. Anthrax vaccine alone is not effective for post-exposure prevention of anthrax; vaccination is accompanied by 60 days of antibiotic therapy. In addition to military use, anthrax vaccine is recommended for pre-exposure use in those persons whose work involves repeated exposure to Bacillus anthracis spores.

Addressing immunization barriers, benefits, and risks.

Immunization rates in the United States still fall short of the Healthy People 2010 goals for children and adults. To improve rates of immunization, physicians need to understand and address barriers to immunization, including fragmented health-care delivery, missed opportunities to vaccinate, and the patient's fear of adverse reactions. This article addresses these issues and suggests strategies by which rates can be improved, such as patient reminders, standing orders, and assessment of and feedback on practitioner performance. Additionally, it provides suggestions to help physicians better communicate vaccine risks and benefits to their patients, potentially affecting an individual's acceptance of those risks. It describes the appropriate use of materials such as the Vaccine Information Statements. Physicians should also be prepared to answer patients' questions about alleged or controversial vaccine adverse events.

Vaccine adverse events: separating myth from reality.

Vaccines have turned many childhood diseases into distant memories in industrialized countries. However, questions have been raised about the safety of some vaccines because of rare but serious adverse effects that have been attributed to them. Pain, swelling, and redness at the injection site are common local reactions to vaccines. Fever and irritability may occur after some immunizations. Currently, no substantial evidence links measles-mumps-rubella vaccine to autism, or hepatitis B vaccine to multiple sclerosis. Thimerosal is being eliminated from routine childhood vaccines because of concerns that multiple immunizations with vaccines containing this preservative could exceed recommended mercury exposures. Family physicians should be knowledgeable about vaccines so that they can inform their patients of the benefits of immunization and any proven risks. If immunization rates fall, the incidence of vaccine-preventable illnesses may rise.