Societal impact of combination vaccines: experiences of physicians, nurses, and parents.

Crowded immunization schedules can result in missed or delayed dosing. Combination vaccines help immunize children on time, limit the required number of injections, and allow new vaccines to be added to the schedule. In the United States, a pentavalent vaccine combining diphtheria, tetanus toxoids, and acellular pertussis (DTaP), recombinant hepatitis B (HepB), and inactivated poliovirus vaccine (IPV) is available. Here, we describe the findings of informal surveys among providers, nurse managers, business managers, and parents on their attitudes toward and experiences with the DTaP-HepB-IPV vaccine. Combination vaccine use is expected to increase as more become available and awareness of their benefits grows.

Hepatitis A: disease burden and current childhood vaccination strategies in the United States.

Hepatitis A can be a serious disease and represents a substantial health and economic burden. In recent years, a decline in the number of cases of hepatitis A has been observed, which has been attributed in part to the implementation of vaccination policies in states with high disease incidence. In May 2006, the Advisory Committee on Immunization Practices published updated recommendations to include routine hepatitis A vaccination for all children beginning at 12 to 23 months of age. In this review, information on hepatitis A disease burden is presented with a discussion on the new recommendations and implementation of hepatitis A vaccination.

Public health perspectives on the rising incidence of pertussis.

OBJECTIVES: Pertussis is one of the few vaccine-preventable diseases on the rise in the United States, particularly among adolescents. We analyzed the epidemiology of pertussis, focusing on disease burden in public health, and examined methods for controlling pertussis and reducing its incidence. DESIGN, SAMPLE, AND MEASUREMENTS: We evaluated current knowledge about pertussis, reported cases of pertussis in the United States, and the changing recognition, diagnosis, and management of the disease. The development of a pertussis vaccine, now licensed and recommended for use in adolescents and adults, was reviewed. RESULTS: Of reported cases in 2004, 38% occurred in adolescents. The increased incidence of pertussis may be the result of better diagnosis, better reporting, and increased awareness of the disease. The burden of adolescent and adult pertussis is significant and includes medical visits, laboratory tests, treatment for cases and contacts, time lost from school and work, disruption of schools experiencing outbreaks, and public health and media turmoil. At current disease rates, the financial cost of adolescent pertussis in this decade is projected at $3.2 billion. CONCLUSIONS: Efforts are needed to increase health care providers' knowledge of pertussis disease and vaccines, improve on-time infant immunization rates, promote immunization registries and public health surveillance, and ensure adequate compensation for vaccine purchase and administration. Universal recommendations for and widespread use of acellular pertussis vaccines in adolescents are the most effective measures in controlling the disease.

Homecare issues in rotavirus gastroenteritis.

PURPOSE: This article will describe the burden of rotavirus gastroenteritis (RGE) and its management, highlighting educational issues that nurse practitioners can assist caregivers to enhance at-home management. DATA SOURCE: A Medline search of the medical literature was used to identify articles that describe the burden, clinical presentation, and management of RGE. CONCLUSIONS: RGE is a serious medical condition characterized by diarrhea and vomiting and is a major cause of morbidity and hospitalization among children aged 5 years or younger. Proper at-home treatment can be challenging; however, improved home care may limit emergency department visits and hospitalizations. IMPLICATIONS FOR PRACTICE: Mild to moderate RGE may be successfully managed at home if caregivers are adequately educated in deciding when a child needs to be evaluated in a physician's office and in managing dehydration at home.

Strengthening the supply of routinely recommended vaccines in the United States: recommendations from the National Vaccine Advisory Committee.

Between late 2000 and the spring of 2003, the United States experienced shortages of vaccines against 8 of 11 preventable diseases in children. In response, the Department of Health and Human Services requested that the National Vaccine Advisory Committee (NVAC) make recommendations on strengthening the supply of routinely recommended vaccines. The NVAC appointed a Working Group to identify potential causes of vaccine supply shortages, develop strategies to alleviate or prevent shortages, and enlist stakeholders to consider the applicability and feasibility of these strategies. The NVAC concluded that supply disruptions are likely to continue to occur. Strategies to be implemented in the immediate future include expansion of vaccine stockpiles, increased support for regulatory agencies, maintenance and strengthening of liability protections, improved communication among stakeholders, increased availability of public information, and a campaign to emphasize the benefits of vaccination. Strategies requiring further study include evaluation of appropriate financial incentives to manufacturers and streamlining the regulatory process without compromising safety or efficacy.

Communicating the benefits of combination vaccines to parents and health care providers.

Infants may receive as many as 5 separate injections at an office visit in order to comply with the 2002 childhood immunization schedule. Many parents and healthcare providers disagree with administering 4 or 5 injections at one visit, and therefore may delay some injections until another visit. This practice may lead to decreased compliance and can increase costs for the parent. New combination vaccines will help to simplify the immunization schedule, and health care providers will need to be able to address parental concerns regarding these vaccines. Nurses are often responsible for administering vaccines in the office setting, and therefore are also influential in deciding which vaccines should be ordered. The purpose of this article is to educate nurses on communicating the benefits of combination vaccines to parents and other healthcare providers.