US disaster planners' attitudes regarding preevent vaccine for first responders and point-of-dispensing workers.

Disaster planners' attitudes toward pre-event anthrax and smallpox vaccine for first responders and point-of-dispensing (POD) workers have not been examined. An online questionnaire was sent to US Cities Readiness Initiative (CRI) and non-CRI public health disaster planners in 2013. Multivariate logistic regressions were used to assess determinants of belief that first responders and POD workers should be offered the anthrax and/or smallpox vaccine before an event. A total of 301 disaster planners participated. Only half (50.6%, n=126) were aware of the ACIP recommendation that first responders could be offered pre-event anthrax vaccine. Many (66.0%, n=164) believed that pre-event anthrax vaccine should be offered to first responders. The oldest respondents were least likely to believe anthrax vaccine should be given (OR: 0.27, 0.12, 0.63, p<.001). Fewer disaster planners believed that pre-event anthrax vaccine should be offered to POD workers compared to first responders (55.0% vs 66.0%, X(2)=151, p<.001). Almost 20% (18.3%, n=47) reported having already received pre-event smallpox vaccine. Among the unvaccinated (n=210), half (52.0%, n=105) were willing to receive pre-event smallpox vaccine if it was offered free of charge. Half (53.4%, n=133) believed that POD workers should be offered smallpox vaccine before an event. Many disaster planners support pre-event anthrax vaccination for first responders and POD workers, and about half support pre-event smallpox vaccine for POD workers. Jurisdictions should consider partnering with first responder agencies to implement a pre-event anthrax vaccination program.

Infection prevention and mass vaccination training for U.S. point of dispensing staff and volunteers: a national study.

BACKGROUND: Points of dispensing (PODs) are deployed for medical countermeasure mass dispensing. However, infection prevention and vaccine administration pre-event training offered and just-in-time (JIT) education planned for POD workers have not been assessed. METHODS: Disaster planners were sent an online questionnaire in 2013. McNemar tests compared training offered to staff versus volunteers and pre-event training versus JIT training. RESULTS: In total, 301 disaster planners participated. The most frequent pre-event training included hand hygiene (59.1% and 28.0%) and personal protective equipment (PPE) selection (52.1% and 24.1%) for staff and volunteers, respectively. Few provided pre-event training on the cold chain technique (14.8% and 5.1%) or smallpox vaccine administration (4.7% and 2.3%) for staff or volunteers. For all topics except smallpox vaccine administration, more staff than volunteers received pre-event training (P < .01). The most frequent planned JIT training includes hand hygiene (79.8% and 73.5%) and PPE selection (79.4% and 70.0%) to staff and volunteers. For all topics, more JIT education is planned for staff than volunteers (P < .001). More JIT training is planned than has been given pre-event for all topics (P < .001). CONCLUSION: More pre-event training is needed on infection prevention and vaccine administration to ensure safe and successful POD deployment.

Hepatitis A outbreak activity in the United States: responding to a vaccine-preventable disease.

BACKGROUND: The occurrence of hepatitis A in the United States is heterogeneous because of disease cycles with substantial variation in incidence among states and involvement of numerous behavioral risk factors. In spite of the Advisory Committee on Immunization Practices' (ACIP) 1999 recommendation for routine hepatitis A immunization in states with high rates of disease and the fact that disease rates are at a historic low, outbreaks continue to occur. METHODS: We reviewed outbreaks of hepatitis A in the United States occurring from 1994 through 2004. We searched PubMed, ProMed, Google, and the CDC Foodborne Disease Outbreak and Epi-X Internet sites to ascertain the number and type of hepatitis A outbreaks. The CDC's MMWR publication and the Hepatitis Control Report were also searched. RESULTS: A total of 256 hepatitis A outbreaks were identified from 1994 through 2004. The mean number of outbreaks was 23 per year (median 25). The number of outbreaks in states with traditionally low/intermediate endemic rates of hepatitis A remained relatively constant during the study period. Outbreaks declined significantly (P = 0.01) in states with previously high rates of disease--most of which have implemented hepatitis A vaccination programs. CONCLUSIONS: Outbreaks of hepatitis A continue to occur in the United States despite the licensure of two safe and effective vaccines in 1995 and the apparent decline in the number of outbreaks in states with previously high rates of hepatitis A. The recent ACIP recommendation for universal hepatitis A vaccination at age 1 year in all states will contribute to a further reduction in hepatitis A outbreaks.

Gorse GJ, et al. "Immunogenicity and tolerance of ascending doses of a recombinant protective antigen (rPA102) anthrax vaccine: a randomized, double-blinded, controlled, multicenter trial" [Vaccine 24 (2006) 5950-5959].

In the study reported by Gorse et al. a unique, educational opportunity was lost. The vaccine and biodefense communities almost experienced the rare chance in a Phase I study to scientifically compare head-to-head an early-stage, investigational recombinant anthrax vaccine (rPA102) with the safe, effective and already FDA-licensed anthrax vaccine, AVA (BioThrax). The authors take a stab at making safety and immunogenicity comparisons between the candidate vaccine and AVA (BioThrax) but the study design and analytical approach makes this inappropriate. Inaccurate and poorly substantiated editorial comments in the paper's introduction compound these methodological problems. The reader is presented with a series of false and misleading statements about AVA (BioThrax). Out-of-date sources are relied upon and these references are offered to the reader as the best evidence available when more current papers with up-to-date information and data exist. Additionally, the conclusions in several original contributions are misrepresented in this paper by Gorse et al. Issues with protocol and bias notwithstanding, the single most compelling observation from this trial could be that the response of those subjects in this study population (n=19) who received AVA on the altered schedule and route of two doses of AVA (BioThrax) delivered intramuscularly (IM) in just 4 weeks mounted a robust immune response. Given the more than 30 year history of the safe and effective use of AVA (BioThrax) as well as the more current data on AVA (BioThrax) a strong case can be made for continued funding to investigate the feasibility of adding another route of delivery (IM) and optimizing the schedule for this already FDA-licensed vaccine.

A mathematical model of hepatitis a transmission in the United States indicates value of universal childhood immunization.

BACKGROUND: US recommendations issued in 1999 for hepatitis A (HA) childhood immunization varied according to regional HA incidences prior to vaccination. Mathematical models of HA transmission, especially those accounting for herd protection, can be useful in formulating new, highly effective recommendations that could lead to disease elimination. METHODS: A mathematical model of HA transmission was designed to assess the impact of different vaccination strategies on the evolution of HA infection over time in the United States. The model represents HA transmission dynamics and is stratified by age and regions defined in the Advisory Committee for Immunization Practices 1999 recommendations. The model accounts for herd protection and HA importation, using an age-dependent "force of infection" varying over time as a function of the prevalence of subjects with infectious HA. RESULTS: The model predicts a clear benefit of vaccinating all US children at as young an age as possible. Nationwide routine immunization at 1 year of age with 70% coverage would prevent 57% of additional cases during the period 1995-2029, compared with the continuation of the regional strategy of vaccinating children at 2 years of age, as recommended by the Advisory Committee for Immunization Practices in 1999. In contrast, the model also predicts that nationwide routine immunization for children 12 years of age only would result in a 14% increase of HA cases during the period 1995-2029, compared with the number of cases predicted with the regional strategy of the immunization of 2-year-olds. CONCLUSIONS: These findings highlight the importance of accounting for herd protection induced by early childhood HA vaccination. They also support the very recent Advisory Committee for Immunization Practices recommendations for universal HA immunization of 1-year-olds.