Slowing decline in blood collection and transfusion in the United States - 2017.

INTRODUCTION: The National Blood Collection and Utilization Survey (NBCUS) has demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 11.6% in red blood cell (RBC) collections and 13.9% in RBC transfusions during 2013-2015. This study described the 2017 NBCUS results. METHODS: The 2017 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS: Response rates for the 2017 NBCUS were 88% for blood collection centers and 86% for transfusing hospitals. Compared with 2015, the number of RBC units collected during 2017 (12,211,000; 95% confidence interval [CI], 11,680,000-12,742,000) declined by 3.0%, and transfused RBC units (10,654,000, 95% CI, 10,314,000-10,995,000) declined by 6.1%. Distributed platelet (PLT) units (2,560,000; 95% CI, 2,391,000-2,730,000 units) increased by 5.1%, and transfused PLT units (1,937,000, 95% CI, 1,794,000-2,079,000) declined by 2.3%. Distributed plasma units (3,209,000; 95% CI, 2,879,000-3,539,000) declined by 13.6%, and transfused plasma units (2,374,000; 95% CI, 2,262,000-2,487,000) declined by 12.9%. CONCLUSION: The 2017 NBCUS suggests a continued but slowing decline in demand for RBCs. The decline in blood collection and use will likely continue. Despite decreasing demand and increasing manufacturing costs of blood products, the US blood industry has met the regular and emergent needs of the country.

Continued decline in blood collection and transfusion in the United States-2015.

BACKGROUND: In 2011 and 2013, the National Blood Collection and Utilization Survey (NBCUS) revealed declines in blood collection and transfusion in the United States. The objective of this study was to describe blood services in 2015. STUDY DESIGN AND METHODS: The 2015 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS: Response rates for the 2015 NBCUS were 78.4% for blood collection centers and 73.9% for transfusing hospitals. In 2015, 12,591,000 units of red blood cells (RBCs) (95% confidence interval [CI], 11,985,000-13,197,000 units of RBCs) were collected, and 11,349,000 (95% CI, 10,592,000-11,747,000) were transfused, representing declines since 2013 of 11.6% and 13.9%, respectively. Total platelet units distributed (2,436,000; 95% CI, 2,230,000-2,642,000) and transfused (1,983,000; 95% CI, 1,816,000 = 2,151,000) declined by 0.5% and 13.1%, respectively, since 2013. Plasma distributions (3,714,000; 95% CI, 3,306,000-4,121,000) and transfusions (2,727,000; 95% CI, 2,594,000-2,859,000) in 2015 declined since 2013. The median price paid per unit in 2015-$211 for leukocyte-reduced RBCs, $524 for apheresis platelets, and $54 for fresh frozen plasma-was less for all components than in 2013. CONCLUSIONS: The 2015 NBCUS findings suggest that continued declines in demand for blood products resulted in fewer units collected and distributed Maintaining a blood inventory sufficient to meet routine and emergent demands will require further monitoring and understanding of these trends.

Cost projections for implementation of safety interventions to prevent transfusion-transmitted Zika virus infection in the United States.

BACKGROUND: In August 2016, the Food and Drug Administration advised US blood centers to screen all whole blood and apheresis donations for Zika virus (ZIKV) with an individual-donor nucleic acid test (ID-NAT) or to use approved pathogen reduction technology (PRT). The cost of implementing this guidance nationally has not been assessed. STUDY DESIGN AND METHODS: Scenarios were constructed to characterize approaches to ZIKV screening, including universal ID-NAT, risk-based seasonal allowance of minipool (MP) NAT by state, and universal MP-NAT. Data from the 2015 National Blood Collection and Utilization Survey (NBCUS) were used to characterize the number of donations nationally and by state. For each scenario, the estimated cost per donor ($3-$9 for MP-NAT, $7-$13 for ID-NAT) was multiplied by the estimated number of relevant donations from the NBCUS. Cost of PRT was calculated by multiplying the cost per unit ($50-$125) by the number of units approved for PRT. Prediction intervals for costs were generated using Monte Carlo simulation methods. RESULTS: Screening all donations in the 50 states and DC for ZIKV by ID-NAT would cost $137 million (95% confidence interval [CI], $109-$167) annually. Allowing seasonal MP-NAT in states with lower ZIKV risk could reduce NAT screening costs by 18% to 25%. Application of PRT to all platelet (PLT) and plasma units would cost $213 million (95% CI, $156-$304). CONCLUSION: Universal ID-NAT screening for ZIKV will cost US blood centers more than $100 million annually. The high cost of PRT for apheresis PLTs and plasma could be mitigated if, once validated, testing for transfusion transmissible pathogens could be eliminated.

Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in São Paulo, Brazil.

OBJECTIVE: To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine. METHODS: An observational cross-sectional study was conducted at five public health posts in São Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression. RESULTS: Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]). CONCLUSION: Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil.

Paving pathways: Brazil's implementation of a national human papillomavirus immunization campaign.

In 2014, Brazil introduced an HPV immunization program for girls 9-13 years of age as part of the Unified Health System's (SUS) National Immunization Program. The first doses were administered in March 2014; the second ones, in September 2014. In less than 3 months more than 3 million girls received the first dose of quadrivalent HPV vaccine, surpassing the target rate of 80%. This paper examines three elements that may influence the program's long-term success in Brazil: sustaining effective outreach, managing a large technology-transfer collaboration, and developing an electronic immunization registry, with a focus on the State of São Paulo. If these three factors are managed, the Government of Brazil is primed to serve as a model of success for other countries interested in implementing a national HPV vaccination program to decrease HPV-related morbidity and mortality.

Paving pathways: Brazil's implementation of a national human papillomavirus immunization campaign / Allanando el camino: implementación de una campaña nacional de vacunación contra el virus del papiloma humano en Brasil

In 2014, Brazil introduced an HPV immunization program for girls 9-13 years of age as part of the Unified Health System's (SUS) National Immunization Program. The first doses were administered in March 2014; the second ones, in September 2014. In less than 3 months more than 3 million girls received the first dose of quadrivalent HPV vaccine, surpassing the target rate of 80%. This paper examines three elements that may influence the program's long-term success in Brazil: sustaining effective outreach, managing a large technology-transfer collaboration, and developing an electronic immunization registry, with a focus on the State of São Paulo. If these three factors are managed, the Government of Brazil is primed to serve as a model of success for other countries interested in implementing a national HPV vaccination program to decrease HPV-related morbidity and mortality.

En el 2014, se introdujo en Brasil un programa de vacunación contra los VPH dirigido a niñas de 9 a 13 años de edad como parte del Programa Nacional de Vacunación del Sistema Unificado de Salud (SUS). Las primeras dosis se administraron en marzo del 2014; las segundas, en septiembre del 2014. En menos de tres meses, más de tres millones de niñas recibieron la primera dosis de vacuna tetravalente contra los VPH, superando la tasa prevista de 80%. En este artículo se analizan tres elementos que pueden influir en el éxito a largo plazo del programa en Brasil: el mantenimiento de actividades de extensión eficaces, la administración de una amplia colaboración en materia de transferencia de tecnología, y la creación de un registro electrónico de vacunaciones, con hincapié en el Estado de São Paulo. Si se gestionan estos tres factores, el Gobierno de Brasil está dispuesto a servir como modelo exitoso a otros países interesados en introducir un programa nacional de vacunación contra los VPH con objeto de disminuir la morbilidad y la mortalidad relacionadas con los VPH.

Paving pathways: Brazil’s implementation of a national human papillomavirus immunization campaign / Allanando el camino: implementación de una campaña nacional de vacunación contra el virus del papiloma humano en Brasil

In 2014, Brazil introduced an HPV immunization program for girls 9–13 years of age as part of the Unified Health System’s (SUS) National Immunization Program. The first doses were administered in March 2014; the second ones, in September 2014. In less than 3 months more than 3 million girls received the first dose of quadrivalent HPV vaccine, surpassing the target rate of 80%. This paper examines three elements that may influence the program’s long-term success in Brazil: sustaining effective outreach, managing a large tech¬nology-transfer collaboration, and developing an electronic immunization registry, with a focus on the State of São Paulo. If these three factors are managed, the Government of Brazil is primed to serve as a model of success for other countries interested in implementing a national HPV vaccination program to decrease HPV-related morbidity and mortality.

En el 2014, se introdujo en Brasil un programa de vacunación contra los VPH dirigido a niñas de 9 a 13 años de edad como parte del Programa Nacional de Vacunación del Sistema Unificado de Salud (SUS). Las primeras dosis se administraron en marzo del 2014; las segundas, en septiembre del 2014. En menos de tres meses, más de tres millones de niñas recibieron la primera dosis de vacuna tetravalente contra los VPH, superando la tasa prevista de 80%. En este artículo se analizan tres elementos que pueden influir en el éxito a largo plazo del programa en Brasil: el mantenimiento de actividades de extensión eficaces, la administración de una amplia colaboración en materia de transferencia de tecnología, y la creación de un registro electrónico de vacunaciones, con hincapié en el Estado de São Paulo. Si se gestionan estos tres factores, el Gobierno de Brasil está dispuesto a servir como modelo exitoso a otros países interesados en introducir un programa nacional de vacunación contra los VPH con objeto de disminuir la morbilidad y la mortalidad relacionadas con los VPH.

"Those who love, vaccinate": parental perceptions of HPV vaccination

In March 2014, Brazil began its national HPV immunization campaign targeting girls ages 9-13 OBJECTIVE: Describe determinants of parental decisions to vaccinate their daughters against HPV METHODS: In this qualitative study, thirty semi-structured interviews were conducted at five health posts in São Paulo, Brazil. Interview questions explored parental opinions of disease prevention methods, vaccines in general, and the HPV vaccine. Interviews were analyzed using grounded theory RESULTS: Overall, parental knowledge about HPV and the vaccine was low, yet most eligible daughters had been vaccinated. Parents perceived the HPV vaccine to be normal, preventative, and protective. Parents viewed themselves as accountable for their children's health, and saw the vaccine as a parenting tool for indirect control. Trust in healthcare professionals and an awareness of the dangers of "nowadays" (uncertainties regarding disease and sexual behavior) were also important in vaccine decision-making. These factors held more explanatory power for decisions to vaccinate than parental knowledge levels. This was the first study to qualitatively examine the perception of publically provided HPV vaccination among parents with eligible daughters in Brazil. The findings help interpret the greater than 90% coverage for the first HPV vaccine dose in Brazil. The results indicate that attempts to understand, maintain, or modify vaccination rates require the consideration of context specific factors, which influence both parent perspectives and vaccination decisions CONCLUSION: HPV knowledge levels are not predictive of parental decisions to vaccinate daughters. Context specific factors from the sociocultural dimensions of parenting, sexuality, gender, and the healthcare system are more influential in vaccine decision-making...

Em Março de 2014 o Brasil lançou uma campanha nacional de vacinação contra o HPV para meninas de idades 9 a 13. : Descrever determinantes das decisões dos pais para vacinar as filhas contra HPV MÉTODO: neste estudo qualitativo foram realizadas trinta entrevistas semi-estruturadas em cinco UBSs em São Paulo. A entrevista examinou as opiniões dos pais sobre métodos de prevenção de doença, vacinas em geral e a vacina contra o HPV. As entrevistas foram analisados utilizando grounded theory RESULTADOS: no geral os pais demonstraram baixo conhecimento sobre HPV e a vacina contra o HPV. Apesar disso a maioria das meninas elegíveis foram vacinadas. Os pais consideraram a vacina contra o HPV normal, preventiva e protetora e se identificaram como os responsáveis pela saúde dos filhos e descreveram a vacina como uma forma indireta de controle dos pais. Confiança em profissionais de saúde e os perigos de "hoje em dia" (dúvidas em termos de doenças e relações sexuais) mostraram-se importantes nas decisões de vacinação. Estes fatores tiveram maior poder explicativo para as decisões de vacinação do que os níveis de conhecimento dos pais.Este foi o primeiro estudo que examinou qualitativamente o propósito da vacinação contra o HPV entre pais de meninas elegíveis no Brasil. Os resultados ajudam a interpretar a cobertura superior a 90% para a primeira dose da vacina contra o HPV no Brasil. Estes resultados indicam que esforços direcionados a entender ou modificar taxas de vacinação exigem a consideração destes fatores que são específicos ao contexto e direcionam perspectivas e decisões de vacinação CONCLUSÃO: conhecimento dos pais sobre HPV talvez não seja preditivo para a vacinação das filhas. Fatores específicos ao contexto sociocultural de parentalidade, sexualidade, gênero e o sistema de saúde influenciaram na decisão de vacinação...

"Those who love, vaccinate": parental perceptions of HPV vaccination

INTRODUCTION: In March 2014, Brazil began its national HPV immunization campaign targeting girls ages 9-13 OBJECTIVE: Describe determinants of parental decisions to vaccinate their daughters against HPV METHODS: In this qualitative study, thirty semi-structured interviews were conducted at five health posts in São Paulo, Brazil. Interview questions explored parental opinions of disease prevention methods, vaccines in general, and the HPV vaccine. Interviews were analyzed using grounded theory RESULTS: Overall, parental knowledge about HPV and the vaccine was low, yet most eligible daughters had been vaccinated. Parents perceived the HPV vaccine to be normal, preventative, and protective. Parents viewed themselves as accountable for their children's health, and saw the vaccine as a parenting tool for indirect control. Trust in healthcare professionals and an awareness of the dangers of "nowadays" (uncertainties regarding disease and sexual behavior) were also important in vaccine decision-making. These factors held more explanatory power for decisions to vaccinate than parental knowledge levels. This was the first study to qualitatively examine the perception of publically provided HPV vaccination among parents with eligible daughters in Brazil. The findings help interpret the greater than 90% coverage for the first HPV vaccine dose in Brazil. The results indicate that attempts to understand, maintain, or modify vaccination rates require the consideration of context specific factors, which influence both parent perspectives and vaccination decisions CONCLUSION: HPV knowledge levels are not predictive of parental decisions to vaccinate daughters. Context specific factors from the sociocultural dimensions of parenting, sexuality, gender, and the healthcare system are more influential in vaccine decision-making.(AU)

INTRODUÇÃO: em Março de 2014 o Brasil lançou uma campanha nacional de vacinação contra o HPV para meninas de idades 9 a 13. : Descrever determinantes das decisões dos pais para vacinar as filhas contra HPV MÉTODO: neste estudo qualitativo foram realizadas trinta entrevistas semi-estruturadas em cinco UBSs em São Paulo. A entrevista examinou as opiniões dos pais sobre métodos de prevenção de doença, vacinas em geral e a vacina contra o HPV. As entrevistas foram analisados utilizando grounded theory RESULTADOS: no geral os pais demonstraram baixo conhecimento sobre HPV e a vacina contra o HPV. Apesar disso a maioria das meninas elegíveis foram vacinadas. Os pais consideraram a vacina contra o HPV normal, preventiva e protetora e se identificaram como os responsáveis pela saúde dos filhos e descreveram a vacina comouma forma indireta de controle dos pais. Confiança em profissionais de saúde e os perigos de "hoje em dia" (dúvidas em termos de doenças e relações sexuais) mostraram-se importantes nas decisões de vacinação. Estes fatores tiveram maior poder explicativo para as decisões de vacinação do que os níveis de conhecimento dos pais.Este foi o primeiro estudo que examinou qualitativamente o propósito da vacinação contra o HPV entre pais de meninas elegíveis no Brasil. Os resultados ajudam a interpretar acobertura superior a 90% para a primeira dose da vacina contra o HPV no Brasil. Estes resultados indicam que esforços direcionados a entender ou modificar taxas de vacinação exigem a consideração destes fatores que são específicos ao contexto e direcionam perspectivas e decisões de vacinação CONCLUSÃO: conhecimento dos pais sobre HPV talvez não seja preditivo para a vacinação das filhas. Fatores específicos ao contexto sociocultural de parentalidade, sexualidade, gênero e o sistema de saúde influenciaram na decisão de vacinação.(AU)