Observed responses of mesospheric water vapor to solar cycle and dynamical forcings.

This study focuses on responses of mesospheric water vapor (H2O) to the solar cycle flux at Lyman-α wavelength and to wave forcings according to the multivariate ENSO index (MEI). The zonal-averaged responses are for latitudes from 60°S to 60°N and pressure-altitudes from 0.01 to 1.0 hPa, as obtained by multiple linear regression (MLR) analyses of time series of H2O from the Halogen Occultation Experiment (HALOE) for July 1992 to November 2005. The solar responses change from strong negative H2O values in the upper mesosphere to very weak, positive values in the tropical lower mesosphere. Those response profiles at the low latitudes agree reasonably with published results for H2O from the Microwave Limb Sounder (MLS). The distribution of seasonal H2O amplitudes corresponds well with that for temperature and is in accord with the seasonal net circulation. In general, the responses of H2O to MEI are anti-correlated with those of temperature. H2O responses to MEI are negative in the upper mesosphere and largest in the northern hemisphere; responses in the lower mesosphere are more symmetric with latitude. The H2O trends from MLR for the lower mesosphere agree with those reported from time series of microwave observations at two ground-based network stations.

In-office influenza vaccination by US pediatric providers varies greatly and is higher among smaller offices.

During the 2010-2011 US influenza season, 105 pediatric and 13 family practice offices participated in a prospective observational study of in-office influenza vaccination of children. Office characteristics, influenza vaccinations, and vaccination-related activities were reported. Among pediatric offices, first dose vaccination rates (2% to 60%), 2-dose compliance (11% to 100%), the duration of vaccine availability (60-302 days), and office visit type (well vs sick vs clinic) used for vaccinations varied greatly. Pediatric offices had higher vaccination coverage than family practice offices, offered vaccine longer, and administered more vaccinations during sick visits. Smaller offices and higher staff vaccination rates were associated with higher vaccination coverage. Smaller offices and video reminders in waiting rooms were associated with enhanced 2-dose compliance among children younger than 9 years. A greater understanding of interoffice variability in influenza vaccine delivery by US pediatric providers should allow for the creation of more effective strategies to improve pediatric influenza vaccination rates.

Influenza vaccination of parents and guardians by US pediatricians.

In the 2008-2009 and 2009-2010 influenza seasons, 84 pediatric offices participating in a prospective observational study were surveyed about whether the office offered influenza vaccine to parents and guardians of pediatric patients. Each season, approximately half of all offices cited offering seasonal influenza vaccine to parents. In 2008-2009, reported barriers to parental vaccination included reimbursement, medicolegal concerns, and logistics. In 2009-2010, 51% of offices (n = 43) administered one parental seasonal vaccination for every 29 pediatric seasonal vaccinations and one parental H1N1 vaccination for every 23 pediatric H1N1 vaccinations. Currently, the number of parental vaccinations per office is small but parental vaccination by pediatricians may increase in the future given the new recommendations that all adults 18 to 49 years of age should be vaccinated annually. Efforts should be taken to address barriers to parental vaccination so that pediatricians are better able to vaccinate parents/guardians of their patients against influenza.

Timing of the availability and administration of influenza vaccine through the vaccines for children program.

BACKGROUND: influenza vaccine must be distributed and administered each year during a limited time interval. To our knowledge, no previous studies have simultaneously evaluated the delivery and administration of privately purchased vaccines and influenza vaccines acquired through the Vaccines for Children (VFC) program. METHODS: a prospective, observational study was conducted in US outpatient pediatric offices, tracking all influenza vaccinations during the season by age group, first or second vaccination, the child's need for 1 or 2 doses, type of vaccine, and VFC status. RESULTS: a total of 42 and 84 practices completed the study in 2007 to 2008 and 2008 to 2009, respectively. In both seasons, initial shipments of VFC influenza vaccine generally arrived 4 to 5 weeks later than non-VFC shipments; VFC vaccine administration also started 1 month later than administration of privately purchased vaccine. Vaccine administration peaked in early November and late October in years 1 and 2, respectively, and declined rapidly thereafter. Overall, approximately one-half of all children who required 2 doses of vaccine were estimated to have received 2 doses. In both years, 2-dose compliance rates in the VFC population were 17% to 19% lower than those in the non-VFC population, possibly resulting from the VFC population's shorter time interval for second dose receipt. CONCLUSIONS: the VFC program is critical to ensuring financially vulnerable children have access to vaccination. Manufacturers, distributors, and public health officials should deliver VFC influenza vaccine to providers as quickly as possible. Pediatric healthcare providers should increase efforts to vaccinate all populations, especially the VFC population, in later months.

A prospective observational study of US in-office pediatric influenza vaccination during the 2007 to 2009 influenza seasons: use and factors associated with increased vaccination rates.

In the United States, annual influenza vaccine is now recommended for all children 6 months through 18 years of age. This 2-year observational study of US outpatient pediatricians' offices captured office demographics and characteristics, recorded all influenza vaccinations administered and vaccination-related activities during the influenza season, and correlated office characteristics and activities associated with increased vaccine uptake. Offices generally offered the influenza vaccine from September through February and March; however, approximately 80% of vaccinations occurred in October through December. In 2008-2009 compared with 2007-2008, offices administered the vaccine earlier and later into the season. Estimated in-office rates of first-dose administration, 2-dose compliance, and use of the intranasal vaccine also increased. Qualitative analyses suggest that increased first-dose administration and 2-dose compliance rates are associated with smaller office size and a greater duration of vaccine availability, respectively, during both seasons.