Cost-effectiveness of using Quantiferon Gold (QFT-G)® versus tuberculin skin test (TST) among U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis.

OBJECTIVE: The purpose of this study was to determine the cost benefit to routinely using QFT-G versus the standard TST for screening U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis. DESIGN AND SAMPLE: A comparative cost analysis of the monetization between QFT-G and TST was conducted: Data from the health department's Chest Clinic patients seen in 2007 were used to model cost predictions. MEASURES: The net costs of screening, x-rays, the standard 9 months of latent tuberculosis infection treatment, laboratory, and administration for U.S. born patients and foreign born patients were investigated. RESULTS: There are no apparent cost savings for U.S. born individuals, but due to the higher specificity of QFT-G for foreign born BCG-vaccinated individuals, there are unnecessary expenditures associated with the higher number of false positives incurred when using TST compared with QFT-G on 1,000 foreign born individuals (69%, 18%). CONCLUSION: QFT-G is cost-effective and should be used at local health department clinics that want to achieve savings in screening and treating those suspected of having TB infection, especially for high-risk populations such as foreign born individuals.

H1N1 influenza vaccine compliance among hospital- and non-hospital-based healthcare personnel.

BACKGROUND: The 2009 pandemic H1N1 influenza vaccine had lower uptake compared to seasonal influenza vaccine, and most studies examining uptake of H1N1 vaccine focused on hospital-based healthcare personnel (HCP). Determinants of H1N1 vaccine uptake among HCP in all work settings need to be identified so that interventions can be developed for use in encouraging uptake of future pandemic or emerging infectious disease vaccines. OBJECTIVE: To identify factors influencing nonhospital HCP H1N1 influenza vaccine compliance. DESIGN AND SETTING: An H1N1 influenza vaccine compliance questionnaire was administered to HCP working in myriad healthcare settings in March-June 2011. METHODS: Surveys were used to assess H1N1 influenza vaccine compliance and examine factors that predicted H1N1 influenza vaccine uptake. RESULTS: In all, 3,188 HCP completed the survey. Hospital-based HCP had higher compliance than did non-hospital-based personnel (Χ2 = 142.2, P < .001). In logistic regression stratified by hospital setting versus nonhospital setting, determinants of H1N1 vaccination among non-hospital-based HCP included extent to which H1N1 vaccination was mandated or encouraged, perceived importance of vaccination, access to no-cost vaccine provided on-site, no fear of vaccine side effects, and trust in public health officials when they say that the influenza vaccine is safe. Determinants of hospital-based HCP H1N1 vaccine compliance included having a mandatory vaccination policy, perceived importance of vaccination, no fear of vaccine side effects, free vaccine, perceived seriousness of H1N1 influenza, and trust in public health officials. CONCLUSIONS: Non-hospital-based HCP versus hospital-based HCP reasons for H1N1 vaccine uptake differed. Targeted interventions are needed to increase compliance with pandemic-related vaccines.

Seasonal and H1N1 influenza vaccine compliance and intent to be vaccinated among emergency medical services personnel.

BACKGROUND: Only limited data are available on emergency medical technicians' (EMT) influenza vaccination compliance. METHODS: A questionnaire was administered to St. Louis EMTs during March to June 2011 to assess compliance with the 2010/2011 and 2009/2010 seasonal and pandemic H1N1 influenza vaccinations, factors that predicted uptake of 2010/2011 seasonal influenza vaccine, and intent to be vaccinated. RESULTS: In all, 265 EMTs participated. EMTs' attitudes and beliefs toward influenza vaccines differed significantly when comparing vaccinated to nonvaccinated EMTs. EMTs whose employer had a mandatory vaccination policy were significantly more likely to receive the seasonal influenza vaccine (100% vs 75.6%, respectively) or the H1N1 vaccine (100% vs 66.8%, respectively) compared with those without such a policy (χ(2) = 8.8, P < .001 and χ(2) = 6.7, P < .01, respectively). In logistic regression controlling for demographics, determinants of 2010/2011 seasonal influenza vaccination included belief that EMTs should be vaccinated every year, perceived importance of vaccination, perception that influenza vaccine has few adverse effects, and past vaccine-seeking behavior. In logistic regression controlling for demographics, determinants of intent to be vaccinated included having the vaccine available on-site and free of charge and belief that EMTs should be vaccinated every year. CONCLUSION: EMT-targeted interventions should be used to increase vaccine compliance, including implementing a mandatory vaccination policy and addressing EMTs' beliefs and attitudes about vaccine in an education campaign.

Seasonal influenza vaccine compliance among hospital-based and nonhospital-based healthcare workers.

BACKGROUND: Influenza vaccination among nonhospital healthcare workers (HCWs) is imperative, but only limited data are available for factors affecting their compliance. OBJECTIVE: To examine the factors influencing influenza vaccine compliance among hospital and nonhospital HCWs. Design and Setting. A vaccine compliance questionnaire was administered to HCWs working in myriad healthcare settings in March-June 2011. METHODS: Online and paper surveys were used to assess compliance with the 2010/2011, 2009/2010, and H1N1 influenza vaccines and to examine factors that predicted the uptake of the 2010/2011 seasonal influenza vaccine. RESULTS: In all, 3,188 HCWs completed the survey; half of these ([Formula: see text]) reported no hospital work time. Compliance rates for all 3 vaccines were significantly higher ([Formula: see text]) among hospital versus nonhospital HCWs. In logistic regression stratified by hospital versus nonhospital setting, and when controlling for demographics and past behavior, the determinants of vaccination against the 2010/2011 seasonal influenza among nonhospital-based HCWs included having a mandatory vaccination policy, perceived importance, no fear of vaccine adverse effects, free and on-site access, and perceived susceptibility to influenza. Determinants of hospital-based HCW vaccine compliance included having a mandatory vaccination policy, belief that HCWs should be vaccinated every year, occupational health encouragement, perceived importance of vaccination, on-site access, and no fear of vaccine adverse effects. The strongest predictor of compliance for both worker groups was existence of a mandatory vaccination policy. CONCLUSIONS: The reasons for vaccine uptake among nonhospital-based versus hospital-based HCWs differed. Targeted interventions should be aimed at workers in these settings to increase their vaccine compliance, including implementing a mandatory vaccination policy.

Importance of routine public health influenza surveillance: detection of an unusual W-shaped influenza morbidity curve.

Seasonal influenza causes excess morbidity and mortality at the extremes of age: It disproportionately affects the very young and the very old, typically resulting in "U"-shaped age-distributed curves. By means of a well-established public health department surveillance system using positive influenza tests submitted from sentinel sites, the authors generated annual influenza-specific morbidity curves over a 10-year period (1998-2008) for St. Louis County, Missouri. The authors detected an unusually high incidence of cases of medically attended test-positive influenza, particularly in young adults, during the 2007-2008 season, resulting in an unexpected "W"-shaped age-distributed morbidity curve that was distinctly unique in comparison with the prior 9 influenza seasons. Public health influenza surveillance programs are useful tools for detecting emerging epidemiologic trends that may have clinical importance.