Pharmacist vaccination – an Australian first, but what was the impact?

Introduction/background/issues The Queensland Pharmacist Immunisation Pilot is Australia’s first to allow pharmacists vaccination. The pilot ran between April 1st 2014 and August 31st 2014, with pharmacists administering influenza vaccination during the flu season. The aim of this work was to investigate the benefits of trained registered pharmacists administering vaccinations in a community pharmacy setting. Methods Participant demographics and previous influenza vaccination experiences were recorded using GuildCare software. Participants also completed a ‘post-vaccination satisfaction survey’ following their influenza vaccination. Results/discussions A total of 10,889 participant records were analysed. Females accounted for 63% of participants, with the majority of participants aged between 45-64 years (53%). Overall, 49% of participants had been vaccinated before, the majority at a GP clinic (60%). Most participants reported receiving their previous influenza vaccination from a nurse (61%). Interestingly, 1% thought a pharmacist had administered their previous vaccination, while 7% were unsure which health professional had administered it. It was also of note that approximately 10% of all participants were eligible to receive a free vaccination from the National Immunisation Program, but still opted to receive their vaccine in a pharmacy. Over 8,000 participants took part in the post-vaccination survey, 93% were happy to receive their vaccination from a pharmacy in the future while 94% would recommend this service to other people. The remaining 7% and 6% respectively had omitted to fill in those questions. Conclusions/implications These findings have helped pave the way for expanding the scope of practice for pharmacists with the aim to increase vaccination rates across Australia. Key message • Scope of practice and ability for health providers like pharmacists to provide services such as vaccination in primary care. • New service delivery to improve access to service, and increase immunisation rates.

The health professional behind the syringe: Benefits of a pharmacist vaccination program

Background: The Queensland Pharmacist Immunisation Pilot (QPIP) which ran in 2014 was Australia’s first to allow pharmacists to administer vaccinations. An aim of QPIP was to investigate the benefits of trained pharmacists administering vaccinations in a community pharmacy setting. Methods: Participant demographics and previous influenza vaccination experiences were recorded using GuildCare software. Participants also completed a ‘post-vaccination satisfaction survey’ following their influenza vaccination. Results: A total of 10,889 participant records and 8,737 satisfaction surveys were analysed. Overall, 1.9% of the participants reported living with a chronic illness, and 22.5% were taking concomitant medications. As part of the consultation before receiving the vaccine, participants acknowledged the opportunity to discuss other aspects of their health with the pharmacist, including concerns about their general health, allergies, and other medications they were taking. It was worth noting that 17.5% of people would not have received an influenza vaccination if the QPIP service was unavailable. Additionally, approximately 10% of all participants were eligible to receive a free vaccination from the National Immunisation Program, but still opted to receive their vaccine from a pharmacist. Conclusion: The findings from this pilot demonstrate the benefit of a pharmacist vaccination program in increasing vaccination rates, and have helped pave the way for expanding the scope of practice for pharmacists.

Queensland pharmacist immunisation pilot phase 1 pharmacist vaccination - Influenza final report

The results of the pilot demonstrated that a pharmacist delivered vaccinations services is feasible in community pharmacy and is safe and effective. The accessibility of the pharmacist across the influenza season provided the opportunity for more people to be vaccinated, particularly those who had never received an influenza vaccine before. Patient satisfaction was extremely high with nearly all patients happy to recommend the service and to return again next year. Factors critical to the success of the service were: 1. Appropriate facilities 2. Competent pharmacists 3. Practice and decision support tools 4. In-­‐store implementation support We demonstrated in the pilot that vaccination recipients preferred a private consultation area. As the level of privacy afforded to the patients increased (private room vs. booth), so did the numbers of patients vaccinated. We would therefore recommend that the minimum standard of a private consultation room or closed-­‐in booth, with adequate space for multiple chairs and a work / consultation table be considered for provision of any vaccination services. The booth or consultation room should be used exclusively for delivering patient services and should not contain other general office equipment, nor be used as storage for stock. The pilot also demonstrated that a pharmacist-­‐specific training program produced competent and confident vaccinators and that this program can be used to retrofit the profession with these skills. As vaccination is within the scope of pharmacist practice as defined by the Pharmacy Board of Australia, there is potential for the universities to train their undergraduates with this skill and provide a pharmacist vaccination workforce in the near future. It is therefore essential to explore appropriate changes to the legislation to facilitate pharmacists’ practice in this area. Given the level of pharmacology and medicines knowledge of pharmacists, combined with their new competency of providing vaccinations through administering injections, it is reasonable to explore additional vaccines that pharmacists could administer in the community setting. At the time of writing, QPIP has already expanded into Phase 2, to explore pharmacists vaccinating for whooping cough and measles. Looking at the international experience of pharmacist delivered vaccination, we would recommend considering expansion to other vaccinations in the future including travel vaccinations, HPV and selected vaccinations to those under the age of 18 years. Overall the results of the QPIP implementation have demonstrated that an appropriately trained pharmacist can deliver safely and effectively influenza vaccinations to adult patients in the community. The QPIP showed the value that the accessibility of pharmacists brings to public health outcomes through improved access to vaccinations and the ability to increase immunisation rates in the general population. Over time with the expansion of pharmacist vaccination services this will help to achieve more effective herd immunity for some of the many diseases which currently have suboptimal immunisation rates.

Human papillomavirus infection and vaccination: Awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9–17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter’s age (P<0.01), mother’s education level (P<0.01), mother’s occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. Acceptability increased along with increased daughters’ age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were “My daughter is too young to have risk of cervical cancer (30.95%)”, “The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)”, “Worry about the safety of the vaccine (22.85%)”. Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. These results may help inform appropriate health education programs in this population.

Looking at the other side: Families, public health and anti-vaccination

The choice to vaccinate or not to vaccinate a child is usually an ‘informed decision’, however, it is how this decision is informed which is of most importance. More frequently, families are turning to the Internet, in particular social media, as a data source to support their decisions. However, much of the online information may be unscientific or biased. While issues such as vaccination will always see dissenting voices, engaging with that ‘other side’ is difficult in the public policy debate which is informed by evidence based science. This chapter investigates the other side in light of the growing adoption and reliance on social media as a source of anti-vaccine information. The study adopts a qualitative approach to data collection and is based on a critical discourse analysis of online social media discourse. The findings demonstrate the valuable contribution this approach can make to public policy work in vaccination.

Vaccination status of Australian community pharmacy

From the moment Queensland's Chief Health Officer, Dr Jeannette Young, laid down the gauntlet to Queensland pharmacists kicking off the Queensland Pharmacists Immunisation Pilot (QPIP) for the 2014 influenza season, community pharmacy in Australia was never going to be the same.

Factors associated with 2009 pandemic influenza A (H1N1) vaccination acceptance among university students from India during the post-pandemic phase

Background: There was a low adherence to influenza A (H1N1) vaccination program among university students and health care workers during the pandemic influenza in many parts of the world. Vaccination of high risk individuals is one of the recommendations of World Health Organization during the post-pandemic period. It is not documented about the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period. We aimed to analyze the student's knowledge, attitude and willingness to accept H1N1 vaccination during the post-pandemic period in India. Methods: Vaccine against H1N1 was made available to the students of Vellore Institute of Technology, India from September 2010. The data are based on a cross-sectional study conducted during October 2010 to January 2011 using a self-administered questionnaire with a representative sample of the student population (N = 802). Results: Of the 802 respondents, only 102/802 (12.7%) had been vaccinated and 105/802 (13%) planned to do so in the future, while 595/802 (74%) would probably or definitely not get vaccinated in the future. The highest coverage was among the female (65/102, 63.7%) and non-compliance was higher among men in the group (384/595; 64.5%) (p < 0.0001). The representation of students from school of Bio-sciences and Bio-technology among vaccinees is significantly higher than that of other schools. Majority of the study population from the three groups perceived vaccine against H1N1 as the effective preventive measure when compared to other preventive measures. 250/595 (42%) of the responders argued of not being in the risk group. The risk perception was significantly higher among female (p < 0.0001). With in the study group, 453/802 (56.4%) said that they got the information, mostly from media. Conclusions: Our study shows that the vaccination coverage among university students remains very low in the post-pandemic period and doubts about the safety and effectiveness of the vaccine are key elements in their rejection. Our results indicate a need to provide accessible information about the vaccine safety by scientific authorities and fill gaps and confusions in this regard.

Vaccination for pregnant women: Need to address

Pregnancy is a critically important state for any women in her life time. Administration of a vaccine to a pregnant woman is not a routine event and it is generally preferred to administer vaccines either prior to conception or in the postpartum period. Currently vaccination with inactivated vaccines are recommended due to potential risk to mother and fetus with live vaccines. Multiple factors determine the administration of the vaccines for example age, life style, medical conditions (e.g., asthma, diabetes etc.), type and location of travel and status of previous vaccination. If pregnant woman is exposed to these vaccines or if pregnancy occurs soon after vaccination, the women should be counselled regarding the risks to the fetus and vaccination should not be a reason to consider termination of pregnancy. Further research in vaccination among pregnancy is warranted for the safety of the pregnant women and their newborn for a healthy living and better life.

Stalking influenza by vaccination with pre-fusion headless HA mini-stem

Inaccuracies in prediction of circulating viral strain genotypes and the possibility of novel reassortants causing a pandemic outbreak necessitate the development of an anti-influenza vaccine with increased breadth of protection and potential for rapid production and deployment. The hemagglutinin (HA) stem is a promising target for universal influenza vaccine as stem-specific antibodies have the potential to be broadly cross-reactive towards different HA subtypes. Here, we report the design of a bacterially expressed polypeptide that mimics a H5 HA stem by protein minimization to focus the antibody response towards the HA stem. The HA mini-stem folds as a trimer mimicking the HA prefusion conformation. It is resistant to thermal/chemical stress, and it binds to conformation-specific, HA stem-directed broadly neutralizing antibodies with high affinity. Mice vaccinated with the group 1 HA mini-stems are protected from morbidity and mortality against lethal challenge by both group 1 (H5 and H1) and group 2 (H3) influenza viruses, the first report of cross-group protection. Passive transfer of immune serum demonstrates the protection is mediated by stem-specific antibodies. Furthermore, antibodies indudced by these HA stems have broad HA reactivity, yet they do not have antibody-dependent enhancement activity.

An observer-based vaccination control law for an SEIR epidemic model based on feedback linearization techniques for nonlinear systems

This paper presents a vaccination strategy for fighting against the propagation of epidemic diseases. The disease propagation is described by an SEIR (susceptible plus infected plus infectious plus removed populations) epidemic model. The model takes into account the total population amounts as a refrain for the illness transmission since its increase makes the contacts among susceptible and infected more difficult. The vaccination strategy is based on a continuous-time nonlinear control law synthesised via an exact feedback input-output linearization approach. An observer is incorporated into the control scheme to provide online estimates for the susceptible and infected populations in the case when their values are not available from online measurement but they are necessary to implement the control law. The vaccination control is generated based on the information provided by the observer. The control objective is to asymptotically eradicate the infection from the population so that the removed-by-immunity population asymptotically tracks the whole one without precise knowledge of the partial populations. The model positivity, the eradication of the infection under feedback vaccination laws and the stability properties as well as the asymptotic convergence of the estimation errors to zero as time tends to infinity are investigated.

Novel Papillomaviruses in Free-Ranging Iberian Bats: No Virus-Host Co-evolution, No Strict Host Specificity, and Hints for Recombination

Papillomaviruses (PVs) are widespread pathogens. However, the extent of PV infections in bats remains largely unknown. This work represents the first comprehensive study of PVs in Iberian bats. We identified four novel PVs in the mucosa of free-ranging Eptesicus serotinus (EserPV1, EserPV2, and EserPV3) and Rhinolophus ferrumequinum (RferPV1) individuals and analyzed their phylogenetic relationships within the viral family. We further assessed their prevalence in different populations of E. serotinus and its close relative E. isabellinus. Although it is frequent to read that PVs co-evolve with their host, that PVs are highly species-specific, and that PVs do not usually recombine, our results suggest otherwise. First, strict virus-host co-evolution is rejected by the existence of five, distantly related bat PV lineages and by the lack of congruence between bats and bat PVs phylogenies. Second, the ability of EserPV2 and EserPV3 to infect two different bat species (E. serotinus and E. isabellinus) argues against strict host specificity. Finally, the description of a second noncoding region in the RferPV1 genome reinforces the view of an increased susceptibility to recombination in the E2-L2 genomic region. These findings prompt the question of whether the prevailing paradigms regarding PVs evolution should be reconsidered.

On some new mathematical models for infective diseases: analysis, equilibrium, positivity and vaccination controls

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Novel Papillomaviruses in Free-Ranging Iberian Bats: No Virus-Host Co-evolution, No Strict Host Specificity, and Hints for Recombination

Papillomaviruses (PVs) are widespread pathogens. However, the extent of PV infections in bats remains largely unknown. This work represents the first comprehensive study of PVs in Iberian bats. We identified four novel PVs in the mucosa of free-ranging Eptesicus serotinus (EserPV1, EserPV2, and EserPV3) and Rhinolophus ferrumequinum (RferPV1) individuals and analyzed their phylogenetic relationships within the viral family. We further assessed their prevalence in different populations of E. serotinus and its close relative E. isabellinus. Although it is frequent to read that PVs co-evolve with their host, that PVs are highly species-specific, and that PVs do not usually recombine, our results suggest otherwise. First, strict virus-host co-evolution is rejected by the existence of five, distantly related bat PV lineages and by the lack of congruence between bats and bat PVs phylogenies. Second, the ability of EserPV2 and EserPV3 to infect two different bat species (E. serotinus and E. isabellinus) argues against strict host specificity. Finally, the description of a second noncoding region in the RferPV1 genome reinforces the view of an increased susceptibility to recombination in the E2-L2 genomic region. These findings prompt the question of whether the prevailing paradigms regarding PVs evolution should be reconsidered.

Prevalência e fatores relacionados à infecção por HPV em mulheres assistidas pela Estratégia Saúde da Família em Juiz de Fora, Minas Gerais.

O câncer do colo do útero ocasiona 7% dos óbitos por câncer na população feminina brasileira, com taxa de incidência estimada em 15,33/100 mil, sendo a infecção pelo papilomavírus humano (HPV) causa necessária. O rastreamento com citologia do esfregaço cervical convencional é ação escolhida no Brasil e em outros países para prevenir e controlar o câncer, através da detecção precoce das lesões pré-neoplásicas. Porém, apresenta falhas na cobertura, com desigualdade de acesso, e na qualidade, devido aos problemas nas etapas operacionais, desde a coleta na unidade até a interpretação dos resultados. O rastreamento é oportunístico, e uma alternativa organizada pode ser a utilização de cadastros populacionais, como os disponíveis pela Estratégia Saúde da Família (ESF). A efetividade do rastreamento pode ser aumentada com a incorporação de novas técnicas, destacando-se aquelas de biologia molecular, que testam o HPV nas mulheres, em acréscimo ao rastreamento com citologia ou a substituindo integralmente. O conhecimento acerca dos fatores relacionados à infecção vem sendo ampliado para compreender por que mulheres que se encontram em risco semelhante de transmissão apresentam infecção e outras, não. A inexistência de um sistema de vigilância dos tipos circulantes de HPV prejudica a avaliação do cenário atual, inclusive no que se refere à recente implantação da vacinação contra o HPV no calendário básico de vacinação. Neste estudo, o objetivo foi estimar a prevalência de infecção pelo HPV no grupo de mulheres estudadas, relacionando estes achados aos fatores relacionados à infecção, que podem auxiliar na identificação de mulheres mais vulneráveis à infecção e à presença de lesões pré-neoplásicas. 2062 mulheres da periferia de Juiz de Fora, após serem convocadas para rastreamento, participaram do estudo, desenvolvido em duas unidades com a ESF, tendo respondido a um questionário padronizado, submetidas ao exame citológico cervical convencional e testadas para o HPV com o teste cobas 4800 (Roche). A adesão das mulheres convocadas foi semelhante àquela observada em estudos de outros delineamentos, os quais podem contribuir para o seu entendimento. Foram calculadas estimativas de prevalência de infecção pelo HPV segundo características selecionadas. A prevalência global de infecção pelo HPV foi 12,61%. A análise multivariada por regressão de Poisson com variância robusta mostrou associação estatisticamente significativa para ser solteira, consumir bebida alcoólica e ter três ou mais parceiros sexuais ao longo da vida, com razões de prevalência ajustadas de 1,40, 1,44 e 1,35, respectivamente. A prevalência de lesões precursoras do câncer do colo do útero foi 7,27%. A qualidade do esfregaço, avaliada pela representatividade dos epitélios coletados, mostrou que há variação da prevalência de lesões pré-neoplásicas mediante qualidade do esfregaço, porém, não há variação nos resultados do teste HPV mediante a representatividade celular, achado que consistente com uma sensibilidade maior e possivelmente um melhor valor preditivo positivo. A testagem do HPV mostrou ser útil, especialmente entre mulheres com resultado de citologia normal.

Humoral and protective response of Indian major carps to immersion vaccination with Aeromonas hydrophila

Fry of the Indian major carps, Catta catla (Ham.), Labeo rohita (Ham.) and Cirrhinus mrigala (Ham.) were immunized at 4 and 8 weeks post hatching (wph) by direct immersion in a suspension (10 super(8) cells ml super(-1))of heat inactivated Aeromonas hydrophila. Following the same procedure, booster dose was administered 20 days after the first immersion. Antibodies as well as protective response produced in both the groups after the first and the booster immersion were different and significant (P<0.05). No significant difference was found between the species in the two age groups. The specimens immunized 8 wph showed higher antibody titres and protection than the 4 wph group. C. catla had higher relative percent survival followed by L. rohita and C. mrigala.