Poor immunization outcomes: Overcoming provider barriers.

This research consists of three separate but related papers on barriers to immunization services and health policy. Although these issues are relevant for all immunization services, the focus is on hepatitis A (HAV) and hepatitis B (HBV). There are supply barriers, which inhibit providers of care from reaching those in need of immunization, and demand barriers, which prevent patients from accessing services. These papers address aspects of supply barriers. The first paper addresses the question of who should be immunized against HAV when target groups are not clearly identified. Various risk groups were analyzed regarding the comparative risk of contracting and transmitting hepatitis A. This analysis recommends that the following groups be prioritized for HAV vaccine programs: sewage workers, residents of institutional communities, residents of Native American reservations (and other high-risk communities), overseas travelers and workers, and the military. The second paper discusses the results of a survey designed to determine the attitudes of nursing personnel in newborn nurseries who took on new duties of obtaining consent from parents and providing HBV vaccine to newborns. Among other findings, nursing staff need more training, including education about vaccine efficacy and appropriateness. Health care personnel who have to implement a new immunization program, not just those who decide on such policies need significant education in order to successfully fulfill their new duties. The third paper reports the results of the use of an alternative schedule for administering HBV vaccine to adolescents. The 0, 2, 4 month immunization schedule for adolescents is an alternative for adolescents, but there had been no studies to confirm the effectiveness of this schedule. Students who completed the series provided serological samples to determine the rate of seroconversion. This study found that the alternative schedule is quite effective in achieving protective antibody titers. Because of difficulties in reaching this age cohort and older teenagers, use of this modified immunization schedule may permit school-based or other public health programs to immunize a larger number of adolescents at risk in a shorter time frame.Dr.P.H.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/132052/2/9957658.pd