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6-7.0). The rate was the highest among former smokers (3.3%, 95% CI 2.3-4.4) compared to current smokers (1.8%, 95% CI 0.9-2.7) and never smokers (2.5%, 95% CI 1.4-3.6). People living with finance-reimbursed vaccination policy, a positive factor for vaccination, had a higher vaccination rate (11.5%, 95% CI 10.8-12.2) (p less then 0.05). People with older age, higher education level, occupation of professionals or technical personnel, living in rural areas or Northern China, former/never smoking were more likely to be vaccinated (p less then 0.05). CONCLUSIONS The influenza vaccination rate is low among adults aged ≥40 years, those ≥60 years and those with chronic diseases in China. Reimbursement policy targeting the elderly should be implemented widely and strategies towards patients with chronic diseases need urgent attention to increase the influenza vaccination coverage. BACKGROUND Clinical trials and spontaneous reporting systems have revealed rare but biologically plausible adverse events following varicella immunization. Few post-marketing controlled studies have been conducted to assess the relationship between the varicella vaccine and these outcomes. OBJECTIVES To evaluate the risk of pneumonia, idiopathic thrombocytopenic purpura (ITP), meningitis, encephalitis and ischemic stroke following varicella immunization. MATERIALS AND METHODS This nationwide observational study was based on Taiwan National Health Insurance data and National Immunization Information System from 2004 through 2014. Primary analysis included children aged 12-35 months who received the single varicella vaccine on the date of administration. The self-controlled risk interval design compared the incidence of pre-specified outcomes during a risk interval of 1-42 days post-vaccination and a control interval of 43-84 days. The outcomes of interest were defined as admitted pneumonia, ITP, meningitis, encephalitis, and ischemic stroke, as well as fracture as a negative control. Conditional Poisson regression was used to assess the incidence rate ratio (aIRR) with adjustments for age and seasonal effects. RESULTS Among 1,194,189 children, who receiving the varicella vaccine, there was no observed increase in the risk for ITP (aIRR 1.00; 95% CI, 0.76-1.33), meningitis (aIRR 1.21; 95% CI, 0.49-2.95), encephalitis (aIRR 1.00; 95% CI, 0.62-1.60), or ischemic stroke (aIRR 1.24; 95% CI, 0.31-4.95). A clustering feature with pneumonia occurred during days 36-42 post-vaccination (aIRR 1.10; 95% CI, 1.02-1.18). An increase in the risk for ITP was observed in children receiving the varicella and MMR vaccines concomitantly (aIRR 1.70; 95% CI, 1.19-2.43), but not among those receiving the varicella vaccine only. CONCLUSIONS We detected a small risk of incidental pneumonia associated with varicella vaccine in the 6th week after immunization. There was no increase in the risk of other pre-specified adverse events. Measles outbreaks occur periodically in remote and difficult to reach areas in countries such as the Democratic Republic of Congo. The possibility to keep measles vaccines at temperatures outside the cold chain for a limited period prior to administration would be an advantage for organizations such as Médecins Sans Frontières, which repeatedly respond to measles outbreaks in difficult contexts. Using stability data at 37 °C and 40 °C provided by Serum Institute of India Private Limited we applied the product release model for Extended Controlled Temperature Conditions (ECTC) to evaluate the possibility of an out of the cold chain excursion. Measles vaccine in the lyophilized form remains above the minimum required potency at the end of the shelf-life for up to 6 days at 37 °C or for 2 days at 40 °C. This evaluation supports the use of a monodose presentation of measles vaccine in ECTC. This could be an advantage for outbreak response in isolated and difficult to reach areas. However the operational advantages of this approach need to be established. OBJECTIVE The purpose of this systematic review was to explore pharmacists' impact on older adults' access to vaccines in terms of realized accessibility, financial accessibility, and vaccine availability. METHODS Five databases were searched using a search strategy developed in PubMed and translated to other databases. Included studies were English-language, United States-based primary literature published between 1994 to present day. Studies were excluded if they were incomplete studies or did not focus on at least one of three dimensions of access to immunizations realized accessibility, availability, and financial accessibility. The following data were gathered title, authors, year published, sub-dimension of accessibility, health care setting, intervention or data source, pharmacist role, type of immunization, duration of study, sample size, and main outcome measures. RESULTS Twenty-five studies met the inclusion criteria. DEG-77 mouse Of those, the majority evaluated realized accessibility (n = 22, 88%). Eleven studies evaluated vaccine availability, and one study addressed financial accessibility. Pharmacists had a variety of roles in the immunization process, including screener, educator, immunizer, or documenter, and often played more than one role (n = 10, 40%). Pharmacists participated in the vaccination process across multiple health care settings, including in community pharmacies (n = 8, 32%) and hospitals (n = 7, 28%). In the majority (n = 21, 84%) of studies, pharmacists positively impacted older adults' access to vaccines. The most common vaccinations studied were pneumococcal and influenza vaccinations (n = 20, 80%). CONCLUSION Vaccinations are important in protecting and maintaining the health of older adults. Pharmacists improved access to vaccinations and served many roles in the vaccination process. Future research should explore how pharmacists impact access to vaccines beyond vaccination rates, especially regarding the financial impact on patients. BACKGROUND Men and women in county jails make up a population that is difficult to reach with traditional preventive health interventions. Collaborations between local health departments and county jails represent an opportunity to enhance public health by reaching a vulnerable population with services like vaccinations. The objective of this study was to coordinate planning and implementation of a collaborative program between a local health department (HD) and a county jail to offer human papillomavirus (HPV) vaccinations to adolescents (ages 10-17) and young adults (ages 18-26) in the jail and to identify facilitators and barriers to inform future program development. METHODS A county-municipal jail and a local HD in Kansas participated. A case study method was employed based on data collected from a focus group, telephone interviews, and site observations, September 2016 to December 2017. Data were coded using codes roughly drawn from the consolidated framework for implementation research (CFIR). Codes were then consolidated into themes related to barriers and facilitators.
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