Current research studies/projects include:

Acute gastroenteritis surveillance to determine rotavirus disease burden and vaccine effectiveness
 
Sponsored by the Centers for Disease Control and Prevention
 
Investigators:
Dr. Julie Boom, Dr. Carol J. Baker

Description:
Members of the Center for Vaccine Awareness and Research and Centers for Disease Control and Prevention (CDC) are conducting a study that assesses the number of hospital visits that are due to rotavirus gastroenteritis and the effectiveness of available vaccines at preventing rotavirus. Although rotavirus is rarely fatal in the US, it is the leading cause of vomiting and diarrhea in young children, and is thought to cause more than 700,000 healthcare encounters each year in children less than 5 years of age.

There are currently two vaccines that protect young children against rotavirus that are given at 2, 4, and 6 months of age as part of the primary immunization series. Results from 2008 demonstrated that one of these vaccines protected against 85-89% of rotavirus infections among children who had received all three recommended doses of vaccine. The vaccine also prevented rotavirus infections in children who had received only 1 or 2 doses. Findings from 2009 suggest that rotavirus vaccines continue to prevent illness in the second year of life.

In 2009, under the direction of Dr. Julie Boom, Texas Children’s Hospital became part of a six-site national network that continues to monitor hospitalizations and Emergency Department visits due to acute gastroenteritis and assesses the effectiveness of rotavirus vaccines. Additionally, members of the Center for Vaccine Awareness and Research are working with the CDC to determine if unvaccinated children who live with vaccinated siblings are indirectly protected against rotavirus.
 

Adolescent Vaccination: Taking It to the Schools
 
Sponsored by sanofi pasteur
 
Investigators:
Dr. Amy B. Middleman

Description:
This project has been conducted since 2008 and continues still as data analyses continue. The aims of this project are two-fold:

• to determine parents’ perspectives and attitudes regarding school-based immunization programs
• to provide a school-based immunization program during the 2008-2009 academic school year to 5 HISD middle schools in underserved areas for the Tdap and meningococcal vaccines
  

Data already analyzed from this study have indicated significant parental support of school-based immunization programs. Although few parents have had experience with such programs (few exist in Houston), over 40% of parents indicated that they would be willing to have their child participate. Through this program, approximately 500 youth were immunized by the program during the Spring semester of 2009. Interestingly, most recent analyses have shown that although parents may not initially indicate a willingness to use such a program, many will fell comfortable with a school-based program when given the opportunity.

The data from this study will help inform public health personnel that many do support and would utilize a school-based immunization program. Such programs could have a significant impact on improving immunization rates among the adolescent population.
 

Focusing on Flu for Adolescents
 
Sponsored by the MedImmune
 
Investigators:
Dr. Amy B. Middleman, Dr. Jean S. Doak

Description:
School-based immunization programs have been shown to be very successful at improving adolescent immunization rates. With new recommendations for universal annual influenza immunization for all persons age 6 months and older, the schools are the most likely site to immunize the most children and adolescents. Little is known, however, about the elements of a program that may be most appreciated by both adolescents and parents. What should a program include that would engage adolescents and make them more likely to ask their parents to consent for their participation? What elements would parents like to have included in a program?

This project will begin with focus groups comprised of elementary, middle, and high school students and parents. Through honest discussion in small groups, our team hopes to determine what types of factors might increase school-based program participation rates. From these data, questionnaires will be developed and distributed among a larger number of elementary, middle and high school students and their parents to quantify the importance of these potential program elements.

The results from the study will hopefully help guide program designers to include program elements most important to the students and parents being approached for participation. It will provide students and parents with a voice to express what they would most like to see in a school immunization program. The goal is to improve program participation and protect the maximum number of adolescents from disease.
 

The Cocoon Strategy - Preventing Severe and Fatal Pertussis (Whooping Cough) in Infants Through Family Immunization
 
Sponsored by the Baylor Methodist Community Health Fund 
 
Investigators:
Dr. C. Mary Healy

Description:
Since January 2008 the Center for Vaccine Awareness and Research has been implementing “The Cocoon Strategy” vaccination program to protect newborn infants from the life-threatening infection pertussis, more commonly known as whooping cough. This cocoon vaccination strategy has been recommended by the Centers for Disease Control and Prevention (CDC) since 2006 but is not routine in healthcare organizations. The “cocoon strategy” aims to protect newborn infants from becoming infected with pertussis by administering Tdap (tetanus, diphtheria and acellular pertussis) booster vaccines to mothers and family members of newborn infants. In this way, mothers and family members are protected from getting pertussis and passing it on to their young infants.

Under the direction of Dr. C. Mary Healy, program leader and director of Vaccinology and Maternal Immunization, the Center for Vaccine Awareness and Research administers Tdap booster vaccine to families at Houston’s Ben Taub General Hospital.   The “cocoon strategy” involves first educating the mother and her family about pertussis and the Tdap vaccine before administering booster vaccine. The program team, working in collaboration with hospital staff, communicates with families in English and Spanish. The first phase of this program, vaccinating mothers, started in January 2008 and currently more than 90% of Tdap-eligible mothers receive the vaccine before leaving the hospital.  In June 2009, the second phase of the program expanded its Tdap vaccination service to other family members of newborn infants and administered approximately 2000 Tdap booster doses in the first 8 months of operation.  The majority of family members who receive Tdap (98%) receive it before the infant is one week of age and 87% live with the infant.  

The Cocoon Strategy Program is one of the first and largest in the nation to provide CDC recommended Tdap booster vaccines to adult family members and has been at the forefront in identifying barriers that may affect the widespread implementation of this immunization strategy.  These include financial constraints, lack of necessary infrastructure and the need for targeted education, convenient service, and easily accessible immunization records. The program has administered more than 10,000 immunizations and, as pertussis outbreaks continue to occur periodically in the U.S., Dr. Healy has been contacted by medical professionals from around the country seeking information on how to develop a similar program. 

The program is made possible grant funding from the Baylor Methodist Community Health Fund and the Children’s Health fund of the Harris County Hospital District Foundation. The program continues to deliver this important service to families while exploring efficient processes to optimize this intervention and potentially reduce serious pertussis disease in the community.

The REACH Project: Reseach Examining Adolescent Response to a Challenge Dose of Hepatitis B Vaccine
 
Sponsored by the Centers for Disease Control and Prevention
 
Investigators:
Dr. Amy B. Middleman, Dr. Carol J. Baker

Description:
Recent studies from other countries where hepatitis B disease is more common have shown that many adolescents who received the primary vaccination series for hepatitis B as infants do not respond to a booster dose of hepatitis B vaccine. This implies that their immunity to the disease may have decreased.

For this study, 17-19 year olds born in the United States who received all three doses of their hepatitis B vaccination series before the age of 10 months will be enrolled. After blood is drawn to assess immunity to hepatitis B at baseline, each participant will receive a booster dose of the hepatitis B vaccine. Blood will then be drawn from each participant 2 weeks later. The immune response to the booster dose will be assessed to determine if he/she has responded to the vaccine in a way that indicates the ability to respond quickly and effectively against hepatitis B disease itself if exposed.

This study is being conducted with the help of our collaborators, Texas Children’s Pediatric Associates. With their help, we hope to complete this study in approximately 2 years.