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Felsher M, Shumet M, Velicu C, Chen YT, Nowicka K, Marzec M, Skowronek G, Pieniążek I. A systematic literature review of human papillomavirus vaccination strategies in delivery systems within national and regional immunization programs. Hum Vaccin Immunother 2024; 20:2319426. [PMID: 38410931 PMCID: PMC10900274 DOI: 10.1080/21645515.2024.2319426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
The uptake of human papillomavirus (HPV) vaccine remains suboptimal despite being a part of routine vaccination within national immunization program(s). This indicates probable challenges with the implementation of HPV immunization program(s) in various countries. The objective of this systematic literature review (SLR) was to identify implementation strategies for HPV vaccination within national and regional immunization programs worldwide with an aim to provide guidance for countries targeting to increase their HPV vaccine coverage rate (VCR). A comprehensive literature search was conducted across Medline and Embase and included articles published between January 2012 and January 2022. Of the 2,549 articles retrieved, 168 met inclusion criteria and were included in the review. Strategies shown to improve HPV vaccination uptake in the reviewed literature include campaigns to increase community awareness and knowledge of HPV, health care provider trainings, integrating HPV vaccination within school settings, coordinated efforts via multi-sectoral partnerships, and vaccination reminder and recall systems. Findings may help national authorities understand key considerations for HPV vaccination when designing and implementing programs aiming to increase HPV VCR in adolescents.
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Fallucca A, Priano W, Carubia A, Ferro P, Pisciotta V, Casuccio A, Restivo V. Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies. JMIR Public Health Surveill 2024; 10:e52926. [PMID: 39042433 PMCID: PMC11303899 DOI: 10.2196/52926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. OBJECTIVE This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. METHODS In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. RESULTS The analyses showed an overall efficacy of RR 1.22 (95% CI 1.19-1.26) for RCTs and RR 1.70 (95% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95% CI 0.12-0.95; before-after: coefficient 1.27, 95% CI 0.70-1.84). CONCLUSIONS Community, family, and health care-based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases.
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Affiliation(s)
- Alessandra Fallucca
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Walter Priano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Alessandro Carubia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Patrizia Ferro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Vincenzo Pisciotta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
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Rohweder CL, Morrison A, Mottus K, Young A, Caton L, Booth R, Reed C, Shea CM, Stover AM. Virtual quality improvement collaborative with primary care practices during COVID-19: a case study within a clinically integrated network. BMJ Open Qual 2024; 13:e002400. [PMID: 38351031 PMCID: PMC10868276 DOI: 10.1136/bmjoq-2023-002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Quality improvement collaboratives (QICs) are a common approach to facilitate practice change and improve care delivery. Attention to QIC implementation processes and outcomes can inform best practices for designing and delivering collaborative content. In partnership with a clinically integrated network, we evaluated implementation outcomes for a virtual QIC with independent primary care practices delivered during COVID-19. METHODS We conducted a longitudinal case study evaluation of a virtual QIC in which practices participated in bimonthly online meetings and monthly tailored QI coaching sessions from July 2020 to June 2021. Implementation outcomes included: (1) level of engagement (meeting attendance and poll questions), (2) QI capacity (assessments completed by QI coaches), (3) use of QI tools (plan-do-check-act (PDCA) cycles started and completed) and (4) participant perceptions of acceptability (interviews and surveys). RESULTS Seven clinics from five primary care practices participated in the virtual QIC. Of the seven sites, five were community health centres, three were in rural counties and clinic size ranged from 1 to 7 physicians. For engagement, all practices had at least one member attend all online QIC meetings and most (9/11 (82%)) poll respondents reported meeting with their QI coach at least once per month. For QI capacity, practice-level scores showed improvements in foundational, intermediate and advanced QI work. For QI tools used, 26 PDCA cycles were initiated with 9 completed. Most (10/11 (91%)) survey respondents were satisfied with their virtual QIC experience. Twelve interviews revealed additional themes such as challenges in obtaining real-time data and working with multiple electronic medical record systems. DISCUSSION A virtual QIC conducted with independent primary care practices during COVID-19 resulted in high participation and satisfaction. QI capacity and use of QI tools increased over 1 year. These implementation outcomes suggest that virtual QICs may be an attractive alternative to engage independent practices in QI work.
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Affiliation(s)
- Catherine L Rohweder
- Center for Women's Health Research, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Abigail Morrison
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kathleen Mottus
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alexa Young
- Center for Health Promotion and Disease Prevention, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren Caton
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Ronni Booth
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christine Reed
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christopher M Shea
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Khalid K, Lee KY, Mukhtar NF, Warijo O. Recommended Interventions to Improve Human Papillomavirus Vaccination Uptake among Adolescents: A Review of Quality Improvement Methodologies. Vaccines (Basel) 2023; 11:1390. [PMID: 37631958 PMCID: PMC10459466 DOI: 10.3390/vaccines11081390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Routine human papillomavirus (HPV) vaccine uptake continues to be suboptimal since its recommendation in 2006 for girls and in 2011 for boys. This paper aims to review published quality improvement (QI) methodologies on interventions to improve HPV vaccine uptake among adolescents. METHODS Science Direct and Scopus databases were searched for QI initiatives evaluating the effect of multimodal interventions to improve HPV vaccination rates (initiation and/or completion of series) among adolescents. Studies that included an outcome of interest among adolescents aged 10 to 18 years old were included. Two investigators worked independently to screen for potential articles and a designated investigator extracted data on study characteristics and evaluated the outcomes. RESULTS A preliminary search yielded a total of 523 articles and 13 were included in the final analysis. Common strategies were provider-specific (i.e., webinar, telementoring, train-the-trainer approach) and patient- and/or parent-specific interventions (i.e., reminder emails, phone calls and text messages, social events), with an emphasis on education and knowledge empowerment. System-level interventions such as policy changes and revised protocols were less commonly prescribed despite being associated with a more significant weight on the overall outcome. CONCLUSIONS Creative, sustainable, and economical multilevel interventions that focus not only on provider training and public education but also incorporate local policies and system enhancements can substantially improve HPV vaccination coverage among adolescents.
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Affiliation(s)
- Karniza Khalid
- Specialized Diagnostic Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur 50588, Malaysia
| | - Kun Yun Lee
- Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Nur Farihan Mukhtar
- Department of Obstetrics and Gynecology, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar 01000, Malaysia;
| | - Othman Warijo
- Kedah State Health Department, Ministry of Health Malaysia, Alor Setar 05400, Malaysia;
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Zhu Y, Wu CF, Giuliano AR, Fernandez ME, Ortiz AP, Cazaban CG, Li R, Deshmukh AA, Sonawane K. Tdap-HPV vaccination bundling in the USA: Trends, predictors, and implications for vaccine series completion. Prev Med 2022; 164:107218. [PMID: 36007751 PMCID: PMC9691592 DOI: 10.1016/j.ypmed.2022.107218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) promotes taking a 'bundling approach' (i.e., administering Tetanus, diphtheria toxoids, and acellular pertussis [Tdap] and human papillomavirus [HPV] vaccines in the same way and on the same day) for adolescent vaccinations. Recent trends and patterns in Tdap-HPV vaccination bundling in the USA remain undocumented. In addition, the implications of bundling Tdap-HPV vaccination for HPV vaccine series completion remain unknown. To address these critical knowledge gaps, we performed a retrospective study using a nationwide sample of privately insured adolescents (Optum's de-identified Clinformatics® Data Mart Database). Tdap-HPV vaccination bundling (per 100 Tdap vaccination encounters) during 2014-2018 was estimated overall, for 50 states, and by adolescents' age, sex, and provider specialties. Survival model estimated the likelihood of series completion among 9-14-year-old adolescents. From 2014 to 2018, 560,806 adolescents received a Tdap vaccine of which 172,604 (30.8%) received the HPV vaccines on the same day. Tdap-HPV vaccination bundling (per 100 Tdap vaccinations) increased nationally, from 22.9 in 2014 to 39.1 in 2018 (Ptrend < 0.001); bundling was lowest in New York and New Jersey. The likelihood of receiving the Tdap and HPV vaccines bundled was higher for young and female adolescents. Adolescents who received their first HPV vaccine bundled with the Tdap vaccine were more likely to complete the series compared to those who received it alone (Hazards Ratio = 1.45; 1.43-1.48). HPV vaccination bundling has increased in recent years in the USA. The increased likelihood of HPV vaccine series completion provides important evidence supporting the adoption of same-day Tdap-HPV vaccine administration in clinical practice to boost HPV vaccination coverage.
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Affiliation(s)
- Yenan Zhu
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America; Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Chi-Fang Wu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ana P Ortiz
- Department of Biostatistics and Epidemiology, University of Puerto Rico Comprehensive Cancer Center, Puerto Rico
| | - Cecilia Ganduglia Cazaban
- Center for Healthcare Data, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, United States of America
| | - Ashish A Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
| | - Kalyani Sonawane
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America.
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Constable C, Ferguson K, Nicholson J, Quinn GP. Clinician communication strategies associated with increased uptake of the human papillomavirus (HPV) vaccine: A systematic review. CA Cancer J Clin 2022; 72:561-569. [PMID: 35969145 DOI: 10.3322/caac.21753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil-9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians' recommendations play a significant role in parents' decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer-prevention messaging.
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Affiliation(s)
- Catherine Constable
- Department of Medicine, New York University (NYU) Langone Medical Center, New York, New York, USA
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Kyle Ferguson
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Joey Nicholson
- NYU Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Gwendolyn P Quinn
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York, USA
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Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: a systematic review of the literature. Prev Med Rep 2022; 27:101804. [PMID: 35656229 PMCID: PMC9152779 DOI: 10.1016/j.pmedr.2022.101804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 12/22/2022] Open
Abstract
Early childhood vaccination coverage is low in rural areas of the United States. Reminder-recall & positive family-provider relationships facilitate vaccine uptake. Parental hesitancy is a barrier to early childhood vaccination in the rural U.S. Vaccine referrals & distance to providers are also rural-specific barriers. To increase vaccine coverage, interventions across rural populations are needed.
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies’ methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents’ relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural–urban immunization disparities.
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Newcomer SR, Freeman RE, Albers AN, Murgel S, Thaker J, Rechlin A, Wehner BK. Missed opportunities for human papillomavirus vaccine series initiation in a large, rural U.S. state. Hum Vaccin Immunother 2022; 18:2016304. [PMID: 35119342 PMCID: PMC8993074 DOI: 10.1080/21645515.2021.2016304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates are lower in rural versus urban areas of the United States. Our objective was to identify the types of vaccination clinic settings where missed opportunities for HPV vaccine series initiation most frequently occurred in Montana, a large, primary rural U.S. state. We analyzed a limited dataset from Montana’s immunization information system for adolescents who turned 11 years old in 2014–2017. Vaccination visits where the HPV vaccine was due but not administered were missed opportunities. We compared missed opportunities across six types of clinic settings, and calculated adjusted relative risks (RR) using a generalized estimating equation model. Among n = 47,622 adolescents, 53.9% of 71,447 vaccination visits were missed opportunities. After adjusting for sex, age, and rurality of clinic location, receiving vaccines in public health departments was significantly associated with higher risk of missed opportunities (aRR = 1.25, 95% confidence interval = 1.22–1.27, vs. private clinics). Receipt of vaccines in Indian Health Services and Tribal clinics was associated with fewer missed opportunities (aRR = 0.72, 95% CI: 0.69–0.75, vs. private clinics). Our results indicate the need for interventions to promote HPV vaccine uptake in public health departments, which are a critical source of immunization services in rural and medically underserved areas of the U.S.
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Affiliation(s)
- Sophia R Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.,Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Rain E Freeman
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.,Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Alexandria N Albers
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.,Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Sara Murgel
- Montana Department of Public Health and Human Services, Cancer Control Programs, Helena, MT, USA
| | - Juthika Thaker
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.,Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Annie Rechlin
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, USA
| | - Bekki K Wehner
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, USA
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Tang J, Li M, Zhao C, Shen D, Liu L, Zhang X, Wei L. Therapeutic DNA Vaccines against HPV-Related Malignancies: Promising Leads from Clinical Trials. Viruses 2022; 14:v14020239. [PMID: 35215833 PMCID: PMC8874761 DOI: 10.3390/v14020239] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
In 2014 and 2021, two nucleic-acid vaccine candidates named MAV E2 and VGX-3100 completed phase III clinical trials in Mexico and U.S., respectively, for patients with human papillomavirus (HPV)-related, high-grade squamous intraepithelial lesions (HSIL). These well-tolerated but still unlicensed vaccines encode distinct HPV antigens (E2 versus E6+E7) to elicit cell-mediated immune responses; their clinical efficacy, as measured by HSIL regression or cure, was modest when compared with placebo or surgery (conization), but both proved highly effective in clearing HPV infection, which should help further optimize strategies for enhancing vaccine immunogenicity, toward an ultimate goal of preventing malignancies in millions of patients who are living with persistent, oncogenic HPV infection but are not expected to benefit from current, prophylactic vaccines. The major roadblocks to a highly efficacious and practical product remain challenging and can be classified into five categories: (i) getting the vaccines into the right cells for efficient expression and presentation of HPV antigens (fusion proteins or epitopes); (ii) having adequate coverage of oncogenic HPV types, beyond the current focus on HPV-16 and -18; (iii) directing immune protection to various epithelial niches, especially anogenital mucosa and upper aerodigestive tract where HPV-transformed cells wreak havoc; (iv) establishing the time window and vaccination regimen, including dosage, interval and even combination therapy, for achieving maximum efficacy; and (v) validating therapeutic efficacy in patients with poor prognosis because of advanced, recurrent or non-resectable malignancies. Overall, the room for improvements is still large enough that continuing efforts for research and development will very likely extend into the next decade.
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Affiliation(s)
- Jianming Tang
- Aeonvital Biomedical Research Institute, Beijing 102208, China; (L.L.); (X.Z.)
- Correspondence: or
| | - Mingzhu Li
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100033, China; (M.L.); (C.Z.); (D.S.); (L.W.)
| | - Chao Zhao
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100033, China; (M.L.); (C.Z.); (D.S.); (L.W.)
| | - Danhua Shen
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100033, China; (M.L.); (C.Z.); (D.S.); (L.W.)
| | - Lei Liu
- Aeonvital Biomedical Research Institute, Beijing 102208, China; (L.L.); (X.Z.)
| | - Xiujun Zhang
- Aeonvital Biomedical Research Institute, Beijing 102208, China; (L.L.); (X.Z.)
| | - Lihui Wei
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100033, China; (M.L.); (C.Z.); (D.S.); (L.W.)
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Szilagyi PG, Humiston SG, Stephens-Shields AJ, Localio R, Breck A, Kelly MK, Wright M, Grundmeier RW, Albertin C, Shone LP, Steffes J, Rand CM, Hannan C, Abney DE, McFarland G, Kominski GF, Seixas BV, Fiks AG. Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates: A Cluster Randomized Clinical Trial. JAMA Pediatr 2021; 175:901-910. [PMID: 34028494 PMCID: PMC8145158 DOI: 10.1001/jamapediatrics.2021.0766] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common. OBJECTIVES To evaluate the effect of online communication training for clinicians on missed opportunities for HPV vaccination rates overall and at well-child care (WCC) visits and visits for acute or chronic illness (hereafter referred to as acute or chronic visits) and on adolescent HPV vaccination rates. DESIGN, SETTING, AND PARTICIPANTS From December 26, 2018, to July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices to communication training vs standard of care in staggered 6-month periods. A total of 48 primary care pediatric practices in 19 states were recruited from the American Academy of Pediatrics Pediatric Research in Office Settings network. Participants were clinicians in intervention practices. Outcomes were evaluated for all 11- to 17-year-old adolescents attending 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians). Analyses were as randomized and performed on an intent-to-treat basis, accounting for clustering by practice. INTERVENTIONS Three sequential online educational modules were developed to help participating clinicians communicate with parents about the HPV vaccine. Weekly text messages were sent to participating clinicians to reinforce learning. Statisticians were blinded to group assignment. MAIN OUTCOMES AND MEASURES Main outcomes were missed opportunities for HPV vaccination overall and for HPV vaccine initiation and subsequent doses at WCC and acute or chronic visits (visit-level outcome). Secondary outcomes were HPV vaccination rates (person-level outcome). Outcomes were compared during the intervention vs baseline. RESULTS Altogether, 122 of 188 clinicians in intervention practices participated; of these, 120, 119, and 116 clinicians completed training modules 1, 2, and 3, respectively. During the intervention period, 29 206 adolescents (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 WCC and 28 123 acute or chronic visits to intervention practices; 33 914 adolescents (17 069 girls [50.3%]; mean [SD] age, 14.2 [2.0] years) made 17 910 WCC and 35 281 acute or chronic visits to control practices. Intervention practices reduced missed opportunities overall by 2.4 percentage points (-2.4%; 95% CI, -3.5% to -1.2%) more than controls. Intervention practices reduced missed opportunities for vaccine initiation during WCC visits by 6.8 percentage points (-6.8%; 95% CI, -9.7% to -3.9%) more than controls. The intervention had no effect on missed opportunities for subsequent doses of the HPV vaccine or at acute or chronic visits. Adolescents in intervention practices had a 3.4-percentage point (95% CI, 0.6%-6.2%) greater improvement in HPV vaccine initiation compared with adolescents in control practices. CONCLUSIONS AND RELEVANCE This scalable, online communication training increased HPV vaccination, particularly HPV vaccine initiation at WCC visits. Results support dissemination of this intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03599557.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | | | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Abigail Breck
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | - Mary Kate Kelly
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Wright
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Robert W. Grundmeier
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina Albertin
- Department of Pediatrics, University of California, Los Angeles, UCLA Mattel Children’s Hospital, Los Angeles
| | - Laura P. Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Jennifer Steffes
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Cynthia M. Rand
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Chloe Hannan
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dianna E. Abney
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Greta McFarland
- Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Gerald F. Kominski
- UCLA Center for Health Policy Research, University of California Los Angeles, Los Angeles
| | - Brayan V. Seixas
- UCLA Center for Health Policy Research, University of California Los Angeles, Los Angeles
| | - Alexander G. Fiks
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Primary Care Research, American Academy of Pediatrics, Itasca, Illinois,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hofstetter AM, Opel DJ, Stockwell MS, Hsu C, Zhou C, Mangione-Smith RM, Englund JA. Associations Between Health Care Professional Communication Practices and Influenza Vaccination of Hospitalized Children. Acad Pediatr 2021; 21:1142-1150. [PMID: 34217901 DOI: 10.1016/j.acap.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Health care professionals (HCPs) (eg, nurses, doctors) play a key role in vaccine uptake. Few studies describe HCP influenza vaccine communication with parents of hospitalized children. METHODS This study included English- and Spanish-speaking parents of influenza vaccine-eligible children hospitalized at a tertiary care pediatric hospital between October 2018 and May 2019. A survey was completed online or via telephone 2 to 15 weeks (median 4 weeks) after discharge. It examined parental intent to vaccinate their child during hospitalization and parent-reported inpatient HCP communication practices (eg, vaccine recommendation strength, format for initiating the recommendation). Multivariable logistic regression examined the associations between HCP communication practices and influenza vaccination during hospitalization, adjusting for demographic, clinical, and visit characteristics. RESULTS Parents (n = 194; 63.0% response rate) were mostly white (66.8%) and English-speaking (97.4%). Their children were primarily 5 through 17 years (67.0%) with chronic disease (68.6%); 24.7% were vaccinated before discharge. Most parents initially had no plan (55.6%) or planned to decline (31.1%) influenza vaccine for their child during hospitalization. Of these parents, 22.2% decided to accept the vaccine, 66.7% citing a HCP conversation as the main reason for changing their mind. Overall, 75.3% recalled a HCP conversation about influenza vaccination. Of these parents, 61.0% reported a HCP recommendation (53.8% described it as "very strong"; 11.1% noted a presumptive initiation format). A parent-reported HCP conversation (adjusted odds ratio [AOR] 5.23, 95% confidence interval [CI] 1.64-16.68) and recommendation (AOR 5.59, 95% CI 2.01-15.51) were associated with influenza vaccination during hospitalization. CONCLUSION This study highlights the importance of discussing and recommending influenza vaccination with parents of hospitalized children.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, University of Washington School of Medicine (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash; Seattle Children's Research Institute (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash.
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash; Seattle Children's Research Institute (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University (MS Stockwell), New York, NY; Department of Population and Family Health, Mailman School of Public Health, Columbia University (MS Stockwell), New York, NY
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute (C Hsu and RM Mangione-Smith), Seattle, Wash
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash; Seattle Children's Research Institute (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash
| | - Rita M Mangione-Smith
- Kaiser Permanente Washington Health Research Institute (C Hsu and RM Mangione-Smith), Seattle, Wash
| | - Janet A Englund
- Department of Pediatrics, University of Washington School of Medicine (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash; Seattle Children's Research Institute (AM Hofstetter, DJ Opel, C Zhou, and JA Englund), Seattle, Wash
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