Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination

National Inpatient Immunization Patterns: Variation in Practice and Policy Between Vaccine Types

BACKGROUND

Many hospitalized children are underimmunized, yet little is known about current systems supporting inpatient vaccination. We aim to describe national pediatric inpatient immunization practices and determine if variation exists among adolescent, childhood, and influenza vaccines.

METHODS

An electronic survey regarding hospital vaccination practices was sent to physician, nurse, and pharmacy leaders via the Pediatric Research in Inpatient Settings Network in spring 2019. Hospitals reported the presence of various practices to support inpatient vaccination stratified by vaccine type: tetanus, diphtheria, and acellular pertussis, meningococcal, human papillomavirus, childhood series, and influenza. One-way analysis of variance testing compared differences in numbers of practices and χ² tests compared proportions of sites reporting each practice between vaccine types. Qualitative responses were evaluated via content analysis.

RESULTS

Fifty-one of 103 eligible hospitals completed the survey (50%). Standardized policies existed in 92% of hospitals for influenza, 41% for childhood, and 29% for adolescent vaccines. Hospitals identified an average of 5.1 practices to deliver influenza vaccines, compared with 1.5 for childhood; 0.9 for tetanus, diphtheria, and acellular pertussis; 0.7 for meningococcal; and 0.6 for human papillomavirus vaccines (P < .001). Standardized screening tools, visual prompts, standing orders, nurse- or pharmacy-driven screening or ordering, staff education, and quality improvement projects were reported more often for influenza vaccines than other vaccine types (P < .01 for all comparisons). Common barriers to delivery included communication difficulties, lack of systems optimization, and parent and provider discomfort with inpatient immunization.

CONCLUSIONS

Existing hospital infrastructure supports influenza vaccine delivery over other vaccine types, potentially creating missed inpatient vaccination opportunities.

Increasing HPV Vaccination Support Through a Pilot Film-Based Community Engagement

Mass media interventions are considered an effective tool to improve support for preventive health behavior. We conducted a retrospective analysis of data collected during 2016-2017 community screenings of the film Someone You Love: The HPV Epidemic to raise public awareness about human papillomavirus (HPV). The objective was to examine the change in participants' support for HPV vaccination after viewing the film. The film was screened five times at four different communities. Each screening was followed by a discussion session with local health care experts. A 9-item structured survey measured the impact of the film on motivation and overall support for HPV vaccine on a 4-point Likert scale. We used Wilcoxon Signed Rank test to examine the change in vaccination support. We obtained 64 survey responses. Participants were informed about the film through word of mouth and friends (20%), flyers (19%), and their health care providers (9.4%). Fifty-five percent were parents/guardians, and 75% were aged 26-65 years. About 28% and 22% of participants reported their daughters or sons had completed all 2 or 3 HPV shots. Results from Wilcoxon Signed Rank Test indicated statistically significant increase in vaccination support (Z =  - 5.44, p < 0.001) after viewing the film. The median response from before to after changed from "supportive" to "very supportive". Community film screening followed by discussion with local health care experts is a promising strategy for increasing HPV vaccine support. Future work should address increasing access to the film, examine the film's impact on increasing HPV vaccine uptake and assessing program cost effectiveness.