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Lawal S, St-Jean M, Hu Y, Bakos B, Dawar M, Thumath M, MacDonald A. Assessing sociodemographic disparities in HPV vaccine uptake among grade 6 and 9 students in the Vancouver Coastal Health region. Vaccine 2024; 42:126147. [PMID: 39060199 DOI: 10.1016/j.vaccine.2024.07.048] [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: 02/21/2024] [Revised: 06/05/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To identify sociodemographic factors associated with HPV vaccine uptake in a universal, in-school HPV vaccination program, among grade 6 and 9 students in the regional health authority of Vancouver Coastal Health (VCH), British Columbia (BC), Canada during the 2021/22 school year. VCH operates within the southwest corner of the province of BC serving a mix of urban and rural regions. HPV vaccine is offered in school to all grade 6 students using a two-dose series, with catch up immunizations offered to students in grade 9. METHODS We conducted a cross-sectional study of grade 6 and 9 students enrolled in VCH schools for the 2021/22 school year, who also resided within the VCH region. We modelled the associations between sociodemographic explanatory variables (individual-level and group-level) and fully vaccinated outcome using a cross-classified (non-nested) multilevel model. RESULTS Among the 17,939 students eligible, 74 % were fully vaccinated for HPV. Immunization coverage was associated with grade, geographic area of residence, school category, social and material deprivation. We demonstrated that grade modified the association between material deprivation and being fully vaccinated. Grade 9 students, including those residing in more materially deprived neighbourhoods, had substantially higher odds (OR 2.01 [95 % CI 1.08, 3.75]) of being fully vaccinated relative to grade 6 students in the least materially deprived neighbourhoods. CONCLUSIONS Though publicly funded HPV vaccine is offered to all students in grade 6 and 9, in a space that maximizes programmatic access, sociodemographic factors associated with under-immunized populations were identified. This information can be leveraged for strategic targeting of resources to underimmunized schools or students to mitigate impacts. The repeat offering of HPV vaccine in an older grade (grade 9 in BC) is a key programmatic strategy to reach under-immunized populations and should be complemented by other creative approaches.
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Affiliation(s)
- Samie Lawal
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada.
| | - Martin St-Jean
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Yumian Hu
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Brendan Bakos
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
| | - Meena Dawar
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada; School of Population and Public Health, University of British Columbia, British Columbia V6T 1Z3, Canada
| | - Meaghan Thumath
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada; School of Nursing, University of British Columbia, British Columbia V6T 2B5, Canada
| | - Adrienne MacDonald
- Office of the Chief Medical Health Officer, Vancouver Coastal Health, British Columbia V5Z 4C2, Canada
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Carter A, Klinner C, Young A, Strnadová I, Wong H, Vujovich-Dunn C, Newman CE, Davies C, Skinner SR, Danchin M, Hynes S, Guy R. "I Thought It Was Better to Be Safe Than Sorry": Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia. Vaccines (Basel) 2024; 12:922. [PMID: 39204045 PMCID: PMC11359071 DOI: 10.3390/vaccines12080922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/26/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
The uptake of human papilloma virus (HPV) and other adolescent vaccinations in special schools for young people with disability is significantly lower than in mainstream settings. This study explored the factors believed to influence parental decision making regarding vaccine uptake for students with intellectual disability and/or on the autism spectrum attending special schools in New South Wales, Australia, from the perspective of all stakeholders involved in the program. Focus groups and interviews were conducted with 40 participants, including parents, school staff, and immunisation providers. The thematic analysis identified two themes: (1) appreciating diverse parental attitudes towards vaccination and (2) educating parents and managing vaccination questions and concerns. While most parents were described as pro-vaccination, others were anti-vaccination or vaccination-hesitant, articulating a marked protectiveness regarding their child's health. Reasons for vaccine hesitancy included beliefs that vaccines cause autism, concerns that the vaccination may be traumatic for the child, vaccination fatigue following COVID-19, and assumptions that children with disability will not be sexually active. Special school staff regarded the vaccination information pack as inadequate for families, and nurses described limited educational impact resulting from minimal direct communication with parents. More effective communication strategies are needed to address vaccine hesitancy among parents with children with disability.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Christiane Klinner
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
| | - Alexandra Young
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
| | - Iva Strnadová
- School of Education, UNSW Sydney, Sydney, NSW 2052, Australia;
- Disability Innovation Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Horas Wong
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW 2050, Australia;
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia;
| | | | - Christy E. Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia;
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia; (C.D.); (S.R.S.)
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2050, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia; (C.D.); (S.R.S.)
| | - Margie Danchin
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Sarah Hynes
- Health Protection NSW, Sydney, NSW 2065, Australia;
| | - Rebecca Guy
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
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McIndoe L, Wilson E, Ferson MJ, Sheppeard V. Beyond Averages: Unpacking Disparities in School-Based Vaccination Coverage in Eastern Sydney: An Ecological Analysis. Vaccines (Basel) 2024; 12:888. [PMID: 39204014 PMCID: PMC11360741 DOI: 10.3390/vaccines12080888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
School vaccination programs are crucial for achieving high immunisation coverage among adolescents, but substantial disparities exist across schools and regions. This ecological study aimed to determine associations between school characteristics and vaccination coverage for diphtheria-tetanus-acellular pertussis (dTpa) and human papillomavirus (HPV) vaccines among year 7 students in southeastern Sydney. An analysis of data from 70 mainstream schools participating in the 2019 South Eastern Sydney Local Health District School Vaccination Program utilised quasi-Poisson regression models to assess associations between vaccination coverage and school attendance, socio-educational status, Aboriginal enrolments, language background other than English (LBOTE), school sector (government, Catholic, or independent), and coeducation status. Median school coverage was 88% for dTpa, 88% for HPV-girls, and 86% for HPV-boys, with interquartile ranges of 82-93%, 84-92%, and 78-91%, respectively. Higher school attendance was associated with increased dTpa vaccination coverage (PR 1.14, 95% CI 1.02-1.27). Single-sex schools showed higher HPV vaccination coverage compared to coeducational schools for both girls (PR 2.24, 95% CI 2.04-2.46) and boys (PR 1.89, 95% CI 1.72-2.08). No significant associations were found for ICSEA, Aboriginal enrolments, LBOTE, or school sector. School attendance and coeducational status significantly influenced vaccination coverage, with differential impacts on dTpa and HPV vaccines. These findings highlight the need for targeted strategies to address disparities in school-based vaccination programs. Research using qualitative methods could be useful to understand the beliefs and attitudes contributing to these disparities in vaccine uptake so that programs can be tailored to maximise participation.
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Affiliation(s)
- Leigh McIndoe
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, NSW 2031, Australia; (L.M.); (M.J.F.)
| | | | - Mark J. Ferson
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, NSW 2031, Australia; (L.M.); (M.J.F.)
- School of Population Health, University of New South Wales, Sydney, NSW 2050, Australia
| | - Vicky Sheppeard
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, NSW 2031, Australia; (L.M.); (M.J.F.)
- School of Public Health, University of Sydney, Camperdown, NSW 2050, Australia
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Tuckerman J, Mohamed Y, Justice F, Andersson T, Wyatt K, Broun K, Bastable A, Overmars I, Kaufman J, Danchin M. Stakeholder perspectives of immunisation delivery for adolescents with disability in specialist schools in Victoria, Australia: 'we need a vaccination pathway'. BMC Public Health 2024; 24:1973. [PMID: 39044189 PMCID: PMC11267833 DOI: 10.1186/s12889-024-19322-y] [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: 08/15/2023] [Accepted: 07/01/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Adolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability. OBJECTIVE To identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake. METHODS Qualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF 'Journey to Immunization' model. RESULTS 32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program. CONCLUSIONS Our study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake.
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Affiliation(s)
- Jane Tuckerman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia.
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia.
| | - Yasmin Mohamed
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia
| | - Frances Justice
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia
| | - Tove Andersson
- Centre for Behavioural Research in Cancer, Behavioural Science Division, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Behavioural Science Division, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Kate Broun
- Prevention Division, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Alice Bastable
- Prevention Division, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Isabella Overmars
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
| | - Jessica Kaufman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia
| | - Margie Danchin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC, 3010, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia
- Royal Children's Hospital, 50 Flemington Road, Parkville, 3052, Australia
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Jain M, Yadav D, Jarouliya U, Chavda V, Yadav AK, Chaurasia B, Song M. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens 2023; 12:1380. [PMID: 38133265 PMCID: PMC10745624 DOI: 10.3390/pathogens12121380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Human papillomavirus (HPV) is implicated in over 90% of cervical cancer cases, with factors like regional variability, HPV genotype, the population studied, HPV vaccination status, and anatomical sample collection location influencing the prevalence and pathology of HPV-induced cancer. HPV-16 and -18 are mainly responsible for the progression of several cancers, including cervix, anus, vagina, penis, vulva, and oropharynx. The oncogenic ability of HPV is not only sufficient for the progression of malignancy, but also for other tumor-generating steps required for the production of invasive cancer, such as coinfection with other viruses, lifestyle factors such as high parity, smoking, tobacco chewing, use of contraceptives for a long time, and immune responses such as stimulation of chronic stromal inflammation and immune deviation in the tumor microenvironment. Viral evasion from immunosurveillance also supports viral persistence, and virus-like particle-based prophylactic vaccines have been licensed, which are effective against high-risk HPV types. In addition, vaccination awareness programs and preventive strategies could help reduce the rate and incidence of HPV infection. In this review, we emphasize HPV infection and its role in cancer progression, molecular and immunopathogenesis, host immune response, immune evasion by HPV, vaccination, and preventive schemes battling HPV infection and HPV-related cancers.
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Affiliation(s)
- Meenu Jain
- Department of Microbiology, Viral Research and Diagnostic Laboratory, Gajra Raja Medical College, Gwalior 474009, Madhya Pradesh, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Urmila Jarouliya
- SOS in Biochemistry, Jiwaji University, Gwalior 474011 Madhya Pradesh, India;
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, Palo Alto, CA 94305, USA;
| | - Arun Kumar Yadav
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot 151203, Punjab, India;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Minseok Song
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea;
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Gupta S, Kumar P, Das BC. Challenges and opportunities to making Indian women cervical cancer free. Indian J Med Res 2023; 158:470-475. [PMID: 38237905 PMCID: PMC10878483 DOI: 10.4103/ijmr.ijmr_1052_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Shilpi Gupta
- Stem Cell & Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research, Amity University Uttar Pradesh, Noida 201 303, Uttar Pradesh, India
| | - Prabhat Kumar
- Stem Cell & Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research, Amity University Uttar Pradesh, Noida 201 303, Uttar Pradesh, India
| | - Bhudev Chandra Das
- Stem Cell & Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research, Amity University Uttar Pradesh, Noida 201 303, Uttar Pradesh, India
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Hotez PJ. Vaccine Preventable Disease and Vaccine Hesitancy. Med Clin North Am 2023; 107:979-987. [PMID: 37806729 DOI: 10.1016/j.mcna.2023.05.012] [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] [Indexed: 10/10/2023]
Abstract
Global immunization programs have saved tens of millions of lives over the last 2 decades. Now, the recent successes of COVID-19 vaccines having saved more than 3 million lives in North America during the pandemic may open the door to accelerate technologies for other emerging infection vaccines. New vaccines for respiratory syncytial virus, norovirus, influenza, herpes simplex virus, shingles, dengue fever, enteric bacterial infections, malaria, and Chagas disease are advancing through clinical development and could become ready for delivery over the next 5 years. The successful delivery of these new vaccines may require expanded advocacy and communications efforts.
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Affiliation(s)
- Peter J Hotez
- Department of Pediatrics and Molecular Virology and Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Texas Medical Center, One Baylor Plaza, Suite 164a, Houston, TX 77030, USA.
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Ebrahimi N, Yousefi Z, Khosravi G, Malayeri FE, Golabi M, Askarzadeh M, Shams MH, Ghezelbash B, Eskandari N. Human papillomavirus vaccination in low- and middle-income countries: progression, barriers, and future prospective. Front Immunol 2023; 14:1150238. [PMID: 37261366 PMCID: PMC10227716 DOI: 10.3389/fimmu.2023.1150238] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Human papillomavirus (HPV) is a viral infection that, if does not go away, can cause health problems like genital warts and cancer. The national immunization schedules for individuals before sexual debut, significantly decreased HPV-associated mortality and it will be affordable. However, immunization programs remain vulnerable to macroeconomic factors such as inflation, fiscal policy, employment levels, and national income. This review aims to investigate the association between national income in lower-middle-income countries to explore recent advances and potential issues, as well as how to deal with challenges.
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Affiliation(s)
- Narges Ebrahimi
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Yousefi
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Gholamreza Khosravi
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Marjan Golabi
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Monireh Askarzadeh
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Shams
- Department of Medical Immunology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Behrooz Ghezelbash
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Eskandari
- Immunology Department, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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