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Caselli D, Aricò M, Fiasca F, Tafuri S. Policy of vaccination of "fragile children": Results of a survey of 14 Italian children's hospitals. Hum Vaccin Immunother 2023; 19:2245701. [PMID: 37614161 PMCID: PMC10453964 DOI: 10.1080/21645515.2023.2245701] [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: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
Children with chronic disease are at higher risk of invasive infectious disease, including several vaccine-preventable infections. The Italian Association of Pediatric Hospitals (AOPI) carried out a survey of immunization practices: 14/16 AOPI hospitals completed the survey; 50% of them include 100-199 beds, while 21% have <100 beds. In 12/14 hospitals (86%) all vaccinations included in the National Immunization Plan (plus influenza e COVID-19 vaccines) are available for inpatients, in selected wards (n = 4), on single pediatrician initiative (n = 3), by a centralized in-hospital immunization service (n = 2), and the remaining 3 in a "protected vaccination area" or in a COVID-19 pathway. The wards in which vaccination is more frequently offered to in-patients are: General Pediatrics, Neonatology, Pediatric Hematology & Oncology, Pediatric Diabetology, Pediatric Cardiology, and Pediatric Infectious Diseases (range, 58% to 83%). In 58% of vaccinating hospitals, <500 vaccinations/year are reported, while in 17% this number is >2,000/year. A COVID-19 vaccination team is in place for any inpatient child older than 12 years in 42% of hospitals, in 42% only for "fragile" children. A centralized in-hospital immunization service is an emerging model that may contribute to increase compliance to vaccination of fragile patients and to fight against vaccination hesitancy.
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Affiliation(s)
- Désirée Caselli
- Infectious Diseases, Children’s Hospital Giovanni XXIII, A.O.U.C. Policlinico di Bari, Bari, Italy
| | - Maurizio Aricò
- Department of Pediatrics, S.Spirito Hospital, U.O.C. Pediatria A.S.L. Pescara, Pescara, Italy
| | - Fabiana Fiasca
- Department of Life, Health and Environmental Sciences, Università dell’Aquila, L'Aquila, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Mansfield LN, Choi K, Delgado JR, Macias M, Munoz-Plaza C, Lewin B, Bronstein D, Chang J, Bruxvoort K. Decision-Making about COVID-19 Vaccines among Health Care Workers and Their Adolescent Children. West J Nurs Res 2023; 45:665-673. [PMID: 37096318 PMCID: PMC10280115 DOI: 10.1177/01939459231170981] [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] [Indexed: 04/26/2023]
Abstract
Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children (N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents' or adolescents' choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one's vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent's decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients' and parents' vaccine decisions.
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Affiliation(s)
- Lisa N. Mansfield
- National Clinician Scholars Program,
Division of General Medicine & Health Services Research, Department of Medicine,
David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA,
USA
- School of Nursing, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Choi
- Department of Research &
Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- School of Nursing, University of
California, Los Angeles, CA, USA
- Department of Health Policy and
Management, Fielding School of Public Health, University of California, Los Angeles,
CA, USA
| | - Jeanne R. Delgado
- National Clinician Scholars Program,
Division of General Medicine & Health Services Research, Department of Medicine,
David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA,
USA
- Division of General Pediatrics,
Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern
California Keck School of Medicine, Los Angeles, CA, USA
| | - Mayra Macias
- Department of Research &
Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Corrine Munoz-Plaza
- Department of Research &
Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bruno Lewin
- Southern California Permanente Medical
Group, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David Bronstein
- Southern California Permanente Medical
Group, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Chang
- Department of Research &
Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Katia Bruxvoort
- Department of Research &
Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Epidemiology, School of
Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Nascimento VFD, Piber RS, Britis RF, Riegel F, Unicovsky MA, Terças-Trettel ACP, Luis MAV. Opiniões de idosos acerca da vacina anticovid e sua possível recusa. PERSONA Y BIOÉTICA 2023. [DOI: 10.5294/pebi.2023.27.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Objetivo: conhecer as opiniões de idosos acerca da vacina anticovid e sua possível recusa. Metodologia: trata-se de estudo exploratório e qualitativo, realizado em um município de pequeno porte, do extremo Norte de Mato Grosso, Brasil. A coleta de dados ocorreu em março de 2021, por meio de entrevista semiestruturada. Para a análise dos dados, utilizou-se o software ATLAS.ti®. Resultados: a maioria dos idosos demonstrou aceitação e desejo em ser imunizada, porém aqueles com baixa escolaridade apresentaram maior rejeição à vacina, os quais foram percebidos pelos demais idosos como irresponsáveis. Os participantes mencionam que todos possuem o direito de escolha. Conclusões: apesar de os idosos terem opinado positivamente sobre a vacina, ações educativas, principalmente junto àqueles com baixa escolaridade, devem ser intensificadas, a fim de que o comportamento de recusa, caso prevaleça mesmo após diálogos e esclarecimentos, não influencie terceiros e coloque em risco a saúde da comunidade.
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O'Leary ST. Why the American Academy of Pediatrics recommends initiating HPV vaccine at age 9. Hum Vaccin Immunother 2022; 18:2146434. [PMID: 36404635 DOI: 10.1080/21645515.2022.2146434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American Academy of Pediatrics (AAP) recommends starting the human papillomavirus (HPV) vaccine series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series. This recommendation differs from the Advisory Committee on Immunization Practices (ACIP), which recommends HPV vaccination be initiated at age 11 or 12 years, stating the series can be started at age 9 years. This commentary discusses the reasoning behind AAP's decision to differ from ACIP, as the AAP and ACIP schedules are essentially harmonized for all other vaccines. Reasons include recognition that (1) vaccination uptake is suboptimal; (2) offering vaccination earlier offers provider's flexibility in introducing the vaccine; (3) initiating the vaccine at age 9 or 10 may be preferable for parents or adolescents who do not want to receive ≥3 concomitant vaccines at age 11 or 12; (4) earlier initiation may disentangle HPV recommendations from discussions of sexuality; (5) earlier recommendation might alleviate HPV vaccine hesitancy "fatigue;" (6) the immune response is robust at younger ages with no evidence of waning protection; and (7) there is a dearth of evidence supporting starting the recommendation at age 11 or 12 within the "adolescent immunization platform."
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO, USA
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Silva IDAG, de Sá ACMGN, Prates EJS, Malta DC, Matozinhos FP, da Silva TMR. Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019. Rev Lat Am Enfermagem 2022; 30:e3834. [PMID: 36449928 PMCID: PMC9699524 DOI: 10.1590/1518-8345.6296.3834] [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: 06/09/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to analyze the prevalence of schoolchildren vaccinated against human papillomavirus (HPV) and the reasons related to non-vaccination. METHOD cross-sectional study, with data from the 2019 National Survey of School Health. The sample consisted of 160,721 students aged 13 to 17 years. The prevalence and confidence intervals (95%CI) of vaccinated adolescents were estimated according to location, sex, and administrative dependence of the school. The differences between the strata were evaluated with the Chi-square test. Adjusted prevalence ratios (aPR) and 95%CI were estimated with the Poisson regression model. RESULTS most of the students were vaccinated (62.9%), and the prevalence of girls (76.1%) was higher than that of boys (49.1%). The most prevalent reason for not vaccinating was "did not know they had to take" (46.8%), with the highest aPR in public schoolchildren in Brazil (1.6; 95%CI 1.5;1.7), from the Northeast region (1.2; 95%CI 1.1;1.2), and in students from private schools in the Northeast regions (1.1; 95%CI 1.1;1.2) and North (1.3; 95%CI 1.2;1.4). CONCLUSION one out of every two Brazilian schoolchildren was vaccinated against HPV. Misinformation was a recurring reason for non-vaccination. The North and Northeast regions had the highest prevalence of non-vaccinated people, observed mainly in adolescents from public schools. HIGHLIGHTS (1) 63% of Brazilian schoolchildren reported having been vaccinated against human papillomavirus (HPV).(2) In Brazil, in 2019, the prevalence of immunized girls was higher than that of boys.(3) Misinformation and fear are reasons for hesitating vaccination.(4) Social and health inequalities may reflect upon HPV vaccination.(5) Achieving the goal of 80% in HPV vaccination coverage is a challenge in Brazil.
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Affiliation(s)
- Isabella de Alcântara Gomes Silva
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brazil
| | | | - Elton Junio Sady Prates
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brazil
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brazil,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brazil
| | - Tércia Moreira Ribeiro da Silva
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brazil
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Mitchell H, Lim R, Gill PK, Dhanoa J, Dubé È, Bettinger JA. What do adolescents think about vaccines? Systematic review of qualitative studies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001109. [PMID: 36962668 PMCID: PMC10022047 DOI: 10.1371/journal.pgph.0001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022]
Abstract
Adolescence presents a key opportunity to build vaccine-related health literacy and promote vaccine confidence and uptake. Although adolescents are central to vaccination programs, their views around vaccines are frequently underrepresented in qualitative literature. We reviewed qualitative studies to systematically identify and summarize existing evidence on adolescents' own understanding of vaccines and experiences with vaccine decision-making, including self-consent when applicable. CINAHL; Embase; Ovid Medline; and Psych Info database searches were last updated on May 28, 2022. Data pertaining to general study characteristics, participant demographics, and qualitative content were extracted independently by two reviewers and analyzed using textual narrative synthesis. Out of 3559 individual records, 59 studies were included. The majority of the studies were conducted in high-income countries and 75% focused on human papilloma virus vaccines, with the remaining studies looking at COVID-19, meningococcal, hepatitis B and influenza vaccines or adolescent experiences with vaccines in general. Adolescent self-consent was explored in 7 studies. Perspectives from sexual and gender minorities were lacking across studies. Adolescents often had limited understanding of different vaccines and commonly perceived vaccine information to be directed towards their parents rather than themselves. Many adolescents felt school-based vaccine education and information available through healthcare providers were insufficient to make informed decisions about vaccines. While adolescents described obtaining vaccine information from traditional and online media, face-to-face interactions and opinions from trusted adults remained important. Adolescents generally relied on their parents for vaccine-decision making, even when self-consent was an option. A notable exception to this included marginalized adolescents who could not rely on parents for health-related advice. Qualitative literature about adolescent vaccines would be enriched by studies examining vaccines other than the HPV vaccine, studies examining adolescent vaccine programs in low and middle-income countries, and by deliberately eliciting vaccine experiences of adolescent with diverse sexual orientation and gender identities.
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Affiliation(s)
- Hana Mitchell
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Lim
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Prubjot K Gill
- University of British Columbia Library, University of British Columbia, Vancouver, BC, Canada
| | - Joban Dhanoa
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Francis JK, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents. Prev Med Rep 2021; 24:101562. [PMID: 34976628 PMCID: PMC8683895 DOI: 10.1016/j.pmedr.2021.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Providers (29%) experience HPV-specific vaccine hesitancy from parents. Providers feel least confident in responding to families’ religious beliefs. Some providers (25%) agree with dismissal policies for families refusing vaccines.
Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers’ confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher’s exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being “very confident” in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents’ religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.
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Mihalek AJ, Hall M, Russell CJ, Wu S. Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery. Hosp Pediatr 2021:hpeds.2021-005924. [PMID: 34807982 DOI: 10.1542/hpeds.2021-005924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery. METHODS An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery. RESULTS Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery. CONCLUSIONS The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.
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Affiliation(s)
- Alexandra J Mihalek
- Hospitalist Division, Children's Hospital of Orange County, Orange, California
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Wu
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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National and State-Specific Estimates of Settings of Receiving Human Papillomavirus Vaccination Among Adolescents in the United States. J Adolesc Health 2021; 69:597-603. [PMID: 33867229 PMCID: PMC9080285 DOI: 10.1016/j.jadohealth.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Human papillomavirus (HPV) vaccination in the United States has been recommended for girls since 2006 and for boys since 2011. However, settings of receiving HPV vaccination have not been assessed. The purpose of this study is to assess settings of receiving HPV vaccination among adolescents in order to understand what strategies are needed to improve vaccination uptake. METHODS Data from the 2018 National Immunization Survey-Teen (NIS-Teen) were analyzed to assess place of HPV vaccination overall, and by gender, quarter, and other selected variables among adolescents in the United States. The 2016-2018 NIS-Teen data were combined to assess state-specific place of HPV vaccination. RESULTS Among vaccinated adolescents aged 13-17 years, a doctor's office was the most common place where HPV vaccination was received (79.2%), followed by clinics, health centers, or other medical facilities (13.5%), health department (4.1%), hospital or emergency room (2.3%), schools (.5%), and pharmacies or stores (.4%). Overall, 99.1% of adolescents aged 13-17 years received HPV vaccination at medical settings and only .9% at nonmedical settings. Reported vaccination in nonmedical settings by state ranged from less than .1% in Delaware, Florida, and New Hampshire to 4.1% in North Dakota, with a median of 1.0%. CONCLUSIONS Doctor's offices were the most common medical setting for adolescents to receive HPV vaccination. Less than 1% of adolescents received vaccination at nonmedical settings. Continuing work with medical and nonmedical settings to identify and implement appropriate strategies are needed to improve HPV vaccination coverage among adolescents.
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Ramanadhan S, Fontanet C, Teixeira M, Mahtani S, Katz I. Exploring attitudes of adolescents and caregivers towards community-based delivery of the HPV vaccine: a qualitative study. BMC Public Health 2020; 20:1531. [PMID: 33036585 PMCID: PMC7547455 DOI: 10.1186/s12889-020-09632-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/29/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. However, uptake remains far below the Healthy People 2020 targets for the US. Given the barriers to population-level vaccination policies and challenges to incorporating additional action items during clinical visits, we sought to explore alternative delivery mechanisms, specifically delivery of the vaccine in community settings. METHODS We conducted six focus groups (three with adolescents aged 11-14 who had not received the HPV vaccine and three with caregivers of adolescents meeting those criteria) from Black, Latino, and Brazilian communities in Massachusetts. We utilized a framework analysis approach that involved a multi-stage coding process employing both prefigured and emergent codes. Initial interpretations were refined through consultation with an advisory board. RESULTS Adolescents and caregivers expressed a range of concerns about the HPV vaccine and also described interest in learning more about the vaccine, emphasizing the importance of a relationship with a trusted provider as a facilitator of vaccine acceptance. Regarding community-based delivery of the vaccine, reactions were mainly negative. However, adolescents and caregivers noted that receiving information in community settings that could seed a conversation with a trusted provider would be welcome. Interestingly, the notion of a trusted provider seemed to extend broadly to practitioners linked to the trusted main provider. CONCLUSIONS The study highlights an opportunity for increasing HPV vaccination among some racial and ethnic minority populations by leveraging trusted community organizations to provide information and seed conversations with a potentially broad group of trusted providers. A task-shifting approach, or reliance on staff with fewer formal credentials, may offer opportunities to support vaccination in resource-constrained settings.
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Affiliation(s)
- Shoba Ramanadhan
- Harvard T.H. Chan School of Public Health, 677 Longwood Avenue, Kresge 7th floor, Boston, MA, 02115, USA.
| | | | - Marina Teixeira
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Sitara Mahtani
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Ingrid Katz
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Harvard Global Health Institute, 42 Church St, Cambridge, MA, 02138, USA
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Klasko-Foster LB, Przybyla S, Orom H, Gage-Bouchard E, Kiviniemi MT. The influence of affect on HPV vaccine decision making in an HPV vaccine naïve college student population. Prev Med Rep 2020; 20:101195. [PMID: 32983851 PMCID: PMC7498828 DOI: 10.1016/j.pmedr.2020.101195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/30/2020] [Accepted: 08/23/2020] [Indexed: 01/05/2023] Open
Abstract
The HPV vaccine is recommended for all adolescents starting at age 11, but coverage is low, especially in the young adult population. The CDC is prioritizing catch-up vaccination and has expanded recommendations for all young adults to age 26. College students may be ideal targets for HPV vaccine interventions as they typically have on-site clinics that offer prevention services and students are in the position to make decisions about their own healthcare. We examined the risk perceptions of 101 HPV vaccine-naïve college students, both in terms of risk cognition (beliefs about susceptibility to HPV-related cancers and genital warts) and affect (worry and fear regarding HPV-related health outcomes) as they relate to HPV vaccine intentions. Participants completed an online survey, reporting absolute and comparative risk perceptions for HPV-related cancers/genital warts, fear and worry related to getting HPV-related cancer and/or genital warts, desire for positive emotions, affective associations with the HPV vaccine, and intentions to get the HPV vaccine. More fear/worry about vaccination was directly associated with increased vaccine intentions. The perceived risk to intentions relation included an indirect effect via fear/worry. Desire for positive affect strengthened this relation. Positive affective associations with the HPV vaccine were also related to increased vaccine intentions. Given the public health impact of increasing HPV vaccine coverage for young adults, educational strategies framing the HPV vaccine positively while decreasing fear/worry related to negative health outcomes might increase interest in on-campus catch-up vaccination.
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Kara Elitok G, Bulbul L, Altuntas SB, Altuntas B, Günindi G, Haltaş M, Yuvarlan A, Toprak D, Bulbul A. Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians. Hum Vaccin Immunother 2020; 16:1132-1138. [PMID: 32040380 DOI: 10.1080/21645515.2020.1715146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.
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Affiliation(s)
- Gizem Kara Elitok
- Department of Family Medicine, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Lida Bulbul
- Department of Pediatrics, University of Health Sciences Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - Bülent Altuntas
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gözde Günindi
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Haltaş
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Yuvarlan
- Department of Family Medicine, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Dilek Toprak
- Deparment of Family Medicine, University of Namık Kemal, Tekirdağ, Turkey
| | - Ali Bulbul
- Department of Pediatrics, University of Health Sciences Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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14
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Asare M, Agyei-Baffour P, Lanning BA, Barimah Owusu A, Commeh ME, Boozer K, Koranteng A, Spies LA, Montealegre JR, Paskett ED. Multi-Theory Model and Predictors of Likelihood of Accepting the Series of HPV Vaccination: A Cross-Sectional Study among Ghanaian Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020571. [PMID: 31963127 PMCID: PMC7014126 DOI: 10.3390/ijerph17020571] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 12/21/2022]
Abstract
HPV vaccines are efficacious in preventing HPV related cancers. However, the vaccination uptake in Ghana is very low. Studies that utilize theoretical frameworks to identify contributory factors to HPV vaccination uptake in Ghana are understudied. We used multi-theory model (MTM) constructs to predict initiation and completion of HPV vaccination series in Ghanaian adolescents. Adolescents (n = 285) between the ages of 12 and 17 years old were recruited from four selected schools in Ghana to participate in the cross-sectional study. Linear regressions were used to analyze the data. Most participants were female (91.2%) and senior high school students (60.0%). Many of the participants had neither heard about HPV (92.3%) nor HPV vaccinations (95.4%). Significant predictors of adolescents’ likelihood of getting the first dose of HPV vaccination were perceived beliefs and change in a physical environment (p < 0.001), with each variable accounting for 6.1%and 8.8% of the variance respectively. Significant predictors of adolescents’ likelihood of completing HPV vaccination recommended series were perceived beliefs, practice for change, and emotional transformation (p < 0.001), with each variable accounting for 7.8%, 8.1%, and 1.1% of the variance respectively. Findings underscore important opportunities for developing educational interventions for adolescents in Ghana to increase the HPV vaccination uptake.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences Baylor University, One Bear Place, Waco, TX 97343, USA;
- Correspondence:
| | - Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (P.A.-B.); (A.K.)
| | - Beth A. Lanning
- Department of Public Health, Robbins College of Health and Human Sciences Baylor University, One Bear Place, Waco, TX 97343, USA;
| | - Alex Barimah Owusu
- Department of Geography and Resource Development, University of Ghana, Legon, Ghana;
| | - Mary E. Commeh
- Ghana Health Services, Non-Communicable Disease Control, Accra, Ghana;
| | - Kathileen Boozer
- Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA; (K.B.); (L.A.S.)
| | - Adofo Koranteng
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; (P.A.-B.); (A.K.)
| | - Lori A. Spies
- Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA; (K.B.); (L.A.S.)
| | - Jane R. Montealegre
- Department of Pediatrics and Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Electra D. Paskett
- Department of Internal Medicine, Division of Cancer Prevention and Control in the College of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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15
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Pfaff N, Garnett C, Mihalek AJ, Mamey MR, Wu S. Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination. Glob Pediatr Health 2019; 6:2333794X19894123. [PMID: 31840039 PMCID: PMC6900615 DOI: 10.1177/2333794x19894123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022] Open
Abstract
Over a decade after its debut, human papillomavirus (HPV) vaccine coverage
remains suboptimal. The inpatient setting presents a largely unexplored
opportunity to increase vaccination rates. This study aims to describe pediatric
resident attitudes toward inpatient immunization and compare differences by
vaccine, in particular HPV. An anonymous survey of beliefs and practices
regarding inpatient vaccines was distributed to pediatric resident physicians at
a single freestanding urban children’s hospital in September 2017. A total of 58
surveys were collected (64% response rate). We found that pediatric residents
were more likely to report that they never or rarely discuss the HPV vaccine
during hospitalization compared with the primary childhood series
(P = .001), Tdap (P = .02), and the
influenza vaccine (P < .001), and rarely offer the HPV
vaccine during hospitalization compared with childhood vaccines
(P = .003) and influenza (P = .001). This
suggests that provider hesitancy still exists for the HPV vaccine, presenting
opportunities for further education and inpatient interventions.
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Affiliation(s)
- Nora Pfaff
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Mary Rose Mamey
- Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Susan Wu
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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16
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Patel EU, Grabowski MK, Eisenberg AL, Packman ZR, Gravitt PE, Tobian AAR. Increases in Human Papillomavirus Vaccination Among Adolescent and Young Adult Males in the United States, 2011-2016. J Infect Dis 2019; 218:109-113. [PMID: 29584878 DOI: 10.1093/infdis/jiy165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/22/2018] [Indexed: 12/31/2022] Open
Abstract
In the United States, human papillomavirus (HPV) vaccination has been recommended for females since 2006 and males since 2011. We assessed temporal trends in HPV vaccine coverage (defined as receipt of ≥1 dose) among 9-26-year-old participants in the 2011-2016 National Health and Nutrition Examination Surveys. While coverage increased overall, from 37.7% to 45.7%, among females (adjusted prevalence difference [aPD], 7.1%; 95% confidence interval [CI], .1%-13.7%), there was no change among female adolescents aged 9-17 years. For males, coverage increased overall, from 7.8% to 27.4% (aPD, 18.8%; 95% CI, 14.1%-23.5%), and among every stratum of age, race/ethnicity, health insurance status, poverty level, and immigration status (P ≤ .05). The increase in HPV vaccine coverage observed among males is encouraging, but coverage remains below national targets for both males and females.
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Affiliation(s)
- Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
| | - M Kate Grabowski
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
| | - Anna L Eisenberg
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Zoe R Packman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
| | - Patti E Gravitt
- Department of Global Health, George Washington University, Washington, D.C
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
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17
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Mihalek AJ, Kysh L, Pannaraj PS. Pediatric Inpatient Immunizations: A Literature Review. Hosp Pediatr 2019; 9:550-559. [PMID: 31209128 DOI: 10.1542/hpeds.2019-0026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Timely vaccine uptake in children remains suboptimal. Eliminating missed opportunities is key to increasing childhood immunization rates, and hospitalization offers another potential setting to vaccinate. OBJECTIVE To better understand pediatric inpatient immunization programs, including vaccination rates of inpatients, parental and provider attitudes, barriers to vaccine delivery, and interventions to increase provision of inpatient vaccines. DATA SOURCES A search was conducted of PubMed, Embase, and Web of Science to identify articles and conference abstracts related to pediatric inpatient immunization. STUDY SELECTION Inclusion criteria were studies published in English between January 1990 and January 2019 in which pediatric vaccination in the hospital setting was discussed. Findings from 30 articles and conference abstracts were summarized and organized by topic area. DATA EXTRACTION Abstracts were screened for relevance, articles were read, and themes were identified. RESULTS Children who are hospitalized have been shown to have lower immunization rates compared with the general population, with 27% to 84% of pediatric inpatients due or overdue for vaccines nationally when verified with official records. Unfortunately, little is done to catch up these children once they have been identified. Access to accurate vaccine histories remains a major barrier in inpatient immunization programs because providers frequently under document and parents over recall a child's vaccine status. Strategies identified to increase inpatient vaccination included creation of a multidisciplinary immunization team, educational interventions, visual reminders, catch-up vaccine plans, order sets, and nursing-driven screening. When offered inpatient vaccination, a majority of parents accepted immunizations for their children. CONCLUSIONS Hospitalization may provide an opportunity to augment vaccine uptake. Further research is needed to develop evidence-based strategies to overcome barriers to inpatient vaccination.
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Affiliation(s)
- Alexandra J Mihalek
- Divisions of Hospital Medicine and .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynn Kysh
- Children's Hospital Los Angeles, Los Angeles, California; and
| | - Pia S Pannaraj
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.,Infectious Diseases
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18
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Griffin DS, Muhlbauer G, Griffin DO. Adolescents trust physicians for vaccine information more than their parents or religious leaders. Heliyon 2018; 4:e01006. [PMID: 30619955 PMCID: PMC6313814 DOI: 10.1016/j.heliyon.2018.e01006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/27/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
Although, evidence clearly supports vaccination as the most cost effective approach to controlling infectious diseases there are many individuals questioning, delaying and refusing vaccines. The main purpose of this study was to find out what source of information adolescents trust the most on vaccines. We conducted a cross-sectional survey of public high school students using a paper-based questionnaire in a region with a high rate of vaccine acceptance to assess sources they trusted most for vaccine information. Surveys were administered over a one-week period in the fall of 2017. We gave forms to 200 students to obtain parental consent and student assent and then distributed our questionnaire to the 125 students who completed these consent/assent forms. A total of 105 completed questionnaires were returned. The major finding was that students reported physicians as their most trusted source for vaccine information. Secondary analysis was performed looking at the perceptions teenagers have relative to risks and effectiveness of vaccines for the prevention of communicable diseases. Most teenagers (62%) reported their physician or other medical professional as the most trusted source and 24% cited parents/guardians. We found that physicians were the most trusted source for information about vaccinations, above parents, in this group of high school students.
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Affiliation(s)
- Daisy S Griffin
- Schreiber High School, Department of Social Studies, Port Washington, NY 11050, USA
| | - George Muhlbauer
- Schreiber High School, Department of Social Studies, Port Washington, NY 11050, USA
| | - Daniel O Griffin
- Columbia University Medical Center, Department of Biochemistry and Molecular Biophysics, New York, NY 10032, USA.,Columbia University Medical Center, Department of Medicine-Division of Infectious Diseases, New York, NY 10032, USA
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19
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Shay LA, Baldwin AS, Betts AC, Marks EG, Higashi RT, Street RL, Persaud D, Tiro JA. Parent-Provider Communication of HPV Vaccine Hesitancy. Pediatrics 2018; 141:peds.2017-2312. [PMID: 29765009 PMCID: PMC6005174 DOI: 10.1542/peds.2017-2312] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5754332185001PEDS-VA_2017-2312Video Abstract OBJECTIVES: To prevent human papillomavirus (HPV)-related cancers, providers must effectively communicate with HPV vaccine-hesitant parents. Here, we developed a typology characterizing parent-provider communication around HPV vaccine hesitancy. METHODS We audio-recorded 43 visits with unvaccinated adolescents at 6 pediatric clinics in Dallas, Texas in which parents were undecided about HPV vaccination. We qualitatively coded how parents verbally expressed hesitancy (assertive response, asking a question, or expressing concern) and whether providers responded with acquiescence (agree to defer vaccination) and/or persistence (continue discussion). We described the frequency of parent and provider communication codes and same-day vaccination. RESULTS Among the 43 visits, 37 parents expressed hesitancy ≥1 times in many ways. Assertive responses were most common (27 visits), followed by questions (16 visits), and concerns (12 visits). When the first expression of hesitancy was a question or concern, 71% and 75% of adolescents, respectively, received same-day vaccinations, whereas 33% of adolescents who received an initial assertive response were vaccinated. Providers responded with only persistence in 18 visits, a mix of acquiescence and persistence in 13 visits, and only acquiescence in 6 visits. When providers only used persistence, 17 of 18 adolescents were vaccinated; when providers responded with only acquiescence, no adolescents received the vaccine. CONCLUSIONS Our exploratory analysis reveals that providers engaging hesitant parents and addressing their concerns can lead to same-day HPV vaccination. Data reveal that even parents making assertive statements are amenable to influence by providers. Our findings reveal an important missed opportunity when providers simply acquiesce to parental hesitation.
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Affiliation(s)
- Laura A. Shay
- Department of Health Promotion & Behavioral
Sciences, UTHealth School of Public Health in San Antonio, San Antonio,
Texas
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist
University, Dallas, Texas
| | - Andrea C. Betts
- Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, Texas;,Department of Health Promotion & Behavioral
Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Emily G. Marks
- Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, Texas
| | - Robin T. Higashi
- Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, Texas
| | - Richard L. Street
- Department of Communication, Texas Agricultural and
Mechanical University, College Station, Texas;,Department of Medicine, Baylor College of Medicine,
Houston, Texas
| | - Donna Persaud
- Parkland Health and Hospital System, Dallas, Texas;
and
| | - Jasmin A. Tiro
- Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, Texas;,Harold C. Simmons Comprehensive Cancer Center,
Dallas, Texas
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20
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NP, Hightower AD, Younge M, Eagan A, Blumkin A, Albertin CS, DiBitetto K, Concannon C, Vincelli P, Yoo BK, Humiston SG. Impact of elementary school-located influenza vaccinations: A stepped wedge trial across a community. Vaccine 2018; 36:2861-2869. [DOI: 10.1016/j.vaccine.2018.03.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
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21
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Fisher-Borne M, Preiss AJ, Black M, Roberts K, Saslow D. Early Outcomes of a Multilevel Human Papillomavirus Vaccination Pilot Intervention in Federally Qualified Health Centers. Acad Pediatr 2018; 18:S79-S84. [PMID: 29502642 DOI: 10.1016/j.acap.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings. METHODS FQHC systems were randomly selected to receive either a $90,000 2-year grant, a $10,000 3-month grant, or training and technical assistance without funding. All 3 intervention groups conducted provider training and education, completed a capacity assessment tool, and measured HPV vaccination rates. Annual HPV vaccine series initiation and completion rates for active, 11- to 12-year-old patients were measured to evaluate project outcomes. RESULTS HPV vaccine series initiation rates among 11- to 12-year-old patients increased by 14.6 percentage points from a baseline of 41.2% before the intervention (2014) to the intervention year (2015). Changes in HPV second dose and series completion rates were not statistically significant. Meningococcal and tetanus, diphtheria, and acellular pertussis vaccination rates also increased significantly, by 13.9 and 9.9 percentage points from baseline rates of 49.1% and 52.5%, respectively. CONCLUSIONS The first year of this pilot project showed early success, particularly with HPV vaccine series initiation. On the basis of these promising results, ACS is expanding clinical quality improvement projects to increase HPV vaccination across the country.
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22
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Abstract
The adolescent period heralds the pediatric patient's transition into adulthood. It is a time of dynamic development during which effective preventive care measures can promote safe behaviors and the development of lifelong health habits. One of the foundations of preventive adolescent health care is timely vaccination, and every visit can be viewed as an opportunity to update and complete an adolescent's immunizations.In the past decade, the adolescent immunization schedule has expanded to include 2 doses of quadrivalent meningococcal conjugate vaccine, 1 dose of tetanus, diphtheria, acellular pertussis, absorbed vaccine, 2 or 3 doses of human papillomavirus vaccine, depending on the child's age, and an annual influenza vaccine. In addition, during adolescent visits, health care providers can determine whether catch-up vaccination is needed to meet early childhood recommendations for hepatitis B; hepatitis A; measles, mumps, rubella; poliovirus; and varicella vaccines. New serogroup B meningococcal vaccines are now available for those at increased risk for meningococcal disease; in addition, these serogroup B meningococcal vaccines received a Category B recommendation for healthy adolescents, where individual counseling and risk-benefit evaluation based on health care provider judgements and patient preferences are indicated. This clinical report focuses on the epidemiology of adolescent vaccine-preventable diseases by reviewing the rationale for the annual universally recommended adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. In addition, the barriers that negatively influence adherence to this current adolescent immunization schedule will be highlighted.
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Affiliation(s)
- Henry H Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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