Factors associated with HPV vaccine uptake in teenage girls: A systematic review

Willingness to pay for vaccines in China: A systematic review and single-arm Bayesian meta-analysis

The effective implementation of vaccination heavily depends on the society's willingness to pay (WTP). There is currently a dearth of comprehensive evidence about WTP for vaccines in China. This systematic review aims to review studies on the WTP for vaccines, to summarize factors affect WTP in China. Base-case analysis and Sensitivity analysis of WTP for every vaccine were estimated via single-arm Bayesian meta-analysis. A total of 28 studies were included for systematic review. The point estimates and 95% Credible Interval of pooled WTP for influenza and HPV (9-valent) vaccine were $27.409 (23.230, 31.486), $464.707 (441.355, 489.456). Influencing factors to WTP were age, income, peer influence, health condition and etc. Future research should give focus to improving sample representativeness and survey tool, conducting intervention trials, identifying effective methods to promote WTP.

Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis

Objectives

To systematically identify, appraise, and summarise published evidence on individual socioeconomic and health-related factors associated with human papillomavirus (HPV) vaccination initiation and completion among females of paediatric age.

Study design

A global systematic review with meta-analysis (PROSPERO: CRD42023445721).

Methods

We performed a literature search in December 2022 and supplemented the search on August 1, 2023. Appropriate data were pooled using an inverse variance, random-effects model and the results were expressed as odds ratios, with 95 % confidence intervals. A statistically significant point pooled increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥70 % was very strongly associated.

Results

We included 83 cross-sectional studies. Among several significantly associated factors, being an older girl: 1.67 (1.44-1.93), having health insurance: 1.41 (1.16-1.72), and being in a public school: 1.54 (1.05-2.26) strongly increased the odds of vaccination initiation, and nativity in the country of study: 1.82 (1.33-2.50), use of contraception: 2.00 (1.16-3.46), receipt of influenza vaccination: 1.75 (1.54-2.00) and having visited a healthcare provider: 1.85 (1.51-2.28) in the preceding year very strongly increased the odds of vaccination initiation. Likewise, being an older girl: 1.36 (1.23-1.49) and having visited a healthcare provider in the preceding year: 1.46 (1.05-2.04) strongly increased the odds of vaccination series completion, and school-based vaccination: 3.08 (1.05-9.07), having health insurance: 1.72 (1.27-2.33), and receipt of influenza vaccination in the preceding year: 1.72 (1.62-1.83) very strongly increased the odds of vaccination series completion. We made similar observations when the studies were limited to the United States.

Conclusions

Several individual socioeconomic/health-related factors may determine initiating and completing the HPV vaccination series among paediatric females. These factors provide insights that may be key to identifying girls at increased risk of not being vaccinated and may aid targeted public health messaging.

A Qualitative Study of Social Processes, HPV Vaccine Attitudes, and Vaccination Behavior Among Hesitant Adopter Parents

Despite the availability of a highly effective human papillomavirus (HPV) vaccine, uptake remains below Healthy People 2030 targets, particularly in rural areas where HPV-related cancers are more prevalent. This study aimed to explore how social processes influence parents' HPV vaccination decisions, focusing on vaccine-hesitant parents who vaccinated their child(ren) against HPV despite their hesitancy, eg, "hesitant adopters." We conducted a qualitative exploratory analysis of in-depth interviews with hesitant adopter parents (n = 8) to explore how social interactions with trusted interlocutors influenced their decision-making. Hesitant adopter parents identified relevant professional expertise, direct experience with the HPV vaccine, and social proximity to interlocutors as influential factors. We argue that rather than a single moment or decision, vaccination decision-making is a dynamic, ongoing process affected by social processes. This study adds nuance to our understanding of how prior vaccination behavior functions in future vaccine acceptance.

Predictors of COVID-19 vaccine recommendation practices among healthcare providers in the US

OBJECTIVE

To understand relationships between COVID-19 vaccine perceptions, confidence, trust, sociodemographic/practice characteristics, and COVID-19 vaccine recommendation practices among US healthcare providers.

METHODS

In November 2021, an electronic survey was administered to nurses and physicians in the US via Qualtrics®. The survey included: (1) COVID-19 perceptions, (2) vaccine confidence, (3) trust, (4) uptake, (5) recommendation practices, and (6) sociodemographic/practice characteristics. Binary logistic regressions were used to obtain unadjusted/adjusted odds ratios in predicting recommendation practices of COVID-19 vaccine.

RESULTS

The survey included 304 participants. In adjusted analyses, not believing that COVID-19 was man-made, not living in southeastern US (as compared to living in southeast), having no concerns about COVID-19 vaccines, having more positive perceptions about the vaccines, and having more trust in healthcare, media, vaccine manufacturers, and public health authorities was significantly (p < 0.05) related to routinely recommending the vaccine for all patients 12 and older. Providers who did not think COVID-19 was man-made had 6.1 (95 % CI = 1.10 - 33.5) times the odds to recommend the vaccine. Providers not practicing in the southeast region had 5.2 (95 % CI = 1.39 - 19.8) times the odds to recommend the vaccine.

CONCLUSION

To increase provider recommendation of COVID-19 vaccines, beliefs about disease origin, concerns, and trust should be addressed.

PRACTICE IMPLICATIONS

Clear, accurate, and trusted information delivery about COVID-19 vaccines to healthcare providers is needed, and in turn this may reduce patient vaccine hesitancy.

Factors that influence caregivers' and adolescents' views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis

BACKGROUND

Human papillomavirus (HPV) vaccination in adolescents provides a powerful tool for preventing cervical cancer in women and other HPV-associated diseases in people of all genders. HPV vaccines have been progressively introduced in many countries. However, worldwide, many adolescents do not receive HPV vaccination, for various reasons. The HPV vaccine might be costly or unavailable, healthcare systems might lack capacity for its delivery, or adolescent health might not be prioritised. Some caregivers and adolescents may not accept available HPV vaccines and vaccination services. We currently lack a comprehensive understanding of the factors that influence HPV vaccination views and practices, and why some caregivers and adolescents may be less accepting of the vaccine. Qualitative research can contribute to this understanding and help inform policy and practice, including the development of more relevant, acceptable and effective interventions to promote public acceptance and uptake of HPV vaccination in adolescents. This qualitative evidence synthesis supplements a Cochrane review of the effectiveness of interventions to improve uptake of adolescent vaccination, including HPV vaccination.

OBJECTIVES

The objectives of the review are to identify, appraise, and synthesise qualitative studies that explore caregivers' or adolescents' views, experiences, practices, intentions, decision-making, acceptance, hesitancy, or nonacceptance of HPV vaccination; to gain an understanding of the factors that influence caregiver and adolescent views and practices regarding HPV vaccination for adolescents; and to explore how the findings of this review can enhance our understanding of the related Cochrane intervention review.

SEARCH METHODS

We searched MEDLINE, Embase, CINAHL, PsycInfo, and Scopus for eligible studies (February 2023). We updated this search in October 2024, but these results have not yet been fully incorporated.

SELECTION CRITERIA

We included studies that utilised qualitative methods for data collection and analysis; focused on caregivers' or adolescents' views, practices, acceptance, hesitancy, or refusal of HPV vaccination for adolescents aged 9 to 19 years of age; and were from any setting globally where HPV vaccination is provided.

DATA COLLECTION AND ANALYSIS

We used a prespecified sampling frame to capture a sample of eligible studies that were from a range of geographical and income-level settings, were conceptually rich in relation to the review's phenomenon of interest, and included HPV vaccination for diverse genders. We extracted contextual and methodological data from each sampled study. We used a thematic synthesis approach to analyse the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We integrated the findings of this review with those from the related Cochrane review of intervention effectiveness (by Abdullahi and colleagues), by mapping whether the trial interventions reflected or targeted the factors identified by this review as influencing caregivers' or adolescents' views and practices regarding HPV vaccination.

MAIN RESULTS

We included 206 studies in the review and sampled 71 of these for our synthesis. Of these, 35 studies were conducted in high-income countries, 26 studies in middle-income countries, 8 studies in low-income countries, and 2 studies in multiple-income settings. Studies came from all six World Health Organization (WHO) regions and included urban and rural settings. We downgraded our confidence in several findings, mainly due to concerns about how the studies were conducted (methodological limitations), concerns about perspectives lacking from some types of participants or in some settings (relevance), or because of variability in the data or insufficient evidence to support all aspects of a review finding (coherence). Many complex factors were found to influence caregivers' and adolescents' HPV vaccination views and practices, which we categorised into eight overarching themes: 1) A lack of biomedical knowledge; 2) Perceptions of a range of interrelated risks and benefits (or lack thereof) associated with HPV vaccination; 3) Routine responses to vaccination generally or more specific views or experiences of other vaccines and vaccination programmes; 4) Complex nuclear familial decision-making dynamics; 5) Extended familial and social relations and networks, particularly extended family members, peers, traditional or religious leaders, and the media; 6) Interrelated socio-cultural beliefs and practices regarding adolescence, sexuality, gender, parenting and health; 7) Trust or distrust in the institutions, systems or experts associated with vaccination, most particularly teachers and the school, the pharmaceutical industry, government, science and biomedicine, and healthcare professionals; and 8) Access to, and experiences of, HPV vaccination programmes and delivery services, such as the convenience (or lack thereof) of HPV vaccination services, the cost of the vaccine, language barriers, the feminisation of HPV vaccination programmes and procedural aspects of school-based vaccination delivery. We did not identify any major differences in the occurrence of these overarching themes between subgroups. However, for various subthemes certain differences emerged in relation to place, gender and socio-economic status, and between caregivers and adolescents. The interventions tested in the related Cochrane review of intervention effectiveness most commonly targeted caregivers' and adolescents' lack of biomedical knowledge and their perceptions of the risks and benefits of HPV vaccination, with the other influencing factors identified by our review being underrepresented.

AUTHORS' CONCLUSIONS

Our review reveals that caregivers' and adolescents' HPV vaccination views and practices are not only influenced by issues related to individual knowledge and perceptions of the vaccine, but also an array of more complex, contextual factors and meanings: social, political, economic, structural, and moral. Successful development of interventions to promote the acceptance and uptake of HPV vaccination for adolescents requires an understanding of the context-specific factors that influence HPV vaccination views and practices in the target setting. Through this, more tailored and in turn more relevant, acceptable, and effective responses could be developed. The eight overarching themes that emerged from our review could serve as a basis for gaining this understanding.

Factors associated with uptake of human papilloma virus vaccine among adolescent girls: A cross sectional survey on insights into HPV Infection Prevention in Kabarole District, Western Uganda

BACKGROUND

Human papilloma virus (HPV) infection imposes a substantial global disease burden and represents a critical public health concern. The persistently low uptake of HPV vaccination poses a significant obstacle to reducing cervical cancer incidence, particularly in remote rural areas of developing nations.

OBJECTIVE

This study aims to assess the extent of Human papilloma virus vaccine coverage among adolescents and explore the associated determinants to facilitate enhanced planning strategies within the Kabarole district.

METHODOLOGY

Employing a cross-sectional survey approach, data were gathered from 240 adolescent girls residing in the Kabarole district between 01/09/2022 and 18/10/2022. Simple and multiple logistic regression analyses were employed to investigate the relationships between HPV vaccination uptake and various independent variables, including demographics, HPV knowledge, and health system factors.

RESULTS

Of the 240 adolescents enrolled, the overall prevalence of uptake of HPV vaccination was 63%. The uptake of human papilloma was associated with demographics knowledge about HPV and health systems factors. The multivariate analysis showed that parents who completed secondary level of education were 4.1 times more likely to take their children for HPV vaccination compared to parents whose education level was primary or had no formal education (AOR = 4.06; 95%CI (1.69 - 6.87); p = 0.004). Distance from home to facility was associated with uptake HPV vaccination. Participants who came from the distance of more than 5 km were 60% less likely to uptake HPV vaccination compared to those who come from 5km or less (OR = 0.4; 95%CI (0.34 - 0.89); p = 0.006). Results further revealed that parents whose knowledge about HPV vaccination was moderate were three times more likely to take up HPV vaccine compared to those whose knowledge was low (OR =  2.99; 95%CI(1.14 - 7.87); p = 0.026).

CONCLUSION

HPV vaccination uptake was at 63% and relatively lower than national average. Education of parents, Knowledge of HPV vaccination and distance to facility were factors significantly associated with uptake of human papilloma virus vaccine.

Knowledge and willingness towards human Papillomavirus vaccination among the parents and school teachers of eligible girls in Dhaka, Bangladesh: A school-based cross-sectional study

Background

Cervical cancer ranks as the common prevalent cancer, among women worldwide especially impacting low-resource countries. In Bangladesh, this accounts for 12 % of all cancer cases. The development of cancer is closely linked to Human Papillomavirus (HPV) infection. Despite the availability of HPV vaccines, their uptake remains limited in Bangladesh. Thus, this research aims to assess the knowledge and willingness of parents and school teachers regarding HPV vaccination for eligible girls in Bangladesh.

Methodology

This study involved 406 parents and school teachers of girls aged 9-14 years from Dhaka city. A cross-sectional study design was used. Data collection was done through a questionnaire administered by interviewers after pre-testing and refinement for clarity and reliability. Analysis was carried out using Stata 17 software. Chi-square tests and logistic regression were used to uncover associations and predictors related to knowledge levels and willingness.

Results

Findings revealed that a majority of participants (64.04 %) exhibited an understanding of HPV and cervical cancer yet a high percentage (98.28 %) expressed willingness to engage in HPV vaccination initiatives. participants with primary (AOR = 3.306, p < 0.005), secondary (AOR = 8.806, p < 0.001), and higher education (AOR = 5.059, p < 0.001), as well as those from upper-middle-income groups (AOR = 3.038, p < 0.001), had significantly higher knowledge of HPV and cervical cancer.

Conclusion

The research emphasizes lack of knowledge regarding HPV and its vaccination among parents and educators in Bangladesh despite a willingness to vaccinate. These results emphasize the importance of tailored initiatives and better access, to health information to increase HPV vaccine acceptance and lower the incidence of cervical cancer.

Predictors of HPV vaccination coverage among adolescents in Tennessee during the COVID-19 pandemic: A cross-sectional study

Geographical disparities exist in human papillomavirus (HPV) vaccination rates with Southern states having the lowest rates. Parental attitudes remain understudied in different Southern locations. We assessed factors related to HPV vaccination receipt among children aged 9-17 years in Tennessee, and if those factors differed by child's age and gender. A cross-sectional survey of 506 parents was performed via random digit dial from May to August 2022. A multivariable logistic regression model was used to estimate adjusted odds ratios and 95 % confidence intervals to predict sociodemographic and overall vaccine-related factors associated with HPV vaccine receipt or non-receipt (referent) for their child, and exploratory analyses to determine if those factors differed by child's age and gender. In adjusted logistic regression models, HPV vaccine receipt was significantly positively associated with the child's age (13-17 years) and the parent and child having had the influenza vaccine this season and the COVID-19 vaccine, and negatively associated with children who were male and had a parent employed part-time/unemployed/retired/student/disabled. Significant associations for HPV vaccine receipt were with increased levels of agreement of the parent having enough information for decision-making, belief the vaccine was beneficial, and increased levels of trust and perceived effectiveness of the vaccine. Increased levels of hesitancy and increased levels of agreement that the vaccine might cause infertility issues in the child, was unsafe, and natural immunity is better than vaccine immunity had negative associations with HPV vaccine receipt. All associations were more pronounced among older than younger children, and all but one association (overall vaccine trust) was more pronounced among males compared with females. Strategies to improve HPV vaccine uptake should be targeted to and/or include males and parents with children aged 9-12 years, and include education on the importance and process of protecting the body through HPV vaccination and vaccines in general.

Australian parents' experiences with adolescent age-based vaccinations during the COVID-19 pandemic

PURPOSE

In Australia, adolescents are scheduled to receive vaccinations against diphtheria, tetanus, pertussis, human papillomavirus, and meningococcal disease, delivered via school vaccination programs and general practitioners (GPs). Public health measures implemented in response to the COVID-19 pandemic impacted uptake of some adolescent age-based vaccinations. Limited information is available on parents' approaches to vaccinating their adolescent children during the pandemic. We aimed to explore parents' experiences of adolescent age-based vaccinations during the pandemic, and factors they perceived as hindering or facilitating vaccination.

METHODS

In July 2022 we recruited 21 Australian parents of adolescent children eligible for age-based vaccinations in 2021. We recruited from metropolitan and regional settings, and from states where uptake was most and least affected by pandemic disruptions. We conducted 30-min virtual or phone interviews and analysed the data thematically.

RESULTS

Parents described how experiences before and during the COVID-19 pandemic influenced their perspectives on and experiences with adolescent age-based vaccinations. Motivation to vaccinate their children was informed by personal beliefs and experiences with the healthcare system. Parents described practical issues, including ease of access to the school vaccination program or a GP, and knowledge about vaccination schedules and services. Parents suggested enhancing promotion of adolescent vaccination benefits and information sharing, and recommended improving access to vaccination services outside the school program.

DISCUSSION

Findings have potential to improve delivery of adolescent age-based vaccinations, including during future pandemics. While this study was conducted in the Australian context, findings and recommendations have relevance to overseas adolescent age-based vaccination programs.

Sociodemographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents in France 2021-22

Human Papillomavirus (HPV) vaccine coverage was <50% in France in 2022 and even lower among socially disadvantaged populations. We aimed to evaluate socio-demographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents, and related attitudes and knowledge items. Parents of adolescents attending middle schools across France, who participated in a randomized trial responded to an anonymous baseline survey, conducted between November 2021 and February 2022. We used logistic regression models adjusting for a child's age and sex to explore sociodemographic determinants (including at-home multilingualism, occupational categories, local deprivation index and urbanity) of HPV vaccine awareness, uptake, and intention. Among the 1889 participants from 61 schools, parents working as factory workers/farmers had significantly lower odds of vaccine awareness compared to executives/professionals, both if they reported (OR = 0.07; 0.03-0.15) or not (OR = 0.20; 0.11-0.36) speaking also another language than French at home. Parents in lower occupational categories with multilingual families were less likely to have the intention to vaccinate their child (OR = 0.19; 0.07-0.56). Recent physician visit or vaccine offer was strong positive determinants of awareness, uptake and intention. A substantial gradient across occupational categories was observed for attitudes and knowledge around HPV vaccine usefulness, safety, and accessibility. This study confirms the disparities on HPV vaccine uptake in France and provides insight into mechanisms of social disparities in HPV vaccine awareness, access and intention.

Human papillomavirus vaccination uptake and determinant factors among adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis

Despite the ongoing global vaccination campaign aimed at preventing human papillomavirus (HPV) related health issues, the uptake of the HPV vaccine remains unacceptably low in developing regions, particularly in sub-Saharan Africa (SSA). Therefore, this systematic review and meta-analysis aimed at determining the pooled prevalence and associated factors of HPV vaccine uptake among adolescent school girls in SSA. Electronic bio-medical databases were explored. Pooled prevalence, publication bias, meta-regression, sub-group, and sensitivity analysis were performed. The estimated pooled prevalence of HPV vaccine uptake was 28.53% [95% CI: (5.25, 51.81)]. Having good knowledge and a positive attitude was significantly associated with HPV vaccine uptake in SSA. Subgroup analysis revealed the highest uptake was 62.52% from Kenya and the lowest was 3.77% in Nigeria. The HPV vaccine uptake is low. It underscores the need for community education, school-based immunization, and education programs that promote the uptake of the vaccine to increase coverage.

Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis

Background

Cervical cancer burden in South Asia is among the highest globally. Due to the lack of national immunization programs, the prevalence of human papillomavirus (HPV) infection and vaccine uptake remains unknown. This systematic review and meta-analysis aim to determine the prevalence of HPV vaccine uptake in South Asia.

Methods

We conducted a comprehensive search of MEDLINE (via PubMed), Embase, the Cochrane Library, and the Web of Science, covering the period from inception to May 20, 2024. We included observational studies reporting HPV vaccine uptake in South Asia, without any language filters or restrictions. The search strategy involved MeSH terms and relevant keywords related to "Papillomavirus Infections," "Vaccination," and "Uptake." MetaXL and STATA were used to perform a proportional meta-analysis and meta-regression analysis.

Results

Out of 3,913 articles identified, 17 articles (10,585 participants) were included in the systematic review. The pooled prevalence of vaccine uptake was 8% (95% CI 1-21). There was high heterogeneity between studies (I 2 = 100%). The pooled prevalence of adequate knowledge of the HPV vaccine was 41% (95% CI 28-55, I 2 = 99%). The pooled prevalence of a favorable attitude toward the HPV vaccine was 56% (95% CI 47-66, I 2 = 98%). In the univariate meta-regression model, good knowledge significantly predicted HPV vaccine uptake (p = 0.003), while no covariates were found to be significant predictors of attitudes toward HPV vaccine uptake.

Conclusion

The findings of this meta-analysis indicate a low pooled prevalence of HPV vaccine uptake (8%) in South Asian countries. The pooled prevalence of adequate knowledge and a favorable attitude toward the vaccine were 41 and 56%, respectively. In the univariate meta-regression model, knowledge of the HPV vaccine uptake was the only significant predictor of vaccine uptake.

Systematic review registration

Systematic review is registered at Prospero through the link https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024547393.

Predictors of Human Papillomavirus (HPV) Vaccine Acceptability Among Physicians, Their Knowledge on Cervical Cancer, and Factors Influencing Their Decision to Recommend It

Introduction

In Saudi Arabia, the HPV vaccine is administered to young females through school-based immunization programs; however, the program's efficacy depends on parental consent, with physicians acting as primary determinants in parental decision-making regarding HPV vaccination.

Methods

In this cross-sectional study, we recruited 128 physicians and assessed their knowledge and attitudes toward cervical cancer, HPV, and the HPV vaccine, and unraveled predictors of HPV vaccine acceptability and factors that would influence recommending the vaccine.

Results

Although the major factor that influenced recommending the vaccine negatively was the fear of vaccine side effects, a positive influence of the physician's personal reading (91%), recommendations from colleagues (88%), and government directives (87%) provided reassurance and increased confidence in recommending the vaccine. Longer clinical experience and institutional awareness were found to be a predictors of favorable recommendation of HPV vaccination. Physicians in vaccine-related medical specialty with more than 4 years of experience were 5 to 6 times more likely to have positive attitude and better knowledge regarding HPV and HPV vaccination. A notable finding was that participants who reported knowing a woman suffering from cervical cancer had more positive attitudes compared to those who did not.

Discussion

This study identified physicians' personal reading, peer recommendations, and government directives as factors affecting the physicians' decision to recommend HPV vaccine, and found that longer clinical experience and institutional awareness were predictors influencing physicians to recommend the vaccine. It also emphasizes on the influence of healthcare providers in promoting the HPV vaccination and the need for designing interventions targeting specific demographic and professional groups that would be more effective in improving better knowledge and promoting positive attitudes towards these critical public health issues.

Acceptance of Human Papillomavirus (HPV) vaccine among the parents of eligible daughters (9-15 years) in Bangladesh: A nationwide study using Health Belief Model

BACKGROUND

To align with the 2030 vision of the World Health Organization (WHO) to ensure 90% of girls receive the HPV vaccine before turning 15, Bangladesh has recently started the (HPV) vaccine campaign nationwide. Therefore, our study aimed to assess the level of its acceptance among parents of eligible daughters in Bangladesh.

METHODS

This nationwide cross-sectional study was conducted among the self-identified parents of daughters in the age group of 9-15 years between June 28 and August 2, 2023. A total of 2,151 parents were conveniently selected from all eight divisions of Bangladesh. Data was collected through face-to-face interviews using a semi-structured questionnaire. The Health Belief Model was used to appraise respondents' beliefs concerning HPV and its vaccination. Adjusted odds ratios (AOR) with a corresponding 95% confidence interval (CI), and a p-value of <0.05 was considered statistically significant. R Studio (Version 2023.09.0+463) was used as an interface for data analysis, while R (the programming language) was used for statistical computations.

RESULTS

The mean age of the study participants was 38.18 (±5.86) years. The overall acceptance rate of the HPV vaccine was 86.61% (95%CI: 85.09-88.02). The vaccine acceptance level was positively associated with all the domains of the HBM (p<0.001), except in the perceived barrier domain (p = 0.489). After adjustment for other factors, it was found that higher age was associated with a decreased acceptance (AOR: 0.92; 95% CI: 0.89-0.95). The urban residents exhibited 42% lower odds of vaccine acceptance than rural (AOR: 0.58; 95% CI: 0.36-0.92). Similarly, participants of the middle-income group had 44% lower odds than the lower-income group (AOR: 0.56; 95% CI: 0.32-0.97).

CONCLUSION

Our study found a reasonably good level of acceptance of the HPV vaccine among the parents of eligible daughters. Multiple factors such as younger age, urban residence, belonging to the middle income group, history of regular routine health check-ups, knowledge of cervical cancer, positive perception about benefits of the vaccine, and positive cues to actions were associated with HPV vaccine acceptance.

The effect of alcohol, tobacco, and other drug use on vaccine acceptance, uptake, and adherence: a systematic review

BACKGROUND

Vaccine hesitancy is increasingly recognized as a health challenge affecting populations worldwide. Given the biological vulnerabilities and structural barriers people who use substances and/or have behavioral addictions face, this systematic review aims to evaluate whether this subpopulation is less prone to adhere to vaccination recommendations.

METHODS

Electronic searches of published original research were conducted in PubMed, EMBASE, Scopus, and PsycINFO from database inception to December 2022. Our strategy encompassed retrievals regardless of languages and date of publication. Animal studies, abstracts without a full manuscript, and studies which were considered to have lower robustness of scientific evidence were excluded. Outcomes measured were vaccine acceptance, uptake, and adherence. Results were interpreted through a narrative synthesis.

RESULTS

The search yielded 103 retrievals encompassing data collected on 5 576 374 persons who were predominantly residents of Europe (n = 39) and North America (n = 27). Tobacco use, the substance for which many studies were found (n = 91), was significantly associated with poorer vaccine acceptance, uptake and adherence for influenza, COVID-19, human papillomavirus (HPV), and maternal and childhood vaccines. Peri-natal and parental substance use was identified as a risk factor for suboptimal vaccine-related outcomes concerning maternal COVID-19 and childhood vaccines. Finally, people identified as 'using', 'abusing', or 'misusing' drugs or substances may be at decreased odds of all outcomes in various vaccines.

CONCLUSIONS

Collectively, the studies identified several groups with statistically significant greater vaccine hesitancy and decreased engagement among whom targeted measures could be beneficial. Timely evidence, especially on behavioral addictions and substances besides tobacco, is lacking, and warrants urgent attention.

HPV vaccine behaviors and intentions among a diverse sample of women aged 27-45 years: implications for shared clinical decision-making

BACKGROUND

The Advisory Committee on Immunization Practices issued a shared clinical decision-making (SCDM) recommendation for HPV vaccination in persons aged 27-45. Since expanded eligibility for the vaccine was issued, little information has been available about HPV vaccine behaviors and intentions among women in this age group.

METHODS

We conducted a cross-sectional online survey among women aged 27-45 years recruited through a Qualtrics™ respondent panel (N = 324) to answer the following questions (1) What is the prevalence of HPV vaccination among a diverse sample of adult women aged 27-45 years? (2) What are the characteristics of those who have or have not previously been vaccinated? and (3) What factors are associated with the intention to obtain the HPV vaccine among those who had never been vaccinated? Multivariable logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs).

RESULTS

Only 31.1% had at least one dose of the HPV vaccine. In multivariable analyses, those more likely to have been vaccinated were younger and were more likely to believe that the vaccine was effective. Of those unvaccinated or unsure, 54.8% indicated they were likely to get vaccinated in the future. Factors associated with future vaccine intention (compared to those not intending) included beliefs about vaccine testing, perceived likelihood of HPV infection, greater comfort in asking one's provider for vaccination, and prior negative healthcare experiences.

CONCLUSIONS

Our findings suggest that many women in this age group are interested in HPV vaccination. While the recommendation is for SCDM rather than routine vaccination for all women in this age group, efforts to promote informed decision-making among mid-adult women may include educating women about the rigorous vaccine testing and approval process, their risk factors for HPV infection, and encouraging them to engage in SCDM with their medical providers. Targeted efforts to reach women who have had negative experiences with healthcare may also be needed.

A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake

Human papillomavirus (HPV) vaccination has revolutionized cervical cancer prevention. Clinical trials confirm that the quadrivalent (HPV types 6, 11, 16, 18) and bivalent (HPV types 16, 18) vaccines effectively prevent HPV infections and cervical neoplasia. The latest HPV vaccine protects against nine virus types responsible for 90% of cervical cancer cases globally. Despite their undoubted effectiveness in reducing morbidity and mortality associated with HPV infections, challenges in vaccine coverage and uptake persist. The current study aimed to identify the primary challenges associated with HPV vaccination, propose effective strategies to improve vaccination uptake, and compile relevant evidence into a comprehensive overview to inform policy and practice. A systematic review protocol, following PRISMA-P and PRISMA guidelines, was established. Articles were sourced from the Web of Science using keywords from a comprehensive review of HPV vaccination challenges and strategies. Studies published between 1 January 2020, and 1 May 2024, including RCTs and observational, qualitative, and cross-sectional studies, were included, while reviews, protocols, and commentaries were excluded. Titles, abstracts, and full texts were screened per PRISMA guidelines. The review identified five key strategies to improve HPV vaccination uptake: parental and school engagement, use of technology and multimedia tools, healthcare providers' role, multicomponent interventions, and targeted interventions for immigrant groups. This review emphasized the need for a multifaceted approach to improving vaccination rates, offering a robust foundation for policy and stakeholder initiatives.

Attitudes, Beliefs, and Intention to Receive a COVID-19 Vaccine for Pediatric Patients With Sickle Cell Disease

Sickle cell disease (SCD), which occurs primarily in individuals of African descent, has been identified as a preexisting health condition for COVID-19 with higher rates of hospitalization, intensive care unit admissions, and death. National data indicate Black individuals have higher rates of vaccine hesitancy and lower COVID-19 vaccination rates. Understanding the key predictors of intention to receive a COVID-19 vaccine is essential as intention is strongly associated with vaccination behavior. This multisite study examined attitudes, beliefs, intentions to receive COVID-19 vaccines, and educational preferences among adolescents, young adults, and caregivers of children living with SCD. Participants completed an online survey between July 2021 and March 2022. Multivariate logistic regression was used to examine the association between participant age and COVID-19 vaccine attitudes, beliefs, and vaccine intentions. Of the 200 participants, 65.1% of adolescents, 62.5% of young adults, and 48.4% of caregivers intended to receive a COVID-19 vaccine for themselves or their child. Perception that the vaccine was safe was statistically significant and associated with patient and caregiver intention to receive the COVID-19 vaccine for themselves or their child. Participant age was also statistically significant and associated with the intent to get a booster for patients. Study findings highlight key concerns and influencers identified by patients with SCD and their caregivers that are essential for framing COVID-19 vaccine education during clinical encounters. Study results can also inform the design of messaging campaigns for the broader pediatric SCD population and targeted interventions for SCD subpopulations (eg, adolescents, caregivers).

Using machine learning algorithms to predict COVID-19 vaccine uptake: A year after the introduction of COVID-19 vaccines in Ghana

The impact of vaccine hesitancy on global health is one that carries dire consequences. This was evident during the outbreak of the COVID-19 pandemic, where numerous theories and rumours emerged. To facilitate targeted actions aimed at increasing vaccine acceptance, it is essential to identify and understand the barriers that hinder vaccine uptake, particularly regarding the COVID-19 vaccine in Ghana, one year after its introduction in the country. We conducted a cross-sectional study utilizing self-administered questionnaires to determine factors, including barriers, that predict COVID-19 vaccine uptake among clients visiting a tertiary and quaternary hospital using some machine learning algorithms. Among the findings, machine learning models were developed and compared, with the best model employed to predict and guide interventions tailored to specific populations and contexts. A random forest model was utilized for prediction, revealing that the type of facility respondents visited and the presence of underlying medical conditions were significant factors in determining an individual's likelihood of receiving the COVID-19 vaccine. The results showed that machine learning algorithms can be of great use in determining COVID-19 vaccine uptake.

Attitudes of mothers of preadolescent girls on HPV vaccine in Italy: do we need a turning point?

BACKGROUND

The aim of this study was to investigate the knowledge, awareness, and attitude of mothers of preadolescent girls regarding the HPV vaccination and cervical cancer, and to understand how to improve the efficacy of the Italian vaccination campaign through the gathered data.

METHODS

A questionnaire-based survey was conducted in mothers of unvaccinated 9 to 12-year-old girls in Italy from November 2018 to July 2019, to evaluate their awareness and the attitude toward HPV, its vaccination, and the information sources of the vaccination campaign. The selection of the distribution sites of the questionnaire was performed with randomization of 50 major places of aggregation located throughout the Italian territory.

RESULTS

Three hundred mothers of unvaccinated girls were included in the study and divided into two groups (191 subjects <45 years old, 109 subjects >45 years old). Results showed that 79.6% of <45 years old knew what HPV is, compared to 60.6% of >45 years old (P value <0.001); only 60.2% (<45 years old) and 54.1% (>45 years old) showed awareness about the HPV vaccine (P value 0.03). The percentage of parents against vaccination in preadolescent was higher in the >45 years old (29.4%); however, most of them appeared favorable to the information campaigns regarding the vaccine (P value <0.001).

CONCLUSIONS

Our study showed that mothers of unvaccinated preadolescent girls have suboptimal knowledge on the topic. Moreover, the implementation of communication strategies dedicated to the population segment appears as a central aspect. As HPV vaccination keeps being a public health concern, it is fundamental to understand which trigger should be managed by healthcare decision makers to boost the vaccination campaigns.

Factors Affecting COVID-19 Vaccine Decision-Making and Satisfaction: A Survey of U.S. High School Students

PURPOSE

To investigate self-reported individual-, household-, and community-level factors impacting COVID-19 vaccination decision-making among a sample of high school-aged US adolescents.

METHODS

We surveyed adolescents ages 15-17 living in the United States during September and October 2022 (n = 454). Univariable and targeted bivariable and multivariable analyses were conducted to examine associations between adolescent characteristics and COVID-19 vaccination status, satisfaction with vaccination status, reasons weighed for and against vaccination, and experience of perceived access barriers.

RESULTS

More than three-quarters of high school-aged adolescents in our sample reported satisfaction with their current COVID-19 vaccination status, and respondents were more likely to report satisfaction with their COVID-19 vaccination status when they reported actively participating in the decision.

DISCUSSION

Adolescents remain an important age group for targeted public health and policy interventions given that their vaccination rates still lag behind averages for adults. Allowing for minor consent to vaccination, as well as parent-, school-, or peer-based interventions, may prove especially effective for addressing rates among high school-aged students.

Influences on COVID-19 booster uptake among adults intending to receive a booster: a qualitative study

Bivalent COVID-19 vaccine boosters have been recommended for all Americans 12 years of age and older. However, uptake remains suboptimal with only 17% of the United States (US) population boosted as of May 2023. This is a critical public health challenge for mitigating the ongoing effects of COVID-19 infection. COVID-19 booster uptake is not currently well understood, and few studies in the US have explored the vaccination process for booster uptake in a 'post-pandemic' context. This study fills gaps in the literature through qualitative analysis of interviews with a racially/ethnically diverse sample of Arkansans who received the COVID-19 vaccine main series and expressed intent to receive a booster (n = 14), but had not yet received the COVID-19 booster at the time we recruited them. All but one did not receive the booster by the time of the interview. Participants described influences on their vaccination behavior and uptake of boosters including reduced feelings of urgency; continued concerns about the side effects; social contagion as a driver of urgency; increasing practical barriers to access and missing provider recommendations. Our findings highlight the importance of considering vaccination as an ongoing, dynamic process drawing on past/current attitudes, prior experience, perceptions of risk and urgency and practical barriers. Based on these findings, healthcare providers should continue to provide strong, consistent recommendations for COVID-19 boosters to patients, even among those with histories of vaccine uptake.

Awareness of HPV vaccine and its socio-demographic determinants among the parents of eligible daughters in Bangladesh: A nationwide study

Background

Vaccination against Human papillomavirus (HPV) is recommended to avoid HPV infections and its associated diseases, including cervical cancer. However, there is no awareness study among Bangladeshi population. Hence, this nationwide study was conducted to explore HPV vaccine awareness and its determinants among parents of eligible adolescent girls.

Methods

This study was conducted among the parents of daughters aged 9-15 years from 42 out of 64 randomly selected districts of Bangladesh between June 28 to August 2, 2023. A multistage sampling method was used to enroll 2151 study participants from all eight divisions of Bangladesh. A semi-structured questionnaire was used for face-to-face interviews in this study. The statistical software Stata (Version 17) was used for statistical analyses.

Results

The average age of the participants was 38.18 (±5.86) years. Only 22.32 % of the participants were aware of the HPV vaccine. Every additional year of age increased the likelihood of being aware of the HPV vaccine by 3 % (AOR: 1.03; 95%CI: 1.00-1.06). Participants residing in the urban area had 3.56 times higher odds of awareness than rural and semi-urban people. Businessmen and housewives had 60 % (AOR: 0.40; 95 % CI: 0.22-0.69) and 77 % (AOR: 0.23; 95 % CI: 0.16-0.33) lower odds in comparison to job holders. The lower-income group exhibited significantly higher odds of awareness (AOR: 0.25, 95%CI: 0.16-0.39) compared to the middle and the higher-income group. Participants who never went through routine health check-ups had 77 % lower odds of being aware than those who availed of regular routine check-ups (AOR: 0.23; 95%CI: 0.16-0.34).

Conclusion

Awareness of the HPV vaccine among the general population of Bangladesh is very low. Age, residence, occupation, monthly income, and routine medical check-ups were associated with HPV vaccine awareness. A nationwide awareness campaign would increase this awareness level among the Bangladeshi population, especially among the parents of daughters.

Do boys have the same intentions to get the HPV vaccine as girls? Knowledge, attitudes, and intentions in France

BACKGROUND

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.

METHODS

This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.

RESULTS

The participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.

CONCLUSIONS

These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

Barriers to cervical cancer prevention in a safety net clinic: gaps in HPV vaccine provider recommendation and series completion among Ob/Gyn patients

Objective

The primary objective of this study was to evaluate patients' knowledge regarding HPV vaccination and vaccine uptake in a diverse patient population. The secondary objective was to evaluate factors influencing the decision to vaccinate, potential barriers to vaccination, and to assess whether HPV vaccines were offered to or discussed with eligible patients in a safety net Obstetrics and Gynecology (Ob/Gyn) clinic.

Methods

A 28-item survey was developed using Likert scale survey questions to assess patient agreement with statements regarding HPV and the vaccine. The surveys were administered to patients in the Ob/Gyn outpatient clinics from May 2021 through September 2022. Additionally, pharmacy data were reviewed and chart review was performed as a quality improvement initiative to assess the impact of expanded HPV vaccine eligibility to patients with private insurance on vaccine uptake. Descriptive statistics were performed.

Results

304 patients completed surveys from May 2021 through September 2022. The median age of respondents was 32 (range 18-80). 16 (5%) were Non-Hispanic White, 124 (41%) were Hispanic White, 58 (19%) were Non-Hispanic Black, 6 (2%) were Hispanic Black, 29 (9.5%) were Haitian, 44 (14%) were Hispanic Other, 7 (2%) were Non-Hispanic Other, 20 (6.6%) did not respond. 45 (14%) patients were uninsured. Many patients (62%) reported that a physician had never discussed HPV vaccination with them. Seventy nine percent of patients reported they had never received the HPV vaccine, and 69% of patients reported that lack of a medical provider recommendation was a major barrier. Among patients to whom HPV vaccination had been recommended, 57% reported that the vaccine was not available the same day in clinic.

Conclusion

Our study demonstrated that many patients never had a provider discuss HPV vaccination with them and never received the HPV vaccine. Additionally, amongst those who did initiate HPV vaccination, completion of the series remains a key barrier. Ensuring that providers discuss HPV vaccination and that patients receive HPV vaccines, along with expanding access to and convenience of HPV vaccination are critical aspects of preventing cervical cancer.

Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis

INTRODUCTION

Cervical cancer is the most common malignant tumor among women. It is the main cause of death among women in sub-Saharan African countries. Particularly, the incidence and mortality rates are highest in East Africa. Even though the burden of human papilloma virus-related cervical cancer is high in East Africa, there is no conclusive evidence about the prevalence of human papilloma virus vaccine uptake and its predictors.

OBJECTIVE

To assess the pooled prevalence of human papilloma virus vaccine uptake and its determinants in East Africa.

METHOD

Eligible articles were searched on PubMed, Embase, Scopus, Cochrane Library, Google Scholar, and Google. Those articles incorporating the outcome of interest, both analytical and descriptive study designs, and published or unpublished articles at any time were included. Keywords and Medical Subjects Heading terms or synonyms of human papilloma virus vaccine and Boolean operators were used to retrieve the articles. To assure the quality of articles, Joana Brigg's Institute critical appraisal checklist for cross-sectional studies was used. Sensitivity analysis was conducted to assess the heterogeneity among the studies, and a random effect model was used to analyze the pooled effect size.

RESULT

A total of 29 articles were included, and the pooled prevalence of HPV vaccine uptake in East Africa was 35% (95% CI: 26-45%). Good knowledge (OR = 1.6, 95%CI; 1.43-1.8), positive attitude (OR = 2.54, 95% CI; 2.13-3.03), ever heard about HPV vaccine (OR = 1.41, 95% CI; 1.03-1.94), mother educational status above college (OR = 1.84, 95%CI; 1.03-3.31), middle wealth index (OR = 1.33, 95%CI; 1.04-1.7), ≥ 9 family size (OR = 0.76, 95%CI; 0.68-0.98), availability of promotion (OR = 2.53, 95%CI: 1.51-4.26), availability of adequate vaccine (OR = 4.84, 95%CI; 2.9-8.08), outreach vaccination practice (OR = 1.47, 95%CI; 1.02-2.12) and family support (OR = 4.3, 95% CI; 2.98-6.21) were the significant factors for the uptake of human papilloma virus vaccine.

CONCLUSION

As compared to the global strategic plan, the pooled prevalence of HPV vaccine uptake in east Africa was low. The uptake of the HPV vaccine was higher among adolescents than youths. Knowledge about the HPV vaccine, attitude towards the HPV vaccine, ever hearing about the HPV vaccine, residence, mother's educational status, mother's occupational status, wealth index, and family size were the significant determinants of HPV vaccine uptake. Therefore, we recommend focusing on awareness creation and behavioral change to expand the uptake of vaccines in East Africa.

"Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

Dutch dental hygiene students' knowledge of HPV-related oropharyngeal squamous cell carcinoma and HPV vaccination

INTRODUCTION

The incidence of human papillomavirus (HPV)-related oropharyngeal cancer is rising, thus the understanding of HPV infection and vaccination among oral healthcare professionals is becoming increasingly important. This study aimed to investigate the knowledge of Dutch dental hygiene students on HPV infection and vaccination and assessed various aspects of HPV-related oropharyngeal cancer.

METHODS

This descriptive cross-sectional study invited the entire Dutch dental hygiene student population registered in September 2016 to complete an online questionnaire concerning the knowledge of HPV infection and vaccination, including the aspects of HPV-related Oro-Pharyngeal Squamous Cell Carcinoma (OPSCC). Data were analysed using t-tests, Mann-Whitney U tests and Chi-square tests.

RESULTS

Invited were all 1248 Dutch dental hygiene students and 232 (18.6%) students completed the questionnaire. More than 95% of the students indicated HPV infection as a risk factor for OPSCC and 48.7% was aware of the availability of HPV vaccination. Additionally, students considered it important to discuss HPV as a risk factor for oropharyngeal cancer with their patients. In general, the students scored highest on the questions about risk factors for OPSCC and poorest on the questions about general HPV knowledge and HPV vaccination. Although the mean overall knowledge score was significantly higher in senior compared with junior students, knowledge scores of senior students remained insufficient.

CONCLUSION

This study identified deficits in knowledge of HPV and HPV vaccination among Dutch dental hygiene students. Future research should focus on improving the content of dental hygiene curricula and development of ongoing educational tools for dental hygienists.

Factors associated with parental Human Papillomavirus (HPV) vaccination intention of daughter: A national survey in Finland

BACKGROUND

Human papillomavirus (HPV) vaccines are offered free of charge in Finland to 10-12-year-old children. Nationally about 80% of girls are vaccinated, with regional differences in first dose coverage varying from 62% to 82% in girls born in 2011. This study examined the factors associated with HPV vaccination intention. Furthermore, we assessed the realisation of HPV vaccination among the daughters of the participating parents.

METHODS

A web-based survey was conducted for randomly selected parents of girls (N = 6 465) aged 10 to 14 years of age. Data was collected in February and March 2022 in five Finnish high and low coverage municipalities. The national vaccination register was employed to assess realisation of vaccination.

RESULTS

Participation rate was 13.7% (n = 883 parents). Almost all parents were aware of the association between HPV and cervical cancer, but only one fifth was aware of other diseases associated with HPV. Adherence to the national vaccination programme, parents' mother tongue, and trusting in official information were associated with positive vaccination intention. The most often reported reason for non-vaccination was fear of adverse effects (22%). Overall, parental attitudes towards HPV vaccination were positive, with 83% of parents indicating their daughter had received or will receive the vaccination. Vaccination realisation was subsequently examined and 88% of the daughters were vaccinated.

CONCLUSIONS

Despite low knowledge of HPV-related diseases overall, majority of parents held a positive intention to vaccinate their daughter. Realisation of intention was high in our study, higher than the national uptake. Foreign-origin parents had lower intention to vaccinate their daughters. As information on HPV and its vaccine is available in 11 languages, there is a need to re-think accessibility. In-depth interviews are needed to better explore the reasons behind non-vaccination.

Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review

BACKGROUND

In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness.

OBJECTIVE

To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns.

DESIGN

Qualitative systematic review and thematic analysis.

METHODS

Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes.

RESULTS

22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision.

CONCLUSIONS

Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule.

REGISTRATION

The review was registered on PROSPERO, registration ID CRD42021236120.

Attitudes About the Human Papillomavirus Vaccine Among Patients With and Without Cervical Dysplasia

OBJECTIVES

The aims of the study are to examine the perception of the human papillomavirus (HPV) vaccine among those with and without a history of cervical dysplasia and to examine perceptions of the vaccine for their children.

MATERIALS AND METHODS

Patients were recruited to complete a survey about the HPV vaccine for both themselves and their children. Patients in a colposcopy clinic with a history of abnormal cervical cytology and patients in a benign gynecology clinic without a history of abnormal cervical cytology were recruited. Participants' medical records were reviewed. Demographics and survey answers were described, and Fisher exact test was used to compare the groups.

RESULTS

One hundred eighty-three patients participated: 73 in colposcopy clinic and 110 in benign clinic. The majority self-identified as Black (74% colposcopy, 71% benign, p = .588) and reported an income less than $39,000 a year (77% colposcopy, 65% benign, p = .089). Fifty-six percent in benign clinic agreed the HPV vaccine is a good way to protect oneself from disease compared with 48% in colposcopy clinic ( p = .022). When examining results based on cytology, fewer patients in the highest-grade cytology group agreed the vaccine was effective (30% high-grade, 48% normal, 57% low-grade, p = .027) or a good way to protect themselves from disease (29% high-grade, 53% normal, 62% low-grade, p = .002). There was otherwise no statistically significant difference between the groups on questions regarding self or child vaccination.

CONCLUSIONS

In a majority Black, low-income population, patients without a history of abnormal cervical cytology have more favorable perceptions of the HPV vaccine's effectiveness in preventing disease. Those with the highest-grade cytology had more negative perceptions of the vaccine's effectiveness and protectability.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

Socioeconomic inequalities in vaccine uptake: A global umbrella review

This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.

Vaccine value profile for cytomegalovirus

Cytomegalovirus (CMV) is the most common infectious cause of congenital malformation and a leading cause of developmental disabilities such as sensorineural hearing loss (SNHL), motor and cognitive deficits. The significant disease burden from congenital CMV infection (cCMV) led the US National Institute of Medicine to rank CMV vaccine development as the highest priority. An average of 6.7/1000 live births are affected by cCMV, but the prevalence varies across and within countries. In contrast to other congenital infections such as rubella and toxoplasmosis, the prevalence of cCMV increases with CMV seroprevalence rates in the population. The true global burden of cCMV disease is likely underestimated because most infected infants (85-90 %) have asymptomatic infection and are not identified. However, about 7-11 % of those with asymptomatic infection will develop SNHL throughout early childhood. Although no licensed CMV vaccine exists, several candidate vaccines are in development, including one currently in phase 3 trials. Licensure of one or more vaccine candidates is feasible within the next five years. Various models of CMV vaccine strategies employing different target populations have shown to provide substantial benefit in reducing cCMV. Although CMV can cause end-organ disease with significant morbidity and mortality in immunocompromised individuals, the focus of this vaccine value profile (VVP) is on preventing or reducing the cCMV disease burden. This CMV VVP provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of CMV vaccines. The CMV VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the CMV VVP and have described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.

Acceptance of Annual Booster Doses of COVID-19 Vaccines Among Indian Healthcare Professionals: A Pan-India Cross-Sectional Survey

Introduction The emergence of coronavirus disease 2019 (COVID-19) posed significant challenges to global health, leading to the declaration of a pandemic by the World Health Organization. Vaccination efforts have effectively reduced severe outcomes and mortality, but breakthrough infections and new variants are of concern. In response, annual booster doses of COVID-19 vaccines are being considered to maintain immunity. Healthcare professionals, as frontline workers, play a pivotal role in vaccination campaigns. This study explores their attitudes toward and willingness to accept annual COVID-19 booster doses in India. Methods A pan-India cross-sectional survey was conducted among healthcare professionals, including faculty, resident doctors, interns, and nursing staff, across Indian medical and nursing colleges. Convenience sampling was used to collect responses via an online questionnaire. The questionnaire assessed demographics, vaccine status, attitudes toward COVID-19 vaccination, and willingness to accept annual booster doses. Multivariate analysis was performed to identify predictors of booster dose acceptance. Results A total of 535 participants responded from 28 states and 8 union territories of India. Most were 34.2 years (± 11.1 SD), and 372 (69.5%) had taken Covishield (Serum Institute of India, Pune, India) as their primary vaccine. While 525 (98.1%) had taken the first dose and 518 (96.8%) of them had taken the second dose, only 333 (62.2%) had received a booster. Around 318 (60%) of healthcare professionals were willing to accept an annual booster dose. The mean attitude score toward annual booster doses was 75.4 (range: 28-111). Healthcare professionals' trust in government recommendations and medical experts significantly influenced their willingness to accept annual booster doses. Conclusion This study provides insights into the attitudes of healthcare professionals in India toward annual COVID-19 booster doses. At the same time, a significant proportion showed a willingness to accept boosters.

Comparison of awareness, attitudes and knowledge on human papilloma virus vaccination in Singapore: 2019 versus 2013

Introduction

This study aimed to assess the changes in the awareness, attitudes and knowledge regarding human papillomavirus (HPV) vaccination among the local population. The secondary aims were to identify barriers and to evaluate the effectiveness of national HPV vaccination campaigns over a six-year period in Singapore.

Methods

We conducted and compared two cross-sectional surveys in 2013 and 2019 among female participants attending a general gynaecology clinic.

Results

A total of 597 participants completed the survey in 2013 and 2019. The participants were comparable in their race, marital status, educational level, occupation and monthly household income. Knowledge scores for cervical cancer and HPV infection showed significant improvement from 2013 to 2019. There was no significant difference in knowledge scores for HPV vaccination, which resulted in similar uptake of the HPV vaccine. Age, educational level and knowledge of HPV vaccine were significant predictors of acceptance of the HPV vaccine. The top two reasons for declining the HPV vaccine were the lack of knowledge and cost, as noted in the 2019 survey.

Conclusion

The Singapore government's efforts to improve cervical cancer awareness through national campaigns and policy changes have led to an improvement in knowledge of HPV infection. However, this has not translated into improvements in the vaccine acceptance rates. The decision for vaccine uptake is complex, and there are multiple factors to be addressed to ensure cost-effective implementation of the strategies. Our study highlights the need for effective dissemination of vaccine information, additional subsidies and consideration of a mandatory school-based vaccination programme.

Parental perceptions of the HPV vaccine for prevention of anogenital and oropharyngeal cancers

Background and Objectives

Human papillomavirus (HPV) is implicated in the development of both anogenital and oropharyngeal cancers. Although HPV vaccination prevents the majority of anogenital and head and neck cancers (HNC), vaccination rates remain low, especially among males. Known barriers to vaccination are knowledge gaps and vaccine acceptability. The objective of this study is to explore parental knowledge, perceptions, and decision-making processes about HPV and HPV vaccination for both anogenital and HNC.

Methods

This qualitative study recruited parents of children and adolescents aged 8-18 to participate in semi-structured telephone interviews. Data were analyzed using thematic analyses, informed by an inductive approach.

Results

A total of 31 parents participated in the study. Six themes emerged: 1) knowledge about HPV vaccines, 2) perceptions and attitudes toward cancers, 3) role of child's sex in HPV vaccination, 4) decision-making processes around HPV vaccination, 5) communication with health care providers about HPV vaccines, and 6) influence of social networks. There were significant knowledge gaps about the vaccine's indications and effects, especially for males and HNC prevention. Parents had concerns related to risks of the HPV vaccine. They cited pediatricians as important sources of information about vaccination and critical to their decision-making.

Conclusions

This study identified many parental knowledge gaps related to HPV vaccination, with information about males, HNC prevention, and risks particularly lacking. As parents identified pediatricians as the most important sources of information regarding HPV vaccination, this should empower pediatricians to educate families about this important preventive health measure, with a focus on addressing concerns about vaccine risks.

Facilitating human papillomavirus vaccination pathways by extending vaccination competencies to community pharmacists: A cross-sectional survey on the acceptability and expectations among healthcare professionals and parents

Background

Human papillomavirus (HPV) vaccination coverage rate (VCR) remains low in France (37.4% in girls in 2021). The French health authority recommended in 2022 to extend vaccination competencies to additional healthcare providers (HCPs), including community pharmacists (CPs).

Objectives

To understand the acceptability by general practitioners (GPs), CPs and parents of adolescents of extending vaccination competencies and to identify benefits and barriers of new vaccination pathways.

Methods

This cross-sectional research used a qualitative and quantitative approach. For the quantitative survey, GPs, CPs and parents of adolescents eligible to HPV vaccination completed an online questionnaire. Participants were asked to imagine themselves in different pathways and evaluate them.

Results

A total of 200 GPs, 201 CPs and 800 parents were included. The level of acceptability of extending vaccination competencies to other HCPs was high in CPs (86% rated ≥7/10), but low in GPs (35%) and intermediate in parents (61%). Parents ranked first (44%) a pathway where GPs prescribed while CPs vaccinated because GPs inspire confidence as vaccine prescribers (80%) and parents prefer to be informed on vaccination by them (80%). CPs ranked first (42%) a scenario where they vaccinated after invitation of adolescents from the French National Health Insurance Fund (NHIS). They emphasized the simplicity of this scenario (94%) and the potential increase of VCR (91%), but asked to be more informed on HPV vaccination (77%) and favored television (83%) for communication campaigns.

Conclusions

GPs and parents, in contrast with community pharmacists, were only moderately supportive of the extension the vaccination competencies. Confidence in the HCP remains the primary factor for adherence to a vaccination pathway beyond the simplicity of the pathway. Training of CPs, traceability tool, support from authorities and communication campaigns are levers that will support CPs in their new role and contribute to increase parents' acceptability toward CPs.

Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent schoolgirls in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Cervical cancer is an international public health issue. Nearly all cases of cervical cancer are caused by the human papillomavirus. The HPV vaccine prevents more than 75% of cervical cancer. The extent to which adolescent girls' knowledge and uptake of the HPV vaccine have to be investigated in order to build effective promotion strategies and increase the uptake of the vaccine. The evidence that is currently available in this area is controversial and inconclusive. Hence, this study has estimated the pooled proportion of good knowledge, positive attitude, and uptake of the HPV vaccine and its associated factors among adolescent schoolgirls in Ethiopia.

METHODS

PubMed, Google Scholar, AJOL, ScienceDirect, and DOAJ were used to search relevant studies. A total of 10 studies were included. The data were extracted by two reviewers using Microsoft Excel and exported to STATA Version 17 for analysis. A random effects model was applied during the analysis. Heterogeneity and publication bias across the studies were evaluated using I² statistics and Egger's test, respectively. The PROSPERO registration number for the review is CRD42023414030.

RESULT

A total of eight studies comprising 3936 study participants for knowledge and attitude and five studies with 2,481 study participants for uptake of HPV were used to estimate the pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine, respectively. The pooled proportions of good knowledge, positive attitude, and uptake of the HPV vaccine were 55.12%, 45.34%, and 42.05%, respectively. Being an urban resident (OR = 4.17, 95% CI = 1.81, 9.58), having good knowledge (OR = 6.70, 95% CI = 3.43, 13.07), and a positive attitude (OR = 2.04, 95% CI = 1.51, 2.74), were significantly associated with the uptake of the vaccine.

CONCLUSION

The pooled proportions of good knowledge, a positive attitude, and uptake of the HPV vaccine were low in Ethiopia. Being an urban resident and having good knowledge and a positive attitude towards the HPV vaccine were significantly associated with the uptake of the HPV vaccine. We recommend increasing adolescent knowledge, positive attitudes, and uptake of HPV vaccination through school-based seminars, health education, and community mobilization.

Attitudes towards HPV and COVID school-entry policies among adults living in Puerto Rico

Prior to the COVID pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. The COVID pandemic and administration of COVID vaccines might have impacted attitudes toward HPV vaccination. This study compared attitudes toward HPV and COVID vaccines with respect to school-entry policies among adults living in PR. A convenience sample of 222 adults (≥21 years old) completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID vaccines, attitudes toward vaccination policies for school-entry, and perceptions of sources of information. We assessed the magnitude of association between the agreement of school-entry policies for COVID and HPV vaccination by estimating the prevalence ratio (PR_adjusted) with 95% Confidence Intervals (95% CI). The most trusted source of information for HPV and COVID vaccines were healthcare providers (42% and 17%, respectively) and the CDC (35% and 55%, respectively), while the least trusted were social media (40% and 39%, respectively), and friends and family (23% n = 47, and 17% n = 33, respectively). Most participants agreed that HPV (76% n = 156) and COVID vaccines (69% n = 136) should be a school-entry requirement. Agreement with school policy requiring COVID vaccination was significantly associated with agreement of school policy requiring HPV vaccination (PR_adjusted:1.96; 95% CI:1.48-2.61) after controlling for potential confounders. Adults living in PR have an overall positive attitude about mandatory HPV and COVID vaccination school-entry policies, which are interrelated. Further research should elucidate the implications of the COVID pandemic on HPV vaccine attitudes and adherence rates.

Relation of Personal Characteristics with Human Papillomavirus Vaccination Outcomes: Assessing the Mediating Role of Vaccine Hesitancy Dimensions

Recent findings suggest that the rate of certain cancers can be reduced by increasing human papillomavirus (HPV) vaccination coverage, resulting in considerable research interest on the antecedents of HPV vaccine receipt to identify avenues to promote vaccination. The current article continues this stream of research by (1) studying the three HPV vaccination outcomes of willingness, receipt, and word-of-mouth, (2) investigating the antecedent effects of sociodemographic characteristics, health insurance status, provider conversation, and political orientation, and (3) testing the mediating role of vaccine hesitancy dimensions using a recently developed conceptualization. We achieve these goals by conducting a cross-sectional study with 404 participants (Agemean = 37.64; AgeSD = 14.91; 57% female; 72% white; 100% located in U.S.). Our results show that provider conversations and political orientation had the most consistent and strong effects of the personal characteristics, whereas perceptions that vaccines pose health risks and perceptions that vaccines are not needed for healthy individuals produced the most consistent and strong effects of the vaccine hesitancy dimensions. Other personal characteristics and vaccine hesitancy dimensions also produced intermittent significant effects, including age, education, and race. Together, these results support that personal characteristics and vaccine hesitancy dimensions relate to a broader range of outcomes associated with HPV vaccination than previously known, and these results also support that the recently developed conceptualization of vaccine hesitancy is apt for understanding HPV vaccine perceptions. Our discussion concludes with highlighting avenues for future research and practice that can leverage our discovered relations to improve HPV vaccination outcomes.

HPV Vaccination Adherence in Working-Age Men: A Systematic Review and Meta-Analysis

BACKGROUND

Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. HPV vaccination adherence rates in men are generally lower than in women. The aim of this systematic review and meta-analysis was to assess adherence to HPV vaccination in young working-age males (18-30 years old).

METHODS

A systematic review was performed using three databases: PubMed, Scopus, and Web of Science, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

After duplicate removal, the initial search resulted in 478 eligible papers. With the exclusion of 425 papers after screening the abstracts, full texts of 53 articles were reviewed. Subsequently, 45 were excluded. Among the eight studies included, four (50%) examined the vaccination adherence in young adults through data registered in nationwide insurance or private companies' databases, three (37.5%) in young adults in different settings through data collected from surveys and questionnaires, and one (12.5%) an HPV vaccination campaign in a family medicine residency practice.

CONCLUSION

Adherence to HPV vaccination in men of working age (18-30 years) does not appear to be adequate (pooled prevalence 11%). In order to achieve a higher level of compliance, it is important to place an emphasis on vaccination campaigns in schools as well as in the workplace, after consultation with and approval from local, regional, and federal public health agencies.

Associations between Vaccination Behavior and Trust in Information Sources Regarding COVID-19 Vaccines under Emergency Approval in Japan: A Cross-Sectional Study

We examined the association between COVID-19 vaccination behavior and trust in COVID-19-related information sources during the initial period of COVID-19 vaccination in Japan. A cross-sectional survey was conducted in August 2021, 5 months after the start of COVID-19 vaccination for the general public under emergency approval. Participants were recruited using non-probability quota sampling from among Japanese residents who were under a declared state of emergency. Sociodemographic data, vaccination behavior, and levels of trust in eight media sources of information and three interpersonal information sources were assessed using an online survey form. A total of 784 participants completed the survey. The results of multiple logistic regression analysis showed that age, household income, underlying medical conditions, and living with family were significantly associated with COVID-19 vaccination behavior. Regarding COVID-19 vaccine information sources, trust in public health experts as a source of media information and primary care physicians as a source of interpersonal information showed significantly positive associations with COVID-19 vaccination behavior (odds ratio [OR] = 1.157, 95% confidence interval [CI] 1.017-1.31; OR = 1.076; 95% CI 1.006-1.150, respectively). Increasing trust in public health experts and primary care physicians and disseminating vaccine information from these sources will help promote vaccination under emergency approval.

Factors associated with HPV vaccine acceptability and hesitancy among Black mothers with young daughters in the United States

Introduction

Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population.

Methods

Black mothers (N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother's HPV Perceptions, Mother's Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale ("I will definitely not have my daughter get the vaccine" to "I will definitely have my daughter get the vaccine") which was dichotomously recoded for binomial logistic regressions.

Results

Half of the sample (48%) intended to vaccinate their daughter. Number of daughters, mother's HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers' intentions to vaccinate their daughters against HPV when controlling for all other factors.

Discussion

In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination.

Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review

Despite the availability of effective and safe human papillomavirus (HPV) vaccines that reduce the incidence and impact of cervical cancer and other cancers, HPV vaccine coverage rates remain persistently low and the cervical cancer burden disproportionately high among Indigenous people globally. This study aimed to systematically identify, appraise, and summarize the literature on documented barriers and supports to HPV vaccination in Indigenous populations internationally. Forty-three studies were included and an inductive, qualitative, thematic synthesis was applied. We report on 10 barrier themes and 7 support themes to vaccine uptake, and provide a quantitative summary of metrics. Focusing on Indigenous perspectives reported in the literature, we propose recommendations on community-research collaboration, culturally safe intergenerational and gender-equitable community HPV vaccine education, as well as multi-level transparency to ensure informed consent is secured in the context of reciprocal relationships. Although the voices of key informant groups (e.g., HPV-vaccine eligible youth and community Elders) are underrepresented in the literature, the identification of barriers and supports to HPV vaccination in a global Indigenous context might help inform researchers and health policy makers who aim to improve HPV vaccine uptake in Indigenous populations.

A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination

Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.

Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.

Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.

Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.

Impact of a physician recommendation on COVID-19 vaccination intent among vaccine hesitant individuals

OBJECTIVE

To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy.

METHODS

We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, "Would you get vaccinated at this visit?".

RESULTS

Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially "not sure" and 13.1% of the initially "no" participants became less hesitant following any recommendation. Among the "not sure" participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%- 39.5% for the explicit recommendations. The "protect others" message was most effective among initially "no" participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation.

CONCLUSION

A physician recommendation may reduce COVID-19 vaccine hesitancy.

PRACTICE IMPLICATIONS

An explicit recommendation and "protect others" message appear to be important elements of a physician recommendation for COVID-19 vaccination.

A favorable impression of vaccination leads to a better vaccination rate for the human papillomavirus vaccine: A Japanese questionnaire survey investigation

Background

The Japanese vaccination rate for infants and children is seemingly excellent, except for the human papillomavirus (HPV) vaccine. Regardless of its efficacy, the inoculation rate in Japan has dropped to approximately 1 % since 2013 because of negative information about vaccine side effects. We aimed to demonstrate the factors that lead to low vaccine acceptance rates (e.g., caregiver attitudes, popular misconceptions) to inform the relevant target demographic of a stronger intention to immunize and to facilitate recovery of HPV vaccine coverage.

Methods

We conducted this study using data from two questionnaire surveys. Statistical analyses of factors affecting vaccine impressions and mediation effects of HPV vaccine impressions were performed. The difference in the knowledge about each vaccine was evaluated.

Results

Of the respondents, 95.9 % reported their intent to vaccinate their infants, whereas 58.2-78.3 % felt that they sufficiently understood the aims, efficacy, and risks of vaccination and 66.6 % had a positive impression of vaccines. Overall, 21.3 % of parents responded that they planned to have their child vaccinated against HPV, and 25.8 % had a favorable impression of this vaccine. Among factors affecting vaccine impressions, we found that parents had anxiety about vaccines when they felt that their knowledge of vaccines was insufficient. Additionally, impressions of the HPV vaccine had a mediating effect on the association between the impressions of infant vaccines and parents' intent to provide the vaccine to their children.

Conclusion

These findings show that as a society, we need to improve impressions and knowledge regarding vaccines, including but not exclusively the HPV vaccine. Moreover, although the recovery of HPV vaccine coverage is strongly desired for improving public health, simply improving impressions about the HPV vaccine or educating parents with substantive knowledge is insufficient. Instead, improving impressions and understanding of the vaccination itself is necessary.