Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

Human Papillomavirus Vaccinations: Provider Education to Enhance Vaccine Uptake

Human papillomavirus (HPV) is the number one sexually transmitted infection (STI) worldwide. The Centers for Disease Control and Prevention (CDC) approximated that 92% of HPV-related cancers might be prevented by receiving the HPV 9-valent vaccine (Gardasil 9). The 2-dose HPV vaccine for children ages 11 to 12 years provides almost 100% protection against strains affiliated with cervical, vaginal, and vulvar cancers. Provider education is essential to decrease clinical knowledge deficits and increase vaccination uptake. Evidence-based provider recommendations expressed to eligible individuals improves vaccination rates. Evidence-based approaches for vaccine-hesitant parents involve using the presumptive announcement approach, asking for and addressing main concerns, and trying again if the parent initially declines. Seventy percent of parents who initially decide not to get their child vaccinated later agree to the vaccine or schedule a follow-up appointment. The CDC guidelines for HPV vaccinations, including the catch-up and adult guidelines, are reviewed. A clinical vignette with case scenarios and a Q&A quiz are included.

Effectiveness of a COVID-19 Vaccine Rollout in a Highly Affected American Indian Community, San Carlos Apache Tribe, December 2020-February 2021

COVID-19 has disproportionately affected American Indian Tribes, including the San Carlos Apache Tribe, which resides on 1.8 million acres in Arizona and has 16 788 official members. High vaccination rates among American Indian/Alaska Native people in the United States have been reported, but information on how individual Tribes achieved these high rates is scarce. We describe the COVID-19 epidemiology and vaccine rollout in the San Carlos Apache Tribe using data extracted from electronic health records from the San Carlos Apache Healthcare Corporation (SCAHC). By mid-December 2020, 19% of the San Carlos Apache population had received a positive reverse transcription polymerase chain reaction test for SARS-CoV-2, the virus that causes COVID-19. The Tribe prioritized for vaccination population groups with the highest risk for severe COVID-19 outcomes (eg, those aged ≥65 years, who had a 46% risk of hospitalization if infected vs 13% overall). SCAHC achieved high early COVID-19 vaccination rates in the San Carlos community relative to the state of Arizona (47.6 vs 25.2 doses per 100 population by February 27, 2021). These vaccination rates reflected several strategies that were implemented to achieve high COVID-19 vaccine access and uptake, including advance planning, departmental vaccine education sessions within SCAHC, radio and Facebook postings featuring Tribal leaders in the Apache language, and pop-up community vaccine clinics. The San Carlos Apache Tribe's vaccine rollout strategy was an early success story and may provide a model for future vaccination campaigns in other Tribal nations and rural communities in the United States.

Feasibility of Instituting a Clinical Otolaryngology Human Papillomavirus (HPV) Vaccination Program

OBJECTIVES

To measure baseline human papillomavirus (HPV) vaccination rates among tertiary and community-based Otolaryngology - Head and Neck Surgery (Oto-HNS) clinic patients and to determine risk factors for under-vaccination.

METHODS

Retrospective chart review of patients aged 9 to 26 years presenting to an Oto-HNS clinic from 2017 to 2019. Patients were considered complete for HPV vaccination if they received two doses of HPV vaccine with the first dose received before age 15 years or three doses of HPV vaccine otherwise.

RESULTS

8,532 unique patients met the criteria. At the index visit, 3,110 (36.5%) had completed the HPV series, 5,422 (63.5%) were due for one or more doses, with 4,981 (58.4%) eligible for vaccination at the time of their appointment. Of those dues, most (3,148/5,422 or 58%) were past due by age (≥13 years old). Of the 3,148 patients past due, 745 (23.7%) were partially vaccinated and 2,403 (76.3%) were vaccine naïve. Male sex and younger age were both independently associated with incomplete vaccination (p < 0.0001).

CONCLUSION

This study demonstrates that the implementation of on-site HPV vaccination has the potential to increase the opportunities for vaccination among vaccine-eligible patients, especially among young males. Otolaryngologists have the potential to provide meaningful preventive services in the fight against HPV-mediated disease.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:116-123, 2023.