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Thilly N, Michel M, Simon M, Bocquier A, Gagneux-Brunon A, Gauchet A, Gilberg S, Le Duc-Banaszuk AS, Bruel S, Mueller JE, Giraudeau B, Chevreul K. Effectiveness of a School- and Primary Care-Based HPV Vaccination Intervention: The PrevHPV Cluster Randomized Trial. JAMA Netw Open 2024; 7:e2411938. [PMID: 38780943 PMCID: PMC11117086 DOI: 10.1001/jamanetworkopen.2024.11938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
Importance The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. Objective To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination. Design, Setting, and Participants A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities' socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented. Intervention The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. Main Outcomes and Measures The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination. Results A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents' education and motivation (-0.08 percentage points [95% CI, -2.54 to 2.39 percentage points]) and GPs' training (-1.46 percentage points [95% CI, -3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, -1.25 to 5.50 percentage points]; P = .007 for interaction). Conclusions and Relevance In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT04945655.
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Affiliation(s)
- Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
- Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Maïa Simon
- Université de Lorraine, APEMAC, Nancy, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, France
| | | | - Amandine Gagneux-Brunon
- CIC-1408 Vaccinologie, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, Lyon, France
- Institut Presage Chaire Prevacci, Université Jean Monnet, Saint-Priest-en-Jarez, France
| | - Aurélie Gauchet
- Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, Grenoble, France
| | - Serge Gilberg
- Department of General Practice, Université Paris Cité, Paris, France
| | | | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of Medicine, Université Saint-Etienne-Lyon, Saint-Etienne, France
- Health, Systemic, Process UR 4129 Research Unit, Université Claude Bernard Lyon 1, Lyon, France
| | - Judith E. Mueller
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
- Université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, SPHERE U1246, Inserm, Tours, France
- Inserm CIC 1415, CHRU de Tours, Tours, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
- Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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Choi J, Gabay EK, Cuccaro PM. School Teachers' Perceptions of Adolescent Human Papillomavirus (HPV) Vaccination: A Systematic Review. Vaccines (Basel) 2024; 12:361. [PMID: 38675743 PMCID: PMC11053788 DOI: 10.3390/vaccines12040361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
School nurses are uniquely positioned to educate students about immunizations, including human papillomavirus (HPV) vaccination, but schools are often without a nurse for different reasons. In lieu of nurses, teachers who closely interact with students and are traditionally well-trusted by parents may be able to communicate about HPV vaccination, alleviating parental vaccine hesitancy. This systematic review explores school teachers' perspectives on adolescent HPV vaccination and factors influencing their willingness to make vaccine recommendations. We searched three databases with appropriate medical subject headings and keywords to identify relevant studies. We reviewed fifteen studies and provided an extensive summary and a comparison of the results across the studies. Teachers had low to moderate levels of HPV knowledge with low self-efficacy to counsel parents about the HPV vaccine and expressed concerns about the vaccine condoning adolescent sexual activity, vaccine side effects, and parental disapproval. Nonetheless, some teachers showed interest in learning about vaccine effectiveness in preventing HPV-associated cancers and wanted guidance on vaccine communication with parents, viewing schools as adequate venues to promote and deliver HPV vaccines. Schools should consider educating teachers on HPV and HPV vaccination, with a focus on effective vaccine communication practices to increase adolescent HPV vaccine uptake.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Efrat K. Gabay
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
| | - Paula M. Cuccaro
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
- Center for Health Promotion and Preventive Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA;
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Tron A, Schlegel V, Pinot J, Bruel S, Ecollan M, Bel JL, Rossignol L, Gauchet A, Gagneux-Brunon A, Mueller J, Banaszuk AS, Thilly N, Gilberg S, Partouche H. Barriers and facilitators to the HPV vaccine: a multicenter qualitative study of French general practitioners. Arch Public Health 2024; 82:2. [PMID: 38178269 PMCID: PMC10768163 DOI: 10.1186/s13690-023-01227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In France, human papillomavirus (HPV) vaccination coverage is low, with 30.7% of 17-year-old girls having received a complete HPV vaccination schedule in 2020. AIM To determine the perspective and behaviors of general practitioners (GPs) regarding HPV vaccination with their patients and if a reluctance is observed. DESIGN AND SETTING A qualitative study based on semi-directed individual interviews was conducted between December 2019 and December 2020. A representative sample of GPs with various profiles were included in 4 French regions. METHOD A purposive sampling was used and interviews were continued until data saturation was reached. The analysis was based on the grounded theory. RESULTS Twenty-six GPs aged 29-66 years were interviewed. The measures taken by the French health authorities (lowering the target age, reimbursing the vaccine, extending the target population to boys) were perceived as facilitators. The reported barriers were organizational, due to low attendance of adolescents, and relational, mainly due to parental vaccine hesitancy. Physicians had to deal with fears about the perceived risks and concerns about sexuality conveyed by HPV vaccination and linked to the socio-cultural characteristics of the families. Physicians developed strategies, including scientific knowledge mobilization, empowerment of families by promoting health through prevention, repetition of the vaccination proposals, personal experience and relationship. Different practices were identified according to three GP typologies: effective, convinced but unpersuasive, and reluctant physicians. CONCLUSION Based on these results, specific interventions, including communication techniques, especially for hesitant or unpersuasive physicians, are needed to enable GPs to become more effective.
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Affiliation(s)
- Arthur Tron
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France.
| | - Vincent Schlegel
- Institut de recherche et de documentation en économie de la santé (IRDES), 117 bis rue Manin, Paris, 75019, France
| | - Juliette Pinot
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, P2S UR4129, F-69008, France
- CIC-INSERM 1408, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Marie Ecollan
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Josselin Le Bel
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Louise Rossignol
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Aurélie Gauchet
- Laboratory of Psychology, University Grenoble Alps, Grenoble, France
| | - Amandine Gagneux-Brunon
- CIC-INSERM 1408, Saint-Etienne University Hospital, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France
| | - Judith Mueller
- EHESP French School of Public Health, Institut Pasteur, Paris cedex 15, Paris, France
| | - Anne-Sophie Banaszuk
- Centre régional de Coordination des Dépistages des Cancers-Pays de la Loire, 5 rue des Basses Fouassières, Angers, 49000, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, F-54000, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, F-54000, France
| | - Serge Gilberg
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
| | - Henri Partouche
- Faculté de Santé, Département de médecine générale, Université de Paris, UFR de Médecine - Site Cochin, 24, rue du Faubourg Saint-Jacques, Paris, F-75014, France
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Shin H, Choi S, Lee JY. An Integrative Review of the Influence on Human Papillomavirus Vaccination Adherence among Adolescents. Healthcare (Basel) 2023; 11:2534. [PMID: 37761731 PMCID: PMC10530987 DOI: 10.3390/healthcare11182534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
To enhance the vaccination rate of adolescents against HPV, understanding their current vaccination intentions and identifying the factors that influence their decision to vaccinate are imperative. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to search for relative literature. Five electronic databases (CINAHL, PubMed, Web of science, Research Information Sharing Service (RISS) and Korea Citation Index (KCI)) were searched from 2007 to 2022, and 19 studies were selected for final review. The Mixed Methods Assessment Tool (MMAT) was used as a critical appraisal tool to evaluate the quality for various types of research designs. This integrative review revealed three themes, including facilitators (personal characteristics and environmental factors), barriers (lack of awareness and knowledge about HPV, concerns about side effects, and the burden of costs), and ways to increase vaccination uptake (knowledge promotion and HPV vaccines coverage by public insurance). To encourage HPV vaccine uptake, it is essential to enhance public knowledge, create compelling advertisements, and ensure that the vaccines are covered by public insurance. Moreover, providing educational programs that emphasize the effectiveness and significance of HPV vaccines to adults who can influence the vaccination decisions of adolescents is vital.
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Affiliation(s)
- Hyewon Shin
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea; (H.S.); (S.C.)
| | - Sunyeob Choi
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea; (H.S.); (S.C.)
| | - Ju-Young Lee
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Nakayita RM, Benyumiza D, Nekesa C, Misuk I, Kyeswa J, Nalubuuka A, Murungi T, Udho S, Kumakech E. Factors associated with uptake of human papilloma virus vaccine among school girls aged 9-14 years in Lira City northern Uganda: a cross-sectional study. BMC Womens Health 2023; 23:362. [PMID: 37420225 PMCID: PMC10329291 DOI: 10.1186/s12905-023-02511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Cervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9-14 years in Lira City, northern Uganda. METHODS A cross-sectional study was conducted among 245 primary school girls aged 9-14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively. RESULTS HPV vaccination uptake was at 19.6% (95% CI,14.8-25.1) among the school girls aged 9-14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19-25.88), P ≤ 0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60-34.28), P ≤ 0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37-14.19), P = 0.013]. CONCLUSION The study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.
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Affiliation(s)
- Renniter Mirembe Nakayita
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Deo Benyumiza
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda.
| | - Catherine Nekesa
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Ivan Misuk
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Julius Kyeswa
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Aisha Nalubuuka
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Tom Murungi
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Samson Udho
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, P.O. BOX 1035, Lira City, Uganda
| | - Edward Kumakech
- Department of Nursing, Faculty of Nursing and Midwifery, Lira University, P.O. Box 1035, Lira City, Uganda
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Ailloud J, Branchereau M, Fall E, Juneau C, Partouche H, Bonnay S, Oudin-Doglioni D, Michel M, Gagneux-Brunon A, Bruel S, Thilly N, Gauchet A. How can we improve the acceptability of vaccination against Human Papillomavirus (HPV) in France? An original qualitative study with focus groups comprising parents and school staff, interviewed separately. Vaccine 2023:S0264-410X(23)00656-4. [PMID: 37344259 DOI: 10.1016/j.vaccine.2023.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It has been proven that vaccination is effective against Human Papillomavirus (HPV) infections, genital warts, and pre-cancerous and cancerous cervical lesions. Nevertheless, the HPV vaccine coverage of 37.4 % in 2021 in France is one of the lowest in Europe. To explore and understand the reason why French population is so late compared to its neighbours, we carried out focus groups with mothers and with National Education school staff. We aimed to identify knowledge and perceptions of HPV in both study populations, as well as factors influencing HPV vaccination. METHODS Between January 2020 and March 2021, we performed a qualitative study using an inductive approach with a thematic content analysis (TCA). We conducted semi-structured focus groups with 29 people including 15 mothers of adolescents in middle schools and 14 school staff from the national education system. RESULTS Different factors influenced the decision-making process of parents and school staff: knowledge and perceptions of HPV and its vaccine, sources of information about HPV and vaccination. Mothers' discourses differed from those of school staff. They mentioned the importance of gynaecological monitoring and the negative image of pharmaceutical companies, and questioned internet as a reliable source of information. For their part, school staff mentioned cultural and/or religious affiliation, municipalities' role to inform the population, and ethical dilemma or logistical challenges regarding HPV vaccination in schools. CONCLUSION The results of these focus groups provided information on which elements may harm or help HPV vaccination. Identified perceptions, beliefs, knowledge, barriers, and facilitators will help us to build an intervention program focus on general practitioners (GP), school staff, parents, and adolescents.
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Affiliation(s)
- Julien Ailloud
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, Angers, France
| | - Estelle Fall
- Université de Lorraine, APEMAC, F-57000 Metz, France
| | - Catherine Juneau
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France; Health Psychology Lab, McGill University, Montreal, Canada
| | - Henri Partouche
- Département de Médecine générale, Université Paris Cité, France
| | | | - Damien Oudin-Doglioni
- Institut Pasteur, Université Paris Cité, Global Health Department, Epidemiology of Emerging Diseases Unit, France
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Sébastien Bruel
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France; Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000 Nancy, France
| | - Aurélie Gauchet
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France.
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