Identifying and Overcoming Perceived Barriers of Providers towards HPV Vaccination: A Literature Review

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States associated with nearly 26,000 cases of cancer annually. With the recent addition of Gardasil 9, three vaccines are now licensed by the Food and Drug Administration (FDA) and recommended by the Advisory Committee on Immunization Practices (ACIP) for HPV prevention. While providers are the preferred source in educating individuals on HPV and HPV vaccination, low uptake percentages indicate that providers are missing valuable opportunities to educate and strongly recommend HPV vaccination. It is critical to examine perceived barriers and attitudes among providers related to HPV and HPV vaccination to identify factors that influence vaccination coverage. This paper aims to expand provider knowledge and awareness of factors that may facilitate an increase in HPV vaccination coverage and subsequent cancer prevention.

Differences in Pertussis Incidence by Income among Oregon Teens during an Outbreak

That disease and poverty are connected is a cornerstone of public health thought. In the case of pertussis, however, it is possible that the expected relationship to poverty is reversed. Grounds exist for considering that increases in income are associated with increases in pertussis rates, both in terms of real risk through social and network features and through the possibility of greater likelihood of care seeking and detection based on income. Using reported adolescent pertussis cases from a 2012 outbreak in Oregon, pertussis incidence rates were determined for areas grouped by zip code into higher, middle, and lower median household income. Adolescents of ages 13–16 years in higher income areas were 2.6 times (95% CI 1.8–3.8) more likely as all others to have reported pertussis during the 2012 outbreak and 3.1 (95% CI 1.4–6.5) times as likely as those in lower income areas. The higher pertussis rates associated with higher income areas were observed regardless of Tdap rate differences. These results suggest that income may be associated with disease risk, likelihood of diagnosis and reporting, or both. Further evaluation of this finding is warranted.

Response of Various Stakeholders towards Newly Introduced Japanese Encephalitis Vaccine in a North Indian State

Introduction. Many attempts had been made to introduce newer vaccines into national immunization schedule of India. Special vaccines campaigns for diseases like JE were also initiated, which required a lot of preparation before vaccinating the beneficiaries. Objectives. To ascertain response of various stakeholders regarding launch of Japanese encephalitis vaccination campaign by state government in district Ambala, Haryana. Methodology. A 30-cluster survey was done to assess the vaccine coverage and views of the stakeholders. Various officials of state health services were also interviewed. Results. JE vaccine coverage was found to be 93.9%. Majority (59.8%) of the parents were informed about JE vaccination by the health worker. Many (83; 41.7%) parents said that they got their child vaccinated for JE since it “endangers life of children” and 82 (41.2%) said that “since everybody got it.” All the staff was trained for JE vaccination campaign. Conclusion. JE vaccination campaign was a success with adequate preparation. Majority of people accepted vaccine in good faith in the government rather than due to their knowledge about disease.

Vaccination Decision-Making and HPV Knowledge: How Informed and Engaged Are Young Adult HPV Vaccine Recipients in Australia?

Objectives. To date, there has been limited research on the decision-making process of HPV vaccine recipients. This study aimed to explore HPV-related knowledge, vaccination decision-making, and post vaccination attitudes about sexual behaviour in women who participated in the Australian school- and population-based HPV vaccine program. Materials and Methods. 102 female university students who had received the HPV vaccine (<27 years) completed scales on knowledge, vaccination decision-making, and post vaccination sexual attitudes. Results. HPV-related knowledge was low (M=57%), and women felt moderately involved in the vaccination decision (M=62%). Most women had not changed their sexual attitudes as a consequence of vaccination; however, some reported that since vaccination they feel less concerned about sexual health (19%). There were no significant differences between school- and population-based recipients on HPV knowledge (P=.559) or post vaccination sexual attitudes (P=.709). School-based recipients were significantly less autonomous in their decision-making (P=.001). Conclusion. Poor knowledge indicates a need for provision of information about HPV and post vaccination sexual health. Additionally, policy makers and health professionals may benefit from reiterating the importance of continued sexual health practices to HPV vaccine recipients. Future research should assess whether young women need to be more involved in the informed decision-making process for HPV vaccination.

Immunogenicity and Protective Efficacy of a Polyvalent DNA Vaccine against Human Orthopoxvirus Infections Based on Smallpox Virus Genes

DNA vaccines combining plasmids carrying the variola virus genes M1R, A30L, and F8L of intracellular virion surface membrane proteins as well as A36R and B7R of the extracellular virus envelope proteins under control of Rous sarcoma virus or cytomegalovirus promoters have been constructed. These DNA vaccines induced production of a high titers of vaccinia virus-neutralizing antibodies in mice similar to those elicited by the live vaccinia virus immunization. Mice vaccinated by created DNA vaccine were completely protected against a lethal (10 LD50) challenge with highly pathogenic ectromelia virus. These results suggest that such vaccine should be efficient in immunization of humans against smallpox.

Obstetrical Healthcare Personnel's Attitudes and Perceptions on Maternal Vaccination with Tetanus-Diphtheria-Acellular Pertussis and Influenza

Objectives. To assess perceptions of obstetrical healthcare personnel (HCP) regarding routine delivery of Tdap and influenza vaccines to pregnant and postpartum women and identify perceived barriers to vaccination. Methods. Anonymous Web-based survey of obstetricians and nurses caring for pregnant and/or postpartum women. Results. We contacted 342 HCP and received 163 (48%) completed surveys (33/142 (23%) obstetricians, 130/200 (65%) nurses). Among obstetricians, 72% and 63% thought it was “beneficial” to immunize postpartum women against influenza and pertussis, respectively. Only 8% reported vaccinating >75% of pregnant women in their care against influenza. Similarly, <1% of obstetricians reported vaccinating against pertussis. Of all HCP surveyed, 92% and 58% were familiar with ACIP recommendations for influenza and pertussis, respectively. Reported perceived barriers included patient refusal to be vaccinated, reimbursement difficulties, and discomfort in providing vaccine education. Ninety-four percent of respondents agreed that standing orders would be helpful to ensure postpartum vaccination. Conclusions. HCP were less familiar with ACIP recommendations for Tdap compared to influenza vaccines. Substantial discrepancy existed between perceived benefit of vaccination and reported immunization practices. Most identified barriers could be addressed with provider training; however, other barriers require review and changes in systematic policies related to vaccine reimbursement.

Effects of a Commercial Canine Gonadotropin Releasing Hormone Vaccination on Intact Male Llamas and Alpacas

We have investigated the effect of immunization against gonadotropin releasing hormone (GnRH) using a commercial canine GnRH vaccine on testosterone concentration, testicular volume, testicular histology, and intermale behavior in intact male llamas and alpacas. Llamas (n=28) and alpacas (n=20) were either immunized (received 3 mL of vaccine given intramuscularly) or treated as controls (received 3 mL of sterile diluent given intramuscularly) at 0, 3, and 6 weeks. Blood samples and testicular volume measurements were taken at 0, 3, 6, 9, and 12 weeks. Owner surveys grading behavior at 0 and 12 weeks were received for 14 llamas. Two llamas at each time point undergoing the vaccination procedure were also castrated for testicular histological examination. Vaccinated animals elicited a GnRH antibody titer, and there was a significant decrease in testosterone concentration and testicular volume when compared with control animals. Intermale aggressive behavior was also significantly decreased in the surveyed llamas. However, histological examination revealed no significant changes. GnRH immunization using the canine GnRH vaccine may be an effective method for reducing intermale aggression in llamas and alpacas by decreasing circulating testosterone concentrations but cannot be recommended as an immunosterilant because of its lack of efficacy in interrupting spermatogenesis.

Global Epidemiology of Invasive Haemophilus influenzae Type a Disease: Do We Need a New Vaccine?

Until recently, the significance of invasive disease caused by Haemophilus influenzae serotype a (Hia), in contrast to H. influenzae serotype b (Hib), has been largely underestimated. However, during the last decade, Hia was recognized as an important pathogen causing severe infections in young children with a high case-fatality rate comparable to Hib disease before the introduction of pediatric immunization against this infection. Remarkably, the highest incidence rates of invasive Hia disease have been found in some indigenous populations, such as North American Indians and Inuit of Alaska and Northern Canada, reaching the order of magnitude of the incidence rates of Hib in the pre-Hib vaccine era. The reasons for an increased susceptibility to Hia infection among some specific populations groups are unknown. The goal of this paper is to summarize the current knowledge on Hia global epidemiology and to discuss potential prevention of this infection using specific immunization.

Comparison of Oral Tolerance to ApoB and HSP60 Peptides in Preventing Atherosclerosis Lesion Formation in Apob48−/Ldlr− Mice

Antigen-specific immune modulation is emerging as an attractive therapeutic option to prevent atherosclerosis. We compared the efficacy of oral administration of peptides derived from apolipoprotein B (ApoB; 661–680) and heat shock protein 60 (HSP60; 153–163), in the prevention of atherosclerotic lesion formation hyperlipidemic low density lipoprotein receptordeficient (LDLr−/−), apolipoprotein B-100 only (apoB100/100) mice model. Oral administration of peptides induced tolerance as seen by an increase in regulatory T cells in the peripheral immune system. Tolerance to ApoB peptide reduced plaque development by 28.7% (P<0.001) while HSP60 was effective in reducing lesion development by 26.8% in ApoB48/LDLr−/− mice. While tolerance to HSP60 resulted in increase in anti-inflammatory cytokines (IL10 and TGF-β), ApoB tolerance was effective in reducing the lipid deposition in the lesion. Our results suggest that the two peptides have distinct mechanisms of controlling the development of atherosclerosis in mice.