Vaccine Counseling Research Articles

Vaccine hesitancy in patients with solid tumors: a cross-sectional single-center survey

BackgroundVaccination rates are still suboptimal in cancer patients. Oncologists play a central role in recommending vaccines to their patients. Our goal was to investigate vaccine acceptance among cancer patients and understand the factors shaping their choices, thereby aiding physicians in better supporting their patients’ vaccination decisions.MethodsWe designed a prospective cross-sectional survey exploring vaccination status, attitudes, and reasons for hesitancy towards vaccinations against the main vaccine preventable diseases (VPDs) among patients undergoing active cancer treatment. The primary endpoint was to evaluate the proportion of vaccinated subjects in our cohort of cancer patients. The secondary endpoints were to assess the proportion of vaccinated subjects against different types of VPDs: flu, COVID-19, pneumococcal disease, Herpes Zoster (HZ).ResultsBetween 12 February and 01 March 2024, a total of three hundred and seventeen patients with cancer were invited to respond to the survey, 309 of whom (97%) agreed to do it. Two hundred seventy-three patients (0.88, 95% confidence interval [CI] 0.84–0.91) had received at least one vaccination. Two hundred thirty-one patients (74.76%) reported that at their first oncology visit their oncologist recommended vaccinations, primarily anti-flu (92.21%) and anti-SARS-CoV-2 (83.55%) vaccinations, while less frequently the anti-pneumococcal (42.42%) and anti-HZ (37%) vaccines were recommended. On the univariate analysis, age over 75 years (p = 0.041), marital status (p = 0.003) and the oncologist’s vaccine recommendation during the first visit (p < 0.001) were significantly associated to vaccine acceptance. At the multivariable analysis, these variables were independently associated with vaccine willingness. Overall in our cancer population, the two main reasons for vaccine hesitancy were the lack of recommendation by the oncologist (55.41%, n = 128) and the lack of awareness of the importance of vaccination in the context of oncological care (49.35%, n = 114).ConclusionsThis survey emphasizes the importance of vaccine counseling by the oncologist to their patients. Oncologists can motivate patients to receive the correct vaccine schedule by addressing doubts and concerns about the potential negative impact of the vaccine on cancer and cancer therapies.

Improving vaccination counseling rates in first time patients with cancer: A multi-disciplinary approach.

315 Background: ASCO guidelines 2024 recommend that “clinicians determine vaccination status and ensure that adults newly diagnosed with cancer about to initiate treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines.” Prior to the study, Baylor Scott and White Hematology Oncology Round Rock (BSWHRR) clinic lacked a formalized process for vaccine education. The primary aim of this study was to increase vaccination counseling for first-time cancer patients with solid tumors or hematologic malignancies. The secondary endpoint was to optimize vaccination status for this group of patients. Methods: Inclusion criteria were patients 18 years or older with initial diagnosis of solid tumor or hematologic malignancy, receiving chemotherapy and/or immunotherapy for the first time, and treated within BSWHRR. Exclusion criteria were patients with subsequent malignancy, malignancy requiring second line chemotherapy and/or immunotherapy, or deceased. Patients meeting these criteria n=57 were collected during the pre-intervention period October 15-December 15. Post-intervention data n=52 was collected 6 weeks following the initiation of the intervention from February 18 – April 18. The intervention included a 2-sided handout containing current recommendations for vaccination schedules in immunocompromised adults. These handouts were provided along with counseling at 2 separate encounters (during the initial consult and during chemotherapy education). The handout included instructions for scheduling vaccines with the Baylor Scott and White Pharmacy and/or their PCP. This multi-disciplinary approach included nurse navigators, triage nurses, pharmacists, and physicians. A standardized documentation process was initiated and utilized for both consult and chemotherapy education encounters. Results: Following the introduction of vaccine education handouts and standardized documentation, vaccine counseling rates during the consult visit improved from 0% to 49%. Vaccine counseling rates during chemotherapy education visits increased from 0% to 71%. Overall, the number of patients that attended and were counseled during at least one of these visits increased from 0% to 70%. The secondary endpoint of increasing vaccination rates showed that non-seasonal vaccination rates improved. Pneumococcal vaccination rates improved from 33% to 42%, a 27% increase. Shingles coverage improved from 16% to 25%, a 56% increase. Conclusions: This study showed that a multidisciplinary approach, utilization of patient/physician education handouts, and standardization of documentation was effective in achieving a substantial increase in vaccination counseling rates for patients with newly diagnosed malignancy. The intervention was also effective in achieving the secondary endpoint of increasing pneumococcal and shingles vaccinations.

Importance of optimizing routine immunization schedules in pediatric heart transplantation

ObjectiveVaccination is the most effective preventive measure to reduce the risk of infection in patients receiving immunosuppressive treatment, such as heart transplant (HT) patients. The objectives of this study are to describe and evaluate the vaccination status of a group of pediatric HT recipients. Material and methodsRetrospective descriptive study of 75 pediatric patients who underwent HT at a tertiary hospital between January 2000 and September 2020. Demographic, clinical (immunization before and after HT, and attendance to vaccination counselling consultation), and analytical (hepatitis A and B serology before and after HT) variables were collected. ResultsPatients >12 months reached the HT with better vaccination coverage than those <12 months: 78.9 % versus 60.7 % had a complete vaccination schedule (P=.15). Post-HT vaccination update rate is low; only 13.3 % of patients had a complete schedule according to their age. The post-HT vaccination update of the human papillomavirus vaccine is higher in women (P=.02). We did not find statistical differences between other vaccines according to sex. A total of 13.3 % of patients attended post-HT vaccination counselling consultation, being better immunised than those who did not (P=.01). ConclusionsThe evaluation and optimization of vaccination schedules of patients with HT remains suboptimal. A follow-up of these patients and their relatives in vaccination specialised consultations can improve the immunization status of pediatric HT recipients.

Insights into maternal pertussis vaccination counselling: a qualitative study on perspectives and experiences among midwives and gynaecologists in the Netherlands

BackgroundHealthcare professionals (HCPs) play a significant role in the decision-making process of pregnant women on maternal vaccinations. Whereas a high proportion of HCPs discuss maternal vaccinations with pregnant women, confidence in discussing maternal vaccinations is lacking and HCPs experience inadequate training to discuss maternal vaccinations with pregnant women. Furthermore, different practical barriers might influence the consultation process, such as lack of time. More studies on the barriers, as well as facilitators, to discussing maternal vaccinations is needed and will help us to better understand and support HCPs in discussing maternal vaccinations.MethodsThis qualitative study involved semi-structured interviews with fourteen HCPs working as midwives or gynaecologists in the Netherlands. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis was conducted using inductive and deductive approaches. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.ResultsThe thematic analysis of the data pointed to the following five themes of HCP counselling: the consultation process, attitude, perceived norm, perceived control and improvement ideas. Most HCPs follow a similar approach in maternal pertussis vaccination consultations, beginning by assessing clients’ understanding, providing basic information, and addressing questions. However, consultation timing and prioritization vary among HCPs. Challenges in consultations include client requests for clear advice, with HCPs trained to remain neutral, emphasizing client autonomy in decision-making. Most HCPs acknowledge the importance of their consultations in informing pregnant women about maternal pertussis vaccination.ConclusionsThis study offers a confirmation of the awareness of the pivotal role of HCPs in informing pregnant women about the maternal pertussis vaccination. HCPs stress the importance of neutral counselling, enabling pregnant women to make well-informed decisions independently. Because of upcoming vaccine hesitancy nowadays, HCPs must be equipped with the knowledge and confidence to navigate difficult conversations. Continuous education and training might help to increase HCPs’ confidence in handling difficult consultations. Additionally, making the information materials for pregnant women available in multiple languages and incorporating more visuals to enhance comprehension could support HCPs in reaching a broader group of pregnant women.

Declining number of general practitioners can impair influenza vaccination uptake among Italian older adults: Results from a panel analysis

BackgroundSeasonal influenza vaccination coverage in Italian older adults is insufficient and well below the minimum target of 75%. In Italy, most influenza vaccine doses are administered by general practitioners (GPs), whose number has been declining. In parallel, the number of patients per GP and GP workload increased dramatically, which theoretically may impair vaccination counselling. In this ecological study, we aimed to assess whether influenza vaccination coverage in older adults is associated with the density of GPs having high number of patients.MethodsThe study outcome was the influenza vaccination coverage rate in adults aged ≥ 65 years and registered in 20 Italian regions over the last 23 years. The independent variable of interest was the proportion of GPs with more than 1,500 adult patients, which is an imposed normative ceiling. This latter variable was considered as a proxy of GP overload. By adopting a panel regression approach, different specifications of fixed- and random-effects models were run to assess the association of interest, when adjusted for several social structural, economic and healthcare-related variables.ResultsOver the last two decades, most regions showed a negative association between influenza vaccination coverage rates and the density of GPs with a high number of patients. This latter negative association was confirmed (P < 0.05) in different panel model specifications. In particular, in the fully adjusted two-way fixed-effects model, each 10% increase in the number of GPs with more than 1,500 patients was associated with a 1.7% decrease in influenza vaccination coverage. However, this association was present only in region-years where at least 18% of GPs were deemed overloaded.ConclusionsIn the upcoming years, the number of Italian GPs is projected to decline further. At the same time, the aging Italian population will determine an even greater workload for GPs. This study demonstrated that increased GP workload may partially explain the spatiotemporal variation in influenza vaccination uptake in the Italian elderly. With the imperative of increasing or at least maintaining influenza vaccination coverage rates, several short- and mid-term initiatives should be implemented in order to optimize GP workload during seasonal immunization campaigns.

Coronavirus Disease 2019 (COVID-19) Vaccination Status Prior to Delivery and Administration Among Hospitalized Obstetric Patients

Background This chart review aimed to assess the COVID-19 vaccination status of pregnant patients prior to hospitalization for delivery and vaccine administration while hospitalized postpartum. Methods This was a retrospective chart review of pregnant patients admitted for delivery at WakeMed Hospital during a six-month period who were offered COVID-19 vaccination immediately following delivery. We analyzed demographic characteristics by vaccination status prior to admission, during hospitalization, and at discharge. ANOVA, chi-squared, and multinomial logistic regression analyses were performed. Results Data analysis was performed on 1,476 obstetric patients admitted for delivery, of which 260 (17.6%) were vaccinated prior to admission. Of the 1,216 unvaccinated postpartum patients, 257 (21.1%) received a vaccine dose. Among our population, for every year increase in age, the odds of being vaccinated before admission and receiving vaccination while hospitalized postpartum were higher than those of remaining unvaccinated. The odds of being vaccinated before admission versus remaining unvaccinated at discharge were lower for Black patients compared to White patients. The odds of receiving vaccination during hospitalization were higher for Asian and Hispanic/ Latino patients compared to White patients. The odds of being vaccinated prior to admission versus remaining unvaccinated at discharge were higher for those with private insurance compared to those with public insurance. Limitations At the time of our intervention, we did not collect data on COVID-19 infection status of the patient at the time of admission. Additionally, vaccination counseling and administration had not been added to standardized order sets, thus variations in counseling by providers may have impacted patient acceptance. Conclusions Compared to patients who remained unvaccinated following discharge, patients vaccinated prior to admission were more likely to be older with private insurance, and less likely to be Black, while patients vaccinated during hospitalization once postpartum were more likely to be older and either Asian or Hispanic/Latino.

Examining dental providers counseling on human papillomavirus vaccine: Insights from parents and dental professionals.

To (1) assess perceptions of parents of patients ages 9-17 years regarding human papillomavirus (HPV) vaccine counseling and a same-day HPV vaccine program, and (2) assess perceptions among dental staff who actively participated in the same administration program. We conducted a post-evaluation, convenience survey of parents of patients aged 9-17 and dental staff at a large-urban federally qualified healthcare center (FQHC) from July 25, 2022, to August 26, 2022. Parent and staff perceptions were assessed using validated instruments whenever possible. Data were analyzed descriptively. Overall, 101 parents participated (response rate: 89%). Overall, 80 parents (74.3%) reported wanting to discuss diseases prevented by the HPV vaccine with their dental provider. Twenty parents (20%) reported receiving counseling on the HPV vaccine by their dentist; 95% (n = 19) of those parents reported it did not change their comfort with their provider and 60% (n = 12) reported their child received the vaccine that day. Overall, 44 dental staff members (32% DDS/DMD, 14% RDH-BS-Dental Hygiene, 55% Other) completed surveys (response rate: 100%). Of these, 39 (88.6%) were willing to recommend the HPV vaccine and participate in a referral program. Nearly all dentists and hygienists (95%) reported discussing the vaccine was within their scope of practice, and most (65%) agreed vaccine administration should be within their scope. In a single site convenience survey within an urban, federally qualified health care system, most parents, and dental staff perceived HPV vaccine counseling and administration favorably and clinically appropriate during routine dental visits.

Experiences of Midwestern obstetric clinicians during the Coronavirus disease 2019 pandemic

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic led to healthcare system changes aimed at minimizing disease transmission that impacted experiences with obstetric healthcare. ObjectiveTo explore experiences of clinicians providing obstetric care during the COVID-19 pandemic. Study DesignQualitative, in-depth, semi-structured interviews were conducted with five nurse practitioners and 16 obstetrical physicians providing a mix of outpatient and inpatient obstetric care during the COVID-19 pandemic in a mid-sized, Midwestern city in the United States. Interviews elucidated challenges and facilitators of obstetric care provision and vaccination of pregnant patients against COVID-19 during the pandemic. Transcripts were coded inductively then deductively using the Health Equity Implementation Framework (HEIF), which integrates a disparities framework and implementation framework to highlight multilevel factors that influence obstetric care. Thematic analysis was conducted, and thematic saturation was reached. ResultsWe interviewed 21 clinicians. Clinicians recounted personal challenges such as social isolation and burnout that could be countered by social support. Challenges within the clinical encounter included implementation of infection mitigation efforts, vaccine counseling, and limitations of telehealth. However, when successfully implemented, telehealth facilitated care and circumvented barriers. Clinicians cited challenges at the healthcare system level such as rapidly evolving knowledge and recommendations, restrictive visitor policies, personnel shortage, and inadequate institutional resources to support pandemic-related stressors. However, interdisciplinary care and guidelines available for clinicians facilitated care. Clinicians reported that challenges at the societal level included financial strain, lack of childcare, medical mistrust, politicization of medicine, misinformation, and racism. Societal-level facilitators included insurance access, community outreach, positive policy changes, and fostering trust in medicine. ConclusionThe pandemic produced unique stressors and exacerbated existing challenges for clinicians providing obstetric care. Applying the HEIF to the findings emphasizes the influence of societal factors on all other levels. Identified facilitators can inform interventions to address stressors in obstetric care that have resulted from the changed sociopolitical landscape of the pandemic.

A scoping review of global COVID-19 vaccine hesitancy among pregnant persons

Uptake of the COVID-19 vaccine among pregnant persons is lower than the general population. This scoping review explored pregnant people’s attitudes towards the COVID-19 vaccine, reasons for vaccine hesitancy, and whether attitudes about COVID-19 vaccines differ by country of origin. A scoping review was conducted across PubMed, Embase, CINHAL, and Scopus. Inclusion criteria were articles published in English from 2019–2022 focused on attitudes towards COVID-19 vaccination among pregnant persons. Data analysis was done via the 5Cs framework for vaccine hesitancy: Constraints, Complacency, Calculation, Confidence, and Collective Responsibility. 44 articles were extracted. A lack of confidence in vaccine safety was the most prevalent theme of hesitancy among pregnant persons. This was largely driven by a lack of access to information about the vaccine as well as mistrust of the vaccine and medical professionals. Meanwhile, vaccine acceptance was mostly driven by a desire to protect themselves and their loved ones. Overall, COVID-19 vaccine hesitancy among pregnant persons continues to be high. Vaccine hesitancy is primarily driven by fear of the unknown side effects of the vaccine on pregnant persons and their fetuses along with a lack of information and medical mistrust. Some differences can be seen between high income and low- and middle-income countries regarding vaccine hesitancy, showing that a single solution cannot be applied to all who are vaccine hesitant. General strategies, however, can be utilized to reduce vaccine hesitancy, including advocating for inclusion of pregnant persons in clinical trials and incorporating consistent COVID-19 vaccine counseling during prenatal appointments.

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

ObjectivesParents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for...

The use of community-oriented primary care (COPC) model to generate vaccine demand: The case of a remote fishing community in Cameroon

BackgroundCameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model. MethodologyThis cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis. ResultsOver 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention. ConclusionThe use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.

Pediatric Human Papillomavirus Vaccination Rates Within a Tertiary Military Medical Center.

To determine our center's human papillomavirus (HPV) vaccination rate and identify common negative perceptions surrounding the vaccine to guide more effective HPV vaccine counseling. We reviewed immunization records for patients ages 11 to 26 that receive care at Brooke Army Medical Center. Vaccine uptake rate was determined by dividing the number of patients who had completed the HPV vaccine series by the total target population. From October 2021 to December 2022, a clinic survey was distributed to parents (for patients ages 11-17) or patients themselves (ages 18-26) during otolaryngology visits to poll vaccination status and attitudes toward the vaccine. A total of 3038 patients ages 11 to 26 are enrolled for primary care at Brooke Army Medical Center, but only 962 (32%) are vaccine complete. Thirty-five surveys were collected during the study period. Twenty-two surveys (63%) from patients/parents reported they/their child had received the HPV vaccine. Concerns about vaccine safety, sexual behaviors, lack of immunization requirement for school, and difficulty getting scheduled were the most common reasons patients were unvaccinated. Counseling patients on the HPV vaccine can be difficult given the common misconceptions surrounding vaccination, but understanding these attitudes will allow otolaryngologists to educate patients more effectively. This matters since patients more knowledgeable about HPV are more likely to receive the vaccine. Our clinic has developed new strategies in partnership with primary care departments to facilitate more streamlined vaccination for eligible patients, and moving forward we plan to trend HPV vaccination rates over time to determine our impact on uptake.

"Do not inject our babies": a social listening analysis of public opinion about authorizing pediatric COVID-19 vaccines.

Designing effective childhood vaccination counseling guidelines, public health campaigns, and school-entry mandates requires a nuanced understanding of the information ecology in which parents make vaccination decisions. However, evidence is lacking on how best to "catch the signal" about the public's attitudes, beliefs, and misperceptions. In this study, we characterize public sentiment and discourse about vaccinating children against SARS-CoV-2 with mRNA vaccines to identify prevalent concerns about the vaccine and to understand anti-vaccine rhetorical strategies. We applied computational topic modeling to 149 897 comments submitted to regulations.gov in October 2021 and February 2022 regarding the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee's emergency use authorization of the COVID-19 vaccines for children. We used a latent Dirichlet allocation topic modeling algorithm to generate topics and then used iterative thematic and discursive analysis to identify relevant domains, themes, and rhetorical strategies. Three domains emerged: (1) specific concerns about the COVID-19 vaccines; (2) foundational beliefs shaping vaccine attitudes; and (3) rhetorical strategies deployed in anti-vaccine arguments. Computational social listening approaches can contribute to misinformation surveillance and evidence-based guidelines for vaccine counseling and public health promotion campaigns.

Improving Vaccine Uptake Among Solid Organ Transplant Candidates

Vaccination in the pretransplantation phase is a key to improving the morbidity and mortality of solid organ transplant patients. A quality improvement project was undertaken to improve vaccine uptake among solid organ transplant candidates with the inclusion of a nurse practitioner-led infectious disease pretransplantation consultation service. Vaccination rates for coronavirus disease 2019, influenza, tetanus, diphtheria, and pertussis, zoster, pneumococcal pneumonia, and hepatitis A were higher compared with the national vaccination rates. Implementation of a nurse practitioner-led pretransplantation vaccination review and counseling service can result in improved vaccination rates if implemented at transplant centers.

Peer education as a strategy to promote vaccine acceptance: A randomized controlled trial within New York community healthcare practices

BackgroundEffective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination. MethodsFrom March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child’s pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment. Results144 parent–child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09–4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22–5.86), p = 0.009). ConclusionsPeer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).

Human Papillomavirus Vaccination Hesitancy, Screening Disparities, and Associated Factors Among Sexual and Gender Minority Women: A Systematic Review of Global Literature [ID 2683547

INTRODUCTION: Human papillomavirus (HPV) ranks as the most prevalent sexually transmitted infection globally, with a significant association with cervical cancer in cervix-having individuals. Understanding the epidemiological patterns of HPV vaccination rates and behaviors within the context of sexual and gender minority (SGM) women is essential in identifying factors hindering the initiation of HPV vaccination and screening. METHODS: A systematic review was conducted by searching five databases (PubMed, CINAHL, Embase, Web of Sciences, MedLine). Eligibility criteria included the following: reported HPV vaccination or screening outcomes, conducted among SGM women, data collected since 2010. All studies were independently screened and synthesized following PRISMA guidelines. Of 44 items, 13 studies met the criteria. RESULTS: Sexual and gender minority women reported substantial HPV vaccine hesitancy and decreased screening practices compared to their non-SGM peers, with the degree of vaccine hesitancy and delayed screening varying among bisexual, lesbian, and transgender individuals. Individual factors associated with HPV vaccine hesitancy and decreased screening include socioeconomic status, vaccination awareness, and SGM identity. Meanwhile, interpersonal and structural factors include community biases, family support, lack of provider LGBTQ+ health education, and structural racism. CONCLUSION: Sexual and gender minority women experience a substantial health care disparity surrounding HPV vaccination hesitancy and screening status. Results from this study substantiate the need for the standardization of health care practice, individual patient vaccine counseling, and the expansion of sexual and gender minority health training at all tiers of medical education. Furthermore, additional disaggregated research is needed to understand the unique health circumstances of bisexual, lesbian, and transgender individuals, as the current research landscape fails to capture the community’s health needs.

Vaccination: Adherence and Hesitancy among Pregnant Women for COVID-19, Pertussis, and Influenza Vaccines.

In the realm of antenatal care, vaccinations serve as a cornerstone, crucial for safeguarding the health of both the mother and the fetus, while also extending protection to the newborn against communicable diseases. Nevertheless, vaccine adherence among pregnant women remains very low. The aim of our study was to evaluate the uptake of vaccines (influence, pertussis, and COVID-19) among women during pregnancy and to understand pregnant women's knowledge of vaccines and the diseases they protect against. The purpose was to investigate the reasons why pregnant women chose not to be vaccinated and to develop effective strategies for informing them about the importance of vaccination for both maternal and fetal safety. A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, "Ospedale Santa Maria della Misericordia" in Udine, from 1 December 2021 to 30 June 2022. During this period, a self-completed paper questionnaire was administered to women at the end of pregnancy or during the puerperium. A total of 161 questionnaires were collected. Higher educational level was found to be significantly associated with influenza vaccination uptake (p = 0.037, OR = 2.18, 95% CI 1.05-4.51). Similarly, for pertussis vaccination, adherence was mainly associated with higher educational level (p = 0.014, OR = 2.83, 95% CI 1.24-6.47), but also with Italian nationality (p = 0.003, OR = 3.36, 95% CI 1.56-8.43) and pregnancy attended by a midwife or private gynecologist (p = 0.028, OR = 0.39, 95% CI 0.17-0.90). Regarding the COVID-19 vaccine, the only factor positively influencing uptake was Italian nationality (p = 0.044, OR = 2.66, 95% CI 1.03-6.91). Women's fear that vaccines would endanger the fetus appeared to be the most important reason for refusing vaccinations. Simultaneously, patients also exhibited a desire to receive more information about maternal vaccination, particularly from their general physician or gynecologist. For this reason, it is imperative to enhance maternal vaccination counselling, making it a routine step in prenatal care from the first antenatal visit until the postpartum period.

Causes and Effects of COVID-19 Vaccine Hesitancy Among Pregnant Women and its Association with Adverse Maternal, Placental, and Perinatal Outcomes.

Populations identified to be severely affected by COVID-19, such as pregnant patients, require special consideration in vaccine counseling, access, and provider education. Maternal infection with COVID-19 poses a significant risk to the maternal-fetal dyad with known adverse placenta destruction [1-5]. Despite the widespread access and availability of vaccinations, vaccine hesitancy continues to persist and is highly prevalent in pregnant populations [6-9]. Addressing the multitude of social ecological factors surrounding vaccine hesitancy can aid in providing holistic counseling [10]. However, such factors are foremost shaped by maternal concern over possible fetal effects from vaccination. While changes in policy can help foster vaccine access and acceptance, increasing global provider education and incorporation of motivational interviewing skills are the first steps towards increasing maternal acceptance.

Physicians' Human Papillomavirus Vaccine Communication With Parents of Different Skin Color: Feasibility of Measuring Indicators of Implicit Bias With Virtual Reality

PurposeVirtual reality (VR) may be a viable method to observe and describe signals of implicit bias. Using the context of the human papillomavirus vaccine counseling, we sought to describe physicians' communication practices exploring differences when counseling parents with different skin colors. MethodsPhysicians (N = 90) at an academic primary care center were recruited for a VR study in which they counseled dark or light-skinned parent avatars who expressed hesitation about human papillomavirus vaccination for their adolescent child. Investigators coded previously recorded simulations. Associations between communication and parent skin color were examined using t-tests and Chi-square tests. ResultsBoth direct (e.g., addressing the concern immediately) and circuitous (e.g., providing alternative information) communication patterns were observed. Physicians used passive voice less commonly when counseling dark-skinned versus light-skinned avatars (p < .05). DiscussionVR demonstrated feasibility in capturing clinicians' communication behaviors including measuring eight distinct indicators of implicit bias.

Associations of Mental Health Issues with Health Literacy and Vaccination Readiness against COVID-19 in Long-Term Care Facilities-A Cross-Sectional Analysis.

Vaccinations against COVID-19 are of the utmost importance in long-term care facilities. During the pandemic, mental health issues increased significantly. This cross-sectional analysis aimed to assess the associations of depression and anxiety with health literacy in people in need of care and the association of depression and burnout with vaccination readiness against COVID-19 in health care workers (HCWs). Within our cross-sectional study, people in need of care were assessed for symptoms of depression (PHQ-9), anxiety (GAD-7), and health literacy (HLS-EU-Q16). Among HCWs, we assessed symptoms of depression (PHQ-9) and burnout (MBI-HSS), as well as psychological antecedents of vaccination (5C) to measure vaccination readiness against COVID-19. A multivariate regression analysis was performed. Symptoms of a major depression were significantly associated with reduced health literacy (p = 0.010) in people in need of care. Among HCWs, symptoms of depression and burnout reduced vaccination readiness against COVID-19 significantly. In particular, collective responsibility was reduced in HCWs suffering from burnout symptoms (p = 0.001). People in need of care and their HCWs could benefit from intensified target group-specific vaccination counseling. Additionally, more attention should be paid to the protection of mental health in long-term care facilities.