Vaccination Guidance Research Articles

Prevalence of cervicovaginal human papillomavirus infection and genotype distribution in Shanghai, China

BackgroundThe evaluation of human papillomavirus (HPV) prevalence rate dynamics and genotype distribution could support the adoption of more targeted prevention and treatment of cervical cancer. We aimed to assess the infection status and genotype characteristics of HPV among gynecological outpatients in Shanghai, China.MethodsClinical specimens were collected from patients attending gynaecological department of the Putuo Hospital, Shanghai University of Traditional Chinese Medicine, between January 2015 and December 2019. The cervicovaginal infection of 17 high-risk genotypes and 10 low-risk genotypes were analyzed by Luminex-based multiple assays.ResultsThe overall HPV infection rate was 18.81% (95% CI 18.31–19.30%) in Shanghai city, with high-risk, low-risk and mixed high- and low-risk HPV prevalence being 11.65% (95% CI 11.24–12.06%), 4.19% (95% CI 3.94–4.44%) and 2.96% (95% CI 2.74–3.17%), respectively. The five most prevalent high-risk genotypes were HPV-52 (2.95%), HPV-16 (2.34%), HPV-58 (2.07%), HPV-53 (1.67%) and HPV-39 (1.36%). The most common low-risk genotype was HPV-61 (1.52%), followed by HPV-6 (1.29%) and HPV-81 (1.19%). Moreover, the coverage of HPV genotype by nonavalent vaccine was 10.42%, and non-vaccine-covered high-risk genotype was 7.70%. The 15–24 years age group demonstrated the highest HPV prevalence (43.14%), and significant differences were observed among different age groups (P < 0.001).ConclusionsThis study revealed the HPV prevalence and genotype distribution among women in Shanghai city, which could serve as guidance for HPV vaccination and preventative strategies against cervical cancer in this area.

Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Boosters: An Influenza Vaccine Perspective.

ABSTRACTChanges to severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine guidance since their initial authorization may lead to confusion and hesitancy. Suggested recommendations for an annual SARS-CoV-2 vaccine naturally draw comparisons with the influenza vaccine program. Considering viral and vaccine characteristics between these pathogens provides an important perspective that can help increase vaccine confidence with SARS-CoV-2 vaccines.

SARS-CoV-2 vaccine safety in adolescents with inflammatory rheumatic and musculoskeletal diseases and adults with juvenile idiopathic arthritis: data from the EULAR COVAX physician-reported registry

BackgroundThere is a lack of data on SARS-CoV-2 vaccination safety in children and young people (CYP) with rheumatic and musculoskeletal diseases (RMDs). Current vaccination guidance is based on data from...

American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 4.

ObjectiveTo provide guidance to rheumatology providers on the use of COVID‐19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs).MethodsA task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID‐19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9‐point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings.ResultsDespite a paucity of direct evidence, statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID‐19 vaccines, including supplemental/booster dosing, in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination.ConclusionThese guidance statements are intended to provide direction to rheumatology health care providers on how to best use COVID‐19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.

Survey of awareness, attitudes, and compliance with COVID-19 measures among Vermont residents.

The objective of this research was to examine residents’ awareness, attitudes, and compliance with COVID-19 public health guidelines in Vermont, which emerged as an early leader in national pandemic response. Our methods included conducting an online survey of adult Vermont residents between January and April 2021. We analyzed demographics associated with awareness and compliance, and identified features associated with non-compliance. Our results show that of the 2,208 adult Vermont residents who completed the survey, 90% were extremely aware of the state’s COVID-19 guidelines, and 95% reported knowing exactly what to do to follow recommended actions. Political affiliation emerged as a primary factor related to attitudes and compliance. Self-identified Republicans were less likely to agree that public health measures keep people safe or help businesses stay open, and were less likely to follow masking, quarantine, social distancing, and vaccine guidance than Independents, Progressives, and Democrats. The large differences in COVID-19 infection and death rates across the country, and recent shift toward a "pandemic of the unvaccinated," underscore the need for identifying public health strategies that work in some areas in order to adapt and apply them to areas that have struggled with controlling the virus. Consistent with national surveys, our results show that resistance to public health guidance is a partisan challenge even in states with high compliance. Identifying populations that are less supportive or hesitant to follow guidelines while understanding factors that motivate compliance can help inform strategies for developing targeted programs to encourage collective action on pandemic response. Developing communication strategies that reach people who do not believe COVID-19 guidelines keep them safe is necessary to reach universal compliance.

The Vaccine Communication Demands on Community-Based Workforces.

Community-based organizations (CBOs) are experiencing some of the highest demand in years for a wide spectrum of health and social services. Their client-facing employees have taken on a new, challenging role as a sought-after source of COVID-19 vaccine information and guidance. These workforces operating on the frontlines, do their best to meet the increased need for services and information, often without additional resources or training to do so. The most effective immediate response to this challenge is a comprehensive communication support system working in tandem with CBOs. Our three organizations, the New York Vaccine Literacy Campaign at the CUNY Graduate School of Public Health and Health Policy, Hunger Free NYC, and Health Leads, have collaborated in key short-term approaches to meet these needs. We outline these processes and anticipated outcomes and offer lessons learned to advocate for long-term structural changes needed to increase community-level communication support.

COVID-19 Vaccinations: Summary Guidance for Cancer Patients in 28 Languages: Breaking Barriers to Cancer Patient Information.

BackgroundCovid-19 vaccination has started in the majority of the countries at the global level. Cancer patients are at high risk for infection, serious illness, and death from COVID-19 and need vaccination guidance and support.Guidance availability in the English language only is a major limit for recommendations’ delivery and their application in the world’s population and generates information inequalities across the different populations.Methods Most of the available COVID-19 vaccination guidance for cancer patients was screened and scrutinized by the European Cancer Patients Coalition (ECPC) and an international oncology panel of 52 physicians from 33 countries. ResultsA summary guidance was developed and provided in 28 languages in order to reach more than 70 percent of the global population.ConclusionLanguage barrier and e-guidance availability in the native language are the most important barriers when communicating with patients. E-guidance availability in various native languages should be considered a major priority by international medical and health organizations that are communicating with patients at the global level.

Receptiveness of American adults to COVID-19 vaccine boosters: A survey analysis.

ObjectiveThis Short Communication report summarizes results from a recent survey on the willingness of American adults to accept COVID-19 vaccine boosters. We seek to identify evolving hesitancies and objections to booster shots among those who previously accepted vaccination.MethodsA representative, web-based survey of 600 adults in the State of Florida was fielded, and the results are analyzed using both descriptive and inferential statistical methods.ResultsThe survey responses show that while booster shot hesitancy is relatively low among vaccinated Americans, nearly a third (30.4%) say that they are only somewhat likely or less to receive a vaccine booster shot. Statistical analysis shows that trust in public health guidance is the driving factor behind booster shot hesitancy, while significant differences also exist based on race and level of education. The most frequently cited objections to booster shots include concerns over the necessity of additional shots and adverse reactions to the initial vaccination.ConclusionObjections to booster shots highlight emerging communications challenges that health professional will need to consider and address as vaccine guidance continues to evolve.InnovationThis study contributes to innovation in health communications by identifying emerging challenges and barriers in the ongoing effort to promote COVID-19 vaccination.

Impact of COVID-19 in Pregnant Women and Their Newborns

Impact of COVID-19 in Pregnant Women and Their Newborns

Skin Adverse Reactions to Novel Messenger RNA Coronavirus Vaccination: A Case Series.

Vaccines are actually the most effective strategy to control the COVID-19 spread and reduce mortality, but adverse reactions can occur. Skin involvement with novel messenger RNA coronavirus vaccines seems frequent but is not completely characterized. A real-world experience in the recent vaccination campaign among health care workers in Sardinia (Italy) is reported. In over a total of 1577 persons vaccinated, 9 cases of skin adverse reactions were observed (0.5%). All reactions have been reported to the Italian Pharmacovigilance Authority. Eight occurred in women (mean age 46 years), and five were physicians and four nurses. All patients had a significant allergology history but not for the known vaccine excipients. After dose one, no injection site reactions were observed, but widespread pruritus (n = 3), mild facial erythema (n = 1), and maculopapular rash (n = 3) occurred in the following 24–48 h in three patients. These three patients were excluded from the second dose. Of the remaining six patients, one developed mild anaphylaxis within the observation period at the vaccination hub and five delayed facial erythematous edema and maculopapular lesions, requiring antihistamines and short-course corticosteroid treatment. Spontaneous reporting is paramount to adjourning vaccination guidance and preventive measures in order to contribute to the development of a safe vaccine strategy. Dermatologist’ expertise might provide better characterization, treatment, and screening of individuals at high risk of skin adverse reactions.

COVID-19 Vaccine Guidance for Patients with Cancer in Mexico: Report From the Working Group of the Mexican Society of Oncology

COVID-19 Vaccine Guidance for Patients with Cancer in Mexico: Report From the Working Group of the Mexican Society of Oncology

Tolerance of COVID-19 vaccination in patients with systemic lupus erythematosus: the international VACOLUP study.

Tolerance of COVID-19 vaccination in patients with systemic lupus erythematosus: the international VACOLUP study.

Protecting the vulnerable: SARS-CoV-2 vaccination in immunosuppressed patients with interstitial lung disease

Protecting the vulnerable: SARS-CoV-2 vaccination in immunosuppressed patients with interstitial lung disease

Mask and vaccination guidance from AAP

In updated face mask guidance issued just as schools were getting out in June, the American Academy of Pediatrics (AAP) recommended continuing well‐fitting face masks for children and teens age 2 and older who are not yet fully vaccinated.

Living Organ Donor Perspectives and Sources of Hesitancy about COVID-19 Vaccines.

Living organ donation declined substantially in the United States during the COVID-19 pandemic due to concerns about donor and transplant candidate safety. COVID-19 vaccines might increase confidence in the safety of living organ donation during the pandemic. We assessed informational preferences and perspectives about COVID-19 vaccines among US living organ donors and prospective donors. We conducted a national survey study of organ donors and prospective donors on social media platforms between 12/28/2020-2/23/2021. Survey items included multiple choice, visual analog scale, and open-ended responses. We examined associations between information preferences, history of COVID-19 infection, influenza vaccination history and COVID-19 vaccine acceptance using multivariable logistic regression and performed a thematic analysis of open-ended responses. Among 342 respondents from 47 US states and the District of Columbia, 35% were between 51-70 years old, 90% were non-Hispanic white, 87% were women; 82% were living donors (94% kidney) and 18% in evaluation to donate (75% kidney).The majority planned to or had received COVID-19 vaccination (76%), whereas 11% did not plan to be receive a vaccine, and 12% were unsure. Adjusting for demographics and donor characteristics, respondents who receive yearly influenza vaccinations had higher COVID-19 vaccine acceptance than those who do not (adjusted Odds Ratio [aOR] 5.06, 95% Confidence Interval [CI] 2.68-9.53). Compared to respondents who prioritized medical information sources (e.g., personal physicians and transplant providers), those who prioritized news and social media had lower COVID-19 vaccine acceptance (aOR 0.34, 95% CI 0.15-0.73). Low perceived personal benefit from vaccination and uncertainty about long-term safety were common themes among those declining COVID-19 vaccines. Donor informational source preferences were strongly associated with the likelihood of accepting a COVID-19 vaccine. Vaccine guidance for organ donors who are unsure about COVID-19 vaccines could incorporate messaging about safety and benefits of vaccination for healthy people.

American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 2.

ObjectiveTo provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID‐19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs).MethodsA task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID‐19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9‐point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings.ResultsDespite a paucity of direct evidence, 74 draft guidance statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID‐19 vaccines in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination.ConclusionThese guidance statements, made in the context of limited clinical data, are intended to provide direction to rheumatology health care providers on how to best use COVID‐19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.

Recommendations for COVID-19 vaccination in people with rheumatic disease: Developed by the Singapore Chapter of Rheumatologists.

AimPeople with rheumatic diseases (PRD) remain vulnerable in the era of the COVID‐19 pandemic. We formulated recommendations to meet the urgent need for a consensus for vaccination against SARS‐CoV‐2 in PRD.MethodsSystematic literature reviews were performed to evaluate: (a) outcomes in PRD with COVID‐19; (b) efficacy, immunogenicity and safety of COVID‐19 vaccination; and (c) published guidelines/recommendations for non‐live, non‐COVID‐19 vaccinations in PRD. Recommendations were formulated based on the evidence and expert opinion according to the Grading of Recommendations Assessment, Development and Evaluation methodology.ResultsThe consensus comprises 2 overarching principles and 7 recommendations. Vaccination against SARS‐CoV‐2 in PRD should be aligned with prevailing national policy and should be individualized through shared decision between the healthcare provider and patient. We strongly recommend that eligible PRD and household contacts be vaccinated against SARS‐CoV‐2. We conditionally recommended that the COVID‐19 vaccine be administered during quiescent disease if possible. Immunomodulatory drugs, other than rituximab, can be continued alongside vaccination. We conditionally recommend that the COVID‐19 vaccine be administered prior to commencing rituximab if possible. For patients on rituximab, the vaccine should be administered a minimum of 6 months after the last dose and/or 4 weeks prior to the next dose of rituximab. Post‐vaccination antibody titers against SARS‐CoV‐2 need not be measured. Any of the approved COVID‐19 vaccines may be used, with no particular preference.ConclusionThese recommendations provide guidance for COVID‐19 vaccination in PRD. Most recommendations in this consensus are conditional, reflecting a lack of evidence or low‐level evidence.

Cocooning against COVID-19: The argument for vaccinating caregivers of patients with cancer.

Current national COVID‐19 vaccination guidelines and recommendations focus vaccine guidance on patients with cancer. In this COVID‐19 vaccination race, “cocoon vaccination” strategies, which include informal caregivers and household contacts as priority groups for SARS‐CoV‐2 vaccination, could be an additional strategy used to protect patients with cancer who may have limited immune responses to current vaccinations. Medical systems specializing in cancer care should support education and vaccination campaigns which target informal caregivers and household contacts in addition to cancer patients.

Commentary: Perinatal Coronavirus Disease 2019 and Maternal Vaccination: What More Do We Need to Know?

Neonates represent a unique at-risk population for coronavirus disease 2019 (COVID-19). Their potential exposures to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are multiple: in utero, intrapartum and postpartum, from their mothers and family members and from healthcare workers, for those on neonatal units. Understanding the pathogenesis and epidemiology of COVID-19 in this group is essential to define optimal infection prevention and management guidelines. Mark et al1 have summarized the emerging data on outcomes among pregnant women with COVID-19 and neonates with perinatal COVID exposure, and this provides a welcome addition to the literature. Nevertheless, with more than 106 million reported cases of COVID-19 worldwide, it seems that our understanding of the effect of SARS-CoV-2 on pregnant women, fetuses and infants is far from complete. The authors reviewed studies published through August 15, 2020, on outcomes among pregnant women with confirmed COVID-19 and neonates with perinatal SARS-CoV-2 exposure. They identified 196 unique studies reporting 1922 pregnant women and 1361 neonates, dominated by reports from the United States. Only 61 neonates (4%) tested positive. Where it occurs, it seems that neonatal COVID-19 is largely postnatally acquired and a self-limited illness with good outcomes. However, we cannot yet be confident with these conclusions. As the authors acknowledge, further, large and prospective case-control and cohort studies are needed to fully understand the risk and impact of COVID-19 on neonates. To that end, national and international COVID-19 registries are a welcome step forward, but these must adopt standardized terminology and reporting for maximal benefit. Such studies should include both symptomatic pregnant women, as well as those who are asymptomatic, as the latter are common, and we know little about them. We do not yet know, for example, the implications of maternal asymptomatic or mild infection for the fetus and newborn infant. Many other important questions remain unanswered, such as the effect of COVID-19 in early pregnancy on miscarriage, intrauterine fetal growth restriction, congenital anomalies, long-term growth and neurodevelopmental outcomes. A major implication of identifying a burden of disease in the fetus and newborn is its potential for prevention through maternal vaccination. A more pressing rationale for vaccination in pregnancy is the burden of disease that currently exists in pregnant women themselves. We have some insight into this from the review where Caesarean section, premature labor, ICU admission and need for mechanical ventilation appear more common in affected pregnant women.2–5 Given this increased risk, pregnant women should have the option to be vaccinated, just as with their nonpregnant peers. For many of the vaccine technologies now in clinical trials or widespread use under emergency use authorization, either no trials have ever been done in pregnant women or no studies of COVID-19 vaccines have yet commenced in pregnant women. A comprehensive document published by the Pregnancy Research Ethics for Vaccines, Epidemics and New Technologies Working Group in 2019 provided ethical guidance for preparedness, research and response for pregnant women and vaccines against emerging epidemic threats.6 Alas, the call was not taken up with the urgency required, and so we are now left with a range of tentative and variable national recommendations for pregnant women currently living through this pandemic. We welcome the recent announcement of clinical trials in pregnancy and postpartum and hope that clear guidance for vaccination of pregnant and breast-feeding women can emerge rapidly.

COVID-19 vaccine guidance for patients with cancer participating in oncology clinical trials.

Emerging efficacy data have led to the emergency use authorization or approval of COVID-19 vaccines in several countries worldwide. Most trials of COVID-19 vaccines excluded patients with active malignancies, and thus data on the safety, tolerability and efficacy of the vaccines in patients with cancer are currently limited. Given the risk posed by the COVID-19 pandemic, decisions regarding the use of vaccines against COVID-19 in patients participating in trials of investigational anticancer therapies need to be addressed promptly. Patients should not have to choose between enrolling on oncology clinical trials and receiving a COVID-19 vaccine. Clinical trial sponsors, investigators and treating physicians need operational guidance on COVID-19 vaccination for patients with cancer who are currently enrolled or might seek to enrol in clinical trials. Considering the high morbidity and mortality from COVID-19 in patients with cancer, the benefits of vaccination are likely to far outweigh the risks of vaccine-related adverse events. Herein, we provide operational COVID-19 vaccine guidance for patients participating in oncology clinical trials. In our perspective, continued quality oncological care requires that patients with cancer, including those involved in trials, be prioritized for COVID-19 vaccination, which should not affect trial eligibility.