Vaccination Recommendations Research Articles

Does the Vaccination against Tick-Borne Encephalitis Offer Good Value for Money for Incidence Rates below the WHO Threshold for Endemicity? A Case Study for Germany.

A closed-cohort Markov model was developed to estimate the cost-effectiveness of TBE vaccination. We compared primary vaccination applied to the whole population (aged above 1 year) and to a subpopulation aged between 60 and 85 years to a scenario without vaccination. Since TBE incidence is often underestimated, we included under-ascertained TBE cases and non-CNS TBE infections. Germany was used as a case study due to the availability of detailed incidence data. Our incidence threshold analysis showed that TBE vaccination offers good value for money well below the WHO threshold in most of the analyzed scenarios. Our results support a recommendation for TBE vaccination even in settings with low numbers of reported cases, especially for older patients. Furthermore, this analysis identified major research gaps regarding the costs, utilities, and clinical progression of TBE.

Analyzing Changes in Attitudes and Behaviors towards Seasonal Influenza Vaccination in Spain’s Adult Population over Three Seasons

Background/Objectives: The experience of the COVID-19 pandemic has turned the spotlight on the importance of public health measures and disease prevention. Despite this, the acceptance of influenza vaccination has remained low in most countries (and far from the 75% target set by the World Health Organization). The objective of this study has been to investigate how attitudes and behaviors regarding influenza vaccination in the Spanish adult population have changed over the last three years (from 2021 to 2024) in order to analyze trends in influenza vaccination. Methods: To this end, a cross-sectional study was conducted through 2206 telephone interviews, and the results were compared with those obtained in previous campaigns. Results: The findings indicate a significant decline in overall vaccination intent. Healthcare professionals remain the most influential factor in encouraging vaccination, yet there is a notable increase in the lack of vaccine recommendations, contributing to the decision not to vaccinate. This study also reveals low awareness of the influenza vaccine campaign, emphasizing the need for improved public health communication. Conclusions: To counteract these trends, this study recommends intensifying awareness campaigns, strengthening the role of healthcare providers in vaccine advocacy, and tailoring communication strategies. These efforts are crucial to enhancing vaccination coverage and protecting vulnerable populations against influenza.

Overcoming Barriers to Childhood and Adolescent Vaccination: Opportunities in Precision Health Promotion

Abstract Background Vaccination remains one of the greatest success stories in public health as cost-effective interventions to reduce morbidity and mortality from infectious diseases at the population level. However, the COVID-19 pandemic created unprecedented challenges to the immunization sector. Uptake of routine childhood and adolescent vaccinations was forestalled by challenges related to pandemic lockdowns/quarantine, reduced patient-provider interactions, parental reluctance to seek preventative services, poor access to health services, and loss of income and/or health insurance. Compared to pre-pandemic estimations, the pandemic era brought a consequential decline in coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This study sought to address suboptimal adolescent vaccine delivery systems and bolster uptake in the post-pandemic era with the introduction of precision health promotion strategies centered around the use of Personal Health Libraries (PHL). Methods Leveraging artificial intelligence (AI), and semantic web technologies to integrate contextual knowledge (i.e., clinical, biomedical, and SDoH data) with patient preferences, proposed PHL platforms could aid in generating personalized evidence-based recommendations useful to both care provider promotion of vaccination and mitigating patient and caregiver hesitancy. The proposed application stands to provide customized digital health interventions by 1) facilitating remote knowledge acquisition, exchange, and visualization of the benefits of on-time vaccination, 2) improving health information-seeking behaviors to reduce hesitancy, 3) bolstering patient reminder and recall systems for follow-up and series completion, and 4) learning usage patterns to incorporate end-user preferences to empower patients, promote best practices, and enable them to make informed health decisions. Results The proposed PHL would serve as an ecosystem to manage and deliver tailored vaccine-related information to inform health decision-making regarding ACIP-recommended immunizations. Such a resource could administer health education and promotion that addresses common misconceptions regarding vaccination, alleviate safety, efficacy, and side effect concerns, and deliver evidence-based support of vaccines as primary protective measures (i.e., cancer prevention). Conclusion The use of PHL would enable rapid and real-time collection and interpretation of patient data beyond the traditional clinical setting, supplying care providers with tools for optimal vaccination recommendation to bolster uptake in the post-pandemic era. Moreover, the application would enable patients and caregivers to readily access vital health information and play a crucial role in addressing the obstacles encountered when seeking accurate and dependable vaccine-related information.

COVID-19 Vaccination Recommendations for Immunocompromised Patient Populations: Delphi Panel and Consensus Statement Generation in the United States.

The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US. A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements. Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%-96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%-69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups. Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians.

Consensus Statements on Assessments and Vaccinations Prior to Commencement of Advanced Therapies for the Treatment of Inflammatory Bowel Diseases.

Given the introduction of new advanced therapies for inflammatory bowel diseases (IBDs), expanded risk mitigation strategies are essential. To create a comprehensive set of statements on assessment procedures and vaccinations before starting monoclonal antibodies, Janus kinase (JAK) inhibitors or sphingosine-1-phosphate (S1P) modulators for IBD. We examined literature, guidelines and drug product information regarding vaccination and assessment recommendations for initiating advanced IBD therapies. Using a modified Delphi approach, delegates voted anonymously on the acceptability of these statements prior to and following consensus discussion. We developed eight statements on the domains of infectious diseases screening, vaccinations and assessments prior to commencing JAK inhibitors and S1P modulators. Six statements received agreement. Pre-advanced therapy screening for infectious diseases was established, and the vaccination protocol was revised. Malignancy, cardiovascular and thromboembolic risk assessments are necessary before initiating JAK inhibitors. Those starting S1P modulators need cardiac and ophthalmic assessments. These consensus statements combine vaccination and assessments on the currently available advanced therapies for IBD as a single comprehensive document that may reduce IBD complications associated with use of advanced therapies. Knowledge gaps identified during the consensus process will provide further research opportunities.

Delphi Panel Consensus Statement Generation: COVID-19 Vaccination Recommendations for Immunocompromised Populations in the European Union.

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare systems globally. The lack of quality guidelines on the management of COVID-19 in rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients has resulted in a wide variation in clinical practice. Using a Delphi process, a panel of 16 key opinion leaders developed clinical practice statements regarding vaccine recommendations in areas where standards are absent or limited. Agreement among practicing physicians with consensus statements was also assessed via an online physician survey. The strength of the consensus was determined by the following rating system: a strong rating was defined as all four key opinion leaders (KOLs) rating the statement ≥ 8, a moderate rating was defined as three out of four KOLs rating the statement ≥ 8, and no consensus was defined as less than three out of four KOLs provided a rating of ≤ 8. Specialists voted on agreement with each consensus statement for their disease area using the same ten-point scoring system. Key opinion leaders in rheumatology, nephrology, and hematology achieved consensuses for all nine statements pertaining to the primary and booster series with transplant physicians reaching consensus on eight of nine statements. Experts agreed that COVID-19 vaccines are safe, effective, and well tolerated by patients with rheumatological conditions, renal disease, hematologic malignancy, and recipients of solid organ transplants. The Delphi process yielded strong to moderate suggestions for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines and the necessity of the COVID-19 booster for the immunocompromised population. The expert panel had mixed feelings concerning the measurement of antibody titers, higher-dose mRNA vaccines, and the development of disease-specific COVID-19 guidance. These results confirmed the necessity of COVID-19 vaccines and boosters in immunocompromised patients with rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients. Statements where consensus was not achieved were due to absent or limited evidence.

Inequalities in the risk and prevention of invasive meningococcal disease in the United States - A systematic literature review.

Vaccination remains the most effective strategy to prevent invasive meningococcal disease (IMD), with MenACWY, MenB and MenABCWY recommended for adolescents/young adults in the United States (US). However, vaccination coverage remains suboptimal, which could be related to population inequalities. To understand the impact of IMD risk, prevention and control inequalities, a global systematic literature review (Medline, Embase, 2012-2022) was conducted on individual, socioeconomic, and environmental inequalities associated with IMD risk, prevention and control in all ages. Studies on IMD risk (n = 15) and prevention (n = 14) inequalities were identified. IMD incidence proportions were higher in Medicaid versus commercially insured populations, and IMD mortality was higher in poorer neighborhoods. White adolescents, adolescents from lower income families, and with lower maternal education were more likely to receive MenB vaccination; while Black and Hispanic adolescents, and adolescents with higher family incomes, were more likely to receive MenACWY vaccination. Meningococcal vaccination was associated with being up-to-date with other vaccinations, having multiple healthcare/well child visits, having a pediatrician as healthcare provider (HCP), and attending private facilities; while being uninsured was associated with lower vaccination. States with a MenACWY vaccination mandate and higher pediatrician-to-children ratios had higher vaccination rates. Important inequalities were due to individual differences, socioeconomic, and environmental factors. IMD prevention is suboptimal, especially among adolescents/young adults. To improve health equity, health policy makers could ameliorate meningococcal vaccination coverage across the US, with simplified and stronger meningococcal vaccine recommendations from public health authorities, and initiatives to enhance parental/patient and HCP knowledge of IMD and vaccine recommendations.

Prophylaxis of respiratory syncytial virus infection: current status and prospects for vaccine development

INTRODUCTION. Respiratory syncytial virus (RSV) is one of the most widespread pathogens that typically cause acute upper and lower respiratory tract infections in children and adults. Monoclonal antibody products have long been used for passive immunoprophylaxis in premature infants with bronchopulmonary dysplasia. However, vaccines have recently been licensed for the prophylactic immunisation of older adults with various risk factors for severe RSV infection (primarily, chronic cardiovascular and respiratory diseases and diabetes mellitus).AIM. This study aimed to review the current status of the development of vaccines for active immunisation against RSV infection, including the epidemiological rationale for their development, clinical trial results for licensed vaccines, recommendations for vaccination, and promising pipeline vaccines for RSV prevention.DISCUSSION. Initially hindered by the unique immunopathogenesis of RSV infection and the genetic hypervariability of RSV for a long time, attempts to develop an RSV vaccine succeeded when international researchers managed to identify a conservative neutralising antibody target capable of inducing specific immunity against RSV. This target, the RSV capsid protein stabilised in its prefusion (pre-F) conformation, can mediate viral entry into the cell following a conformational change. Several subunit vaccines based on recombinant pre-F proteins have successfully passed clinical trials and have been approved for the immunisation of older adults. In addition, one of these vaccines has been recommended for use during pregnancy to prevent RSV infection in newborns and infants. Currently, programmes are being implemented to develop novel RSV vaccines based on messenger RNA (mRNA) and non-replicating attenuated influenza vectors. This article examines and summarises the efficacy and safety parameters of two RSV vaccines approved in multiple countries around the world. Both vaccines have satisfactory safety profiles and comparable prophylactic efficacy parameters.CONCLUSIONS. Prelicensure clinical trials of novel RSV vaccines, including those being developed in the Russian Federation, should include prophylactic efficacy assessments in target patient populations. For vaccines approved by leading international regulators, clinical trials required for approval in the Russian Federation will be limited to bridging studies confirming the immunogenicity and safety of the vaccines.

Association of the belief in conspiracy narratives with vaccination status and recommendation behaviours of German physicians

Vaccine hesitancy has been identified as one of the top ten threats to global health by the World Health Organization (WHO). The belief in conspiracy narratives is repeatedly discussed as a major driver of vaccine hesitancy among the general population. However, there is a lack of research investigating the role of the belief in conspiracy narratives in vaccination decisions and recommendation behaviours of physicians. This is particularly relevant as physicians are one of the major and trusted sources of information for patients’ vaccination decisions. This study therefore investigated the association between believing in COVID-19-related conspiracy narratives and physicians’ own COVID-19 vaccination status and their recommendation behavior for COVID-19 and other vaccines (e.g., HPV or flu). In a cross-sectional survey among German physicians (N = 602, April 2022) two conspiracy narratives were assessed, stating that the coronavirus is a hoax or that it is human-made. Additional control variables included trust in health institutions, the rejection of complementary and alternative medicine (CAM), the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility) and demographic variables. Hierarchical regressions indicated that greater belief in the conspiracy narrative claiming that the coronavirus is a hoax was associated with lower COVID-19 vaccination uptake and fewer COVID-19 vaccination recommendations among physicians. The results for recommendation behavior remain robust even when controlling for other variables. Contrary to our assumption, believing that the coronavirus is human-made was not related to vaccination status nor vaccine recommendation behavior. In conclusion, believing in conspiracy narratives that question the existence and thus also the danger of the virus is an important independent predictor of vaccine hesitancy among physicians that should be addressed in future public health interventions.

Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

BackgroundBefore, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating. ObjectivesTo study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy. DesignA cross-sectional survey. SettingsSalaried, community (self-employed) and mixed nurses in France. Participants18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323). MethodsIn February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors) a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults). ResultsAmong the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10−3) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10−3) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses. ConclusionsSatisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.

Healthcare Provider Recommendations for COVID-19 Vaccination: Prevalence, Disparities, and Correlates

ObjectiveWe assessed healthcare provider recommendations for COVID-19 vaccination, disparities across sociodemographic factors, and associations with health care coverage, social norms, COVID-19 vaccine hesitancy, and Fox News preference. MethodsWe utilized random sample survey data of Arkansas residents (N=2,201) collected in October 2022 to identify adults with a personal provider who make up the analytical sample of this study (n=1,804). ResultsOver a third (37.2%; n=607) of the weighted sample did not receive a recommendation. Adjusted odds of receiving a recommendation were positively associated with health care coverage (aOR=1.66; 95% CI [1.05, 2.64]) and negatively associated with perceiving "very few” (aOR=0.48; 95% CI [0.33, 0.72]) or “some but not many” (aOR=0.57; 95% CI [0.41, 0.80]) rather than “nearly all” people close to them to be vaccinated. Adjusted odds of receiving a recommendation were negatively associated with being very hesitant (vs. not at all hesitant) (aOR=0.65; 95% CI [0.47, 0.88]). ConclusionProvider recommendations for COVID-19 vaccination were not provided for a large portion of Arkansas adults, inconsistently provided across sociodemographic groups, and associated with health care coverage, social norms, and vaccine hesitancy. Practice ImplicationsIntervening on disparities in COVID-19 vaccination may require addressing disparities in provider recommendations.

Provider Perceptions and Use of Audit-Feedback and Communication Strategies to Improve Human Papillomavirus Vaccine Uptake

ObjectiveHuman papillomavirus (HPV) vaccine uptake remains suboptimal among US adolescents. A cluster randomized trial was conducted at six primary care practices in southeast Minnesota to assess the impact of parent reminder-recall letters and provider audit-feedback reports on 11–12-year-old HPV vaccine uptake. Audit-feedback reports included access to a web toolkit with instruction on two communication approaches. We evaluated the process of the audit-feedback report intervention to inform future adaptations. MethodsWe sent a survey to providers assigned to the intervention and asked about their use and perceptions of the reports, web toolkit, the communication approaches, and HPV vaccine recommendation. ResultsSurveys from 95 providers were analyzed. Most (97.9%) recalled receiving audit-feedback reports, with 92.4% finding them somewhat to very easy to understand, 86% somewhat to very familiar with their content and objectives, and 69.9% using them five or more times in the past year. Few respondents (11.6%) recalled receiving access to the web toolkit. Web analytics showed that the toolkit was rarely used. Most reported familiarity with communication approaches but less than half reported that these positively impacted the tone of the clinical encounter. Higher familiarity with audit-feedback reports (OR=2.58) and perceived peer approval about using presumptive language (the first of two communication approaches) to recommend HPV vaccination (OR=2.16) correlated with higher frequency of vaccine recommendation. ConclusionsImplementation of the audit-feedback reports showed good acceptability. Low utilization of the web toolkit suggests a need to further examine provider preferences on delivery and usability of training materials.

Current vaccination and immunization strategies in dermatology

Vaccinations are an important pillar of public health. They have high benefits for individuals and society as awhole by specifically preventing or mitigating infectious diseases. In many cases, they offer benefits that go beyond protection against the disease in question, e.g., protective cardiovascular effects. Vaccination recommendations in Germany are drawn up by the Standing Committee on Vaccination (STIKO), while the European Medicines Agency (EMA) is responsible for the approval of vaccines in the EU. Vaccinations may be carried out by physicians regardless of their specialty. In dermatology, vaccinations against varicella (chickenpox), herpes zoster, and human papillomavirus are established. The development of vaccines against other dermatologically relevant diseases and cancer vaccines is the subject of intensive research. Particularly in the case of immunosuppression, the physician must also take into consideration which vaccinations are possible and useful or contraindicated. TypeI or typeIV allergies to components of vaccinations are very rare, but reactions at the injection site often occur as adermatological side effect. Urticarial reactions are also possible, as does the worsening of underlying dermatological conditions such as psoriasis vulgaris.

Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.

280 Background: Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%. Methods: A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations. Results: Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation. Conclusions: The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution. Influenza vaccine administration vs outpatient visits in the ID clinic. Month/Year # Outpatient visits # Vaccines administered in clinic % of vaccines administered Influenza Sep-Dec 2022 1827* 54 2.95% Influenza Sept 2023-March 2024 2682 251 9.36% *Includes video and telephone visits.

Cost-Effectiveness of 9-Valent HPV Vaccination for Patients Treated for High-Grade Cervical Intraepithelial Neoplasia in the UK

Patients who have been treated for high-grade cervical intraepithelial neoplasia (CIN grade ≥2) are at a high risk for subsequent CIN and other cancers and diseases related to human papillomavirus (HPV). HPV vaccination can reduce the risk of subsequent disease in patients surgically treated for grade 2 or greater CIN; however, there is no formal recommendation for prophylactic HPV vaccination in this high-risk population, and the cost-effectiveness is unknown. To assess the incremental lifetime outcomes, costs, and cost-effectiveness of integrating peritreatment 9-valent HPV (9vHPV) vaccination in combination with posttreatment surveillance for the prevention of cervical cancer and other HPV-attributable diseases in patients surgically treated for grade 2 or greater CIN vs posttreatment surveillance alone from a UK payer perspective. This economic evaluation used 3 independent Markov model structures. Model inputs for vaccine efficacy, utilities, and costs were obtained from published sources, and cervical cancer screening data were obtained from the National Health Service Cervical Screening Program. Costs were adjusted to 2022 to 2023 reference years. Data were analyzed from October 2022 to September 2023. Peritreatment vaccination with 9vHPV in combination with posttreatment surveillance compared with posttreatment surveillance alone. Clinical outcomes included grade 1, 2, or 3 CIN; cervical cancer; vaginal cancer; vulvar cancer; anal cancer; head and neck cancer; genital warts; and recurrent respiratory papillomatosis. Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold (WTP) of £20 000 (US $26 200) per quality-adjusted life-year (QALY) were estimated. Deterministic sensitivity analysis and probabilistic sensitivity analysis were performed. Vaccination with 9vHPV in conjunction with posttreatment surveillance was cost-effective, with a favorable ICER of £13 789.07 (US $18 064.68) per QALY gained (ie, below the WTP of £20 000 per QALY) vs posttreatment surveillance alone. The resulting ICER was £52 358.01 (US $68 588.99) per HPV-related cancer averted and £64 090 (US $83 958.18) per HPV-related cancer death averted. The ICER was most sensitive to discount rate, incidence of HPV infection, vaccine price, and age at initial treatment for grade 2 or greater CIN. Results of the probabilistic sensitivity analysis showed peritreatment 9vHPV vaccination was cost-effective at the WTP recommended by the UK's Joint Committee on Vaccination and Immunisation (90% of iterations <£30 000 [US $39 300] per QALY) in 100% of iterations. These findings suggest that peritreatment prophylactic 9vHPV vaccination is a cost-effective option for preventing subsequent HPV-attributable diseases in patients surgically treated for grade 2 or greater CIN.

COVID-19 vaccinations pre- and antepartum: a consideration of the evidence and discussion of issues.

The COVID-19 vaccine should be universally offered to pregnant women and women planning pregnancies. This is on the basis that COVID-19 infection can complicate the pregnancy and have adverse health implications in pregnancy, as compared to non-pregnant women, which the vaccine helps to mitigate. This is the recommendation of many governing bodies in medical care. However, certain issues require consideration, which are not discussed in the current guidelines. These include the induction of fever by the vaccines and the role fever can play in teratogenicity, the induction of hyper-coagulable and thrombocytopenic states by the vaccines and other known contraindications to the vaccines. In this article, we develop strategies to minimize risks in these situations. We also discuss the theoretical advantage of calling for a booster COVID-19 vaccinate in all pregnant women in the late second or early third trimester, even if previously immunized, and encourage further research, to investigate the possible benefits of this proposed intervention. This article acts as an educational supplement to help clinicians manage pregnant women and addresses many issues, not discussed in most COVID-19 vaccine recommendations by international societies related to pregnant women. This article is a literature review of the current, limited data. The information extrapolated allowed for suggestions regarding COVID-19 vaccination during pregnancy. RESULTSAND CONCLUSIONS: The study discusses hypothetical issues, to minimize any risks associated with COVID-19, and serves as a compilation of data to further the current literature, in proving that COVID-19 vaccines have minimal risks in pregnancy.

Influenza vaccine allocation in tropical settings under constrained resources.

Influenza virus seasonality, synchronicity, and vaccine supply differ substantially between temperate and tropical settings, and optimal vaccination strategy may differ on this basis. Many national vaccine recommendations focus on high-risk groups, elderly populations, and healthcare workers despite previous analyses demonstrating broad benefits to vaccinating younger high-contact age groups. In this study, we parameterized an age-structured nonseasonal asynchronous epidemiological model of influenza virus transmission for a tropical low-income setting. We evaluated timing and age allocation of vaccines across vaccine supplies ranging from 10 to 90% using decade-based age groups. Year-round vaccination was beneficial when compared with more concentrated annual vaccine distribution. When targeting a single age group for vaccine prioritization, maximum vaccine allocation to the 10-19 high-contact age group minimized annual influenza mortality for all but one vaccine supply. When evaluating across all possible age allocations, optimal strategies always allocated a plurality of vaccines to school-age children (10-19). The converse, however, was not true as not all strategies allocating a plurality to children aged 10-19 minimized mortality. Allocating a high proportion of vaccine supply to the 10-19 age group is necessary but not sufficient to minimize annual mortality as distribution of remaining vaccine doses to other age groups also needs to be optimized. Strategies focusing on indirect benefits (vaccinating children) showed higher variance in mortality outcomes than strategies focusing on direct benefits (vaccinating the elderly). However, the indirect benefit approaches showed a lower mean mortality and a lower minimum mortality than vaccination focused on the elderly.

SARS-CoV-2 Vaccination Coverage in Italian Children with Celiac Disease

Background: Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods: We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0–19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients’ eligibility for vaccination at different times. Results: Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions: Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.

Differences in PCV13 Recommendation Practices between Pediatric Care Providers and Primary Care Providers in China: A Cross-Sectional Survey of Behavior and Social Drivers.

Objectives: This study examines the recommendation behaviors and influencing factors for the 13-valent Pneumococcal Conjugate Vaccine (PCV13) among 3579 Chinese healthcare workers (HCWs), including 1775 pediatric care providers (Peds-PCPs) and 1804 primary care providers (PCPs). Data were collected from May to July 2023 through a national cross-sectional survey using a structured questionnaire, distributed across hospitals providing pediatric services in five provincial-level administrative divisions. Methods: The sociodemographic data, vaccine knowledge, and recommendation practices were analyzed using Pearson's chi-square test, Wilcoxson rank-sum test, and multivariate logistic regression. Results show that while PCPs are more likely to recommend PCV13, vaccine hesitancy persists among Peds-PCPs. Logistic regression revealed that higher influenza vaccination intention, salary, vaccine consultation frequency, familiarity with immunization, work ethic, and flexible schedules positively impacted HCWs' recommendation behavior. Results: Factors influencing Peds-PCPs' recommendations include vaccine training (OR: 1.470, CI: 1.049-2.509), safety recognition (OR: 1.986, CI: 1.163-3.391), concern over rejection (OR = 1.274, CI: 1.076-1.508) and vaccine cost (OR = 1.203, CI: 1.023-1.414). For PCPs, influencing factors were the perceived susceptibility of children to pneumonia (OR = 2.185, CI: 1.074-4.445), acceptance of herd immunity (OR: 1.717, CI: 1.101-2.677), and belief that parents with better family conditions are more likely to accept vaccine recommendations (OR = 1.229, CI: 1.024-1.477). Conclusion: This survey underscores the need for tailored interventions to address differing perceptions and enhance confidence in the safety and efficacy of vaccines among HCWs, particularly Peds-PCPs.

Abstract A123: Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States

Abstract Background: Human Papillomavirus (HPV) vaccination is essential to prevent occurrences of a variety of HPV associated cancers. The awareness of HPV and its vaccine could be associated with the use of telehealth. The aims of this study were to examine the association between awareness of HPV and HPV vaccine with receiving telehealth for health care within the past year. Methods: Data from the Health Information National Trends Survey (HINTS) 6 (N=5,887) were utilized. Dependent variable was awareness of HPV and HPV vaccine. The independent variable was those who received care from a doctor or health professional using telehealth. Weighted multivariable logistic regression was performed to determine association of awareness of HPV and its vaccine with receiving healthcare using telehealth while adjusting for age, gender, race, education, and census region. Results: The study sample consisted of 68.28% awareness of HPV and 63.47% awareness of HPV vaccine. After controlling for covariates, we found those who were aware of HPV and HPV vaccine have received telehealth care (aOR=1.40, 95%CI:1.11-1.78; aOR= 1.40, 95%CI:1.09 -1.80), respectively. In the adjusted model, the awareness of HPV for being female (aOR=2, 95%CI:1.60-2.48) and college graduates (aOR=3.80, 95%CI: 2.59-6.56). In the adjusted model, the awareness of HPV vaccine for being female (aOR= 2.68, 95%CI:2.13-3.36) and college graduates (aOR=4.68,95%CI:2.77-7.91). HPV and HPV vaccine awareness, Non Hispanic Whites had significantly higher adjusted odds compared to other race/ethnicity groups. Conclusion: Hence public health programs could be directed to promote use of telehealth to increase awareness of HPV causing cancers, reduce stigma associated with vaccination, boost healthcare recommendation and uptake of HPV vaccination considering socio demographic factors. Citation Format: Manali Desai, Iman Igab, Ogochukwu Ezeigwe, Devesh Malgave. Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A123.