IMPORTANCE: Vaccines against human papillomavirus (HPV) are recommended for routine use in adolescents aged 11 to 12 years in the United States, but uptake remains suboptimal. Educational ...interventions focused on parents and patients to increase coverage have not generally demonstrated effectiveness. OBJECTIVE: To systematically review the literature on effectiveness of interventions conducted at the practice or community level to increase uptake of HPV vaccines in the United States. EVIDENCE REVIEW: Keyword searches of the PubMed, Web of Science, and MEDLINE databases identified studies of adolescents that included the outcome of HPV vaccination published through July 2014. References of identified articles were also reviewed. A total of 366 records were screened, 38 full-text articles were reviewed, and 14 published studies were included. Results were summarized by different intervention approaches. FINDINGS: Practice- and community-based intervention approaches included reminder and recall (n = 7), physician-focused interventions (eg, audit and feedback) (n = 6), school-based programs (n = 2), and social marketing (n = 2) (2 interventions tested multiple approaches). Seven studies used a randomized design, and 8 used quasiexperimental approaches (one used both). Thirteen studies included girls, and 2 studies included boys. Studies were conducted in a variety of populations and geographic locations. Twelve studies reported significant increases in at least one HPV vaccination outcome, one reported a nonsignificant increase, and one reported mixed effects. CONCLUSIONS AND RELEVANCE: Most practice- and community-based interventions significantly increased HPV vaccination rates using varied approaches across diverse populations. This finding is in stark contrast to a recent review that did not find effects to warrant widespread implementation for any educational intervention. To address the current suboptimal rates of HPV vaccination in the United States, future efforts should focus on programs that can be implemented within health care settings, such as reminder and recall strategies and physician-focused efforts, as well as the use of alternative community-based locations, such as schools.
The impact of human papillomavirus (HPV) vaccination has been observed in the United States through declining cervical precancer incidence in young women. To further evaluate vaccine impact, we ...described trends in HPV vaccine types 16/18 in cervical precancers, 2008-2014.
We analyzed data from a 5-site, population-based surveillance system. Archived specimens from women age 18-39 years diagnosed with cervical intraepithelial neoplasia grades 2-3 or adenocarcinoma
(CIN2+) were tested for 37 HPV types. We described the proportion and estimated number of cases of CIN2+ by HPV-type groups over time. Trends in HPV16/18-positive CIN2+ were examined, overall and by vaccination status, age, histologic grade, and race/ethnicity, using Cochrane-Armitage tests.
In 10,206 cases, the proportion and estimated number of cases of HPV16/18-positive CIN2+ declined from 52.7% (1,235 cases) in 2008 to 44.1% (819 cases) in 2014 (
< 0.001). Declining trends in the proportion of HPV16/18-positive CIN2+ were observed among vaccinated (55.2%-33.3%,
< 0.001) and unvaccinated (51.0%-47.3%,
= 0.03) women; ages 18-20 (48.7%-18.8%,
= 0.02), 21-24 (53.8%-44.0%,
< 0.001), 25-29 (56.9%-42.4%,
< 0.001), and 30-34 (49.8%-45.8%,
= 0.04) years; CIN2 (40.8%-29.9%,
< 0.001) and CIN2/3 (61.8%-46.2%,
< 0.001); non-Hispanic white (59.5%-47.9%,
< 0.001) and non-Hispanic black (40.7%-26.5%,
< 0.001).
From 2008-2014, the proportion of HPV16/18-positive CIN2+ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.
The declining proportion of HPV16/18-positive CIN2+ provides additional evidence of vaccine impact in the United States.
Post-licensure monitoring of the impact of HPV vaccines is critical to track the progress being made toward cervical cancer elimination and to identify areas where further progress can accelerate the ...achievement of this important public health goal. Over the past decade, a large body of evidence has revealed convincing benefits of HPV vaccination in preventing cervical infections and precancers at the individual-level (i.e., direct effectiveness) as well as in reducing the population-level burden of disease (i.e., overall effectiveness). At this time, effectiveness of the vaccines on preventing cervical cancer is just beginning to emerge given that there is a prolonged latency period for invasive disease. As we enter the era of cervical cancer elimination, these early and promising results may be expected in other countries in the near future. Thus, monitoring the direct and overall effectiveness for cervical cancer is an urgent research priority. In this article, we summarize what is known about the effectiveness of HPV vaccines on precancerous outcomes, and we highlight considerations for continuing these important public health activities going forward to monitor progress toward cervical cancer elimination.
•Vaccine efficacy and both direct and overall effectiveness studies can estimate the health benefits of HPV vaccine.•Direct effectiveness is evident for cervical outcomes and provides evidence of substantial benefits to individuals.•Overall effectiveness is also evident in real-world settings at the population level due to both direct and herd effects.•Knowledge gained from HPV vaccine monitoring on cervical disease can inform future similar efforts for cervical cancer.•Timing and coverage of vaccination programs, screening, and monitoring health disparities will be important considerations.
Most early childhood immunizations require 3 to 4 doses to achieve optimal protection. Our objective was to identify factors associated with starting but not completing multidose vaccine series.
...Using 2019 National Immunization Survey-Child data, US children ages 19 to 35 months were classified in 1 of 3 vaccination patterns: (1) completed the combined 7-vaccine series, (2) did not initiate ≥1 of the 7 vaccine series, or (3) initiated all series, but did not complete ≥1 multidose series. Associations between sociodemographic factors and vaccination pattern were evaluated using multivariable log-linked binomial regression. Analyses accounted for the survey's stratified design and complex weighting.
Among 16 365 children, 72.9% completed the combined 7-vaccine series, 9.9% did not initiate ≥1 series, and 17.2% initiated, but did not complete ≥1 multidose series. Approximately 8.4% of children needed only 1 additional vaccine dose from 1 of the 5 multidose series to complete the combined 7-vaccine series. The strongest associations with starting but not completing multidose vaccine series were moving across state lines (adjusted prevalence ratio aPR = 1.45, 95% confidence interval CI: 1.18-1.79), number of children in the household (2 to 3: aPR = 1.29, 95% CI: 1.05-1.58; 4 or more: aPR = 1.68, 95% CI: 1.30-2.18), and lack of insurance coverage (aPR = 2.03, 95% CI: 1.42-2.91).
More than 1 in 6 US children initiated but did not complete all doses in multidose vaccine series, suggesting children experienced structural barriers to vaccination. Increased focus on strategies to encourage multidose series completion is needed to optimize protection from preventable diseases and achieve vaccination coverage goals.
Abstract Background Prevention of pre-invasive cervical lesions is an important benefit of HPV vaccines, but demonstrating impact on these lesions is impeded by changes in cervical cancer screening. ...Monitoring vaccine-types associated with lesions can help distinguish vaccine impact from screening effects. We examined trends in prevalence of HPV 16/18 types detected in cervical intraepithelial neoplasia 2, 3, and adenocarcinoma in situ (CIN2+) among women diagnosed with CIN2+ from 2008 to 2012 by vaccination status. We estimated vaccine effectiveness against HPV 16/18-attributable CIN2+ among women who received ≥1 dose by increasing time intervals between date of first vaccination and the screening test that led to detection of CIN2+ lesion. Methods Data are from a population-based sentinel surveillance system to monitor HPV vaccine impact on type-specific CIN2+ among adult female residents of five catchment areas in California, Connecticut, New York, Oregon, and Tennessee. Vaccination and cervical cancer screening information was retrieved. Archived diagnostic specimens were obtained from reporting laboratories for HPV DNA typing. Results From 2008 to 2012, prevalence of HPV 16/18 in CIN2+ lesions statistically significantly decreased from 53.6% to 28.4% among women who received at least one dose ( Ptrend < .001) but not among unvaccinated women (57.1% vs 52.5%; Ptrend = .08) or women with unknown vaccination status (55.0% vs 50.5%; Ptrend = .71). Estimated vaccine effectiveness for prevention of HPV 16/18-attributable CIN2+ was 21% (95% CI: 1–37), 49% (95% CI: 28–64), and 72% (95% CI: 45–86) in women who initiated vaccination 25–36 months, 37–48 months, and >48 months prior to the screening test that led to CIN2+ diagnosis. Conclusions Population-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.
Nursing homes house populations that are highly vulnerable to coronavirus disease. Point prevalence surveys (PPSs) provide information on the severe acute respiratory syndrome coronavirus 2 infection ...status of staff and residents in nursing homes and enable isolation of infectious persons to halt disease spread. We collected 16 weeks of public health surveillance data on a subset of nursing homes (34/212) in Connecticut, USA. We fit a Poisson regression model to evaluate the association between incidence and time since serial PPS onset, adjusting for decreasing community incidence and other factors. Nursing homes conducted a combined total of 205 PPSs in staff and 232 PPSs in residents. PPS was associated with 41%-80% reduction in incidence rate in nursing homes. Our findings provide support for the use of repeated PPSs in nursing home staff and residents, combined with strong infection prevention measures such as cohorting, in contributing to outbreak control.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this study, we evaluated factors associated with receipt of meningococcal serogroup B (MenB) vaccine among adolescents in the United States.
We used public use data files from the National ...Immunization Survey-Teen from 2017 to 2018. Logistic regression was used to model associations among sociodemographic, healthcare, and vaccination variables of interest and MenB vaccine receipt (≥1 vs. 0 dose). To explore associations between state-level meningococcal vaccination requirements and MenB vaccine uptake, we performed a secondary analysis stratified by presence of a quadrivalent meningococcal (MenACWY) vaccination requirement for secondary school attendance in the adolescent’s state of residence (no requirement vs. a one- or two-dose requirement).
Among 7,288 adolescents, MenB vaccine receipt was significantly associated with up-to-date human papillomavirus (adjusted odds ratio aOR 1.74, 95% confidence interval CI 1.29–2.35) and MenACWY (aOR 5.81, 95% CI 4.14–8.13) vaccination status in multivariable analysis. Adolescents with private insurance were less likely to be vaccinated (aOR .61, 95% CI .46–.79) compared to adolescents with other health insurance types. In secondary analyses, health insurance was no longer significantly associated with MenB vaccine uptake among adolescents in states with a MenACWY requirement.
We found that MenB vaccination is associated with receipt of other vaccines recommended for use in adolescents. Adolescents with private health insurance were less likely to be vaccinated against MenB, although state MenACWY requirements appeared to modify the effect of insurance on MenB vaccine receipt. Further work to understand how these factors may influence delivery and acceptance of MenB vaccine can inform interventions and strategies to improve uptake.
Background Two vaccines against human papillomavirus (HPV), a necessary cause of cervical cancer, are currently licensed and recommended for routine administration in the U.S. to girls in a ...three-dose series. Purpose This study examined effects of race/ethnicity, poverty, and year on completion of the three-dose HPV vaccine series among those who initiated vaccination. Methods Data from the 2008–2009 National Immunization Survey-Teen for girls aged 13–17 years who received at least one dose of HPV vaccine ( n =7606) were analyzed in 2010–2011 using logistic regression to adjust for covariates including measures of access to care. Results During this 2-year period, 55% of adolescent girls who initiated vaccination completed the three-dose series. Completion was significantly higher in 2009 (60%) compared to 2008 (48%; p <0.001). After controlling for covariates, adolescents who were black (AOR=0.48, 95% CI=0.40, 0.57) or Hispanic (AOR=0.75, 95% CI=0.64, 0.88) were significantly less likely to complete vaccination than whites. Adolescents living below the federal poverty level were significantly less likely to complete vaccination than adolescents with household incomes >$75,000 (AOR=0.76, 95% CI=0.63, 0.92). There was no significant interaction between race/ethnicity and year ( p =0.92). Although poverty was associated with lower completion rates in 2008, this association was not observed in 2009 ( p <0.05 for poverty–year interaction). Conclusions HPV vaccination completion rates increased between 2008 and 2009. However, significant differences by race/ethnicity and poverty were observed, and the racial/ethnic differences persisted.
The growing shale gas ("fracking") industry depends on a mobile workforce, whose influx could have social impacts on host communities. Sexually transmitted infections (STIs) can increase through ...sexual mixing patterns associated with labor migration. No prior studies have quantified the relationship between shale gas activity and rates of three reportable STIs: chlamydia, gonorrhea, and syphilis.
We conducted a longitudinal, ecologic study from 2000-2016 in Ohio, situated in a prolific shale gas region in the United States (US). Data on reported cases of chlamydia, gonorrhea, and syphilis by county and year were obtained from the Ohio Department of Health. All 88 counties were classified as none, low, and high shale gas activity in each year, using data from the Ohio Department of Natural Resources. Annual rate ratios (RR) and 95% confidence intervals (95% CIs) were calculated from mixed-effects Poisson regression models evaluating the relationship between shale gas activity and reported annual STI rates while adjusting for secular trends and potential confounders obtained from the US Census.
Compared to counties with no shale gas activity, counties with high activity had 21% (RR = 1.21; 95%CI = 1.08-1.36) increased rates of chlamydia and 19% (RR = 1.27; 95%CI 0.98-1.44) increased rates of gonorrhea, respectively. No association was observed for syphilis.
This first report of a link between shale gas activity and increased rates of both chlamydia and gonorrhea may inform local policies and community health efforts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Primary prevention through the use of human papillomavirus (HPV) vaccination is expected to impact both cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). While CIN is well ...described, less is known about the epidemiology of AIS, a rare cervical precancer. We identified AIS and CIN grade 3 (CIN3) cases through population‐based surveillance, and analyzed data on HPV types and incidence trends overall, and among women screened for cervical cancer. From 2008 to 2015, 470 AIS and 6,587 CIN3 cases were identified. The median age of women with AIS was older than those with CIN3 (35 vs. 31 years; p < 0.01). HPV16 was the most frequently detected type in both AIS and CIN3 (57% in AIS; 58% in CIN3), whereas HPV18 was the second most common type in AIS and less common in CIN3 (38% vs. 5%; p < 0.01). AIS lesions were more likely than CIN3 lesions to be positive for high‐risk types targeted by the bivalent and quadrivalent vaccines (HPV16/18, 92% vs. 63%; p < 0.01), and 9‐valent vaccine (HPV16/18/31/33/45/52/58, 95% vs. 87%; p < 0.01). AIS incidence rates decreased significantly in the 21–24 year age group (annual percent change APC overall: −22.1%, 95% CI: −33.9 to −8.2; APC among screened: −16.1%, 95% CI: −28.8 to −1.2), but did not decrease significantly in any older age group. This report on the largest number of genotyped AIS cases to date suggests an important opportunity for vaccine prevention of AIS, and is the first to document a decline in AIS incidence rates among young women during the vaccine era.
What's new?
Adenocarcinoma in situ (AIS) is a rare histologic type of cervical precancer. Little is known about the epidemiology of AIS, however, and this information is important in the era of human papillomavirus (HPV) vaccination for cervical cancer prevention. In this study, the authors report on the largest collection of genotyped AIS cases to date from the multisite U.S. population‐based HPV Vaccine Impact Monitoring Project. From 2008 to 2015, 470 AIS cases were documented, compared to 6,587 cervical intraepithelial neoplasia grade 3 (CIN3) cases. AIS was diagnosed at an older age than CIN3 and was associated most frequently with HPV16 or HPV18. These are the first data on AIS incidence trends in the vaccine era; the authors document a decline in incidence among young women, which may be in part attributable to early vaccine impact.
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