Search Results (437)

Background: Most cancers caused by human papillomavirus (HPV) are preventable through vaccination, yet uptake among U.S. college students remains below national targets. This study examined HPV vaccination rates and factors associated with vaccine uptake among students aged 18–26 years at a large, diverse public university in New York State following the COVID-19 pandemic. Methods: In March 2022, an online survey was distributed to 19,351 students aged 18–26 years; responses were received from 708 students (~4%) and included in the analysis. Descriptive statistics and multivariable logistic regression was used to identify predictors of HPV vaccination. Results: Overall, 59% of students reported receiving at least one HPV vaccine dose, while 17.7% were unsure of their vaccination status. Among students whose healthcare provider recommended the HPV vaccine, 76.4% were vaccinated compared to 16.7% without one (p < 0.001). Healthcare provider recommendation was the strongest predictor of vaccination (OR 17.9; 95% CI: 8.45–37.91). Additional factors significantly associated with uptake included agreement that the HPV vaccine is safe (OR 2.56; 95% CI: 1.54–4.27), importance of a sexual partner being vaccinated (OR 2.65; 95% CI: 1.90–3.69), and valuing family opinion (OR 1.67; 95% CI: 1.23–2.26). Students most preferred receiving HPV information from healthcare providers (73.4%), followed by Internet searches (51.8%) and social media (35.1%). Conclusions: HPV vaccination uptake among college students remains below national targets. Strengthening provider recommendations, addressing safety concerns, and implementing multimodal education strategies during preventive visits for young adults are essential to improve coverage and reduce HPV-related cancer risk. Full article

Background: Melanoma outcomes have improved in recent years as a result of modern systemic therapies. A major molecular feature of melanoma is abnormal telomerase activation; this is most often caused by telomerase reverse transcriptase (TERT) promoter mutations, which occur in 50–82% of cases and are the most common noncoding alteration in this cancer. Telomerase maintains telomere length, allowing melanoma cells to avoid senescence and continue dividing. However, how telomerase activity influences melanoma cell doubling time remains unclear, and the pathways linking TERT expression to faster cell-cycle progression require further study. Although telomerase inhibitors show promise in preclinical models, their clinical use is limited by delayed cytotoxicity and resistance. Materials and Methods: A scoping review was conducted using Scopus, ScienceDirect, MEDLINE/PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Keywords included “telomerase,” “melanoma,” “cancer,” “cell proliferation,” and “doubling time,” using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Telomerase-related biomarkers were found to correlate with disease stage and survival. Suggested therapeutic strategies include enzyme inhibitors, cytotoxic nucleotide incorporation, telomere destabilization, and immunotherapies such as peptide or dendritic cell vaccines, etc. Conclusions: Understanding both telomere-dependent and -independent TERT functions is essential for developing effective biomarkers and therapies that overcome resistance and slow melanoma progression. Full article

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and thematically analyzed by two coders, with discrepancies resolved by consensus and reviewed by a third researcher. Results: Participants identified five key dyadic themes and four HCP themes. Adolescents described the gameplay as intuitive and enjoyable, highlighting interactive challenges and realistic avatars. Parents valued the clarity of HPV information and noted that the game helped initiate health-related conversations. Both adolescents and parents suggested enhancements including voice narration and greater customization and agreed that the game was well suited for 10–15-min clinic wait times, with text messaging preferred for follow-up. HCPs emphasized challenges such as parental hesitancy and competing clinical demands and viewed the game as a feasible adjunct to support vaccine-related discussions. Conclusions: Findings suggest the acceptability, usability, and perceived clinical applicability of a brief, clinic-based digital game for HPV-related education and engagement among adolescents and their parents. Full article

This study investigates the codon usage characteristics of Japanese encephalitis virus (JEV) genotype 5 (G5). Based on 339 complete JEV genome sequences, we systematically compared the codon usage patterns of G5 with other genotypes (G1–G4) using a multi-faceted approach, including evolutionary analysis, nucleotide composition, Relative Synonymous Codon Usage (RSCU), Principal Component Analysis (PCA), Effective Number of Codons Plot analysis (ENC-Plot), Parity Rule 2 analysis (PR2), Neutrality plot analysis, dinucleotide abundance analysis and Codon Adaptation Index analysis (CAI). The results indicate that G5 forms a distinct evolutionary branch, with both its overall GC content (50%) and GC content at the third codon position (GC3, 53%) being lower than those of other genotypes. RSCU analysis revealed a preferential use of A/U-ended codons in G5, indicating a trend towards reduced GC3 usage. ENC analysis demonstrated a stronger codon usage bias in G5 (mean ENC = 54.2). Furthermore, ENC-plot, PR2, and neutrality plot analyses collectively suggested that G5 is subject to stronger natural selection pressure. Analysis of dinucleotide abundance showed a significant increase in CA values in G5, while CAI analysis indicated higher translational efficiency in human hosts compared to Culex mosquito hosts. Our findings suggest that G5 JEV, potentially through reduced Cytosine-phosphate-Guanine (CpG) usage and optimized codon preference, may enhance its capabilities for immune evasion and host adaptation, and could possess the potential for efficient replication in humans or other mammalian hosts. This research provides crucial theoretical insights into the molecular evolutionary mechanisms of G5 JEV and informs related vaccine development. Full article

Background/Objectives: Vaccination programs are highly effective public health interventions, yet parental hesitancy toward combination vaccines has led to growing demand for alternative vaccination schedules, defined in this study as parental requests to split or replace recommended combination vaccines with single-antigen vaccines for non-clinical reasons. While parental attitudes have been widely studied, little empirical evidence exists on the real-world use of single-antigen vaccines and their public health implications in countries with otherwise high coverage. This study examined the prevalence patterns and parental motivations for requesting such alternative vaccination schedules in Israel, where national guidelines recommend specific combination vaccines, including measles-mumps-rubella-varicella (MMRV) and the pentavalent diphtheria-tetanus-pertussis–inactivated polio–Haemophilus influenzae type b (DTaP+IPV+Hib) vaccines, but informal accommodations exist. Methods: A mixed-methods design was employed: a retrospective cohort analysis of vaccination data from 2018 to 2021 (before and during the COVID-19 pandemic) focused on measles (first dose at 12 months) and pertussis (four-dose primary series), followed by semi-structured interviews with Maternal and Child Health clinic providers, policymakers, and parents. Results: Alternative vaccination schedules involving single-antigen measles or pertussis vaccines are occasionally used despite official policy, accounting for less than 1% of vaccinations overall. Outcomes include delayed administration, lower uptake of combination vaccines, and incomplete protection in certain groups. Parents cited safety concerns, fear of immune overload, and mistrust of authorities. These concerns were often amplified by misinformation, while providers described balancing parental preferences with the need for adequate coverage. Conclusions: This study provides new evidence on how vaccine hesitancy translates into service utilization, highlights the tension between individualized parental decision-making and contribution to collective health, and underscores the need for communication, policy strategies and service designs that sustain high coverage while addressing community-specific concerns. Full article

Background: Hospital-acquired influenza remains a persistent threat that amplifies morbidity, mortality, length of stay, and operational strain, particularly among older and immunocompromised inpatients. The COVID-19 era reshaped control norms—normalizing N95 use during surges, ventilation improvements, and routine multiplex PCR—creating an opportunity to strengthen hospital outbreak management. Methods: We conducted a targeted narrative review of WHO/CDC/Infectious Diseases Society of America (IDSA) guidance and peer-reviewed studies (January 2015–August 2025), emphasizing adult inpatient care. This narrative review synthesizes recent evidence and discusses theoretical implications for practice, rather than establishing formal guidelines. Evidence was synthesized into pragmatic practice statements on detection, diagnostics, isolation/cohorting, antivirals, chemoprophylaxis, vaccination, surveillance, and communication. Results: Early recognition and test-based confirmation are pivotal. For inpatients, nucleic-acid amplification tests are preferred; negative antigen tests warrant PCR confirmation, and lower-respiratory specimens improve yield in severe disease. A practical outbreak threshold is ≥2 epidemiologically linked, laboratory-confirmed cases within 72 h on the same ward. Effective control may require immediate isolation or cohorting with dedicated staff, strict droplet/respiratory protection, and daily active surveillance. Early oseltamivir (≤48 h from onset or on admission) reduces mortality and length of stay; short-course post-exposure prophylaxis for exposed patients or staff lowers secondary attack rates. Integrated vaccination efforts for healthcare personnel and high-risk patients reinforce workforce resilience and reduce transmission. Conclusions: A standardized, clinician-led bundle—early molecular testing, do-not-delay antivirals, decisive cohorting and Personal protective equipment (PPE), targeted chemoprophylaxis, vaccination, and disciplined communication— could help curb transmission, protect vulnerable patients and staff, and preserve capacity. Hospitals should codify COVID-era layered controls for seasonal influenza and rehearse unit-level outbreak playbooks to accelerate response and recovery. These recommendations target clinicians and infection-prevention leaders in acute-care hospitals. Full article

Background: The R21 malaria vaccine is a next-generation, WHO-prequalified vaccine that was introduced to reduce the burden of clinical malaria. In alignment with WHO recommendations, multi-dose vaccine presentations are preferred for large-scale immunization and inclusion in the Expanded Programme on Immunization (EPI). Accurate protein quantification is a critical quality control parameter for lot release, but it remains challenging when the antigen is present at low protein concentrations or formulated with complex matrices, including adjuvants, stabilizers, and preservatives. Methods: In this study, multiple protein estimation methods including Micro-BCA, BCA, and Bradford assays were evaluated to determine their suitability for quantifying the R21 antigen formulated with Matrix-M1 adjuvant and 2-PE preservative. The Bradford assay was selected as the most appropriate method, based on a comparative assessment of precision, accuracy, and linearity. Further optimization was undertaken to identify suitable buffer systems, and the method was validated in accordance with ICH Q2(R2) guidelines. Results: Validation results demonstrated that the assay is specific, accurate, precise, and repeatable, with a limit of quantitation (LOQ) of 2 µg/mL. The method demonstrated comparable performance to ELISA and was found to be sensitive enough to detect changes in antigen concentration resulting from unintended adsorption of R21 to vial surfaces. The assay offers a rapid, high-throughput, and cost-effective solution for protein quantitation in commercial manufacturing, lot release, and stability studies. The protein content of the drug product, quantified using the Bradford method, demonstrated robust in vivo immunogenicity in both release and stability studies. Conclusions: The robustness and reproducibility of the assay establish a new benchmark in quality control for virus-like particle (VLP)-based vaccines with complex formulations, thereby supporting the precision and reliability required for global malaria prevention efforts. Full article

Background/Objectives: Sepsis survivors frequently experience long-term complications known as Post-Sepsis Syndrome. Many survivors and their relatives express ongoing dissatisfaction with the quality and accessibility of health information. Yet the specific informational needs and preferred formats remain insufficiently defined. To identify the informational needs of sepsis survivors and their relatives across different stages of illness and recovery. Methods: This qualitative study, conducted within the AVENIR project, included semi-structured telephone interviews with 12 survivors and 6 relatives in Germany. Interviews were transcribed verbatim and analyzed using qualitative content analysis according to Mayring. Results: Eighteen interviews highlighted phase-specific gaps in information. Relatives reported urgent needs for timely, comprehensible and empathetic communication during the ICU phase, often while under decision pressure. Survivors described limited capacity to process information during the acute phase and sought orientation only after cognitive and emotional stabilization. After discharge, both groups reported an “information vacuum”, marked by insufficient guidance on long-term physical and psychological consequences, rehabilitation, vaccination, and follow-up care. Many participants received no informational material, or only general or inconsistent information. Desired content emphasized basic sepsis knowledge, explanations of persistent symptoms, practical coping strategies, and navigation of support services. Preferred formats included peer support and repeated, personal conversations with healthcare professionals, complemented by trusted online and printed resources. Conclusions: Sepsis survivors and relatives experience notable, role- and phase-specific information deficits that extend from the ICU into long-term recovery. Timely, reliable, and accessible information may help reduce uncertainty, support coping, and strengthen autonomy for both survivors and relatives. Full article

Background/Objectives: Despite global efforts, COVID-19 revealed severe spatial vaccine inequities, disproportionately affecting low- and middle-income countries (LMICs). Scholars across disciplines proposed numerous—and often competing—terms and theories to explain these disparities. In this review and within the context of the COVID-19 pandemic, we assess the usage, definition, and appropriateness of these terms and their linked theories or frameworks. Methods: We conducted a scoping review aiming to clarify key definitions, concepts, and frameworks of eight prominent terms used in the literature regarding COVID-19 global and/or regional vaccine inequities (i.e., vaccine nationalism, vaccine apartheid, vaccine colonialism, vaccine imperialism, vaccine racism, vaccine diplomacy, vaccine solidarity, and vaccine internationalism). The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for Scoping Reviews and included papers from January 2020 to the end of October 2024. Results: We included 79 papers in our study. The majority (71%) were published in 2021–2022, with less than one-quarter authored by scholars from LMICs. Vaccine imperialism was consistently defined but rarely used, while vaccine nationalism and vaccine apartheid appeared more frequently with varied meanings. Yet, in most cases, all of these concepts identified economic interests of vaccine-producing countries as the root cause of the observed vaccine inequities. Vaccine diplomacy showed similar ambiguity, viewed by some as worsening inequities and by others as potentially mitigating them. The terms vaccine racism, vaccine colonialism, and vaccine solidarity were not explicitly identified but appear to be embedded within the definitions of other prominent terms detected. Conclusions: Across the preselected terms examined, we found numerous—and often conflicting—definitions, revealing the fragmented and competing understandings of the major drivers fueling global vaccine inequities. This lack of coherence inhibits evidence synthesis or shared theoretical progress but, most importantly, might undermine current and future efforts to address these inequities. Full article

Background: Rabies is a fatal yet preventable zoonosis. In Saudi Arabia, uneven surveillance and limited public awareness may delay post-exposure prophylaxis (PEP). In Makkah, where residents regularly encounter free-roaming dogs, knowledge gaps could elevate exposure risks. Objectives: This study aims to assess public knowledge, attitudes, and post-bite practices regarding rabies, including wound washing and access to PEP among adult residents of the Makkah Region, and to examine associations with pet dog ownership. Methods: A cross-sectional survey was conducted in the Makkah Region (March–June 2025). An online validated bilingual questionnaire targeted residents ≥ 18 years via social media. Descriptive statistics, chi-square tests, 95% confidence intervals, and binomial logistic regression were applied in IBM SPSS v26; p < 0.05 was significant. Results: Of 523 respondents, 91.8% lived in Makkah city, 52.8% were female, and the age distribution was 18–24 years (44.2%), 25–34 years (35.6%), 35–44 years (12.0%), and ≥45 years (8.2%). Pet dog ownership was rare (1.9%), yet 39.4% reported stray dogs in their communities. Overall, 60.6% knew what rabies is and 63.7% knew it is vaccine-preventable, but 52.2% wrongly believed that transmission occurs only via dog bites. Hospitals (79.7%) and health centers (79.2%) were the most cited vaccination sites; social media was the dominant information source (74.6%). No significant association was found between pet ownership and rabies awareness (all p > 0.05). In multivariable regression (n = 509), adequate rabies knowledge increased the odds of an appropriate intended response (AOR 1.85, 95% CI: 1.27–2.68). Participants aged 30–40 years and those >50 years had significantly lower odds (AOR 0.45, 95% CI: 0.24–0.85 and AOR 0.23, 95% CI: 0.09–0.56, respectively). Conclusions: Despite moderate awareness, critical misconceptions and inconsistent first aid intentions persist. Priority actions include clear, locally adapted education on immediate wound washing and prompt PEP, standardized bite management pathways across facilities, reliable access to vaccines and immunoglobulin, and targeted social media micro-campaigns. By identifying public misconceptions, knowledge gaps, and preferred communication channels, this study provides baseline evidence to guide community awareness programs, intersectoral collaboration, and One Health-based surveillance essential for Saudi Arabia’s progress toward the global “Zero rabies by 2030” goal. Full article

Objective: Online maps and booking tools aim to reduce barriers to vaccination by helping users locate nearby clinics, understand service availability, and provide information about vaccination choices. The aim of this research was to explore the potential of online vaccination booking and mapping tools in facilitating antenatal vaccination uptake among Māori and Pacific hapū māmā (pregnant women) in Aotearoa. Methods: This was a qualitative descriptive study that used kaupapa Māori methodology. Focus groups with hapū māmā and semi-structured interviews with healthcare workers were conducted. Transcripts were analyzed thematically. Results: Seven hapū māmā and forty healthcare professionals participated. Three main themes were developed from interviews with hapū māmā: (i) limited awareness of online maps and bookings for vaccination services; (ii) the need for accessible, user-friendly information; and (iii) preference for flexible booking systems. Three themes were developed from the healthcare worker interviews: (i) difficulties with accessibility; (ii) promotion of tools; and (iii) usability of online platforms. Discussion: Although antenatal vaccinations are publicly funded, systemic and digital barriers persist, especially for Māori and Pacific communities. Online tools have the potential to support maternal vaccination, but require improved visibility, cultural relevance, and functionality to be effective. Full article

Background: Varicella zoster virus (VZV) remains a significant cause of pediatric morbidity in populations in Lebanon, yet comprehensive data on population immunity and vaccination uptake are limited. This study aimed to estimate VZV seroprevalence and identify factors associated with immunity and vaccine uptake among children and adolescents in Northern Lebanon. Methods: A cross-sectional study was conducted among 180 participants aged 1–18 years recruited from urban and rural settings in North Lebanon. After receiving informed parental consent, sociodemographic and clinical information were collected via structured questionnaires. Anti-VZV IgG and IgM antibodies were measured using validated Enzyme-Linked Immunosorbent Assays (ELISA). Associations with seropositivity and vaccination uptake were analyzed using multivariable logistic regression. Results: IgG seroprevalence was 79.4% (95% CI: 72.7–85.1), indicating prior exposure or immunization, while IgM antibodies, reflecting recent infection, were detected in 5.0% (95% CI: 2.3–9.4) of participants. Among vaccinated participants, IgG seropositivity was 63.6% (95% CI: 43.5–83.7) in the one-dose group and 89.5% (95% CI: 83.0–96.0) in the two-dose group. Completing the two-dose regimen was significantly associated with a higher IgG seropositivity (OR = 0.110, 95% CI: 3.2–52.4, p = 0.002). Parental reporting of history of varicella showed high sensitivity (99.0%) and overall accuracy (90.8%) in predicting seropositivity. Primary vaccination barriers included preference for natural infection (67%), perceived non-necessity (19%), and cost (10%). Regular pediatric follow-up strongly predicted vaccination (OR = 15.239, p < 0.001), whereas low parental awareness was associated with decreased vaccine uptake (OR = 0.027, p = 0.015). Conclusions: Suboptimal VZV vaccination coverage and persistent susceptibility underscore the need to integrate varicella vaccination into Lebanon’s national immunization schedule. Targeted educational efforts and enhanced pediatric healthcare engagement are critical to increasing vaccine uptake and reducing disease burden. Full article

Background: Identifying latent tuberculosis infection (LTBI) is critical for pediatric TB control in China, especially among students from high-burden areas. With no gold-standard test, we compared the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), focusing on factors related to test discordance. Materials and Methods: TST was administered to 1047 local and 900 migrant students; all migrants also received IGRA. TST cutoffs of 5 mm and 10 mm were applied. Agreement was measured using Cohen’s Kappa, and determinants of discordance were analyzed with binary logistic regression. Results: Migrant students had higher TST positivity than locals (28.89% vs. 19.67%, p < 0.001). The agreement between IGRA and TST-12 mm (k = 0.491) was higher than that observed for TST-10 mm (k = 0.466) and TST-5 mm (k = 0.356). Subgroup analyses across sex, residence, ethnicity, BMI, TB contact, and BCG history confirmed superior consistency for TST-12 mm. Individuals without BCG vaccination were less likely to show discordance between IGRA and TST-12 mm (OR = 0.32, 95% CI: 0.10–0.81). Conclusions: Using a 12 mm cutoff improves TST accuracy for students from high-burden areas. IGRA should be preferred for individuals with BCG vaccination history. Full article

Background: Human immunodeficiency virus (HIV) affects more than 39 million people worldwide, with Uganda ranked 10th among countries with the highest number of cases. As new preventative HIV injectables emerge, it is vital to think about how best to tailor strategies to promote these injectable drugs, like PrEP and vaccines, when available, to the different populations most in need. Discrete choice experiments (DCEs) are economics-derived methods used to determine factors that influence engagement in a certain behavior. Objective: This study used a DCE to determine the preferences for a preventative HIV injectable drugs/vaccines among people at risk of HIV acquisition in urban and peri-urban areas of Uganda. Methods: In June 2024, we implemented a cross-sectional DCE survey in three urban sites in Uganda in English and Luganda. The survey collected information on demographics, HIV risk, vaccine confidence and responses to the 13 injection product choice tasks presented to determine preferences. We used community-based, respondent-driven sampling methods to recruit participants from three key populations: (1) female sex workers; (2) people who identify as lesbian, gay, bisexual or transgender; and (3) young women (18–24 years). We collected the data on tablets using the Sawtooth Lighthouse Studio software (v. 19.15.6), taking into consideration privacy and confidentiality, given the sensitivity of the information and recent governmental policies in Uganda. Data were analyzed using a split-sample mixed logit regression analysis. The study was approved by local ethical regulatory bodies. Results: From the total of 406 participants screened for this study, 376 participants met the eligibility criteria and were included in the final analysis (85 young women, 159 female sex workers, and 132 who identified as lesbian, gay, bisexual or transgender). The average age was 23.7 (SD: 5.7). The majority of participants had received some secondary school or vocational school (202, 53.7%) The attributes that explained the preferences were primarily severe compared to mild side effects (β: −0.69, 95% CI: −0.78, −0.60), a 30% increase in vaccine/drug effectiveness (β: 0.39, 95% CI: 0.34, 0.44), and a 50,000 UGX (or USD ~13.64) increase in cost (β: −0.22, 95% CI: −0.27, −0.17). There were no significant differences between the preferences for different injectable types. The sensitivity analyses suggested potential differences in preferences by the amount of help participants received from research assistants when completing the survey, although not by income level. Conclusions: Side effects had the greatest impact on participants’ preferences for injectable HIV prevention methods, followed closely by effectiveness and cost. It is therefore essential to develop affordable or free prevention options with minimal side effects. Policymakers should focus on reducing the financial barriers to access and emphasize transparent communication about the effectiveness and safety of these injectables in health promotion campaigns to maximize adoption and improve public health outcomes. Full article

This white paper, prepared by a consortium of Canadian national and provincial organizations and experts, outlines urgent strategies to curb the rising incidence of HPV-related cancers, of which, cervical cancer is currently the fastest-growing cancer in Canada. Despite school-based vaccination programs, the national HPV vaccine uptake remains suboptimal at about 64%, far below the 90% coverage target by 2025 necessary to eliminate cervical cancer by 2040. The report emphasizes a multi-pronged approach: support access to HPV vaccination with expanded funding policies and education around school-based programs while addressing inequities in underserved populations. HPV testing is highlighted as the preferred method for cervical cancer screening, offering higher sensitivity than Pap smears. Self-collection is presented as an innovative strategy to reduce barriers, particularly for marginalized groups, with promising evidence from Canadian pilots and international models. Crucially, we call for investment in comprehensive, population-based databases to track vaccination, screening participation, and follow-up care. Robust registries would allow targeted outreach to under- or never-screened individuals, ensure timely follow-up of abnormal results, and measure the impact of prevention programs across Canada. With vaccination, equitable access to HPV testing, integration of self-collection, and strong data systems, Canada can achieve its goal of eliminating cervical cancer within two decades. Full article