Search Results (574)

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

Introduction: The proportion of elderly patients with IBD is steadily increasing due to the aging population and improved survival. Patients in this age group present specificities in diagnosis and treatment, particularly regarding the use of biological agents, where immunosenescence, multimorbidity, and polypharmacy affect the precise assessment of benefit and risk. Aim: This systematic review, which was conducted in accordance with the PRISMA 2020 statement, aims to synthesize available data on the epidemiology, clinical characteristics, and therapeutic management of IBD in the elderly, with emphasis on the most recent data and practical guidelines for the use of biological therapies. Methods: A systematic search of PubMed, Scopus, and Embase was conducted. A total of 40 studies were included, comprising 5 randomized controlled trials, 15 prospective cohort studies, and 20 retrospective observational studies. Eligible studies included randomized controlled trials, observational cohort studies, and population-based analyses. Given substantial clinical and methodological heterogeneity, findings were synthesized narratively. Data on demographics, disease phenotype, comorbidities, and treatment outcomes were extracted and analyzed. In addition, a narrative synthesis of major randomized trials of biologic therapies, recent guidelines, and data from prospective studies and patient registries was performed with a focus on safety and real-world outcomes in the elderly. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) and the Cochrane Risk of Bias tool. Results: The majority of included studies (85%) were found to have a low to moderate risk of bias, providing a reliable basis for the synthesis. Data show an increasing incidence of IBD in the elderly, often with a milder clinical course and a higher ratio of UC to CD. Multimorbidity and polypharmacy are significant challenges that increase the risk of adverse events. Although classic therapies remain effective, in many cases, a lower threshold is required to initiate advanced therapies, such as biologic agents. Anti-tumor necrosis factor (anti-TNF) agents, as well as biologics with alternative mechanisms of action such as vedolizumab (α4β7 integrin antagonist) and ustekinumab (interleukin-12/23 inhibitor), represent key therapeutic options in elderly patients with IBD. These biologic factors have efficacy comparable to that in younger patients and are considered attractive options due to reduced systemic immunosuppression and favorable safety profiles. JAK inhibitors are a practical option but are associated with an increased thromboembolic risk and require careful patient selection. Older age is associated with higher absolute rates of serious infections, hospitalizations, and, in some series, mortality. Individualized decision-making, including frailty assessment, vaccination coverage, infection control, and dose adjustments based on renal and hepatic function, is essential for optimal care. Conclusions: IBD in the elderly is a distinct clinical entity with unique challenges in diagnosis and management. A multidisciplinary approach and individualized treatment strategies are essential to ensure the balance between disease control and minimizing the risks associated with comorbidity and polypharmacy. Further research, including specifically designed clinical trials, is needed to optimize treatment and outcomes in this unique patient group. Full article

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies. Full article

Background/Objectives: The COVID-19 pandemic disproportionately impacted rural areas across the United States, including rural North Carolina (NC). Consistent with national patterns, COVID-19 vaccination coverage as of December 2022 was higher for non-rural (72%) than rural (58%) NC counties. The role of trusted sources of vaccine information used by rural and non-rural residents is unknown. Methods: Using data from two surveys distributed by the COVID-19 Community Research Partnership from 8 June 2021 through 21 December 2021, we compared self-reported sources of trusted COVID-19 vaccine information by non-rural and rural counties and by county-level predominant political vote in the 2020 Presidential election. Results: While NC respondents were highly vaccinated (94%), fewer residents from rural counties self-reported COVID-19 vaccination than those from non-rural counties (91% versus 95%). The most common reported source of trusted vaccine information was federal health agencies. The proportion citing a federal health agency was higher for respondents from non-rural (80%) than rural (72%) counties and was higher for vaccinated (75%) than unvaccinated (42%) rural respondents. The next two most trusted sources of vaccine information were state/local health officials (48%) and health care providers (42%). Among trusted resources reported by 10–15% of respondents, those from rural counties were less likely to use hospital websites, employers, or news sources than those from non-rural counties. More respondents from counties with >60% vote for the 2020 Democratic Presidential candidate cited federal health agencies, state and local officials, and new sources than respondents from counties with >60% vote for the 2020 Republican Presidential candidate. Conclusions: By identifying the trusted sources of vaccine information for residents in non-rural and rural NC counties, future vaccine implementation efforts can tailor communication efforts to increase vaccine uptake and potentially reduce the rates of hospitalizations and death from vaccine-preventable diseases such as COVID-19 or other future pandemics. Full article

Recognizing cervical cancer as a major public health concern, Romania was among the first EU countries to introduce human papilloma virus (HPV) vaccination in 2008. Despite multiple strategies implemented over the past 17 years, HPV vaccine coverage remains one of the lowest in the EU, while cervical cancer mortality rates are among the highest. To explore the underlying factors, we conducted a cross-sectional study involving 209 family physicians at the national level. The study assessed their attitudes, practice, knowledge, and training needs related to HPV vaccination. The majority of physicians (90%) reported that they provide HPV vaccination services, and 88.5% considered themselves to have good and very good knowledge about HPV, which they routinely share during consultations with patients. However, respondents noted that both physician and public attitudes toward HPV vaccination are only moderately positive, which limits vaccine uptake and the success of prevention efforts. Parental hesitation was the main barrier, mentioned by 81.8% of respondents. The majority (71.3%) of doctors indicated that they were able to adequately respond to patients’ questions, but 81.4% of respondents expressed the view that additional training is needed for healthcare professionals on HPV infection and vaccination. These findings highlight the need for coordinated efforts to increase demand and trust in HPV vaccination. Recommended strategies include targeted professional training, public information campaigns, and the development of strong cross-sector partnerships to support vaccination efforts. Full article

Background: Bordetella pertussis causes pertussis, a respiratory infection with whooping cough. Despite a high vaccine coverage, pertussis resurged post-COVID-19 pandemic. Meanwhile, isolates resistant to macrolides—the first-line therapy—have increased in several countries, including Japan. Culturing B. pertussis and detecting resistance are difficult; reports remain limited in Japan. Methods: From March to August 2025, we collected nasopharyngeal samples from children aged 0–15 years with suspected pertussis at six Japanese clinics. Pediatricians obtained swabs and tested them using gene-amplification kits (e.g., BioFire^® SpotFire^® in four clinics, LAMP Pertussis Detection^® in two clinics). B. pertussis was confirmed by PCR; isolates were sequenced to identify macrolide-resistant mutations. Results: Samples were taken from 54 children, the number of boys and girls was 34 and 20, and their median age was 12 years old. Among 54 B. pertussis isolates, 43/52 (82.7%) sequenced strains harbored the A2047G mutation associated with macrolide resistance. Resistance rates at each clinic varied from 40% to 96%. Conclusions: These findings indicate a post-pandemic rise in macrolide-resistant B. pertussis in Japan. Ongoing resistance surveillance is essential, and repurposing residual clinical samples after routine testing is useful given culture and detection challenges. Full article

Cervical cancer remains the fourth most common malignancy among women worldwide. Despite well-developed prevention measures, incidence and mortality continue to rise, especially in low- and middle-income countries due to low screening coverage and unavailability of human papillomavirus (HPV) vaccination. The cervical cancer screening coverage could be improved by the implementation of a self-sampling modality for HPV testing. Multiple research pieces support the validity and reliability of a self-sampling modality as an alternative approach to clinician-collected samples for primary cervical cancer screening via HPV genotyping. Moreover, growing research evidence on the self-sampling modality reception shows high acceptance of the method among screened populations. Studies on the self-sampling approach economic efficiency also revealed a high cost-effectiveness of HPV testing through a self-sampling modality compared to other screening modalities for cervical cancer. It is specifically important for low-resource settings, which should use the self-sampling cost advantages to improve cervical cancer screening coverage by attracting underscreened populations. Overall, self-sampling modality has a higher participation rate and better patient satisfaction reported; thus, the method is highly recommended by the World Health Organization for cervical cancer screening. Full article

In southern Brazil, dengue transmission in the state of Paraná has shown a significant increase in the number of cases since the first recorded occurrence in 1995, with more frequent outbreaks in the west, northwest, and north of the state. We evaluated the impact of a campaign of dengue vaccination administered to a fraction of the population in 30 municipalities in the state by conducting a 15-year interrupted time-series ecological study using data obtained from an official Brazilian data register. We modeled dengue incidence using Poisson regression adjusted by covariates (demographic, climate, and epidemiological factors), allowing for specific temporal variation for each site. A reduction of 18.7% in dengue incidence rate was estimated for a vaccination coverage of 100%. Although there was an increase in the crude dengue incidence rate, considering the three-dose coverage achieved in the municipalities, we estimated an 8.2% relative reduction in the incidence rate. This reduction would increase to 17% with a hypothetical coverage of 90%. The campaign was more effective in small municipalities since they had higher vaccination coverage. These findings underscore the significant impact of the vaccination campaign on reducing dengue incidence trends across the targeted municipalities. Full article

Objective: To explore the problems with non-National Immunization Program vaccinations in Hubei Province and to provide the basis for follow-up vaccination and management. Methods: Vaccination data on non-NIP/NIP vaccine doses were extracted from the Hubei Provincial Immunization Planning Information Management System. Descriptive epidemiological analyses were conducted to examine dose administration, vaccine-type composition, regional distribution, and substitution patterns. The trend χ² test was used to assess temporal significance. Multistage regression analysis was performed using Joinpoint software. Results: From 2011 to 2024, a total of 91,009,259 doses (annual average: 6,500,661) with 35 types of non-NIP vaccines were administered in Hubei Province, China. The top five vaccines by doses administered were influenza vaccine, rabies vaccine, Hemophilus influenzae type b conjugate vaccine, varicella attenuated live vaccine, and enterovirus 71 inactivated vaccine. Before 2024 (2011–2023), vaccine utilization showed a long-term upward trend: per 10,000, population usage rose from 657.07 (2011) to a peak of 2393.21 (2023) (Increase: 264.22%, χ² = 138.62, p < 0.05) (AAPC = 10.92%, p < 0.05) and non-NIP’s share of total vaccines increased from 25.52% (2011) to 65.95% (2023), (Increase: 154.33%, χ² = 89.47, p < 0.05) (AAPC = 8.74%, p < 0.05). A notable reversal occurred in 2024. Non-NIP doses dropped from 13,971,544 (2023) to 10,238,861 (2024) with population usage falling from 2393.21 (2023) to 1755.03 (2024) (decrease: 26.66%) per 10,000, with the top three declines being in inactivated polio vaccine (IPV) (decrease: 49.53%), influenza vaccine (decrease: 44.21%), and oral rotavirus attenuated live vaccine (decrease: 43.50%). The total number of substitutive non-National Immunization Program (non-NIP) vaccine doses administered reached 16,618,755, with an overall substitution rate of 10.10%. This rate showed a steady upward trend from 5.57% in 2011 to 24.74% in 2023 (trend χ² = 15.11, p < 0.05), yet it increased to 28.03% in 2024. Conclusions: Non-NIP vaccines and NIP-substitute use grew steadily for over a decade, then contracted sharply in 2024. Decision-makers should investigate the sudden dip, differentiate discretionary from replacement demand, and reallocate funds to sustain equity and prevent further erosion of coverage. Full article

Background: Children with congenital heart disease (CHD) are at substantially increased risk for respiratory infections, which occur more frequently and with greater severity than in healthy peers. This heightened vulnerability stems from multifactorial immune impairment, including defects in innate and adaptive immunity, chronic inflammation related to abnormal hemodynamics and hypoxia, reduced thymic function, and genetic syndromes affecting both cardiac and immune development. Viral pathogens—particularly respiratory syncytial virus (RSV), influenza viruses, and SARS-CoV-2—account for most infections, although bacterial pathogens remain relevant, especially in postoperative settings. Methods: This narrative review summarizes current evidence on infection susceptibility in children with CHD, the epidemiology and clinical relevance of major respiratory pathogens, and the effectiveness of available preventive measures. Literature evaluating immunological mechanisms, infection burden, vaccine effectiveness, and passive immunization strategies was examined, along with existing national and international immunization guidelines. Results: Children with CHD consistently exhibit higher rates of hospitalization, intensive care unit admission, mechanical ventilation, and mortality following respiratory infections. RSV, influenza, and SARS-CoV-2 infections are particularly severe in this population, while bacterial infections, though less common, contribute substantially to postoperative morbidity. Preventive options—including routine childhood vaccines, pneumococcal and Haemophilus influenzae type b vaccines, influenza vaccines, COVID-19 mRNA vaccines, and RSV monoclonal antibodies—demonstrate strong protective effects. New long-acting RSV monoclonal antibodies and maternal vaccination markedly enhance prevention in early infancy. However, vaccine coverage remains insufficient due to parental hesitancy, provider uncertainty, delayed immunization, and limited CHD-specific evidence. Conclusions: Respiratory infections pose a significant and preventable health burden in children with CHD. Enhancing the use of both active and passive immunization is essential to reduce morbidity and mortality. Strengthening evidence-based guidelines, improving coordination between specialists and primary care providers, integrating immunization checks into routine CHD management, and providing clear, condition-specific counseling to families can substantially improve vaccine uptake and clinical outcomes in this vulnerable population. Full article

Introduction: Children with chronic kidney disease (CKD) are susceptible to infections due to impaired immunity, immunosuppressive treatments, and dialysis, which lead to increased mortality, morbidity, and hospitalization rates. Immunization is an efficient preventive strategy, but despite the long-existing guidelines, vaccination rates of children with CKD remain suboptimal. Aim: This review aims to summarize the available data on vaccine-preventable infection morbidity and vaccination coverage in children with CKD, the reasons of vulnerability and suboptimal vaccination of this population and strategies that have been proposed for their overcoming. Results: Vaccination coverage studies for children with CKD are limited and outdated but, despite their variability, they confirm suboptimal vaccine coverage. The vulnerability of children with CKD to infectious dis-eases has been better understood with advanced molecular studies of their immune re-sponse. Several barriers, some of them unique to this population, hamper adherence with vaccination guidelines. Targeted interventions at different levels that have already been tried in adults with CKD, such as enhanced communication with families, cocooning strategies for the most vulnerable, education of specialists on vaccines, and organization of vaccination teams, seem promising in improving vaccination rates and infection prevention. Conclusions: The suboptimal protection from infections of children with CKD can be improved with prioritization of vaccination in their complicated care. Full article

Background: Global declines in immunisation rates and a resurgence in measles pose a threat, even in countries like Australia that have achieved elimination status. National coverage in Australia is measured at static timepoints, so it is unclear at what age children received their vaccines. This may permit the emergence of immunity gaps, leaving children susceptible to measles between those reporting timepoints. Methods: A cross-sectional retrospective analysis was conducted using routinely collected data from the Australian Immunisation Register for children residing in Hunter New England Local Health District (HNELHD), New South Wales, born from 1 January 2015 to 1 June 2019 as a quality improvement initiative. Coverage, age at immunisation, and on-time immunisation were described by demographic, local geographic and age variables. Reverse survival analysis was conducted to determine the timing of achieving 95% MCV2 coverage. To ensure the cultural integrity of the research, an Aboriginal researcher co-led the design, analysis and interpretation of results. Results: The analysis included 53,390 children. Measles coverage exceeded the national and international target of 95% MCV2 coverage, with coverage in Aboriginal children surpassing national rates for all children. Pockets of low coverage were identified in several smaller geographic areas and subpopulations. Median age of MCV1 receipt was 375 days (IQR: 369–390 days), and MCV2 was 560 days (IQR: 551–583 days). More recent birth cohorts had earlier immunisation. On-time immunisation rates were high, and most children receiving measles immunisation late were still immunised within six months of the schedule date. The 95% MCV2 coverage threshold was achieved at 1582 days of age. Conclusions: Robust measles immunisation coverage and timeliness were found in HNELHD, Australia. Timeliness data analysis is a useful adjunct to static coverage data in understanding immunisation protection. Improving immunisation data availability, accessibility, and timeliness offers potential to better inform targeted public health activity. Full article

Background: Socioeconomic disparities may affect COVID-19 booster vaccination uptake, potentially undermining public health efforts. This study assessed the association between first booster dose coverage and municipal socioeconomic deprivation in the Apulia region of southern Italy. A secondary objective was to evaluate whether SARS-CoV-2 incidence modified this relationship. Methods: We conducted a retrospective observational study including Apulian residents aged ≥5 years from 1 January 2021, to 31 December 2022. First booster doses were identified using an algorithm based on dose chronology and national guidelines. Vaccination and infection data were retrieved from regional databases. Socioeconomic deprivation was measured using the Social and Material Vulnerability Index (SMVI) developed by the Italian National Institute of Statistics (ISTAT). Booster coverage was calculated at the municipal level. A multivariable Poisson’s regression model was used to estimate the association between SMVI and booster uptake, adjusting for age group, primary vaccine type, SARS-CoV-2 incidence, and municipal vaccination rates. Analyses were stratified by sex. Results: A total of 2,732,258 individuals received a first booster dose. Booster coverage decreased with increasing SMVI. Among females, a significant reduction was observed in the highest deprivation category (RR > 102 vs. <99: 0.95; 95% CI: 0.94–0.97) and it was similar in males (RR: 0.95; 95% CI: 0.93–0.96). A significant interaction between age and deprivation was found in both sexes, with a sharper decline in younger individuals. Municipal vaccination rates were positively associated with booster uptake. SARS-CoV-2 incidence was positively associated with uptake only in males. Conclusions: The analysis revealed a significant association between lower socio-cultural level and lower adherence to the first booster dose of the COVID-19 vaccine. The decline is more pronounced among subjects younger than 50 years with high levels of vulnerability. The findings of this study suggest that to overthrow vaccine hesitancy, knowledge of the social setting allows for targeted communications to the different groups in the population. Further research is needed to define different approaches in the different social groups. Full article

Background/Objectives: To estimate (a) survival after SARS-CoV-2 infection by COVID-19 vaccination status, and (b) COVID-19 vaccine effectiveness in a middle-income country. Methods: In this retrospective cohort study, secondary analysis of data from the national surveillance and vaccination databases was conducted. The primary outcome was COVID-19 death classified based on the WHO criteria. Data were analysed by vaccination status, age, sex, geographic region, and wave period. Kaplan–Meier curves were plotted; log-rank followed by multiple comparison tests were used to compare survival probabilities. Cox proportional-hazards models with time-varying covariates estimated hazard ratios (HR). Vaccine effectiveness was computed as (1-HR) × 100. Results: A total of 55,299 COVID-19 cases were captured by the national surveillance system between 1 April and 31 December 2021. Of these, 45,774 (1581 vaccinated, 44,193 unvaccinated) were included in the analysis. After a follow-up of 327 days, there were 22 deaths (case fatality rate (CFR) 1.5%) among 1581 COVID-19 vaccinated cases and 1821 deaths (CFR 4.1%) among 44,193 unvaccinated cases. There was one COVID-19 death per 10,000 person days in vaccinated cases compared with 2.7 COVID-19 deaths per 10,000 person days in unvaccinated cases. After adjustment for age, sex, and geographic region, the effectiveness against COVID-19 death across all vaccine types (ChAdOx1 nCoV-19, BNT162b2, Ad26.COV2.S, or BBIBP-CorV) was 68% (95% CI: 51–79). Effectiveness was 75% (95% CI: 59–84) for ChAdOx1 nCoV-19. Vaccine effectiveness across all vaccine types was higher in younger cases, (82% (95% CI: 52–93), 18–64 years vs. 63% (95% CI: 41–77), ≥65 years), females (84% (95% CI: 63–93), females vs. 53% (95% CI: 24–71), males) and those vaccinated in the past 3 months (71% (95% CI: 47–85), past 0–3 months vs. 56% (95% CI: 23–75), 3–6 months). Conclusions: COVID-19 vaccines were effective in preventing COVID-19 death in a population with low vaccination coverage. Limitations of the analysis include the use of surveillance data (under-reporting of cases, missing data), exclusion of partially vaccinated cases, and insufficient data on important confounders (circulating variants and comorbidities). Full article

Background: Influenza presents significant risks to older adults; however, vaccination coverage in China remains low despite robust recommendations. Factors such as vaccine hesitancy, physician recommendations, health status, and socioeconomic conditions influence vaccination rates. This study uses large-scale influenza vaccination data from urban older adults in six cities and applies structural equation modeling to investigate the determinants of both influenza vaccination uptake and future intention. Methods: A cross-sectional survey was conducted from December 2024 to January 2025 across six major Chinese cities, involving 13,363 community-dwelling adults aged ≥60 years. Vaccine hesitancy was measured using the validated 5C scale. Structural equation modeling with weighted least squares mean and variance adjusted estimation was employed to assess direct and indirect effects of physician recommendation, socioeconomic status, medical status, and subjective health on influenza vaccination uptake. Results: The vaccination uptake rate is 34.05%, while the intention rate is 32.20%. Vaccine hesitancy is the strongest negative predictor of vaccination (β = −0.488, p < 0.001). Physician recommendation has the largest total effect (β = 0.351), with 45.60% of this effect mediated through reduced vaccine hesitancy. Medical status is directly associated with lower uptake; it consistently promoted intention. Higher socioeconomic status also positively affected vaccination (total effect = 0.167), partly via lower hesitancy. Conclusions: Vaccine hesitancy serves as a pivotal mediator in influenza vaccination uptake and intention among Chinese older adults. Strengthening physician recommendations and addressing socioeconomic disparities are key strategies to reduce hesitancy and improve coverage. Full article