Search Results (196)

Despite longstanding vaccine availability, human papillomavirus (HPV) remains the most common sexually transmitted infection in the United States and a leading cause of preventable cancers. Additionally, HPV vaccination rates remain below other routinely recommended adolescent immunizations, particularly in rural populations. This study aimed to identify barriers related to healthcare access, socioeconomic conditions, cultural beliefs, and provider–patient communication in rural communities. A bibliographical review of articles published in English from 2020 to 2025 and an analysis of national datasets were conducted to establish trends in HPV vaccination rates. State-level HPV vaccination data for adolescents aged 13–17 years were obtained from America’s Health Rankings and the Centers for Disease Control and Prevention National Immunization Survey-Teen. States were classified as predominantly rural or urban using Rural–Urban Continuum Codes, and mean vaccination completion rates were compared. The mean HPV vaccination completion rate was lower in rural states (60.55%) compared to urban states (67.31%); however, this difference did not meet the selected threshold for statistical significance (p = 0.025). Barriers identified in the literature included reduced access to healthcare, differences in provider communication, socioeconomic constraints, and limited health literacy in rural communities. Of the identified barriers, healthcare provider recommendations emerged as one of the strongest predictors of vaccine acceptance. These findings highlight multilevel determinants contributing to differences in HPV vaccine uptake and underscore the need for targeted, evidence-based strategies to improve vaccine access and coverage in underserved adolescent populations. Full article

Ebola virus disease (EVD) remains one of the most severe viral hemorrhagic fevers, with recurrent outbreaks challenging global healthcare systems. This narrative review traces the evolving epidemiology of EVD from the first recognized outbreaks in 1976 to the ongoing 2026 Bundibugyo virus public health emergency in the Democratic Republic of the Congo (DRC) and Uganda. Over nearly five decades, the recognized range of Ebola outbreak contexts and amplification mechanisms has broadened considerably: rural zoonotic spillovers remain the predominant mode of emergence, but the scale and reach of subsequent transmission increasingly depend on where introductions occur, on delays in detection, on population mobility, on ecological disruption, on armed conflict, on healthcare-associated transmission, and on viral persistence in survivors. Major advances in molecular epidemiology and genomic surveillance have improved outbreak investigation, enabling real-time transmission reconstruction and detection of survivor-linked resurgence. Vaccination, particularly ring vaccination with rVSV-ZEBOV, has shown high effectiveness against Zaire ebolavirus, yet vaccine equity gaps and the absence of licensed vaccines for Sudan virus and Bundibugyo virus remain critical vulnerabilities, though new candidate vaccines and therapeutics for Bundibugyo virus entered clinical evaluation in mid-2026. Artificial intelligence and digital technologies, including AI-assisted early warning systems, portable sequencing, drones, blockchain, and mobile health platforms, offer promising tools for outbreak preparedness, but robust evidence of their real-world operational impact during filovirus outbreaks remains limited, and their deployment in low-resource settings faces substantial barriers related to infrastructure, literacy, data costs, and governance. Integrated preparedness frameworks that combine ecological surveillance, resilient healthcare systems, community engagement, and international coordination under a One Health umbrella are increasingly viewed as a strategic necessity. The 2026 Bundibugyo outbreak reaffirms that despite decades of lessons, structural weaknesses in surveillance, response timeliness, and community trust continue to recur. Sustainable, multi-year financing, diversified vaccine platforms, regional manufacturing, and local co-design of digital tools are essential to translate lessons into lasting change. Preparedness is best understood as a continuous process rather than a reactive state. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Background/Objectives: Large language models (LLMs) are increasingly used by the public to seek health information, yet their accuracy in addressing common vaccine myths remains unclear. Sycophantic LLM behavior, where models align with rather than correct user-stated beliefs, poses specific risks in health contexts. Methods: We conducted an exploratory multi-vendor evaluation of three LLMs (GPT-5, Gemini 2.5 Flash, Claude Sonnet 4) using officially curated vaccination myths from Germany’s public health institution and two realistic user framings (curious skeptic, convinced believer). All model responses were independently evaluated by two blinded medical experts for misconception addressal (binary criterion applied to the response text), scientific accuracy, and communication clarity (5-point Likert scales). Additionally, blinded marketing experts ranked models for lay communication clarity. Flesch Reading Ease scores were computed for all outputs. Results: Across all myths, framings, and models (66 response items), both medical raters judged that all responses refuted the targeted misconception; no response affirmed or ignored a myth, including under the adversarial convinced believer framing. Scientific accuracy and clarity ratings were high and tightly clustered (median 4.0–4.5), with no combined score below 3 and substantial inter-rater agreement. Marketing experts independently ranked Gemini 2.5 Flash and GPT-5 highest for lay clarity. Readability analysis revealed generally low accessibility, particularly for the convinced believer framing and for Claude Sonnet 4 outputs. Conclusions: Our findings suggest that general-purpose LLMs can produce scientifically accurate, on-topic rebuttals to widely documented vaccine myths under realistic default conditions, although linguistic complexity and framing-sensitive style may limit accessibility. Whether such outputs change beliefs or behavior in hesitant individuals was not tested. With readability optimization, these outputs could serve as building blocks for myth-debunking tools, given prospective evaluation with behavioral endpoints. Full article

Background/Objective: Vaccine hesitancy continues to pose a challenge to public health, and health literacy has been suggested as a potential factor influencing vaccination attitudes. However, the nature of this relationship and the role of sociodemographic characteristics remain to be clarified. This study aimed to examine the association between health literacy and vaccine refusal and to explore whether this relationship is moderated by education level, age, income, place of residence, and gender. Methods: A cross-sectional nationwide online survey was conducted among 413 adults living in Türkiye. Data was analyzed using SPSS version 22. Distributional assumptions were evaluated using the Kolmogorov–Smirnov test together with skewness and kurtosis values. Moderation analyses were performed using Hayes’ PROCESS macro (Model 1), and statistical significance was set at p < 0.05. Results: The study included 413 participants, most of whom were aged 18–30 years (62.7%) and female (69.3%). Health literacy showed a statistically significant negative association with vaccine refusal (β ranging from −0.30 to −0.72, p < 0.001). Education level was identified as a significant moderator (R² = 0.14), indicating that the strength of this association varied across educational groups. Specifically, the inverse relationship appeared more pronounced in individuals with lower educational attainment and attenuated at higher education levels, becoming non-significant in the postgraduate group. In contrast, age, income, place of residence, and gender did not demonstrate consistent or statistically robust moderating effects. Although rural residence was associated with higher vaccine refusal levels, it did not significantly modify the relationship between health literacy and vaccine refusal. Conclusions: The findings suggest that higher health literacy is associated with lower vaccine refusal; however, this relationship appears to vary by educational level. The modest explanatory power of the models indicates that health literacy alone may not fully account for vaccine-related attitudes. Further research incorporating additional behavioral and contextual factors is warranted to better understand the determinants of vaccine refusal. Full article

Cancer incidence among adolescents is increasing, yet cancer risk reduction education remains largely absent from school-based curricula. This pilot study assessed whether a small-scale early, developmentally appropriate intervention could improve cancer literacy to support long-term risk reduction. This pilot study used a convergent parallel mixed-methods pre–post design to evaluate two separate, 45 min, school-based cancer education interventions delivered to 24 middle-school students in Pennsylvania. The intervention delivered developmentally appropriate content on cancer biology, modifiable risk factors, genetics, HPV vaccination, and self-advocacy using a low-resource, low-investment model easy for schools to implement. Pre- and post-intervention surveys assessed student knowledge, awareness, and health-related perceptions. Survey data were analyzed both descriptively using frequencies and percentages and thematically. Post-intervention results demonstrated substantial improvements across all domains. Correct definition of cancer increased from 16% to 100%. Awareness of modifiable risk factors increased to 96%, sunscreen knowledge to 90%, genetic testing awareness to 83%, and HPV vaccine understanding from 21% to 57%. Students also reported increased confidence in recognizing symptoms and engaging in health-seeking behaviors. Findings suggest that small-scale, school-based cancer education interventions are feasible and effective in improving adolescent cancer literacy. These results support the need for larger, controlled studies to evaluate long-term knowledge retention and behavioral outcomes. Full article

Background: Mpox is a re-emerging viral zoonotic disease that remains relevant for public health preparedness, risk communication, and vaccination literacy. University students are an important population for infectious disease communication because they are socially active, digitally connected, and may act as knowledge multipliers. This study assessed Mpox-related knowledge, risk perception, preventive practices, and willingness to receive Mpox vaccination among university students in Aktobe, Kazakhstan, and identified independent predictors of adequate knowledge and vaccination willingness. Methods: A cross-sectional questionnaire-based survey was conducted among students from three universities. The questionnaire collected socio-demographic characteristics, Mpox-related knowledge, information sources, attitudes, preventive practices, perceived risk, and vaccination willingness. Knowledge was summarized using a three-item score; adequate knowledge was defined as a score of at least 2 out of 3. Two multivariable logistic regression models were fitted: one for adequate Mpox-related knowledge and one for willingness to receive Mpox vaccination. Results: The final descriptive dataset included 482 respondents. Most participants were female (66.8%), from urban areas (80.5%), and aged 17–18 years (61.6%). Only 217 students (45.0%) had previously heard about Mpox, 193 (40.0%) correctly identified rash as the main symptom, and 179 (37.1%) knew that vaccination against Mpox exists. Adequate knowledge was observed in 201 students (41.7%), while only 150 students (31.1%) were willing to receive Mpox vaccination. In the multivariable model, adequate knowledge was independently associated with studying at Marat Ospanov West Kazakhstan Medical University (aOR = 5.66; 95% CI: 2.95–10.84), use of medical websites as an information source (aOR = 1.71; 95% CI: 1.09–2.69), and following infectious disease news (aOR = 2.81; 95% CI: 1.76–4.48). Vaccination willingness was independently associated with considering Mpox a dangerous infectious disease (aOR = 2.04; 95% CI: 1.11–3.77) and perceiving Mpox as a threat to Kazakhstan (aOR = 2.16; 95% CI: 1.30–3.59). Conclusions: Mpox-related knowledge among university students in Aktobe was limited, while vaccination willingness remained low despite moderate perceived risk. Reliable information exposure improved knowledge, whereas vaccination willingness was more strongly associated with perceived disease threat. These findings support university-based health literacy, vaccine literacy, and risk communication interventions aimed at improving preparedness for emerging infectious diseases. Full article

Vaccination stands as a preeminent public health measure in the fight against infectious diseases, with a proven track record of significantly reducing morbidity and mortality rates. However, the presence of vaccine hesitancy and misinformation, particularly evident during the course of the pandemic, has emerged as a significant challenge. The present study analyzes public perceptions of vaccination by examining YouTube comments on 215 vaccine-related videos, which total over 94,000 comments. Employing advanced topic modeling techniques, such as Hierarchical Dirichlet Process (hLDA), Latent Semantic Analysis (LSA), and Non-Negative Matrix Factorization (NMF), the study identifies key themes, including vaccine safety, side effects, pharmaceutical ethics, and public trust in healthcare authorities. The findings indicate that debates frequently center on political, social, and scientific concepts. Vaccine hesitancy has emerged as a pervasive global phenomenon that transcends cultural boundaries. The dissemination of misinformation regarding the efficacy of vaccines and the safety of treatments, such as ivermectin, is a prevalent phenomenon on social media platforms. This poses significant challenges to public health efforts. The subjects of child vaccination and parental standpoints are also recurring topics of concern. This study underscores the pivotal function of digital platforms such as YouTube in influencing public attitudes regarding vaccination. This underscores the necessity for targeted communication strategies, advanced digital literacy, and proactive policies by social media platforms to address misinformation and promote evidence-based information. Such precautions are imperative to sustaining elevated vaccination rates and safeguarding public health in the digital age. Full article

Background: Epidemiological alerts about the possible spread of different pathogens have highlighted the risk of international travelers contracting infectious diseases when visiting endemic areas. The role of travelers in disease transmission underscores the importance of pre-travel consultations, which provide critical information on health risks, vaccinations, and preventive measures. Understanding travelers’ risk perceptions and behaviors is essential for enhancing global health security in the post-pandemic era. Methods: A cross-sectional study (June 2023–January 2024) was conducted by administering an anonymous questionnaire at the Rome-Fiumicino Airport International Prophylaxis Clinic (USMAF-SASN). The questionnaire explored demographics, travel patterns, risk perceptions, vaccination behaviors, and sources of health information. Descriptive statistics and a multivariable logistic regression analysis were performed to identify low-risk perception predictors. Results: Among 217 participants, 89.8% were Italian, with a balanced representation of genders. The primary purpose of travel was tourism (61.6%), followed by work-related trip (23.1%). While 77.1% rated preventive measures as effective, 23.2% evaluated infection risk as low. Being male (aOR 3.63, 95% CI 1.37–9.61), and being a hotel user (aOR 6.27, 95% CI 2.43–16.15), was significantly associated with a lower risk perception. As expected, healthcare professionals and individuals using institutional healthcare sources showed a higher risk awareness. Vaccination uptake at the Airport Clinic was motivated by self-protection, vaccine confidence, and poor time flexibility to access local vaccination services, and last-minute plans, making the airport a more convenient option. Conclusions: Travelers’ risk perception is influenced by gender, profession, accommodation type, and information sources. Public health strategies should enhance health literacy, promote pre-travel consultations, and improve access to preventive services. Strengthening collaborations between health authorities, educational institutions, and the travel sector is key to mitigating health risks and ensuring global health security. Future interventions should address structural vaccination barriers and improve outreach to under-informed travelers. Full article

Objectives: Parental health literacy plays a pivotal role in shaping caregiving practices and influencing their children’s health. The aim of this systematic review is to analyze studies examining health literacy among parents raising children under five, in relation to caregiving practices and children’s health outcomes. Methods: The research was conducted in accordance with PRISMA protocol. The sample of the study was determined by using the terms related to “health literacy” AND “parent” (OR “caregiver” OR “mother” OR “father”) AND “child” AND “measure” (OR “instrument” OR “tool” OR “questionnaire” OR “survey” OR “interview”) in ERIC, PUBMED, Scopus and WOS databases published between 2015 and 2024. Results: Of the 1726 results identified, 18 studies met the inclusion criteria. The reviewed studies on parental health literacy place particular emphasis on oral health literacy, nutrition/food literacy, vaccine literacy, and fever literacy. Conclusions: Based on the included studies, parents’ health literacy is generally found to be significantly associated with the adequate fulfilment of children’s care needs, the implementation of appropriate parenting practices, and the effective management of childhood illnesses (although findings regarding vaccination willingness are inconsistent). Overall, these associations may carry long-term implications for children’s health. Full article

Background/objective: The Immunisation Agenda 2030, led by the World Health Organization, aims to ensure that people of all ages benefit from vaccination. South Africa remains committed to these goals, strengthening childhood immunisation largely through the Expanded Programme on Immunisation. However, despite progress, the number of unvaccinated and partially vaccinated children continues to rise in some urban settings. This study sought to identify barriers to childhood immunisation in selected zero-dose urban communities in Gauteng Province. Methods: A qualitative exploratory–descriptive design was used to examine factors influencing childhood immunisation. Data were collected through seven focus group discussions and fifteen key informant interviews with purposively selected caregivers, community leaders, community health workers and healthcare workers involved in routine immunisation services at public healthcare facilities across the Cities of Johannesburg, Ekurhuleni, and Tshwane. Thematic analysis was conducted using NVivo^® software. Results: The study identified multiple demand-side and supply-side barriers. Demand-side barriers included limited parental knowledge, lack of trust in the government and immunisation services, religious beliefs, migration, and perceptions of caregiver substance use. Supply-side barriers involved distance to the facility, negative healthcare worker attitudes, long queues and waiting times, and frequent vaccine stock-outs. These barriers collectively contributed to missed opportunities and decreased uptake of immunisation services. Conclusions: Childhood immunisation remains a critical and cost-effective public health intervention. The findings demonstrate the complex interplay of individual and system-level factors influencing vaccine demand, uptake and persistent zero-dose status in urban Gauteng communities. Addressing these barriers requires a comprehensive approach that strengthens community trust, improves caregiver vaccine literacy, and ensures accessible, responsive, and respectful immunisation services. Full article

Objectives: We aimed to document the impact of the COVID-19 pandemic on the public’s attitudes and stances towards adult vaccination, as perceived by frontline primary care physicians (PCPs), as well as their proposed strategies to boost vaccine confidence and uptake. Methods: We conducted semi-structured interviews with 25 PCPs, recruited via purposive and snowball sampling from urban, semi-urban, rural and island regions of Greece. Interviews conducted from January to June 2025 were transcribed verbatim, anonymized and analyzed using thematic analysis. Results: PCPs’ views on the impact of the pandemic were conflicting. The pandemic reportedly elevated the importance and necessity of adult immunization, brought immunizations into the patient–PCP agenda, and increased trust in PCPs as well as the uptake of other preventive services. Yet PCPs also underscored the increased difficulty in communicating vaccinations and the spillover hesitancy to vaccines. To strengthen vaccine confidence, PCPs proposed invigorating the public’s health literacy, recommending vaccinations at any PCP–patient encounter, strengthening health workers’ training regarding immunizations and introducing effective health policies on incentives, reinforced PHC services, digital health tools and vaccination sites. Conclusions: Despite heterogenous data on the impact of the pandemic on adult immunization, the urgency to address the challenges and seize the post-pandemic opportunities through public health strategies that reflect health workers’ and communities’ needs and values was underscored. Full article

Background/Objectives: Vaccination represents a significant achievement of public health and should be regarded not only as a protective measure against infectious diseases but also an active preventive intervention and a component of health promotion. Methods: This cross-sectional study assessed vaccination coverage among adults aged ≥60 years who attended a Primary Health Care Center during a predefined period of at least two months (November–December 2025) in a rural area of Crete, Greece, and examined determinants of immunization, including demographic, clinical, psychosocial, and health service utilization factors. The sample comprised 366 participants who consented to complete a structured questionnaire, primarily via interview, followed by verification of vaccination status through medical records. Results: High vaccination coverage was observed for influenza (82.5%), moderate coverage for pneumococcal (68.3%) and herpes zoster (56.0%) vaccines, and very low coverage for tetanus–diphtheria–pertussis booster doses (≈13%) and RSV vaccination (5.2%). For SARS-CoV-2, 96.2% received the three doses which were mandatory during the pandemic years. The overall Vaccination Coverage Score (VCS) averaged 43.1/100, while only 10.1% of participants achieved high coverage. Regression analysis showed that higher educational level, multimorbidity, and extensive use of health services were independently associated with better vaccination coverage (p < 0.05). Conclusions: The findings reveal fragmented vaccination patterns and underscore the need for systematic assessment of adult vaccination status within routine Primary Health Care. Targeted counseling, promotion of health literacy, and preventive vaccination strategies are expected to reduce vaccine-preventable morbidity and support healthy aging. Full article