Search Results (1,559)

Background/Objectives: Vaccine hesitancy remains a significant public health challenge in Japan, particularly following the HPV vaccine suspension (2013–2022) that severely damaged vaccination trust. Although prior studies have linked individual social capital to vaccination behavior in Japan, whether and how personal vaccination beliefs modify this association remains poorly understood. This study examined associations between individual social capital (resources accessed through personal social networks) and COVID-19 vaccination intention, and how these associations interact with personal vaccination beliefs based on the 7C model. Methods: A nationwide web-based survey (January 2024) included 7210 participants aged 20–69. Individual social capital was measured using civic participation, social cohesion (community trust), and reciprocity (mutual helping). Personal beliefs were assessed via the 7C model (psychological vaccination determinants framework) and factor-analyzed. Logistic regression examined associations; interaction analyses tested whether social capital effects differed across belief patterns. Results: Overall, 73.1% expressed intention to receive COVID-19 vaccination for 2024–2025. All social capital components positively associated with vaccination intention: social cohesion (adjusted OR = 1.80, 95% CI:1.58–2.04), reciprocity (adjusted OR = 1.64, 95% CI:1.33–2.02), and civic participation (adjusted OR = 1.29, 95% CI:1.10–1.51). Factor analysis identified three belief domains: individual and collective health responsibility, trust in vaccination systems, and safety concerns. Health responsibility beliefs substantially reduced social capital–vaccination associations when included in models. Safety concerns moderated effects of social cohesion (p < 0.001) and reciprocity (p = 0.011), with stronger effects among those with lower concerns. Civic participation was associated with vaccination intention mainly among those with higher institutional trust. Conclusions: Individual social capital was significantly associated with vaccination intention through complex belief interactions. Safety concerns act as crucial moderators. Multifaceted strategies addressing social capital, safety concerns, and institutional trust may be needed to increase vaccine uptake. Full article

Background/Objectives: The Novavax COVID-19 vaccine (Nuvaxovid™) was authorized in France in December 2021, assisting in ending the global pandemic and providing an alternative to other COVID-19 vaccines. Understanding Nuvaxovid recipients’ profile is essential for guiding vaccination decision-making and maintaining protection amid declining COVID-19 vaccination rates. Methods: This retrospective, observational study characterizes the evolution of French Nuvaxovid recipients’ demographic and clinical characteristics using the Système National des Données de Santé (SNDS) database. Five study seasons (spring 2022, autumn 2022, spring 2023, autumn 2023, spring 2024) were defined based on French vaccination guidelines and Nuvaxovid authorization dates. T-test and Chi-square tests were used to compare between consecutive seasons and subgroups. Results: Nuvaxovid administration was reported in 9805 recipients during spring 2022, 5601 during autumn 2022, 531 during spring 2023, 980 during autumn 2023, and 909 during spring 2024. Statistically significant increases in the proportions of high-risk (spring 2022: 35.4%, spring 2024: 90.5%) and ≥65-year-old (spring 2022: 19.9%, spring 2024: 84.4%) Nuvaxovid recipients were observed, p < 0.05. Comorbidities, notably cardiovascular disease, became progressively more prevalent (spring 2022: 7.1%, spring 2024: 33.7%, p < 0.05). Nuvaxovid was used nationwide, with a higher proportion of recipients in the southeast, a region typically exhibiting lower vaccine coverage. Most Nuvaxovid recipients increasingly received a heterologous regimen (autumn 2022: 91%, spring 2024: 98.6%, p < 0.05), with Nuvaxovid as the ≥4th dose (55–97.2%, p < 0.05). Meanwhile, higher proportions of <65-year-old and not-at-risk recipients received Nuvaxovid as primary series (autumn 2022: 46.9% <65-year-old vs. 5.6% ≥65-year-old, 53.9% not at risk vs. 11.9% at risk, p < 0.05). Conclusions: The use of Nuvaxovid evolved in accordance with changing clinical recommendations, and mix-and-match vaccination strategies and heterologous vaccination patterns suggest that it served as an important protein-based alternative for those switching from other COVID-19 vaccines. Nuvaxovid offers a valuable choice, so that the most vulnerable continue to be vaccinated. Full article

Background/Objectives: Patients with heart failure (HF) are vulnerable to vaccine-preventable infections, yet vaccination data remain limited. We assessed perceived vaccination knowledge, attitudes, self-reported vaccine receipt, and variation by age, sex, region, and delivery pathway among digitally connected patients with HF enrolled in a nationwide telemonitoring program. Methods: This cross-sectional electronic survey was conducted from 5 to 28 November 2025, during the ongoing 2025–2026 influenza and COVID-19 vaccination campaigns, among app-connected Satelia^® Cardio participants across France. Of 4856 invited app-connected patients, 1100 completed the questionnaire (response rate: 22.7%). Uptake of seasonal influenza and COVID-19 booster vaccination for the 2025–2026 season and lifetime receipt of pneumococcal, tetanus–diphtheria–pertussis–poliomyelitis (Tdap-polio), and herpes zoster vaccines were analyzed using Wilson 95% confidence intervals (CIs), age-adjusted logistic regression, and regional models adjusted for age and sex. Results: Respondents had a mean age of 71.5 years (SD: 12.6), and 718 (65.3%) were men. Overall, 87.5% considered vaccination useful, 96.0% knew where to be vaccinated, and 55.1% wanted telemonitoring-based reminders. Current-season reported vaccination was 62.2% for influenza and 31.4% for the COVID-19 booster, whereas lifetime self-reported receipt was 38.5% for Tdap-polio, 34.5% for pneumococcal vaccination, and 11.5% for herpes zoster. Influenza and COVID-19 uptake increased with age, whereas pneumococcal uptake peaked at 65–74 years. Pneumococcal receipt was higher in women than men (42.2% vs. 30.4%; age-adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.29–2.17; p < 0.001). Community pharmacies delivered most influenza and COVID-19 vaccinations. Conclusions: Vaccination attitudes were favorable, while current-season vaccination and lifetime-reported vaccine receipt showed distinct patterns across age groups. These descriptive findings identify potential target groups for future telemonitoring-based preventive interventions, whose effectiveness requires prospective evaluation. Full article

Background: Organized cervical cancer screening aims to reduce the burden of advanced disease through earlier detection. However, a substantial proportion of women continue to present with locally advanced cervical cancer (LACC) requiring definitive chemoradiation. This study evaluated temporal changes in the demographic and clinicopathological characteristics of women with LACC treated with definitive chemoradiation before and after implementation of the organized cervical cancer screening program in Serbia. Methods: This retrospective single-center cohort study included 200 consecutive women with histologically confirmed LACC treated with definitive chemoradiation at the Institute of Oncology and Radiology of Serbia. Two cohorts were analyzed: a pre-screening cohort (2010–2011, n = 100) and a post-screening cohort (2022–2023, n = 100). Demographic and clinicopathological characteristics, including age, histopathology, FIGO stage, lymph node involvement, and geographic distribution, were compared. For study purposes, all patients were retrospectively restaged according to the FIGO 2018 classification using the best available clinical, radiological, and pathological data. Results: Women in the post-screening cohort were significantly older at diagnosis than those in the pre-screening cohort (mean age 54.9 vs. 49.7 years, p = 0.0046), with a substantially higher proportion of patients older than 64 years (28% vs. 2%, p < 0.0001). Although the overall distribution of FIGO stages II–IV did not differ significantly, a marked redistribution of FIGO 2018 substages was observed (p < 0.0001), characterized by an increased proportion of stage IIIC disease and significantly more frequent lymph node involvement (63% vs. 41%, p = 0.0018). Geographic distribution remained stable, with most patients referred from the Belgrade administrative district. Conclusions: This study demonstrated clinically relevant temporal changes in the demographic and clinicopathological characteristics of women requiring definitive chemoradiation for LACC in Serbia. More than a decade after implementation of organized cervical cancer screening, tertiary referral centers continue to manage a substantial burden of patients with locally advanced disease requiring complex, resource-intensive treatment. These findings should not be interpreted as a direct evaluation of the national screening program but may provide valuable insights for healthcare planning in Serbia and other countries with similarly resource-constrained healthcare systems. Strengthening participation in organized screening, ensuring timely diagnostic evaluation, and improving HPV vaccination uptake remain essential to reduce the burden of advanced cervical cancer. Full article

Nanoparticle-based drug delivery systems have become an important component of modern nanomedicine, enabling improved drug protection, controlled release, targeted delivery, and the modulation of pharmacokinetic behavior. Their therapeutic performance is governed by physicochemical properties such as size, shape, surface chemistry, and material composition, which influence biological interactions, biodistribution, cellular uptake, and clearance. This review examines major nanoparticle platforms, including polymeric, lipid-based, inorganic, carbon-based, and hybrid systems, together with passive and active targeting and endogenous and externally triggered release strategies. Current and emerging applications in oncology, infectious diseases, central nervous system disorders, gene therapy, and vaccines are discussed alongside theranostic and combination-delivery approaches. Particular emphasis is placed on computational modeling, artificial intelligence, and digital twins for formulation optimization and personalized nanomedicine. Key barriers to clinical translation, including manufacturing scalability, biological variability, limitations of EPR-mediated targeting, regulatory standardization, and long-term safety, are critically evaluated. Finally, emerging directions in sustainable nanomanufacturing and biomimetic delivery are discussed. By integrating biological mechanisms with computational, manufacturing, regulatory, and clinical considerations, this review provides a translational perspective on advancing nanoparticle drug-delivery systems from laboratory development toward clinical implementation. Full article

Background: Aluminum-adjuvanted hepatitis B vaccines effectively prevent primary HBV infection but predominantly favor humoral immunity and have limited capacity to induce strong cellular responses. To improve immune-response quality, we developed a Ganoderma lucidum polysaccharide-modified hybrid nanoparticle adjuvant (GHNP) for hepatitis B surface antigen (HBsAg) vaccination. Methods: Cationic PEG-PCL/DOTAP hybrid nanoparticles (HNPs) were surface-modified with Ganoderma lucidum polysaccharide (GLP) at different mass ratios and characterized by particle size, polydispersity index, zeta potential, and transmission electron microscopy. Antigen uptake, RAW264.7 cell viability, MHC II expression, and TLR2/4-associated TNF-α secretion were evaluated in vitro. C57BL/6 mice were immunized intramuscularly with PBS, HBsAg, HBsAg + Aluminum, HBsAg@HNP, or HBsAg@GHNP6 on Days 0, 14, and 28. HBsAg-specific antibodies, splenocyte activation, proliferation, and cytokine secretion were assessed. Results: GHNP6 showed suitable physicochemical properties, acceptable cytocompatibility at concentrations up to 10 μg·mL⁻¹, and efficient model-antigen uptake. GHNP increased MHC II expression in RAW264.7 cells, and TLR2/4 inhibition reduced nanoparticle-associated TNF-α secretion, supporting involvement of these pathways in immune activation. In vivo, HBsAg@GHNP6 induced robust HBsAg-specific IgG responses and a higher IgG2a/IgG1 ratio than HBsAg@HNP and HBsAg + Aluminum. It also produced the highest splenocyte proliferation after HBsAg restimulation, with lower IL-6 secretion than HBsAg + Aluminum and moderately increased IFN-γ compared with PBS and free HBsAg. Conclusions: GHNP integrates nanoparticle-assisted antigen delivery with GLP-mediated immunomodulation and represents a promising strategy for enhancing cellular immune responses while maintaining humoral immunity in HBsAg vaccination. Full article

Background/Objectives: Rural populations in the United States experienced consistently lower COVID-19 vaccination rates than urban populations during the pandemic. While barriers to vaccination have been well documented, less is known about facilitators of uptake in rural settings. This study aimed to identify facilitators of COVID-19 vaccination in rural communities from the perspectives of Washington State University (WSU) Extension personnel and to examine these factors using the Consolidated Framework for Implementation Research (CFIR) Outer Setting domain. Methods: A qualitative descriptive study was conducted using semi-structured key informant interviews with WSU Extension personnel. Twenty-one participants representing 34 of 40 Extension offices across Washington State were interviewed in Fall 2023. Interviews were transcribed, de-identified, and analyzed using deductive thematic analysis. Findings were organized into the seven CFIR Outer Setting constructs: critical incidents, local attitudes, local conditions, partnerships and connections, policies and laws, financing, and external pressures. Results: Perceived facilitators of COVID-19 vaccination were identified across all CFIR Outer Setting constructs. Trust emerged as a central theme, with participants reporting that vaccine acceptance was higher when information was delivered by trusted local sources, including Extension personnel, healthcare providers, community leaders, and informal networks. Participants described leveraging partnerships with public health agencies, schools, faith-based organizations, and community groups as enhancing outreach and information dissemination. Additional facilitators identified by participants included no-cost vaccine and personal protective equipment availability, accessible community-based vaccination sites, culturally appropriate educational materials, and coordinated communication systems. Conclusions: Rural vaccination efforts were supported by trust, strong community partnerships, and locally tailored strategies. These findings may inform future public health emergency responses in rural communities. Full article

This review describes the cellular and molecular mechanisms underlying multi-dose bacille Calmette-Guérin (BCG) as an investigational immunotherapy for glycemic improvement in autoimmune diabetes. The BCG data is most often human clinical trial data over the last 15 years paired with mechanistic insights. BCG as a vaccine has an excellent safety record with a century-long safety record in tuberculosis prevention worldwide and, for 36 years, has been FDA-approved at higher doses for the treatment of bladder cancer. Our group and others have conducted multiple clinical trials evaluating multi-dose BCG immunotherapy in adults with the two forms of longstanding autoimmune diabetes. In type 1 diabetes (T1D), clinical trials of multi-dose BCG have shown stable repeated reductions in the FDA-recommended biomarker glycated hemoglobin (HbA1c) to near-normal levels (vs placebo) for at least 8 years. This improvement paradoxically occurs without any recovery of pancreatic function from its negligible baseline level. Evidence from long-term trials, together with companion global mechanistic studies, indicates that glycemic improvement is associated with BCG-induced correction of aerobic glycolysis defects in lymphoid and myeloid cells, an outcome also observed in the granuloma of BCG’s close relative, tuberculosis. Restoration of energy metabolism to aerobic glycolysis in diabetic lymphoid cells increases glucose utilization, thereby enhancing systemic glucose uptake from the bloodstream, as demonstrated by longitudinal PET/CT imaging. In contrast, latent autoimmune diabetes in adults (LADA), a form of slow autoimmune diabetes that occurs late into adulthood, has minimal or lacks the clinically significant aerobic glycolysis defect. In LADA with multi-dose BCG immunotherapy glycemic improvement in BCG-treated patients does not occur commonly, based on 8 years of data. LADA nevertheless displays other favorable immune and clinical responses suggestive of BCG-induced regulatory T cell (Treg) induction. In LADA, multi-dose BCG decreases inflammation, thus halting pancreatic autoimmunity with insulin rescue and also halts inflammatory driven insulin resistance. BCG’s consistent clinical benefits in autoimmune diabetes coincide with the gradual pace of upstream epigenetic reprogramming of genes involved in metabolic and T cell pathways without changing genotype. Understanding the mechanistic chain linking BCG-induced epigenetic changes to clinical efficacy may offer insights into the treatment and potential prevention of autoimmune diabetes. Full article

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

Background/Objectives: Hepatitis A virus (HAV) infection is a relevant biological risk in some occupational settings and has long been discussed as an occupational health concern among municipal waste collection workers. Data on HAV seroprevalence and vaccination history in this occupational group remain limited in Italy. This study investigated HAV seroprevalence, self-reported vaccination history, and factors associated with HAV seropositivity among waste collection workers in Sardinia. Methods: This retrospective cross-sectional study analyzed HAV seroprevalence and self-reported vaccination history among 326 workers in Sardinia, Italy, using occupational health surveillance data (2017–2024). Recorded variables included age, sex, smoking habits, years of service, work setting, vaccination status, and serological results. Chi-square and Mann–Whitney U tests assessed group differences; logistic regression identified factors independently associated with HAV seropositivity. Results: HAV seroprevalence was 44.2%; only 0.9% of participants reported previous HAV vaccination. Multivariable analysis identified older age, but not years of service, as independently associated with HAV seropositivity once age was modeled as a continuous variable—a pattern more consistent with birth-cohort differences in lifetime HAV exposure than with cumulative occupational exposure. Worksite 7 showed a higher prevalence ratio of HAV seropositivity relative to the reference site, but this finding was based on a small subsample and should be considered exploratory; observed worksite-level differences may reflect organizational rather than geographic factors. Conclusions: Older age, rather than occupational tenure, was independently associated with HAV seropositivity among Sardinian waste workers, a pattern consistent with birth-cohort differences in lifetime exposure. The high seroprevalence and very low vaccination uptake highlight the need to strengthen prevention through improved vaccination access, awareness, and better integration of occupational and public health strategies. Full article

Background: HPV vaccination coverage in Pakistan is extremely low, and there are complex psychosocial, cultural, and logistical barriers that currently impede vaccinations. There is no validated measurement tool that is appropriate to the context to measure these determinants systematically. Objective: To develop and validate a multidimensional instrument measuring important factors associated with HPV vaccine uptake and readiness in Pakistan through partial least squares structural equation modelling (PLS-SEM). Methods: A cross-sectional survey was administered to caregivers of girls aged 9–16 years, recruited via purposive/convenience sampling from schools, EPI sites, and household outreach in three Punjab/ICT districts (Rawalpindi, Islamabad, Bahawalpur) during September–November 2025, coinciding with Pakistan’s national HPV vaccination campaign (700 initial responses; 639 retained after screening). The instrument comprised 75 initial items across six constructs: thinking and feeling, social processes, motivation, practical issues, cultural integration, and the vaccination uptake composite index (a composite index of actual vaccination receipt, intention, perceived importance, and perceived access). The measurement model was evaluated for indicator/construct reliability, convergent validity (AVE), and discriminant validity (HTMT, Fornell–Larcker, cross-loadings); the structural model tested direct effects, mediation via motivation, and moderation by practical issues and cultural integration. Results: The number of indicators after model refinement was 27 in six constructs. All outer loadings exceeded 0.70 (range: 0.765–0.939). Cronbach’s α ranged from 0.854 to 0.928, composite reliability from 0.912 to 0.945, and AVE from 0.710 to 0.850. All the HTMT ratios were less than 0.90; Fornell–Larcker and cross-loadings criteria supported discriminant validity. The relationships between thinking and feeling (β = 0.098, p < 0.001) and social processes (β = 0.155, p < 0.001) with vaccination uptake were significantly mediated by motivation. Social and cognitive pathways were moderated by cultural integration. The model accounted for 65.8% of the variance in motivation and 59.4% in uptake of vaccination. Conclusions: The instrument was found to have good psychometric properties and to be suitable suitable for evaluating the determinants of HPV vaccination in conservative, resource-constrained countries such as Pakistan. Findings have direct implications for targeted public health interventions to improve HPV vaccine readiness and uptake. Full article

Adult vaccination is a critical component of preventive healthcare, reducing morbidity and mortality from vaccine-preventable diseases. Despite established recommendations, adult immunisation coverage remains suboptimal, particularly for vaccines beyond influenza and COVID-19. In the United Arab Emirates (UAE), limited evidence exists regarding adult vaccine uptake and determinants influencing immunisation behaviour within its diverse population. Understanding vaccine-specific coverage and associated sociodemographic, healthcare, and workplace factors is essential to guide targeted strategies that strengthen adult immunisation. A cross-sectional study was conducted among 1330 adults aged ≥ 18 years residing in the UAE. Data were collected using a structured self- or interviewer-administered questionnaire assessing uptake of recommended adult vaccines, including COVID-19, influenza, pneumococcal, herpes zoster, Tdap, and HPV. Sociodemographic characteristics, healthcare access, insurance status, workplace factors, and perceived barriers were also assessed. Descriptive statistics summarised vaccination coverage, and associations between uptake and key determinants were examined using SPSS version 30. Statistical significance was defined as p < 0.05. Overall, 71.0% reported receiving at least one adult vaccine. Uptake was highest for COVID-19 (64.9%) and influenza (57.8%), while pneumococcal, herpes zoster, and Tdap coverage remained low (12–13%). HPV uptake was 22.6% among females and 18.9% among males. Higher uptake was observed among females and adults. Social encouragement, insurance coverage, and healthcare access were associated with vaccination, whereas lack of awareness and logistical barriers hindered uptake. Although overall uptake was moderate, significant gaps persist. Integrating vaccination into routine healthcare services and addressing structural and communication barriers are necessary to improve adult vaccination coverage. Full article

Background: Over the past decade, the East New Britain Provincial Health Authority in Papua New Guinea has worked with partner research organisations to implement data-driven interventions to improve immunisation coverage. This paper reports on facility assessments conducted as part of a cross-sectional study to understand improvements and identify enablers and barriers to routine childhood immunisation in the province. Methods: Between May and August 2023, nine urban and rural health facilities, providing immunisation services at the time of the study in five areas, were assessed using an adapted World Health Organisation (WHO) Service Availability and Readiness Assessment tool. The tool evaluated facility characteristics, routine childhood immunisation readiness and vaccine supply data. Data were analysed using descriptive statistics and findings were mapped to adapted WHO health system categories to identify service delivery improvement priorities. Findings: Several aspects of immunisation service availability and quality had improved since an assessment in 2016/17. Strengths included fixed-facility and outreach service models tailored to catchment populations, high availability of cold chain and vaccine administration equipment, improved immunisation guidance and job-aids. Priority areas included increasing workforce capacity, improving health record completion to inform outreach, increasing availability of guidelines and reporting tools, reducing stock-outs and enhancing stock tracking. Conclusions: Offering accessible vaccination at every opportunity and using quality data to inform programme implementation and resource allocation are priorities for the Provincial Health Authority. This facility-level assessment identified existing immunisation delivery strengths and highlighted community- and provincial-level priority investment areas to strengthen facility capacity and routine immunisation service delivery. Full article

Background/Objectives: Human papillomavirus (HPV) causes several cancers in both females and males. In France, HPV vaccination coverage among adolescents remains suboptimal, particularly among boys, and knowledge about HPV infection and vaccination is limited. This study assessed HPV-related knowledge, attitudes, and vaccination uptake among adolescents attending Rural Family Homes (RFHs). Methods: A sequential mixed-methods study was conducted between September 2023 and June 2024 among 895 adolescents aged 15–19 years attending 19 RFHs in France. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, general vaccination knowledge, HPV-related knowledge, vaccination status, and determinants of vaccine uptake. Focus groups involving 59 adolescents explored perceptions of, barriers to, and information needs regarding HPV vaccination. Quantitative data were analyzed using chi-square tests and multivariable logistic regression; qualitative data were analyzed thematically. Results: Overall, 44% of participants had received at least one HPV vaccine dose and 31% received at least two doses. Coverage was significantly higher among girls than boys (55% vs. 28%, p < 0.001). Only 35% demonstrated adequate HPV-related knowledge. Parents and general practitioners were the main information sources. Vaccination uptake was associated with favorable subjective norms, female sex, and the belief that vaccination reduces cancer risk. Qualitative findings revealed persistent misconceptions about HPV-related risks, particularly among boys, and a substantial need for reliable information. Conclusions: Adolescents attending RFHs showed limited HPV-related knowledge and suboptimal vaccination coverage, particularly boys. Parental support and healthcare professional recommendations were associated with vaccine uptake. Targeted educational interventions and catch-up vaccination strategies among this population are needed to improve coverage and reduce the burden of HPV-related diseases. Full article

Background: The COVID-19 pandemic exposed major vulnerabilities in healthcare accessibility and may have influenced preventive attitudes among people living with HIV (PLWH). However, the relationship between pandemic-related healthcare experiences and vaccination uptake remains insufficiently understood. Materials: A cross-sectional survey was conducted among 203 adults living with HIV receiving follow-up care in Romania between October 2025 and March 2026. The questionnaire evaluated vaccination uptake, vaccine-related perceptions, healthcare information sources, and pandemic-related experiences. Multivariable logistic regression analysis was performed to identify factors independently associated with vaccination uptake. Results: Only 38.9% of participants reported receiving at least one vaccine within the previous three years. The main barriers to vaccination were perceived lack of necessity, lack of physician recommendation, fear of adverse effects, and lack of trust. Multivariable logistic regression identified positive vaccine-related beliefs (OR = 0.454, 95% CI: 0.235–0.876, p = 0.019) and CD4+ T-cell count above 500 cells/mm³ (OR = 0.448, 95% CI: 0.232–0.867, p = 0.017) as independently associated with lower odds of being non-vaccinated. More than half of participants (52.7%) reported at least one pandemic-related disruption or negative health impact. The pandemic-related negative impact composite was not significantly associated with vaccination status (p = 0.209), whereas confirmed COVID-19 infection was more frequent among vaccinated participants than among non-vaccinated participants (43.0% vs. 28.2%, p = 0.030). Pandemic-related negative impact was associated with a greater demand for physician-provided information (p = 0.011). Conclusions: Pandemic-related healthcare experiences were associated with greater demand for physician-provided preventive information, while confirmed COVID-19 infection was more frequent among vaccinated participants. Positive vaccine-related beliefs and higher CD4+ T-cell counts were independently associated with vaccination uptake, while lack of physician recommendation remained a major barrier to vaccination. These findings emphasize the critical role of physicians in improving vaccination coverage among people living with HIV in the post-pandemic era. Full article