Cervical cancer prevention through human papillomavirus vaccination: using the “teachable moment” for educational interventions

Source: Obstetrics & Gynecology, 2010 Apr; 115(4): 834-8.

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Date of publication: April 2010

Publication Type: Journal Article

In a nutshell: Cervical cancer represents a global women’s health issue. The emergence of vaccines against the most common types of human papillomaviruses causing cervical cancer represents a significant advance in cervical cancer prevention. Adolescent girls are the primary target population for vaccination-a population that traditionally has been difficult to reach. Obstetricians and gynecologists may hold the key to improving adolescent human papillomavirus vaccinations through the novel use of their existing relationships with adolescents’ mothers during the routine cervical cancer screening visit. We propose using maternal cancer screenings, specifically breast and cervical cancer screening episodes, as “teachable moments,” naturally occurring life or health events thought to motivate a person to adopt risk-reducing health behaviors spontaneously, to improve human papillomavirus vaccination rates among adolescents.

Length of publication: Unknown

Early waning of maternal measles antibodies in era of measles elimination: longitudinal study

Source: British Medical Journal, 2010 May 18; 340 (182)

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Date of publication: May 2010

Publication Type: Journal Article

In a nutshell: OBJECTIVE: To investigate the duration of the presence of maternal antibodies to measles in infants. DESIGN: Prospective study (May 2006 to November 2008). SETTING: Five hospitals in the Province of Antwerp, Belgium. PARTICIPANTS: Of 221 pregnant women recruited, 207 healthy woman-infant pairs were included-divided into a vaccinated group (n=87) and naturally immune group (n=120), according to vaccination documents and history. MAIN OUTCOME MEASURE: Measles IgG antibodies measured by enzyme linked immunosorbent assay (ELISA) at seven time points (week 36 of pregnancy, birth (cord), and 1, 6, 9, and 12 months); decay of maternal antibody in infants modelled with linear mixed models. RESULTS: Vaccinated women had significantly fewer IgG antibodies (geometric mean titre 779 (95% confidence interval 581 to 1045) mIU/ml) than did naturally immune women (2687 (2126 to 3373) mIU/ml) (P<0.001). Maternal values were highly correlated with neonatal values (r=0.93 at birth). Infants of vaccinated women had significantly lower antibody concentrations than did infants of naturally immune women (P<0.001 at all ages over the follow-up period). Presence of maternal antibodies endured for a median of 2.61 months-3.78 months for infants of naturally infected women and 0.97 months for infants of vaccinated women. At 6 months of age, more than 99% of infants of vaccinated women and 95% of infants of naturally immune women had lost maternal antibodies according to the model. CONCLUSIONS: This study describes a very early susceptibility to measles in infants of both vaccinated women and women with naturally acquired immunity. This finding is important in view of recent outbreaks and is an argument for timeliness of the first dose of a measles vaccine and vaccination of travelling or migrating children under the age of 1 year.

Length of publication: 7 page article

Further information: Babies should be given MMR jab earlier to cover immunity ‘gap’ for measles, Telepgraph, 19 May 2010

Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers

Source: Journal of Advanced Nursing, 2010 May 21 [Epub ahead of print]

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Date of publication: May 2010

Publication Type: Journal Article

In a nutshell: Aim: This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians. Background: Immunization is an important and effective public health intervention. Understanding immunization providers’ attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change. Method: A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours. Results: Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89·2% vs. 63·2%P < 0·001); nurses felt more pressure from parents to administer all recommended vaccines (82·4% vs. 48·7%P < 0·001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98·8% vs. 73·8%P < 0·001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88·9%, 87·1% respectively P = 0·65). Conclusion: The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

Length of publication: 10 page article

Exploring communication strategies to use with parents on childhood immunisation

Source: Nursing Times, 2010; 106: 19 [early online publication]

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Date of publication: May 2010

Publication Type: Journal Article

In a nutshell: While childhood immunisations are voluntary in the UK, healthcare professionals strongly encourage uptake, which is also endorsed by the Department of Health. A few parents refuse immunisation outright but many more are uncertain about the risks and benefits. Parental uncertainty about immunisations was exacerbated during the controversy over the mumps, measles and rubella vaccine. This prompted many studies exploring parents’ views about immunisation delivery, which reported considerable criticism of the approach of healthcare professionals  to this issue. The National Institute for Health and Clinical Excellence (2009) recently published guidance on reducing differences in immunisation uptake. Six key areas were identified for improvement: immunisation programmes; information systems; training; the contribution of nurseries, schools and colleges; targeting groups at risk of not being fully immunised; and hepatitis B immunisation for babies. This article examines the literature on healthcare professionals’ views about the universal childhood immunisation programme and information provision for parents. It also highlights relevant issues in relation to improving access and information delivery.

Length of publication: Unknown

Flu vaccination for ex-preterms and infants under 6 months – are we getting it right?

Source: Archives of Diseases in Childhood, May 2010; 95 (5): 400-401

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Date of publication: May 2010

Publication Type: Letter

In a nutshell: Seasonal or pandemic flu causes illness and sometimes death, in vulnerable infants under 6 months old. Current UK and WHO guidelines recommend that only infants over 6 months receive any sort of flu vaccination, based on the lack of approval for the vaccines for infants under 6 months old, making its use in these infants “off-label”. However, WHO guidance is also clear that “at-risk” populations defined as “… certain chronic health conditions (such as chronic heart or lung disease, metabolic or renal disease or immunodefi ciencies)” should be offered the seasonal flu vaccine. Some graduates of neonatal units are a high-risk population for flu infection once discharged into the community, but are often less than 6 months old. To date, there has been concern that non-adjuvanted, non-live vaccines were not sufficiently immunogenic to confer protection in infants less than 6 months old, but newer adjuvanted vaccines (including Pandemrix, GlaxoSmithKline, Middlesex, UK) are now available.

Length of publication: 2 page letter

Cheap inhalable measles vaccine ‘will make syringes obsolete’

Source: Telegraph

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Date of publication: May 2010

Publication Type: News Item

In a nutshell:  A cheap inhalable measles vaccine could soon be available to families that could pave the way for an end to treatment by syringe for children, scientists say. Human trials of the treatment are scheduled to begin within weeks, which could lead to inexpensive vaccines for illnesses ranging from tuberculosis to cervical cancer. American researchers also hope the trials, which come after five years of development, could reduce the need for painful injections.

Length of publication: 1 page news item

Antibody Persistence after Serogroup C Meningococcal Conjugate Immunization of United Kingdom Primary-School Children in 1999–2000 and Response to a Booster: A Phase 4 Clinical Trial

Source: Clinical Infectious Diseases

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Date of publication: May 2010

Publication Type: Journal Article

In a nutshell: Background: After immunization with serogroup C meningococcal (MenC) conjugate vaccine, antibody responses and vaccine effectiveness are sustained in adolescents, in contrast to rapid waning in young children. We investigated the persistence of serum bactericidal antibody (SBA) titers in children 6 years after immunization with MenC vaccine (primed between 2 months and 6 years of age). The response to a Haemophilus influenzae type b–MenC conjugate (Hib-MenC) booster was also measured. Methods: A phase 4 clinical trial was conducted among 250 healthy 6–12-year-old children. SBA titers were measured before, 1 month after, and 1 year after Hib-MenC administration. The correlate of protection was an SBA titer of >8. Results: An SBA titer of >8 was observed in 61 (25% [95% confidence interval {CI}, 20%–30%]) of 244 participants (mean age, 9.1 years; mean interval since MenC immunization, 6.75 years). The proportion with an SBA titer of >8 and the SBA geometric mean titer increased with age, from 12% (95% CI, 4%–23%) to 48% (95% CI, 29%–67%) and from 2.90 (95% CI, 2.11–3.99) to 17.20 (95% CI, 6.80–43.5), respectively, from a mean age of 7.0 to 12.1 years. One month after the Hib-MenC booster, all participants had an SBA titer of >8, which was sustained in 99.6% at 1 year. Conclusions: As a result of waning antibody, the majority of 6–12-year-old children in the United Kingdom have inadequate serological protection against MenC. The persistence of MenC immunity and the response to a Hib-MenC booster is dependent on age at priming. A booster was highly effective in this cohort and could sustain population immunity against MenC disease.

Length of publication: 10 page article

Further information: Meningitis C vaccine ‘wears off in early teens, BBC News, 7 May 2010

Immunisations among school leavers: is there a place for measles-mumps-rubella vaccine?

Source: Euro Surveill, 2010 Apr 29; 15 (17).

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Date of publication: April 2010

Publication Type: Journal Article

In a nutshell: To ascertain measles-mumps-rubella (MMR) immunisation coverage among school leavers in an inner city London borough following a local MMR catch-up initiative, a questionnaire was sent to parents and guardians of adolescents who attended the 12 secondary schools in Haringey and were due for the school leavers’ vaccination. The questionnaire enquired about previous history of MMR vaccination and a history of adverse events or contraindications to the vaccine. The electronic immunisation records of 400 children (30-35 students from each school) included in the catch up initiative were randomly selected. The childrens’ school health records were manually compared with the electronic records. The mean age of the children was 14.7 years, and 224 (56%) were male. Of the 373 records examined prior to the local MMR catch-up initiative, 98 children (26%) had never received MMR, 173 (46.5%) had only had one dose, 100 (27%) had two doses, and two children had three doses of the vaccine. During the school leavers’ MMR immunisation, 171 (43%) received a dose of MMR and the number of children immunised with two doses increased to 206 (55.3% versus 27% P<0.001), doubling the coverage. Offering MMR vaccination as part of the school leavers immunisation is logistically convenient and it may limit the extent of outbreaks.

Length of publication: Unknown

Use of multimedia as an educational tool to improve human papillomavirus vaccine acceptability – A pilot study

Source: Gynecologic Oncology, 2010 May 8 [Epub ahead of print]

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Date of publication: May 2010

Publication Type: Journal Article

In a nutshell: Objective: To determine, through a pilot study, whether use of a video-based educational tool can influence overall human papillomavirus (HPV) vaccine acceptability, views on vaccine mandates, school vaccination, and acceptable age for vaccination. Methods: Written surveys addressing HPV knowledge and vaccine acceptability were administered to study participants from January to March 2007. An initial 32-question survey was completed, followed by an 8-minute educational video, and a post-video assessment. Results: Out of 256 subjects, 73.0% watched the video and completed all surveys. Eighty percent of the subjects had heard of HPV, while 65.0% knew, prior to viewing the video, that the vaccine was available. Individual vaccine acceptability increased from 66.7% to78.0% after the video (p = .0014). Prior to the video, 54.8% of subjects supported mandatory HPV vaccination, with 51.1% supporting school vaccination, and 66.7% accepting vaccination if it were free. After the video, these percentages increased to 72.6% (p < .0001), 65.1% (p < .0001) and 86.6% (p < .0001) respectively. Initially, 56.5% of subjects would vaccinate their child at 15 years of age or younger. After the video, 94.1% approved of vaccination from age 9 (p < .0001). Secondary analysis revealed Hispanics, African Americans, and lower income families were more likely to accept HPV vaccination after the video. A perception that vaccination promotes sex, and whether or not participants talk to their children about sex, did not affect acceptability. Conclusion: Using an educational video significantly increased overall HPV vaccine acceptability and acceptance in younger age groups. This may be an effective means of increasing awareness and acceptability of HPV vaccination.

Length of publication: 5 page article

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