Parent report of provider HPV vaccine communication strategies used during a randomized, controlled trial of a provider communication intervention.

OBJECTIVE: To assess secondary, parent-reported outcomes from a randomized controlled trial (RCT) of a provider communication intervention aimed at improving adolescent HPV vaccination. METHODS: A paper survey was provided to a random sample of 777 parents of adolescents from 8 control and 8 intervention clinics participating in the larger trial. Chi-square or Fisher's exact tests assessed associations between study arm and providers' HPV vaccine communication strategies, parents' vaccination attitudes and parent's HPV vaccine acceptance. Exploratory analyses assessed the association between receipt of 'very strong' or presumptive HPV vaccine recommendation (regardless of study arm) and parent's perceptions about their providers' vaccine communication, and parents' attitudes and acceptance of the HPV vaccine. RESULTS: The response rate was 47%. There were no differences between study arms in parents' report of how their provider communicated about the HPV vaccine, parent vaccination attitudes, or uptake of the HPV vaccine. Receipt of a 'very strong' recommendation was associated with greater perceived urgency for getting vaccinated, greater trust in the information received from the provider, decreased vaccine hesitancy, and increased vaccine receipt. Receipt of a presumptive recommendation was associated with a lower likelihood of having concerns about the vaccine's safety, lower vaccine hesitancy, and an increased likelihood of vaccination. Neither recommendation strategy appeared to negatively impact parents' visit experience or trust in the information being provided. Similar results were found in sub-analyses of vaccine hesitant parents. CONCLUSIONS: Providing very strong, presumptive HPV vaccine recommendations is associated with improved parent vaccination attitudes and acceptance, and does not seem to have significant negative impacts, even among parents who are vaccine hesitant. Response bias in our sample could explain why there were no reported differences between study arms in parents' reports of how their adolescent's providers communicated about the HPV vaccine.

Typhoid fever in travelers: who should be targeted for prevention?

To clarify indications for typhoid vaccination, we reviewed laboratory-confirmed cases of typhoid fever reported to the United States Centers for Disease Control and Prevention between 1994 and 1999. To estimate the risk of adverse events associated with typhoid vaccination, we reviewed reports to the Vaccine Adverse Event Reporting System for the same period. Acute Salmonella enterica serotype Typhi infection was reported for 1393 patients. Of these patients, recent travel was reported by 1027 (74%), only 36 (4%) of whom reported having received a vaccination. Six countries accounted for 76% of travel-associated cases (India [30%], Pakistan [13%], Mexico [12%], Bangladesh [8%], The Philippines [8%], and Haiti [5%]). For 626 travelers who traveled to a single country, the length of stay was