Pediatric solid organ transplant recipients demonstrate robust cell-mediated and humoral responses to three doses of mRNA SARS-CoV-2 vaccine.

Pediatric solid organ transplant recipients (pSOTR) often demonstrate suboptimal vaccine responses and are not included in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine efficacy trials. This population has shown variable humoral immunity following SARS-CoV-2 vaccination, and no studies have assessed cell-mediated responses after SARS-CoV-2 vaccination in pSOTR. SARS-CoV-2-specific interferon-gamma release assay (IGRA), immunoglobulin G (IgG), and receptor-binding domain (RBD)-angiotensin-converting enzyme 2 (ACE2) blocking antibody (Ab) were measured in pSOTR aged 5-17 years after 2-3 doses of SARS-CoV-2 mRNA vaccine. In all, 33 subjects were included, with 25 tested after the second dose of mRNA vaccine (V2) and 21 tested after the third dose of mRNA vaccine (V3). Of the 19 subjects who had IgG testing after V3, 100.0% (19/19) had a positive IgG response. Of the 17 subjects who had IGRA testing after V3, 94.1% (16/17) had a positive IGRA response. RBD-ACE2 blocking antibody increased significantly from V2 to V3 (p = .007). Subjects <1 year from transplant demonstrated a significantly larger increase in RBD-ACE2 blocking Ab from V2 to V3 than did those >1 year from transplant (p = .05). SARS-CoV-2 vaccination induces humoral and cell-mediated responses in the majority of pSOTR, with improved quantitative humoral response after three doses.

Longitudinal Evaluation of Clinical Decision Support to Improve Influenza Vaccine Uptake in an Integrated Pediatric Health Care Delivery System, Houston, Texas.

OBJECTIVE: Our study retrospectively evaluated the implementation of an influenza vaccine best practice alert (BPA) in an electronic medical record within an integrated pediatric health care delivery system. METHODS: An influenza BPA was implemented throughout a large pediatric health care delivery system in Houston, TX, to improve vaccine uptake. Outcomes were measured retrospectively over 3 years of BPA implementation and compared with a control year prior to BPA implementation. Primary outcomes were influenza vaccine uptake, distribution of influenza vaccines ordered by week, proportion of BPA displays ignored, and missed vaccination opportunities. RESULTS: Influenza vaccine uptake declined from the pre-BPA year (47.2%; 95% confidence interval [CI]: 47.0, 47.4) to the last study year (45.1%; 95% CI: 44.9, 45.2). BPA displays were increasingly ignored by clinical staff throughout the study years from 59.6% in 2014-2015 to 72.5% in 2016-2017. For providers, BPA displays were ignored less frequently each year from 53.4% in 2014-2015 to 51.4% in 2017-2017. Within the primary care outpatient group, the proportion of missed vaccination opportunities in sick visits decreased from 86.8% during the pre-BPA year to 81.0, 79.8, and 82.7% during the subsequent study years 2014-2015, 2015-2016, and 2016-2017, respectively. CONCLUSION: Implementation of a widespread influenza BPA in an integrated pediatric health care delivery system did not produce meaningful increases in influenza vaccine uptake. Differences between clinical staff and providers on BPA use warrant further investigation.

Update on barriers to human papillomavirus vaccination and effective strategies to promote vaccine acceptance.

PURPOSE OF REVIEW: This article provides a clinically relevant review and analysis of the latest research regarding barriers to human papillomavirus (HPV) vaccination and strategic efforts to promote this vaccine. RECENT FINDINGS: HPV vaccines are safe, effective, and could prevent the majority of HPV-attributable cancers, if vaccination coverage is high. However, uptake of HPV vaccine lags behind other vaccines recommended for 11 to 12-year olds. A lack of provider recommendation has consistently been found to be a key barrier to increasing vaccination rates. Lack of knowledge about the vaccine among parents coupled with an overestimation of parental vaccine hesitancy among providers also hinder vaccine uptake. Strongly recommending the vaccine as a safe, routine immunization that prevents cancer, and coadministering it with tetanus, diphtheria, and acellular pertussis vaccine and quadrivalent meningococcal conjugate vaccine, enhance vaccine uptake. In some cases, reminder and recall systems result in additional increases in vaccination rates. SUMMARY: Recent publications reveal new information about the implementation of HPV vaccines. Provider recommendation is a key approach, as is offering it routinely at the same time as other universally recommended adolescent immunizations. With the integration of these concepts into the clinical setting, adolescents can be better protected against HPV and its associated diseases.

Human papillomavirus epidemiology and vaccine recommendations: selected review of the recent literature.

PURPOSE OF REVIEW: This article provides a clinically relevant review and analysis of the latest research and recommendations regarding human papillomavirus (HPV) vaccine. RECENT FINDINGS: Although studies have found that bivalent and quadrivalent HPV vaccines are well tolerated and effective, high-risk HPV types not included in these vaccines are responsible for a significant burden of disease worldwide. Clinical trials have found that the recently licensed 9-valent vaccine, which includes five additional high-risk HPV types, is well tolerated and efficacious. This vaccine was added to the Advisory Committee on Immunization Practices HPV vaccination recommendations in 2015. A two-dose series in girls and boys 9-14 years old with a 6- or 12-month interval between doses has been shown to result in antibody titers noninferior to those measured after the three-dose series in women 16-26 years old. The Food and Drug Administration is considering these data. SUMMARY: Recent publications highlight the safety and effectiveness of HPV vaccines, the licensure of the 9-valent HPV vaccine, and the revision of HPV vaccine recommendations.