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1.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
2.
Expert Opin Drug Saf ; 19(1): 107-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31674255

RESUMO

Objectives: Complex regional pain syndrome (CRPS) cases have followed human papillomavirus (HPV) vaccination, but no causal link has been established.Methods: Using insurance claims, the authors observed unvaccinated 11-year-old girls for CRPS diagnoses. The authors used time-dependent Cox regression to identify health-related CRPS predictors using diagnosis codes. Next, the authors identified HPV vaccinations using procedural codes. HPV vaccination and CRPS predictors were considered time-dependent covariates to estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for CRPS, 30, 90, and 180-days post-vaccination.Results: 1,232,572 girls received 563 unique CRPS diagnoses. In a 10% sub-cohort of 123,981 girls accounting for potential confounders and predisposing risk factors (i.e. injury, infection, mental illness, primary care use), CRPS hazard was not significantly elevated 30 days (HR: 0.90, 95% CI: 0.46, 1.73), 90 days (HR: 1.17, 95% CI: 0.83, 1.65), or 180-days post-vaccination (HR: 1.11, 95% CI: 0.83, 1.47).Conclusion: The results support the safety and continued administration of HPV vaccines to adolescents.


Assuntos
Síndromes da Dor Regional Complexa/epidemiologia , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Criança , Estudos de Coortes , Síndromes da Dor Regional Complexa/diagnóstico , Feminino , Humanos , Vacinas contra Papillomavirus/efeitos adversos , Fatores de Risco , Fatores de Tempo , Estados Unidos
3.
J Community Health ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31520188

RESUMO

We assessed the association of state legislation with adolescent human papillomavirus (HPV) vaccination rates in states that legislated information dissemination or administration of HPV vaccination. Using insurance claims, we calculated monthly HPV vaccination rates (November 2009-December 2017) among adolescents in states that passed HPV vaccination legislation during that period: Missouri (July 2010), Kentucky (February 2012), Indiana (March 2013), Oregon (June 2013). We used segmented regression to estimate levels and trends of HPV vaccination rates, comparing pre-legislation to post-legislation segments, adjusting for seasonal vaccination patterns and changes to the vaccination recommendation among males during the study period. Indiana's legislation allowed pharmacists to administer HPV vaccination; legislation in Kentucky, Missouri, and Oregon included provisions HPV and cervical cancer education. No statistically significant increases in HPV vaccination levels or trends were observed in the post-legislation segments among adolescents overall; however, a significant post-legislation increase in vaccination trends was observed among boys in Missouri (ß = 0.16, p = 0.03). Evidence for a positive impact of legislation on HPV vaccination rates is limited. The scarcity of policies that directly facilitate or promote HPV vaccination, and the breadth of exemptions to school vaccination requirements, may limit the effectiveness of these policies. Continuing efforts to introduce and pass legislation that directly facilitates HPV vaccination, combined with promoting existing evidence-based interventions, can provide opportunities to identify the most effective strategies to increase adolescent HPV vaccination rates.

4.
J Matern Fetal Neonatal Med ; : 1-9, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31510821

RESUMO

Background: Maternal colonization with group B Streptococcus (GBS) is a predictor of neonatal sepsis. In Nicaragua, neonatal sepsis is a major cause of hospitalization, but it can be prevented with intrapartum antibiotic prophylaxis. We undertook this study to estimate the pooled prevalence of rectovaginal GBS colonization among pregnant women 35-40-week gestation in Nicaragua, and sensitivity of GBS isolates to various antibiotics. Methods: We systematically searched electronic databases of peer-reviewed and unpublished literature using prespecified search terms. We included English- and Spanish-language studies of rectovaginal GBS colonization and/or antibiotic sensitivity of GBS isolates that followed internationally-recognized diagnostic standards, from various sites and years. Two reviewers independently abstracted data and assessed risk of study bias. We then meta-analyzed the pooled prevalence of rectovaginal GBS colonization and antibiotic sensitivity of GBS isolates. We performed subgroup analyses by geographic location, urbanicity, and study risk of bias. Main results: Prevalence of rectovaginal GBS colonization from 13 samples in 11 studies was 0.14 (95% CI: 0.09, 0.21). Effect size heterogeneity was identified between coastal (0.12 [95% CI: 0.07, 0.19]) and central study sites (0.23 [95% CI: 0.18, 0.28]), and between predominantly rural (0.06 [95% CI: 0.02, 0.10]) and urban (0.28 [95% CI: 0.19, 0.37]) samples of pregnant women. GBS sensitivity to penicillin, the first-line antibiotic for intrapartum prophylaxis, was 0.89 (95% CI: 0.71, 1.00) based on seven studies. Conclusions: Maternal GBS colonization was substantial in some study sites. Most GBS isolates are sensitive to recommended antibiotics, and intrapartum antibiotic prophylaxis may effectively prevent neonatal sepsis in Nicaragua.

5.
Cancer Causes Control ; 29(11): 1115-1130, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30284670

RESUMO

PURPOSE: The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries. METHODS: Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9-14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers' attitudes towards a 2-dose schedule were assessed through focus group discussions. RESULTS: Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source. CONCLUSIONS: Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Esquemas de Imunização , Mães/psicologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Argentina , Criança , Feminino , Humanos , Malásia , Vacinas contra Papillomavirus/efeitos adversos , República da Coreia , África do Sul , Espanha , Inquéritos e Questionários , Neoplasias do Colo do Útero/virologia , Vacinação
6.
Sex Transm Dis ; 45(10): 666-672, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29664764

RESUMO

BACKGROUND: High-oncogenic-risk human papillomavirus (hrHPV) is necessary, although insufficient, to promote cervical cancer. Like HPV, Epstein-Barr virus (EBV) is a common pathogen with the capacity to promote epithelial neoplasms. We examined the association between cervical EBV, hrHPV, and cytology in female sex workers in Nairobi, Kenya. METHODS: Women (n = 332) with known cervical cytology and hrHPV mRNA results were evaluated for cervical EBV DNA by conventional polymerase chain reaction. Prevalence ratios (PRs) were calculated to assess the relationships between EBV, hrHPV, and cervical cytology. Prospective analyses used risk ratios and time-to-event analyses to determine the association of EBV with hrHPV clearance and with abnormal cytology outcomes. RESULTS: Baseline prevalence of hrHPV and EBV was 29% and 19%, respectively. Higher EBV prevalence was found among women with older age, HIV, hrHPV, abnormal cytology, Mycoplasma genitalium infection, smoking habits, younger age at sexual debut, and less frequent condom use. At baseline, women with EBV had a higher prevalence of hrHPV infection than did EBV-negative women (52% vs. 24%; HIV-adjusted PR [95% confidence interval], 1.8 [1.3-2.6]). Epstein-Barr virus-positive women had a higher prevalence than did EBV-negative women of high-grade precancer (15% vs. 2%) and abnormal cytology (37% vs. 15%), although HIV- and hrHPV-adjusted associations were not significant (high-grade precancer: PR, 2.0 [0.7-5.9]; abnormal cytology: PR, 1.4 [0.9-2.2]). In prospective analyses, a marginal association was observed between baseline EBV detection and delayed hrHPV clearance. CONCLUSIONS: Our data support a possible role for EBV as a high-risk marker or cofactor for HPV-mediated cervical cancer development.


Assuntos
Colo do Útero/virologia , Herpesvirus Humano 4/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/citologia , Colo do Útero/patologia , Técnicas Citológicas , DNA Viral/genética , Detecção Precoce de Câncer , Feminino , Herpesvirus Humano 4/genética , Humanos , Quênia/epidemiologia , Programas de Rastreamento , Papillomaviridae/genética , Prevalência , Estudos Prospectivos , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
7.
Am J Trop Med Hyg ; 98(6): 1848-1856, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29692314

RESUMO

The ongoing Zika pandemic has affected many countries that are common travel destinations. We assessed the willingness to receive a prophylactic Zika virus (ZIKV) vaccine, currently under development, among travelers to areas with reported autochthonous ZIKV transmission. We surveyed United States (U.S.) residents aged 18-44 years who had ever heard of ZIKV and planned to travel to Florida and/or Texas (N = 420) or a U.S. territory or foreign country (N = 415) in 2017, using a nationally representative internet panel. Travelers to Florida and/or Texas reported less concern about ZIKV infection than travelers to other destinations (27% versus 36%, P = 0.01). Female sex, Hispanic ethnicity, discussing ZIKV with medical professionals, ZIKV risk perception, and self-efficacy for ZIKV prevention predicted concern about ZIKV infection in both groups. Travelers to Florida and/or Texas (43%) and other destinations (44%) were equally willing to receive a ZIKV vaccine. Hispanic ethnicity, discussing ZIKV with medical professionals, and concern about ZIKV infection predicted vaccine willingness in both groups. Likelihood of using existing ZIKV prevention methods, confidence in the U.S. government to prevent ZIKV spread, self-efficacy for ZIKV prevention, and knowledge about ZIKV symptoms further predicted vaccine willingness in travelers to other destinations. In multivariable analyses, only concern about ZIKV infection was associated with vaccine willingness in both groups (prevalence ratio [95% confidence interval]: Florida and/or Texas: 1.34 [1.06, 1.69]; other: 1.82 [1.44, 2.29]). Targeted communications can educate travelers, particularly travelers who are pregnant or may become pregnant, about ZIKV risk to generate ZIKV vaccine demand.


Assuntos
Vacinação , Vacinas Virais/imunologia , Infecção por Zika virus/prevenção & controle , Zika virus/imunologia , Adolescente , Adulto , Feminino , Florida/epidemiologia , Humanos , Incidência , Masculino , Programas de Rastreamento , Gravidez , Texas/epidemiologia , Viagem , Estados Unidos/epidemiologia , Adulto Jovem , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia
8.
Papillomavirus Res ; 3: 126-133, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28720446

RESUMO

INTRODUCTION: Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls. METHODS: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country. RESULTS: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs. CONCLUSIONS: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.

9.
J Adolesc Health ; 61(3): 281-287, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28739327

RESUMO

PURPOSE: The purpose of the study was to describe the patterns of use of universally recommended adolescent vaccines in the United States. METHODS: We identified 11-year-olds using the MarketScan insurance claims database (2009-2014). Human papillomavirus (HPV), tetanus-diphtheria-acellular pertussis (Tdap), and meningococcal (MenACWY) vaccination claims were identified using diagnosis and procedure codes. Generalized linear models estimated vaccination incidence rates and correlates of adolescent vaccination and timely vaccination. RESULTS: Among 1,691,223 adolescents, receipt of Tdap (52.1%) and MenACWY (45.8%) vaccinations exceeded receipt of HPV vaccination (18.4%). While both sexes had similar Tdap and MenACWY vaccination proportions, girls received HPV vaccination more frequently than boys (21.9% vs. 15.1%). Adolescents received HPV vaccination later (mean age: 11.8 years) than Tdap or MenACWY vaccination (mean age: 11.2 years for both). Half of vaccinated adolescents received Tdap and MenACWY vaccination only; however, coadministration with HPV vaccine increased with birth cohort. Western adolescents had the highest incidence rates of HPV vaccination, and Southern adolescents had the lowest. Rural adolescents were less likely than urban adolescents to receive each vaccination except in the Northeast, where they were more likely to receive HPV vaccination (incidence rate ratio: 1.09, 95% confidence interval: 1.2005-1.13). Timely HPV vaccination was associated with female sex, urbanicity, Western residence, and later birth cohort. CONCLUSIONS: HPV vaccination occurred later than Tdap or MenACWY vaccination and was less frequent in boys and rural adolescents. Girls, Western and urban residents, and younger birth cohorts were more likely to receive timely HPV vaccination. Vaccine coadministration increased over time and may encourage timely and complete vaccination coverage.


Assuntos
Esquemas de Imunização , Papillomaviridae/imunologia , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Vacinas Meningocócicas/administração & dosagem , Modelos Estatísticos , Fatores Sexuais , Estados Unidos , Vacinação/métodos , Vacinas Conjugadas/administração & dosagem
10.
Int J Environ Res Public Health ; 11(3): 2911-21, 2014 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-24619123

RESUMO

Some jurisdictions have reduced workforce and reallocated responsibilities for public health preparedness and emergency management to more efficiently use resources and improve planning and response. Key informant interviews were conducted in six counties in North Carolina (USA) to discuss perceptions of the challenges and opportunities provided by the new shared positions. Respondents feel that planning and response have improved, but that requirements related to activities or equipment that are eligible for funding (particularly on the public health side) can present an impediment to consolidating public health preparedness and emergency management roles. As the financial resources available for public health preparedness and emergency management continue to be reduced, the merging of the roles and responsibilities of public health preparedness and emergency management may present jurisdictions with an effective alternative to reducing staff, and potentially, readiness.


Assuntos
Defesa Civil/organização & administração , Planejamento em Desastres/organização & administração , Administração em Saúde Pública , North Carolina
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