Introduction Vaccination is an important tool to prevent infectious disease morbidity and mortality. Increased vaccine hesitancy and declining vaccination are contributing to larger infectious disease outbreaks. This review presents the current state of research and knowledge on vaccine hesitancy, focused on the United States (US).Areas covered This review covers the history of vaccination and vaccine hesitancy, recent and ongoing outbreaks, and updates in understanding of vaccine hesitancy and use of new psychology-based tools to address it. Articles for inclusion were sourced from extant understanding of the vaccine hesitancy literature as well as PubMed searches to ensure appropriate context.Expert opinion Population-level outreach and effective communication about vaccines is a central component to addressing vaccine hesitancy and restoring and maintaining trust in the vaccination system. With new ways of understanding vaccine hesitancy rooted in the psychology of decision-making, there is a need for research into outreach, message development, and implementation, within the information and social media environment that allows even faster dissemination of mis- and dis-information. Balancing the rigor of communications and implementation research with the need for timely communications is a pressing challenge to be faced by public health and medical professionals when addressing vaccine hesitancy.

BACKGROUND:Despite well-documented national declines in cervical cancer incidence among young women following human papillomavirus (HPV) vaccine implementation, state-level data remain limited. METHODS:Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System. RESULTS:Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95% CI = 0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100 000. Reductions exceeded 50% in DC (RR = 0.48, 95% CI = 0.15 to 0.81), Rhode Island (RR = 0.48, 95% CI = 0.21 to 0.76), Michigan (RR = 0.48, 95% CI = 0.38 to 0.57), and Hawaii (RR = 0.49, 95% CI = 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15%-50%. Ten states showed slower decreases (<15%). Notably, progress was lacking in Vermont (RR = 1.11, 95% CI = 0.21 to 2.00), West Virginia (RR = 1.09, 95% CI = 0.63 to 1.56), Idaho (RR = 0.97, 95% CI = 0.42 to 1.52), Arkansas (RR = 0.96, 95% CI = 0.64 to 1.29), and Alabama (RR = 0.96, 95% CI = 0.71 to 1.21). Across states, higher vaccination rates were correlated with lower RRs (ie, faster decline) (rho=-0.42, P = .0027). Every 10% increase in vaccination rates was associated with an 11.5% (95% CI = -17.2% to -5.4%) reduction in RRs, adjusted for screening rates. CONCLUSION:Declines in cervical cancer incidence in young women during the HPV vaccination era varied substantially by state, aligning with HPV vaccination rates.

Importance Respiratory syncytial virus (RSV) infection is the leading cause of infant hospitalizations in the US. Two immunization options are available to protect infants against hospitalization—maternal vaccination during pregnancy or RSV antibody shot administration for infants after birth. Gaps in immunization coverage suggest missed opportunities to protect infants against RSV-associated hospitalization. Objective To describe RSV immunization intentions, behaviors, and preferences among pregnant women and parents of young children (ages 0-5 years). Design, Setting, and Participants For this survey study, 2 concurrent national cross-sectional surveys were implemented in April 2024. Participants were recruited from a representative online survey panel of US adults. Participants were 18 years or older and either pregnant or the parent of a young child. Data were analyzed from May to November 2025. Main Outcomes and Measures The outcomes of interest were prevalence of positive intention to receive RSV antibody shot for child among pregnant women and parents and prevalence of positive intention to receive RSV maternal vaccine among pregnant women. Results Of 1765 parents and 174 pregnant women, most were aged 30 years or older (parent: 78.1% [95% CI, 76.2%-80.0%]; pregnant women: 64.0% [95% CI, 56.8%-71.1%]). Among pregnant women eligible for vaccination, 55.5% (95% CI, 47.7%-63.3%) reported a positive intention toward maternal RSV vaccination. Among pregnant women with negative or unsure intention, 35.8% (95% CI, 24.3%-47.3%) would probably or definitely accept RSV vaccination following a strong health care practitioner recommendation. Among parents, 59.8% (95% CI, 57.5%-62.1%) reported a positive intention toward RSV antibody shot administration for their child. Among parents with negative or unsure intention, 27.0% (95% CI, 23.7%-30.2%) would probably or definitely accept the RSV antibody shot for their child following a strong health care practitioner recommendation. More participants preferred maternal vaccination (parents: 48.3% [95% CI, 46.0%-50.6%]; pregnant women: 58.2% (95% CI, 50.9%-65.6%]) over infant RSV antibody shot administration (parents: 9.4% (95% CI, 8.1%-10.8%]; pregnant women: 6.2% (95% CI, 2.6%-9.8%). Top reasons for negative or unsure intentions in both groups included lack of information and safety concerns. Conclusions and Relevance In this survey study, pregnant women and parents of young children preferred maternal RSV vaccination for protecting infants against RSV infection. For some participants with negative or unsure intentions about RSV immunization, a strong health care practitioner recommendation shifted intention toward accepting immunization. Future research efforts should design and evaluate novel communication strategies for providing information about RSV immunization options to eligible families, in addition to strengthening health care practitioner recommendation in favor of immunization.

BackgroundAfrican adolescents and young adults account for a disproportionate number of new HIV infections. There is an urgent need to identify scalable and cost-effective behavioral HIV prevention strategies for this population. Using a condom at first sex is associated with a higher likelihood of consistent use later. Tumaini (“Hope for the Future” in Swahili; Emory University) is a choose-your-own-adventure smartphone game that has been shown to reduce the risk of unprotected first sex by end line in a 45-month randomized controlled trial in western Kenya. ObjectiveThis study aimed to assess the impact of Tumaini on proximal outcomes related to condom use at first sex (specifically, behavioral intentions, self-efficacy, attitudes, and knowledge) longitudinally across mid-adolescence in the above trial. MethodsAdolescent participants (n=996, mean baseline age 14, SD 0.56 years) were randomized 1:1 to receive either a smartphone loaded with Tumaini or an attention-control math game for 5 to 7 weeks at 3 time points (mean age 14.0, SD 0.56; 15.3, SD 0.55; and 16.0, SD 0.56 years, respectively). They completed a behavioral survey at 13 time points, through mean age 17.7 (SD 0.56) years. Using generalized estimating equations and controlling for age at baseline, we modeled mean scores (overall and stratified by gender) on a range of condom-related survey items over time to assess mean differences at specific time points. We applied appropriate Bonferroni corrections to inferences about cross-arm differences in mean changes relative to baseline at 4 time points (after each intervention period and at end line; α=.05/4) and within-arm mean changes relative to baseline at each of the 12 post-baseline time points (α=.05/12). Analyses were conducted as intent-to-treat. ResultsAt end line, 97.8% (n=974) of the sample had been retained. Participants in both arms dedicated a mean total of >30 hours to their assigned game. There was significant improvement across all condom-related proximal outcomes in the intervention arm relative to the control arm immediately after initial intervention exposure. For almost all outcomes, a significant cross-arm difference was also present at end line and for most outcomes at the 2 intervening comparison time points. Some outcomes saw stronger intervention effects on female participants (eg, self-efficacy to refuse unprotected sex) or male participants (eg, knowledge that condoms are an effective way to prevent HIV). In each arm, intention to use a condom at first sex was consistently higher among male participants; however, female intervention-arm scores overtook male control-arm scores following initial intervention exposure. ConclusionsTumaini significantly improved theory-based proximal outcomes related to condom use, with effects sustained 45 months post initial exposure and 16 months post most recent exposure. Adolescents benefited from even short-term exposure, though repeated exposure generally sustained and reinforced intervention effects. As access to smartphones increases, Tumaini has potential for high scalability and impact on condom-related outcomes. Trial RegistrationClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/study/NCT04437667 International Registered Report Identifier (IRRID)RR2-10.2196/35117

BACKGROUND:Low-cost and scalable behavioural interventions to prevent HIV among young people in Africa are needed. As access to smartphones grows, digital interventions will become increasingly viable. We assessed the efficacy of an interactive narrative-based smartphone game (Tumaini) designed to increase age and condom use at first sex. METHODS:In this two-arm, non-blinded, individually randomised trial, participants aged 12-14 years were recruited at community level in Kisumu, Kenya. Sex-stratified block randomisation (1:1; block size of 10) was undertaken by study staff with no contact with participants. For three 5-7-week gameplay periods during school holidays in the first 3 years, participants in the intervention group received Tumaini and participants in the control group received Brainilis, a maths game, on study-provided low-cost smartphones. Participants were followed-up for 45 months, completing a baseline survey and 12 follow-up surveys. Assignment was known to trial staff but masked to data analysts. The primary outcome was a binary measure of high-risk sexual debut (no condom use) versus low-risk (condom use) or no sexual debut, assessed at endline in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT04437667, where it is suspended pending extension. FINDINGS:Between Oct 1 and Dec 3, 2020, 996 adolescents (mean age 14·0 years [SD 0·6]; 499 in the intervention group and 497 in the control group) were enrolled. At endline, 974 (485 in the intervention group and 489 in the control group, and 484 female and 490 male) completed the study and were included in the intention-to-treat analysis. Excluding those reporting sexual debut before baseline, 10% (41 of 409) of participants in the control group reported a high-risk sexual debut compared with 6% (23 of 407) of participants in the intervention group (risk ratio [RR] 0·56 [95% CI 0·34-0·92]). For female participants, 10% (21 of 207) in the control group and 3% (seven of 206) in the intervention group reported a high-risk sexual debut (RR 0·34 [95% CI 0·15-0·77]). For male participants, this outcome was not significantly different, with 10% (20 of 202) of participants in the control group versus 8% (16 of 201) of participants in the intervention group reporting a high-risk sexual debut (RR 0·80 [95% CI 0·43-1·51]). There was no difference in experience of or age at sexual debut. No serious adverse events resulted from trial participation. INTERPRETATION:The results of the study provide evidence to support the potential of digital behavioural HIV prevention, serious games for sexual health, and pre-sexual risk intervention among adolescents in sub-Saharan Africa. FUNDING:US National Institute of Mental Health and Emory Center for AIDS Research.

Nonvaccination and undervaccination with the COVID-19 vaccine may be attributed to multifaceted barriers including hesitancy and access issues. Using data from the CDC's Research and Development Survey, a nationally representative survey fielded from November 3 to December 12, 2022 (n = 6821), we examined the adjusted population attribution fraction (PAF) of COVID-19 nonvaccination and undervaccination attributed to vaccine hesitancy by sociodemographic characteristics. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 84.8%, and the adjusted PAF of undervaccination attributed to vaccine hesitancy decreased with increasing COVID-19 vaccine doses (76.0%, 41.0%, and 16.9% for ≥2, ≥3, and ≥4 doses, respectively). The proportion of adults who considered the social benefit of the vaccine, risk of contracting COVID-19, and information received from a medical provider increased with greater number of COVID-19 vaccine doses received. In contrast, the proportion of adults who were concerned about long-term impacts, speed of vaccine development, and personal risk of getting vaccinated decreased with greater number of COVID-19 vaccine doses received. Understanding the PAF estimates from the acute phase of the pandemic serves as an important comparison for postpandemic vaccination estimates, and is needed for messaging as COVID-19 cases, hospitalizations, and deaths resurge in the fall of 2024.

PURPOSE:This analysis aims to understand temporal HPV vaccination coverage patterns by Health and Human Services Region (hereafter, Region) and state from 2008 to 2020. METHODS:We analyzed National Immunization Survey-Teen data (2008-2020), assessing 6 measures addressing initiation and up-to-date status by sex, as available over time. We compared, annually, Regional coverage to the national average and state-level coverage to the Regional average, identifying states and Regions as positive or negative deviants for each measure if coverage estimates diverged by at least 5 percentage points in either direction. RESULTS:Regions 1 and 9 were positive deviants and Regions 4 and 6 were negative deviants. Within deviant Regions, there were positive and negative deviant states identified, including positive deviant states within negative deviant regions (e.g. North Carolina in Region 4) and the inverse (e.g. Connecticut in Region 1). CONCLUSIONS:Through this novel visualization of national, Regional, and state-level HPV vaccine uptake, we unmasked patterns to support future evaluations and interventions. Future work should focus on identification and assessment of factors leading to success and opportunities for improvement for HPV vaccine promotion efforts.

Background: Interactive, narrative-based digital health interventions may positively influence vaccination-related attitudes, intentions, and uptake. However, evidence on their implementation and evaluation for vaccine communication has not yet been comprehensively synthesized. Our research questions (RQs) were to describe the use of interactive, narrative-based digital health interventions for vaccine communication (RQ1), their impact on individuals’ vaccine intention or uptake (RQ2), and factors associated with their implementation (RQ3). Methods: A scoping review was conducted using Arksey and O’Malley’s 5-stage framework and the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO from inception to 18 April 2023. To be included in the review, studies had to include empirical findings from primary data collection, address vaccine communication, use narrative communication that enabled audience engagement (i.e., interactivity), and deliver the narrative through a digital health device or modality. Results: The search identified 6834 records, with 25 studies meeting the inclusion criteria. For RQ1, the interventions most often focused on HPV vaccination (12 studies). Communication objectives included addressing vaccine hesitancy and increasing vaccination confidence or knowledge. Intervention delivery formats included multi-device compatibility (utilizing more than one device type, 7 studies) and incorporated interactive features, such as gamification and push notifications. Invented narratives were the most frequent narrative approach (8 studies). For RQ2, vaccination outcomes were reported in nearly half the studies (12 studies), with vaccination intention assessed in 8 studies and both vaccination intention and uptake assessed in 4 studies. For RQ3, implementation factors were reported in nearly half the studies (12 studies), with the most frequently reported outcome being acceptability (6 studies). Conclusions: Evidence supporting interactive, narrative-based digital health interventions for vaccine communication can be strengthened by diversifying narrative strategies, expanding the range of interactivity modalities tested, and focusing on a broader range of vaccines. Further research is needed to assess the effectiveness of these interventions, particularly of vaccine uptake. The insights from this scoping review may inform the development of novel future interventions for vaccine communication. The generalizability of these findings may be limited by the small number of studies in some categories and the preponderance of studies from high-income settings.

African adolescents and young adults account for a disproportionate number of new HIV infections. There is an urgent need to identify scalable and cost-effective behavioral HIV prevention strategies for this population. Using a condom at first sex is associated with higher likelihood of consistent use later. Tumaini (“Hope for the Future” in Swahili) is a choose-your-own-adventure smartphone game that has been shown to reduce risk of unprotected first sex by endline in a 45-month randomized controlled trial in Western Kenya. We sought to assess the impact of Tumaini on proximal outcomes related to condom use at first sex, specifically, behavioral intentions, self-efficacy, attitudes, and knowledge, longitudinally across mid-adolescence in the above trial. Adolescent participants (n=996, mean baseline age 14.0 years) were randomized 1:1 to receive either a smartphone loaded with Tumaini or an attention-control Math game for 5-7 weeks at three timepoints (mean ages 14.0, 15.3, and 16.0 years). They completed a behavioral survey at 13 timepoints through mean age 17.7 years. Using generalized estimating equations and controlling for age at baseline, we modeled mean scores (overall and stratified by gender) on a range of condom-related survey items over time to assess mean differences at specific timepoints. We applied appropriate Bonferroni corrections (α= 0.05/4 and α= 0.05/12) to inferences about cross-arm differences in mean changes relative to baseline at four time points (after each intervention period and at endline) and within-arm mean changes relative to baseline at each of the 12 post-baseline timepoints. Analyses were conducted as intent-to-treat. At endline, 97.8% of the sample (n=974) had been retained. Participants in both arms dedicated a mean total >30 hours to their assigned game. There was significant improvement across all condom-related proximal outcomes in the intervention arm relative to the control arm immediately after initial intervention exposure. For almost all outcomes, a significant cross-arm difference was also present at endline, and for most outcomes at the two intervening comparison timepoints. Some outcomes saw stronger intervention effects on female participants (e.g., self-efficacy to refuse unprotected sex) or male participants (e.g., knowledge that condoms are an effective way to prevent HIV). In each arm, intention to use a condom at first sex was consistently higher among male participants; however, female intervention-arm scores overtook male control-arm scores following initial intervention exposure. Tumaini significantly improved theory-based proximal outcomes related to condom use, with effects sustained 45 months post-initial exposure and 16 months post-most recent exposure. Adolescents benefited from even short-term exposure, though repeated exposure generally sustained and reinforced intervention effects. In the context of increasing access to smartphones, Tumaini has potential for high scalability and impact on condom-related outcomes. ClinicalTrials.gov, NCT04437667

BACKGROUND:There are inadequate proactive interventions that take advantage of medical contacts during pregnancy to build confidence in vaccines recommended for children after birth. In addition, prenatal providers' perceptions on implementing such proactive childhood vaccination-focused interventions are not well understood. METHODS:A multicomponent prenatal intervention on childhood vaccines was designed for expectant parents to include a prenatal provider recommendation encouraging age-appropriate vaccines for children after birth, an educational website on vaccine recommendations and resources, and a phone consultation with a vaccine navigator during pregnancy. Members of national prenatal provider organizations in the USA were recruited from April to June 2022 for an online cross-sectional survey to assess their demographic and practice characteristics, perceived role as vaccine advocates, training needs, perceived intervention feasibility, and perceived implementation factors. RESULTS:After data validation, 495 of 1677 responses were included for analysis. Providers expressed agreement (65.1%) with the importance of discussing vaccinations with others, but fewer (46.7%) agreed that they changed people's views on vaccination. Over half of providers agreed or completely agreed that the proposed intervention was feasible, as measured through the four-item Feasibility of Intervention Measure (% agreement range reported across items for educational website: 71.4%-75.2%; provider recommendation: 54.0%-59.7%; and vaccine navigator: 53.9%-56.7%). Availability of adequate staff resources (48.0%), time constraints (47.8%), and adequate training on childhood vaccines (45.4%) were the top three perceived implementation challenges. Perceived facilitators included availability of patient education resources on childhood vaccines (57.7%). CONCLUSION:The proposed intervention to build confidence in childhood vaccines was perceived by providers to be feasible in prenatal settings. Supportive strategies that reduce time and staff burden and increase provider competency to discuss childhood vaccines will be necessary to overcome perceived implementation challenges. Intervention feasibility and implementation factors should be reassessed upon actual implementation of the intervention.

Maternal immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended in many countries, but coverage in many low-income countries remains suboptimal. Targeted vaccination of women of child-bearing age could be a supplemental strategy to address this gap, but there are limited longitudinal immunogenicity data in this population outside of high-income countries. We compared antibody responses to Tdap between 30 non-pregnant women and 156 pregnant women enrolled in a clinical trial of maternal Tdap vaccination in Guatemala. Pre-vaccination antibody concentrations among both groups were similar for all vaccine antigens. At 2 months post-vaccination, antibody concentrations against vaccine antigens increased in both groups and were higher among non-pregnant women. By 9 months, antibody concentrations had decayed and were no longer different by study group. These findings reinforce existing recommendations for Tdap vaccination with every pregnancy. Vaccination of non-pregnant women may be considered in settings where maternal Tdap coverage is low.

(Abstracted from Obstet Gynecol 2024;144(6):782–789 Approximately 95% of cervical cancer cases can be attributed to human papillomavirus (HPV), which also causes anal, oropharyngeal, penile, vaginal, and vulvar cancers. The US Food and Drug Administration originally approved a vaccine for HPV in 2006 and expanded the age group approved for the vaccine in 2018.

This survey study of pregnant persons and parents of young children in the US examines vaccination intentions during pregnancy and vaccination behaviors after the child's birth for vaccines recommended from birth to age 18 months.

The COVID-19 pandemic heightened health inequities among historically marginalized groups. Community-based and culturally responsive interventions, like the Natural Helper (NH) model, leverage trusted community members to impart health related information. The VaxUP! intervention sought to reach non-Hispanic Black and rural people living in Southwest Georgia by deploying NHs to address vaccine hesitancy and support vaccination. We recruited and trained 31 NHs to engage with their community and to make vaccine appointments. As part of the process evaluation, tracking forms that included closed- and open-ended questions were analyzed to understand NH activities. NHs reached over 1950 people and booked over 600 vaccine appointments. Most encounters occurred over the telephone and through one-on-one interactions. During the interactions, NHs discussed many COVID-19 related topics and most frequently discussed vaccination benefits and COVID-19 information. Through this intervention, NHs were able to engage their community in conversations about the COVID-19 vaccine and book appointments.

BACKGROUND:Vaccination is important for controlling infectious disease; however, there are logistical barriers associated with needle and syringe-based vaccination. Non-needle-based vaccination methods could address many of these barriers and are in pre-clinical and clinical development. New technology is sometimes followed by hesitancy, affecting acceptance and uptake, highlighting the importance of understanding the perceptions of vaccine delivery methods by potential vaccine recipients. METHODS:To understand perceptions of non-needle-based vaccination methods in the state of Georgia, we surveyed 427 Georgia residents. Respondents were asked about their perceptions of vaccines and new medical technology, willingness to accept a non-needle-based vaccine, and whether they would recommend specific vaccination devices. RESULTS:Race and ethnicity were found to impact vaccine hesitancy and trust in new medical developments hesitancy. Of 427 participants, 29.3 % were more likely to accept non-needle-based devices over needle/syringe, 35.1 % were just as likely to accept, 14.4 % were unsure, and 20.6 % indicated that non-needle-based methods would not make them more likely to receive a vaccine. Race, urbanization, insurance status, vaccine hesitancy, and trust in new medical developments affected willingness to accept a non-needle-based vaccine. Needle/syringe vaccine devices were the most accepted method based on a picture and short description (77.6 %), inhaled vaccine devices were the least recommended (46.8 %); nasal spray (64.3 %), jet injector (60.0 %), skin patch (57.3 %), and oral delivery (54.0 %) were between these values. CONCLUSIONS:While needle/syringe is the preferred method of vaccination, there are clear preferences among non-needle-based vaccine delivery methods; however, demographic factors that are associated should be considered as these devices move through clinical testing. Our future work will involve in-depth interviews to further identify important themes affecting vaccine acceptance in Georgia. Due to potential hesitancy, we need to strengthen our understanding of themes associated with vaccine perceptions to enable design of accurate and persuasive materials for physicians and patients.

Introduction: Being up-to-date with all recommended vaccines is needed to protect children from vaccine preventable diseases. Understanding vaccination patterns is needed to develop messaging and strategies to increase vaccination uptake and confidence. Methods: Data from the 2011 to 2021 National Immunization Surveys was used to assess trends and disparities in vaccination patterns, zero vaccination status, and up-to-date status of U.S. children by 19-35 months. Results: From 2011 to 2021, adherence to the recommended schedule using the stringent definition increased from 35.7 % to 52.2 % (p < 0.01), adherence to the alternate schedule decreased from 28.2 % to 15.1 % (p < 0.01), and proportion of children who were not up-to-date decreased from 49.0 % to 33.3 % (p < 0.01). However, the proportion of children who had zero vaccinations did not change from 2011 (0.9 %) to 2021 (0.9 %; p = 0.08). In 2021, children 19-23 months were less likely to follow the recommended schedule than children 24-29 months (49.2 % compared to 56.4 %, p < 0.01). Adherence to the recommended schedule among children 19-23 months decreased in 2021 compared to 2020 overall and for some subpopulations (e.g. those with nonHispanic (NH) Black parents (33.2 % compared to 44.9 %, p < 0.01). Furthermore, it was lowest among children of NH Black parents living at or below the federal poverty level (31.2 %) compared to their respective NH White counterparts (43.6 %, p < 0.01). Conclusions: While there were overall increases in adherence to the recommended schedule from 2011 to 2021, a sustained catch-up program is needed to prevent missed vaccinations and achieve equitable vaccination coverage for all children.

We present VaxConcerns, a taxonomy for vaccine concerns and misinformation. VaxConcerns is an easy-to-teach taxonomy of concerns and misinformation commonly found among online anti-vaccination media and is evaluated to produce high-quality data annotations among crowdsource workers, opening the potential adoption of the framework far beyond just academic or medical communities. The taxonomy shows high agreement among experts and outperforms existing taxonomies for vaccine concerns and misinformation when presented to non-expert users. Our proof-of-concept study on the changes in anti-vaccination content during the COVID-19 pandemic indicate impactful future use cases, such as longitudinal studies of the shift in vaccine concerns over time.

OBJECTIVE:To assess whether routine postpartum human papillomavirus (HPV) vaccination is acceptable and feasible and to identify key themes and strategies that can be used to increase postpartum HPV vaccination rates. DATA SOURCES:PubMed and ClinicalTrials.gov were queried from inception to July 2024 for postpartum and HPV vaccination. Studies were limited to human subjects and the English language. METHODS OF STUDY SELECTION:Screening was performed for studies of any method that evaluated HPV vaccination in the postpartum period (N=60). Only original research that reported either uptake or acceptability of the HPV vaccine was included. Thirty-nine studies were eliminated after abstract review because they did not meet the inclusion criteria. TABULATION, INTEGRATION, AND RESULTS:Nine studies were categorized according to the primary aim of the study (defining the problem, assessing patient perspectives, or testing interventions to increase vaccination) and demonstrated that postpartum HPV vaccination programs can significantly increase HPV vaccination rates and are feasible and acceptable to patients. CONCLUSION:Incorporating HPV vaccination into standard postpartum care provides an opportunity to reach vulnerable patient populations, reduces cost for patients, and has the ability to prevent HPV-related cancers.