Joshua T. B. Williams

This cohort study compares hepatitis B vaccination series completion by 18 months in infants who did vs did not receive a birth dose.

Importance: Seasonal influenza causes morbidity and mortality in vulnerable communities. Narrative reminder recall (ie, digital stories using multimodal narratives that uplift community voices) may be scalable as an equity-promoting intervention to increase vaccination rates. Objectives: To assess (1) the reach of texts with pediatric influenza vaccine digital stories among caregivers of young children and (2) associations of caregiver intervention assignment with time to child influenza vaccination. Design, Setting, and Participants: This pilot randomized clinical trial included caregivers and their children (aged 6 months to 5 years) from 2 safety-net clinics in historically Black neighborhoods in Denver, Colorado between September 16, 2024, and March 31, 2025. Caregivers aged 18 years and older who preferred English and their children, provided they had 1 well visit in the past 18 months and would be aged 6 to 71 months during the influenza season, were included. Intervention: The digital storytelling intervention included texts with links to 5 stories (3 featuring caregivers who identified as Black or African American) sent in October 2024. Usual care included 1 message sent via an electronic health record messaging portal to caregivers of all children eligible for influenza vaccines. Main Outcomes and Measures: The primary outcome was digital story reach (ie, the proportion of caregivers viewing 1 or more digital stories for any length of time). Time to first influenza vaccination was recorded for children. Adjusted Cox proportional hazards modeling (with 95% CI) fit time to vaccination by group and baseline covariates. Kaplan-Meier curves analyzed the proportions of children remaining unvaccinated by group over time. Results: Intention-to-treat analyses included 200 children (100 per group; mean [SD] age, 29.1 [16.1] months; 96 male [48%]; 77 Black or African American [39%]; 90 Hispanic or Latino/a [45%]; 54 White [27%]) and their 198 caregivers (100 usual care; 98 intervention; mean [SD] age, 30.5 [7.5] years; 176 mothers [89%]; 77 Black or African American [39%]; 87 Hispanic or Latino/a [44%]; 25 White [13%]). Overall, 686 of 686 texts (100%) were delivered; digital stories were viewed by 7 caregivers (7%). More children of intervention caregivers were vaccinated when influenza activity peaked on February 15, 2025, (percentage unvaccinated, 62% [95% CI, 53%-72%] in intervention vs 74% [95% CI, 66%-83%] in usual care; Z test, 1.82; P = .03). In adjusted analyses, children of intervention caregivers were 63% more likely to be vaccinated compared with children of caregivers receiving usual care (adjusted hazard ratio, 1.63; 95% CI, 1.01-2.64). Conclusions and Relevance: In this pilot randomized clinical trial of a text message digital storytelling intervention centering Black families, intervention receipt was associated with improved pediatric influenza vaccination, although intervention reach was low. Trial Registration: ClinicalTrials.gov Identifier: NCT06274359

This Viewpoint discusses the current Advisory Committee on Immunization Practices and American Academy of Pediatrics race-based guidelines on the administration of nirsevimab and suggested race-conscious revision of the current guidance.

Objectives: To (1) assess perceptions of parents of patients ages 9–17 years regarding human papillomavirus (HPV) vaccine counseling and a same‐day HPV vaccine program, and (2) assess perceptions among dental staff who actively participated in the same administration program.Methods: We conducted a post‐evaluation, convenience survey of parents of patients aged 9–17 and dental staff at a large‐urban federally qualified healthcare center (FQHC) from July 25, 2022, to August 26, 2022. Parent and staff perceptions were assessed using validated instruments whenever possible. Data were analyzed descriptively.Results: Overall, 101 parents participated (response rate: 89%). Overall, 80 parents (74.3%) reported wanting to discuss diseases prevented by the HPV vaccine with their dental provider. Twenty parents (20%) reported receiving counseling on the HPV vaccine by their dentist; 95% (n = 19) of those parents reported it did not change their comfort with their provider and 60% (n = 12) reported their child received the vaccine that day.Overall, 44 dental staff members (32% DDS/DMD, 14% RDH‐BS‐Dental Hygiene, 55% Other) completed surveys (response rate: 100%). Of these, 39 (88.6%) were willing to recommend the HPV vaccine and participate in a referral program. Nearly all dentists and hygienists (95%) reported discussing the vaccine was within their scope of practice, and most (65%) agreed vaccine administration should be within their scope.Conclusion: In a single site convenience survey within an urban, federally qualified health care system, most parents, and dental staff perceived HPV vaccine counseling and administration favorably and clinically appropriate during routine dental visits.

Importance: Pregnant people and infants are at high risk of severe COVID-19 outcomes. Understanding changes in attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is important for public health messaging.Objective: To assess attitudinal trends regarding COVID-19 vaccines by (1) vaccination status and (2) race, ethnicity, and language among samples of pregnant and recently pregnant Vaccine Safety Datalink (VSD) members from 2021 to 2023.Design, Setting, and Participants: This cross-sectional surveye study included pregnant or recently pregnant members of the VSD, a collaboration of 13 health care systems and the US Centers for Disease Control and Prevention. Unvaccinated, non-Hispanic Black, and Spanish-speaking members were oversampled. Wave 1 took place from October 2021 to February 2022, and wave 2 took place from November 2022 to February 2023. Data were analyzed from May 2022 to September 2023.Exposures: Self-reported or electronic health record (EHR)–derived race, ethnicity, and preferred language.Main Outcomes and Measures: Self-reported vaccination status and attitudes toward monovalent (wave 1) or bivalent Omicron booster (wave 2) COVID-19 vaccines. Sample- and response-weighted analyses assessed attitudes by vaccination status and 3 race, ethnicity, and language groupings of interest.Results: There were 1227 respondents; all identified as female, the mean (SD) age was 31.7 (5.6) years, 356 (29.0%) identified as Black race, 555 (45.2%) identified as Hispanic ethnicity, and 445 (36.3%) preferred the Spanish language. Response rates were 43.5% for wave 1 (652 of 1500 individuals sampled) and 39.5% for wave 2 (575 of 1456 individuals sampled). Respondents were more likely than nonrespondents to be White, non-Hispanic, and vaccinated per EHR. Overall, 76.8% (95% CI, 71.5%-82.2%) reported 1 or more COVID-19 vaccinations; Spanish-speaking Hispanic respondents had the highest weighted proportion of respondents with 1 or more vaccination. Weighted estimates of somewhat or strongly agreeing that COVID-19 vaccines are safe decreased from wave 1 to 2 for respondents who reported 1 or more vaccinations (76% vs 50%; χ²₁ = 7.8; P < .001), non-Hispanic White respondents (72% vs 43%; χ²₁ = 5.4; P = .02), and Spanish-speaking Hispanic respondents (76% vs 53%; χ²₁ = 22.8; P = .002).Conclusions and Relevance: Decreasing confidence in COVID-19 vaccine safety in a large, diverse pregnant and recently pregnant insured population is a public health concern.