Michelle L. Henninger

Background: Efficacy and immunogenicity of single-dose human papillomavirus (HPV) vaccination have been demonstrated among females; less is known about single-dose vaccination among males. We assessed sex differences in antibody response 12–48 months postvaccination among adolescents who received a single 9-valent HPV vaccine (9vHPV) dose. Methods: Participants were recruited from an integrated healthcare delivery system in Oregon and southwest Washington. Adolescents who received a single 9vHPV dose at ages 9–12 years, 12–48 months prior to study enrollment, were identified. Serum antibody testing for each 9vHPV type (HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58) was conducted using M9ELISA. We compared antibody detection and geometric mean antibody concentrations (GMCs) among males to females. Results: Among 111 male and 96 female participants, age at vaccination (>95% at age 11 or 12 years) and time since vaccination (median, 20 months) were similar by sex. Among males and females, 80.2% and 89.6%, respectively, had detectable antibodies for all types, with no significant sex difference. Type-specific detection ranged from 84.7% to 99.1% for males and 91.7% to 99.0% for females, with no significant sex differences. GMCs were 31%–50% lower among males than females for all types (range of GMC ratios adjusted for time since vaccination, 0.50–0.69). Conclusions: One to 4 years after single-dose 9vHPV vaccination, males had similar detection but lower antibody concentrations than females. Because very low levels of antibody are thought to protect against HPV, the clinical significance of these sex differences is unknown.

Introduction: In the past decade, hepatitis C virus (HCV) infections among pregnant women increased dramatically in the United States, rising in parallel with the opioid crisis and increasing the number of children at risk for HCV. People with HCV infection that remains untreated are also at increased risk of cirrhosis, liver cancer, and death. Objective: To describe timing of HCV testing during pregnancy and postpartum HCV treatment among women with opioid use disorder (OUD). Methods: This analysis draws from the MATernaL and Infant clinical NetworK (MAT‐LINK) surveillance system's cohort of women with OUD during pregnancy, which is collected from electronic health records of seven healthcare systems. Women were included if they had OUD during pregnancy and a known pregnancy outcome during January 1, 2014–August 31, 2021. Antenatal HCV testing was examined by characteristics of pregnant women (including age, race, ethnicity, insurance, urbanicity, parity, and medication for OUD) using multinomial regression. Hepatitis C diagnosis (positive antibody or nucleic acid test or diagnostic code) and postpartum treatment were also examined. Results: Among the 5533 pregnancies in this cohort, 1506 (27.2%) had no testing or diagnostic code for hepatitis C including 1296 who received prenatal care. Among 910 pregnancies with no prenatal care, 700 (76.9%) had HCV testing or diagnostic codes. Among pregnancies with HCV testing or diagnostic codes, 55.8% had a hepatitis C diagnosis. Women were more likely to have HCV testing if they were White or Hispanic, had government‐funded insurance, or received medication for OUD during the pregnancy. From five clinical sites with prescription information available, 9.7% ( n = 81/836) of those with a detectable viral load had a direct‐acting antiviral prescription in the first year postpartum. Conclusion: Women with OUD during pregnancy have a high burden of hepatitis C. Despite national recommendations, gaps remain in HCV testing during pregnancy and HCV treatment postpartum. HCV testing among women with no prenatal care indicates that testing is occurring outside of traditional prenatal care settings. Receiving medication for OUD was associated with being tested for HCV during pregnancy. Improved HCV testing, treatment, and management for pregnant women with OUD represent opportunities for improving overall health and eliminating HCV infection.

Introduction: Coverage rates for recommended adolescent vaccinations such as HPV and influenza (flu) are far below the 80% Healthy People Target. Promoting vaccination in nontraditional settings such as the dental office may provide a unique opportunity to improve vaccination rates and prevent cancer. Methods: In a cluster randomized trial of 16 Kaiser Permanente Northwest (KPNW) Dental clinics, dental teams were randomized to deliver an intervention to recommend vaccination to 11-17-year-olds who were due for a recommended vaccination, or to deliver usual care. We mailed surveys to the parents or guardians of adolescents asking whether they received a vaccine recommendation during their dental visit and assessing their comfort with the intervention. Results: Nearly 64% of 11-17-year-olds who had a dental visit during the study period were due for one or more recommended vaccination. Most (72%) parents indicated that they were either comfortable or neutral about dental providers making vaccine recommendations. Over two-thirds (69%) of parents who recalled receiving the specific vaccine recommendation reported that their child subsequently received some or all the vaccines recommended during the dental visit or that they planned to do so. However, a sizeable minority of parents, 31%, reported that they did not plan to follow up with recommended vaccinations. Discussion: Most parents are accepting of dental providers making vaccination recommendations. Promoting vaccination in alternative settings such as dental clinics may be a promising technique to prevent cancer, other disease and death through closing vaccination gaps.