Current Human Papillomavirus Vaccines Research Articles

Contribution of Human papillomavirus in neuroendocrine tumors from a series of 10,575 invasive cervical cancer cases

AimsNeuroendocrine tumors (NET) of the cervix are rare tumors with a very aggressive course. The human papillomavirus (HPV) has been linked to its etiology. The objective of this study is to describe HPV prevalence and genotype distribution of NET. Methods and ResultsForty-nine tumors with histological neuroendocrine features were identified among 10,575 invasive cervical cancer (ICC) cases from an international study. HPV DNA detection was done using SPF10/DEIA /LiPA25 system. Immunohistochemical (IHC) staining for neuroendocrine markers (chromogranin A, synaptophysin, CD56) and for p16INK4a as a surrogate for HPV transforming infection was performed. In 13 samples with negative IHC for all 3 neuroendocrine markers studied, it was possible to conduct electron microscopy (EM).NET represented 0.5% of the total ICC series and HPV was detected in 42 out of 49 samples (85.7%, 95%CI:72.8%,94.1%). HPV16 was the predominant type (54.8%), followed by HPV18 (40.5%). p16INK4a overexpression was observed in 38/44 cases (86.4%). Neuroendocrine IHC markers could be demonstrated in 24/37 (64.9%) cases. EM identified neuroendocrine granules in 8 samples with negative IHC markers. ConclusionsOur data confirms the association of cervical NET with HPV and p16INK4a overexpression. Specifically, HPV16 and 18 accounted together for over 95% of the HPV positive cases. Current HPV vaccines could largely prevent these aggressive tumors.

Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment.

BackgroundHuman papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination.ObjectiveThe objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions.MethodsCurrent HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions’ content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models.ResultsA total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention.ConclusionsThis analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians.

169 - Evaluating HPV Vaccination Rates at Johns Hopkins All Children's Hospital General Pediatrics Clinic

Purpose: Human Papilloma Virus (HPV) infection leads to 26,000 new genitourinary and oropharyngeal cancers yearly. Routine recommendation for HPV adolescent immunization was made in 2007 for girls and 2011 for boys. Although this series is efficacious, HPV vaccination rates remain low nationwide, especially when compared to other vaccines of the adolescent platform. Our Pediatric and Adolescent Medicine clinic is evaluating our current HPV vaccination rates with the goal to reach series completion in at least 80% of our adolescents 13–17 years of age by the use of PDSA cycles.

A pilot study on the identification of human papillomavirus genotypes in tongue cancer samples from a single institution in Ecuador.

The relationship between human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma has been established. However, data from Ecuador is limited. The objective of this study was to characterize HPV infection in Ecuadorian patients with tongue cancer. Fifty-three patients with tongue cancer treated at the tertiary referral center Sociedad de Lucha Contra el Cancer (SOLCA), Guayaquil, between 2006 and 2011 were identified. Linear Array® HPV genotyping was used to identify the presence and types of HPV on formalin-fixed paraffin-embedded biopsy samples from these patients with tongue cancer. HPV was identified in 42% (n=22) and high-risk (HR) HPV in 17% (n=9), with 18 different HPV types identified. The most common types were the HR HPV 33 (14%) and low-risk HPV 67 (14%), followed by the HR HPV 58. More than one HPV type was identified in 27.3% of cases. HPV 33 was frequently associated with other HPV types. No statistically significant differences in gender (P=0.58) and age (P=0.12) were observed between HPV-positive and HPV-negative cases. HPV was identified in almost half of the tongue cancer samples, with subtypes 33 and 67 being the most common. This suggested that HPV played an important role in this disease in the population studied. Given these results, current HPV vaccines may not be as effective in reducing tongue cancer rates in this population.

High Prevalence of Human Papillomavirus Types 56 and 70 Identified in the Native Populations of Sabah, Malaysia

Background:Cervical cancer is currently the third most common female cancer in Malaysia, with the human papillomavirus (HPV) considered as one of the important contributory factors. This study was conducted to determine HPV prevalence, its genotype distribution, and other potential risk factors among women in Kota Kinabalu, Sabah in order to evaluate the likely efficacy of current HPV vaccines in the local population.Methods:A total of 240 cervical samples were collected and subjected to DNA extraction, PCR amplification using the MY09/MY11 primer pair, and restriction fragment length polymorphism (RFLP) for HPV detection and genotyping. Sociodemographic, clinical, and behavioural data were also collected via questionnaires.Results:The prevalence of HPV infection was 9.6%. The most common HPVs among 13 genotypes were high-risk HPV-56 (16.7%) and probable high-risk HPV-70 (16.7%) followed by HPV-16, -58, -53, -61, -33, -59, and -66 (in decreasing order of prevalence) including the rare genotypes: HPV-62, -81, -82 and -84. Statistical analyses using logistic regression models showed that HPV infection was significantly associated with employment (OR 4.94; CI 1.58-15.40) and education at secondary/high school level (OR 0.13; CI 0.03-0.62).Conclusion:Distribution of HPV genotypes in Sabah indicated a high prevalence of HPV-56 and -70 which are among the rare HPV types in West Malaysia and merit consideration in future strategies for HPV vaccination specifically for local Sabahan women.

Broadly neutralizing antiviral responses induced by a single-molecule HPV vaccine based on thermostable thioredoxin-L2 multiepitope nanoparticles

Vaccines targeting the human papillomavirus (HPV) minor capsid protein L2 are emerging as chemico-physically robust and broadly protective alternatives to the current HPV (L1-VLP) vaccines. We have previously developed a trivalent L2 vaccine prototype exploiting Pyrococcus furiosus thioredoxin (PfTrx) as a thermostable scaffold for the separate presentation of three distinct HPV L2(20–38) epitopes. With the aim of achieving a highly immunogenic, yet simpler and more GMP-production affordable formulation, we report here on a novel thermostable nanoparticle vaccine relying on genetic fusion of PfTrx-L2 with the heptamerizing coiled-coil polypeptide OVX313. A prototype HPV16 monoepitope version of this nanoparticle vaccine (PfTrx-L2-OVX313; median radius: 8.6 ± 1.0 nm) proved to be approximately 10-fold more immunogenic and with a strikingly enhanced cross-neutralization capacity compared to its monomeric counterpart. Vaccine-induced (cross-)neutralizing responses were further potentiated in a multiepitope derivative displaying eight different L2(20–38) epitopes, which elicited neutralizing antibodies against 10 different HPVs including three viral types not represented in the vaccine. Considering the prospective safety of the PfTrx scaffold and of the OVX313 heptamerization module, PfTrx-OVX313 nanoparticles lend themselves as robust L2-based immunogens with a high translational potential as a 3rd generation HPV vaccine, but also as a novel and extremely versatile peptide-antigen presentation platform.

Type-specific human papillomavirus prevalence in cervical intraepithelial neoplasia and cancer in Iran.

In Iran, human papillomavirus (HPV) vaccination is not currently included in the national vaccination program and there are no comprehensive approaches to cervical screening program. Regional data on distribution of HPV types in women is important to predict the impact of current HPV vaccines. Although several studies on distribution of HPV types in cervical precancer and cancer have been conducted in Iran, in most of them HPV positive samples were subjected to specific-primer genotyping (mainly 16 and 18), and leaving the other HPV genotypes almost undetermined. Therefore, the present study aimed to investigate the distribution of HPV types in cervical neoplasia from West and Northwest of Iran. A total of 112 women with atypia, cervical intraepithelial neoplasia, and invasive cervical cancer were included. A PCR assay was performed in all samples to detect the presence of the HPV genome using the GP5+/6+ L1 consensus primer set. All HPV positive samples were subjected for sequencing. In overall, HPV prevalence was 20% in atypica, 44.5% in cervical intraepithelial neoplasia I, 92.3% in cervical intraepithelial neoplasia II-III, and 98.2% in invasive cervical cancer. The most frequent HPV type was HPV 16 (79.2%), which was followed by HPV types 18, 6, and 33 at the frequencies of 6.5%, 5.1%, and 2.7%, respectively. The least HPV types were found to be 31, 45, 53, 58, and 66. In conclusion, this study shows that the current HPV vaccines could have great impact to reduce the burden of cervical cancer in Iran.

Cervical Cancer Screening and Prevention in 78 Sexually Transmitted Disease Clinics-United States, 2014-2015.

Human papillomavirus (HPV) infections cause approximately 30,700 cancers annually among US men and women, cervical cancer being the most common. Human papillomavirus vaccination is recommended routinely for US girls and boys at age 11 to 12 years, and for those not previously vaccinated, through age 26 and 21 years for women and men, respectively. Our objective was to assess current cervical cancer screening and HPV vaccination practices among sexually transmitted disease (STD) clinics in the United States. We surveyed a geographically diverse convenience sample of US STD clinics identified by members of the National Coalition of STD Directors within 65 state, territorial, and local jurisdictions. An online multiple-choice survey about clinical services was administered to clinic directors or designees during October 2014 to February 2015. Survey respondents included 78 clinics from 46 states and territories. Of these clinics, 31 (39.7%) offered both cervical cancer screening and HPV vaccination, 6 (7.7%) offered cervical cancer screening only, 21 (26.9%) offered HPV vaccination only, and 20 (25.6%) offered neither cervical cancer prevention service. Among those not offering the service, the most commonly reported barrier to cervical cancer screening was time constraints (25/41, 61.0%); for HPV vaccination it was reimbursement (11/26, 42.3%). By early 2015, in a geographically diverse group of 78 STD clinics, 39.7% provided nationally recommended HPV vaccination and cervical cancer screening, whereas 25.6% provided neither. Further research could identify strategies for STD clinics to reduce HPV-associated cancers by increasing provision of HPV vaccination and cervical cancer screening services, particularly among medically underserved populations.

Working to Increase Vaccination for Human Papillomavirus: A Survey of Wisconsin Stakeholders, 2015.

IntroductionInfection with human papillomavirus (HPV) is common and can progress to various types of cancer. HPV infection can be prevented through vaccination; however, vaccination rates among adolescents are low. The objective of this study was to assess efforts among Wisconsin stakeholders in HPV vaccination and organizational capacity for future collaborative work.MethodsWe conducted a cross-sectional online survey of 277 stakeholders in HPV vaccination activities, from April 30, 2015, through June 30, 2015. Stakeholders were public health professionals, health care providers, educators, quality improvement professionals, researchers, and advocates identified as engaged in HPV vaccination work. ResultsOf the 277 invited stakeholders, 117 (42%) responded to the survey. Findings showed that most current HPV vaccination activities targeted 3 groups: adolescents and parents, clinical and health professionals, and communities and health systems. The main activities directed at these groups were providing printed educational materials, professional education, and media campaigns to raise awareness. Common barriers reported were lack of understanding about the link between HPV and cancer, requests to delay vaccination, difficulty completing the 3-dose vaccine series, and reluctance to discuss sexuality.ConclusionHPV vaccination rates are far below those of other vaccinations administered to adolescents in Wisconsin. Our study showed that various local efforts were being made to increase HPV vaccination uptake; however, many barriers exist to initiation and completion of the vaccine series. Future interventions should address barriers and employ evidence-based strategies for increasing HPV vaccination rates.

Looking beyond human papillomavirus (HPV) genotype 16 and 18: Defining HPV genotype distribution in cervical cancers in Australia prior to vaccination.

Australia has implemented a high-coverage HPV vaccination program but has not, to date, established the distribution of HPV types that occur in cervical cancers in Australia. This information is important for determining the potential for cervical cancer prevention with both current and broader spectrum HPV vaccines. We analysed 847 cervical cancers diagnosed 2005 to 2015 in tertiary centres in the three most populous Australian states with resolution of specimens containing multiple HPV types using laser-capture microdissection. Archived FFPE tissue was reviewed by specialist pathologists, sandwich sectioned, and initially whole-tissue sections genotyped for HPV. Samples were first genotyped using SPF10-LiPA25 (version 1). Negative samples were screened with DNA ELISA kit HPV SPF10, followed by genotyping with SPF+ LiPA if ELISA positive. If still negative, samples were tested on a qPCR assay targeting the E6 region of HPV16, 18, 45 and 33. Of the 847 cancers (65.1% squamous, 28.7% adenocarcinoma, 4.3% adenosquamous, 2.0% other), 92.9% had HPV detected. Of the HPV-positive cancers, 607 of 787 (77.1%) contained HPV16 or 18, 125 of 787 (15.9%) contained HPV31/33/45/52 or 58, and 55 (7.0%) another HPV type. There was a strong correlation between HPV type and age, with younger women most likely to have HPV16/18 detected and least likely HPV negative. Our findings indicate that cervical cancers diagnosed in Australia more frequently contain HPV16/18 than in international series. This could be due to cervical screening in Australia increasing the proportion of adenocarcinomas, in which types 18 and 16 more strongly predominate, due to prevention of squamous cancers.

Human Papillomavirus Associated Cancers of the Head and Neck: An Australian Perspective.

Human papillomavirus (HPV) associated head and neck squamous cell carcinomas (HNSCCs), have become a serious global health problem. Despite decreases in HPV-negative HNSCCs, the prevalence of HPV-positive HNSCCs has significantly increased. HPV-positive cancers are associated with superior survival outcomes when compared to HPV-negative cancers, which appears likely to be associated with differences in the molecular pathogenesis of the two diseases. While therapies are still problematic, the current HPV vaccine programs hold a promise for the primary prevention of HPV-related HNSCCs and since Australia was the first to introduce a nationwide HPV vaccine program, it is in a unique position to observe the effects of the vaccine on HNSCCs. This review discusses the epidemiological trends associated with HPV in HNSCC, with reference to the differences between HPV-positive and HPV-negative HNSCCs and the prevention potential of HPV vaccines.

Type-Specific Human Papillomavirus Prevalence in Iranian Women with Normal Cervical Cytology: The Impact of Current HPV Vaccines

Objective: Human papillomavirus (HPV) vaccination is currently not included in the national vaccination program in Iran. Regional data on the distribution of HPV types in women are important as they can predict the impact of currently available vaccines and help health policy makers to consider all the possibilities with regard to HPV vaccination. Methods: A total of 1,218 Iranian women with normal cervical cytology were included in this study. The presence of the HPV genome was investigated in all specimens by PCR assay, and all HPV-positive samples were genotyped. Results: Totally, HPV was detected in 88 samples (7.2%). According to different geographical regions, the HPV prevalence varied: the highest HPV prevalence was observed in the North (11.7%) and the lowest in the Center (4.5%) of Iran, and this difference reached a statistically significant level (p < 0.05). In this study, the most frequent HPV types were HPV 16, 18, 66, and 11, representing 63.8% of all HPV infections. Conclusion: Based on this study, it is estimated that HPV vaccines could have a great impact on the prevention of cervical cancer in Iran. This study highlights the necessity of introducing educational programs in high schools, robust screening programs, and vaccination in Iran.

Human Papillomavirus-Associated Cancers

Research Article| October 01 2016 Human Papillomavirus-Associated Cancers AAP Grand Rounds (2016) 36 (4): 40. https://doi.org/10.1542/gr.36-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Human Papillomavirus-Associated Cancers. AAP Grand Rounds October 2016; 36 (4): 40. https://doi.org/10.1542/gr.36-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cancer, human papilloma virus vaccine, papillomavirus, human papillomavirus Source: Viens LJ, Henley J, Watson M, et al. Human papillomavirus-associated cancers—United States, 2008–2012. MMWR. 2016; 65(26): 661Google Scholar Investigators from the Centers for Disease Control and Prevention (CDC) reviewed data from a national registry to estimate the annual national rates of cancers attributable to human papillomavirus (HPV). For the study, they analyzed information from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results initiative. Data from 2008–2012 were reviewed. Invasive cancers catalogued in the databases were flagged as HPV-associated cases if they occurred in anatomic locations, including the cervix, vulva, vagina, penis, oropharynx, anus, and rectum, and were of cell types in which HPV DNA is frequently found. To determine the number of HPV-attributable cases, the researchers multiplied the number of each type of HPV-associated cancer cases by the percentage of these cancers attributable to HPV. Rates were compared in males and females for different cancer types. In addition, the numbers of cancers attributable to specific HPV types, including types 16 and 18, which can be prevented by the HPV vaccines, were calculated. The authors estimated that an average of 38,793 HPV-associated cancers were diagnosed each year from 2008–2012, including 23,000 cases annually among females and 15,793 among males. There were more oropharyngeal cancer cases in males, and more anal and rectal HPV-associated cancers in females. Overall, it was estimated that 79% of HPV-associated cancers were attributable to HPV. Of the 30,700 HPV-attributable cancers diagnosed per year from 2008–2012, 28,400 were caused by HPV types that can be prevented with the 9-valent HPV vaccine and 24,600 were tied to HPV types 16 and 18, which can be prevented with all current HPV vaccines. The authors conclude that surveillance for HPV-associated cancers using reliable population-based registries should continue so that the effect of HPV vaccines and/or different screening guidelines for cervical cancer can be monitored. Dr. Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. HPV is the most common sexually transmitted disease in the United States, with three-quarters of sexually active women infected with a high-risk HPV strain by age 50.1 Though the first HPV vaccine was introduced in 2006, vaccine uptake has been slower than expected, with only 42% of girls and 28% of boys 13–17 years old having received all 3 HPV vaccine doses in 2015.2 The current study provides further data on the potential protective effect of the HPV vaccine against over 70% of the HPV-associated cancers in women and men, including cancers of the cervix, vulva, vagina, penis, anus, rectum, and oropharynx. The main study limitation is the use of a population-based cancer registry that does not record the HPV status of each case; hence, the investigators relied on estimates for the proportion of each cancer caused by the various HPV strains. Prior studies in the United States examining... You do not currently have access to this content.

High prevalence of human papillomaviruses in Ghanaian pregnant women

Data about the prevalence of human papillomaviruses (HPV) in African women with normal and abnormal cervical cytology are still scarce. Current HPV vaccines contain HPV types, which mainly represent the HPV epidemiology of industrial countries. As further developments of HPV vaccines are going on, it is necessary to regard regional differences in HPV type prevalence to ensure optimal protection by the vaccine. Vaginal swabs of Ghanaian pregnant women, routinely collected before delivery to rule out bacterial infections causing early onset sepsis, were screened for 12 high-risk (HR), 13 probably/possibly (pHR), and 18 low-risk (LR) HPV types. Most pregnant women come for delivery to the hospital. This was considered as appropriate possibility to have an unselected group of women. HPV DNA were detected in 55/165 women (33.3, 95% CI 26.3-41.1%). Thirty-four out of fifty-five (61.8, 95% CI 47.7-74.3%) of HPV-positive women were infected with HR and/or pHR HPV types. The five most prevalent HR or pHR HPV types were HPV-52 and HPV-67 (7 women each, 4.2, 95% CI 1.9-8.9%), HPV-53 (six women, 3.6, 95% CI 1.5-8.1%), HPV-45 (five women, 3.0, 95% CI 1.1-7.3%), and HPV-18 (four women, 2.4, 95% CI 0.8-6.5%), respectively. HPV-16 was found in two women only (1.2, 95% CI 0.2-4.8%). Future HPV vaccine research may devote special interest to HPV-67 and HPV-53 provided further studies confirm their high prevalence in the general population of Sub-Saharan African countries. The true carcinogenic potential of HPV-67, which is a member of species alpha9 including HPV-16, and so far categorized as pHR, should be clarified.

9-Valent human papillomavirus recombinant vaccine (Gardasil® 9): a guide to its use in the EU

The 9-valent human papillomavirus (HPV) [types 6, 11, 16, 18, 31, 33, 45, 52, 58] recombinant vaccine (Gardasil® 9) provides an extended coverage of protection against HPV-related infection and disease relative to available (first generation) HPV vaccines. It is approved in the EU from the age of 9 years for the prevention of HPV-related premalignant lesions and cancers affecting the cervix, vulva, vagina and anus caused by vaccine HPV types, and genital warts caused by specific HPV types. In females negative for vaccine HPV types, the 9-valent HPV vaccine prevented cervical, vulvar and vaginal disease and persistent infection related to HPV types 31, 33, 45, 52 and 58 in women aged 16–26 years, and elicited an immune response to HPV types 6, 11, 16 and 18 that was noninferior to that elicited by the quadrivalent HPV vaccine in females aged 9–26 years. In addition, protective efficacy for each of the 9 HPV types in the vaccine can be inferred in girls and boys aged 9–15 years and men aged 16–26 years based on the robust immune response in bridging studies. The vaccine is generally well tolerated and is predicted to be cost effective relative to current HPV vaccination strategies.

Immunogenicity of next-generation HPV vaccines in non-human primates: Measles-vectored HPV vaccine versus Pichia pastoris recombinant protein vaccine

Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide. HPVs are oncogenic small double-stranded DNA viruses that are the primary causal agent of cervical cancer and other types of cancers, including in the anus, oropharynx, vagina, vulva, and penis. Prophylactic vaccination against HPV is an attractive strategy for preventing cervical cancer and some other types of cancers. However, there are few safe and effective vaccines against HPV infections. Current first-generation commercial HPV vaccines are expensive to produce and deliver.The goal of this study was to develop an alternate potent HPV recombinant L1-based vaccines by producing HPV virus-like particles into a vaccine that is currently used worldwide. Live attenuated measles virus (MV) vaccines have a well-established safety and efficacy record, and recombinant MV (rMV) produced by reverse genetics may be useful for generating candidate HPV vaccines to meet the needs of the developing world.We studied in non-human primate rMV-vectored HPV vaccine in parallel with a classical alum adjuvant recombinant HPV16L1 and 18L1 protein vaccine produced in Pichia pastoris. A combined prime-boost approach using both vaccines was evaluated, as well as immune interference due to pre-existing immunity against the MV.The humoral immune response induced by the MV, Pichia-expressed vaccine, and their combination as priming and boosting approaches was found to elicit HPV16L1 and 18L1 specific total IgG and neutralizing antibody titres. Pre-existing antibodies against measles did not prevent the immune response against HPV16L1 and 18L1.

Human Papillomavirus Genotype Distribution in Invasive Cervical Cancer in Pakistan.

Few studies have assessed the burden of human papillomavirus (HPV) infection in Pakistan. We aim to provide specific information on HPV-type distribution in invasive cervical cancer (ICC) in the country. A total of 280 formalin-fixed paraffin-embedded tissue blocks were consecutively selected from Shaukat Khanum Memorial Cancer Hospital and Research Centre (Lahore, Pakistan). HPV-DNA was detected by SPF10 broad-spectrum PCR followed by DNA enzyme immunoassay and genotyping by LiPA25. HPV-DNA prevalence was 87.5% (95%CI: 83.0–91.1), with 96.1% of cases histologically classified as squamous cell carcinoma. Most of the HPV-DNA positive cases presented single infections (95.9%). HPV16 was the most common type followed by HPV18 and 45. Among HPV-DNA positive, a significantly higher contribution of HPV16/18 was detected in Pakistan (78.4%; 72.7–83.3), compared to Asia (71.6%; 69.9–73.4) and worldwide (70.8%; 69.9–71.8) and a lower contribution of HPVs31/33/45/52/58 (11.1%; 7.9–15.7 vs. 19.8%; 18.3–21.3 and 18.5%; 17.7–19.3). HPV18 or HPV45 positive ICC cases were significantly younger than cases infected by HPV16 (mean age: 43.3, 44.4, 50.5 years, respectively). A routine cervical cancer screening and HPV vaccination program does not yet exist in Pakistan; however, the country could benefit from national integrated efforts for cervical cancer prevention and control. Calculated estimations based on our results show that current HPV vaccine could potentially prevent new ICC cases.

Human Papillomavirus Vaccine Uptake in Texas Pediatric Care Settings: A Statewide Survey of Healthcare Professionals

The purpose of this study was to identify barriers to and facilitators of human papillomavirus (HPV) vaccination in children aged 9-17years across Texas. A literature review informed the development of a web-based survey designed for people whose work involves HPV vaccination in settings serving pediatric patients. The survey was used to examine current HPV vaccine recommendation practices among healthcare providers, barriers to HPV vaccination, reasons for parent/caregiver vaccine refusal, staff and family education practices, utilization of reminder and recall systems and status of vaccine administration (payment, ordering and stocking). 1132 responses were received representing healthcare providers, administrative and managerial staff. Respondents identified perceived barriers to HPV vaccination as parental beliefs about lack of necessity of vaccination prior to sexual debut, parental concerns regarding safety and/or side effects, parental perceptions that their child is at low risk for HPV-related disease, and parental lack of knowledge that the vaccine is a series of three shots. Of responding healthcare providers, 94% (n=582) reported they recommend the vaccine for 9-12year olds; however, same-day acceptance of the vaccine is low with only 5% (n=31) of providers reporting the HPV vaccine is "always" accepted the same day the recommendation is made. Healthcare providers and multidisciplinary care teams in pediatric care settings must work to identify gaps between recommendation and uptake to maximize clinical opportunities. Training in methods to communicate an effective HPV recommendation and patient education tailored to address identified barriers may be helpful to reduce missed opportunities and increase on-time HPV vaccinations.

The potential impact of prophylactic human papillomavirus vaccination on oropharyngeal cancer.

The incidence of oropharyngeal cancer (OPC) is significantly increasing in the United States. Given that these epidemiologic trends are driven by human papillomavirus (HPV), the potential impact of prophylactic HPV vaccines on the prevention of OPC is of interest. The primary evidence supporting the approval of current prophylactic HPV vaccines is from large phase 3 clinical trials focused on the prevention of genital disease (cervical and anal cancer, as well as genital warts). These trials reported vaccine efficacy rates of 89% to 98% for the prevention of both premalignant lesions and persistent genital infections. However, these trials were designed before the etiologic relationship between HPV and OPC was established. There are differences in the epidemiology of oral and genital HPV infection, such as differences in age and sex distributions, which suggest that the vaccine efficacy observed in genital cancers may not be directly translatable to the cancers of the oropharynx. Evaluation of vaccine efficacy is challenging in the oropharynx because no premalignant lesion analogous to cervical intraepithelial neoplasia in cervical cancer has yet been identified. To truly investigate the efficacy of these vaccines in the oropharynx, additional clinical trials with feasible endpoints are needed. Cancer 2016;122:2313-2323. © 2016 American Cancer Society.

Abstract B89: HPV is not just a woman's business! Understanding the gaps in men's knowledge of HPV and HPV vaccine

Abstract Background: The human papillomavirus (HPV) vaccine was first approved for use in females in 2006, and then in 2009, for both males and females. However, the knowledge of HPV and HPV vaccine, and uptake of the vaccine has been suboptimal and worse among males. In addition, the burden of HPV-associated cancers in the United States is very high among males, especially in head and neck, anal, and penile cancers. If the current HPV vaccination trend persists, then the Healthy People 2020 goal of achieving 80% HPV vaccination will not be achieved. Objective: The aim of this study was to quantify gaps in HPV and HPV vaccine knowledge among adult males in the United States. Methods: Data from the Health Information National Trends Survey 4 Cycle 4 (November 2014) were analyzed for 3,677 survey participants aged 18 years and older. Primary outcome of interest was men's knowledge of HPV and HPV vaccine. Secondary outcome of interest were men's knowledge that HPV causes certain cancers. Participants were asked if they have heard about the HPV and HPV vaccine. Respondents who answered “no” were excluded (n = 1,389). Final sample size used for analyses for the secondary outcomes of interest was 2,288. Results: Sixty-four percent of respondents (56% of men and 72% of women) had heard of HPV and the HPV vaccine. In multivariate analyses, after adjusting for known covariates, males were 67% (95% CI: 0.25 – 0.45) less likely to have heard of HPV, and 76% (95% CI: 0.18 – 0.32) less likely to have heard of the HPV vaccine compared to females. Seventy percent (73% of men and 67% of women) knew that HPV is sexually transmitted disease (STD), 78% (76% of men and 79% of women) knew HPV causes cervical cancer, but only 29% of men and women knew it causes penile cancer, 26% (27% of men and 25 % of women) knew it causes anal cancer, and 30% (31% of men and 29% of women) knew it causes oral cancer. Among those that had heard of HPV, there was no statistical difference in knowledge between males and females with regard to the knowledge that HPV causes cervical, penile, anal and oral cancer. However males were less likely than females to know that HPV causes cervical cancer while females were less likely to know that HPV causes oral cancer. Modified by race, non-Hispanic Black women were 54% less likely to have heard of HPV (OR = 0.46, 95% CI: 0.24 – 0.88); and 64% less likely to have heard of HPV vaccine (OR = 0.36, 95% CI: 0.19 – 0.67), compared to non-Hispanic White women. Similarly, compared to non-Hispanic White women, Hispanic women were 51% less likely to have heard of HPV vaccine (OR = 0.49, 95% CI: 0.27 – 0.88). For men, compared to non-Hispanic White men, Hispanic men were 69% less likely to have heard of HPV vaccine (OR = 0.31, 95% CI: 0.16 – 0.62). Conclusion: A two-third of respondents were aware of HPV and HPV vaccine, but a clear gender and racial gap still exist in HPV and HPV vaccine knowledge. This underscores the need for more tailored interventions specifically targeted towards males and minority racial groups in order to increase knowledge and uptake of the HPV vaccine. It also highlights the need for more deliberate efforts on the part of physicians to discuss the HPV vaccine with eligible patients and parents Citation Format: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Betelihem B. Tobo, Kahee Agid Mohammed. HPV is not just a woman's business! Understanding the gaps in men's knowledge of HPV and HPV vaccine. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B89.