Male HPV Vaccination Research Articles

Low coverage of HPV vaccination in the national immunization programme in Brazil: Parental vaccine refusal or barriers in health-service based vaccine delivery?

BackgroundThe World Health Organization has recommended the introduction of HPV vaccines into national immunization programme (NIP), but vaccination coverage remains low worldwide. We assessed the coverage and the parental acceptance of female and male HPV vaccination in Brazil after its introduction into the NIP.MethodsWe conducted a random-digit-dial survey of parents in seven major Brazilian cities from July-2015 to October-2016. A knowledge, attitude and practices questionnaire was developed and validated by expert analysis, semantic analysis, and pre-testing.Results826 out of 2,324 (35.5%) eligible parents completed the interview. Parental acceptance of the HPV vaccine for daughters and sons 18 years of age or less was high (92% and 86%, respectively). Parents refusing vaccination were less likely to know that: HPV is sexually transmitted and causes genital warts, HPV vaccination is more beneficial before sexual debut, and HPV vaccine reactions are minor, and they were more likely to believe HPV vaccination can cause severe adverse events. Parents accepting HPV vaccine for daughters but not forsons were more likely to ignore that the vaccine is recommended for boys. Attitudes associated with HPV vaccine acceptance included: general belief in vaccines, trust in the NIP and in the HPV vaccine efficacy. Among girls eligible for HPV vaccination through the NIP, 58.4% had received a two-dose scheme and 71.1% at least one dose. “No vaccination/missed vaccination at school” was the most common reason for missed HPV vaccination in theNIP.ConclusionsOne year after introduction in the NIP, most parents surveyed in Brazil accepted HPV vaccination for their daughters and sons. Low coverage in the NIP seemed to be due to challenges in adolescent vaccine delivery and HPV vaccination barriers at health-care centers, rather than to vaccine refusal.

Increasing trend of penile cancer cases in Bali compared to other regions in Indonesia

Penile cancer is a rare type of cancer in developed countries and found high in the developing country. This study aims to compare penile cancer cases in Bali and other regions in Indonesia. A 10 years review cases from cancer registry of Pathologic Anatomy Indonesia were done from 2004 to 2013. Penile cancer cases were found highest in Bali compared to other regions in Indonesia. This cancer showed an increase in number from the year of 2004 and reached its peak in 2013. Penile cancer is the most common cancer found in Balinese male population from the latest cancer registry in 2013. Risk factors associated with penile cancer are phimosis, lichen sclerosis, HPV infection, and history of wart or condyloma, lack of circumcision, multiple sex partners, and early sexual activity. Lack of circumcision is an important risk factor found in Bali. Penile cancer shows an improvement during the last 10 years and provides a new insight on the cancer issues in Bali. A preventive efforts such as improving hygiene factors on male reproductive organs, do circumcision, save sex practice and new recommendations for a routine male HPV vaccination may further reduce penile cancer cases.

Using Intervention Mapping to Develop and Adapt Two Educational Interventions to Increase HPV Vaccination Among Hispanic Adolescents

Background: HPV vaccination among Hispanic adolescents falls below the national goal. Tailored interventions to increase vaccination among Hispanic populations are needed to reach national goals and to reduce HPV-related cancer disparities. Aim: We used the intervention mapping (IM) framework to develop and adapt two educational interventions, a print fotonovela and a tailored interactive multimedia intervention (TIMI), targeting Hispanic parents of adolescents to increase HPV vaccine uptake. Methods: To develop the interventions, we followed IM steps 1-6 to 1) develop a logic model of the problem and identify modifiable factors associated with vaccination by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; 2) develop behavioral outcomes, identify determinants, and develop a matrix of change objectives; 3) develop a program theme and program components, identify theoretical methods, and operationalize methods as practical applications; 4) develop an intervention design plan; 5) develop implementation strategies; and 6) evaluate the interventions. To adapt the interventions, we followed steps 1-6 for the new target population, Hispanic parents of adolescent males. Throughout the adaptation process, we assessed the outputs from the original intervention development process to identify needed adaptations. Results: Through formative research in step 1, we identified modifiable determinants associated with parental decision-making about vaccinating their daughters. In step 2, we crossed performance objectives with these factors to produce a matrix of change objectives that served as a blueprint for program development. We then identified tailoring and targeting, framing and anticipated regret, modeling, skill building, and education and counseling as theoretical methods to address the determinants and create behavior change. We produced two program components, a print fotonovela and TIMI, with the theme “For Our Daughters.” Our implementation plan identified lay health workers as implementers. A logic model of change guided evaluation planning. We later adapted the intervention content for parents of Hispanic adolescent males and changed the theme to “For Our Children.” We identified new knowledge gaps as parents were less informed about the HPV vaccine for males. We made surface adaptations including filming new scenes to produce a new fotonovela and TIMI. We conducted content analysis to ensure intervention messages corresponded to change objectives. Conclusion: IM provided a systematic methodology for program development and adaptation to produce two educational interventions to increase HPV vaccination among Hispanic adolescents. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.

Physicians’ current use and preferences for male HPV vaccine-related patient education materials

Understanding physician preferences for educational materials to support male HPV vaccination is critical to improving vaccine uptake. Pediatric (Peds) and Family Medicine (FM) physicians in Florida completed a survey from May-August 2014 assessing current use of male-specific HPV vaccination patient education materials, and preferences for materials to increase HPV vaccination uptake. Peds and FM responses were compared with chi-squared or nonparametric tests. Most participants were FM (53.2%), White (66.6%), non-Hispanic (74.1%), and provided male patients/parents with HPV educational materials (59.1%). More than half (55.5%) provided a CDC factsheet for parents. Peds were more likely to indicate they provide educational materials (p<0.0001) than FM. The preferred source was the CDC (77.8%). Peds preferred using a factsheet as the medium of information more often than FM (85.6% vs. 68.0%; p<0.0001). When asked about preferences for targeted materials, 74.8% of providers indicated they would prefer materials targeted towards patients, 63.2% preferred information targeted towards parents, and 20.7% indicated they prefer non-targeted materials. Future research should focus on the development and testing of new HPV vaccine-specific materials and communication strategies for Peds and FM physicians.

HPV vaccination: acceptance and influencing factors among young men in Germany.

This study aims to determine the factors that influence the acceptance of the HPV vaccination among German males. In 2014, we conducted a population-based cross-sectional study in men aged 15-25 years. A questionnaire was mailed to male trainees of the Bayerische Motorenwerke AG (BMW) insured at the BMW health insurance company. The response rate was 10.8%. Of the 378 included men, 74.1% would agree to receive HPV vaccination. Most men primarily consult their physician for health-related topics, but 92.9% had never been informed about HPV infection, risk factors and prevention methods by their doctor. Our results demonstrate a high acceptance of male HPV vaccination. Education about HPV infection is low and should be intensified by medical professionals.

Parent HPV vaccine perspectives and the likelihood of HPV vaccination of adolescent males

In 2013, approximately one-third of US adolescent males age 13–17 y had received ≥1 doses of HPV vaccines and only 14% had received ≥3 doses. This study used a nationally representative, online survey to explore experiences and attitudes related to HPV vaccination among parents with adolescent sons. Analyses compared the perspective of parents who do not intend to initiate HPV vaccine for ≥1 adolescent son to that of parents who are likely to initiate or continue HPV vaccination. Of 809 parents of sons age 11–17 years, half were classified as Unlikely to Initiate HPV vaccination and 39% as Likely to Vaccinate. A higher proportion of the Likely to Vaccinate group felt their son's doctor was knowledgeable about HPV vaccine, did a good job explaining its purpose, and spent more time discussing HPV vaccine; in contrast, over half of the Unlikely to Initiate group had never discussed HPV vaccine with their child's doctor. The majority of parents in both groups showed favorable attitudes to adolescent vaccination in general, with lower levels of support for HPV vaccine-specific statements. Physician-parent communication around HPV vaccine for adolescent males should build on positive attitude toward vaccines in general, while addressing parents' HPV vaccine-specific concerns.

Parental attitudes towards male human papillomavirus vaccination: a pan-European cross-sectional survey.

BackgroundHuman papillomavirus (HPV) is a common sexually transmitted virus that can lead to severe diseases in both women and men. Today, HPV vaccination is offered to females only across Europe. We aimed to examine parental attitudes to HPV vaccination of their sons given brief information about HPV in both genders.MethodsA literature study on acceptability of male HPV vaccination was carried out to inform the construction of a study questionnaire. Following up on a Danish study from 2012, this questionnaire was applied in 1837 computer assisted interviews with parents of sons in the UK, Germany, France and Italy. In each country, the parents were representative in terms of geographical dispersion, city size and age of sons in the household. The applied questionnaires took the varying vaccination policies and delivery systems into account. The data were analysed pooled and for each country using significant statistical tests (chi-2) with a 95 % confidence interval.ResultsApproximately ¾ of parents in the UK, Germany and Italy were in favour of HPV vaccination of their sons. In France, this applied to 49 % of respondents. Favourable parents wanted to protect their sons from disease and found gender equality important. Parents in doubt about male HPV vaccination needed more information about HPV diseases in men and male HPV vaccination; Rejecting parents were generally sceptical of vaccines and feared vaccination side-effects. Parents in countries with active vaccination policies (UK and Italy) tended to trust the importance of national vaccination programmes. Parents in countries with passive vaccination strategies (Germany and France) had greater need for information from health care professionals (HCP) and public health authorities.ConclusionGiven brief information about HPV in both genders, parental acceptance of HPV vaccination of sons is as high as acceptance levels for girls. All parents should be informed about HPV to make informed decisions about HPV vaccination for their children. There is a need for joint efforts from public health authorities and HCPs to provide parents with such information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1863-6) contains supplementary material, which is available to authorized users.

A model of health care provider decision making about HPV vaccination in adolescent males

IntroductionIn the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended. MethodA total of 20 U.S. pediatric HCPs participated in 20–30min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis. ResultsThe providers had been in practice for 1–35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers’ preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the “newness” and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated. ConclusionsProviders’ opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.

Is male HPV vaccination cost effective?

Is male HPV vaccination cost effective?

Incremental benefits of male HPV vaccination: accounting for inequality in population uptake.

BackgroundVaccines against HPV16/18 are approved for use in females and males but most countries currently have female-only programs. Cultural and geographic factors associated with HPV vaccine uptake might also influence sexual partner choice; this might impact post-vaccination outcomes. Our aims were to examine the population-level impact of adding males to HPV vaccination programs if factors influencing vaccine uptake also influence partner choice, and additionally to quantify how this changes the post-vaccination distribution of disease between subgroups, using incident infections as the outcome measure.MethodsA dynamic model simulated vaccination of pre-adolescents in two scenarios: 1) vaccine uptake was correlated with factors which also affect sexual partner choice (“correlated”); 2) vaccine uptake was unrelated to these factors (“unrelated”). Coverage and degree of heterogeneity in uptake were informed by observed data from Australia and the USA. Population impact was examined via the effect on incident HPV16 infections. The rate ratio for post-vaccination incident HPV16 in the lowest compared to the highest coverage subgroup (RRL) was calculated to quantify between-group differences in outcomes.ResultsThe population-level incremental impact of adding males was lower if vaccine uptake was “correlated”, however the difference in population-level impact was extremely small (<1%) in the Australia and USA scenarios, even under the conservative and extreme assumption that subgroups according to coverage did not mix at all sexually. At the subgroup level, “correlated” female-only vaccination resulted in RRL = 1.9 (Australia) and 1.5 (USA) in females, and RRL = 1.5 and 1.3 in males. “Correlated” both-sex vaccination increased RRL to 4.2 and 2.1 in females and 3.9 and 2.0 in males in the Australia and USA scenarios respectively.ConclusionsThe population-level incremental impact of male vaccination is unlikely to be substantially impacted by feasible levels of heterogeneity in uptake. However, these findings emphasize the continuing importance of prioritizing high coverage across all groups in HPV vaccination programs in terms of achieving equality of outcomes.

Acceptability of HPV vaccine for males varies

Acceptability of HPV vaccine for males varies

HPV vaccination among adolescent males: Results from the National Immunization Survey-Teen

US guidelines provided a permissive recommendation for HPV vaccine for males in 2009, with an updated recommendation for routine vaccination in 2011. Data on vaccine uptake among males, however, remain sparse. We analyzed 2010–2011 data (collected mostly prior to the recommendation for routine vaccination) from the National Immunization Survey-Teen for a nationally representative sample of adolescent males ages 13–17 (n=22,365). We examined HPV vaccine initiation (receipt of at least one dose based on healthcare provider records) as the primary outcome. Analyses used weighted logistic regression. HPV vaccine initiation increased from 1.4% in 2010 to 8.3% in 2011. Parents who reported receiving a healthcare provider recommendation to get their sons HPV vaccine were much more likely to have vaccinated sons (OR=19.02, 95% CI: 14.36–25.19). Initiation was also higher among sons who were Hispanic (OR=1.83, 95% CI: 1.24–2.71) or who were eligible for the Vaccines for Children program (OR=1.53, 95% CI: 1.01–2.31). Only 31.0% of parents with unvaccinated sons indicated their sons were “somewhat likely” or “very likely” to receive HPV vaccine in the next year. The most common main reasons for parents not intending to vaccinate were believing vaccination is not needed or not necessary (24.5%), not having received a provider recommendation (22.1%), and lack of knowledge (15.9%). HPV vaccination is low among adolescent males in the US, and provider recommendation for vaccination is likely key to improving vaccine uptake. Given the updated recommendation for routine vaccination and the changes in health insurance coverage that are likely to follow, continued efforts are needed to monitor HPV vaccination among males.

44. Detection of the human papillomavirus infection (HPV) on the internationally used environmental surfaces: ready for a ‘take-off

Background Incidence rates continue to increase for HPV-associated anal cancer in both women and men. HPV is the most common viral STI but the transmission of the virus via environmental surfaces has been neither confirmed nor disproved. Studies of HPV DNA on environmental surfaces could provide insights of the magnitude of this problem. In the modern era, international travel has become a routine. We investigated the HPV contamination of the surfaces that frequently contact anogenital skin, specifically toilet seats in airport rest rooms. Methods: Within a pilot study started in St Petersburg, samples from apparently clean areas of (fe)male toilet seats at the departure zones of 36 airports in 22 countries were collected with the same cytobrush sampling procedure as typically used in HPV epidemiological studies, routinely β-globin RT-PCR tested for human DNA and HPV genotyped by the proficient in the WHO HPV LabNet global proficiency panel Luminex assay for 13 oncogenic and 23 non-oncogenic HPV types. Results: Comparable to the reports from high sexual risk-taking groups in humans, HPV DNA was found in 22.1% of the 172 samples, high-risk HPVs in 16.3%, HPV-16 in 14.5% and multiple HPV types in 1.7%. Conclusions: Caution is required when interpreting the presence of HPV DNA as an ‘infection’: the presence of HPV DNA does not necessarily indicate the presence of infectious virus and this study therefore does not provide any evidence regarding routes of HPV transmission. Data on incidence, prevalence and clearance of HPV infection in men are essential for the development of models estimating the effect of male HPV vaccination.

Advertisements promoting HPV vaccine for adolescent males: Does source matter?

Advertisements promoting HPV vaccine for adolescent males: Does source matter?

HPV vaccine and adolescent males

In 2009, the United States approved quadrivalent HPV vaccine for males 9–26 years old, but data on vaccine uptake are lacking. We determined HPV vaccine uptake among adolescent males, as well as stage of adoption and vaccine acceptability to parents and their sons. A national sample of parents of adolescent males ages 11–17 years ( n = 547) and their sons ( n = 421) completed online surveys during August and September 2010. Analyses used multivariate linear regression. Few sons (2%) had received any doses of HPV vaccine, and most parents and sons were unaware the vaccine can be given to males. Parents with unvaccinated sons were moderately willing to get their sons free HPV vaccine (mean = 3.37, SD = 1.21, possible range 1–5). Parents were more willing to get their sons vaccinated if they perceived higher levels of HPV vaccine effectiveness ( β = 0.20) or if they anticipated higher regret about their sons not getting vaccinated and later developing an HPV infection ( β = 0.32). Vaccine acceptability was also modest among unvaccinated sons (mean = 2.98, SD = 1.13, possible range 1–5). Sons were more willing to get vaccinated if they perceived higher peer acceptance of HPV vaccine ( β = 0.39) or anticipated higher regret about not getting vaccinated and later developing an HPV infection ( β = 0.22). HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males. Vaccine acceptability was moderate among both parents and sons. Efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.

HPV vaccine for adolescent males: Acceptability to parents post-vaccine licensure

We examined mothers’ willingness to get their adolescent sons HPV vaccine. In December 2009, 2 months after approval of HPV vaccine for males, we surveyed a national sample of mothers with sons aged 9–18 ( n = 406). More mothers were definitely or probably willing to get their sons HPV vaccine if the vaccine were free (47%) than if it cost $400 out of pocket (11%). The importance of HPV vaccine possibly protecting their sons’ future female partners from HPV-related disease was the strongest correlate of willingness. These findings are important to increasing acceptability to parents of HPV vaccine for their sons.

HPV vaccine for adolescent males: Acceptability to parents post-vaccine licensure

HPV vaccine for adolescent males: Acceptability to parents post-vaccine licensure