Human Papillomavirus Immunization Research Articles

The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis.

Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy. In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities. To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities. We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community. Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively.

Assessing the Knowledge of HPV-Associated Oropharyngeal Squamous Cell Carcinoma, HPV Vaccination, and Practice Scope among Saudi Dental Students in the Western Region.

(1) Background: Human papillomavirus (HPV) infection is significantly associated with oropharyngeal squamous cell carcinoma (HPV-OPSCC), which is one of the fastest-growing cancer incidences globally. Dental practitioners play a crucial role in the primary and secondary prevention of HPV-OPSCC. There is little known about dental students' awareness regarding HPV-OPSCC and HPV vaccination, as well as their intention to promote 'primordial prevention' among their patients. HPV vaccine, and the extent of their professional responsibilities. (2) Methods: This cross-sectional study was conducted in the western region of Saudi Arabia and involved undergraduate dental students (n = 688) from six public and private dental schools. Participants were requested to complete a sequential-section anonymous online survey, with 257 successfully completing all sections of the questionnaire. The association between participant characteristics and HPV-OPSCC, HPV vaccination awareness ratings, and perceived engagement in prevention were analyzed using ANOVA and chi-squared testing. A binary logistic regression analysis was conducted to examine the variables linked to these outcomes. (3) Results: Generally, the overall level of awareness of HPV-OPSCC and HPV vaccination was acceptable, with an average score of 53.44 ± 29.3 out of 100. However, a significant knowledge gap was observed, with 53% of respondents being unaware of the common sites for HPV-OPSCC and 63.8% being uninformed of the appropriate age for HPV vaccination. Females and those with a prior history of sexually transmitted diseases (STDs) had considerably higher levels of HPV vaccination knowledge (p < 0.05). The participants showed a favorable attitude towards their responsibility of informing patients about HPV-OPSCC and advocating HPV immunization. (4) Conclusions: This study underscores the need to enhance dental students' understanding of HPV-OPSCC and HPV immunization, enabling them to effectively engage in primary and secondary preventative efforts against HPV-OPSCC.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study.

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

Knowledge and Attitudes of Human Papillomavirus (HPV) Vaccination among Secondary School Students in Selangor, Malaysia

Cervical cancer is a significant cause of female mortality in Malaysia, primarily linked to Human Papillomavirus (HPV) infection. To address this, the Malaysian government launched a HPV vaccination program targeting secondary school students. This study aimed to investigate the level of knowledge and attitude toward HPV vaccination and its association with demographics as a determinant among Malaysian secondary school students. A survey study using random sampling was conducted for 182 secondary school students in Selangor between the aged 13-17 years old. A validated questionnaire was used to collect data on demographics, knowledge, and attitudes toward HPV vaccination. The students demonstrated moderate knowledge (M=3.75, SD=.85) and generally positive attitudes (M=3.48, SD=3.57) towards HPV vaccination. Gender (χ2=6.39, p=.011), ethnicity (χ2=6.57, p=.037), religion (χ2=15.51, p=.004), and age (χ2=12.61, p=.013) were statistically significant factors affecting knowledge. Gender (χ2=8.44, p=.004) and family income (χ2=11.63, p=.040) significantly influenced attitudes. The Malaysian national HPV immunisation program has been effective, but improvements are needed. These include adopting a gender-neutral approach, educating parents to foster positive attitudes, and promoting acceptance of HPV vaccination. Strategies like introducing sexual education and collaboration with the Ministry of Health School Health Unit (UKS) are vital for enhancing public awareness and understanding of HPV vaccination.

Cannabis sativa: Cervical cancer treatment- Role of phytocannabinoids-A story of concern

This litrature review paper highlights the role of phytocannabinoids in controlling cervical cancer. Cervical cancer is one of the leading causes of cancer death among females worldwide. Cervical cancer (CC) is a malignant form of tumor which originates in the cervix. Cervical cancer, which develops in a woman’s cervix, is the second-most common cancer among women in India The causative agent of cervical cancer is persistent infection with high-risk subtypes of the Human Papillomavirus (HPV) and the E5, E6 and E7 viral onco-proteins cooperate with host factors to induce and maintain the malignant phenotype. Human papillomavirus (HPV) is responsible for subclinical/clinical lesions in cervical cancer. HPV types 16 and 18 are the most common HPV types identified in invasive cervical cancer. Currently, the recommended therapeutic regimens include chemotherapy, radiation therapy either alone or in combination and surgical interventions. However, they present several limitations including side effects or ineffectiveness. Medicinal plants including Cannabis sativa have been used for decades for health benefits and to treat several different diseases including cervical cancer. Cannabis has been used for thousands of years for recreational, medicinal, or religious purposes. Phytocannabinoids are cannabinoids that occur naturally in the cannabis plant. The two phytocannabinoids the most well known for their therapeutic properties are, Δ9-tetrahydrocannabinol (THC) and Cannabidiol (CBD). Cannabis and cannabinoids hold big promise for cancer therapy. However, there is a need to understand more about the role of Endocannabinoid system (ECS) in normal human physiology and malignant transformations. Molecular mechanisms of Endocannabinoid system (ECS) regulation and anticancer properties of cannabis also need to be clarified. The treatment durations in the existing trials are also of concern. Future epidemiological and clinical studies are required to further assess the benefits of herbal medicines for the prevention of cervical cancer. In addition, preclinical and human clinical trial evaluations of cannabis for cervical cancer treatment have not specifically been conducted, so further investigations related to this are warranted. Therefore, HPV immunization programme is the best ideal solution for the eradication of cervical cancer.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases-A Comprehensive Review.

Human papillomavirus (HPV) encompasses a diverse array of viruses, comprising approximately 200 serotypes that affect humans. While the majority of HPV strains are associated with benign skin or mucous membrane growths, a subset is implicated in severe health conditions, such as cervical, anal, vulvar, and vaginal cancers. Despite the established effectiveness of HPV vaccines in preventing cervical and anal carcinomas in particular, their therapeutic potential in addressing cutaneous diseases linked to diverse HPV strains remains an intriguing area of investigation. This narrative review critically examines the existing literature to assess the viability of HPV immunization as a therapeutic intervention for prevalent cutaneous conditions. These include genital and extragenital cutaneous warts, epidermodysplasia verruciformis, and keratinocyte carcinomas. The findings suggest a promising dual role for HPV vaccines in preventing and treating dermatologic conditions while emphasizing future research directions, including the immunization perspective against β-HPVs. Moreover, the presence of conflicting study outcomes underscores the imperative for larger-scale, randomized trials with well-matched control groups to validate the efficacy of HPV immunization in the dermatologic context. This review contributes valuable insights into the evolving landscape of HPV-vaccine applications in the field of dermatology.

Vaccination Effectiveness against Human Papillomavirus in Kazakhstan.

The purpose was to determine the effectiveness of human papillomavirus immunization and its impact on cervical cancer development in Kazakhstan. The current research is a case-control study with two groups: a main group and a control group. A total of 725 subjects participated in the research. The association between vaccination and cervical cancer development was calculated both for the two groups as a whole and for individual patients, who were selected based on criteria of residence, presence of immunodeficiency or chronic cardiac or renal pathology, as well as analysis of age at which the vaccine dose was received. There was a statistically significant association between the absence of the human papillomavirus vaccine and the risk of cervical cancer in all groups. When considering the entire cohort, the chance of finding a risk factor (lack of vaccination) was almost 7 times higher in the main group than in the control group. Thus, an association between vaccination and cervical cancer risk was found in each of the pairs of subjects. The effectiveness of vaccination in preventing cervical cancer was not observed in patients who were vaccinated after 18 years of age, while most patients in the control group were vaccinated in their teens. The practical significance of the research is not only to further study the problem of human papillomavirus (HPV) vaccination in Kazakhstan but also to popularize HPV immunization to prevent cervical cancer (CC).

A comprehensive narrative review of challenges and facilitators in the implementation of various HPV vaccination program worldwide.

Cervical cancer has been considered as one of the most common cancers in women (15-44 years) globally, but the advent of the human papilloma virus (HPV) vaccine has raised the anticipation that eradication of cervical carcinoma might be achieved in the near future as several prophylactic cervical carcinoma vaccines have already been currently licensed in various countries. Countries should devise strategies, practices and policies to attain and sustain higher levels of HPV immunization coverage as still 68% countries have introduced HPV vaccine in their national immunization programs even after 17 years following the licensure of the first prophylactic HPV vaccine. A comprehensive literature analysis was conducted using various databases and search engines, to include the most relevant research articles and data available and critically discussed the operational gaps that need to be answered to achieve adequate coverage of HPV vaccination. The present review highlights the existing HPV vaccination strategies, unmet needs and challenges needed to be addressed for proper implementation framework as well as the collaborations required to achieve decent vaccination coverage. Well-coordinated vaccination strategy with focus on adolescent girls and if possible, boys can lead to dramatic impact on disease reduction around the world.

Effectiveness of catch-up and routine program of the 9-valent vaccine on cervical cancer risk reduction in Japan.

In 2013, the national human papillomavirus (HPV) immunization program began. However, in June 2013, Japan's Ministry of Health, Labor and Welfare (MHLW) announced a "temporary" suspension of its recommendation for the human papillomavirus vaccine. Finally, in November 2021, the MHLW ended its suspension of the recommendation of the HPV vaccine. To address the 9-year gap in HPV vaccinations the suspension had caused, the MHLW conducted a program of catch-up vaccinations from April 2022 to March 2025. Finally, in April 2023, the 9-valent HPV vaccine was approved for both the routine and catch-up vaccination programs in Japan. In this study, we investigated the potential effects of the introduction of the 9-valent vaccine on the increased risk of cervical cancer in females born after fiscal year (FY) 2000. We estimated the lifetime relative risk of cervical cancer incidence and death using the improved routine and catch-up vaccination rates after the recent resumption of the governmental recommendation for women and girls to have the HPV vaccination. These relative risks were calculated using a lifetime risk of 1.000 for cervical cancer incidence and death for females born in FY 1993. We predicted that even if a 90% vaccination rate were to be achieved by FY 2024 with the 9-valent vaccine among women born between FY 2000 and FY 2005, the risk would remain higher than for the vaccination generation. Therefore, for women born between FY 2000 and FY 2005, it will be necessary to significantly improve the cervical cancer screening rate to compensate for this increased risk.

Knowledge, attitudes, and practices towards human papillomavirus (HPV) and HPV vaccination among male nurses.

This study aimed to determine the knowledge, attitudes, and practices of male nurses towards human papillomavirus (HPV) and HPV vaccination and to examine whether knowledge about the HPV vaccine affects attitudes and beliefs about HPV vaccines. HPV is responsible for ≈5% of all cancers worldwide. Therefore, vaccination against HPV is recommended to prevent HPV infections and HPV-related cancers in men and women. The study group included 383 male nurses who were asked to complete online questionnaires. The data were collected using the following tools: a sociodeomographical characteristics form, the Human Papillomavirus Knowledge Scale (HPVKS), and The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS). It was determined that the general HPV knowledge of the male nurses participating in the study was at a moderate level, but their knowledge of HPV screening test, HPV vaccination, and current HPV vaccination programmes were at a low level. Male nurses' HPV vaccination rates were relatively low, and most of them did not intend to be vaccinated. In addition, CHIAS Attitudes and Beliefs scores of the male nurses were at an average level and HPV knowledge affected the attitudes and beliefs of the nurses. These results demonstrate an opportunity to improve information and awareness about HPV and vaccines by nursing education.

High-risk human papillomavirus distribution according to human immunodeficiency virus status among women with cervical cancer in Abidjan, Côte d'Ivoire, 2018 to 2020.

As human papillomavirus (HPV) immunisation and HPV-based cervical cancer (CC) screening programmes expand across sub-Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high-risk (HR)-HPV distribution among women with CC in Côte d'Ivoire. From July 2018 to June 2020, paraffin-embedded CC specimens diagnosed in Abidjan, Côte d'Ivoire were systematically collected and tested for HR-HPV DNA. Type-specific HR-HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0-60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373-833] cells/mm3 and 86% were on antiretroviral therapy (ART). The overall HR-HPV prevalence was 89.4% [95% CI: 84.7-94.1]. All were single HR-HPV infections with no differences according to HIV status (P = .8). Among HR-HPV-positive CC specimens, the most prevalent HR-HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9-86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3-86.5] in women without HIV (P = .3). The study confirms the major role of HPV16/18 in CC in Côte d'Ivoire and should support a regional scale-up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR-HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Côte d'Ivoire, both for WLHIV and women without HIV.

European consensus statement on expert colposcopy

BackgroundFollowing the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only.This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AimsTo provide expert guidance on complex colposcopy cases through published evidence and expert consensus. Material & methodsMembers of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. Results & discussionThe agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.

Attitudes and Beliefs of Parents About HPV Vaccination in Their Daughters During COVID-19 Pandemic: A Cross Sectional Study

Objective: This study aimed to determine parents’ current attitudes and beliefs using a standardised scale towards Human Papilloma Virus and its vaccine during COVID-19 Pandemic. Material and Methods: This is a descriptive cross sectional study including a total of 303 parents who applied to a training and research hospital pediatric clinic with a daughter aged 9-18 years old. A demographic variable questionnaire and The Turkish version of the Carolina Human Papilloma Virus Immunization Attitudes Scale (CHIAS) were assessed. Results: The Turkish version of the Carolina Human Papilloma Virus Immunization Attitudes Scale mean± SD scores of harms/barriers/effectiveness/uncertainty factors subgroup were calculated as 2.2±0.6, 2.5±0.7, 2.3±0.7, 2.9±0.8, respectively. 19.8% of parents were aware of Human Papilloma Virus and 22.5% of them declared to be willing to vaccinate their daughters against the infection. Human Papilloma Virus acceptance rate was still modest and lower than for vaccines in general during COVID-19 Pandemic. Conclusion: According to the result of this study, during COVID-19 Pandemic, the both female and male awareness and intention to vaccinate their daughters against Human Papilloma Virus is low. This is the first study analyzing parents’ current attitudes and beliefs using a standardised scale towards Human Papilloma Virus in Turkey and also is the first analyzing this subject during COVID-19 pandemic in the literature. Health education programs given by family doctors, pediatricians and community health professionals to parents is critically important in accepting this vaccine.

HPV Vaccination Prevalence among Lebanese Female University Students: A Cross-Sectional Study.

Cervical cancer is the fourth most common cancer in women, worldwide. Most often, cervical cancer is caused by a human papillomavirus (HPV) infection. A lack of studies concerning HPV knowledge and vaccination among the Lebanese population is noticed. We aim to assess the prevalence of HPV vaccine administration among female university students in Lebanon alongside determining the predictors influencing vaccine uptake. Lastly, knowledge scores concerning HPV and HPV vaccination are also computed. This is a cross-sectional analytical study. It is an anonymous, online-based, close-ended questions survey conducted between the 24th of February 2021 and the 30th of March 2021. Our questionnaire was addressed to females aged between 17 and 30 years and enrolled in a Lebanese university. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) v.26. We used bivariate analysis to compare the rate of vaccination with different variables. We used the chi-square test for categorical variables and Student's t-test for continuous variables. Logistic linear regression was conducted between the state of vaccination and other statistically significant variables from the bivariate analysis. We have received a total of 454 questionnaires. Among the respondents, only 18.9% had received a minimum of one dose of the HPV vaccine. The mean age of up taking the first dose of the vaccine was 17.5 years. In addition, 48% of the respondents were not willing to take the HPV vaccine during the upcoming year. Barriers to not taking the HPV vaccine were mainly the low levels of knowledge concerning HPV and its vaccine. In the multivariate analysis, three predictors were found to affect the rate of HPV vaccination: university type, paternal educational level, and HPV vaccine knowledge score. In detail, a student enrolled in a public university had 77% likelihood of not being vaccinated. Furthermore, female students with a paternal educational level higher than a university degree had 88% probability of being vaccinated. Finally, every increase in the HPV vaccination knowledge of one point increased the likelihood of being vaccinated by 37%. A low vaccination rate among female university students in Lebanon was noticed in our study. In addition, a lack of HPV and HPV vaccine knowledge was found in our population. An awareness campaign alongside public vaccination programs is recommended in order to accomplish higher rates of HPV immunization.

Impact of the human papillomavirus vaccine in low-resource settings

Despite being approved since 2006, adoption of the human papillomavirus (HPV) vaccine in low-income and-middle-income countries (LMICs), especially in sub-Saharan Africa, has been slow. As of 2019, 14 (26%) of 54 countries in sub-Saharan Africa had national HPV vaccination programmes,1Bruni L Saura-Lázaro A Montoliu A et al.HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019.Prev Med. 2021; 144106399Crossref Scopus (184) Google Scholar despite the evidence that the vaccine significantly reduces the incidence of cervical cancer, especially when provided before sexual debut.2Lei J Ploner A Elfström KM et al.HPV vaccination and the risk of invasive cervical cancer.N Engl J Med. 2020; 383: 1340-1348Crossref PubMed Scopus (496) Google Scholar Rwanda was among the first African countries to implement a national school-based HPV vaccination programme,3Kuehn B Summit leaders urge greater HPV vaccination in Africa.JAMA. 2019; 3221853Crossref Scopus (1) Google Scholar which has consistently shown high (≥90%) coverage over the past decade.4Binagwaho A Wagner CM Gatera M Karema C Nutt CT Ngabo F Achieving high coverage in Rwanda's national human papillomavirus vaccination programme.Bull World Health Organ. 2012; 90: 623-628Crossref PubMed Scopus (168) Google Scholar Rwanda's success provides an opportunity to assess the effectiveness of the vaccine at the population level, with the first cohort of girls vaccinated in 2011 now becoming sexually active. In The Lancet Global Health, Felix Sayinzoga and colleagues5Sayinzoga F Tenet V Heideman DAM et al.Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys.Lancet Glob Health. 2023; (published online May 16.)https://doi.org/10.1016/S2214-109X(23)00193-6Summary Full Text Full Text PDF Google Scholar report the findings of a study that aimed to provide the first results on HPV vaccine effectiveness from Africa. Using repeated cross-sectional surveys in sexually active young women in Rwanda before (in 2013–14) and after (in 2019–20) HPV vaccine introduction, this study showed an adjusted overall vaccine effectiveness of 47% (95% CI 31–60) against vaccine-targeted HPV types (HPV6, 11, 16, and 18). Although the overall vaccine effectiveness in this study was lower than the efficacy estimated in clinical trials,6Arbyn M Xu L Simoens C Martin-Hirsch PPL Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors.Cochrane Database Syst Rev. 2018; 5CD009069PubMed Google Scholar these results are highly encouraging for LMICs working to improve HPV vaccine coverage rates or introduce the vaccine. Although it is still too early to assess the effect of the HPV vaccine on the incidence of cervical cancer in Rwanda, Sayinzoga and colleagues5Sayinzoga F Tenet V Heideman DAM et al.Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys.Lancet Glob Health. 2023; (published online May 16.)https://doi.org/10.1016/S2214-109X(23)00193-6Summary Full Text Full Text PDF Google Scholar found a reduction in the prevalence of vaccine-targeted HPV types from 12% in the baseline survey to 5% in the repeat survey. These data can serve as a foundation for future studies to assess the effect of the vaccine on the incidence of cervical cancer, as well as other HPV-associated anogenital and head and neck cancers. The efficacy of the HPV vaccine in reducing cervical cancer cases has been shown in several studies,2Lei J Ploner A Elfström KM et al.HPV vaccination and the risk of invasive cervical cancer.N Engl J Med. 2020; 383: 1340-1348Crossref PubMed Scopus (496) Google Scholar primarily in high-income countries where HPV-vaccinated cohorts are older. If Rwanda continues to have high population-level vaccine coverage, evaluation of the vaccine effect on cervical cancer incidence might be possible in a few decades due to the tremendous vaccination efforts. The study by Sayinzoga and colleagues5Sayinzoga F Tenet V Heideman DAM et al.Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys.Lancet Glob Health. 2023; (published online May 16.)https://doi.org/10.1016/S2214-109X(23)00193-6Summary Full Text Full Text PDF Google Scholar highlights the complexity of HPV prevention among women living with HIV. The authors found that the overall vaccine effectiveness was lower among women living with HIV compared with HIV-negative women (24% [95% CI –62 to 64] vs 55% [36 to 69]). Although this result might be confounded by education or possible earlier exposure to HPV, this finding is concerning for sub-Saharan African countries, which also face the greatest burden of HIV infection, and requires further studies. Ongoing efforts to understand HPV vaccine effectiveness in women living with HIV include an ongoing observational study in Kigali, Rwanda.7Murenzi G Shumbusho F Hansen N et al.Long-term human papillomavirus vaccination effectiveness and immunity in Rwandan women living with and without HIV: a study protocol.BMJ Open. 2022; 12e061650Crossref PubMed Scopus (1) Google Scholar Preliminary findings show that the HPV vaccine is not as effective among women living with HIV compared with HIV-negative women.8Murenzi G, Shumbusho F, Hansen NJ, et al. Human papillomavirus prevalence by HPV vaccination status in Rwandan women living with and without human immunodeficiency virus. 35th International Papillomavirus Conference; April 17–21, 2023 (abstr 1390).Google Scholar Although this is not good news, these findings provide an opportunity to investigate alternative ways to improve primary prevention in women living with HIV, including the use of a booster vaccine to maximise protection, or other strategies. More studies are required to answer these questions related to vaccine effectiveness in women living with HIV. Overall, the present study fits well in the current cervical cancer research and practice context, where essential evidence from sub-Saharan Africa and other low-resource settings needed to guide policy is scarce. The key message from this manuscript is that the HPV vaccine can reduce the prevalence of HPV infection following introduction of a school-based vaccination campaign in an African nation. It is expected that, over time, the vaccine will result in a reduction in the incidence of cervical cancer in Rwanda, as shown by evidence from Sweden.2Lei J Ploner A Elfström KM et al.HPV vaccination and the risk of invasive cervical cancer.N Engl J Med. 2020; 383: 1340-1348Crossref PubMed Scopus (496) Google Scholar It is important to note that Rwanda's universal primary education enables the success of the school-based vaccination programme, resulting in high HPV vaccination coverage. To replicate Rwanda's success, countries with low primary school enrolment rates should find innovative ways of reaching girls who are not in school at their vaccine-eligible age. Sayinzoga and colleagues5Sayinzoga F Tenet V Heideman DAM et al.Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys.Lancet Glob Health. 2023; (published online May 16.)https://doi.org/10.1016/S2214-109X(23)00193-6Summary Full Text Full Text PDF Google Scholar found that HPV vaccine coverage was lower among participants who had completed less years in school, hence the lower vaccine effectiveness in this group. These findings support WHO's global call for cervical cancer elimination with a target of 90% or greater HPV vaccination rates for girls and vaccine coverage is most crucial in LMICs, where women bear the greatest burden of this preventable cancer. National governments that have not introduced the HPV vaccine and other international partners can use this evidence to formulate relevant policies to urgently implement and scale-up vaccination for girls everywhere. We declare no competing interests. Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveysIn Rwanda, the prevalence of vaccine-targeted HPV types has been significantly decreased by the HPV vaccine programme, most notably in women who were attending school during the catch-up programme in 2011. HPV vaccine coverage and population-level impact is expected to increase in future cohorts who are eligible for routine HPV vaccination at age 12 years. Full-Text PDF Open Access

The long view of vaccination to secure the future

“Whether this distribution of benefits will be attractive to finance ministers depends on many factors”—so state Chloe Puett and colleagues in their analysis of the long-term economic benefits of Shigella vaccination to prevent linear growth faltering (LGF) in The Lancet Global Health.1Puett C Anderson IV, JD Bagamian KH et al.Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study.Lancet Glob Health. 2023; 11: e892-e902Summary Full Text Full Text PDF Google Scholar The cost of vaccination can be a considerable deterrent in the introduction of a new vaccine, and has contributed to the low coverage rates of rotavirus vaccines and the human papillomavirus (HPV) vaccine, which, where it has been introduced, is only focused on girls and young women,2Bruni L Saura-Lázaro A Montoliu A et al.HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019.Prev Med. 2021; 144106399Crossref Scopus (173) Google Scholar despite having been shown to be beneficial in men.3Stanley M HPV vaccination in boys and men.Hum Vaccin Immunother. 2014; 10: 2109-2111Crossref PubMed Scopus (28) Google Scholar The strength of the analysis by Puett and colleagues is the novel approach it takes in describing benefit–cost ratios (BCRs), calculating the enhanced future productivity of children who have received a Shigella vaccine, through the reduction of LGF.1Puett C Anderson IV, JD Bagamian KH et al.Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study.Lancet Glob Health. 2023; 11: e892-e902Summary Full Text Full Text PDF Google Scholar Assuming a retirement age of 64 years, they calculated that the income effect of the BCR in low-income countries (LICs) and lower-middle-income countries (LMICs) would be 11·60, compared with a BCR of 8·53 when upper-middle-income countries were included.1Puett C Anderson IV, JD Bagamian KH et al.Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study.Lancet Glob Health. 2023; 11: e892-e902Summary Full Text Full Text PDF Google Scholar These analyses could be extended to other vaccines, including those in the process of being introduced (eg, the HPV and rotavirus vaccines) and others in the pipeline or in early development (eg, vaccines for respiratory syncytial virus, other enteric diseases, and tuberculosis). However, Puett and colleagues’ estimates are highly conservative, as they do not include other potential cost-benefits of Shigella vaccines. Shigella is highly transmissible and requires only a small infective dose; it is increasingly becoming multidrug-resistant and can either be endemic or cause significant outbreaks.4Kotloff KL Shigella infection in children and adults: a formidable foe.Lancet Glob Health. 2017; 5: e1166-e1167Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar One can therefore intuit that, besides the cost-benefit in future productivity, a more immediate and medium-term cost-benefit would be seen, because of decreased transmission and herd immunity, diminished use of antimicrobials (particularly of new, expensive compounds), and reduced health-care consultations and hospitalisations (obviating the need for a public health response due to Shigella outbreaks and limiting the indirect costs on households by containing income losses while caring for sick children). Historically, the introduction of new vaccines has been based upon short-term economic decisions, such as health-care costs saved and the national impact of income losses prevented (due to parents caring for sick children), or alternatively on the number of disability-adjusted life years (DALYs) averted,5Deogaonkar R Hutubessy R van der Putten I Evers S Jit M Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries.BMC Public Health. 2012; 12: 878Crossref PubMed Scopus (77) Google Scholar but a comprehensive analysis of the benefits of vaccines in the short, medium, and long term would be more realistic in delineating the true societal benefits. Income losses in LICs and LMICs due to LGF have been estimated at US$176·8 billion per birth cohort (or $616·5 billion at purchasing power parity rates), while lost educational attainment corresponds to 69·4 million years.6Fink G Peet E Danaei G et al.Schooling and wage income losses due to early-childhood growth faltering in developing countries: national, regional, and global estimates.Am J Clin Nutr. 2016; 104: 104-112Summary Full Text Full Text PDF PubMed Scopus (54) Google Scholar With improvements in the quality of water, sanitation, and hygiene (WaSH)—between 1990 and 2017, diarrhoeal deaths in children younger than 5 years decreased by a substantial 13·3% globally due to improved sanitation alone7GBD 2017 Diarrhoeal Disease CollaboratorsQuantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017.Lancet Infect Dis. 2020; 20: 37-59Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar—an even greater effect on LGF and productivity can be expected. Poor nutrition can impact childhood diarrhoea mortality, and accounted for the greatest number of deaths due to diarrhoea in this age group (69·3%) in the Global Enteric Multicenter Study; likewise, improving nutrition would also lead to a decrease in LGF.8Brander RL Pavlinac PB Walson JL et al.Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study.BMC Med. 2019; 17: 214Crossref PubMed Scopus (12) Google Scholar For a realistic overview, however, the true contribution of LGF needs to be appreciated in context. Recent evidence from combined data in birth cohort studies in six emerging economies indicates that the first 1000 days of life are particularly important for learning and development, and LGF might affect both schooling attainment and intelligence quotient (IQ) scores during this period.9Poveda NE Hartwig FP Victora CG et al.Patterns of growth in childhood in relation to adult schooling attainment and intelligence quotient in 6 birth cohorts in low- and middle-income countries: evidence from the Consortium of Health-Oriented Research in Transitioning Societies (COHORTS).J Nutr. 2021; 151: 2342-2352Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar However, the effect of early-life stature on schooling and adult IQ is attenuated when controlling for childhood IQ.10Stein AD Adair LS Donati G et al.Early-life stature, preschool cognitive development, schooling attainment, and cognitive functioning in adulthood: a prospective study in four birth cohorts.Lancet Glob Health. 2023; 11: e95-104Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar To realistically ensure that our future generations attain their full educational and economic potential, a multipronged approach that includes vaccination, timely and accurate diagnosis of disease, nutrition, WaSH, and promotion of cognitive stimulation is needed.1Puett C Anderson IV, JD Bagamian KH et al.Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study.Lancet Glob Health. 2023; 11: e892-e902Summary Full Text Full Text PDF Google Scholar, 10Stein AD Adair LS Donati G et al.Early-life stature, preschool cognitive development, schooling attainment, and cognitive functioning in adulthood: a prospective study in four birth cohorts.Lancet Glob Health. 2023; 11: e95-104Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Increasing life expectancy globally combined with a decreasing birth rate in many countries has resulted in a significant shift in the global age distribution from 1990 to 2020, changing the population pyramid into a shape resembling a bullet, and we risk having too few economically active individuals to support the global population of the future. Lest we shoot ourselves in the foot, perhaps we need to reconsider how we regard our children: not simply as the most vulnerable of our society, but to remind ourselves that they are the future health-care workers who will care for us, the engineers and scientists who will further develop new vaccines, WaSH, and diagnostic tools for infectious diseases, the educators and entrepreneurs who will ensure sustainability in economic productivity, and the leaders who would strive for a better world for all. We declare no competing interests. Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling studyLGF is a secondary outcome of Shigella infection and reduction in LGF is not often quantified as a health or economic benefit of vaccination. However, even under conservative assumptions, a Shigella vaccine only moderately effective against LGF could pay for itself from productivity gains alone in some regions. We recommend that LGF be considered in future models assessing the economic and health impacts of interventions preventing enteric infections. Further research is needed on vaccine efficacy against LGF to inform such models. Full-Text PDF Open Access

Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients.

The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9-25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01-1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers.

Association between human papillomavirus infection or immunization and risk for rheumatoid arthritis.

Human papillomavirus (HPV) is a virus primarily transmitted through sexual contact. Little is known about the association between HPV infection or immunization and the risk for rheumatoid arthritis (RA). The purpose of this study was to evaluate whether HPV infection or immunization is related to the risk for RA in adults. Data were obtained from the 2007-2016 National Health and Nutrition Examination Survey (NHANES). We developed three independent multivariate logistic regression models to evaluate the association between HPV infection or immunization and the risk for RA in adults. Finally, we analyzed 15,677 and 8,944 subjects, respectively. In all models, HPV infection was positively associated with an increased prevalence of RA in adults aged 18-59 years, with the highest value of the odds ratio (OR) in model 2 (after weighting: OR 1.095, 95% CI 1.092, 1.097), whereas HPV immunization significantly reduced the prevalence of RA in adults aged 18-59 years, with the lowest OR in model C (after weighting: OR 0.477, 95% CI 0.472, 0.481). These associations persisted after correction for confounders such as age, sex, race, education level, marital status, smoking, diabetes, hypertension, hyperlipidemia, and BMI. In summary, our study suggests that HPV infection is positively associated with the prevalence of RA in adults, and HPV immunization can reduce the prevalence of RA in adults. However, our findings need more powerful to prove these associations through rigorously designed prospective studies.

Communication strategies to improve human papillomavirus (HPV) immunisation uptake among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesDeveloping countries face the greatest cervical cancer disease burden and mortality with suboptimal immunisation uptake. This review explores the communication strategies adopted, successes, challenges and lessons learnt in sub-Saharan countries...

The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study

The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001). Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.