Human Papillomavirus Vaccination In Women Research Articles

Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV.

The objectives were to evaluate the safety and immunogenicity of the nonavalent human papillomavirus (nHPV) vaccine in adult Spanish women living with HIV (WLHIV); the prevalence of anal and cervical dysplasia and nHPV vaccine genotypes in the anus and cervix; and risk factors for high-risk HPV (HR-HPV) infection in anal mucosa. In this single-center, open-arm, non-randomized clinical trial, the nHPV vaccine was administered at 0, 2, and 6 months to WLHIV enrolled between February 2020 and November 2023, measuring vaccine antibody titers pre-vaccination and at 2, 6, and 7 months after the first dose. Cervical and anal cytology and HPV PCR genotyping studies were performed. Women with abnormal cytology and/or anal or cervical HPV infection at baseline underwent high-resolution anoscopy and/or colposcopy. A total of 122 participants were included with mean age of 49.6 years: 52.5% smoked; 10.7% had anal-genital condylomatosis; 38.5% were infected by HR-HPV in the anus and 25.4% in the cervix, most frequently HPV 16; 19.1% had anal intraepithelial neoplasia 1-(AIN1); and 3.1% had cervical intraepithelial neoplasia 1 and 2 (CIN1/CIN2). Vaccine administration did not modify viral-immunological status (CD4 [809 ± 226.8 cells/uL vs. 792.35 ± 349.95; p = 0.357]) or plasma HIV load (3.38 ± 4.41 vs. 1.62 ± 2.55 cop/uL [log]; p = 0.125). Anti-HPV antibodies ([IQR: 0-0] vs. 7.63 nm [IQR: 3.46-19.7]; p = 0.0001) and seroconversion rate (8.2% vs. 96.7% [p = 0.0001]) were increased at 7 versus 0 months. There were no severe vaccine-related adverse reactions; injection-site pain was reported by around half of the participants. HR-HPV infection in the anus was solely associated with a concomitant cervix infection (HR 5.027; 95% CI: 1.009-25.042). nHPV vaccine in adult WLHIV is immunogenic and safe.

Barriers to HPV Vaccination in Women at a Federally Qualified Health Center [ID: 1377846

INTRODUCTION: Human papillomavirus (HPV) vaccination significantly decreases the rate of HPV-related diseases; however, vaccine uptake is limited in the United States. New York State set a goal of 80% HPV vaccination by 2023. First-dose rates at our Federally Qualified Health Center (FQHC) in 2021 were 68% in girls aged 13–19 years and 31% in women aged 20–29 years. Little research surrounding barriers to HPV vaccination in adults exists. METHODS: An anonymized survey was distributed to providers at a network of FQHCs using REDCap. Question domains included provider demographics, provider attitudes, and practices. Questions were subdivided by patient age group. Descriptive statistics were analyzed. RESULTS: Our response rate was 15%. Respondent specialties included family practice (49%), women's health (27%), pediatrics (13%), and internal medicine (11%). Frequency of vaccine recommendation decreased as patient age increased. Most common barriers for vaccination included previous vaccination, parental or patient objection, and lack of time for counseling. Additional barriers in the 19–45 age group included concerns about efficacy and cost. Common reasons for patient refusal included objection to vaccination, feeling low risk for infection, lack of knowledge, and side effect concerns. CONCLUSION: The expansion of HPV vaccination eligibility to include women aged 27–45 in 2018 provided an opportunity to protect more patients against HPV-related diseases. Patient and provider knowledge about HPV risk and vaccine efficacy can limit the implementation. Significant barriers for vaccine administration included the lack of provider engagement, knowledge about the vaccine, and time for counseling. This study underscores the need for provider and patient education about the benefits of HPV vaccination, especially in the 19–45 age group.

Vaccinating women previously treated for human papillomavirus-related cervical precancerous lesions is highly cost-effective in China.

The 2021 Chinese Expert Consensus on the Clinical Application of the Human Papillomavirus (HPV) Vaccine recommended vaccination for women who previously received ablative or excisional treatment for high-grade squamous intraepithelial lesion (HSIL). This study evaluates the cost-effectiveness of HPV vaccination in women previously treated for cervical precancerous lesions. We used a Markov model to simulate the disease progression of both low- and high-risk HPV subtypes. We followed a cohort of 100,000 women aged 18-45 years who received treatment for cervical precancerous lesions for a lifetime (80 years). We used the Incremental Cost-Effectiveness Ratios (ICER) with a 5% discount rate to measure the cost-effectiveness of nine vaccination strategies, including a combination of HPV bivalent (HPV-2), quadrivalent (HPV-4) and nonavalent vaccine (HPV-9), each with three vaccination doses (one-, two- and three-dose). We conducted one-way sensitivity analysis and probabilistic sensitivity analysis. We followed the CHEERS 2022 guidelines. Compared to the status quo, the nine vaccination strategies would result in $3.057-33.124 million incremental cost and 94-1,211 incremental quality-adjusted life-years (QALYs) in 100,000 women previously treated for cervical precancerous lesions. Three vaccination strategies were identified on the cost-effectiveness frontier. In particular, ICER for one-dose HPV-4 vaccination was US$10,025/QALY compared to the status quo (no vaccination); ICER for two-dose HPV-4 vaccination was US$17,641//QALY gained compared to one-dose HPV-4 vaccination; ICER for three-dose HPV-4 vaccination was US$27,785/QALY gained compared with two-dose HPV-4 vaccination. With a willingness-to-pay of three times gross domestic product per capita (US$37655), three-dose HPV-4 vaccination was the most cost-effective vaccination strategy compared with the lower-cost non-dominated strategy on the cost-effectiveness frontier. A probabilistic sensitivity analysis confirmed a 99.1% probability of being cost-effective. If the cost of the HPV-9 is reduced to 50% of the current price, three-dose HPV-9 vaccination would become the most cost-effective strategy. Three-dose HPV-4 vaccination is the most cost-effective vaccination strategy for women treated for precancerous cervical lesions in the Chinese setting.

Importance of the HPV vaccine in women and the role of nursing

Introduction: the human papillomavirus (HPV) is one of the most common infections of the reproductive tract, responsible for a variety of cancers and other conditions in both men and women, it is considered a sexually transmitted disease. Thus, becoming a public health problem, as an alternative, governments have implemented the HPV vaccine to the national scheme. Objective: to know the role of the nurse in the prevention of HPV through the importance of the use of vaccines Methodos: qualitative, descriptive research, through a bibliographic review in databases of high academic prestige such as: Pubmed, Redalyc, Scopus, Investigative Nursing, through the structure of the PRISMA method. Results: the systematic review showed that the year 2018 is in which more publications on HPV, the main reason being ignorance about the application of HPV, health personnel being an important factor, reaching key points such as the school population, concentrating clearly on the management and prevention of the same Conclusion: the misinformation about HPV came to have high rates of infection in various parts of the population, but the prompt action of both health services and nursing staff helped to significantly reduce the number of people infected with HPV

Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis

ObjectiveTo explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment.DesignSystematic review and...

Human papilloma virus vaccine: literature review

Inga Vasilevskytė1,2 1Vilniaus universitetas, Medicinos fakultetas, Vilnius, Lietuva 2Vilniaus universiteto ligoninė Santaros klinikos, Akušerijos ir ginekologijos katedra ABSTRACT The human papillomavirus (HPV) is one of the most common sexually transmitted infections, causing a variety of precancerous conditions and cancers in men and women. Cervical cancer is one of the most common forms of cancer that poses a risk to women’s health, and human papillomavirus infection is closely linked to the pathogenesis of cervical cancer. Every year in the world there are about 20 million people suffering from the human papillomavirus, and about 6 million become infected. However, despite a variety of preventive measures and treatments, such as HPV screening, preventive vaccines, surgery remains high worldwide. This review aims to systematically review the safety and efficacy of HPV vaccines in women and the indications and contraindications for immunization. Objective: To review the types of human papillomavirus, their effects on health, types of HPV vaccines, indications and contraindications for immunization, and the safety and efficacy of vaccines. Methods: The literature review was performed based on the scientific databases of PubMed, Medline, Web of Science of selected publications examining the prevalence of human papillomavirus, the types of HPV vaccines, their safety and efficacy, and the indications and contraindications for immunization. Systematic reviews and meta-analyzes no older than 10-15 years were included in the literature review. A total of 30 articles were reviewed, of which 9 were rejected. Conclusions: The analysis of the literature presents the epidemiology of HPV, the types of vaccines, their safety and efficacy, and indications and contraindications for vaccination. Keywords: Human papillomavirus, complications, HPV vaccine safety.

Human papillomavirus vaccination in women undergoing excisional treatment for cervical intraepithelial neoplasia and subsequent risk of recurrence: A systematic review and meta-analysis.

In this review and meta-analysis we aimed to investigate whether human papilloma virus (HPV) vaccination administered after excisional treatment of cervical intraepithelial neoplasia (CIN) is associated with a reduced risk of recurrence of CIN grade 2 or worse (CIN2+). We performed a systematic literature search in three online databases through June 2021. Observational studies and randomized controlled trials (RCTs) were eligible for inclusion if the prophylactic HPV vaccine was administered after excisional treatment for histologically verified CIN. Only English language literature was included. The primary outcome measure was recurrence of CIN2+ after treatment. A meta-analysis was performed using fixed and random-effects models, and results were reported as pooled odds ratios (OR) with 95% confidence intervals (95% CI). Quality assessment was performed using ROB2-tool for RCTs and ROBINS-I for observational studies. The protocol was registered in PROSPERO (CRD42021238257). A total of 1561 studies were identified, of which nine, including 19 971 women, were included. Two studies were RCTs and seven were observational studies. Using the fixed-effect model on the two RCTs, the OR for recurrence of CIN2+ was 0.29 (95% CI 0.16-0.53). Due to considerable heterogeneity in observational studies, the random-effects model was used to estimate pooled OR for CIN2+ recurrence in these studies. Thus, using unadjusted data from observational studies, the OR for CIN2+ recurrence was 0.35 (95% CI 0.18-0.67), whereas when using adjusted data, the OR for CIN2+ recurrence was 0.54 (95% CI 0.21-1.35). However, quality assessment revealed a serious risk of bias for the majority of the studies included. HPV vaccination post-treatment was associated with a significantly reduced risk of CIN2+ recurrence when using unadjusted estimates from observational studies and RCTs. We found no significant effect of HPV vaccination on risk of CIN2+ recurrence when using the outcome measure from observational studies with the least risk of bias. Large, well-designed randomized placebo-controlled trials are needed to determine whether post-treatment HPV vaccination should be recommended to all women undergoing excisional treatment for CIN.

HPV Vaccination in Women Treated for Cervical Intraepithelial Neoplasia: A Budget Impact Analysis.

Human Papillomavirus (HPV) is the most common sexually transmitted infection. Its progression is related to the development of malignant lesions, particularly cervical intraepithelial neoplasias (CINs). CINs correlate with a higher risk of premature births, and their excisional and ablative treatment further increases this risk in pregnant women. These complications are also correlated with higher healthcare costs for their management. In Italy, more than 26,000 new cases of CINs are estimated to occur yearly and their economic burden is significant. Therefore, the management of these conditions is a public health priority. Since HPV vaccination is associated with a reduced risk of relapse in women surgically treated for HPV-related injuries, we estimated the economic impact of extending HPV vaccination to this target population. This strategy would result in a significant reduction in the general costs of managing these women, resulting in an overall saving for the Italian Health Service of €155,596.38 in 5 years. This lower cost is due not only to the reduced incidence of CINs following vaccination, but also to the lower occurrence of preterm births. Extending HPV vaccination to this target population as part of a care path to be offered to women treated for HPV injuries is therefore desirable.

Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.

BackgroundA nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines.Methods and findingsWe utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages.ConclusionsOur results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.

Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27–45 years of age compared to women 16–26 years of age: An open-label phase 3 study

BackgroundEfficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16–26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27–45 versus 16–26 years of age. MethodsThis international, open-label study (NCT03158220) was conducted in women 16–45 years of age. Participants (16–26 years, n = 570 and 27–45 years, n = 642) received a three-dose 9vHPV vaccination regimen (day 1, month 2, month 6). Month 7 geometric mean titers (GMTs) and seroconversion percentages to anti-HPV 6/11/16/18/31/33/45/52/58 were assessed. Participants were followed for safety throughout the study. ResultsAt month 7, anti-HPV 6/11/16/18/31/33/45/52/58 GMTs in women 27–45 years were compared to those in women 16–26 years of age. The primary hypothesis of non-inferiority of anti-HPV 16/18/31/33/45/52/58 GMTs in older versus younger women was met. The lower bound of the GMT ratio 95% confidence interval (27–45 years to 16–26 years) was 0.60–0.67 depending on HPV type, exceeding the non-inferiority margin of 0.5 for all HPV types. Month 7 seroconversion percentages in women 27–45 years of age were >99% for all HPV types. Injection-site and vaccine-related systemic adverse events (AEs) were observed in 87.5% and 25.1% of women 16–26 years, and 85.2% and 24.1% of women 27–45 years of age, respectively; no vaccine-related serious AEs were reported and no deaths occurred during the study. ConclusionsThe 9vHPV vaccine elicited non-inferior anti-HPV GMTs in women 27–45 years compared with women 16–26 years of age for HPV 16/18/31/33/45/52/58. The vaccine was generally well tolerated with a similar AE profile across the age groups. These data support bridging 9vHPV vaccine efficacy findings in women 16–26 years to women 27–45 years of age.Clinical trial registration NCT03158220.

Updated clinical guideline for human papillomavirus vaccine: the Korean Society of Gynecologic Oncology guidelines.

Since the human papillomavirus (HPV) vaccine guidelines were developed by the Korean Society of Gynecologic Oncology (KSGO) in 2011, 2016, and 2019, several recent studies on the efficacy and safety of HPV vaccines in middle-aged women and men have been reported. Furthermore, there has been an ongoing debate regarding the efficacy of the HPV vaccine in women with prior HPV infection or who have undergone conization for cervical intraepithelial neoplasia (CIN). We searched and reviewed studies on the efficacy and safety of the HPV vaccine in middle-aged women and men and the efficacy of the HPV vaccine in patients infected with HPV and those who underwent conization for CIN. The KSGO updated their guidelines based on the results of the studies included in this review.

Abstract PO-274: Human papillomavirus vaccination rates and knowledge among Latinx women in East Los Angeles

Abstract Background: The Latinx population in the United States faces tremendous health disparities, particularly with regards to cervical cancer. Data from the American Cancer Society show that cervical cancer incidence and mortality rates among Latinx women in the US are 40% and 26% higher than in US whites, respectively. These data are surprising considering cervical cancer is highly preventable through use of the Human Papilloma Virus (HPV) vaccination. About 70% of cervical cancer cases are the result of infection with HPV 16 or 18. The 9vHPV vaccine targets HPV 16 and 18 as well as 7 other HPV strains, and it was recently approved for use by the CDC in women through the age of 45. In 2015, only 44% of US Hispanic girls between the ages of 13 and 17 were vaccinated with all three HPV doses. Prior studies have shown that lack of information, cost, and fear are some of the main barriers that prevent Latinx women from receiving the HPV vaccination and vaccinating their children, and that these factors differ across subgroups of Latinx women. Methods: Our goal was to address these health disparities by assessing whether the Latinx population in East Los Angeles also showed low rates of HPV vaccination, and if so, why these women had not received the vaccination. We administered a promotora led survey (in Spanish) to a random sample of 89 Latinx women (aged 25-79) in East Los Angeles to assess rates of HPV vaccination in women and their children, attitudes towards the HPV vaccine, knowledge about the vaccine, and barriers to vaccination. We hypothesized that there would be differences in knowledge about the HPV vaccine, as well as differences in vaccination rates, based on age (>50) and country of origin (Mexico or other) in Latinx women. Results: We found a significant lack of knowledge about the HPV vaccine that persisted across all 89 women. None of the women surveyed had received a single dose of the HPV vaccinations themselves, either because they “did not think it was necessary,” or “did not know why it was important.” About 76% of women surveyed said they did not know what causes most cervical cancer (99% CI [65%-88%]), and of the 23% of women who said they did know what causes cervical cancer, none of the women cited HPV as a cause (99% CI [12%-35%]). Only 55% of women surveyed had heard about the HPV vaccine (99% CI [41%-68%]), and 82% of women did not understand the purpose of the HPV vaccine (99% CI [72%-93%]). However, Chi Square analysis revealed no significant age or country of origin differences in knowledge about the HPV vaccine or vaccination rates. Conclusions: These data show the need for culturally appropriate interventions that are both language specific and literacy level appropriate, in order to increase knowledge about the importance of HPV vaccination among Latinx women of East Los Angeles, particularly how it relates to cervical cancer prevention. Improved access to health education in the community could increase vaccination rates and decrease rates of cervical cancer in this population. Citation Format: Sarita Sooklal, Rosa Barahona, Lourdes Baezconde- Garbanati. Human papillomavirus vaccination rates and knowledge among Latinx women in East Los Angeles [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-274.

Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four nordic countries.

BackgroundThe quadrivalent human papillomavirus (qHPV) vaccine prevented vaccine HPV type-related infection and disease in young women in the 4-year FUTURE II efficacy study (NCT00092534). We report long-term effectiveness and immunogenicity at the end of 14 years of follow-up after enrollment in FUTURE II.MethodsYoung women (16–23 years of age) from Denmark, Iceland, Norway, and Sweden who received three qHPV vaccine doses during the randomized, double-blind, placebo-controlled FUTURE II base study were followed for effectiveness for an additional ≥10 years through national registries. Tissue samples including but not limited to those collected during organized cervical cancer screening programs were obtained from regional biobanks to be adjudicated for histopathology diagnosis and tested for HPV DNA. The observed incidence of HPV16/18-related high-grade cervical dysplasia (primary outcome) was compared with recent historical background incidence rates in an unvaccinated population. Serum was collected at years 9 and 14 to assess antibody responses.FindingsNo cases of HPV16/18-related high-grade cervical dysplasia were observed in the per-protocol effectiveness population (N = 2121; 24,099·0 person-years of follow-up) during the entire study. Vaccine effectiveness of 100% (95% CI 94·7–100) was demonstrated for ≥12 years, with a trend toward continued protection through 14 years post-vaccination. Seropositivity rates at study conclusion were >90% (HPV6/11/16) and 52% (HPV18) using competitive Luminex immunoassay, and >90% (all four HPV types) using the more sensitive IgG Luminex immunoassay.InterpretationVaccination of young women with qHPV vaccine offers durable protection against HPV16/18-related high-grade cervical dysplasia for ≥12 years, with a trend toward continued protection through 14 years post-vaccination, and induces sustained HPV6/11/16/18 antibody responses for up to 14 years post-vaccination. There was no evidence of waning immunity, suggesting no need for a booster dose during that period.FundingMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

HPV Vaccination as Adjuvant to Conization in Women with Cervical Intraepithelial Neoplasia: A Study under Real-Life Conditions.

Background: Recent studies have shown preliminary evidence that vaccination against human papillomavirus (HPV) could decrease the risk of persistent/recurrent HSIL in women treated for high-grade cervical intraepithelial lesion (HSIL). We aimed to determine the benefits of HPV vaccination in patients undergoing conization for HSIL in real-life conditions and evaluate vaccination compliance associated with different funding policies. Methods: From January 2013 to July 2018, 265 women underwent conization in our center. From January 2013 to July 2017, treated patients (n = 131) had to pay for the vaccine, whereas after July 2017 the vaccine was publicly funded and free for treated women (n = 134). Post-conization follow-up controls were scheduled every six months with a Pap smear, HPV testing, and a colposcopy. Results: 153 (57.7%) women accepted vaccination (vaccinated group), and 112 (42.3%) refused the vaccine (non-vaccinated group). Persistent/recurrent HSIL was less frequent in vaccinated than in non-vaccinated women (3.3% vs. 10.7%, p = 0.015). HPV vaccination was associated with a reduced risk of persistent/recurrent HSIL (OR 0.2, 95%CI: 0.1–0.7, p = 0.010). Vaccination compliance increased when the vaccine was publicly funded (from 35.9% [47/131] to 79.1% [106/134], p < 0.001). Conclusions: HPV vaccination in women undergoing conization is associated with a 4.5-fold reduction in the risk of persistent/recurrent HSIL. Vaccination policies have an important impact on vaccination compliance.

Immune Response Following Quadrivalent Human Papillomavirus Vaccination in Women After Hematopoietic Allogeneic Stem Cell Transplant

Human papillomavirus (HPV) infection is found in about 40% of women who survive allogeneic hematopoietic stem cell transplant and can induce subsequent neoplasms. To determine the safety and immunogenicity of the quadrivalent HPV vaccine (HPV-6, -11, -16, and -18) in clinically stable women post-allogeneic transplant compared with female healthy volunteers. Participants received the quadrivalent HPV vaccine in intramuscular injections on days 1 and 2 and then 6 months later. This prospective, open-label phase-1 study was conducted in a government clinical research hospital and included clinically stable women posttransplant who were or were not receiving immunosuppressive therapy compared with healthy female volunteers age 18 to 50 years who were followed up or a year after first receiving quadrivalent HPV vaccination. The study was conducted from June 2, 2010, until July 19, 2016. After all of the results of the study assays were completed and available in early 2018, the analysis took place from February 2018 to May 2019. Anti-HPV-6, -11, -16, and -18-specific antibody responses using L1 virus-like particle enzyme-linked immunosorbent assay were measured in serum before (day 1) and at months 7 and 12 postvaccination. Anti-HPV-16 and -18 neutralization titers were determined using a pseudovirion-based neutralization assay. Of 64 vaccinated women, 23 (35.9%) were receiving immunosuppressive therapy (median age, 34 years [range, 18-48 years]; median 1.2 years posttransplant), 21 (32.8%) were not receiving immunosuppression (median age, 32 years [range, 18-49 years]; median 2.5 years posttransplant), and 20 (31.3%) were healthy volunteers (median age, 32 years [range, 23-45 years]). After vaccine series completion, 18 of 23 patients receiving immunosuppression (78.3%), 20 of 21 not receiving immunosuppression (95.2%), and all 20 volunteers developed antibody responses to all quadrivalent HPV vaccine types (P = .04, comparing the 3 groups). Geometric mean antibody levels for each HPV type were higher at months 7 and 12 than at baseline in each group (all geometric mean ratios >1; P < .001) but not significantly different across groups. Antibody and neutralization titers for anti-HPV-16 and anti-HPV-18 correlated at month 7 (Spearman ρ = 0.92; P < .001 for both). Adverse events were mild and not different across groups. Treatment with the HPV vaccination was followed by strong, functionally active antibody responses against vaccine-related HPV types and no serious adverse events. These findings suggest that HPV vaccination may be safely administered to women posttransplant to potentially reduce HPV infection and related neoplasia. ClinicalTrials.gov Identifier: NCT01092195.

Efficacy of HPV Vaccination in Women Receiving LEEP for Cervical Dysplasia: A Single Institution's Experience.

The aim of this study was to assess the role of a human papilloma virus (HPV) vaccine after loop electrosurgical excision procedure (LEEP) in reducing recurrent cervical dysplasia. A series of 503 women with cervical dysplasia received LEEP between January 2012 and October 2018. Of these patients, 379 were treated between January 2012 and June 2017, thus ensuring an adequate follow-up time. We made three attempts to establish telephone contact with each patient; 77 women did not respond and were excluded from the final study population, which consisted of 302 patients. One hundred eighty-two (60.7%) women were vaccinated with an HPV vaccine within 4 weeks of LEEP and 103 (34.3%) were followed up with but not vaccinated. Recurrence of cervical dysplasia requiring a further LEEP procedure occurred in 30 (10.5%) women, of whom 17 (16.5%) were not vaccinated and 13 (7.1%) were vaccinated (p-value = 0.010). At univariate analysis, HPV vaccination after LEEP (odds ratio (OR) = 0.4, p-value = 0.020) emerged as an independent protective factor. Choosing as an outcome of the analysis only recurrence as severe cervical lesions, the protective role of HPV vaccination after LEEP was found to be much more relevant with an odds ratio of 0.2 (95% CI = 0.1–0.6, p-value = 0.02). Administration of an HPV vaccine after LEEP seems to reduce the risk of recurrence, thus suggesting that HPV vaccination has a role as an adjuvant treatment after LEEP.

A Review of Sexually Transmitted Infections in Australia - Considerations in 2018.

Sexually transmitted infections (STIs) bear a high burden of disease and, subsequently, high health costs globally. Chlamydia, gonorrhoea, syphilis, and trichomoniasis contribute to nearly one million infections every day worldwide. Sexually transmitted infections continue to be the most frequently notified condition to the Australian National Notifiable Diseases Surveillance System and the numbers continue to increase. Australia has achieved several significant successes in reducing STIs and blood-borne viruses (BBV) including the significant decrease in genital warts in those less than 30 years old since 2007 following the launch of human papillomavirus vaccines in women, the virtual elimination of mother to child transmission of HIV, and the increased uptake of successful hepatitis C treatment following the availability of direct acting antiviral treatment on the Pharmaceutical Benefits Scheme. However, several challenges remain, including the ongoing rise of chlamydia, gonorrhoea, and syphilis over the last five years; the emergence of antibiotic resistance; and the increasing disparity in the prevalence of STIs and BBV in men who have sex with men, young people, and Aboriginal and Torres Strait Islander people, and challenges in the delivery of services to rural and remote Australia. In this paper, we aim to provide a snapshot of the current landscape and challenges for chlamydia, gonorrhoea, mycoplasma, syphilis and HIV infections in Australia.

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

ObjectivesPeople living with HIV have increased Human Papillomavirus (HPV) related lesions and malignancies. We describe HPV DNA recovered from the cervix and anal canal, explore the effect of vaccination on HPV detection, and examine the durability of vaccine titers in women living with HIV-1 who were vaccinated with the quadrivalent HPV vaccine. MethodsAIDS Clinical Trials Group A5240 was a prospective study of the quadrivalent HPV (qHPV) vaccine in 315 HIV-1 infected women in three CD4 strata (A: >350, B; 201–350, C: ≤200 cells/mm3). Vaccine was administered at entry, week 8 and week 24. Cervical and anal HPV DNA specimens were collected at baseline, weeks 28 and 52; serum for antibody testing was obtained at baseline, weeks 28 and 72. ResultsVaccine antibody titers decreased across all four HPV types at week 72 compared to week 28. Lower proportions of sustained seropositivity were observed in women with lower CD4 counts for all four vaccine types, with the lowest titers for HPV 18. Despite the decrease, the geometric mean titer levels were above the seroconversion cut-off levels for all types except HPV 18 in the lowest CD4 stratum. Of the 174 participants who had a negative baseline HPV 16 antibody and developed antibody response at week 28, 95%, 88%, and 86% retained seropositivity at week 72 in strata A, B, and C respectively. Lower antibody retention was observed in women with CD4 < 200 compared to CD4 > 350 (p = 0.016). Anal HPV detection was more prevalent compared to cervical detection at all visits. Among high risk types, type 52, 31, 16, 18 and 51 were the most common in the cervical compartment, while types 16, 35, 18, and 51 were the most prevalent in the anal canal at baseline (listed in the order of prevalence). Later detection of HPV not present at baseline was uncommon in either compartment. Serial recovery of HPV over time was more commonly observed in the anal canal. ConclusionThe qHPV vaccine elicits durable titer response above the seroconversion cut-off levels in HIV-infected women. However, the titer levels were substantially lower by Week 72, most noticeably in type 18. HPV DNA was detected more frequently in the anal canal. Detection of non-vaccine high risk HPV suggests a role for the nonavalent vaccine.

Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain.

Bivalent human papillomavirus (HPV) vaccine was incorporated into the childhood vaccination calendar in Galicia, Spain in 2008. The objectives of this study were to estimate direct, indirect and total effectiveness of HPV vaccine and to identify sexual habits changes in the post-vaccination period in Galicia, Spain.Endocervical scrapings of 745 women attending 7 Health Areas of the Galician Public Health Service were collected in the post-vaccination period, from 2014–2017. Two groups were studied: women born between 1989 and 1993 (n = 397) and women born in 1994 or later (n = 348). Twelve high-risk human papillomavirus (HR-HPV) genotypes were detected by Cobas® 4800 HPV test (Roche Diagnostics, Mannheim, Germany). The Linear Array® HPV Genotyping Test (Roche Diagnostics) was used for HR-HPV genotype detection other than HPV 16/18. Information about sexual habits was collected by a self-filled questionnaire. Post-vaccination data were compared to previously published pre-vaccination data obtained between 2008 and 2010 in Galicia from women of the same age (18–26 years old, n = 523). The Stata 14.2 software was employed for statistical analyses.Data from 392 unvaccinated and 353 vaccinated women were compared. For unvaccinated and vaccinated women, HPV 16/18 prevalence was 9.2% and 0.8%, respectively, and HPV 31/33/45 prevalence was 8.4% and 1.1%, respectively. Direct, indirect and total effectiveness of the HPV vaccine were (%, 95% CI): 94 (72−99), 30 (-11−56) and 95 (79−99), respectively, for HPV 16/18 and 83 (46−94), -10 (-88−33) and 84 (54−94), respectively, for HPV 31/33/45. The number of women with first intercourse before 17 years old and 3 or more sexual partners along life was higher in the post-vaccination period (p < 0.05). A positive impact of bivalent HPV vaccine was observed, both on direct and cross protection. Sexual habits could have changed in the post-vaccination period.

Health Belief Model on the Determinants of Human Papilloma Virus Vaccination in Women of Reproductive Age in Surakarta, Central Java

Background: Cervical cancer is a type of cancer that develops in a woman's cervix. Cervical cancer is caused by a human papillomavirus (HPV). Cervical cancer ranked fourth against most women's cancer. The incidence of cervical cancer was estimated at 528,000 (7.9%) cases worldwide causing 266,000 deaths in 2012. The HPV vaccine can protect women from HPV infection, thus lowering the risk of cervical cancer. This study aimed to analyze the determinants of HPV vaccination in women of reproductive age in Permata Harapan Oncology Clinic, Surakarta, Central Java, using Health Belief Model. Subjects and Method: This was an analytic observational study with a case-control design. This study was conducted at Permata Harapan Oncology Clinic, Surakarta, from January to February 2018. A total study of 200 study subjects was selected by fixed disease sampling. The dependent variable was HPV vaccination. The independent variables were knowledge, perceived seriousness, perceived susceptibility, perceived barrier, perceived benefit, family income, and family support. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results: HPV vaccination increased with better knowledge (OR=7.97; 95% CI= 1.50 to 42.38; p= 0.015), perceived seriousness (OR=22.81; 95% CI= 6.06 to 85.86; p<0.001), perceived susceptibility (OR=4.03; 95% CI= 1.25 to 13.09; p=0.020), , perceived benefit (OR­=6.57; 95% CI= 1.88 to 22.98; p=0.003), family income (OR=5.32; 95% CI= 1.57 to 18.07; p=0.007), and family support (OR=6.86; 95% CI= 1.55 to 30.36; p= 0.011). HPV vaccination decreased with perceived barrier (OR=0.14; 95% CI= 0.04 to 0.51; p=0.003). Conclusion: HPV vaccination increases with better knowledge perceived seriousness, perceived susceptibility, perceived benefit, family income, and family support, but decreases with perceived barrier. Keywords: HPV vaccination, knowledge, perceived seriousness, perceived susceptibility, perceived barrier, perceived benefit, family income, family support Correspondence: Yulia Fitriani. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: yuliafitriani38@gmail.com. Mobile: 085655708946. Journal of Health Promotion and Behavior (2018), 3(1): 16-26 https://doi.org/10.26911/thejhpb.2018.03.01.02