Human Papillomavirus Vaccine Recommendations Research Articles

HPV Vaccination Practices Among Medical Trainees in Pediatrics, Obstetrics and Gynecology, and Family Medicine.

The human papillomavirus (HPV) vaccine has been proven effective in preventing HPV-related cancer. However, vaccination uptake in the United States remains unacceptably low. The aim of this study is to determine whether residents' HPV vaccination status, demographics, or residency training setting are predictive of vaccination prescribing practices. This was an anonymous, IRB-approved, opt-in survey of OBGYN, Family Medicine, and Pediatric residents. Using the National Residency Match Program Web site, surveys were sent to program directors requesting their residents' participation. Demographics, practice settings, HPV vaccination status, reasons for being inappropriately vaccinated, and resident vaccination-prescribing practices were analyzed. A total of 853 residents participated. A total of 56.7% of respondents were fully vaccinated against HPV. The most common reasons for being unvaccinated were as follows: age (51.7%, n = 122), monogamous (30.9%, n = 73), do not believe it works (22.5%, n = 53), and affordability/insurance did not cover (14.4%, n = 34). Residents working in an urban setting were more likely to be vaccinated than those in suburban (odds ratio [OR] = 1.93, 95% confidence interval [CI], 1.364-3.229, p < .001) or rural (OR = 2.08, 95% CI 1.461-3.359, p 0.01) settings. Males were less likely than females (OR = 0.90, 95% CI 0.702-0.997, p < .001) to be vaccinated. Single residents were more likely to be vaccinated than married (OR = 2.56, 95% CI 2.444-2.704, p < .001) or divorced (OR = 2.15, 95% CI 1.822-3.264, p 0.21) residents. Vaccinated residents were more likely to recommend HPV vaccination to their patients than those who were unvaccinated (OR = 1.83, 95% CI 1.321-2.548, p .004). A significant portion of Family Medicine, Pediatrics, and OBGYN residents have not received appropriate vaccination against HPV. Vaccination is highest among residents who identify as female, single, or working in urban settings. Vaccinated residents were also found to be almost 2 times as likely to recommend vaccination to their patients. As such, our data suggest that targeted provider education is needed to increase vaccination rates for both trainees and their patients.

Evaluation of a human papillomavirus vaccination training implementation in clinical and community settings across different clinical roles.

Improving human papillomavirus (HPV) vaccination is a national priority but uptake declined following the coronavirus pandemic. A strong predictor of HPV vaccination in the USA is a strong provider recommendation. Therefore, we developed a brief, asynchronous training on HPV vaccine recommendations in clinical and community settings as part of a multisite quality improvement initiative. This paper aims to describe the implementation and initial outcomes of the training provided. A 20-minute training on HPV vaccine bundled recommendations, motivational interviewing, and brief responses to patient concerns (Communicating about HPV vaccination to Adults and Teens; HPV CHAT) was implemented at seven safety-net clinics, two practice-based research network clinics, and nine county immunization clinics. We integrated training with clinical care teams; thus, we assessed immediate training outcomes across their different clinical roles compared to pre-training. In April-May 2022, HPV CHAT training was launched. One hundred eighty-seven people participated in the training and completed the pre-/postevaluation surveys. Knowledge about the HPV vaccine guidelines improved with notable changes in correctly reporting vaccine eligibility (P < .05). A significant change in participants' confidence when addressing safety concerns and answering questions about the HPV vaccine (clinicians, 26.8% and 17.1%; nurses, 29.0% and 23.2%, and clinical staff, 18.2% and 37.7%) was observed. At post-test, more than 85% of clinicians and nurses reported their plan to routinely recommend the HPV vaccine. This quality improvement initiative demonstrated implementation feasibility of a brief HPV vaccine training that improved provider and clinical staff knowledge, confidence, and intention to routinely recommend HPV vaccination.

Safety and immunogenicity of Innovax bivalent human papillomavirus vaccine in girls 9–14 years of age: Interim analysis from a phase 3 clinical trial

BackgroundWorld Health Organization human papillomavirus (HPV) vaccination recommendations include a single- or two-dose schedule in individuals 9–20 years old and advice for generating data on single-dose efficacy or immunobridging. The ongoing Phase 3 trial of Innovax’s bivalent (types 16 and 18) HPV vaccine (Cecolin®) assesses in low- and middle-income countries alternative dosing schedules and generates data following one dose in girls 9–14 years old. Interim data for the 6-month dosing groups are presented. MethodsIn Bangladesh and Ghana, 1,025 girls were randomized to receive either two doses of Cecolin at 6-, 12-, or 24-month intervals; one dose of Gardasil® followed by one dose of Cecolin at month 24; or two doses of Gardasil 6 months apart (referent). Serology was measured by enzyme-linked immunosorbent assay (ELISA) and, in a subset, by neutralization assays. Primary objectives include immunological non-inferiority of the Cecolin schedules to referent one month after the second dose. Safety endpoints include reactogenicity and unsolicited adverse events for 7 and 30 days post-vaccination, respectively, as well as serious adverse events throughout the study. ResultsInterim analyses included data from the two groups on a 0, 6-month schedule with 205 participants per group. One month after Dose 2, 100% of participants were seropositive by ELISA and had seroconverted for both antigens. Non-inferiority of Cecolin to Gardasil was demonstrated. Six months following one dose, over 96% of participants were seropositive by ELISA for both HPV antigens, with a trend for higher geometric mean concentration following Cecolin administration. Reactogenicity and safety were comparable between both vaccines. ConclusionsCecolin in a 0, 6-month schedule elicits robust immunogenicity. Non-inferiority to Gardasil was demonstrated one month after a 0, 6-month schedule. Immunogenicity following one dose was comparable to Gardasil up to six months. Both vaccines were safe and well tolerated (ClinicalTrials.gov No. 04508309).

Knowledge regarding human papillomavirus and cervical cancer prevention among medical students from Chulalongkorn University in Thailand

BackgroundCervical cancer is one of the leading causes of death among women in Thailand. General practitioners, within their primary healthcare role, play a vital role in the cervical cancer screening program, as they are the healthcare professionals most easily accessible to the general population. This study aims to determine the level of knowledge of cervical cancer and human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer screening among last-year medical students.MethodsA cross-sectional study was conducted among sixth-year medical students using an electronic self-administered questionnaire. The two-part questionnaire comprised demographic data and 12 true/false questions that assessed knowledge regarding HPV infection, HPV vaccination, and cervical cancer screening recommendations. Pilot testing revealed a high Cronbach’s alpha and test–retest reliability coefficient.ResultsA 67% response rate was achieved. Among the 198 respondents, only one (0.5%) student correctly answered over 80% of the questions while most respondents (172, 71.7%) correctly answered less than 60% of the questions. Less than half of the respondents correctly identified crucial aspects such as the primary cause of cervical cancer, recommended vaccination age, cytology sensitivity compared to HPV testing, and the recommended screening frequency for average-risk women.ConclusionsThis study highlights a significant lack of comprehension among Thai medical students concerning HPV infection, vaccination, and cervical cancer screening guidelines. Encouraging educational enhancement, effective communication, and heightened awareness of these crucial topics within the medical school curriculum are imperative.

Practices of French General Practitioners Regarding Vaccination of Boys Against Human Papillomavirus (HPV), One Year After the Application of Its Official Recommendation

In 2019, French health authorities extended the recommendation for human papillomavirus (HPV) vaccination to include boys aged 11 to 19 years. We describe HPV vaccination practices among French general practitioners (GPs) since this recommendation wasapplied. We also identified factors associated with the propensity to propose HPV vaccination to boys. Cross-sectional study, between May and August 2022, among French GPs using a questionnaire asking about the GPs, their practices, and opinions regarding HPV vaccination, including whether they systematically proposed HPV vaccination to eligible boys or not. We investigated factors associated with systematic proposal of HPV vaccination, using univariate and multivariate logistic regression. In total, 360 GPs participated (76.6% females; mean age 34.7 ± 7.8 years; 22.9% had additional training in gynecology or pediatrics); 5.5% reported that they systematically offered HPV vaccination to boys prior to the recommendation, whereas 61.2% do so systematically since the recommendation. Factors associated with systematic proposal to boys (post recommendation) were female GP sex (78.6% versus 66.2%; OR = 2.0 [95% confidence interval (CI) 1.2–3.3]; p = 0.007) and systematic proposal prior to the recommendation (8.5% versus 0.7%; OR = 13.3 [1.7–101.7]; p = 0.01). Protection against HPV-induced cancer was cited as an argument to vaccinate girls (98.3% versus 89.2%; p < 0.0001); while reducing the risk of transmission was more commonly an argument to vaccinate boys (78.1% versus 51.8%; p < 0.0001). This study underlines the positive impact of the official recommendation for HPV vaccination of boys on the attitude of GPs, with an increase in the systematic proposal of HPV vaccination to boys.

The receipt of the human papillomavirus vaccine’s influence on future human papillomavirus vaccine recommendations by medical and dental students

BackgroundWith a growing vaccine-hesitant population and with the increase in oral cancers, particularly in a younger population, there is a heightened need for dental and medical providers to advocate for vaccination, including the human papillomavirus (HPV) vaccine. This study aimed to assess HPV vaccine knowledge, personal immunization status, and attitudes and opinions of dental students (DSs) and medical students (MSs). MethodsStudents from 1 medical and 4 dental schools in the United States completed an anonymous online survey assessing knowledge and attitudes and opinions about the HPV vaccine, including personal HPV vaccine status and confidence in vaccine counseling. ResultsSeventy percent of the 453 students who completed the survey were vaccinated for HPV. Male students were significantly less likely to have received the HPV vaccine (odds ratio [OR], 0.37; 95% CI, 0.24 to 0.56). MSs were 1.75 times more likely to have received the HPV vaccine than DSs (95% CI, 1.16 to 2.63). Those who were vaccinated and those who were not vaccinated substantially differed in opinions and knowledge of the HPV vaccine. Vaccinated students were more than 5 times more likely to report they would recommend HPV vaccines to friends and family (OR, 5.22; 95% CI, 2.57 to 10.87), recommend HPV vaccines to patients (OR, 2.71; 95% CI, 1.39 to 5.26), and advocate for HPV vaccines (OR, 2.42; 95% CI, 1.24 to 4.70). In the linear regression model, age (P = .0204 and P < .00003), profession (P < .00001), and HPV vaccination status (P < .00001) predicted HPV knowledge. ConclusionsThese findings show that MSs are more likely to be vaccinated. In addition, HPV-vaccinated people had better knowledge, attitudes, and opinions than those who were not vaccinated. Receipt of the HPV vaccine increased advocacy for the vaccine. Educating these professionals about the efficacy and impact of the HPV vaccine could increase their advocacy for the vaccine.

Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals

ObjectivePresumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. MethodsIn 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. ResultsParticipants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04–0.28, all p < 0.05). ConclusionTo better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.

Abstract PR008: Human papillomavirus vaccination knowledge, health beliefs, recommendation receipt, and intentions among unvaccinated Spanish-speaking young adult Hispanic/Latino sexual minority men

Abstract Sexual minority men are at increased risk for human papillomavirus (HPV) infections and subsequent HPV-related health concerns, including anal cancer. HPV vaccination remains an underutilized prevention strategy among sexual minority men, including Hispanic/Latino (H/L) individuals. As part of a mixed methods project, we conducted a cross-sectional survey among Spanish-speaking H/L sexual minority men ages 18-26 to characterize awareness, knowledge, health beliefs, provider recommendation, and HPV vaccine intentions. Multiple in-person and social media strategies were used to recruit participants who self-identified as having had sex with a man and/or being attracted to men and were of H/L ethnicity; able to read, write, and understand Spanish; aged 18-26 years; living in either Florida or Puerto Rico; and with internet access. Data were collected between August 2021-August 2022 using an online survey. Following data cleaning, descriptive analyses using SAS focused on unvaccinated participants (n=102). Results indicated that most participants (86%) were living in Puerto Rico and self-identified as gay (84%). Fifty-six percent reported having heard of the HPV vaccine. Only 19% reported having received a provider recommendation for the HPV vaccine, and less than one-quarter (21%) reported strongly agreeing that people important to them would want them to receive the HPV vaccine. Most individuals (69%) correctly identified that HPV can cause genital warts. However, over half responded either incorrectly or ”do not know” to questions regarding the link between HPV and anal (54%), oral (61%), or penile (65%) cancers. Over half of participants (56%) responded incorrectly or “do not know” to an item about whether most sexually active individuals are at risk for being infected with HPV. Twenty percent responded incorrectly or “do not know” to an item assessing whether men can be infected with HPV. Regarding comparative risk, 28% reported believing themselves to be at average risk for HPV compared to people their age, whereas 14% and 27% reported being at below average risk and at much below average risk, respectively. Most participants (56%) reported they were either not at all or only a little concerned with the safety of the HPV vaccine; however, 25% responded they were very or extremely concerned. Participants reported positive attitudes toward the efficacy of the HPV vaccine in preventing genital warts, penile cancer, and anal cancer. Further, the majority (69%) indicated strongly agreeing or agreeing with an item that assessed their perceived ability to make an appointment to receive the HPV vaccine. Regarding intentions, only 12% reported being very likely to receive the HPV vaccine in the next year, whereas 30% reported being very likely to receive the vaccine at some point in the future. Findings suggest numerous potential malleable targets for future interventions to promote HPV vaccination among H/L young adult sexual minority men, including prompting provider recommendations and addressing patient education needs and health beliefs. Citation Format: Shannon M. Christy, Steven K. Sutton, Mariana Arevalo, Cyril Patra, Cathy D. Meade, Melisa Ramos, Juliana Borrego, Erin Park, Susan T. Vadaparampil, Julio C. Jimenez, Julian Sanchez, Melissa Marzan-Rodriguez. Human papillomavirus vaccination knowledge, health beliefs, recommendation receipt, and intentions among unvaccinated Spanish-speaking young adult Hispanic/Latino sexual minority men [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR008.

1172. Compliance with Human Papillomavirus Vaccination At The HIV Outpatient Program in New Orleans, Louisiana

Abstract Background Guidelines recommend the human papillomavirus (HPV) vaccine for all adults through age 26, shared clinical decision-making for those aged 27 through 45 years who are inadequately vaccinated, and for all people with HIV up to age 45 years. The intent of this study is to evaluate HPV vaccination rates at the HIV Outpatient Program (HOP) at University Medical Center in New Orleans. Methods Immunization records from patients aged 18 through 45 years attending a physician visit in the LSU Infectious Diseases fellows’ HIV primary care clinic at HOP in 2022 were reviewed. The purpose of this project was to assess compliance with HPV vaccination recommendations among the infectious diseases fellows. Results Among patients under age 27, 15 of 21 visits (71%) had completed HPV vaccines series. 4 visits (19%) had incomplete status and 2 visits (10%) did not have any HPV vaccines record. Among patients aged 27 through 45 years, 73 of 194 visits (38%) had completed HPV vaccines series. 34 visits (18%) had partial vaccination records and 87 visits (45%) had no records. Conclusion Vaccination compliance among the LSU ID fellows was less than ideal, only 71% of visits for patient aged up to 27 years attending LSU ID fellows’ clinic had completed HPV vaccine series, compared to the Health People 2020 recommendation of 80%. Only 38% of visits for patients aged 27 through 45 years are fully vaccinated with HPV vaccines. Patients in this age group are often labeled “aged out” for HPV vaccines by health maintenance reminders however, due to having HIV, they are still eligible and should be vaccinated. These results led to the institution of quality improvement project to address HPV vaccinations. This intervention will focus on educating all HOP providers about the vaccination recommendations and updating the health maintenance care gaps reminder in the electronic medical record. Disclosures All Authors: No reported disclosures

Human Papillomavirus Vaccination Status and Correlates Among Mid-Adult Women: Connecticut, USA, 2016-2019.

Background: In 2019, the CDC expanded their recommendations for human papillomavirus (HPV) vaccination beyond age 26 years to include shared clinical decision-making (SCDM) among adults aged 27-45 years ("mid-adults"). The purpose of this study was to describe HPV vaccination status among mid-adult women before the implementation of SCDM for HPV vaccination. Methods: A cross-sectional survey was conducted during 2016-2019 in Connecticut, United States, and enrolled women born in 1981 or later (birth cohorts eligible for HPV vaccination). This analysis was restricted to participants aged 27 years and older at the time of the survey. Correlates of vaccination status, sources of vaccine information, and reasons for not receiving the vaccine were examined. Results: Among 298 participants, 64.4% had not received HPV vaccine. Other than age (younger age was associated with being vaccinated), no other demographic or behavioral correlates were associated with vaccination. Compared with unvaccinated women, vaccinated women were more likely to have heard about the HPV vaccine from a doctor (odds ratio [OR] = 3.45, 95% confidence interval [CI]: 2.00-5.88) and less likely to have heard about it from television (OR = 0.23, 95% CI: 0.13-0.41). The main reasons for not being vaccinated were "vaccine not offered" (48%) and "too old" (40%). Conclusions: A majority of mid-adult women in this study were not previously vaccinated against HPV, signaling the large opportunity for SCDM with this population. This may be facilitated by ensuring health care providers and mid-adult women know about the availability and potential benefits of HPV vaccination to inform decision making.

Association between administration or recommendation of the human papillomavirus vaccine and primary care physicians’ knowledge about vaccination during proactive recommendation suspension: a nationwide cross-sectional study in Japan

ObjectiveThe Japanese government suspended the proactive recommendation of the human papillomavirus vaccine (HPVv) in 2013, and the vaccination rate of HPVv declined to <1% during 2014–2015. Previous studies have shown...

Health and economic effects of introducing single-dose or two-dose human papillomavirus vaccination in India

BackgroundCervical cancer is a major public health problem in India, where access to prevention programmes is low. The WHO-Strategic Advisory Group of Experts recently updated their recommendation for human papillomavirus...

Age, gender and socioeconomic disparities in human papillomavirus (HPV) awareness and knowledge among Japanese adults after a 7-year suspension of proactive recommendation for the HPV vaccine: A nationally representative cross-sectional survey

The Japanese government’s 2013 suspension of its proactive recommendation for Human papillomavirus (HPV) vaccination resulted in low HPV vaccination coverage and was unique. However, data on awareness and knowledge of HPV vaccines in the general population was limited. Here, to investigate more recent awareness and knowledge of HPV vaccines by age, gender, and socioeconomic status, we used data from the INFORM Study 2020, a nationally representative cross-sectional survey of self-administered questionnaires with 1,998 Japanese individuals aged 20 to 59 years. We found that 47.5% of females and 21.0% of males had heard of HPV, and 33.6% of females and 16.8% of males had knowledge of HPV vaccine efficacy. After adjusting for potential confounders, females aged 50–54 years were more likely to be aware of HPV than females aged 20–24 (AOR, 2.02, 95%CI: 1.12–3.65). Females (AOR, 2.13, 95%CI: 1.48–3.07) and males (AOR, 1.64, 95%CI: 1.03–2.59) with higher education had more awareness than those with less education. Females with higher education had more knowledge about HPV vaccine efficacy than those with less education (AOR, 1.70; 95%CI: 1.16–2.50). We found a generally low level of awareness and knowledge about HPV vaccines in Japan, which might be attributable to the suspension of proactive recommendations. Additionally, we identified disparities in awareness and knowledge by age, gender, socioeconomic status, and health literacy. Enhancing HPV awareness and understanding of HPV vaccines and implementing targeted efforts for specific subpopulations within Japan after the resumption of proactive recommendation for HPV vaccines, are imperative.

Acceptability and readiness to promote human papillomavirus vaccination at ages 9–10 years: a feasibility study among North Carolina clinics

While 9-valent human papillomavirus (HPV) vaccination is approved by the US Food and Drug Administration for use in adolescents as young as age 9, providers typically recommend it at ages 11–12. Studies suggest that recommending HPV vaccination at 9 or 10 years of age could increase up-to-date vaccination by age 13, which could especially benefit rural populations with reduced access to primary health care and lower HPV vaccination coverage than urban areas. This study aimed to assess the feasibility of the age-9 recommendation of HPV vaccination in rural clinics. We conducted in-depth interviews with providers and staff from two primary care clinics in central North Carolina to understand attitudes toward recommending HPV vaccination to 9- and 10-year-olds. All interviewees agreed that HPV vaccination was important for cancer prevention and should be recommended before the onset of sexual activity, agreeing that HPV vaccination could be initiated before age 11 to improve timeliness and completion of the vaccination series. However, opinions were mixed on whether HPV vaccination should be initiated as young as 9 years old. Two key informants recruited from two university-affiliated clinics described their experiences recommending HPV vaccination to 9- and 10-year-olds, including a modified vaccination schedule that promotes HPV vaccination during routine well-child visits, prior to pubertal onset, and alongside other recommended adolescent vaccines. Age-9 recommendation and administration of HPV vaccination is possible with minimal changes to current clinical practices and could increase the convenience and acceptability of HPV vaccination in under-vaccinated settings.

Underlying background of the current trend of increasing HPV vaccination coverage in Japan.

Cervical cancer is prevalent among women, with a reported 604,127 cases in 2020 worldwide. The incidence of cervical cancer has been mitigated in most high-income countries by promoting the human papilloma virus (HPV) vaccine. However, in Japan, cervical cancer is still a leading cause of mortality and the most prevalent cancer among women aged between 15 and 39. This can be attributed to the 7-year suspension of HPV vaccination recommendations by the Japanese government. A decline in vaccination coverage followed this suspension, caused by a small number of reported adverse events, resulting in a steep decline in vaccination coverage from over 70% to less than 1%. However, there have been indications of a change in trend in Japan. In 2020, a group of volunteer doctors initiated awareness-raising activities through social networking services and other platforms, and the target population that received at least one dose of the vaccine in 2020 increased to 15.9%. Additionally, in July 2020, the Japanese government approved the updated 9-valent HPV vaccine and resumed recommendations in November 2021. As a result, 30.1% of those eligible for routine HPV vaccination received at least one dose of the vaccine from April to September, 2022. However, the HPV vaccine coverage in Japan is still far from the 90% recommended by the World Health Organization, and continued communication and education on the vaccines benefits are necessary to achieve optimal coverage.

An Interactive Educational Tool to Improve Human Papillomavirus Vaccine Knowledge and Recommendation Among Nurses.

In United States, only 57% of women and 53% of men in the recommended age groups have received all recommended doses of the human papillomavirus (HPV) vaccine. Healthcare provider education has been associated with strong vaccine recommendation and vaccination uptake. Our objective was to create a 7-min interactive online educational tool to improve knowledge and willingness to recommend the HPV vaccine among nurses. This is a prospective pre-test/post-test study to evaluate the effectiveness of the educational tool consisting of 10 flashcards in a question-answer format. Oncology nurses at our cancer center were invited to participate by email, which led them to the educational tool (i.e., intervention) along with pre- and post-test questions on HPV-associated cancers, vaccine-eligible age groups, dosing schedules, adverse events, and willingness to recommend. Of the 110 participants (mean age of 41.2 ± 11.4, 98% female, 64% >10 years of practice), there was improvement in knowledge after intervention in HPV-associated cancers (81% to 97%; p = 0.02), percentage of cervical caused by HPV (33% to 64%; p < 0.05), and dosing schedule (47% to 93%; p < 0.05). All participants correctly stated that continued screening is needed after vaccination both pre- and post-intervention. Eighty-five percent strongly agreed that the intervention improved their HPV knowledge, and 77% stated they were more likely to recommend the HPV vaccine after the intervention. While nurses are willing to recommend the vaccine, there remains persistent knowledge gaps. A brief 7-min self-administered online interactive flashcard educational intervention is effective in improving the HPV vaccine knowledge among nurses.

Anti-HPV vaccination in women treated for HPV-related lesions: effective vaccination strategy for achieving HPV-related diseases control

Human Papillomavirus (HPV) vaccination is able to reduce the risk of relapse in women undergoing surgery for HPVrelated lesions. The surgical treatment of these lesions can correlate with a greater risk of preterm parts. The extension of the recommendation of HPV vaccination to patients treated for a previous HPV-related lesion would entail a lower expense for the Health System. Therefore, an increase in the use of HPV vaccination is desirable also in this target population as well as the implementation of a care pathway dedicated to women treated for HPV lesions that includes vaccination in the prevention activities of relapses.

Frequency of health care provider recommendations for HPV vaccination: a survey in three large cities in China.

Human papillomavirus (HPV) infection, an important pathogenic factor for cervical cancer, can be prevented by the HPV vaccine. Health care provider (HCP) recommendations contribute to improve HPV vaccination coverage. The aim of this study was to assess the frequency of HCP recommendations for HPV vaccination and associated factors. From Nov 8 to Dec 6 in 2018, a cross-sectional study was conducted through online questionnaires among HCPs (n = 1,371) from hospitals in three large cities in China (Shanghai, Guangzhou, and Shenzhen). Data on demographic characteristics, the frequency of HPV vaccination recommendations, HPV knowledge and related attitudes were collected through the questionnaires. Among 1,371 participants, only 30.2% reported that they frequently recommended HPV vaccination. Multivariate analyses indicated that female sex, being employed in obstetrics or gynecology departments and community health service centers, and having higher self-reported and actual knowledge of HPV were factors associated with a higher recommendation frequency. Factors including a self-perceived non-obligation to provide recommendations and difficulties in discussing sexual topics were significantly correlated with less frequent recommendations. Employment in a community health service center (OR = 2.068, 95% CI: 1.070-3.999) was the strongest factor associated with the frequency of HCPs' recommendations for HPV vaccination. The frequency of HCPs' recommendations for HPV vaccination in China was much lower than that in many developed countries. To enhance the recommendation frequency, medical institutions should help HCPs gain more knowledge of HPV and master communication skills. At the same time, the government should take measures to enhance the accessibility of HPV vaccines. The media should help to alleviate people's concerns and encourage them to face up sexual health.

Factors associated with uptake of human papilloma virus vaccine among school girls aged 9–14 years in Lira City northern Uganda: a cross-sectional study

BackgroundCervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9–14 years in Lira City, northern Uganda.MethodsA cross-sectional study was conducted among 245 primary school girls aged 9–14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively.ResultsHPV vaccination uptake was at 19.6% (95% CI,14.8–25.1) among the school girls aged 9–14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19–25.88), P ≤ 0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60–34.28), P ≤ 0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37–14.19), P = 0.013].ConclusionThe study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.

HPV vaccine information, knowledge, attitude, and recommendation intention among male college students in China

ABSTRACT This study aimed to describe the status quo of human papilloma virus (HPV)-related knowledge and attitude among Chinese male college students and explore the factors influencing HPV vaccination intention. A national, cross-sectional online survey was conducted among male college students in China to investigate their HPV-related information, knowledge, attitudes, and vaccine recommendation intentions. Path analysis based on the information, knowledge, attitude, and intention model was used to assess the relationships between predictors. In total, 823 male college students participated in the survey. More than 80% of the respondents believed that the HPV vaccine was necessary for their female partners, whereas 136 (16.52%) respondents knew nothing about HPV or HPV vaccines. Information exposure was a positive predictor of HPV-related knowledge. Knowledge subsequently had a positive impact on trust in HPV vaccines, and sufficient knowledge and a positive attitude increased the intention to recommend HPV vaccination (p < .001). Among the demographic characteristics, age and a major in medicine were positively associated with the information score (p < .05). The male college students’ HPV-related knowledge was inadequate and negatively influenced their vaccine recommendation intentions. If we take advantage of the Internet and individual sources to increase students’ exposure to information, we will improve their HPV-related knowledge and attitudes; thus, the intention to recommend HPV vaccination will ultimately be stronger.