Introduction Of HPV Vaccination Research Articles

Cervical Cancer and Human Papilloma Virus (HPV) Vaccines: A primer for General Physicians

India contributes close to 20% of the global cervical cancer burden. This article reviews the preventive strategies against cervical cancer and suggest a few way forward for the prevention of cervical cancer in India. A literature review of online databases (Embase, Google Scholar, PubMed, Scopus) and reports from government websites regarding cervical cancer and HPV vaccination in India was conducted. Currently, four different HPV vaccines are available in India: a bivalent vaccine, a nonavalent vaccine and two quadrivalent vaccines. To reduce India’s cervical cancer burden, the National Technical Advisory Group on Immunization (NTAGI) has advocated the widespread implementation of HPV vaccination. An indigenous HPV vaccine was given market authorisation by the Drugs Controller General of India (DCGI) in July 2022. There is a need to raise awareness regarding the benefits of HPV vaccines in India. The introduction of indigenous HPV vaccine might enhance the supply logistics and may increase the uptake of the vaccine.

Global perspectives of determinants influencing HPV vaccine introduction and scale-up in low- and middle-income countries.

Achieving WHO cervical cancer elimination goals will necessitate efforts to increase HPV vaccine access and coverage in low-and-middle-income countries (LMICs). Although LMICs account for the majority of cervical cancer cases globally, scale-up of HPV vaccine programs and progress toward coverage targets in LMICs has been largely insufficient. Understanding the barriers and facilitators that stakeholders face in the introduction and scale-up of HPV vaccination programs will be pivotal in ensuring that LMICs are equipped to optimize the implementation of HPV vaccination programs. This qualitative study interviewed 13 global stakeholders categorized as either academic partners or global immunization partners to ascertain perspectives regarding factors affecting the introduction and scale-up of HPV vaccination programs in LMICs. Global stakeholders were selected as their perspectives have not been as readily highlighted within the literature despite their key role in HPV vaccination programming. The results of this investigation identified upstream (e.g., financial considerations, vaccine prioritization, global supply, capacity and delivery, and vaccine accessibility, equity, and ethics) and downstream (e.g., vaccine acceptability and hesitancy, communications, advocacy, and social mobilization) determinants that impact program introduction and scale-up and confirmed that strong political commitment and governance are significant in garnering support for HPV vaccines. As LMICs introduce HPV vaccines into their national immunization programs and develop plans for scaling up vaccination efforts, strategic approaches to communications and advocacy will also be needed to successfully meet coverage targets.

Abstract 79: The Impact of COVID-19 on HPV Immunization Programs in Countries With High Cervical Cancer Burdens: Global and National Perspectives

Abstract Purpose: The COVID-19 pandemic has had a considerable impact on HPV immunization efforts within low-and-middle-income countries (LMICs). This is a cause for concern as LMICs account for the global burden of deaths attributable to cervical cancer; yet the direct and indirect impacts of COVID-19 on HPV immunization programs have not been well described in the literature. Our study explored COVID-19 specific challenges in HPV vaccine introduction and scale-up in LMICs through interviewing stakeholders with context specific knowledge in cervical cancer prevention efforts within LMICs. Methods: This qualitative study involved a stakeholder analysis coupled with semi-structured in-depth interviews with n=31 global stakeholders (i.e. academic institutions, global immunization partners) and national stakeholders (i.e. ministry of health officials, non-governmental organizations). Purposive sampling was used to select participants with content knowledge and experience in HPV vaccine programming. Data was analyzed using qualitative content analysis. Inductive codes were categorized into broader themes describing challenges HPV vaccination programs faced during the COVID-19 pandemic. Results: Five broad themes emerged from the analysis: HPV vaccine prioritization, funding considerations, supply chain challenges, HPV vaccine delivery platforms and catch-up dosing, and vaccine hesitancy. The amplified focus of COVID-19 vaccines resulted in decreased prioritization and funding towards HPV vaccination efforts. In certain settings, HPV vaccines were found to be the least prioritized antigen. Decreased demand, coupled with global supply chain shortages due to COVID-19, resulted in sizeable challenges for HPV vaccine introduction and scale-up. Nearly all stakeholders described how anti-COVID-19 vaccine sentiments magnified hesitancy towards HPV vaccines. Particularly revealing, were delivery challenges as a consequence of school closures. This resulted in stakeholders’ acknowledgment of the need to establish alternative delivery platforms and strategies for catch-up dosing. Conclusion: Understanding how emerging infectious disease outbreaks impact HPV vaccination efforts in countries with high cervical cancer burdens is critical. Increasing HPV vaccine prioritization within countries, developing strategies to overcome existing shortfalls, along with addressing vaccine hesitancy will be key in generating momentum towards HPV immunization programs. Citation Format: Dominique Guillaume, Due-e-Nayab Waheed, Mieke Schlieff1, Kirthini Muralidharan, Alex Vorsters, Rupali Limaye. The Impact of COVID-19 on HPV Immunization Programs in Countries With High Cervical Cancer Burdens: Global and National Perspectives [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 79.

HPV virus as the main cause of cervical cancer, vaccination - literature review

HPV infection is one of the most common viral infection of the female and male reproductive tract worldwide. Most of the human papillomavirus infections cause no symptoms and go away on their own. Some infections develop into persistent infection, which can lead to the development of cancer of the cervix, anogenital, oral cavity and pharynx.In this paper, we focused on cervical cancer, which is the second most common cancer in the world among women. More than 300,000 women died from this cancer in 2020. The invention and introduction of prophylactic HPV vaccines has played a significant role in reducing the number of viral infections, thus reducing the incidence of benign and malignant diseases caused by them and the mortality resulting from them. There are three vaccines on the pharmaceutical marketfor prevention of specific HPV infection. They are: a bivalent vaccine Cervarix, a tetravalent vaccine Gardasil and a nonavalent vaccine Gardasil 9. These vaccines are safe because they do not contain an attenuated virus particle, but their production is based on a virus-like particle of the main capsid protein L1-VLP. Gardasil 9 targets nine HPV types andcomparing to the other two vaccines it is the most effective at preventing the development of preinvasive cervical cancer. WHO recommends administering them to girls aged 9 to 14 in a two-dose schedule or from 15 years of age in a three-dose schedule. The side effects of the above-mentioned vaccines were mostly associated with a cutaneous reactions around the site of injection (pain, redness, swelling), and some people also experienced systemic symptoms such as a headache, a fever, vomiting, a dizziness, muscle pain and a diarrhea. The following article is an analysis of the current knowledge on the effectiveness and safety of prophylactic HPV vaccines based on publications available in the Pubmed and Google Scholar databases.

Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic

BackgroundHPV vaccination has been recommended and reimbursed for girls in Germany since 2007. In June 2018 the German Standing Committee on Vaccination (STIKO) recommended the gender-neutral vaccination of adolescents aged 9 to 14 years with catch-up through age 17. Objectives of this study were to describe the uptake of vaccination in boys before and during the COVID-19 pandemic.MethodsThe study used data from a proprietary electronic medical record database and a database with information on nationally dispensed vaccine doses. The monthly number of first doses of HPV vaccinations in boys and girls aged 9–17 years in the period from 01/2018 to 12/2021 was determined. In addition, for boys the cumulative vaccination rates were calculated for initiated and completed vaccination series.ResultsFour months after the introduction of mandatory reimbursement for boys, the monthly numbers of first doses were comparable to that of girls. Compared to the same month in 2019, the number of first doses declined by up to 49% (girls) in 2020 and 71% (boys) in 2021. At the end of 2021, the vaccination rate for 15-year-old boys (2006 birth cohort) reached 44.4% for initiated and 26.4% for completed series.ConclusionAfter an initial dynamic increase in HPV vaccinations in boys, the impact of COVID-19 was particularly strong in the second year of the pandemic. At the end of 2021 vaccination rates were still low. Efforts are needed to catch-up on adolescents that missed doses during the pandemic and to increase uptake.

Prevalence of vaginal HPV infection among adolescent and early adult girls in Jos, North-Central Nigeria

PurposeKnowledge of the prevalence of HPV infection among adolescent and early adult girls is essential to determining the best age for the introduction of HPV vaccine, monitoring vaccine efficacy, and giving insight into determinants of persistent high-risk HPV infection, a necessary cause of cervical cancer. Yet, there have been limited studies of HPV infection among adolescent and early adult girls in low-and-middle-income countries.MethodsIn this cross-sectional study, we randomly selected 205 girls, aged 9–20 years, from 10 schools in central Nigeria. We obtained informed consent and assent, collected data, and trained participants to self-collect vaginal samples using swab stick. We genotyped HPV using SPF10-DEIA/LiPA25 and analyzed data using Stata 14®.ResultsThe mean (SD) age of the girls was 14.9 (2.3) years. We found HPV in 13.2% of vaginal swabs. The earliest age at which anyHPV and hrHPV infections were detected was 10 and 12 years respectively. The prevalence of any HPV peaked at 16 and 17 years, hrHPV at 16 years, lrHPV at 17 and 18 years and multiple hrHPV 18 years of age. The prevalence of hrHPV infection was 1.5% among the 9–12 years age group, 2.9% among 13–16 years and 3.4% among 17–20 years old. The commonest hrHPV types detected were 52 (3.9%), 18 (1.5%) and 51 (2.4%). The most common lrHPV types was 6 (2.9%).ConclusionThe prevalence of HPV infection in these urbanized young girls in Nigeria is high and commences after 9 years of age. HPV vaccination in this population should start at 9 years of age or younger to prevent the establishment of persistent HPV infection.

The projected cost-effectiveness and budget impact of HPV vaccine introduction in Ghana

BackgroundCervical cancer is responsible for around one-quarter of all cancer deaths among Ghanaian women. Between 2013 and 2015, Ghana conducted a pilot of HPV vaccination among 10–14-year-old girls in four regions; however, the country has yet to introduce the vaccine nationally. This study projected the cost-effectiveness and budget impact of adding HPV vaccination into Ghana’s national immunization program. MethodsWe used a proportional outcomes model (UNIVAC, version 1.4) to evaluate the cost-effectiveness of introduction with bivalent (Cervarix™) and quadrivalent (Gardasil®) vaccines from government and societal perspectives. Vaccine introduction was modeled to start in 2022 and continue over ten birth cohorts using a combined delivery strategy of school (80%) and community outreach (20%). We modeled vaccination in a single age cohort of 9-year-old girls vs. a multi-age cohort of 9-year-old girls (routine) and 10–14-year-old girls (one-time campaign) compared to no vaccination. Health outcomes included cervical cancer cases, hospitalizations, deaths, and disability-adjusted life years (DALYs). We applied a discount rate of 3% to costs and outcomes. All monetary units are reported in USD 2018. ResultsNational HPV vaccination in Ghana was projected to be cost-effective compared to no vaccination in all scenarios evaluated. The most cost-effective and dominant strategy was vaccination among 9-year-old girls, plus a one-time campaign among 10–14-year-old with the bivalent vaccine ($158/DALY averted from the government perspective; 95% credible range: $19–$280/DALY averted). Projected average annual costs of the vaccine program ranged from $11.2 to $15.4 M, depending on strategy. This represents 11–15% of the estimated total immunization costs for 2022 ($100,857,875 based on Ghana’s comprehensive Multi-Year Plan for Immunization, 2020–2024). DiscussionOur model suggests that introducing HPV vaccination would be cost-effective in Ghana under any strategy when willingness-to-pay is at least 40% GDP per capita ($881). Inclusion of a one-time catch-up campaign is shown to create greater value for money than routine immunization alone but would incur greater program costs.

Potential impact of HPV vaccine on incidence of high-grade vulvar, vaginal, and anal precancers among females and males aged 15 to 39 years, United States 2000 to 2017.

5594 Background: Since introduction of HPV vaccine, cervical precancers have decreased, but the vaccine’s impact on non-cervical anogenital precancers is unknown. These precancers are identified opportunistically and are not routinely collected in most cancer registries. Methods: We examined high-grade vulvar (VIN3), vaginal (VAIN3), and anal (AIN3) precancers among persons aged 15-39 years using 2000-2017 data from select cancer registries covering 27.8% of the U.S. population. Incidence trends were evaluated with Joinpoint regression. Results: VIN3 rates declined 21% per year post-HPV vaccination introduction among women. VAIN3 rates declined 19.1% per year among women aged 15-29 years, also post-HPV vaccination introduction. Compared to the pre-vaccination period when AIN3 rates were increasing, AIN3 rates were stable among women aged 15-29 years and among men aged 30-39 years. Conclusions: Decreases in rates of VIN3 and VAIN3 after HPV vaccine introduction among younger age groups were similar to declines observed in cervical precancers, suggesting HPV vaccine impact.

Experience of Human Papillomavirus Vaccination Project in a Community Set Up-An Indian Study.

Background:Initial introduction of HPV vaccination from 2006 to 2008 was largely confined to high-income countries (HIC), such as Australia, the United States, and Europe, where cervical cancer incidence is lowest. Much of the post-introduction literature has come from HICs, with a focus on coverage levels achieved, provider acceptability and early impact of vaccination on disease endpoints. However, there are a few literature evaluating the mechanics of delivery, feasibility of the health system and acceptability from low and middle income countries (LMICs). The primary objective was to evaluate the feasibility, acceptability and safety of two dose HPV vaccination in adolescent girls between 9-14 years. Methods:After an orientation camp followed by filling up of prevaccine questionnaires by parents on HPV related diseases and its vaccines and informed consent, girls between9-14years were vaccinated. They were asked to report any side effects in the next 24 hours after each dose. Parents were contacted on Day 7 and Day 30 to enquire about any side effects . Total 3 visits were required i.e two for the vaccination and one visit at 7th month post completion of second dose. To estimate the acceptability, successful completion of two doses by at least 80% of the girls were measured. For measurement of acceptability, either of the parents were recalled along with their daughter at 7th month and were asked to fill up a pre-set questionnaire. Results:After institutional ethical clearance, 555 girls were recruited in the study from rural parts of West Bengal, India between July, 2017 to November, 2017. Out of which, 544 girls (98%) received their 2nd dose between January, 2018 and May, 2018 without any serious adverse effects. No serious adverse effect was reported on follow up till December, 2019. Conclusion:The introduction of HPV vaccination is feasible in large scale and the vaccine is well accepted and safe.

Declining rates of cervical intraepithelial neoplasia in British Columbia, Canada: An ecological analysis on the effects of the school-based human papillomavirus vaccination program.

Since 2008, girls in British Columbia (BC), Canada, have been offered HPV vaccination through a school-based, publicly funded immunization program. The oldest birth cohort eligible for the vaccination program was born in 1994 and uptake is on average 63%. To evaluate the impact of the HPV vaccine in BC, ecological trends in cervical intraepithelial neoplasia (CIN) rates were assessed in young women before and after the implementation of the HPV vaccination program. Information on all Pap smears and histopathological abnormalities, in calendar years 2004-2017 in women 16-28 years of age in BC were obtained from the population-based BC Cancer Cervix Screening Program database. Rates of CIN 2 and 3 were calculated as the number of cases divided by the number of cytology specimens for that period. Rate ratios (RR) were calculated by negative binomial piecewise regression. Age-centered incidence rates of CIN 2 and 3 in BC declined significantly among women 16-23 years of age after HPV vaccine introduction compared to before vaccine introduction. The overall reduction postvaccination for CIN2 and 3 in women 16-23 years was respectively 62% (95% CI 54-68%) and 65% (95% CI 58-71%). Age-specific rates for CIN2 significantly declined for those 18-22 years of age and for those 19, 20 and 23 years of age for CIN3. Among women 24-28 years of age no decline in CIN2 and 3 rate over time was observed. The observed reduction in CIN 2 and 3 rates since the introduction of the school-based HPV vaccine program might illustrate the population impact of the BC provincial school-based HPV vaccination program.

HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019

WHO/UNICEF estimates for HPV vaccination coverage from 2010 to 2019 are analyzed against the backdrop of the 90% coverage target for HPV vaccination by 2030 set in the recently approved global strategy for cervical cancer elimination as a public health problem.As of June 2020, 107 (55%) of the 194 WHO Member States have introduced HPV vaccination. The Americas and Europe are by far the WHO regions with the most introductions, 85% and 77% of their countries having already introduced respectively. A record number of introductions was observed in 2019, most of which in low- and middle- income countries (LMIC) where access has been limited. Programs had an average performance coverage of around 67% for the first dose and 53% for the final dose of HPV. LMICs performed on average better than high- income countries for the first dose, but worse for the last dose due to higher dropout. Only 5 (6%) countries achieved coverages with the final dose of more than 90%, 22 countries (21%) achieved coverages of 75% or higher while 35 (40%) had a final dose coverage of 50% or less. When expressed as world population coverage (i.e., weighted by population size), global coverage of the final HPV dose for 2019 is estimated at 15%.There is a long way to go to meet the 2030 elimination target of 90%. In the post-COVID era attention should be paid to maintain the pace of introductions, specially ensuring the most populous countries introduce, and further improving program performance globally.

Strong reduction in prevalence of HPV16/18 and closely related HPV types in sexually active adolescent women following the introduction of HPV vaccination in Argentina

Strong reduction in prevalence of HPV16/18 and closely related HPV types in sexually active adolescent women following the introduction of HPV vaccination in Argentina

Economic evaluation of human papillomavirus vaccination in the Global South: a systematic review.

Many reviews have been conducted on the economic evaluation of the HPV vaccine in global north countries. But there is a dearth of such reviews in the Global South countries. Hence, this systematic review aims to summarize studies done in these countries. Four databases PubMed, Embase, Cochrane Library, and Google Scholar from 2009 to 2019 were searched for economic evaluations on HPV vaccination in the Global South countries. PRISMA guidelines were followed to include full-text articles. 40 original articles were shortlisted for full-text review. Studies had varied models, assumptions, and results according to different scenarios. Most studies concluded HPV vaccination to be cost-effective under varied scenarios and vaccine cost was the most influential parameter affecting the sensitivity analyses, consequently incremental cost-effectiveness ratio. A wide range in the cost-effectiveness ratio was observed in the included studies due to different study settings, populations, and inconsistencies in modeling practices (variations in methodological approaches). This review suggests the introduction of HPV vaccination alone or in combination with screening according to different countries. The price of the vaccine should be economical and funds for the vaccine should be provided by public sector firms.

The contagious nature of a vaccine scare: How the introduction of HPV vaccination lifted and eroded MMR vaccination in Denmark

BackgroundHuman papillomavirus (HPV) vaccine coverage was high in Denmark until it plunged following negative media coverage. We examined whether the decline in HPV vaccination undermined uptake of another adolescent vaccine, measles, mumps and rubella (MMR). MethodsThe Danish national health register provided data on uptake of MMR vaccine dose 2 (at age 13) for children born from 1991 to 2003 (n = 827,716). The primary exposure variable comprised three time periods: before HPV vaccine introduction, during high HPV vaccine coverage, and after the drop in HPV vaccine coverage. To examine the effect of HPV vaccination on MMR2 uptake, we estimated MMR2 uptake by age 13 using logistic regression, controlling for gender, birth month, birth year, and maternal education. FindingsMMR2 vaccination coverage was high for both girls and boys (86% and 85%) in 2009. Following the introduction of HPV vaccine for girls in 2009, MMR2 coverage increased for girls even as it decreased for boys (gender gap 4·6 percentage points, 95% CI 4·3 to 4·8). Coverage with MMR2 for girls continued to be high over the following four years, and almost all girls (91%) who received MMR2 vaccination also received HPV1 vaccination within the same week. When negative media coverage led to a decline in HPV vaccination, MMR2 uptake for girls also declined. By 2015, MMR2 coverage for girls and boys had become similar again (80% and 79%). Families with the highest level of maternal education showed the strongest decline in MMR2 coverage for girls. InterpretationConcomitant vaccine provision can increase overall vaccine uptake. However, reduced demand for one vaccine may reduce concomitant vaccination and undermine resiliency of a country’s vaccination program. FundingDrs. Gørtz and Ejrnæs appreciate generous funding from the Novo Nordisk Foundation (grant no. NNF17OC0026542) and from the Danish National Research Foundation through its grant (DNRF-134) to the Center for Economic Behavior and Inequality (CEBI) at the University of Copenhagen.

Impact of HPV vaccination on cervical screening performance: a population-based cohort study

BackgroundHuman papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.MethodsWe included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 years. We assessed their first cytology and following histopathological diagnosis using Swedish National Cervical Screening Registry (NKCx). By linkage with the national Swedish HPV vaccination registry, we determined PPV of abnormal cytology for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and the differences with 95% confidence intervals (CIs) according to vaccination status.ResultsThe PPV of high-grade cytology for CIN2+ was 69.9% (95% CI, 67.9–71.9), 64.9% (95% CI, 59.8–69.8) and 57.4% (95% CI, 50.9–63.7) among women unvaccinated, initiating vaccination at age 17–22 years and initiating vaccination before age 17 years, corresponding to reduction in PPV by 8% (95% CI, 0–15%) and 17% (95% CI, 7–26%) in vaccinated groups after adjustment for birth cohort, respectively.ConclusionThe PPV of cytology for CIN2+ decreased among vaccinated women, and the decrease was stronger for girls vaccinated at younger ages. A switch from cytology to HPV testing might potentially improve the screening performance.

Incidence of vulvar high-grade precancerous lesions and cancer in Denmark before and after introduction of HPV vaccination

ObjectiveTo assess the incidence of vulvar high-grade precancerous lesions and cancer in Denmark during 1997–2018. MethodsWe identified incident vulvar cancer cases in the Danish Cancer Registry and incident cases of vulvar precancerous lesions in the Danish Pathology Register. We calculated age-standardized incidence rates of vulvar squamous cell carcinoma (VSCC), non-SCC and precancerous lesions, and age-specific incidence rates of VSCC and precancerous lesions. Incidence trends were evaluated using linear Poisson regression to estimate the average annual percentage change (AAPC). For vulvar precancerous lesions, trends were evaluated in the period before (1997–2007) and after (2008–2018) implementation of HPV vaccination. ResultsIn the 22-year study period, the age-standardized incidence rate of VSCC increased from 1.23 (1997–1998) to 1.98 per 100,000 (2017–2018), corresponding to an average yearly increase of 2.95% (95%CI: 2.15–3.75). The incidence of non-SCC increased only slightly. Overall, the incidence of vulvar precancerous lesions increased (AAPC = 2.38%; 95%CI: 1.75–3.02). After implementation of HPV vaccination, the incidence of vulvar precancerous lesions decreased significantly in women aged <20 (AAPC = −22.10% (95%CI: −35.27 to −6.26)) and 20–29 years (AAPC = −6.57, 95% CI: −10.63 to −2.33), whereas the incidence increased in the majority of age groups ≥50 years. ConclusionsOverall, the incidence of VSCC and vulvar precancerous lesions increased during 1997–2018. However, after introduction of HPV vaccination, the incidence of vulvar precancerous lesions decreased among women aged <20 and 20–29 years, pointing towards a possible effect of HPV vaccination in this group. This development should be followed in the future.

Universal Human Papillomavirus Vaccination and its Impact on the Southern Italian Region.

HPV is still the most common sexually transmitted infection, leading to the onset of many disorders while causing an increase in direct and indirect health costs. High Risk (HR) HPV is the primary cause of invasive cervical cancer and contributes significantly to the development of anogenital and oropharyngeal cancers. The introduction of universal HPV vaccination has led to a significant reduction in vaccine-targeted HPV infections, cross-protective genotypes, precancerous lesions and anogenital warts. Despite the several limitations of HPV vaccination programs, including vaccine type specificity, different schedules, target age-groups and poor communication, the impact has become increasingly evident, especially in countries with high vaccine uptake. We carried out a review of the most recent literature to evaluate the effects of HPV vaccination on vaccinetargeted HPV genotypes and to assess the level of cross-protection provided against non-vaccine HPV types. Subsequently, to assess the rates of HPV infection in a southeast Italian region, we performed an epidemiological investigation on the impact of vaccination on genotypes and on the prevalence and distribution of HPV infection during the twelve-year period 2006-2017 in the Local Health Unit (LHU) of Lecce. The vaccination coverage of about 70% among girls in the LHU led to an initial reduction in vaccine-targeted HPV types and cross-protective genotypes. However, the results on this population should be interpreted cautiously because the period since the start of vaccination is too short and the coverage rate is not yet optimal to evaluate the efficacy of vaccination in lowering the prevalence of non-vaccine HR HPV types in the vaccinated cohort and in older subjects. Nevertheless, it is expected that direct effects will increase further and that herd immunity will begin to emerge as vaccination coverage increases.

Strengthening national teams of experts to support HPV vaccine introduction in Eastern Mediterranean countries: Lessons learnt and recommendations from an international workshop

Several countries have started to introduce the HPV vaccine into their national immunisation programme, with the majority of these countries being high or upper-middle income countries. Currently, 91 countries have introduced the HPV vaccine globally. One of the regions lagging behind in the introduction of the HPV vaccine is the Eastern Mediterranean Region, with currently only Libya and the United Arab Emirates having introduced the HPV vaccine.In order to support countries in the Eastern Mediterranean Region with their decision-making process for HPV vaccine introduction, a regional workshop was organised to explore the current status of HPV vaccine introduction plans in the Eastern Mediterranean countries, gaps in information about HPV disease burden in the region and the need for quality HPV data to make an informed decision to introduce the HPV vaccine, socio-cultural and religious challenges with HPV vaccine introduction, and the role of NITAGs in formulating recommendations for HPV vaccine introduction.Participating countries reflected on their respective status of decision making process about HPV vaccine introduction; they discussed any needs for operational research to support the decision-making process; and highlighed technical and financial support that might be required from partners to assist with HPV vaccine introduction. Recommendations were made on how to advance the decision-making process for HPV vaccine introduction.The workshop increased the awareness of the need of data on burden of disease and the associated benefits of HPV vaccination in Eastern Mediterranean countries. The importance of collaboration between different programmes including: immunisation, adolescent health, school health, sexual and reproductive health and cancer control programmes was clearly emphasized.

Therapeutic Vaccines Against Human Papilloma Viruses: Achievements and Prospects.

Human papillomaviruses of high carcinogenic risk (HR HPVs) are major etiological agents of malignant diseases of the cervix, vulva, penis, anal canal, larynx, head, and neck. Prophylactic vaccination against HPV, which mainly covers girls and women under 25, does not prevent vertical and horizontal HPV transmission in infants and children and does not have a therapeutic effect. As a result, a significant proportion of the population is not protected from the HPV infection and development of HPV-associated neoplastic transformation and cancer, which indicates the need for development and introduction of therapeutic HPV vaccines. Unlike prophylactic vaccines aimed at the formation of virus-neutralizing antibodies, therapeutic vaccines elicit cellular immune response leading to the elimination of infected and malignant cells expressing viral proteins. The ideal targets for vaccine immunotherapy are highly conserved HR HPV oncoproteins E6 and E7 expressed in precancerous and tumor tissues. Here, we describe expression of these proteins during different stages of HPV infection, their antigenic and immunogenic properties, and T-cell epitopes, the response to which correlates with natural regression of HPV-induced neoplastic changes. The review describes patterns of E6 and E7 oncoproteins presentation to the immune system as components of candidate vaccines along with the results of the most promising preclinical trials and animal models used in these trials. Special attention is paid to vaccine candidates which have shown efficacy in clinical trials in patients with HPV-associated neoplastic changes.

Cervical Human Papillomavirus Prevalence, Genotypes, and Associated Risk Factors among Female Sex Workers in Greater Accra, Ghana.

Cervical cancer is a largely preventable disease mediated by persistent infection with high-risk Human Papillomaviruses (Hr-HPV). There are now three approved vaccines against the most common HPV genotypes. In Ghana, mortality due to cervical cancer is on the rise, due to the absence of an organized and effective cervical cancer prevention and control program. Data on circulating HPV genotypes is important for studying the likely impact of mass introduction of HPV vaccination of the female population before sexual debut. High HPV prevalence has been reported in Female Sex Workers (FSWs), who constitute an important active group for maintenance of HPV in the population. This study was conducted to determine the size of HPV prevalence in this group and to provide information for future assessment of the impact of vaccine introduction in the country. We conducted a cross-sectional study where the snowballing technique was used to identify and select FSW's ≥18 years, operating within suburbs of Greater Accra Region (GAR). A risk factor assessment interview was conducted and cervical swabs were collected for HPV-DNA detection and genotyping by Nested Multiplex PCR. Hundred participants, age ranging from 18 to 45 years, median 24 years, were studied. The prevalence of Cervical HPV was 26%. Eleven genotypes were detected comprising 9 high-risk in order of decreasing prevalence HPV-16 (8%), HPV-35 (5%), HPV-33/39/-68 (3%), HPV-52/51/59 (2%) and HPV-18 (1%) and 2 Low-risk types, HPV-42(3%), and HPV-43 (1%). Three women had HPV types that could not be genotyped by our method. Oral contraceptives use was associated with a reduced chance of HPV infection (P=0.002; OR=0.19, 95% CI 0.07-0.54). This study found a high HPV prevalence among FSWs in the GAR. A high number of Hr-HPV genotypes seen are vaccine preventable, providing additional compelling argument for implementing a national cervical cancer prevention plan including vaccination.