Women attending the University of Saskatchewan Student Health Services are being offered human papillomavirus (HPV) vaccination but are not filling their prescriptions. We sought to identify gaps in knowledge of the link between HPV infection, cervical dysplasia, and cervical cancer among women attending the Student Health Services, and to identify barriers to HPV vaccination among this cohort of women.
Women attending the University of Saskatchewan Student Health Services for any reason were invited to complete an 18-question survey. The survey included questions regarding knowledge of the purpose of Pap smears, the role of HPV infection in cervical dysplasia and cancer, and HPV vaccination. The questions were designed to elicit both quantitative and qualitative data. Data analysis included basic descriptive analysis and summarization of qualitative data.
Four hundred surveys were distributed, and 371 (91%) were returned. Eighty-two percent of participants were aware of the HPV vaccine, and 40% ranked their knowledge of HPV as good or very good; however, only 6% correctly answered questions about methods of preventing HPV infection. Participants identified cost (62%), concerns over adverse effects (43%), and lack of knowledge (36%) as barriers to undergoing vaccination. Comments about the HPV vaccine reflected frustration with cost and concerns about adverse effects. When participants were asked if they would undergo vaccination if it were free, 60% responded "yes," 31% responded "maybe," and 8% responded "no."
The young women in our survey had significant gaps in knowledge of HPV infection and prevention, and educational programs must be structured to address these deficits. Institutions promoting vaccination must deal with the barriers of cost and fear of adverse effects.
Acceptability of human papillomavirus (HPV) vaccination seems to be high in the Western world but fewer data are available for men than for women. There are also concerns that HPV vaccination might lead young people to change their healthcare-related behaviours. We investigated these issues in a population-based survey performed in Sweden during January-May, 2007, just after HPV vaccination had been licensed. A total of 10567 men and women aged 18 to 30 years participated. The intention to accept HPV vaccination among these young adults was relatively high but could likely be improved with higher awareness of HPV-related diseases as well as of the safety and efficacy of vaccines in general. Also, the cost of the vaccine needs to be affordable. Even though few young adults stated their healthcare-related behaviours would change after HPV vaccination, a significant number were uncertain, suggesting a need for continued educational efforts when HPV-vaccinating this group.
Acceptability of human papillomavirus vaccination and sexual experience prior to disclosure to health care providers among men who have sex with men in Vancouver, Canada: implications for targeted vaccination programs.
Men who have sex with men (MSM) may benefit from human papillomavirus (HPV) vaccine due to increased risk for HPV infection and related disease. We assessed HPV vaccine acceptability and sexual experience prior to disclosure to Health Care Providers (HCP) to understand implications of targeted vaccination strategies for MSM.
From July 2008 to February 2009, 1169 MSM aged =19 years were recruited at community venues in Vancouver. We assessed key variables from a self-administered questionnaire and independent predictors of HPV vaccine acceptability using multivariate logistic regression.
Of 1041 respondents, 697 (67.0%) were willing to receive HPV vaccine and 71.3% had heard of HPV. Significant multivariate predictors of higher vaccine acceptability were (adjusted odds ratio [95% CI]): previous diagnosis of genital warts (1.7 [1.1, 2.6]), disclosure of sexual behavior to HCP (1.6 [1.1, 2.3]), annual income at least $20,000 (1.5 [1.1, 2.1]), previous hepatitis A or B vaccination (1.4 [1.0, 2.0]), and no recent recreational drug use (1.4 [1.0, 2.0]). Most MSM (78.7%) had disclosed sexual behavior to HCP and median time from first sexual contact with males to disclosure was 6.0 years (IQR 2-14 years); for men =26 years these were 72.0% and 3.0 years (IQR 1-8 years) respectively.
Willingness to receive HPV vaccine was substantial among MSM in Vancouver; however, acceptability varied by demographics, risk, and health history. HPV vaccine programs delivered by HCP would offer limited benefit given the duration of time from sexual debut to disclosure to HCP.
In September 2007, a school-based human papillomavirus (HPV) vaccination program targeting grade 8 girls (approximately 13 years old) and delivered by public health was implemented in Ontario, Canada. We assessed reports of adverse events following immunization (AEFI) from the school-based program as part of quadrivalent HPV (HPV4) vaccine safety surveillance and to contribute to a comprehensive HPV vaccine program evaluation.
AEFIs following HPV4 vaccine (Gardasil(®)) administered between September 1, 2007 and December 31, 2011 were extracted from the province's reportable disease system. Confirmed AEFI reports among females 12-15 years old (i.e. assumed to have received vaccine through the program) were included. Events were grouped according to provincial AEFI case definitions. Rates were calculated using doses distributed as the denominator.
Between 2007 and 2011, 133 confirmed AEFIs were reported while 691,994 HPV4 vaccine doses were distributed in the school-based program. The overall reporting rate was 19.2 HPV4 AEFI per 100,000 doses distributed. Annual reporting rates decreased from 30.0 to 18.3 per 100,000 doses distributed. Frequently reported events included 'allergic reaction-dermatologic/mucosa' (25%), 'rash' (22%), and 'local/injection site reaction' (20%); 26% of reports had a non-specific event of 'other severe/unusual events' selected. Ten serious AEFIs were reported (7.5% of reports) including 2 anaphylaxis, 2 seizures, 1 thrombocytopenia and 1 death. Further review found that the reports of anaphylaxis did not meet the Brighton anaphylaxis definition and the death was attributed to a preexisting cardiac condition.
Overall these findings are consistent with the safety profile of HPV4 vaccine from pre-licensure clinical trials and post-marketing surveillance reports and importantly, no new safety signals were identified, especially no reports of VTE in this younger female population. Continued assessment of HPV4 AEFI surveillance data may be important to detect and investigate safety signals.
OBJECTIVES: To describe Alaska Native parents' knowledge of and attitudes towards cervical cancer, the human papillomavirus (HPV) and the HPV vaccine. STUDY DESIGN: This was a qualitative study composed of 11 focus groups (n = 80) that were held in 1 small village, 2 towns and 1 large urban centre in Alaska. METHODS: A convenience sample of Alaska Native parents/guardians was recruited in each community to participate in focus groups and to fill out a quantitative survey. RESULTS: While many parents had heard about HPV, most were unaware of its link with cervical cancer. The majority wanted to vaccinate their daughters because they had health and safety concerns; believed that vaccines work; had personal experiences with cancer; or believed that their daughters were susceptible to HPV. Reasons for refusal included general concerns about vaccines; a need for more information; a fear of side effects; wanting more vaccine research; and a fear of being in an experimental trial. CONCLUSIONS: The majority of parents were interested in having their daughters vaccinated. Acceptance of the vaccine was primarily based on a parent's desire to protect her/his child from cancer; while reasons for refusal revolved around trust issues and fear of unknown negative consequences of the vaccine.
In addition to cancer of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, precancer and cancer lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (papillomas) are associated with the low-risk (LR) HPV types, most notably with HPV6 and HPV11. Until recently, the main interest in HPV research has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. With the recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11), it has become timely to make a systematic survey on the annual disease burden due to these 2 HPV genotypes in our country. These types of data should form the foundation for all calculations of the annual costs needed to treat these diseases by conventional means. Accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV6 and HPV11 vaccines. If proven useful for any of these purposes, this document will have fulfilled its purpose. In the first step, published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. GLOBOCAN 2004 (IARC) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website for obtaining these (y 2005) numbers in Finland. The evidence linking HPV to each individual tumour category was classified as: 1) established, 2) emerging, and 3) controversial. All published evidence was weighted for each individual malignant, premalignant and benign lesion, anatomic region by region, while assessing the attributable fraction of HPV6/11 genotypes in each lesion. Because benign and most of the precancer lesions are not registered by FCR or GLOBOCAN, different approaches had to be used to derive the best estimates for their incidence, based on published literature or other registries (e.g. genital wart registry of the UK and Wales, and mass screening registry of FCR). With a lack of reasonable consensus, a lower and an upper limit was set for the range of estimates. In cases with different age-specific incidence (e.g. genital warts), the population pyramid of Finland was used to calculate the incident cases. Where well established, the different incidence rates among males and females were used to calculate the numbers of incident cases by gender. The malignant neoplasms with established or emerging evidence on the causal role of HPV are listed by their ICD-10 codes in Table I. Included in this list are also 2 controversial malignancies (colorectal cancer and endometrial cancer), of which the contradictory HPV data are critically discussed. The third major cancer in this same category (prostate cancer) was not included in the list, because the data are clearly insufficient to categorize this entity even among the emerging HPV associated malignancies. Estimated disease burden due to HPV6/11 in Finland, calculated as numbers of annual new cases by anatomic region and tumour type is given in Table II, and summarized in Figure 1. The present analysis implicates that a minimum of 12,666 to 13,066 new cases of HPV6- or HPV11-associated clinical lesions would be detected each y in Finland, if all were registered. Notably, these numbers represent the disease burden due to these 2 HPV types. However, these clinical lesions only represent a small minority of the total viral burden due to the infections by these 2 HPV genotypes. This is because the vast majority of all infections by these ubiquitous viruses are latent, being transient in nature and spontaneously resolving within a few months (up to 1 y), without ever developing a clinically detectable disease. This spontaneous clearance does not make these latent infections less important, however, because as long as the virus reservoir exists, it serves as the source of viral transmission to susceptible individuals, with a multitude of HPV6/11 associated pathologies as a potential outcome, as described in this document. The implications of these data in the era of effective prophylactic HPV vaccination against HPV6 and HPV11 should be clear.
Many countries have initiated school-based human papillomavirus (HPV) vaccination programs. The real-life effectiveness of HPV vaccines has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. In 2009, Norway initiated a school-based HPV vaccination program for 12-year-old girls using the quadrivalent HPV vaccine (Gardasil®), which targets HPV6, 11, 16, and 18. Here, we aim to assess type-specific vaginal and oral HPV prevalence in vaccinated compared with unvaccinated girls in the first birth cohort eligible for school-based vaccination (born in 1997).
This observational, cross-sectional study measured the HPV prevalence ratio (PR) between vaccinated and unvaccinated girls in Norway. Facebook advertisement was used to recruit participants and disseminate information about the study. Participants self-sampled vaginal and oral specimens using an Evalyn® Brush and a FLOQSwab™, respectively. Sexual behavior was ascertained through a short questionnaire.
Among the 312 participants, 239 (76.6%) had received at least one dose of HPV vaccine prior to sexual debut. 39.1% of vaginal samples were positive for any HPV type, with similar prevalence among vaccinated and unvaccinated girls (38.5% vs 41.1%, PR: 0.93, 95% confidence interval [CI]: 0.62-1.41). For vaccine-targeted types there was some evidence of lower prevalence in the vaccinated (0.4%) compared to the unvaccinated (6.8%) group (PR: 0.06, 95%CI: 0.01-0.52). This difference remained after adjusting for sexual behavior (PR: 0.04, 95%CI: 0.00-0.42). Only four oral samples were positive for any HPV type, and all of these participants had received at least one dose of HPV vaccine at least 1 year before oral sexual debut.
There is evidence of a lower prevalence of vaccine-targeted HPV types in the vagina of vaccinated girls from the first birth cohort eligible for school-based HPV vaccination in Norway; this was not the case when considering all HPV types or types not included in the quadrivalent HPV vaccine.
ErratumIn: PLoS One. 2019 Dec 12;14(12):e0226706 PMID 31830145
To determine the prevalence of anogenital warts (AGWs) and concurrent sexually transmitted infections (STIs) in men who have sex with men (MSM), and their knowledge of human papillomavirus (HPV). Attitudes towards the HPV vaccine among MSM are explored. A web-based cross-sectional survey on AGWs, sociodemographic factors and sexual behaviour conducted in August 2009 in Denmark. Overall 25.2% of the 1184 respondents reported a prior or current episode of AGWs. The prevalence of AGW was significantly higher in homosexuals compared with bisexuals, in men with high levels of education and in those with a high number of sexual partners within the last year. MSM with a history of another STI reported a significantly higher prevalence of warts. More than 70% did not know what causes AGWs. If a free HPV vaccine were to be offered, 94.4% would like to receive it. These data suggest a high prevalence of AGWs in Danish MSM. The awareness of HPV is low; however, the acceptance of a HPV vaccine seems high.
Policy debates about immunization frequently focus on classic trade-offs between individual versus collective well-being. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal-rather than a public-matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse.
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