IMMUNISATION SCHEDULE OF THE SPANISH ASSOCIATION OF PAEDIATRICS: 2020 RECOMMENDATIONS

Vacuna del virus del papiloma humano: valoración bioética de la discriminación por sexo

La infección por el virus del papiloma humano (VPH) constituye la causa necesaria, aunque no suficiente, de la enfermedad de transmisión sexual más frecuente en el mundo, responsable del 4,5 % de todos los cánceres en ambos sexos. La vacunación frente al VPH, con niveles de eficacia y seguridad similares en ambos sexos, está dirigida básicamente a mujeres, para reducir la incidencia de infección y sus consecuencias, como el cáncer de cérvix. La transmisibilidad del virus en ambos sexos y la inmunidad colectiva que proporciona la vacunación universal hace que su extensión al sexo masculino constituya una cuestión no solo de salud pública, sino también un dilema bioético relacionado con la protección de la salud y la equitativa distribución de los recursos. Este trabajo aborda el análisis bioético de la extensión de la vacunación contra VPH a ambos sexos.

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.

Women's knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context

AIMS AND OBJECTIVES

To explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain.

BACKGROUND

Worldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored.

DESIGN

Qualitative descriptive study.

METHODS

Three focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used.

RESULTS

Women expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results.

CONCLUSIONS

There was a self-perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness.

RELEVANCE TO CLINICAL PRACTICE

Midwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.

A Study of Varicella Seroprevalence in a Pediatric and Adolescent Population in Florence (Italy). Natural Infection and Vaccination-Acquired Immunization

Background: Varicella is a well-known infectious disease that can have severe complications, also in young children. The Universal Varicella Vaccination (UVV) program was introduced in Tuscany (Italy) in 2003, with a two-dose vaccine schedule given to children between their 13th and 15th month, and at 5–6 years old, as a monovalent for varicella (V) or tetravalent (measles, mumps, rubella and varicella (MMRV)) formulation. Although varicella notifications have dramatically fallen in the last two decades, varicella disease underreporting remains a challenge. Methods: A qualitative immunoenzymatic test (ELISA) was used to measure the presence of anti-varicella antibodies in 165 sera of subjects aged 1–18 years residing in the province of Florence (Italy). Information regarding the anamnestic and vaccination status (including disease notification) was also collected. Results: Our study showed an overall varicella seropositivity of 75.8% (reaching the maximum at 96.3% in the 15–18 years age group). We found that varicella disease notification had been recorded for only 7/165 subjects; however, since 42/165 recalled having had the disease, we can hypothesize that some of them must have been underreported. Furthermore, our study showed that the presence of antibodies after the varicella vaccination remained over time, lasting up to 12 years. Conclusions: Although varicella seroprevalence is <95% in almost all our age groups (except for the 15–18 years age group), our data are encouraging and reflect the success of the introduction of the UVV program and the vaccination campaigns promoted in the Tuscany region.