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HPV vaccine and cervical cancer policy and policymaking research interest in sub-Saharan Africa: A scoping review. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Awareness and Knowledge Among Dental and Medical Undergraduate Students Regarding Human Papilloma Virus and Its Available Preventive Measures. Ann Glob Health 2020; 86:150. [PMID: 33282693 PMCID: PMC7693809 DOI: 10.5334/aogh.2826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background India is a major contributor to the global burden of human papilloma virus (HPV) infection and associated diseases like cervical and oropharyngeal cancers. Hence, it is essential to recognize the existing knowledge pool of current healthcare students about HPV and its preventive measures to translate this into benefits for the society in the future. Objective To determine the awareness and knowledge among dental and medical undergraduate students regarding HPV and its diagnosis and prevention. Methods This cross-sectional study enrolled in 577 dental and undergraduate medical students from a tertiary-care teaching hospital. A questionnaire containing 20 closed-ended multiple-choice questions was used to assess their knowledge regarding HPV and its transmission, cervical cancer and its screening, as well as HPV vaccines and their attitude towards them. Descriptive statistics, Mann Whitney U test, and Chi square test were employed for statistical analysis. p ≤ 0.05 was considered statistically significant. Results The study consisted of 52.68% dental and 47.31% medical students, with a mean age of 20.95 ± 1.82 years, M:F ratio of 0.7:1, and a mean overall score of 10.75 ± 5.18 (average). The mean scores for knowledge about HPV, its vaccination, and its diagnosis were 7.98 ± 3.26 (good), 1.61 ± 0.95 (average), and 1.15 ± 1.16 (average), respectively. These scores showed no significant difference between the courses as well as the genders (p > 0.05). Conclusion Overall, the dental and medical undergraduate students presented an average level of knowledge and awareness regarding HPV and its prevention. This reflects a greater need for educating healthcare professionals in order to have a ripple effect on society at large.
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Amith M, Roberts K, Tao C. Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC Bioinformatics 2019; 20:706. [PMID: 31865902 PMCID: PMC6927108 DOI: 10.1186/s12859-019-3193-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling. Results The ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction. Conclusion With an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.
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Affiliation(s)
- Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Kirk Roberts
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA.
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Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh. Trop Med Infect Dis 2018; 3:tropicalmed3030072. [PMID: 30274468 PMCID: PMC6160906 DOI: 10.3390/tropicalmed3030072] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Immunization has become one of the major contributors to public health globally as it prevents communicable disease, particularly in children. The objective of this study was to estimate the extent of timely immunization coverage and to investigate the determinants of incomplete and untimely vaccination. Methods: The study used data from the latest Bangladesh Demographic Health Survey (BDHS) 2014. A total sample of 1631 children aged 12–23 months who had an Expanded Program on Immunization (EPI) card and immunization history were analyzed. Multivariable logistic regression models were used to determine the significant influencing factors on untimely vaccination (BCG, pentavalent vaccine/OPV, and measles) and incomplete vaccination. The results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval and a significance level p < 0.05. Results: The proportions of children who received timely vaccinations were 24% for BCG, 46% for pentavalent 3, and 53% for measles, whereas 76%, 51%, and 36% children failed to receive the BCG, pentavalent 3, and measles vaccines, respectively, in a timely manner. The proportion of early vaccination was 3% for pentavalent 3 and 12% for measles. Several significant influencing factors including age, maternal education and working status, awareness of community clinics, socioeconomic status, and geographic variation significantly contributed to untimely and incomplete vaccination of children in Bangladesh. Conclusions: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.
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Silas OA, Achenbach CJ, Murphy RL, Hou L, Sagay SA, Banwat E, Adoga AA, Musa J, French DD. Cost effectiveness of human papilloma virus vaccination in low and middle income countries: a systematic review of literature. Expert Rev Vaccines 2018; 17:91-98. [PMID: 29183182 DOI: 10.1080/14760584.2018.1411195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Low and middle income countries (LMICs) bear more than 50% of the current cervical cancer burden over the last decade with linkages to lack of HPV vaccination, high levels of poverty, illiteracy and nonexistent or poor screening programs. Governments of LMICs need enough convincing evidence that HPV vaccination will be more cost-effective in reducing the scourge of cervical cancer. AREAS COVERED A systematic review to identify suitable studies from MEDLINE(via PubMed), EMBASE and Electronic search through GOOGLE for original and review articles from 2007 to 2014 on cost-effectiveness of human papilloma virus vaccination of pre-adolescent girls in LMICs was conducted. A total of 19 full articles were finally selected and reviewed after screening out those not consistent with the inclusion and exclusion criteria. EXPERT COMMENTARY Most studies on cost-effectiveness of HPV vaccine in LMICs show that lowering cost of HPV vaccination with or without Pap smear screening is cost-effective in areas with high incidence of cervical cancer.
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Affiliation(s)
| | - Chad J Achenbach
- b Feinberg School of Medicine, Department of Medicine , Northwestern University and Center for Global Health , Chicago , IL , USA
| | - Robert Leo Murphy
- b Feinberg School of Medicine, Department of Medicine , Northwestern University and Center for Global Health , Chicago , IL , USA
| | - Lifang Hou
- b Feinberg School of Medicine, Department of Medicine , Northwestern University and Center for Global Health , Chicago , IL , USA
| | - Solomon Atiene Sagay
- c Department of Obstetrics and Gynecology Faculty of Medical Sciences , University of Jos/Jos University Teaching Hospital Plateau State , Jos , Nigeria
| | - Edmund Banwat
- d Microbiology Department, Faculty of Medical Sciences , University of Jos/Jos University Teaching Hospital Plateau State , Jos , Nigeria
| | - Adeyi A Adoga
- e Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences , University of Jos/Jos University Teaching Hospital Plateau State , Jos , Nigeria
| | - Jonah Musa
- c Department of Obstetrics and Gynecology Faculty of Medical Sciences , University of Jos/Jos University Teaching Hospital Plateau State , Jos , Nigeria
| | - Dustin Douglas French
- b Feinberg School of Medicine, Department of Medicine , Northwestern University and Center for Global Health , Chicago , IL , USA
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Takamatsu R, Nabandith V, Pholsena V, Mounthisone P, Nakasone K, Ohtake K, Yoshimi N. Cervical cytology and human papillomavirus among asymptomatic healthy volunteers in Vientiane, Lao PDR. BMC Cancer 2017; 17:872. [PMID: 29258466 PMCID: PMC5738160 DOI: 10.1186/s12885-017-3900-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Cervical cancer is the most common cancer in women living in Vientiane, Lao People’s Democratic Republic (PDR). This study examines cervical cytology using a liquid-based cytology (LBC) method and reports the presence of high-risk (HR) human papillomavirus (HPV). Methods We collected cervical samples from 1475 asymptomatic and healthy volunteers from six hospitals in Lao PDR. A total of 1422 volunteers (mean age 39.1 ± 6.4 years, range 30-54 years) were included in the final analysis. We performed HPV typing using the polymerase chain reaction technique to detect HR-HPV samples with abnormal cytology. Results The overall rates of abnormal cytology and HR-HPV–positive in the samples were 9.3% (132/1422) and 47.7% (63/132), respectively. The samples with abnormal cytology included 13 high-grade squamous intraepithelial lesions and one squamous cell carcinoma case. The results showed that the most common type of HPV was HPV16 (20.5%) followed by HPV58 (9.1%). Conclusions Healthy women in Vientiane, the capital of Lao PDR, have high rates of abnormal cervical cytology and are likely to be HR-HPV-positive. A system for detection and prevention of cervical cancer in these women should be developed in the near future. Electronic supplementary material The online version of this article (10.1186/s12885-017-3900-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reika Takamatsu
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan.
| | - Viengvansay Nabandith
- Setthathirath Hospital, Donekoi Village, Sisatthanak District, P.O.Box 527, Vientiane, Lao PDR
| | - Vatsana Pholsena
- Setthathirath Hospital, Donekoi Village, Sisatthanak District, P.O.Box 527, Vientiane, Lao PDR
| | - Phouthasone Mounthisone
- Mittaphab Hospital, Phonsavang Village, Chanthabouly District, P.O.Box 6035, Vientiane, Lao PDR
| | - Katsu Nakasone
- Department of Pathology, Ryukyu University Hospital, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Kentarou Ohtake
- Clinical Laboratory, Medical Examination Center of Chubu Medical Association, 1-584 Miyagi, Chatan-cho, Nakagami-gun, Okinawa, 904-0113, Japan
| | - Naoki Yoshimi
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
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Rajiah K, Maharajan MK, Fang Num KS, How Koh RC. Knowledge about Human Papillomavirus and Cervical Cancer: Predictors of HPV Vaccination among Dental Students. Asian Pac J Cancer Prev 2017; 18:1573-1579. [PMID: 28669170 PMCID: PMC6373794 DOI: 10.22034/apjcp.2017.18.6.1573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The objective of this study is to determine the influence of dental students’ knowledge and attitude
regarding human papillomavirus infection of cervical cancer on willingness to pay for vaccination. Basic research
design: A convenience sampling method was used. The minimal sample size of 136 was calculated using the Raosoft
calculator with a 5 % margin of error and 95% confidence level. Participants: The study population were all final
year dental students from the School of Dentistry. Methods: A self-administered questionnaire was used to measure
knowledge levels and attitudes regarding human papillomavirus vaccination. Contingent valuation was conducted
for willingness to pay for vaccination. Main outcome measures: The Center for Disease Control and Prevention has
stated that human papillomavirus are associated with oropharynx cancer and the American Dental Association insist on
expanding public awareness of the oncogenic potential of some HPV infections. Thus, as future dental practitioners,
dental students should be aware of human papillomavirus and their links with cancer and the benefits of vaccination.
Results: Knowledge on HPV and cervical cancer did not impact on attitudes towards vaccines. However, significant
correlation existed between knowledge and willingness to pay for vaccination. Conclusions: Dental students’ knowledge
on HPV and cervical cancer has no influence on their attitude towards HPV vaccines. However, their willingness to
pay for HPV vaccination is influenced by their knowledge of cervical cancer and HPV vaccination.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia.
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Bardach AE, Garay OU, Calderón M, Pichón-Riviére A, Augustovski F, Martí SG, Cortiñas P, Gonzalez M, Naranjo LT, Gomez JA, Caporale JE. Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model. BMC Public Health 2017; 17:152. [PMID: 28148228 PMCID: PMC5289055 DOI: 10.1186/s12889-017-4064-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4064-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariel Esteban Bardach
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina.
| | - Osvaldo Ulises Garay
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - María Calderón
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Andrés Pichón-Riviére
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Federico Augustovski
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Sebastián García Martí
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Paula Cortiñas
- Salud Chacao, Final Av. Ávila, Edif. Salud Chacao. Urb. Bello Campo. Chacao, 1060, Caracas, D.C, Venezuela
| | - Marino Gonzalez
- Unit of Public Policy, Simon Bolivar University, Edificio Física y Electrónica I, Planta Baja. Valle de Sartenejas, Estado Miranda, Caracas, Venezuela
| | - Laura T Naranjo
- GlaxoSmithKline Biologicals, Clayton, Ciudad del Saber Edificio 230, Panama City, Panama
| | - Jorge Alberto Gomez
- GSK Vaccines Latin America, Carlos Casares 3690, B1644 BCD, Victoria, Buenos Aires, Argentina
| | - Joaquín Enzo Caporale
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
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Castellsagué X, Ault KA, Bosch FX, Brown D, Cuzick J, Ferris DG, Joura EA, Garland SM, Giuliano AR, Hernandez-Avila M, Huh W, Iversen OE, Kjaer SK, Luna J, Monsonego J, Muñoz N, Myers E, Paavonen J, Pitisuttihum P, Steben M, Wheeler CM, Perez G, Saah A, Luxembourg A, Sings HL, Velicer C. Human papillomavirus detection in cervical neoplasia attributed to 12 high-risk human papillomavirus genotypes by region. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2016; 2:61-69. [PMID: 29074187 PMCID: PMC5886863 DOI: 10.1016/j.pvr.2016.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND We estimated the proportion of cervical intraepithelial neoplasia (CIN) cases attributed to 14 HPV types, including quadrivalent (qHPV) (6/11/16/18) and 9-valent (9vHPV) (6/11/16/18/31/33/45/52/58) vaccine types, by region METHODS: Women ages 15-26 and 24-45 years from 5 regions were enrolled in qHPV vaccine clinical trials. Among 10,706 women (placebo arms), 1539 CIN1, 945 CIN2/3, and 24 adenocarcinoma in situ (AIS) cases were diagnosed by pathology panel consensus. RESULTS Predominant HPV types were 16/51/52/56 (anogenital infection), 16/39/51/52/56 (CIN1), and 16/31/52/58 (CIN2/3). In regions with largest sample sizes, minimal regional variation was observed in 9vHPV type prevalence in CIN1 (~50%) and CIN2/3 (81-85%). Types 31/33/45/52/58 accounted for 25-30% of CIN1 in Latin America and Europe, but 14-18% in North America and Asia. Types 31/33/45/52/58 accounted for 33-38% of CIN2/3 in Latin America (younger women), Europe, and Asia, but 17-18% of CIN2/3 in Latin America (older women) and North America. Non-vaccine HPV types 35/39/51/56/59 had similar or higher prevalence than qHPV types in CIN1 and were attributed to 2-11% of CIN2/3. CONCLUSIONS The 9vHPV vaccine could potentially prevent the majority of CIN1-3, irrespective of geographic region. Notwithstanding, non-vaccine types 35/39/51/56/59 may still be responsible for some CIN1, and to a lesser extent CIN2/3.
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Affiliation(s)
- Xavier Castellsagué
- Institut Catala d'Oncologia (ICO), IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Catalonia, Spain.
| | - Kevin A Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA
| | - F Xavier Bosch
- Institut Catala d'Oncologia (ICO), IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Darron Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis IN, USA
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Daron G Ferris
- Department of Obstetrics and Gynecology, Georgia Regents University Cancer Center, Georgia Regents University, Augusta, GA, USA
| | - Elmar A Joura
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women׳s Hospital, Murdoch Childrens Research Institute, Department of Obstetrics and Gynecology, University of Melbourne, Australia
| | | | | | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, AL, USA
| | - Ole-Erik Iversen
- Institute of Clinical Medicine, University of Bergen/Haukeland University Hospital, Bergen, Norway
| | - Susanne K Kjaer
- Danish Cancer Society Research Center, Copenhagen Denmark and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Joaquin Luna
- Department of Obstetrics and Gynecology, Clinica Colsanitas, Fundacion Universitaria Sanitas, Bogota, Colombia
| | | | - Nubia Muñoz
- National Institute of Cancer, Bogotá, Colombia
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland
| | | | - Marc Steben
- Direction des Risques Biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Montréal, QC, Canada
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gonzalo Perez
- Merck & Co., Inc., Kenilworth, NJ, USA; Universidad del Rosario, Bogota, Colombia
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Zhang Q, Liu YJ, Hu SY, Zhao FH. Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China. BMC Cancer 2016; 16:848. [PMID: 27814703 PMCID: PMC5097411 DOI: 10.1186/s12885-016-2893-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. METHODS A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. RESULTS Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. CONCLUSIONS In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine cost needs to be reduced in order to make it very cost-effective and affordable as well, in particular in poverty areas with high disease burden.
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Affiliation(s)
- Qian Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi-Jun Liu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Preventive Medicine, School of Public Health, Zunyi Medical College, Zunyi, 563099, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Human Papillomavirus Genotype Distribution in Invasive Cervical Cancer in Pakistan. Cancers (Basel) 2016; 8:cancers8080072. [PMID: 27483322 PMCID: PMC4999781 DOI: 10.3390/cancers8080072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/16/2022] Open
Abstract
Few studies have assessed the burden of human papillomavirus (HPV) infection in Pakistan. We aim to provide specific information on HPV-type distribution in invasive cervical cancer (ICC) in the country. A total of 280 formalin-fixed paraffin-embedded tissue blocks were consecutively selected from Shaukat Khanum Memorial Cancer Hospital and Research Centre (Lahore, Pakistan). HPV-DNA was detected by SPF10 broad-spectrum PCR followed by DNA enzyme immunoassay and genotyping by LiPA25. HPV-DNA prevalence was 87.5% (95%CI: 83.0–91.1), with 96.1% of cases histologically classified as squamous cell carcinoma. Most of the HPV-DNA positive cases presented single infections (95.9%). HPV16 was the most common type followed by HPV18 and 45. Among HPV-DNA positive, a significantly higher contribution of HPV16/18 was detected in Pakistan (78.4%; 72.7–83.3), compared to Asia (71.6%; 69.9–73.4) and worldwide (70.8%; 69.9–71.8) and a lower contribution of HPVs31/33/45/52/58 (11.1%; 7.9–15.7 vs. 19.8%; 18.3–21.3 and 18.5%; 17.7–19.3). HPV18 or HPV45 positive ICC cases were significantly younger than cases infected by HPV16 (mean age: 43.3, 44.4, 50.5 years, respectively). A routine cervical cancer screening and HPV vaccination program does not yet exist in Pakistan; however, the country could benefit from national integrated efforts for cervical cancer prevention and control. Calculated estimations based on our results show that current HPV vaccine could potentially prevent new ICC cases.
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Serrano B, Alemany L, Ruiz PAD, Tous S, Lima MA, Bruni L, Jain A, Clifford GM, Qiao YL, Weiss T, Bosch FX, de Sanjosé S. Potential impact of a 9-valent HPV vaccine in HPV-related cervical disease in 4 emerging countries (Brazil, Mexico, India and China). Cancer Epidemiol 2014; 38:748-56. [PMID: 25305098 DOI: 10.1016/j.canep.2014.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/06/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND We estimated the potential impact of an investigational 9-valent human papillomavirus (HPV) vaccine (HPVs 6/11/16/18/31/33/45/52/58) in HPV-related cervical disease in Brazil, Mexico, India and China, to help to formulate recommendations on cervical cancer prevention and control. METHODS Estimations for invasive cervical cancer (ICC) were based on an international study including 1356 HPV-positive cases for the four countries altogether, and estimations for precancerous cervical lesions were extracted from a published meta-analysis including 6 025 HPV-positive women from the four mentioned countries. Globocan 2012 and 2012 World Population Prospects were used to estimate current and future projections of new ICC cases. RESULTS Combined proportions of the 9 HPV types in ICC were 88.6% (95%CI: 85.2-91.3) in Brazil, 85.7% (82.3-88.8) in Mexico, 92.2% (87.9-95.3) in India and 97.3% (93.9-99.1) in China. The additional HPV 31/33/45/52/58 proportions were 18.8% (15.3-22.7) in Brazil, 17.6% (14.2-21.2) in Mexico, 11.3% (7.5-16.1) in India and 11.9% (7.5-17.2) in China. HPV6 and 11 single types were not identified in any of the samples. Proportion of the individual 7 high risk HPV types included in the vaccine varied by cytological and histological grades of HPV-positive precancerous cervical lesions. HPV 16 was the dominant type in all lesions, with contributions in low grade lesions ranging from 16.6%(14.3-19.2) in Mexico to 39.8% (30.0-50.2) in India, and contributions in high grade lesions ranging from 43.8% (36.3-51.4) in Mexico to 64.1% (60.6-67.5) in Brazil. After HPV 16, variations in other majors HPV types were observed by country, with an under representation of HPV 18 and 45 compared to ICC. CONCLUSION The addition of HPVs 31/33/45/52/58 to HPV types included in current vaccines could increase the ICC preventable fraction in a range of 12 to 19% across the four countries, accounting the 9-types altogether 90% of ICC cases. Assuming the same degree of efficacy of current vaccines, the implementation of the 9-valent HPV vaccine in Brazil, Mexico, India and China would substantially impact on the reduction of the world cervical cancer burden.
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Affiliation(s)
- Beatriz Serrano
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Laia Alemany
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain.
| | | | - Sara Tous
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | | | - Laia Bruni
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Asha Jain
- Cancer Prevention and Relief Society, Raipur, India.
| | | | - You Lin Qiao
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Thomas Weiss
- Global Health Outcomes, Merck & Co., Inc., West Point, PA USA.
| | - F Xavier Bosch
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain.
| | - Silvia de Sanjosé
- Unit of Infections and Cancer. Catalan Institute of Oncology, Barcelona, Spain; CIBER Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain.
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Infrastructure requirements for human papillomavirus vaccination and cervical cancer screening in sub-Saharan Africa. Vaccine 2014; 31 Suppl 5:F47-52. [PMID: 24331747 DOI: 10.1016/j.vaccine.2012.06.066] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 06/14/2012] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
Abstract
The availability of both human papillomavirus (HPV) vaccination and alternative screening tests has greatly improved the prospects of cervical cancer prevention in sub-Saharan African (SSA) countries. The inclusion of HPV vaccine in the portfolio of new vaccines offered by the Gobal Alliance for Vaccines and Immunization (GAVI) to GAVI-eligible countries has vastly improved the chances of introducing HPV vaccination. Further investments to improve vaccine storage, distribution and delivery infrastructure and human resources of the Extended Programme of Immunization will substantially contribute to the faster introduction of HPV vaccination in SSA countries through both school- and campaign-based approaches. Alternative methods to cytology for the prevention of cervical cancer through the early detection and treatment of cervical cancer precursors have been extensively evaluated in the past 15 years, in Africa as well as in other low-resource settings. Visual inspection with 3-5% dilute acetic acid (VIA) and HPV testing are the two alternative screening methods that have been most studied, in both cross-sectional and randomised clinical trials. VIA is particularly suitable to low-resource settings; however, its efficacy in reducing cervical cancer is likely to be significantly lower than HPV testing. The introduction of VIA screening programmes will help develop the infrastructure that will, in turn, facilitate the introduction of affordable HPV testing in future. Links with the existing HIV/AIDS control programmes is another strategy to improve the infrastructure and screening services in SSA. Infrastructural requirements for an integrated approach aiming to vaccinate single-year cohorts of girls in the 9-13 years age-range and to screen women over 30 years of age using VIA or affordable rapid HPV tests are outlined in this manuscript. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Ladner J, Besson MH, Rodrigues M, Audureau E, Saba J. Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009-2013. BMC Public Health 2014; 14:670. [PMID: 24981818 PMCID: PMC4085395 DOI: 10.1186/1471-2458-14-670] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/23/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cervical cancer is the third most common cancer in women worldwide, with high incidence in lowest income countries. Vaccination against Human Papilloma Virus (HPV) may help to reduce the incidence of cervical cancer. The aim of the study was to analyze HPV vaccination programs performance implemented in low and middle-income countries. METHODS The Gardasil Access Program provides HPV vaccine at no cost to help national institutions gain experience implementing HPV vaccination. Data on vaccine delivery model, number of girls vaccinated, number of girls completing the three-dose campaign, duration of vaccination program, community involvement and sensitization strategies were collected from each program upon completion. Vaccine Uptake Rate (VUR) and Vaccine Adherence between the first and third doses (VA) rate were calculated. Multivariate linear regressions analyses were fitted. RESULTS Twenty-one programs were included in 14 low and middle-income countries. Managing institutions were non-governmental organizations (NGOs) (n = 8) or Ministries of Health (n = 13). Twelve programs were school-based, five were health clinic-based and four utilized a mixed model. A total of 217,786 girls received a full course of vaccination.Mean VUR was 88.7% (SD = 10.5) and VA was 90.8% (SD = 7.3). The mean total number of girls vaccinated per program-month was 2,426.8 (SD = 2,826.6) in school model, 335.1 (SD = 202.5) in the health clinic and 544.7 (SD = 369.2) in the mixed models (p = 0.15). Community involvement in the follow-up of girls participating in the vaccination campaign was significantly associated with VUR. Multivariate analyses identified school-based (β = 13.35, p = 0.001) and health clinic (β = 13.51, p = 0.03) models, NGO management (β = 14.58, p < 10(-3)) and duration of program vaccination (β = -1.37, p = 0.03) as significant factors associated with VUR. CONCLUSION School and health clinic-based models appeared as predictive factors for vaccination coverage, as was management by an NGO; program duration could play a role in the program's effectiveness. Results suggest that HPV vaccine campaigns tailored to meet the needs of communities can be effective. These results may be useful in the development of national HPV vaccination policies in low and middle-income countries.
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Affiliation(s)
- Joël Ladner
- Rouen University Hospital, Epidemiology and Public Health Department, Hôpital Charles Nicolle, 1, rue de Germont, 76 031 Rouen, France
| | | | | | - Etienne Audureau
- Hôpital Henri Mondor Hospital, Public Health, Assistance Publique Hôpitaux de Paris, Paris Est University, Créteil, France
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Tracy JK, Schluterman NH, Greene C, Sow SO, Gaff HD. Planning for human papillomavirus (HPV) vaccination in sub-Saharan Africa: A modeling-based approach. Vaccine 2014; 32:3316-22. [DOI: 10.1016/j.vaccine.2014.03.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
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Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 2014; 32:1527-35. [PMID: 24581979 PMCID: PMC6794147 DOI: 10.1016/j.vaccine.2013.07.087] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023]
Abstract
An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.
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Affiliation(s)
- Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Nicola Low
- Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lori M Newman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gail Bolan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Kamb
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Romanowski B, Schwarz TF, Ferguson LM, Ferguson M, Peters K, Dionne M, Schulze K, Ramjattan B, Hillemanns P, Behre U, Suryakiran P, Thomas F, Struyf F. Immune response to the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose or 3-dose schedule up to 4 years after vaccination: results from a randomized study. Hum Vaccin Immunother 2014; 10:1155-65. [PMID: 24576907 PMCID: PMC4896558 DOI: 10.4161/hv.28022] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This randomized, partially-blind study (ClinicalTrials.gov registration number NCT00541970) evaluated the immunogenicity and safety of 2-dose (2D) schedules of the HPV-16/18 AS04-adjuvanted vaccine. Results to month (M) 24 have been reported previously and we now report data to M48 focusing on the licensed vaccine formulation (20 μg each of HPV-16 and -18 antigens) administered at M0,6 compared with the standard 3-dose (3D) schedule (M0,1,6). Healthy females (age stratified: 9–14, 15–19, 20–25 years) were randomized to receive 2D at M0,6 (n = 240) or 3D at M0,1,6 (n = 239). In the according-to-protocol immunogenicity cohort, all initially seronegative subjects seroconverted for HPV-16 and -18 antibodies and remained seropositive up to M48. For both HPV-16 and -18, geometric mean antibody titer (GMT) ratios (3D schedule in women aged 15–25 years divided by 2D schedule in girls aged 9–14 years) at M36 and M48 were close to 1, as they were at M7 when non-inferiority was demonstrated. The kinetics of HPV-16, -18, -31, and -45 antibody responses were similar for both groups and HPV-16 and -18 GMTs were substantially higher than natural infection titers. The vaccine had a clinically acceptable safety profile in both groups. In summary, antibody responses to a 2D M0,6 schedule of the licensed vaccine formulation in girls aged 9–14 years appeared comparable to the standard 3D schedule in women aged 15–25 years up to 4 years after first vaccination. A 2D schedule could facilitate implementation of HPV vaccination programs and improve vaccine coverage and series completion rates.
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Affiliation(s)
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre; Stiftung Juliusspital; Würzburg, Germany
| | | | | | | | - Marc Dionne
- Centre Hospitalier Universitaire; Québec, QC Canada
| | | | | | | | - Ulrich Behre
- Hauptstrasse 240 Kehl Baden-Württemberg, Germany
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Harper DM, Verdenius I, Ratnaraj F, Arey AM, Rosemergey B, Malnar GJ, Wall J. Quantifying clinical HPV4 dose inefficiencies in a safety net population. PLoS One 2013; 8:e77961. [PMID: 24223131 PMCID: PMC3819328 DOI: 10.1371/journal.pone.0077961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE HPV4 is the most expensive vaccine requiring three appropriately timed doses to provide maximal efficacy against two oncogenic HPV types. The primary purpose of this study is to quantify the use of HPV4 vaccine in a safety net health care system in terms of its inefficiencies. METHODS A retrospective study of HPV4 dosing from 2006-2009, among females 10-26 years old who sought care in a safety net health care system was conducted to determine dose usage patterns among those at highest risk for cervical cancer. Dose descriptors abstracted from the electronic medical record (EMR) included timing and number in series as well as characteristics of the person to whom and visit at which the dose was given. Dose inefficiencies were separated into "less than three doses" and "mistimed doses" for analysis. RESULTS The majority (66%) of HPV4 doses administered were insufficient to induce the maximal immune response necessary for HPV infection prevention. Among on-time doses, 58% were singleton or doublet doses. Mistimed doses accounted for 19% of all doses administered with late intervals being more common than early intervals among those receiving more than one dose (9% vs. 4%, p<0.001). Third doses were mistimed twice as often as second doses (10% vs. 5%, p<0.001). Black women were more likely to have a mistimed second dose and Hispanic women more likely to have a mistimed third dose compared to white women (OR = 1.70 (95% CI: 1.11, 2.61 and 2.44 (1.19, 5.00), respectively). The HPV4-only visit type at which HPV4 was initiated was the most significant predictor of on-time doublet completion. CONCLUSIONS In a safety net health care system the large inefficiencies associated with HPV4 vaccination must be addressed in order to maximize our patient's cervical cancer prevention.
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Affiliation(s)
- Diane M. Harper
- Center of Excellence, Women’s Health, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- * E-mail:
| | - Inge Verdenius
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, The Netherlands
| | - Felicia Ratnaraj
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Anne M. Arey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth Rosemergey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
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Schoeps A, Ouédraogo N, Kagoné M, Sié A, Müller O, Becher H. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso. Vaccine 2013; 32:96-102. [PMID: 24183978 DOI: 10.1016/j.vaccine.2013.10.063] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. METHODS This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. RESULTS Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. CONCLUSIONS Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.
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Affiliation(s)
- A Schoeps
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | - N Ouédraogo
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - M Kagoné
- Centre de Recherche en Santé de Nouna (CRSN), BP 02 Nouna, Burkina Faso
| | - A Sié
- Centre de Recherche en Santé de Nouna (CRSN), BP 02 Nouna, Burkina Faso
| | - O Müller
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - H Becher
- University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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Gottlieb SL, Newman LM, Amin A, Temmerman M, Broutet N. Sexually transmitted infections and women's sexual and reproductive health. Int J Gynaecol Obstet 2013; 123:183-4. [PMID: 24144238 DOI: 10.1016/j.ijgo.2013.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sexually transmitted infections (STIs) are widespread globally and result in a large burden of sexual and reproductive health consequences that disproportionately affect women, including pregnancy complications, cancer, infertility, and enhanced HIV transmission. A new WHO publication, available online, outlines key points of action and new and future technologies for global STI prevention and control. Highlights from the WHO publication are described in the present article.
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Affiliation(s)
- Sami L Gottlieb
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
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Abstract
Cervical cancer is both preventable and curable, yet it remains one of the leading causes of mortality in women worldwide. Approximately 88% of cervical cancer cases are diagnosed in low-resource countries, yet very few resources are allocated to prevention and treatment programs. In fact, it is estimated that only 5% of women in low-resources countries are screened appropriately for cervical cancer. Cytology-based programs are not feasible because of lack of healthcare infrastructure and cost, thus alternative methods of cancer screening, such as visual inspection with acetic acid and HPV-DNA testing, have been intensively studied and are reviewed in this article.
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Abstract
Cervical cancer is a global health crisis that disproportionately affects developing nations and underserved populations. Two vaccines targeting HPV-16 and 18, which account for 70% of invasive cervical carcinomas, are licensed in the United States and numerous countries worldwide. Both vaccine formulations have shown excellent efficacy with minimal toxicity. Numerous questions remain, including cost-effectiveness, vaccination of males, societal acceptance of HPV vaccination, and cervical dysplasia screening in the HPV-immunized population. Access to vaccination for underserved populations both in developed and resource-poor nations remains an issue. Multivalent vaccines that encompass additional oncogenic HPV strains are under development.
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Brotherton JML, Gertig DM. Primary prophylactic human papillomavirus vaccination programs: future perspective on global impact. Expert Rev Anti Infect Ther 2013; 9:627-39. [PMID: 21819329 DOI: 10.1586/eri.11.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Of the 40 types of human papillomavirus that can infect the mucosal epithelium, four types can now be prevented using prophylactic vaccination. Two of these types (high-risk types 16 and 18) cause 70% of cervical cancers, a proportion of other genital cancers and a subset of head and neck cancers. The low-risk types 6 and 11 cause 90% of genital warts and the disease recurrent respiratory papillomatosis. Thus, if primary HPV vaccination programs can be implemented effectively, the potential for a reduction in global disease burden is great. This article considers the current issues and challenges in delivering primary HPV vaccination programs effectively and the likely impact of the vaccines in both the near and more distant future.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service Registries, Victorian Cytology Service, PO Box 310, East Melbourne, Victoria 8002, Australia.
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Nunes JK, Cárdenas V, Loucq C, Maire N, Smith T, Shaffer C, Måseide K, Brooks A. Modeling the public health impact of malaria vaccines for developers and policymakers. BMC Infect Dis 2013; 13:295. [PMID: 23815273 PMCID: PMC3711926 DOI: 10.1186/1471-2334-13-295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 06/17/2013] [Indexed: 11/15/2022] Open
Abstract
Background Efforts to develop malaria vaccines show promise. Mathematical model-based estimates of the potential demand, public health impact, and cost and financing requirements can be used to inform investment and adoption decisions by vaccine developers and policymakers on the use of malaria vaccines as complements to existing interventions. However, the complexity of such models may make their outputs inaccessible to non-modeling specialists. This paper describes a Malaria Vaccine Model (MVM) developed to address the specific needs of developers and policymakers, who need to access sophisticated modeling results and to test various scenarios in a user-friendly interface. The model’s functionality is demonstrated through a hypothetical vaccine. Methods The MVM has three modules: supply and demand forecast; public health impact; and implementation cost and financing requirements. These modules include pre-entered reference data and also allow for user-defined inputs. The model includes an integrated sensitivity analysis function. Model functionality was demonstrated by estimating the public health impact of a hypothetical pre-erythrocytic malaria vaccine with 85% efficacy against uncomplicated disease and a vaccine efficacy decay rate of four years, based on internationally-established targets. Demand for this hypothetical vaccine was estimated based on historical vaccine implementation rates for routine infant immunization in 40 African countries over a 10-year period. Assumed purchase price was $5 per dose and injection equipment and delivery costs were $0.40 per dose. Results The model projects the number of doses needed, uncomplicated and severe cases averted, deaths and disability-adjusted life years (DALYs) averted, and cost to avert each. In the demonstration scenario, based on a projected demand of 532 million doses, the MVM estimated that 150 million uncomplicated cases of malaria and 1.1 million deaths would be averted over 10 years. This is equivalent to 943 uncomplicated cases and 7 deaths averted per 1,000 vaccinees. In discounted 2011 US dollars, this represents $11 per uncomplicated case averted and $1,482 per death averted. If vaccine efficacy were reduced to 75%, the estimated uncomplicated cases and deaths averted over 10 years would decrease by 14% and 19%, respectively. Conclusions The MVM can provide valuable information to assist decision-making by vaccine developers and policymakers, information which will be refined and strengthened as field studies progress allowing further validation of modeling assumptions.
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Wigle J, Coast E, Watson-Jones D. Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): health system experiences and prospects. Vaccine 2013; 31:3811-7. [PMID: 23777956 PMCID: PMC3763375 DOI: 10.1016/j.vaccine.2013.06.016] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 11/22/2022]
Abstract
Multi-method review of challenges introducing HPV vaccine in developing countries. HPV vaccine delivery methods can overcome inadequate health systems. Political will is essential for successful HPV vaccine roll-out.
Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low- and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programmes in low- and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasised sociocultural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared.
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Affiliation(s)
- Jannah Wigle
- Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK
- Corresponding author. Tel.: +44 0207 955 6335.
| | - Ernestina Coast
- Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK
| | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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MacPhail C, Venables E, Rees H, Delany-Moretlwe S. Using HPV vaccination for promotion of an adolescent package of care: opportunity and perspectives. BMC Public Health 2013; 13:493. [PMID: 23692596 PMCID: PMC3681713 DOI: 10.1186/1471-2458-13-493] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background Adolescents are a difficult population to access for preventive health care, particularly in less resourced countries. Evidence from developed countries indicates that the HPV vaccine schedule may be a useful platform from which to deliver other adolescent health care services. We conducted a qualitative cross sectional study to assess the potential for using the HPV vaccine in the South African public health care system as an opportunity for integrated health care services for adolescents. Methods Parents, young adolescents, community members and key informants participated in interviews and focus group discussions about feasibility and acceptability, particularly the use of the HPV vaccination as the basis for an integrated adolescent package of care. Health care providers in both provinces participated in focus group discussions and completed a pairwise ranking exercise to compare and prioritise interventions for inclusion in an adolescent package of care. Results Participants were in favour of integration and showed preference for detailed information about the HPV vaccine, general health information and specific sexual and reproductive health information. Among health care workers, results differed markedly by location. In North West, prioritisation was given to information, screening and referral for tobacco and alcohol abuse, and screening for hearing and vision. In Gauteng integration with referral for male circumcision, and information, screening and referral for child abuse were ranked most highly. Conclusions There is generally support for the delivery of adolescent preventive health services. Despite national priorities to address adolescent health needs, our data suggest that national policies might not always be appropriate for vastly different local situations. While decisions about interventions to include have traditionally been made at country level, our results suggest that local context needs to be taken account of. We suggest low resource strategies for ensuring that national policies are introduced at local level in a manner that addresses local priorities, context and resource availability.
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Affiliation(s)
- Catherine MacPhail
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Serrano B, Alemany L, Tous S, Bruni L, Clifford GM, Weiss T, Bosch FX, de Sanjosé S. Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease. Infect Agent Cancer 2012; 7:38. [PMID: 23273245 PMCID: PMC3554470 DOI: 10.1186/1750-9378-7-38] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/17/2012] [Indexed: 11/12/2022] Open
Abstract
Background Information on human papillomavirus (HPV) type distribution is necessary to evaluate the potential impact of current and future HPV vaccines. We estimated the relative contribution (RC) to invasive cervical cancer (ICC) and precancerous cervical lesions of the nine HPV types (HPV 6/11/16/18/31/33/45/52/58) included in an HPV vaccine currently under development. Methods Estimations on ICC were based on an international study of 8,977 HPV positive cases and estimations on precancerous cervical lesions were extracted from a published meta-analysis including 115,789 HPV positive women. Globocan 2008 and 2010 World Population Prospects were used to estimate current and future projections of new ICC cases. Results RC of the 9 HPV types in ICC was 89.4%, with 18.5% of cases positive for HPV 31/33/45/52/58. Regional variations were observed. RCs varied by histology, ranging between 89.1% in squamous cell carcinomas (SCC) and 95.5% in adenocarcinomas (ADC). HPV 16/18/45 were detected in 94.2% of ADC. RC of the 9 types altogether decreased with age (trend test p < 0.0001), driven by the decrease in older ages of HPV 16/18/45. In contrast, the RC of HPV 31/33/52/58 increased with age. Due to population growth alone, projected estimates of ICC cases attributable to the 9 types are expected to rise from 493,770 new cases in 2012 to 560,887 new cases in 2025. The RCs of individual high risk HPV types varied by cytological and histological grades of HPV-positive precancerous cervical lesions, and there was an under representation of HPV 18 and 45 compared to ICC. Conclusions The addition of HPV 31/33/45/52/58 to HPV types included in current vaccines could prevent almost 90% of ICC cases worldwide. If the nine-valent vaccine achieves the same degree of efficacy than previous vaccines, world incidence rates could be substantially reduced.
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Affiliation(s)
- Beatriz Serrano
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), IDIBELL, Institut Català d'Oncologia (ICO) - Catalan Institute of Oncology, Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat,, Barcelona, Spain.
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Ozawa S, Mirelman A, Stack ML, Walker DG, Levine OS. Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: a systematic review. Vaccine 2012; 31:96-108. [PMID: 23142307 DOI: 10.1016/j.vaccine.2012.10.103] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 10/19/2012] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions. METHODS To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit). RESULTS Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination. CONCLUSIONS This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
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Kane MA, Serrano B, de Sanjosé S, Wittet S. Implementation of Human Papillomavirus Immunization in the Developing World. Vaccine 2012. [DOI: 10.1016/j.vaccine.2012.06.075] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vanagas G, Padaiga Z. Healthcare spending in the case of a HPV16/18 population-wide vaccination programme. Scand J Public Health 2012; 40:406-11. [PMID: 22821227 DOI: 10.1177/1403494812455467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness. OBJECTIVES To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania. STUDY DESIGN For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only. RESULTS HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone. CONCLUSIONS In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.
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Affiliation(s)
- Giedrius Vanagas
- Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Patton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, Degenhardt L, Richardson D, Astone N, Sangowawa AO, Mokdad A, Ferguson J. Health of the world's adolescents: a synthesis of internationally comparable data. Lancet 2012; 379:1665-75. [PMID: 22538181 DOI: 10.1016/s0140-6736(12)60203-7] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the world's adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents.
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Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Woo YL, Omar SZ. Human papillomavirus vaccination in the resourced and resource-constrained world. Best Pract Res Clin Obstet Gynaecol 2012; 25:597-603. [PMID: 21684811 DOI: 10.1016/j.bpobgyn.2011.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 03/30/2011] [Accepted: 05/15/2011] [Indexed: 10/18/2022]
Abstract
Human papillomavirus has been established as the causal agent for cervical cancer. The identification of a clear cause presents an unparalleled opportunity for cancer control. As such, the development of prophylactic human papillomavirus vaccines has been rightly hailed as one of the significant scientific triumphs of the past 20 years. This story of scientific triumph over disease, however, is not yet complete. The fruit of scientific labour must be delivered to the people in order to fulfil the underlying intent of the research (i.e. to prevent cancer and save lives). The success of a vaccination programme, however, does not depend on the biological efficacy of the vaccine alone. Various other local factors, such as poverty, gender inequality, cultural traditions, or religious beliefs, can significantly constrain the success of any vaccination programme. In this chapter, we provide an overview of how the human papillomavirus vaccine works and its global uptake, as well as, how variations in local contexts can affect the successful implementation of a vaccination programme. Other factors besides vaccine costs also need serious attention. With better understanding of such factors, policy makers and medical health professionals will be better equipped to make informed decisions to maximise the potential benefits of the human papillomavirus vaccines for the most number of people in individual countries.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Liu FW, Vwalika B, Hacker MR, Allen S, Awtrey CS. Cervical cancer and HPV vaccination: Knowledge and attitudes of adult women in Lusaka, Zambia. ACTA ACUST UNITED AC 2012; 3. [PMID: 24991482 DOI: 10.4172/2157-7560.1000138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fong W Liu
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, United States
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University Teaching Hospital, Nationalist Road, Lusaka, Zambia ; Rwanda Zambia HIV Research Group, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30329, United States
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, United States ; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States ; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30329, United States
| | - Christopher S Awtrey
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, United States ; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
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Kreimer AR, Rodriguez AC, Hildesheim A, Herrero R, Porras C, Schiffman M, González P, Solomon D, Jiménez S, Schiller JT, Lowy DR, Quint W, Sherman ME, Schussler J, Wacholder S. Proof-of-principle evaluation of the efficacy of fewer than three doses of a bivalent HPV16/18 vaccine. J Natl Cancer Inst 2011; 103:1444-51. [PMID: 21908768 PMCID: PMC3186781 DOI: 10.1093/jnci/djr319] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Three-dose regimens for human papillomavirus (HPV) vaccines are expensive and difficult to complete, especially in settings where the need for cervical cancer prevention is greatest. METHODS We evaluated the vaccine efficacy of fewer than three doses of the HPV16/18 vaccine Cervarix in our Costa Rica Vaccine Trial. Women were randomly assigned to receive three doses of the HPV16/18 vaccine or to a control vaccine and were followed for incident HPV16 or HPV18 infection that persisted in visits that were 10 or more months apart (median follow-up 4.2 years). After excluding women who had no follow-up or who were HPV16 and HPV18 DNA positive at enrollment, 5967 women received three vaccine doses (2957 HPV vaccine vs 3010 control vaccine), 802 received two doses (422 HPV vs. 380 control), and 384 received one dose (196 HPV vs. 188 control). Reasons for receiving fewer doses and other pre- and post-randomization characteristics were balanced within each dosage group between women receiving the HPV and control vaccines. RESULTS Incident HPV16 or HPV18 infections that persisted for 1 year were unrelated to dosage of the control vaccine. Vaccine efficacy was 80.9% for three doses of the HPV vaccine (95% confidence interval [CI] = 71.1% to 87.7%; 25 and 133 events in the HPV and control arms, respectively), 84.1% for two doses (95% CI = 50.2% to 96.3%; 3 and 17 events), and 100% for one dose (95% CI = 66.5% to 100%; 0 and 10 events). CONCLUSION Four years after vaccination of women who appeared to be uninfected, this nonrandomized analysis suggests that two doses of the HPV16/18 vaccine, and maybe even one dose, are as protective as three doses.
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Affiliation(s)
- Aimée R Kreimer
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, EPS/7084, Rockville, MD 20852, USA.
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Natunen K, Lehtinen J, Namujju P, Sellors J, Lehtinen M. Aspects of prophylactic vaccination against cervical cancer and other human papillomavirus-related cancers in developing countries. Infect Dis Obstet Gynecol 2011; 2011:675858. [PMID: 21785556 PMCID: PMC3140204 DOI: 10.1155/2011/675858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/12/2011] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer and other human papillomavirus- (HPV-) related cancers are preventable, but preventive measures implemented in developing countries and especially in low-income rural regions have not been effective. Cervical cancer burden derived from sexually transmitted HPV infections is the heaviest in developing countries, and a dramatic increase in the number of cervical cancer cases is predicted, if no intervention is implemented in the near future. HPV vaccines offer an efficient way to prevent related cancers. Recently implemented school-based HPV vaccination demonstration programmes can help tackle the challenges linked with vaccine coverage, and access to vaccination and health services, but prevention strategies need to be modified according to regional characteristics. In urban regions WHO-recommended vaccination strategies might be enough to significantly reduce HPV-related disease burden, but in the rural regions additional vaccination strategies, vaccinating both sexes rather than only females when school attendance is the highest and applying a two-dose regime, need to be considered. From the point of view of both public health and ethics identification of the most effective prevention strategies is pivotal, especially when access to health services is limited. Considering cost-effectiveness versus justice further research on optional vaccination strategies is warranted.
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Affiliation(s)
- Kari Natunen
- School of Health Sciences, University of Tampere, Tampere, Finland.
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Fathers' intentions to accept human papillomavirus vaccination for sons and daughters: exploratory findings from rural Honduras. Int J Public Health 2011; 57:143-8. [PMID: 21698492 DOI: 10.1007/s00038-011-0271-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 06/06/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Little is known about fathers' attitudes toward human papillomavirus (HPV) vaccination in low-resource settings. We sought to determine the awareness of HPV vaccination among Honduran fathers, and to assess their intention to accept HPV vaccination for their sons and daughters. METHODS We conducted 100 structured interviews of fathers recruited from medical and business settings between May 2007 and June 2008. After assessing baseline knowledge, fathers received a brief explanation of HPV infection, cervical cancer, genital warts, and HPV vaccination. They were then asked whether they would accept HPV vaccination for their sons and daughters. RESULTS Prior to receiving information about HPV, 85% of fathers believed that cervical cancer was preventable, over two-thirds could correctly name some form of prevention, 22% of fathers had heard of HPV, and 17% had heard of HPV vaccination. After receiving HPV-related information, 100% of fathers intended to accept HPV vaccination for their sons and 94% intended to accept HPV vaccination for their daughters. CONCLUSIONS Few Honduran fathers were aware of HPV or HPV vaccination, but after receiving information, most would accept HPV vaccination for their sons and daughters.
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Luciani S, Prieto-Lara E, Vicari A. Providing Vaccines Against Human Papillomavirus To Adolescent Girls In The Americas: Battling Cervical Cancer, Improving Overall Health. Health Aff (Millwood) 2011; 30:1089-95. [DOI: 10.1377/hlthaff.2011.0315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Silvana Luciani
- Silvana Luciani ( ) is an adviser on chronic disease prevention and control at the Pan American Health Organization (PAHO), in Washington, D.C
| | | | - Andrea Vicari
- Andrea Vicari is an adviser on immunization in the Comprehensive Family Immunization Project at PAHO
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Ditzian LR, David-West G, Maza M, Hartmann B, Shirazian T, Cremer M. Cervical Cancer Screening in Low- and Middle-Income Countries. ACTA ACUST UNITED AC 2011; 78:319-26. [DOI: 10.1002/msj.20263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Coleman MA, Levison J, Sangi-Haghpeykar H. HPV vaccine acceptability in Ghana, West Africa. Vaccine 2011; 29:3945-50. [PMID: 21481327 DOI: 10.1016/j.vaccine.2011.03.093] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 03/14/2011] [Accepted: 03/25/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical cancer is a leading cause of cancer-related mortality among women in Ghana. As of this writing no data are available concerning knowledge, attitudes and acceptability of human papillomavirus (HPV) vaccination by women in Ghana. METHODS Between November and December 2009, a self-administered survey was used to elicit information from 264 Ghanaian women, ages 18-65. RESULTS Overall, 40% had heard about HPV vaccine and 94% were willing to vaccinate themselves or their daughters. Ideal age for vaccination was 12.7 years. Most women (75%) thought the vaccine should be received regardless of one's number of sex partners. The most prevalent concerns were whether the vaccine would be administered safely using clean needles (82%), and possible future side effects (77%). Concerns about cost and vaccine encouraging earlier sex were reported by nearly half. Significant barriers to vaccine acceptance were women's lack of knowledge about the gravity of cervical cancer in Ghana and utility of Pap test in detecting it, low perceived risk for cervical cancer, low social support to vaccine use, and low self-efficacy to find a doctor or clinic to get vaccinated (p<05). About 55% of the women did not know the vaccine only works among those who are not yet infected with HPV. Schools and television were the most preferred methods of educating the public and cervical cancer prevention ranked as the ideal message (80%). Most respondents believed the decision to vaccinate their daughter should be made by both parents (34%) or in conjunction with the daughter (37%), as opposed to the government (17%). CONCLUSIONS Educational programs addressing specific barriers identified in the current study have the potential to significantly improve HPV vaccine uptake in Ghana.
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Affiliation(s)
- Maame Aba Coleman
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX 77030, USA
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Luciani S, Jauregui B, Kieny C, Andrus JK. Human papillomavirus vaccines: new tools for accelerating cervical cancer prevention in developing countries. Immunotherapy 2011; 1:795-807. [PMID: 20636024 DOI: 10.2217/imt.09.48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Despite the available knowledge and tools to prevent cervical cancer, it remains the second most common cancer in women, with four-fifths of the cases occurring in developing countries. Projections are for a 90% increase in global cervical cancer cases by 2020 if no additional public-health interventions are implemented. Prophylactic human papillomavirus (HPV) vaccines, which have proven immunogenicity, safety and efficacy, are now commercially available; and coupled together with quality screening have the potential to dramatically accelerate reductions in cervical cancer mortality rates and save millions of women's lives. The current cost of the new HPV vaccines and new screening technologies, however, are a major barrier to their widespread implementation. There is an urgent need for HPV vaccines and new technologies for effective screening to become more available and affordable, especially to poor communities everywhere.
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Affiliation(s)
- Silvana Luciani
- Chronic Disease Prevention & Control Project, Pan American Health Organization, DC 20037, USA
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Katz IT, Ware NC, Gray G, Haberer JE, Mellins CA, Bangsberg DR. Scaling up human papillomavirus vaccination: a conceptual framework of vaccine adherence. Sex Health 2010; 7:279-86. [PMID: 20719215 DOI: 10.1071/sh09130] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 04/13/2010] [Indexed: 12/31/2022]
Abstract
This review article provides a conceptual framework for human papillomavirus (HPV) vaccine acceptance and adherence, with a focus on improving understanding of the sociocultural factors impacting vaccine adherence behaviour. We include a systematic review of the slowly expanding literature on HPV vaccine acceptability and uptake in developed nations, as well as the relatively few publications from poorer nations, where more than 80% of global cervical cancer related deaths occur and where the vaccine will probably have the largest impact. We suggest that this conceptual framework will not only improve our understanding of HPV vaccine uptake and adherence, but it may also guide future sociobehavioural research geared towards improving adherence to the HPV vaccine and other multi-step vaccines in a young population at risk for sexually transmissible infections.
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Affiliation(s)
- Ingrid T Katz
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Vanagas G, Padaiga Ž, Kurtinaitis J, Logminienė Ž. Cost-effectiveness of 12- and 15-year-old girls’ human papillomavirus 16/18 population-based vaccination programmes in Lithuania. Scand J Public Health 2010; 38:639-47. [DOI: 10.1177/1403494810377684] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is a large difference in the prevalence of cervical cancer between European countries. Between European Union countries, cervical cancer is the most prevalent in Lithuania. Currently we have available vaccines for different types of human papillomavirus virus (HPV), but we lack evidence on how the vaccination would be cost-effective in low-resource Eastern European countries like Lithuania. Objectives: To create a simulation model for the Lithuanian population; to estimate epidemiological benefits and cost-effectiveness for a HPV16/18 vaccination programme in Lithuania. Study design: For the cost-effectiveness analysis, we used Lithuanian population mathematical simulation and epidemiological data modelling. We performed comparative analysis of annual vaccination programmes of 12-year-old or 15-year-old girls at different vaccine penetration levels. Population: Lithuanian female population at all age groups. Results: A vaccination programme in Lithuania would gain an average of 35.6 life years per death avoided. Vaccinated girls would experience up to 76.9% overall reduction in incidence of cervical cancers, 80.8% reduction in morbidity and 77.9% reduction in mortality over their lifetime. Cost per life year gained with different vaccine penetration levels would range from 2167.41 to 2999.74. Conclusions: HPV vaccination in Lithuania would have a very positive impact on the epidemiological situation and it would be cost-effective at all ranges of vaccine penetration. Vaccination in Lithuania in the long term potentially could be more cost-effective due to avoiding early disease onset and lower accumulation of period costs.
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Padmanabhan S, Amin T, Sampat B, Cook-Deegan R, Chandrasekharan S. Intellectual property, technology transfer and manufacture of low-cost HPV vaccines in India. Nat Biotechnol 2010; 28:671-8. [PMID: 20622834 PMCID: PMC3138722 DOI: 10.1038/nbt0710-671] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Swathi Padmanabhan
- Center for Genome Ethics, Law & Policy, Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina, USA
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Lazcano-Ponce E, Allen-Leigh B. Innovation in cervical cancer prevention and control in Mexico. Arch Med Res 2010; 40:486-92. [PMID: 19853189 DOI: 10.1016/j.arcmed.2009.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
Disparities related to cervical cancer continue to exist in Mexico, including insufficient screening coverage, problems with quality control and a resulting greater risk of mortality among women from marginalized areas. A lack of opportunities and requirements for continuing education and accreditation of healthcare personnel involved in the screening program is also an issue. HPV DNA testing and HPV vaccines are recent technological innovations that offer a potential solution to the continued negative impact of cervical cancer among Mexican women. This essay attempts to answer questions such as: Why should HPV testing be integrated into the early detection program in Mexico? How can HPV testing best be integrated into the program in Mexico? How-from a public health perspective that seeks to reduce disparities-can HPV vaccination best be implemented in Mexico? HPV testing allows increased positive predictive value while also reducing costly and unnecessary overtreatment of low-grade abnormalities, and HPV vaccines offer the possibility of primary prevention of cervical cancer. The strategy proposed for Mexico includes primary prevention with HPV vaccination for girls aged between 12 and 16 years (before sexual initiation), Pap testing with excellent quality control for women 24-34 years of age and high-risk HPV DNA testing for women 35 years and older. HPV samples would be either clinically collected or self-collected and women with positive HPV test results would receive follow-up high-quality Pap testing. This approach is creative and focuses on reducing disparities and providing high-quality care that is also cost effective.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Mexico, D.F., Mexico
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Levin CE, Sellors J, Shi JF, Ma L, Qiao YL, Ortendahl J, O'Shea MK, Goldie SJ. Cost-effectiveness analysis of cervical cancer prevention based on a rapid human papillomavirus screening test in a high-risk region of China. Int J Cancer 2010; 127:1404-11. [DOI: 10.1002/ijc.25150] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vermund SH, Bhatta MP, Sahasrabuddhe VV. Papillomavirus infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Gary M Clifford
- International Agency for Research on Cancer, 69372 Lyon cedex 08, France.
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49
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WHO. Human papillomavirus vaccines: WHO position paper. Biologicals 2009; 37:338-44. [DOI: 10.1016/j.biologicals.2009.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 04/29/2009] [Indexed: 10/20/2022] Open
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50
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The Epidemiology behind the HPV Vaccine Discovery. Ann Epidemiol 2009; 19:239-44. [DOI: 10.1016/j.annepidem.2009.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 01/30/2009] [Indexed: 11/22/2022]
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