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Chow EP, Fairley CK, Atkinson S, Bradshaw CS, Chen MY. Validation of self-reported human papillomavirus vaccination in young adult men who have sex with men. Hum Vaccin Immunother 2024; 20:2371179. [PMID: 38972858 PMCID: PMC11229729 DOI: 10.1080/21645515.2024.2371179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/19/2024] [Indexed: 07/09/2024] Open
Abstract
The Victorian Government introduced a time-limited human papillomavirus (HPV) catch-up program for gay, bisexual, and other men who have sex with men (GBMSM) aged ≤ 26 years in 2017-2019. We conducted a retrospective observational study to examine the accuracy of the self-report of HPV vaccination status using computer-assisted self-interviewing versus their immunization history via electronic health records. We included GBMSM aged 23-30 years visiting the Melbourne Sexual Health Centre (MSHC) in 2020-2021 because they were age-eligible for the HPV catch-up program in Victoria, Australia. Individuals who were unsure about their vaccination status were categorized as 'unvaccinated'. Of the 1,786 eligible men, 1,665 men self-reported their HPV vaccination status: 48.8% (n = 812) vaccinated, 17.4% (n = 289) unvaccinated, and 33.9% (n = 564) unsure. Self-reported HPV vaccination had a sensitivity of 61.3% (95%CI: 58.3 to 64.2%; 661/1079), a specificity of 74.2% (95%CI: 70.5 to 77.7%; 435/586), a positive predictive value of 81.4% (95%CI: 78.6 to 84.0%; 661/812), a negative predictive value of 51.0% (95%CI: 47.6 to 54.4%; 435/853), and an accuracy of 52.6% (95%CI: 50.1 to 55.0%). Our results showed that only half of GBMSM know and report their HPV vaccination status correctly. Novel approaches such as digital vaccine passports may be useful for individuals to accurately report their vaccination status to guide accurate clinical decisions and management.
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Affiliation(s)
- Eric P.F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sidney Atkinson
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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2
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Chow EPF, Phillips TR, Bowesman H, Ong JJ, Tran J, Aung ET, Chen MY, Fairley CK. Human papillomavirus vaccine coverage in male-male partnerships attending a sexual health clinic in Melbourne, Australia. Hum Vaccin Immunother 2022; 18:2068929. [PMID: 35714275 PMCID: PMC9302508 DOI: 10.1080/21645515.2022.2068929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aimed to investigate the sexual mixing by human papillomavirus (HPV) vaccination status in male-male partnerships and estimate the proportion of male-male partnerships protected against HPV. We analyzed male-male partnerships attending the Melbourne Sexual Health Center between 2018 and 2019. Data on self-reported HPV vaccination status were collected. Newman’s assortativity coefficient was used to examine the sexual mixing by HPV vaccination status. Assortativity refers to the tendency of individuals to have partners with similar characteristics (i.e. same vaccination status). Of 321 male-male partnerships where both men reported their HPV vaccination status, 52.6% (95% CI: 47.0–58.2%) partnerships had both men vaccinated, 32.1% (95% CI: 27.0–37.5%) partnerships had only one man vaccinated, and 15.3% (95% CI: 11.5–19.7%) had both men unvaccinated. The assortativity on HPV vaccination status was moderate (assortativity coefficient = 0.265, 95% CI: 0.196–0.335). There were about 15% of male-male partnerships where both men were not protected against HPV. Interventions targeting vaccinated individuals to encourage their unvaccinated partners to be vaccinated might increase the HPV vaccine coverage.
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Affiliation(s)
- Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tiffany R Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Henry Bowesman
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Julien Tran
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Ei T Aung
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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3
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Hernandez-Aguado JJ, Sánchez Torres DÁ, Martínez Lamela E, Aguión Gálvez G, Sanz Espinosa E, Pérez Quintanilla A, Martínez-Carrillo DA, Ramírez Mena M, Coronado Martín PJ, Zapardiel I, de la Fuente-Valero J. Quadrivalent Human Papillomavirus Vaccine Effectiveness after 12 Years in Madrid (Spain). Vaccines (Basel) 2022; 10:vaccines10030387. [PMID: 35335019 PMCID: PMC8952248 DOI: 10.3390/vaccines10030387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
A fully government-funded human papillomavirus (HPV) vaccination program started in 2007 in Spain (only 11–14-year-old girls). The first of those vaccinated cohorts, with the quadrivalent vaccine (Gardasil), turned 25 years old in 2018, the age at which cervical cancer screening begins in Spain. The current study could provide the first evidence about the effectiveness of the quadrivalent vaccine against HPV in Spain and the influence of age of vaccination. The present ambispective cohort study, which was conducted on 790 women aged 25 and 26 years old, compares the rate of HPV prevalence and cytologic anomaly according to the vaccination status. The overall infection rate was 40.09% (vaccinated group) vs. 40.6% (non-vaccinated group). There was a significant reduction in the prevalence of HPV 6 (0% vs. 1.3%) and 16 (2.4% vs. 6.1%), and in the prevalence of cytological abnormalities linked to HPV16: Atypical Squamous Cells of Undetermined Significance (ASCUS) (2.04% vs. 14%), Low-grade Squamous Intraepithelial Lesions (LSIL) (2.94% vs. 18.7%) and High-grade Squamous Intraepithelial Lesion (HSIL) (0% vs. 40%), in the vaccinated group vs. the non-vaccinated group. Only one case of HPV11 and two cases of HPV18 were detected. The vaccine effectively reduces the prevalence of vaccine genotypes and cytological anomalies linked to these genotypes.
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Affiliation(s)
- Juan J. Hernandez-Aguado
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
- Correspondence:
| | - Damián Ángel Sánchez Torres
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Esther Martínez Lamela
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Gema Aguión Gálvez
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Eva Sanz Espinosa
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Almudena Pérez Quintanilla
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Daniela A. Martínez-Carrillo
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
| | - Mar Ramírez Mena
- Gynecology Oncology Unit, Institute of Women’s Health, San Carlos Clinical Hospital (IdISSC), Complutense University, 28040 Madrid, Spain; (M.R.M.); (P.J.C.M.)
| | - Pluvio J. Coronado Martín
- Gynecology Oncology Unit, Institute of Women’s Health, San Carlos Clinical Hospital (IdISSC), Complutense University, 28040 Madrid, Spain; (M.R.M.); (P.J.C.M.)
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain;
| | - Jesús de la Fuente-Valero
- Gynecology Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (D.Á.S.T.); (E.M.L.); (G.A.G.); (E.S.E.); (A.P.Q.); (D.A.M.-C.); (J.d.l.F.-V.)
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Chow EP, Fairley CK, Wigan R, Hocking JS, Garland SM, Cornall AM, Tabrizi SN, Chen MY. Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study. JMIR Public Health Surveill 2021; 7:e32407. [PMID: 34874884 PMCID: PMC8691408 DOI: 10.2196/32407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. OBJECTIVE We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. METHODS We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. RESULTS The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7%; 61/128), a specificity of 85.9% (95% CI 75.0%-93.4%; 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9%; 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3%; 55/122). CONCLUSIONS Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.
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Affiliation(s)
- Eric Pf Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Alyssa M Cornall
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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5
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Toh ZQ, Quang C, Tooma JA, Garland SM, Mulholland K, Licciardi PV. Australia's Role in Pneumococcal and Human Papillomavirus Vaccine Evaluation in Asia-Pacific. Vaccines (Basel) 2021; 9:vaccines9080921. [PMID: 34452046 PMCID: PMC8402478 DOI: 10.3390/vaccines9080921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Australian researchers have made substantial contributions to the field of vaccinology over many decades. Two examples of this contribution relate to pneumococcal vaccines and the human papillomavirus (HPV) vaccine, with a focus on improving access to these vaccines in low- and lower-middle-income countries (LLMICs). Many LLMICs considering introducing one or both of these vaccines into their National Immunisation Programs face significant barriers such as cost, logistics associated with vaccine delivery. These countries also often lack the resources and expertise to undertake the necessary studies to evaluate vaccine performance. This review summarizes the role of Australia in the development and/or evaluation of pneumococcal vaccines and the HPV vaccine, including the use of alternative vaccine strategies among countries situated in the Asia-Pacific region. The outcomes of these research programs have had significant global health impacts, highlighting the importance of these vaccines in preventing pneumococcal disease as well as HPV-associated diseases.
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Affiliation(s)
- Zheng Quan Toh
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Chau Quang
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Joseph A. Tooma
- Australia Cervical Cancer Foundation, Fortitude Valley, QLD 4006, Australia;
| | - Suzanne M. Garland
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3052, Australia
- Regional WHO HPV Reference Laboratory, Centre Women’s Infectious Diseases Research, The Royal Women’s Hospital, Parkville, VIC 3052, Australia
| | - Kim Mulholland
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Paul V. Licciardi
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (Z.Q.T.); (C.Q.); (S.M.G.); (K.M.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence:
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Chow EPF, Carter A, Vickers T, Fairley CK, McNulty A, Guy RJ, Regan DG, Grulich AE, Callander D, Khawar L, Machalek DA, Donovan B. Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18. THE LANCET. INFECTIOUS DISEASES 2021; 21:1747-1756. [PMID: 34339639 DOI: 10.1016/s1473-3099(21)00071-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013. METHODS We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007). FINDINGS We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40-0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53-0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28-0·36) and male individuals (0·51, 0·43-0·61) aged 15-20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06-0·09) and male individuals (0·11, 0·08-0·15) aged 15-20 years in the gender-neutral vaccination period. INTERPRETATION The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school. FUNDING Seqirus Australia and the Australian Government Department of Health.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Allison Carter
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Simon Fraser University, Burnaby, BC, Canada.
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- School of Public Health and Community Medicine, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laila Khawar
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Dorothy A Machalek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
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Carvalho NSD, Silva RJDCD, Val ICD, Bazzo ML, Silveira MFD. Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection. Rev Soc Bras Med Trop 2021; 54:e2020790. [PMID: 34008731 PMCID: PMC8210485 DOI: 10.1590/0037-8682-790-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article addresses human papillomavirus (HPV) infection, one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects and guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is a significant public health issue since it is the most prevalent sexually transmitted infection globally, capable of triggering the oncogenic process of cervical cancer and the possibility of anogenital warts. Important information is presented for gaining knowledge about HPV and action strategies for infection prevention and control, provision of quality care, and effective treatment of the disease. Infection by the human papillomavirus is the sexually transmitted infection of the highest contagion, superior to genital herpes and HIV.
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Affiliation(s)
| | | | | | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Florianópolis, SC, Brasil
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8
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Luo LP, He P, Liu QT, Jiang YH, Zhang YN, Li QZ, Li Q, Li ST, Yang F, Ling H, Dai XG, Li ZY, Chen HL. Prevalence and genotype distribution of HPV infection among 214,715 women from Southern China, 2012-2018: baseline measures prior to mass HPV vaccination. BMC Infect Dis 2021; 21:328. [PMID: 33827456 PMCID: PMC8028771 DOI: 10.1186/s12879-021-06019-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background The epidemiology on the human papillomavirus (HPV) among females in Southern China is not well-established. Baseline data on the prevalence of HPV infection in China prior to mass prophylactic HPV vaccination would be useful. Thus, this study aims to determine the type-specific HPV prevalence and distribution among females from Southern China prior to mass HPV vaccination. Methods A retrospective cross-sectional study employing 214,715 women attending ChenZhou NO.1 People’s Hospital for cervical screening during 2012–2018 was conducted prior to widespread HPV vaccination. HPV genotype was detected using nucleic acid molecular diversion hybridization tests. The overall prevalence, age-specific prevalence, type distribution, and annual trend were analyzed. Results The overall HPV prevalence was 18.71% (95% confidence interval [CI], 18.55–18.88%) among Southern China females. During 2012–2018, the prevalence of HPV infection showed a downward tendency, from 21.63% (95% CI, 21.07–22.20%) in 2012 to 18.75% (95% CI, 18.35–19.16%) in 2018. Age-specific HPV distribution displayed a peak at young women aged less than 21 years (33.11, 95% CI, 31.13–35.15%), 20.07% (95% CI, 19.70–20.44%) among women aged 21–30 years, 17.29% (95% CI, 17.01–17.57%) among women aged 31–40 years, 17.23% (95% CI, 16.95–17.51%) among women aged 41–50 years, 21.65% (95% CI, 21.11–22.20%) among women aged 51–60 years, and 25.95% (95% CI, 24.86–27.07%) among women aged over 60 years. Of the 21 subtypes identified, the top three prevalent high-risk HPV (HR-HPV) genotypes were HPV52 (5.12%; 95% CI, 21.11–22.20%), − 16 (2.96%; 95% CI, 2.89–3.03%), and − 58 (2.51%; 95% CI, 2.44–2.58%); the predominant low-risk HPV (LR-HPV) genotypes were HPV81 (1.86%; 95%CI, 1.80–1.92%) and − 6 (0.69%; 95% CI, 0.66–0.73%) respectively. Incidence of HR-HPV only, LR-HPV only and mixed LR- and HR-HPV were 15.17, 2.07 and 1.47% respectively. Besides, single HPV infection accounted for 77.30% of all positive cases in this study. Conclusions This study highlights 1) a high prevalence of HPV infection among females with a decreasing tendency towards 2012–2018, especially for young women under the age of 21 prior to mass HPV vaccination; 2) HPV52, − 16 and − 58 were the predominant HPV genotypes, suggesting potential use of HPV vaccine covering these HPV genotypes in Southern China.
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Affiliation(s)
- Li-Pei Luo
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Ping He
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Qiao-Tu Liu
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Yang-Hua Jiang
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Yang-Nan Zhang
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Qing-Zhao Li
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Qiu Li
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Sheng-Tao Li
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Fan Yang
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Hua Ling
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Xin-Gui Dai
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China
| | - Zhong-Yu Li
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China. .,Institute of Pathogenic Biology, Hengyang Medical College, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, 421001, P.R. China.
| | - Hong-Liang Chen
- The First School of Clinical Medicine, Southern Medical University, Chenzhou NO.1 People's Hospital, Chenzhou, 423000, P.R. China. .,Institute of Pathogenic Biology, Hengyang Medical College, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, 421001, P.R. China.
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9
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Zhao Y, Xin X, Deng H, Xu J, Weng W, Zhang M, Li J, Gao Y, Huang X, Liu C. Improving the Acceptability of Human Papillomavirus Vaccines Among Men Who Have Sex With Men According to the Associated Factors: A Systematic Review and Meta-analysis. Front Pharmacol 2021; 12:600273. [PMID: 33867977 PMCID: PMC8044753 DOI: 10.3389/fphar.2021.600273] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/15/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives: To investigate the acceptability of human papillomavirus (HPV) vaccination among men who have sex with men (MSM) and its associated factors. Methods: We searched studies written in English in PubMed, EMBASE, and Web of Science with no geographical or time restrictions. We evaluated the quality of the included literature. We calculated the pooled acceptability and performed meta-analysis of selected studies, including factors associated with the acceptability among MSM, using Review Manager (v5.3). Results: The acceptability among the 15 studies (n = 8,658) was 50% (95% CI: 0.27-0.72). The meta-analysis of seven articles (n = 4,200) indicated that having a college or higher degree (OR = 1.62, 95% CI: 1.35-1.95), disclosure of sexual orientation to healthcare professionals (HCPs; OR = 2.38, 95% CI: 1.47-3.86), vaccination with at least one dose for hepatitis A or B (OR = 2.10, 95% CI: 1.42-3.10), awareness of HPV (OR = 1.85, 95% CI: 1.21-2.83), knowledge of HPV (SMD = 0.28, 95% CI: 0.16-0.39), perceived susceptibility to HPV infection (SMD = 0.31, 95% CI: 0.11-0.50), and perceived severity of HPV-related disease (SMD = 0.40, 95% CI: 0.28-0.51) can promote acceptance of HPV vaccines. Meanwhile, people who have had unprotected anal sex or have more sex partners tend to have low acceptance of HPV vaccines. Conclusions: HPV education should be actively promoted according to the factors that influence the acceptability of HPV vaccines among the MSM population. HPV education should be especially aimed at people with low academic qualifications and people with risky sexual behaviors, and should emphasize the aspects of susceptibility to and severity of HPV-related disease. More intervention trials should be conducted to increase the credibility of the results.
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Affiliation(s)
- Yang Zhao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Xin
- Shenyang Sixth People’s Hospital of Shenyang, Shenyang, China
| | - Huiwen Deng
- The First Hospital of China Medical University, Shenyang, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of Liaoning Province, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Juan Li
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases,Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Cuie Liu
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Beijing, China
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10
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Carvalho NSD, Silva RJDCD, Val ICD, Bazzo ML, Silveira MFD. [Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection]. ACTA ACUST UNITED AC 2021; 30:e2020790. [PMID: 33729414 DOI: 10.1590/s1679-4974202100014.esp1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
This article addresses human papillomavirus (HPV) infection, this being one of the topics covered by the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects, as well as guidelines for health service managers and health workers about diagnosing and treating people with papillomavirus infection. This theme is an important public health problem, since it is the most prevalent sexually transmitted infection in the world, capable of triggering the oncogenic process of cervical cancer, as well as the possibility anogenital warts occurring. Important information is presented for gaining knowledge about HPV, as well as action strategies for infection prevention and control, provision of quality care and effective treatment of the disease.
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Affiliation(s)
| | | | | | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Florianópolis, SC, Brasil
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11
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Systematic literature review of cross-protective effect of HPV vaccines based on data from randomized clinical trials and real-world evidence. Vaccine 2021; 39:2224-2236. [PMID: 33744051 DOI: 10.1016/j.vaccine.2020.11.076] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The extent of cross-protection provided by currently licensed bivalent and quadrivalent HPV vaccines versus direct protection against HPV 31-, 33-, 45-, 52-, and 58-related disease is debated. A systematic literature review was conducted to establish the duration and magnitude of cross-protection in interventional and observational studies. METHODS PubMed and Embase databases were searched to identify randomized controlled trials (RCT) and observational studies published between 2008 and 2019 reporting on efficacy and effectiveness of HPV vaccines in women against non-vaccine types 31, 33, 45, 52, 58, and 6 and 11 (non-bivalent types). Key outcomes of interest were vaccine efficacy against 6- and 12-month persistent infection or genital lesions, and type-specific genital HPV prevalence or incidence. RCT data were analyzed for the according-to-protocol (bivalent vaccine) or negative-for-14-HPV-types (quadrivalent vaccine) efficacy cohorts. RESULTS Data from 23 RCTs and 33 observational studies evaluating cross-protection were extracted. RCTs assessed cross-protection in post-hoc analyses of small size subgroups. Among fully vaccinated, baseline HPV-naïve women, the bivalent vaccine showed statistically significant cross-protective efficacy, although with wide confidence intervals, against 6-month and 12-month persistent cervical infections and CIN2+ only consistently for HPV 31 and 45, with the highest effect observed for HPV 31 (range 64.6% [95% CI: 27.6 to 83.9] to 79.1% [97.7% CI: 27.6 to 95.9] for 6-month persistent infection; maximal follow-up 4.7 years). No cross-protection was shown in extended follow-up. The quadrivalent vaccine efficacy reached statistical significance for HPV 31 (46.2% [15.3-66.4]; follow-up: 3.6 years). Similarly, observational studies found consistently significant effectiveness only against HPV 31 and 45 with both vaccines. CONCLUSIONS RCTs and observational studies show that cross-protection is inconsistent across non-vaccine HPV types and is largely driven by HPV 31 and 45. Furthermore, existing data suggest that it wanes over time; its long-term durability has not been established.
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12
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Brotherton JML, Wheeler C, Clifford GM, Elfström M, Saville M, Kaldor J, Machalek DA. Surveillance systems for monitoring cervical cancer elimination efforts: Focus on HPV infection, cervical dysplasia, cervical screening and treatment. Prev Med 2021; 144:106293. [PMID: 33075352 PMCID: PMC8403014 DOI: 10.1016/j.ypmed.2020.106293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
In order to achieve the global elimination of cervical cancer as a public health problem, close surveillance of progress in public health and clinical activities and outcomes across the three pillars of vaccination, screening and treatment will be required. Surveillance should ideally occur within an integrated system that is planned, funded, and regularly evaluated to ensure it is providing timely, accurate and relevant feedback for action. In this paper, we conceptualise the main public health surveillance objectives as process and outcome measures in each of the three pillars. Process measures include coverage/participation measures for vaccination, screening and treatment alongside the ongoing assessment of the quality and reach of these programs and activities. Outcome measures related to the natural history of human papillomavirus (HPV) infection include HPV infection prevalence, precursor cervical lesions and cervical cancers (including stage at diagnosis, cancer incidence and mortality). These outcome measures can be used for monitoring the effectiveness of the three core activities in the short, medium and long term to assess whether these interventions are effectively reducing their occurrence. We discuss possible methods for the surveillance of these measures in the context of country capacity, drawing from examples in Australia, the USA and in low and middle income countries.
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Affiliation(s)
- Julia M L Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia.
| | - Cosette Wheeler
- Department of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, Cedex 08, France
| | - Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 8th floor, 141 52 Huddinge, Stockholm, Sweden
| | - Marion Saville
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; University Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - John Kaldor
- Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Dorothy A Machalek
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia; Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC 3052, Australia
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13
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Nygård M, Hansen BT, Kjaer SK, Hortlund M, Tryggvadóttir L, Munk C, Lagheden C, Sigurdardottir LG, Campbell S, Liaw KL, Dillner J. Human papillomavirus genotype-specific risks for cervical intraepithelial lesions. Hum Vaccin Immunother 2020; 17:972-981. [PMID: 32990181 PMCID: PMC8018444 DOI: 10.1080/21645515.2020.1814097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prevalence of different HPV genotypes is changing after HPV vaccination. The associated risks are needed for optimizing cervical cancer screening.To estimate HPV type-specific prevalence, odds ratio (OR), and positive predictive value (PPV) for cervical cytological abnormalities, we determined 41 different HPV genotypes in cervical samples from a population-based sample of 8351 women aged 18-51 years before HPV vaccination era (V501-033; NCT01077856).Prevalence of HPV16 was 4.9% (95% CI: 4.4-5.5) with the PPV for high-grade cytology 11.2%, and OR 11.9 (95% CI: 8.5-16.5). Carcinogenic HPVs included in the nonavalent vaccine (HPV16,18,31,33,45,52,58) had a population prevalence of 14.4% (95% CI: 13.5-15.4), with PPV of 8.0% (95% CI: 6.8-9.3) and OR 23.7 (95% CI: 16.0-63.5) for high-grade cytology. HPV types currently included in most screening tests, but not vaccinated against (HPV35,39,51,56,59,66,68) had a joint prevalence of 8.5% (95% CI: 7.8-9.2) with PPV of 4.4% (95% CI: 3.3-5.7) and OR of 2.9 (95% CI: 2.0-4.0) for high-grade cytology. The other 27 non-carcinogenic genotypes had a prevalence of 11.8%, PPV of 2.9% (95% CI:2.1-3.9), and OR 1.5 (95% CI: 1.1-2.2.) for high-grade cytology.These results suggest that HPV screening tests in the post-vaccination era might perform better if restricted to the HPV types in the nonavalent vaccine and screening for all 14 HPV types might result in suboptimal balance of harms and benefits.
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Affiliation(s)
- Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Gynecologic Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Hortlund
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christian Munk
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Camilla Lagheden
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Kai-Li Liaw
- Merck Research Laboratories, Merck Sharp & Dohme, Kenilworth, NJ, USA
| | - Joakim Dillner
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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14
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Human papillomavirus genotyping on Reunion Island: A cross-sectional study of stored tissue samples. Eur J Obstet Gynecol Reprod Biol 2020; 252:294-299. [PMID: 32650188 DOI: 10.1016/j.ejogrb.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aim to illustrate and evaluate the prevalence and distribution pattern of cervical human papilloma virus (HPV) genotypes on La Réunion Island, a French overseas territory, with the aim to guide future vaccination policies. STUDY DESIGN Between January 2008 and July 2012, files of women undergoing gynaecological examination were retrospectively evaluated at the University Hospital, Reunion Island. Inclusion criteria required cervical biopsies with histopathological diagnosis of high-grade lesions or cancer and ASCUS Pap Smears (atypical squamous cells undetermined significance) results. The INNO-LIPA HPV Genotyping Extra® test was used for HPV genotyping. RESULTS A total of 401 ASCUS Pap Smears and 94 cervical biopsies were analyzed, of which 162 smears and 63 biopsies were HPV DNA positive (40.4 % and 67 % respectively). Detailed breakdowns of HPV genotype-specific distribution reported prevalence of HPV 16, 31, 33, 51 and 52. Of the 63 HPV-positive biopsies, 61 (96.8 %) contained at least one HPV genotype that is contained in the 9-valent HPV vaccine. The incremental preventable fraction of HPV infections that could have been added by the new 9-valent vaccine to the current bivalent vaccine was estimated at 26.2 %. CONCLUSIONS Immunization with 9-valent vaccine should be effective, and in the long term, may reduce cervical cancer incidence in Reunion Island. Nevertheless, vaccination rates and coverage need to be maintained and improved.
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15
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Subasinghe AK, Wark JD, Phillips S, Cornall A, Brotherton JML, Garland SM. Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females. Sex Health 2020; 17:510-516. [PMID: 33341122 DOI: 10.1071/sh20033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
Background The prevalence of genital tract vaccine-type human papillomavirus (HPV) is on the decline due to high vaccine uptake through the national HPV immunisation program in Australia. The aim of this study was to investigate HPV vaccine coverage and factors associated with HPV in a vaccine-eligible sample of young Australian females. METHODS Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. RESULTS Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. CONCLUSIONS In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.
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Affiliation(s)
- Asvini K Subasinghe
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Present address: Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - John D Wark
- The University of Melbourne Department of Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia
| | - Alyssa Cornall
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Vic. 3002, Australia; and Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3053, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
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16
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Monitoring human papillomavirus prevalence among young Australian women undergoing routine chlamydia screening. Vaccine 2019; 38:1186-1193. [PMID: 31767467 DOI: 10.1016/j.vaccine.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Australia has recently implemented major changes in cervical cancer prevention policies including introduction of primary human papillomavirus (HPV) screening starting at age 25, and replacement of the quadrivalent HPV vaccine with the nonavalent vaccine in the national school-based program. We assessed the feasibility and utility of conducting HPV testing in residual clinical specimens submitted for routine Chlamydia trachomatis screening, as a means of tracking HPV vaccine program impact among young sexually active women. METHODS De-identified residual specimens from women aged 16-24 years submitted for chlamydia testing were collected from three pathology laboratories in Victoria and New South Wales. Limited demographic information, and chlamydia test results were also collected. Patient identifiers were sent directly from the laboratories to the National HPV Vaccination Program Register, to obtain HPV vaccination histories. Samples underwent HPV genotyping using Seegene Anyplex II HPV 28 assay. RESULTS Between April and July 2018, 362 residual samples were collected, the majority (60.2%) of which were cervical swabs. Demographic data and vaccination histories were received for 357 (98.6%) women (mean age 21.8, SD 2.0). Overall, 65.6% of women were fully vaccinated, 9.8% partially, and 24.7% unvaccinated. The majority (86.0%) resided in a major city, 35.9% were classified in the upper quintile of socioeconomic advantage and chlamydia positivity was 7.8%.The prevalence of quadrivalent vaccine-targeted types (HPV6/11/16/18) was 2.8% (1.5-5.1%) overall with no differences by vaccination status (p = 0.729). The prevalence of additional nonavalent vaccine-targeted types (HPV31/33/45/52/58) was 19.3% (15.6-23.8%). One or more oncogenic HPV types were detected in 46.8% (95% CI 41.6-52.0%) of women. CONCLUSIONS HPV testing of residual chlamydia specimens provides a simple, feasible method for monitoring circulating genotypes. Applied on a larger scale this method can be utilised to obtain a timely assessment of nonavalent vaccine impact among young women not yet eligible for cervical screening.
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17
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Chow EP, Danielewski JA, Murray GL, Fehler G, Chen MY, Bradshaw CS, Garland SM, Fairley CK. Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne, Australia. Vaccine 2019; 37:6271-6275. [DOI: 10.1016/j.vaccine.2019.08.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 01/18/2023]
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18
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Patel C, Brotherton JM, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, Marshall H. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? ACTA ACUST UNITED AC 2019; 23. [PMID: 30326995 PMCID: PMC6194907 DOI: 10.2807/1560-7917.es.2018.23.41.1700737] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: A National human papilloma virus (HPV) Vaccination Programme for the prevention of HPV infection and associated disease using the quadrivalent HPV vaccine (4vHPV) has been funded and implemented in Australia since 2007, initially for girls only and extended to boys in 2013, with uptake rates among the highest observed worldwide. Aim: We report on the impact of this national programme on HPV prevalence and associated disease burden and estimate the potential impact of adopting a nonavalent HPV (9vHPV) vaccine. Methods: We performed a non-systematic literature review of studies measuring the burden of HPV-associated disease and infection in Australia before and after introduction of HPV vaccination. We also included key national reports with estimates of HPV-related disease burden. Results: Substantial declines in high-grade cervical disease and genital warts among vaccine-eligible women have been observed. Reductions in genital warts incidence and HPV prevalence among heterosexual men of similar age were observed before introduction of the male vaccination programme, indicating a substantial herd effect. 9vHPV vaccine is expected to prevent up to 90% of cervical and 96% of anal cancers. Of an estimated 1,544 HPV-associated cancers in 2012, 1,242 would have been preventable by the 4vHPV vaccine and an additional 187 anogenital cancers by the 9vHPV vaccine. Conclusions: Vaccination using 4vHPV vaccine has had a large demonstrable impact on HPV-related disease in Australia. A switch to 9vHPV could further reduce the HPV-associated cancer burden. With continued high coverage among both males and females, elimination of vaccine-type HPV disease seems achievable in Australia.
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Affiliation(s)
- Cyra Patel
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Julia Ml Brotherton
- School of Population and Global Health, University of Melbourne, Parkville, Australia.,VCS Population Health, VCS Foundation, East Melbourne, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Sanjay Jayasinghe
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Basil Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, North Adelaide, Australia.,Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, North Adelaide, Australia
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19
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Chow EPF, Tabrizi SN, Fairley CK, Wigan R, Machalek DA, Regan DG, Hocking JS, Garland SM, Cornall AM, Atchison S, Bradshaw CS, McNulty A, Owen L, Marshall L, Russell DB, Kaldor JM, Chen MY. Prevalence of human papillomavirus in teenage heterosexual males following the implementation of female and male school-based vaccination in Australia: 2014-2017. Vaccine 2019; 37:6907-6914. [PMID: 31562001 DOI: 10.1016/j.vaccine.2019.09.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Australia introduced a school-based human papillomavirus (HPV) vaccination program for females aged 12-13 years in 2007, with a three-year catch-up to age 26; and for boys aged 12-13 from 2013, with a two-year catch-up to age 15. This study aimed to compare the prevalence of penile HPV between teenage heterosexual males in cohorts eligible or non-eligible for the school-based male vaccination program. METHODS Between 2014 and 2017, sexually active heterosexual males aged 17-19 were recruited from sexual health centres and community sources across Australia. Males provided a self-collected penile swab for 37 HPV genotypes using Roche Linear Array and completed a questionnaire. We calculated adjusted prevalence ratios (aPR) of HPV between males in two periods: 2014-2015 (preceding implementation of school-based male vaccination) and 2016-2017 (eligible for school-based male vaccination). Self-reported vaccine doses were confirmed with doses reported to the National HPV Vaccination Program Register. RESULTS Overall, 152 males were recruited in 2014-2015 and 146 in 2016-2017. Numbers of female sex partners and condom use did not differ between the two periods. The prevalence of quadrivalent vaccine-preventable [4vHPV] genotypes (6/11/16/18) was low in both periods (2.6% [2014-15] versus 0.7% [2016-17]; p = 0.371; aPR 0.28 [95% CI: 0.03-2.62]). Compared with men in 2014-2015, men in 2016-2017 had a lower prevalence of any of the 37 HPV genotypes tested (21.7% versus 11.6%; aPR 0.62 [95% CI: 0.36-1.07]) and any of the 13 high-risk genotypes tested (15.8% versus 7.5%; aPR 0.59 [95% CI: 0.30-1.19]). Prevalence of low-risk HPV genotypes did not differ between the two periods. Of the males recruited in 2016-2017, 55% had received ≥1 vaccine dose. CONCLUSION The prevalence of 4vHPV genotypes among teenage heterosexual males in both cohorts was low, presumably due to herd protection from the female-only vaccination program. Further studies are required to determine the impact of universal HPV vaccination on HPV prevalence in males.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Sepehr N Tabrizi
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - Dorothy A Machalek
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Suzanne M Garland
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Alyssa M Cornall
- Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Steph Atchison
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Louise Owen
- Statewide Sexual Health Service Tasmania, Tasmania, Australia.
| | - Lewis Marshall
- South Terrace Clinic, Fremantle Hospital, Perth, Western Australia, Australia.
| | - Darren B Russell
- Cairns Sexual Health Service, Queensland Health, Cairns, North Queensland, Australia; College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
| | - John M Kaldor
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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Machalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Rachel Skinner S, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination. J Infect Dis 2019; 217:1590-1600. [PMID: 29425358 DOI: 10.1093/infdis/jiy075] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction A quadrivalent human papillomavirus vaccination program targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of 14-26 year olds through 2009. We evaluated the program's impact on HPV prevalence among women aged 18-35 in 2015. Methods HPV prevalence among women aged 18-24 and 25-35 was compared with prevalence in these age groups in 2005-2007. For women aged 18-24, we also compared prevalence with that in a postvaccine study conducted in 2010-2012. Results For the 2015 sample, Vaccination Register-confirmed 3-dose coverage was 53.3% (65.0% and 40.3% aged 18-24 and 25-35, respectively). Prevalence of vaccine HPV types decreased from 22.7% (2005-2007) and 7.3% (2010-2012), to 1.5% (2015) (P trend < .001) among women aged 18-24, and from 11.8% (2005-2007) to 1.1% (2015) (P = .001) among those aged 25-35. Conclusions This study, reporting the longest surveillance follow-up to date, shows prevalence of vaccine-targeted HPV types has continued to decline among young women. A substantial fall also occurred in women aged 25-35, despite lower coverage. Strong herd protection and effectiveness of less than 3 vaccine doses likely contributed to these reductions.
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Affiliation(s)
- Dorothy A Machalek
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,School of Population and Global Health, University of Melbourne, Victoria
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - Julia M L Brotherton
- School of Population and Global Health, University of Melbourne, Victoria.,National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Victoria
| | - Deborah Bateson
- Family Planning New South Wales, Sydney.,Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria
| | | | - S Rachel Skinner
- Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead
| | - Bette Liu
- School of Public Health and Community Medicine
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
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21
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Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019; 394:497-509. [PMID: 31255301 PMCID: PMC7316527 DOI: 10.1016/s0140-6736(19)30298-3] [Citation(s) in RCA: 549] [Impact Index Per Article: 109.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination. METHODS In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks. FINDINGS We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years. INTERPRETATION This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects. FUNDING WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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22
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Fairley CK, Zou H, Zhang L, Chow EPF. Human papillomavirus vaccination in men who have sex with men - what will be required by 2020 for the same dramatic changes seen in heterosexuals. Sex Health 2019; 14:123-125. [PMID: 27658180 DOI: 10.1071/sh16067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022]
Abstract
This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. The reproductive rate for HPV infection in heterosexuals is not well established, but 70% vaccination coverage in women has resulted in a fall of more than 90% in genital warts and HPV types 16/18 in young women and 80% fall in young men indicating that the critical vaccination threshold has been exceeded for this group. Published data on the three elements of the reproductive rate for HPV infection (i.e. transmission probability per sexual partnership, rate of partner change and duration of infectiousness) suggest they are higher in MSM than heterosexuals. This indicates that the reproductive rate for HPV will be higher in MSM and hence the critical vaccination threshold will also be higher. But while vaccinating 70% of girls protect 70% of sexual partnerships in heterosexuals, vaccinating 70% of boys protect more than 70% of partnerships in MSM. Only 9% (30% by 30%) of sexual partnerships in MSM are not protected with 70% coverage. Therefore vaccinating 70% of boys will protect 91% of sexual partnerships in MSM. However the efficacy of the HPV vaccine is much lower when sexually active MSM are vaccinated rather than boys. We argue that if MSM are to have the same benefit from the HPV vaccine that heterosexuals had, boys and not adult MSM will need to be vaccinated.
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Affiliation(s)
- Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Huachun Zou
- Kirby Institute, University of New South Wales, Sydney, Kensington, NSW 2033, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
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23
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Chow EPF, Grulich AE, Fairley CK. Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. Lancet HIV 2019; 6:e396-e405. [PMID: 31006612 DOI: 10.1016/s2352-3018(19)30043-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/23/2022]
Abstract
Since 2012, the increasingly widespread promotion and uptake of HIV treatment as prevention and pre-exposure prophylaxis in men who have sex with men has been associated with increased sexually transmitted infections (STIs). However, numbers of STI cases have been rising for more than 20 years and the introduction of biomedical HIV interventions cannot explain the majority of the rises in STIs. The increases appear to have occurred mostly because of gradual changes in behaviour over many years, coupled in some settings with more condomless anal intercourse, and as a result of the increased screening for previously undetected asymptomatic infections. If control of STIs is to be improved, then a far greater emphasis on increased use of existing effective STI control strategies will be required, in addition to the investigation of new interventions. Central to effective STI control is accessible clinical care and screening services, which are currently inadequate in most settings. Insufficient action carries a risk of increased STI epidemics, including of newly resistant organisms.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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24
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Abstract
We examined the proportion of anogenital warts in men who have sex with men attending a sexual health center. Anal warts were most common in younger men who have sex with men (5.8% for age <21 years) and became less common with age (2.8% in age >50 years), but penile warts occurred at approximately the same proportion (~1.5%) over all age groups.
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25
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Woestenberg PJ, Bogaards JA, King AJ, Leussink S, van der Sande MA, Hoebe CJ, van Benthem BH. Assessment of herd effects among women and heterosexual men after girls-only HPV16/18 vaccination in the Netherlands: A repeated cross-sectional study. Int J Cancer 2018; 144:2718-2727. [PMID: 30426502 PMCID: PMC6590597 DOI: 10.1002/ijc.31989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/12/2018] [Accepted: 11/02/2018] [Indexed: 01/07/2023]
Abstract
Data on the impact of human papillomavirus (HPV) vaccination on the population HPV prevalence are largely obtained from women. We assessed the impact of the girls‐only HPV16/18 vaccination program in the Netherlands that started in 2009, on trends in HPV prevalence among women and heterosexual men, using data from the PASSYON study. In this cross‐sectional study, the HPV prevalence among 16‐ to 24‐year‐old visitors to sexually transmitted infection clinics was assessed in 2009, 2011, 2013, and 2015. We compared the genital postvaccination HPV prevalence with the prevaccination prevalence (2009) using Poisson GEE models. In total, we included 4,996 women and 1,901 heterosexual men. The percentage of women who reported to be vaccinated increased from 2.3% in 2009 to 37% in 2015. Among all women, the HPV16/18 prevalence decreased from 23% prevaccination to 15% in 2015 (adjusted prevalence ratio [aPR] 0.62, ptrend < 0.01). Among heterosexual men, the HPV16/18 prevalence decreased from 17% prevaccination to 11% in 2015 (aPR 0.52, ptrend < 0.01). Of the heterosexual men with a steady partner, HPV16/18 prevalence was lower among those whose steady partner had been vaccine‐eligible in the national immunization program (aPR 0.13). Among unvaccinated women, the HPV16/18 prevalence in 2015 was not different from prevaccination. The decreasing HPV16/18 prevalence among heterosexual men and the reduced HPV16/18 prevalence among heterosexual men with a vaccine‐eligible steady partner strongly suggests herd protection from girls‐only vaccination. Absence of notable herd effects among unvaccinated women 6 years postvaccination may be due to the moderate vaccine uptake among girls in the Netherlands. What's new? Human papillomavirus (HPV) is a sexually transmitted virus that plays a causal role in the development of anogenital and oropharyngeal cancers in both men and women. The population‐level impact of HPV vaccination programs on the HPV prevalence has however mainly been studied in women. This study shows decreasing trends in the HPV16 and HPV18 prevalence among both women and heterosexual men after the introduction of a girls‐only HPV16/18 vaccination program in the Netherlands. The findings provide compelling evidence for herd protection in men. Because HPV16/18 are the most oncogenic types, HPV‐related cancers are expected to decline in both sexes after girls‐only HPV vaccination.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Suzan Leussink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marianne Ab van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christian Jpa Hoebe
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Birgit Hb van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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26
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McGrath L, Fairley CK, Cleere EF, Bradshaw CS, Chen MY, Chow EPF. Human papillomavirus vaccine uptake among young gay and bisexual men who have sex with men with a time-limited targeted vaccination programme through sexual health clinics in Melbourne in 2017. Sex Transm Infect 2018; 95:181-186. [PMID: 30409917 DOI: 10.1136/sextrans-2018-053619] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In mid-2017, the Victorian Government funded a free time-limited human papillomavirus (HPV) vaccination catch-up programme for gay and bisexual men who have sex with men (MSM) aged up to 26 years through sexual health clinics or other immunisation centres. We aimed to examine the uptake of the HPV vaccine among young MSM attending the Melbourne Sexual Health Centre (MSHC). METHODS MSM aged ≤26 attending MSHC between 27 April 2017 and 31 December 2017 were included in the analysis. HPV vaccine uptake was calculated based on the first consultation of each patient during the period. Multivariable logistic regression was performed to examine the association between vaccine uptake and patient factors. RESULTS There were 2108 MSM aged ≤26 who attended MSHC over the study period, with 7.6% (n=161) reporting previous HPV vaccination. Of the 1947 eligible men, 1134 (58.2%, 95% CI 56.0% to 60.4%) were offered the vaccine by the clinicians, and 830 men received it on the day. The vaccine coverage among all eligible MSM was 42.6% (95% CI 40.4% to 44.9%; 830 of 1947) and among MSM who were offered the vaccine by the clinicians was 73.2% (95% CI 70.5% to 75.8%; 830 of 1134). Men with a history of genital warts (adjusted OR (aOR)=3.11, 95%CI 1.39 to 6.99) and those who had >4male partners in the last 12 months (aOR=1.38, 95% CI 1.04 to 1.85) were more likely to receive the HPV vaccine on the day. 304 men declined the vaccine; most men did not specify the reason (31.3%, n=95), while 27.3% (n=83) needed time to think. CONCLUSION Although vaccine uptake was 73.2% among those offered, the actual coverage of those eligible remained unsatisfactory (42.6%) in a sexual health clinic. This highlights a clinic-based targeted MSM programme may not reach sufficiently high vaccine coverage to provide MSM with the same vaccine benefits as heterosexuals.
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Affiliation(s)
- Launcelot McGrath
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eoin F Cleere
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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27
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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28
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Franceschi S, Clifford GM, Baussano I. Options for design of real-world impact studies of single-dose vaccine schedules. Vaccine 2018; 36:4816-4822. [PMID: 29571973 PMCID: PMC6066174 DOI: 10.1016/j.vaccine.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 11/25/2022]
Abstract
Based on existing evidence for efficacy, savings, and advantages in delivery, some countries may elect to pilot or roll out single-dose human papillomavirus (HPV) vaccination (instead of, or in combination with, two-dose) in advance of a WHO policy decision. Accelerated evidence of population-based effectiveness (hereafter referred to as overall effectiveness, OE) of one-dose vaccine programs could be gained through regular surveys of HPV prevalence in young women before and after vaccination introduction. In order to offer the earliest information on OE, one-dose HPV vaccination should target one or more birth cohorts as close as possible to the age when sexual activity most often starts in a given population. A catch-up one-dose vaccination program of girls up to 18 years of age who would have been too old to profit from the introduction of a routine HPV vaccination program in preadolescents would minimize the interval between vaccination and the possibility to monitor vaccination impact in young women. In addition, catch-up is especially desirable in low- and middle-income countries with little access to screening as "missed" cohorts may face high risk of cervical cancer death. HPV prevalence should be firstly monitored in age groups of women who may already be sexually active but still reluctant to admit it and to accept vaginal examination for the collection of cervical cells. Hence, HPV testing from urine samples, for which good concordance with cervical cells has been proven, offers a feasible approach to assess periodically vaccine OE in representative samples of 17-20 year-old women. This type of observational study would greatly benefit from the presence of a population census and the creation of a vaccination registry. A real-world demonstration of OE of the new schedule would complement the findings of ongoing clinical trials and immunogenicity studies on the efficacy of single-dose HPV vaccination.
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Affiliation(s)
- Silvia Franceschi
- Cancer Epidemiology Unit, Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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29
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Lefèvre H, Schrimpf C, Moro MR, Lachal J. HPV vaccination rate in French adolescent girls: an example of vaccine distrust. Arch Dis Child 2018; 103:740-746. [PMID: 29222179 DOI: 10.1136/archdischild-2017-313887] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the clinical issues of human papillomavirus (HPV) vaccination to develop explanatory hypotheses for the low level of vaccination among adolescent girls in France where the full course coverage is low (<15%). DESIGN We used semistructured interviews. Our qualitative and phenomenological procedure applied interpretative phenomenological analysis. PARTICIPANTS 16 physicians regularly faced with the prescription of HPV vaccine, represented several medical specialties (paediatrics, general practice, internal medicine, gynaecology), with hospitalist or private practices. MAIN OUTCOME MEASURES The results connect three superordinate themes grouping three concentric levels: within society, during the consultation and in the individual doctor's feelings. RESULTS The modalities and contents of the information about HPV vaccination raise questions about the limitations of the information doctors receive. The ineluctable association between sexuality and HPV vaccination explains their reluctance to raise topics considered to be private. The reasons for HPV vaccination illustrate the difficulty of arguing in favour of it. In view of the frequent parental reluctance, which weakens the parent-physician alliance, physicians must take responsibility for defending the benefits of vaccination. They nonetheless remain citizens whose opinions may implicitly echo the general reluctance, promoted by disinformation. In delaying or avoiding the subject of vaccination, they involuntarily become an instrument of anti-vaccination discourse. CONCLUSIONS It is imperative to improve the distribution of credible information about vaccination, unbiased and scientifically supported by a strong institutional position and to rethink the place of the clinician in the system of adolescent health and disease prevention in France.
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Affiliation(s)
- Hervé Lefèvre
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,French Clinical Research Group, Adolescent Medicine and Health, Paris, France
| | - Cécile Schrimpf
- AP-HP, Cochin Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie Rose Moro
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jonathan Lachal
- AP-HP, Cochin Hospital, Paris, France.,CESP, Faculty de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Oakley F, Desouki MM, Pemmaraju M, Gargano JM, Markowitz LE, Steinau M, Unger ER, Zhu Y, Fadare O, Griffin MR. Trends in High-Grade Cervical Cancer Precursors in the Human Papillomavirus Vaccine Era. Am J Prev Med 2018; 55:19-25. [PMID: 29778314 DOI: 10.1016/j.amepre.2018.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/19/2018] [Accepted: 03/21/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The 2006 introduction of human papillomavirus vaccine targeted against genotypes 6, 11, 16, and 18 should result in decreased cervical dysplasia in vaccinated women. However, new cervical cancer guidelines to increase screening intervals complicate interpretation of trends. The hypothesis is that cervical dysplasia would decrease only in young vaccine-eligible women, and not older women. METHODS The authors identified Davidson County, Tennessee, women aged 18-39 years with cervical intraepithelial neoplasia (CIN) grade 2 or greater and adenocarcinoma in situ, denoted as CIN2+, through pathology reports from laboratories serving this population. Biopsy specimens for human papillomavirus genotyping were collected. Trends in CIN2+ rates and associated human papillomavirus genotypes, 2008 through 2013, were examined. RESULTS The authors identified 2,031 women with CIN2+. Rates of CIN2+ fell from 188.9 to 58.7 per 100,000 women aged 18-20 years (annual percentage change= -24.2, 95% CI= -41.4, -2.1) and from 495.6 to 332.4 per 100,000 women aged 21-24 years (annual percentage change= -10.2%, 95% CI= -16.3, -3.4). There was no significant change in CIN2+ rates for women aged 25-29 or 30-39 years. In biopsy specimens from 1,319 of 2,031 (65%) women, at least one human papillomavirus genotype was identified in 1,270 (96%). The prevalence of at least one of four vaccine human papillomavirus genotypes (6, 11, 16, and 18) declined from 59% in 2008 to 52% in 2013 (p=0.003). CONCLUSIONS Diagnosis of CIN2+ decreased in women aged 18-24 years, but not in older women. Both changes in screening and human papillomavirus vaccination could have contributed to the decline of CIN2+ in young women.
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Affiliation(s)
| | - Mohamed M Desouki
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manideepthi Pemmaraju
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia M Gargano
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Martin Steinau
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, California
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
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Dillner J, Nygård M, Munk C, Hortlund M, Hansen BT, Lagheden C, Liaw KL, Kjaer SK. Decline of HPV infections in Scandinavian cervical screening populations after introduction of HPV vaccination programs. Vaccine 2018; 36:3820-3829. [PMID: 29778519 DOI: 10.1016/j.vaccine.2018.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To monitor the changes in prevalence of human papillomavirus (HPV) infections in women <50 years of age, participating in cervical screening programs of Denmark, Norway, and Sweden, before and after introduction of quadrivalent HPV (qHPV) vaccination. METHODS Liquid-based cytology samples were collected from 6538 women who attended cervical screening in Denmark, Norway, and Sweden in 2006-2008 and from 6332 similarly enrolled women in 2012-2013. Denmark started organized qHPV vaccination in 2008, Norway in 2009, and Sweden in 2012. All HPV testing and genotyping was performed using identical enrollment and analysis methods, by accredited general primer polymerase chain reaction methods with typing using the Luminex system. RESULTS Overall HPV positivity declined slightly from 36.5% in 2006-2008 to 34.5% in 2012-2013. The decline was most pronounced among women 18-26 years of age: from 54.4% to 48.1% (P < 0.001). The decline was substantial for vaccine HPV types (HPV6/11/16/18: decline from 22.3% to 16.6%; P < 0.001) and was seen for both low-risk vaccine types (HPV6/11 declined from 5.0% to 2.5%) and high-risk vaccine types (HPV16/18 declined from 18.9% to 14.9%). Among women 27-50 years of age, there was no change between the time periods (22.5% and 21.6%, respectively). The significant decline in the younger age group was different in the 3 countries. CONCLUSION This population-based study enrolling >12,000 women participating in cervical screening in the 3 Nordic countries before and after introduction of organized qHPV vaccination demonstrated a marked decline in HPV infection in the younger population in the 2 countries where qHPV vaccination programs started in 2008-2009, suggesting that organized HPV vaccination programs resulted in a decrease of HPV types circulating in the general population.
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Affiliation(s)
- Joakim Dillner
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Mari Nygård
- Dept. of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Hortlund
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo T Hansen
- Dept. of Research, Cancer Registry of Norway, Oslo, Norway
| | - Camilla Lagheden
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kai-Li Liaw
- Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Dept. of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
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32
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Tejada RA, Vargas KG, Benites-Zapata V, Mezones-Holguín E, Bolaños-Díaz R, Hernandez AV. Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis. SALUD PUBLICA DE MEXICO 2018; 59:84-94. [PMID: 28423114 DOI: 10.21149/7824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/10/2016] [Indexed: 11/06/2022] Open
Abstract
Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.
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Affiliation(s)
- Romina A Tejada
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú
| | - Kris G Vargas
- Department of Epidemiology, Erasmus MC. Rotterdam. Netherlands
| | - Vicente Benites-Zapata
- Centro de Investigación de Salud Pública, Instituto de Investigación, Facultad de Medicina Humana, Universidad de San Martín de Porres. Lima, Perú
| | - Edward Mezones-Holguín
- Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud. Lima, Perú.,School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú
| | - Rafael Bolaños-Díaz
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú.,Organización médica para el desarrollo de la salud. Lima, Perú
| | - Adrián V Hernandez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic. Ohio, USA
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Mesher D, Soldan K, Lehtinen M, Beddows S, Brisson M, Brotherton JML, Chow EPF, Cummings T, Drolet M, Fairley CK, Garland SM, Kahn JA, Kavanagh K, Markowitz L, Pollock KG, Söderlund-Strand A, Sonnenberg P, Tabrizi SN, Tanton C, Unger E, Thomas SL. Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes. Emerg Infect Dis 2018; 22:1732-40. [PMID: 27648688 PMCID: PMC5038419 DOI: 10.3201/eid2210.160675] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
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Plummer EL, Vodstrcil LA, Danielewski JA, Murray GL, Fairley CK, Garland SM, Hocking JS, Tabrizi SN, Bradshaw CS. Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples - A pilot study. PLoS One 2018; 13:e0190199. [PMID: 29293559 PMCID: PMC5749747 DOI: 10.1371/journal.pone.0190199] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives Recurrence following recommended treatment for bacterial vaginosis is unacceptably high. While the pathogenesis of recurrence is not well understood, recent evidence indicates re-infection from sexual partners is likely to play a role. The aim of this study was to assess the acceptability and tolerability of topical and oral antimicrobial therapy in male partners of women with bacterial vaginosis (BV), and to investigate the impact of dual-partner treatment on the vaginal and penile microbiota. Methods Women with symptomatic BV (Nugent Score of 4–10 and ≥3 Amsel criteria) and their regular male sexual partner were recruited from Melbourne Sexual Health Centre, Melbourne, Australia. Women received oral metronidazole 400mg twice daily (or intra-vaginal 2% clindamycin cream, if contraindicated) for 7-days. Male partners received oral metronidazole 400mg twice daily and 2% clindamycin cream topically to the penile skin twice daily for 7-days. Couples provided self-collected genital specimens and completed questionnaires at enrolment and then weekly for 4-weeks. Genital microbiota composition was determined by 16S rRNA gene sequencing. Changes in genital microbiota composition were assessed by Bray-Curtis index. Bacterial diversity was measured by the Shannon Diversity Index. Results Twenty-two couples were recruited. Sixteen couples (76%) completed all study procedures. Adherence was high; most participants took >90% of prescribed medication. Medication, and particularly topical clindamycin in males, was well tolerated. Dual-partner treatment had an immediate and sustained effect on the composition of vaginal microbiota (median Bray-Curtis score day 0 versus day 8 = 0.03 [IQR 0–0.15], day 0 vs day 28 = 0.03 [0.02–0.11]). We observed a reduction in bacterial diversity of the vaginal microbiota and a decrease in the prevalence and abundance of BV-associated bacteria following treatment. Treatment had an immediate effect on the composition of the cutaneous penile microbiota (median Bray-Curtis score day 0 vs day 8 = 0.09 [0.04–0.17]), however this was not as pronounced at day 28 (median Bray-Curtis score day 0 vs day 28 = 0.38 [0.11–0.59]). A decrease in the prevalence and abundance of BV-associated bacteria in the cutaneous penile microbiota was observed immediately following treatment at day 8. Conclusion Combined oral and topical treatment of male partners of women with BV is acceptable and well tolerated. The combined acceptability and microbiological data presented in this paper supports the need for larger studies with longer follow up to characterize the sustained effect of dual partner treatment on the genital microbiota of couples and assess the impact on BV recurrence.
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Affiliation(s)
- Erica L. Plummer
- Department of Molecular Microbiology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Lenka A. Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer A. Danielewski
- Department of Molecular Microbiology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Gerald L. Murray
- Department of Molecular Microbiology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Suzanne M. Garland
- Department of Molecular Microbiology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sepehr N. Tabrizi
- Department of Molecular Microbiology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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35
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Goggin P, Sauvageau C, Gilca V, Defay F, Lambert G, Mathieu-C S, Guenoun J, Comète E, Coutlée F. Low prevalence of vaccine-type HPV infections in young women following the implementation of a school-based and catch-up vaccination in Quebec, Canada. Hum Vaccin Immunother 2017; 14:118-123. [PMID: 29049007 DOI: 10.1080/21645515.2017.1385688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In Quebec, Canada, a school-based HPV vaccination for girls has been offered since 2008. The vaccine used in the program targets HPV16/18, responsible for ∼70% of cervical cancers and HPV6/11, responsible for the majority of anogenital warts. The objective of this study was to assess the prevalence of HPV in vaccinated and unvaccinated women. METHODS Women aged 17-29 years were eligible to participate. Participants' age, vaccination status and diverse risk factors were assessed by a computer-assisted questionnaire. Biological specimens were obtained by self-sampling. HPV genotyping was performed by Linear Array. RESULTS A total of 2,118 women were recruited. 2,042 completed the questionnaire and 1,937 provided a vaginal sample. Vaccination coverage varied from 83.5% in women aged 17-19 to 19.1% in those aged 23-29. The overall prevalence of HPV in sexually active women was 39.4% (95%CI: 37.0-41.7) and 56.7% of infected women had multiple type infections. The prevalence of vaccine HPV types varied by age and vaccination status except for women aged 23-29 for whom similar results were observed. Vaccine HPV types were detected in 0.3%, 1.4% and 10.5% of vaccinated women aged 17-19, 20-23, and 23-29 (p<0.05), respectively. HPV16 or HPV18 were detected in 10 women having received at least one dose of vaccine. Nine of these women were already sexually active at the time of vaccination. CONCLUSION Infections with HPV types included in the vaccine are rare in women aged less than 23 years and are virtually absent in those who received at least one dose of vaccine before sexual debut.
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Affiliation(s)
- P Goggin
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - C Sauvageau
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - V Gilca
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - F Defay
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - G Lambert
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - S Mathieu-C
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,c Département de Psychopédagogie et D'andragogi, Faculté des Sciences de L'éducation , Université de Montréal , Montréal , Québec , Canada
| | - J Guenoun
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - E Comète
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - F Coutlée
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada.,e Département de Microbiologie et Immunologie , Université de Montréal , Montréal , Québec , Canada
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Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Watt C, Bhatia R, Moore C, Cubie H, Cruickshank M, Robertson C. Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1293-1302. [DOI: 10.1016/s1473-3099(17)30468-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023]
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College women, HPV genotyping and sexual behavior before HPV vaccination: Results from samples stored for a long time. J Infect Public Health 2017; 11:286-289. [PMID: 28993170 DOI: 10.1016/j.jiph.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 11/21/2022] Open
Abstract
HPV is the sexually transmitted agent most common among young people, like college students. The aim of study was to associate sexual behavior characteristics of women with HPV, detected in genital samples taken before the introduction of the HPV vaccine. Female students during 2001-2005 donated genital samples and the samples were re-analyzed in 2013 for HPV genotyping by RT-PCR. The frozen storage of the students' genital samples allowed the detection of HPV DNA and its genotyping after years of sample collection. HPV prevalence was 22%, HPV16 3.9%, and HPV18 1.1%. Age, multiple sexual partners and the partner's age at first sexual intercourse were significantly associated to HPV. Students with ≥ 3 sexual partners and who did not use condom had 12.8 higher odds of being HPV positive. These results made possible the analysis of HPV prevalence changes, before HPV vaccine introduction.
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38
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Aung ET, Fairley CK, Tabrizi SN, Danielewski JA, Ong JJ, Chen MY, Bradshaw CS, Chow EPF. Detection of human papillomavirus in urine among heterosexual men in relation to location of genital warts and circumcision status. Sex Transm Infect 2017; 94:222-225. [PMID: 28866637 DOI: 10.1136/sextrans-2016-053031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/01/2017] [Accepted: 08/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) surveillance is important to monitor the effectiveness of national HPV vaccination programmes. Positivity of HPV in urine in men varies with different sampling methods. We aimed to determine the positivity for detection of HPV-6/11 in urine samples among men in relation to the position of genital warts and circumcision status. METHOD We analysed stored chlamydia-positive urine specimens in young heterosexual men aged less than 25 years attending Melbourne Sexual Health Centre, Australia, between 2004 and 2015, for HPV genotypes. Positivity of HPV-6/11 and high-risk genotypes were stratified according to the position of genital warts and circumcision status. Positivity of HPV-6/11 was calculated using diagnosis of warts as the gold standard. Warts were classified as proximal penile warts from suprapubic area to midshaft of penis, and distal penile warts from distal shaft of penis to meatus. RESULTS Of the 934 specimens, 253 (27.1%) men were positive for any HPV and 82 men (8.8%) had genital warts. The ORs of HPV-6/11 detection in urine were 4.63 (95% CI: 1.68 to 12.78) and 40.20 (95% CI: 19.78 to 81.70) times higher among men who had proximal penile warts and distal penile warts, respectively, compared with men who did not have genital warts. Circumcised men were less likely to have high-risk HPV (OR 0.31; 95% CI: 0.14 to 0.65) than uncircumcised men. Uncircumcised men were more likely to have distal penile warts than circumcised men (OR 8.22; 95% CI: 1.34 to 337.46). CONCLUSION Positivity of HPV-6/11 in urine increases greatly in men with distal penile warts. Circumcised men are less likely to have distal penile warts, any HPV or high-risk HPV detected. Urine is likely to be an alternative sampling method for HPV-6/11 surveillance programme in men in countries with low circumcision rates.
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Affiliation(s)
- Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer A Danielewski
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Zhang L, Regan DG, Ong JJ, Gambhir M, Chow EP, Zou H, Law M, Hocking J, Fairley CK. Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective. Vaccine 2017; 35:4923-4929. [DOI: 10.1016/j.vaccine.2017.07.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
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Baussano I, Lazzarato F, Ronco G, Lehtinen M, Dillner J, Franceschi S. Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study. J Infect Dis 2017; 216:336-344. [PMID: 28859431 PMCID: PMC5853887 DOI: 10.1093/infdis/jix299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination is still not reaching many high-risk populations. HPV16/18 vaccines offer cross-protection against other types, for example, HPV45. Both direct vaccine efficacy and indirect herd protection contribute to vaccination effectiveness. Methods We used a dynamic transmission model, calibrated to cervical screening data from Italy, to estimate vaccination effectiveness against HPV16 and HPV45 infection, assuming for HPV45 either 95% or lower cross-protection. Results Basic reproductive number was smaller (2.1 vs 4.0) and hence vaccine effectiveness and herd protection stronger for HPV45 than for HPV16. The largest difference in the reduction of infection prevalence in women <35 years old was found at 70% coverage in girls-only vaccination programs (99% vs 83% for total protection for HPV45 and HPV16, respectively, mainly owing to stronger herd protection, ie, 37% vs 16%). In gender-neutral vaccination, the largest difference was at 40% coverage (herd protection, 54% vs 28% for HPV16 and HPV45, respectively). With ≥80% coverage, even 50% cross-protection would reduce HPV45 by ≥94%. Conclusions The characteristics of individual high-risk HPV types strongly influence herd protection and determine the level of coverage and cross-protection required to reduce or eliminate the infection through HPV vaccination. HPV16 infection and related cancers are the most difficult to eliminate.
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Affiliation(s)
| | - Fulvio Lazzarato
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology, AOU Città della Salute e della Scienza, Hospital of Turin
| | - Guglielmo Ronco
- Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology, Turin, Italy
| | - Matti Lehtinen
- University of Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
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Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, Marrazzo JM, Sonder GJB, Schwebke JR, Hoornenborg E, Peeling RW, Philip SS, Low N, Fairley CK. Sexually transmitted infections: challenges ahead. THE LANCET. INFECTIOUS DISEASES 2017; 17:e235-e279. [PMID: 28701272 DOI: 10.1016/s1473-3099(17)30310-9] [Citation(s) in RCA: 447] [Impact Index Per Article: 63.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
Abstract
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henry J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeanne M Marrazzo
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jane R Schwebke
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Elske Hoornenborg
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Rosanna W Peeling
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan S Philip
- Disease Prevention and Control Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
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Smith MA, Canfell K. Projected impact of HPV vaccination and primary HPV screening on cervical adenocarcinoma: Example from Australia. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:134-141. [PMID: 28720447 PMCID: PMC5883242 DOI: 10.1016/j.pvr.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 01/26/2023]
Abstract
Cytology-based cervical screening appears to have had a limited effect on the incidence of adenocarcinoma, however HPV vaccination and HPV-based screening will likely play a role in reducing future burden. Using Australia as an example, we estimated the future burden (2015-2040) of adenocarcinoma in the absence of other interventions; and the impact of HPV vaccination (introduced 2007) and HPV-based screening (commencing 2017). Future burden was estimated considering underlying trends in adenocarcinoma, using national data (1982-2010). The relative reduction in adenocarcinoma due to HPV vaccination and HPV-based screening was derived from observed clinical data. Adenocarcinoma incidence rates have been increasing since the early-mid 2000s (average annual increases from 3.0%(25-49 years) -8.1%(20-24 years)). If these trends continue, rates would increase from 1.4 to 2.4/100,000 in <50 years and from 2.2 to 4.4/100,000 in 50+ years by 2040. Taking into account coverage, HPV vaccination will reduce 2040 incidence by 36-39%, mainly in women <50 years (61% reduction). Taking into account uncertainties in trends and screening effectiveness, HPV-based screening will reduce incidence by an additional 19-43%, mainly in women 50+ years (additional 30-68% reduction). Together, these interventions will reduce incidence by 55-81%.
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Affiliation(s)
- Megan A Smith
- School of Public Health, University of Sydney, NSW 2006, Australia; Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
| | - Karen Canfell
- School of Public Health, University of Sydney, NSW 2006, Australia; Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
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Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States. Vaccine 2017; 35:3033-3040. [PMID: 28461067 DOI: 10.1016/j.vaccine.2017.04.060] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Together with access, acceptance of vaccines affects human papillomavirus (HPV) vaccine coverage, yet little is known about media's role. Our aim was to determine whether measures of information exposure derived from Twitter could be used to explain differences in coverage in the United States. METHODS We conducted an analysis of exposure to information about HPV vaccines on Twitter, derived from 273.8 million exposures to 258,418 tweets posted between 1 October 2013 and 30 October 2015. Tweets were classified by topic using machine learning methods. Proportional exposure to each topic was used to construct multivariable models for predicting state-level HPV vaccine coverage, and compared to multivariable models constructed using socioeconomic factors: poverty, education, and insurance. Outcome measures included correlations between coverage and the individual topics and socioeconomic factors; and differences in the predictive performance of the multivariable models. RESULTS Topics corresponding to media controversies were most closely correlated with coverage (both positively and negatively); education and insurance were highest among socioeconomic indicators. Measures of information exposure explained 68% of the variance in one dose 2015 HPV vaccine coverage in females (males: 63%). In comparison, models based on socioeconomic factors explained 42% of the variance in females (males: 40%). CONCLUSIONS Measures of information exposure derived from Twitter explained differences in coverage that were not explained by socioeconomic factors. Vaccine coverage was lower in states where safety concerns, misinformation, and conspiracies made up higher proportions of exposures, suggesting that negative representations of vaccines in the media may reflect or influence vaccine acceptance.
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Ali H, McManus H, O'Connor CC, Callander D, Kong M, Graham S, Saulo D, Fairley CK, Regan DG, Grulich A, Low N, Guy RJ, Donovan B. Human papillomavirus vaccination and genital warts in young Indigenous Australians: national sentinel surveillance data. Med J Aust 2017; 206:204-209. [PMID: 28301790 DOI: 10.5694/mja16.00597] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the impact of the national human papillomavirus (HPV) vaccination program (available to girls and women [12-26 years] since 2007 and to boys [12-15 years] since 2013) on the number of diagnoses of genital warts in Australian Aboriginal and Torres Strait Islander (Indigenous) people. DESIGN, SETTING, PARTICIPANTS Analysis of routinely collected data from patients attending 39 sexual health clinics (SHCs) in the Genital Warts Surveillance Network for the first time.Major outcome: The average annual proportion of Indigenous and non-Indigenous SHC patients diagnosed with genital warts during the pre-vaccination (2004-2007) and vaccination periods (2008-2014), stratified by age group and sex. RESULTS 7.3% of the 215 599 Australian-born patients with known Indigenous status and seen for the first time at participating SHCs during 2004-2014 were Indigenous Australians. The average proportion of female Indigenous patients diagnosed with warts was lower during the vaccination period than during the pre-vaccination period (in those under 21, summary rate ratio [SRR], 0.12; 95% CI, 0.07-0.21; P < 0.001); in 21-30-year olds: SRR, 0.41; 95% CI, 0.27-0.61; P < 0.001); there was no significant difference for women over 30 (SRR, 0.84; 95% CI, 0.51-1.36; P = 0.47). The proportion of male Indigenous heterosexual SHC patients under 21 diagnosed with warts was also lower during the vaccination period (SRR, 0.25; 95% CI, 0.12-0.49; P < 0.001), with no significant changes among older Indigenous men over 30. CONCLUSIONS There were marked declines in the proportions of diagnoses of genital warts in young Indigenous women and men attending SHCs after the introduction of the HPV vaccination program. If high levels of HPV vaccine coverage are sustained, HPV-related cancer rates should also decline.
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Affiliation(s)
- Hammad Ali
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | - Hamish McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | | | | | - Marlene Kong
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | | | - Dina Saulo
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | | | - David G Regan
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | - Andrew Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | - Nicola Low
- Institute of Social and Preventive Medicine, Universität Bern, Bern, Switzerland
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW
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Smith M, Canfell K. Impact of the Australian National Cervical Screening Program in women of different ages. Med J Aust 2017; 205:359-364. [PMID: 27736623 DOI: 10.5694/mja16.00289] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Australian National Cervical Screening Program (NCSP) will transition in 2017 from cytology-based screening every two years, starting from age 18-20 years, to HPV-based screening every 5 years, starting from age 25. To examine the impact of the program before this transition we analysed trends in the incidence of cervical cancer, by age and histological subtype. DESIGN, SETTING AND PARTICIPANTS National cervical cancer incidence data, 1982-2010. MAIN OUTCOME MEASURES Standardised rate ratios (SRR) for 3-yearly average cervical cancer incidence, relative to the rate during 1988-1990, by age group and histological type. RESULTS Between 1988-1990 and 2008-2010, cervical cancer incidence fell substantially in women aged 25-49 (SRR, 0.55; 95% CI, 0.51-0.59), 50-69 (SRR, 0.46; 95% CI, 0.42-0.51) and 70 years or more (SRR, 0.50; 95% CI, 0.43-0.58), but not in women aged 20-24 years (SRR, 0.70; 95% CI, 0.46-1.05). These declines were primarily driven by drops in squamous cell carcinoma (SCC) in women aged 25-49 (SRR, 0.50; 95% CI, 0.46-0.55), 50-69 (SRR, 0.39; 95% CI, 0.35-0.45) and more than 70 years (SRR, 0.43; 95% CI, 0.36-0.51). However, rates have now plateaued in women aged 25-69 years. The incidence of adenocarcinoma did not consistently decline across the program period in any age group. The incidence of neither SCC (SRR, 0.91; 95% CI, 0.55-1.51) nor adenocarcinoma (SRR, 0.91; 95% CI, 0.35-2.40) declined in women aged 20-24 years. CONCLUSION Although women aged 20-24 years have been included in the NCSP since its inception, no significant impact on cervical cancer incidence was observed in this age group. The NCSP has had a substantial impact on SCC and overall cervical cancer incidence in women aged 25 years and over. Its impact on the incidence of adenocarcinoma, in contrast, has been limited.
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After a Decade of Human Papillomavirus Vaccination, How to Bend the Vaccination Uptake Curve Upward. J Low Genit Tract Dis 2017; 21:1-3. [DOI: 10.1097/lgt.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beyranvand Nejad E, Welters MJP, Arens R, van der Burg SH. The importance of correctly timing cancer immunotherapy. Expert Opin Biol Ther 2016; 17:87-103. [PMID: 27802061 DOI: 10.1080/14712598.2017.1256388] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The treatment options for cancer-surgery, radiotherapy and chemotherapy-are now supplemented with immunotherapy. Previously underappreciated but now gaining strong interest are the immune modulatory properties of the three conventional modalities. Moreover, there is a better understanding of the needs and potential of the different immune therapeutic platforms. Key to improved treatment will be the combinations of modalities that complete each other's shortcomings. Area covered: Tumor-specific T-cells are required for optimal immunotherapy. In this review, the authors focus on the correct timing of different types of chemotherapeutic agents or immune modulators and immunotherapeutic drugs, not only for the activation and expansion of tumor-specific T-cells but also to support and enhance their anti-tumor efficacy. Expert opinion: At an early phase of disease, clinical success can be obtained using single treatment modalities but at later disease stages, combinations of several modalities are required. The gain in success is determined by a thorough understanding of the direct and indirect immune effects of the modalities used. Profound knowledge of these effects requires optimal tuning of immunomonitoring. This will guide the appropriate combination of treatments and allow for correct sequencing the order and interval of the different therapeutic modalities.
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Affiliation(s)
- Elham Beyranvand Nejad
- a Department of Medical Oncology , Leiden University Medical Center , Leiden , The Netherlands.,b Department of Immunohematology and Blood Transfusion , Leiden University Medical Center , Leiden , The Netherlands
| | - Marij J P Welters
- a Department of Medical Oncology , Leiden University Medical Center , Leiden , The Netherlands
| | - Ramon Arens
- b Department of Immunohematology and Blood Transfusion , Leiden University Medical Center , Leiden , The Netherlands
| | - Sjoerd H van der Burg
- a Department of Medical Oncology , Leiden University Medical Center , Leiden , The Netherlands
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Kahn JA, Widdice LE, Ding L, Huang B, Brown DR, Franco EL, Bernstein DI. Substantial Decline in Vaccine-Type Human Papillomavirus (HPV) Among Vaccinated Young Women During the First 8 Years After HPV Vaccine Introduction in a Community. Clin Infect Dis 2016; 63:1281-1287. [PMID: 27655996 DOI: 10.1093/cid/ciw533] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine effectiveness and herd protection are not well established in community settings. Our objective was to determine trends in vaccine-type HPV in young women during the 8 years after vaccine introduction, to assess changes in HPV prevalence and characterize herd protection in a community. METHODS We recruited 3 samples of sexually experienced, 13-26-year-old adolescent girls and young women (hereafter women; N = 1180) from 2006-2014: before widespread vaccine introduction (wave 1) and 3 (wave 2) and 7 (wave 3) years after vaccine introduction. We determined the prevalence of vaccine-type HPV (HPV-6, -11, -16, and -18) among all, vaccinated, and unvaccinated women at waves 1, 2, and 3, adjusted for differences in participant characteristics, then examined whether changes in HPV prevalence were significant using inverse propensity score-weighted logistic regression. RESULTS Vaccination rates increased from 0% to 71.3% across the 3 waves. Adjusted vaccine-type HPV prevalence changed from 34.8% to 8.7% (75.0% decline) in all women, from 34.9% to 3.2% (90.8% decline) in vaccinated women, and from 32.5% to 22.0% (32.3% decline) in unvaccinated women. Among vaccinated participants, vaccine-type HPV prevalence decreased significantly from wave 1 to wave 2 (adjusted odds ratio, 0.21; 95% confidence interval, .13-.34) and from wave 1 to wave 3 (0.06; .03-.13). The same decreases were also significant among unvaccinated participants (adjusted odds ratios, 0.44; [95% confidence interval, .27-.71] and 0.59; [.35-.98], respectively). CONCLUSIONS The prevalence of vaccine-type HPV decreased >90% in vaccinated women, demonstrating high effectiveness in a community setting, and >30% in unvaccinated women, providing evidence of herd protection.
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Affiliation(s)
- Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Lea E Widdice
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Lili Ding
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Darron R Brown
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
| | - Eduardo L Franco
- Department of Oncology and Department of Epidemiology & Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - David I Bernstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
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Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme: a retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2016; 17:68-77. [PMID: 27282422 DOI: 10.1016/s1473-3099(16)30116-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Australia introduced a national quadrivalent human papillomavirus (4vHPV) vaccination programme for girls and young women in April, 2007. The HPV genotypes targeted by the female vaccine could also affect the protection afforded to heterosexual men. We examined the prevalence of 4vHPV targeted vaccine genotypes and the nine-valent HPV (9vHPV)-targeted vaccines genotypes among sexually active, predominantly unvaccinated heterosexual men from 2004 to 2015. METHODS We did a retrospective, observational study of urine and urethral swab specimens from heterosexual men aged 25 years or younger attending the Melbourne Sexual Health Centre between July 1, 2004, and June 30, 2015, who tested positive for Chlamydia trachomatis. We extracted HPV DNA and used the PapType HPV assay to detect 14 high-risk HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and two low-risk genotypes (6 and 11). We calculated the prevalence of any HPV genotype, genotypes 6 or 11, genotypes 16 or 18, genotypes in the 4vHPV group (6, 11, 16, or 18), five additional genotypes in the 9vHPV group (31, 33, 45, 52, or 58), and non-vaccine-targeted genotypes (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, or 68). FINDINGS We obtained data between July 1, 2004, and June 30, 2015, and did the data analysis in December, 2015. Of 1764 specimens obtained, we included 1466 in our final analysis (the others were excluded because they had indeterminate results or were duplicates). The prevalence of any HPV genotype and genotypes 31, 33, 45, 52, and 58 did not change from 2004-05 to 2014-15, but we noted reductions in genotypes 6 and 11 (from 12% [95% CI 6-21%], to 3% [1-7%], ptrend=0·008), 16 and 18 (from 13% [95% CI 7-22%] to 3% [1-6%], ptrend<0·0001), and 4vHPV-targeted genotypes (from 22% [95% CI 14-33%] to 6% [3-10%], ptrend<0·0001). Prevalence of non-vaccine-targeted genotypes increased from 16% [95% CI 9-26%] to 22% [17-29%], ptrend<0·0001). In Australian-born men, 4vHPV-targeted genotype prevalence decreased from 11 of 55 [20%, 95% CI 10-33%] to two of 74 [3%, 0-11%], ptrend<0·0001); an even greater decline occurred in Australian-born men aged 21 years or younger (from four of 13 [31%, 95% CI 9-61%] to none of 25; ptrend<0·0001). Genotypes 16 and 18 decreased (adjusted prevalence ratio [PR] 0·32, 95% CI 0·14-0·74; p=0·008) but not genotypes 6 and 11 (adjusted PR 0·50, 0·16-1·56; p=0·234) in the postvaccination period among men who had arrived in Australia within 2 years from countries with a bivalent vaccine (2vHPV) programme (England, Scotland, Wales, Cook Islands, Northern Ireland, or the Netherlands), compared with the prevaccination period. No change was noted in 4vHPV genotypes in men born overseas in other countries. INTERPRETATION The marked reduction in prevalence of 4vHPV genotypes among mainly unvaccinated Australian-born men suggests herd protection has occurred from the female vaccination programme. Additionally, the decline in genotypes 16 and 18, but not genotypes 6 and 11, among overseas-born men predominantly from countries with a 2vHPV vaccine programme suggests that these men received benefits from herd protection for genotypes 16 and 18 from their vaccinated female partners in their own countries. These reductions could translate to reductions in HPV-related malignant conditions in men, even in countries with female-only vaccination programmes. FUNDING The Australian National Health and Medical Research Council Program.
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Chow EPF, Fairley CK. Assortative sexual mixing among heterosexuals in Australia: implications for herd protection in males from a female human papillomavirus vaccination program. Sex Health 2016; 13:SH15246. [PMID: 27144872 DOI: 10.1071/sh15246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/09/2016] [Indexed: 02/28/2024]
Abstract
The aim was to investigate the assortative sexual mixing by country of birth among heterosexuals in Australia. An analysis of 1060 heterosexual couples who attended the Melbourne Sexual Health Centre between 2011 and 2014 was conducted. Of the 1060 couples, 27% (n = 281) were both Australian-born men and women, and 42% (n = 445) were both overseas-born. Of the 171 couples with women aged ≤21 years, 41% (n = 70) were both born in Australia and 33% (n = 56) were both born overseas. A strong assortative mixing pattern by country of birth was observed among all 1060 couples (r = 0.361; 95% CI: 0.320-0.403), and among 171 couples with women aged ≤21 years (r = 0.481; 95% CI: 0.379-0.584).
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