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de Azevedo Bispo RK, Fonseca MCM, de Góis Speck NM. Prevalence and Type of HPV Genital Infection in Girls: A Systematic Review and Meta-Analysis. J Low Genit Tract Dis 2024:00128360-990000000-00127. [PMID: 39058320 DOI: 10.1097/lgt.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This investigation explored the prevalence of human papillomavirus (HPV) infection by subtypes in girls aged up to 12. METHODS Four indexed databases, PubMed, EMBASE, Cochrane, and LILACS, were evaluated. Twenty-nine observational studies published between 1992 and 2018 were included. RESULTS The prevalence of genital condyloma acuminatum or HPV-positive serology due to prior infection among girls with suspected/confirmed sexual abuse was 25%, and without a history or information about abuse, 8%. The analysis indicated that low-risk HPV types were the most prevalent among this group, corresponding to 86.6% of the identified types. Human papillomavirus 6 and 11 were the most prevalent types, followed by HPV 16 and 2. Moreover, the analysis identified limited epidemiological data on genital warts in children up to 12 years. Several studies focused on convenience sampling, sexually abused girls, or failed to separate data by gender. CONCLUSION Findings of our systematic review and prevalence meta-analysis indicate that the occurrence of HPV infection in girls aged 12 or younger is relatively rare, underscoring the significance of understanding the prevalence of HPV in the pediatric population. However, it is essential to be cautious when applying these results to the pediatric population, given cases of girls who are suspected of or have suffered sexual abuse. There is a pressing need for further research to fill the information gap on HPV infection in this vulnerable group.
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Affiliation(s)
| | | | - Neila Maria de Góis Speck
- Postgraduate Program at Department of Gynecology at the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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2
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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3
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Loenenbach A, Pawlita M, Waterboer T, Harder T, Poethko-Müller C, Thamm M, Lachmann R, Deleré Y, Wichmann O, Wiese-Posselt M. Seroprevalence of mucosal and cutaneous human papillomavirus (HPV) types among children and adolescents in the general population in Germany. BMC Infect Dis 2022; 22:44. [PMID: 35012452 PMCID: PMC8751243 DOI: 10.1186/s12879-022-07028-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background In Germany, HPV vaccination of adolescent girls was introduced in 2007. Nationally representative data on the distribution of vaccine-relevant HPV types in the pre-vaccination era are, however, only available for the adult population. To obtain data in children and adolescents, we assessed the prevalence and determinants of serological response to 16 different HPV types in a representative sample of 12,257 boys and girls aged 1–17 years living in Germany in 2003–2005. Methods Serum samples were tested for antibodies to nine mucosal and seven cutaneous HPV types. The samples had been collected during the nationally representative German Health Interview and Examination Survey for Children and Adolescents in 2003–2006. We calculated age- and gender-specific HPV seroprevalence. We used multivariable regression models to identify associations between demographic and behavioral characteristics and HPV seropositivity. Results We found low but non-zero seroprevalence for the majority of tested HPV types among children and adolescents in Germany. The overall seroprevalence of HPV-16 was 2.6%, with slightly higher values in adolescents. Seroprevalence of all mucosal types but HPV-6 ranged from 0.6% for HPV-33, to 6.4% for HPV-31 and did not differ by gender. We found high overall seroprevalence for HPV-6 with 24.8%. Cutaneous HPV type seroprevalence ranged from 4.0% for HPV-38 to 31.7% for HPV-1. In the majority of cutaneous types, seroprevalence did not differ between boys and girls, but increased sharply with age, (e.g., HPV-1 from 1.5% in 1–3-years-old to 45.1% in 10–11-years-old). Associations between behavioral factors and type-specific HPV prevalence were determined to be heterogeneous. Conclusions We report the first nationally representative data of naturally acquired HPV antibody reactivity in the pre-HPV-vaccination era among children and adolescents living in Germany. These data can be used as baseline estimates for evaluating the impact of the current HPV vaccination strategy targeting 9–14-years-old boys and girls. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07028-8.
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Affiliation(s)
- Anna Loenenbach
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch-Institute, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Harder
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch-Institute, Berlin, Germany
| | | | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Raskit Lachmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch-Institute, Berlin, Germany
| | | | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch-Institute, Berlin, Germany
| | - Miriam Wiese-Posselt
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch-Institute, Berlin, Germany.,Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
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4
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King EM, Mesher D, Sonnenberg P, Linley E, Panwar K, Beddows S, Soldan K, Borrow R, Jit M, Gilson R. HPV16 and HPV18 seropositivity and DNA detection among men who have sex with men: a cross-sectional study conducted in a sexual health clinic in London. Sex Transm Infect 2020; 97:382-386. [PMID: 33361466 PMCID: PMC8311088 DOI: 10.1136/sextrans-2020-054726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives Men who have sex with men (MSM) have an increased risk of human papillomavirus (HPV) infection and related diseases compared with men who have sex exclusively with women. From April 2018, there has been a phased roll-out of HPV vaccination offered to MSM aged up to 45 years old who are attending sexual health clinics and HIV clinics in England. The vaccine is most effective if delivered prior to HPV infection. We estimated the proportion of MSM with no current vaccine-type infection and no serological evidence of prior infection, in a study undertaken prior to vaccine introduction. Methods We conducted a cross-sectional study among 484 MSM aged 18–40 years old who attended a sexual health clinic in London between 2010 and 2012. We estimated the prevalence of current and past infection by testing for HPV DNA in anogenital samples and for serum antibodies to HPV16 and HPV18. Results The median age was 30 years (IQR 25–35). The prevalence of HPV16 and HPV18 DNA was 13.2% and 6.2%, respectively. Seropositivity for HPV16 and HPV18 was 28.5% and 17.1%, respectively, with 11.4% seropositive for both types. Seropositivity for the same HPV type was strongly associated with anogenital DNA detection. 279 MSM (57.6%) tested negative for both HPV16 and HPV18 serology and were DNA negative for these two types; only 5 MSM (1.0%) were seropositive and DNA positive for both HPV types. Conclusions This is the first study to determine both the prevalence of HPV DNA in anogenital samples and HPV seroprevalence among MSM attending a sexual health clinic in the UK. Over half of MSM in this study had no evidence of a previous or current infection with either of the high-risk HPV types included in the quadrivalent vaccine, which supports the rationale for opportunistic HPV vaccination of MSM attending sexual health clinics.
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Affiliation(s)
- Eleanor M King
- Institute for Global Health, University College London, London, UK
| | - David Mesher
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Ezra Linley
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, UK
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK
| | - Kate Soldan
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK.,Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK .,The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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5
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Anh DD, Choisy M, Clapham HE, Cuong HQ, Dung VTV, Duong TN, Hang NLK, Ha HTT, Hien NT, Hoa TTN, Hung TTM, Huong VTL, Huyen DTT, Khanh NC, Lewycka SO, Linley E, Mai LTQ, Nadjm B, Nghia ND, Pebody R, Phuong HVM, Tan LM, Van Tan L, Thai PQ, Thanh LV, Le Thanh NT, Thuy NTT, Thuong NT, Thanh LT, Thao NTT, Tuan NA, Uyen PTN, Rogier van Doorn H. Plans for Nationwide Serosurveillance Network in Vietnam. Emerg Infect Dis 2019; 26. [PMID: 31855527 PMCID: PMC6924907 DOI: 10.3201/eid2601.190641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In recent years, serosurveillance has gained momentum as a way of determining disease transmission and immunity in populations, particularly with respect to vaccine-preventable diseases. At the end of 2017, the Oxford University Clinical Research Unit and the National Institute of Hygiene and Epidemiology held a meeting in Vietnam with national policy makers, researchers, and international experts to discuss current seroepidemiologic projects in Vietnam and future needs and plans for nationwide serosurveillance. This report summarizes the meeting and the plans that were discussed to set up nationwide serosurveillance in Vietnam.
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Gilham C, Sargent A, Peto J. Triaging women with human papillomavirus infection and normal cytology or low-grade dyskaryosis: evidence from 10-year follow up of the ARTISTIC trial cohort. BJOG 2019; 127:58-68. [PMID: 31541495 PMCID: PMC6916371 DOI: 10.1111/1471-0528.15957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 12/12/2022]
Abstract
Objectives To estimate long‐term cervical intraepithelial neoplasia grade 3 (CIN3) risks associated with different triage strategies for human papillomavirus positive (HPV+) women with a view to reducing unnecessary referrals. Design The ARTISTIC trial cohort was recruited in Manchester in 2001–03 and was followed up for CIN3 and cancer notification through national registration until December 2015. Results The 10‐year cumulative risk of CIN3+ was much higher for women with HPV16/18 infection (19.4%, 95% CI 15.8–23.8% with borderline/low‐grade cytology and 10.7%, 95% CI 8.3–13.9% with normal cytology) than for those with other HPV types (7.3%, 95% CI 5.4–9.7% with borderline/low‐grade cytology and 3.2%, 95% CI 2.2–4.5% with normal cytology). Among the 379 women with normal to low‐grade cytology and new HPV infection, the 10‐year cumulative CIN3+ risk was 2.9% (95% CI 1.6–5.2%). Conclusions The CIN3 risk is confined to women with persistent type‐specific HPV so partial genotyping test assays identifying HPV16/18 as a minimum are essential for efficient risk stratification. Immediate referral to colposcopy for HPV+ women with borderline or low‐grade cytology and referral after a year if still HPV+ with normal cytology may be unnecessary. Low‐grade lesions can safely be retested to identify those with persistent HPV. Recall intervals of 1 year for HPV16/18 and 2 years for other high‐risk HPVs are justified for women with normal cytology and might also be considered for women with borderline/low‐grade cytology. The minimal risk of invasive cancer that has progressed beyond stage 1A must be weighed against the advantages for patients and the NHS of reducing the number of referrals to colposcopy. Tweetable abstract Cervical screening would be better for women and cheaper for the NHS if women with HPV and normal to low‐grade cytology were retested after a year or two when many infections will have cleared. Cervical screening would be better for women and cheaper for the NHS if women with HPV and normal to low‐grade cytology were retested after a year or two when many infections will have cleared.
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Affiliation(s)
- C Gilham
- London School of Hygiene & Tropical Medicine, London, UK
| | - A Sargent
- Clinical Virology, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Peto
- London School of Hygiene & Tropical Medicine, London, UK
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Mousa M, Al-Amri SS, Degnah AA, Tolah AM, Abduljabbar HH, Oraif AM, Abduljabbar HS, Mirza AA, Azhar EI, Hashem AM. Prevalence of human papillomavirus in Jeddah, Saudi Arabia. Ann Saudi Med 2019; 39:403-409. [PMID: 31804132 PMCID: PMC6894452 DOI: 10.5144/0256-4947.2019.403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Human papillomaviruses (HPVs) are small, non-enveloped, double-stranded DNA viruses that consist of more than 200 genotypes. Low-risk genotypes are associated with warts or benign lesions, whereas high-risk genotypes are usually associated with malignancies and cancers including cervical cancer. However, the real prevalence and incidence of HPV in Saudi Arabia may be understated due to a lack of comprehensive data reporting. OBJECTIVES Determine the positivity rate of HPV in men and women in Jeddah, Saudi Arabia. DESIGN Cross-sectional. SETTING Tertiary care center in Jeddah. SUBJECTS AND METHODS Self-collected vaginal swab samples were obtained from females attending the gynecological clinic in the period between October 2017 and April 2018 at a tertiary care center, Jeddah, Saudi Arabia. PCR-positive HPV samples were sequenced to determine genotype. Additionally, serum samples were collected from healthy male and female blood donors and screened for HPV IgG antibodies by ELISA. MAIN OUTCOME MEASURES Molecular and serological positivity for HPV. SAMPLE SIZE 119 self-collected vaginal swabs from females at a gynecology clinic and 966 serum samples from healthy blood donors. RESULTS Of the 119 tested vaginal swabs, 7 samples (5.9%) were positive for HPV DNA. Several genotypes were identified. Most of the positive samples were from Saudi females in the age range of 31-50 years seeking care for infertility. Of the 966 serum samples, only 16 samples (1.7%) were positive for HPV IgG antibodies. CONCLUSION While the prevalence of HPV in men and women in our sample from the western region of Saudi Arabia was low, our data clearly show that it is not uncommon among high-risk groups and people are still exposed to the risk of HPV infection. Most importantly, these data provide valuable information that could aid in enhancing national awareness about HPV and in introducing an HPV vaccination program. LIMITATIONS Single hospital and a convenience sample CONFLICT OF INTEREST: None.
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Affiliation(s)
- Manar Mousa
- From the Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sawsan S Al-Amri
- From the Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Afnan A Degnah
- From the Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,From the Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Tolah
- From the Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanin H Abduljabbar
- From the Reproductive endocrinology and infertility unit, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ayman M Oraif
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hassan S Abduljabbar
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Mirza
- From the Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I Azhar
- From the Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,From the Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anwar M Hashem
- From the Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,From the Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
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Datta S, Pink J, Medley GF, Petrou S, Staniszewska S, Underwood M, Sonnenberg P, Keeling MJ. Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infect Dis 2019; 19:552. [PMID: 31234784 PMCID: PMC6591963 DOI: 10.1186/s12879-019-4108-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection. METHODS We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection. RESULTS At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective. CONCLUSIONS Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.
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Affiliation(s)
- Samik Datta
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK. .,National Institute of Water and Atmospheric Research, Wellington, 6021, New Zealand.
| | - Joshua Pink
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Graham F Medley
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Sophie Staniszewska
- Royal College of Nursing Research Institute, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Matt J Keeling
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK
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Morris BJ, Hankins CA, Banerjee J, Lumbers ER, Mindel A, Klausner JD, Krieger JN. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Front Public Health 2019; 7:4. [PMID: 30766863 PMCID: PMC6365441 DOI: 10.3389/fpubh.2019.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Male circumcision (MC) is proven to substantially reduce men's risk of a number of sexually transmitted infections (STIs). We conducted a detailed systematic review of the scientific literature to determine the relationship between MC and risk of STIs and associated conditions in women. Methods: Database searches by "circumcision women" and "circumcision female" identified 68 relevant articles for inclusion. Examination of bibliographies of these yielded 14 further publications. Each was rated for quality using a conventional rating system. Results: Evaluation of the data from the studies retrieved showed that MC is associated with a reduced risk in women of being infected by oncogenic human papillomavirus (HPV) genotypes and of contracting cervical cancer. Data from randomized controlled trials and other studies has confirmed that partner MC reduces women's risk not only of oncogenic HPV, but as well Trichomonas vaginalis, bacterial vaginosis and possibly genital ulcer disease. For herpes simplex virus type 2, Chlamydia trachomatis, Treponema pallidum, human immunodeficiency virus and candidiasis, the evidence is mixed. Male partner MC did not reduce risk of gonorrhea, Mycoplasma genitalium, dysuria or vaginal discharge in women. Conclusion: MC reduces risk of oncogenic HPV genotypes, cervical cancer, T. vaginalis, bacterial vaginosis and possibly genital ulcer disease in women. The reduction in risk of these STIs and cervical cancer adds to the data supporting global efforts to deploy MC as a health-promoting and life-saving public health measure and supplements other STI prevention strategies.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
| | - Catherine A. Hankins
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | | | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey D. Klausner
- Division of Infectious Diseases and the Program in Global Health, Fielding School of Public Health, University of California Los Angeles Care Center, Los Angeles, CA, United States
| | - John N. Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
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10
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Jit M, Brisson M. Potential lives saved in 73 countries by adopting multi-cohort vaccination of 9-14-year-old girls against human papillomavirus. Int J Cancer 2018; 143:317-323. [PMID: 29446090 PMCID: PMC6001440 DOI: 10.1002/ijc.31321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/17/2022]
Abstract
Up to 2016, low- and middle-income countries mostly introduced routine human papillomavirus (HPV) vaccination for just a single age-cohort of girls each year. However, high-income countries have reported large reductions in HPV prevalence following "catch-up" vaccination of multiple age-cohorts in the year of HPV vaccine introduction. We used the mathematical model PRIME to project the incremental impact of vaccinating 10- to 14-year-old girls compared to routine HPV vaccination only in the same year that routine vaccination is expected to be introduced for 9-year-old girls across 73 low- and lower-middle-income countries. Adding multiple age-cohort vaccination could increase the number of cervical cancer deaths averted by vaccine introductions in 2015-2030 by 30-40% or an additional 1.23-1.79 million over the lifetime of the vaccinated cohorts. The number of girls needed to vaccinate to prevent one death is 101 in the most pessimistic scenario, which is only slightly greater than that for routine vaccination of 9-year-old girls (87). These results hold even when assuming that girls who have sexually debuted do not benefit from vaccination. Results suggest that multiple age-cohort vaccination of 9- to 14-year-old girls could accelerate HPV vaccine impact and be cost-effective.
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Affiliation(s)
- Mark Jit
- London School of Hygiene & Tropical MedicineLondonWC1E 7HTUnited Kingdom
- Public Health EnglandLondonWC1E 7HTUnited Kingdom
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Université LavalLondonWC1E 7HTUnited Kingdom
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11
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Mupandawana ET, Cross R. Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study. Reprod Health 2016; 13:97. [PMID: 27549328 PMCID: PMC4994299 DOI: 10.1186/s12978-016-0209-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12-13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher. The study's objectives were to explore factors influencing UK based African parents' acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views. METHODS A qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing. RESULTS HPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it's still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person's disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood. CONCLUSION Tailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.
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Affiliation(s)
| | - Ruth Cross
- Leeds Beckett University, 518 Calverley, Portland Way, LS1 3HE, UK
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12
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Brabin L, Kitchener HC, Stern PL. Implementation of prophylactic HPV vaccination: progress and future challenges. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Comparison of different assays to assess human papillomavirus (HPV) type 16- and 18-specific antibodies after HPV infection and vaccination. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1329-32. [PMID: 23740920 DOI: 10.1128/cvi.00153-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We compared the measurement of human papillomavirus (HPV)-specific serum antibody levels with the virus-like-particle multiplex immunoassay (VLP-MIA), competitive Luminex immunoassay (cLIA), and glutathione S-transferase (GST) L1-based MIA. Using a large panel of serum samples, these assays showed mutually good correlations for both naturally induced and vaccine-derived HPV-specific antibody levels. However, an adaptation of the GST L1-based MIA resulted in an improved correlation with both cLIA and VLP-MIA.
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14
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Draper E, Bissett SL, Howell-Jones R, Waight P, Soldan K, Jit M, Andrews N, Miller E, Beddows S. A randomized, observer-blinded immunogenicity trial of Cervarix(®) and Gardasil(®) Human Papillomavirus vaccines in 12-15 year old girls. PLoS One 2013; 8:e61825. [PMID: 23650505 PMCID: PMC3641072 DOI: 10.1371/journal.pone.0061825] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/12/2013] [Indexed: 12/04/2022] Open
Abstract
Background The current generation of Human Papillomavirus (HPV) vaccines, Cervarix® and Gardasil®, exhibit a high degree of efficacy in clinical trials against the two high-risk (HR) genotypes represented in the vaccines (HPV16 and HPV18). High levels of neutralizing antibodies are elicited against the vaccine types, consistent with preclinical data showing that neutralizing antibodies can mediate type-specific protection in the absence of other immune effectors. The vaccines also confer protection against some closely related non-vaccine HR HPV types, although the vaccines appear to differ in their degree of cross-protection. The mechanism of vaccine-induced cross-protection is unknown. This study sought to compare the breadth and magnitudes of neutralizing antibodies against non-vaccine types elicited by both vaccines and establish whether such antibodies could be detected in the genital secretions of vaccinated individuals. Methods and Findings Serum and genital samples were collected from 12–15 year old girls following vaccination with either Cervarix® (n = 96) or Gardasil® (n = 102) HPV vaccine. Serum-neutralizing antibody responses against non-vaccine HPV types were broader and of higher magnitude in the Cervarix®, compared to the Gardasil®, vaccinated individuals. Levels of neutralizing and binding antibodies in genital secretions were closely associated with those found in the serum (r = 0.869), with Cervarix® having a median 2.5 (inter-quartile range, 1.7–3.5) fold higher geometric mean HPV-specific IgG ratio in serum and genital samples than Gardasil® (p = 0.0047). There was a strong positive association between cross-neutralizing antibody seropositivity and available HPV vaccine trial efficacy data against non-vaccine types. Conclusions These data demonstrate for the first time that cross-neutralizing antibodies can be detected at the genital site of infection and support the possibility that cross-neutralizing antibodies play a role in the cross-protection against HPV infection and disease that has been reported for the current HPV vaccines. Trial Registration ClinicalTrials.gov NCT00956553
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Affiliation(s)
- Eve Draper
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - Sara L. Bissett
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | | | - Pauline Waight
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, London, United Kingdom
| | - Kate Soldan
- HIV/STI Department, Health Protection Agency, London, United Kingdom
| | - Mark Jit
- Statistics, Modelling and Economics Department, Health Protection Agency, London, United Kingdom
| | - Nicholas Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, United Kingdom
| | - Elizabeth Miller
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Health Protection Agency, London, United Kingdom
- * E-mail:
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15
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Nicol AF, Grinsztejn B, Friedman RK, Veloso VG, Cunha CB, Georg I, Pilotto JH, Moreira RI, Castro CAV, Silver B, Viscidi RP. Seroprevalence of HPV vaccine types 6, 11, 16 and 18 in HIV-infected and uninfected women from Brazil. J Clin Virol 2013; 57:147-51. [PMID: 23490398 DOI: 10.1016/j.jcv.2013.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/04/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information on vaccine-type HPV seroprevalence is essential for vaccine strategies; however, limited data are available on past exposure to HPV-quadrivalent vaccine types in HIV-infected woman in Brazil. OBJECTIVES To assess the seroprevalence for HPV types 6, 11, 16 and 18 in HIV-infected and uninfected women, from Rio de Janeiro, Brazil and to investigate potential associations with age and pregnancy status. STUDY-DESIGN 1100-sera were tested by virus-like particle (VLPs)-based ELISA for antibodies to HPV types 16, 18, 6 and 11. Statistical analysis was carried out by STATA/SE 10.1 and comparisons among HIV-infected and HIV-uninfected women were assessed by Poisson regression models with robust variance. RESULTS HPV-6, 11, 16 and 18 seroprevalence was significantly higher among HIV-positive women (29.9%, 8.5%, 56.2% and 38.0%, respectively) compared to HIV-negative women (10.9%, 3.5%, 30.8% and 21.7%, respectively), when adjusted by age and pregnancy status. Overall, 69.4% of HIV-infected and 41.5% of HIV-uninfected women tested positive for any HPV quadrivalent vaccine type. However 4.7% and 1.1%, respectively, tested positive for all HPV vaccine type. In HIV-uninfected women who were pregnant, we found a higher HPV-11 seroprevalence (8.5% vs. 1.5%; P < 0.001) and a lower HPV 16 seroprevalence (22.6% vs. 34.2%; P = 0.010) compared to not pregnant women. HIV-uninfected women, aged 40 or more years old had a higher HPV 16 seroprevalence compared to women aged less than 40 years old. CONCLUSIONS We did not observe a strong association between age and positive HPV antibodies nor an association between pregnancy and HPV seroprevalence. HPV seroprevalence was significantly higher among HIV-infected women compared to HIV negative women. In both populations the seroprevalence to all four HPV vaccine types was low suggesting that women may potentially benefit from the HPV vaccines.
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Affiliation(s)
- A F Nicol
- Laboratory of Interdisciplinary Medicine, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil.
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16
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Scherpenisse M, Mollers M, Schepp RM, Boot HJ, de Melker HE, Meijer CJLM, Berbers GAM, van der Klis FRM. Seroprevalence of seven high-risk HPV types in The Netherlands. Vaccine 2012; 30:6686-93. [PMID: 22959981 DOI: 10.1016/j.vaccine.2012.08.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 06/07/2012] [Accepted: 08/28/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND To obtain insight into the age-specific seroprevalence for seven high-risk human papillomavirus (hr-HPV) serotypes (HPV16, 18, 31, 33, 45, 52, and 58) among the general population in the pre-vaccination era in The Netherlands. METHODS From a cross-sectional population-based study (ISRCTN 20164309) performed in 2006/2007 6384 sera of men, women and children were tested for seven hr-HPV specific antibodies using a fluorescent bead-based multiplex immunoassay with virus-like particles of the seven HPV serotypes. RESULTS An increase in seroprevalence was observed in adolescents, especially for the most prevalent HPV type 16 (up to 11.3%). The increase was most pronounced in women, but was less clear for the other six HPV serotypes. Relatively stable seroprevalences were found in the middle aged cohorts and a slight decrease in the elderly. For the age cohorts >14 years, the seroprevalence among women (25.2%) was higher compared with men (20.3%) (p=0.0002). We found that 10.1% of the population was seropositive for multiple HPV serotypes. CONCLUSIONS The HPV vaccination program is targeted at preadolescents as is justified by the results in this study in which a step-up in HPV seroprevalence is observed at ages of sexual debut. Although direct interpretation of seroprevalence data are hampered by cross-reactivity and seroconversion rate, these data are useful as baseline to evaluate long-term population effects of the HPV16/18 vaccination program.
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Affiliation(s)
- Mirte Scherpenisse
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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17
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Howell-Jones R, de Silva N, Akpan M, Oakeshott P, Carder C, Coupland L, Sillis M, Mallinson H, Ellis V, Frodsham D, Robinson TI, Gill ON, Beddows S, Soldan K. Prevalence of human papillomavirus (HPV) infections in sexually active adolescents and young women in England, prior to widespread HPV immunisation. Vaccine 2012; 30:3867-75. [PMID: 22516212 DOI: 10.1016/j.vaccine.2012.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 03/08/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The introduction of an HPV immunisation programme in England should result in a significant reduction in the prevalence of vaccine type infections in young women. Here we describe type-specific HPV prevalence in three samples of the young female population in England, prior to the beginning of mass immunisation in 2008. METHODS Residual vulva-vaginal swab samples from females aged under 25 years undergoing chlamydia testing as part of the National Chlamydia Screening Programme (NCSP) or Prevention of Pelvic Infection (POPI) trial were collected from sites across England, together with available demographic and sexual behaviour data. Residual samples were screened for HPV infection using the Hybrid Capture 2 (hc2) HPV DNA Test, including the high-risk (HR) and low-risk (LR) probes. Hc2 positive samples were genotyped using the Roche Linear Array (LA) HPV Genotyping Test. RESULTS A total of 3829 samples were included: 2369 from 16 to 24 year old NCSP participants, 275 from 13 to 15 year old NCSP participants and 1185 from 16 to 24 year old POPI participants. Variations in HPV prevalence between and within the different samples followed a pattern largely consistent with differences in sexual behaviour. The prevalence of total HR HPV infection, of HPV 16 and/or 18 (16/18) infection and of five HR HPV types closely related to HPV 16/18 (HPV 31, 33, 45, 52 or 58) amongst 16-24 year old NCSP participants was 35% (95% CI 33-37%), 18% (95% CI 16-19%), and 16% (95% CI 14-18%), respectively. Risk of HR HPV infection increased with age during the teen years and was higher in women who reported two or more sexual partners in the last year and in women with chlamydia infection. Approximately half of women with HPV 16/18 infection also had another non-vaccine HR HPV type present. CONCLUSIONS Prior to HPV immunisation, there was a high prevalence of HPV infections in the lower genital tract of young, sexually active females in England. The overall, type-specific, and multiple infection prevalence closely reflected age and sexual activity. These data provide a baseline against which the early impact of HPV immunisation on the prevalence of HPV 16/18 and closely related types in young women can be measured, in order to inform immunisation and cervical screening policies.
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Affiliation(s)
- Rebecca Howell-Jones
- HIV/STI Department, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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18
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Huo Z, Bissett SL, Giemza R, Beddows S, Oeser C, Lewis DJM. Systemic and mucosal immune responses to sublingual or intramuscular human papilloma virus antigens in healthy female volunteers. PLoS One 2012; 7:e33736. [PMID: 22438987 PMCID: PMC3306286 DOI: 10.1371/journal.pone.0033736] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/16/2012] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED The sublingual route has been proposed as a needle-free option to induce systemic and mucosal immune protection against viral infections. In a translational study of systemic and mucosal humoral immune responses to sublingual or systemically administered viral antigens, eighteen healthy female volunteers aged 19-31 years received three immunizations with a quadravalent Human Papilloma Virus vaccine at 0, 4 and 16 weeks as sublingual drops (SL, n = 12) or intramuscular injection (IM, n = 6). IM antigen delivery induced or boosted HPV-specific serum IgG and pseudovirus-neutralizing antibodies, HPV-specific cervical and vaginal IgG, and elicited circulating IgG and IgA antibody secreting cells. SL antigens induced ~38-fold lower serum and ~2-fold lower cervical/vaginal IgG than IM delivery, and induced or boosted serum virus neutralizing antibody in only 3/12 subjects. Neither route reproducibly induced HPV-specific mucosal IgA. Alternative delivery systems and adjuvants will be required to enhance and evaluate immune responses following sublingual immunization in humans. TRIAL REGISTRATION ClinicalTrials.govNCT00949572.
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MESH Headings
- Administration, Sublingual
- Adult
- Alphapapillomavirus/immunology
- Antibodies, Neutralizing/biosynthesis
- Antibodies, Neutralizing/blood
- Antibodies, Viral/biosynthesis
- Antibodies, Viral/blood
- Antigens, Viral/administration & dosage
- Capsid Proteins/immunology
- Cervix Uteri/immunology
- Female
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18
- Human papillomavirus 11/immunology
- Human papillomavirus 16/immunology
- Human papillomavirus 18/immunology
- Human papillomavirus 6/immunology
- Humans
- Immunity, Mucosal
- Immunoglobulin A, Secretory/biosynthesis
- Immunoglobulin G/biosynthesis
- Immunoglobulin G/blood
- Injections, Intramuscular
- Oncogene Proteins, Viral/immunology
- Papillomavirus Vaccines/administration & dosage
- Vagina/immunology
- Young Adult
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Affiliation(s)
- Zhiming Huo
- Infectious Diseases, St George's - University of London, London, United Kingdom
| | - Sara L. Bissett
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - Raphaela Giemza
- Infectious Diseases, St George's - University of London, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - Clarissa Oeser
- Infectious Diseases, St George's - University of London, London, United Kingdom
| | - David J. M. Lewis
- Surrey Clinical Research Centre, University of Surrey, Guildford, United Kingdom
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19
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Tiggelaar SM, Lin MJ, Viscidi RP, Ji J, Smith JS. Age-specific human papillomavirus antibody and deoxyribonucleic acid prevalence: a global review. J Adolesc Health 2012; 50:110-31. [PMID: 22265107 PMCID: PMC3572199 DOI: 10.1016/j.jadohealth.2011.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 10/14/2011] [Accepted: 10/15/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Global data on human papillomavirus (HPV) serological and deoxyribonucleic acid (DNA) prevalence are essential to optimize HPV prophylactic vaccination strategies. METHODS We conducted a global review of age-specific HPV antibody and studies with both antibody and DNA prevalence for HPV-16, -18, -6, and -11. RESULTS One hundred seventeen studies were included; participants' ages ranged from several hours to >90 years. HPV-16 seroprevalence was generally higher in Africa, Central and South America, and North America, more prevalent among women than among men, and peaked around ages 25-40 years. HPV-18 seroprevalence was generally lower than HPV-16 with a later age peak. Data were limited for HPV-6 and -11, both of which peaked at ages similar to HPV-18. Among 9-26-year-old females, HPV-16 seroprevalence ranged from 0%-31% in North America, 21%-30% in Africa, 0%-23% in Asia/Australia, 0%-33% in Europe, and 13%-43% in Central and South America. HPV-16/-18 DNA prevalence peaked 10-15 years before corresponding HPV-16/-18 antibody prevalence. CONCLUSIONS Females within the HPV vaccine-eligible age-group (9-26 years) had a range of dual HPV-16 DNA and serology negativity from 81%-87%, whereas 90%-98% were HPV-16 DNA negative. Serology and DNA data are lacking worldwide for females younger than age 15 years, the prime target group for vaccination.
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Affiliation(s)
- Sarah M Tiggelaar
- Department of Cancer Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Vanderbilt University, School of Medicine, Nashville, TN USA
| | - Margaret J Lin
- Department of Cancer Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Washington University School of Medicine, Saint Louis, MO, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Raphael P Viscidi
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jia Ji
- Department of Cancer Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Division of Pharmaceutics, College of Pharmacy, Ohio State University, Columbus, OH, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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20
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Human papillomavirus antibody reference reagents for use in postvaccination surveillance serology. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:449-51. [PMID: 22278326 DOI: 10.1128/cvi.05641-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suitably controlled serosurveillance surveys are essential for evaluating human papillomavirus (HPV) immunization programs. A panel of plasma samples from 18-year-old females was assembled, the majority of the samples being from recipients of the bivalent HPV vaccine. Antibody specificities were evaluated by three independent laboratories, and 3 pools that displayed no antibodies to any HPV type tested or intermediate or high levels of antibody to HPV16, HPV18, HPV31, and HPV45 were created. These pools will be useful as control reagents for HPV serology.
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21
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Abstract
BACKGROUND Most studies of human papillomavirus (HPV) epidemiology have employed DNA testing, which measures current infections. Serum antibodies offer a longer-term marker of infection in individuals who seroconvert and can therefore provide additional information about the exposure of populations to HPV. METHODS Sera from a population-based sample of males and females aged 10 to 49 years, in England, were tested for type-specific HPV antibodies using a multiplexed competitive Luminex assay and previously defined cutoffs of 20, 16, 20, and 24 mMU mL for HPV 6, 11, 16, and 18, respectively. Seropositivity and geometric mean titers of seropositives were analyzed by HPV type, gender, and age. Catalytic models were developed to explore potential effects of antibody waning over time and changing risk of infection by age-cohort. RESULTS Seroprevalence for HPV 6, 11, 16, and 18 was 16.4%, 5.7%, 14.7%, and 6.3%, respectively, among females and 7.6%, 2.2%, 5.0%, and 2.0%, respectively, among males. Seroprevalence in females was significantly higher than males (P < 0.001 for all types) and showed a decline in older ages that was not seen in males. There was no evidence of declining antibody titers with increasing age. Model results suggest that cohort effects mediated through changes in sexual behavior better explain the observed trend in seroprevalence than waning antibodies over time. CONCLUSIONS Preimmunization HPV seroprevalence in England shows similar trends to reports from other developed countries. We find the lower seroprevalence in older females probably reflects changes in sexual behavior over the last few decades. This study provides baseline data to monitor the impact of the immunization programme.
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22
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Neutralization of non-vaccine human papillomavirus pseudoviruses from the A7 and A9 species groups by bivalent HPV vaccine sera. Vaccine 2011; 29:8585-90. [PMID: 21939712 PMCID: PMC3359499 DOI: 10.1016/j.vaccine.2011.09.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/18/2011] [Accepted: 09/07/2011] [Indexed: 01/21/2023]
Abstract
The majority of cervical cancers are associated with infection by one or more Human Papillomavirus (HPV) types from just two distinct Alpha-Papillomavirus species groups, A7 and A9. The extent to which the current HPV16/18 vaccines will protect against other genetically related HPV types is of interest to inform vaccine implementation, cervical disease surveillance and the development of second generation HPV vaccines. The aim of this study was to determine the frequency and titer of neutralizing antibodies against a range of A7 (18, 39, 45, 59, 68) and A9 (16, 31, 33, 35, 52, 58) HPV types using sera from individuals immunized with the bivalent HPV vaccine within the school-based, UK national HPV immunization programme. Serum samples were collected from 69 girls aged 13–14 years, a median 5.9 months (inter-quartile range, IQR, 5.7–6.0) after their third vaccine dose. Cross-neutralizing antibodies against HPV31, HPV33, HPV35 and HPV45 were common and strongly associated with the titer for the related vaccine-type, but were considerably lower (<1%) than their related vaccine type-specific response. The low prevalence of these HPV types in the population and the ages within the study cohort suggest these responses are due to vaccination. It is unclear whether such low levels of neutralizing antibodies would be sufficient to protect at the site of infection in the absence of other immune effectors but the coincidence with HPV types reported from efficacy studies is intriguing. The utility of neutralizing antibodies as surrogate markers of protection remains to be determined.
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23
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Hilton S, Hunt K, Bedford H, Petticrew M. School nurses' experiences of delivering the UK HPV vaccination programme in its first year. BMC Infect Dis 2011; 11:226. [PMID: 21864404 PMCID: PMC3176210 DOI: 10.1186/1471-2334-11-226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 08/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United Kingdom (UK) in September 2008, school nurses began delivering the HPV immunisation programme for girls aged 12 and 13 years old. This study offers insights from school nurses' perspectives and experiences of delivering this new vaccination programme. METHODS Thirty in-depth telephone interviews were conducted with school nurses working across the UK between September 2008 and May 2009. This time period covers the first year of the HPV vaccination programme in schools. School nurses were recruited via GP practices, the internet and posters targeted at school nurse practitioners. RESULTS All the school nurses spoke of readying themselves for a deluge of phone calls from concerned parents, but found that in fact few parents telephoned to ask for more information or express their concerns about the HPV vaccine. Several school nurses mentioned a lack of planning by policy makers and stated that at its introduction they felt ill prepared. The impact on school nurses' workload was spoken about at length by all the school nurses. They believed that the programme had vastly increased their workload leading them to cut back on their core activities and the time they could dedicate to offering support to vulnerable pupils. CONCLUSION Overall the first year of the implementation of the HPV vaccination programme in the UK has exceeded school nurses' expectations and some of its success may be attributed to the school nurses' commitment to the programme. It is also the case that other factors, including positive newsprint media reporting that accompanied the introduction of the HPV vaccination programme may have played a role. Nevertheless, school nurses also believed that the programme had vastly increased their workload leading them to cut back on their core activities and as such they could no longer dedicate time to offer support to vulnerable pupils. This unintentional aspect of the programme may be worthy of further exploration.
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Affiliation(s)
- Shona Hilton
- MRC CSO Social and Public Health Sciences Unit, Glasgow, UK.
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Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, Hankins CA. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol 2011; 2011:812368. [PMID: 21687572 PMCID: PMC3113366 DOI: 10.1155/2011/812368] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/09/2011] [Indexed: 01/30/2023] Open
Abstract
Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ronald H. Gray
- Population and Family Planning, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Xavier Castellsague
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - F. Xavier Bosch
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - Daniel T. Halperin
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA
| | - Jake H. Waskett
- Circumcision Independent Reference and Commentary Service, Radcliffe, Manchester M261JR, UK
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Hilton S, Smith E. "I thought cancer was one of those random things. I didn't know cancer could be caught...": adolescent girls' understandings and experiences of the HPV programme in the UK. Vaccine 2011; 29:4409-15. [PMID: 21514348 PMCID: PMC3176894 DOI: 10.1016/j.vaccine.2011.03.101] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/23/2011] [Accepted: 03/28/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The UK human papillomavirus (HPV) vaccination programme aims to provide girls aged 12-13 with protection against two of the most carcinogenic strains (types 16 and 18) of this sexually transmitted virus which together account for 70% of cases of cervical cancer. Despite evidence suggesting a general lack of knowledge about HPV and its link with cervical cancer, vaccine uptake rates were generally high in the UK for the first year of the HPV vaccination programme. In countries that implemented the HPV programme ahead of the UK, studies have found that girls' and parents' levels of awareness about HPV have increased since implementation of the programme but that knowledge continues to be limited. This study offers some of the first insights from the UK into adolescent girls' understandings of HPV, its link with cervical cancer, and experiences of vaccination, since the programme was introduced in September 2008. METHOD Eighteen focus groups were conducted between December 2009 and May 2010 with schoolgirls aged between 12 and 18 living in various parts of the UK. RESULTS Eighty seven girls participated in these discussions. Typically, girls knew very little about HPV or how they could best protect themselves from HPV infection. Although many of the girls linked HPV to cancer, only half specifically associated it with cervical cancer. Most girls had no idea how long the vaccine would offer them protection. They assumed that HPV vaccination must be important for their health because it was recommended by people they trusted, namely parents and immunisation experts. Just over half of the girls were aware that in the future they would need to attend for cervical screening. Key concerns which girls expressed about HPV vaccination reflected their anxieties about needles, anticipated pain on injection, privacy during vaccination and fears about needle cleanliness. CONCLUSION Our data point to a need to continue to address gaps in knowledge about HPV and to provide information to address girls' concerns about vaccination. This could be achieved through targeted campaign materials and by ensuring those involved in delivering the programme are aware of girls' anxieties to prevent limited knowledge and fears about vaccination becoming barriers either to HPV vaccination.
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Affiliation(s)
- Shona Hilton
- MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, United Kingdom.
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Vaccarella S, Franceschi S, Clifford GM, Touzé A, Hsu CC, de Sanjosé S, Pham THA, Nguyen TH, Matos E, Shin HR, Sukvirach S, Thomas JO, Boursaghin L, Gaitan J, Snijders PJF, Meijer CJLM, Muñoz N, Herrero R, Coursaget P. Seroprevalence of antibodies against human papillomavirus (HPV) types 16 and 18 in four continents: the International Agency for Research on Cancer HPV Prevalence Surveys. Cancer Epidemiol Biomarkers Prev 2011; 19:2379-88. [PMID: 20826835 DOI: 10.1158/1055-9965.epi-10-0336] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few human papillomavirus (HPV) seroprevalence studies have been carried out in women from low-resource countries. METHODS Seroprevalence of antibodies against HPV16 and HPV18 was assessed in 7,074 women ≥15 years of age (median 44 years) from eight world areas. Serum antibodies against HPV16 and HPV18 were tested for using enzyme-linked immunosorbent assay. HPV DNA was assessed using a general primer GP5+/6+-mediated PCR. RESULTS HPV16 and HPV18 seroprevalence both ranged from <1% (Hanoi, Vietnam) to >or=25% (Nigeria). Of women who were HPV16 or HPV18 DNA-positive, seropositivity for the same type was 39.8% and 23.2%, respectively. Seropositivity for either type was directly associated with markers of sexual behavior. HPV16 and/or 18 (HPV16/18)-seropositive women had an increased risk of having cytologic abnormalities only if they were also HPV DNA-positive. A high international correlation was found between HPV16/18 seroprevalence and overall HPV DNA prevalence (r = 0.81; P = 0.022). However, HPV16/18 seroprevalence was substantially higher than the corresponding DNA prevalence in all study areas (although to different extents) and, contrary to DNA, tended to increase from young to middle age, and then decline or remain fairly constant. In all study areas, the vast majority of the information on the burden of exposure to HPV16/18 derived from serology. CONCLUSIONS The correlation between HPV DNA and HPV serology was not very good at an individual woman level, but high at a population level. IMPACT HPV serology is a poor marker of current infection or related lesions, but it can contribute, together with DNA, in evaluating the variations in the burden of HPV infection worldwide.
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Affiliation(s)
- Salvatore Vaccarella
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
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Abstract
The United Kingdom Joint Committee on Vaccination and Immunisation provides advice to the Ministers of Health on all aspects of vaccination. Under recent legislation a recommendation from the Committee confers the right to the vaccine concerned to the population of England Wales. A critical aspect of both advice and recommendations is that the vaccination is shown to reach a cost-effectiveness threshold. This usually requires sophisticated mathematical modelling and economics.
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BELL L, SEALE C. The reporting of cervical cancer in the mass media: a study of UK newspapers. Eur J Cancer Care (Engl) 2010; 20:389-94. [DOI: 10.1111/j.1365-2354.2010.01222.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coverage of Jade Goody's cervical cancer in UK newspapers: a missed opportunity for health promotion? BMC Public Health 2010; 10:368. [PMID: 20576115 PMCID: PMC2909165 DOI: 10.1186/1471-2458-10-368] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 06/24/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been claimed that publicity surrounding popular celebrity Jade Goody's experience of cervical cancer will raise awareness about the disease. This study examines the content of newspaper articles covering her illness to consider whether 'mobilising information' which could encourage women to adopt risk-reducing and health promoting behaviours has been included. METHODS Content analysis of 15 national newspapers published between August 2008 and April 2009 FINDINGS In the extensive coverage of Goody's illness (527 articles in the 7 months of study) few newspaper articles included information that might make women more aware of the signs and symptoms or risk factors for the disease, or discussed the role of the human papilloma virus (HPV) and the recently introduced HPV vaccination programme to reduce the future incidence of cervical cancer. For example, less than 5% of articles mentioned well-known risk-factors for cervical cancer and less than 8% gave any information about HPV. The 'human interest' aspects of Goody's illness (her treatment, the spread of her disease in later months, her wedding, and her preparations for her children's future) were more extensively covered. CONCLUSIONS Newspaper coverage of Goody's illness has tended not to include factual or educational information that could mobilise or inform women, or help them to recognise early symptoms. However, the focus on personal tragedy may encourage women to be receptive to HPV vaccination or screening if her story acts as a reminder that cervical cancer can be a devastating and fatal disease in the longer term.
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Bogaards JA, Xiridou M, Coupé VMH, Meijer CJLM, Wallinga J, Berkhof J. Model-based estimation of viral transmissibility and infection-induced resistance from the age-dependent prevalence of infection for 14 high-risk types of human papillomavirus. Am J Epidemiol 2010; 171:817-25. [PMID: 20231211 DOI: 10.1093/aje/kwp466] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Viral transmissibility and natural resistance to infection are key determinants in assessing the population impact of human papillomavirus (HPV) vaccination, yet information on these parameters is scarce. Using data from 2 large-scale surveys on sexual behavior in the Netherlands (carried out in 2005-2006), the authors employed a Bayesian framework to fit a transmission model to the cross-sectional age-dependent prevalence of HPV DNA in cervical smears (data collected in 1992-2002), assuming that the prevaccine situation reflected an endemic equilibrium, and calculated type-specific estimates of transmissibility and infection-induced resistance. The posterior median transmission probability per heterosexual partnership covered a range of 0.43-0.94 among the 14 high-risk types of HPV. The transmission probability of HPV-16 was estimated at 0.80 (95% posterior interval: 0.60, 0.99) and that of HPV-18 at 0.93 (95% posterior interval: 0.72, 1). The model predicted that the decrease in HPV prevalence with age could not solely be explained by sexual activity and screening but also by resistance to reinfection, which is lost at a rate of 0.014-0.047 (1%-5%) per year. These results support the notion that HPV infection is highly transmissible, and they suggest a gradual loss of type-specific immunity over time. Because high transmission potential is associated with a low impact of herd immunity, extensive vaccination coverage will be required to substantially reduce cervical cancer incidence.
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Affiliation(s)
- Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands.
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Abstract
BACKGROUND A vaccine to prevent human papillomavirus (HPV) 6, HPV 11, HPV 16, or HPV 18 and associated diseases is licensed for females, and it may be licensed for men in the future. There are limited data on HPV 6/11, 16, and/or 18 seroprevalence in men. METHODS A total of 490 men aged 18 to 40 years were enrolled in a study of HPV in men in Tucson, AZ, and Tampa, FL. Enrolled men completed a self-administered questionnaire, and HPV serology was performed using HPV 6/11, 16, and 18 VLP assays. RESULTS Overall, seroprevalence to HPV 16 was 12.1%, HPV 6/11 was 9.7%, and to HPV 18 was 5.4%. Seroprevalence to HPV 6/11, 16, and/or 18 was 21% and was highest among 35 to 40 year olds (48%); prevalence in this age group was significantly higher compared to the 18 to 24 year olds (adjusted odds ratio (aOR) 6.8, 95% confidence interval (CI) 3.7, 12.8). Independent predictors of seropositivity to HPV 6/11, 16, and/or 18 were older age, greater number of female sex partners in the past 3 months, and current smoking. CONCLUSIONS HPV vaccine-type seroprevalence was highest in 35 to 40 year old men. These data on the epidemiology of HPV seroprevalence in men are useful for discussions regarding recommendations for HPV vaccine if licensed for use in men.
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Hilton S, Hunt K, Langan M, Bedford H, Petticrew M. Newsprint media representations of the introduction of the HPV vaccination programme for cervical cancer prevention in the UK (2005-2008). Soc Sci Med 2010; 70:942-50. [PMID: 20064682 PMCID: PMC2835855 DOI: 10.1016/j.socscimed.2009.11.027] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 11/11/2009] [Accepted: 11/24/2009] [Indexed: 12/04/2022]
Abstract
In September 2008, the human papillomavirus (HPV) immunisation programme was introduced in the UK for schoolgirls aged between 12 and 18 years of age. The vaccine shows high efficacy in preventing infection against HPV types 16 and 18 responsible for 70% of cervical cancer. However, to be most effective, the vaccine needs to be administered before exposure to the viruses and therefore, ideally, before young people become sexually active. The introduction of any new vaccine, and perhaps particularly one given to young teenage girls to prevent a sexually transmitted cancer-causing virus, has the potential to attract a great deal of media attention. This paper reports on content analysis of 344 articles published between January 2005 and December 2008 in 15 UK newspapers. It includes both manifest and latent analysis to examine newsprint media coverage of the introduction of the HPV vaccination programme and its role in HPV advocacy. We concluded that the newspapers were generally positive towards the new HPV vaccination and that over the 4 years period the newsworthiness of the HPV vaccination programme increased. In 2008 two events dominated coverage, firstly, the introduction of the HPV programme in September 2008 and secondly, in August 2008 the diagnosis on camera of cervical cancer given to Jade Goody, a 27 year old mother of two, who gained fame and notoriety in the UK through her participation in several reality television shows. There are two conclusions from this study. Firstly, the positive media coverage surrounding the introduction of the HPV vaccination programme is to be welcomed as it is likely to contribute towards influencing public perceptions about the acceptability and need for HPV vaccination. Secondly, the focus on prevalence rates of HPV infection among women and on women's sexual behaviours, in relation to HPV vaccination ‘encouraging’ promiscuity, is an unhelpful aspect of media coverage.
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Affiliation(s)
- Shona Hilton
- Medical Research Council, Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, United Kingdom.
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Choi YH, Jit M, Gay N, Cox A, Garnett GP, Edmunds WJ. Transmission dynamic modelling of the impact of human papillomavirus vaccination in the United Kingdom. Vaccine 2009; 28:4091-102. [PMID: 19909831 DOI: 10.1016/j.vaccine.2009.09.125] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/22/2009] [Accepted: 09/30/2009] [Indexed: 11/25/2022]
Abstract
Many countries are considering vaccination against human papillomavirus (HPV). However, the long-term impact of vaccination is difficult to predict due to uncertainty about the prevalence of HPV infection, pattern of sexual partnerships, progression of cervical neoplasias, accuracy of screening as well as the duration of infectiousness and immunity. Dynamic models of human papillomavirus (HPV) transmission were developed to describe the infection spread and development of cervical neoplasia, cervical cancer (squamous cell and adenocarcinoma) and anogenital warts. Using different combinations of assumptions, 9900 scenarios were created. Each scenario was then fitted to epidemiological data and the best-fitting scenarios used to predict the impact of vaccination. Results suggest that vaccinating 12-year-old girls at 80% coverage will result in a 38-82% reduction in cervical cancer incidence and 44-100% reduction in anogenital warts incidence after 60 years of an ongoing vaccination programme if vaccine protection lasts 20 years on average. The marginal benefit of vaccinating boys depends on the degree of protection achieved by vaccinating girls.
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Affiliation(s)
- Yoon Hong Choi
- Immunisation Department, HPA Centre for Infections, 61 Colindale Avenue, Colindale, London, United Kingdom.
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Abstract
In September 2008 the UK Department of Health initiated a human papillomavirus (HPV) immunisation programme for girls aged 12-13 for prevention of cervical cancer, which is most often caused by two HPV types. An important question, yet to be addressed, is whether boys should also be vaccinated. Men also get HPV and transmit it sexually, not just women. Certain HPV types are associated with genital warts, which have significant morbidity, and with difficult to treat non-cervical malignancies, including vulval, penile, anal and oro-pharyngeal cancer, which are best prevented through vaccination. Moreover, increased persistence of HPV infection is associated with HIV infection. A review of the literature and evidence from modelling suggest that vaccinating boys would increase vaccination impact and may be necessary to achieve herd immunity targets. Excluding boys sends the wrong message that girls and women alone are responsible for sexual health. Although protective efficacy of the vaccine in men has not yet been fully established, the rationale for vaccinating boys as well as girls at an early age is strong, assuming efficacy is established. Meanwhile, provision of the quadrivalent vaccine should become UK policy, in order to include protection against genital warts, the argument for which is strengthened if boys are also vaccinated.
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Affiliation(s)
- Tamara Kubba
- Royal Free and University College Medical School, University College London, London, UK.
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36
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de Kok IMCM, van Ballegooijen M, Habbema JDF. Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands. J Natl Cancer Inst 2009; 101:1083-92. [DOI: 10.1093/jnci/djp183] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Jit M, Gay N, Soldan K, Hong Choi Y, Edmunds WJ. Estimating progression rates for human papillomavirus infection from epidemiological data. Med Decis Making 2009; 30:84-98. [PMID: 19525483 DOI: 10.1177/0272989x09336140] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A Markov model was constructed in order to estimate type-specific rates of cervical lesion progression and regression in women with high-risk human papillomavirus (HPV). The model was fitted to age- and type-specific data regarding the HPV DNA and cytological status of women undergoing cervical screening in a recent screening trial, as well as cervical cancer incidence. It incorporates different assumptions about the way lesions regress, the accuracy of cytological screening, the specificity of HPV DNA testing, and the age-specific prevalence of HPV infection. Combinations of assumptions generate 162 scenarios for squamous cell carcinomas and 54 scenarios for adenocarcinomas. Simulating an unscreened cohort of women infected with high-risk HPV indicates that the probability of an infection continuing to persist and to develop into invasive cancer depends on the length of time it has already persisted. The scenarios and parameter sets that produce the best fit to available epidemiological data provide a basis for modeling the natural history of HPV infection and disease.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, United Kingdom.
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Syrjänen S, Waterboer T, Sarkola M, Michael K, Rintala M, Syrjänen K, Grenman S, Pawlita M. Dynamics of human papillomavirus serology in women followed up for 36 months after pregnancy. J Gen Virol 2009; 90:1515-1526. [DOI: 10.1099/vir.0.007823-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We determined L1 antibodies for human papillomavirus (HPV) types 6, 11, 16, 18 and 45 by multiplex serology in our prospective HPV family study. We report seroprevalence, seroconversion and antibody decay in 290 women (mean age, 25.5 years) sampled before delivery and at 12, 24 and 36 months of follow-up. Multiplex HPV genotyping of the baseline oral and genital scrapings was performed. At baseline, seroprevalence of HPV 6, 11, 16, 18 and 45 was 53.3, 21.5, 34.9, 21.5 and 9.0 %, respectively. Seropositivity for low-risk HPV (LR-HPV) was associated significantly with age at onset of sexual activity (P=0.001), number of sexual partners until age 20 (P=0.018), lifetime number of sexual partners (P=0.0001), history of genital warts (P=0.0001) and being seropositive for high-risk (HR) HPV (P=0.0001). The same covariates also predicted seropositivity for HR-HPV. During follow-up, 26.7, 13.9, 17.0, 16.8 and 6.6 % of the women seroconverted to L1 antigen of HPV 6, 11, 16, 18 and 45, respectively, between 18.2 and 23.8 months. Independent predictors of seroconversion to LR-HPV were unemployment (P=0.019) and absence of anal sex practice (P=0.031), and to HR-HPV, absence of smoking history and lifetime number of sexual partners. Decay of HPV 6, 11, 16, 18 and 45 antibodies was observed in 2.3, 4.0, 5.3, 4.5 and 1.5 % of the women, respectively, with decay time varying from 27.2 to 35.8 months. These data imply that (i) a substantial proportion of young women are seropositive for both LR- and HR-HPV types, (ii) they frequently undergo seroconversion within 18–24 months, predicted by common covariates, and (iii) antibody decay over 3 years is rare.
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Affiliation(s)
- Stina Syrjänen
- MediCity Research Laboratory and Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tim Waterboer
- Department of Genome Modifications and Carcinogenesis, Infection and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marja Sarkola
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
- MediCity Research Laboratory and Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Kristina Michael
- Department of Genome Modifications and Carcinogenesis, Infection and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marjut Rintala
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
| | - Kari Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Seija Grenman
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
| | - Michael Pawlita
- Department of Genome Modifications and Carcinogenesis, Infection and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Abstract
The human papillomavirus (HPV) vaccine was introduced in to the national immunization programme at the beginning of the 2008/2009 school year, being offered routinely to all 12-13-year-old girls with the aim of protecting them against cervical cancer. There are two particularly high risk HPV types for which there are now highly effective vaccines available. It is estimated that with the introduction of the HPV vaccination programme the lives of over 400 women per year will be saved in the UK. This article provides insight into some of the issues surrounding the introduction of the HPV vaccine into the national immunization programme. HPV is discussed and its relation to cancer outlined. Genital warts, associated HPV transmission and treatment options are summarized. Issues associated with the vaccine, its safety, and some practical aspects are discussed.
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Affiliation(s)
- Ian Peate
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Hertfordshire, UK
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Seroprevalence of antibodies against serogroup C meningococci in England in the postvaccination era. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:1694-8. [PMID: 18827191 DOI: 10.1128/cvi.00279-08] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The United Kingdom introduced meningococcal serogroup C conjugate (MCC) vaccines in 1999, resulting in substantial declines in serogroup C disease and carriage. Here, we measured the age-specific prevalence of serum bactericidal antibodies (SBA) to Neisseria meningitidis serogroup C and immunoglobulin G (IgG) concentrations to serogroups A, C, W-135, and Y in 2,673 serum samples collected in England between 2000 and 2004. We compared the seroprevalence of SBA titers of > or =8 in the postvaccination era with results from an earlier prevaccination study conducted using the same methods. We found that the percentages of individuals with protective SBA titers were higher in 2000 to 2004 in all of the age groups targeted for MCC vaccination. In the postvaccine era, the prevalence of protective titers was high (75%) in children who had recently been offered routine immunization, but this fell to 36% more than 18 months after scheduled immunization. In the cohorts targeted in the catch-up campaign, the percentage achieving SBA titers of > or =8 was higher in children offered the vaccine at ages 5 to 17 years than in children offered the vaccine at ages 1 to 4 years. The geometric mean concentration (GMC) IgG for serogroup C followed a similar pattern, corresponding to the age at and time since scheduled MCC vaccination. Serogroup-specific IgG GMCs for W-135 and Y were low and showed little variation by age. Serogroup A IgG GMCs were higher, possibly reflecting exposure to cross-reacting antigens. Although the incidence of serogroup C disease remains low due to persisting herd effects, population antibody levels to serogroup C meningococci should be monitored so that potentially susceptible age groups can be identified should herd immunity wane.
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Abstract
OBJECTIVE To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom. DESIGN Economic evaluation. SETTING UK. Population Schoolgirls aged 12 or older. MAIN OUTCOME MEASURES Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options. RESULTS Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of pound30,000 (euro37,700; $59,163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing pound13- pound21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts. CONCLUSIONS Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Centre for Infections, Health Protection Agency, London NW9 6BT.
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Newall A, Brotherton J, Quinn H, McIntyre P, Backhouse J, Gilbert L, Esser M, Erick J, Bryan J, Formica N, MacIntyre C. Population Seroprevalence of Human Papillomavirus Types 6, 11, 16, and 18 in Men, Women, and Children in Australia. Clin Infect Dis 2008; 46:1647-55. [DOI: 10.1086/587895] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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