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Rashid H, Dey A, Wang H, Beard F. Sustained Decline in Hospitalisations for Anogenital Warts in Australia: Analysis of National Hospital Morbidity Data 2003-2020. Trop Med Infect Dis 2024; 9:79. [PMID: 38668540 PMCID: PMC11055050 DOI: 10.3390/tropicalmed9040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
In Australia, school-based human papillomavirus (HPV) vaccination was introduced initially for girls in 2007, and then also for boys in 2013. While studies have shown declines in the incidence of anogenital warts, there is a paucity of recent data analysis assessing the impact of vaccination on more severe disease. The National Hospital Morbidity Database of the Australian Institute of Health and Welfare (AIHW) hospitalisation admission data that included ICD-10-AM code A63.0 ('anogenital warts') as the diagnoses, for the years 2003-2020, were analysed to estimate hospitalisation rates per 100,000 mid-year population. The annual average hospitalisation rates per 100,000 population for anogenital warts in both genders combined in the age groups 10-19 years, 20-29 years, and 30-39 years decreased, respectively, from 16.9, 49.6, and 23.6 in 2003-2007 (pre-vaccine period) to 2.6, 15.2, and 14.6 in 2008-2020 (post-vaccine period), equating to declines of 84.7%, 69.4%, and 38.2%, respectively. Following the introduction of the boy's vaccination, hospitalisation rates decreased further in the respective age bands from 4.3, 22.8, and 18.4 in 2008-2013 (early post-vaccine period) to 1.1, 9.3, and 11.7 in 2014-2020 (late post-vaccine period), equating to respective declines of 73.4%, 59.3%, and 36.4%. This analysis confirms that there is a substantial incremental decline in anogenital warts hospitalisations among Australians aged 10-39 years.
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Affiliation(s)
- Harunor Rashid
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.D.); (F.B.)
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
| | - Aditi Dey
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.D.); (F.B.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
| | - Han Wang
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
| | - Frank Beard
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.D.); (F.B.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
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Wang W, Kothari S, Baay M, Garland SM, Giuliano AR, Nygård M, Velicer C, Tota J, Sinha A, Skufca J, Verstraeten T, Sundström K. Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Rev Vaccines 2021; 21:227-240. [PMID: 34845951 DOI: 10.1080/14760584.2022.2008243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies. AREAS COVERED We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis. EXPERT OPINION The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
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Affiliation(s)
- Wei Wang
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Suzanne M Garland
- Department Obstetrics and Gynaecology, University of Melbourne, Centre Women's Infectious Diseases Research, Royal Women's Hospital, and Infection & Immunity Murdoch Children's Research Institute, Parkville, Australia
| | - Anna R Giuliano
- Center for Immunizaton and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christine Velicer
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Joseph Tota
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Anushua Sinha
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | | | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
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Khawar L, McManus H, Vickers T, Chow EPF, Fairley CK, Donovan B, Machalek DA, Regan DG, Grulich AE, Guy RJ, McGregor S. Genital warts trends in Australian and overseas-born people in Australia: A cross-sectional trend analysis to measure progress towards control and elimination. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100251. [PMID: 34590059 PMCID: PMC8403758 DOI: 10.1016/j.lanwpc.2021.100251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Background: Substantial declines in genital warts have been observed in countries with quadrivalent/nonavalent human papillomavirus (q/n HPV) vaccination programmes, with Australia showing the most pronounced and long-term reductions. No study has assessed progress towards elimination of genital warts in a nation-wide sample of patients, and migrants' contribution to population-level control of genital warts. We assessed Australia's progress towards genital warts elimination by examining trends in diagnoses in Australian- and overseas-born patients of sexual health clinics (SHCs) across Australia. Methods: A cross-sectional trend analysis of new genital warts diagnoses among first-time patients of 34 SHCs, between 2004 and 2018, was performed. Rate ratios (RR) were calculated using Poisson regression models, for comparing trends in proportions of new genital warts diagnoses in Australian- and overseas-born patients during the pre-vaccination era (2004-2007) and the vaccination era (2008-2018), and by 2018 relative to 2004-2007. Findings: A total of 439,957 new patients (Australian-born: 230,230; overseas-born: 209,727) were seen at SHCs, 6•4% were diagnosed with genital warts (Australian-born: 7•1%; overseas-born: 5•6%). By 2018, there had been a 64% reduction in the proportion of all SHC patients with a genital warts diagnosis relative to 2004-2007 (RR: 0•36, 95% CI: 0•35-0•38). The decline was more pronounced at 72% (RR: 0•28, 95% CI: 0 •27-0•30) among Australian-born patients, with the greatest reduction in women and men aged <21 years, at 98% (RR: 0•02, 95% CI: 0•01-0•03) and 92% (RR: 0•08, 95% CI: 0•06-0•11), respectively. By 2018, there was a 49% reduction in the proportion of overseas-born patients diagnosed with genital warts (RR: 0•51, 95% CI:0•48-0•54), and a 21% reduction in overseas-born patients from countries with no or bivalent HPV (bHPV) vaccination programme (RR: 0•79, 95% CI: 0•71-0•90). Interpretation: The substantial reductions in Australian-born people is a testament to the efficacy of quadrivalent (qHPV) and nonavalent (nHPV) vaccines and the high and wide-spread vaccination coverage in Australia. However, population-wide elimination of genital warts in Australia is dependent on other countries initiating or expanding their own HPV vaccination programmes. Funding: The Australian Government Department of Health and Seqirus Australia.
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Affiliation(s)
- Laila Khawar
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Hamish McManus
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Tobias Vickers
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Dorothy A Machalek
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Women's Infectious Diseases, the Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Skye McGregor
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
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Chow EPF, Carter A, Vickers T, Fairley CK, McNulty A, Guy RJ, Regan DG, Grulich AE, Callander D, Khawar L, Machalek DA, Donovan B. Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18. THE LANCET. INFECTIOUS DISEASES 2021; 21:1747-1756. [PMID: 34339639 DOI: 10.1016/s1473-3099(21)00071-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013. METHODS We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007). FINDINGS We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40-0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53-0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28-0·36) and male individuals (0·51, 0·43-0·61) aged 15-20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06-0·09) and male individuals (0·11, 0·08-0·15) aged 15-20 years in the gender-neutral vaccination period. INTERPRETATION The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school. FUNDING Seqirus Australia and the Australian Government Department of Health.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Allison Carter
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Simon Fraser University, Burnaby, BC, Canada.
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- School of Public Health and Community Medicine, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laila Khawar
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Dorothy A Machalek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 737] [Impact Index Per Article: 245.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Prilepskaya VN, Gomberg M, Kothari S, Yee K, Kulkarni A, Garland SM, Giuliano AR. Estimating the Burden of Illness Related to Genital Warts in Russia: A Cross-Sectional Study. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:182-188. [PMID: 33088844 PMCID: PMC7549541 DOI: 10.36469/jheor.2020.17246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infections are the etiologic agents of genital warts (GW). HPV is one of the most frequent sexually transmitted viral infections, and nearly 65% of individuals with partners who have GW also develop GW. In Russia, as in many other countries, overall GW prevalence data are scarce. Given the lack of Russian data, our study estimated GW prevalence in physician practices and GW-related health care resource use in Russia among male and female patients aged 18-60 years. METHODS Russian physicians recorded daily patient logs for a two-week period and conducted a 30-minute survey to estimate GW prevalence and related resource use between January and June 2012. Age, gender, and GW diagnosis status was recorded. Prevalence was obtained for each physician and calculated into a single estimate across all physician types. Overall prevalence estimate and 95% confidence interval were weighted by the estimated number of physicians in each specialty and the proportion of total patients visiting each specialist type. Health care resource use was reported and compared among different physician specialties. RESULTS The overall GW prevalence estimate was 9162 cases per 100 000 for male and female patients aged 18-60 years, with 9917 for obstetrician/gynecologists (OB/GYN), 8298 for urologists (URO), and 7833 for dermatologists (DERM). For males, GW prevalence was 8769 cases per 100 000, with the highest prevalence in the 30-34 age group. In females, GW prevalence was 9304 cases per 100 000, with the highest prevalence in the 18-24 age group. Among overall existing GW cases, 63.1% were recurrent and 34.2% were resistant. For all patients in our study, GW prevalence was higher in females. Male patients had the highest prevalence for those aged 30-34 years, and female patients for those aged 18-24 years. These results are consistent with data reported in other countries. Study limitations include estimates and results representative of the urban population of Russia. Despite its limitations, this study provides a GW prevalence estimate in Russia not previously available. CONCLUSIONS GW is a significant public health concern in Russia, and the GW prevalence was higher in female patients compared to male patients.
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Affiliation(s)
- Vera N. Prilepskaya
- Ministry of Healthcare of the Russian Federation, Research Center for Obstetrics, Gynecology, and Perinatology, Moscow,
Russia
| | - Mikhail Gomberg
- Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow,
Russia
| | | | - Karen Yee
- Cubist Pharmaceuticals, Lexington, MA,
USA
| | | | - Suzanne M. Garland
- The Royal Women’s Hospital, Murdoch Childrens Research Institute, Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria,
Australia
| | - Anna R. Giuliano
- Center for Infection Research in Cancer (CIRC) at Moffitt Cancer Center, Tampa, FL,
USA
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Lukács A, Máté Z, Farkas N, Mikó A, Tenk J, Hegyi P, Németh B, Czumbel LM, Wuttapon S, Kiss I, Gyöngyi Z, Varga G, Rumbus Z, Szabó A. The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis. BMC Public Health 2020; 20:691. [PMID: 32460747 PMCID: PMC7254696 DOI: 10.1186/s12889-020-08753-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Our main question was whether HPV vaccine has any effects on the prevention of GW reported in randomised controlled clinical trials (RCTs) and time-trend analyses. METHODS This meta-analysis was performed according to the PRISMA guidelines using the PICO format. We searched in three electronic databases (PubMed, Embase, Cochrane Trials), and assessed heterogeneity using the Q-test and I-squared statistics, meta-regression was also performed. Odds ratios (OR) and their confidence intervals (CI) were calculated. The sensitivity was tested by leave-one-out method. We evaluated the presence of publication bias using the funnel plot graph and the Copas selection model. The strength of evidence was assessed using the GRADE approach. RESULTS Eight RCTs (per-protocol populations) and eight time-trend ecological studies were included in this meta-analysis. A significant reduction (pooled OR = 0.03, 95% CI: 0.01-0.09; I-squared = 53.6%) of GW in young women was recorded in RCTs, and in time-trend analyses both in young women (pooled OR = 0.36, CI 95% = 0.26-0.51; I-squared = 98.2%), and in young men (pooled OR = 0.69, 95% CI = 0.61-0.78; I-squared = 92.7%). In subgroup analysis, a significant reduction of the number of GW events was observed especially in women under 21 years (pooled OR = 0.33, 95% CI = 0.17-0.63). Leave-one-out analysis showed that similar results could be obtained after excluding one study, meta-regression did not show significant difference. CONCLUSIONS Prophylactic, quadrivalent HPV vaccination can prevent GW in healthy women and men, therefore, it should be included in routine immunization programme.
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Affiliation(s)
- Anita Lukács
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, 6720, Hungary.
| | - Zsuzsanna Máté
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, 6720, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Tenk
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balázs Németh
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Márk Czumbel
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Sadaeng Wuttapon
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szabó
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, 6720, Hungary
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Buenconsejo L, Kothari-Talwar S, Yee K, Kulkarni A, Lara N, Roset M, Giuliano AR, Garland S. Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study. Infect Agent Cancer 2019; 14:26. [PMID: 31624494 PMCID: PMC6781391 DOI: 10.1186/s13027-019-0240-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines. Methods Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups. Results Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively). Conclusions Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.
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Affiliation(s)
| | | | - Karen Yee
- 3Cubist Pharmaceuticals, Lexington, MA USA
| | | | | | | | - Anna R Giuliano
- 5Center for Infection Research in Cancer (CIRC) at Moffitt Cancer Center, Tampa, FL USA
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Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019; 394:497-509. [PMID: 31255301 PMCID: PMC7316527 DOI: 10.1016/s0140-6736(19)30298-3] [Citation(s) in RCA: 538] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination. METHODS In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks. FINDINGS We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years. INTERPRETATION This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects. FUNDING WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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Tsai TF, Kothari-Talwar S, Yee K, Kulkarni A, Lara N, Roset M, Giuliano AR, Garland SM. Estimating the burden of genital warts in Taiwan. Sex Health 2019; 14:485-491. [PMID: 28968509 DOI: 10.1071/sh17013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/21/2017] [Indexed: 01/11/2023]
Abstract
Background This study aimed to estimate the prevalence of genital warts in Taiwan among those seeking healthcare, as well as genital-warts-related healthcare resource use and costs, and self-reported genital-warts-related psychosocial impact. METHODS Genital warts prevalence estimates were extracted from a daily record of patients examined from 31 October 2011 to 4 May 2012 by 67 physicians in Taiwan. Physicians recorded the total number of patients and genital warts patients seen daily for 2 weeks. These physicians also completed a survey regarding healthcare resource use, treatment, follow-up care, and referral patterns. Patient psychosocial impact was estimated using a self-administered survey. RESULTS The overall prevalence of genital warts in Taiwan was estimated at 1.1%, with a higher prevalence among men. A total of 146 genital warts case patients were included in the study (76 men, 70 women). Median costs for diagnosis and treatment were US$222 for male and US$351.8 for female patients. Male genital warts subjects reported a negative psychosocial impact on their well-being and health-related quality of life - psychosocial impact results are reported in the Supplementary Material file. CONCLUSIONS Genital warts prevalence was higher among male patients; female patients incurred higher costs. Among men, genital warts had a negative psychosocial impact on well-being and health-related quality of life.
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Affiliation(s)
- Tsen-Fang Tsai
- National Taiwan University Hospital, No. 7, Zhongshan S Road, Zhongzheng District, Taipei City, 100, Taiwan
| | | | - Karen Yee
- Cubist Pharmaceuticals, 65 Hayden Avenue, Lexington, MA 02421, USA
| | - Amit Kulkarni
- Merck & Co. Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Nuria Lara
- Intercontinental Marketing Services Health, Carrer de Provença, 392, 08025 Barcelona, Spain
| | - Montserrat Roset
- Intercontinental Marketing Services Health, Carrer de Provença, 392, 08025 Barcelona, Spain
| | - Anna R Giuliano
- Center for Infection Research in Cancer at Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Suzanne M Garland
- Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia
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11
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Woestenberg PJ, King AJ, van Benthem BHB, Donken R, Leussink S, van der Klis FRM, de Melker HE, van der Sande MAB, Hoebe CJPA, Bogaards JA. Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity: Evidence for Cross-Protection Against Oncogenic Types Among Dutch STI Clinic Visitors. J Infect Dis 2019; 217:213-222. [PMID: 29140439 PMCID: PMC5853250 DOI: 10.1093/infdis/jix582] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023] Open
Abstract
Background Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population. Methods We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional survey in Dutch sexually transmitted infection clinics. Vaginal swabs were analyzed using a polymerase chain reaction-based assay (SPF10-LiPA25) able to detect the 12 high-risk HPV (hrHPV) types 16/18/31/33/35/39/45/51/52/56/58/59. We compared hrHPV positivity between self-reported vaccinated (≥1 dose) and unvaccinated women, and estimated VE by a logistic mixed model. Results We included 1087 women of which 53% were hrHPV positive and 60% reported to be vaccinated. The adjusted pooled VE against HPV-16/18 was 89.9% (81.7%-94.4%). Moreover, we calculated significant VE against nonvaccine types HPV-45 (91%), HPV-35 (57%), HPV-31 (50%), and HPV-52 (37%). Among women who were offered vaccination 5/6 years ago, we estimated similar VE against HPV-16/18 (92%) and all hrHPV types (35%) compared to women who were offered vaccination <5 years ago (83% and 33%, respectively). Conclusion We demonstrated high VE of the bivalent vaccine against HPV-16/18 and cross-protection against HPV-45/35/31/52. Protection against HPV-16/18 was sustained up to 6 years postvaccination.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Birgit H B van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Robine Donken
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suzan Leussink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Fiona R M van der Klis
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Marianne A B van der Sande
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Julius Center, University Medical Center Utrecht, The Netherlands.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian J P A Hoebe
- Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Geleen
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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13
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Genital Wart and Human Papillomavirus Prevalence in Men in the United States From Penile Swabs: Results From National Health and Nutrition Examination Surveys. Sex Transm Dis 2018; 45:412-416. [DOI: 10.1097/olq.0000000000000761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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14
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Sabeena S, Bhat PV, Kamath V, Arunkumar G. Global human papilloma virus vaccine implementation: An update. J Obstet Gynaecol Res 2018. [PMID: 29517117 DOI: 10.1111/jog.13634] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human papillomavirus (HPV) infections continue to be one of the most common sexually transmitted infections worldwide. The oncogenic potential of this virus was well established in anogenital malignancies and oropharyngeal cancers. Even though a fall in cervical cancer rates has been reported worldwide, the subsequent rise in HPV-associated head and neck cancers among men and women have been reported from developed countries, necessitating the vaccination of adolescent boys as well. The objective of this narrative review is to provide an update on the current status of HPV vaccination worldwide. This will be helpful for clinicians in counseling parents and guardians as this vaccine mainly targets sexually naïve preadolescents. An electronic search of the databases was carried out to retrieve information concerning HPV vaccine implementation between July 2006 and 2017, with special emphasis on the current viewpoints, controversies and ethical issues. Globally, 74 countries have implemented the HPV vaccine in the national immunization schedule, and this vaccine is listed as an essential medicine by WHO. About 60% of the low- and lower-middle-income countries have implemented the vaccine with financial assistance from Gavi and WHO. The HPV vaccine is a safe vaccine with no serious adverse effects as per the data available from developed nations as well as low/lower middle/upper middle-income countries. However, long-term follow-up is essential to substantiate the impact of the vaccination programs in cancer prevention.
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Affiliation(s)
- Sasidharanpillai Sabeena
- Manipal Centre for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parvati V Bhat
- Department of Obstetrics and Gynecology, Dr TMA Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Incidence of anogenital warts in Liuzhou, south China: a comparison of data from a prospective study and from the national surveillance system. Emerg Microbes Infect 2017; 6:e113. [PMID: 29259326 PMCID: PMC5750456 DOI: 10.1038/emi.2017.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/18/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022]
Abstract
To determine the incidence of anogenital warts (AGWs) in the Chinese general population, we compared the data from a prospective study and from the National Notifiable Disease Report System (NNDRS). A cohort study including 2378 women and 2309 men aged 18-55 years old enrolled from Liuzhou, China, was conducted with three scheduled visits at 6-month intervals from May 2014 to March 2016. And, a questionnaire survey was performed to collect the diagnosis history of AGWs at the enrollment visit. The data on reported AGW cases of Liuzhou in the NNDRS from 2006 to 2015 were also analyzed. Overall, the incidence rates of AGWs in the prospective study, in the self-reported diagnosis during past 12 months and in the NNDRS were 1.26 per 1000 person-years (95% confidence interval (CI): 0.16-2.37), 2.35 (95% CI: 1.17-4.20) and 0.183 (95% CI: 0.178-0.187), respectively. Human papillomavirus 6 or 11 were found in all the AGW biopsy samples (10/10). The onset time of AGWs in women was earlier, and the cumulative risk increased more quickly at a young age along with each subsequent younger birth cohort (P<0.0001), whereas slight differences were observed in the different male birth cohorts (P=0.0785). The sexual behavior of individuals and their sexual partners had a strong relationship with self-reported AGWs. Our study indicates that the incidence of AGWs in China is as high as that in developed countries, and the data based on the national surveillance system seriously underestimate the real disease burden of AGWs.
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Abstract
The reproductive tract of females lies at the core of humanity. The immensely complex process that leads to successful reproduction is miraculous yet invariably successful. Microorganisms have always been a cause for concern for their ability to infect this region, yet it is other, nonpathogenic microbial constituents now uncovered by sequencing technologies that offer hope for improving health. The universality of Lactobacillus species being associated with health is the basis for therapeutic opportunities, including through engineered strains. The manipulation of these and other beneficial constituents of the microbiota and their functionality, as well as their metabolites, forms the basis for new diagnostics and interventions. Within 20 years, we should see significant improvements in how cervicovaginal health is restored and maintained, thus providing relief to the countless women who suffer from microbiota-associated disorders.
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Flagg EW, Torrone EA. Declines in Anogenital Warts Among Age Groups Most Likely to Be Impacted by Human Papillomavirus Vaccination, United States, 2006-2014. Am J Public Health 2017; 108:112-119. [PMID: 29161070 DOI: 10.2105/ajph.2017.304119] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To detect decreases in anogenital warts (AGW) among sex and age groups likely to be affected by human papillomavirus vaccination. METHODS We estimated annual AGW prevalence during 2006 to 2014 using health care claims among US private health insurance enrollees aged 15 to 39 years. We derived AGW diagnoses using 1 of the following: (1) condylomata acuminata diagnosis, (2) viral wart diagnosis combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion, or (3) AGW medication combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion. RESULTS Prevalence decreased during 2008 to 2014 among females aged 15 to 19 years (annual percentage change [APC] = -14.1%; P < .001) and during 2009 to 2014 among women aged 20 to 24 years (APC = -12.9%; P < .001) and among women aged 25 to 29 years (APC = -6.0%; P = .001). We observed significant declines among men aged 20 to 24 years (APC = -6.5%; P = .005). Prevalence increased or was stable in all other sex and age groups. CONCLUSIONS We observed AGW decreases among females in the age groups most likely to be affected by human papillomavirus vaccination and decreases in men aged 20 to 24 years. Decreased prevalence in young men is likely attributable to herd protection from vaccination among females.
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Affiliation(s)
- Elaine W Flagg
- Both authors are with the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A Torrone
- Both authors are with the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Simms KT, Hall M, Smith MA, Lew JB, Hughes S, Yuill S, Hammond I, Saville M, Canfell K. Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia. PLoS One 2017; 12:e0163509. [PMID: 28095411 PMCID: PMC5240951 DOI: 10.1371/journal.pone.0163509] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18-20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). METHODS We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). FINDINGS The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low-grade cytology in the current program (who are returned for 12-month follow-up). At the population level, immediate colposcopy referral provides an incremental 1-3% reduction in cervical cancer incidence and mortality compared with 12-month follow-up, but this is in the context of a predicted 24-36% reduction associated with the new HPV screening program compared to the current cytology-based program. Furthermore, immediate colposcopy substantially increases the predicted number of colposcopies, with >650 additional colposcopies required to avert each additional case of cervical cancer compared to 12-month follow-up. Compared to 12-month follow-up, immediate colposcopy has an incremental cost-effectiveness ratio (ICER) of A$104,600/LYS (95%CrI:A$100,100-109,100) in unvaccinated women and A$117,100/LYS (95%CrI:A$112,300-122,000) in cohorts offered vaccination [Indicative willingness-to-pay threshold: A$50,000/LYS]. CONCLUSIONS In primary HPV screening programs, partial genotyping for HPV16/18 or high-grade triage cytology in OHR HPV positive women can be used to refer the highest risk group to colposcopy, but 12-month follow-up for women with OHR HPV and low-grade cytology is associated with a low risk of developing cervical cancer. Direct referral to colposcopy for this group would be associated with a substantial increase in colposcopy referrals and the associated harms, and is also cost-ineffective; thus, 12-month surveillance for women with OHR HPV and low-grade cytology provides the best balance between benefits, harms and cost-effectiveness.
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Affiliation(s)
- Kate T. Simms
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michaela Hall
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan A. Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Susan Yuill
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Ian Hammond
- Steering Committee for the Renewal Implementation Project, National Cervical Screening Program, Department of Health, Canberra, Australian Capital Territory, Australia
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Marion Saville
- Victorian Cytology Service, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Walvik L, Svensson AB, Friborg J, Lajer CB. The association between human papillomavirus and oropharyngeal squamous cell Carcinoma. Oral Oncol 2016; 63:61-65. [DOI: 10.1016/j.oraloncology.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022]
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Change Suboptimal Tactics and Promote a National Mandatory Human Papillomavirus Vaccination Program. J Low Genit Tract Dis 2016; 20:348-351. [DOI: 10.1097/lgt.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Vaccination Against Human Papilloma Viruses Leads to a Favorable Cytokine Profile of Specific T Cells. J Immunother 2016; 39:316-20. [DOI: 10.1097/cji.0000000000000137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Madhivanan P, Pierre-Victor D, Mukherjee S, Bhoite P, Powell B, Jean-Baptiste N, Clarke R, Avent T, Krupp K. Human Papillomavirus Vaccination and Sexual Disinhibition in Females: A Systematic Review. Am J Prev Med 2016; 51:373-83. [PMID: 27130864 DOI: 10.1016/j.amepre.2016.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/10/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Some parents believe human papillomavirus (HPV) vaccination increases the chance of risky sexual behaviors among adolescents. This review summarizes the evidence available on adolescent girls and women engaging in risky sexual activity following HPV vaccination. EVIDENCE ACQUISITION Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in 2014 and updated in 2015. Literature was searched for articles published between 2004 and 2015 in MEDLINE, PsycInfo, CINAHL, Cochrane Database, Web of Science, and EMBASE without language limits. Studies were screened according to predefined inclusion and exclusion criteria. Methodologic quality of the included articles was assessed. EVIDENCE SYNTHESIS The search resulted in 21 articles to be included in the review, with 527,475 participants. Included studies were conducted in 12 different countries using experimental and observational study designs. The review included data on girls aged as young as 11 years to women aged 40 years. Studies measured changes in sexual behaviors using a variety of outcomes, including age at sexual debut; risky sexual behaviors; use of condoms and contraception; and clinical indicators such as rates of sexually transmitted infections, HIV, and pregnancy terminations. Available data showed either no association between vaccination status and the outcomes of interest or a positive association between safer sexual behaviors, such as condom use and receipt of HPV vaccination. Methodologic quality of all but one study was moderate or weak. CONCLUSIONS This review did not find sufficient evidence to support compensatory sexual risk behaviors following HPV vaccination among adolescent girls or women.
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Affiliation(s)
- Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida; Public Health Research Institute of India, Mysore, Karnataka, India.
| | - Dudith Pierre-Victor
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Soumyadeep Mukherjee
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Prasad Bhoite
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Brionna Powell
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | | | - Rachel Clarke
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Tenesha Avent
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India; Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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Borena W, Grünberger M, Widschwendter A, Kraxner KH, Marth E, Mayr P, Meier J, Ruth N, Guerrero AT, Marth C, Holm-von Laer D. Pre-vaccine era cervical human papillomavirus infection among screening population of women in west Austria. BMC Public Health 2016; 16:889. [PMID: 27565569 PMCID: PMC5002092 DOI: 10.1186/s12889-016-3581-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background In order to evaluate the newly implemented gender-neutral HPV vaccination program, knowledge on the pre-vaccine prevalence of HPV infection is of paramount importance. Data on HPV infection among the women with no known previous cytological abnormalities are inexistent in Austria. This study presents data on the prevalence and distribution of HPV genotypes among women with no known cytological abnormalities in west Austria. Methods Women between 18 and 65 years of age attending annual cervical cancer screening examinations were included in the study. Data on socio-demographic and reproductive factors were collected using structured questionnaires. Corresponding cervical swab samples were tested for the presence of HPV DNA and were genotyped. Questionnaire data and HPV status were linked with the corresponding cytological findings. Results A total of 542 women were included in the study. The mean age of the study participants was 35.9 (SD = 11.5). The prevalence of HPV infection was 20.5 %. HPV 16 (6.5 %), HPV 33 (3.3 %) and HPV 31 (3.0 %) were the dominant genotypes detected. Multivariate analysis showed that women younger than 30 years of age, smokers, women with a higher number of lifetime sexual partners and those living in the eastern districts of the study region were at significantly higher risk of HPV infection. Conclusions With this study we present the first data on the prevalence of cervical HPV genotypes among a screening population in Austria. The results not only fill the missing information on HPV infection in this group of women in the country, they also provide baseline data for a future evaluation of the impact of the Austrian gender-neutral HPV immunization program. Moreover, our finding of higher HPV prevalence in the eastern compared to the western district of the study region may – at least partly – explain the east–west gradient in the standardized incidence rate of cervical cancer in the region. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3581-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wegene Borena
- Division of Virology, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria.
| | - Margarethe Grünberger
- Division of Virology, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria
| | - Andreas Widschwendter
- Department of Gynaecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | - Aida Tort Guerrero
- Division of Virology, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria
| | - Christian Marth
- Department of Gynaecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dorothee Holm-von Laer
- Division of Virology, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria
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Brotherton JML, Giuliano AR, Markowitz LE, Dunne EF, Ogilvie GS. Monitoring the impact of HPV vaccine in males-Considerations and challenges. ACTA ACUST UNITED AC 2016; 2:106-111. [PMID: 29074169 PMCID: PMC5886861 DOI: 10.1016/j.pvr.2016.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Abstract
In this article, we examine the issues involved if national or sub-national programs are considering extending post HPV vaccine introduction monitoring to include males. Vaccination programs are now being extended to include males in some countries, in order to improve population level HPV infection control and to directly prevent HPV-related disease in males such as anogenital warts and anal cancers. Coverage and adverse events surveillance are essential components of post-vaccination monitoring. Monitoring the impact of vaccination on HPV infection and disease in men raises some similar challenges to monitoring in females, such as the long time frame until cancer outcomes, and also different ones given that genital specimens suitable for monitoring HPV prevalence are not routinely collected for other diagnostic or screening purposes in males. Thus, dedicated surveillance strategies must be designed; the framework of these may be country-specific, dependent upon the male population that is offered vaccination, the health care infrastructure and existing models of disease surveillance such as STI networks. The primary objective of any male HPV surveillance program will be to document changes in the prevalence of HPV infection and disease due to vaccine targeted HPV types occurring post vaccination. The full spectrum of outcomes to be considered for inclusion in any surveillance plan includes HPV prevalence monitoring, anogenital warts, potentially pre-cancerous lesions such as anal squamous intraepithelial lesions (SIL), and cancers. Ideally, a combination of short term and long term outcome measures would be included. Surveillance over time in specific targeted populations of men who have sex with men and HIV-infected men (populations at high risk for HPV infection and associated disease) could be an efficient use of resources to demonstrate impact. Males surveillance can provide information about both herd protection and direct impact. Dedicated specimen collection is needed for HPV prevalence surveillance in males. Anogenital wart monitoring is a useful early indicator of HPV vaccine impact. Trends in HPV-related male cancers will be the ultimate indicator of success.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS Inc., PO Box 310, East Melbourne, Victoria 8002, Australia; School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Anna R Giuliano
- Centre for Infection Research in Cancer, Moffit Cancer Centre, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-02, Atlanta, GA 30333, USA
| | - Eileen F Dunne
- Behavioral & Clinical Research Section, HIV/STD Research Program Thailand MOPH - U.S. CDC Collaboration, DDC 7 Building, 4th Floor Ministry of Public Health, Soi 4 Tivanon Rd., Nonthaburi 11000 Thailand
| | - Gina S Ogilvie
- University of British Columbia and BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC, Canada V6H 3N1
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Bachelet VC. Two doses and not three for the human papilloma virus vaccine in Chile. Medwave 2016; 16:e6373. [DOI: 10.5867/medwave.2016.01.6373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Su S, Chow EPF, Muessig KE, Yuan L, Tucker JD, Zhang X, Ren J, Fairley CK, Jing J, Zhang L. Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:2. [PMID: 26732281 PMCID: PMC4702370 DOI: 10.1186/s12879-015-1322-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/12/2015] [Indexed: 02/06/2023] Open
Abstract
Background The 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs. Method Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection. Result Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis. Conclusion Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Kathryn E Muessig
- The University of North Carolina Project-China, Guangzhou, China. .,Department of Health Behaviour, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Lei Yuan
- The School of Sociology and Population Studies, Renmin University of China, Beijing, China.
| | - Joseph D Tucker
- The University of North Carolina Project-China, Guangzhou, China. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Xiaohu Zhang
- China Food and Drug Administration Institute of Executive Development, Beijing, China. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
| | - Jiehui Ren
- The School of Sociology, Tsinghua University, Beijing, China.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Jun Jing
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. .,Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.
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Abstract
The incidence of cancer is rising in parallel with an ageing populous thus increasing the strain on both treatment options and budgets for healthcare providers worldwide. New cancer therapies are being developed but at what cost? The new treatments are expensive and poor survival rates still exist for some cancers. What is needed now is to prevent or at least limit the disease occurring in the first place. This review evaluates the current situation and the progress in upcoming strategies as well as suggesting some areas for further research within the increasingly important field of cancer chemoprevention. The key principles of cancer chemoprevention are discussed and areas for improvement highlighted. Despite significant progress, chemoprevention has not been widely adopted. Cancer chemoprevention has many challenges to face but this only emphasises the size of the task. These hurdles include a lack of awareness of the benefits, a lack of interest and a lack of investment in taking prevention forward. Despite the huge potential importance of cancer prevention and clinical success stories such as the well-publicised HPV vaccine, the challenges remain significant. With cancer and its treatment being a global issue, the opportunities offered by chemoprevention must be re-evaluated and uptake of chemoprevention actively encouraged. If chemoprevention is to be adopted successfully, a holistic approach is required. This approach will involve multidisciplinary teams of healthcare providers and scientists with the big challenge particularly for medicinal chemists being to design and synthesise the ideal chemopreventative agent.
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Affiliation(s)
- Lewis K Penny
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Abstract
PURPOSE OF REVIEW To provide a clinically relevant synopsis of the latest research and recommendations regarding adolescent immunizations. RECENT FINDINGS Immunization is an important and effective strategy for preventing morbidity and mortality in adolescents. Although there has been progress in recent years, coverage rates in the US remain suboptimal, particularly for the human papillomavirus vaccine. Much work has been done to better understand and address the barriers to adolescent immunization, so that all teens may be protected against serious vaccine-preventable diseases. In addition, several recent studies have focused on the effectiveness of current adolescent vaccines and the development of new vaccines to protect against additional types of human papillomavirus and serotype B Neisseria meningitidis. Decreased pertussis vaccine effectiveness has led to new recommendations for pregnant women, including adolescents, to protect them and their young infants. The present review highlights selected literature on acellular pertussis, meningococcal, and human papillomavirus vaccines. Research findings on various strategies to improve adolescent vaccine uptake are also discussed in this review. SUMMARY Research on adolescent immunizations and their delivery continues to have an impact on clinical practice and will shape future guidelines. Through this work, we can learn how best to protect adolescents against vaccine-preventable diseases.
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Abstract
Both primary and secondary prevention of cervical cancer are now available. Immunizations against human papillomavirus (HPV) types 16 and 18 have the potential to prevent 70% of cancers of the cervix plus a large percentage of other lower anogenital tract cancers. Screening guidelines were recently changed to recommend cotesting with cytology plus an HPV test. The addition of HPV testing increases the sensitivity and negative predictive value of screening over the Papanicolaou (Pap) test alone.
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Affiliation(s)
- Lauren Thaxton
- Department of Obstetrics and Gynecology, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131, USA
| | - Alan G Waxman
- Department of Obstetrics and Gynecology, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131, USA.
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Effio CL, Hubbuch J. Next generation vaccines and vectors: Designing downstream processes for recombinant protein-based virus-like particles. Biotechnol J 2015; 10:715-27. [PMID: 25880158 DOI: 10.1002/biot.201400392] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/11/2015] [Accepted: 03/19/2015] [Indexed: 12/28/2022]
Abstract
In recent years, the development of novel recombinant virus-like particles (VLPs) has been generating new perspectives for the prevention of untreated and arising infectious diseases. However, cost-reduction and acceleration of manufacturing processes for VLP-based vaccines or vectors are key challenges for the global health system. In particular, the design of rapid and cost-efficient purification processes is a critical bottleneck. In this review, we describe and evaluate new concepts, development strategies and unit operations for the downstream processing of VLPs. A special focus is placed on purity requirements and current trends, as well as chances and limitations of novel technologies. The discussed methods and case studies demonstrate the advances and remaining challenges in both rational process development and purification tools for large biomolecules. The potential of a new era of VLP-based products is highlighted by the progress of various VLPs in clinical phases.
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Affiliation(s)
- Christopher Ladd Effio
- Karlsruhe Institute of Technology, Institute of Process Engineering in Life Sciences, Section IV: Biomolecular Separation Engineering, Karlsruhe, Germany
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Mariani L, Vici P, Suligoi B, Checcucci-Lisi G, Drury R. Early direct and indirect impact of quadrivalent HPV (4HPV) vaccine on genital warts: a systematic review. Adv Ther 2015; 32:10-30. [PMID: 25620536 PMCID: PMC4311067 DOI: 10.1007/s12325-015-0178-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Since 2007, many countries have implemented national human papillomavirus (HPV) vaccination programs with the quadrivalent HPV (4HPV) vaccine that has been shown to be efficacious in clinical trials involving 25,000 subjects. Two vaccine serotypes, HPV16 and 18, are responsible for cervical cancer and other HPV-related cancers, but the impact of the 4HPV vaccine on these cancers cannot be seen immediately as there is a considerable lag between infection with HPV and cancer development. The other two serotypes, HPV6 and 11, are responsible for genital warts (GWs), which develop within a few months after infection, making GWs an early clinical endpoint for the assessment of the impact of 4HPV vaccination. METHODS We performed a systematic literature search in PubMed to identify all published studies on 4HPV vaccination, including those that assessed the impact of 4HPV vaccination programs on the incidence of GWs at a population level around the world. RESULTS A total of 354 records were identified in the PubMed search. After screening and obtaining full papers for 56 publications, 16 publications presenting data on the impact or effectiveness of 4HPV vaccination on GWs were identified. These reported data on the impact or effectiveness of 4HPV in six countries [Australia (n = 6), New Zealand (n = 2), United States (n = 3), Denmark (n = 2), Germany (n = 1), and Sweden (n = 2)]. In Australia, no GWs were diagnosed in women aged <21 years who reported being vaccinated. A 92.6% reduction in GWs incidence was reported for all women in this age group, where the vaccine uptake rate (VUR) was 70% for 3 doses. The highest reductions were reported in countries with high VURs, mostly through school-based vaccination programs, although high VURs were obtained with some non-school-based programs. CONCLUSION The results are coherent with the GWs incidence reduction reported in clinical trials and are an early indicator of what can be expected for the long-term clinical impact on vaccine-type HPV-related cancers.
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Affiliation(s)
- Luciano Mariani
- HPV-UNIT, Department of Gynecologic Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Department of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Suligoi
- AIDS Unit, Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome, Italy
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